Anne 0:04
Welcome to the voices in bioethics Podcast. Today we are welcoming Eric Maisel to the podcast. He’s the creator and lead editor for the Ethics International Press Critical Psychology and Critical Psychiatry Series. His books include Why Smart Teens Hurt, Redesign Your Mind, Rethinking Depression and The Future of Mental Health, among many other books. He also writes the Rethinking Mental Health Blog for Psychology Today. He’s a retired family therapist and active creativity coach providing workshops and education. Welcome to the podcast, Eric.
Eric 0:39
Hello, Anne, great to be with you.
Anne 0:41
I’ve been really fascinated by your work as you know, which I put in the category of speaking truth to power. Astute Analytica predicts the mental health industry will reach $582.4 billion by 2031. It’s difficult to sort of upset the mental health applecart. Yet, you really provide a critical perspective quite effectively and I just wanted to ask why you consider the challenges to the current model of an ethical nature? What are the ethical issues? And why is this problem an ethical problem?
Eric 1:14
Well, we understand that the word ethics takes us into the area of relativity and so it’s hard to know what we exactly mean by the word, but I think we generally agree that lying isn’t ethical. Now, if you’re caught in a war, and you’re a prisoner, and you don’t tell the whereabouts of your battalion, we think that kind of lying is just fine. There’s even lying, that’s ethical, but we don’t think, I don’t think that the lying that’s going on with respect to psychiatry, psychology, psychotherapy, that that lying is okay and so I think that’s why it’s an ethical concern. Second, kids have few advocates, as we know, millions of kids are being subjected to chemicals called medication that they probably ought not to be subjected to. I think we don’t think that’s okay, I think it is not okay to subject people who have no choice in the matter, to take powerful chemicals that are very often gateway drugs to addiction. So it’s another place of ethics to help people who are being treated unfairly and unjustly.
Anne 2:23
So the treatment of moderate emotional and behavioral traits has grown significantly, and really accounts for most of that industry growth, including both drugs and therapy. Do you distinguish the treatment of mild to moderate from severe mental illness?
Eric 2:41
We’ve got to go all the way back to languaging here, and that’s the question of is there such a thing as mental illness? And what does that phrase purport to mean? If it has no particular meaning, then there’s no reason to distinguish between moderate or mild mental illness or mental disease or mental disorders, and more severe ones. If there’s nothing there, in the sense of no particular disorder than adding whether it’s ADHD on the one side or schizophrenia on the other side, whether appending a label won’t make any difference if the underlying thing isn’t real. So I would say I don’t distinguish between the two, I think all of that labeling is faulty. The idea of labeling on the basis of symptom pictures should strike any thinking person as strange. We don’t believe that medicine, diagnosis that way, it diagnosis on the basis of causes, not just symptom pictures, and sure it’s fine to treat symptoms, take two aspirin and go to bed. But that doesn’t deal with the underlying something, if there is an underlying something. So I would say that we have to go back to what the essential game is and that it isn’t medicine, but a linguistic or labeling game going on.
Anne 4:00
And would you feel more comfortable if there were some kind of biological or chemical marker for some disorders?
Eric 4:08
Not if it was just foisted upon us. Not if I didn’t believe it, I’ll put it that way. Markers can be found for anything. The common phrase that mental disorders or bio psychosocial is a way of saying, we don’t know what they are. We’re going to cover every base by using all the words we can use. So I would not trust biological markers unless, well, let me say it a little differently. If you hate your job, that can’t be a medical condition it can’t be a medical issue. And if you were to find that one person’s brain, another person’s brain look different. One person hated his job, one person loved his job. Those markers would not be indicating anything about a medical condition, just that two brains look different if they’re feeling differently or thinking about different things. So I would be very unbelieving in markers unless the underlying rationale made some sense to me. And I’m sure your audience is aware that the DSM, the Diagnostic and Statistical Manual of the American Psychiatric Association, is completely silent on causation, which ought to feel a little shocking, like, how can you deal in a pseudo medical arena, and not be interested in what’s causing things. So until we get clearer on what the idea of a mental disorder is, what’s causing mental disorders, until we get clear on that, I would not trust biological markers of phantom things.
Anne 5:36
Okay. And I think that hate your job analogy is a very important one. And it speaks to one of the problems that I wanted to discuss with you. There’s a trend toward diagnosing children and adolescents who seem to not score well on tests or get good grades. And the diagnosis could be a bunch of things that could be ADHD, or some kind of cognitive or mental disorder, including things like slow processing or even anxiety. So consequently, many children are sort of rewarded for the diagnosis with extra time on tests and with drugs designed to force them to pay attention and to focus more. I just wondered how you see that trend? And are these children being medicated for the sake of their parents or doctors views on performance and grades?
Eric 6:27
Yeah, for me, the issue isn’t accommodation, I understand that that’s an issue. But for me, that isn’t the issue. The underlying issue is what’s going on. And as you know, psychology, psychiatry takes no interest in what I call original personality, that is how we come into the world. Take zero interest in and anybody who’s had kids or puppies or kittens knows that every creature is exactly itself comes into the world already itself, with a certain amount of chi or a certain amount of this, or a certain amount of that maybe a different amount of anxiety. As I say psychiatry and psychology is absolutely uninterested in that reality that people come into the world differently. So a child comes into the world, with a lot of chi, a lot of basic energy, maybe a lot of intelligence, a smart energetic kid, who really just ought to play outdoors a lot. The only problem is that they’re not playing outdoors enough, that child comes into the world, bounces off walls, is bored at school, is the youngest in his class. That’s a robust finding that workers are diagnosed with ADHD, depending on how young or old they are in their class, the younger the kid, less mature or just finding it harder to deal with the subject matter. So if that’s the child, we’re talking about an energetic, perfectly fine kid who’s bouncing off walls who has a racing brain because they have a good brain, there’s no reason to affix a mental disorder label to that child, that’s a current practice, that’s a new practice, which should not happen. So if that child is then accommodated, that feels like a separate question or sort of further down the road question then what’s going on. And parents ought not to accept this labeling. And we understand why they do it gets their teachers and principals and school counselors and other people off their back, that allows their kids to fit in better function in school. But that’s not a good reason to affix a label that isn’t a diagnosis.
Anne 8:33
So it seems a lot of parents, and people in general, people in the general public are complicit in the diagnosis, or they’re asking or seeking out the medical attention for these behavioral traits. Do you think they’re heavily influenced by how normalized psychiatric and psychological interactions have become?
Eric 8:53
Yeah, I think they felt seen, I think that they’re not in a sense colluding or playing along with the game, I think they actually felt seen. And that makes perfect sense. Because if I say to you, do you like purple? Do you like to get up early? If you say yes to those things and then I say, well, you know, if I put purple and getting up early in the three or four other things together, we’re going to call that x. And that’s you. And I’m gonna go, wow, that’s me. That’s exactly me. I love purple. So there is that game that interchange that interaction, where I provide you with a symptom picture, so to speak with stuff I provide you with stuff, and you hand it back to me. Because we’ve lost common language. Nobody says they’re sad anymore, or that they’re despairing. I come in and I’ll say I’m depressed. You’re the psychiatrist. Do you have only 15 minutes with me. You’re going to reply, yes, you’re depressed and we’re done. Except for the writing of script. We’re done. So I think people actually feel seen they feel like they’re being recognized in the symptom pictures. And that’s really just an excellent marketing game. But I understand why people buy into it because as I say, I think they recognize themselves. Virtually all of my clients nowadays feel like they have ADD or ADHD, all the adults, they all have glommed on to that as who they are. Because it makes sense that, oh, that’s why I’m distracted. Maybe you’re distracted, because the world is very distracting. No, no, no, I’m distracted because I have ADHD. So they’ve got the useful, convenient label to append to some set of behaviors that feel recognizable to them.
Anne 10:38
That leads me to another question. I think a lot of people are almost asserting the world has changed so much that their anxiety is caused by certain modern circumstances or that the world has changed on us and that that’s why we have these new diagnoses. How do you respond to that?
Eric 10:55
I think there’s truth to that. I think we’ve lost sort of the center or the game plan or the idea we’ve lost something. Over the last decade, we know that fascism is rising. We know that authoritarian personalities abound, we understand about climate change, we could name a million things that are stressors, and I think it’s appropriate. The Doomsday Clock is three ticks closer to the world ending, etc. All of these are real things. Even if you’re very existential in the sense of being philosophical, and understanding that we’re just excited matter coming and going, even if you’re that person, and sort of want to sort of tread lightly on the earth and not take yourself too seriously. It’s still hard not to feel anxious nowadays. So I do think that that is a true thing, that people are feeling more anxious, and more pressure, right under more pressure, people are working 23 and a half hours a day, nowadays, so many solopreneurs are having to work all the time to make a living, the loss of pressure. And also, I think the extent to which anxiety may be a feature of original personality, as I mentioned a moment ago, has not been taken into account. Because if you’re a smart, sensitive reality testing person who comes into the world, you’re good at reality testing, you’re going to be good at seeing how bad things are. And that’s going to make you anxious. So I do believe that anxiety levels have grown. That doesn’t mean that those are mental disorders, but rather, the way our natural warning system against danger is operating. World feels more dangerous. And as the world feels more dangerous, we’re going to experience that as anxiety symptoms.
Anne 12:40
And do you think taking in too much news, and kind of having news and social media everywhere is contributing to that anxiety?
Eric 12:48
Absolutely. I work with Korean performing artists. I’ve been doing that for 30 years, I demand of them that they stop checking in on the news first thing, and that they get to their creative work first thing for all kinds of reasons. Yeah, but people are taking on too much news. For me, there’s a simple distinction. And that is if you’re taking in the news for the sake of taking action, if you need to know where to march, then you need to know the address. So in that sense, yes, we need the information to go do the work we intend to do. But if it’s just information with nowhere to go with it, then I think that’s unnecessary and unhelpful.
Anne 13:24
And do you think this psychiatry and psychology literature has kind of changed? Now that literature notes creep create expansions, in terms like abuse, neglect, trauma, mental disorder and bullying, that these words are defined differently from how they will once defined and that each of those categories has grown broader. And do you think that that leads to some of this willingness to categorize oneself in something that ends up turning into a mental health bucket?
Eric 13:55
Absolutely. If your audience knows how DSM diagnoses are created, that’s where the creep originated with folks, usually guys sitting around a table in a room saying, what’s the next mental disorder, we can create a whole cloth. And some of them get rejected by the marketplace, they try to float one or another kind of idea that you’re only allowed to grieve for so long, they actually managed to pass that one recently that you’re only entitled to grieve for a certain amount of time. But that’s the way these mental disorders are created, not because they are found out there, but they are created by folks sitting around and making them up. And so of course, anything that permits Big Pharma to create a new chemical is going to be wanted by the mental health profession, and so the creep will keep creeping.
Anne 14:48
And do you think in some of these assessments, there essentially is some circular reasoning. For example, if someone describes themselves as liking solitude, then they are defined as an introvert And then that can be related to some of these other things that eventually hit those checkboxes.
Eric 15:05
Most of it is completely circular because it’s all self report. So there are no tests there, no blood tests there, no brain tests for real, there are no real tests. So it’s all self report. So whatever I say, you collect and feed back to me. So it’s all circular. It’s completely circular. And there’s no investigating as to what’s going on. If I come in, and my hands are rough, and you call it roughtis nothing’s happened. Zero thing has happened. What you need to ask me is, am I a bricklayer? Or what’s going on? You need some information. And both psychology and psychiatry are not interested in accumulating that information, because they’re not really after information, because that would be about causation. That would be looking for causes. And they’re not looking for causes. They don’t need causes. They just need this linguistic interaction.
Anne 16:01
And then they describe themselves in a very scientific way. Do you think there is a way to validate the research? Or is it just that a lot of people agree with that, so then they get bigger and bigger buckets of data of people having been diagnosed with the disorders?
Eric 16:19
Yeah. Validity is, of course, a complicated concept that can’t be teased apart in a split second. But I’ll just give you one example of how validity is not much thought about or cared about, let’s say in psychological testing, let’s just go there for one second, you may know that the MMPI, which is one of the most used psychological tests was what’s called empirically norm, that is, different groups were looked at, namely people in psychiatric institutions and people not in psychiatric institutions. And whatever distinguished their answers was considered distinguishing. Hear, the way people in psychiatric institutions reply, and hear the way people not in psychiatric institutions reply, and that was supposed to provide validity to the underlying test. But we have no idea what the people in psychiatric institutions were doing there. We don’t know who that they might have been in Russia, dissidents, who knows. And that’s why the results are so so to speak, peculiar. For instance, graduate students, and convicted felons score about the same two standard deviations above the mean, on certain scales. Because what’s being observed there as a certain kind of rebelliousness, not mental disorder, et cetera. There’s a ton, we could say about the lack of validity everywhere in the psychological and psychiatric community, kind of, especially in psychological testing, which of course want to be so important to parents, whose kids are given various kinds of tests, which are not themselves valid, and which lead to diagnoses which then lead to chemicals, which are gateway drugs to addiction. You may know just happened a few days ago, that the FDA came out with a blackbox warning around ADHD drugs, as addicting. Finally, they confessed to that those in my world have known that forever that what’s this opioid addiction about? Well, partly, it’s about giving millions and millions of kids gateway drugs for no good reason, illegitimately and unfairly. So that was, I’m not sure how we got from validity to there. But that’s where one goes.
Anne 18:32
Sure. Another question to do with children and adults. How alike are people supposed to be in their behavior and their emotional experience, it seems to me these drugs, make people more of like, they make an outlier, who you know, wants to behave and not pay attention, forced to pay attention and study more, they do things that make people more like each other.
Eric 18:55
Exactly. So as I say, I work with creating performing artists, there is, I think, roughly a creative personality. One time I sort of scoured the creativity literature and came up with 75 personality traits of the creative person, I think there is a certain kind of person who pops out of the womb stubborn, looks around wonders who their parents are and what’s going on and why the world is made up this way. And struggles to remain an individual, his or her life. And that person is going to be that 2% or 5% or 10% outlier and we need that person. Gosh knows. We need our smart, sensitive, creative people who are going to produce our symphonies and vaccines and what have you. And we need them to not be necessarily extroverted, maybe they need to be in solitude 14 hours a day. So be it if that’s what they need to do. If they have racing brain issues, which I’m not going to call mania or bipolar, because that’s just languaging. A brain that’s working, if they have racing brain is because then they do have to figure out how to mediate their mania so to speak, that is they’ll have challenges and issues. But we don’t want to just medicate away that racing brain because then we’ve slowed them down, we’ve dulled them. And then we don’t get civilization, we don’t get the things we need, from our best and brightest if we try to slow them down and dumb them down, and just make them into zombies.
Anne 20:25
Yeah, it’s interesting that the drugs particular to ADHD are now highly criticized for that, that stimulants are making people perhaps lose some creativity while they get their behavior into what is considered a normal zone and some groups seem a little bit exempt from this sort of heavy hand of psychology and psychiatry. And one of those groups is religious officials. So I was at a meeting recently with a monk and a priest, and they are people who at different times had taken vows of poverty, celibacy, and at one point silence. And it’s interesting to me that they seem to have a past, they go into these specific things, and nobody says, Oh, you must have such and such.
Eric 21:13
To me, it’s straightforward. Or here’s where I come from on that I mentioned before authoritarian personality, that’s a phrase from the 1950s. That fellow named Adorno, and other researchers at the University of California came up with and they were trying to figure out not who Hitler was, but who Hitler’s followers were. That was the thrust of their investigation. This was, of course, in the aftermath of World War Two. And some people were interested as to what had happened in World War Two and who these authoritarians were. And so an authoritarian literature arose. And one of his findings was the way in which a fascist always went to bed with the religious, that political authoritarians always got into bed with religious authoritarians. And the professional classes, the authoritarian classes, necessarily upheld each other’s privilege and values. So to me that religion gets a pass comes from the authoritarian nature of religion and the way in which it is like psychiatry, an authoritarian thing. And so they are essentially as one may be the staunchest atheists under the sun and the other an actually religious person, but they’re still bedfellows in this regard. And that is they need to bully other people with their beliefs, they need to betray our common humanity. And so that’s the place I come from there, it seems very straightforward. While the religious would get an exemption, they’re playing on the same team.
Anne 22:47
And taking a step back and looking at the industry as a whole, what I call the mental health industry, people seem to equate getting mental health care with sort of a success or a successful decision. In other medical arenas, finishing the care could indicate a cure or a success, is graduating from therapy and getting off medications a sign of success, would that be the better measurement?
Eric 23:15
It’s complicated, isn’t it? So let’s tease it apart a little bit, or try to tease it apart with psychotherapy, we know that that’s not real science, that therapists who are good, are good because they’re warm and supportive, and intuitive and wise, understand the other thing, not because they’re doing science. So there can be great benefits from psychotherapy, but they’re the same benefits you might get from a good friend, that kind of benefit, where somebody’s listening to you. Maybe making some suggestions, maybe making supportive facial gestures, etc. Being on your side. And so, graduating there, so to speak, you may come away from the psychotherapy experience with a very good experience. Maybe you have learned a few things about yourself gained insight. Maybe you’ve gotten clear on the work you need to do to become the person you intend to be all of that. So I think that there’s a sense in which it can be a very positive experience in psychotherapy, as long as it’s not considered the territory of science or medicine. It’s a pseudo scientific place where masters level counselors get to call the people they work with patients, how bizarre where do they get to call them patient? No, it’s just two human beings sitting together having a conversation and sometimes that conversation is very beneficial, and sometimes it isn’t. So I think it’s hard to tease apart. What so to speak, graduating from all of this really means and I guess, we have to say it’s contextual and person by person as to whether they get something out of it. I’m a coach. I believe that the logic of coaching is actually better than the logic of therapy in the sense that there’s no game around you having some mental disorder. It’s just what do you want to get accomplished? And what’s standing in the way of that, and let’s name some goals and get them accomplished. There, it’s clear what the outcomes are, if you’ve got those goals accomplished, then wishing was successful, it’s much less clear what exactly is supposed to happen in psychiatry, and psychology as to outcome.
Anne 25:33
In the bioethics community, I find that mental health and specifically psychology and psychiatry are bullet proof to an extent I find that there’s a common sort of one voice in favor of them. And it’s incredibly hard to critique them. And I just wondered how you backup the critical viewpoint or whether you face people challenging your views?
Eric 26:00
Well, the short answer is sure as to people challenging. I think, for me, any intelligent person who spends a little time will see through it, those are the headlines, you have to spend some time to see through it. So I don’t think it’s that difficult to understand how you can’t diagnose on the basis of symptom pictures. That’s not medicine. It’s not, no doctor would say I’m not interested in what’s causing this rash. I’m completely uninterested. Just gonna call it rashtis and we’re done. Anybody who thinks about this a bit, whether it’s about psychotherapy, or psychiatry, or psychological testing, I think will come to the same conclusion. So it doesn’t take expertise to see through what’s going on here. Just have to use your smarts, your common sense to understand that not only is the DSM silent on causation is silent on treatment, what kind of document of many hundreds of pages that purports to be the DSM Diagnostic and Statistical Manual, Diagnostic and Statistical Manual? What kind of manual can have nothing to say about causation or treatment? It’s all about symptom pictures and labels, and things to affix on people. So as I say, anybody who looks at this for a moment, quietly and carefully, I think would see through what’s going on here.
Anne 27:22
And do you find in psychology and psychiatry, some people would like to use the term misdiagnosis when they feel that they were over diagnosed with mental disorders and illnesses? I don’t know if you’re familiar with Pathological by Sara Fey, but she considers herself a victim of many misdiagnosis. Do you think that even that term is to medical for what’s really happening?
Eric 27:47
Absolutely. There never was a diagnosis, she got X number of labels. And maybe none of the labels make sense to her or fit. But there never was a diagnosis, there were just the offering of labels. So I agree that Miss diagnosing all of that diagnose, I’ve sat on panels and in groups of alternatives to the DSM well, so that’d be somebody else’s diagnostic scheme. When there’s no diagnosing going on. We don’t need alternatives to the DSM we need the DSM to go away. And we need the idea of claiming that you hating your marriage is a mental disorder, we need that to go away. There’s a sense in which that ought to be diagnosed, as opposed to just asserted or announced or said, but not diagnosed. So that’s my take on that all pseudo medical language should be excised from this world, this mental health world, including mental health.
Anne 28:50
It’s really difficult, I find to recognize that the language that we’re using quite commonly has been completely psychologized and medicalized that these aren’t words, yeah, these aren’t words my parents or grandparents would have used.
Eric 29:09
I just want to piggyback because it just pops into my head about CO opting of language is so interesting. So obsession, got co opted in the 1880s, by psychology and became defined as an unwanted intrusive thought. So all of a sudden, you couldn’t have a productive obsession. By definition, obsession is a negative thing. But creative people have known for a zillion billion years, you can have productive obsession, you can be obsessed about your novel or your suite of paintings or your symphony. And we need to be obsessed about something. So that’s another language in place of co optation, around obsession, and OCD and all of these things. So it’s endless. The co-opting is endless.
Anne 29:49
I’m Anne Zimmerman and this has been the Voices in Bioethics podcast with Eric Maisel. Thank you.
Eric 29:56
Thank you so much for having me.