Dhru Purohit Show - Does Long-Term Use of Psychiatric Drugs Do More Harm Than Good? with Robert Whitaker

Episode Date: April 14, 2022

This episode is brought to you by ButcherBox and Pendulum. The world of pharmaceuticals is a deceiving one. While it might be easy to trust that any drug on the market today has been rigorously tested for efficacy and safety, that’s not always the case, especially when it comes to psychiatric drugs.  We’ve all heard the term “chemical imbalance,” and many people struggling with depression or other mood disorders have had this narrative hammered into them. They’re told that elevated or inadequate levels of neurotransmitters are to blame, but this theory is being increasingly questioned.  Today on The Dhru Purohit Podcast, Dhru digs into the questions surrounding psychiatric drugs with Robert Whitaker.  Robert Whitaker is the author of four books and coauthor of a fifth, three of which tell of the history of psychiatry. In 2010, his Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness won the US Investigative Reporters and Editors book award for best investigative journalism.  Prior to writing books, he worked as a science reporter at the Albany Times Union newspaper in New York, for a number of years. He is the founder of madinamerica.com, a website that features research news and blogs by an international group of writers interested in “rethinking psychiatry.” In this episode, we dive into:  -Does long-term use of psychiatric drugs do more harm than good? (4:29) -How short-term clinical trials are built to market drugs by pharmaceutical companies (23:59) -The chemical imbalance theory (31:04) -The long-term effects of psychiatric drugs (39:36) -Psychiatry’s disease model (49:18) -Rethinking the use of antipsychotics (50:14) -The importance of creating a new environment when it comes to treating mental illness (1:03:33) For more on Robert Whitaker, follow him on Instagram @madinamerica, Facebook @madinamerica, Twitter @mad_in_america, and through his website, madinamerica.com. Get his book, Anatomy of an Epidemic, here.  This episode is brought to you by ButcherBox and Pendulum. For a limited time, new subscribers to ButcherBox will receive free ground beef FOR LIFE. When you sign up today, ButcherBox will send you 2 lbs of 100% grass-fed, grass-finished beef free in every box for the life of your subscription + $10 off. To receive this offer, go to ButcherBox.com/dhru. Pendulum is the first company to figure out how to harness the amazing benefits of Akkermansia in a probiotic capsule. To receive 20% off your first purchase of Pendulum’s Akkermansia probiotic supplement, go to Pendulumlife.com and use code DHRU20. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

You know, more and more people are getting treated, and yet our outcomes keep getting worse. More on people on disability. More and more people committing suicide. More and more problems with early death. What's going on? Welcome to the Drew Perot podcast. Each week, we explore the inner workings of the brain and the body with one of the brightest minds and wellness, medicine, mindset. And I'll add to that for today's episode, Journalism.

This week's guest is author and previously journalist Robert Whitaker. Now, today we're talking about a very complicated and somewhat controversial topic. And that topic is really answering this core question that Robert Whitaker set off to ask and answer many years ago. And that question is, do psychiatric drugs do more long-term harm, long-term harm, than good? Now, as you can imagine, investigating this topic is opening a whole can of worms, and we wanted to invite the gentleman that wrote the definitive book on this topic for making the argument that long-term usage of many psychiatric drugs is not only understudied, but not studied at all. And there needs to be a more honest conversation about the pros and cons informed patient consent when, patients are put on long-term usage of psychiatric drugs. Now, today's argument is being presented by Robert Whitaker because he outlined this argument

inside of his book, Anatomy of an Epidemic, Magic Bullets, Psychiatric Drugs, and the astonishing rise of mental illness. By the way, this book, which came out in 2010, won the U.S. investigative reporters and editor's book award for Best Investigative Journalism. Now, in addition to this book, Robert is also the author and co-author of five books, which all tell the history of psychiatry. And again, on today's podcast, Robert is making the argument for a very specific viewpoint. Maybe in a future podcast we'll have someone else on who has a different viewpoint, or even better, I'd love to host a debate between people who have varying viewpoints on this very complicated and crazy world

of psychiatric medicine. Now, prior to writing books, Robert worked as a science reporter at the Albany Times Union newspaper in New York for a number of years. In addition to his books that he's authored and co-authored, he's the founder of mad in America.com, a website that features research news and blogs by an international group of writers interested in rethinking psychiatry. Now, Robert isn't a doctor, and he's the first to share that with people who follow his work. But I want to add in that it was a doctor, a friend of mine, a psychiatrist based here in Los Angeles,

who was the person that introduced me to Robert's work because this psychiatrist knew that our system is broken. And we have to rethink psychiatric care if we're going to get to the root of the problem. On today's podcast, we talk about all that and more. If you have anyone in your life that is on psychiatric drugs, this conversation is for you. And might I also add, if you're ever considering making any changes to your medication, please consult your health care practitioner and your doctor. It's okay for you to get education. It's okay for this podcast to be a part of that education.

But when it comes to making any modifications to those medications, you have to and you must work. with your doctor. If your doctor isn't open-minded, you can go and look for an integrative doctor or a functional medicine doctor in your area or even a psychiatrist who's more open-minded and can make the right decisions for your health with you. Now, on to today's episode with Robert Whitaker. Robert, thank you for being on the podcast. I've shared with you that I'm a big fan. We've had some past podcast guests that are also big fans of yours, Dr. Omid Naim in particular, who's been a regular guest to this podcast. And I want to be a big fan. to start off big picture and get your thoughts on a question, a central question that you've

looked at through the course of your career and with your books, some of which are award-winning books in this topic. Do drugs that we're using for mental health, psychiatric drugs, do they do more long-term harm than good? That's the topic we want to ask today and dive into, so I'd love to start off with that question. Well, you know, this is a question the whole country should be asking. I mean, if you look at the percentage of people that are on these drugs long term, it's something like 20% now. So you want to have evidence, of course, that you're doing more good than harm. I mean, that's what the evidence-based medicine should be able to show us. And I just want to say, too, the very fact that we're

medicating our kids so regularly now, we really want to be sure that this is actually helping them grow up and thrive. Unfortunately, the evidence is quite clear if you really want to look at it, and we can talk about both the studies that have been done and also the biological reasons for why the only conclusion to draw, if you really look at the evidence, is that the drugs do more harm than good. Now, in what way do I mean this? When we talked about assessing any medical intervention, over time, you really need to know what are the natural recovery rates. You know, we hear about Hippocrates. He says, do no harm, right? And we like to think that means, oh, don't make your patient worse than when he comes in. But it's actually much more complex than that. Hippocrates was saying

there's often a capacity in nature to recover from whatever ails you, including like psychiatric problems. And your intervention to not do harm has to improve on that natural capacity to recover. And that natural capacity to recover is just missing from our modern understanding of how psychiatric drugs affect long-term outcomes. So when I wrote about this, when I first took this investigation really to heart and wrote anatomy of an epidemic, one of the first things to do is to try to figure out what are the natural outcomes for these different disorders. Anyway, just the short answer to your question is this. As you look at long-term outcomes, what you find are a couple of things. You do find over and over again over the long term. In fact,

it's the untreated patients, those who are not staying on the drugs long term for whatever the category is who end up doing better over the long term. And by the way, that's even for psychotic disorder. That's even for schizophrenia on the whole, in the aggregate. And we have long-term studies that show that. They just don't get promoted to the public. So what you see in a capsule over and over again is this, whether it be depression, whether it be psychosis, whether it be bipolar disorder, these different diagnostic categories, or ADHD, on the whole, in the aggregate, they're increasing the likelihood A that people will remain symptomatic years later. That's one. two, that there will be more likely end up disabled or functionally impaired.

And three, that so often is disabled with antidepressants and stimulants, that the initial use of the drug may put them on a path where they end up with more severe diagnoses as well. And that's what you see not just in an individual study, but when you try to look at the research literature in the whole, which has been collected ever since 1955, which is the beginning of the psychopharmacology era, you see this story emerging time and time again.

And it emerges from, by the way, the very best, what we consider the very best research, National Institute of Mental Health Studies, for example, are key to this whole story. And then there's some other sort of national studies that have been conducted in other countries that also tell the same story. And that's why, you know, this is so contradictory

to what we were sort of prepared to believe as a society, right? But what makes the conclusion so convincing is that it's basically an evidence puzzle you put together that appears over time, this story, this conclusion, and it really is consistent over and over again, beginning with early research in the 60s. And then finally, and we can explore this is, and all this occurs away from the public. But within the research literature, going back to the seven, there was a beginning of an understanding of why this might be so. And the basic biological explanation for this is that these drugs all perturb normal neurotransmitter systems. We don't

know what's wrong. We're not fixing a pathology. And that in response to that perturbation of a normal system, your brain undergoes this compensatory adaptation and ends up operating in an abnormal state. And researchers for a long time have said, this, I think, is the problem. problem with these drugs. Over the long term, they induce these physical changes, biological changes that actually make people more vulnerable to the symptoms that drugs are supposed to treat. Now, that's actually a very biological explanation. There's other elements to drug treatment that clearly come into play. So, for example, how about hope? How about sense of like you can make changes in your life in your environment to sort of end up in a different place. Well, that whole

story that drugs are the answer doesn't lend itself to that sort of larger response to whatever is troubling people in which they change environments, that sort of thing. It robs people of hope. All the things that actually in medicine we know are so essential, you know, to better long-term outcomes. And finally, one last thing. So you can wind me up with a question, and then I just keep going. But anyway, you know, you're interested in functional medicine and how the body affects, you know, outcomes as well. I mean, health arises not just from in the brain, but in the body as well. Well, so often these drugs interrupt or harm sort of physiological functions in the gut, that sort of thing, cause metabolic dysfunction. So there's this other problem

with drugs, is that they induce physical problems as well. So, yeah, I hate, I mean, this is really a tragedy and it's an answer, a conclusion that we need to address. But unfortunately, it's quite clear that over the long term, the use of these medications worsen outcomes in the aggregate. They do more harm than good. And my only caveat here is there is a spectrum of outcomes with these medications. And so there are some people who do okay on them. But we're talking about outcomes in the aggregate and also compared to what is sort of the natural capacity to recover. You know, before we go into some of those studies and the research and a little bit of the narrative that put us in this big fat mess that we're into today, I wanted to give you an

opportunity. You know, you're no stranger to the topic or term of controversy. And I'm no stranger either for some of the episodes. It seems to be that anytime you have some questions about some of the narratives that are being presented in any category, nutrition, immune system, could be any aspect, mental health, how the body functions, how the brain functions, you're naturally going to be an outlier. And as an outlier, people will often take your words out of context or only focus on one aspect. So we'd love up front before we continue further to give you an opportunity to say or share

that, you know, it's not that you find that there's no space for medications. This piggybacks off the last thing that you were saying. there could be some place for these psychiatric medications that are there, what you're talking about in your last answer here is on the whole and their over-prescribingness in our society, both here in the United States, as well as globally. Is that an accurate way to describe it? This episode is sponsored by Butcher Box. I've tried a lot of different diets. And the one that I've found that feels best for me personally is the Peking Diet, created by my friend and business partner, Dr. Mark Hyman.

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bacterial strain, Pendulum is offering my community 20% off your first purchase of their pendulum acrimancia probiotic supplement. All you have to do is go to their website, pendulumlife.com. That's pendulum p-e-l-u-m-l-U-M-L-U-M-L-I-F-E dot com, and use the code Drew 20, spelled D-H-R-U-20 for 20% off your first. first purchase. Well, certainly there's been an over-prescribing, no question about that. And the more you get away from their primary uses, the more likely, you know, you're going to do some harm.

I stay away. I mean, I think your question's really good here. Let me just step back for a second as to who I am. Because there's sometimes a sense if you end up in a controversial space, people think, oh, you have a horse to ride or something like that. I have a very traditional background. So my background was, A, I was a medical, I covered medicine for newspapers, the Albany Times Union for a time. I was the medical reporter.

Then I did a time at, I was a night science journalism fellow at MIT, so I got that training in how to report on science. Then I was director of publications at Harvard Medical School for a time. and this was in the 1990s when the idea of evidence-based medicine really came to the fore. And one of the ideas about evidence-based medicine is there's a capacity of doctors to be diluted about the merits of their therapies. So this is why you really have to go to the evidence as opposed to just what they say. Now, at this time, I was very much a believer in the common wisdom because when I reported on psychiatry, I'd call up experts and they'd say,

listen, these drugs, they fix chemical imbalances in the brain. They're like insulin for diabetes. I believe that, of course, because that's what the experts were telling me. Now, my whole entry, and I think this is key because you're basically asking me, Drew, you know, what sort of mindset or background do I bring to this whole topic? And also, by the way, after I left Harvard Medical School, I co-founded a publication called Sensor Watch, what looked at the development of the testing of new drugs. So I got very involved in sort of how trials are designed and that sort of thing. But anyway, here's how I got involved in psychiatry and this whole story. I never had much of an interest in psychiatry. But in 1998, I was doing a series for the Boston Globe

on abuses of psychiatric patients in research settings. Okay. And at this time, I had a completely conventional understanding. I thought we were making great progress in treating skills. schizophrenia, great progress in teetting depression, these drugs-fixed chemical imbalances. So I was doing that series and we wrote about these drugs-fixing chemical imbalances, but right at the end, just before it was published, I sort of was directed to some studies that seemed to belie the story of progress, especially around the antipsychotics. It was two studies. One was a study by Harvard researchers at Harvard Medical Researchers that had charted outcomes for

schizophrenia over the past century. Now, remember, the conventional narrative is antipsychotics comes in in 1995, and it produces this great advancing care, makes it possible to empty the asylums. Well, what Harvard researchers had found was that actually outcomes for schizophrenia patients had declined since 1975, and were now no better than they had been in the first third of the 20th century when people were locked up in asylums and treated with all sorts of crazy therapies. Well, that belied this narrative of progress. That made me ask myself, well, how could that be? And then there were two studies done by the World Health Organization that compared outcomes in three developing countries, India, Nigeria and Colombia, with outcomes. This is for schizophrenia patients, in the U.S. and five other developed countries. Now, the first study was five years in length, and they came up with a very stunning finding. They found that outcomes were by far much better in India and Nigeria than any of the Western countries. So much so, and listen to this. They concluded that living in a developed country is a strong predictor you won't recover if you're diagnosed with schizophrenia. And I'm like, wow, living in a developed country with all our medical achievements,

be a strong predictor you won't recover. Then the World Health Organization Authority said, wow, this is odd. Let's do another study. And they said, in this study, our hypothesis is one of the reasons for the better outcomes in the developing country is the patients there are more medication compliant. People in the West, they resist what the doctors tell them, but in these poor countries, they're going to stay on their antipsychotic medications. So that was the hypothesis. So they now looked at medication adherents in the second study, and what did they find? They found that in the poor countries, particularly India and

Nigeria, where the outcomes were the best, they used the drugs acutely, but not chronically. They didn't keep their schizophrenia patients on the medications for long periods of time. Now, this was completely contrary to the understanding and the practices here in the United States that are developed countries. And then they went back. So they only, only 16% in, if actually in India, Nigeria, only about 10% of patients were kept on the drugs long term, schizophrenia patients. And then the WHO investigators went back 15 years later and they said, wow, the outcomes are so diverged. They diverged so much. in these poor countries, people are so many are back to work, they're asymptomatic, etc. Those were the two studies that made me want to investigate is the story we are telling

herself about these medications. Is it true? Can you find it in the evidence base for what we believe is true? So my point is, I didn't come at this as a non-believer or as a, say, a therapist who believes in other types of things. I came at this as a believer, as a reporter who had been told that this is what we know. So now going back, now jump ahead to your other question. Really in medicine, there's always a question about for whom and for how long, right? In other words, if you want to make best use of medications, you have to figure out for whom and for how long the drug should be used. And that's what I believe we need to get back to with the use of psychiatric medications is for who and for how long. And so like, for example,

you'll find in the world of psychosis, there's a program in Northern Finland where they've sort of figured that out for whom and for how long with the use of antipsychotics. And once they figure that out, their outcomes improved dramatically. So I'm not against the use of medications. What I'm for is their judicious use around this for whom and for how long. And part of the judicious use needs to have as an element, informed consent, and consideration of long. term outcomes. So I'm really glad you brought this out. It's a question of for whom and for how long and incorporating into our knowledge base this long-term evidence. No, thank you for clarifying that because I think it's an important point. And I would add one more question to that, which is probably

a subpart of one of those two questions anyway, for whom, for how long. We recently had on Dr. John Abramson from Harvard, also a guest lecturer in Harvard, family physician. And he, in his book, The Sickening, he's also helping us understand that because all these medical studies are proprietary and the way that they're funded and you really never have medical review, scientists, doctors, publications that have access to the raw data. There's that whole transparency piece that's there. But there's also this question that we don't really ask the question of these pharmaceutical companies compared to what, right? So for who, for how long, and also compared to what, right? Compared to what are we saying that this antipsychotic or this SSRI is going to be a better intervention when it especially seems that since the time of your publication of your

book, there's been an explosion in more practitioners, medical doctors, researchers coming out and talking about the body and the brain connection. And inside of there, there's so many. things, whether it's nutrition, group programs, EMDR and walking therapy, that in them themselves are potential tools that are in the toolbox for practitioners that have strong evidence base and also, more importantly, have extremely low chances of really any side effects that are going to be coming in. So I think those are important questions to ask, as you mentioned, for whom and for how long and additionally compared to what other interventions are we talking about.

Yeah, this is really a big problem. So, first of all, what you're talking about is in the drug, the industry funded studies. Those are generally short, those are short term studies, six weeks. So first of all, you have the problem is we're not even looking at long-term outcomes, right? Second of all, the drug companies are going to design their studies to try to make their drug look good. And there's various ways you can do this with designs, eligibility criteria, that sort of thing. So that's a problem. Then, of course, they analyze it. And they're going to do everything they can to put a positive spin on that. And we know this. And Dr. Abridsson writes about this in his book, Sickening. So this information we get from short-term trials, it's not that those aren't scientific trials. Those are marketing trials, basically. And going to your point, Drew, no, their trials built to market drugs. That's what they're done.

They're not done to really assess the safety and efficacy of the drugs. The drug company isn't interested in that. The drug company is interested in a result it can use to basically to sell the drug. That's the purpose of the trial. In fact, by the way, when they design their trials, drug companies, they bring their marketing people into the room and say, what story do we need to tell in order to sell these drugs? So there's the design to tell a story. But going to your point with psychiatric drugs, not compared to what?

You say compared to placebo. That's not true. It's not even compared to placebo. What happens in the drug industry trials for antidepressants or antipsychotics is they take a group of people, a select group of people, that are doing usually okay on the drug, okay, and then they have a design like this. They yank hack, let's say, with an antipsychotic. You get a group of patients somewhat stable on the drug, and then you randomize them in this way. Well, first of all, what you do is you wash them all out, you abruptly take them off the drug, which is going to provoke a withdrawal. effect, right? And then half are randomized the placebo and half are put back on the drug they've

been on of the type. So you have a group of patients that have been accustomed to the drug, and they're compared to people who've been abruptly withdrawn from the drug. So it's not a placebo group. It's a discontinuation group. And a discontinuation group, we know there are withdrawal symptoms. So the very, the placebo group is actually a group that can be expected to do poorly because they're going through withdrawal from the drug. So that's the first problem with those. trials. And now the second thing you're talking about is we should be comparing them to an alternative form of therapy. And I'll give you an example of what happens when this. There was an NIMH funded study that ran like this related to depressed elderly adults. One group got an SSRI alone. One group got

SSRI plus exercise therapy and one got exercise therapy alone. Now, exercise therapy, we knew sort of what you're going is that has additional benefits. Aerobic capacity improves. Maybe you're out for a walk in nature, whatever it might be. But we know that exercise actually can be positive for mood. So what happened? After, what was it? After, got to get this right.

After 16 weeks, there was for drug plus exercise. I think that was the best sort of reduction in symptoms, even better than exercise alone. But then at the end of 10 months, the best was exercise alone. They had the best stay well rate. And in fact, not only was drug worse, but drug plus exercise was worse.

In other words, drug was acting as an anchor on exercise. So that was an NIMH-funded study. Now, the expectation was that drug plus exercise, will be the recommended form of care, right? You can combine them. But what they actually found was it was exercise alone that had the best long-term results. And when they asked people in that study,

why did you find exercise so helpful? It wasn't just the benefit of, you know, getting in better shape and all. But they also had a sense that, oh, with exercise, they were taking sort of control of their own fate as well. they were asserting some willpower towards it as well. But we never hear about this.

But this is the point. You should be comparing a drug therapy to some other therapy, including exercise therapy, maybe rock climbing therapy for kids. In other words, there's a lot of different ways you can change environments to help people. But that's not how we test drugs. We test drugs, especially psychiatric drugs, in this artificial environment that is biased against placebo and it's short term and results are spun as they're presented to the public. It's fascinating. It's really fascinating. I mean, so many of these things come into these narratives

that then become memes in our society. And even though we find them to be not true, they're sort of baked into just people's understanding. And one of those narratives is this narrative of chemical imbalances. So let's talk about where did that narrative of a chemical imbalance come from? And when did we start to know that not only was it not the full story, but that actually it could be missing the boat entirely? Yeah, this is, you know, memes and all. This was a story that was so successful in selling drugs to the, you know, to the population. I'll tell you, I believed in it. And I'll tell you how my path to seeing that that we didn't hold true a rose. So when I was doing that series for the Boston Globe in 1998,

long time ago now, everyone, and it was really focused on psychotic patients. Okay. So everybody, and we had these new antipsychotic, Cyprexia, Risperdol, that were said to be a second generation of atypical antipsychotic so much better than the first generation. And everybody I called up said, oh, these drugs fix a chemical balance in the brain like insulin for diabetes. So, So that was the framework for the series, which, by the way, was a finalist for the Pulitzer Prize. So I should have been invested in that story. But what happened was right towards the end, even after the series was prepared, I started questioning some of the things that were the framework. And one of them was this idea these drugs, fixed chemical imbalances.

So I called up a leading researcher and I said, listen, I just want to find, I just want to read the research where you found that schizophrenia is due to. too much dopamine and therefore these drugs fix it. And I swear to God, this is what the guy told me. He said, well, we didn't really find that. It's a metaphor like insulin for diabetes. And I said, well, I understand it's a metaphor. Just tell me where you found that people who, you know, have schizophrenia, had these overactive dopamine systems. He said, well, we didn't really find that. We tell people this because it becomes an explanation they can understand as to why they should take the drug. And I was gobsmacked by this. And then I went and I believe it or not, I got through to some experts at Janssen, where the maker of risperdol, which was marketing these drugs is fixing

a chemical imbalance, their drug risperol. But I got not to the PR person, I managed to find a research and he said, ah, this is embarrassing. I don't know why we say this. It's just, that's not what we found. So now this actually was one of the things I wanted to write about. I felt like the public, the public is being told one thing. And by the way, we reporters were repeating that. And yet, apparently the science literature tells something else. So here's what you find when you actually dig into the scientific literature. You find that the chemical imbalance theory arose, not from understanding or discoveries of what was happening in people so diagnosed, but from an understanding of how the drugs acted on the brain. So, for example, we get antipsychotics in the 1950s. And in the 1960s,

they finally understand what these new drugs do. I mean, they're called antipsychotics. They were introduced as major tranquilizers, but they get renamed as antipsychotics. What they do is they block dopamine receptors in the brain. And as you know how neurons communicate in the brain, you have a presynaptic neuron that releases that chemical messenger, that neurotransmitter into that tiny gap between neurons, which we call the synaptic cleft. And then that molecule, say dopamine, binds with receptors on the,

post-synaptic neuron. That's how neurons communicate. Now, what the antipsychotics do, like thoracin and all, they sit on that receptor. It's like pouring glue into that receptor, so the molecule can't bind with receptor. And this thwarts dopamine transmission. So, researchers said, well, we think these drugs work. So maybe since they work by blocking dopamine, people have overactive dopamine, okay, symptoms? And now they have. have to, we're going to start doing research in the 70s to see if that's true. And I can follow with that. The antidepressant story was the same. And the whole chemical imbalance story rises from antidepressants and antipsychotics. So the first antidepressants do. Well,

let's just focus on the SSRI, the selective serotonin reaic intubiners. So serotonin goes that into that synaptic cleft, that gap between neurons. And then the brain has to have a way to remove that molecule from that synaptic cleft in order to make a crisp messaging system. And the molecule, serotonin is removed in one of two ways. Either an enzyme comes along and metabolizes that molecule and the metabolites are carted off his waste, but most just goes back up into the pre-synaptic neuron via re-uptake channels, and it's stored there for later reuse, okay? That's the serotonin.

What does an SSRI do? It blocks that re-uptake process. so serotonin stays longer in the synaptic cleft than normal. You're upping seriatric activity. So researchers hypothesized, maybe serotonin is due to, excuse me, maybe depression is due to too little serotonin in the brain. That's the root of the hypothesis. That's where it came from.

Now they have to see, do depressed patients actually have low serotonin? While as early as 1984, the NIMH did a study, precisely on that. And here's what they found. We're not finding anything that shows that there's a lesion or an abnormality in serotonin in depressed patients. Now, that was in 1984.

Now, Prozac comes to market in 1987, and we hear all about how it fixes a serotonin imbalance in the brain, a low serotonin. They continue to do other types of research to try to find is there something wrong with the serotonergic system? system. Now, you can go to the 1998 American Psychiatric Association textbook of psychiatry, and here's what it says. This, it's called the monoamine hypothesis of depression, is dead. It didn't pan

out. We've done all this ways of looking to see if people with depression have low serotonin, and we didn't find it to be true. And then, in their own textbook, they say, you know, this is really sort of a stupid or a silly hypothesis because there's no reason that the underlying pathology of a disorder should be the opposite of what the drug does. That's 1998. The dopamine hyperactivity theory was basically seen as not proving true by the early 1990s. There was still some sense that maybe there's a momentary sort of increase in dopamine activity at the moment of psychosis, but there actually wasn't a lesion in the brain. And here's what you'll find in the research literature.

Kenneth Kenner, something like 2004. He's one of the world's leading researchers into the chemical imbalance theory. He says this, we have hunted for big, simple neurochemical explanations for psychiatric disorders, and we have not found them. Ronald Pies, who's the American, he was the editor-in-chief of Psychiatric Times, which is a trade publication for the American Psychiatric Association. In 2011, he said this about the chemical imbalance theory. The chemical and balance theory of mental disorders is a kind of urban myth,

never a theory seriously propounded by well-informed psychiatrists. Now, in a way, he's right. well-informed psychiatrists always knew his hypothesis and they knew it was falling apart in the 1980s. But what happened was, even as that was happening in the scientific literature, the APA, American Psychiatric Association, some of the advocacy groups, and certainly the drug industry were nevertheless promoting it as having been found to be true. That's the great betrayal of the American public. they were told a falsehood that they had something wrong with their brains, something known to be wrongs with the brain, the drugs could fix it, and this is why they needed to take the drugs long term. And that was never supported in the science.

And there's even a worse part to this story. Please. Here's the worst part, the most unsettling part. in the 1970s, the NIMH funded four studies into the longer-term effects or outcomes with antipsychotics. NIMH funded, not drug companies, okay? Four studies. Because they were worried, it seemed like patients were relapsing more frequently now than they were before the use of these drugs. All four studies found that to be true.

Greater relapse now. And these were studies that compared, by the way, at the time, time, schizophrenia patients treated with drugs in the hospital and without drugs and they followed them anywhere from two or three years. Each time the relapse rate was for those in the medicated groups. And so an NIMH researcher by the name of William Carpenter raises a very haunting question. He says, we know that once psychotic patients are on antipsychotics, they are more likely to relapse if they then come off. Okay. And that's the relapse studies. Once you're on, if you abruptly take away the drug, you're at high risk of relapse. He says,

but what about the patients had never been treated with neurolaptics to begin with? We raise the possibility that these drugs may make people more vulnerable to psychosis over the long term than in the normal course of the illness. This is the moment they worry about the drugs causing a change in the brain that worsen symptoms in the long term. And then researchers from McGill University in Canada put together an explanation for what was happened. What was happening was this, and this becomes central to the whole problem with psychiatric drugs, including antidepressants. The drugs block antipsychotics, block dopamine receptors. They act as a break on dopamine transmission. Now, your brain, being this extraordinary

neuroplastic organ with all these feedback mechanisms says, uh-oh, I got to maintain my my dopaminergic pathways, which are so central to brain function. And I've got to now accelerate my own physiology to compensate for this blockade. I've got to put down the accelerator. And the way it does it, it's twofold. The presynaptic neurons for a period of time put out more dopamine than normal. Now that compensatory adaptation tends to burn out after a while. But then my post-synaptic neurons, they're going to increase the density of the receptors. The brain is trying make itself more sensitive to whatever dopamine that is now available. It increases this number of receptors. So the researcher said, what you've done is you've created a dopamine, a drug-induced

dopamine super sensitivity. And this has the effect of making people more biologically vulnerable to relapse. That would be the normal case of the illness. And it can induce a chronic psychosis, a tardic psychosis. And they began to say, they did a study and they said, you know, about 5% of people on these drugs become chronically psychotic each year. Now, the confirming evidence is this. At the same time, that... So, just the chemical balance story is this. And then I'll go into the confirming evidence in a second.

We were told that people have this abnormality in the brain, right? The drugs fix it. What they found is the drugs caused the very abnormality hypothesized to cause the problem in the first place. And it's the same with the antidepressants. So you go on an SSRI. It acts as an accelerator on serotonergic transmission. So what does your brain do, trying to maintain a homeostatic equilibrium, that normal functioning?

It dials down its own serotonergic machinery. It acts as a break. There's always this opposite effects. So you go on an SSRI, what your brain does, it starts putting out less serotonin than normal, and it reduces a density of its receptors for serotonin. on the post-synaptic neurons. And by the way, this is codified. This understanding of psychiatric drugs is actually presented in a paper by the head of the National Institute of Mental Health in 1996,

Stephen Hyman. He says this. All these drugs work by perturbing normal neurotransmitter function. In response to that perturbation, the brain goes through a compensatory adaptations, trying to maintain a homeostatic equilateral, normal function. And at the end of this compensatory process, the brain is now operating in a manner that is both quantitatively and qualitatively different than normal. So we're told these drugs are normalizing agents.

The science says they're abnormalizing agents. And researchers looking at how the antipsychotics can induce sort of an increase chronicity point to this, and researchers looking at why people on antidepressants long term tend to be more chronically ill look at the same mechanism. They say the drugs seem to be inducing these changes that cause a tardive or long-lasting dysphoria. Now, so this is the sort of image of what is going on with these drugs that emerges in the 80s. Now, there's a long, there's been, the best long-term study of antipsychotics is done by two people from the University of Chicago, or the University of Illinois at Chicago named Martin

Harrow and Tom Job. And in the 70s, where there's this time about worrying about long-term outcomes, they mount an ambitious 20-year study where it's going to be a naturalistic study. They're going to look at people treated with drugs in the hospital, 200 patients, 64 diagnosed with schizophrenia, the others with mild or psychotic disorders. They're all going to be treated conventionally. They're going to be discharged. And they're just going to follow them at 2.0. and a half, four and a half, seven, a half, ten, 15 and 20 years. And here's what they find, which you haven't read about, but you should. This is the best

long-term study in the United States history, even anywhere in the Western world. They found that those who got off starting about a year, year and a half, two years after initial discharge. So they get off, they take themselves off, they find, they start to do better at it at the end of two years. And then what they see is there's a remarkable increased recovery rate for those off, including schizophrenia patients, than those who stay on, such that by year four and a half, the recovery rate for those off medication, this is schizophrenia patients, is eight times higher for those off than those

staying on the medication. And that recovery rate difference stays true throughout their study. There's been eight long-term studies now related to this, and all, not one has found that after two years, the antipsychotics improve long-term outcomes. And in fact, Martin Harrow in 2007, he went to the American Psychiatric Association and he said, I conclude that schizophrenia patients off antipsychotic medications have significantly better global outcomes. And when they went back and tried to understand why, and they've done money, many papers on this, they point to this drug-induced dopamine supersensitivity. Now, I could tell you the same story with long-term outcome studies with antidepressants, where they end up much more

chronically ill than in the natural course of the disorder, and researchers pointing to this same sort of mechanism as the problem. And here's, and Drew, here's the big problem. I'm a journalist. I'm a I'm not a researcher, I'm not one. But I can read research and I can read what they say and I can read what their studies show. And my job as a journalist is to try to be an honest purveyor of information from the scientific literature to the public. Now, it makes me a controversial figure, but not by those who are actually doing the research. Like Martin Harrow and Tom Job, I know them well, they think, oh, you know, thank you for, you know, presenting our research in this way.

But that's our problem. You know, you use the word over prescribing. It's prescribing within a narrative that is not scientifically based. That's the problem. Right. There's no actual truth to support the long-term usage of these things that are there. Instead, we're using other sort of almost. like observational connections and going backwards in time and saying, well, because of this,

this is happening. So that's good usage. And mind you, don't worry about the people who have been on long-term depression medication and antidepressants who are more likely to end up with bipolar disorder. And don't worry about these other things that are being found in the long-term studies that you're referencing. They're either an anomaly or how dare you even question the premise because what we're talking about has been, you know, scientific consensus, right? There's scientific consensus, quote unquote. So how dare you even question the premise? Yeah. There's not scientific consensus. There's guild consensus. Do you know what I mean by a guild? Psychiatry is. Totally. And for those that are not watching our video, I was putting scientific

consensus in quotes on my hand over here. Yeah. Yeah. But that's the point. Psychiatry adopted its disease model in 1980 and with its publication of DSM3. And once it adopts a disease model, these things are diseases in the brain, drugs are going to be the first line therapy. That becomes their product, right? Then so much of the counseling and other therapy, they leave to others. As a guild, they can't now say like, oh, oh my God, our product is causing this chronification of disorders because what are they going to do about what they do? Now, there are psychiatrists who do different things, but in large they prescribe drugs. They even started calling themselves psychopharmacologists.

That's the problem. It's a guild story, and the guild try to present evidence that supports what they do as opposed to this broader line of research, this broader story. And can I mention one thing, for example? Please. What can come from looking at this science? In 1992, a group in Northern Finland said, we're going to rethink our use of antipsychotics. And what we're going to do, they knew some of this research, we're not going to put people who are newly psychotic on the drugs right away.

We're going to see if they can start to recover with sort of psychosocial care and maybe a use of a sleeping agent every once in a while, help them regain sleep. Then they said, but if someone's not getting better after four or five weeks, we'll use an antipsychotic, low dose, help them sort of tranquilize them and maybe engage better with this psychosocial care. A lot of it was family therapy. And then after six months, we're going to see of those who've been on the drugs who can come off successfully. So this goes back to this for whom and for how long, right? They're going to end up with three groups. Those who can recover with never being medicated,

those who recovered who needed them for a short time, and those who need them long term. Now, they began doing this in 1992. And for the next 20 years, they studied every single, this is in Northern Finland, in a place called Torneum, Every single patient who came in psychotic, they studied their long-term outcomes. And their long-term outcomes became dramatically different than anywhere else in the Western world. At the end of five years of their first episode psychotic patients, 80% were asymptomatic at the end of five years and working or back in school.

They weren't on disability. Only 20%, and maybe it was even more like 15% were now on disability. That became the chronic population. What was their medication use, antipsychotic use? At the end of five years, two-thirds of their first episode patients had never been exposed to antipsychotics. They found with intensive psychosocial family care, people could gradually get better and really recover it with never being exposed to the drugs. There was another 13% or so that needed the drugs for a time. And then 20% did seem to need the drugs long term.

They just couldn't function at all without the drug. the use of the medication. So they found a for whom and for how long model. And now their 19 year results are much better than the rest of Finland that uses the conventional care, much less disability, much less medication use, better social functioning. And so this goes to your point, Drew, are we talking about never use of the drugs? No, we're talking about best use of the drugs. and here's a clear example of possibilities if you take all this in. Now, I don't really know how they deal with the thought of what I talked about before, this increasing the drug-induced dopamine super sensitivity.

However, they do use very low doses, and that may be part of it as well. I'm not sure. But what the point here is, if we will be honest about the science and the risks with these, including the risks of becoming bipolar with antidepressants and stimulants and all, we could build a system of care that had a place for drugs in them, but it would be a very different place, and it would be a place where there's informed consent, there's worry about the harms,

and frankly there's a focus on trying to minimize the use of the drugs, especially over any longer period of time. Well, you know, one of my favorite quotes from a Nobel Prize winner, Max Planck is, you know, I'm sure you're familiar with it, A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die and a new generation grows up that is familiar with it. So it seems, you know, we have a few parallel things that are happening. One, we cannot deny the role of, in the United States, advertising and how advertising has really shaped the drug industry and being able to advertise directly to

patients and to get patients to go to their doctor and say, hey, I think I should be on this drug. And now the patients are creating demand for the doctor to then say, okay, I guess I got to learn about this, you know, drug. And the other component that's there is because the problem has gotten so bad, I've seen many of your talks on YouTube that have been uploaded over the years. and I always love watching you speak solo because you go and you orchestrate and paint this beautiful picture of if this was all working, why through all these different measures that we're tracking is the problem getting worse and worse and worse every single year that humanity continues on since the invention of these drugs that have been in.

So we have this perfect storm of advertising an explosion of patients asking their doctors for this medication that's there, as well as the problem continuing to get worse. And I guess I would ask you, you know, are you hopeful? Are you hopeful at all that things are starting to change maybe because a new generation is coming in? Or do you see a doubling down on the original misguided science and us going further down the rabbit hole? Boy, that's a great way to present it. You know, first of all, if you want to look at this as a business story, it's an extraordinarily successful business story. So, for example, in 1987, we in the United States spent about $800 million in psychiatric drugs.

Now, with all this, you know, advertising, drug advertising to consumers, which really took off in the late 80s and 1990s, they built an incredible market for psychiatric drugs. And we're spending something like 40. By 2008, we were spending $40 billion on psychiatric drugs. That's a 50-fold increase in the market size in 20-some years. Now, from a business, you know, capitalist point of view, that's just a success story. They sold a product to the United States, and they did it by, you know, with ads that created a demand. And, you know, one of the, go on the ads.

We were talking about this the other day. I was given a presentation, and they said, well, you know, the ads are like this. You see someone, you don't see someone lying in bed with depression. What you see is someone all of a sudden with the drug walking on the beach with a beautiful person. Oh, we all want to walk on the beach with a beautiful person. And then, you know, there's this thing about the harms where they say it real fast, right? You may not have sex and you blah, blah, blah. But you're just focused on the image.

And they did a great job about creating a demand. including in parents saying they can fix their kids with drugs as well. So now they go to the doctor. And it's not just that they're asking for the drug. They're demanding the drug, in essence. And a doctor sort of has this, what's called an allopathic compulsion. A person comes to a doctor wanting to leave with something. They don't really want to come to a doctor and say, like, I don't have anything for you.

I don't have a pill for you. So there's sort of a ritual of a doctor prescribing something. something so that the patient goes home happy. So that pulls it, takes it into this thing. And, you know, I think it's like 85% of psychiatric drugs are actually prescribed by GPs, who frankly are responding to that demand. It's sort of like moving people through their, you know, their line of patients during the day. So that's what we have going. It's very successfully commercially. And yet we have these worsening outcomes. Now, there's a new book out by the former head of the NIMH named Tom Insul.

And he says, he basically raises this very question. He says, you know, more and more people are getting treated. And yet our outcomes keep getting worse. More on people on disability. More and more people committing suicide. More and more problems with early death. What's going on? Now, you began with that quote from Max Planck.

So he recognizes the problem, but he didn't dare go to your answer that maybe the treatments are the problem. So what he said is, it seems like a paradox that as more people are being treated, we're having these worse outcomes. And he knows, by the way, that there's all this research showing those problems, but he didn't dare save because he's a retiring psychiatrist. And so what he says is the problem is the drugs can't do it all. The problem is society doesn't provide enough psychosocial support. Okay, I'm all on board with giving more psychosocial support, but he didn't dare look at the harmful effects of the drugs. So who's going to do it? It's not going to be the people who made a career and a livelihood of telling

this story. They just won't. So where is our hope? I have the chance sometimes to speak with psychiatric residents, young doctors, young psychiatrists. I have had the good fortune for the last four or five years to be asked to present to psychiatric residents at Temple Medical School. And they're open-minded. The younger people are open-minded because the evidence of failure is everywhere around them. What do we say about the DSM and its diagnostic categories? The people who build it, Alan Francis and other people who create it say, like, these aren't valid. These are just constructs. They're not valid disorders. That's like the people in the nose say the DSM is not valid. The people in the nose say, yeah, we didn't find the chemical imbalances.

We didn't find that. We don't know about any of the pathology. We really aren't finding the genes. So the whole biological effort is a failure. It's a paradigm that has failed. And if you're a young psychiatrist, you now have a chance to create a new paradigm. So that's my hope. is that young, smart, caring people. And you know what? You talk to psychiatric residents? They're young, smart, caring people. They are.

They're wonderful human beings. The problem is, where can they do this? Because then the minute they graduate, they enter a system that is set up to Medicaid and to diagnose. In fact, they can't get paid unless they do that. So my hope comes from these young people who are, you know,

inheriting a broken system, which calls out for change. At the same time, they're entering a system that produces profits and has set up to do the same thing that they've been doing for the last 40 years. So I am a half-glass guy. On the one hand, on my optimistic day, I say like, and there's so much disenchantment with the population at large with the problems. Can we really keep doubling down on this way of doing things? Because we're all burning out.

It's not working. At the same time, systems, you know, systems that are, you know, that have been built up around this. There's so many providers built up around this. It's really hard. It's like a big ocean liner that just keeps budding into the iceberg. But it's hard to change that liner's core. So I'm both optimistic and extremely pessimistic. And frankly, Tom Insel's book makes me pessimistic.

Tom Hinsel knows better. He actually talked about the failure of the drugs seven years ago. But now he's doing a book for the public and he says, listen, let's just shift this way and let's actually give people homes and meaning in their life because the drugs can't do everything. He avoids the central issue because it just isn't politically acceptable for his guilt. And to my mind, it showed a lack of courage. I'm all for, you know, helping people.

People find a meaning in life, social life, making sure people have homes. Couldn't be more imbured with that. But you have to look at the drugs and he won't look at the drugs. That's what made me pessimistic. Yeah. It's a challenging place to be, especially for somebody who's worried about their reputation, which is why, again, when you have people that come from the outside and maybe have a reputation that they're not worried about or not that everybody's not worried about their reputation,

but their reputation is known for questioning things and going to audiences and people who their audience comes to them to say, hey, what do we know and what do we not know about this subject? And that's why I'm so passionate about the world of podcasting and now so many people going to places like YouTube and podcast. And sure, is there a lot of riffraff? Is there a lot of conversations that don't make sense that don't have merit? Of course there is. But guess what? You turn on the news and you get the same.

thing, right? So it's more that if you do find individuals that have the credibility that can show their homework as you have, then you can listen in and say, wow, what's a different alternative look like? How could I look at things differently? And, you know, sometimes the individuals who are deep naysayers in the subject or even are maybe even upset because you're having the conversation in the first place, their default argument, even if they partially believe some of the things that you're talking about is, well, what else could we do? Right. Like drugs work and like what else are we going to do? Patients have a very short attention span. They don't want to go into these lifestyle modification things. They don't want to exercise, even though exercise is on par and

beats out a lot of medications when it comes to psychiatric drugs that are there. What do you say to that when people come back and say, well, does the public have an appetite for going down a different path in the first place? Well, you know, appetites in the public are created with marketing and all. You can create appetites. And, you know, you can create appetites with information. So, you know, I've really focused on how the story that we've organized ourselves around is be lied by the science. okay, and I've really focused on that. But once you see that, that it's belied by the science,

it opens up the very question that you're raising, what can we do differently? And actually, I think the real problem is where the money is. There's not much money for promoting these alternatives, as there are for promoting drugs, you know, because there's just not the profits. But I honestly believe it's been such a failure, this sort of brain, you know, this drug-based paradigm of care.

People are eager for more holistic approaches. And yes, we in America have been conditioned to have the easy answer, the pill, right? Just take your pill and you don't have to do anything else and your kid will be better and you'll be better. And these other things do take time and they take a commitment and that sort of thing. they also but there's two parts of this there's also a society that can build better environments for people to be in including kids they can build you know so for example i know a guy who works with some of the worst kids the worst the most troubled kids in california now he's a world-class rock climber it's one of the world's best rock climbers what he does is he takes these kids from oakland and san francisco

who are seen as so disturbed, and then he starts taking them out to rock climb. Okay? He's not teaching them therapy. What he's teaching them is when you rock climb, what happens? Well, you've got someone belaying you, so you have to trust the person up above. And sometimes you're belaying somebody, so they have to trust you. So all of a sudden he's building trust. People go up a wall, they confront fears.

And then when they drive back and forth, what happens? they have a chance to talk to a mentor. And all of a sudden, there's a bond for me. Now, there's no, quote, therapy going on, but he's creating a new environment for these kids to be in. So one of the things is when you asked, sometimes you can just create better environments for people to be in. In other words, it's not all reliant on the person.

Another example of this is a guy, there's a group in Connecticut. They're called Volunteers for Psychotherapy. And they basically work with people who've come out of mental hospitals. And here's what they say. We'll give you an hour of psychotherapy for free. Can come talk to us. But you have to pay for it by doing two hours of volunteer work. So now what does the volunteer work do? Well, now, of a sudden, they're helping others. They're not always the one being helped. And maybe it's working at an animal shelter, delivering food to the

elderly, whatever it might be. But now they're getting a chance to help others, feel good about that, have a purpose in life. And, you know, one of the things, one of the person who does this likes to joke is, I'm not sure how valuable the therapy is, but I'm pretty sure the volunteer work is helpful. So that's that. And then the other thing is, how do we promote wellness? Now, there's a lot of things about promoting exercise, diet, sleep. Somehow, you know, there's not.

There's, I mean, I mean, there's an industry there and you can make some money, but it's not like corporations extracting huge profits. But somehow we have to build that appetite, which is there for self-care. How do you eat well? Why is exercise important? You know, why is it important to have some socialization, like going out to whether it be bowling or a book group or anything like that? So these are the solutions. you see? And here's the amazing thing. What you find is if you can build more supportive environments, they're always, in some ways, they're always helpful, including for psychotic patients. And there's a long

line of history showing that to be so. So we know we can do better environments. We know we can build better environments for kids. So we as a society need to take that on as our responsibility, because it's so expensive to have this explosion, mental distress in our society. And then somehow we just have to promote these sort of physical wellness as a path to mental wellness as well. And I know Dr. Hyman does it. I believe he's done initiatives at the federal level

to promote these sort of wellness initiatives. And you and I are human beings, right? So what is the first thing that throws us off? If I eat crap, if I eat crap day after day after day, I start feeling sort of crappy. So, I mean, having a good diet is often so important. You know, I know people who work with, you know, youth teenagers who come, you know, from pretty impoverished background. And they'll ask them, what was your breakfast like?

What do you think their breakfast is like? First of all, half the time their parents are working their asses off trying to, you know, service jobs and all. Oh, I got a donut on the way. And there was a program, by the way, in the 90s that began to say, let's change our cafeterias in schools. Okay, I think there was a place in Appleton that did this, Appleton, Wisconsin. Instead of having the crap we serve, let's have, starting with breakfast, really, you know, cooked, baked, healthy foods. We'll do that for breakfast.

We'll do it for lunch, and we'll do this. will teach the kids how to cook and will teach them the importance of using real foods guess what happened in that in that school district oh and also they took out all the coke machines you know how there's a lot of schools that got coke machines to make money and all this stuff they took those out what happened there well academic achievement went up uh ADHD diagnosis went way down in other words this was successful just bringing in this sort of nutritional approach but it didn't stay because there was some money involved with actually delivering good food to kids, delivering breakfasts, and it just never expanded into other schools.

But that's an example of a society that is trying to raise its kids with good nutrition. And you see this in France. They actually care about what food they're treating their kids. So long-winded answer to your question, there are things we can do, but somehow we have. have to have a national way for building better environments and encouraging these appetites and discouraging the idea that appeals a simple solution to our many problems. I think that's well said. And going back to some of the work that we were talking about earlier, also the understanding that maybe these studies that have been held up as the definitive reason that these drugs are used,

especially in the case of psychiatric drugs for long-term usage, really questioning the narrative to begin with. And, you know, in his book The Sickening, just going back to that, just because we had him recently on the podcast, and it sounds like you're aware of his work. I don't know if you guys have met at all before, but I would love to connect you guys. But they've changed emails.

I don't know if we've ever met in person, but we've written each other emails. Yeah, Dr. John Abramson, one of the things he was saying is that, you know, you go to your average physician that are there, again, well-intentioned, well-meaning, they want to be there. They all got into medicine for good reason and to make a difference. Most of them don't know that the peer reviewers don't have access to the raw data, that they are reliant on the pharmaceutical company's interpretation

of the data and their conclusions, and they're basing their peer review on those. And in the book, there's also solutions on how to get there. We need a public citizens group that's independently looking at these things so that the pharmaceutical companies can protect their sort of, you know, their intellectual property because there might be some other drug development that might be in there, but we need a public citizens group to be able to look at this and say, asked this very question that you were asking earlier, was this pharmaceutical trial designed primarily for marketing purposes? That doesn't inherently make it bad, but is it gotten egregious and completely out of whack

for the pursuit of profits and not looking at the actual real world usage of how these things fly into the system. So even helping people understand, like when I came across that information and I started sharing it with, I have many doctors in my family, my brother-in-law, many of my cousins, uncles, other stuff. I grew up in the world of psychiatric medicine. My dad was the CFO of a group of psychiatric hospitals growing up. Oh, okay.

And I heard the sort of standard lines that were there. And, you know, he's more on the administrative side. He's not on the, but I heard the terms chemical imbalances growing up. So until we start to question the premise of how, you know, the sausage that's going into the sausage machine in the first place, we are not going to be able to unwind and start to think for ourselves. You know, I want to ask you, sorry, were you about to say something? No, no, you're exactly right. I mean, the problem is there is a process for basically indoctrinating doctors.

I mean, it starts with what you're talking about, industry-funded trials. But then they also pay, quote, thought leaders to give continuing medical educate, the industry pays people, to give community medical education classes, and to give talks to doctors. So the doctors goes out to a talk, and he's actually not, the GP may not even be familiar with the literature, but now he's got this guy from some famous university or something saying, here's why you need to use this drugs.

So there's a whole sausage-making industry for promoting the drugs. And the amount of money, by the way, that I did a report on this for the website I ran, Mad in America, there are 64 psychiatrists in the last decade who've got over a million dollars from pharmaceutical companies to promote their drugs through community. medical education programs, et cetera. So that, just to say what you're saying and John's saying is, this is the problem. There's a process for selling a story that well-meaning doctors here, but they don't have the time really to go into the actual studies. And then we have the problem as what John says, we can't even see the data on these studies. So this is part of the problem.

We have a corporate enterprise that creates the story that medicine adheres to. You know, your book, Anatomy of an Epidemic, came out in 2010, I believe. Is that right? 2010, it came out. That's right. And so that's now 12 years. The book has been out. And there's, if individuals are familiar with the term anti-fragile, that something that's

anti-fragile gets stronger when it's stress tested. And I would love to hear from you because as you eloquently stated in the beginning of the interview, you had no skin in the game. In fact, you kind of came from the place of you were the champion of these SSRI drugs trying to explain individuals how well they worked and how great they did. And they were insulin for diabetes. They were addressing this very specific mechanism. And we should be also thankful because that's the miracle of modern science and the researchers that are. out there. So if anything, you would have skin in the game to continue to promote that. But you said you were asking a basic question. And because you had that question, you were open-minded,

you were willing to go with whatever direction that that question continued to take you down. Now, as part of that process, because you're a reporter, you're constantly on the lookout, well, you're a journalist now, but in the past you were a reporter. You want to actually challenge your ideas. You want to hear the arguments, the debates. You've participated in a few debates. We'll link to a couple of them in the in the show notes. Since the book had originally come out in 2012, have there been fair criticisms, debates that you've been part of, or dialogue that you've had that have made the book and your central message of do these psychiatric drugs actually cause more harm long term than good? Have there been a handful of,

or a couple of things that you've come across that have made your argument even stronger, but they were good criticisms that came into the foray. Anything that you can think of? You know, that's such a wonderful question. I love the thing about anti-fagility. So, you know, when I reported, when I wrote anatomy of an epidemic,

you know, the literature is vast. I did my, and I went about it this way. I first wanted to say, well, what is the evidence for the use of the drugs this way, okay? what do they cite for the long-term use? And so for antipsychotics, it's relapse studies that I mentioned. We have people on the drugs. One group is taken off.

One group stays on, and the group taken off does relapse more free-fronted. And that's the same basically with the antidepressants. So I first wanted to say, okay, what is the evidence cited? Does that prove long-term? And is there even anybody, is there any studies? that do show long-term benefits. So I first tried to flesh out the evidence for the use of the drugs. And just to go through this process a little bit,

then I would find people saying, well, we really don't have evidence for the long-term use. So now I knew it was a valid question. And then I could go through this process of trying to put together a puzzle. Even so, when I was done, and I did it, you know, I looked at long-term outcomes for antipsychotics, antidepressants, changing bipolar outcomes and stimulants, right?

And benzodiazepine. It's a lot to cover in a book. I'm a journalist. I'm not a researcher. And so it's a pretty vulnerable position to say, hey, guys, I think you're wrong. I think here's what your evidence shows. So I was, you know, I wondered, did I miss something? And to this end, I still feel.

felt we need more research on this. We need more attention to that. So I actually helped found something called the Foundation for Excellence in Mental Health Care, a nonprofit that would help fund further research into long-term outcomes. In other words, maybe they would fund stuff that be lied what I knew to be true, what I thought to be true, because I thought that that is what you should do. If you don't, you know, the evidence I put together I found compelling at the time, But it wasn't as robust as you might want, okay, because it just hasn't been the way we look at drugs. So part of my spiel was we need more research. And maybe this will be proven to be wrong.

And in a way, it would be nice if I weren't proven to be wrong because the story I was telling, told of great harm done. Now, the criticism I really got. So the first thing I want to see is, is anybody going to say I misquoted him? and nobody and I cited a hundred of says studies. No research themselves said I misidentified their study or presented it out of context. Now, others said I did, but not the researchers themselves. And one of the reasons I knew I wouldn't be saying about misquoting is because I didn't quote anybody from an interview. I quoted them from their written discussions in their own papers.

Because now I knew like, you said this. Here's the context. You can't tell me, you know, I was doing something. You published this paper. And so because of that, I did go through this period where no one said I misquoted them. So that was important to me. And that starts to make you feel stronger. Now, one of the key studies was the one by Heroin Job, okay?

Heroin Job in 2007 had said, yeah, we'll get this recovery rate eight times higher from the unmedicated schizophrenia patients. But they said, and I wrote this in the book, it's not the drugs causing the worst outcomes, it's just that there's a percentage of good prognosis patients who can do better off medication. Okay, so they weren't blaming the drugs in 2007. They were just saying there's this good prognosis patients

that can do better off. So I did write that in the book, but I also pointed out to Martin Harrow. I went to him, I said, but wait a minute. You also have this data where, this is sort of an interesting story, you also have this data for milder psychotic disorders. The milder people do better off than the milder people on. I said, but here's the real thing that I would lead, you know, makes me question whether it's just good prognosis. The people with milder disorders who got, who stayed on the

drugs did worse than schizophrenia who got off. Now, schizophrenia is supposed to be a more chronic worst thing. And I swear to God, he said, wow, we really hadn't thought about that. And they went back and now looked at this and then they said, it's the drugs. Now, that was after 2010, okay, after the book was published. And they've now published like six, seven papers saying it's the drugs. That's what we're seeing happening. It so happens. I talked to Martin Harold just Sunday because his partner Tom Job died last week. And he's saying, yeah, this is what we haven't shown. But here's my point. A lot of people went after me from Martin Harrow. They said, oh, he's, he doesn't even understand Martin Harrow study. It's a naturalistic study.

It was just the good, the people of the good prognosis went up. And they used that to attack me. Meanwhile, I knew Martin Harrow was telling me, like, you know, I think you're showing us something with their own data. We didn't really see. And they spent a decade doing it. This is where I got stronger is when they went back to their own data. And they even cite me saying Whitaker is right. Wow. So I felt real strong. And the other thing is I got in these debates.

People would attack me, say, you're a horrible human being and stuff. But they never presented data that told a different story. Right. It's easier to call you crazy that it is to actually point by point go through each one and say, here's your evidence and here's our counter evidence. Instead, it was something else. It was, you know, it was killed a messenger, really. So that made me feel much stronger about it as well.

And then, so for example, both on ant, I know of people that actually did retrospective studies on antidepressants, they all concluded. There was one in Switzerland. There's one in the United States. And using this state and said, yeah, listen, there was a number of studies saying, antidepressants are making things more chronic. This came out after 2010. There were people that have done studies about looking at long-term outcomes with antipsychotics.

They've all been negative. Now, I feed this as tragic, but it does make me feel less fragile because the evidence that was there in 2010 got stronger. I did a second edition in 2015 and looked at all this evidence. So, unfortunately, in a way, the evidence is so much stronger. in 2022 than it was in 2010. And, you know, I still get, you know, hammered and that sort of thing, but you've watched me present. I just try to present the evidence, you know,

and I'm not, when I present in public and I've been in debates and I've done in grand rounds, I just say, here's your evidence. And you can yell at me and stuff, but it's your evidence. And unfortunately, it just keeps getting stronger and stronger. But I love your question because just can I say one thing, Drew? Sorry, I'm going on. Your question is so important. If you do something like this, you should have an open mind that you can be proven wrong.

If you don't have that, then you're no longer being a good sort of approaching it with a scientific mind. So your question is right on. No, and I think it takes a lot of courage. I want to take a moment to acknowledge you because I'm sure there have been many as fulfilling and as beautiful as this work has been, even though you might have had doubt along the way of like, is there something that I'm missing? Is there some part of the piece that I don't get?

How is it that I, you know, I'm not a medical doctor. I'm coming across this stuff. And the researchers of the medical doctors themselves might be missing this. And yet still, even though when you double check and triple check your work and make sure you're not misquoting people, there's a little bit of attempt that takes that leap of faith for courage. You know, it's that courage to say that this is most likely going to have, at least if people go and Google me, reputational damage.

I'm not going to have certain career opportunities. And yet still, the message is so important that I have to tell the story because if I don't, who else will tell this story? Right. Yeah, eventually somebody will. But is that going to be in another 25 years? Is that another 30 years? And how many more patients get worse? How many people get sick?

And how many doctors who genuinely want to do the right thing behind their patients that they're taking care of are like, well, I just didn't know. I didn't know any different. So I want to acknowledge you for that, you know, because it's, even though it's been quite some time that you've been out there, still at very much. much feels that, you know, this message that you're putting out there, it's now really starting to get into the zeitgeist of the people that can take it to the next level and incorporated through their work. But meantime, I can't, I bet you have countless stories of how often you

were passed up for an opportunity or you were not allowed to do something or that you got criticism from people that you admired because they just looked at the surface level of it. So just want to acknowledge how much that took from you over the years. You know, it has taken a toll because you do get your character, you know, attack. And if people don't know, and all of a sudden you're seeing as, you know, counter to these experts at these universities and all who are speaking out, it's pretty easy to think you must be the crank, right? Because they don't know. So that's been, I'll be, you know, there's so many things that are much more difficult than this, but it is difficult to, to,

to just stay true to this. I mean, it does hurt your reputation. You know, magazines even said, you can't write for us now because you'll be seen as bad biased. Once you break with conventional wisdom, it's really tough. On the other hand, it's been extraordinarily rewarding, emotionally, professionally. I've had nothing more rewarding in my whole life to see, to have a hand in sort of changing this discussion, what you're talking about, and actually to see alternatives do spring up. Like Israel now is rethinking its care of psychotic patients. They're forming these satiria houses. They brought me over there to help talk about that.

They're changing where they're basically looking at this for whom and for how long. Norway at a governmental level said we need to have medication-free treatment for people who want it, because there's reason, including for psychotic patients, because there's reason that will produce better outcomes. A hospital in Norway started up calling itself the first medication-free, you know, hospital in the world. and it came from seeing it wasn't a conference I presented at

but it was a conference where people took slides from me about Martin and Hale presented it and the psychiatric nurse said we've got to do something different and now there's a whole hospital so you know I've had a I'll add in one more impact in that if I could if I'll add in one more to that

the doctor the psychiatrist that introduced me to your work Dr. Omid Naim good friend of mine incredible psychiatrist if anybody's looking for an integrative and open-minded psychiatrist that sort of thinks the way that you're talking about in the book of like creating other alternatives. He's based here in Los Angeles. But he was inspired through partly your influence and other people that he's exposed to over the year. He was inspired to create a nonprofit called a LaMeda project. And they go into

group homes and they provide a more integrative approach for these kids who are extremely troubled. And I just want to say like, you know, sometimes we don't even know the impact that our work has and they're doing incredible work. They just partnered with the YMCA of Los Angeles and are rolling out a program. And they have people like actor Ben Affleck and other top celebrities that are all part of their nonprofit that are there to like spread the word further. So when I hear about stories like that, I feel extremely hopeful. Boy, that's a beautiful.

You just made my day to hear this. I mean, yeah, I feel hopeful with that too. and if I even had a small role in helping make that happen or encouraging it, then that's just what reward could you have than that from your work? That's like the best thing that you can possibly hear. Robert, is there any final words that you want to leave our audience with, especially for people who, you know, I think at this point in time, everybody knows somebody and even the person listening might be somebody

who's been told that there's a central chemical imbalance. need to be on these drugs long term. And they have questions that are there. And they're trying to weigh out the pros and cons. Of course, at the end of the day, this podcast is not medical advice. We're always trying to provide people with information where you can find, hopefully, an open-minded doctor. It doesn't even have to be integrated, just open-minded, somebody that will see you as a human

being and work with you on putting together a personalized treatment plan that's best for you. But yeah, any final words that you want to leave our audience with? Well, first of all, thank you for the interview. It's been really good to have this chance to speak with you in this sort of depth. So thank you for the interview. You know, I do run a website called Madden America.com, and we do have informational pages on there related to drugs. So part of the message I say to people is I believe in informed consent.

And so my whole thing is to provide information that can help people make informed choices. So we do try to provide, you know, summaries of research and access to the documents themselves on our website. So they can go there and find that. But the message I think is once you get away from the chemical imbalance story, you can find a message of incredible hope. And for your own future and for the future of kids. What you find in nature is, yeah, people can lapse into depression. People can lapse into psychosis. They can have sort of these manic episodes.

And, you know, kids certainly can be misbehave in school. But what you see in nature is an extraordinary resilience and the capacity to change and the capacity to develop new paths in life. Especially if you change your environments. Like, you just talked about a program that sounds like getting these troubled kids a chance to, I don't know, maybe play basketball. certain things like that or engage in certain activities. And really, if we really look at the going back to the beginning, the natural spectrum of outcomes, what you find over and over again is this so many psychiatric problems can be episodic and kind if you get the right sort of psychosocial care, including psychosis.

But not everyone recovers from that, but, you know, the majority can, first episode, psychosis. So the hope is human beings are resilient. We do respond to our environment. We are built to respond to our environments. So if you can change environments so often, that can be a path to better lives, better recoveries. I do think one of the problems is we have such a stressful society in terms of work and all that and how parents are taking, you know.

But that's the message I would give is we human beings, yes, we struggle, we suffer. We struggle with our minds. We can have awful feelings. And these feelings can persist. But we also have this extraordinary capacity for resilience and change. And if one of the real problems of the chemical imbalance, it makes it things you don't have that chance of changing. It's like that you have this fixed problem in your head. That's not true. And we human beings, we change in response to our environment. And hope is such an elixir for that. a positive elixir. And what you're talking about functional medicine,

thinking about nurturing the body, the body is part of the mind. I mean, absolutely the same thing. You know, that's another path towards a better way forward. So as sort of pessimistic as can this all sound, I hope this hour and a half,

which has been such a pleasure, leaves people with a sense of hope. The change is possible. and we just have to find ways to discover some of these strengths within ourselves. I think the most hopeful message is always the message that says that, hey, even though it might be a little overwhelming to hear that our lifestyle as a society, or maybe your lifestyle as an individual person, or the lack of community or social isolation, or your diet in some cases, or not having access to just good group therapy, Again, that falls on the individual, but it also falls on society.

And as overwhelming as that can feel like, oh my gosh, you're saying that I'm part of the problem, it's actually the most hopeful message because the law of responsibility says, if you're part of the problem, you can actually do something to benefit it. But the other alternative idea is that if you're just fundamentally broken, guess what? You're broken. And so you're a victim for the rest of your life. And don't worry, don't do anything besides take these medications because, nothing can be done in the first place.

So actually, I'll take, even though the first one can feel overwhelming when you step into it, I'll always take that because at least I can do something about it. Robert, thank you for being on the podcast. It's an absolute pleasure. If people have not picked up one of your books, and I always recommend anatomy of an epidemic, magic bullets, psychiatric drugs, and the astonishing rise of mental illness. You know, it won the U.S. investigative reporters and editors book award. It's a great place for people to start if you're a reader.

And if you're a listener and a watcher, I'll link to some of the other favorite interviews and debates that you've put out there. And also, Matt in America, your resource website. So, Robert, thank you for being on the podcast. It's a true pleasure to finally get a chance to connect with you. Drew, thank you very much. It was an honor and pleasure for me. I really enjoyed it.