The Taproot Podcast - Part 7 - A Psycho-History of American Psychology: Those That Walk Away from Omelas

Episode Date: May 13, 2026

If you have ever felt like a failure because the "evidence-based" protocol didn't fix you, or if you are a clinician feeling the crushing weight of a system that rewards compliance over competence—this episode is your validation. The wall is hollow. The science has become science-flavored capitalism. But the real work is still happening in the cracks of the system, in the rooms where two human beings are brave enough to put down the worksheets and simply look at each other. "The way a profession defends a failed paradigm against its own data is the same way a patient defends a failed self-image against their own felt experience." In the explosive penultimate episode of Psychotherapy on the Couch, Joel takes a magnifying glass to the single greatest crisis of modern American psychiatry: the moment the apparatus proved its own foundation was a lie, and then decided to just keep building on it anyway. This episode dives deep into the STAR*D study—a $35 million federal initiative designed to prove the medication-first paradigm worked. It didn't. But instead of changing course, the industry buried the data, ignored the severe suicidality rates, and proceeded to build decades of clinical guidelines on a fiction. This isn't just a story about bad science; it's a clinical case study in institutional dissociation. When the cold machine looks in the mirror and sees a monster, it doesn't change—it just shatters the glass. 🎧 In This Episode, We Explore: The STAR*D Cover-Up: How the largest antidepressant study in history quietly swapped its protocols to hide a true sustained recovery rate of just 2.7%—and buried data showing severe, treatment-emergent suicide attempts. Institutional Dissociation: Tracing the exact psychological mechanism patients use to avoid painful truths, and watching the entire mental health profession do it at scale. The Replication Crisis: Why the "gold standard" of Evidence-Based Practice is often anything but, and how hundreds of heavily cited, peer-reviewed studies (especially around CBT) fail to be replicated in the real world. The Hijacking of Beck and Ellis: How the original, nuanced cognitive interventions of Aaron Beck and Albert Ellis were flattened by the apparatus into manualized, twelve-session worksheets built for insurance billing, rather than human healing. The Powell Memo & The Think Tank Pipeline: How a 1971 corporate blueprint systematically captured the American research establishment, replacing university-led science with dark-money think tanks and financialized clinical encounters. The Omelas Choice: Borrowing from Ursula K. Le Guin, we confront the agonizing reality of the modern therapist: Do you dissociate to survive inside the machine, or do you walk away and risk losing your ability to help anyone at all? STAR*D Study, Replication Crisis in Psychology, CBT Efficacy, Evidence-Based Practice (EBP), Antidepressant Research, NIMH, Thomas Insel, Institutional Dissociation, The Powell Memo, Think Tank Pipeline, Aaron Beck, Albert Ellis, Psychiatric Reform, Mental Health Infrastructure, Ursula K. Le Guin Omelas, QEEG Brain Mapping.

Hey guys, it's Joel and welcome to the Taproot Therapy Collective Podcast, Part 7 of psychology on the couch, what American psychology can see, what it can't see, and why it struggles to tell the difference. So before I get into this episode, I'm going to put one idea in front of you that I'm going to keep coming back to it because I think it's the spine of what's kind of gone wrong with my profession, and we're creeping up to the end of, and a profession that, granted, can never be gotten 100% right and then be put in a box and be done. But one of the things that American institutions have had happen to them over the last 40 years, especially meaning-making, you know, human institutions, largely soft science institutions. Or maybe soft science is the wrong word, maybe institutions like education that it is incumbent on them to continue to evolve across their existence. And it's this. It's the way the profession defends a failed paradigm against its own data, because that's easier than change. And it's the way that, you know, a patient defends a failed self-image against their own felt experience or against the accountability of the real world when they have an internal world or an internal system of values and action and being that they think is more important than the results that's getting them in real life. And then can I have to take this moment where they say, okay, well, I thought this was the right way to do it, but the right way to do it keeps getting me burned.

So maybe I need a better internal working model. You know, that's anyone who's been in therapy, you've felt that has. I feel that happen all the time when I'm like, but I should get these results from having this tactic because it's correct. And then it's not getting me the results. I got to change. That doesn't go away. Psychotherapy makes you better at that it doesn't fix it for you. It makes you aware and capable of guiding your own process or it should. So that micro of the individual doing that deflection on the inside being the same as the macro,

or the large organization of hundreds of thousands of individuals sometimes. doing this on the outside is the same. And I want to build that bridge to explain why we're talking about the culture at the same time as the individual in therapy, at the same time as clinical practice of psychotherapy, you know, broadly across decades. So that macro tells the same lies that the micro tell. It has to.

They're just magnified. And it flatters the same biases the macro does that the micro has and vice versa. And we get sick. we get stuck in the same way. And so this episode is about how a profession that had spent $35 million to study whether its own treatment paradigm worked, got an answer back that it didn't like, and then proceeded for 20 years as if the study had never happened. And I want you to hear that as this clinical case study. Okay. Not as a story about science and infrastructure, although, and even though it is a story about the struggle of an institution, try and hear it like it's an

individual that is struggling and deflecting from change on the psychotherapy couch. So in the late 90s, the National Institute of Mental Health funded the largest and most expensive antidepressant study in the history of American psych. The sequenced treatment alternatives to relieve depression study. Supposed to find the best thing to treat depression. And it's known to everyone in the field by star D or if you're typing it star astered D. So $35 million in federal money go into this thing. Forty thousand and 41 patients are enrolled. Huge study. 41 clinical sites. The most rigorous protocol the federal government could

design. And the question that the study was built to answer was simple. In the real world with real patients, what percentages of depressed people actually get better when treated accordingly to current best practices? Evidence-based practice. So this is not a marginal study. Stardy is the study. You've got hundreds of other studies that cite it and point back to it. It's going to be very meta-analyzed. It's supposed to be something that everyone refers to for the next generation of research and it, it is. It didn't just waste the money that went into it them. It wasted the studies built around it because of that system, siding it, cleaning it up, meta-analizing it for the next two decades, apologizing for it, advertising its failures more broadly. It's designed to be this empirical foundation of,

the medication first treatment paradigm that had taken over American psychiatry in the 80s and 90s. And the paradigm said, if you want to see a psychiatrist, we're just going to tell you that you're going to get better. You're not going to be depressed. There's no problem. If you're willing to try on average, four or five any depressants and then do six to 12 sessions of CBT to clean up any of the weird behavioral things that you might be doing, that's all that anyone needs to be functioning psychologically well. And these things have a ton of nuance. This stuff. is examining medication precisely, but this is sort of the puzzle piece that it's fit into what it's built to find. I'm going to go through the whole study because it's very hard to turn these things into a compelling story.

But this is kind of what the study is supposed to be finding. And if you need more than that, then maybe you just have a personality disorder. You're not actually depressed or you're not really doing what you're saying you're doing. Or you're not motivated or something that the industry can blame you as this externality that's not a patient seeking treatment and getting better. Something that's not psychiatry or academic psychology's fault. It's your fault. And so everything depended on this study

to put the nail in the head of this issue. And so the justification for 40 years of pharmaceutical research dollars is sort of supposed to be found by this thing. And the basis for clinical guidelines that determine what insurance companies would pay for, which they already are paying for them this way. So the study better find that that's right.

And for what physicians were trained to prescribe, which they already kind of were prescribing like this, which is why you could do a giant study across it. It already had been pre-considered best practice before, you know, being found by science. And science is iterative. You got to do smaller studies before bigger studies. And then you do the big one to put the last nail in the coffin. Like I get it.

But this is supposed to be the penultimate one. And so they were going to prove that this whole system that they'd been building that had kind of patchwork evidence. Or, you know, they were drawing a picture, making an assumption based on the smaller evidence, was going to be totally put. to bed. And the original results are published in 2006. And the headline is that cumulative remission rate of 67%. So two-thirds of patients after up to four sequential medications, as long as you're willing to try four, and then say, this doesn't work, and then get on another one, they achieved remission from depression. So close to 70%. And if you tried at least four medications, you know,

you called your psychiatrist, you said this one doesn't work, you tried another one. On average, you'd get remission from depression. So they want to say, you know, 67% about. You know, 70% of people are treatable by this system. And, you know, the other 30% will figure out, and that we'll flag them as treatment resistant and we'll do more science to figure out how to get to that. And so this is vindication because it's proof that the system can justify itself and that the treatment paradigm that we've really already been doing for about 10 to 15 years was correct. And so the number circulated immediately into clinical guidelines, textbooks, residency curriculum, you know, for psychiatrists, training, curricula for therapists, insurance authorization for

criteria that you were supposed to tell a patient. No, no, no, that's not right. You have to go back and participate in this system, in this way, you know, turn off, because this is the science, that if you try four or five of these things, you're going to get better. And beyond that, it's kind of on work that you do or motivation that you're supposed to have, you know, some, you know, other kind of internal resilience. Or you've got another problem that we just haven't discovered yet, like a personality disorder or something that is the real reason why you're, you're not thinking that these things work. And so hundreds of, you know, hundreds of of thousands of people were denied other psych services, you know, or longer-term therapy,

or different kinds of therapy that were not evident space because of this study, and still are. And for a decade and a half, every American psychiatrist treating depression operated within a clinical universe organized around the assumption that the standard pharmacological approach worked for two-thirds of patients. And as somebody worked in the hospital for a part of this time, and then in clinical therapy for a lot of this time, you know, psychiatrists are doing the same thing that a lot of the good therapists that I talk about are doing. I mean, they'll just kind of tell you, yeah, this isn't right. You know, and that's why I titrate, I do these things, and I look for this flavor of a mood disorder,

and they call this technically depression. I got to use the ICD code for, you know, depression. But, you know, here's what I think's going on. I mean, they always, these people were always actually doing the real science and the real, you know, loving, caring good work in the field to be healers. So it's not everybody, but this is, again, about incentive structures and system. This is a pretty big one. So everybody in the study had to follow the rules.

You know, we made a system that was designed to basically dump evidence-based practice out when you hit the right buttons. And as long as you hit those buttons, then anything that it shot out, you were supposed to call evidence-based practice and assume that it was this reflection of reality that was right. When you had the right inputs, when you checked the right diagnostic, you know, boxes, when you made sure that these things went through an ethics commission, when you made sure that they were double-blinded so people didn't know what they were getting, when you made sure that which you know double blind come on you i've known multiple patients they were in a double blind research study for like ketamine or something and they were like

i got the placebo because i didn't trip after i ate the pill it was sawdust not ketamine i mean you can tell if you got ketamine or not um anyway that's an aside but and so because we had this you know machine um that this cold machine that we built that's supposed to say that everything that comes out is evidence-based practice as long as you obey the rules of what you input into it and it has to be treated as such. And if you don't do that, you're fringe and you're weird or, you know, what they usually tell you is like, oh, you just don't understand, but there's double-blind research, randomized controlled trials mean that even the researchers and the patients don't know who the, I know how it works, man. It's like, I wouldn't say the director

because somebody will probably email me, but there's like a really big director who I like the way that he makes movies. And if you, I don't like the way that he makes movies, just because he's not making movies for me. That's fine. You can watch him. But if you say that, people will explain to you what he's doing. They're like, oh, but he's really obsessed with the 70s. And so it's like, tension is building for like a really long time. And like everything's like really small. Like it's a play.

And like the set is like and there's always a spotlight over somebody's head. And then like it gets really violent. And I'm like, I understand the period of, you know, cool that he's mining. I understand the vein. I understand why he makes movies. They're not why I watch movies. I'm not bad at understanding his influences. It's someone who like likes film.

I don't think that what he's doing. doing is good. And that's fine. You can. It's kind of like that. A lot of times when you voice these critiques, people will just start explaining to you, like how evidence-based practice works. Like, if you have more information about how complicated these machines are, you'll just fall into line. I know how they work. And they don't work well. You know, we know that these studies numbers were fiction because over the following years, you know, a small group of independent researchers working under what is called the restoring invisible and abandoned. trial initiative or riot they fought through the Freedom of Information Act to finally get the

patient level data set which is something that really I mean I guess there's ways to release some of it without all of it and there's probably ethical concerns along this but really you should be able to get the anonymized data from any of these studies if we want to call it science because you should be able to read what did the clinician actually encounter in the room that they turned into a number for the study not just the number and that should be uh something that every study has to track and maintain. You should be able to pull that. It isn't generally something that we do. We just kind of act like, well, what do you need the thing that the person said and that was later interpreted into a number because we gave you the number? Well,

numbers are metaphors from distance. I want the data. And so, or the data is not the number, I would argue again. So, you know, this all should have been available anyway, but they have to fight. Pigeau is a really big one who does it. I mean, a lot of these people are very dedicated, they're funded, and they have kind of an axe to grind against this thing because they don't think it's right. And without them, we never would have known any of this information. And then it became this big scandal for the whole industry. But the original protocol specified that depression, but they were treated the whole time that they're trying to do this like they were just crazy people trolling the system. And so that depression severity, the original

protocol, what it said was that the way that you measured how severe a person's depression was to make sure that they were going into the study with depression and that they were coming out of the study without depression if it was working was called a Ham D. And this is a clinical administered blinded assessment that's been the standard for half a century. It's a good measure of depression. And so when the investigators ran their numbers using Ham D, which is what the study said it did, because that's a very good measurement engine. The remission, the remission, the remission, rates were not impressive. So they switched it halfway through the study. So mid-study, they realized they weren't getting the results they wanted. And again, this is not probably one person or a

cabal covering this stuff up. It's just a system being like, well, we're hitting the right buttons and we're not getting the right results. So we got to go back and then you get the same process that happens in an individual that's deflecting, right? And I wasn't there. No one will ever probably know or cop to what happened in the study. But we find out later that mid-study, they said, oh wait, we're going to use the QIDS SR. And this is a self-reported questionnaire, totally different from a blinded study. So the patient fills it out unblinded, knowing what treatment they're receiving, if it was supposed to be the evidence-based practice, when or not.

And so the placebo effect is not controlled for the way that it would be in a blinded study. And then the self-reporting instruments produce systematically higher remission rates than blinded clinician-administered ones where the patient doesn't know. what they're marking on the assessment, basically. They're just answering honestly because they're not short of shooting for a target they think they're supposed to hit. And so because the person knows whether they were supposed to get better or not, that is going to influence how better they think they got. That doesn't necessarily mean that the self-reporting a placebo effect is going to hold up over a long period of time.

But it does mean that when you're doing this study that's short, they may end up showing you some data that is not right. And so the investigators also concluded in this publication that, you know, the remission count of 931 patients who, according to the protocol's own enrollment criteria, should never really have been in the study because they weren't depressed enough based on the hamd. 99 had this baseline depressive score that was too low to qualify. Like they were just saying that they had dysphoric periods, but it wasn't really treatment resistant depression that medication is supposed to be prescribed for. Or even significant depression. And so 508 had only mild depression, and they shouldn't have been in the study, because it wasn't when it was studying. And their depression not being severe is what they came in with.

And 324 had no documented baseline severity score at all. So we don't really know what was going on with them. And then 124 patients were inappropriately included in the augmentation analysis, despite already being in remission from depression, that already received other treatment. So they maybe thought of themselves as depressed, responded to a study offering to, you know, compensate them or let them participate in this thing because it said, hey, are you depressed or do you have depression? And they'd been in treatment for it. But really, if you look at their clinical data, they've been cured of depression or they'd been in remission of depression for a while. So the study really shouldn't have let them end if it's doing a Hamdi at the beginning. And the numbers showed that.

So they were already cured of the depression one way or another before they started. And so, of course, you know, it's still going to be gone by the end. of the study if they didn't have it when they started. Of course, it's going to be mild if they had mild depression when they started the study. And of course, if you have the people who are depressed who are being told and want to hope that they got, oh yeah, I got the right one. I didn't get the placebo. I got the real one that they got the real treatment. They're going to report more strongly that they got better. So when the riot team excluded the protocol violations, meaning if you did one of these things that was against what the study said its rules were, you

removed everyone who broke the rules and you looked at the where they actually obeyed the rules for this remaining population of patients who actually got better was not close to 70 percent it wasn't 67 percent it was 2.7 percent so 108 patients who were willing to try four or five antidepressants CBT the normal treatment paradigm that's running the country largely still is running the country out of 4,000 and 41 people 108 got better two point. And that's the way that we have been training the machine and assuming that it worked. And even though this caused a whole lot of consternation and like new rules that academia would make up to make sure that its studies were evidence based, which we never really test if those rules actually make outcomes better. We just sort of do that based on vibes and then say they do.

But, you know, they said, hey, we'll change some things behind the scenes. And granted, they did. It's a lot easier now because I actually pulled these things to get the raw data from the studies, which is available. So if you're going to talk about a study at me on LinkedIn, you probably should have read that data because if you don't, you don't really know what's up. You're reading basically an op-ed by a researcher. And I get all of these people all the time. It's a lot easier to get this data after STARTD because one of the things that was good that they encouraged you to do is keep the actual. actual results that you were turning into the number, you know, with your assessment or your study, like the actual transcript of what the person says or a little bit closer to as much data as you could collect based on the type of study that you're doing.

And I have a ton of people where I just, I read the date of a study and I say like, hey, this thing isn't really measuring this because like it's pretending it like made this revolutionary point. But really, it's kind of making an obvious point that everyone knows. And the people are like, no, no, no, but the study says 70%. Or the study says 95%. I'm like, yeah, but what I'm saying is like read the transcript. It's stupid. Don't assume that you have read a research paper. You understand the research.

This stuff's available. You can get it. If it's important to you, sometimes you have to jump through a couple hoops. If you have to jump through a lot of hoops, maybe wonder why they don't want you to have that information. But, you know, what it doesn't change is that these are rules that were proven wrong and proven not evidence-based. And they still run the world.

They still run my world. The profession never said, oh, oops, we screwed up. It's shocking how a few therapists know about this, let alone patients are just normal Americans. You know, this wasn't on CNN. It wasn't on Fox News. This wasn't something that a lot of people even knew existed. And it shows you how little we care about American psych or how little it bleeds into the pop culture in the way that it used to. If you went back to the 70s, which there's some good things about that too.

But it's just not really on the radar of the world because in any other profession, you know, if this was cardiology, right? You know, another thing that's probably kind of boring that most people don't want to just learn about until they have to because they have a heart problem. You know, but cardiology is a real hard science that is evidence-based. And the intervention, you know, it would be abandoned overnight. If you said if a hundred people go in for this heart surgery with real doctors and a real hospital with hundreds of thousands of dollars of medical billing per year per unit, oh, half get better, but the surgery's over. Oh, wait, no, it's not half. It's actually two percent of them.

you know, if this were oncology, you know, the FDA would pull drugs and say, like, what the hell are you doing? You're giving somebody a cancer drug and only 98% of the people are getting worse or staying the same. Like the 2% that's just, you know, heads would roll. If this were any field where numbers were actually taken seriously, which is the thing that they want to say that they do, the numbers again, their metaphors from distance for the system's own blind spots, not forces of accountability, which if you wanted to build that system, I don't have a problem with numbers. You know, they were just using numbers to prove bullshit that they thought they'd already proved. And then they were still believing the bullshit when the numbers

didn't reflect that world back to them, which I'm sorry, that's the world you're in. And then that entire treatment apparatus would have to be rebuilt in any other profession. And Syke didn't even really seem to notice, which to me is a lot more nefarious than a cabal. It's a lot more nefarious than a, you know, a big, you know, Da Vinci Code conspiracy theory to run the world because it's just a system that means that the vast majority of clinicians are so dissociated from that the things they think they know, the things that they are taught, the things that they're holding up to are just like little factoids that deflect from the real body of knowledge that it is their job to understand. And it reminds me of the, uh,

the education system in Fahrenheit 451, which I haven't read since seventh grade. So like I'm probably getting some of this wrong. But in the education system in Fahrenheit 451, the kids spend all this time in school. But the school is basically fake knowledge that is real. So it's like trivia. It's things that are like trivia that you can memorize that make you feel like you've acquired knowledge. But they're not an understanding of how any sort of system works. So they're not threatening to any kind of system.

So they sit in the class and they're like, oh yeah, you know, President Bathtub, he was fat. And like this president, he did whatever. And they do all these things without really understanding the world that they're in. They're memorizing dates. They're memorizing names. They're memorizing basically history like it is a vocabulary test. You know, Abraham Lincoln is the person who did these things.

And that, there is some similarity here. So in American psychiatry, the original 67% figure is still cited sometimes. It can still pop up in people's like. LinkedIn, Infographics and PowerPoint researchers teaching kids in school. I see it on tons of different like, you know, welcome to social work, welcome to clinical psychology 101, you know, master's degree, slideshows. And not as embarrassing as it should be if it's still on things that you're teaching, even though, you know, maybe the professional researchers retracted a lot of it and had to print like,

you know, I'm sorry. They didn't have to give the money back. What if they had to give the money back? Maybe that people would be a little bit more careful if there was some personal accountability in this accountability creating system. You want to give us $44 million? So, you know, training programs still teach the medication algorithm that it was used to justify in the biomedical lens that was supposed to replace all the weird woo-woo stuff that psychotherapy didn't really need to bother itself with because it was too deep and too abstract. And just

because you can see it doesn't mean that it's real. You know, the 15-minute med check that's still in your clinical encounter with the psychiatrist, why a CR&P, a lot of times, times, we'll get to spend more time with you, make a little bit more of informed thing, is because of the system. And it's because they can get to know exactly what's going on with you in 15 minutes. There's that assumption built into that. And a lot of people aren't even getting 15 from a psychiatrist, but that is what the billing code says. And that assumption that is enough is still with us. And the infrastructure has continued to operate as if the 67% figure is real, because the alternative is acknowledging that the dominant paradigm doesn't work for 97%

of patients receiving it. And that would mean that would have to go back and dismantle the apparatus, which is something that American psychology, the cold machine of it, cannot do. And the apparatus has become independent of the truth, conditions that originally justified it that we all assumed would just fall in line later. We've been making those for 40 years, and nothing has ever fell behind the assumption that we're making to actively justify that we picked the right direction. And the wall's own data destroyed the wall's own case. And the wall just kept standing, and we kept

moving goalposts. So feel the parallel of the micro and the macro of the patient and the system being afraid of the worm ghost and clinging to the cold machine that is the right way to do it, the rules, the objective proof, the objective proof, the objective, reality, the system that is supposed to bring accountability, that everyone else in reality is just not obeying the way that they should if they knew the rules better, the rules that I know, not the thing that I feel, the self-evident truth, that the story is telling us.

You know, the same way that people will make this case in life, that there are, you know, punishments and rewards if you obey the system. Well, that's not true. In life, there are just consequences of your actions. And understanding the system is going to be part of that, even bad ones. But the moral imperative of this is the way that it works. And if you conform to it, you're doing better, is a belief in the system over the real. And so listen to that in this story.

You know, when a patient comes into the room and you find evidence that they can't afford to integrate, evidence that their family of origin was doing something harmful when they needed to remember the family as loving. or and their own story is good, not a sad one. Or evidence that their work is killing them or the mask that they have to wear to do that work or the system that requires their work to extract something from them, even though their identity is built on that. And they need to view it as something that is not damaging because they get a reward from it, you know, usually egoic or financial.

Or evidence that the relationship that they're in is unsafe because their nervous system is telling them that, that this person is maybe pretending to be loving, but really, behind the scenes, they're setting this person up to fail, knowingly or unknowingly. That's happening in a relationship. But they need to view the last 20 years with this person as being safe. Nothing really needs to change. The problem's all me, you know.

You watch something specific happen when you stumble on evidence that's going to contradict a patient center narrative. You know, they acknowledge the evidence, and then they file it, and then they continue, and then the next session, it's gone. The next session, it never happened. Six months later, they bring up the same problem in a different costume, but they want to make sure that they phrase it differently so that you can't link it to the thing

that they don't want to see. And it's the job of a talented therapist to be able to acknowledge and overcome that in a way that I would argue maybe can't be taught or can't be taught through just direct if there's some that type of education that is trivia. And so, you know, the federal government brought the field, you know, a $35 million mirror and the mirror reflected back a face that the field could not afford to see. They could talk about how the study had this problem, and so they're going to make changes,

but they couldn't really say we did something wrong because the system doesn't work. The field acknowledged the reflection in academic venues, and the field filed this reflection. It was so important that we sit and think about stuff, that it's deep so that we don't have to change. And then the field continued. And the next year, the reflection was gone.

The next year, it never happened. 20 years later, the same problem is back in different costumes, and the apparatus looks at it with no recognition that this is the same system. Same thing that happened with the DSM, 4, 5, and 6, is going to happen with 6, I believe. And that is the same defense that this patient runs at the personal scale, run by an entire profession at the institutional scale. Same mechanism, same payoff, same cost. I'm going to keep showing you this parallel throughout the rest of this episode and series, because once you see it, if you want to, to see it, you can't unsee it. And this episode is about what happens to a profession when it's empirically established foundation collapses underneath it. And the profession refuses to notice,

which is scarier than an act of conspiracy theory or a lie or a cabal. It's a dissociative element of faith in a system that you don't understand, you can't understand, but you have to participate in it, but you can't feel it while you participate in it, so you become blind. Because if you saw it, would make your mind rebel. So you've got to just not see the thing that you are feeling all the time. You've got to not understand the implications of what you're doing. It's about the replication crisis, the biomarkers that never arrived, the moment in 2013 when the NIMH director said the Stardee criteria of the field were wrong. But once you understand what Stardy actually showed, and once you understand that nothing changed in response to that, even though there was a whole lot

of talking, which the field is very good at, and a whole lot of more rules. It's really good at coming up with new rules. You understand that we're not only dealing with science, we're dealing with infrastructure. And the infrastructure only responds to its own logic, not to evidence, but it will dress its own logic up as evidence or expect you to treat it as such. And the mystery and the certainty that used to guide the profession, the ability to sit with the uncertainty, the ability to know that there were things that were not, that were present, but not necessarily measurable.

I think those are inseparable parts of what we lost. And I think perennially they will continue to pop up to remind us that they're inseparable, but we have to be able to see them. One of the more damning parts of Star D was it was supposed to investigate what happens when you were suicidally depressed. And you go to a psychiatrist and the medication that you got put on doesn't work. What are your other options? And so looking under the hood wasn't really supposed to be what they found. You're not really supposed to do any kind of depth work or you're,

realign knowledge of yourself, your life, your expectations of life, or accept phases of life, or things like that. Any kind of semantic, even, work. Not even, you know, CBT is needed. Any kind of looking at the culture you're in or how it's affecting you or the way you're making meaning. Those things are not looked at. This was trying to find a solution to suicidality without those things. And so the study didn't really want to find what it found, but it wanted to find that there was this option for you without doing any of those things. And that's what it was designed to do. And the standard clinical practice was to add a second medication. So Stardee had this specific arm to track those patients that had failed the first time and were still suicidally depressed called

step two. That compared those two different augmentation strategies. Is it better to give people bupropion or busparone? And you know, Buespar or wellbutrin. And they published results that said that the two strategies were roughly equivalent in efficacy, and both were modestly helpful. Both were reasonable choices. Clinician could use whichever one they wanted, and that that was evidence-based. And just to opine for a second here, you know, the setup of Stardy is that you start with cetallopram, right, which is this antidepressant, and then if you fail on that one, you move to busperone, you know, Bustpar or Wellbutrin.

And Welbutin's an antidepressant, Busebron's in anti-anity, and to find them equally, just to say that they're both equally effective, it's kind of funny because what I've said for a long time is that depression and anxiety are, you know, should be more seen as the spectrum diagnosis where you wiggle back and forth. That's kind of if you look at this data, which we'll get into later, but if you look at it as just data, diagnoses probably should work that way, but we're still stuck using these diagnoses that we can't change because they're so old. And so then we have to try and make the data fit them. But I mean, just saying, hey, when someone's super depressed, you can treat them with an antidepressant or you can treat them with an anti- anxiety medication and it does the same thing for depression. Well, it's kind of telling you that anxiety is a component of depression and vice versa, that it's this sort of you're counterbalancing and energy, but we don't want to look at these things that way. So anyway, so if you fail at SatylauPram and step one of Stardy and step two, you get put on either BUSBarr or Welbutrin and they say both of these are the same. They're both reasonable choices. There's not really one that the evidence prefers over the other. But when the riot team got the underlying data and they broke it out by

treatment emergent suicidal ideation, the new emergence of suicidal thoughts and patients who had not had them at the start of treatment. Yeah, Stardy wasn't controlling for that. So these are patients who went in, they said they were, but they weren't. So these are patients who went in to the study, got put on a drug, got put on another drug, and now they're suicidal. But suicidality was not the thing that they came in with. So they got worse, much worse, because they started off, you know, depressed enough to qualify for the study, supposedly. And they're ending, on their third medication, suicidal. So that wasn't what they went to psychiatry for.

The medication had made them suicidal. And I mean, I'm inferring maybe some of them would have become suicidal anyway, but the rate in Buesprone argumentation, like that arm 13.9%, almost one in seven patients who started on Buseparone began having suicidal thoughts that they had not had before. In the Bupropion arm, the Lelbutrin arm,

the rate was 3.6%. So roughly four times less. So it seems, seems like, well, Butrin is a better option than BUSBAR for suicidal depression. You know, this is clinically an enormous difference. If you're an honest psychiatrist trying to choose between those two argumentation strategies, but if you're an honest psychiatrist looking at the data and you don't have access to everything that the riot team basically had to subpoena, then you don't know any of this stuff.

And, you know, the suicidality difference is exactly the kind of information that you need to know. And it's the difference between a medication that might help and a medication that might kill the patient. And maybe they do have an anxious depression. And the same drug is fine. If you have good data and you can say, hey, look, this is an option. We're going to try this. This is a potential side effect. We're going to put you on this plan.

And if you become suicidal, you've got to page our clinic immediately. You know, I did that at the hospital a lot when we were making a change that we thought was probably good, but may have a temporary or lasting adverse side effect that we needed to be aware of. And the investigators had all this data and they did not publish it. They hit it from themselves bureaucratically. I don't think they put it under the rug because they were embarrassed. I think they could not see it because they were part of this machine.

And they covered it up because it wasn't what they were looking for. They knew what the study was, quote unquote, supposed to find before they did the study. So when it didn't show them that, they could not see it. And that's how we do research still. And again, I'm not saying antipsychotic medication makes you worse. Don't take antidepressants. There is a need for these things. They work.

I see them work all the time. I've been on them myself. I've been suicidal before. I've been on wobutrin. It was effective. And I've watched that happen in patients. It's just that it's not a 100% this works for everything. We've solved mental health and we're moving forward thing.

There are things that need to be understood by clinicians who need that information. And so I'm not telling you don't take your medication. I'm not telling you don't go to therapy. Absolutely do not take that away from what I'm saying. I'm critiquing the way that we could have understood what would help people better with more nuanced. You know, granted, these drugs help a lot of people. That's why we were doing the studies. We wanted to find out how much people they helped and when and

and what kind of people. And clinically, though, that enormous difference, psychiatrists were all told and was just the same. And if you said, hey, I don't think this is the same. It doesn't feel the same to me. I don't feel, well, that's not what the evidence says, is what a lot of people got told, you know, psychiatrists and patients, you know, residents, psychiatrists and patients. And the riot team also examined records for severe suicidal behaviors, the medical category for actual suicide attempts, people who are starting to do things, not think about doing things, starting to make plans that will lead to their death, their own death, consciously. You know, walking up to the edge of a building, cutting themselves deeper and deeper, dark things, and the treating clinicians at the study sites had documented 16 such events across the trial,

the official serious adverse events report, and the document that gets submitted to regulators informs the basis of the published safety record, listed only four. and 12 actual suicide attempts documented by clinicians who saw the patients were never reported. And look, these are the best researchers in the world, the ones with the most laurels, the most money, the most you won the system of doing evidence-based practice, and this is what the system produced. And I don't think there's one guy in a room saying, like, oh, crap, we found this and we're not, you know, going to cover it up. And I don't even think, like, a lot of critiques of this study, because one of the reasons they started changing things was a placebo or what they thought was a placebo. I think it was like St. John's word or a mugwort or something. It was like an herbal supplement.

They were finding that it was working better than the well butrin in some of the cases. And so that was one of the reasons for one of the multiple reasons why this study, they started changing their own measurement of depression and effectiveness. I mean, to me, it would be less scary if we found out that like Pfizer had taken all the best researchers in the world and then paid them off and been like, oh, I want you to change data and here's a million dollars. What's more scary than that, which I think you could, is what happened was that you have basically a dissociated class that can't see what's in front

of it anymore because they're so tied to the way things are supposed to work. And the way that things are supposed to work has been divorced from how they actually do. It's willful blindness because we can't possibly admit how complicated systems are. We have to reduce them down to, you know, something that we can measure. And this is one of the bigger studies we're even able to do. And if we can't reduce them, then we'll reduce them down into something. And we'll just keep the direction going that we're going in. And eventually somebody else will find evidence that the direction that we decided to go in,

which usually is the easiest one for the current establishment to go in, is right. Well, this is coming up on the 60th year of when I first started about us doing these. And that hasn't happened. We don't have any data that this is the right direction, that these diagnoses mean anything other than we know what they're called and we like them and we wrote our books about them. And I mean, they're better than nothing. Well, like I said, anxiety and depression.

I mean, this is probably a spectrum or, you know, some sort of spectral diagnosis. Maybe there's multiple points on the star. It's not just a left-right spectrum. But these things do not operate the way that we pretend they do. And to me, fraud is less scary than the bureaucratic incentive doing this. I mean, I think fraud is. way less prevalent and way less of a problem. And after working in the places that I've worked, then the bureaucratic incentive. And I don't think that Starr D investigators sat in a room

and tried to cover up a suicide attempt. I think it was a structurally disturbing event that the structure had to control for and did. And for investigators who were operating inside of an apparatus whose continued funding, whose institutional reputation, whose entire reason to be, depended on demonstrating that medication first paradigm worked and that the very minimal time limited therapy protocol to the extent that it was needed at all was just part of that. I think they believed the thing that was the easiest for them to believe. For the system to operate on. And they believed it so strongly that they could not see reality that was outside of the apparatus.

And this is what apparatus capture looks like. It's what the trap of the cold machine does. You can see the machine. You lose the worm ghost. And that's why I spent in episode four talking about Thomas, pension in the paranoid style. That's why I spent time talking about IBM punch cards. The infrastructure simply absorbs the criticisms. It co-ops them. And it issues a measured response like we did to the Stard E study. I'm sorry, we'll do evidence-based practice harder.

And it continues to operate on that lie. And the mechanisms to change, you know, question the underlying gears of this thing are gone. So when the Stardy study had, was deconstructed in this way by the riot team, and they realized that nothing that you were supposed to take away from the study is what the data and the study actually said. There was this bigger kind of result of that that they took away. Researchers like the riot team that were kind of the outsider, you know, researchers, started doing studies where,

they were taking apart or they wanted to take apart recent papers from different leading psychology journals that are getting cited everywhere, you know, kind of stopping this from happening again. And it had been peer reviewed and then been published. And I mean, other, you know, I have friends that like work at CERN and these hard science places. And peer review does not look like it looks like in psych there. In psych, you have kind of like five weirdos opinions. and then they usually contradict, so you can't really implement them.

And then if you have enough money, you can publish a paper. Like that, I'm sorry, like I know a lot of researchers, like I've been involved in research, peer review and psych, if you've got enough money

and you want to publish something with a premise that's too stupid to say out loud, that's essentially like an op-ed, you can publish those. And, you know, so they wanted to take the papers that had passed all of these gates. and they had, you know, had total empirical credibility.

And then they would just simply try and reproduce them. If it's scientific and you're saying that we should act on this because it's reproducible and you controlled for everything, let's go ahead and do the same thing again. The study will, you know, reproduce itself. So they started trying to do that. And of hundreds of these original studies, only 36 were successfully replicated that were kind of the benign, least influential or at least threatening to the industry. And, you know, of the ones that were nominally replicated, the effect sizes in the replication were like, on average, half the size reported in the original papers.

So I'm talking about hundreds of papers here that were failed to be replicated. Like, I can't go through each one, which one was CBT, which one was this medication paradigm versus that one, because this is already going to be boring and a data full episode talking about the way that research works, which, you know, even social workers dread learning at school. But none of them were really replicable. So they weren't contributing to any sort of thing that we could do in the future to avoid problems or to find solutions. And so that answer, largely from this movement, it turns out, you know, is that half the time you can't even replicate somebody else's data in the same world. It's not even close. And these are the ones that are supposed to be double blind and randomized controlled trial and huge sample sizes and multiple rounds of peer review. an internal replication and three teams replicating the same thing before we can say,

well, it happened in three or six rooms, so we can assume that it's going to happen in every room. These are like the big studies and they don't work. And that's not a small problem. Like the published literature of a science is supposed to be the cumulative record of what is known. And in the 70s, we were writing journals where there were techniques that you could use in the room. And there was subjective wisdom. You can open a journal and somebody says like, hey, I think that there's like an intercritic that shows up and it tells people that they are not good enough and it tends to team up with like

a pusher self. Now, intercritic and pusher are not real things. They're useful metaphorical lenses, but they're hard to measure because they're psychological concepts. Well, how are you going to research psychology without psychological concepts? If you open a medical journal in psych now, what you get is all these people doing meta-analysis, so that they can be cited by other papers, so that their score goes up,

so that they look better as a researcher, they're more likely to get funded or hired by the university. That's not a really good system because there's nothing in these new medical journals, in these new psychology journals, and these new therapy journals, that is, one, interesting to me at all, but two, that I can take and use in the room.

The subjectivity has been stripped out of it, and that means that everyone is kind of exiled. Who might just be talking in a subjective way about how to help somebody with something that's useful, and not hiding behind what Deodor Porter would call the metaphors from distance or the insecurity of numbers that have come to define the profession and have come to oil the machine.

There's a replication crisis that isn't really being acknowledged, and most of the replication crisis was around CBT. The idea that CBT was the best form of therapy that you could ever get was something that was found over and over and over again throughout the 90s, and insurance said, okay, we'll forget everything else. we haven't really been able to replicate that. When you look at actual clinical data,

CBT is something that most their patients say, yeah, these are kind of some techniques about how to think differently to gaslight myself into filling well when I feel bad. And I don't like it and I'm leaving. Now, I mean, there could be a lot of reasons for that. Maybe CBT is the best thing ever, but we're not controlling for clinicians that are good.

We're just graduating anybody with a pulse. They can afford it. I don't know what the problem is. I'm not trying to do a research study to explain that. But what I'm saying is that that isn't replicable. And the problems, the reason it's not replicable is something that we don't want to discover because any of the answers to that question would be something that blow the industries functioning up.

And research has become designed not to do that. It's supposed to speak power to truth, not truth. not truth to power. And so the quieter problem in CBT literature is, you know, when patients leave a CBT trial a lot of the time, because they say that the therapy is not helpful, which part of the goal of therapy and part of the skill of being a therapist is to engage someone. You have to pull them into a place they haven't been before. You have to take them somewhere that they're not familiar with.

You have to give them a new perspective pretty quickly. And if you don't, they should live. leave because that's part of the art, right? Which, you know, is hard to turn into a number. But when a CBT patient leaves a trial because they say, I've already tried this, I saw it on the Sopranos, like I've already read the self-help books, I've already watched the YouTube, this just doesn't feel helpful. I'm getting out at Session 7. They're just removed from the study. That doesn't prove that CBT doesn't work because the patient didn't complete 12 sessions. Well, who are you left with when you have people that say, I am so beaten down, I am so broken. I am so broken.

I am just such a workhorse of it doing what daddy told me to do that I'm going to keep going to 12 sessions when I knew it session two it didn't work. I mean, that seems like something that contaminates the science to me. That is tautology dressed as evidence. And the patients who could have told you something important about the limits of the models are precisely the patients whose voices are not in the data set because they didn't complete the intervention. But the intervention's job is to get people. to participate in it because it's a relational science and it's a relational process but not when you're studying it this way and so there's a deeper move underneath all this and I want to name it because in my view the actual rhetorical capture that the apparatus pulled off the phrase evidence-based practice

or evidence-based therapy has been quietly redefined to mean something that it wasn't really supposed to mean you know, if you just look at the definition of those words. You know, Jonathan Shedler, who's interesting, you know, he's written, he's a psychoanalyst, he's Freudian leading. You know, he's written some of the most careful and, you know, as someone who's familiar with the process, they're not just critiquing it. Careful and nuanced critiques of all of it. You know, evidence-based practice therapy sounds like it should mean therapy based on evidence,

and any thoughtful clinician would sign up for that. Of course, studying, causing effect, how could that hurt? anything. But the term as it's actually used in licensure boards and insurance protocols and graduated training programs and clinical practice guidelines as I would find out in the hospital has come to mean something narrow and strange. It means manualized therapy of the kind that can be tested in randomized controlled trials. That doesn't mean evidence based. It means randomized controlled trial therapy that turns everything into a number while it's doing it. They can be replicated by another clinician. And I've met some of the best clinicians in the world and I like them and I've talked to

them. I can't replicate what they do. I can take it and I can make it inform what I do. But I can't turn it into a formula. And I don't think that any of the people who have studied with me or gone through supervision with me or the patients who have seen being gone and become therapist can take what I do and turn that into something that they can replicate as a formula either. I don't think therapy, I think therapy itself is outside of that paradigm. If you put it in that paradigm, you're forgetting what it is and you're reducing what it is. So these protocols that they want are almost always brief. They're almost always cognitive behavioral.

And they're almost always with these pre-specified symptom reduction outcomes measured on standardized instruments. You're not allowed to create change. that you didn't intend. Well, I'm sorry. Therapy that is good creates changes all over the place that it didn't intend. The whole idea of evidence-based therapy on its own narrow methodological terms is built for a population and a kind of therapy that does not exist in the real world. It can't. Yet it controls the real world. And the conclusions drawn from this idea by licensure boards, by insurance companies, by professional guidelines,

you know, all the real world institutions that run our world is that it can still. And no one really seems to be on my side. I mean, they'll go to you, they'll go, like, with you to the bar and tell you this stuff.

People don't really seem to be interested in saying it professionally in the way that I am. And maybe that's because I'm stupid and I'm painting a target on my back. But honestly, like after 10 years in this world, like, I can't really live with myself anymore. I'm not saying the whole thing's bullshit. I'm not trying to blow it up. I'm just saying like, this is a pretty simple idea that like 85-ish percent of the good clinicians that I talk to

will just tell you, yeah, of course it works like that. We just have to do what we can around that system, but we can't change it. Why? Why can you not change it? So if you want somebody's opinion about this other than mine, again, Jonathan Shedler is probably the guy to look at. I think that he makes probably the better case that CBT is this load-bearing wall of American psychology. And you know, it's what insurance pays for, what graduate programs teach, what gets called evidence-based practice like we talked about already. But his meta-analysis, they're good at picking apart the quality of why that wall is getting thinner. So Johnson and Freiburg 2015, that's one that I cite in my book a lot, which hopefully will come out in a year or two whenever it gets peer-reviewed. But in psychological bulls, and they talk about how CBT for depression across multiple decades, different effect sizes, it declined.

The effect size and the advocacy at all. And that trend was statistically significant, and it continued across time. CBT got worse from the time when it had been validated as this gold standard across, you know, five-year, two-year and ten-year periods. So, you know, earlier studies showed these huge effects. and then the effects decreased. So later studies showed effects that on their own would never have justified building the whole paradigm that we built in the first place.

And, you know, Christia is one of the people who responds to Shedler a lot and defends CBT and says, hey, no, actually it hasn't gotten that bad or you're exaggerating things or you need to tighten your research to see how good it actually is, even though it's getting slowly worse or something. So, you know, Christia tightened the criteria for what counts as a real randomized controlled trial. And he said, when you do that, the decline goes away. You just have to have stronger, more double-blinded, more randomized controlled trials that have these features. And then, if you consider that as evidence, it proves that CBT is validated on an evidence-based practice level in these experiments.

But read what he's actually saying. He's saying in a vacuum that doesn't exist in any clinical setting, not real-world data. Just an experiment that you could do with certain controlled treatment holds. You can make this thing still behave like it did the first time that we proved it worked in a lab. Clinicians can't reproduce those conditions, dude. Like, why publish that paper? Patients don't live inside of studies. They live inside of life, and they live inside of decades that are progressively moving forward and changing things.

At least, you know, we're kind of stuck in the 80s, but whatever. So, you know, the apparatus has become a closed loop, and you're not disproving that by saying that like when you do science a certain way, you get the same result. The question is not that. As we talked about in that cybernetics episode, the question is not does the math work? The question is, does the math replicate reality in a way that the math is useful? That's what science is. You know, Drew Weston is another one with Shedler that's made this point for years. You know, that patients in these trials are not the patients that walk into the offices. If you look at the average patient in America and you look at the average patient in a CBT study, the committed,

the comorbidities and the trauma history and the messy life circumstances, they're all screened out because they would make the data of this study too noisy. But you can't kill the ghost in the machine. Like, it's not that I want psychotherapy to be weird or it's not that I want psychology to be weird. It's that psychology is weird. And if you need it to not be that, you may just not be weird enough to study it. You should be in another science, maybe a harder science. You know, we run the treatment on a patient who doesn't exist in clinical practice, and then we call that result evidence of what that you could do something if you wanted to do well everyone knew that anyway does that thing mimic real life and the thing that we do in research like increasingly

doesn't at all anywhere and i need to curb some of my own like opining because this is already such a dense episode that has to summarize so many things that are not on their face interesting but like the assumption underneath all of this is that you can arrive at this intervention that understand psychology and then it will work forever, that things don't change, which is wild, because other professions that bump up against psychology don't assume that. Like if you said in 1955, this ad sells the best coal cream, you wouldn't be like, okay, we arrived at the best commercial ever,

let's just air it forever. You would still be aware that that thing would need to change that you couldn't use the model that you made to make this coal cream ad, sell coal cream or, you know, what the next thing is to the next generation, because people evolve this, you know, basically immune system response to advertising, to where it looks dated, it looks bad. Therapy is the same. You know, anyone in advertising would know that.

Why doesn't psychotherapy know this about itself? The culture absorbs the technique. But psychology has built itself on top of this opposite assumption that the mind is more like a chemical reaction that can be studied than a conversation and a reaction to the culture or a counterbalancing force, which is why it can't respond to, problems that the culture creates. CBT probably was markedly more effective than psychoanalysis in 1965.

But when you watch the effect sizes go away, it's not that it was a reduction then, and it isn't now. It always was. That reduction was useful because psychoanalysis was a bloated mess and the culture was less complicated. And now, the kind of anxiety that the current American can and needs to sit with to get better is vastly bigger and more complicated than it was in the future. 50s or the 60s. So you're not watching a treatment fail. You're watching a culture eat it because

the treatment can't change in response to the culture. And the first time somebody hears in 1978 that their thoughts are not facts, that hits and they're like, well, my dad didn't do that. Wow, he never told me this. The 100th time after wellness apps and HR trainings and TikTok therapists and multiple cults that have integrated this information and advertising, the patient walks in already fluent in CBT running it on themselves badly as the center critic. And then the clinical room has nothing left to offer that they haven't already heard. Worse. They're just hearing the same thing that they've heard already from a therapist who's supposed to contain a different answer. And so the decline is evidence that CBT was real. It worked well enough that the culture

metabolized it, and now it doesn't. It doesn't have the leverage that it once had because the leverage came partly from novelty and authority. And maybe that doesn't sound scientific. So I don't know that it will ever be found as a result by science. But the same point cuts the other way. The depth and semantic traditions that don't show up well in this kind of trial aren't failing. The measurement is not built to see them. It actually can't because they discover things that were never a goal of therapy in the first place, but are a goal of humanity and are a goal of psychology or should be.

And you can't put brain spotting on TikTok and inoculate the culture against it. You can't manualize the moment a patient's shoulders, for the first time in 20 years and they realized that they always went up every time I got angry. So the replication crisis in CBT, and we'll talk about brain spotting later, I realize I haven't mentioned it yet and just mentioned it now. But the replication crisis in CBT taken seriously is not a crisis of CBT. It is a crisis of the apparatus's ability to know what it has been measuring or what measurements mean. To cut to the chase of the replication crisis in CBT and to just get to the meat of it. So this series is supposed to be talking about the way that American psychotherapy was changed and captured by certain forces.

As you get closer to the present, maybe I step on more people's toes. But again, like, I'm just reading you history and the way that these forces operate and the way that I see them affecting the clinical room from this top level, from 100 years ago to right now. So this is just history, guys. You have to understand this next bit as something that is explaining to you why. academia is confused, why it intentionally confuses itself, and why well-meaning people cannot tell real authority in soft science research from bullshit, basically. And I'm not calling all of it bullshit. I'm saying it's more confused than it used to be. And this is a net, not a cloth. I'm not going to weave every point together, but this moment, the same moment that CBT's happening, the same

moment that Reagan is happening, the same moment where my industry goes off the wheels, it is related to forces in business, it is related to forces in politics. There's no way for me to do this honestly and not point that out. And you know, you infer what you want to. In August of 1971, Lewis Powell, who's a corporate lawyer, he writes this 38-page memorandum to the United States Chamber of Commerce that changes more than really anybody outside of certain kinds of sociopolitical fields would ever realize the influence of. And it's publicly available. I recommend that you Google this because it takes five minutes to read it. Unlike a lot of the things that I say are good.

This is five minutes of your time. But, you know, this is, he declares war on the New Deal establishment, says that we're following this thing that is based on what people want. And what the evidence is saying is the best direction for the country to go in based on, based on its own goals, or what its own stated ends are. But those own stated ends of the country, maybe they have these messy consequences for corporations, for business, for the profit motive. We got to go back and we got to look at, you know, if that thing is really what we want. And so he argues that business has to fight back because there's this regulatory state that's saying that you have to do things that doesn't kill people or that at least makes the products that you're selling do the thing that they say they're doing, especially when they're around something like medical practice.

And that this is inconvenient and it's too far. And so Powell says, you know, that there's this, you know, he calls it a cultural left, but we've already sort of looked at what the cultural left in America was. I think those people were going away anyway. I think they wanted the thing that was happening anyway to basically happen faster. So he says, business has to fight back and just regular lobbying is not enough. What's needed is this systematic construction. of an intellectual and ideological infrastructure.

And it needs to replace, you know, the scientific establishment. It needs to compete with universities on their own ground because they're doing this research. But really, they need to be doing what we want and not what they're doing. And this isn't 71. And so he targets specific things. He says there's these faculty members at elite schools. There's the public broadcasting infrastructure that's just share. sharing all this information for free.

There's investigative journalism that's telling people what companies are doing. There's these anti-corporate textbooks that are explaining how political change happened in the past. There's consumer advocacy where people are saying, hey, this product sucks. Did the company selling it break the law, number one? And then two, can consumers organize to demand, you know, better things? And then there's environmental regulators that don't want to see, or at least want the public to know about the cost on the planet that the company is doing. There's all these things that I don't like because they go against the profit motive. And this will come back to therapy,

I promise. But so he says, you know, what we should do is if there's wealthy donors who also see these guys as a bad guy like I do, they've got to kind of fund a parallel apparatus who build something that look like the same thing as the university. So think tanks, he suggests. and endowed professorships at the universities. You know, you approach the universities and you build a, you know, giant hall. And then you say, there's a couple people, I think, that could think about something interesting that need to be taken just as seriously as everybody else who got here based on merit. For free market meritocracy, we need to make sure we can buy some board seats.

And he also says, you know, the legal foundations, the media operations, the people doing the news. these are worth investing at this level that, you know, no one really sees because it'll just come up. And also, you've got to look grassroots. So you've got to get people on the ground excited about something. And this is all coordinated and it's on message. And there's a group behind the scenes who's dedicated to making sure that this regulatory state looks like an enemy of freedom in the corporate sector. Because what Reagan did wasn't really enough. we had to make sure that we weren't against the system.

We were mistaken for the old system while both systems were competing. You didn't have a fight between two. You just sort of said, hey, look, this science looks a little bit better. Let's do that science at the same time that universities are doing science like it used to be done. And, you know, the 70s is wildly important to the series. That's why we jump to it from the past. It's why we jump, you know, back into it talking about these developments. because so many seeds of this stuff was then.

And again, read the memo. If you think that that's not what it says, Google it and read it. It's not a French document. And it's referenced still by people who like the, you know, changes that it created. And so it's received as this strategic blueprint by a small group of very wealthy families

who really understood what he was putting down. The Koch family is one of them. You know, the Melanaires, the Coors family, the DeVos family, they've all referenced this guy. The Bradley's, the Olin's. You know, and so five decades in, this network would pour out now what totals into not even adjusted for inflation, billions of dollars into the construction of the same apparatus. You didn't used to have, like you ever wonder who pays for like the 500 million think takes publishing stuff that you can like go Google and they're always. researching this and those guys make a lot they're not you know uh university of Alabama they're not even like Harvard level payroll people and they just sort of sit

there with like the tweed suit and the elbow patches eating scotch eggs and publishing this stuff and they make 500,000 dollars a year in some cases um usually starting you know in the low six figures 100 150 120 I've known a couple of people that have gone that way uh they make a lot and who pays for that because, I mean, I don't know, I don't make that. Most people don't make that. That movement of who pays for them starts now. And so there's this, there's a lot of different things, like the Hoover Institution and the Atlas Network and the Federalist Society,

and they slowly begin to approach university science and say, hey, actually, we're doing science better. We're just doing it. There's a different way that's more efficient. They all do that. that in different language. You could write a book going through capital fund donors and donors trust and dark money pass-throughs and people have, which is why I'm not going to try and repeat all of it because there's better books out there if you care about that kind of thing. But you look at who's doing

research in the 50s and its universities. And you look at who's doing the majority of research around things that affect capital expenditure and human life and medical services that most people will encounter in their lifetime by the 90s, and it's not universities anymore. And why not? I mean, this is all tax deductible. You get to have a gala. You get to say, I'm giving the money away. It's not mine anymore.

And it's all structured as charitable giving, and you can't really tell what these organizations do, and all of it is invisible to the person who's watching cable news is this person who's just watching cable news. and then a credentialed expert comes on from the super smart university of knowing big things about the thing that I am talking about right now.edu or dotgov or dot org. And they say some stuff. Well, you go back to the 50s and those people worked at colleges and they had sort of meritocracy weighed their way up through a hierarchy that had some problems and some blind spots,

but was sort of centralized and sort of based on merit that you knew what you were talking about. You look at the news now, the people who are making those decisions came from these think tanks. You can't really tell the difference, or at least the general public can't. And a lot of times, even people who were fairly educated, I mean, I've spent so much time hearing somebody say something that was really wild and then being like, where did this person come from? Okay, they won all these awards from these organizations, but where did they come from? Okay, they sit on the board of this company that writes all, or this think tank or this thing that has a benevolent sounding name, and they write all of these, like, important documents that I can get for free as PDFs on their different sites and things, and they publish, and they say that they have these PhDs, but like, where did they have them from? And, like, where did they come from? A lot of times you can't really tell where they came from.

They just sort of showed up on the board, and the fact that they had authority was the reason that they should hold authority. which is my critique of the system. Not the private donor system, but like the organization of basically the organization of American psychology and the broader like American research establishment, you could no longer tell if people just showed up because they were appointed by somebody to something that sounded important and so they got to be important or they had done anything that really distinguished them. And you still can't. I mean, that's the game. It's become smoke and mirrors. And this does move into this American public education. It being restructured through standardized testing,

which converted the embodied work of teaching into these measurable outputs. Just you could do the same series that I'm doing now in psychology and how this optimization and efficiency metricing of it and making sure it's accountable. But we've got to turn it to a number to make sure it works. How can we compare people unless we turn them into it? to a number. You could look at the effect on that of every field, which on its face is a good idea. I like accountability. But you look at how it's implemented and who's doing it and why they're doing it almost every time it's done in American culture. And it's not for a good reason and it's not by people

who care about the thing that they claim they want to make better. American economics is restructured. You know, the Keynesians go out. I don't want to make this too. big of a topic. But the same thing that I'm saying happened to psychology. I can't not mention that it happened to psychology because it happened to everything else, because everybody who would have cared quit paying attention. And everybody who said that they were going to care had a reason to go away in the next generation. But like, again, this is about psychotherapy. The death practitioners retired. The cohort that replaced them was trained inside a new structure. They weren't indoctrinated into a conspiracy. They didn't kill the dissenters. They didn't stifle a

rebellion. They just said, this is the way it is now, and we're going to tell everybody who's a baby who's coming in, that it's always been this way. And that no other way ever makes sense, except that wasn't true, but no one knew. And this new structure looked like it worked because the older cohort was still sort of carrying the load-bearing weight of the thing until they weren't. And by the time the older cohort was gone, the rebuild had become structurally impossible. And the people who were sort of doing the thing that they didn't really know where it came from anymore, but had inherited from the older cohort were being incentivized not to do that anymore or to leave the field. You know, just like education, just like politics in a lot of cases, just like many fields of soft science research.

And so you have all these people coming in that say, you know, where is the explanation for why these, things exist and then those people retire and everyone else is told oh they exist for this reason which on its face is kind of crazy but that fits the academy and they become the new normal if it's public education if it's federal civil service if it's the State Department if it's the labor movement if the pattern is general this capture of psychology was synchronized with the capture of every other meaning-bearing institution in American life and it's run on the same playbook funded by the same network operated

at the same timeline because it's the same thing and it's not one person and it's not a cabal it's a system it's a cold machine and the mental health apparatus specifically was restructured by exactly this networking through exactly these mechanisms and if you don't want to admit that not only do you not know psychology or the history of your profession you don't know the history of the contrary, because the DSM3 shipped in 1980, and Reagan is inaugurated in 81. Managed care emerged in the same window. The pharmaceutical industries direct-to-consumer advertising was made legal in 1997 by an FDA rule changed that almost nobody outside the industry understood the significance of

at the time, and many people inside the industry did not. And the clinical encounter was financialized, and the diagnostic categories were standardized into billing codes to fit that model. And the treatment protocols were manualized into procedures that could be delivered by interchangeable providers under insurance authorization. And the entire intellectual infrastructure that might have resisted that

or even understood that it was happening was driven out. Of every other profession in these colleges or given competition that it couldn't compete with at the same time that the depth psychological tradition, the humanistic clinicians, the semantic practitioners, the contemplative traditions,

were systematically defunded, marginalized, and excluded from the credentialing pathways that determined who got to call themselves a real clinician and do research and publish things that someone actually read. And when I say actually read, I'm not kidding. Because the people who I don't like that are like the star researchers who are the most important in the world based on citation scores, based on H indexes, and based on the journal impact factors that they publish in, no one reads them either. I'm not kidding, man.

Like more people read my blog, which is not good and I am not important than the most prestigious scientist in the world, anyone pulled their paper and said, hey, I want to use this in a clinical psychology therapy session because I want to be a good therapist. If you look at the amount of people that actually read those things, and I wish that there was a way to make journals release those metrics or that there was a metric at all that was trackable, like they claim, who actually used this, learned something, and that. and then did it with a patient and said upvote or like a Reddit score, simple stuff. Citation scores are the raw tally of how many times other academic papers have referenced a researcher's study. So if you write something really broadly, a lot of people cite it. And so that means that we don't write things that are interesting anymore. We write things that are op-eds in papers. And we write things that are subjective in books.

But we just, in academic journals where people are supposed to go for the institutional knowledge of the profession, we write these giant meta analyses that cite everything. So if you want to say anything, you got to cite me. And then that makes my H index go up, which is a metric that tracks the productivity and the impact of any clinician, which your advancement score is based on if you're trying to get tenure in these universities. And then the journals want more of both of these because that's a journal impact factor, a JIF, which measures the yearly average of how many people have cited your journal. So this is like SEO.

It's like the website that you go to where you're like, why did I end up on this website when I cite that I typed in this basic question, but Google is saying, well, this one has all this information that's like weird and a lot of things point to it so it's important. You're like, that's not what I want. It's not what I ask. But it's giving it to you because it meets this criteria. that is this cold machine.

But if you go to how many clinicians have pulled a paper from one of these things, read it, used it, and done anything with it with a patient that affected their clinical practice in 100 years, not even like 50, like 100 years, you will watch it go down every year because it is just this game that we have to keep track of as the symbolic system to make sure that academia functions,

which is part of this machine, man. my blog outranks how many people read this stuff and my blog is not good and I am not an important guy why is the readership for something that I say get more emails saying hey I use this than the academic journals that are supposed to make sure

that clinical practice is evidence-based, scientific, and working and we're all informed by that as clinicians right if any of the people that care about the evidence-based practice paradigm or research think this is wrong go back and tell me what you have used that was made in the last 50 years that wasn't you know basically the forward to somebody's book that they were already going to publish like stephen porges and then they put it out on LinkedIn to get engagement there was actual a product actually you know made from the machine of the infrastructure that we have now. Because if you look at what people's PhD product was,

it was I wanted to research this. I wanted to research that. But then I wasn't able to because my PhD advisor said that I couldn't. And then I found five PhD advisors that said that I, no one wanted to do the thing that I wanted to do. And then I found this one guy and then he said that I could. And what we compromised on was this screener that I came up with, which is a way to detect anxiety that is 50 questions.

Dude, if you need 50 questions to figure out if somebody has anxiety, get out of the field. And I realize that makes anxiety hard to research because, like, you don't know statistically for a study if they have it or not. If you don't know if they have it and you won't just say somebody can detect if somebody's anxious, you don't need to be a therapist. But my question stands. Like the other processes that we had before, the academic processes before the Powell stuff and the capture of academic. end upendium, essentially. They produced products that were new models of therapy, that were new innovative techniques. You go back and you look at what we have now, it's a repackaging. I mean, even IFS, that's just putting Jungian psychotherapy together with Christralt therapy in a way that you can

teach to, you know, basically standardize enough to put inside of a treatment unit so that you don't have to have people sit in it for, you know, seven years until you can say that they're a Jungian therapist or something. And I like IFS fine, but what do we invent it? What is new? And what is new that the academic literature will let you pay attention to? I mean, we are very hostile to a lot of new models that are good because they're too weird. I'm sorry, not too weird. They are too complicated to be researched. They are not manualizable. They are not acceptable to a randomized controlled trial. And another thing, we're not willing to admit that the mechanism of action inherent in them may be too complicated for us to ever really understand. We may just be able to

understand the conditions in which it arises in a therapeutic relationship with a certain kind of person and a certain kind of buy-in and a certain kind of process. We can't say, oh, well, here's the exact thing and what it did the brain. We may not really ever be able to do that. And if you're not going to be comfortable with that, I don't know how well you can research what I do. Going back broadly to how the emperor has no clothes in these systems after this time, but that everybody sort of assumes the emperor must have more clothes than they think they do because it's hard and scary to think about that. You know, I was talking about how there's this general property of institutions that happens across all of American life, which is why we

talk about politics and other things like on a series like this. It affects more. things than just CBT. Like CBT, again, I don't hate it. I don't hate the people who made it. I do it. I like and respect the founders of it. I don't like the way that the machine uses these things because it uses things in the way that even the people like we talked about with the DSM 4 and 5 or Aaron Beck, the people who made them said wrong, bad, don't do that with my creation. But this pattern continues. You know, there's an institution that carries a body of practical wisdom in the bodies and the habits and the tacit knowledge of one generation of practitioners. And if you want my take on the CBT, you know, replication crisis, this is what it is.

The wisdom of this profession does not live primarily in the manuals or in the techniques. It lives in the space between the numbers. And it doesn't live in training programs. It lives in like the way that we learn to feel with someone competent. And so there is a generational passing on that is the important thing that you can't measure. And so I think what happened is that you had people who came from depth schools in the 50s, 60s, 70s, even the 80s, because they were still functioning. They were still there. And then as they started to retire, even though they said what I'm doing is CBT, why these broads,

studies that didn't look at randomized controlled trials only like Christia did, but the entire field said, wait a minute, as CB2 took over and it was the only thing that existed, outcomes got worse. You know, Christia would tell you, well, when you do this in a vacuum, CBT still works. Okay, fine, but when you trained to the real world to do it, which is the thing science is supposed to inform, all of a sudden the profession got worse over time. Why? I think people were still bringing in training and information and a mode of being that as they died or retired, which therapists are more likely to die than retire, by the way, the good ones, they do it until they die.

They left CBT to stand on its own merits because it was the people who were trained by the CBT teachers, not just all of the teachers and the CBT was what they had to do to bill insurance. I think it was there were these depth schools as as they died off, the profession as a whole got worse, but it doesn't know why. But we have to keep researching with randomized controlled trials to figure out why. And so we can't know. So it's not that the knowledge is lost or that I did it or that the system is bad. It's just that it's we can't really understand. We have to keep doing science the way that we do science.

In psychotherapy, of course, through randomized controlled trials. trial because if we don't, how could we ever figure out the problem? But that solution to the problem was invented by people who never wanted you to know why the problem was there, because they didn't want to know why it was in the macro, bigger world, because they didn't want to know why it was in themselves. And that is this methodological trap. It's this structural argument that I've been trying to make this whole time. It's not a rhetorical point. It's grounded in the literature. if you read it, that, you know, the field has worked to keep, you know, this peripheral written, serious researchers using the field's own standards and absorbed into the apparatus's filing system,

the same way other critiques of American policy or the American system have been absorbed. You know, those conclusions that Shedler and Weston came up with never really had a good rebuttal. You know, Christia didn't make one that worked. You know, but they haven't changed clinical practice, even though no one could rebut it. And they published in a scientific journal and they got a PhD, so it should have changed it, right? No, we don't follow science. Science follows money. They didn't change reimbursement.

They didn't change the footnotes and articles that no one reads. You know, they didn't change the apparatus. It continues. is, the cold machine that we've made. In the actual therapy hour, the actual encounter between two people, the limit is not technical. The limit is human. The limit is how much the machine will free you to engage with your own humanity. And most patients are not wanting to go into theirs, and it's why the therapist, it's so important

to do it because, you know, I have so many people that say, I just feel human. I just feel good at the end of therapy. And at the beginning, I'm not a gun owner and I'm not advocating for violence, but like, had I held a gun to their head just rhetorically and said, you know, are you human? Do you feel human? Do you feel? Do you have emotions? They would have said yes. And at the end of therapy, they're telling me I didn't know how to do that. That's always been its job. Can this cold machine actually teach us how to do that? Because I don't think so. You know, the actual reason that most therapy doesn't produce results that we wish to produce increasingly as a contrary. And increasingly as therapists that haven't engaged with this history is not the absence of the right protocol or technique. It's the presence of the same defended structure on both sides of the encounter that increasingly the profit motive and the system make impossible to provide. And this is why providers are not better than they are. This is why patients do not get better. This is why the field has produced manualized protocols and checklists and PhD programs instead of things that you can open an academic journal and read and use.

The protocol is a defense against the limits of the average clinician. It's not one that helps an excellent clinician excel. And when you do that, you don't make shitty clinicians better. You make good clinicians and excellent clinicians leave the field forever. And this is not a strategy for producing depth work. It's a strategy for trying to set the floor so that nobody feels embarrassed. But you felt embarrassed anyway. Go ahead and admit it and then get better.

And that's why the problem happens at the educational level. You know, graduate schools cannot admit that. They are selling education in something. But that thing is, at its essence, unteachable. And that's why they pretend for their... marketing that it has to be. And they pretend for their own graduation metrics about how many people left and got licensed and how many left and got whatever, that you just can teach it. You can teach protocols and you can teach the diagnostic framework. You can teach the ethics codes and the

documentation requirements and the assessment instruments, but you can't teach somebody how to sit with another person without flinching from what is actually present in the room. They kind of come in knowing that or they don't? Or they go into a program and they learn the parts of themselves they're afraid of, ideally, and they learn to deal with those, which increasingly, as we strip this language out of the profession, we don't do anymore. And a lot of the people that I make this argument, too, say like, hey, well, you know, the thing is that these things are like not hard sciences. You know, they haven't read Theodore Reporter, but they make this argument. I'm like, man, I have friends in the hard sciences. One of my close friends, like works for CERN and does quantum physics and programs,

basically the algorithms that make the magnets and the computer fire the particle. And this guy almost fell out of school a lot of times because they came to him and they were like, you're not good enough. You don't have it. You got in, you paid us money, and we're kicking you out. And that happens in STEM. It does not happen in social work. And that moment for him where they came him and they told him that at Vanderbilt. He was like, well, I need to get better. When I was in school, the peers that I have that no longer work in the profession who had issues when they got into the field, when they had problems, the school said, do you feel okay? What's wrong? Why did we let you in? You got into this program, so you must be good. They didn't say, hey, you have an obvious emotional

blind spot that is messing up your relationship with everyone in this program, all of your professors, and will prevent you from working in this field. And if you don't deal with it, you will never help a patient, ever, ever. And so why don't you do that if you really are honest about your drive to help people? Because I think that what you might be doing is mistaking other people for this version of yourself that needs to be enabled and you want to be enabled and that's not the real world. So are you okay? Can you get it together? And do you want to accomplish your own goals?

And we're going to hold you accountable and make sure that you do. if you want to. That's something that I've never seen a psychology graduate school do ever in the last 10 years, ever, anywhere. Why? Why do hard sciences do that and we can't? You want to hide behind the language of hard science? Can you ask that question and tell someone,

do you want to be better at what you do? Do you want this to be something that you can own your own self enough to help examine in someone else? Your humanity. And that's where we are. You know, by the 2010s, this apparatus that we traced, you know, in the last episode, had its own empirical foundation systematically demolished in its own language, but it used that language to hide that fact from itself.

You know, the flagship clinical trial of the medication first paradigm exposed as a methodological fiction that it doesn't know how to do what it claimed it did. And then it just said, well, maybe there's a reason for that. But we don't know what it is. yet, which is what happened with the DSM3, is it kept saying with the language of science, in the language of academic publishing, and the language of academic advancement and synod structures. Well, we must be right.

We just don't know why we're right yet, except we keep being proven wrong. Dude, how much more time do you need? The director of the federal research agency, in his own retrospective, said, I gave you $20 billion. And you failed to move the needle, not in a direction, but in any direction that was consistent. You just kept kind of saying stuff. So admit that's what the field is. Or go back and say, we don't know how to find biomarkers to diagnosis that we made up with

Freudian language a hundred years ago. And I don't have an answer. I'm just saying you got to pick a direction. And then we get a scientific method. We got to make a hypothesis. We got to test the hypothesis. We got to see if it works. We got to admit when we were wrong, which is the place we're at now.

And then we got to go back and have another one. Pick one of those two directions. This wall is hollow and the wall continues to stand. Because by the time anyone proved that the wall was hollow, the wall had become structural and the structural removal would cost the institution too much more. money to remove. And this is the resting state of American psychiatry and the broader psychology that follows it as we enter this present moment. This is an apparatus operating on an empirical foundation that its own research enterprise has abandoned, a profession bifurcated between an academy

that knows the score and a clinic that cannot afford to know it, and patients sorted into categories that the federal government has declared invalid, whose insurance reimbursement is still precipitated on it working. Medications prescribed for indications barely distinguishable from placebo effect. In some cases, not all, and medication does have an effect. I've seen it. I'm just saying we don't quite know what that is, and that's a safer place for me to be as a human, then having the certainty of the machine. I can tell you what I've felt, what I've seen, and how I kind of know that they work being on interdisciplinary treatment teams and fighting with psychologists and psychiatrists about, no, but this is what I saw. Can we get this other thing? Well, the research

says, but every time he takes it, it goes this direction. And the psychiatrist on those teams was good. And they listened to me and said, okay, we'll try this one. Let's try and triangulate. It sounds like there's a mood thing. We've lost those conversations. And the wall is not all of psychiatrists. The wall is part of psychology that got captured. Underneath the wall, around the wall, in the cracks of the wall, in the basement, in the back rooms, and the private practices, and the supervision groups, and the somatic training, and the intensives, and the indigenous traditions, and all of the stuff that most good psychologists are interested in, where they actually obtain wisdom and not obtain merit.

There's these clinicians who can sit with a person and let what happens happen. and anticipate it, not predicted. And the traditions that understood that the body and the soul and the breath were the same conversation, those therapists were trained in modalities that the apparatus doesn't credential anymore. And if it does, it credentials them in something else that they can still do it, but they bill for it. And the researchers now finally with the technological tools to study what the body does in the room, when something genuinely changes, they're not allowed to do that because it

might refute the model that we have. There was this promise that eventually they were going to be able to see things that would validate what we were moving towards. We have biomarkers now. We have QEG. We have the ability to be able to see these things and understand them at the deep level. I mean, I would not have the ability to understand what I understand without our QAG brain mapping lab. What they do at peak neuroscience is amazing. But they're willing to admit that it's half art, half science. And the profession largely is not. And so the biomarkers that they've found are not allowed.

And so from here, where do we go? Like, where do we go as a profession or somebody who cares about this as a possible branch of science? And not just some weird, maybe you find somebody cool, but like really, how do you quantify it? So, like, we don't know. I would like it to be a science. I'm on that side of the argument.

Some people are not. But past the 70s, when you pass, you know, 79, you have to say these things. And I don't know how to say I'm on a podcast because they bump up against too many things that are still going on right now, which is crazy because this is supposed to be this evolving thing and they're very old. I didn't know how to close the series. I didn't know how to approach this moment. even when I had people emailing me saying, we can't wait until the moment when you do and seeing how you're going to do it.

And I'm like, well, I got the notes for it, man, but I don't know how I'm going to do it. So here you go. Here's the end. You know, in 1973, Laguin, or so Laguin, who's one of my favorite authors ever, and I really wish that she had lived

to my adulthood so that I could just speak with her because she's wonderful. She published a short story. And the story describes this city that has unbelievable happiness. And the narrator of the story keeps saying, we can't even tell you what the city is like because everyone there is so happy. And the harvest are so abundant and the streets are so clean that even if we described it accurately, which we can't, you wouldn't even believe it.

And the art is so rich and the festivals are constant and the citizens are intelligent and inhumane. And it has no kings, it has no soldiers, it has no priests, it has no slaves, there's no It's just everything that you've ever wanted, but you didn't know how to do it, but we can't even tell you how to do it. So much of it is that description. But it has this one feature and one cost and one term. And in the contract for the city that you didn't even know you signed. But it does make the whole thing possible. So it's not even like you agree to it.

It's just like it can't exist if you don't. There's a basement somewhere. There's this cave. And the story is called those who walk away from O'Melas. There's this cave in O'Meilas, and a small windowless room, a single child is kept in perpetual filth, darkness, and misery, and the child is fed just enough to stay alive. Because if they die, the city dies, but the child has never spoken too kindly. But that's a requirement. And the child sits in its own waist in this dim corner, and it weeps for help.

But it has to know help will never come or else we can't have all this stuff. And every citizen of O'Mailas, when they reach a certain age, is taken to see the child, and they are told the truth. And the serenity of the city, the wisdom of its philosophers, the depth of its friendships, the tenderness of its love, the impossibility of its existence. It's all based on them seeing that, and then choosing not to see it for the rest of their life. Because everybody else walked away from O'Meelas. and they left.

And when they left, we don't know where they went. Maybe they died. Maybe they got sad and lived in a worse city. Maybe they ascended to another place. And maybe they just disappear. That once you say, I don't want to be here, you're gone. And there's so many readings of that that people might do that are like Marxist, or this is about capitalism, or this is about the engine of, you know,

if we have an empire, they're suffering or something. maybe and maybe that fruit is there. I'm not totally interested in that when it comes to her story because I don't think that's what she cares about at all. What I think she's saying is that there is a perfect system until you realize that system doesn't actually exist. And then you have to say, what does the future look like? And can it look different? And can it be better? And if it does, I have to walk away from this one.

And when I do, I don't know what's coming next. And nobody can tell me. It's off the map. And I know that most people didn't do that. And if I'm in this industry right now and I know the history, which is not a ton of people, where I creep up on it in grad school, or I creep up on it as this informed patient,

or I creep up on it as a desperate therapist, I have to see that the establishment itself, O'Me-Mailas saw that same question numbers of times and they walked away and that's the question that faces every therapist every researcher and every patient when anyone who is not just desperate but is maybe just curious is looking at the why and the when and the how of what's happening and then has to say, but what if we went another direction? And what if we did something different? I don't know, man. Maybe it would be worse. I'm pointing out the system we have right now. I don't even have an answer for you. I'm just saying that there's this moment where you walk into the

basement of O'Meilus. And then you say, do I continue to know what I just knew? And the system is making you choose harder and harder between whether you look at that system and you remember your knowledge or you say, I'm going to walk away. And it used to be that there was this way that you could kind of thread the needle and weave back and forth. And then eventually you could believe that you could kind of change the system. And I believe in changing the system, which is why I am a therapist who is a network who is working inside of a society to do stuff and I'm not, you know, some weird, you know, person trying to blow the industry up. Again, my interest is still in making the system better. But it is making less and less room for you if you were doing that. And the future

of the industry, my fear is, is going to tell you, you either have to forget everything that you ever know that you knew you have to dissociate or you got to walk away from omelus and the system will never be able to see you again but it doesn't care because you will have no effect on omelas old film flicker on a crack smoking in your father's coat dust in the beam like a cheap disco Cold machines, warm's your soft, sad, laughing notes, get carried through the tangled wires. Cold machines, warm ghosts, you sing, and something in me shakes, I'm holding on. We were not mistake. About a strike in 79, names that never made the news, I can taste.

on every line the rust the rain the loose and screw cold machines warm under power lines your soft machines warm you sing and something in me break some