Inside Bipolar Podcast: Psychiatry's Controversies: Overprescription, Skepticism, and Finding the Middle Ground

Inside Bipolar Podcast Episode Transcript:

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.
Announcer: You’re listening to Inside Bipolar, a Healthline Media Podcast, where we tackle bipolar disorder using real-world examples and the latest research.

Gabe: Hey everyone, thanks for listening. I’m Gabe Howard and I live with bipolar disorder.

Dr. Nicole: And I’m Dr. Nicole Washington, a board certified psychiatrist.

Gabe: We want to remind everybody that we love getting your questions and feedback. It’s really easy to just hit us up at show@psychcentral.com. You can also follow Dr. Nicole on Instagram and TikTok @DrNicolePsych, or you can follow me, Gabe Howard, on TikTok or Instagram @AskABipolar. Trust me, we are great follows. You should absolutely check us out.

Dr. Nicole: If I go over to your TikTok, Gabe, am I going to see clips of this show?

Gabe: You are absolutely going to see clips of this show. You know, you can put clips of the show on your TikTok as well. I know that you stay all doctor-y

Dr. Nicole: [Laughter]

Gabe: Given educational points and stuff, but if you want to see what Dr. Nicole and I look like while we’re recording this show, I think you know where to go.

Dr. Nicole: I’ll work on that. I’ll get my people on it. I’ll get my people on it.

Gabe: Your people will call my people

Dr. Nicole: Yes.

Gabe: And we’ll just arrange. Today we’re going to be talking about the anti-psychiatry movement

Dr. Nicole: Yay! My favorite topic.

Gabe: I, you know, I don’t want to address it. I don’t want to address it. We have gotten lots of DMs, emails and people and they send us these articles and they’re like, hey, how come you never cover X? And the X that we’re not covering came straight out of the anti-psychiatry movement, and it’s presented as fact. And they want to know why healthline media, a medically reviewed, fact checked, empirically supported website, won’t cover it. And I don’t want to just write people back and say, because it’s BS, because that seems disingenuous. Because, and here’s here’s where it gets us in trouble. Dr. Nicole, there’s always this little kernel, this small little kernel of truth in the article that makes it so I can’t just flat out ignore it.

Dr. Nicole: Yeah, it’s always a tough topic when you’re on my end of the game. When you’re on my side, it’s always very difficult. But you’re right, there are certain parts of it that make a lot of sense, and when you start peeling back the layers and you get to the core of it, you can see how it started. It just seems like in some ways it has taken off and grown lots of legs and become a big old monster. But I think we can all agree that it probably started from a pretty accurate space.

Gabe: And the accurate place, more often than not is the overprescription of psychiatric medications, something that Healthline has covered both in articles and in other podcasts. Over on the inside mental health space, with numerous doctors and numerous experts numerous times. And the the fact that that some medications are overprescribed or may be overprescribed is very compelling. And as a journalist, I want to discuss that. But over on the anti-psychiatry side, they always draw a conclusion that I cannot get behind and that we cannot get behind, which is and that is why bipolar disorder doesn’t exist. That is why depression is made up. That is why nobody actually has fill in the blank. And you should stop taking your medication. And I know that you see these in your practice a lot, Dr. Nicole, where people say, well, I don’t want to take this medication because I heard that it was overprescribed. And

Dr. Nicole: Mm-hmm.

Gabe: You’re sitting there and you’re like, you’re trusting an article on the internet over me?

Dr. Nicole: People do it all the time. That is extremely difficult when people come in with their own preconceived negative ideas about what you do. It’s going to be very difficult to have a good, strong working relationship when the person comes in already thinking that you’re out to get them, or that what you’re putting out to them is is not valuable or is dangerous, even that’s that’s hard to start off a relationship on that footing.

Gabe: How do you get them on your side, Dr. Nicole. Because the anti-psychiatry movement is not constrained by fact, they can say whatever they want, they can weave whatever tapestry they want, whereas you can only defend it using science. You can only use truth. And unfortunately, you know, comforting lies are always going to hit better than, well, frankly, inconvenient truths.

Dr. Nicole: Its extremes are hard for me. Extremes of any opinion are very difficult for me, because I think that most things in life are not black and white, and typically those who fall at the extreme ends are usually not accurate. So at the extreme end of this, this mental health movement and the people who are pro psychiatry and pro that these diagnoses are real and pro, you know, medication is valuable. I think the people who are at the extreme of that end, who think that medication is the absolute end all, be all. And it has to be that for every single person. I think that’s dangerous too, because that’s that’s not always the answer either.

Gabe: And I think it’s important to bring that up, that the pro psychiatry group can

Dr. Nicole: Yes.

Gabe: Also cause a lot of damage.

Dr. Nicole: Yes we can. The extremes of anything typically are going to be where the danger lies, but those are also typically the louder people. They are typically the ones making the most noise and getting the most attention. So medication is great. I think medication can work for a lot of people. I don’t think it’s the full answer, and I don’t even think sometimes it’s the answer at all for some people. And there are people I see and I tell them I don’t. I don’t think you need medicine. I think you need this or this or that. After I get to have a conversation with them and see what’s going on. On the other end of this, this continuum, you have the anti-psychiatry folks, the ones at the extreme end who don’t believe in these, these mental illnesses and who, who, who believe that we’re just out here doing dangerous things and giving people things that are harmful and dangerous at the extreme end, that that can be very dangerous to someone who genuinely has a disorder that can be helped with medication. But I am not naive enough to think that they just made this up off the top of their head. Mental health treatment in this country was barbaric and and torturous at at points in our history. When we think about how we’ve dealt with people who have mental illness. So why would somebody want to be in that, in that number? Why why would somebody want to be a part of that movement that started with just such trauma to the people who had these disorders?

Gabe: It’s fascinating that you brought up trauma, because that’s another thing that we don’t address. Using my personal story, when I was admitted to the psychiatric hospital, it saved my life. I want to be very clear. It saved my life. It got me a diagnosis of bipolar disorder. It not only got me my first medications with help stabilized me, but it hooked me up with community services, therapy, learning coping skills, understanding my illness. All of these things led to me reaching recovery, but nobody wanted to address how traumatizing it was for a 26 year old man, right? I had a good job. I was a homeowner, I was married, I drove a nice car, and suddenly I’m locked. I am locked up against my will behind a closed door with everybody and their brother telling me that, well, frankly, I’m crazy, I’m nuts, I’m insane, I’m mentally ill. It. And when I said how terrible that was and how hard it was, all I got is what we’re supposed to do. It was for your own good. It was for your own good. So I can certainly understand where a movement could come up and say, listen, we’re we’re not addressing how traumatizing this is.

Gabe: And also, again, using my personal story, I was way over medicated when I left the hospital and I was really lucky and we got that worked out. But I can see how if you don’t have as good a care, or if you don’t have as good of a support system, or if you don’t have as good as advocates, you could stay on too much medication for a long time. And that’s a really slippery slope. The reason that you were on too much medication is because, unfortunately, you didn’t receive the type of care that you needed to. The reason that you’re on too much medication is because of a salacious and malicious conspiracy, with pharmaceutical companies and doctors at the front of it to push medications on people that don’t need it in order to make profit. And if you steer into the conspiracy theory, you’re going to want to quit the whole thing. And I want to be very clear, if I would have steered into a conspiracy theory and quit the whole thing, I’m not sure that I would be here. And if I was, I’m not sure what version of Gabe would exist.

Dr. Nicole: Mm-hmm. But we always talk about how two things can be true. That

Gabe: Yes.

Dr. Nicole: Is something we always talk about. Two things can be true. It is 100% true that pharmaceutical companies are trying to make money. Why do you think they do all of that direct to consumer advertising? Why do you think there are all these commercials with people looking very happy on their drugs, holding hands, ice skating, doing whatever it is that happy people do? Why is that? Because they want you to go to your doctor’s office and say, oh, I’d like to take that one. Those people look really happy. Can you give me that one? It is a business. They want to make money off of people’s illness the same way they want to make money off of people’s diabetes and off of their hypertension and their heart disease and their cancer. They’re in this to make money. Yes, it helps people. We need the drugs to to help people with chronic illnesses and diseases and acute illnesses and diseases. But at the end of the day, the drug companies want to make money. So we can’t think that, oh, they’re so great. They just want to help the people. I don’t think that’s 100% there either. So that part is true. We know. But it also doesn’t mean that those drugs can’t be helpful for you in some way and push you more towards the life that you want.

Gabe: Well, now, just out of curiosity, and I’m asking you as a doctor, why don’t pharmaceutical companies in the medical community adopt the same policies as like, law enforcement , where you do it on a completely volunteer basis just to help out your fellow humans? I think that that might make the world a better place if you did the same thing that other helping professions do and work for free.

Dr. Nicole: Think about this. Do you know any police officers who work for free? Like do you know?

Gabe: Don’t they all work for free?

Dr. Nicole: You know anyone who does those jobs for free?

Gabe: [Laughter]

Dr. Nicole: Everybody wants to get paid.

Gabe: Exactly, exactly.

Dr. Nicole: Everybody has to make a living. Everybody wants to be able to afford the things they want to be able to afford. Everybody wants to get paid for what they do.

Gabe: I. Everybody deserves to get paid for what they do. That is how somebody becomes a professional and excels at it. I’ll be the first to admit I don’t want teachers, firefighters, law enforcement to work for free because then their attention is divided. They are, by definition, focusing on something else so that they can eat and raise their families and have housing. And then as an afterthought, when they have free time with whatever energy is left over, they would spend helping other people. So, listen, I’m not trying to get too far afield of the point. The point is, is that this is America. This is how capitalism works. People are paid for their skill sets. So I just want to sort of bop the notion aside that because pharmaceutical companies and the medical establishment makes a profit, that they have done something wrong. But here’s where the pendulum swings back the other way. I have never once met a teacher law enforcement firefighter who is making record profits and billions upon billions of dollars not only for their companies, but for their stakeholders, their stockholders, etc. there is such an extreme amount of money here and it’s got to be difficult. When you are sick, you can’t afford your medication, and you look at the palatial headquarters of the average pharmaceutical company. So this again swings the pendulum back the other way to where the anti-psychiatry folks, they raise a really, really good points.

Dr. Nicole: Yeah.

Gabe: I can’t even say on this show that I wish they didn’t exist, because some of their points are so important that even though they’re not bringing them up in the way that I feel has a lot of integrity, I’m still glad the point is out there.

Dr. Nicole: They bring up great points and there is a swing when there is such a large amount of money involved that then people do start to do some things that don’t feel right, or they feel a little unethical, and we’re talking massive amounts of money. One of the things that gets frustrating for me as the physician is that people assume that we’re in cahoots.

Gabe: You’re not?

Dr. Nicole: [Laughter] No, we’re not.

Gabe: You’re not?

Dr. Nicole: We’re not. We’re not in cahoots.

Gabe: You’re not? You’re not the same same?

Dr. Nicole: Not. We are not thick as thieves. We’re not, we’re not, we’re not. So if I prescribe a certain drug, I don’t get a kickback from that drug company. I don’t get the check. I don’t get a check in the mail for all the prescriptions of a certain drug I write. Matter of fact, that’s illegal. That that can’t happen. I could lose my license. That is an ethical violation, that that does not happen. But I think a lot of people believe that those kinds of things happen. I. Started my career at a time where we had pharmaceutical reps, representatives that would come around to the office and bring lunches, and they would have dinners and stuff. But years before I was even in practice, and I’ve been in practice for a minute, y’all. Pharmaceutical companies would have very lavish things that they could do for physicians who prescribe their drug often. So there was a time in history when you could say, wow, like there is some incentive for you to prescribe a certain drug because this rep is taking you, you know, on this trip, or you’re going to do this thing that used to happen many years ago, and we’re talking decades ago because I’ve been in practice almost 20 years now. That doesn’t happen anymore. And the reason those things don’t happen is probably because somebody said, hey, this isn’t right.

Dr. Nicole: It probably was some anti-psychiatry folks saying, hey, you are in bed with these pharmaceutical companies. And then somebody said, oh, you know what? That’s probably not a good look. And so then things changed. Since I’ve been in practice, it’s it’s gone even more tight and more restricted. You don’t see the fancy pens and notepads and clocks on the wall and all these office supplies with pharmaceutical names on them, with drug names on them, because those things don’t happen anymore, because those things got tightened even further. I’m pretty sure a lot of that stuff comes from the anti-psychiatry folks who are saying, hey, hey, what are y’all doing? Like, what is happening here? That is valuable to have happen. It is great that we have these things in place to kind of keep us honest. And the checks and balances, again, it’s just the extremes. The ones who are, like all psychiatrists, bad, all meds are bad, all psychiatrists are crooks and hustlers. All just that extreme viewpoint can be so dangerous to somebody who actually has bipolar disorder, and who needs medication to achieve stability and to stay out of jail, and to stay out of the hospital and to stay out of dangerous situations.

Gabe: And to stay alive.

Dr. Nicole: Yes.

Gabe: And to stay alive.

Dr. Nicole: Yes, it can be very it’s just it’s the extremes that I think I have the biggest issue with.

Gabe: The extremes are always going to be the biggest issue for me. As you were talking, I was like, well, anybody that says it’s only medication, it’s only therapy, it’s only coping skill. Do what you’re told, do what you’re told. That that bothers me. And I think this is why the, the, the two encampments for, for lack of a better word, bother me is because they both want fealty. They both want followers. They both want you to 100% agree with them. I’m I’m desperate to find the movement that says, hey, look, we got some issues here.

Dr. Nicole: Mm-hmm.

Gabe: Let’s fix those issues. Now, that said, there are some incredible advocates that have struck that balance. People who I respect a lot, Rob Wipond, Brooke Siem come to mind, and they talk about these things pretty rationally. I’m not saying that they don’t have a lean nobody here that that anyone is perfect. But that’s also kind of my next point. Nobody’s perfect. If you completely follow a person, a podcast, a movement, a group, and just do whatever they say without applying your own critical thinking skills, bad things are going to happen. And that’s what scares me about the anti-psychiatry movement. It’s right in the name. So you’re a vulnerable person, you’ve just been diagnosed, you’ve got all these problems in your life, but the one that you’re focusing on is what psychiatry is doing to you. And you completely forget how you were committed to a psychiatric hospital, how you lost your job, how you’ve lost your family, how maybe you’ve gotten arrested, how maybe you’ve had a suicide attempt. You forgot about every bad thing that ever happened to you, and instead you flip this switch that psychiatry and big pharma. I’m making air quotes. And the Dr. Nicoles, again, air quotes are the problem and you’ve completely removed yourself from the situation. And that’s what I want to make sure that our listeners are understanding when they’re listening to this, and they’re evaluating the data that’s out there. It is so easy to spin a narrative when you are not constrained by facts.

Dr. Nicole: That is a I’m going to write that down. I like that I’m going to write that down and put it on my wall and repeat it to people, because I think that fits this conversation so well. But our system is very broken, and our system is what shifts people, I think, towards the anti-psychiatry movement. Our system does this. Our system makes people feel like everybody is out to get them. You have a mental health emergency. Who do we call? The police. You are struggling mentally. What do we do? We lock you up. You’re passionate because you may not see it as agitation and aggression and hostility, but you’re you’re overly passionate. You’re advocating for yourself. And what do they do? They give you shots. They put you in seclusion like these. These are the images that people have in their mind, especially when they have more severe forms of illness. And they just go with them. And then they find these people who are saying like, yeah, psychiatrists, terrible psychiatrists, psychiatrists are terrible. The medication is going to kill you. Look at all those side effects. This is horrible. And they find comfort and they find their people over there. They find people who are listening to them and who get them. So I say, if you’re not in that anti-psychiatry movement group, then maybe you should reevaluate how you interact with these people when they are in front of you and see if you can help them come to a more middle ground where I think it’s healthy to side eye, I mean, I side eye everybody and everything. It’s always healthy to side eye and be discerning. You don’t just take everything somebody tells you at face value, but it gives you an opportunity to be a little more balanced. When you can find kindness and you can find some kind of connection with both sides.

Gabe: One of the things that I think about a lot is that if you pick a side, you’re wrong. I don’t know who said it, but, but, but somebody in politics said if you pick a side, you’ve already lost. And I think about that a lot because there’s just not a side to pick. You might agree with some over here, you might agree with some over here. And I’m using politics because I think you’d be really hard pressed to find an American who 100% agrees with one side and 100% disagrees with the other, if they were open and honest and evaluated it reasonably. And I know that I am like that. And sometimes I vote for people and they’re like, but Gabe, you’re against XYZ. I am, I am against XYZ. Politics are imperfect. I’m using politics because politics, they spark just as many passionate disagreements, discussions, arguments, flipped over tables, ruined Thanksgiving dinners as as unfortunately, discussing psychiatry and discussing medication adherence and discussing living with mental illness. There are so many things, pardon the pun, that drives us nuts about pharmaceutical companies, about doctors, about the way we are treated as people living with bipolar disorder. But again, if you join a group that tells you what you want to hear on either side, you’re 100% right, you’re 100% wrong. You’re probably not going to be as well as you want to be.

Sponsor Break

Dr. Nicole: And we’re back discussing the history of psychiatry and how it has contributed to the anti-psychiatry movement.

Gabe: I feel that more often than not, the anti-psychiatry side is able to pull people in by making things up. One of the things I want to talk about, Dr. Nicole, are studies. Studies are supposed to be science based, but a lot of times the anti-psychiatry side will take a study and they will interpret it in a way that is, well, false. And they lead you down this rabbit hole to prove that the study is not good. But what I want to ask you specifically, Dr. Nicole, because you are a woman of science, it’s difficult to read studies. You had to go to school to learn how to read a study. What advice do you have for your patients who are saying, look, I’m holding a study, and I was told that this study says what you are telling me to do is dangerous.

Dr. Nicole: Mm-hmm.

Gabe: How can they read the study and provide comfort in knowing that it’s not dangerous? It’s just been misinterpreted.

Dr. Nicole: If we’re not careful, any of us can fall into that trap. I can look at a poorly conducted study and pull the positives out and say, see this? This study proves that this is effective. You can pull a study that says what you want it to say that’s poorly conducted and say, see, it says what I want, what I want it to hear. Any of us can do that, positive or negative, any of us can do that. And and it happens all the time. Most reputable studies are going to have a little section at the end that talks about limitations of the study. So it kind of gives you, even if you don’t understand all the sciency part, if you just are reading the conclusion, the results, the discussion part, look at the limitations, look at what it tells you. The limitations are if the study is five people, probably not as strong a study as you would want it to be. And it’s going to tell you that it’s going to say the study size, you know, was not adequate enough. More research needs to be done. Da da da da da. Those are important things to look at that little limitation section. Because I do get people who come to me with a study and they say, see, look. And I just we start at the limitations and we say, I start from the beginning knowing what were the limitations of this before. I then go back up and read the whole thing.

Dr. Nicole: That’s usually how I look at one. Like, I want to know what you felt like wasn’t great about it, and then I’ll go back and read it, knowing that stuff on the front end. And I encourage you, if you have a question, you know, bring that study to your person and say, hey, have you seen this? Like, what am I supposed to make of this? But please, no science is ever changing. The date may also matter if this study was from the 90s. The early 2000 were 20 years later, you know, are there more recent studies that have either supported and found very similar results to that study? Are there studies that have come out and refuted that study? It can get confusing sometimes. You may read a study, and for every one you find that supports what you’re thinking, you’ll find the same number saying, oh no, those are wrong. That means we still just don’t know yet. Like we still are in the process of really trying to figure out what’s accurate and what’s not. Science is ever changing, so we can’t just latch on to something and say, oh, this is it, 100%. It doesn’t work that way. And it’s tough when you have people coming to you who are all in on this being 100% accurate when it’s faulty or has a lot of holes in it or limitations. And that’s coming from both sides.

Gabe: One of the reasons that we wanted to do this episode is because of all the emails that we got of people saying, well, why shouldn’t I listen? Why shouldn’t I follow them? And I again, I, I really am thinking about Gabe at his most vulnerable, and it would have been just so easy for me to be pulled into this group. Dr. Nicole, do you think that the anti-psychiatry side is aware of how they’re impacting a vulnerable population, even among topics that are really important to get out there? I, I don’t think that they necessarily do a good job of explaining that it’s not one size fits all because they say things like bipolar disorder isn’t real or schizophrenia isn’t real, or all medication is bad for all people. And I think really all 100% one that’s black and white thinking. So black and white thinking I believe is is problematic. But if any group can accurately speak for 100% of people, I mean, that that’s that’s pretty impressive. I mean, I have to say that would be that would be impressive.

Dr. Nicole: Yeah, I, I don’t encounter a ton of. 100% anti-psychiatry people because they’re avoiding me. They have no reason to. They have no reason to to be in my life unless they’re involuntarily committed somewhere that they have very little to, no reason at all to encounter a psychiatrist. So I don’t interact with a lot of these people, but I have seen some of the comments, and I and I have received feedback and about how medications are dangerous and nobody should take them. And I, I mean, I just that is very dangerous thinking to me. Do I believe that there are people who choose to manage their life and their illness without medication? I do. Do I think those people are selling themselves short? Absolutely I do. I think that they’re missing out on lots of stability and lots of great things. But I also believe that they have the right to make that decision for themselves. And I’m I’m not into being paternalistic, which is always one of the big complaints that I hear from the full on anti-psychiatry people is that psychiatry is paternalistic, and we try to tell you what to do and take over your life. And, and we’re just just out here harming people left and right. Do you do what works for you? As long as it doesn’t endanger anybody else? Do what you do. But it’s it’s dangerous. It’s it’s scary. And it makes me sad for the people who, for whatever reason, have been hurt by the psychiatry movement and have moved over to the anti-psychiatry movement because I feel like they could have a better quality of life if they just found the middle.

Gabe: I think it’s important to understand that psychiatric medications can be dangerous, right? That’s why they have to be prescribed. You can’t just go down to your local grocery store and buy them over the counter. They are by definition, dangerous. There’s, as you always say, Dr. Nicole. They have this unsexy list of side effects. That’s why it has to be overseen by a doctor. So any general statement coming from anybody who says psychiatric medications are dangerous, that’s not an untrue statement. It’s

Dr. Nicole: Mm-hmm.

Gabe: The conclusion that I always have a problem with, and that’s why nobody should take them. And I think about examples, and the best one I have is a car. Could you imagine if somebody had a bad experience driving a car? Right. Let’s go with the worst one. They get in an accident and everybody in the car dies. And the solution to this is anti-cars. All cars need to go away forever. We’re not going to try to make cars safer. We’re not going to try to teach people how to drive. We’re not going to explore stoplights or speed limits. Nope. Somebody died in a car so nobody can have a car. I am 100% positive that cars are dangerous. I am 100% positive that being in a car, driving a car, being around a car carries risks. And I also want them to be as safe as possible. So if somebody started an anti car movement, I would think, wow, you’re so close. Seatbelts are important. Stop signs are important. Traffic laws are important. Obeying the speed limit is important. But why do you draw to the conclusion that the automobile industry is corrupt, only trying to make money, and we must end the whole thing. And I think anybody listening can hear the analogy in this.

Dr. Nicole: Mm-hmm.

Gabe: I want psychiatry to be safer, but

Dr. Nicole: Mm-hmm.

Gabe: I don’t think we’re going to get there. If the only solution that we’re willing to accept is the complete removal of psychiatry. I also think that it’s dangerous for people. Dr. Nicole, as a psychiatrist, how do you feel about the only thing that these sides are willing to accept is for you to turn in your medical license, stop prescribing medication, and admit that your whole career has been a lie.

Dr. Nicole: I do think there’s a little bit of difference though, so one, I wouldn’t say they are dangerous, right? Cars can be dangerous. Drugs

Gabe: Okay.

Dr. Nicole: Can be dangerous if not

Gabe: Okay.

Dr. Nicole: Handled appropriately. Anything

Gabe: Fair.

Dr. Nicole: Can be dangerous. Water can be dangerous. If you are not appropriate with your consumption, you can literally overdose on water. Caffeine great. Give you a boost. Can be dangerous if you consume too much in a day. Any medication over the counter, meds included, can be dangerous if not managed and monitored in a proper way. It just is what it is. But the difference between medications and cars. Nobody’s forced to drive a car. Nobody is forced to get a car. Nobody is forced to drive. Nobody says, oh, you must drive this car. You don’t have a choice. I’m gonna pick you up and put you in the seat and put you in the seatbelt, and I’m gonna make you drive this car. Nobody does that to anybody. You make a decision, you have full control over what you decide. As far as that goes, people don’t always get the decision when it comes to mental health medication. And that is where I think these movements grow, because psychiatry in general has largely been, especially when you think about the early stages of psychiatry as a profession. There was no autonomy for the people involved. We didn’t have mental health laws, and people with mental illness didn’t have rights, and we just didn’t have that stuff. I think that’s how we got to this place.

Gabe: I think this all comes down to abuse and trauma. I really, really, really, really do. I think that psychiatry is rife with abuse. Hard. Stop now. It is better than it was 100 years ago. But really, that’s the best you’re going to do. 100 years ago, when any man could point at any woman and have her committed for hysteria, now we’re patting ourselves on the back that that’s no longer the case and that’s the improvement. And now, now that we no longer do lobotomies, we’re all happy that we’ve improved like we need to do better, we need to do so much better. And I think that a lot of people have been abused by psychiatry. Now, that’s not exactly a controversial statement for a patient to make. I’m curious, Dr. Nicole, as a psychiatrist, how do you feel about that statement?

Dr. Nicole: Well, we have to own it. We have to own it. We have to agree with it. We have to call out those who came before us, and we have to be able to say, yeah, our practice was barbaric. And as we’ve grown as a field and as we’ve learned more, we’re trying to do better as a person of color. I take care of a ton of people of color. Psychiatry has been horrible to people of color. I mean, you can go as far back to slavery. And it being thought that slaves who wanted to run away from their masters were suffering from mental illness, because surely a black person in this country had to be crazy if they didn’t want to be a slave like we. We have not been kind to people. There are ongoing studies of how psychiatry as a whole has been. Dangerous for people of color. Lots of categories of people have been hit hard by the things that psychiatry has done. So I have to own that. I have to own it. I have to own up to it and say that yes, I am a part of this thing that I’m not always proud of.

Gabe: The specific diagnosis that you’re talking about is drypta mania. And it was a real diagnosis done by real doctors to the African American community for not wanting to be a slave. So the fact that that exists, you can understand the foundational roots of anti-psychiatry are not without merit. I especially with that. But I’ve got to ask, do you feel that there’s a drifter mania equivalent today, or is that completely gone? Where where do you feel about where the abuses stand today?

Dr. Nicole: I think psychiatry and mental health in general can be pretty dismissive to people’s experiences. Homosexuality is a great example that comes up when the first DSM came out. And in the second version of it, we’re on the fifth version now. But when the first one came out in the 50s, the second one came out. In the later 60s, homosexuality was listed as a mental health disorder. By the time we got to the DSM three and the later version of the two, then we started seeing shifts in how we described it. So it went from homosexuality being the the disorder to sexual orientation disturbance being the problem. So, you know, things evolve, things evolve. And here we are with the DSM five and now we have gender dysphoria. And that describes the folks who are distressed with the sex and gender that they were assigned at birth. So we see how these things evolve. But this isn’t that long ago. This is not that long ago at all. When I think about my mom, my mom was born somewhere between the DSM one and two. So this isn’t that long ago. When you think about it, when you think that when Gabe, when you and I were little kids, we had just gotten to the point where homosexuality wasn’t in the DSM, which is

Gabe: Correct, correct.

Dr. Nicole: Which is crazy. Like, that’s crazy to think that this is where we are. And there are still in recent history, people who were supporting special treatments for people who were homosexual, this, this industry, this field, this, this career field that I’ve entered. It is not it’s not looking great when you when you start picking away at all the things that we’ve done to add to the trauma that people experience, we have not always been on the right side of history.

Gabe: When we came up with the idea to do this episode because of the emails that we were getting and because we wanted to address it, I really thought that I was going to be able to conclusively say, listen, the anti-psychiatry movement is wrong. You should never read anything they write. You should not follow them. They’re a bunch of wackadoos, for lack of a better word. And and I got to tell you, they’re there. They’ve got a good foundation. They’ve got a reason to be worried. I like the fact that they’re holding people accountable.

Dr. Nicole: I think you have to read both. Like you said, if it’s fair to read what the anti-psychiatry movement is putting out, it’s fair to hear what they have to say. But that can’t be the only thing that you’re reading, because then everything gets skewed and then everything that you see is related to that. I want to also hear what the counterargument is from the people who are pro psychiatry, from the people who who are advocating for people to take the medication and to be in treatment and to do these things. I want to hear from those people. I want to hear what they have to say. I want to hear from both sides and be able to make a decision of what’s best for me. This happens in all aspects of life. We’ve we’ve touched on politics. We of course, don’t want to watch the extremes of either. Well, I don’t want to watch the extremes of either. I want to hear somebody who’s pretty critical of both sides. I want to hear and read what what are both sides saying? So I can try to figure out how to piece that information together for myself. The danger is when you’re only submerging yourself in one side or the other.

Dr. Nicole: That’s all you see. If that’s all you’re searching, then guess what? That’s what’s going to be on your algorithms, on your social media platforms. So you will then be neck deep in other people who think like you, and who are saying the same things that you’ve been reading and who are starting to believe the same things, and then it gives you this false sense of, well, that’s what everybody thinks. Well, yeah, everybody in in your world. So I encourage you to always try to be as balanced as possible, especially when it comes to your care. Don’t ever take what I say as the 100% gospel truth. If you are questioning whether I’m telling you something right, go out there and do some research and come back and let’s talk about it. Tell me what you think about what I said. Tell me what your questions are. Tell me why you think I’m wrong. You can think I’m wrong. That’s fine. And that doesn’t make you an anti-psychiatry person just because you think I’m wrong. Which, to be fair, sometimes people get labeled as anti-psychiatry just because they don’t want to do what is being recommended to them. And that’s not always the case either.

Gabe: I am really glad that you brought that up. I know that we are running short on time, but just because you disagree with the psychiatrist, or even if you disagree with a treatment, you are allowed. I think the anti-psychiatry movement comes in when you’re disagreeing for other people, when you’re telling other people what to do, when you’re drawing conclusions based on large swaths of people. If you personally don’t want to do it, that is not what anti-psychiatry is. That is patient choice. That is personal empowerment. That is your prerogative. You may well be wrong, but that’s between you and your Dr. Nicole. It’s when you go public and you start saying everybody with bipolar disorder should do X, everybody with bipolar disorder should not do X. I know because I did this research that says the following things. And that research is not grounded in reality. That is the anti-psychiatry movement that we are most worried about.

Dr. Nicole: Standing up for yourself and advocating for yourself, even if we disagree, doesn’t necessarily make you anti-psychiatry. You could be you could be anti-psychiatry and decide, I’m just not going to do any of this. And if that’s the decision you make, then we honor that. I don’t force people to take medication. I don’t force people to come see me. If we’re in a hospital, that’s a whole different ballgame and a whole different story. But if if we’re in an outpatient setting and we’re just talking about your desires for your care, and you decide that that’s just not what you’re going to do, it’s just not what you’re going to do. And you can decide on what piece of the continuum of anti-psychiatry pro psychiatry you want to land on at any given moment. That’s your decision, and I respect your decision, but I may not agree with your decision.

Gabe: And that’s all we can ask. All we can ask is for respect. All right, everybody, thank you so much for being here. We need a favor. We always ask for favors at this point, Dr. Nicole, you think people are doing them for us?

Dr. Nicole: [Laughter] We should ask for them at the beginning next time.

Gabe: Next. Next time we will. But listen, here’s what we need you to do. We want you to recommend the Inside Bipolar Podcast to everyone you know, share episodes that you love on social media and tell people why. Text your friends, email your friends, mention us and support groups that you belong to. The reality is this sharing the show with the people you know is how we’re going to grow. And we don’t want to be a secret any longer. And also, wherever you downloaded this podcast, please follow or subscribe to the show. It’s absolutely free and if you have time, leave us a review. Tell us what you love! My name is Gabe Howard and I’m an award winning public speaker and I could be available for your next event. I also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon. However, you can grab a signed copy with free show swag or learn more about me by heading over to gabehoward.com. Also, if you have a moment, give me a follow on TikTok or Instagram @AskABipolar.

Dr. Nicole: And I’m Dr. Nicole. You can find me on pretty much all social media platforms @DrNicolePsych.

Gabe: And we will see everybody next time on Inside Bipolar.

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