The One You Feed - Sarah Fay on The Challenges of Mental Health Diagnoses

Episode Date: March 15, 2022

Sarah Fay is an author and activist.  Her writing appears in many publications, including The New York Times, The Atlantic, Time Magazine, The New Republic, Longreads, The Michigan Quarterly Review, The Rumpus, The Millions, McSweeney’s, The Believer, and The Paris Review, where she served as an advisory editor.  She is currently on the faculty of the English departments at Northwestern University and DePaul University. In this episode, Eric and Sarah discuss her book: Pathological: A True Story of Six Misdiagnoses But wait – there’s more! The episode is not quite over!! We continue the conversation and you can access this exclusive content right in your podcast player feed. Head over to our Patreon page and pledge to donate just $10 a month. It’s that simple and we’ll give you good stuff as a thank you!Sarah Fay and I Discuss the Challenges of Mental Health Diagnoses and…Her book, Pathological: A True Story of Six Misdiagnoses Defining mental illness and how mental health diagnoses come from the book, “Diagnostic & Statistical Manual of Mental Disorders” (DSM).  Her many diagnoses of mental health disorders in her lifetimeHow DSM diagnoses lack validity and reliability How chemical imbalance theory has been debunked and cannot be provenThe problems with primary care physicians diagnosing psychiatric conditions and overprescribingHow mental illness diagnoses can often become our identityThe different schools of thought on treating mental health conditions with medicationEmotions are vibrations in our bodies and responses to our thoughtsPathological: The Movement and the three important questions to ask yourselfSarah Fay Links:Sarah’s WebsitePathological: The MovementInstagramFacebookIf you enjoyed this conversation with Sarah Fay you might also enjoy these other episodes:Rethinking Mental Health with Eric MaiselGabe Howard on Mental HealthSee omnystudio.com/listener for privacy information.

I think sometimes our conversation, the reason why it goes to pill shaming and big pharma is bad, which, you know, that's a deserved reputation that they have, is that we're skipping the real problem, which is that DSM diagnoses are too easy to receive and are being given out too easily. Welcome to The One You Feed. Throughout time, great thinkers have recognized the importance of the thoughts we have. Quotes like, garbage in, garbage out, or you are what you think, ring true. And yet, for many of us, our thoughts don't strengthen or empower us. We tend toward negativity, self-pity, jealousy, or fear.

We see what we don't have instead of what we do. We think things that hold us back and dampen our spirit. But it's not just about thinking. Our actions matter. It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction, how they feed their good wolf. I'm Jason Alexander. And I'm Peter Tilden. And together together our mission on the Really No Really podcast is to get the true answers to life's baffling questions

like why the bathroom door doesn't go all the way to the floor what's in the museum of failure and does your dog truly love you

we have the answer go to reallynoreally.com and register to win $500 a guest spot on our podcast or a limited edition signed Jason bobblehead the Really No Really podcast follow us on the iHeartRadio app, Apple podcasts,

or wherever you get your podcasts. Thanks for joining us. Our guest on this episode is Sarah Fay, an author and activist. Her writing appears in many publications, including New York Times, The Atlantic, Time Magazine, and she's also on faculty in the English department at Northwestern University. Today, Sarah and Eric discuss her newest book, Pathological, The True Story of Six Misdiagnoses. Hi, Sarah. Welcome to the show. Hi. Thank you so much for having me. I'm such a huge fan, as I was saying. Well, I'm so happy to have you on. We're going to be discussing your book, Pathological, the true story of six misdiagnoses. But before we do that, we'll start like we always do with a parable. And the other is a bad wolf, which represents things like greed and hatred and fear. And the grandchild stops and thinks about it for a second and looks up at their grandparent and says, well, which one wins? And the grandparent says, the one you feed. So I'd like to start off

by asking you what that parable means to you in your life and in the work that you do. I've thought so much about this and it makes me think of mental health, but not in the way you might expect. So a mentally healthy person, someone with mental health sees two wolves and actually sees, you know, the wolf giving quote unquote good emotions and the wolf giving quote unquote bad emotions or transferring them and can choose between them and can feed one or the other. And my experience of mental illness is that it was not that concrete. It was a confluence of emotions at all times. And they got confused and they often cascaded over me and I couldn't have a command over them so that it felt as though

at times both wolves were like eating me or I was fending them off or I was chasing them or they were chasing me. And so it was almost the wrong scene that mental illness really brings about a lack of self-awareness that I was striving for at all times, but I didn't have the self-awareness to be able to choose one of the wolves and feed them at the time. And I have that now, which I am so grateful for. Yeah. You define somewhere, you said, this is how I define mental illness, mental, emotional, and behavioral responses that don't correspond to reality and render the person acutely dysfunctional. And I think that ties to what you just said, which is that our mental,

emotional, and behavioral responses don't really correspond to reality. We can't see clearly. Exactly. And those are very different from DSM diagnoses. So the diagnoses, the mental health diagnoses that we receive come from the Diagnostic and Statistical Manual of Mental Disorders, otherwise known as the DSM. And that's a book. And I didn't know that at the time. And when I found that out, that our diagnoses do not come from scientific discoveries, do not come from medically on high, but that they come from this book. And I started researching that book because I'm a journalist and found out that the book and its diagnoses are determined by a group

of mental health professionals based on their opinions and their theories and little else. So not hard data. And they're really hypotheses of trying to categorize our mental and emotional lives, but not anything to necessarily rely on. The other thing about DSM diagnoses is that they can't define dysfunctional. And that's what a DSM diagnosis is really supposed to rely on. What's the level at which someone is categorized as dysfunctional? The distinction between mental illness and DSM diagnoses is that serious mental illness in particular, which I had or have, means really losing the ability to function independently and inability to live independently. I couldn't live independently for five years.

And there is an extreme situation happening. And that doesn't mean that all of us don't suffer in our mental and emotional lives. We do. And the DSM has attempted to really encapsulate and try to essentially diagnose as many people as possible and give them a DSM disorder. So let's back up a little bit from that for a second, but you were diagnosed with six different things over the course of your life. Tell us what those were. I was diagnosed with anorexia when I was 12. Then I was diagnosed with anxiety disorder when I was in my 20s and major depressive disorder also in my 20s. When I was in my 30s and in a doctoral program, I was diagnosed first with attention deficit hyperactivity disorder, then obsessive compulsive disorder. And then finally, I was diagnosed with bipolar two and then bipolar one.

I was diagnosed with bipolar two and then bipolar one. So my diagnoses though, also between obsessive compulsive disorder and bipolar one, I was also told that I had depressive and anxious elements is what they called it. So again, giving me comorbid diagnoses is what they're called. And so what you're saying about a mental health diagnosis is they all come from something known as the DSM-5, the Diagnostic and Statistical Manual of Mental Disorders, as you said. And they are based on opinion. They're not based on like, oh, I can do a lab test and find this thing out. I can do an x-ray or a CAT scan or any number of other things where I can sort of confirm a diagnosis. Although we can do this with, I think certain types of dementia, right? Postmortem, we can sort of go, yep,

yep. Okay. It was Alzheimer's, right? But everything else, there's no, there's no marker for it. So what we're doing is the psychiatry community is going, all right, this is what our people we think are best qualified to do this. Think roughly what these look like. How many diagnosis do we have now in the DSM-5? What's difficult is that it depends how you count them, which says a lot about the arbitrariness of the book, as we should be able to say definitively. But we started with 128 in the DSM-1 and now have 541 diagnoses. Actually, 542 with the new edition of the DSM, which is coming out in March. So you were diagnosed with six different things. Now, you're clearly not saying that you weren't

suffering mental illness during those periods, but you also sort of reject the diagnosis. Tell me a little bit about that journey for you and how that fits together in your mind now. And going back to what you were saying, DSM diagnoses lack validity and reliability. And validity means, as you were saying, that they have an external reality outside of self-reported symptoms and the opinion of a clinician. But DSM diagnoses don't exist outside of that. So as you said, there's no test, no x-ray, nothing we can do to prove a person has the diagnosis or that the diagnosis even exists in objective reality. The other thing about them is that they aren't what's

called discrete disease entities. And all that means is that the symptoms overlap. So the reason I received six different diagnoses and the reason so many people receive different diagnoses is because the diagnoses aren't solid. They aren't stable as categories. And when I say they were hypothetical, there's a really disturbing story about Robert Spitzer, who is the architect of the DSM-3. That was in 1980. And it was really the addition that pushed us toward the brain, looking at mental illness or mental dysfunction in the brain, not the mind, and not neurosis, but disease. And when he was asked why major depressive disorder, you had to have five of

nine symptoms, he said, well, we just went around the table and everybody thought that six just sounded like too many and four sounded like too few. Yeah. And that is the same diagnosis we have today. So to say that they're arbitrary. Yeah. Reliability is what the DSM hoped to rest on after that. So once they said, yes, we have no validity and psychiatry completely admits to this. I mean, you could ask any psychiatrist and they would tell you. Thomas Insull, who was the director of the National Institute for Mental Health, came out and said, DSM diagnoses have 0% validity. And Stephen Hyman, who was also director of the NIMH, said that the DSM is an absolute scientific

nightmare. So again, I'm just quoting them. And this is what I discovered as a journalist when I was really trying to crawl out of my time at my darkest. And so reliability though, is basically saying that two different clinicians can see the same patient, possibly at the same time and come up with the same diagnosis. And the reliability scores of DSM diagnoses are atrociously low. And they have also fudged how the scoring is done to make certain diagnoses acceptable. So for instance, generalized anxiety disorder, which is one of the most commonly diagnosed disorders, which I received, has a reliability score on a scale of 0 to 1 of 0.2. And the only ones that score 0.7 or above,

as you mentioned, are dementia and rare chromosomal disorders, which can be biologically proven, as you said. Yeah. You alluded to something there, which is this sort of back and forth in the psychiatric community between sort of a mind neurosis model or a brain disease dilemma. Like, which is it, right? Which reminds me a little bit of the nature and nurture debate, to be honest. It's got a hint of that to it, which the answer, I believe pretty firmly, is very clearly both, right? There's clearly an element of both going on here. But you say that psychiatry has been wrestling with this for a long time.

Yeah, absolutely. For at least a century and a half, if not longer. And so the DSM-III, where we move toward brain and disease, psychiatry and Robert Spitzer really wanted the discipline to be treated as a legitimate medical field. You know, they do have MDs and they did want psychiatrists to be treated the same as physical doctors or general medicine. And they were getting away from neurosis to the point that they removed the word from the DSM between the DSM-2 and the DSM-3. And there's nothing wrong with that. But what's fascinating, so from 1980 until now, we've really been pushing the brain disease model. And we've told people

that they are caused by a chemical imbalance, that diagnoses like major depression are caused by a chemical imbalance. 84% of this country still believes that the chemical imbalance theory is true. It is completely a myth. It is absolutely not proven. And it was debunked about 20 years ago. But the DSM is so much a part of our cultural lives that we have taken up certain aspects of it and moved away from the truth in many ways. The mind has always troubled psychiatry, but what's wonderful is Thomas Insull, who I mentioned, who is a former director of the NIMH, has a book coming out. And in it, he says, we were essentially mistaken in pushing the biological model and leaving out the social elements and aspects that so come into play.

And for him to say that, I mean, he had spoken out about the DSM in 2013 very strongly, but for him to write a whole book about it, it's really wonderful to think of. That psychiatry, that's a very big move and a huge mea culpa for psychiatry to give us. And so it makes me very hopeful. Because a biological answer, it was funny, you were talking with Johan Hari and he mentioned cruel optimism. And in many ways, giving a simplistic answer to a complex problem. DSM diagnoses and the idea that they're biological is a simplistic answer to a complex problem. That's right. And really it helps, it allows us to leave out social, you know, social injustice and economic inequality that

leads to poor mental health. Yeah. It's much safer to say, I mean, I don't even know what the right term to call some of this stuff is. I sort of like the term syndrome because it indicates there's lots of causality. You know, I look at myself and I have had what would look like depression, right? I've been diagnosed with depression. I have been treated for depression. I have what quote unquote feels like depression, but cause wise, I mean, I'm like, who knows? I mean, it could be so many different factors. It's almost impossible to unwind, you know, like what all causes these very complex things. And I agree with you when you sort of start to see multiple things

that all have the same symptom profile. You go, there's something maybe that we're not understanding here. There was a Johns Hopkins study that looked at patients diagnosed with schizophrenia and they were reassessed by another clinic and half of them were given diagnoses of mood disorders or anxiety. Now, schizophrenia with psychosis and anxiety and major depression, those should not overlap to the point that 50% of people are being reassessed. Can't tell them apart. Exactly. I've got a question about the chemical imbalance theory. Is it that it's been debunked or is it just simply that we have no evidence to say whether that's happening or not? We haven't been able to prove that there's a chemical imbalance going on. It very well could be. We just don't have evidence to say this is what it is specifically. Is that accurate? Exactly. And the thing about the chemical

imbalance theory is that the reason why it's been debunked, that theory, it was always a theory to begin with when it originated. It had not been proven and then was brought to us, but we tended to believe it wholeheartedly. The thing is there are far too many neurons we have. There's no consistency in terms of which subjects are depleted in certain dopamine or serotonin. None of that has been proven, but whether or not mental illness exists in the brain and is caused biologically, I believe that that's possible, 100%. I'm on medication and I love my medication and I would not be well without my medication. And I see a psychiatrist and I respect him greatly.

So clearly there's something that could be biological. But what Thomas Insel said is that we will never find it with DSM diagnoses because they're hypothetical. So we'll never prove the chemical imbalance theory or biology of a DSM diagnosis, but possibly mental illness. Right, right. And I think you get into the it's both kind of thing because, you know, I mean, ultimately it does seem at some level we are a bag of chemicals, right? And electrical firings, you know, because we can go in and we see through brain injury, like you do that to that part of the brain and oh God, well, that's not so good, right? So there's clearly a biological underline and I often say like, okay, so maybe

it is, let's say it's certain neurochemicals. I don't know exactly what they are. I can affect those sort of more directly by taking a medicine. And we're going to talk about medicine in a little while. But I think I also affect them when I climb on that exercise bike over there and ride really hard. Or when I talk to a friend. Or like all these things are at the most base biological level. Changes are happening in our neurochemistry based on things we're doing. So one way to work with it is directly with the chemicals themselves.

But frankly, everything we do is affecting that sort of thing. So again, that's why I always end up with the very profound, like it's, it seems like it's got to be both. Exactly. And the only danger to me about the biological explanation, well, there are many dangers, but one, I think we've incorporated it and have come to believe it far too ardently. But what's really difficult about it is when we say it's biological, the either insinuation or actual outright telling is that these diagnoses are chronic. There is no evidence to suggest that any diagnosis is chronic. I went for a walk with a friend of mine and her 15 year old daughter was diagnosed with major depressive disorder and she was put on an antidepressant. And my friend said,

she's going to have this for the rest of her life. I don't know what I'm going to do. She's not gonna be able to go to college. We have to reassess. And I said, there's no proof that she will have it for the rest of her life, but we're believing it. And so one thing I really call for in my book and the reason why it's something I wish I had had, which is everything that's in my book, it's an exit strategy. Yes. So when you see a mental health professional or your primary care physician who is really giving out the most diagnoses are primary care physicians. You are

given an exit strategy, meaning here's what we're going to try for treatment. Here's what we're going to do when your symptoms abate. Not if, but when. Because imagine if we told cancer patients, you're going to have cancer for the rest of your life. I mean, how much recovery would we see? How much, you know, there'd be no cure. Agreed. Yeah. And I think the other thing that the medical diagnosis has caused that is problematic is the idea, A, we've got primary care physicians diagnosing instantly with very little knowledge and handing out psychoactive chemicals. But secondly, is the idea that, again, if we just say, well, this is just a brain thing. If you take this pill, it's okay. But again, my experience with mental illness or addiction and looking at countless other people is the best way to get

better is sort of a holistic approach to lots of different things. It might involve a medicine. It might involve certain lifestyle changes. It might involve talk therapy. But when we just go, here's your pill and you go on your way, we're not really addressing what could be many of the underlying factors that you mentioned, social factors, right? But we've also got just lifestyle. I mean, there's so many different things. And that's always what I've thought is problematic about this primary care physician and over prescribing is that we're taking a very simplistic view of something to me that seems to be extraordinarily complex. It took until I was in my 40s to see a psychiatrist.

All of my diagnoses came from primary care physicians. That's crazy to me. It is because so much of when we talk about these things, we tend to attack psychiatry and there's good reason to attack psychiatry in some ways. But I think primary care physicians diagnosing is really a huge problem. As you said, it's just, they have very little training, as you mentioned, in giving out psychiatric diagnoses and that training all exists on typically inpatient, the most extreme cases. So seeing people, as you said, for 15 minutes and giving them a diagnosis is, it should be unacceptable. At the same time, I understand they're trying to do it to give people access to care. That's right. That's right. That's the motivation behind it. Right, right. It seems to me that what you've got is we've had a little bit of an overcorrection, right? Which is like, we're way over here and mental illness is incredibly stigmatized.

And it's this really awful thing. Nobody wants to talk about it. Nobody wants to be diagnosed with it. To the other extreme, which is like, well, walk into your doctor. I mean, every time I go to the doctor, I get like an eight question quiz. I know now better than to, you know, like I just answer fine, fine, fine, fine, fine, fine. Cause I just don't really want to get into it with my primary care physician. Right. But I get again, the, what we're trying to correct for, but it feels like we over-corrected

and this all reminds me of, and you reference it in your book a little bit, how we diagnose alcoholism and how we talk about alcoholism, because alcoholism got labeled a disease. That was a vast improvement from moral failing, right? It was a vast improvement from moral failing. And when you start to really break it down, you go, okay, this doesn't really quite make sense to think of this as a disease in the classical sense. Because again, we're diagnosing it based on like, here's 12 questions. How do you answer the 12 questions? If you have seven, you're an alcoholic. If you have five, how do you do, you know, I mean, it's not a real thing that you can diagnose. And yet we made great strides by at least moving towards, we're moving away from moral failing,

but now we've gone, you've gone all the way to, it's just biology. And that seems like we overshoot the mark. And the other thing that's happened, really the de-stigmatization of mental illness has backfired. And what's ended up happening is that some diagnoses are socially acceptable and some aren't. So anxiety, depression, ADHD, not a problem. Yes. Those are acceptable. They're common. No one's going to... It's not that you wouldn't be stigmatized. I'm not trying to lessen that or feel the stigma of that. But then you have schizophrenia and schizoaffective disorder. And the stigmatization of that studies have shown of those diagnoses has increased.

So we really have kind of the have and the have nots. And unfortunately, those are also the people in need of the most care. Alan Francis, who was the chair of the DSM-IV task force, had a great quote or a very telling quote. He said essentially that those who don't need the most care are getting the most care to their detriment, whereas those who need the most care aren't getting it. And certainly when we look at our prisons and jails, that's absolutely happening and our homeless population. I'm Jason Alexander. And I'm Peter Tilden. And together on the Really No Really podcast, our mission is to get the true answers to life's baffling questions like

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It's called Really No Really, and you can find it on the iHeartRadio app on Apple Podcasts or wherever you get your podcasts. I'd like to pivot a little bit and talk about diagnosis in its positive and negative senses, because I think getting a diagnosis, it can go either way, right? It can be a really positive thing in that we're able to sort of get help. We're able to go, oh gosh, okay, what's wrong with me? Someone might know something about it. There can be real benefit to diagnosis. And we know that we can become associated with the diagnosis. We can take on that diagnosis. We can so strongly identify with that diagnosis that it makes us sicker. So in your mind, what's a reasonable way that someone might think about navigating that so that they get the benefit out of a diagnosis without getting the negative pieces of it?

That's what happened to me. I identified so strongly with each diagnosis I was given, and I talk about it in the book, how easy it was to slip into that. I don't think there's anything wrong with that necessarily if I'd known the truth about the diagnoses that I was identifying with. I believe they were biological. I believe they were caused by a chemical imbalance. I believe they were chronic. Every single one, I was told that they were chronic. I was told that my life had shortened when I was diagnosed with bipolar one, and that I would likely become suicidal again. And so I was really fed misinformation. And so if we didn't have so

much misinformation out there, I don't think it would be a problem. And to your point, the autism community, that diagnosis is incredibly powerful for them. It bolsters them. It brings them together and they rally together and they very much identify with it and are very proud of it. So I don't see a problem. That's an example where it's really working. On the other hand, what we have is a lot of people identifying with diagnoses who don't know all the facts about them and whose children are getting these diagnoses and teenagers are getting these diagnoses and teenagers are getting these diagnoses who could like me then go through life and see life through a lens of

diagnosis. So when I started, you know, my editor asked me, you know, why didn't you question these diagnoses like after four or five? And I said, because I just never thought to question them for one thing. We tend not to question our doctors for another. And then also, I just was used to getting diagnoses. I was just used to them changing. I thought this, we were getting to the bottom of something. Right, right. But to your point too, just so we can talk about mental health without talking about diagnoses, going back to the parable, I could not manage my emotions.

I could not process them. I couldn't have told you what happiness felt like or joy or depression or anxiety. Those physical sensations in my body just overtook me and my thoughts just were running a million miles a moment. And so I remember being, I was in a partial hospitalization program and we were all sitting in a room for group therapy and they gave us the emotion wheel, you know, the colored emotion wheel that you have with all those emotions. And there were, must've been a hundred. And I thought, oh my God, I don't even know two. I can tell you what two feel like in my body. So I think we can really move toward teaching our children and teenagers and ourselves. How do you process emotion? How do you identify emotion?

Yeah. Yeah. I think the thing with diagnosis, it's interesting because diagnosis of alcoholic or addict, I think in a lot of ways saved my life. And then that complete identification with it is what caused me to sort of move out and away from 12 step programs. In the beginning, it felt incredibly liberating to be like, Oh, I know what this is. Other people are sharing similar stories. Oh my goodness, there's a path. But after a while, there's something in 12 step culture, which is this idea that like, there's an alcoholic personality, you know, that 10 years sober, you're still sick. Yeah. You know, after a while, this constant sort of delineating between what we were like and what normal people were like. And I was like, I know a lot of normal people. And I

don't think we're that different. Yeah, I get sad, they get sad, I get envious, they get envy. Like we have these common emotions. And so for me, ultimately, then I sort of went, well, that diagnosis, that identity that I am an alcoholic, it's not that I shed that. I don't even know what I would call it. What I know is drinking is probably a very bad idea for me. That's sort of it, you know? And I always get tripped up on words like, you know, am I an alcoholic or was I an alcoholic? And I ultimately don't think it matters, but I didn't want that to be one of my primary identities. You know, and I find identity fascinating because it can be a very liberating thing to have an

identity. We can talk about people who make an identity switch who go, you know what? I'm just not, I'm not the kind of person who smokes. And that helps them not smoke. So they are identifying as a non-smoker. Helpful, right? But we can also, as you were doing, you can identify now as an anorexic and you start learning about what anorexics do. And without knowing it, you're subtly starting to mimic. Exactly. And for me, it didn't help ever because I definitely got worse with each diagnosis. And I think that if I identified with it, again, knowing the truth about them with a little bit of skepticism, just going in and not thinking, okay, these are permanent. This is actually something I need to identify with to get well. And I had the option

to choose. I might've done everything the same. I don't know. But what's interesting to me too, is I absolutely identify as someone with a mental illness. And I say, I either had or have, because we don't know if they're chronic. I don't believe that they are. I believe, and other psychiatrists have said, I'm fully recovered. It's not recovery. I'm not always going to be, I'm fully recovered. And if I'm wrong, I'm wrong. And I'm okay with that. But where it's helpful to have some identity attached to mental illness for me, one is I don't want people to be ashamed. And I want to be an example of being very, I'm very proud that I survived what I survived and what I talk about in the book. So I definitely don't want to, as you say, shed that identity necessarily. The other thing to your point about not drinking is that I live a very structured life. I did not become normal and now I can go party. I mean, I go to bed at the same time. I wake up at the same time. I don't drink. I don't smoke. I don't do drugs. I know that I have

fragile kind of a, it may not be the right word, but I have a fragile system. And I have a very, very strong, but also sort of, again, fragile mind. And I have to take care of myself. Yep. And that's okay with me. Yep. Yep. Yeah. I think it's so interesting to go, all right, well, I have a mental illness because I'm not functioning well. And yet to go like, well, you know, like in your case, well, okay, what is it? Is it anorexia? Is it major depressive disorder? Is it anxiety? Is it ADHD? To be able to go, I don't know. The exact word doesn't matter. What I do know is that I figured out through medicine, through lifestyle changes, through working with my mind, learning to use

emotions differently, I figured out how to work with this in a way that I am functional now. And those three words, I don't know, are so powerful. And that's what saved my life. I was, and this is the kind of awakening moment in my book, which is that I was suicidal. I had run out of medication. My psychiatrist, who was also my therapist at the time, he and I had had a falling out. He wouldn't renew my prescription because I told him I wanted to see someone else. I didn't have a psychiatrist and my sister found one for me and I went to see him and we had our 27 minute session and I waited at the end of it for him to christen me some, either the same diagnosis, bipolar one or a new diagnosis. And he looked at me and he said,

I don't know what you have. And my life changed. And it was just, I thought no one knows what I have. And that's when I started really as a journalist, investigating all of this and trying to find out the truth. Yeah. Let's talk about medicine for a second, because you are on meds that help you. I am on meds for depression that have helped me. You say that there's two movements. One is the sort of common movement, which is like, you know, you show up at your doctor, you get given a medicine. And then there's another movement that says, hey, that's all wrong. Like you shouldn't be taking medicine.

That's very anti-medicine. And I find, again, both extremes sort of problematic. So talk to me a little bit about, you know, how you view all of that. Yeah, it's such an how you view all of that. Yeah. It's such an interesting aspect of all of this. When I was anorexic when I was 12, they weren't prescribing to anorexics at the time. So I did not go on psychotropic drugs until I was in my 30s. So I was very late coming to it, given the number of diagnoses that I received.

And I was completely against it. I did not want to take medication. I was someone who wouldn't take aspirin. So I was very anti, mainly because I'm very sensitive to drugs. And so I just thought, what is going to happen? But I believed a lot of the sort of mythology that my personality was going to change or something like that. But I became so desperate, many people do that I ended up going on an SSRI and an antidepressant. And so now I'm on a cocktail of several drugs. I don't know if I'm on them because my body is dependent on them or if they are working for me.

I tried to go off and my withdrawal was absolutely awful. I mean, I was prescribed many, many drugs and including antipsychotics and that they never tested SSRIs or antidepressants in terms of withdrawal. Right. You know, initially they were meant to be on for three to six months, not 10 years. And I've now been on them for 12 years. camp is medication's bad and the withdrawal community, which I think I have a lot of probably too much judgment about, but they were very instrumental in me feeling like I should go off medication and that medication is bad and that I can do it myself. And that's very destructive. It was so dangerous and I do not recommend anyone even try it without medical supervision. And I do not recommend anyone even try it without medical supervision.

It's just, and find a doctor who will do it with you, but it's dangerous. But that withdrawal community, I think, is missing the mark. Pill shaming isn't helping anyone. This has gotten so confused and we didn't know and we got diagnoses and we went on medication and now we don't know if we can go off. So yeah. Yeah. Yeah. My story is very similar. I was put on antidepressants in, I don't know, maybe early thirties and have been on them more or less since, which is 20 plus years. I have made a few attempts at points to go off of them. Some were very well planned and others were very poorly planned. But the most recent one was not that long ago. I'm going to guess, I don't know, three years,

maybe. And I did it incredibly slowly, like six months kind of slowly, like taper, incredibly slow. And I didn't have withdrawal. I got off of them and it wasn't like I felt awful. But over time, the best way I know how to describe it is I just started feeling like I increasingly was carrying a heavier and heavier weight. Like everything just increasingly got more difficult because nothing has changed in what I'm doing. I'm taking care of myself in the same way. I'm doing all the things I know that I've done that treat my depression. And it seems to be back. And then I would go back on the meds. And I'm like, well, geez, all of a sudden, I feel like a normal person. Again, I feel like myself again. And like you, I don't know, is that because I've been on them so long

that my body has simply adapted? or, you know, is it that I actually need them? And I'm at the point where I'm like, you know, at this juncture, it doesn't seem to matter. The side effect profile for me is so low. They don't bother me. They cause me no problem. And it does seem that I function at a higher level. And so that's kind of where I've landed with them for now is like, and I'm on very low dose SSRIs. I'm on a fraction of the dose I used to be on, but, and I don't know whether in the future I'll be like, well, let me try it again. But at this point I feel pretty at peace with like, this is what works for me. I am too. And I'm, I'm on relatively high levels and my psychiatrist assures me that they aren't dangerous and that I can be on them for the rest

of my life without a problem. Of course, he doesn't know that and no one does, but I don't have a problem with it in the sense that this is what happened for whatever reason. And again, you know, if this is part of my journey through mental illness and that I don't have one anymore and I still need to exercise and I still need to eat right and sleep and take my meds. And plus we don't know how they work. And that's the slightly alarming part of it is we don't know how they work. But yeah, like you, I just always refer to as I like, I sort of throw the kitchen sink at it, right? Like meds are part of it, as is exercise and eating well and sleeping well, and talking to people I care about and doing things that matter. And like,

you know, there's a whole approach that works. But to be in a place where I would say I am functioning at a pretty high level, I'm generally, you know, a pretty content and happy person. I'm like, let's just not rock the boat. Let's just go. Thank you. Thank you. You know, all right. I'm happy to be here. You know, let's carry on. And we're dealing with the repercussions or we're still feeling the repercussions of psychiatry's move to a biomedical model and not approaching it in a way that said, okay, we have to take a holistic view of this. And yes, you might want to take, you know, use medication. You may not, or if you do use medication, let's talk about these things as well. And let me tell you about the side effects and that you may not ever be able to go off of it. I mean, I was so desperate at the time that if someone had told

me all the facts, I may still have taken it. Yep. Yeah. Me too. I mean, when I first went on, I like you was like, I don't want to do. Yep. Yeah, me too. I mean, when I first went on, I like you was like, I don't want to do it. I was relatively newly sober. The idea of getting on a drug did not feel right. And I was like, okay, I'm going to do everything that I hear about that could possibly help that isn't drugs. Right. And if I do all that and I still feel this bad, I'm going to wave the white flag. And that's exactly what happened. I was like, I'm exercising, right? I'm eating, right?

I'm sleeping. I'm going to five meetings a week. I'm taking St. John's ward. I mean, I've tried it all and I'm still suffering, you know? And again, I think that's always the approach that I think is wise. Like start with the minimum intervention you can do and, you know, okay, try exercising. It might do it, right? It might do it.

Then you end up at a point where you're like, all right, nothing else is working. Okay, why suffer? Why suffer needlessly? You know, if there's a way that can help. But again, as we said earlier, I think what we've gotten to culturally is we start with a medical intervention.

That's the starting place for a lot of people. And we start with a diagnosis first. first. So I think sometimes our conversation, the reason why it goes to pill shaming and big pharma is bad, which that's a deserved reputation that they have, is that we're skipping the real problem, which is that DSM diagnoses are too easy to receive and are being given out too easily. And if we can start there and going at the DSM, like I attack a book, not anyone in particular, because I think we're all in this together and it's kind of a mess right now. On a personal level, you've sort of described what we as people can do when we're given a diagnosis. You know, we can question it. We can ask more questions. We can do all that. How do we reform something like the DSM? I mean, I don't

know whether you could argue it's better than nothing, but it's something. Certainly our healthcare system is modeled around like you need a diagnosis in order to get care, to get your insurance to pay for. I mean, this thing is so pretty quickly and deeply entrenched. So where forward? I think there are answers. And I think what tends to happen is this idea that you need a diagnosis to get care. That's true. Absolutely. At the same time, fewer and fewer clinicians are taking insurance. So that's happening at the same time. And so I do believe that the DSM is not going to be reformed anytime soon. And the reason for that is that the latest full text revision is coming out in March and they have only added one diagnosis, made pretty

much text level changes and have done nothing to rectify the mistakes of the past. So I think it's really, the onus is on us. We need to create the change. We've been waiting for psychiatry to do it and it's not happening. So the reason why I wrote this book and why I want this book to be out there and read by as many people as possible and for the pathological, the movement, which I started a public awareness campaign to bring all of this to light is because if we know, if we patients and the parents of patients know the truth, the mental health system will change and it will change for the better. Clinicians will suddenly be put on the spot. They'll have to tell the truth. And, you know,

I think that there is a lack of transparency. I would like to think no one is intentionally lying. There are some, but those are, you know, those are just the bad apples. And I think that for the most part, everyone has good intentions in trying to give care as best they can. Right, right. One other defense of the DSM or, you know, clinical practice and mental health professionals is that the DSM is really flawed and I don't even use it. And that scares me more than anything, because then that means literally you are getting a random diagnosis based solely on someone's opinion, but they use it as a defense as if to say, see, I'm better than this. But very few clinicians are trained to do something

like that. And how can you partially use the diagnoses, but not really? What's also interesting is when mental health diagnoses started to come into play, they were to be used by doctors. So it was a way for doctors to communicate. And this is something my psychiatrist and I were talking about. They were never meant for patients and they were never meant even for patients to know what they had. And so I have a diagnosis. My psychiatrist has changed it three times since I started seeing him. I don't know what it is. I don't want to know. And it's that same idea that he uses it. Our doctors may use it,

but we're identifying with them in a way that they were never meant to be used. I'm Jason Alexander. And I'm Peter Tilden. And together on the Really No Really podcast, our mission is to get the true answers to life's baffling questions like why they refuse to make the bathroom door go all the way to the floor. We got the answer. Will space junk block your cell signal? The astronaut who almost drowned during a spacewalk gives us the answer.

We talk with the scientist who figured out if your dog truly loves you Will space junk block your cell signal? The astronaut who almost drowned during a spacewalk gives us the answer. We talk with the scientist who figured out if your dog truly loves you. And the one bringing back the woolly mammoth. Plus, does Tom Cruise really do his own stunts? His stuntman reveals the answer. And you never know who's going to drop by. Mr. Bryan Cranston is with us today. How are you, too? Hello, my friend.

Wayne Knight about Jurassic Park. Wayne Knight, welcome to Really, No Really, sir. Bless you all? Hello, my friend. Wayne Knight about Jurassic Park. Wayne Knight, welcome to Really No Really, sir. Bless you all. Hello, Newman. And you never know when Howie Mandel might just stop by to talk about judging. Really? That's the opening? Really No Really.

Yeah, really. No really. Go to reallynoreally.com. And register to win $500, a guest spot on our podcast, or a limited edition signed Jason Bobblehead. It's called Really No Really, and you can find it on the iHeartRadio app on Apple Podcasts or wherever you get your podcasts. Let's change gears a little bit. And I want to talk about a recent article you wrote about what are emotions. Actually, that wasn't the title. I think the title was more about like, who invented emotions. I'm less interested in the history of it than I am in talking about like, what the heck

are they? I never knew. If someone had asked me in my twenties, my thirties, my early forties, what is an emotion? I could never have told you. And finally I learned they are vibrations in our bodies. And when someone told me that, I thought, really? That's so wild. And so the question is, do you think that emotions are responses to thoughts or thoughts are responses to emotions? Personally, I think we have a thought first, because as I say, evolutionary psychiatry has been very helpful to me, that I have a primitive brain that is constantly trying to protect me and saying, warning, warning, warning about everything when there is not deadly danger for the most part. And then I have a rational brain. But for the most part, the emotions that I'm having in my

body are responses to my primitive brains firing off of thoughts, however many. Supposedly we have 6,000. Some say 60, but I've heard it's really only 6,000 in a day. And that is all emotions are, yet we fear them. I'm terrified of anxiety. It's just a vibration in my body. It's a vibration in my chest. It doesn't make me fear it any less. But now what I've learned to do is to sit with it. And I'm not a meditator in the sense that meditation can have adverse reactions, particularly for people who are not mentally stable. And that has been my experience with meditation. But to try to feel the emotions in my body, I'm able to do that. I can be directed and have success with something like that of being present. Yep. I mean, what are emotions to you? How do you think of them? I can be directed and have success with something like that of being present. Yeah.

I mean, what are emotions to you? How do you think of them? Well, it's interesting because you get into what's an emotion, what is a feeling, you know, what is a thought. And I've been toying with the notion that thoughts and emotions maybe aren't as separate as we try and label them as because you don't seem to get one without the other. We're trying to break it apart. But my experience is they co arise, you know, which comes first? I don't know. I'm a believer. It's actually it can be both ways. I certainly

know like, I could have a thought like, oh, my partner doesn't love me. And suddenly I feel lousy. We all understand that direction. But there are days that I wake up suddenly I feel lousy. We all understand that direction. But there are days that I wake up and I feel lousy. And it feels like all my thoughts get filtered through the lousy lens. And so it seems to me that it's bi-directional, which then led me to go, well, are they separate? So I've been thinking along the lines of in one of our spiritual habits intensive, we've been talking about it. I've been using the label emotional storm and saying that it's actually a bunch of things arise. There's the, yes, you have thoughts, you have bodily sensations, you have what we would label as feeling sad, angry, almost always there's some urge to do something and those things all co-arise.

And if we can be, as you said, a little bit more like, all right, they feel overwhelming when they're all put together. But if I can sort of tweeze those things apart a little bit, it starts to feel a little bit easier to work with. So that's kind of my thought. I love that. And I think for someone like me, I do need to sort of not pick them apart in a negative way, but parse them and to see, okay, there are circumstances, there's a situation, an event, something, and it's neutral. It's just neutral. And then I have a thought about it. And then I have an emotion and those could be simultaneous. I mean, I agree that they could go back and forth and that we're just so

instinctual that things are happening like that. And then there's an action that I take and then there's a result. And so this is, you know, not something I came up with, but you know, it's a very basic way of seeing the world and our mental and emotional lives. And it just makes sense to me and it helped me slow things down a little bit. Yeah. I'm really intrigued by a question that I've been asking, you know, people I have on the show about, which is, it seems there are broadly sort of two ways of working with difficult thought slash emotion. And I'm oversimplifying, but one is it's very cognitive behavioral therapy. It's right. Let me go in and let me look at the validity. Is it true?

Is it, you know, is it always that way? Am I seeing black and white thinking? I try and sort of get in there and wrestle with the thing a little bit, right? The other approach seems to be just step back and let it be. It's more of the mindfulness based acceptance and commitment therapy. You know, you start pulling on one thread and, you know, you're wrestling with a yarn ball. And what I think is interesting is I actually think they're both very useful ways to approach it. The question I'm really interested in is when is one more effective than the other? And how would you know? I guess maybe it's just you try, you know, I think having both of them in our toolkit is helpful, but I do sort of see that split. I see it in Buddhism. I can see like certain threads of Buddhism that are like, you know, wholesome, unwholesome thoughts go in, pull the weeds out, you know, and other aspects of Buddhism that are like, just step back, let it be. I see cognitive behavioral therapy versus acceptance and commitment therapy. I sort of see that split there. So that's kind of what I've been thinking about with that stuff lately. That's been really

interesting to me. I've tried all of that. So with my partial hospitalizations and all of that, I did CBT, ACT, all of them and DBT. But I also, before that, like you, I tried to meditate it out of me. I meditate it down and yoga it down. And I mean, I did Ashtanga for 20 years and I studied with Thich Nhat Hanh and I studied with Byron Katie. And those are the two sides of the coin that you're really talking about. Byron Katie is all about questioning your thoughts. That's right.

Thich Nhat Hanh is really more about letting them go by. And what I think in answer to your question, I kind of think, or one way, and I'm not good at this, but as you were talking that it's better to watch them go by and step back when you can't affect the result, when you really have no control over the situation. And if you can ask, can I really even do anything about this? Then let it go and step back. But if you can, then maybe it's worth going in and poking around and seeing what am I thinking and what's the result I'm producing? What's the result I want to produce? Yeah. I often say, I think that the serenity prayer is one of the sort of like most foundational things to, you know, finding emotional mental wellness. Can I do something or not?

And it sounds like it's easy, but it's not. That's the hard part is like, when we talk about it, we're like, well, you know, I can't control the weather and I can control whether I brush my teeth, right? Yeah, those are obvious ones that life is far more complex, which is why the serenity prayer says, and you know, please, I could really use the wisdom to know the difference because that's what it takes. It takes discernment and wisdom to know the difference. But I agree with you. I think that's so foundational. And I think it's a little bit addictive almost to try to change things you have no impact on. I mean, I will just spin on it and just try. And the less effect I can have,

the more I tend to ruminate about it and try to have an effect. So it's almost like a, I don't know, it's like a dog with a bone or something. And you just want to go at it and at it and at it. Some of it, I think, depends on your personality type, right? Like there are people who are that way. They're very tenacious. Like I'm going to hang on to it forever. I think I fall a little bit more into the other category, which is like, eh, F it. Like, which is not exactly helpful either when there's situations that you probably should do something about, you know, I probably shouldn't just say, well, you know, I'm going to have a tax bill this year. There's nothing I can do about that. Like I need to engage, you know?

So I think knowing where you fall can really be helpful with that. I think you just nailed the two sides of the spectrum I'm talking about, Byron Katie on one and Thich Nhat Hanh on the other. Would you say that you find both those tools useful at different times? So I studied Byron Katie for about five years. I went to her school. I worked at her school. I mean, I was deep, deep into the work. And with Thich Nhat Hanh, I studied him. I also had the amazing opportunity to interview him. It was incredible. Both came into my life at different times. And again, I'm not sure I write about other people in my book as well, because I wasn't the only one going through this. Meaning one young man I interviewed, he was diagnosed with schizophrenia and he did transcendental meditation. It exacerbated his symptoms and

he ended up stabbing another student at the college he was at and the student died. So meditation isn't always good for everyone. We tend to prescribe it as just this innocuous thing. It was very detrimental to me and both types of meditation. So Katie's work is very much a meditative practice of questioning. But someone with a loose hold on reality, I don't mean to make myself sound like that, but even now, I don't write fiction anymore because I'm lucky I'm here. I don't need to imagine another world. But, but with Katie, if you're always questioning your thoughts and you don't know where to stop, you're going to end up in a very, very dark place, which is where I would, or just questioning all reality. I remember I was doing the work

so much during the day that I thought I could see through my body. You know, it was not good for my mind. And then to meditate, I would love to be the kind of person who could meditate in the Thich Nhat Hanh style or Zen or anything like that. My thoughts have always been too powerful and I don't want to give them that much power, but I am. That kind of no direction at all, it's not something that I want to try to do anymore. I tried for years and years and years. I mean, Eckhart Tolle, I tried to feel my inner body lying on the floor of my living room and it gave me panic attacks. Yeah, I think that's really interesting.

You did write your article about interviewing Thich Nhat Hanh and he's one of those people I would have loved to have talked to. And you describe in the article, you're kind of saying what you're saying now, which is like, hey, meditation can not always the right thing. It's got lots of challenges. And yet when you met Thich Nhat Hanh, you basically said like the guy was glowing. Oh, he was incredible. And I was not mentally in a place. I mean, this was I did all of this during the 30 years that I was in the mental health system. And I wish I had been where I am now to meet him and to be able to take more advantage of it. But he was incredible. And just as I, as you said, he glowed and it's such a cliche. I mean, he like floated into the room and he just seemed to have this peace about him. And he looked so young.

I mean, he was easily in his 80s and he looked 60, maybe. And of course, I would love to have that kind of peace. I also respect him so much because of engaged Buddhism, that he doesn't, you know, he does believe in really engaging in social justice. That's right. Certainly his last book, which is also with my publisher and just on climate change and how we all have to engage. And I feel the same about mental health.

We have to change the mental health system. It's not going to change. Yep. I think your article in these talks about meditation are interesting because Buddhism points to this disillusion of self as ultimate liberation. And you're describing that for some people is not a liberating experience, but an absolutely terrifying experience. And a lot of spiritual teachers will say, of course you're afraid, but you go through that. And on the other side is, is, is peace. But you're saying on the other side of that, for some people, it's psychosis.

You know, it's called the dark night and there is actually a, an organization started by a woman. I'm, I'm forgetting her name now, but where she's collecting experiences of people for whom meditation has either, you know, sparked psychosis or sent them into such a dark place that they felt they might never come out of it. And again, it's just that we tell ourselves and in the cultural conversation, meditation's good. It's good for everyone. I thought there was something wrong with me that I couldn't do it or that I was just not trying hard enough. And I only later found out about people like Shuby for whom transcendcendental Meditation, you know, it's, it set off his already fragile mind or again, fragile. I don't like that word, but you know what I'm saying?

That, that, you know, a mind that's, you can't question reality. I believe if you aren't in a place that's somewhat mentally healthy. Yeah. It's kind of like saying run a marathon when you haven't run in 20 years. Yeah. That's not going to go well. It makes me think a little bit. I mean, this is going in a direction we don't have time to go in, which is the next mental health craze is psychedelics. You know, talk about an area

that is fraught for people who have mental illness, right? Because we're saying on one hand, it helps mental illness. Oh, it can help with depression. It can help with my experience with psychedelics has been very much what you said. When I'm in an okay place, you know, in the past, they were very powerful and illuminating things. When I was in a dark place, it was terror. My stupid brother convinced me on the night of my grandmother's funeral. This is a long time ago, right? We're talking 30 years ago on the night of my grandmother's funeral to take, I don't know whether we took mushrooms or LSD. I don't know which it was, but I knew it was a bad idea. I knew it. And he convinced me the entire night. My recollection is him outside the window laughing like to me, which sounded like the devil and me

laying on a bed feeling like I was being crucified for eight hours. Like, I mean, it was truly a horror experience. And so I think to your point, this idea of questioning reality, which can be a really powerful thing to do. I'm very focused on that as my own spiritual practice, but I'm coming to it from what feels like a place of strength. You know, I do see how it could be truly terrifying to just nothing has any meaning. Oh, okay. That depending on where you are, that's either like, oh, that's really profound and could really be liberating or, oh, I mean, we're not all Byron Katie. We're not all going to sit around and have the world come to us to want us to have us help them question their thoughts. But I try to be open to all mental health treatments because again, I think we're just in a place where sort of answer to this, just because I know someone who had a psychotic break from marijuana and he is still told that he has bipolar and he's convinced, no, I don't. It was just from smoking pot that that happened.

So I worry too. I really do. And the other part of this is my understanding is the Buddha never meant for lay people to meditate. It was strictly monks only. And so then you're in a protected space. You're in the monastery. You don't use money. You don't, you know, you aren't having sex. You are in society. And so you are able to question reality in a way that is protected. And so unless I have that protection, I'm going to just be a lay person. Well, there is, there's certainly some wisdom in that, but I think what you just said a couple

of minutes ago is probably ultimately the most important thing to me, which is you got to find what works for you. What I think is so important also is if you're struggling with mental illness, like I think it's just so important to say like, don't give up. You may not have found what works for you yet, but you might, you know, you might. And so carry on, you know, in AA, we say keep coming back. And I think that's so important, because all we're saying is like, you may not get this the first time, right? But you're welcome. Come on, keep trying, keep trying, you know. Now, I think the thing we should be saying is sometimes you need to try something other than AA instead of just keep coming back here. You may need to go somewhere else.

But the spirit of, hey, I'm going to keep looking for an answer, I think is so important. Absolutely. And I mean, it took me six diagnoses. So, you know, keep trying. And I did almost end my life. I don't want anyone to have to go through that. You know, one thing I was very careful about in my book is not to attack psychiatry because that leaves people without hope. And I had one particular very dangerous psychiatrist. I had some irresponsible primary care physicians, but I

had one that was extremely well-intended who gave me three of my diagnoses, but he was very well intended. And I had a psychiatrist who helped me save my own life. So there's just going to be a lot out there. And I think we need to start, you know, again with the DSM and the pages where these diagnoses are coming from. Yep. So we'll have links in the show notes, but tell people about the movement that you're working on and the three questions people can ask themselves about diagnosis. Where do they find that? And again, links will be in the show notes, but I'll let you just give it to everybody

here. So it's www.pathological.us and it is Pathological the Movement. And I realized that in my book, I really, you know, use my experience because I think it's one that many, many people have shared or their loved ones have shared and then give them all the information I wish I had sort of wrapped into it. Yeah. But that I hadn't given really clear action steps for people because it's a memoir and it's really, you know, a narrative and supposed to be that. So I started pathological, the movement, and the three questions are, is my diagnosis valid and or reliable? And the answer to the first is no, definitively.

And the answer to the second is it depends. And then the second question, which is so important is, has my diagnosis been proven to be chronic? Yeah. No. And then the third question, what does that mean in terms of me, my diagnosis and the treatment you're suggesting? And that I hope will open up a different conversation. At the same time, when I was going through what I was going through, I could not have asked those questions. There's just no way. But if I had been thinking about them, that's really what I want from the movement is just to have us thinking about them because then we're going in eyes wide open. movement is just to have us thinking about them because then we're going in eyes wide open. And I think that's what's important is to have eyes as wide open as you can,

as much information as you can. And yes, sometimes we crawl across the door to get help and we just take what we can get. But I do think this is a very important conversation. And the thing you said earlier that resonated and then I do need to wrap up was really thinking about talking with your person who's helping you about an exit strategy. You know, like, how are we monitoring this? How are we going to determine whether I should keep doing it? What's this look like longer term so that people don't necessarily end up in a place where you and I are, where we're going, well, I don't know if I really need them or if my body's just dependent on it over 20 years of doing this. Again, you and I are in good places. I'm not saying like it could be in a far worse place, but I do think would have liked to

have had that conversation at year two or year one or year three instead of year 20. Especially medications, some medications, not all, but you know, antidepressants have a pretty productive profile when you're taking them for three to six months and then going off of them and you're not having the same dangers. And again, the other issue that comes up so much in terms of dysfunction is how long are your symptoms lasting? And at what point does it become too long? Because intermittent depression is actually a part of the human experience. Right. Yes. Well, why don't you and I stick around in the post-show conversation for a couple of minutes? Because I'd love to talk about that because I think, you know, wrestling

with do I have depression or do I just have a normal melancholy kind of temperament is a really interesting question. So listeners, you can get access to the post-show conversation, ad-free episodes, all kinds of other good stuff at when you feed.net slash join. Sarah, thanks so much for coming on. I absolutely loved reading the book. I've loved this conversation. I think it's a really important thing to get out in the world. And I'm glad you're doing it. Thank you so much for having me. It's such a privilege. If what you just heard was helpful to you, please consider making a monthly donation to support the One You Feed podcast. When you join our membership community with this monthly pledge, you get lots of exclusive members-only benefits. It's our way of saying thank you for your support. Now, we are so grateful for the members of our

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