Podcast: Do We Medicate Normal Behaviors? With Dr. David Cohen

Inside Mental Health Podcast Guest and Host Bio

For 20+ years, Professor David Cohen has been doing research on psychoactive drugs (prescribed, licit, and illicit) and their desirable and undesirable effects. He has also authored and co-authored over 120 articles and book chapters on these and other subjects.

Recently he was one of the main experts interviewed in “Medicating Normal,” an in-depth documentary about the overuse and harmful impact of commonly prescribed psychiatric drugs.

About 1 in 5 Americans takes daily psychiatric medications, including antidepressants, anti-anxiety medications, mood stabilizers, and sleeping pills. Most people take them for months and years.

While these medications can provide effective short-term relief, Dr. David estimates about 30–35% of regular users experience harm and/or are made worse by the drugs. But the real percentage could be higher because harms are not studied carefully.

Driven by profit, pharmaceutical companies, which spend billions of dollars annually promoting psychiatric drugs, keep evading the serious study of the dangers and long-term harms these drugs can cause. And no other responsible agency is taking up the slack.

Our host, Gabe Howard, is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.

To book Gabe for your next event or learn more about him, please visit gabehoward.com.

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.

Part 1:

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Welcome to the podcast, everyone. I’m your host Gabe Howard and calling in today we have Dr. David Cohen. For 20 plus years, Dr. Cohen has been doing research on psychoactive drugs and their desirable and undesirable effects. Recently, he was one of the main experts interviewed in the PBS documentary Medicating Normal, an in-depth look at the overuse and harmful impact of commonly prescribed psychiatric drugs. Dr. Cohen, welcome to the podcast.

David Cohen, PhD: Thank you, Gabe Howard. I’m very happy to be here.

Gabe Howard: You know, this is not the first time that this podcast has delved into the idea that psychiatric medications could be overprescribed, and it’s a sentiment that’s gaining traction. And studies are starting to back up these claims. But the criticism that we get every time we do any sort of topic like this is that we’re pill shaming. We’re discouraging people who need to be medicated from seeking treatment. And as someone who lives with bipolar disorder, I want to disclose, psychiatric medications absolutely saved my life. Without them, I, I wouldn’t be married. I wouldn’t be hosting this show. I, I might not even be alive. And I understand the pushback, but I think good information is good information and that people need to evaluate their own medical care. But I’m curious, Dr. Cohen, how do you respond to people who feel that your work is endangering people?

David Cohen, PhD: Um, I listen to them. I want to hear exactly what they have to say about it. How do they feel it’s endangering people. But of course I disagree. Usually I find that it’s a prejudgment. They’ve already made their mind up without knowing the kind of work that I do.

Gabe Howard: Let’s jump in and focus on young people for a moment. Let’s talk about today what percentage of young people are currently being medicated with psychiatric drugs in in the 2020s?

David Cohen, PhD: Great question. So, in the 2020s, we don’t know very well because there’s always a lag, you know, by the time the information about a given year is available. It takes two, three, four years. So we never know quite the situation as it is now. So I would say in the late 2019, early 2020s, very early, we have some idea and we could say that about one in 9 or 10 kids roughly, broadly varies among the age groups, one in 9 or 10 children up to the age of 18 in the United States today is taking a prescribed psychiatric drug. To change their behavior or for whatever reason.

Gabe Howard: Now, I understand in the 1980s that number was less than 1%, and now it seems like that number is about 10% or ten times higher. And it seems to me, just sincerely, it seems to me that if in 1980, 1% of young people were diagnosed with cancer, and then in we’re going to go with 2019, the data that’s available, that number rose ten times or even five times. We’d want concrete answers as to why that is. Do we know why the numbers are increasing so dramatically?

David Cohen, PhD: Um, we have very good ideas, although, again, people can disagree. But you in your question now, you’ve actually answered a little bit. You went from drug prescriptions and you kind of slid into diagnoses. We went from using a drug to being diagnosed with a problem. And this is an important distinction that has to be made. But at first it tells us that clearly drug use is related to diagnosis. And so one element of the answer is we are diagnosing much more than we used to. And no one can quite disagree with that. Not only are we diagnosing more often, which means that a professional is involved in making a diagnostic judgment much more often than would have been involved in the 1980s for the very same behavior. Why is that? Why are we diagnosing more often? Because we’re medicalizing more. We’re looking at the behavior and viewing it much more often today as a symptom of a disease, or a disease itself, or a defect or a disability, rather than as a behavior that’s approved or not approved, breaking rules, misconduct, misbehavior. And so that itself refers to a process we generally call medicalization. Turning, say, badness into sickness. Not wanting to blame them, a humanitarian urge. We don’t want to blame someone for something they might be doing wrong or something they might be doing that just doesn’t quite fit. So we say they’re sick, and that’s one first piece of the puzzle. We have dramatically increased the medicalization of not only deviant behaviors like suicide or alcoholism or violence, but even normal behaviors, common behaviors like sleeplessness or forgetfulness or inattention or even racism. All these things can get lumped into their diseases, their sicknesses, rather than there’s something maybe a bit more complex that we have to deal with in different ways.

Gabe Howard: Dr. Cohen, if I can play devil’s advocate for a little bit, I think here is where I struggle. I showed the symptoms of bipolar disorder at a fairly young age. I had mania, I had delusions, I had suicidal depression. And my parents, they they did not take me to a doctor. They did not try to medicate me. They didn’t do anything. And and it almost ended my life. Now I know that bipolar disorder is much more serious than than maybe some of the things we’re talking about. But how can people tease that out? My parents feel very guilty for not getting me any medical treatment at the age of 16, whereas now we’re sort of talking about it in, in well, maybe they shouldn’t have. Maybe they did the right thing. This all seems very, very difficult for parents to decide. Well, I don’t want to overmedicate my children, but of course, nobody wants to deny their children needed medical care either.

David Cohen, PhD: Right. Except you’re emphasizing medical care. You said I had this problem, and my parents didn’t get me medical care. So you see where some of the divergent views is, what constitutes care, what response might have been very helpful to you, say, at 16 or 15 or 14 that might not have been medical care, but care nonetheless? There’s a lot of things that are involved in caring for people besides giving drugs. And so, that’s that’s my first answer. Definitely, you and many other people probably were in huge need of attention and care and listening and understanding what, what what could be going on. What how might we explain how you were acting? What did you think of it? What did you want? What did you need? And that’s how people often care for these things. We didn’t ignore people making outlandish statements or delusions or thinking or having false beliefs. We haven’t ignored these things before medical care came along. We’ve dealt with these things throughout history. And so confirms my first point I was trying to make, is that we have medicalized and possibly yourself in your answer, have conflated medical care, taking someone to a doctor, to taking someone to somebody else with a different school of thought and techniques and philosophy and methods for dealing with extreme distress and extreme mental states.

Gabe Howard: It’s an incredibly interesting point that you raise that the majority of people think that treating mental health means getting medication.

David Cohen, PhD: Oh my goodness, yes.

Gabe Howard: I don’t have data on it, but I think if you asked people how to help somebody with mental illness, I think the vast majority of them would say medication versus anything else. Therapy, supports, stabilization, etc.

David Cohen, PhD: But, but, Gabe, forgive me for jumping into this, but that you nailed it right there. In fact, you are illustrating with this comment. Yes, most people probably would say that, but this is a recent development. This is something this we’re taking that for granted. That medication is the number one form of care today if you have a mental health problem. But it was not always like this. That is, in fact, what I mean by medicalization, that people tend to think that this is the normal and natural way to begin helping. Having this view that medication is the the fundamental, the essential, the paradigmatic way, as we say, of offering care or responding to distress. Whereas in fact, just 30 years ago it was just, you know, maybe the second or the third way, you had other ways to to respond to distress. And that we have come so far is itself a sign of the problem. Not so much that it’s a cause of the problem.

Gabe Howard: But what is the cause of the problem? How did we get here? One percent of kids taking drugs to 10% of kids taking prescription drugs in just a few decades. That is huge. How did that happen?

David Cohen, PhD: Well that, because we changed how we approach the problems, number one. But many other things happened. For example, the family has changed dramatically. The nature of the family, it’s changed to accommodate a growing role for women as workers outside the home, as more autonomous, there’s been fewer children in families. Families have been smaller. It’s got more single parents. As the mobility of parents increased, it’s changed to lose grandparents, who were people who who knew children also and who were comfortable disciplinarians. There’s so many things happen to the family over the last 40, 50 years. There are incredible changes that we can see looking back, but all of that contributed to viewing and looking and dealing with children differently. And when you bring into that the slew of new diagnoses that appeared with DSM-III in 1980, including the mother of them all, ADHD, or at the time ADD, well, then you begin to see and all the the professionals, the learning disability and the psychological and the mental health professionals that that were raring to go and diagnose everyone with these new diagnoses. So we had a whole industry.

David Cohen, PhD: And all of these put together, including the role of the pharmaceutical industry, because they promoted not just the pills but the diagnoses. Diagnoses are much more important to the drug industry than to almost anyone else. They don’t have to push the pill. They have to push the diagnoses. And once you accept that that this is what my child has, my child has this problem rather than acts this way or makes these decisions or doesn’t have this information. Once you say my child has this somewhere, then you quickly move to say, let’s fix it. You know that children suffer from these diseases and we have very effective drugs that are going to take care of the problem and have no downsides. That has been the push from the industry. Modern science. It’s safe and approved. You’ll be silly not to try them. So together, all of these changes, over time, lead us to the situation where 9 in 10 people think, well, proper way to treat what we call mental health problems is just take someone to the doctor.

Sponsor Break

​​Gabe Howard: And we’re back with Dr. David Cohen from the PBS documentary Medicating Normal. What are parents supposed to do, though? There’s clearly something that’s bothering them about the behavior of their child, the attitude of their child, or just they’re concerned about their child. So, they do the right thing. They go to a doctor and a doctor has to give them a diagnosis. And the diagnosis leads to treatment. The treatment is the medication. They’re the parents are following all the rules. They’re doing everything right. And now we’re in this situation where we’ve got this overprescription. And I think parents are they’re really defensive about this because they’re like, what did you want me to do? I paid attention to the mental health of my child, and I went to a doctor. And now you’re saying that this other bad thing has happened? I sort of feel like parents are getting a bad rap here.

David Cohen, PhD: That’s what again, that’s precisely the situation. Everyone. Not just parents. Everyone is doing what they’re supposed to do, but what they’re supposed to do in our culture. So this is a good segue to simply let’s compare with some other countries. The biggest chunk of comparable countries are European countries. Now, when it comes to medicating children, if there’s one difference between the two, say, between the United States and the European countries, it’s that though you have a very similar rate of medicating adults, about 1 in 5, 1 in 4 for some drugs, 1 in 3 adults is on psychiatric drugs. In Europe for children it’s much, much less. It’s sometimes 30 to 40 times smaller. The rate of kids being medicated in Europe today overall with psychiatric drugs is about what it was here in the US in the 1980s. That’s where they draw the line. That’s cultural. They’re doing what they’re supposed to do because the society is organized a little differently. They’re not as inclined to see what is happening to their kid as a defect in the child’s brain. They’re going to look at other things, and the professionals are also going to look at other things. For example, in France, you’re not supposed to start medication before 6. It’s simply not done. Very, very rare. Here, three years. Three years of age, four years old is when kids are started on medications for behavioral problems. These are scientific societies also. They have highly trained professionals. They use the same medical models, but they draw a line somewhere. The problem is not about oh, what are parents supposed to do? The problem is what are we all supposed to do?

Gabe Howard: I have to say, when you were talking and you said six years old, I thought, that’s ridiculous. You can’t you can’t give psychiatric drugs to a six year old. And and then you said, in America, it’s three. I,

David Cohen, PhD: Well, of course

Gabe Howard: I.

David Cohen, PhD: In America we have we have a rate already of about for three-year-olds. The rate for three-year-olds today, is about 1% of three-year-olds. That’s 1 in 100. We have examples of one year olds and two year olds being medicated with simultaneously with several psychiatric drugs. I mean, these are documented examples. And three-year-olds, we have population figures. We didn’t used to look that young before, but we do now. And we could document that. It’s about 1%. That’s 1%. And for six-year-olds, I’m afraid to begin to tell you. But it is several more percentages of that. And I can tell you that in some communities, 8- to 12-year-olds, it’s almost 12%. It’s 1 in 8 kids that you see in the schoolyard is taking a pharmaceutical grade amphetamine.

Gabe Howard: I’m just really struggling sincerely, how any doctor could prescribe that.

David Cohen, PhD: Easily. By writing a prescription. They can do it because their colleagues do it. They can do it because their professional associations tell them this is a common neurobehavioral disorder of childhood that responds to treatment. And so that’s it. It’s where we’ve come. It’s where we are today. Because it’s all about raising and educating children and everybody has an opinion on that. That’s what this is about, this is how we raise and we educate and we discipline and we correct and we model and we teach children. Because now we can look back a little bit and look, okay, so what has this 50-year drug revolution actually brought us? What have all these treatments actually done now that we could look at that to? We’re no longer just in the midst of it.

Gabe Howard: Well, let’s talk about that. Are we in a better place? Has this? Fifty years of data. That’s, that’s a lot of data. That’s that’s that’s a couple of generations.

David Cohen, PhD: That’s a lot of data. Well, I don’t know any expert who says we are in a better place today. I really don’t. Every expert I know, including Tom Insel, the former director of the National Institute of Mental Health, made these pronouncements that at a population level, we were losing ground even compared to pre drug, meaning even compared to the 50s. And for the most severe, what are considered the most severe disorders like schizophrenia. We did not have shortened episodes, we did not have fewer episodes. We did not have fewer patients. We did not have any measure of improvement of any aspect of of the disorders were available. Suicide rates have dramatically increased. The incidence has increased, the prevalence. There’s no there’s no satisfaction from any a spectrum of the consumers. It’s worse across the board. And more people are on drugs and more drugs. They’re not on one drugs. They’re on three drugs. So I’m not sure exactly what this what it has brought us exactly to have come to the place where 9 in 10 might think that what we need is taken to the doctor and get the medication. I’m not sure that it is justified by the data. Now, I will hasten to add that if I ask you, Gabe, people that I meet, I hear stories on the at the individual level of people who have been helped tremendously. There’s no denying that. Just like I hear stories of people who have been harmed. But at the population level, looking at the statistics over time. It looks bleak.

Gabe Howard: I sit in this very awkward place because, as I’ve said, psychiatric medications saved my life. I’m so thankful for them. But I do have serious, serious questions about overprescription, about their use, about when it’s appropriate to take them and when it’s not appropriate to take them. And I will say, as a mental health advocate, I’m not getting really solid answers on this. And one of the things that you said, it popped this in my head a little bit, because whenever I share that, I take my medication and I get, well, standing ovation, I’m a hero. People love me. It’s it’s a positive and powerful story. But whenever anybody stands up and says, hey, I was overprescribed medication, the side effects were horrible. It hurt me. People roll their eyes and tell them, well, you didn’t do it right. You weren’t med compliant, you didn’t listen. It really seems like the PR, the information, the the discussion around the water cooler is psychiatric meds are good and we just push down any sort of data that shows that they have any negative whatsoever. I still have to ask though, what are people supposed to do with that?

David Cohen, PhD: Well, Gabe, first of all, if I may say, you have just expressed now, I think better than anyone could have said it, exactly what the current cultural climate is. We praise certain narratives about the effect of drugs. And we literally, we literally demonize, we exclude, we put out of our consciousness other narratives about the same drugs. So we praise narratives, stories that say drugs helped me. And we we don’t want to listen to stuff that says drugs hurt me. And that is there’s no better example of how this is totally a cultural moment. It’s not a it’s not a scientific moment. It’s a cultural, social phenomenon. And that is what when when I look in my work at drugs themselves, sometimes I don’t see them as objects, but as kind of symbols. They’re like charged objects. They’re like like amulets, talismans. There are things on which we project. We project. We we put on them how we think about life and goodness and what’s being moral and virtuous and what we should do, because that’s what we learn.

David Cohen, PhD: What’s happened over the last 40 years and 50 years is drugs themselves have become this. They’re no longer specialized tools of physicians, really. They’re not. They’re just like a lifestyle product. They’ve been turned into things that, you know, you supposed to know more about them way before you even get to the doctor’s office. The choice. You’ve already made it. You’re only going to the doctor just to get access to it, because it’s been sold to you already. The drugs have been advertised like like we advertise cars and jeans and watches and. And so that’s what’s happened over the last 30, 40 years is knowledge about the drugs has moved completely out of science. And that’s different than it used to be. So I’m not saying it’s good or bad, but that has helped all of the the changes. That we make decisions about drugs in relation to our values. And when people praise or or condemn people for expressing certain views about drugs or other treatments, whether it be vaccines or whether, you know. It’s all about our values and what we know, what we believe is a society and what we’ve been taught

Gabe Howard: But aren’t doctors supposed to be the last line of defense? I would just like to believe that if somebody walks in and says, hello, I want x, y, z. A doctor doesn’t just write the prescription, otherwise they just might as well be over-the-counter.

David Cohen, PhD: But then you’re not informed because the average visit takes about 6.5 minutes with a doctor and they don’t even know you. So how do you think they’re going to come to their decision? That’s the way it is. In fact, I mean, there’s all kinds of studies that even measure this. So, you know, Gabe, wake up. It’s like that. That’s why we have probably 65 or 70 million people in the US on psychiatric drugs. And I’m not including the opiates. I’m not including cannabis. I’m not including alcohol. I’m not including coffee. Which you might think I’m being glib here, but these are also powerful psychoactive drugs that change how you feel, how you think, how you act. That may not be prescribed today, but either were prescribed or will be prescribed tomorrow, including the psychedelics. As we go back and forth with all what’s in fashion and what counts as a good drug and what counts as a bad drug. All that changes every decade. It’s not as reassuring a space as you might think it is.

Gabe Howard: All right, listeners, this is our to be continued moment. Please make sure to tune in to part two of this episode to hear more of Dr. Cohen’s insights, including how the difference between pharmaceuticals and illicit street drugs isn’t so much scientific as it is cultural. And of course, what you and your family can do about all of this. All right, we’ll see everybody in part two, available right now.

Announcer: You’ve been listening to Inside Mental Health: A Psych Central Podcast from Healthline Media. Have a topic or guest suggestion? E-mail us at show@psychcentral.com. Previous episodes can be found at psychcentral.com/show or on your favorite podcast player. Thank you for listening.

Part 2:

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Welcome back, everyone. I am your host, Gabe Howard, and this is part two of our discussion with Dr. David Cohen. Dr. Cohen was recently featured in the PBS documentary Medicating Normal, The Untold Story of what can happen when profit driven medicine intersects with Human Beings in distress. Dr. Cohen, in part one of the episode, you talked about how the percentage of people in the US taking psychiatric medications, especially kids, has risen dramatically in the last few decades. And as I said before, I personally take psychiatric medications to treat my bipolar disorder, and I feel that I have really benefited from them. But they also have a lot of downsides. I get frustrated because it seems like two camps have set themselves up and very much dug in their heels. We’ve got the anti-psychiatry side that says that all medications are bad, hard stop, and then we’ve got the medical side that says that all medications are good hard stop. Now. It’s ridiculous on its face. Could you imagine if somebody

David Cohen, PhD: Mm-hmm.

Gabe Howard: Said, well, water is 100% good. Well, but what about hurricanes? What about drowning? What about flooding? Water is bad in those cases. Well, of course in those cases they are bad. So, we understand that even something as necessary and as good as water can be dangerous. But again, when we try to have this nuanced conversation about psychiatric medications, the two camps immediately set up and they immediately just start lobbing insults at each other.

David Cohen, PhD: Well, the first thing that I want to say is that this idea that there really are two camps is itself a little bit of an oversimplification. There’s always some nuance. I myself am not sure which camp I’m into. And I can see both sides. I know, and I’ve seen and I’ve experienced how a drug can help someone to do something they would like to do or to overcome some difficulty. On the other hand, I’ve seen people being terribly harmed by drugs and being dismissed simply by voicing their concern.

Gabe Howard: Whenever I’m in a conversation about prescribed psychiatric drugs, one of the things that I always think about is a concept called self-medicating. Lots of people experiencing psychiatric distress will try to make themselves better using illegal street drugs or even alcohol. Basically, anything that they can get their hands on without a prescription, without a doctor, without a barrier. Now, obviously we’re focusing on prescription drugs right now, but it does make me wonder what’s the difference? Is there a difference between an FDA approved psychiatric drug and just illegal street drugs that people can get? Well, frankly, anywhere. Do they have anything in common? Do they match at all or are they worlds apart?

David Cohen, PhD: All that we call psychoactive drugs, they all share, they all produce. How could altered states, altered mental states, altered psycho behavioral states, whether it’s alcohol or opiate or what we call an antidepressant or a stimulant, they produce a certain class of effects that that all the drugs share, whether they’re prescribed or whether they’re over-the-counter or whether they’re sold on the street, on the so-called black market. Then if they’re in that class of drugs, that’s what they do. Why the drug happens to be illegal today and its sister drug is not is legal like amphetamine and cocaine. That’s not there’s very little scientific explanation for that. The drugs have essentially similar effects, but where one came from and who was supporting it and what historical time and who was mostly using it and who began to promote it and manufacture it and who allowed that where and when.

David Cohen, PhD: All of that plays much more into it than the scientific or chemical or behavioral question of what effect does the drug produce on the average user or on this person of that age and so forth? So that’s what I mean. And the other point when related to your question, is that there’s a nearly constant back and forth between the world of licit and the world of illicit drugs. The drugs are regularly switching places. The legal becomes illegal. The illegal becomes legal. The same drug can simultaneously be illegal for one use and FDA approved for another use, like methamphetamine. Or nicotine. And many other examples that are occurring before our eyes. With the psychedelics, especially psilocybin, becoming the go to drug for addiction, whereas in fact it was before it was the, the, the epitome of irresponsible use was using a psychedelic drug. Now we have micro dosing, and I’ve even seen some people say maybe we should give it to kids. So, you see, everything changes back and forth if you live long enough, or if you just keep your eyes open for 10 to 15 years, every decade, there’s a major change like that. These are just reversals. They’re not instructive scientifically because we know exactly what we knew about the drug before the change. We don’t have new information about it. It’s just our attitudes changed.

Gabe Howard: It really reminds me of food guidance. I remember when I was a kid. Eggs were bad. And then, as you said, I waited five, ten, 15 years and eggs were good, and then eggs were bad and then eggs were good, cholesterol then eggs were bad, cholesterol. And then eggs caused this. And then eggs got.

David Cohen, PhD: Yeah.

Gabe Howard: Egg. Just the poor egg people just have to be suffering so much. Because depending on the day or the news program, eggs are either the greatest thing that you can eat for your health or they will kill you. I’m exaggerating for effect, but as you said, eggs have stayed the same. Eggs are exactly the same. Eggs have never changed.

David Cohen, PhD: Never changed.

Gabe Howard: There’s just the only thing that’s changed is some generations think eggs are good, some generations think eggs are bad, and they’re backed up by science, it seems.

David Cohen, PhD: And Gabe, that’s a fantastic example. I wasn’t thinking about food, but of course it completely applies to food and food too. You have the pyramid of food, the approved food. You have a federal agency that tells you what are the desired foods and how much of each you should take. And all of that changes too. It’s very similar to drugs, and it’s also you see it also in behavior. And a great example, if you study psychiatry and mental health is masturbation. This is an incredible change where it used to be seen as a cause of insanity. It used to be seen as a cause of mental illness. And today, what caused? Today is if you don’t do it, there’s something wrong with you. So, you see, we they’re called value reversals. They’re value reversal. If you just look at it, you’ll just go along and say, oh, look. Oh, it’s recommended now, maybe I should try it. You know, that’s not the point. Maybe you should. Maybe you shouldn’t. It doesn’t matter. The point is, how come it was different before? And more important, what will it be tomorrow? That’s the point. Because ultimately we’re geared to the future. What should we do? So just know that the claims about drugs and foods and behaviors are going to be changing. They will not be the same. They’ll be wildly different. So be a bit more skeptical. Be a bit more critical, be a bit more detached about the claims that you’re laying your allegiance to. Don’t just accept it lock, stock and barrel.

David Cohen, PhD: Because look what happened before and look what’s likely to happen again. And so, you’re right. For sex, for eating, for many things. I mean, of course, exercise and stuff like that. And weight, for example overweight, underweight and how the technology, how we have new scales. Like anorexia barely was discussed as a, as an issue before we had small scales we could weigh ourselves on scales didn’t used to be in the homes. You didn’t have a $20 thing that you could spend on and know your weight instantly. You had to practically pay to weigh yourself. You had to go in public places and go in these big contraptions. It’s just like the way a little technology, a change, completely alters how we think about things and creates like a generational change. And that’s what I try to bring up a little bit in the conversation, that we have to look at these issues more as cultural issues, social issues. But in the individual conversation, if I’m seated across somebody and it’s just me and them and they’re telling me about them and their trouble, it’s a different story. I have to listen to what they say and how they see it. And what is the pain and what is the problem. And so, it’s a different story than looking at changing norms and changing practices overall in the society. But just because it doesn’t have a simple solution doesn’t mean we can ignore it.

Gabe Howard: It’s incredible trying to wrap your mind around this, especially when we w consider how serious suicidality is in our young people. They’re really, really impacted. And death is very serious. I, I don’t know why I’m trying to convince my listeners that death is serious, but it’s serious. And then all of this information comes at you. And maybe the reason that we don’t understand this as well as perhaps we need to is because ultimately, we don’t take mental health and mental illness as serious as we need to in society. I think if somebody was diagnosed with cancer, this idea that you need to do more research, you need to have more understanding, you really need to dedicate a significant amount of time to understanding. It would not land with such a thud. But when we talk about mental health, mental illness and we say, look, you need to dedicate a significant amount of time to learning. Working with your doctor and really digging deep. People are like, yeah, but I’m awfully busy. I don’t know that I have a lot of time for that.

David Cohen, PhD: Well, so may I respectfully disagree with you on this. I think that you definitely want to spend a lot of time thinking of how you should live your life, and when you bring up the but not necessarily calling it mental health and illness, I find that to me, that’s part of the problem. We’re under a kind of tyranny of mental health because we’ve just, again, brought too much under that orbit. And as a reason, because we have the word health in there will immediately jump to the medical side of it, you see, because health medicine is so close. So, then we’ll go to the doctor for what are actually existential, their philosophical, their moral problems. How should I do this? Is it right to do that? And it’s no accident that that famous line of the philosopher Camus, Albert Camus, who he talked about suicide as the fundamental philosophical problem and practical problem of existence. In other words, he didn’t say it’s a health and illness problem. This is a damn serious issue that almost everybody has to grapple with at some point or other. And I I’m very sympathetic to this. I don’t call it a health problem. It’s a serious issue. It’s a fundamental issue if you’re alive and if you’re a thinking person, you’re going to think about that at some point. And that must be handled very seriously, but not necessarily medically in my view.

Sponsor Break

Gabe Howard: And we’re back talking to Dr. David Cohen from the PBS documentary, Medicating Normal.Dr. Cohen. I love the concept that not every single thing that bothers us is a medical issue or a mental health issue. While it potentially could be, I like that you gave push back on this idea that it might not be. Because you’re right. I do think a lot of people look at something and they decide before they’ve done any research, before they’ve really talked to any medical professional, looked at any science whatsoever. They’re like, aha, mental health crisis, mental illness. And it is vogue right now. And shows like mine, we help educate. But we also have popularized the concept of discussing mental

David Cohen, PhD: Yes.

Gabe Howard: Health crises and mental illness. And it’s the literal definition of a double-edged sword. I want people to have this information, but I think that sometimes maybe people are scared of the information or they reach the wrong conclusion. I believe you said we need to remain vigilant and open minded, and

David Cohen, PhD: Yes.

Gabe Howard: I think those are those are powerful, powerful statements when it comes to the mental health issues that our country is having. Because you’re right. I bet a good many normal things are falling under mental health crisis, whereas when actuality they’re just. Life can be hard sometimes, and seeking a medical solution for life can be hard sometimes is going to cause, well, more issues

David Cohen, PhD: It.

Gabe Howard: Than it’s going to resolve.

David Cohen, PhD: I couldn’t have said it better. Couldn’t have said it better.

Gabe Howard: Well, that’ll be $100. And [Laughter]

David Cohen, PhD: [Laughter] And at today’s prices, that’s pretty cheap.

Gabe Howard: That’s not a bad deal. I’ve said.

David Cohen, PhD: Not a bad deal.

Gabe Howard: I struggle with this so much. I don’t want people who are like me to not get help, but I don’t want people who are like my friends, my family, my loved ones to think that every time something bad happens in their life, they have a serious and persistent mental issue because having one is terrible.

David Cohen, PhD: Well. But but, Gabe. That’s. Well, but I think that’s where we’ve gone as a, as a certainly in the US we’ve really gone there. It’s like any kind of pain or distress that, that doesn’t, you know, remit easily. That’s going to last a little bit. It’s now it’s a disease. It’s just that any kind of serious trap that can befall you is basically a disease. That’s it. There’s no I’m sure I’m exaggerating. I hear myself now and I say, no, that’s a little too much. But that’s how I feel half the time. It’s like, can we please have something that is very difficult and lasts for a while that is not going to be considered a disease? Do we always have to ask the let’s ask the clergy what they think. Let’s ask the philosopher what they think. Let’s ask the scientist. Let’s ask the poet. Let’s let’s not necessarily say this is a technical problem. This person’s gone to school to study it so they know, no, I don’t think so. I think that a lot more creative solutions can come out of just people grappling with it with a like-minded thinkers or their families and their clergy and their rabbi or priest or what have you. I really I’m truly convinced of that. So, I’ll beg to disagree a little bit, meaning that there’s too much of this mental health stuff. We’ve just turned too much into mental health. It’s just well-being. It’s just it’s just living your life. It’s not about mental health. Just like every ache and pain is not about disease. It’s just about, you know, hey, straighten up or walk better or move more. And it’s not all about treating something. [Laughter]

Gabe Howard: I have to ask, though, for. For parents, for loved ones, for yourself. What should you do? You obviously went to a doctor because you felt that you or a loved one, was in trouble. You’ve relied on the information from the FDA. The federal government approved the medication for this purpose. You’ve relied on the information from the doctor. As you said, you’ve relied on information from podcasters, influencers, health websites. Et cetera. To educate yourself so that you can be informed. And then you’ve been given this and you’re told to take it as prescribed, which, again, is another message in our society. Take your medicine as prescribed. Be med compliant. What can people do to get out of that loop so that they or their loved ones, are in the best position to solve the problem that they’re trying to solve in the first place?

David Cohen, PhD: Wow. Well, it’s a tough question. You know, there is a task that faces every citizen in a society. In any society, it’s always faced. What am I going to do? How am I going to solve this problem? How am I going to change myself or learn something new? And who am I going to listen to? This is a universal task that at some point, let’s say around the 17th or 16th century, at least in the West as we know it, we began to think that you have to be a critical thinker. Which means you have to weigh what people told you against other sources of information, and you had to apply certain standards of reason and logic. And common sense. And that was your duty as a citizen, not merely to listen to what the authorities told you. Because who were the previous authorities? Well, they were the church. And who was before them? Well, they were the Witchman or the Witchdoctors and who was the before that?

David Cohen, PhD: So, there’s always an authorities that tell you what to do. But we always forget that the authorities are self-interested. They pursue their own interests also. So, to be a critical thinker, which is the task I repeat, you face as a citizen in any social group, is to emancipate yourself a little bit from what the authorities tell you, simply because they’re the authorities in your group. You’ve got to think for yourself. And so, you have to find some like-minded people, and you have to find some people that you don’t agree with, but that you respect and that you say, how are they thinking? How are they going about this? Who else could I ask? What have been other examples of this problem before I came along, before these authorities came along, who else is dealing with this? Who else is saying something else, and what are they offering and what’s available to me? And how difficult is it? And if it’s so difficult, does it mean I should ignore it? Or maybe this is the one. This is the path I have to follow. These are questions that have to be answered in your own case. But I hope I’ve made the case that you can’t just follow what people tell you to do. And if you want to do that, well then don’t.

David Cohen, PhD: Don’t complain. And just do it. And when and when adverse effects come along, which they always do, they always do. Whether you look at over time, we kind of tend to regret the way we used to do things. Right. This is almost a law of social behavior. The way we’re dealing with children now, I shudder to think how we’re going to think about that when 30 years from now, just like how we made children work in factories in the 1880s. We were living in a in a society that that was dedicated to production. And we mobilized all the resources of all human beings to work in factories and everything, including children as young as five and six and seven and eight, who cared about sending them to school? And so, we now look back and say, my goodness, how could we have done that? We were worshiping this cult of production of goods at any cost. Well, what are we worshiping today? Is it the cult of performance? Is it? I don’t know, I can’t quite tell exactly, but we have to look at this critically and everybody’s got to do it for themselves. I’m sorry to say I’m not letting anybody off the hook, but that’s what it’s about.

Gabe Howard: Dr. Cohen, thank you so much for being here. You’ve answered a lot of questions. You’ve raised a lot of questions. And I think you’ve given our listeners something to think about so that they can be better informed for themselves, their children, their loved ones, for the people around them. And I think that’s really, really, really, really valuable. Now, the documentary Medicating Normal is out now. It was done by PBS, but how can folks reach you?

David Cohen, PhD: They can reach me by emailing me. I’m an old-fashioned person who uses email. I do not have a personal website. I have a page on at UCLA University of California in Los Angeles where I work as a professor, but my email is my last name Cohen, C O H E N at Luskin L U S K I N dot UCLA dot edu. Cohen@luskin.ucla.edu. That’s how people can contact me.

Gabe Howard: Thank you. Thank you so much once again for being here.

David Cohen, PhD: It’s truly my pleasure. Thank you so much for your provocative questions. Thank you.

Gabe Howard: Dr. Cohen, you are very welcome. And I want to give a big thank you to all of our listeners.My name is Gabe Howard, and I’m an award-winning public speaker, and I could be available for your next event. I’m also the author of “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon, but you can grab a signed copy with free show swag or learn more about me just by heading over to my website at gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and you don’t want to miss a thing. And can you do me a favor? Recommend the show. Share it on social media. Send an email. Send a text message. Mention in a support group. Hell, share it at family dinner because sharing the show is how we grow. I will see everybody next Thursday on Inside Mental Health.

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