The Blindboy Podcast - Dr. Pat Bracken

Episode Date: August 7, 2019

Pat Bracken is a psychiatrist and a doctor of Philosophy. He is critical of mainstream psychiatry and the power that pharmaceutical companies hold over the field. Hosted on Acast. See acast.com/privacy for more information.

Hello and welcome to the Blind Buy Podcast. How are you getting on? Have you been having a good week? I'm doing pretty good at the last stages of book editing and the finish line is in sight, which is fantastic. The finish line is definitely in sight. That is a good feeling. which is fantastic, the finish line is definitely in sight that is a good feeling as soon as that book is done I am going to play the Xbox in my underpants

that is something that I sorely miss I haven't really been I've been able to do a little bit of video gaming small bit maybe like a half an hour a couple of times a week but I miss having the Small bit, maybe like a half an hour a couple of times a week. But I miss having the free time to be able to play Xbox in my underpants for a couple of hours and to feel guilty about it.

I've been so busy, I want that. I want to essentially waste time and then feel guilty about wasting time as an act of leisure. That is what my organism needs. Those are my needs at the moment. And I think in about a week's time, yes, this will be possible. Fabulous feedback for last week's podcast. I really fucking enjoyed it because it was it was bonkers it was

the only thing planned about that podcast was the fucking Michael Fassbender's piece of prose at the start but it really do you know what

I felt great after doing last week's podcast. I felt really good because I engaged a lot of creative thinking in order to solve a problem. And I felt invigorated after that. You know, a battery exploded and I just felt like turning it into a song it's just

it's what hit me it's what came at me in the moment and rather than saying that don't be ridiculous that's stupid I went with it and was quite happy with the result

and I needed that I think to do you know why I needed it I'll tell you why because there's two types of creativity there's the fun silly creativity and then there's the more serious disciplined creativity and right now because I'm in book editing territory and because I've just finished, we'll say, doing voiceovers and helping with the edit on the BBC series, I was engaging serious analytical creativity,

which is... I don't know how to describe it. I'm still using my creative brain. I'm still solving problems creatively. Having to come up with ideas. But it's less fun. It's very focused. It has a purpose.

It's refining something that's already created. And making it better. And that can be quite draining. It's the professional side of creativity. But then there's the other side of creativity. Which is much more powerful and that's the fun playful creativity

that's where it's where ideas it's where good ideas come from and a key to engage in that type of creativity is when you sit down to create anything, there's a little voice in your brain that says,

don't be ridiculous, don't be silly. So when you're entertaining possible creative solutions in your head, your internal critic will come in and say, that's silly, that's stupid, that'll never work. In order to engage fun creativity, you have to not listen to that voice at all and you explore and entertain whatever notion comes into your

head in a really fun playful way because you don't care if it's going to be good or bad you're just trying to have the crack and last week's episode for me was definitely that i definitely got that feeling and i just felt i felt good for the next few days afterwards i felt um de-stressed and happy because it is important for all of us to for your own mental health like creativity isn't just for people who are fucking professional artists creativity everyone has creativity in different ways and

it should be a part of all of our lives our daily lives as a way to find personal meaning do you get me and fun creativity

in particular it's going back to Carl Jung that I mentioned in the earlier podcast exploring your what's known as your free child all right now is that transaction analysis no transaction analysis and carl young both have the free child concept which is the part of ourselves as adults that engages the curiosity and playfulness

and humour and creativity and not giving a shit that we all had as kids that society kind of beats out of you a little bit so yeah last week that's what that podcast did for me

so I'm very happy with that and thank you for the lovely feedback good crack there at the weekend too I went to I had a live podcast at a festival called

All Together Now in Waterford and I thought here's the mad thing actually now that I think of it And I thought, here's the mad thing. Actually, now that I think of it, I've just realized it. So at this live podcast altogether now, shit went very wrong.

Okay, when you're working in entertainment, shit can go very wrong very quickly. Like a number of things can go very wrong very quickly and not like a number of things can go very wrong very quickly and for this it did so it was an early gig at this festival in Waterford and it was like 12 o'clock in the day it was blind boys brunch that's what it was billed as so I was supposed to be doing a live podcast as brunch or something and i had guests lined up i was going to interview the whalers bob marley's band you know the whalers because they're gigging at the festival but whatever happened you know festivals everyone's very busy lines were crossed and nobody said to the whalers what time the actual podcast was on so i'm traveling up to the gig it's like nine in the morning then i find out the whalers what time the actual podcast was on so i'm traveling up to the gig it's like nine in the morning then i find out the whalers aren't going to be present so it's like shit okay

i've got a i've got a live podcast in two hours and i don't have any guests now when you get to a festival at 12 o'clock in the day on a Sunday, it's tough to get fucking guests. So I had all the people at the festival going, listen, just ring around. Find me comedians, musicians, artists who will be interviewed by me at 12 o'clock in the day on a Sunday. And nobody had their phone on because it's a fucking festival. And they all went and had a lot of pints the night before so I'd no fucking guest so then I thought I said to myself fuck it it's an hour I'll read some of my book and I'll go out and it'll just be me on my own and maybe

I might bring a few audience members up on stage or something we'll have crack I'll do the hour on my own and I bet it'll be crack and we'll work it out then I find out I thought I was playing in a little tent you know because usually when I do a podcast at festivals I'm playing in a tent that holds maybe 150 200 people small enough audience so with that in mind, I was going, absolutely, I can do an hour on my own, no hassle. Then I find out I'm gigging on this fucking bandstand. And so I get up, ready to do the gig. I'm not joking.

About maybe 2,500 people showed up. Like the festival had 20,000 people. 2,500 people, two and a half thousand people sitting down on the grass, and there was a lovely break in the weather, and the sun had come through, and a lot of people were just like, yeah, I want to see a bit of Blind Boys podcast at 12 o'clock on a Sunday to relax, because I've been pissed all the time, and I had a hangover, so I had fucking two and a half thousand people there, been pissed all the time and I had a hangover so I had fucking two and a half thousand people there and I'm like shit what am I gonna do so just before I'm ready to go out on stage I spot a man

called Ian Wilson and Ian he was working at the festival he was backstage Ian is a legend he is he was the producer for Dave Fanning's show on 2fm for years and he was like the main person in irish radio who would have been booking bands and musicians since 1979 so literally 10 minutes before stage i said to ian wilson please ian will you just come on and be my guest i'll ask you whatever questions because I knew as well he's good crack he's very smart and myself and himself he's been really good to myself and the bandits over the years I knew we'd have a buzz and I knew he's the type of person who he'd be able to take the piss out of himself if I was slagging him and stuff so he said fuck it

yeah so I dragged Ian up on stage and it turned out to be a really really good uh experience and i don't think that was a crisis situation that that's you know the one of those things in the job where it's like oh fuck the shit that's going that can go wrong is going wrong and in those high stress situations you are faced with the with a choice of will i panic will i give up or will i do everything in my power to find a solution and i didn't panic for one bit um i didn't give up give up would have meant saying well my guests aren't here so i'm not going to do the podcast you're going to have to cancel it i wouldn't fucking do that because then that leaves the audience disappointed i'd never do that so instead i was able to respond to the situation kind of creatively in the moment

and to be okay with that and to go, fuck it, it'll be grand. There, Ian, he's good crack. Do you get me? I think the only reason that I was in the mental headspace to be able to respond to that crisis in a calm fashion is because last week's podcast had a degree of emotional catharsis for me whereby because I engaged my free child creativity it completely distressed me and

it was like recharging my batteries so as a result then I could directly link that to a challenge that i was faced with where i responded rationally calmly and creatively in the moment what i'm getting at what i'm getting at is the importance of creativity in all of our daily lives. As a way to. Find personal meaning. And to have emotional catharsis. To. Catharsis means. Cathar is like.

I think it's a fucking medical word for spit. Is it? Catharsis means getting it out of yourself. Whatever is bothering you. It's like massaging your emotions. Creativity is a good way to do it. Laughter. Fun.

These are great tools that we have. To get to a base level of. Good healthy emotions. And don't be saying to yourself. Oh I'm not creative. I'm not an artist. Don't mind that bullshit. Everyone has creativity in them everybody

and you know why because think back to when you were a little child before the age of 5 did you play with crayons did you play with Lego yes you did of course you did all children play all children are creative

just what happens is we get a little bit older and society decides you're good at creativity and you're not good at creativity and people tend to stay away from it then if they believe they don't have a talent we'll say fuck that um everyone can be creative and it is not just the sole property of professional fucking artists get yourself an adult colouring book get yourself some Lego

do you know what I mean fucking start baking cakes anything that requires you to solve problems but using a really fun enjoyable part of your brain that's creativity really

okay so I've got a I've got a treat this week em I've got a cracker of a fucking live podcast with an amazing individual called Dr. Pat Bracken who is

he's a psychiatrist and he's a doctor of philosophy um and he is he was the head of the west cork mental health board I hope I have that correct. But he's a practicing psychiatrist who has traveled the world. And what makes Pat unique is that he's an incredibly outspoken psychiatrist regarding the actual field of psychiatry itself. And he's incredibly outspoken and critical about the role that pharmaceutical companies have in shaping what psychiatry is. It's a topic that I've wanted to speak about a lot on this podcast but I don't because I'm too out of my depth when it comes to it and as well I'm conscious that you know i have a lot of listeners that listen for mental health reasons i know loads of you are taking antidepressants taking anti-anxiety medication

taking anti-psychotic medication whatever you're prescribed and i want to be cautious that I'm not pill shaming do you know what I mean there is incredibly reasonable evidence based rational critique to be made of the heavy use of medications for mental health

and the reason this critique exists is because it is very much driven by capitalism and it's driven by pharmaceutical companies it's very cheap if if we say with a national health system it's incredibly cheap for a national health system to favor medication over something like counseling which is more expensive so i'm not like i said i'm not pill shaming i'm not giving out about medication or drugs not none of that that's far beyond my depth um every single person is different every person has different needs and medication plays a role in that okay but what i am cautious of is just like i said the role of pharmaceutical companies in influencing and

pushing medication where maybe for some people medication isn't the best solution for them. Do you get me? So Pat Bracken, who I'm going to talk to shortly in a few minutes. Pat is one of the leading psychiatrists in the country. He's an expert. So I have an expert in the field. Giving his views, his professional learned views on this rather than me talking out of my hoop if you get me is there anything else i have to fucking mention

yes i have and i can announce this now i have an australian tour coming up lads where the fuck hold Hold on now. I'm going through my phone. I'm trying to find it. Right, yeah, so I have them. So, yes, I can announce I am going to be doing some live podcasts in Australia. I can't fucking wait.

Haven't been in Australia in a few years. These are going to sell out very quickly, lads, because, like I said my Canadian fucking my Canadian podcast sold out in under 2 hours and I have a lot of listeners in Australia I think it's jeez there's nearly

200 200,000 250,000 of my listeners are in Australia so these will sell out quickly I believe the tickets for these go on sale on either the 13th or 14th of August you'll get them at troubadourmusic.com so here's my Australian dates 2nd of February I'm in Perth 4th of February Brisbane 6th of February Sydney 8th of February Melbourne

I cannot wait I am looking forward to that that is going to be tremendous crack is that it yeah that's it so there you go lads they're in February and those dates will go

on sale on 13th or 14th of August, okay, um, before I get into the live podcast, I will do the ocarina pause, but I don't want to do an ocarina pause this week, because I was given a class fucking musical instrument and it's called a a goya drum and it's a they're made up in dublin it was given to me so it's not this isn't an advert it was it was given to me like as a gift i'm just saying what it is but like so i was given this drum they're made up in dublin out of repurposed steel i think what it is from looking at it, it's the bottom of a, like a cal or gas canister

that has been turned into this steel drum. So, instead of the ocarina pause this week, we're going to have the Gaia drum pause. Because it sounds very interesting and I only started playing with it today, but I can't wait to

arse around with it more because it has lovely strange tones. It's a drum actually that's specifically used for meditation, I believe. For when people, and used in meditation and used in music therapy. But it's in the key of D. So you could also use it as an instrument if you wanted. So here we go, here's the Goya drum pause. And move it close now because I have it on a chair. Thank you. Show those living with mental illness and addiction that they're not alone. Help CAMH build a future where no one is left behind.

So, who will you rise for? Register today at sunrisechallenge.ca. That's sunrisechallenge.ca. On April 5th, you must be very careful, Margaret. It's a girl. Witness the birth. Bad things will start to happen. Evil things of evil. It's all for you. No, no, don't.

The First Omen. I believe the girl is to be the mother. Mother of what? Is the most terrifying. Six, six, six. It's the mark of the devil. Hey! Movie of the year.

It's not real. It's not real. It's not real. Who did that? The First Omen. Only in theaters April 5th. How class is that so that was the guy a drum pause yeah so i turned off the piano in the background for a little bit there because they were in different keys and it would have sounded quite disgusting so we're just going to wait for the the piano should come back on. Now, where is it? There we go. Yeah, so also,

this podcast isn't sponsored, so you can support this podcast by visiting the Patreon page, patreon.com forward slash theblindboypodcast. Do you like the podcast? Is it helping you out if you met me in real life would you buy me a coffee or a pint well you can do that by visiting the patreon page you can become a patron the podcast this practice it fucking it changes my life i say it every week

look i've got a regular income now as an artist which is absurd I know how much money is in my bank account and how much I earn, I can plan it's like having a real job so thank you so much to all of my patrons in my many years of operating as a professional creative I've never had this

a regular fucking income and I do now so thank you so much also what you can do is you know subscribe to the podcast if you're listening on spotify follow the podcast if you're listening to it on the podcast app on your iphone subscribe to the podcast rate the podcast leave reviews of the podcast um what else word of mouth do you know the reason i'm able to go over and do gigs in australia is because

mainly i think it's it's it's that lovely paddy factor that emigrating paddy factor a big thing with this podcast because i i would hear from australian listeners of this podcast you know australian people and a general theme is like obviously around the time of the recession a lot of irish people emigrated to like australia canada whatever and a common story that comes back to me is an Irish person was listening to this podcast and then they played it in their office we'll say for a

bunch of Australians and that's how I got new fans so it's like Irish people were carrying this podcast around and then showing their mates who weren't Irish. Who wouldn't know who the fuck I am. Or know who the rubber bandits are.

And now I just have these listeners. Who are Australian. So word of mouth. You know. If you can't afford the Patreon. If you're not someone. If you can't be arsed fucking. Writing comments. On an app. Then just tell a friend about the podcast just someone is interested in podcast go do you know what

listen to blind by that's how you can give me a helping hand all right i'm gonna move on to the live part of this episode. This is an interview with Pat Bracken. An incredibly interesting, knowledgeable, compassionate person. Just a pleasure to fucking listen to. I hope you enjoy this one. If you're into mental health health here's a fucking expert talking I'll see you next week and one last thing actually with this

podcast there's elements in it where I'm asking I ask incredibly simple questions and also there's points where I explain incredibly simple things about psychology or psychiatry right this is not me trying to explain it to pat bracken the expert this is me as the role of interviewer kind of assuming that the people listening may not know

so i go quite heavily simple and stuff just in case you're going why is blind by trying to explain psychiatry to a psychiatrist what a prick it's not i'm uh taking on the role of interviewer also there is a factual inaccuracy in this i say that the painter amedio medigliani died by suicide. He didn't. His girlfriend died by suicide two days after his death of tuberculosis. So just to point that out. There you go. Enjoy.

This was recorded recently actually in Skibbereen in Cork. If you're wondering, it's Skibbereen Arts Festival. What is the difference between a psychiatrist and a counsellor? That's very straightforward. I can answer that one. Is it one of those ones where the answer is so simple it's not even on Google?

Yeah, yeah. A psychiatrist is a doctor, basically. So to be a psychiatrist, you have to go through a medical training, you have to qualify as a doctor training you have to qualify as a doctor you have to study all the things that other doctors study the body the nervous system and you have to study pharmacology and you have to be able to prescribe so you do all of those things and then after you train as a doctor you go away and you do some specialist training

in mental health so you study psychology and you study a bit of therapy and you study anything that's relevant really to the field and you do another five or six years doing that and then you qualify as a psychiatrist whereas a counselor or a psychotherapist doesn't have a medical training and they study basically theories of the mind and ways of helping people by talking to them so that's but how much of like another thing i know i could be wrong but i seem to think that people who have mental illness go to psychiatrists and then people who have mental health issues that's more psychotherapy like is that wildly incorrect uh it's more complicated than that i mean i've been doing mental health work for 30 years over 30 years

and the thing that kind of i'd say after, the most essential thing about mental health and mental illness is that it's messy. The whole territory is messy. We don't even agree on what to call the things that we encounter. There's no agreement between psychiatrists, between psychologists and others. There are some people who are anti-psychiatry, so they say all of this psychiatry stuff is bullshit. There's a very famous psychiatrist in New York, Thomas Sass, who said that mental illness was a myth, that there's no such thing as mental illness.

And he has a very wide following he's dead now but he's you know a lot of people would follow him and and that so the whole territory something like that even pat right that's a that's a statement like that can you kind of unpack that for us because what he's what he's not saying there is that all people are making it up what what do you mean what what did he mean when he says mental illness isn't real what what does he think is the being fabricated what he's saying is that you use the term illness when it comes to something wrong with your body mm-hmm and you can put that in

an x-ray machine or you can take blood and you can say that's what's wrong with this person. What Sass said is that you can't do anything like that with the mind. That the mind isn't like a part of the body and that while people have serious problems with their mental world and struggle with that and suffer because of it. It's not an illness-type suffering, is what he said. And so the idea that those kind of problems should become the remit of doctors,

for him, was a big mistake. And what he used the term, a myth of mental illness, was to say that this whole discourse saying that mental health problems were just illness like bodily illness he argued that that was a big mistake and a wrong move and that we should keep mental health problems outside of the remit of medicine altogether now i have sympathy with that but I think he went too far with it because to my mind whatever else we are the mind isn't up here in a box and the body down here in a box. I think we're a lot more complicated than that. We don't exist in that kind of dualistic way.

We're much more integrated so if you drink too beer, you'll feel shitty the following day. As I always say, if you have a hangover, I always get mails from people going, geez, my mental health is very bad, the next day after a lot of pints. And the simple answer is, yeah, yeah, you took a lot of depressants last night,

so now you're depressed. Do you know what I mean? Yeah, yeah, yeah, you took a lot of depressants last night, so now you're depressed. Do you know what I mean? Yeah, yeah, yeah. So to me, it's complicated, and it's not straightforward. So your question, is there mental illness and mental health, and can you make some kind of nice demarcation between the two so that the people with mental illness go to psychiatrists and mental health problems. I think it's a lot more complicated than that.

Do you think that labels are helpful? Like, you're known as someone who is critical of psychiatry. What would you think we'd say of... So there's a thing, if you don't know it, it's called the Diagnostics and Statistics Manual, which is... It's like a checklist for different mental illnesses. So if someone has depression, there's a checklist of, well, this, this, this, and this.

And it's one thing that I'm, here's, I'm always a little bit sceptical of it. I feel it's kind of simple, and the thing, being gay was in this manual up until about 1976 it was in the manual as a mental illness you know what I mean so something that has that flaw I'm going holy fuck do you know what I mean how do you feel about the DSM the DSM is is a big problem, I think, because basically the history of the DSM, the DSM is the Diagnostic and Statistical Manual of the American Psychiatric Association. So it's an American system. It's something that the American Psychiatric Association dreamed up. And the history of it is that there was a DSM-1 and a DSM-2.

But the big change, the one that we all now talk about as DSM, came in 1980 with DSM-3. And that was a revolution. Because up to that time, up to about 1980, American psychiatry was largely under the influence of psychoanalysis. They were heavily influenced by Sigmund Freud. And to be a psychiatrist at that time in America, you basically had to be a psychoanalyst. Certainly, if you wanted to progress within the field of psychiatry, you had to go away and train as a psychoanalyst. So if you want to be a professor, say, of psychiatry you had to go away and train as a psychoanalyst so if you want to be a

professor say of psychiatry all the professors were psychoanalytically trained and they would see patients as you know a small number of patients and see them for sessions after sessions after sessions and psychoanalysis is when when most people think of psychiatry in popular culture you imagine someone lying back on a lounge as a person writes their thoughts and that exists because that's the old psychoanalytic model tell me your dreams i'm trying to get at your unconscious mind and like a lot of that is very irrelevant now to how modern therapy happens isn't it well psychoanalysts still exist and psychoanalysis um you know is still popular and and and that but it it's not as dominant a way of thinking about mental health issues as it was in america certainly up to 1980 and basically what happened

then was that a bunch of psychiatrists said this is bullshit we're seeing patients for hours and hours they're not getting better we're a bit of a laughingstock there were studies done that compared diagnosis between British psychiatrists and American psychiatrists and they were all completely haywire so what American psychiatrists were calling schizophrenia the British psychiatrists were calling bipolar disorder and we were kind of Catholicism it was it was a mess and it made psychiatry look a bit stupid so some people thought the answer to our problems is to make psychiatry even more medical so let's get a diagnostic system that's really so he

sharp it comes from a place of insecurity. Yes, absolutely comes from a place of insecurity. So they think we're silly hippies playing around with this stuff. Let's make this look like something medical and then maybe we'll be taken seriously. Exactly. That's exactly what happened. It was literally that blind boy. It was that sense of we look stupid

we can't make diagnosis the way you know neurologists do or endocrinologists do so so it's like like like a like a politician in a bad suit do you know what i mean like a country politician all of a sudden they want to be taken seriously up in the doll so they get a bad soup they just look like a bus conductor that's that's my metaphor right there for what is what happened with psychiatry but the other thing that happened at the at the same time yeah that the dsm came in was that pharma pharmaceutical industry started to get interested in psychiatry in mental illness they started to think this where it gets slightly conspiratorial. It does, yeah, it does.

He's going to have a hot take, lads. It's not just my hot take. Look, this is just history, and I don't think anyone disputes this now. In fact, the president of no less an organization than the American Psychiatric Association, Schafferstein, back in 2000, talked about psychiatry becoming, instead of having the bio-psycho-social model,

he said, what we've ended up with is the bio-bio-bio model. Basically, that's what's happened. And that was from within psychiatry. So in that 20 years from 1980 tonight to 2000 pharma moved into our territory big time they started to invest a lot of money they put a lot of money into the development of the dsm because the idea of the dsm was we'll be able to make a diagnosis of depression based on a few five symptoms. Bingo, you've got that.

And then we have a pill for this. And then we have a pill that we can put with that. And they managed to get their pills like Prozac. Came out in about 1980. And they managed incredibly to get that on the front page of Newsweek magazine twice. It was a remarkable marketing kind of achievement. So there was a new class of antidepressants came in around the same time.

There was new kinds of antipsychotics. And this was a big time for psychopharmacology. Huge promises were made. And basically psychiatry became completely biological and it moved very rapidly away from psychoanalysis and that image you had of the going to the psychiatrist and someone lying on the couch and talking about your dreams and your mother and your fantasies and whatever that was gone in. In a period of five to ten years, you went to your psychiatrist,

you had a 15-minute consultation, he or she asked you about your symptoms, and you went out the door with a prescription. And that happened. And here's the thing, too, and I don't know, is it simplistic to say that the DSM is essentially a checklist?

Yes. So, like, this is essentially a checklist? Yes. So, like, this is the thing that bothers me. So when I was 18, 19, and I started to present with very bad anxiety, very bad depression, okay? Yeah. I didn't know what it was I had. I just knew I was having moments of utter terror where I thought I was going to die all the time and it was no crack and because I didn't have a label or an understanding

for it I started to depersonalize which meant that I like I would I was literally scared of my own shadow like literally I don't I'm not using that metaphorically. My anxiety would be so bad that if I would see my shadow on the wall, I would start to get confused that I can't tell the difference between me and I can't tell the difference between my shadow and then that would make me feel very afraid. I'd also be worried about my hands.

I'd fixate on my hand and I'd say, how do I know this is my hand? And then I'd get a panic attack. Now the issue is is that I was so fucking anxious that I could have... If someone had asked me a checklist for schizophrenia or psychosis, some of the things that I'm saying sounded psychotic they weren't I did not have psychosis what I had they're just things that happen with anxiety and low self-esteem um so that kind of scares me like how easy it would have been to misdiagnose me with something far more serious and then for me to get thrown into a system whereby I end up on anti-psychotic medicine and may not need it.

What I have Pat on for, this is something I've wanted to speak about for ages, this particular topic, which is kind of critical of drugs, right? But the thing is, I'm not a fucking expert. Pat is, so I'm careful talking about it. But as well, like you know,

I speak about mental health on the podcast. I have a lot of followers and their anti-anxiety medication, their antidepressants, this is what has them alive. This is what helps them get through. So I'm very conscious of what's called pill shaming. That's a thing that exists where people feel that because they're being medicated, they're being shamed for this when they're going, well, this is what's fucking working for me. So what I always tend to say is that it's about the individual. Every individual has different fucking needs. So I would never take a position on my podcast of pills are bad and psychotherapy or CBT alone is brilliant. It's like, no, no, no. Everyone has individual needs and it's a spectrum of different things that can be used to help yourself. But one thing I will say is I know firsthand lads in Limerick who have

broken up with their girlfriends and then they're sad because they broke up with their girlfriends and then they go to the doctor because they're so sad and now the doctor's giving them antidepressants and it's like so you got antidepressants because you broke up with your fucking bior but like that's scary that's frightening because now they're on fucking antidepressants and coming off antidepressants isn't something you just do like that. So I'm seeing that happening to people I know and that scares the fuck out of me.

So that's kind of why I want to speak to Pat tonight. What do you think about some of that stuff I was saying there about, I mean, even GPs being very happy with what they're popping out at people? I think it's a huge issue. a phobl yn cael eu bodoli am yr hyn y maen nhw'n ei ddweud. Rwy'n credu ei fod yn broblem mawr. Rwy'n credu y dylai chi siarad am 10-20% o'r cyfoeth yn wlad Cymru sy'n cynnwys antidepreswm a phroblemau eraill

sy'n gysylltiedig â'r psychiatriaeth. Rwy'n cytuno â chi nad yw hyn yn ymwneud â'r hyn rydych chi'n ei alw fel pil-shaming. Rwy'n seichiau, rwy'n ddoddwr, rwy'n prysgu'r pethau hyn, felly rwy'n rhan o'r system honno. Ond rwy'n credu ein bod ni'n rhaid i ni fod yn fwy ystyried sut rydyn ni'n defnyddio meddygaeth. Rhaid i ni fod yn, y byddwn i'n ei alw, y term rydw i'n ei ddefnyddio yw meddygrediad cyfrifol. Rhaid i ni cynnig meddygrediad mwy cyfrifol i'n systemau gofal. A'r hyn rwy'n ei olygu yw meddwl am ble mae'r arferion hyn yn dod o hyd, ble mae'r syniadau yn dod o hyd, ble mae'r hyn, beth yw'r hanes o sut y gynhyrchiad hwnnw. A dyna'r hyn these practices come from? Where do the ideas come from? What is the history of how this came

about? And that's what we were doing there with analysing the background to the DSM. And that didn't come through scientific breakthrough. No. There was no scientific breakthrough in that. That was a professional kind of guild decision on behalf of my profession to say, we look like a bunch of idiots here. We've got to do something. Like you said, putting on the politician, putting on the suit, we have to do something to make us look better. And that's where the DSM came from. It didn't come from science. And what's actually happening now in America, in American psychiatry, is a whole bunch of American researchers and psychiatrists are saying the DSM is a load of bullshit. It doesn't actually help us to understand what's going on with people.

These diagnoses that we've operationalized, that we've made lists of, just were handed down to us by the previous generations of psychiatrists. So the concepts, the divisions within the DSM, actually all come from the psychoanalysts of a previous generation. And terms like schizophrenia were dreamed up by psychiatrists back in the 1920s and 30s. So they don't actually correspond in any way. There's never been what we call a biomarker, like a blood test or an X-ray or anything that gives any solidity to the diagnosis used in psychiatry.

Even today, there isn't a single biomarker that's used. There's no brain scan that you use to diagnose. It's all measures of behavior. It's all based on what we call a clinical basis. One thing you said there a while back, which I found interesting, you were saying that when the American psychoanalysts were showing their results

and they were contrasting this with the British, you were getting different results with a British person than an American. Now, is that because cultural context? No, I think what they actually showed was that the psychiatrists were just doing it differently. The training of the psychiatrists, the way they were thinking was different. So the whole thing was to get the psychiatrist thinking right and to introduce a system that if you saw someone with this problem in New York and you saw the same problem in London, you were making the same diagnosis.

And in some ways, those systems have brought some what we call reliability. In other words, some kind of correspondence has come. But that still doesn't say anything about what those what they're agreeing about yeah it doesn't tell you what they're what what the problem is in some ways um i saw i know you you do a lot of stuff or you speak a lot around trauma um were you doing some work in uganda with trauma or something basically my my history was that i i qualified in medicine here in in cork and went straight into psychiatry i only did psychiatry did you know i did medicine to do psychiatry okay so you knew you did something about psychiatry this is what i want to do

absolutely yeah how did that come about i was always interested even as a young fella in madness and states of craziness um i was fascinated with an art movement called surrealism oh very good yeah you're interested in dad yeah dad and the surrealists and the surrealists kind of came together in the 1930s in Paris, and their take on things was it was kind of a reaction to the madness of the First World War and the so-called rational bourgeois civilization that had led to millions of people being slaughtered on the fields of France and Belgium. And the Surrealists were disgusted with that,

and there was a whole artistic movement that said, if that's what bourgeois rationality gave us let's go for irrationality and they became fascinated with dreams and madness and they were the first anti-psychiatrists actually they wrote letters to the heads of hospitals in Paris demanding that people with mental illness be not confined.

Some of the books that they wrote, like that André Breton and others wrote, were actually simulating states of madness. Wow, okay. Breton himself, who founded the movement, was training to be a psychiatrist at the end of the first world war

and he basically moved away from medicine and became a poet so I was fascinated with these guys so you're coming at this from an artistic point of view a creative artistic point of view you're familiar with Salvador Dali so Dali would be

the main surrealist that we know. And Dali's paintings, really, he would have been deep into psychoanalysis. So what he used to do a lot of the time was he developed a technique called lucid dreaming, whereby it's a way of... I think you can look up how to do it online, but basically it's like you wake yourself up

during the middle of sleep and you write down what you can look up how to do it online, but basically it's like you wake yourself up during the middle of sleep and you write down what you can remember for your dream. And if you do it more and more and more, apparently some people can remember everything that was in the dream, but also control things that are happening within it. So a lot of Dali's paintings were symbols that he could recall from the depths of his unconscious that had to do with

sexuality fucking like he's got a lobster telephone and it's basically for some reason he just he dreamt about uh filleting a lobster on a beach so he's like okay let's make it into a telephone and then the lobster genitals are near my mouth. Have that, society. So that's what he was, it was the most possible irrational thing that you could go, and when you try and, a good example would be, you know Twin Peaks, David Lynch?

He's the modern surrealist. He'd be the closest thing. There's a lovely thing that David Lynch said, which sums up all his work. Like, because his films are fucking nuts, and so so is his tv stuff it's very very irrational and he was being quizzed and quizzed and quizzed about just tell us what the fucking film means will you just tell us what it means and he said you need to stop looking at my films in terms of them being good or bad and instead look at them the way you'd have a dream if you have a dream last night that's I don't know you're up in central and all your teeth

fall around around the ground and then a cocker spaniel walks in with an umbrella on his head whatever if you when that happens you wake up and you go Jesus that dream was a bit weird wasn't it you don't look at your dream and go, it started off great, but the plot was quite ropey there by the middle, but it tied it, you know what I mean? We actually have quite a lot of compassion about our dreams. We're able to accept that. That dream I had last night was bonkers.

I'm going to get on with my day now. So Lynch was going, that's how you need to look at my films. Don't say you saw a bad film. Just say, I just had a weird film I need to have some coffee now but that's surrealism it's you don't look for meaning within it because it's based upon the utter irrational depths of the human unconscious mind so that's also Dali also developed a technique that he literally called the paranoiac critical method yeah and it was about trying to

like in paranoia you believe things are happening that are not happening you know you start to read into situations threats and meanings that aren't actually there and what he tried to do is to read into landscapes even people, eyes ears, etc and he literally called it the paranoia critical method

that's interesting, just as you said that it's after, remember I was saying earlier when I first presented about anxiety I was worried that I might have had psychosis, I was reading about Dali doing that at the same time and I would be looking up at clouds and I'd see a face

or I would look towards the trees and I'd see a person because my anxiety was so fucking high I didn't have the confidence to be able to say like I can happily look up at a cloud now and I can see a face if I want that's just my mind being creative yeah but back then because i was so crippled with anxiety and shame and depression and everything i was like no no i'm hallucinating and now i can't

tell if that's an actual face or not do you get me i do i do yeah so that's where i was at and do you know what the label of anxiety it it took 50 of the pain away for someone to tell me what's been happening to you is called a panic attack that was a lovely feeling yeah yeah um to go that's called a panic attack and then for the psychiatrist to say to me um do you get this do you get your hands trembling all of this i'm going brilliant and he goes yeah that happens to lots of people and what he said to me was it just means that there's a fire alarm in your body and the fire alarm went off but there's no fire yeah and it didn't stop the anxiety but literally 50 percent of the terror and the shame and the fear of what is this and the fear of am I going to,

I don't know what to call her, a cousin as well who had schizophrenia, so it was a big worry of am I presenting with this? And it wasn't, it was just bog standard anxiety. But there's so many things like that, Blind Boy, that if we can normalize and be able to talk, you see, that's what I get from that, is that sense of, and I've had these discussions with very many people who are, a lot of people will come and they'll say, I'm scared, I'm going mad, that nobody else has had this experience, and they haven't talked to anybody else about it. And what you can do just by having that conversation is that you can normalise that or give an account for it. And even something like hearing voices,

which is something that really freaks a lot of people out because we associate it with madness, with schizophrenia and all of these things. Lots of people hear voices. Hearing voices, about 15% of the human population hear voices. Some cultures celebrate that experience. They see it as someone who's been close to the spiritual world. So it's a kind of an experience that some people will look to. In some tribal cultures in Africa,

it's a way to become a healer, is if you have those kind of experiences. But because we don't talk about it, and we hide away from it, it becomes stigmatized, and then it becomes something you're afraid of. So for me, it's not about getting a diagnosis, because a diagnosis kind of puts it into a box and it kind of medicalizes it

so it takes it away then from other things, other possibilities but it is about being able to talk about it and being able to express it and go through the messiness and the fear and all of the other things that

come up with those kind of experiences but i think we've touched on something important which is the relationship between states of madness states of distress states of dislocation and creativity yeah and that whole world and for me that's what's important to get back and to really start exploring that because one of the downsides of the medicalization of mental health problems is that for something to be a medical problem, it takes any kind of meaning out of it.

It just becomes pathology. It just becomes something to get rid of, something to zap with a drug or to just try and get it out of your life. But if you can come at it from a more creative perspective, it's not going to take the pain away necessarily or the suffering away or the struggle away, but it can actually make it more meaningful and it can open up channels where we can actually start communicating a bit easier about mental health stuff and i think that's one of the ways forward with with the whole mental health because the world of mental health

yeah even with myself um and i've often said this like because of the my ability to be creative to come up with ideas to come up with ideas that are imaginative are mad I like I like the irrational I search for the irrational in my work to try and make it into art but the because I have a strong imagination, when I had mental health issues that actually made it really worse. Having a panic attack, but then combining that with the fact that you have a good imagination and you're comfortable living in your head means that it can go, you know what I mean? My brain was going 100%. But now when I write and I am mentally healthy and I am happy I can see that

I'm using the part of myself where the anxiety comes from where the depression comes from those elements of my personality I'm now channeling in a really fucking healthy way into stories that I write into the work that I do and it's not scary it's not frightening I just go these are facets and aspects of my personality. When I'm in a bad way, if my self-esteem is low, if I'm not looking after myself, then they can come and they're not my friends anymore. Then they turn it in on me.

But when I have it in control, I go, brilliant. I have a highly irrational brain and I can turn this into comedy and creativity. Have you heard of the Icarus Project? I have not. The Icarus Project came about 15 years ago. A bunch of young people in the Bay Area in America, San Francisco and that, people who had been diagnosed with bipolar disorder. Francisco and that people who had been diagnosed with bipolar disorder and they'd really struggled and had hard times a lot of them had been hospitalized they were on heavy meds and stuff

like that but there was a guy Sasha DeBruy was was he wrote an article about his own experiences and it was in one of the newspapers in San Francisco and he said look I can accept the medical diagnosis I can I have to take these drugs and whatever but he said this limits me and he said look i can accept the medical diagnosis i can i have to take these drugs and whatever but he said this limits me and he said this stuff in my life is more than that and he wrote this article and he just tried to express it and he was an artist and a whole bunch of people got in touch with him and said look we're struggling with this stuff similar stuff as well gyda hwnnw a dweud, gwelwch, rydyn ni'n anodd gyda'r hyn hwn, y pethau tebyg hefyd. Ac fe ddechreuodd ymdrin â'r peth bipolair hwn. Ie, rydyn ni'n cael yn ddifrydol iawn, rydyn ni'n cael yn uchel neu beth bynnag, ond mae'r hyn yma yn greadigol. Ac fe ddefnyddiadau'r ddifrydfa o Icarus o

mytholeg Grec. Gwych. Yn fath. Roedd hi'n cerdded yn ddwy gydag y Sôn. Yn ymwne to the sun. Exactly. Icarus was the son of Daedalus, who was an inventor in Greek mythology. And Daedalus was imprisoned by King Minos in the island of Crete. And he wanted to escape with his son. So he invented wings. He made these huge wings for himself and for his son Icarus. And he made them with wax. He got bird feathers and put them together with wax. And he said to Icarus, now we're going to fly off the island and escape. But he said, be careful, he said,

because if you fly too high, the wax will melt and we're in trouble. So they took off and flew. And of course, Icarus being young, with the freedom that he got from the wings, of course, flew low and flew too high. And indeed, the sun melted the wax and Icarus fell into the sea and drowned. And what the people in the Icarus Project talk about is dangerous gifts. They believe, and they've articulated this. It's beautiful. Their website is something I always recommend people to go to. And what they talk about is that, look,

this thing came into our lives. We don't know where it came from, this tendency to go low and to go high or whatever. But it actually, in some way, and if we can get together on this and support one another, this can actually be hugely positive. But we have to manage it. We have to learn how to manage it and support one another in managing it. And that to me is a really good image of creativity and mental health problems. But it's across the board. All sorts of creative people. Or most, you know, you think of the artists

that we pay loads of money for. Yeah, like Vincent van Gogh and other people. All my heroes in the arts, especially in painting, they were all most likely had some type of issue. I mean, when it's an artist, we say, oh, they were eccentric. Eccentric is a... I think it's a privileged term that we give to madness

when the person also exhibits some type of creative output. So, like, what was Van Gogh's thing? He had depression, but there was also whatever they were given... He had epilepsy, and whatever drugs they were given he had epilepsy and whatever drugs they were given for the epilepsy at the time caused really really intense hallucinations and that's why he would paint that way but who else uh not paul go again i made you a medigliani like he had extreme bipolar fits of rage um His art, that was quite sad, actually,

because his art is, he was locked into his room with a block of hash, and you just have to paint and paint and paint, and he eventually just threw himself out the window. So, and, you know, Van Gogh, what the fuck did Van Gogh do? He shot himself in the stomach in a field. He painted the crows, didn't he, and shot himself in the stomach.

Yeah. Yeah. So on that note, so we were horsing into conversation backstage we shouldn't have been so should have saved it for stage um i'd love to chat about your time in uganda because you were there for three years uh what you were doing sounded pretty amazing well um it wasn't actually. It was about the worst thought-out project known to man. Basically, when I finished training in Cork

and did my psychiatry in Cork hospitals back in the early 1980s, and I spoke about getting into psychiatry and doing medicine to get to psychiatry because I was interested in madness from surrealism and all of that. Gee, the world of psychiatry in Cork in the 1980s was far from surrealism and creativity and imagination

and Icarus projects and the like. It was pretty dismal. And I was faced with a huge contradiction between caring for people, which you do as a doctor, and controlling, which I suppose I hadn't thought about too much. But actually a large function of psychiatry is controlling people and that goes back to the origins of psychiatry in the asylums the great asylums and madhouses of Europe in the 18th and 19th century and in many ways it defines psychiatry as a profession

and and for me as i say as a doctor at that time that contradiction just became you know so i got to a point where i was going to pack it in and i saw a job advertised for looking for a psychiatrist to work with victims of torture in Uganda. This was back in 1986. And the regime of Idi Amin had fallen, the regime of Milton Abote had fallen, and a new regime under Yoweri Museveni, who's still the president in Uganda, had just come to power. And they were promising a new era of respect for human rights.

And Amnesty International who had been campaigning a lot about Uganda kind of wanted to put some money into a kind of positive project so I applied for the for the job and remarkably was was uh even though I'd never been to Africa um I was I was recruited and uh I met my partner, Joan Giller, who's here tonight, and that's where our work started together, really, working in this whole area of working with victims of torture, victims of rape. And our job, we were sent out there to set up a centre for people who'd been tortured. And we arrived in the middle of Kampala, and it was still a bit of a war zone.

Nothing kind of worked there, and it was still a bit of a war zone nothing kind of worked there and there was soldiers everywhere it was still quite a frightening place to be really but everybody had been everywhere you went someone had been brutalised by soldiers or had had a relative killed I remember talking to the woman who was head of the Department of Psychiatry one day after we got to know each other. We were chatting. Grace Nackesy was her name and she told me about her brother who was the head of air traffic control during the

Israeli raid on Entebbe. It's been made into the Israelis celebrated as, you know, there was films made of it or whatever, when the PLO kidnapped an Israeli plane and landed it in Entebbe, because Idi Amin, who was the president at the time, was sympathetic to the PLO. And anyway, I cut a long story short, was sympathetic to the PLO. Anyway, I'll cut a long story short because this woman's brother

was the head of air traffic control and allowed the plane. The Israelis came in and basically shot dead the PLO guys and rescued the people on the plane because he was working that day. He disappeared. They found his body sometimes later mutilated

in a bog outside of Kampala. So there was nobody. She was someone who I was working with in the department. So the whole of Uganda at that time was pretty traumatised. And the idea of setting up a centre where a couple of white doctors from Europe had some ideas about mental health, we actually started to think we could do a lot of harm here actually because we could start to undermine kind of local ways

of dealing with suffering with trauma or whatever you want to call it with the idea that there's some expertise coming from the West, from white universities or whatever, in psychology, and that if we start to do that in the middle of Kampala, then people will start to think, oh, what we have in our own communities, in our own cultures, of ways of dealing with suffering aren't good enough. And we start to undermine the

danger of uh being colonial without even without trying yeah you know yeah that was exactly our our fear um and as time went on we started to think are there practical ways because actually what people wanted was not psychotherapy or counseling or drugs or anything what everybody wanted was some kind of practical support help with getting schools going again help with getting the economy going again so that people could actually find meaningful work could start to support their families could start to build a society and what really i learned from that was that were you expected to be there and go speak to me about what happened i think that's what the idea because we were working for a center in london it was called at the time the medical foundation for care of victims

of torture it's now a big organization called freedom from torture and they had set up a center in London where refugees who had been tortured could go there for therapy and try and deal with their suffering in London what we were finding in Kampala and I think they had the idea that we would set up something like that and that they could go back to the funders and say overseeing you know all these people and they're all getting better and that was it and like i said early on blind boy mental health is messy but by god it was really messy in uh in uganda at that time and i believe in a lot of societies that have been through stuff like ugandans had been through there, the idea that there is some kind of psychotherapy that's going to get you over this is a real, real problematic idea.

That hasn't stopped armies of counsellors going to every conflict zone on planet Earth in the last 20 years with, you know after doing a counseling course or whatever and going out to tell people how to talk to one another and i think that's the thing that really struck me after some time in africa was africans talk all the time they talk about everything and they're they're they it's an oral culture in uganda um and the idea that you could go as a Western doctor and teach these people how to talk to one another about suffering just struck me as the most arrogant idea that you could imagine. So we spent three years grappling with these ideas, with these things. We tried to set up some practical things like a support group for women who'd been raped

and eventually they took that over themselves and it became a kind of cultural thing rather than a psychotherapy thing. We did some training work in the school of mental health. But for me, it was a huge learning experience. And it really made me kind of rethink all of the stuff that I'd been taught about healing and where healing comes from and I started to really start to understand that healing very often doesn't come just from inside but it's about what's going on around us and what we might call the context and that sense of what the one thing that the Ugandans did want from us, very clearly, was to be on their side

and to witness what they had been through. So everywhere we went, people wanted to tell their story about what had happened. At that time, people were, there was an area to the northwest of Kampala, the capital city called the Loero triangle where it's estimated that about 500,000 people lost their lives in the early 1980s

in what was a genocidal kind of war it became known as the killing fields of Uganda after the Cambodian killing fields of Pol Pot because literally so many people were killed that their bodies were just left in the fields and ditches to rot as people fled from the area. And then as people came back and went to their farms and their homes, there were all these bones, skeletons. So people started to gather these up and put them into piles at crossroads so you'd be driving through the Luero triangle at that time and you'd literally come across this kind of

huge pile of human bones and skulls and that and people were desperate for the world to know about what had happened there and what was going on for them. So there was a value to us being there as witnesses

and being sympathetic witnesses to what had happened and being able to hear what had happened, not turning away from the most awful human suffering. Because that's what human beings tend to do i think when we hear someone's been tortured we hear someone's been raped we go oh no that's too bad i don't want to hear that you need to go to a specialist to talk about that so we create specialist services for people who've been raped or people have been tortured or whatever and we shut down those ordinary possibilities to actually talk but i think that's one of the positive things that we did in in uganda was was just that but as i say i think both joan and i and we've often said is that

we learned more from that experience uh I think we did practically but we did try not to do harm while we were there of course once we left other groups moved in straight away and now there are centres for victims of torture in all sorts of places

Are they handing out like Xanax and antidepressants to victims of trauma down in cultures like that and not no i wouldn't say that and i wouldn't make that accusation but i do think it's a small step from starting the diagnostic way of thinking yeah once you move in to an area of suffering with a diagnostic mindset so you start to say our job here is not to find meaning, solidarity, dignity and pathways through creativity that we've already talked about and all those kind of social and cultural ways of moving on. If you start thinking medically

and you start to think our job here, the priority here is to get in and to make diagnoses and set up clinics and employ psychologists and counselors it's a small step from that to starting the pharma element of mental health coming in on the back of that and i think that that's borne out by by other situations yeah the one yeah, the one thing, we were talking about it backstage, but within, there's also a huge consumerism and capitalist element with all of this too, talking about the drugs. It's for profit.

So when you have the drug companies for profit, then you have to go, well, at what point then is that you know for for humans if when is that for the good of the community like i've said before in the podcast um i don't believe our consumerist society wants to have humans being mentally healthy okay I think how I position it is when you buy a pair of fucking decent shoes you're not buying shoes because you want them on your feet or because they're warm how branding works is what they're doing that they're selling you a better version of yourself so a decent pair of shoes it's like look

at the advertising campaign it's not saying they're comfy it's not saying they'll keep your feet right they're saying these shoes are on a beautiful successful person so what you actually want is success and beauty and if you buy these shoes your mind thinks it'll give it to you but because we exist in that society i don't think consumerism can work if we have decent mental health. Because if you have a solid sense of self-esteem and a grounding in yourself

and you feel confident in who you are, then you just want shoes to keep your feet warm. You're not interested in shoes that make you a better person because you're like, how can shoes make me a better person? Does that make sense? But it's all systematic.

It's all part of a system. And I do think the pharmaceutical companies deliberately going into colleges and kind of getting involved in the training, so that then turns into doctors who, without even knowing it, are kind of pushing pills. I mean, is that too hard to take now have i

gone too far with that language or is there some semblance of truth in what i'm saying no there's there's there's it's this is the one of the biggest industries on on planet earth um a good book to read if you want an insight into the pharmaceutical industry is uh into the pharmaceutical industry is... What's his name, the guy who writes all the spy novels? What's his name, the guy who writes all the spy novels? This... Who? John le Carré, John le Carré wrote a book

called The Constant Gardener. Oh, yes. You might have seen the movie, actually. But John le Carre kind of wrote... He spent all... He trained in British intelligence, but then started writing about espionage, about the KGB and the CIA and British intelligence

and all the rest of it, and what they did and didn't do and all of that and at the end of the Cold War he turned his attention to other areas you know like drugs trade and you know the Russian mafia and other things but The Constant Gardener was about the pharma about the pharmaceutical industry and in none of his books did he write, in any of the other books, did he write anything in the book about the subject, if you like, you know. But at the end of The Constant Gardener,

if you get it, there's a kind of postscript. And basically what Le Carre says in that, he says, look, he says, lads, I've been looking at the KGB and the CIA and Israeli Mossad and all of these organizations and the Russian mafia and whatever. They have nothing on pharma for intrigue, for exploitation, for being from being willing to actually make calculations around numbers of people who will die. You know, if they do one thing and how much money they can pay out to get over that. It's one of the most corrupt industries on planet

Earth, probably after ornaments, it probably is, it's certainly way up there. And I've seen it in medicine, how in the course of my career, they've shaped my territory of psychiatry and mental health to their needs. There's a case example from Japan, right? Basically, through the 1980s, the sales of antidepressants in Western countries were going up and up and up and up. So the profits for pharma were going up and up and up and up so the profits for farmer were going up and up and up and up and they were really happy with this it was one country one industrialized rich country where the profits were the prescriptions for antidepressants weren't going up at all and that was japan and japan japanese people have very different way culturally of talking about sadness and states of despair and whatnot. And I can remember one

time listening after the earthquake, the Kobe earthquake in Japan, and listening to a Western psychologist complaining about the Japanese, that they didn't know how to talk properly about their distress. It was the most arrogant kind of view I've ever seen. But basically, Pharma kind of said, we've got to do something about this. So they literally got together a bunch of anthropologists and others from around the world to say, what messages can we start to put into Japanese culture

that will shift them to start using the word depression. Holy fuck. Yeah, in their talk about states of sadness. Because if we can get them to start using our words, like depression and things like that, instead of more indigenous Japanese words or whatever, we'll have them shifted over and we can then start selling our products to them.

And they literally sat down and planned that. And there's books written about it. There's a Canadian psychiatrist, Lawrence Kermare, who's an anthropologist and psychiatrist, a professor of trans... And he was invited. And he wrote an article about this. And he says,

I knew there was something fishy about this meeting I was going to in Japan because it was first-class travel. The hotels I was staying in were way beyond anything I'd been in before. These were serious about... There was serious money behind this project. But they've literally manipulated doctors, patient groups.

They fund a lot of patient groups, actually, both in America and in Europe. They do all sorts. Anything that you can think of that's going to make them money, they'll do it. And without caring about human beings. Absolutely, absolutely, yeah. There's a Danish physician, Peter Gotsky,

who is one of the people behind, you've probably heard the expression, evidence-based medicine. Yeah. Well, Peter was one of the physicians who set up what was called the Cochrane Collaboration, which was a bunch of doctors around the world who just said,

look, let's get all the information we can about treatments together so that we can offer people absolutely scientific kind of guidance on what treatments work, what don't work, basically. So the Cochrane Collaboration..a chyngor gwyddonol ar beth fydd yn gweithio ac beth ddim. Roedd y gydweithrediad Cochrane yn y llwybr o'r meddygau sydd ar y cyfan. Roedd yn un o'r arweinwyr o'r gydweithrediad Cochrane Cymru. Yn blynyddoedd yn fwy, roedd yn dod o hyd i iechyd meddwl.

Mae'n ysgrifennu llyfr am hyn. mental health and he just he's written a book about this he talks about he uses a quote from someone a kind of a whistleblower within pharma uh talking about you know these guys have organized crime the mob have nothing on these guys in terms of numbers of deaths they've caused how much corruption of government they've brought about they're you know it's quite a remarkable story and i think you know it's not that we don't use drugs. We have to. They're there and we will use them. But we have to be critical in our thinking behind what we're doing with things like medicines. Because if we're not careful, those kind of influences, which are corrupt influences,

those kind of influences, which are corrupt influences, can influence what we're doing and can actually cause more suffering than we bring help to people, I think. So I think it's important, you know, that we don't say that drugs are all bad or whatever. That's nonsense. But the massive expansion of, not just in psychiatry, but in medicine in general of products uh we do have

to be more critical i think as a culture about where all that's coming from you know um one thing i'm thinking the whole time we're talking about that is there a part of you that's concerned that you end up looking like a conspiracy theorist or you end up looking wacky? Do you know what I mean? Like, everything you're saying is on the ball, but the thing is, you... Here's the thing, it's like...

There's the anti-vaxxer movement as well, and they're against big pharma, and the thing is that it's hard to draw these lines. Yeah. So there's a danger of you, just by the way you're speaking, looking like a crackpot. And what's that like? You know what I'm saying.

I do, and it's not comfortable, but things are changing. And there's a guy now a Lithuanian psychiatrist by the name of Danius Puras who's been appointed the UN Special Rapporteur on the right to health and Danius has brought out

two really punching documents in the last few years where he names this stuff he doesn't he doesn't pull his punches about mental health and the way the the the what we might call the biomedical paradigm or the biomedical model has dominated and he's basically saying this is from the un united nations basically saying this stuff is bullshit and we really have to get away from it and we have to start looking at the social determinants of health seriously in a way that's been marginalised up to now. I think other organisations, I'm part of a group called the Critical Psychiatry Network.

We first started meeting in Bradford back 20 years ago when I was living and working there. We were five people in a room to start with. Now the Critical Psychiatry Network, we've got about 240 psychiatrists around the world who are part of this, who are writing, publishing books, challenging and I think we're taking a lot more seriously now than we were. yn cyflawni llyfrau, yn herio. Ac rwy'n credu ein bod ni'n cael ein cymryd yn llawer mwy yn gyffredinol nawr na'n ni. A ydych chi'n profi'r llwybr? Ie, yn sicr. Ond... A fyddai yna meddygwyr neu ddoddwyr sy'n ymwneud â pharma a'u stwgion yn y pennaeth?

Ie, yn sicr. Ie, mae'n ymwneud â hynny. Mae'r cwroesiwn yn ymwneud â hynny. Mae pobl yn hoffi bod yn goroesiwn. yes absolutely yeah that's how it works that's how it works uh there isn't there is no corruption people like being corrupt yeah um i i mean you're talking about lots of money you know yeah and and pharma use what are called opinion leaders there's a little i mean i'm not just making this stuff up this you know this is just, they talk about this themselves, that if you can get kind of a professor of an area on your side and you pay them to do talks and you pay them, sometimes they even have shares in the company, for God's sake.

You know, it's as blatant as that. That you can get these people and you take them around and they'll give talks on a subject area but they'll mention your drug. They won't be talking about your drug directly but they'll be talking about the area and they're a professor and it'll seem as though they're neutral

in what the evidence that they're giving you but they will drop in messages that are quite sympathetic towards your product, basically. And even doing that online, that's now illegal. Like, that's called native advertising now online. It's where you write an article and you think the article is about something, but all of a sudden the person's mentioning Cornflakes a lot.

Do you know what I mean? Yeah, I do. But you can. If you do that yeah if you do that online yeah you have to say sponsored you have to do it or else it violates yeah so why are doctors and professors able to be in the pocket of big pharma and go you know dropping these drugs in throughout it how is that allowed it it's it's it's changing because people like myself and others are campaigning.

You're working with the World Health Organization now? You're working with the World Health Organization now? Yeah, I'm doing a project with the World Health Organization at the moment. And again, WHO, from my way of looking at things, have been part of the problem until very recently. And they're now shifting big time into looking at a social model of, what we call a social model of disability, basically, and using that in mental health and using that alongside a human rights approach to mental health.

And really, you know, what I'm working on at the moment is a service guideline document for them. We're researching that. We're researching services around the world that are working with a really human rights and social model of mental health and that's going to be who policy and who way of looking at things and that's what they're going to promote in terms of mental health services and directly naming what the problem is you know i wouldn't be involved otherwise and they wouldn't have approached, they know who I am,

and the kind of stuff I've been writing about for 20 years. So it does indicate a shift in that territory. And I think the other thing that's happened, of course, is that the farmer are starting to disinvest in mental health because basically there are no new products coming down the tube so what they're doing at the moment is they're they're shifting their ground from western countries to the developing world and to asian countries cigarette companies do the same thing exactly exactly so you can imagine China, what, about a quarter of the world's population? Just think of all the people in China

who in the space of the last 10 or 15 years have been moved from their villages into high-rise cities, doing mundane factory jobs of one sort or another. Just think of all the misery and dislocation and sadness and anxiety that goes with that. Well, by God, if you can convince all of those people, or even 10% of them, that they're depressed and that a drug is going to be the answer to that,

that's a goldmine. And that's how pharma thinks. It doesn't actually give a shit about the people and their problems and whether their drugs will make them better or not. Because don't most of the time that's the science of it and they come with a lot of side effects but they're money spinners and if you can do that in china and you can do that in india well then you've got a third of the world's population and that's how they're that's what they're doing at the moment but there are no new products coming so they're actually starting to disinvest from mental health research that to me is a relief

you know that's a sense of actually that whole biological paradigm that has been dominant for so long is actually going to start fading away and And then, you know, God knows what's going to come, but there is an opportunity for those of us who articulate a social approach or a cultural approach or a creativity approach, that there's some space for us to articulate that and to have a hearing. And I think that's starting to happen, actually. The one thing that...

I won't say it doesn't give me hope the one thing that scares me is like medicine is so much cheaper than like okay one of the biggest issues in ireland when it comes to access to mental health services right um i I was very lucky. I was in college. So if you're in college, one of the best bits in college is you have access to a fucking college counselor. So I was able to go, brilliant, I've got a counselor every week

to talk me through my shit. If I wasn't in college, I'd be paying them 70, 80 quid, 90 quid. I wouldn't have had that money. Most people I know in Limerick who've got depression and anxiety, they can't fucking afford 60 quid I wouldn't have had that money most people I know in Limerick who've got depression and anxiety they they can't fucking afford 60 quid a week to go to CBT therapy or whatever they go to the public services and big long waiting list or whatever but under like neoliberalism and the Irish government

if we so we put things into the hands of the state. Most people I know need to go to public services in order to get mental health. The public service is being run in a kind of a business model. That now means that for the crunching of numbers, doesn't the public service sector then go, well, this counselling here, like, that's mad, mad expensive, but this box of pills is not that expensive at all. Where does that come into it?

Because that's kind of scary. That means that the government would have to triple or quadruple its budget to give the amount of talk therapy that people actually... Do you know what I mean? I do, I do. And I think that there is a calculation in that

but I think we also have to be a bit more creative. I don't think it's all just about psychotherapy replacing and kind of drugs or whatever. I think we need to be a bit more creative that i don't think it's all just about psychotherapy replacing yeah kind of drugs or whatever i think we need to be thinking actually that's where i'm being quite narrow on this because you're talking creative therapy and the social approach can you explain a little bit what that is because i haven't a clue but that okay that can be anything basically i mean down the road here in skibbereen there's 49 north street and there's Kevin O'Shanahan who runs that working for the HSE basically and that's a center for creative creativity it's not about creative therapy as such yeah but it's a it's a place where lots of

different creative kind of things happen and it's open to people with any kind of mental health problem to be connected with that and I know that part of the program for the skibbereen arts festival is actually an open door with that and i really encourage people to go and explore that and find out what's happening there because the thing is blind boy what i would say is that people when they get stuck with the mental health issue and that that's what it can really feel like you're stuck and you just don't know where to go with it that there's my experience is that people find ways of moving on from that being stuck along a range of different pathways and it's not just about drugs fixing that might work for one person it might be really helpful and get them through a period and allow them to move on. Therapy might be very great for another person. Some people can't stand therapy. They

can't stand talking about stuff. So something that involves art might be very important. Gardening might be the thing that works for somebody else. Walking, and for some people, getting out into the countryside, into nature, can be hugely important. Dare I say it, religion can be very important for people in terms of finding a way forward out of despair and finding hope. Poetry. The range of possibilities for us as human beings to move on from being stuck

emotionally or cognitively or whatever are huge and i think that's the kind of thing we have to start talking about and thinking about how do we then and and i saw my job when i worked as a psychiatrist as clinical director was to try and create a service that was open. It's not that we provided all of those things, but it was that we knew where someone could access those things. So if we weren't doing it, we knew an organisation that was. So I kind of saw my job as making those links and spending time nurturing those relationships

and knowing where possibilities were for people to find things. And ultimately as well, are you talking about providing people with a sense of meaning that's unique to them, for the person to find unique meaning? Absolutely, absolutely. What we call, what's known as the recovery approach in mental

health, which is something that's come out of what we might call the service user movement. This is one of the most exciting things that has happened in the field of mental health in the last time of my lifetime, basically, is that people who use mental health services around the world have started to come together in organizations all sorts of different organizations and have started to talk about what's going on for them have started to criticize what's been done to them have started to imagine new ways of doing mental health work and it's multivarious that movement is very very there's a an organization called mad pride which people set up in cork some years ago mad pride exists in the states as well but now there's a

whole program called mad studies in canada where academics who have had mental health problems themselves are starting to write about that, research it, and articulate it in a way that's quite different to the way psychiatry comes at it and thinks about it. So there's a whole movement of people around the world who are starting to talk about mental health from the inside in a very different way and come up with very different solutions to what medicine has come up with. And I see that as the future, basically. I see that as something that's wonderful. But out of

that came the notion of the recovery approach. And that came from people like Judy Chamberlain, who is a very famous service user and campaigner in America. And she basically was someone who was told, you've got a diagnosis of schizophrenia. You just better limit your horizons. Best thing you can do now, Judy, is to keep taking your drugs. Not think about having kids. Not thinking about having a career,

just limit your horizons and stay stable, and we'll maintain you in that position as a stabilized schizophrenic. Well, she said, fuck that. I'm not going to put up with that. And she talked about recovering her own identity and her own self by getting out of the system and wrote a book about it and started a campaign with other people about that.

And the recovery movement, as I've learned it, is from service users. And that's a movement that says mental health isn't about the technical stuff like diagnosis and treatments and models and professionals going away and dreaming up new things to do to us and whatever recovery is about actually the non-technical aspects of life of mental health and problems it's about relationships it's about meanings it's about values it's about things like dignity it's about empowerment it's

about feeling i've got my life back again rather than i'm a patient and i just have to go down to the clinic every couple of weeks and get someone to administer to me it's actually i'm back in control now that doesn't mean that people stop taking drugs or don't go for therapy but they do it from a sense of i'm actually the captain of my ship and I'll tell you what's going to help me and what's not going to help me, not the other way around, so to speak. So that recovery approach now is catching on.

Unfortunately, one of the things that's happened is that professionals have started to colonize it. Okay. And you're gotten recovery researchers now coming from a professional point of view. So there's actually now a resistance to that, again, from within the service user movement. So there's an organization in the UK called Recovery in the Bin

who are saying, look, you've actually spoiled and ruined something that came from us by turning it into so people going around with recovery questionnaires and instruments and all sorts of stuff that's not where this comes from it comes from empowerment and that's something very different so there's a you know there's a whole kind of movement of people that's moving in a very different direction to where psychiatry has been and my point of view when I address my own profession is that if we

don't start to understand that and listen to it and start to develop the skills to hear what people are telling us we're going to get left behind and we're going to be part of the problem rather than part of the solution. I had a bunch of questions off the internet. I didn't get to ask all of them

because we had... And do you know what? Anytime I don't have to ask the questions, it means it's a good podcast because it's a nice flowing conversation. But one of them... Out of all the qualities specific to the irish people which ones are most damaging to our psyche

you know more about that than i do you i'll tell you one thing that i found interesting when you were talking earlier about uh japan because of the the way the japanese people were speaking i have heard post-colonial arguments that the way we speak about sadness in asqualea compared to english that if if to have depression in irish is it's not i am depressed or i have depression it's i have a sadness on me do you know what I mean? so I've heard the argument that we might be better, well we all know we'd be better off

if the Brits didn't come over, we're aware of that now I think it's fair to say you know all about that down in Skibbereen but one thing I do wonder about is now I don't want to get into the notion you've heard of epigenetic trauma One thing I do wonder about is... Now, I don't want to get into the notion... You've heard of epigenetic trauma.

Is that a big load of bullshit? No, I think there's something to it, but I wouldn't want to say that's the answer to everything. Epigenetic trauma is that trauma can genetically be passed on through genes. Is that correct? Well, it's the idea... Epigenetics is the idea that what's passed on through genes is that correct well it's the idea epigenetics is the idea that um what's passed on from one generation to the other in our genes does get modified by

environmental factors okay along the way it's not just pure what's in your genes gets passed on and that expresses itself that actually things that happen to the person can that can actually influence the way that's expressed that's how I understand and because I would like I said before no where the fuck it was but I like I can literally trace I can kind of trace my anxiety back to the famine mm-hmm it's it I know it sounds mad but like I learned to react anxiously and with fear and to worry, that's a learned behaviour that I learned from my dad

who was born in the 30s and he learned that behaviour from his ma and she grew up in the famine and she had crippling crippling anxiety because she lived through the trauma of the fucking famine and he learned

anxiety from that so i can trace my anxiety to my grandmother do you know what i mean yeah yeah yeah like i don't think it's too far of a leap no i i maybe it's because i'm in the midst of irish culture and growing up in it that i can't really see it as clearly as that or something, but I just, I worked in New Zealand. It's a bit of a stretch. Now, I'll admit it's a bit of a stretch. But going straight into the psychiatrist, why have you got anxiety? Well, I think it might be because of the famine.

Have a sandwich. That would be even cheaper than antidepressants um have a sandwich and a can of coke does anyone look at them the massive trauma of something like the famine like half our population gone and where does that trauma go yeah yeah i was gonna say that in New Zealand, the Maori people are the indigenous people of New Zealand. And they basically, for about 500 or 600 years, lived on the islands of New Zealand up to the late 19th century when Europeans came. And they were never defeated as such actually by by the colonial forces there was a treaty the

famous treaty of Waitangi which basically the British signed it was a bit like the treaty of Limerick you know that they kind of said look we'll get these stupid kind of natives to sign this and then we'll take their land yeah from. And that's what they did, basically. But the Treaty of Waitangi still stood there. And very interestingly in New Zealand, it's come right back into jurisprudence and the law because Maori scholars and lawyers and politicians have started to say, hang on a second here,

you signed this treaty with us about cultural rights and respect and all of these things, and you've not done any of this. Now we want to, we actually want this. So there's a whole, it's a very interesting happening in New Zealand at the moment. But one of the things that happened

through colonialism very directly was there was, and you can almost see it over the course of a hundred years they destroyed Maori language they they Maori had a whole system of healers called Tahunga and there was a literally a Tahunga suppression act came in in the 1920s where they banned Maori healing practices. Maori have a very family-orientated way of their organizing anything, basically. It's all about family. And so things like private property and where one nuclear family would... That was completely unknown and whatever. Their culture was completely destroyed. Their way of life was completely destroyed.

And they're really still suffering. And even though there's been a renaissance in their culture and their dance and the haka and things like that that we know and see, when you go there like i was seeing patients and you you could tell that there was a sense of insecurity a struggle with inferiority a struggle with knowing who we are and where we stand in the world that was seeped into family life, into culture, into towns, into villages.

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the very high drug addiction levels very highly criminalized in the criminal justice system so that even though maori make only 15% of the population, over 50% of all the female prisoners in the whole of New Zealand are Maori. So they're way exaggerated in all the problematic... They die about 15 years earlier than the non-Maori section of the population. And I think that's a direct result

of the impact of colonialism on their way of life and the destruction that it had. And you can map that across the world in other indigenous communities, particularly the Aboriginal people in Australia who have very high rates of mental illness, of drug problems, of alcohol problems, of all sorts of difficulties. You can see it in Native American communities as well. And all of those things can be mapped directly back to cultural destruction and confidence and the

destruction of confidence, language, way of of life sense of who they are in the world sense of being uh someone who has a place as i say a place in the world and the dignity that comes with that and i think that's what colonialism can do to to communities and maybe we're an example of that um and as one of the first post-colonial societies yeah you know we're on 100 years now and yeah we've made some progress i think you know and i think some of that confidence is starting to come back 100 years after getting our own country back we're now actually we've got the church off our back and we've got all of that kind of stuff that came in the immediate impact of the colonial era.

So maybe, you know, there are linkages, sociological, anthropological or whatever. And maybe we're just, you know what I mean? What I'm trying to say is like, I could see it very directly in New Zealand amongst Maori, but given that hundred year kind of timeframe and whatever, maybe it's more difficult to see it directly here, if that makes sense.

No, I get you. Yeah. What I'm going to do now is, I'm going to put the microphone to the audience if you have any questions can you put the house lights up but in a gentle way that it doesn't shock anyone there we go now does anybody have a question

it can be about anything it can be a question about dogs I just wanted to ask I can hear someone but I can't see them so I'm just going to I just wanted to ask... I can hear someone, but I can't see them, so I'm just going to... I just wanted to ask the psychiatrist or medical doctor in the context of his experience in Uganda,

first of all, did he come across witchcraft in his travels? And secondly, if he did, did he find that witchcraft was an impediment towards his reaching the people that he wanted to reach? That was a great question.

Wasn't expecting it. Question about witchcraft. Yeah, I mean, the term, if I i might say so and i don't want to sound condescending or anything but the term witchcraft is a very western and almost prerogative you know derogatory term the spirituality in in africa in fact in most parts of the world, most cultures, people live much closer to the spirit world than we do in the Western world. Our religions have become very kind of packaged and very, I suppose, book-orientated. Whereas in Africa, spirituality is alive.

Spirits are everywhere ancestral spirits spirits of forests spirits of lakes are everywhere and come into people's lives and go out of people's lives and yes of course you can't live in Africa

for any length of time without being and I actually worked with what I would call a traditional healer someone I got to know in what I talked about earlier in the Loero triangle she was a woman who had her healing center quite near to a village that we used to go and visit quite a lot and I got to know her over a long period of time and went to sit in with her

during some of her healing sessions. And she was a shamanic healer so she would go into a trance state and the spirits of the tribe, the Bhaganda, would come into her and pronounce on what the problem with the family or with the individual was and would also pronounce on what the kind of ritual answer to that was and it struck me at that time because these were the the baganda were the main tribal group in the south of

of Uganda and they were the ones who had really suffered during that genocide I talked about and their culture and everything, their roads, everything was destroyed. And I felt that what she was doing in some ways, because she was bringing back the ancestral spirits, she was embodying them, bringing them forth into daily life she was doing two things she was offering remedies if you like for skin infections or whatever whether they worked

or not i don't know but she was also bringing back a sense of the tribal identity to the baganda who had suffered so much at that time and i think a a lot of healing is on a number of levels. It's on the surface, but there's also deeper issues going on, assumptions and values, things being worked out. And I think traditional healing in Africa, as in other parts of the world, is a lot more complicated than just witchcraft, if I might say that.

And I think sometimes we're, you know, there are layers to it, and there are charlatans, of course, who will exploit people and take money off people. There are people who will abuse people. But I would say the same thing happens in medicine over here. So I don't think we're in any position to judge another healing system without sorting out our own first so I've I developed a lot of respect for traditional healers and continue to do that

and I believe that traditional healing practices around the world actually have a lot to play, a large role to play in mental health issues but that's a whole other debate I'd say one more question a bit of gender balance if we could Should your regular GP be able

to prescribe antidepressants, Prozac and the like if they're not so good for people um i i don't think without your training sorry without your training well psychiatrists with more training than i have um write the guidelines usually for GPs, and in the guidelines, usually antidepressants are up there very quickly in terms of a solution. I think a lot of GPs would say that they prescribe because they have so little time with people, and I think that's part of the problem is that the whole structure if you like

of a medicalized response to states of distress it's it it the whole system that we have if you like um uh very quickly starts to put people into boxes and then you get drugs attached to those boxes and people come out the door with a prescription i think most people i've i've talked i gave a talk some years back to the irish college of gps pretty much along the lines that i'm talking to you today and i got one of the most warmest receptions from a group of medics ever that i've got because they understood what i was talking about they understood the limitations of psychopharmacology. They understood the need for a range of different responses.

They understood all about the social determinants of mental health and some of those things, because they're dealing with people in their ordinary lives. So I don't think you can kind of start to point the finger at GPs. I think the whole system needs rethinking. And we need to start getting our imagination out of the idea that this is just about doctors and clinics and things like that. And we need to start being more imaginative

in how we as a community start to respond to states of distress, states of madness. And we have to start thinking about more inclusive kind of ways of running our organizations, our workplaces, our educational establishments, so that we don't constantly cause problems for people. Say, in their studies, lots of people have anxiety, stay in an episode of depression. That should not jeopardize your degree course.

That should not be, you know, we have to start thinking about how we set up schools, universities, colleges, workplaces in ways that actually allow us to become more comfortable with mental health issues. And so it's not, oh, you have to go to your doctor and get a diagnosis and get, you know, as though that becomes our only,

that's the only solution we have as a society. And then GPs are getting hundreds of people coming through the door. They've got 10 minutes, 15 minutes. That's not fair on either side in that equation. One thing we didn't touch on, and I wouldn't mind, is you mentioned backstage, like, you know, a lot of the drugs that people have been taking,

we now know that some of them have very bad side effects. Can you speak about some of that? Just for people to understand, you know, why are you out here saying we might need to look at something that... Do you know what I mean? Why are some of these drugs bad? Yeah, well, it's...

And I'm aware, I'm speaking to an audience that, you know, one in five people here will be taking an antidepressant or some drug like that. And I'm not giving a message that, you know, you need to stop these drugs or anything like it. As I say, I'm a doctor, I'm a prescriber, I prescribe these drugs for people. But I would do so after having a clear transparent discussion about the benefits and the limitations and the problematics of these drugs. All drugs have. If I take drugs for arthritis, if I take drugs for high blood pressure, there's going to be problems associated with those drugs. drugs so but I think any patient need is due that level of transparency about the what what those drugs can do what they can't do and what the side effects and

the downside of them are and so we're learning for example about antidepressants that they were always we were always told that these are very straightforward, particularly what we call the SSRI drugs. These are the second-generation antidepressants that are mostly prescribed like Prozac and other drugs like that, that basically people don't have a problem coming off them. In other words, they were always kind of marketed strongly as they didn't have addictive potential,

like benzodiazepines, like Valium, and drugs like that, which in the 1960s were highly prescribed, but then got a real bad press because it became clear that people got hooked on these after they took them and couldn't get off them. Well, the evidence around antidepressants is becoming a lot clearer now that lots of people, not everyone,

and maybe not even a majority of people, but quite a large number of people on antidepressants do have real difficulties coming off them, more so than what the pharmaceutical companies, even though they had this evidence, it's only coming out now because a number of people are campaigning and banging on the door and saying, we want to see the evidence about this. And people have done studies.

So there are lots of benefits from these drugs, but there's also a lot of downsides and I think what I think anyone deserves who is going to be prescribed medication or someone who's taking medication is to know all of the facts about that rather than just a very limited account of it, and a glowing account of it usually is what we're given. A book I would recommend from anyone who wants to get into this seriously is a book called The Myth of the Chemical Cure. It's by a psychiatrist, Joanna Moncrief, someone I know and respect a lot. Joanna works in London. She's a senior lecturer in King's College, I think. And basically what she argues is that we have to stop thinking about these drugs in what she calls a disease-centered way. In other words, that they're curing a disease called depression or anxiety or schizophrenia.

They're not. There isn't any evidence that antidepressants fix something that causes depression. But she says that we should start looking at them from what she calls a drug-centered approach, that these are chemicals that we put into our bodies, and they have various effects on our bodies, much like alcohol, much like cocaine, much like any other chemical that we use. And just as we wouldn't say that cocaine is an antidepressant, but we would talk about it as having certain effects, some of which might be nice and pleasant, others which could be a real pain in the ass and could be really problematic. And so if we start to think about these drugs, these, for example, SSRIs, and just look at what the drug does. Yeah. So some of these drugs can be quite sedating. Now that might be helpful for someone who isn't

sleeping, for example, or who needs a bit of sedation. But for someone who's really struggling with low energy and not getting out of bed, then to take one of those drugs is not going to be very helpful. Some of the antidepressants are alerting. Again, that might be helpful for someone who is struggling with lack of energy, et cetera. So in other words, I think Joanna's way of approaching it is quite sensible, and she works this out in some detail with all of the evidence that's available to us about how these drugs work and i think her work is is particularly helpful when it comes to psychopharmacology so if anyone

wants kind of to look into this further i'd recommend looking in that territory right so there we go that was uh this week's podcast an interview with pat bracken that was an absolute pleasure to speak to pat to hear his breadth of knowledge to hear the passion that he has um it was a real real pleasure and i hope you took something from it uh i'll see you next week