Ask Dr. Drew - Mind of a Mass Shooter: Dr. Sohom Das on Violent Predators & Severe Mental Illness – Ask Dr. Drew – Episode 99

Episode Date: July 22, 2022

Dr. Sohom Das is a Consultant Forensic Psychiatrist based in London. In his professional role, he regularly assesses mentally disordered offenders, in prisons, in courts, and in locked secure forensic psychiatric units, such as Broadmoor Hospital, that are reserved for the most dangerous and violent mentally ill patients. He also works as an experienced expert witness during criminal trials for a range of serious offenses, including murder. Follow Dr. Das at https://www.youtube.com/apsychforsoreminds and http://www.drdas.co.uk/ Read his book "In Two Minds: Stories of Murder, Justice, and Recovery from a Forensic Psychiatrist" at Amazon.com. Ask Dr. Drew is produced by Kaleb Nation (https://kalebnation.com) and Susan Pinsky (http://twitter.com/firstladyoflove). This show is for entertainment and/or informational purposes only, and is not a substitute for medical advice, diagnosis, or treatment. SPONSORED BY • GENUCEL - Using a proprietary base formulated by a pharmacist, Genucel has created skincare that can dramatically improve the appearance of facial redness and under-eye puffiness. Genucel uses clinical levels of botanical extracts in their cruelty-free, natural, made-in-the-USA line of products. Get 10% off with promo code DREW at https://genucel.com/drew GEAR PROVIDED BY • BLUE MICS - After more than 30 years in broadcasting, Dr. Drew's iconic voice has reached pristine clarity through Blue Microphones. But you don't need a fancy studio to sound great with Blue's lineup: ranging from high-quality USB mics like the Yeti, to studio-grade XLR mics like Dr. Drew's Blueberry. Find your best sound at https://drdrew.com/blue • ELGATO - Every week, Dr. Drew broadcasts live shows from his home studio under soft, clean lighting from Elgato's Key Lights. From the control room, the producers manage Dr. Drew's streams with a Stream Deck XL, and ingest HD video with a Camlink 4K. Add a professional touch to your streams or Zoom calls with Elgato. See how Elgato's lights transformed Dr. Drew's set: https://drdrew.com/sponsors/elgato/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome, everybody. My guest today is Dr. Shaham Das. He is a consulting forensic psychiatrist. He is in London, and he regularly assesses mentally ill offenders in prison, court, and in locked, secure psychiatric forensic units. Dangerous, violent, mentally ill patients is his specialty. We'll talk a little bit about some of the violence we're seeing in our streets these days, some of the mass shootings, if he has any opinion about that. Talk about how to rehabilitate people. He's very big on what they're doing there in the UK, which is giving people a chance. And with treatment, how often do you hear me say this, mental illness can be treated. And when they are treated, they are now no longer engaged in the criminal activity.

Guess what? His book is In Two Minds, Stories of Murder, Justice, and Recovery from a Forensic Psychiatrist. There it is. We, of course, are out there on Twitter spaces, and I'll set up the restream in just a second during the intro. And I see you all there. And if you want to come up and speak, just raise your hand. I'll bring you up to the podium, and you'll be streaming out on multiple platforms, Twitter, Twitch, Rumble, et cetera, Facebook, YouTube, and let's get this thing going. Our laws as it pertained to substances are draconian and bizarre. A psychopath started

this. He was an alcoholic because of social media and pornography, PTSD, love addiction, fentanyl and heroin. Ridiculous. I'm a doctor for f**k's sake. Where the hell do you think I learned that? I'm just saying, you go to treatment before you kill people. I am a clinician. I observe things about these chemicals. Let's just deal with what's real. We used to get these calls on Loveline all the time. Educate adolescents and to prevent and to treat.

If you have trouble, you can't stop and you want help stopping, I can help. I got a lot to say. I got a lot more to say. born in Vegas. That's a feeling you can only get with BetMGM. And no matter your team, your favorite player, or your style, there's something every NBA fan will love about BetMGM. Download the app today and discover why BetMGM is your basketball home for the season. Raise your game to the next level this year with BetMGM, a sportsbook worth a slam dunk and authorized gaming partner of the NBA. BetMGM.com for terms and conditions. Must be 19 years of age or older to wager.

Ontario only. Please play responsibly. If you have any questions or concerns about your gambling or someone close to you, please contact Connex Ontario at 1-866-531-2600 to speak to an advisor free of charge. BetMGM operates pursuant to an operating agreement with iGaming Ontario. And we will say it right here. Let's continue to say it right here. Again, appreciate you all being here.

We are out on Twitter spaces. We will look for you there for your questions and calls. I'm on Restream. I'm also watching the Rumble Rants, although for some reason that does not come up for me right now, which is interesting. And of course, as always on Restream, Margaret Campbell saying, Drew wants hospitals back. Apparently that worked well. I want treatment back. I was complaining to Dr. Dawes about what we do in this country, which is

we make everything legal and we leave people on the streets to die. That's our version of rehabilitation. Well done, particularly in California. So let me bring my guest in here. It is Dr. Shaham Dawes. The book is Into Mind, Stories of Murder, Justice, and Recovery from a Forensic Psychiatrist. Dr. Dawes, and I understand also you have a YouTube channel as well. Tell us about that. First of all, thank you so much for having me on dr drew it's an absolute pleasure so yeah i have a youtube channel it's called a psych for sore minds and i basically it's a crossover between offending with a little sprinkling of mental illness so i analyze high-profile cases i interview people that have experience of mental health issues such as people

who've been sectioned in in my country something for everybody section section means being held against your will is that what that means or yeah yeah detained under the mental health act yeah how does the law work there here you can hold people for three days if they are immediately homicidal or suicidal with a plan uh and as once once the plan goes away and they have a place to eat and sleep even if that's on the street they're out i have to say it's it's pretty clunky and it's quite complicated over here in the uk so there's lots of different sections there's civil sections which last up to 28 days and there's like extensions of those that last six months and then there's criminal

sections so this is the kind of thing that I would give evidence for as an expert witness. So when you're detained under a criminal section, you're in a secure hospital for a long period of time, sometimes years, occasionally even decades, really thorough rehabilitation to make those individuals safe so they can be released. How do you make a determination or can you upfront whether somebody is likely to respond to treatment? I think the first thing is you have to assess them thoroughly and actually see what their issue is. So what is their treatable mental illness? Of the patients that I see, a lot of them have severe mental illnesses like schizophrenia, for example. So a typical presentation would be that they're hearing voices and they might have paranoid delusions so they believe that people are watching them following

them poisoning them wanting to hurt them so that's why they offend that's why they lash out so the first step is to see exactly what symptoms they have right or they believe they're saving their children from the devil so they kill them so the devil doesn't get them or weird things like that. Absolutely, yeah. But that to me is kind of the easy part. The hard part for me is the access to stuff, the personality disordered, sociopathy, severe narcissist, this kind of stuff. And those, you know, there's a lot of drug addicts that are functioning in such a fashion that it appears they have one of those personality disorders, and sometimes they go away, or sometimes they hide

them. How do you deal with these characterological issues? So you're absolutely right. I think of it as a spectrum. On one end of the spectrum, you have what I was talking about, which is when they have a mental illness that directly causes their offending. And in theory, that's relatively easy to treat. You get the right medication for the right length of time, you get rid of those symptoms. And on the other end of the spectrum, like you said yourself, you have your personality disorders. And these are people with like antisocial personality disorders or psychopathy. So you'll obviously know this, but for your viewers, they will be impulsive, aggressive. They will not care about the rights and wrongs of other people. They will not care about the law.

So that's a lot more ingrained. It's actually part of their characteristics. And it is possible to rehabilitate those people for years and years of therapy. But for my clinical practice, they need some sort of internal epiphany. they'll never change if we just enforce therapy on them they might go through the hoops they might say the right things and they might be released from hospital but they'll never actually change their patterns of behavior unless it comes from within which i imagine is because it's the exact same thing it's the exact same thing and and i'm sighing because i we have a pandemic of that stuff over here i mean there's just so much of these access to personality problems and uh you know as you can speak to this but problem with the access to folks is uh they're fine it's the

world that's effed up why should they change so what i have found is that they go through this cycle of getting arrested, going to prison, getting sectioned, hospitalized. And after many years of just their freedom being restricted, they finally realize that even if they don't have a change in empathy or morality inside them, they realize that there's a better way that they can fit in with society. So they become pragmatically cooperative they become willing on a certain level they surrender so to a certain point yeah it's interesting and sometimes when they live a certain kind of life they start to have insight right they start to then go oh okay people do you know i can trust somebody i can right and that that i was telling you before the mics heated up that i have a lot of frustration dealing with real criminals.

Because my experience of real criminals is that they'll often sit back like this when I'm trying to work with them. They'll throw this kind of surrender posture. And they're like, tell me, prove to me that you've got something to say. And then they'll kind of often go like into this cooperative mode. Okay. And then this. And then they just close off. You're full of shit like everybody else and that's sort of the body positions i'm used to criminals

displaying right in front of me and and it gets very frustrating it's like how do you get how do you get through that i think you have to have realistic expectations and when the people are on criminal sections in the uk in these secure hospitals they're often there for a very long period of time you know it could be years so it's unrealistic to expect that you're going to make a breakthrough necessarily in the first few weeks or even the first few months. Sometimes it's about going through the cycle again and again and again. And if I'm being honest, sometimes we pressurize, we bully them into engaging in their own rehabilitation. Yeah. So it's about patience and realistic expectations. Yeah, we can't, we don't do any of that here. We really just don't. We used to,

there was a time. Now we just let people essentially die is really what we do or create horrible chaos in everybody's lives. You know, recently, I'm going to have to ask you to analyze a couple of things. I'm not sure if you feel comfortable doing so, and please let me know if you don't. But Amber Heard was in the public recently with Johnny Depp, and I really feel like they did a public service because they showed how messy psychopathology is, that there's not a good person and a bad person necessarily. There's a lot of just shit going down. He was a severe alcoholic and who knows what he did in his blackouts and what his alcoholism had him thinking about and doing. And she was formally diagnosed borderline and histrionic mixed disorder, which creates tons of distortions and acting out behaviors. And how did you see all that so a very good question i have made a few videos on my

channel about this particularly critiquing the expert witnesses in their trials because that's very similar to what i did so here are my my broad thoughts i think that neither of them came out particularly well but i think that we saw uh johnny depp as somebody who's quite vulnerable, who is quite insightful, and who was willing to own up to at least some of his behavior. He admitted there was something broken about him so far. And he, at least on the surface, indicated that he wanted to change. Amber Heard, however, didn't come across that well at all. In fact, I think the public tide of opinion changed on her. So initially, people were quite supportive. And going back to the diagnoses, you mentioned borderline personality disorder, histrionic personality disorder. I mean, I'm a bit skeptical about experts diagnosing somebody for the purposes of a defamation trial.

But I have to say, a lot of her activities and behavior are very typical for those diagnoses so as you will know people with borderline personality disorder tend to have quite explosive relationships they tend to have unstable moods they tend to have turbulent relationships they can be quite impulsive quite aggressive and then you get people with histrionic personality disorder who don't take criticism very well. They need to be the center of attention. And Amber Heard does at least seem to be many of those things. And one big aspect of borderline personality disorder is this fear of being abandoned, which would explain why they stayed in this sort of toxic relationship for such a long period of time.

So I have to say that I think these diagnoses are quite accurate. Yeah, they can't tolerate the borderlines, can't tolerate the breaking and forming of relationships. And to be fair, if I understand it right, they did formal neuropsychiatric testing on her, right? I mean, she actually submitted herself to actual testing, so there was objective data that the psychiatrist was relying on. Now, maybe you ought to speak to that. testing so there was objective data that the psychiatrist was relying on now you know you

maybe you ought to speak to that how reliable is the the various personality profiles and neurological testing that's out there and my big question would be does how much does it change over time and setting sure so i think there's inherently a bit of a gray area if you look at the setting of when somebody's making this diagnosis. So in real life, in patients that I will see, that you will see, generally speaking, people are going to be open, they're going to be honest, because when they're seeing a clinician, they're doing it because they have a problem that they want to solve, and they want an accurate diagnosis. I think when you're doing it in this kind of slightly circus show, when you're both

celebrities, and there's tens of millions of dollars of money that can be attributed to either side then obviously there's an inherent bias about the way somebody might come across so if you're amber heard you might want to exaggerate some of your symptoms particularly the symptoms related to trauma or if you're johnny depp's legal team you might want to really elicit the fact that she's got all these personality disorders to make her look more unstable. So already there's an inherent bias, in my opinion. And as to the neuropsychological testing, I mean, it's generally quite accurate, but it all depends on how truthful the individual is being. So again, if there's an agenda for the individual to come out a certain way, then test i think any psychological psychiatric test can be bent to to come out with a certain

but most of the more comprehensive tests though include evidence of uh adulteration right i mean at least you can say the reliability is x yes you're right they have the reliability factors there's you know truthfulness axes in built in them but if you're clever enough Yes, you're right. They have their reliability factors. There's truthfulness axes built in them. But if you're clever enough and if you're a very talented actor or actress, I believe that you can certainly sway them. Interesting.

That's interesting. Now, so I actually work pretty well with borderlines. I had to deal with a lot of them, obviously on a drug unit, that's very common diagnosis, or at least people behaving as though they had that disorder. Sometimes it all goes away when their drug addiction settles.

But the really frustrating symptom that I found, and I've tried to speak to it to help people understand it, and Amber Heard exemplified this a bit, was their distortions. I did not find that they lied. I found that they typically just experienced something totally different than what happened. That's why, and you'll appreciate, I'm sure you always bring somebody in the room with you, particularly with borderlines, because you walk out and had a nice exchange and the patient goes, he was abusive to me,

he yelled at me, he tried to touch me in inappropriate ways. And you're like, what? That is not what you get. I remember I used to get it sort of like righteous indignation, like, what? How dare they? And then I was like, oh, I get it. This is the disorder. So I just sort of expect it now. How do people sort of, and no one out in the real world sort of understands that's going down. They consider it lying. And then you put memory on top of it. And, of course, memory is a very imperfect mechanism in our brain. So things get further distorted by memory.

How would you coach people up to understand when they're around that and what to do with it? Well, the first thing I would say is that as you indicated yourself borderlines are very emotional so they see everything through this emotional lens i mean i think everybody does to a degree regardless of whether they've got a personality disorder but it's ramped up yeah with borderline so if they're in a good mood if they're angry if they're annoyed maybe even annoyed at somebody else not the clinician in front of them in in the room, they will act out on this. And the other thing that you mentioned is splitting. So borderline people often either absolutely love somebody or they absolutely hate them. So they denigrate when they're in a bad mood. Or they go back and forth.

Oh yeah, absolutely. Or they idolize if they're in a good mood. And as you say, they go back and forth. So I think the first key is understanding that. So you understand the way that they're presenting today is not necessarily how they'll feel tomorrow. And it's not necessarily their core beliefs. It's just that they're reacting emotionally. But I have to say within my cohort of patients, so people that have committed serious offenses, people with borderline generally are not criminalistic. So then they don't intend to be violent or to be offenders they just that's true that's their aggression yeah they can't contain their their aggression at a certain time and and feel sort of weirdly justified in doing something outrageous sometimes because they're they're they're well some people who care

characterize boarding as unregulated hostility if that hostility takes over they can do stuff I see people with antisocial or dissocial personality disorder far more in my patient cohort. And they intentionally offend. They're lifelong offenders. And they don't really regret their actions. They regret that they got caught, but they don't regret their actions. Whereas people with borderline, they lose their temper. They flare up, and then either immediately or days later, they're actually very remorseful and very introspective.

But of course, the cycle keeps happening. Right. I have this distinct feeling that the American society, the general character of the American psyche has become much more borderline or histrionic in the last five years in particular i just all the the sort of weird histrionic delusionality wildness that goes on on social media i wonder if social media had some some role in inciting all this but you know and i i noticed back in the day the the borderlines have said this before it always came in the hospital with at least 20 lawsuits under their belt that was in the 80s and 90s. And the attorneys in this country caught on to what they were doing and developed a bunch of safeguards so that their frivolous lawsuits

were not so commonplace. But I feel like the acting out now has moved into the social media sphere. Yeah, I think it's very easy to be offended on Twitter or on other social platforms. And you see these people, I'd probably say that they're more narcissistic than they are borderline, but they just love the attention. They love being offended on behalf of a group of people. And Twitter is just the perfect platform. You say that something bad has happened to you or that you've experienced some sort of bias from somebody in society then everybody jumps in and pats you on the back and you know says poor you and then you gain popularity you gain a following so you can understand why people yeah do that that that used to be the legal

system that used to be what what happened in legal systems like poor you you're right they they abuse they you were wronged let's go get some money from that person or let's make them suffer and now you just make them suffer right away on social media. So what's the answer to you? It's weird. What's the solution? Well, let's think about it. So how do you deal with borderlines?

Borderline need containment. The answer is more containment, not more encouragement of acting out. And how do we contain ourselves is really the question. And I don't know. I don't know. Maybe some safeguards in social media against actually hurting other people. That would do some of it, like real consequences.

People with this kind of acting out behavior do understand consequences. And as you said, don't intend to be serial offenders and hurt people. They do it in their emotive moments and if something put them you know a beat in front of it and if people understood you know generally that's what was going on this you know we have okay i want you to address this maybe maybe you feel comfortable maybe don't you let me know but we have moved

into this world as you said where things are perceived through the prism of affect and feeling states, which is normal. Humans do that, but that has taken on a priority. That now is the reality, independent of what the evidence suggests, whether cognitively yourself or the actual evidence in the world suggests. What you felt is the reality independent of the reality and as such i think we're just encouraging people to continue to unravel and to not be not not to be connected to a stable sense of self regulated emotions and reality it's the opposite yeah yeah i agree with you and and as as we've both said i think social social media just exacerbates the problem. Because before when somebody was in a bad mood, or had a grievance, they might tell a

few people, they might get it off their chest, it might be quite cathartic, and then they can return to their normal lives. But now that you've got this platform where you can share your opinion, have lots of people jump behind your cause, there's no, there's no endpoint to it, there's no resolution, it actually helps keep your emotions charged if you just continue to be engaged in whatever your original grievance was i've also noticed and this this again this is very difficult territory to talk about without offending somebody or getting in trouble. So I just want to talk in gross generalities that it feels also, in addition to prioritizing emotionality or affect, uber alice,

we've also said and we've taken the position that fluidity and self-concept is an asset. And I don't know about how you were trained, but as I was trained, a lack of stability in our sense of ourself, even it had a broad spectrum to it. Let's say it's not, we've opened up the spectrum to how people can identify themselves, and that's a good thing. But the sense that it can be anything, any minute, I worry about that. I worry about the instability of those sorts of self-concept, whether it's career or race or gender or sexuality or whatever your identification system is, whatever it might be. I'm not taking aim at anything. I'm just talking about the fact

that we have cosine fluidity that is part of what is in the pathology of things like borderline and it just worries me that we're you know i don't know what do you what do you think about that topic so what i would say to that dr drew would be that in my opinion almost all the offenders that i see have some sort of inferiority complex somewhere and that's contained many different forms uh and because they feel or they have feel inferior at some point in their lives they lash out once they think that they have the upper hand and a power dynamic and that could be through violence it could be through mass shooting it could be through you know but joining a gang it could be through stabbing a random person on the street but there's always an inferiority complex it's either that they were

you know bullied when they were younger or they were underappreciated by parents or they were. I'm going to stop you. I'm going to stop you. Cause I really want to drill into what you mean by inferiority complex. Cause what I hear you describing is resentment and feeling that they were done wrong. Like something,

there was an injustice that was unconscionable and they're going to set that scale right is that it's not really inferiority necessarily right it's just it's just an injustice um i mean i think i think the two are intertwined really i think that if they feel that they've been wronged in some way then you know i'm not talking about one incident i'm talking about a pattern over their lifestyles yeah their childhood yeah and they feel uh you know they feel belittled so i would say that it's an inferiority complex uh probably using a layman's term for most of the offenders i see yeah and and would it be accurate to say that oftentimes if not i don't know if it's typical or not that the the original offense

is in relation to the primary caretakers and then that just gets repeated and repeated and repeated across a lifespan you know i have to say doctor i think it is very random i've definitely seen some cases where there's been a very clear direct link between the perpetrator when they were victimized or bullied. So to give you a specific example, I've seen more than one occasion, people who have something like schizophrenia and they hear the voice of a relative stepfather or father who's abused them in the past. But sometimes it does seem a bit random. It seems like whatever trauma they went through as a child, it seems, unless we haven't dug down deep enough, it seems on the surface completely at odds

with the victim that they've chosen. Interesting. And I want to just drift over towards the topics of the day. In this country, we have people picking up high-powered rifles and just shooting randomly at people at a distance um do you have any sense of what that is or were those people uh they they a lot of a lot of ink is being spilled on sort of them appearing being odd or you know having difficulty with social functioning and i'm not sure people even know what they're saying when

they sort of take aim at these people with those sorts of observations but i wonder if you have any insights into what what's going on there uh yeah good question i think that almost all of the perpetrators of mass shooting are what you said so they're usually isolated they're usually marginalized they're usually withdrawn from society. And that can be for another number of reasons. It could be that they're shy, it could be that they're bullied, it could be that they have a form of depression, could even sometimes be on the autistic spectrum. So you have that, and then that's usually always on a background of some kind of social issues. So whether that's poverty, whether that's a lack of a job, whether that's

drug use. So you have all these layers. And then, as we were talking about before, they usually have some kind of grievance. It's either against an individual or a group of individuals, such as, you know, school shootings when they were bullied, or it's against a section of society. So you might have some, you know, right wing individuals who believe that their jobs have been taken by immigrants, for example. In some way, they feel wronged. You have the incel culture. So you have men who feel entitled towards getting sexual partners. There's something that makes them feel, as I was saying before, inferior and feel wronged.

And they just make this snap decision to do something very extreme and understandable about it. Do you have any hope that we're going to tackle some of this stuff? Is there, are there, do you have any theories on how we could, you know, sort of be more preventative? That is a great question.

I think there are solutions, but I think all of the solutions take funding. It's all about money at the end of the day. I think it is harder to do in the States all about money at the end of the day I think it is harder to do in the states than it is to do in the UK because I think your healthcare system and your mental health system is is not as well provided as ours is already so you've got a big deficit to catch up with you've got problems with you know health health insurance whereas our our healthcare is provided for free.

Then you've got access to guns, probably not a particularly comfortable topic to talk about, but it's definitely a factor of why you have these mass shootings in America and you don't have the equivalent kind of crimes in the UK. But to be specific, I think it is about both the social care and psychiatric care. So you can have all the secure units and you can have all the forensic psychiatrists like me that you want, but if you don't take away some of the social problems like poverty, like lack of jobs, like all these deprived areas with gang culture, then I think you're going to be fighting an uphill challenge. So if you can tackle those by funding by extra school activities, by social clubs by providing people

with legitimate ways of making a living and that's going to decrease the chances i think of people lashing out at society it's it's what do you think the uh i don't i don't know i yeah i feel overwhelmed by it because i i feel there's tons jobs now. We can't find enough people to fill the jobs at the moment. And so it's not really a lack of jobs. It may be a failed education system, which is really where we lose people right away. For sure, we need real help there. There is hopelessness and mental health issues that are just profound and just a pandemic of all sorts of trauma and chaos in people's family systems. And then our systems for addressing that are just flimsy at best.

They're just not even – they're not there. You're not allowed even to identify these things and sort of go after them. It's just not happening. I don't know what our problem is. We have an inadequate supply of psychiatrists. We have no psychiatric beds. Our community health care centers are just sort of clearly not been working. They do, people come in and really work hard.

There's services there, but it's hard to get the engagement. It's really an overwhelming situation. It's very difficult and and i think what our government does is kind of throws money at people rather than coming up with a systematic kind of you know evidence-based way of dealing with things they come up with things that get them votes quite literally then that's sort of the the way they go after stuff things that sound good or that make good sound bites on television or that, again, collect votes. We're going to give you $1,000 back.

OK, I'm voting for you. And that is not going to help somebody with these kinds of problems we're talking about. And then, as I've told you before, again, off camera, the laws in this state, you're prevented from helping anyone. I mean, the idea that you could put somebody in in treatment for weeks just it's like nirvana like what it's and it's not it's not that we don't have the resources to do that the law is prevented prevented the the position is who are you to say and families with resources and physicians and all sorts of structured living ready to ready to hand are told to scram who are

they to tell tell anybody how to live their life that's sort of the attitude that our state government takes how dare you tell tell your schizophrenic heroin addicted son how to live his life he's living his best life on the street and you just think he should live the way you want him to it's literally the philosophy that they're that they come up against something with it that does sound like an almost insurmountable problem with the actual culture itself i'm not sure what the solution is yeah it's cultural yeah you're right it's cultural that that's a that just that frame helps me kind of think about it a little bit that we have a real problem in this society with things that interfere with our freedom not only from a standpoint of treatment, but also from the

standpoint of pathology. The idea that our will, our self-will and motivation is affected by an illness, no, not possible. That's still somebody just making their best choices. I wouldn't make those choices, but I'm not them, so who am I to say how they should choose to live their life? And think about that. That's our culture. That's it. Yeah. Now, interestingly— I think that's such a thing as too much freedom, to be honest with you.

That's exactly what it is. And interestingly, if that patient we were talking about that's living their best life has a dementia and we don't jump in and help that person well now we're guilty of abuse we've abused that person by not jumping in and taking care of things but a schizophrenic with the same symptom complex agitation irritability disorganization hallucinatory that patient you're not allowed to walk up to them and offer help. But the dementia patient, if you don't help them, you're guilty of abusing that person. Isn't this crazy? Super duper crazy, right? Same organ system, brain, same symptom complex, and we have laws protecting one and preventing

the other. Yeah, that is just completely illogical. I think our problem in the UK is slightly different from yours. So we have systems in place and we have a culture that wants to help people who are mentally ill, but we don't always have the resources, particularly in the deprived areas. So you mentioned before a lack of hospital beds. I can absolutely resonate with that. So, you know, I work in two criminal courts in London, and I cannot tell you the number

of times where we found somebody detainable. So they're so unwell that they need to be sectioned under the Mental Health Act. We just cannot find the beds. So they end up going back to prison while they're waiting for a bed. And they get the bed by the hospital releasing the least unwell person. So that doesn't necessarily mean a person that's ready for discharge, but they're just desperate for the space and i have to say over my career i've noticed that people patients are coming through the criminal justice system far more often so maybe 15 years ago 20 years ago if they were psychotic hearing voices a risk to themselves they would end up in hospital whereas now because there are so few hospital beds

the level of risk has to ramp up you know they need to be attacking people stabbing random people you know shouting at random people in the street before you even consider sectioning them which to me is just uh just really hard to ensure yep well here we will go one step further if they're swinging a machete around and then go i don't want to kill anybody anymore i'm going to go have dinner you know uh by panhandling at the freeway. And I've got a tent under the freeway. Um, that's it. They get out, but it's, it's, um, it's kind of extraordinary. I worked with one of the LA County Board of Supervisor members who was advocating towards creating a, a, they were, they'd actually had approved and spent millions of dollars developing a large wing of the county facility, criminal facility, the jail, creating a state-of-the-art wing that would have been a psychiatric hospital, essentially. Because all the patients were ending up in the jail, which is not appropriate either.

So what they were going to do was build this huge, this really elaborate state-of-the-art unit it looked fantastic the county supervisors rejected it and instead instead put the jail itself on the result on the on the road to demolition and so you couldn't put anybody in anything and just yet they have to stay out on the streets so what's the reason behind that you know is that to save money is it pure cruelty what's the no it's it's it's it's i i don't want to speak the the the rash the logic i've heard has been bizarre it's it goes something like we we're we're we're excessively racist in the application of our laws which is true uh. And we are overly criminalizing normative behaviors. And this doesn't do anything for anybody anyway, except warehousing people that don't belong there, which is also true.

I mean, there's truth embedded in all this, right? But then their solution is forget the whole thing. Let's just get away with the whole thing. And thereby, there won't be any more mental illness there won't be any more criminals because we won't identify them anymore it's like it's like it's like right it's like like saying um you know kids aren't passing this test they're basically doing this that's that that's their solution yeah they're saying right it's exactly right it's like these kids aren't passing their math exams,

so we're going to either stop giving that math exam or just lower the quality of the exam or just pass everybody. That's our solution. Now everyone passes. Now, no more problem. Everyone passed the math test that they weren't passing before.

And that's the same idea. So it's difficult because there's truth embedded in their criticism of what we've got, but their reaction is this thing that really hurts people. It really harms people, and that's what's sad about it. Listen, Dr. Das, we have to take a quick break here. We've got a lot more to talk about. We're going to take calls as well when we get back. We have people that want to talk to you.

We'll get to it. First, a little message from our friends at Genghis. We'll be right back. We have people that want to talk to you. We'll get to it. First, a little message from our friends at GenuCell. Be right back. I think we have found the holy grail of skincare. GenuCell has absolutely changed certainly my skincare regimen. I like that vitamin C serum, the under eye creams, skin nourishing primer. Susan loves the eyelash enhancers, uses it on her eyebrows as well. GenuCell has everything to make us both feel and look amazing. Best part, the quality of the products. Using pure ingredients like antioxidants, copper peptides, and a proprietary calendula flower base, GenuCell knows how to formulate products to perfection without irritation.

For Susan, she hates that annoying dry area on her nose during allergy season, like right here. She's tried everything, but no matter what, the skin is flaky and dry. Nothing seemed to help until she started using GenuCell's Silky Smooth XV Moisturizer. Soaked right into the skin, she was hooked after one use and now loves all of their products as well. Every single product is developed by a pharmacist, making sure that all the ingredients are safe and effective. Right now, you can try GenuCell's most popular collection

of products and see what I'm talking about for yourself. Go to GenuCell.com and enter code Drew for 10% off. That is G-E-N-U-C-E-L.com and the code is D-R-E-W. Welcome back, everyone. We are talking to Shaham Das. The book is Into Mind, Stories of Murder, Justice and Recovery by my forensic psychiatrist. We'll be taking your calls in just a second. Dr. Doss, what will we get from reading the book? So the book is my professional memoirs. It is a chronological look of how I became a forensic psychiatrist. And I pick out my most kind of gruesome and fascinating cases, the ones that really affected me emotionally and how they shaped me as a psychiatrist and I'd like to think it's a bit

funny a bit sort of silly and humorous in parts as well give me an example in one of the one of the cases okay I'll tell you what I will I will give you a choice Dr. Drew would you rather hear about um like the most sort of tragically emotional case I've seen the most horrific form of self-harming that I've seen or let's get into some good oh faked what what are they fake that sounds like faked mental illness uh fraudster female con artists I'm convinced faked mental illness to get out of a criminal charge talk to me about that's intriguing to me yeah I hope that I think everyone would like to hear the self-harm but I want to hear the the faking one because that's interesting that's really hard to get out of a criminal charge. Oh, talk to me about that. That's intriguing to me. Yeah, I hope that, I think everyone would like to hear the self-harm, but I want to hear the faking one because that's interesting.

That's really hard to sort out. Go ahead. Okay. So in my book, I call her Darina. That's not her real name. I've anonymized all my patients. She was a lady who I assessed a couple of years ago. So she was an ex-model.

She came from a very privileged background. She had lived in the UK since being a teenager. She was a multimillionaire because she married a CEO and then divorced him. So she was on some fraud charges. So Darina, her cousin, and her ex-boss, who she had an affair with, committed this carbon credit fraud for several million pounds. And she was in the background kind of siphoning money, laundering money. So she didn't commit the main bulk of the fraud. And what happened was all three of them were caught, all three of them were tried at the Old Bailey, which is like our main central criminal court in the UK. And during the trial,

Doreena's son, her three-year-old son, caught a very rare form of leukemia and became extremely unwell, almost died. So her trial was stayed, so it was delayed. The other two defendants were tried, found guilty, ended up going to prison. And Darina, when she was up for trial again a year later, she had another forensic psychiatrist assess her for her fitness to plead. So that, as you'll know, is her ability to actually go through the trial process. But what was quite interesting is that she completely disengaged from the court process. So she wouldn't take any phone calls from the solicitors, she wouldn't open any letters. And when the solicitors finally did, the lawyers finally did speak to her, she was just crying profusely in these floods of tears, talking about how upset she was about her her son who even

though he'd recovered he was still extremely unwell and could relapse at any moment so the crown prosecution service which is you know our equivalent of your prosecution asked me to carry out a second opinion assessment on her fitness to plead because they weren't quite buying it and then when i assessed darina I have to say I was slightly suspicious right from the beginning because she's really passive aggressive. She wasn't really answering any of my questions, but interestingly, she was able to answer questions

about her background. So as you'll know, when you take a psychiatric history, you ask about family, childhood, relationship history, she was able to answer all of those questions. But when I asked her about the actual alleged offenses she was completely unable to answer any questions she just had this flood of tears she kept saying that she was really depressed and that the courts wanted to take the children away from her and that I was part of it and basically I didn't let her cry her way out of it so I was you know polite I was empath, but I carried on questioning after her flood of tears. And what I found unfathomable or unfeasible was that she couldn't remember even the

most basic details. So she couldn't even tell me that it was a fraud case. She couldn't tell me that any family members were involved when I specifically prompted her, like her cousin. She couldn't tell me the name of the man that was her ex-boss that she had an affair with so my conclusion of my report was that she probably was fit to plead but she was refusing to engage in the court process at least at least obfuscating right yeah absolutely but at the very least yeah the most interesting part of the story i think is that to my surprise the judge judge actually overruled my evidence. So he went with the other expert, despite the fact I clearly said in my court report that I thought she was capable. So I think the judge, just like Doreena, was using mental illness as a smokescreen.

So I think he thought for humanitarian reasons, didn't need to try her. You know, she's got a very ill child. The other two main co-defendants already in prison and that's fine you know i didn't have a problem with that if it was for humanitarian reasons what i had a problem with is i think the judge was also using mental illness as an excuse as a smoke stream just like she was so yeah very frustrating excuse or a bias like he was like overly sympathetic and biased or is it the same thing i i mean i i think he definitely was over sympathetic there's no denying that but i i i can't prove this but i

genuinely believe that he knew that she was fit to be that she wanted to be because my evidence was so strong really interesting and also her level of functioning she was you know looking after children she was cooking she had something resembling a special life you can't be all those things and unfit yeah it's it's it's interesting so in my world it would be my job would be to get through all that bs and to find out what's really going on yours is just to document the bs say that it is bs yeah exactly or let's take some questions and calls here oh by the way uh on rumble there's a lot of uh talk about evil people are just evil there's no such thing as mental illness how do how do we make people understand that yes there are horrible people

out there that do evil things uh how do we differentiate for people evil versus mentally ill because there's a lot of mental illness of all different stripes and they're not and they and people in those illnesses do horrible things for many many many different reasons and it can look evil and uh i guess you know go ahead you answer that question so well firstly i would say i'm not sure that everybody can be convinced uh if they're not open-minded and they're not rational but if you're if you're really open to listening to my suggestion i would say as we spoke about before dr drew those people with clear mental illnesses who directly act upon those illnesses and i know because i've seen it with my own eyes that if you give them the right medication and you you know look after them give them psychotherapy over a

long period of time then the person they become even months or years later is completely different. So they're completely different. They not Yeah, they don't you mentioned before, people, mothers that have killed their children, because they believe that they have demons inside of them, right. So I've seen something very similar a couple of times in my career. I've done videos about high profile cases on my YouTube channel. And when you see them go through this rehabilitation process, you can see the guilt seep into their souls. And, you know, that's actually part of their rehabilitation is to get them over the depression. But on the other end of the spectrum,

we were talking about personality disorders before. Absolutely, I think there are some people who are inherently bad. I don't know if I'd use the term evil, but I'd certainly use the term psychopathy or antisocial personality disorder. But I would say that they are damaged in some way. There is something that's happened to them at some point in their life that has led to their behavior.

That doesn't excuse their behavior. It doesn't make them any less criminally culpable. I still think they should be punished. They should go to prison if they don't have a treatable mental illness. But it at least explains why they have become who they've become. Yeah, the really monstrous stuff, and I think monster is probably a better word than evil, but the really monstrous stuff is people with a certain genetic,

psychopathic, whatever, parts of the brain where empathy exists isn't working very well, and then you traumatize that person in their childhood, and now you've got a bad mess on your hands. That is where people go bad that is where where evil resides and and i and i don't think those people are treatable i'm not sure i mean you might be able to contain them but they're not really treatable i mean i suppose if you're talking about like pure psychopaths for example then yeah yeah i think that i think they

are untreatable i think that they can some some of their personality disorder can burn out over time and they might decrease their offending for reasons that we spoke about before because they've gone through the cycle of going in and out of prison in and out of hospital there might not be an internal moral epiphany but it might simply be because for their own selfish reasons they don't want to have this kind of lifestyle of constant offending so i don't know if you call that treatable because did you change that or was it you know something that yeah eventually occurred to them yeah but they're changeable let's put it that way yeah some some of them that is it it is interesting to me that a lot

of uh access to stuff does settle in the fourth and fifth decades of life. Like people, they tire of living a certain way. They're willing to try something different. You know, you get tired as you get older. I think that's what it boils down to. Evil is when you know what you're doing and you don't care. Yeah, Casey's saying that. I think that's essentially what we're talking about here. When you only don't care, you can't appreciate that you're hurting.

You really don't care. You really can't even appreciate it. This is Jean. Let's get some calls going here. Connecting up to Jean. Jean, you've got to unmute your mic. There you are. What's going on?

Hi, Dr. Drew. My question is, and to Dr. Soham, in the United States, it appears, and I know, that people that are mentally ill are not treated to the best of the ability our country can do that. True. So there are people that are out doing crazy stuff in society. But then we compare the United States with other countries that treat their mentally ill. And then it comes back and says the United States, you know, we have problems and other countries don't. But they do have a problem, don't they?

It's just. Well, I, Eugene, you, you uh i don't know what happened to you but if i if i'm getting your question right is is the question that we have more psychopathology than other countries or are we just treating it less and less effectively or both right we? We're not treating it. So therefore, we have a lot of people out in society causing harm to other individuals because we don't treat it. We don't put them in mental hospitals when they really, you know, for the average person, think that, you know, they should be treated instead of being out causing. Yep, I agree with you. Let's see what Dr. Das has to say.

So thank you for that question, Jean. I would say that I would be the very first to raise my hand and say that I don't think our system in the UK is perfect by any means. We certainly have a lot of people out on the streets who are risky, who are mentally unwell, some of whom are quite dangerous um but from what from what i understand and from talking to dr drew it seems that there's a slight difference

and the difference is we want to treat them and we have the systems and laws in place to treat them but we just don't have enough resources and hospital beds but from from dr you know more about this than me well and and i and i'm giving you, we have this strange and glorious system here where we are 50 states. And some states, like I was in Indiana a couple years ago, and they were doing a wonderful job in the jails at treating these people. They were wonderful. And I came back. I thought, why can't, you know, my God, I didn't know in in the United States it was possible so a lot of my complaint is about the state of California which is a huge state with millions and millions of people and we are at one extreme and I would

say Indiana at least when I had visited them was at the other where they were you know the insurances were available everyone was, the insurance companies were held accountable to the outcomes, and the prison system included treatment. And I saw, and I actually followed somebody through treatment after a couple of years in prison, and she did fantastically in the treatment. So it's possible in the United States, it's just that it's a state by state issue. And you'll have to forgive my ignorance, but how does insurance tie into this? Because as I said before, all of our treatment is for the NHS and the UK is free. So I'm making assumptions that a lot of the people in your country, they don't get covered. So there isn't an impetus to look after them in the long term. Well, there's various safety nets, so-called. The county has

safety nets, so there's county systems. There is a Medicaid, which in this state is Medi-Cal, which is a pretty decent system. There's Medicare, which treats the over 65 very well. And then there's the employed insured. And unfortunately, that system depends on which state you're in. The insurance companies are allowed to play games in certain states. I've told this story before. I don't want to get too deep into it, but just know that they have games they play to muscle their way to minimize their services provided, even when people have tremendous needs. They require it to go to lower levels of care and outpatient treatment and other things that are not as likely to be effective so that that's again a state to some extent a state-by-state issue and uh you know

it's in this state it is in addition to the resources the the delivery the the resources and then the availability of beds and systems and caretakers we're weak on both and we have laws that prevent us from doing that work on top of everything else so it's it's really it's really bad in california it's sort of ridiculous here uh let's get some more calls here enough of that i'm getting i'm getting wildly cathartic um this is mark let's get mark in MB, Mark. Again, be sure to unmute yourself. I see you're up. There you are. Yeah, hey, interesting talking about the treatment, but I'm more curious about the prevention.

Yeah. So will the pendulum ever be able to be turned as far as prevention? Because it seems like so much of the problems we have with these mass shooters, you know, so many young men come from bad families, you know, and so how do you change that? Just curious your thoughts about that. Oh, I forgot to say hi, Kai. Hi, hi. So appreciate the call, Mark, and the question. So we've sort of talked around this a little bit.

It's a very difficult, challenging topic. And Mark is tilting at the idea that destroyed or disturbed family systems play a significant role. We've talked about the the resource system and the lack of integration and the lack of a culture that helps people is I see as the bigger problem. What about the family of origin? What big an issue can we even tell? I would say, so of the patients that I rehabilitate within the secure units, they're there for many years and we get to know them fairly intimately. We meet their family

members. And I would absolutely agree. I'd say that a vast majority come from broken families. They come from either abuse or poverty, sometimes drug use. In fact, I would go further than that. I would say that it's very rare to find somebody that's not had that kind of background that has led them to both offending and also to serious mental illness.

So I absolutely recognize that's a problem. As to what the solution is, I mean, that is a very difficult question. And I think it boils down to money, as we were saying before, you know, we have a massive problem with funding in social care in the UK, as well as mental health services. So you need the social care to look out for families who live in poverty, and you have abuse problems, and you know, to remove children, and to put them in care. And then on top of that, you need the funding in the mental health services to pick up individuals earlier on so they get the treatment they need before their risk profile increases. Well, in this country, you're not allowed to talk about families.

Just not allowed to talk about it. That the politicians ever talk about. I would argue, based on your observations, that at least teaching people the importance of a healthy family and stability and how much children are affected by instability in the family systems and you know do you have the adverse childhood experience scale the a scale were you over there i've heard of it but we don't use it um yeah so so only maybe 15 years ago in this country did physicians start to accept the reality that bad childhood experiences affect mental health and physical health. It's astonishing to me that it took until well into the 21st century before physicians went, well, we've noticed that these people that have heart disease and are smoking or the heroin addicts or the accidents are all're all people that had one of these things happen to children. Imagine that. And what you're not allowed to educate people about is that divorce,

domestic abuse, which is a big, broad category, a substance-using parent, somebody in prison, divorce. These are all adverse childhood experiences, all of them. And that trying to avoid these things is what children need to be healthy and not end up in Dr. Das' program. But we're not really, because I think people here fear that we're going to start to, we're going to start to prescribe what a healthy family system is, right? And the fear is we're going to go, oh, it's going to be cisgendered, heterosexual.

No, no, no. That's not where we would go. We would go generally, you kind of need two people. One is just like, God bless you if you're trying to do that. But if you've raised a child with two of you, you know it's impossible. So you need the extra, preferably three. Get a grandmother in there too, or a grandfather in there. You need manpower. You need people, number one. And they need to be there over a long period of time. And they need to create stable, safe, quiet environments, loving. That's it. Those are

the requirements for kids to kind of grow up okay. Now, there's many other things that they can get exposed to along the way, for sure, have kind of massive impact you know out in their social spheres and with their you know shit's still going to go down but do you agree with me that we can we don't have to prescribe what a healthy family is in terms of any kind of you know whether it's two males or three males or four or whatever it is it can be just just a stable adult environment where people are helping kids thrive. Yeah, absolutely. I would agree with that. I think the problem for me, Dr. Drew, is that education is only part of the issue. So getting the message across is one thing. Actually doing something

about it is actually really difficult without the state becoming a nanny state. And time and time again, it goes back to the same thing. It costs money to have decent care for children that need to be removed, to have programs for people that are victims and perpetrators of turbulent relationships or domestic violence. Everything costs money at the end of the day. And yeah, I just think it's so difficult, so difficult to change the culture of society as a whole. I agree. But God, I would at least say the first step is to start talking about

it it's always at least the awareness like at least a way in it maybe not education but just awareness agree you know just agreement that yeah yeah it makes a difference not perfect not not the only issue but uh makes a difference uh this is uh let, Dutch Shusta. I can't quite tell what, what your name actually is. Shusta. And you've got it on. There you are. What's happening. Hey, uh, thanks doc.

I appreciate the opportunity to speak in your space. Um, what made me raise my hand and want to speak about a situation here is, um, most of the crime that happens inica is really a social economic issue and i'll break it down like this um we know in the inner city we have like the gang violence that takes place but then we have like you know these mass shootings and different things like that that happen and people say okay well you know this person didn't have a father or um you know uh certain issues that may have happened a broken home or they're suffering, you know, certain issues that may have happened, a broken home or they're suffering from, you know, depression or different things like that.

But we know people in impoverished conditions already face these things and you don't have some of the actual violence that happens or that's perpetuated by like it's a specific type of demographic is what I'm saying. So hold on. So is the comment that pointing at somebody and going, they were impoverished and they were stressed and it becomes almost

a just so argument because many people live like that and don't become violent. Is that the point? Yeah, that's the point that I'm making right now. And so then we say, well, what do we do about it and how do we solve it so um yeah i don't i don't want to rant too much on it but uh from a georgetown study we looked at almost 66 percent of americans receive some type of prescription pill from from a doctor right so uh going by that statistic alone we know that over

half the population they uh have some type of adverse side effects because we know most prescription pills are going to have, you know, suicidal thoughts, thoughts of depression. They're going to have different things that affect you on a subconscious level. So when we really say, well, what's the issue here? Then we can look at Tylenol. We know that Tylenol creates a lack of empathy and we will give tylenol to infants as young as three months but we won't even give water to infants you know until they're about six or seven months so i think the issue here is that we're actually just pumping people full of drugs too much and not actually working through the issues we're not having the conversation and saying okay well why do you feel this way how can how can we show you what you can do to not feel

this way opposed to just taking a pill and when we sit back and look at it most americans are just on some form of a drug and they're really so so no argument for me that we're over medicated uh but but how do you get the resources and the professional army uh mobilized and the laws that allow us to go in and help them. Well, now that's going to be really tricky, right? But now, so, so here in the United States, we're going to be like the last developed, and I hate using the term developed nation, but we're going to be the last developed nation to have socialized healthcare or a form of socialized healthcare. So when we look at what we know should be done, you know, like we're talking with the other doctor, I know this is about him as well. And I appreciate him for being here.

He looks at us Americans is like, you know, like, well, it's not free. Like the government doesn't provide that. Like a lot of people look at Americans. They look at these issues like, well, why isn't the government handling these things? And because it's for profit, we understand that capitalism, especially in medicine, is is really the devil. It's the boogeyman in the room that we don't want to talk about. So we, the people, have to somehow figure out how to get the for-profit middleman out of medicine. We have to do it or else the pharmaceutical company, they're just going to keep winning because they're always going to prescribe a pill for that problem.

All right. So these are big, big, big, big topic. Thank you. Thank you, buddy, for bringing all this up. You know, you almost don't even know where to start with some of these things. I'll let you struggle with it. People have lots of strong feelings, but these are giant sweeping statements and we have to kind of get granular at solving them. Any thoughts? Yeah, so thank you, D'Achusta. So you mentioned many things there. I think you're right. I think that if you look at people from similar demographic backgrounds, there's certainly violence in some areas versus other areas. You know, there's poverty all over the world. There's entire countries where a lot of the population

are in poverty, but the level of violence isn't that high. So I think that you can almost look at violence as a public health issue. So it's almost like a disease that spreads into areas. Even talking about London, I think it's quite different from the States in that it's very, very packed together and you have impoverished estates right next to very well-to-do posh areas and you have intense violence within those estates and i think it's all about modeling so kids grow up in these small ecosystems and see other people like gang members acting violently getting money being drug dealers um so they emulate that whereas somebody who lives in london a couple of miles away will not see that they'll have hard-working parents they'll have legitimate ways of making money they'll have good schooling parents they'll have legitimate ways of making money

they'll have good schooling um so so yeah i i do agree that it's not just the demographics it's also about the environment and what children model and what they copy the culture exactly the culture again yeah the culture our culture is sick it is uh maybe that's a thing to you know look at as a disease model too because that's always the way i felt it's like you study the culture and cases within the culture and move the culture if you can media is the great mover that if you can do that he also made another point um i think you would probably agree that uh if if indeed the number is correct that you know 60 to 70 percent of americans take a psychotropic medication. Certainly the number is big. I'm guessing a lot worse than Great Britain.

And the idea of, and again, he is right about the fact that it is the insurance companies and the drug companies that put the forces in place that motivate the prescribing. In other words, doctors are not paid to sit and talk to a patient they're paid to prescribe something and move them through that's that's the model and it it it reinforces you know what we get can i first first of all ask what tylenol is because i think it has a different chemical name yeah it's acetaminophen you're paracetamol where you are acetaminophen paracetamol where you are i don't knowophen, paracetamol where you are. I don't know what study.

One study does not a truth make. So please, of the millions and millions of prescribing of Tylenol, Dr. Dawes and I work with patients. People have empathy. Plenty of people have empathy. It's not as though empathy has disappeared. And when empathy has disappeared, it's a very specific situation, which we were discussing.

But I will not argue with him that that's overprescribing. I think he's absolutely correct about that. So my thoughts would be, first of all, if that's accurate, if it is literally two-thirds of people in America, then that's mind-blowing to me. I knew it was high, but I didn't think it was anywhere near that high. I think in the UK, we have a problem with overprescription of antidepressants for low level depression, where we both know that it's not particularly affected. It's affected moderate or severe depression.

And I think that's because the GPs, so we call them general practitioners, I think we call them family doctors, are so stretched for time to see individuals. They only have 10 minutes for an appointment. It's much easier to just prescribe an antidepressant. 10 minutes, eternityternity here. And by the way, there's a cultural problem here too. People get angry if you don't prescribe to them.

They get very angry if you don't prescribe the antibiotic, you don't prescribe the anxiety medicine, you don't prescribe the sleep medicine. They're furious when they don't get the, that's a cultural problem. We just put, I don't know if you saw that on the board, the 20% in the last 12 months have received some treatment pharmacologically for mental health disorder. There it is. 19.2%

of adults have received any mental health treatment. I'm assuming that means medication. In the last 12 months, 15.8% have taken prescription medication. There it is. So that's in 12 months. I don't know what the number would be at any given moment. So again, these numbers, we can throw around lots of numbers. I hope people have learned during covid that epidemiology is a it's a fungible uh phenomena of discipline and can be moved in very different ways so pay attention you have you need you know the way science works is you need lots and lots and lots of repetitive studies to get to an understanding that is close approximating the truth you can't look at one study and go there is the truth.

What I think might be different, and please correct me if I'm wrong, is that I think in the States, the pharmacological companies have a lot more gravitas, so they influence doctors because they're part of the whole insurance scheme. In here, our pharmacological companies- No, in fact, the opposite. We as physicians are not allowed to in any way have contact with the pharmaceutical companies, except in academia, they fund a bunch of research and they fund some of the speaking tours and things like that of the academic physicians. But out in the community, you can't even take a pen from a pharmaceutical company or you will hear from your professional ethics committees. So you're not allowed to do that in the practice,

in the practice. But then people step out and they work for the companies or they have them fund their research. So there is a weird, cozy relationship. It's just not directly in the care of the patient. And in terms of care of the patient, the way the insurance companies work is you usually can't prescribe medication that aren't already generic. So the drug companies aren't even interested in what we're doing because they can't really influence what we're doing unless it's these highly specialized situations like rheumatic disease and oncology where they're making money off these highly

expensive or COVID. Now we have Paxlovid out there. Um, so it's, it's a, it's a very complicated, weird relationship. Very weird. People think, people imagine, people fantasize, people fantasize that somehow doctors get paid or kicked back or something. It's the exact opposite. There is absolutely a gigantic barrier between practicing physicians and the drug companies,

except in these certain situations that I mentioned. And that makes it weird. What are you going to ask? Okay. So I have to ask, what do you think is the reason that there is such a high prescription rate in the States, apart from what we've already talked about apart from the culture of wanting tablets is that the main issue it's well the main issue is the the insurance look it's how we got the opiate crisis right 90 of the vicodin prescribed in this country and the world was prescribed in the united states

because when a patient came in with pain you were, the insurance company would only pay for prescriptions. You'd come in and you'd prescribe. They would not pay for psychotherapy, physical therapy, or any of the neuro-biofeedbacks or anything. No. Just get them in, get them out, get them on the pain meds. And then a discipline developed that said that pain medicine

is the answer to everything. And the insurance companies got very involved with that group and supporting them. And it became a discipline. Literally, where people like me, who was objecting strongly to what was going on then, was told that I was causing suffering. And I was a dinosaur. And I was opiophobic. And I was interested in harming people, and I should just get with the game and start prescribing opiates because that was the answer to all that there should be no pain in the United States.

The answer was opiates. Ridiculous. Absurd. So that's the kind of thing that happens. The system kicks in, the disciplines develop, and then the drug companies support the disciplines that support their products. And there it is. And the research and everything else.

Okay, well, listen, I walk away upset. I'm a little more upset than I thought I was going to be. Maybe you can prescribe something for me to help me feel better and sleep well tonight. So again, to answer your question also about the system, there's no reimbursement for spending time with patients. Everything is as quick as possible, and then the culture reinforces all that. People are wanting a medication, they want it now, and they want to get out, and they'll pay for cosmetic procedures and things like that, but they don't want the reality of being biological and having medical problems is just a nuisance and they don't want to be bothered with any of that. And certainly spending time and energy and focus, uh, helping with that is no,

no, no, no, no. Just fix it. Fix it. Get me out of here. Very weird, weird culture. Uh, the book is called, let's put it up there in two minds. Come on now, Caleb. There it is. Uh, stories of murder, justice, and recovery from a forensic psychiatrist. Your YouTube again, Dr. Das, where can they find it? Uh, so it's called a psych for sore minds. There you go. It's right there. Uh, and it's, it's just a range, a smorgasbord of topics related to true crime and mental illness um a bit light-hearted a bit sort of surreal a bit funny but talking about some very dark topics at the same time excellent and uh yeah i appreciate you being here hopefully we can talk to you again uh it was kind of a little bit of a rorschach experience today and you kind of you see the spectrum of people's feelings they're all over the place in terms of you know dealing with these problems and thinking what we should do about it and

i think that's why politicians stay away from it it's it's a it's a rorschach and they don't and they don't know what they're doing and they don't see the solutions and uh and they don't get votes for it and it's not popular and so they just stay away from it and continues to deteriorate and there we are yeah and i think we have to we have to we have to appreciate we're talking about you know treating mentally disordered offenders so they are viewed by many to be the dregs of society so you know it is an area where it can be quite depressing and there is massive lack in services and funding so we have to accept that i guess yeah but thank you so much for having me on pleasure on and uh again i i i'm stirred but i guess that's a good thing uh and i appreciate the college appreciate the restream comments i'm watching you guys i'm also seeing you guys over on

rumble you're getting kind of uh hmm you guys are getting all you're all over the place over there so i'll maybe i'll maybe'll maybe check into the the rumble rant room and Dr. Joss we appreciate you being here thank you so much I'd love to come on again and tell you about some of my crazy stories if you'll have me all right we'll do it we'll do it again all right my friend thank

you and the rest of you we are from New York on Tuesday Wednesday and Thursday of next week same time five o'clock Eastern, 2 o'clock Pacific. The guests, I don't think we have things set up yet for next week. Let me just check for you guys. No, I don't think we have everything scheduled up. Look for me.

I think I'm okay in announcing this. I will be on Legion of Skanks on Monday night. And yes, it's like it sounds, a comedy show. And then Megyn Kelly, I'm going to record that on Monday. I don't know if that airs Monday as well. I saw that on your calendar and laughed. Legion of Skanks. The Legion of Skanks.

That's just the only thing that's on your, Legion of Skanks, and that's on your schedule. There it is. And apparently it's a popular Kill Tony group, and it's a very popular podcast, and they invited me. I said, all right, I'll go see what that's like. Oh, yeah, Tom Cigar says, will you ever do Kill Tony? Well, isn't Legion of Skanks the Kill Tony guys, Toms?

Isn't that the same group? Yes, of course I would. I don't see why not. Of course, I'm very naive when I get into these things. I really don't know what I'm getting into, but we had someone from Legions of Kinks on After Dark, and they were kind of lovely. It was kind of fun.

And so I figured it would be fun to join their group. Caleb, anything else on your docket? Anything to be brought up? This was kind of a bit of a Rorschach ride, wasn't it? We were kind of all over the place here. So I hope people feel like they got something out of it. It was kind of a bit of a Rorschach ride, wasn't it? We were kind of all over the place here. So I hope people feel like they got something out of it. It was very, yeah, very interesting. Very interesting topic here.

Yeah. So, and frustrating and difficult and challenging and hard to solve. And it's, you know, it's not like there's one easy, simple. Oh yeah. I'll be on Gutfeld also. What night, Susan? I see you on the restream.

I don't know what night that is. Is that, it can't be Monday night also because Monday I'm going to Legions of Skanks. Can you put that on there for me? Did we misschedule things, Susan? Wednesday. I'll be on Gutfeld on Wednesday. Excellent.

All right, everybody. Thank you for being here. We'll see you on Tuesday at 3 o'clock. A guest to be determined. I'm sure you can find that information at drdrew.com. and we will see you all then. Ask Dr. Drew is produced by Caleb Nation and Susan Pinsky. As a reminder, the discussions here are not a substitute

for medical care, diagnosis, or treatment. This show is intended for educational and informational purposes only. I am a licensed physician, but I am not a replacement for your personal doctor and I am not practicing medicine here. Always remember that our understanding of medicine and science is constantly evolving. Though my opinion is based on the information that is available to me today, some of the contents of this show could be outdated in the future. Be

sure to check with trusted resources in case any of the information has been updated since this was published. If you or someone you know is in immediate danger, don't call me. Call 911. If you're feeling hopeless or suicidal, call the National Suicide Prevention Lifeline at 800-273-8255. You can find more of my recommended organizations and helpful resources at drdrew.com slash help.