The Upside of Bipolar: Conversations on the Road to Wellness
Living with bipolar disorder sucks! Each week Michelle Reittinger and her guests explore tools and resources that help you learn how to live well with your bipolar. If you are tired of suffering and want to live a healthy, balanced, productive life with your bipolar, this podcast was designed with you in mind.
The Upside of Bipolar: Conversations on the Road to Wellness
EP 64: The Serotonin Myth: Rethinking Mental Health with Dr. Joanna Moncrieff
In her new book "Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth" Professor Joanna Moncrieff exposes how millions have been misled to believe they have brain chemical imbalances requiring drug treatments when no evidence supports this view.
• Depression is a normal human emotional response to life difficulties, not a brain disease
• The "drug-centered" model recognizes psychiatric medications as mind-altering substances that temporarily mask symptoms rather than targeting disease processes
• Disease awareness campaigns funded by pharmaceutical companies deliberately changed public perception of distress as medical conditions
• Scientific studies showing minimal differences between antidepressants and placebos are systematically misinterpreted to support the disease model
• The psychiatric establishment responds to criticism by attacking messengers rather than addressing evidence
• Alternative approaches should focus on understanding distress in context of people's lives rather than medicating normal emotions
• Recent progress in recognizing withdrawal effects and persistent side effects shows growing awareness of medication risks
Website: www.joannamoncrieff.com
Bio:
JOANNA MONCRIEFF is Professor of Critical and Social Psychiatry at University College London, and a consultant psychiatrist for the National Health Service in London. She is author of numerous scientific paper and several books on psychiatry and psychiatric drugs. She is a founder member and co-chairperson of the Critical Psychiatry Network, an influential network of psychiatrists and other doctors. Her latest book is “Chemically Imbalanced: The Making and Unmaking of the Serotonin Myth” (publisher Flint Books), featured in The Sunday Times.
FREE Mood Cycle Survival Guide: https://theupsideofbipolar.com/free/
FREE Facebook Group for Moms with Bipolar: https://www.facebook.com/groups/bipolarmomslivingwell
website: https://theupsideofbipolar.com/
Instagram: https://www.instagram.com/theupsideofbipolar/
Facebook: https://www.facebook.com/theupsideofbipolar/
If we think about the term antidepressant, that to me is a very misleading term, because we don't have drugs that target depression. We have no idea what's going on in the brain, if anything specific, when people feel depressed, and we have no idea what the drugs that we call antidepressants are doing and whether they bear any relationship to any of those processes. So to call a drug an antidepressant is really misleading.
Speaker 2:Hey, welcome to the Upside of Bipolar conversations on the road to wellness. I am so excited that you decided to join me today. We're a community learning how to live well with bipolar disorder and we reject that. The best we can expect is learning how to suffer well with it. I'm your host, michelle Reitinger of MyUpsideOfDowncom, where I help people with bipolar disorder use the map to wellness to live healthy, balanced, productive lives. Welcome to the conversation, welcome to the Upside of Bipolar. I am your host, michelle Reitinger, and I have an incredible episode for you today.
Speaker 2:My guest, joanna Moncrief, is Professor of Critical Social Psychiatry at University College London and a Consultant Psychiatrist for National Health Service in London. She is an author of numerous scientific papers and several books on psychiatry and psychiatric drugs. She is a founding member and co-chairperson of the Critical Psychiatry Network, an influential network of psychiatrists and other doctors. Her latest book, chemically Imbalanced the Making and Unmaking of the Serotonin Myth, published by Flint Books, featured in the Sunday Times. I've had her as a guest before and I'm so thrilled that she's agreed to come back on my podcast today and speak with us, because this book that she has written is life changing. It is probably the best book that I have read on understanding psychiatry, what's happened with us with the disease-centered model, how that has impacted psychiatry as a whole and our society. It's just brilliant. Thank you so much, professor Moncrief, for being on our program today.
Speaker 1:Thank you. Thank you for inviting me, Michelle. It's a pleasure to be back.
Speaker 2:And I want to start again for our audience, to make sure that they know who you are Could you share with the audience what your background is, how you ended up in this field and how you ended up specifically studying drugs and drug action, and what led you to write this book?
Speaker 1:So I'm a psychiatrist that means I'm trained as a medical doctor and then specialized in psychiatry. Psychiatrist that means I'm trained as a medical doctor and then specialised in psychiatry. And I got interested in drug treatment because from the early days of my training it became apparent to me that most people with mental health problems were treated with at least one sort of drug, and usually many sorts of drugs, and not many of them, it seemed to me, really got better. Or if they did get better, it wasn't clear that it was anything to do with the drugs they were taking. So I suppose that piqued my interest and got me questioning what the drugs that are prescribed for mental health problems are actually doing. And that's when I started to think about what I later formulated as the disease-centered and drug-centered models of drug action. So I started to think about, I started to question, I should say, the conventional view that psychiatric drugs work by targeting some underlying disease mechanism. And the more I looked into it, the more I realized that actually there was no evidence for this view. But I did realize that they're not inert substances, they are drugs. They are chemicals that change, that interact with our biology and change and modify the normal way that the body normally works, and so that led me to this idea of what I've called the drug-centered model.
Speaker 1:So that's the idea that drugs that are prescribed for mental health problems, such as antidepressants, but also what we call antipsychotics and mood stabilizers and antialytics like the benzodiazepines, what they're all doing is altering our normal mental states.
Speaker 1:They are producing, they are mind-altering drugs, just in the way that alcohol or cannabis are mind-altering drugs, and therefore what happens is that the altered mental states that the drugs produce are then superimposed onto any underlying problems and difficulties that people have, and sometimes that may be perceived as being helpful.
Speaker 1:For example, you know, if someone's very anxious and agitated and they take a dose of Valium, for example a benzodiazepine, they will feel a bit calmer, just as you would if you had a drink of alcohol. That effect comes about because of the typical alterations produced by Valium, not because Valium is targeting the underlying basis of anxiety or agitation or distress. And so my theory is that that's how all psychiatric drugs are working, including antidepressants, even though it's not generally accepted in the psychiatric world, although it's not blatantly challenged either, because it's difficult to challenge, because these drugs are drugs that affect the brain, that change our normal brain chemistry. There's no denying that. And so, and there's no denying that they do cause that they do alter people's mental states, including people who don't have any psychiatric problems, including when you give them to volunteers or indeed to animals. So those are my ideas about psychiatric drugs.
Speaker 2:Well, and one of the things that I found interesting, as I. First of all, your book is so well organized, because I feel like you present at the beginning the issues at hand. You present the problem and why you're writing this book so that we understand where you're coming from, and I feel like it also draws people in. For me, it drew me in because I thought, yes, absolutely yes, you know, yes, these are issues, yes, these are problems, and I couldn't wait to find out like, okay, so what? You know what are, what's going on here? And? And then you talk about the history and then the science. The science was my by far my favorite part of the book, because one of the biggest issues that we have in our society we have, over time, got become highly specialized, and and we which I think there think there is a ton of benefit to that, because you know it is impossible for every person to become an expert on every aspect of life or health, or you know, and so it serves a great benefit to society to have experts, to have people that spend their life studying specific aspects of the human condition or our bodies are functioning, you know, and, and so there's a benefit to that. But one of the handicaps that has been created by that is that we are becoming dependent on on those experts and and I feel like, in some ways vulnerable because we trust them. We, you know, we need to trust them. We're going them, going to them for a specific reason and that was my experience when I went to a psychiatrist. That was what I was told to do. I was in a lot of mental and emotional distress. I was, you know, then, you know, pleaded my parents pleaded with me to go see a psychiatrist. I went to a psychiatrist and I was told that I had a chemical imbalance and given medications and I there was no way for me to decide whether or not what I was being told was true. And the thing I love the most, I've done a ton of research over the years, you know, as I've gone through the healing process myself and and I've you know, I have a voracious appetite for learning and as I've read a lot of books. Robert Whitaker's Anatomy of an Epidemic was my red pill moment. That was the thing that helped me recognize, like I'm not crazy, like the things that I've been suspecting about what's been going on in my life, my experience with psychiatry are. You know I'm not a crazy person. You know they are true, but I didn't understand the science behind it. I really didn't. You know, even in his book he doesn't break it down the way that you do.
Speaker 2:And I appreciated so much that part of your book because you talk about how research is conducted, why you want a double blind study, for example, and the issues with in psychiatry, specifically with trying to do double blind studies with psychiatric medications, because of the inherent issues with the way that we identify psychiatric issues, with the way that we you know the medication itself. So sorry, there have so many things I want to ask you. So I've got a lot of things in my head right now, but one of the things that I feel like as I was reading that is that the disease-centered model itself creates a problem in approaching all of this, because it creates an inherent bias in the studies that we're doing, in the way that they approach research, because there is an assumption that there is an underlying medical condition. That assumption colors everything.
Speaker 2:And what is I want to know from you, since you were trained as a psychiatrist initially? I mean, I assume I'm assuming that you were presented with that disease centered model. Was that the way you were taught? And then, how did you come out of that? Because I, because I love the way that you present the disease centered versus the drug centered, you know the drug centered, just for our audience understanding that. Well, I'll, actually I'll let you describe that. Sorry, can you describe for our audience what the difference is?
Speaker 1:Yes, I think I have already described it a bit, but it's not necessarily that straightforward. But first of all, I just thought maybe it's good to just go back to the problem that I set out at the beginning of the book, because you've just sort of illustrated what it is so well, and that is the fact that millions and millions of people in Western countries in particular, have been either told explicitly, like you were, or inferred, implied, that they have some biological problem with their brain and that they need a chemical, a drug, to put that right. And that is just that. That is a theory. It's an idea, but it's not supported by evidence and therefore all those people who've been given that impression or told that, have been misled and misinformed, and many, many of them will be taking medication, therefore, on the basis of misinformation. So that, to me, is the problem, and that's why I set out to write the book, and I'm so pleased that you found the scientific bit accessible, because I was worried it was going to be a bit boring, but it is very important. And it's really important because, as you also suggested, the problem is that the people who write these papers have an agenda. Now, that doesn't mean that they're bad people, but they have been taught and sort of inducted into this idea that mental health problems are diseases and that even if we don't know exactly what the disease is, we'll find out sooner or later. And we can just go on assuming that they are and that somehow, even if we don't know what they are, we have drugs that somehow target them. And, as you said, that colours everything, that colours the way that research is set up and, importantly, the way that it's interpreted. So if you go and read the papers without knowing that, without understanding all the assumptions that have gone into generating that research in the first place, you are not necessarily going to be able to understand what those studies have really found.
Speaker 1:And when we think about antidepressant studies the classic study that compares an antidepressant drug with a placebo that is an inactive substance. It's biologically inactive, it doesn't do anything to you, you don't feel any different after you've taken it. Then if you assume that what the drug is doing is acting on a disease process, you miss the fact that it is a drug that is necessarily going to be different from taking a placebo. Necessarily. The experience of taking an active chemical is different from taking an inactive one.
Speaker 1:You know, taking an active chemical that changes your biology is going to make you feel different in one way or another, and if it gets into your brain it going to make you feel different in one way or another. And if it gets into your brain it will probably make you feel a bit emotionally different. Often drugs that we take numb emotions or suppress them in one way or another or change them, make them a bit sort of cruder. So unless you understand that all those effects have basically just been written out of the equation because people are focusing on this idea that what the drug is doing is targeting an underlying disease, you won't be able to fully interpret the research findings creates is even with the informed consent, if somebody believes that their emotional reactions, that they're having to life.
Speaker 2:And that's really what this is. I was in tremendous distress, and nobody asked me about my history, nobody asked me about what I had been through in my life, and so for over a decade I believed I had a biological deficiency, and so there was no curiosity into any of the reasons why I was feeling these things, and as the medications weren't resolving the problems, it made me feel more and more desperate and more and more hopeless. And it's interesting because I've had to go through my own deprogramming over the past 15 years so that I could actually start to see things for what they really were and start to address the problems that had created these symptoms in the first place. The first thing I had to do was heal from the medication. That took a number of years, and then I had to start learning how to identify what was actually causing the distress. A lot of times, when you say that it's not a medical condition, I think what people hear is that you're not in distress, and that is not the case.
Speaker 2:And you talk about that in your book. You talk about what depression actually is, what people are actually suffering from, and I want to know if you can talk as a psychiatrist, if you can address that when you you know when you would. I don't know if you're still practicing and seeing patients, but when you were seeing patients if you weren't now, did you have a mindset shift that occurred from because a disease centered model assumes that there's a deficiency or defectiveness in the person. Where the drug centered model recognizes this is. You're experiencing normal distress. We might be able to help you a little bit through the process of recovering using medication, but that's not actually addressing the problem. It's just going to like for a fever. We're going to bring it down with ibuprofen the same thing as what's happening with the drug. So can you talk about what you know, if you've had a mindset shift as a psychiatrist and what that's been in helping you understand what's actually happening with people when they're depressed?
Speaker 1:Yeah, well, I suppose when I was a young psychiatrist, what I was really struck by was fact that other doctors thought using antidepressants was helpful, but I just didn't. Really it didn't seem clear to me that people were getting better as a consequence of these drugs. A lot of the time people didn't really get better, and when they did get better, almost always something else had shifted in their lives that could explain it, rather than it being due to the antidepressants people were taking. And it was also clear to me that people often get started on antidepressants at a real low point in their lives and the fact that they've you know that they've had to take medication can also be a bit of a wake up call. So sometimes that whole process around going to the doctors can be a spur to people to, you know, to make a change and therefore they improve. But for many people the experience is the same as you have related they take the drugs, they don't actually feel better. Of course the drugs make them feel worse, and then they feel even worse because they think, oh, my goodness, you know I'm not responding to the treatment, I'm non-responsive, I'm, like, you know, the bottom of the pit and there's going to be nothing left for me and end up feeling more and more demoralized and more and more, you know, like a failure and more and more disempowered.
Speaker 1:Labeling distress as a medical condition and telling people or implying to people that the problem is in their brain is really, really harmful. It really can mess with people's self-image and undermine people's agency and hope and all the things that people actually need to help them recover. That's not to say that some people don't need help and support cover. That's not to say that some people don't need help and support. And, like you say, I think the problem is because we've gone down this medical line, because we've gone down this medical route of understanding, of conceptualising mental distress as a medical problem. If you then say it's not medical, exactly as you say, some people feel that you're denying that there's actually a problem, and I don't want to do that.
Speaker 1:I still do work as a psychiatrist. I've worked as a psychiatrist for many years now and obviously many people do have periods of intense distress and some are more vulnerable to it than others, depressed or to getting anxious, often because of things that have happened in their past. But there's a certain amount of individual variation too. Some people will just probably be born a little bit more vulnerable to that sort of thing than other people. We're all different. We have different personalities, but often it is to do with things that have happened to people in the past, and so some people know some people will need more support and help getting through periods of distress than other people, but that doesn't mean that we have to medicalize the situation. There are many other ways of helping people besides telling people they've got a brain disease or a brain disorder and they need chemicals people.
Speaker 2:They've got a brain disease or a brain disorder and they need chemicals yeah, and one of the other. Like I mentioned a little bit earlier, the issue that I have with the informed consent idea is that they're not being presented with any other options, so somebody comes in. I was in severe distress by the time I went to the psychiatrist. It had been going on for a couple of years and I was going through severe depressive periods and then I would get hypomanic and I would have lots of ideas and make lots of impulsive decisions that had a negative impact on my life, which was then making my depression worse, and I felt out of control. I felt out of control. My family was seeing it, they were worried, and so that was adding to the distress because my parents were like something's wrong, you need help right now, and so I was extremely vulnerable.
Speaker 2:By the time I went to the psychiatrist and I've thought about this as I was reading through the you know the informed consent part, I was thinking about it and I thought, if, if I had gone in there and they had said you know, you're, you're? They initially diagnosed me with depression and anxiety. I was so depressed I could hardly talk when I went there, I was crying and I couldn't think. And if I had been told we can give you this drug, it will, you know, possibly help alleviate some of your distress. There's a possibility that it's going to and then listed off the side effects. Even if they told me that you know one of the side effects could be, you know, suicidal ideation, I probably still would have taken it because I wasn't being presented with any other option.
Speaker 2:I was being told that this is the only thing that can help you. And and we do that same thing with medical medications right, we go in and they, they tell you what the side effects, but we're thinking, you know, I'm having heart palpitations and I need help with my heart, or I'm having, you know, circulatory issues, and I, you know. So we, we assume the risk and I feel like it. Yes, it alleviates some of the responsibility on a psychiatrist part, but we're not being given any other options. And I think that is the biggest problem when it comes to informed consent. When I people, when people are saying, when form consent, informed consent, I thought, well, if you're only offered one option and you're only told this is the only option that's available, it could have all these negative side effects, but could also help you when you're in that kind of mindset, you know, when you're feeling desperate. Yeah, yeah, you know, I almost feel like that's not going far enough. Do you know what I?
Speaker 1:mean. So in the UK we do have a national therapy service, so everyone can access a certain number of sessions of CBT type therapy, which you know may not be enough for some people, but I think is a really good start. There is, of course, a bit of a wait for it, and I think one of the difficulties that doctors and other clinicians have is sitting with and tolerating people's distress and holding people, because to me that's something that needs to happen in the sort of situation you describe. There needs to be a holding process. There needs to be a holding process. There needs to be someone to be able to support you until you can get into some therapy and until you're in a place where you can process things a bit better.
Speaker 1:But I think that a lot of clinicians find that really, really difficult and are desperate to have something positive to offer that seems to be a solution at the time. So I think the problem has now become a sort of systematic problem. We're all sort of deluding each other, really, because distress is difficult to deal with. It is uncomfortable to be with someone who's really upset, who's really struggling, and wouldn't it be nice if we had a pill that just took it all away. So we're sort of pretending to ourselves that that's what we have and yet in the long term that's causing so many problems, because it's you know, it's giving people this very damaging message that you know they have a brain problem. And and at least if you as I say, I think which I think you're suggesting you know, at least if someone had said to you look, we've got these drugs, they're not going to solve the problem. They may numb you for a bit and that might be better than what you're going through, but you know they're not a long term solution and they come with all these side effects. So you know, if you do decide to take them, then then don't, don't take them for too long. You know. Get off them as soon as you can. You know that that might have changed the situation for you.
Speaker 2:Well, one of the things I love about you say over and over throughout your book is that depression is a normal part of the human condition. You know, when one of the stories that really resonated with me was and I don't I should have written his name down, but there was a towards later in the book you're talking about a young man who was a footballer and he had I can't remember exactly the sequence of events, but like his girlfriend left him, so he went through a breakup and then he made he was starting to make mistakes at work and you know and so he went to his general practitioner I think GP is also general practitioner for you, correct?
Speaker 1:Yes, yeah.
Speaker 2:So he went to his GP and was told he had, you know, severe depression, you know clinical depression, and he needed medications. And even though he hesitated, you know, he thought well, I don't know what else to do. And so he went ahead and started taking the medications and what eventually resolved, it was him changing his life, you know it was.
Speaker 2:And so I feel like one of the things that I think is really important is not telling people that they have a disorder. You know, that's one thing that I tell people on a regular basis. I have people that I coach through the healing process and when they are feeling discouraged or depressed, we look at their life circumstances. You know, and I'll I have, you know, people who are going through really challenging life circumstances and I said that's, that's a normal reaction to the situation you're in. And and I had one woman say I am so grateful every time you say that it just helps me feel so validated, and I, you know, keep reminding her this is not, this is not disorder. What you're experiencing is not disorder. This is the way that the brain is reacting to distressing situation, like that's a normal thing. You're not abnormal, you are normal. That is how our brains are designed to react, right, and so I think that, oh, go ahead, sorry.
Speaker 1:Yeah. So I think it's useful to think of emotions as the way that intelligent, the intelligent creatures that we are, respond to our environment. You know animals some higher animals, more intelligent animals, have some basic emotions, but not the range of emotions that we have. It is part and parcel of being an intelligent creature that you feel. You know that. You feel what is going on, that what is going on around you makes you react. And so, just as you say you know depression is, you know, feeling depression, feeling depressed when things go wrong is a normal response.
Speaker 1:But again, I think it's important to emphasize that we are all different and some people will respond you know, more to what other people might be a trivial situation that you know that doesn't bother them at all. So there is that variation that happens. And, and if you're someone that's you know over, you know very, very sensitive to things, you may need to find some ways to manage your emotional reactions. But then it's not a bad thing to be sensitive and to feel things. It's a good thing. In some ways it shows how you know that you're a really intelligent person evaluating all the information in your environment.
Speaker 2:Yeah, one of the things that I love that you also do in your book is you talk about how complex we are. I think one of the challenges we love simple. You know our brains want simple, we want simple explanations, we want simple solutions, and so I think that that's one of the reasons why the medical model appeals to us, because it's telling us. You know, it's appealing to think and I felt this way when I was first diagnosed. I had kind of mixed, mixed reactions to it. The first, on one hand, I was, I felt, relieved. I felt relieved that there was an explanation for it. I felt relieved that there was a solution for it. I believed that I was going to be helped by these medications. On the other hand, I thought I was being told that I was broken and I was afraid nobody was going to want me that way. So there were some mixed emotions. But it kind of made it more accessible to me in understanding what was going on in my brain. So I think that we gravitate towards simplified explanations of things and I think that's one of the reasons why that medical model is so appealing and why it was so easy for the public to be so convinced of it so easily, because if you're saying, you know, just, it's like having diabetes and the medications like insulin, that's a very appealing message and it also helps people.
Speaker 2:I think a lot of times we like to feel that we're not responsible, because that would. You know, being responsible for our emotions and being responsible for how we handle life can feel heavy, especially when you're struggling, you know, emotionally and mentally. But I feel like the problem that that has created is like you talk about in your book. We are super complex beings. Our brains are very complex, the way that we handle life. There are so many different variables that play into it and it's not so simple. It isn't as simple as taking a pill. It isn't as simple as saying that you've got to. You know, in fact, one of the things that you're, I think you quote one of your colleagues in here saying that he's convinced that depression has nothing to do with the brain.
Speaker 2:When I read that, I thought that's a really interesting insight, like I had never even thought about it that way, because even even with all the research that I've done, I still kept thinking it's part. You know, something's going on in the brain, because that's where all of our emotions and mental. You know, mental reactions and cognitive. All of that stuff is residing in our brains, in my mind. But it was really interesting to think somebody who studied this so thoroughly is starting to come to the conclusion that maybe it's not even in the brain, maybe it's not part of brain chemistry, maybe it's not. You know, maybe we've got it entirely wrong the way that we're approaching this, and let's let's step back and take a look at it.
Speaker 1:I think it depends on what you mean when you when you say it's in the brain or it's to do with the brain.
Speaker 1:So obviously we need a brain to be human and to have feelings, including to feel depressed. But that doesn't mean that there's a specific brain state or chemical brain state that equates to depression. And I think I use this example in the book that if we think about the chemical state of arousal when we get lots of adrenaline in the system, we talk about the fight or flight response, don't we? And we know that that's associated with the release of adrenaline and other arousal hormones and chemicals. Now that same state of arousal can be associated with many different emotional responses. It can be associated with anger and aggression, it can be associated with fear and anxiety and it can be associated with joy or relation. So it's not necessarily the case that there is a one-to-one relationship between a specific feeling and a specific brain state. It may be and I think this is more likely that there are general brain states, like arousal or lack of arousal, that can be associated with lots of different sorts of feelings.
Speaker 2:Well, one of the things that I was struck by is how unscientific the approach to psychiatry seems to be lately, in recent years, in recent decades, because I remember being taught the scientific method when I was young and that you're supposed to come into things with no bias. Ideally, when you do an experiment, you don't have any specific bias, you just have a question in your mind. You have a question, you develop a hypothesis, you design an experiment that hopefully keeps you know, keeps bias out of the, out of the equation, and then you are open to whatever the results are. And one of the things that I have noticed and I think some of it, has to do with the messaging. We have words like anti psychiatry.
Speaker 2:If somebody is questioning is questioning what's going on in general, generally in psychiatry, they are, you know, it is described, they are described as anti psychiatry. If somebody is, you know, not responding to drug treatment, they are described as treatment resistant, instead of language describing withdrawals that it is. They gave it a name of discontinuation syndrome. I feel like there's a lot of language manipulation that is designed to keep us in this medical model and anybody who questions the medical model is pushed to the outside and identified and instead of feeling scientific, it feels more like a religion to me, because it feels like a dogma, and if you question the dogma, you are a heretic. And so I wanted you know and you've experienced this significantly more than I have in your work and all you're doing is just trying to present the facts, you're just presenting the information. Can you talk about what the reaction is that you've had, especially when you wrote the paper initially and now your book?
Speaker 1:Yeah, yeah. So just coming back to the point that you make about language, though, first because I think that's really interesting. So, if we think about the term antidepressant yeah, that to me is a very misleading term because we don't have drugs that target depression. We have no idea what's going on in the brain, if anything specific, when people feel depressed, and we have no idea what the drugs that we call antidepressants are doing and whether they bear any relationship to any of those processes. So to call a drug an antidepressant is really misleading. And on top of that, drugs that we call antidepressants come from lots of different chemical classes and produce lots of different sorts of effects. So it's very unlikely, it seems to me, that they could be working on a single mechanism, if such a thing exists. So you're absolutely right.
Speaker 1:The problem is that so many assumptions are embedded in the language that we use in psychiatry and mental health and, as you've also noticed, I think the tactic of leading psychiatrists is, although a lot of what passes as evidence-based medicine, research that passes as evidence-based is conducted, a lot of randomized control trials are done in psychiatry, um, and rating measurement scales are used. Whether or not it means anything to measure an emotion like depression is another question. But there is an appearance of scientificy because what look like scientific studies are done and published in scientific journals. But even though that is going on, if you listen to a leading psychiatrist talk about depression or antidepressants, most of what they do is just declare what they think. So they will say but antidepressants work. We know they work. Antidepressants save lives, they say, as if these things are completely clear and well-established.
Speaker 1:When they say that antidepressants work, the evidence base for that is these placebo controlled trials that show very small differences between antidepressants and placebo.
Speaker 1:That can easily be explained in other ways. But even if you put that aside, there's no dispute that the differences are extremely small and probably of no clinical significance. And moreover, these pronouncements that antidepressants save lives, antidepressants have never been convincingly shown to reduce suicide or reduce death rates. And indeed the evidence suggests that in younger people in particular, antidepressants can increase the risk of suicidal behaviour slightly. I don't want to overemphasise that point, but there is fairly consistent evidence now that there is an increased risk of suicidal behaviour in young people in particular who take antidepressants. And yet, as I've said, leading psychiatrists, again and again, are on the television and the radio and everywhere making these authoritative pronouncements, that you know that, we know that these drugs are effective, we know that depression is caused by brain chemical problems or inflammation or some sort of biological abnormalities, they say, or some sort of biological abnormalities, they say. And then when you start looking at the research in detail, it doesn't support those pronouncements at all.
Speaker 2:Well, and one of the things that's odd to me it's very ironic is that often people, instead of actually addressing the substance of what you're talking about, so instead of addressing the substance of your paper're talking about. So, instead of addressing the substance of your paper and instead of truly addressing it, the tactic seems to be to attack the messenger and impugning the character of the messenger and the motives, impugning the motives. And those of us who are trying to help people are not getting wealthy this way. There are easier ways to make a living than to go out there and try to attack a gigantic behemoth establishment. It's, there's a genuine desire to help people and to help people.
Speaker 2:You know, my, my experience has been people will will accuse me of being misdiagnosed, and I say, well, what constitutes it? You know, an accurate diagnosis. All of these diagnoses are based solely on symptoms that are self-reported and every single psychiatrist I saw over eight psychiatrists every single one reaffirmed my diagnosis based on their criteria. So you know, and when you were, I think you talk about in your book that when you brought forth your information, you were, you know, excited at first because people you know you were happy to present the information that you, you know you've done a lot of research. You had a team of people that were doing all this research on this and you were looking forward to being able to share this with the public. And then, very quickly, the tide turned and you were being, you know, canceled from. You know shows were being canceled, you were being impugned your character was being impugned, so can you talk about?
Speaker 1:like your surprise, that's the way that people reacted. Yeah, I mean the reaction with one of the reasons I wrote the book Chemically Imbalanced is because the reaction to our serotonin paper, our paper showing that there is no convincing or consistent evidence to have a link between serotonin paper, our paper showing that there is no convincing or consistent evidence of a link between serotonin and depression was just so extraordinary. The members of the public were shocked, really shocked. Some were angry. Some were angry with me for having told them that there was no evidence to support this view, but others were angry with their doctors for having told them a view that you know, that was now revealed to not be you know, not be a scientific position, having misled them essentially.
Speaker 1:But the reaction from the psychiatric establishment was really remarkable. You know, first of all they were saying, oh, we've known this for years. This isn't news, you know, don't take any notice. Essentially it's not important. We know that there's no connection between serotonin and depression. And then they were saying, oh, but there is some evidence for a connection between serotonin and depression. And then they were saying, oh, but there is some evidence for a connection between serotonin and depression.
Speaker 1:And overall it seemed to me that what they were trying to do was desperately trying to get people to keep believing that depression is a biological condition. They didn't want people to question that. So they either wanted to hush up the fact that the serotonin theory of depression has never been convincingly proved or established and just hope that people would not notice, or, they know, fight back and say no, you know, there is evidence for some serotonin abnormality and for other biological abnormalities. Then, as you say, you know, thrown into that mix is trying to impugn my character, trying to discredit the research, trying to pick holes in the research so that people wouldn't take it seriously, so people would go on believing that depression is a biological condition. So that's what seemed to underpin it this desperate need to get people to continue to believe in this medical view and to continue to take antidepressants.
Speaker 2:Well, and the irony I think I started to mention a little bit before was is that we're being accused of, you know, doing it for financial benefit, when in fact the financial benefit is on the other side, that it is an entire system built on and I do want to say this an entire system built on and I do want to say this because I am not anti-psychiatrist Like I I really genuinely believe most people who get into psychiatry do it to help people. You know, it's a, it's a field that is specifically trying to help people who are in mental or emotional distress. And so my experience with most of my psychiatrists even though I had a lot of really negative experiences with, you know, psychiatrists not listening to me and kind of talking down to me I genuinely believe they wanted to help me I. So I don't want this to come across as me saying psychiatrists are bad but the system itself is the problem. And and when it is, it's kind of similar to when you you know, when you say that it's not a medical issue, somebody who has been treated for years can take offense at that, because their identity has been kind of wrapped up in the belief that they have a medical condition and that they're treating that medical condition with a drug that is supposed to benefit them. I think the same thing happens with psychiatrists, where you are questioning their validity as a medical doctor, and it's interesting too.
Speaker 2:One of the things that you talked about in your book that I found really, really fascinating because we're seeing this playing out right now in our country is that one of the tactics used to try and discredit is to ascribe a right-wing conspiracy to your motives. And it's so ironic because we have and'm not I'm not trying to align you with RFK, necessarily. I don't know where you fall on the political spectrum, but but he he's a Democrat. He has been a Democrat his entire life. He has been very left wing. He's, you know, very left wing in his ideologies all the way through, but now he's being accused of being right wing because he is questioning medical establishment. He is questioning, you know.
Speaker 2:One of the things that he's brought up is the issue with antidepressant use in our country, and he's talking about how they are addictive and people are saying this is a right wing conspiracy. And it's so fascinating to me that that we have, as a society, become so divided politically that all you have to say often is it's a right wing conspiracy and people will completely dismiss everything they have to say because they'll just lump them into this group of you know right wing conspiracy, when it actually has nothing to do with politics at all. There is nothing to do with politics. It's talking about the science itself.
Speaker 1:Yeah, I mean this is. This is another really remarkable thing about the current mental health landscape. At the moment, when I was training, and probably up until about a decade ago, the people who criticized the overuse of drugs and the medicalization of normal feelings and reactions to life were the left. That was a left-wing position to critique medicalization and criticize Big Pharma. And suddenly now it's become a right-wing position because many people on the left have backed away from that and for some reason don't want to be critical of that position anymore.
Speaker 1:So I think that's a shame, because I think we need a left-wing critique as well as a right-wing critique, because I don't think that demedicalising the care and support of people who are in distress means that we should just remove everything and, you know, leave people with nothing, although I do feel that what we're doing at the moment is probably more harmful than doing nothing actually in the long run. So you know. So we need a left-wing position on this and I don't know how the new administration will turn out in the US, but let's hope, you know, rfk Jr certainly has some admirable ambitions from my perspective to rein in the pharmaceutical company, to make the FDA more independent of the pharmaceutical industry and to question, at the very least question, our massive use of antidepressants and consider some of the harms that they cause. All those things seem to be really important things to do to me. So you know, I wish him well with it.
Speaker 2:Yeah, well, and interestingly too, one of the things you talk about in your book is the marketing campaign, essentially to try and bring people back into line, which is raising awareness, bringing awareness to, and I never recognized that growing up and in my young adult years. We would see, you know, raising awareness campaigns for all kinds of stuff. You know heart disease and, and you know I can't think of all the others. But there, you know, there were a lot of different raising awareness campaigns and they often appear to be organic in my mind, by design, I think.
Speaker 2:But I started questioning the raising awareness about bipolar on social media because I thought this isn't doing us any good.
Speaker 2:It's actually harming people because you don't raise awareness of somebody going into insulin shock, right, you don't want to raise awareness of that. That's somebody in distress, we need to help them. We don't raise awareness of somebody having a going into insulin shock, right, you don't? You don't want to raise awareness of that. That's somebody in distress, we need to help them. We don't want to raise awareness and normalize it. You know, we don't want to normalize these things. We want to raise awareness so we can help them identify what's actually going on and and I feel like it's. It is and bringing making people who are just maybe feeling some depression or feeling some low, you know difficulty in their life experience and and might otherwise be able to correct you know course, correct on their own. It is making them think that they've got a medical issue that needs drugs and I feel like it is doing tremendous harm in our society and it is. It is continuing to perpetuate this idea that we've got a medical issue at the heart of this.
Speaker 1:Yeah, so these disease awareness campaigns started in the late 1980s and early 1990s with the introduction of SSRIs, and they were funded by the pharmaceutical industry, although some of them were run by medical institutions funded by the pharmaceutical industry, although some of them were run by medical institutions. And they basically set out to change our intuitive understanding of our feelings and emotions and to inculcate in the population the idea that distress was a medical condition, that you should go and see your doctor and that you should get a medical treatment, that you should go and see your doctor and that you should get a medical treatment, particularly a drug. And they started off with depression. They ran the pharmaceutical industry funded campaigns like the Defeat Depression campaign in the UK and various ones in the US, and then they moved on to bipolar disorder a bit later, in the context of marketing the atypical antipsychotics which had come out at about the same time as the SSRIs but had initially been marketed at people with psychosis or schizophrenia.
Speaker 1:When that market was saturated, the pharmaceutical companies looked to find another market by persuading by, as you say, disease awareness campaigns around bipolar disorder, by trying to persuade people that the ups and downs of life were a medical condition, that they needed to go and get treatment for and also to persuade people who would have seen themselves as depressed that they had bipolar disorder. And this was all in order to market antipsychotics, which has been really really well documented by David Healy, among other people and I talked about it in a previous book, actually but so I think it's really important to acknowledge that our current views about the nature of mental health problems have basically been pushed into us by the pharmaceutical industry pushed onto us by the pharmaceutical industry, so they have deliberately changed our minds about the nature of our feelings and reactions to life.
Speaker 2:So that begs the question we have this so integrated into our society, how do I find our way out of this? I've been doing a lot of research on my own, just first for my own benefit, and then, as I started helping others, I felt like I needed more. I needed to know more. I didn't want to be just speaking out of my own experience, I wanted to speak out of research, and so the books like your, this book was really life changing for me in a lot of ways, because I have I've had kind of little bits of understanding. But but especially anybody in the audience that that wants to know and understand this better, please read this book. It is very accessible. She's written in a way that doesn't you don't have to be a medical professional, which which is so helpful, because I've tried to read medical papers before, I think, as I mentioned to you, and I feel like I need a dictionary next to me of medical terminology because it's so difficult to read them and I don't understand a lot of what I'm reading.
Speaker 2:But the way that you have described the, you know the testing protocols and how the drug action works and what we do know and what we don't know about serotonin, and all of it is so helpful to me and has expanded my mind in ways that I didn't really even understand. I needed to be expanded. What do we do, though? I feel like the more I understand this problem, the bigger it seems to me, because we've got there's a huge financial incentive to keep us sick. There really is. I said that to my husband as I was going through the healing process and getting off the drugs. I wasn't needing to go to a psychiatrist any longer. I told him one day. I said I really feel like there's a financial incentive to keep me sick and I don't know what to do about that. And so what do we do?
Speaker 1:So there are lots of forces acting to encourage medicalization and encourage drug use. As you say, there's a financial system that is, pharmaceutical industry profits, but also keeping psychiatrists in business and numerous other professionals, of course, of course. And so there is a challenge, but I would just like to say, compared to a couple of decades ago, we're in a so much better place. It is so much easier for you and I to connect, for you to connect with other people who have had some similar experiences, and for us to get the word out there.
Speaker 1:So it may feel like an uphill battle and it still is, but we are making a lot more progress than you're probably aware of. I mean, you know things like the withdrawal difficulties that people have getting off antidepressants and the sexual dysfunction. I think those things may never have come to light a few decades ago. There would have been a few little descriptions in the scientific literature and they would have just been ignored out there. That is at least available for other people. I mean, it may take a while for the medical profession to fully take it on board, but at least it's out there and available for people to look for. And I do think that we are having a bit of an impact on the medical profession as well. The Royal College of Psychiatrists, for example, in the UK invited Dr Mark Horowitz, who is a colleague of mine who I write about in the book, to write their withdrawal guidance for people coming off antidepressants, and they've also recently included some information about persistent sexual dysfunction in their information on antidepressants. They've had to be pushed a bit by people who've had bad experiences with these drugs, but they've listened and they have at least, you know, adapted the information that they put out to the public so that it's available to people.
Speaker 1:So I think there is some progress. There's a long way to go because, you know, ideally I think we need to completely demedicalise this area. We need to absolutely stop telling people that you know they have a medical condition, that they have a brain problem, that they need to take a drug. We need to have some imagination, actually, about how to provide other forms of support that get people away from that whole idea. We really need to have huge sort of demedicalisation campaigns on the same scale of those disease awareness campaigns that you know that were run in the past, and we need to devise some services that don't just channel people into the medical system but through which people can get some, you know, some support, some handholding, some direction and guidance and containment.
Speaker 2:You know, sometimes Well, and you talk in your book, towards the end of your book, about some of the alternative treatments that are coming out and unfortunately, I think a lot of those alternative treatments are still being influenced by this idea of the disease in the brain. You know, when you talk about like mushrooms and psychedelics and those kinds of things, anytime somebody brings that to me, I immediately tell them I am not interested in any of that because it is no different in my mind than the psychiatric drugs. You are using a foreign substance to try and alter the brain state of something that we don't really understand. A foreign substance to try and alter the brain state of something that we don't really understand and instead of addressing depression as a condition that is reacting to normal, you know, to life circumstances, we are continuing to try and manipulate the brain with foreign substances.
Speaker 1:So I think what's happening with psychedelics and ketamine has been quite interesting because it started off as a slightly different sort of model. It started off as the idea that you could have a drug-induced experience and through processing that you might get some insights into your difficulties processing that with a therapist. And that may be the case. There may be some people who get insights from taking psychedelic substances. Personally, I think you can probably get as good insights, probably better insights, through doing non-drug induced activities, in that probably have more lasting benefit. But, uh, but, but you know, nevertheless, I wouldn't, wouldn't rule out that some people you know some, some people might not have, uh, interesting or valuable experiences.
Speaker 1:But what we've seen is that actually that whole idea of the therapeutic aspect of this experience has gone out the window, because one or two drug-induced experiences with a therapist is not a very good business model. The business model has to be keeping people coming back for more and more and more. So actually that's what we see has happened with ketamine in the US and it's happening in the UK it's not as widely available but it is available in some services that people are just coming back for more because they're not getting any insight and it's not helping, and so it's just becoming a long term ineffective treatment, just like antidepressants are. And yet we haven't properly researched all its long term side effects. But at least we know from ketamine because there's a recreational drug scene that actually the side effects can be horrendous. You can get terrible bladder problems, you can get cognitive problems, and we shouldn't fool ourselves that people taking therapeutic ketamine are taking less than people who take recreational ketamine. Actually the doses are very similar.
Speaker 2:Yeah, well, and again it is. To me it's like playing Russian roulette with your brain. You know, whenever people say, well, some people get benefit from, you know, receive benefit from this, I always want to know what is the other side of that, what are the downside, what are the potential risks? And, you know, are we willing to play Russian roulette with our brains? And one of the things that was really life-changing for me was listening to a TED Talk by Dr Julia Reklitsch, who has her field of research is micronutrition and making sure that your brains are getting all the nutrients that they need to function in a healthy way, and her approach with when it comes to and she's a psychiatrist or started psychologist or psychiatrist, I can't remember, she's a PhD, but I don't remember what her background is but she says psychiatric drugs and these types of interventions should be the very last thing that we go to. They should be the last thing we try, not the first thing, because those things we know alter the brain In ways, like you have said and in your research you've discovered, we don't fully understand, and so it should be the last line of defense, not the very first thing we go to.
Speaker 2:And for me, in my opinion with all the things that I've read and this is just my opinion but I do think there is value in a triage type situation where there's somebody in acute distress, similar to when somebody is running a super, really, really high fever and there is there is risk for brain damage. You know we want to do something in the short term to bring that down to a safe place, so then we can address what's causing, you know, the physical distress. The same thing needs to happen for our mental distress. When you've got somebody who is in acute crisis, who needs some kind of help and relief in the short term. I can understand very briefly, like you said, in the drug, the drug centered model, we're saying we're going to give you a little bit of relief, but then we need to figure out what's caused this distress in the first place and then go into a more holistic approach.
Speaker 2:You know a way that we're looking at the whole person. You know, if somebody had investigated my background, there are a number of a number of things that were clear sources of emotional and mental distress. There was abuse, there was bullying in my childhood. There were a lot of things that led to what I know I've heard referred to as emotional dysregulation, mental dysregulation. There was no curiosity about any of those things and now that I understand, looking back, I'm like obviously I had some things that caused me to get into that mental state and so I feel like we need to. You know, we're not throwing it all the all the way out, but it needs to be a last line of defense or something that is used in acute situations temporarily, so that we can get somebody back into a safe place where we can work with them.
Speaker 1:Yeah, and we need to understand what we're doing. We need to understand that we're taking a drug that is going to temporarily sedate and numb someone not cure them, not target any symptom mechanism.
Speaker 1:And, as you say, that any drug that enters the brain is potentially damaging. And most of the drugs that we prescribe for mental health problems have not been around for that long, we have not been tested for long periods of times, so we really just don't understand what the consequences of taking them day in, day out for months and years on end actually are. And you know the evidence that some people have really really terrible withdrawal experiences that can go on for years after they've stopped the drug. This evidence suggests that these drugs are somehow interfering with our biological processes in a way that is very harmful and not easily reversible.
Speaker 2:Yeah, I could talk to you for hours. I am so grateful for all the work that you're doing, and I want to highly recommend to my audience that they read this book. Chemically Imbalanced the Making and Unmaking of the Serotonin Myth is so brilliantly written and it's very accessible. It is not something that you have to be a medical professional to understand, which I'm so grateful for, and there's so much more in this book that we haven't even been able to discuss, because you do such a thorough job of describing the problem. You know, helping us to understand the science behind it, you know some of the politics behind it and a lot of the things, maybe, that are motivating the perpetuation of this system. And so is there any last words for our audience, anything that you want to leave us with?
Speaker 1:Question everything, do your own research and be hopeful.
Speaker 2:Yeah, there is tremendous hope and I'm so grateful we have. I'm so thankful that we have psychiatrists like you that are willing to really put the patient first, put us first and and look for what is going to be best for the person who is being helped. And that's what I feel like you're doing is. You are you want to make sure that people have the information at their you know that is accessible, so that they can make their own decisions about how they want to take care of their mental health. And, like I said at the beginning, it's. It is a brilliant thing that we have such a highly specialized society in some ways, because we do have people we can go to for help, but it has also caused us to feel like we can't trust ourselves. You know that we aren't the experts, so we don't know. But books like this make it possible for us to become more informed personally so that we can make more wise decisions about our own mental and emotional health.
Speaker 1:That was really well put, Michelle, and exactly what I was trying to do.
Speaker 2:Wonderful. Thank you so much. I will make sure that this book is linked in the show notes. If somebody wants to connect with you, how can they do that?
Speaker 1:I've got a website, joanna Moncriefcom. I'm on X and B Sky B, and if you want to find my email, you just Google it, I'm sure Perfect.
Speaker 2:Thank you so much. I'll make sure all of those are linked in the show notes. And thank you again for being a guest today. We really appreciate it.
Speaker 1:Thank you, michelle, it was a pleasure.
Speaker 2:Until next time, upsiders. Hey, thanks for joining us today. If you're ready to start on your path to wellness with bipolar, go to myupsideofdowncom and get your free mood cycle survival guide four steps to successfully navigate bipolar mood swings. If you're ready for more, check out the map to wellness. Until next time, upsiders.