A Better Way to Disagree
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I'm Barry Weiss, and this is Honestly.

Over the summer, I had a writer that I really admire named Freddie DeBoer on the podcast to talk not so much about his writing, but about mental illness. Like a lot of people with bipolar disorder, I become extremely grandiose when I'm manic, even more grandiose than I am normally. We talked a lot about his personal struggle with bipolar disorder. My manic periods are dominated by paranoia, by fear that people are conspiring against me.

This very often will manifest itself in my completely baseless decisions that people who have been close to me have, for whatever imagined reason, they've lost loyalty to me, they've turned against me, they're no longer tight with me. I will

make theatrical demands of their attention and of their support. Eventually, I become so aggressive, I push them away. And we also talked about how mental illness has gotten strangely wrapped up in our growing cultural obsession with identity politics. There is an absolute desperate hunger among seemingly all kinds of people to have a

specific and discrete elements of a personality that they can display online so that people see them as cool and interesting and someone they want to be friends with. That mental illness has become not something to manage, but a kind of precious thing that needs to be protected, almost cultivated. If you can say, oh, I have this

disorder, I have this condition, and that conveys a lot of information about you that differentiates you from people, then that seems to be very valuable. It's almost like sickness, he argued, has become chic. I don't think that it's actually in your best interest to think of yourself as your disability first.

I think that that, first of all, it gives you reason not to get better, right? If you are really invested in being, you know, the bipolar guy or the schizoaffective gal or whatever, then you...

We're going to gravitate away from effective treatment, right? Because that means that you're gravitating away from what makes you. And we spent some of that conversation talking critically about an article that we had both read in The New York Times by a writer named Daniel Berkner. If there's one thing that I feel like I should be able to trust from The New York Times, right, it should be that something would be reported out adequately and there would be at least some attempt to balance perspectives.

But if you look in that piece, there's not a single interview with a skeptical psychiatrist. The title of the article was, Doctors Gave Her Antipsychotics, She Decided to Live with Her Voices.

It was a report on something called the Hearing Voices Movement, which advocates for eschewing medication and accepting an alternative reality, even suggesting that we may need to stop talking about mental illness as an illness altogether. The worst things that I think an article like

that Daniel Bergner one does is that it sort of plays at the, well, these are just non-consensus realities, which is not correct, right? Again, when I think someone who's close to me is committing some completely inscrutable crime against me for no reason, it's just not true, right? And it's like if you created an elaborate ruse and then like a prank or something and then noted my reaction to it,

You wouldn't say that's my real self because I was operating under bad information. And it's the same thing there. He went on YouTube and offered a very moving, almost hard-to-watch response.

And he elaborated on that on our show. It's exactly my problem with the gentrification of disability in the sense that you have this small, well-connected, right, able to talk to the New York Times group of patients who are there to be interviewed when you can easily imagine that the patient who is so terribly schizophrenic that they're currently living under a bridge or they are in a long-term institution right now

That person has been systematically left out of the conversation because they don't have the wherewithal to be interviewed for The New York Times for those kind of pieces. What really bothers me about pieces like that is they convince people that we have an over-treatment problem, which is literally the opposite of the reality. It is a matter of great frustration to me that there are so many American liberals whose

general perspective on medication and medicine in general are that they're too hard for ordinary people to come by, too expensive, too hard to get their hands on. But when it comes to psychiatric medicine, they're suddenly convinced that there's an over-treatment problem. We know for a fact that the biggest problem in psychiatric medicine is that too many people need it and don't have access to it. After the interview with Freddie aired, we got a lot of responses.

Many, especially people with mental illness in their family, said they loved it, that they felt it was courageous and refreshing. But other people, not so much. And one of those people was Daniel Bergner, who felt that we had mischaracterized his argument. It was one of those situations where if we had been going back and forth on Twitter, we might have ended up sniping back and forth at each other.

But instead, after getting a long email from him, I invited him on the podcast and he graciously said yes. I'm really glad Daniel reached out for a few reasons. The first is that if he hadn't, I wouldn't have read his book, The Mind and the Moon, which among other things is a humanizing story about his brother's bipolar disorder. And the second is that it's a reminder that it's okay to have a conversation and to still come out on the other side strongly disagreeing with someone.

So for today's show, a better way to disagree about vitally important issues. We'll be right back. Hey, guys, Josh Hammer here, the host of America on Trial with Josh Hammer, a podcast for the First Podcast Network. Look, there are a lot of shows out there that are explaining the political news cycle, what's happening on the Hill, the this, the that.

There are no other shows that are cutting straight to the point when it comes to the unprecedented lawfare debilitating and affecting the 2024 presidential election. We do all of that every single day right here on America on Trial with Josh Hammer. Subscribe and download your episodes wherever you get your podcasts. It's America on Trial with Josh Hammer. Daniel Bergner, welcome to Honestly. Thanks for having me. It's great to be talking with you.

So Daniel, this summer I had Freddie DeBoer on the podcast and it was this very powerful episode called, Does Glorifying Sickness Deter Healing? And in it, we talked about lots of things, but one of the things we talked about was Freddie's bipolar disorder and his views about how misguided he feels our culture's attitude toward mental illnesses. And we talked in part about

Thank you so much for having me.

The place that the book begins, and I think the place that your interest in this subject began, was with your brother named Bob. Can you tell me a little bit about him?

Yes. First, I want to say an even more emphatic thanks to you for inviting me on. You're right. My message to you was in somewhat spicier language than you just recounted. And it's really to your credit that you said, let's have that discussion.

So yes, for me, this all starts with my brother when we were in our early 20s. And it's important to say just as...

The biological vision of psychiatry was taking hold. So this was in the early 80s. My brother was put on a lock or diagnosed as severely bipolar. Our terrified parents were told that if he didn't adhere to his medications, his psychiatric medications, that he might well take his own life. And that's where his journey and our journey started.

He was an aspiring musician, aspiring dancer, and he couldn't perform, couldn't pursue his art on the medications that he was told he would need to take for the rest of his life. They caused tremors, so it inhibited his piano playing.

They left him feeling like he had a blanket on his brain. And so despite that severe diagnosis, after several years against psychiatric advice, he went off his medications. There's lots to tell about what happened in those next few years. But ultimately, his is really a triumphant story

And I think raised profound questions, certainly for him, very much for me, about what we've come to take for granted over the past 40 years or so, which is that our brains, our organs, they should be treated as such medically, and that that's the way to think about mental health. So I said about writing this book that both ask those questions about

mental health and also ask questions about who we are, how to think about ourselves as human beings.

Without ruining the book, your brother goes through lots of different stages. At one point, he's homeless. He doesn't come to your wedding. You admit that you're sort of relieved about that. One of the details, though, that sticks out to me is you talk about how Bob rejects his diagnosis. And I wonder what it means to reject a diagnosis. In other words, if I have cancer...

Even if I decide I'm going to not do chemo or radiation and instead I'm going to do sort of homeopathic remedies or vitamins and herbs, I still have cancer, right? And I sort of wonder if you make a distinction between those things or how it's different.

I do make a distinction because cancer is something we can physically find in the body. We have never, after a century and more of searching, found psychiatric illness in the body. I suppose there are a few very minor peripheral exceptions, but for decades and a century or more,

We've tried to autopsy the brains of people with psychiatric disorders and found no differences. And even now with our technology, which is so vaunted in our imaging of the brain, you cannot look at the brain of a person who's been diagnosed with schizophrenia or another form of psychosis-related disorder and ID that person.

condition by looking at the brain. Now, the exception to that, and I want to be careful, is that over a great deal of time, the brain may atrophy to some degree. And there's a lot of debate, is that atrophy caused by the condition or by the medications? But you cannot take, let's just say a

30-something-year-old person's brain or two 30-something-year-old brains, one that's been diagnosed, one that's not, and distinguish them physically. That's, I think, beyond debate. So we can't diagnose based on anything definite, based on anything physical. Now, that is not to say that there aren't telltale behaviors, beliefs that don't

distinguish disorders. And that's what Freddie DeBoer would emphasize emphatically. What my brother would say, and we have his hospital records, so like psychiatry's conventional terms, there was really no question about that diagnosis. I mean, he thought he had extreme powers. He set off, at least according to our family, to cure our grandfather of Alzheimer's. So all these would fit the DSM's criteria.

He found that diagnosis, and I think, as it turns out, with quite a lot of justification, to be a kind of verdict that he would not accept and that he felt—and ultimately it's proven to be true, spoiler alert—

that he could live his way out of. That doesn't mean that all can, and we're going to get into tricky territory because I don't want to be here preaching that people simply abandon their psychiatric medications, but I do want to be raising some profound questions about the way we think of ourselves, our psyches,

And I hope we'll get to this, the possible really meaningful differences between our brains as organs and our minds as psyche or self. I guess what I, I'm trying to get to your answer about what makes something real? What makes something real? To me, a brain scan is one measure of how something is made real. But if you're seeing a homeless person, you know, I live in the middle of L.A.,

running down the middle of the street, ripping off his clothing, swinging a machete, maybe defecating in public. These are all things I've seen in the past few months of my life. I don't need to see a brain scan of that person to know that they are deeply unwell and sick.

Right. So let's move away then from the brain scans because you, in all likelihood, will not find a distinctive brain scan with that person. So let's move on to behaviors and to the way we think about disorder, illness, difference, etc. Am I denying that the person you describe—and of course, I live in New York, so I'm well aware—

For me to deny a disorder in that person, no, I'm not doing that. But I am saying, for starters, that person is bad.

in a very, very extreme state, even by the standards of those who've been diagnosed with a condition which is already extreme and fairly rare, like schizophrenia or other psychosis-related disorders. So by taking that person, we are ignoring then so many cases of

where we're going to call our shared reality gets distorted or drifted from or someone is existing at times very distant from it. So many people on the spectrum that

would qualify for conventional psychiatric diagnosis, certainly, but would not be out there raving with the machete. So what I tried to do in this book, by telling my brother's story, who was diagnosed as severely bipolar, by telling Caroline's story, who...

really struggles with some of the psychotic hallucinations that are most scary to us. If she weren't a woman, we'd probably be terrified, right? Her voices are telling her that she's about to be harmed and should react with violence. They're telling her to react in extremely harmful ways toward herself. So she represents an extreme, and yet she's

found an alternate way both to conceive of the realities that she lives with and to cope. Now, why is it important to think about this in a creative way? Because whether we're talking about medications for psychosis, the antipsychotics or bipolar, medications which often mix in the antipsychotics with a mood stabilizer like lithium,

We're talking about medications that, loosely speaking, work to some degree for about half of people, work partially for those they do help, and then on top of that, come with severe side effects, which they're...

extreme movement disorders. So some of what you're seeing with that man walking down the street, whether he be a kind of apocryphal man or a real one. He's a composite character. He's a composite character. Maybe they're actually the result of medication because one of the terrible side effects is a movement disorder where you feel constantly so restless that it's been described to me as like there's a puppeteer behind you and you're fighting that puppeteer.

for control of your own body. It's that, it's the tics, it's the extreme weight gain, it's the dysfunctional memory, and I could go on and on. So our medications are far from the salvation that we were promised they would be back in the early 80s.

About 30 to 60 percent of people abandon their medications. Now, some will argue that's because they're delusional. But of course, they're taking their medications when they abandon them. So they shouldn't be overly delusional, at least at that decision point. Some will argue that's because their lives are disorganized. Probably true for some. But some are simply voting with their feet and saying the pros and cons of this weigh so heavily on the negative that

that I can't bear it. And I think you'll hear, if we're willing to listen, you'll hear that over and over. So I really wanted in this book to explore other possibilities since what I was being told over and over by scientists is we've made no progress in medicating mental illness for about half a century. Given that, where do we go?

Right. So I think two things can be true. It can be true that, and obviously I'd grant this, that the side effects of these medications are horrible. The second thing that can be true is there hasn't been enough scientific discovery. And you can acknowledge that these medications for people are profoundly lifesaving. And I guess here's where I just want to understand if I'm hearing you correctly is

What I hear you saying is for many people who are diagnosed with these psychotic disorders like bipolar and schizophrenia, rather than trying to medicate them with the best versions of medications we have, which I think everyone would agree needs innovation, needs fewer side effects, you're saying we should actually consider the fact that

self-acceptance and a sort of rejection of the diagnosis is emotionally, psychologically, and maybe even culturally better for those people. So rather than saying you hear voices, you're a paranoid schizophrenic, it's you hear voices and maybe that's okay. Maybe there's a way to harness them. I think the key word in what you just said is consider. And

If we can cling to that word, the simple answer is yes. I think we should consider those alternatives simply because the medical alternatives that we have are so problematic. They are life-saving for some. And I do so intimately know the family terror that can be involved with these diagnoses. And I've heard from rather close family friends who've said, what else is

were your parents to do other than try to make sure that your brother would stay on those medications? They were frightened and this is the best we have. I guess I would emphasize two things. Again, I am not preaching, hey everybody,

Liberate yourself from medication. No. But it seems to me the reason for reappraisal is not just the problematic track record of the medications. It's not just that we've stalled in finding new medications. It's that there may be something fundamentally amiss in the approach that is behind the

the no progress over the past half century, or really you might calculate it 70 years. So as one of the neuroscientists said to me, and he's this great researcher into depression, and as hardcore as you can get, I mean, he's dissatisfied with the neurotransmitter model, and he's looking at molecular activity inside the brains of people who are resilient to depression. We can get into that later. But he said to me, look,

When I started down this road in late 70s, early 80s, we thought that we'd cure cancer and psychiatric illness would be right beside that. Well, we haven't really cured cancer. And as he put it, cancer is so dumbass simple compared to the psychiatric disorders. The other thing he said was this, look, I can take any other organ in the body.

I can give you a little piece of it. I can often give you just a cell of it, and it will be doing what the organ does. You can go Google heart cell, and it will be pumping. You can't do this with the brain. The neurons, the individual brain cells are not thinking.

The hundred billion cells and their almost infinite interconnections are adding up to thinking, consciousness, self. And that difference may be so great that we're just talking about two different things when we're talking about the brain and the mind. I appreciate you saying, I'm not saying throw out your medication.

But there's a way that you can make the implicit argument that medication is bad by telling and selecting particular stories as emblematic and having them stand in for a certain set of ideas. So the three characters in your book, your brother, Bob, Carolyn, and this lawyer, David, are all highly intelligent. You might even say gifted. And they are all people who

who have the ability to essentially what I call like talking back to their illness, right? They're all aware that they are sick. They have the ability to see their own sickness. Carolyn knows that she hears voices and knows they aren't real. David is able to articulate in very powerful and disturbing language the kind of contours of his depression. And your brother also is able to articulate himself.

I would argue that that kind of thing is absolutely the exception, not the rule. It's that when most people are sick with this kind of psychosis, there's no way to persuade them because they are not able to recognize their sickness. They're not aware of it. So I guess I've wanted to ask you if you view these people as being emblematic or as being exceptional.

Freddie, when medicated, is extremely, extremely lucid and cognizant about his bipolar disorder. But as he will say, when he's manic, he really thought his ex-girlfriend was putting poison in his food or glass in his food. How do you understand the characters you've chosen as sort of being marshaled to make a particular argument about the nature of mental illness? So, yes. Yes.

I have, to some degree, assembled three really compelling characters, really compelling stories to get people to rethink. Sure. On the other hand, what you're describing, that condition of lack of insight into one's own condition, I would also put on a spectrum. So

In the most severe situations of psychosis, I could not, you could not reason with that person. But my experience, and of course I've spent lots of time with people who are diagnosed with various forms of psychosis, my experience is that comes and goes, and I think even Freddie would probably say it comes and goes even when one is not medicated.

And I think what we are too tempted to do as a society is to paint this as an either or. It's just not. People do enter states where they're absolutely unreachable. And one of the compromised positions that some

psychiatry could take is, okay, we're going to medicate those states, not that person, and see if we can't find a way out. One of the people I mentioned in the article just briefly finds a kind of calibrated, a downgraded protocol of medications that allows her to function without the terrible side effects, but allows her condition to be muted just enough. I think that

Conventional psychiatry's mistake is to simply manage risk. You know, that, your composite character is so terrifying.

to the person sharing the street with him or her or to a family member, that it's hard for us not to simply want to control that situation with a maximum amount of medication. But perhaps that isn't the way that's going to help that person find something like

a meaningful life. But it's not just about that person and finding a meaningful life or getting to express themselves creatively. It's also about society and the people around them. I don't need to tell you this. Talk to a parent who's had a child who's going through psychosis who is large and bigger than them and physically threatening them and their other children.

And it might seem like they're thinking, maybe I have someone who can be aware enough of her illness that it can be controlled. The problem is, is you never actually know what could happen next. That's exactly the nature of the disease. And the control that I see you kind of

being skeptical of, let's say, or even maybe demonizing in the book is the thing that literally keeps the people around that person safe. So yes, it might lead to weight gain or it might lead to tremors or it might lead to horrible things, but it also might protect someone from getting like physically assaulted in their family or worse. Right. To me, it's like, it's a little bit like talking about criminal justice reform and only focusing on the people that are in jail for marijuana. Right.

Like here in this book, we have the easy cases. It feels easier to rally behind these people. You look at an example the other day, there's this case of Bailey Homer, 26-year-old in Illinois who two weeks ago killed his mother's friend with a knife in her garage, stabbing the person in his head and body. He had paranoid schizophrenia. His family begged to get him committed. The kid even called 911 on himself and told them he was homicidal.

but they couldn't commit him because he wasn't a danger to himself and others. Let me jump in here with three points, if I can, that might seem disparate at first, but I don't think ultimately they are. Number one, I just want to refer to one of the most accomplished neuroscientists, psychiatrists our country has, and that's Steve Hyman, who ran the National Institute for Mental Health for years. He's now a genetic researcher in the field of psychiatry. And what he...

called for emphatically with me was what he called epistemological humility. That is, we have come to the point where we don't know and we need to keep that constantly in mind. And we can go into more detail about that. But the idea that we can treat these diseases as purely biological and treat them successfully is just not where we're at. But let me come back to you with a question because

because here's where we get into what I objected to in your conversation with Freddie DeBoer. I felt like I was being cast as this excessively woke, kind of typical new New York Times-y writer. And that could not be further, I think, from where I am in general.

I think there are lots of demographic groups that have very heightened propensities for violent crime, much more so than those diagnosed with severe mental illness. So men over women, let's start benignly.

young men way over young women, people who are poor over people who have money, and then let's do the non-benign and offensive and just say, yes, by race, people of color, black people, Hispanic people commit violent crimes at rates varying from three to one to six to one over white people. And we'd like to talk about that. It's a fact and it's relevant here because I don't think

any listener would advocate preventatively sedating any of those high propensity groups as a way to forestall or prevent violent crime. And that is effectively what those who advocate involuntary medication advocate.

But Daniel, the young, the poor people of color that you're mentioning, and obviously all those statistics are real. I wouldn't dispute any of them. What those people have in common with each other that someone with paranoid schizophrenia or manic bipolar does not is they can be reasoned with. That is the difference.

And yet, at the point of picking up a gun, I don't think anyone is being reasoned with. And that's the point you're talking about. So that even, let's talk about the current New York administration, which is, I think you and I would both agree, fairly no-nonsense. Eric Adams is not an exceedingly woke mayor of New York. His new head of Department of Health, whose background is in mental health,

certainly would not advocate an end to medication, but what he would point to as potentially a

not quite curative, but a potential profound solution is that we need to look upstream, he would say, not at the point of crisis as you are, but we need to look upstream at the extreme isolation that people with severe mental illness so often fall into. And that extreme isolation has to do with

with the kind of either or thinking that you are laying out. So what,

Caroline offers us, if I can, is a different way of thinking so that we're not so clearly dividing the reasonable from the unreasonable, the completely other reality from the reality we all share, the possibility of violence on the one hand from, you know, my apparently completely and invariably peaceable nature. We're not making those decisions.

sharp decisions as a way to bring people in rather than pushing them away, which I hope is what my book is partly about, is about arguing against that push away and

And arguing, you know, this is where you're not going to like the language, but arguing for a vision of humanity that's more expansive. I'm not going to like a vision of humanity that's more expansive. Anyone would like that. I think you'll worry that it's too woke. No, no. Here's what I'm worried about. There is reality. We don't live in something called a non-consensus reality. Right.

And to indulge that is to indulge a lie in the same way that it's a lie to say there is no difference biologically between men and women. I don't like lies. That is what I'm opposed to. The person I mentioned before, Bailey Hammer, told his parents that he saw a scaly demon crawling up the walls of his room. I will not ever agree with someone who wants me to say there's a scaly demon. And that's just a non-consensus reality.

And I think as writers and as people also who want, in your humanistic language, a more expansive humanity, I want to help that person. I don't think it's helping that person to indulge the idea that there's a scaly demon or that someone's ex-girlfriend wants to put glass in their food.

So to me, it's not about wokeness or identity politics or anything like that. It's about whether or not we can agree that there's such thing as real and not real. I won't indulge something that suggests that there's a spectrum when it comes to something as important as reality. When you say, I want to help that person.

The question is how? I think that by invoking those violent cases, by going to the extremes, we are distorting the conversation and thus making ourselves less able rather than more able to, as you say, help that person. And what Caroline would say is she runs groups.

groups that do try to help people. And one of the credos is when I'm controlling, I'm not connecting. And what I hear as you speak is that desire to help that person through controlling. And if you think about it, I think many, many family members, parents sort of know this at some level. We may not be able to control and in trying to control,

We're not able to bring that person in any way toward us. And her point is it's that connection that might be the saving or mitigating force. But Daniel, I see that as a false dichotomy. You continue to set up this dichotomy in the book as control versus connection or care. I don't see those things as mutually exclusive or in contradiction at all.

If control, temporary control, is the thing that will save a person's life as they're repeatedly trying to commit suicide, that has to come, yes, before connection. Just like a toddler who's trying to touch a hot stove or wielding a knife, you have to take that knife. And then you say to them, I love you. I did that because I'm stopping you from harming yourself and us.

I think it's interesting that we each are sort of alleging that the other is creating a false dichotomy. And of course, I think there are shades of gray. Well, what's my false dichotomy? Well, the false dichotomy that I'm saying you're in danger of speaking to is one that

where we're drawing sharp lines between well and not well, thus intervening in the most emphatic way possible, whether it's with very serious medications or, as you just said, with hospitalization as a way to begin to solve the situation. What I would say in response is

There's no evidence that a stay in a hospital is going to have long-term benefits as to suicidality. So

We've just started in this country a new, heavily federally funded suicide hotline. And again, I don't want to be telling people not to call a suicide hotline. That's not my message here. But you're told when you call that line that it's confidential. In fact, when you call, your risk for suicide is being scored. And without consent, if you score above a certain point,

a police car and an ambulance will be sent to your door and you'll be involuntarily committed. Now, that is one way to go about things. And for sure, for the two weeks you're in the hospital on average, you will probably not kill yourself. What happens thereafter is where the interesting discussion comes in because what benefit did that hospital stay have? Did it further isolate you

make you feel less agency, make you feel like you had less control over your life and thus more helpless and hopeless? Or did it help? And that's a very open question. And again, I'll go to the alternative paradigm is, again,

something that I think Caroline's quite an innovator on, which is to have suicide prevention groups where nothing you say will trigger a call to any authority whatsoever. That's an absolute rule. And where the idea is that simply by sharing, by connecting, we are lowering the risk of someone taking his or her own life.

I think that's a pretty compelling, intuitive approach, and I think it carries across the field of mental illness. I think it follows Steve Hyman's dictum of epistemological humility, of we don't know.

I guess I don't think I'm engaging in a false dichotomy because people don't start on medication. They start with behaviors that alarm the people that love them and often put them in danger. And the medication is a response to a behavior that's evidence of sickness.

Are there certain instances where well people who just have the blues are getting put on too many SSRIs? Of course. But what we're talking about here is severely mentally ill people. And you seem reticent to even draw a line regarding them. And that worries me because it's basically, if everyone's unwell, then no one's well. To me, it's the erasure of distinction between

that I think, while not obviously intentionally, let's say, woke, winds up in a very similar place. So here's what I mean, okay? I don't at all see your book as intentionally political or your argument as intentionally political. I see it, though, very much dovetailing with a particular, let's call it, cultural agenda that is very much in the zeitgeist right now. So the idea...

super salient in cultures we live in that everything is a construct or every perspective is equal and valid and needs to be affirmed. The idea that your illness maybe is actually a special thing. Here's one example I was thinking of when I read it. There was this panel discussion that was supposed to happen at Harvard back in May and it was

called something like alternative ways to treat autism. And there was this outcry from Harvard students because they objected to the idea that autism should be treated at all. They said it was violently ableist. Now, it'd be one thing if this was limited to the Harvards, but it's all over TikTok. It's in the war that's happening against cognitive behavioral therapy, which has saved the lives of people I know. It is in the movement to decolonize therapy, which tells people that

Making yourself better is a symptom of internalized white supremacy. So I fully understand that your work is originating from a very, very different, much more intellectually rooted place. But ultimately, it's winding up with a lot of the same conclusions. Tell me where I'm wrong. I'm going to say that

There's nothing you just said that's wrong, but that the dovetailing is the mistake. The sweeping it all into one big basket is the mistake. So yes, I would say that my book is not out of the kind of ideological package that you're pointing out. It's out of a reality that science has established

at least at this moment, 50 to 70 years onward from the inception of Medications for Our Minds

the reality that we've not succeeded, we've not found a way, and people should be skeptical of the way we have come to take medication for granted. And let's go to the bipolar diagnosis of children, of minors, which between '97 and 2007 increased by 40 times. Now, it could be

that we had underdiagnosed children with bipolar by 40 times and that the new reality is the reality. But it could also be that drug companies had funded influential psychiatrists to promote the idea that child bipolar was underdiagnosed and, and here's the key, not just to prescribe lithium to those kids,

but to prescribe a very hardcore antipsychotic as a way to sedate, subdue those kids, and thus get into a really much more severe set of often irreversible side effects. It does beg the question, what is...

real? I know you don't like that question very much. I love that question. You seem to believe that scaly demons might be real. I'm looking at Barry Weiss on my computer and I'm guessing she's real and this conversation is real. I think those who

If you want to use scaly demons, those who see scaly demons are tormented by them and wish they didn't see scaly demons. Scaly demons is me trying to be funny in a really heavy subject, but I don't want to straw man myself, right? Let's take it away from hallucinations. When my producer's cousin calls him and is certain that all of her friends hate her,

And that even though they just hung out the night before and had fun, that she thinks they literally want her dead. And she's calling to say goodbye. Now, do you think that that person is sick?

So science depends on categories, right? We can't research things without categories. We can't know in a scientific way without categories. And yet, science is going to have trouble, particularly with our psyches, because they're so individualized. And in order to understand the person you just described, psyches, to really understand, we're going to have to really, really, really listen, listen past them.

quick diagnosis. So I could come in as a psychiatrist and say, okay, that person is suffering from severe delusions. Let's hospitalize for a week or two, get that person on antipsychotics, which we will assume that person will be on for the rest of her life as a preventative measure. Or I could say,

Something in between. I could say, let's hospitalize for a couple of days and let's start a real conversation, see if a real conversation, set of conversations, putting that person in Caroline's group, for starters, would help and see where we go from there. You know, I'm off the top of my head offering in-between ideas. And I think Steve Hyman's point about epistemological humility is to call for

further individualizing care, it's to call for being leery of being categorical in our fear. Even as that fear, the parents of the person you just described, even as that fear is very, very understandable. Even as my parents' fear was very, very, very understandable. After all, my brother was homeless, was arrested multiple times. I mean,

And yes, I checked out on him and was relieved that he didn't come to my wedding because I wanted to have a nice, conventional, peaceable wedding. And that still, when I read aloud those passages from the book, sometimes I get choked up. It just sort of catch me by surprise. Like,

How did that happen? How did I check out so profoundly? And I think it does speak to fear. But there are certain things that deserve to be feared. And the cousin that I just mentioned is not an abstraction. This is a real person who really made that call, whose life is really on the line. I want you to kind of be straight with me here. Like, is that person in your mind sick or

Because I'm unclear about with all the talk about spectrum, what makes a person sick or is no one sick and everyone's on a spectrum of sort of well to unwell. At the risk of going too far, I'm going to say that using the word

sick the way you're advocating, pushing for, I think just may not be constructive. It may not get us anywhere because it's a conception. Let's go back to where this conversation started with cancer. There's so rarely any argument. It is either or. Here,

We're just not in that realm because the mind isn't the brain. We were told the mind was the brain. When my parents told me, your brother's in the hospital, they handed me a book that said psychiatry has entered its third revolution and this revolution is going to allow us to cure our psychiatric conditions with chemicals. That just hasn't proved to be true.

And confronting that failure or that frustration, really confronting it as a culture, because as a culture, we want that fix. We're desperate for it. But confronting that failure and frustration may require not using bright line words like sick. Are we helped by assigning the word sick?

Well, I think I hear you maybe going further than that. And let me explain what I mean. There was a podcast I watched where you spoke about Carolyn and you say this, she is living in multiple spaces. She is sharing experience in alternate realities.

It's an entirely different way of seeing, you say, in describing her. It's a kind of neurodivergence. And then, and this was the one that stayed with me, what is the voice saying that's true? Now, imagine we're speaking about a girl who has starved herself to 90 pounds, and she still says, I see myself as obese, and she insists on it. And she says, if you contradict the fact that I'm obese, you're denying my individual experience of

Now, when we describe that girl, that anorexic girl on death's door as living in multiple spaces or experiencing alternate realities, I don't see the difference here is I think what I'm trying to get across. I see it as indulging a lie that is very potentially life-threatening. When a voice speaks to you, you're not saying, you know, the voice in the anorexic girl's ear is saying, you're fat, you're fat, you're fat. And we don't say that.

What are they saying that's true? We say resist that voice. It's dangerous to you. So conventional psychiatry tends to, not always, but almost always, see the voices of psychosis. And I want to be careful because starving oneself is a different category than psychosis, but tends to understand the voices of psychosis as meaningless. They are

meaningless, random assaults by the brain upon the brain. And Caroline would say, and I think if we think about it intuitively, many of us might say, well, wait a sec, think about dreams for a second. Research tells us that some dreams are indeed random and meaningless, but surely some we know. We wake up and we think, wow, that

That dream came from that place. They're not quite meaningless. So why are we assuming that these voices are meaningless? And now I'm going to give a very extreme example that she recounted to me. A woman, a mother, calls her, and Caroline works late at night hearing from voice hearers and says, I'm hearing a voice repeatedly telling me to cut off my hand

Or the voice is going to harm, badly harm my young child. Now, when I first heard Caroline tell me this, I didn't even ask a follow-up question. It was so overwhelming to me, the darkness of that situation. I just couldn't think my way out of it. And all that stuck with me was, Caroline, you are dealing with some very, very dark things in the people that you try to help.

When later I asked her about it, she said, "You never asked me what I said in return." And where I tried to lead this woman was to the possibility

especially because it was during the pandemic, during times of extreme isolation, when she might be feeling, as all mothers or many mothers do, completely overwhelmed. And there was a fundamental opposition being placed in front of her, a false opposition, but nevertheless a palpable one that was save yourself or harm others.

your child, save yourself or let go of your child. And that this is something that parents feel as an undercurrent, sometimes consciously, and that this was coming to the fore in this absolutely horrific voice hearing episode. Now, once she'd explained that to me, first of all, I just thought,

Yes, it is possible, Caroline, that your voices, your experience, as difficult as it has been, is giving you access to a kind of insight that many of us, perhaps most of us, simply would not have. And second of all, that maybe we should apply that principle more expansively. After the break, more with Daniel Bergner. We'll be right back.

America is the most medicated country in the world, but I don't think you or I or anyone paying attention would argue that we're the most mentally healthy. There's a death by suicide something like every 11 seconds in the country, and that's to say nothing of the suicide attempts. And that's more than it was a generation ago. And that's more than pretty much any other wealthy country in the world. Why do you think that is? I don't know.

One thing I would guess, and here I would be disagreeing with Freddie, who would argue that it's because there's a lack or insufficient access to mental health, which is inarguable. In certain places, you are going to wait and wait and wait to see a psychiatrist.

But I think it would be hard to argue that that is why we're in a mental health crisis, that that is why suicide rates are problematic. And I think someone like Thomas Insull, who's much more conservative on this than I am, Insull is another former NIMH head, would point out we've spent

billions and billions on psychiatric research and haven't moved the needle at all in terms of suicidality. Right now, and I know you guys are experiencing this in New York, but I think LA is particularly bad and certainly San Francisco where my wife is from is terrible. When you look at the homelessness in cities and how many of them suffering from drug addiction, but maybe more of them suffering from mental illness,

And I've been curious about who these people are, how they got onto the streets, you know, and thinking about controversial subject, you know, which is the idea of bringing back a humane and not barbaric version of the mental health hospitals that were phased out by federal and state governments over the past 40 years. I wonder what you make of that idea.

So one of the reasons for really long, profound pause on that is, of course, we went through a reformation of asylums. That was the so-called first revolution in mental health. This happened, loosely speaking, as the late 18th, early 19th century happened.

You know, liberating, we no longer were chaining the mentally ill to walls and leaving them in unheated dungeons and letting people pay to gawk at them. Are we sure that we would do it better this time? And are we sure that...

that isolating people, because again, inevitably, it's a form of isolation. Are we sure that wouldn't cause more damage? I don't see how we can get anywhere near that level of certainty. And that's why I take this trip to Israel and spend time in a soteria house, which I

It's a very kind of fluid environment. People have been diagnosed with quite severe conditions, often psychosis, so often not sharing the reality that you and I are sharing right now. So often you could say beyond reason, but the cure is largely, and I say largely because there is calibrated medication sometimes involved.

But the centerpiece of the approach is two words, being with. That is, Pesach Lichtenberg, who grew up here and now a psychiatrist in Israel, hires basically paid interns who are simply there to be curious, interact with people with significant disorders. And that is seen as...

profoundly mitigative, if not curative. So that's the kind of thing we could be talking about. I'm not sure that our culture is ready to have such faith in an approach that is the opposite of exerting control.

Let's wind back the clock to where your book begins and where we began this conversation, which is with your brother, Bob, who you could argue he was pressured, but actually commits himself and signs himself in to this institution. You don't judge your parents in the book. You say they were so scared. You describe them as being so fearful and you're empathetic to some extent toward them. If you could go back in time,

When your brother started showing signs of his bipolar disorder, or maybe not his bipolar disorder, whatever reality we're living in, what would you do if you were his parent and you could go back and change history for him?

which I think will give us insight into what you would do really if you had a wand and could magically change the way we think about and treat this subject. Right. So the first thing is to just acknowledge, I can't say for sure, and I know how terrified I would be. But I've asked my brother that question many, many times. What would you have wanted done? What would have been better?

Because in some ways, our dad just passed away, but their relationship was never really fully healed, only partially so, because my brother felt seen in such a limiting way by our parents.

And what my brother has said is I would have wanted to be treated as the Turkey Prince was treated. And what he's referring to is a rabbinic parable that Dr. Lichtenberg taught to me in Israel. And to simplify it here, you know, once there was a kingdom,

where the prince thought he was a turkey. The king and queen were distraught. The prince would only sit under the royal dining table and nibble at little bits of bones and bread. And all the king's doctors came and failed to cure him. And finally, a sage comes and gets under the table with the turkey prince and disrobes and eats everything.

bits of bone and bread with the Turkey Prince and in a sense meets the Turkey Prince where he is, listens to the Turkey Prince's reality. And my brothers repeatedly said that was the solace he needed. That was the leadership he would have wanted, the intervention he would have wanted and the,

I can hear my terrified parents' response to that. What would they say? They would say we were dealing...

with a medical condition and the Turkey Prince was ill. And we did everything we could to save the Turkey Prince in the way we knew how. And it's important to say, I mean, my father was a physician, a public health official. He would say, you're completely unreasonable. And we needed to intervene immediately.

in a medical way. We may not be able to reconcile those two visions, but you asked what I would want, and I can only respond with what my brother has said he would have wanted, which was someone to get under the table with him. It's a beautiful parable, but practically speaking right now, for my composite character, who's wandering around the streets of Los Angeles, whose voices are deranging him,

who could be a danger to themselves, certainly to others. What do we do for that person? Okay, so let's go back to that character, that composite. So when you first posed him, he was carrying a weapon. Real guy, swinging a machete, West Hollywood, middle of the day, defecation in the street. Another example, seven blocks from my house, screaming and lunging at

happens constantly. And frankly, if you're a woman and not a very tall woman, that's kind of scary. Like I don't, you know, I've definitely changed my behaviors in terms of where I'll walk alone at night here in a way I never had to do in New York. So those are the different aspects of my composite character, screaming, running into the middle of the street, you know, happens all the time. So machete, that's a crime. I'm dealing with it as a crime first, because that is a bright line.

Defecating in the street, similar. I might take a somewhat softer approach ultimately, but if you're defecating in the street, you are committing a crime and I or society has every right to intervene. Again, I might take a softer approach and we'd have to talk for hours about what that might be. Screaming and menacing at you

Here, and yes, I've been to San Francisco recently and I had the same thought and just like that, wow, is this actually happening in the middle of the day on the sidewalk? It's a wow moment. It's not okay. And if that becomes menacing, and of course there are questions, what is legitimately menacing and what are we perceiving as menacing? But let's leave those aside.

If it comes to criminal behavior, that is where we have bright lines and that is where society gets to intervene and intervene immediately. I guess what I'm hearing there is sort of what I said before. It's not control versus connection and care and curiosity, I might even add, but it's get the situation under control first and then go to care and connection, which are frankly higher order things, right?

It's like food, water, shelter, and then. Well, except, Barry, and I think here, we're just going to always sort of drift back, at least on my end of the conversation, toward complication. So if I'm quietly imagining violent acts and I'm simply imagining them, then we are in a gray area. If I report them and report intent, then

And if they're then again, Caroline would argue, let's not overreact. Let's try to create connection before we even think about control and that control only comes in when thoughts become action.

We could have that conversation for hours. I actually think there are real differences. I think from this conversation, you're a fan of real differences. And there is a real difference between walking down the street, waving a machete and considering money.

violent acts. We don't litigate thought. Right. I guess I would say that wow shock you feel when you look around the streets of San Francisco is a direct outgrowth of policies that are a direct outgrowth of bad ideas, perhaps promoted with the best of intentions, but

based around questions like freedom and choice and not wanting to control people that have led to a situation in a city that is absolutely untenable and unlivable. Yeah, I think San Francisco, at least certain areas of San Francisco, raised that kind of warning. And yet I think we're missing something along the way in sort of presenting this as a, either we go back to a

romanticized 1960s version of what psychiatry does, or we stick to what it does now, which is control first.

And that is, are there other ways to think? And I think that is partly why I wrote this book. Caroline presents some of those alternatives. So imagine that room, whether it's the suicide prevention group or whether it's the hearing voices group, where people are sharing very counterintuitively, they're sharing with

without the risk of being put away. And they're sharing very, very, very dark thoughts. But that doesn't mean that there's not nuance in that room about medication doses, which is a really important thing that we haven't talked about, or temporary medication approaches. There's all ranges of approaches in that room. It's just that we're not treating those people

as categories and we're not reacting to them as if they are just one step away from the machete wheel there because they're not, again, I'll just quote Caroline who just said, we are so inundated by the idea that people suffering from serious mental health conditions are kind of the icons of Halloween, the images, the embodiments of our nightmares that we really are profoundly affected

failing to see other human beings, to see ourselves in other human beings. It's not that I'm not seeing San Francisco. It's not that I'm not worried. It's that I think we might explore more constructively the alternatives that Caroline, that my brother, that Pesach Lichtenberg in Israel, that others offer. Well, Daniel Bergner,

Thank you so much for making the time and for coming on. I really appreciate it. I'm really glad that you responded to the other episode. Thanks, Barry. And thank you for a really great and searching conversation.

A huge thanks to Daniel Bergner for writing me and for joining me today to have this conversation. And my thanks to you as always for listening. If you like this conversation, if you heard things you disagreed with or things you agreed with or things you're just not sure about, all of those are good things. Share this with your friends and family and use it to have a conversation of your own about the state of mental illness and the way that we think about it.

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