The Chris Voss Show - The Chris Voss Show Podcast – Malady of the Mind: Schizophrenia and the Path to Prevention by Jeffrey A. Lieberman

Episode Date: March 26, 2023

Malady of the Mind: Schizophrenia and the Path to Prevention by Jeffrey A. Lieberman Of the many myths and misconceptions that obscure our understanding of schizophrenia, the most pernicious is that there is no effective treatment or cure. Though that may have been true in the past, the current reality couldn’t be more different: today’s treatments have the potential to be game-changing—and often lifesaving. This powerful portrait of schizophrenia, the most malignant and mysterious mental illness, by renowned psychiatrist Jeffrey Lieberman, interweaves cultural and scientific history with dramatic patient profiles and clinical experiences to impart a revolutionary message of hope. For the first time in history, we can effectively treat schizophrenia, limiting its disabling effects—and we’re on the verge of being able to prevent the disease’s onset entirely. In this rigorously researched, profoundly compelling biography of schizophrenia, Dr. Jeffrey Lieberman draws on his four-decade career to illuminate the past, present, and future of this historically dreaded and devastating illness. From his vantage point at the pinnacle of academic psychiatry, informed by extensive research experience and clinical care of thousands of patients, Dr. Lieberman explains how the complexity of the brain, the checkered history of psychiatric medicine, and centuries of stigma combined with misguided legislation and health care policies have impeded scientific advances and clinical progress. Despite this, there is reason for optimism: by offering evidence-based treatments that combine medication with psychosocial services and principles learned from the recovery movement, doctors can now effectively treat schizophrenia by diagnosing patients at a very early stage, achieving a mutually respectful therapeutic alliance, and preventing relapse, thus limiting the progression of the illness. Even more auspiciously, decades of work on diagnosis, detection, and early intervention have pushed scientific progress to the cusp of prevention—meaning that in the near future, doctors may be able to prevent the onset of this disorder. A must-read for fans of medical histories, psychology, and those whose lives have been affected by schizophrenia, this revelatory work offers a comprehensive scientific portrait, crucial insights, sound advice for families and friends, and most importantly, hope for sufferers now and in the generations to come.

You wanted the best. You've got the best podcast, the hottest podcast in the world. The Chris Voss Show, the preeminent podcast with guests so smart you may experience serious brain bleed. The CEOs, authors, thought leaders, visionaries, and motivators. Get ready, get ready, strap yourself in. Keep your hands, arms, and legs inside the vehicle at all times because you're about to go on a monster education roller coaster with your brain. Now, here's your host, Chris Voss. Hi, folks. It's Voss here from thechrisvossshow.com, thechrisvossshow.com. Welcome to the big show, my family and friends. We certainly appreciate you guys coming by the show today.

Today we're going to be talking about the mind, the malady of the mind, schizophrenia and the path to prevention. We have the author of the newest book out, February 21st, 2023. It just came out. Jeffrey A. Lieberman is going to be on the show with us today. We're going to be talking about maladies of the mind uh specifically his book schizophrenia and uh other different things we're going to talk about a few different things narcissism uh psychiatry mental illness and pretty much uh everything about chris foster is to know because as you know as my audience for 13 years i might not be straight in the brain but uh he's going to decide if i have any help or not or if i should probably have a frontal lobotomy. Anyway, as always, we refer the show to your family, friends, and relatives.

We love all the great referrals and things you put on iTunes with those five-star reviews saying how great the show is, and how much it helps you expand your mind. And that's the great thing about this show. If you're smarter, you're sexier in life, and you'll make more money, and everything else. Those aren't guaranteed. The lawyer said I can't guarantee those in any way, shape or form, but I can,

I can just kind of make stuff up because that's what we do on the show. Anyway, guys, I'm kidding. Go to youtube.com for chest Christmas, goodreads.com for chest Christmas, the big LinkedIn newsletter, the big LinkedIn group,

all the stuff that we do across social media. Check that out as well. As I mentioned, he's the author of the latest book, malady of the mind, schizophrenia and the path to prevention you can order it wherever fine books are sold but stay away stay away from those alleyway bookstores because uh you might need a tetanus shot i tripped in one the other day and and uh i've got some gangrene but uh i'll have to get another doctor on the show for that anyway uh jeffrey uh lieberman is a professor and constance and steven lieber chair

in the psychiatry at the columbia university vagilis uh college of physicians and surgeons throughout his 40-year career he has focused on research and clinical care of patients with serious mental illness might be his next case. In addition to his academic and clinical activities, he has played a significant role in influencing government and social policy. In fact, if anybody needs mental health, it's people in government. Not all people, I should say, just maybe some of those senators and House members, in my opinion, that is. Let's see.

He's played a significant role in influencing government and social policy, educating health care providers and the public in an effort to reduce stigma and improve access to and quality of mental health care. Welcome to the show, Jeffrey Lieberman. How are you? I'm good. Thank you very much for having me, Chris. Thanks for coming. It's an honor to have you. We love having brilliant minds on the show because I'm not one of them. Give us a dot com so people can find you on the interwebs please sir it's uh jeffrey lieberman md.com that's my website uh url there you go so uh this is uh i think your second or how many books do you have in i've written believe it or not 800 scientific articles i crap. I've written 17 books for professional doctors and scientists, but this is my second book for the public.

There you go. There you go. So the public can indulge in this. So what motivated you to write your latest book here, Malady of the Mind? Well, I had never written for the lay public before, and then I realized that, you know, if you have an illness, you want to know what the cause is and what the treatment is. And what I came to realize after sort of stepping out of the ivory tower of academia, where you're doing your research and discovering all these new things, was that the problem with mental, you know, if you get sick,

if you have cancer, let's say you're a woman and you feel a lump and you go to a hospital and they diagnose you and they say, oh, we have breast cancer and we believe you need a lumpectomy and chemotherapy and radiation. And you can pretty much get that most places, not everywhere. If you have a mental illness, people don't understand what it is to begin with, how to recognize it. And they're not sure where to go to get treatment for it. And the treatment isn't widely available. And so it was like, okay, we've got vaccines for COVID or we've got vaccines for polio or we've got treatment for diabetes, but it's not available. People don't

know what kind of doctors to go to. In fact, when I wrote my first book in 2015, it was called Shrinks, The Untold Story of Psychiatry. I started off with an epigram from Samuel Goldwyn, you know, of the Metro-Goldwyn-Mayer Street, who said, anybody that sees a psychiatrist needs to have their head examined. And that said to me that psychiatry, my chosen specialty, was the Rodney Dangerfield of medical specialties, meaning it didn't get any respect. And I feel that that is untrue. And it is to the detriment of people who may suffer from mental disorders and need treatment, which is available, but they either don't believe in it, they don't know where to find it, or they're not sure if they actually have something that requires searching for it.

Yeah, it's something that people need to adhere to more. So why did you specifically decide to write about schizophrenia when there's so many other wonderful maladies people can have in their brain, like mine? Well, schizophrenia is kind of the poster child of mental illnesses. So first of all, let's make a distinction, Chris. There's a distinction between mental illnesses. So first of all, let's make a distinction, Chris. There's a distinction between mental illnesses and the worried well. That's my kind of glib term for the ups and downs of daily life, the vicissitudes of one's emotional state in relation to their work or their home life or how things are going for them socially and so forth.

Everybody has variations in their mood, in their ability to concentrate and focus and how they perceive things. But they're able to sort of keep it within bounds and eventually sort of stabilize in a tolerable mental condition where they can function and they're not in mental distress. I mean, except if you're living in Ukraine right now under war conditions or you've got a death in your family that's causing you to grieve. disturbance in thinking, emotion regulation, perception that goes beyond whatever your circumstances are, persists for a, not just a few minutes or a few hours, but, you know, weeks or months, and causes disability, you're not able to function well, and causes distress. And although there are many mental disorders, and we're not talking about, you know, the kind of questionable things

about internet gaming disorder, or something like that, we're talking about schizophrenia, bipolar disorder, melancholic depression, obsessive-confulsive disorder, panic disorder, addiction, autism, dementia. The one that people probably have the most vivid impression of is schizophrenia, because schizophrenia is the equivalent of insanity, madness, lunacy. It's the homeless person in the street in the middle of winter standing there with no shoes in the snow. It's the figure that's portrayed in a movie, whether it's Psycho or Shutter Island or something like that. And it's the scary, mysterious figure that people fear, even serial killers. When I first began training in psychiatry,

I came to New York in the late 1970s, and Son of Sam, David Berkowitz, was a serial killer on the loose. And the inter-bomber came afterwards. Now, this is not to say that people with schizophrenia are very violent, but these types of individuals who are mentally ill and resort to these kinds of behaviors get tremendous and also the pessimism that you're doomed from the womb if you have that condition, that there is treatment for you and it's even actually preventable. And probably important to seek help if you feel that you have it or maybe a loved one is suffering from it, right? You want to know something, Chris? If you have chest pain that turns out to be angina or a heart attack, you may delay going to see a doctor or going to the hospital, but it's probably not more than a few days or maybe in weeks. The average amount of time from when a person, and this usually occurs

between a certain window, late adolescence and early adulthood, 15 to 25, that's when the onset occurs. When people begin to experience symptoms to when they actually see a mental health professional and get diagnosed, it's over a year. Wow. So there's a lot of delay during which bad stuff can happen before anybody comes to the possibility of treatment. And why is that? Is there some sort of, do we need to start, you know, addressing mental illness more in this country where we need to say, hey, man, get some help right away?

Don't wait. Absolutely. Absolutely. But first of all, the fact that the period of onset, the window of onset age-wise, just like Alzheimer's disease doesn't occur until you're elderly. Autism occurs in the first 24 years of life. Schizophrenia's period of onset is 15 to 25 by and large. But that's a period that people are going through changes. As an adolescent, you're experimenting with things, you're maturing, you're developing your own identity,

you're becoming independent. And it's hard to know what are just the normal fluctuation of kids going through those maturational stages and what are the harbingers of an imminent mental illness like schizophrenia. So, you know, parents and pediatricians and others are, you know, they are giving people slack thinking, oh, they're going through a phase, which is true. The other thing is that people don't know what to look for they don't know what the prodromal or the warning signs are you know if you are experiencing pain in your chest uh it radiates down your arm you might think oh is it you know is it just you know heartburn or maybe it's uh i bump myself and it and it's my rib attaching to my sternum

or maybe it's the beginning symptoms of coronary artery disease. You can narrow it down, but when it comes to aberrant behavior, it's very difficult because it overlaps with what is normative behavior. And so that's why it's difficult. And then even if people do think that there's something serious going on that they need to pay attention to, then they think, well, where do I go? Do I go to my GP? Do I go to my clergyman? Do I go to a psychologist, a social worker, a therapist? Do I go to some kind of holistic retreat? There's this fuzzy notion about what mental health care is.

And it's not just being nice to people. It's not just listening when people say things that are distressing them. It's going to a mental health professional that can make a distinction between what's a serious indication of the beginning of a mental disorder or what is something that's just, um, more of this kind of normal, uh, fluctuations in mental state in relation to your, your, your current life circumstances. Yeah. And I would, I would say also see a professional, as you've just stated. Don't consult with social

media. I see a lot of social media professionals that are, I don't know, they don't have jobs or something, so they've decided that's what they are on social media. They're giving a lot of psychological advice, which can, you know, it's just throwing darts at,

I don't know. I'm afraid you hit on a very big emerging problem. That is that, first of all, anybody can hang out a shingle and say they're a therapist. You know, to have a certain credential, you need to be licensed, a licensed psychologist, licensed social worker, licensed physician. But anybody can say they're a therapist. And the other thing is that because of the lack of mental health care facilities, meaning clinics, mental health professionals from psychiatrists, psychologists, psychiatric nurses because of the the gap it's being filled by companies that think digital

technology is the answer and uh you're going to be able to basically get on a phone or pull up an app and get some kind of mental health first aid, and that'll do the trick. That's not going to happen. These are basically, I wouldn't say fly-by-night ventures. They're basically commercially motivated ventures that are filling a void in our healthcare system that aren't intended to be harmful, but they're certainly not going to do the trick in terms of providing the needs to the population in terms of mental health care. There you go. You know, and,

and I think, you know, what you just spoke to, do people have an attitude that, well, this can be just a quick fix, like, like a physical illness.

I just take a pill and, you know, call me in the morning doctor sort of thing. Mental illness, you know, takes longer to fix, doesn't it? Absolutely. First of all, it takes more time to diagnose, longer to fix, and it's not a one-and-done thing.

So in the book, I have many examples of clinical cases, and among the most tragic are individuals, and this is part of why I wanted to write about schizophrenia. Schizophrenia is a brain disorder that is caused by a certain genetic predisposition. Not one gene, but multiple genes. And it's similar to other medical conditions like type 2 diabetes, essential hypertension that are called complex genetic medical disorders because it involves multiple genes producing additively susceptibility to the illness. But it's a particularly cruel mental illness because it comes on when people are coming

into the prime of their life, Late adolescence, young adults. It can strike anybody. It's an equal opportunity disease. Men, women, all races, all geographic ethnic groups. It can be the valedictorian, cheerleader, popular person, or you can be kind of the loner or nerd. And it comes on just as you're beginning to begin your life. When the symptoms occur, most people have no idea what's going on. They just know, wow,

this person is acting very different. I don't know what's going on, drugs, or is he having a bad day or not sleeping? And if it persists and they do get treated or hospitalized, they think, wow, I'm glad that's over. I'm going to go back to school or I'm going to go back to what I was doing. And they want to get back to it quickly, not lose the semester. If they're taking medication, which they should be, they often are having side effects that they don't like or they don't like the stigma of having to think they need something to keep themselves mentally stable so they stop it and then they relapse and uh flash forward you then begin to slide down the slippery slope of intellectual deterioration because schizophrenia is a progressive disorder and it leads people to a state a chronic stage of the illness that can

involve them having persistent symptoms even in the face of treatment and be functionally disabled so they're not able to even come close to fulfilling whatever their potential might have been. And we see this with people on the streets who aren't getting treatment, with people in state mental hospitals. message of the book is that it doesn't have to be that the key to this dreaded, historically mysterious, misunderstood condition is early detection and intervention. You can whip it in the bud, but it has to be recognized and it has to be correctly treated. I think you speak to something broader too, like we mentioned before. If you think you need help, seek it out. Don't wait and have it looked at. One of my best employees of my company over the years had a son.

She had a son who had schizophrenia, and he had a lot of problems. I mean, constantly interactions with the police and getting arrested and different things that were going on with his life and how he was behaving with schizophrenia. And he'd been diagnosed with it and lived with it for years. And to see the fallout of, uh, in her life of being a caretaker for it and people's schizophrenia was, was just massive. It left an indelible print on my, on me. Um, how much of the population is you know fits within the diagnosis of schizophrenia or probably should fit in more than most people

think so um if you talk about mental illness in general and i'm not talking about the worried well or anything again i'm talking about know, hardcore conditions, about 20% of the population will suffer from schizophrenia or suffer from a disease in their lifetime, mental disorder in their lifetime. Now, schizophrenia affects one in 100 people. Wow. So in the United States, that's about 3 million people. Wow. And it's a condition that once you've got it, you've got it for life. It's not like you'll get over, like you, you know, get over the chicken pox or the measles. It's a recurrent condition. And if it's allowed to recur, meaning through relapses,

then we're not getting treated because of either neglect or or you know disbelief it then produces a irreversible damage in the brain that leads to mental disability oh wow so uh it's it's occurs young it if not taken care of, which it hasn't been historically optimally, it becomes disabling. But it doesn't kill you like Alzheimer's or Parkinson's or ALS and other neurodegenerative diseases. It disables you. And so individuals who have it become wards of society, meaning on Medicaid, SSI, disability, requiring government resources, and it also results in caregiver burden to their families, so they become estranged from them. It's very cruel. But there's one other thing, Chris, that's also an example of how our society, you know, there wealth bioterrorism those are

um we have the tools to to treat schizophrenia we have the tools to prevent somebody who's got a bright future and comes down with the illness but doesn't understand what it is. We have the tools to prevent them from suffering the consequences of becoming a ward of society, but we don't deploy them. So our society, our government is not serving us well and paying attention. And to make matters worse, this trend we have now with liberalizing access to recreational, what previously were recreational drugs, cannabis, psychedelics, is going to increase the frequency of schizophrenia. Really? Because cannabis is a trigger for people who are vulnerable to develop it oh wow and the

incidents will definitely go up as more and more states make it easier to get wow that's that's interesting to note um you know i i've met people over the years when i've met people that have usually addiction problems there's their reaction to drugs is different like i've i've met people that have usually addiction problems, there's their reaction to drugs is different. Like I've, I've known people that like, uh, for instance, you know, if I drink, I get relaxed and I get very chill and I just, I just want to be like, yeah, man. All right, cool. But I've met people that, that when they, especially they have an addiction to genetic addiction to alcohol, their reaction to it is completely different, like the opposite, where they become jacked up,

they become very belligerent, they become problematic, they become very combatant. It's like a real opposite thing. I've seen the same thing with cocaine and different other drugs where most people that will take it will be very, you know, they'll have a very common reaction, but then I'll see other people that will take it in a smaller percentage where their reaction is the complete, is a completely different thing. And usually those are the people that have the problems with, with those sort of drugs. And it's interesting how that, you know, I've often gone like, Jesus, how, how come you, you know, you take this, you know, you drink some booze and suddenly you're the biggest, loudest asshole belligerent, you know, and I've actually seen

like a site of physiological change to them too, as well. Uh, I, I had one girlfriend who had an alcohol problem and her face would literally change. It was like Dr. Jekyll and Dr. Hyde, which is probably where that story comes from in that sort of issue of mental illness. Right. Well, what you're describing is the heterogeneity of meaning the variation in pharmacologic response that people have, and that's just a biologic reality. In other words, most people have similar reactions to things. So, for example, you know, if you take aspirin, it'll help to relieve a headache or lower your fever. Or if you take a slug of vodka, you know, it'll make you kind of calmer and more relaxed, less anxious, more talkative, you know, more kind of congenial. But some people react in a very

different way and they become irritable and hostile or they fall asleep or they become physically flushed and feel like they're uncomfortable and jumping out of their skin. But then also, if you continue to use the substance because you like it, you then develop a tolerance to it. And you need to drink or take more of it to get a similar kind of effect that you had initially. And then that leads you down the slippery slope to addiction. But if you take 100 people, and if you give them, okay, let's take the current bad person or bad drug, OxyContin, opiate addiction. If you take 100 people and you treat them for ostensible back pain or something with OxyContin, only about a third of them are susceptible to addiction. So it's not like everyone who takes it is going to develop it, but everyone who takes it, you know, there could be a lot of variability in it.

When I take a history from a patient that I'm evaluating, I, as part of the routine history of their symptoms, their medical history, their family history, I also ask them about, you know, their medical history, their family history. I also ask them about their recreational drug use history and what is their reaction. Not because I'm going to snitch on them or anything, but because how they react to things is diagnostic. And if they smoke pot and they say they get paranoid, immediately that's a tip off. Yeah. If you are anxious and you drink alcohol and it helps you, that's a tip-off to having a general anxiety disorder or panic disorder,

which alcohol is a very good anxiolytic for. The problem is it wears off and you have to drink more to keep going. So what you're describing is actually a real phenomenon and it's an important indicator of somebody's not just reaction to that. In fact, what I say is, what's your favorite recreational drug? And if they say cocaine, so if you're susceptible to psychotic disorders, and you happen to like or get into cocaine, or methamphetamine, or worse, you're in big trouble, because those are the major, major precipitants of psychosis. But the point I'm trying to make, though, is that

our society by arguing, so it's hard to say that cannabis is more dangerous than alcohol or tobacco. These are recreational intoxicants that people can have access to and nobody forbids them legally. On the other hand, for some people, cannabis is going to be a bad thing. It's a bad thing if you have this susceptibility to psychotic disorder, and it's a bad thing particularly if people use it during adolescence because then it affects your maturational development of your brain. There's a lot of discussion about this stuff, and I think more and more people... I think I'm going to start walking around

with psychiatrist cards in my pocket. I can just hand them to family and friends. I can just be like, get help. So when I started writing for the lay media, it was hard to get people interested in a semi-scientific subject like mental illness or schizophrenia or brain function. But the one article that I wrote that had the most hits was titled, The Profession Everybody Needs But Nobody Wants.

Psychiatry is kind of like dentists, I guess, or something. Yeah. psychiatry is kind of like dentists i guess or something yeah well is there is also people have a different have a have a somewhat dated view of it they think of psychiatry is like freud you know laying on a couch pre-associating talking about your dreams and your toilet training and so forth and that's that's not the current state of psychiatry let me ask you this uh you know one thing we've we've had a lot of authors on the show and talked a lot about is, and it's interesting to me, the life patterns of some of the people we've had on the show, but how much childhood trauma ends up, you know, you can see the fallout through most people's

life. You can see my fallout through my life in looking back and and how much childhood trauma sometimes i heard it said one time that people that are a large part of people that are in drug rehab or had drug problems or addiction problems had childhood trauma do you see a lot of that with schizophrenia and other maladies uh is that a correct is that a correct analysis? Well, childhood trauma, experiential trauma, is a potentially toxic effect on the brain and on people in general. You know, the most extreme form of it we see with soldiers in combat and PTSD. But anybody could experience it. You get mugged or you're in a fire or an earthquake or an auto accident. Children, however, when they experience trauma, whether it's through parental abuse or any other type of catastrophic event, they handle it in a different way than adults do.

And although at the time it may appear that they're pretty resilient and not acting or not seeming to have been very disturbed by the event or the repeated events, it's affecting them. And it affects them in a way that comes out later in life. So there's something called when somebody has a diagnosis of depression, for example, meaning that they have mood disturbances, their ability to maintain a normal emotional state is disrupted and they just can't get out of feeling horrible. I mean, this is not just, I feel sad, this is like physical pain that you can't endure. And there's some wonderful first person accounts on this. William Styron wrote Darkness

Visible. Andrew Solomon wrote The Noonday Demon. Kay Jamison wrote An Unquiet Mind. These are physically palpable pain that you feel, not just like, oh, you know, I didn't win at poker last night or my girlfriend broke up with me. So the notion of what something is, is something that people don't necessarily appreciate and understand sort of what needs to be done. But when I say, and this is to parents particularly, it's better to err on the side of caution and seek a consultation to make sure. So, you know, kids may have a terrible thing happen to them and they may look like normal, but then if later in life they experience the onset of an anxiety disorder or a mood disorder like depression,

its ability to be treated and for them to have a good outcome is much more difficult if they have this prior traumatic experience. And there's a very large scientific literature on this. The question is, though, how do you measure trauma? You know, if somebody could say, oh, I had a bad experience, you know, with a teacher who was a bully in class or there was a class bully in school. There's no way we can really measure trauma. It's getting an accurate history and then trying to evaluate what are the likely effects of that on an individual. But the key distinction I guess I'm trying to make is that trauma is something that can affect people at any stage of life, but it has a particularly different and onerous one in children.

And the last thing I'll say about it is in some of the more extreme cases that I've seen, this is a fascinating condition that we don't know a lot about. The adult consequence of childhood trauma, whether it's emotional abuse, physical abuse, or sexual abuse are conditions called dissociative states. Now, dissociative states are things where the most dramatic and extreme version of a dissociative state is multiple personality, when somebody actually can transition from the way they usually are to a totally different type of individual and act in a totally different kind of way. And frequently have no memory of it. But the more common thing is that kids who have grown up after having sustained childhood trauma in a very severe way,

they will have times when they will kind of dissociate, go off into another state of mind, often has behaviors that are completely inconsistent with their normal personality. So someone who is kind of a bookish, conservative, work-oriented young woman might become very provocative and engage in promiscuous or risky behaviors. And then this reverts back after some period of time. But it's a very dangerous condition. And it's one that we don't have good treatments for now. But you've seen movies like The Three Faces of Eve or... Brilliant Mind? No, Brilliant Mind.

That was schizophrenia. John Nash had a card-carrying schizophrenia, no question. And his son has it too. So the family history is consistent with that also. Jesus. Let's open the scope up a little bit more because i i want i always want our show everybody we have on our show we want to educate people and make them smarter with a little bit of comedy we've woven in um we we talked a bit about before the show about you know one of the things

that concerns me is people using social media as a medical diagnosis for just about anything whether it's you know being overweight or addiction. One of the prevalences that I've seen, especially on TikTok, this has become a real big thing with TikTok, and it concerns me because yesterday the TikTok CEO was testifying before Congress, so it's prevalent in the news. But it's so prevalent, and I see so many videos and so many, quote-unquote, experts that have no degree and are just armchair quarterback people who've somehow turned being coaches into in diagnosing narcissism and narcissism.

I've seen in recent years, especially someone who dates a lot. You know, I it's it seems almost like 100% of people that I date in, in mode right now, they will tell me that their prior boyfriends were narcissists and every, the last 10 boyfriends they ever had in their life were narcissists. And it seems like it's become this communal social media narrative that, that 95% of the population, especially men are narcissists. And I don't think that's figures true based on what what i google but i shouldn't believe anything on the internet so do you want to speak to that and why that's become such a conversation piece in our thing or is am i am i giving an accurate description am i just insane you are you are the problem is is that the way narcissism is used in these instances is more as an adjective than as a diagnosis. And we've got a real problem here. How bad it will be, we'll find out, I guess.

But social media, the Internet and then social media is like catnip or cryptocurrency to personality and behavior. It gives people license to do things that they've never had before. You know, I mean, if somebody, you could say narcissism is like egotism. You know, he's egotistic. It's all about himself or herself. Well, yeah, I mean, everybody would like to be somewhat self-interested and self-serving. But, you know, we have normative limits that are called, you know, consciences or good behavior or a sense of proportion. But social media encourages people to just get outside normal boundaries because one,

you know, you can easily do it. You can do it semi-anonymously and don't take responsibility. You don't have to really validate or justify what you're saying or doing. You know, you can just express your opinion or show yourself. I mean, you know, look at this guy, George Santos, who just made up his whole resume and everything. You know, on the internet, you can just create your own persona. And there's no responsibility. Now, narcissism is a term that's actually the term came from this Greek legend or story about Narcissus, who was the person who was so

consumed with their own beauty or appearance that he stared at himself in a pool of water to see his image and then ultimately drowned because he fell in. So you know that's how the term arrived at it but narcissism in a clinical sense means somebody who is so self-involved and self-interested that they're ignorant of other people's needs or reactions and they you know their relationship with other people are simply to serve their own purposes. And they're constantly self referential in anything that happens, you know, like you're telling a story about, oh, you know, I was going into this restaurant, and I saw such and such a person and invited me to sit down and have a drink with him.

And the person says, well, yeah, the other day I was doing the same thing and here's what happened. So everything is self-referential. and a lack of recognition of other individuals and other sort of external elements in the person's reality. I don't want to make any kind of political statement, but, you know, the term has gained new visibility and understanding with our former president, who was very much, you know, illustrated a lot of those kinds of behaviors. So narcissism is considered what's called a personality disorder, meaning it's psychologic as opposed to biologic. It's not the brain so much as it is the person's personality from the way they've been raised and whatever they've inherited from their parents that may

also have been, you know, inclined of that sort. But I think, you know, your observation is accurate is that the internet has encouraged this expression more. And there's one other thing that I think is definitely relevant. And that gets back to the culture thing I was saying and the pathoplastic features that can encourage pathology from the cultural environment. America is a country that was built on the ethos of a rugged individualist who is there for personal freedom, self-determination, master of their own destiny and so uh you know there's a uh cultural ethos of encouraging people to be express their individualism and um in doing so and now with the internet they can express their individualism in this way that provides access and anonymity. The problem is that you can reduce it to kind of, I guess I would say, individual narcissistic immaturity. In other words, a kid just yells, I want this, or I want that, or look at me, or I want to go here.

The internet, the country sort of encourages people to fulfill their dreams, live their own lives, be individualists, as opposed to conformists and adhering to convention. And to do it without any kind of encumbrances or inhibitions. That's what kids do. That's not what adults who are responsible members of society do. So you're right. There is this proliferation of narcissistic behaviors and then faux diagnoses being leveled at people, not because they have

the disorders, but because they're behaving in that way. But, you know, our society is encouraging it both from our historical culture, as well as this more recent advent of the internet, which is social media. Yeah, it's, you know, I'm pulling this up with, I think this is from the Cleveland Clinic. Common narcissistic personality disorder is up to 5% of people that have, it's estimated, and is one of 10 personality disorders. There's another report that males may have it up to 7.7%

in general population of 4.8 females. But I, my, my concern is that I see like, I'm trying to pull it up on Tik TOK here. Um, there are billions of views about narcissism on social media and you see people talk about it. And like you, I And I agree with you. We saw some of the psychiatrist groups write books about the narcissism of President Trump. And it's not political. I mean, this is definitely something that you look at and you go, well, it kind of brought the discussion.

And I'm looking at the term narcissist, the hashtag on TikTok alone, it's 8.5 billion views. And there's not that many people in the freaking world, people. So somebody's attributing a diagnosis that they probably have to more people than actually exist. Exactly. And it's insane. I've looked down the list of narcissism hashtag just on TikTok alone. And I can't go any day on TikTok without seeing some person claiming that they're a narcissist and then all their prior boyfriends or girlfriends are narcissists. there is a state of of of men and women relations of dark triadism of why women are attracted to

men with dark triad traits and why they want men to lead and there's the biology of of why women are you know attracted to that sort of thing a narcissist you know physical sort of thing you know if you study hybristophilia and why women are attracted to people of high breast to feel yeah that are prisoners or death row inmates you know like I I've seen that where I'm like how come how come the guy you know at one point what would face was getting married the guy who killed a bunch of people with the gang the Colton Charles Manson was getting married I'm like how come Charles Manson is a girlfriend and I don't like what's the whole going on but the only reason I'm talking about this is I just want to bring a light to people that please don't use social media as a

psychological or psychological diagnosis please go see a medical professional please go see someone with a degree and and uh yeah yeah you know social media has become really weird like anything that's the topic of the week everyone's a professional expert on it suddenly. Like, you know, when the balloon, the Chinese balloons were getting shot in the sky, suddenly everybody in my social media feed was the ultimate professional on, you know, with years of experience on what Chinese balloons are in the sky.

It's a little bit like, you know, the legend of Prometheus. Prometheus discovers fire, and fire can be used for good or bad purposes. The Internet was an amazing discovery, but this purpose is a double-edged sword. But let me just give you, there's different kinds of what might be called narcissistic behavior. As good narcissism as bad narcissism. So bad narcissism is somebody who's so self-involved and self-consumed that that's all they ever think about. It's no one else.

Nothing else. It's just all about them. Good narcissism is somebody, let's say, who has a messianic, you know, sort of attitude or motivation. They think so highly of themselves. I'm so smart and I'm so capable and I have a mission and I'm going to save the world. And they actually go out and try and do that, but in a sincere way, well-intended, not solely to bring attention to themselves, but to be the person that can do good for the world and they'll get the credit for it or uh they'll be able to bring it about that's kind of a grandiose narcissism which is good um and then a third kind

is what describe either i should mention well there you go there you go while you're doing a little bit depends on your guests and your podcast, I guess. But the people with schizophrenia are also defined by a narcissistic quality. It's one that doesn't hurt anybody except themselves. They're so consumed with their own symptoms, their delusions, their hallucinations, they're trying to figure out what is going on in their head or in their world, because it's at variance with the external reality, they're creating their own reality, because their psychotic symptoms are so intense, that they take them as being, you know, the gospel truth, the absolute reality that's going on, even though there's not really people after them,

even though the CIA hasn't put a computer chip in their body, even though the neighbors aren't trying to poison them, even though the voices they're hearing aren't real voices of people who are saying bad things about them. So there's really different forms of this. But, you know, my personal thing about the social media is there should be more curation of it. But then you've got free speech and you've got freedom of expression.

You know, that's not always good. Yeah. I don't know what the answer is, but there should be some curation that and people say well that's censorship well you know it's not necessarily bad to make sure that stuff that gets posted has some you know legitimacy to it and it's not overtly offensive you know you bring up a really good point that i i think i'm going to become an advocate for you know we had this thing during covid where they would you know social media companies would put like a disclaimer like any author we had on talking about covid or whatever on youtube there's like a little

disclosure that will come up about covid and you know health risks and and you know you should be careful what sort of information you're looking at yeah i i think they need to do this on social media and like tiktok like if someone's talking about a medical diagnosis, whether it's physical or mental in psychology cases, you know, for instance, what we discussed about with narcissism or any sort of other malady that some amateur quarterback, armchair quarterback has decided they're the expert on this week. There should be like some sort of thing that says like you know this person has some interesting uh freedom of expression ideas but please if you really want to study narcissism get professional help and i think maybe there should be a disclosure that maybe more often well that i mean that that that i think you know runs into our political

ethos this thing about um you know a government staying out of people's lives, even though that isn't the case. And so you can't have it both ways. But narcissism, a fundamental element of our narcissism is immaturity. Because all children are narcissistic. All children are narcissistic. And you grow out of that. You grow out of that as a result of peer pressure,

cultural norms, and, you know, being incentivized or disincentivized to conduct yourself in different ways. You know, if you act like a boor that only talks about yourself, you know, people are going to run away from you. or disincentivized to conduct yourself in different ways. If you act like a boor that only talks about yourself, people are going to run away from you. Oh, you just described me. You've got a pretty good listening audience,

so I don't think it's working in a negative way for you. They're here for the car crash. They're just waiting for me to hit the wall. That's what I'm told. They're just like they're watching going, any day now, he's it right right like a formula one racer pretty much yeah let me ask you about one more thing before we wrap the show because i know we've we've gone pretty long but i think this is important discussion for people because the main message of the show i want to take and do is people should buy your book and uh in and understand psychology more but also seek

professional help uh there's been two times in my life where my depression and anxiety have gotten so bad where I had to go get chemicalized and get some help. And they were the best things for me because I was becoming very self-destructive. You alluded earlier in the show about gaming disorders and maladies that may be not quite reaching the level of of and in the cases i'm sure different variant but you know there's been a lot of interesting things that's come out of psychology lately where there's been some criticism of how it seems to be expanding quite a bit of different maladies like you mentioned gaming disorder i know one malady that i'm not excited about is evidently some psychiatrists determine that masculinity is toxic and is a mental disease or suggested it was a mental disease or implied that it was.

Is that happening in the world? generating more diagnoses or more mental illnesses or is maybe woke culture getting a little out of control with just making everything a disease you know kind of like what i'm seeing with narcissism a lot of people that i see declare you know that their prior relationship persons were narcissism is really just them not taking self-accountability and going hey maybe it's me because it's always me i know it's me but so i was president of the american psychiatric association in 2013 and 14 when the current or the most current version of the diagnostics statistical manual which is the bible of diagnoses was launched and there was a a lot of controversy and criticism about proliferating diagnoses and pathologizing normal behavior. And from a clinical medical standpoint, I can tell you that is not

happening. And that is not the goal or the intent. When somebody talks about toxic masculinity, they're basically engaging in an ideological strategy to call attention to something that they feel is pernicious or want to. And so they're weaponizing a clinical diagnosis as a way to do it. Just like now, with cancel culture, we've weaponized certain things that are called microaggressions or implicit bias to take out people. And so this is not, but on the other hand, and this is important, although I don't know how to say it in a few words. Any throughout history, when as medicine evolved, all diseases were recognized and described and diagnosed in the same way. Meaning the first thing that was done was to describe them. So people that had epilepsy had falling sickness, like Caesar.

People that had congestive heart failure had dropsy, meaning that they had edema in their ankles, the fluid dropped to their legs. People that had diabetes, the doctor tasted their urine, if it was sweet, it was mellitus. If it was watery, it was insipid, simpidus. But then when science and technology were developed, you could measure glucose, you could do EKGs, you could do EEGs. And so you had a laboratory diagnosis of the condition. And then the third level is, oh, can you discover the actual cause? I have pneumococcal pneumonia. I can actually grow the bacteria in culture. Or I have Huntington's disease.

I can identify the gene that causes the symptoms of the disorder. Mental illnesses are still at the first level. Describing the symptoms. You know, narcissism is acting in the way that we've described schizophrenia is based on the occurrence of delusions hallucinations thought disorganization depression is sadness and sleep disturbance and worry beyond the scope of the person's circle so we're still doing it phenomenologically. So it's easy prey to say, oh, masculinity is toxic, or to say that sexual addiction by somebody who's, you know,

a womanizer or a manizer, you know, and seeks a lot of sexual partners. It's just descriptive, but it's an opinion. It's not actual evidence that's doing it. And as you've been referring to, you know, the internet gives people a bigger voice than they've ever had before to be able to do it. So let me just say, because I know that we need to wrap up, that if people are wondering if they listen to this, oh, I need to be more sensitive to my family members and friends' behavior. And if I recognize something that I'm concerned about, what should I do? The guidance is this, be over-involved, not under-involved. And you start at the top when you seek help, meaning you go to a psychiatrist and preferably at an academic teaching center first,

and then you can work your way down if it's not anything serious to a therapist that they can refer you to. But the point is that people, if somebody is drinking too much, if somebody is acting bizarre, if somebody appears morose and talks about life not being worth living, they usually kind of feel uncertain what to do, what to say. Oh, it's not my business, and I don't want to say anything that's going to be taken the wrong way. Say something. By asking, you'll never push anybody in the direction of something bad happening. It's better to ask than to stay silent

definitely definitely i love that as a psa and that's what i was planning on wrapping the show with um what's the best way for people the quickest way to reach out because as you mentioned before people can wait too long to get help i've been guilty of that in fact that people you know they'll ask on social media they'll be like if you could go back to your childhood self and teenage self and tell yourself a word of wisdom, what would it be? I'm like, go get psychological help, Chris Voss. Go get some help now. Childhood trauma and looking back through 50 years of childhood trauma and seeing the wreckage is not good.

Don't be me. And a lot of people suffer from that. So what's the best way to reach out if you think you need help or if you have a loved one that you think you need help? Should you hand them a card? Should you get them a phone number? What's the best way to kind of make that decision and cross that line so you don't wait? Well, I try and do what I can to respond or guide people. And if you go to my website, jeffreyliebermanmd.com,

that's the way to connect to myself. But, you know, people live in all kinds of geographic areas and different circumstances. If best thing to do initially is to ask your GP for a referral, if they say, well, I don't know any psychiatrists or none that I trust, then I would call the medical school and the office of the chair of psychiatry and say, I'm having anxiety, I'm having a drinking problem, a drug problem, depression, whatever. Who on your faculty is the specialist in this area that I could see?

And to go that way, there's also the American Psychiatric Association, which have local branches in each city. But you may have to search because, like I said initially, the access and availability is just not comparable to general medical care or other medical specialty care and there's one other thing I'll say Chris that I feel a little bit uncomfortable but I think

it's just so true that I should say it do you know anybody that goes to the second best doctor everybody goes to the second best doctor? Everybody thinks they're the best doctor. So there's good doctors and there's less good doctors. But when it comes to psychiatry, there's more variability. And that's because the field is still, you know, is the late bloomer of medical specialties. So you have to do a little bit of searching sometimes, but people do that. You know, when you have cancer and you don't get a good response from

the initial treatment, people will go online, they look at protocols in different places, they'll travel. I'm not suggesting you have to do that, but you may have to do a little work. But a lot of what I do is re-diagnosing people or changing the treatment regimens from bad ones to the correct ones. So you may have to put some effort in, but it's worth it because when it comes to severe mental illnesses like schizophrenia, it's definitely a situation in which a stitch in time saves nine. Yeah. And don't wait, people. And don't consult with tiktok and social media like seek professional help please quit hiring and and paying people and listening to people that

you know they just decided last week they're the professional in this deal with professionals people have studied this gone to college gotten degrees and etc etc please please stop using social media as the best physicians don't have a lot of time to spend doing that. I can tell you that. There's a good point. There's a good point. So please reach out. I encourage everyone and don't wait. I can cite some examples in my life, but we don't have enough time right now, but there's times where I've dealt with anxiety and depression in my business life and get help as soon as possible. Reach out if you think you need help. It doesn't hurt.

It doesn't hurt. And you're actually a better person for going, hey, maybe I need help. Let's take a look down that journey. Maybe you don't. But it's better to be introspective in that way than just think that you're the perfect human being in the world, which is what I do.

Don't try and tough it out. And don't be cowed by stigma there you go there you go thank you very much jeffrey for coming on the show we really appreciate coming on giving some insight and hopefully we've opened some minds and educated some people and we can save some lives appreciate it chris thank you very much there you go uh order up the book folks wherever fine books are sold stay away those alleyway bookstores cause they're dirty. So go to the good ones. I don't know what that means. I'm just kidding around.

Anyway, guys, malady of the mind, schizophrenia and the path to prevention. It's out on hardcover, paperback, audio book and Kindle and audio CD, wherever fine books are sold. February 21st, 2023, Jeffrey A. Lieberman has been on the show with us today. And as always, we enjoy our audience tuning in and some of the great comments we get. Be sure to go to Goodreads.com, FortunessCrispFoss, YouTube.com, FortunessCrispFoss, LinkedIn, all that good stuff. Thanks for tuning in. Be good to each other.

Stay safe. And we'll see you guys next time.