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Dr. Raghu Kiran Appasani and author Brooke Siem join us for a nuanced discussion about the complexities of prescribing psychiatric medications to children. They explore the importance of informed consent, the inadequacies of the current mental health system, and the societal shift toward over-medicalizing everyday life challenges.

Both Brooke, as an advocate with personal experience, and Dr. Raghu, from a medical perspective, agree on the need for a multifaceted approach to mental health treatment, moving beyond reliance on medication alone. However, they disagree on the best path forward and share their perspectives.

Join us for an enlightening point-counterpoint discussion moderated by host Gabe Howard.

“When people come to me and they ask me these questions, they are never thriving, which is another piece of anecdata for me, that just shows that these drugs don’t really work long term. I mean, I honestly have not met one single person who has been medicated for, let’s say, more than 2 to 3 years for depression, who says they’re thriving. I hear them say they’re coping. They’re, you know, they’re okay. They’re fine. That’s kind of the best it gets. They’re never living their best life. And so I think we just really attribute a lot of that to just like, oh, it’s just being an adult, you know, life’s hard and then you die type of attitude.” ~Brooke Siem

Brooke Siem

Brooke Siem (@brookesiem) is both a chef to professional athletes and the surprising face of psychiatric drug withdrawal awareness and advocacy. Her book, “May Cause Side Effects,” won the 2023 BIBA Prize for memoir and was named as one of “Good Morning America’s” most anticipated reads. Her work on antidepressant withdrawal has also appeared in The Washington Post, New York Post, Psychology Today, and more. She is a Food Network “Chopped” Champion, founder of the newsletter Happiness Is A Skill, and creator of the Fuckit Bucket™.

Dr. Raghu Kiran Appasani is an integrative & addiction psychiatrist, neuroscientist, and social entrepreneur focused on bridging the gap between Western and Eastern practices to create a wholesome society by taking a proactive approach to health. He recently completed his Addiction Psychiatry Fellowship at the University of California-San Francisco (June 2023). His interests lie at the intersection of psychodynamic psychotherapy, integrative/nutritional psychiatry, mental health literacy, advocacy, wellness, entrepreneurship, and psychedelics. His alter ego’s life goal is to become a chef integrating farm-to-table experiences in stunning landscapes around the world.

Dr. Raghu Kiran Appasani

For his contributions, he has been recognized as a World Economic Forum Global Shaper, One Young World Delegate Ambassador, StartingBloc Fellow, Nexus Global Delegate, EchoingGreen, MassChallenge, and Kellogg Innovation Network Delegate. Through his extensive scientific research, he has published more than 35 peer-reviewed articles and edited 5 books. He has given more than 120 talks on mental health, entrepreneurship, global health, and consciousness in parallel with authorship and features on CNN, Vogue, The Boston Globe, ThriveGlobal, The Better India, The Zoe Report, and The Huffington Post.

Clinically, Dr. Appasani is trained in psychodynamic psychotherapy, cognitive behavioral therapy, intensive short-term dynamic psychotherapy (ISTDP), cognitive processing therapy for trauma, motivational interviewing (MI), group therapy, and exposure response prevention. He also completed the MAPS MDMA psychotherapy program as a health equity scholar. His clinical interests lie in psychedelic therapy, mood disorders (depression, bipolar disorder), addiction, anxiety disorders, OCD spectrum, eating disorders, trauma, and personality spectrum conditions.

Gabe Howard

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.

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 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: Hey everybody and welcome to the podcast. I’m your host, Gabe Howard. Calling into the show today, we have Brooke Siem, author of “May Cause Side Effects,” which chronicles her personal experience taking psychiatric medications as a child. Brooke, welcome to the show.

Brooke Siem: Thanks for having me back.

Gabe Howard: Oh, I’m very glad that you are back, Brooke. And also calling in we have Dr. Raghu Appasani. Now, Dr. Raghu is an integrative and addictive psychiatrist and neuroscientist who has published over 35 peer reviewed articles and edited five books. Dr. Raghu, welcome to the show.

Dr. Raghu Kiran Appasani: Thanks so much for having me, Gabe.

Gabe Howard: Of course, of course. Now, today we are here to talk about the use of psychiatric medications in children. And we have Dr. Raghu here to give us the medical perspective, a doctor’s perspective. And Brooke is here to give us some of that personal touch, that personal detail. Now, Brooke, you started taking psychiatric medications, antidepressants at the age of 15 after your father died, and then you continued to take them for another 15 years. And your book is all about what you went through when you stopped taking those medications after all of that time. So I wanted to ask you, Brooke, from your perspective, do you think that these medications are appropriate to prescribe to children?

Brooke Siem: Oh, that’s not a yes or no question. So I feel I’m struggling to put it into one box or another, but I guess I’m going to turn it back around and say, where is the research that shows that it’s effective and safe to medicate kids long term for sure? And I don’t think it exists. I mean, we have some research that comes from pharmaceutical companies, and when you actually start to look at it, it’s quite scary that they’ve approved these drugs based on what we’re seeing in the research that the FDA actually approved these drugs. So, if I have to pick a side, I’m going to go with a strong no, especially given my own experience as a medicated child that did not work out well.

Gabe Howard: Dr. Raghu, what do you think? What’s your opinion as a medical doctor?

Dr. Raghu Kiran Appasani: You know, I don’t disagree completely with Brooke here. However, there are certain situations where medication can be helpful. There does need to be more extensive research on the long term effects of a lot of these medications. However, you know, in the short term, there are situations where it can be useful. And I’ll give you an example of that specifically. So specifically with severe ADHD in children it has been shown that if you are able to provide treatment from an early intervention stage, you can have better outcomes socially, academically and overall well-being. There are side effects to that as well, but there’s very specific situations where they can be helpful.

Brooke Siem: You. Can we expand on the very specific situation? Because I’m struggling to, I mean, where’s the where’s the blood test for ADHD, right. And at what point do we acknowledge that maybe this is an issue with the parents in the house at the school that, you know, maybe, maybe the kid just has energy. I mean, I guess I’m confused as to when we talk about better outcomes. For who? For the parents, for the teachers, what is I would like more specifics on on these extreme examples, just so maybe I can better understand.

Gabe Howard: Let’s narrow this down a little so that we can stay focused. Dr. Raghu, I don’t think that I can ever recall hearing somebody say my child has ADHD and then not follow it up with that they’re treated with medication. Are there children with ADHD who are not medicated but being treated in some other fashion?

Dr. Raghu Kiran Appasani: Yes. And honestly, that’s how it should start. And we should be starting with providing other types of support that are non-pharmacological first, specifically looking at family systems, school systems, you know, is this person in the right environment, learning environment that actually works for them. And also specifically looking at nutritional interventions. Right. And that’s really where the problem is right now within the system is that when people get put on medication, which should be a very extensive conversation with a lot of informed consent and education, providers are not following that trajectory and really questioning, do you still need to be on this at every appointment and every stage? And that’s where it needs to change. So there is a role for medication, but we have to change the way that we actually administer and follow progress and look at the situations that we’re providing that medication in.

Gabe Howard: Brooke, I have to imagine when you hear that said from the medical establishment and somehow, Dr. Raghu, you became the medical establishment on this podcast.

Brooke Siem: Yeah.

Gabe Howard: You’re like, yes, that’s fantastic. But that doesn’t seem to be the way that it’s playing out.

Brooke Siem: When I talk about this stuff, we’re working with a drug that’s not only are the side effects that are advertised easily written off as the disease you already have, which just seems to me concerningly convenient. But also we’re told, oh, but it’s not going to work for 2 to 3 months. And I think with kids, especially given that kids can change so fast there. They can have a huge transformation in 2 to 3 months at every age. So how do you really know what’s happening? How do you know whether or not this is something your kid is actually benefiting from, or if they maybe just needed time and structure and attention? I mean, we just don’t know. And I don’t think it’s as easily comparable because the because the effect of the drug is so much slower to maybe not work.

Gabe Howard: Brooke, as you’re talking, I’m like, that makes perfect sense. But I have to imagine to parents the the. Oh, well, we’ll just wait and see if it gets better is not something that they want to hear. And truthfully, I’m not sure it’s something that’s reasonable. I mean, could could you imagine if a parent is given something, anything and they’re like, okay, what we’re going to do is wait. And then the worst case scenario happens and everybody immediately says you were on notice, you were aware and you just opted to sit there and wait. Dr. Raghu, from from your perspective, is that what you’re up against, that parents are like you have to do something because if we do nothing and a bad outcome occurs, we’re going to be blamed for this. And by extension, you’re going to be blamed for it. Is that how you’re seeing it in your practice or just in practices across the United States from an aggregate?

Dr. Raghu Kiran Appasani: It’s a really good question about the pressure that providers feel from caregivers and parents, right, about their children. And that is something that we we feel a lot of. Right. If you have a child in distress, parents are pretty burnt out sometimes. And they look to you as a provider, as a physician to have a fix. And that is a very Western model of medicine as well, which is do you have a magic bullet fix that will change this for us where, you know, that it can really help us and create a level of safety for our kid. So there is that level of pressure as well that comes on to providers. And, I think you mix burnt out parents with burnt out health care providers in the US, and you’re left with looking at the toolkit of former pharmacological agents and throwing that at people. That’s that’s not the answer right now. And the medical establishment does need to change the way they’re approaching treatment, specifically with what Brooke is saying with the antidepressants.

Brooke Siem: Yeah, I mean, I, I agree with Raghu and what you’re talking about is that parents decisions are being run entirely by fear, and that is not an appropriate way to make decisions about your kid’s life. I understand that in the moment, and especially with all the news and coverage around child suicides and teen suicides, that it’s so terrifying that I imagine that you’re just trying to stop the worst from potentially happening. At the end of the day, I really struggle with what we’re doing to children from a pharmaceutical, from a pharmaceutical perspective, because kids don’t have agency. But that’s probably not going to change anytime soon. So where I’m really struggling is the fact that parents are not getting the full gamut of informed consent and what the true, let’s say, pros and cons are of these drugs, and instead they’re being run by pressure from other parents, from these overworked doctors, by shame.

Brooke Siem: But if you actually sat down with, like, if someone sat down with my mom when I was medicated at 15 and actually showed the trial results from the two drugs, I was put on off label, neither of which were approved for use in children and teens in 2001 and still aren’t today. And you showed the the fact that people don’t really get better and that suicidal ideation goes up. I don’t think she would have made the decision to put me on those drugs, but instead she was told that this was pretty innocuous, no different than an Advil. Or, you know, we always say it’s like if a diabetic needs insulin, right? And they said there was pretty much no side effects, and that’s what she was told. So she was not getting the full spectrum of what could happen. So that’s where I think it needs to change. If a parent gets that information and they still make the choice to medicate their kid. I mean, I’m not in that fight, but at least give them all the information.

Dr. Raghu Kiran Appasani: I agree with Brooke. You know, informed consent is the priority, right? And parents need to be given every single piece of evidence that’s there so that they can make a decision and have a dialog with you about it and have a dialog with their children about it. And that that is technically the gold standard of care in medicine. And if you’re not providing informed consent, it is medical malpractice, and. You know, we’re taught to provide full, informed consent. And that’s what I do in my practice with everyone I work with. But unfortunately, I do see a lot of patients who have seen other providers and they maybe didn’t know about every single potential side effect that was happening. And, you know, I can’t really I don’t I can’t really justify why that happens. But perhaps, again, it comes down to the overall burnout in the system and maybe misinformation as well, or the providers not being well informed about the medication or they’re getting informed about it from a specific pharmacological pharmaceutical company. Right. And they withhold certain types of information as well.

So I would, I would completely agree with her that informed consent is a priority.

Brooke Siem: I mean, I think maybe, perhaps Raj was giving us a little enlightened slice of what psychiatric practice could be. I can promise that everything that could be done is certainly not being done. I mean, for example, when it comes to informed consent, legally, we’re all getting informed consent, right? That’s in that stack of papers you get from the receptionist that’s so thick and filled with information you don’t understand that you just blindly sign because you’re overwhelmed. But that’s not true informed consent. That’s not a conversation. That’s not a real, honest analysis of of what’s going on. To make sure that both the patient and in this case, perhaps the patient’s parents understand. I also think, too, and I guess I’d be very interested in what in, in Raghu’s opinion of this, too. I got in a little bit of an Instagram comment tiff with someone fairly recently because there was, there was a post that was made about, you know, antidepressants not out performing placebos, which we’ve seen over and over again. They don’t outperform placebos. And in the instances that they do, it’s clinically insignificant. And then I got in an argument with someone because they were saying that messages like, this is the reason why people won’t go get help. And so I’d love to know what Raghu thinks of that, because whenever we talk about true informed consent, there’s always a group of people who just are saying like, well, you, you basically can’t say that because what about all these people whose lives could be saved? And to me, it’s almost like when you’re having an argument with someone and they say, oh, it’s because the Bible said so. And it’s like it shuts the conversation down.

Dr. Raghu Kiran Appasani: You know, it’s a it’s a good point. There is also a placebo effect. Right. Which is positive. And I don’t want to minimize that as well. But it it’s a hard argument because there are certain people who were really struggling and suffering. And for them, a certain medication was what changed from, you know, day and night in their life. And they benefit from it and they advocate for that. So, I can understand why they respond that way to a message like that. However, again, this has to come down to providing everyone the education that’s out there, and we can’t hide certain elements of the actual research that’s there, like you’re saying. So, what I really have to say to it is like, how do we actually change the system so that people feel comfortable going and seeking help?

Dr. Raghu Kiran Appasani: And there’s a strong association with, well, if I go to a psychiatrist, I’m just going to get put on a medication. So there’s a huge avoidance piece there. And what that means to me, and what that says to me is that as a clinical establishment, we have to change the way that we represent ourselves and the way that we approach care with patients moving forward. I don’t know if you guys are familiar with the concept of emotional granularity at all, but I really think that that that’s where we’re feeling. Right. And that concept is essentially teaching people to have a vocabulary around a wide spectrum of emotions

Brooke Siem: Mm-hmm.

Dr. Raghu Kiran Appasani: To describe what they’re feeling. And we unfortunately fail at providing that in our educational system at a young age. And so, you know, just imagine that kids are provided with those tools. And when they’re faced with hard things, they can go to that and actually start to use vocabulary and words to describe how they’re feeling versus instead of not being able to and then getting medicated. Right. And so if we can do that, we’ll then be left with the cases that might actually be pretty severe when it comes to mental health and be able to allocate the limited resources in our health care system for those children that need it. And, you know, that could be, I believe, the way to combat this youth mental health crisis, right, is actually a preventative approach of providing education versus this fear reactive approach of just saying, we just need to medicate everyone so we can prevent suicides from happening because that’s not what we see with the data at all.

Brooke Siem: It’s not working. Yeah.

Dr. Raghu Kiran Appasani: And it’s not working. That’s my challenge. And that way we go back to this idea of what I was saying is like, some of this overprescribing is happening from burnt out providers. And so maybe providers won’t be as burnt out if they’re able to actually spend time with the individuals that need it after all of this, primary prevention is put into place as well.

Gabe Howard: Are we seeing any improvement in this area at all? Are there changes coming, Dr. Raghu?

Dr. Raghu Kiran Appasani: It’s definitely been shifting a little bit more.

Brooke Siem: Yeah.

Dr. Raghu Kiran Appasani: In the past, probably, I would say two years. And, you know, also it’s because of people like Brooke, right? And others who have spoken out that parents and caregivers and patients are, they are a little bit more educated. It’s because of social

Brooke Siem: Mm-hmm.

Dr. Raghu Kiran Appasani: Media. It’s because of all of this that it’s a good thing. They’re going to providers and actually kind of challenging and wanting to have more of a dialog.

Brooke Siem: So again, this kind of ties into my question. So I have a little bit of a controversial thought. Hot take that I’m curious to know both of your thoughts about because, you know, we’re talking a lot about the burden on providers, and we’re also talking a lot about how, you know, some kid has a bad day and it’s like, you got to get him into therapy. I’m starting to think that too much mental health talk for our kids is actually what’s causing a good chunk of all these mental health problems, because if you plant the idea of depression or anxiety or suicidal ideation into an eight-year-old, what do you think they’re going to start seeking out and gravitating towards? And so I’m actually kind of starting to wonder if this focus on making sure kids get all this formal mental health care and therapy is actually backfiring and creating more problems.

Dr. Raghu Kiran Appasani: Brooke, that’s a great question, and I’ve been thinking a lot about that as well. And specifically, we’ve seen trends actually on TikTok right around, like the tics that happened.

Brooke Siem: Oh, the Tourette tics? The TikTok tics? Yeah.

Dr. Raghu Kiran Appasani: The TikTok tics and OCD and the overuse of the word trauma and narcissism specifically. And so a lot of these things getting put out of context and, you know, listen, kids sometimes they like labels, right? Like they want to be attached to a diagnosis or a label to fit in with a certain community. Or, you know, it’s maybe cool to say like, oh, I got my therapist or I got my psychiatrist. I think that we do need to be careful from that angle. And that’s another reason why I want to promote the idea of teaching kids how to actually describe what they’re feeling with words, and not just with a label of depression or anxiety.

Brooke Siem: Without psychiatric wards.

Dr. Raghu Kiran Appasani: Yeah. Like actually understanding. Oh, like, I actually feel like this discomfort in my stomach. And maybe I’m feeling, like, a little bit nervous as I’m going into this social situation versus like, I have like anxiety. I need to get put on this medication. Right? I need to go to a therapist. There’s ways of building grit and resilience in a healthy way, which is actually the key to human satisfaction, which is the key to true joy. And if you try to bypass that, you get stuck in this like purgatory.

Gabe Howard: The first thing that I want to say is I think that education is super important, right. So I don’t think the solution of this is that we don’t teach eight-year-olds about the psychiatric words. I think that we give them the full education about the psychiatric wards, and I don’t think that we’re doing that right now.

Brooke Siem: But, Gabe, they can’t comprehend that.

Gabe Howard: This is what people say about sex. They’re eight. You’ve got to call it a hoo hoo and a willy.

Brooke Siem: They’re not the same.

Gabe Howard: But but isn’t it? And that’s what I don’t know. And I want to be, like super clear. Brook, I don’t know, I was just the moderator, so I didn’t prepare.

Brooke Siem: [Laughter]

Gabe Howard: But I often describe this just and this is really my larger point. I describe this as the pendulum effect.

Sponsor Break

Gabe Howard: And we’re back discussing psychiatric medications for children with Brooke Siem and Dr. Raghu Appasani. I’m almost 50 years old, and my dad told me that men don’t cry. They don’t have emotions. Suck it up, rub mud on it, be a man. And I had all these big emotions and I wasn’t allowed to share them at all. So then one day I become an adult and I’m like, I want all the emotions all the time. I want all the kids to have all the emotions, and I want them to know every single one of them. And but I didn’t teach them the other stuff. I didn’t teach them anything about resiliency. I didn’t teach them anything about rubbing mud on it and trying to walk again. I, I taught them that everything that happens, you should fall down and cry because emotions are good. Now, I’m sort of speaking in an analogy and an aggregate, but I think that was missing. And we’ve also done this thing where we’re like, hey, resiliency is bad. If you can’t do it, you should just quit because trying to move forward means you’re not honoring your truth. There’s not a lot of nuance in these conversations right now. It is either you’re so tough that you move forward no matter what, or you understand and you quit. And again, I’m trying to wrap this up like really, really small. And I know this is going to generate like all the nasty emails that I can find, but I really do. I think we’re spending too much time talking about why emotions are okay, instead of talking about what emotions are.

Brooke Siem: I guess, I guess my, my issue with the first part, you said where we should be teaching them the whole gamut, is that pharmaceutical companies have placed pamphlets in schools describing these things that require, “require” pharmaceutical solutions for these psychiatric issues. Like, I know you know, how I was introduced to anorexia over the internet in 2001 when Live Journal was a big thing. I developed an eating disorder in part because I was exposed to it, and it just sort of lined up with the neuroses and the fact that I was a serious ballet dancer, and it made sense to me. And then years later, I had an eating disorder diagnosis. Like, I just think that kids and really, I mean, anyone under, you know, God, when do we start to really think for ourselves? I’m going to go with like late mid to late 20s. Right.

Gabe Howard: Or given the internet, like 60. Maybe not even then.

Brooke Siem: Yeah. Maybe. Maybe not even then. Right. But but especially kids like, let’s just use the under 18 for, for your sake. So suggestible, like so much a product of whatever environment they’re in and whatever information they’ve been exposed to. And I just don’t think it’s reasonable or smart to take a kid who’s having a hard time, because that is what it is to be alive sometimes, and to explain to them that, oh, you’re depressed. Like, let’s let’s teach you what depression is. Let’s teach you with anxiety because, you know, they have their phone, they’re going to go Google it. And then that’s how they learn about suicide. I mean, it’s just we have survived as a species for so much longer than these strategies that we’ve created in the past 40 or 50 years. And I don’t understand why so much of our reaction now is like, you know, all this therapy, all this medication, when when we’ve done a pretty good job of keeping people alive and fairly well satisfied up until about, you know, the 80s. So.

Gabe Howard: That’s when I came around. That’s great.

Dr. Raghu Kiran Appasani: Hmm.

Gabe Howard: When? When I hit about nine years old, everything got bad. Is that what you’re saying, Brooke?

Brooke Siem: Yeah, I yeah, I just, I don’t know, I just think that there’s, there’s some value in just, you know, letting kids feel bad. Letting them work through it and not having to label it as a problem.

Dr. Raghu Kiran Appasani: Yeah. You know, I always come back to this thing, especially as an addiction psychiatrist, to living life is hard. Screwing it up is easy. And I’m on the same page in terms of you just got to like, live and but however, we’re unfortunately in a state where kids already have access to all this stuff online, they’re learning about it from their friends. So you don’t have to say, hey, this is what depression is, this is what suicide is. But there’s a way that you can educate kids to say there’s resources if you feel this way. Right. It’s really comes down to the delivery of how you’re actually going to teach kids about these things. But I do think that it’s more important to teach them about the range of emotions that human beings can experience. Right? And like that’s the beauty of being human is you experience, you can experience every emotion, whether it’s pure joy or it’s horrible depression. And I think that we have to change the narrative to say that it’s okay if you experience these range of emotions. It’s actually a good thing, right? But if you ever get to a place where you want support, it’s there. And so it’s really about how we’re providing the mental health education that I think needs to shift, because we can’t deny that kids are being exposed to TikTok and they’re getting narratives and they’re learning about disordered eating and suicide from people with like zero background experience or credentials in that. So what are we going to do about that is the real question now at this point?

Gabe Howard: One of the things that I’m thinking of is Stephen King has this quote in one of his books. I think it’s the Mr. Mercedes book where he says, the problem is, is that we’ve gotten rid of evil. Any time something bad happens, it’s because they had a bad childhood. It’s because of society. It’s because of a systemic flaw. It’s because of a mental illness. It’s because of a circumstance beyond their control that somehow integrated with something that was in their control. But nobody’s evil anymore. Now, I use that as an example, because I feel that it’s far enough away from what we’re talking about, that it shouldn’t raise any it shouldn’t, you know, offend any group who’s listening. But I think that anybody who tried to actually say nobody is evil would think, well, that’s ridiculous. So the first thing I want to say is saying that nobody has a mental illness, I think is equally ridiculous, but I am concerned that we’ve gotten rid of a bad day. We’ve we’ve gotten rid

Dr. Raghu Kiran Appasani: Mm-hmm.

Gabe Howard: Of this makes me uncomfortable. We’ve gotten rid of, I just don’t like to do it. I do wonder how many children are suffering from anxiety because their parents are desperately trying to turn them into football players or actors or and they don’t like it and they’re scared to do it. So in their reality, every morning they wake up to do this thing that they hate. And if they stopped doing that thing, the anxiety and I’m making air quotes again would go away. Because they’re not anxious, they’re traumatized, they’re they’re terrified. They’re put in situations that are very outside their comfort zone. And I think that might be what you’re saying, Brooke, why does everything have to be a psychiatric disorder? Why can’t you just be ticked off? Why can’t you just have a bad day? Why can’t you just have a crappy job? And that it does worry me because it online and I spend a lot of time reading online. It seems like whenever somebody breaks up with somebody online, their ex was always a narcissist who was gaslighting them. And I do worry about that. What happened to just.

Dr. Raghu Kiran Appasani: What does that mean? Gabe? What is that? What’s the diff? Can someone define those two words like actually.

Gabe Howard: I mean, I can define what they’re supposed to be, but I don’t think that’s the usage. I mean, a narcissist is a psychiatric disorder. I mean, it’s.

Dr. Raghu Kiran Appasani: Now, if you ask the person who writes that word, they don’t know the definition usually.

Gabe Howard: Oh, no no, no.

Brooke Siem: No.

Gabe Howard: It means they were selfish. And it means they told them stuff that they didn’t agree with. That’s that’s what people think that a gaslighting narcissist is. They tried to convince me of something that I didn’t agree with, that that’s the that’s the first stop. And they were an asshole. Is that more of what you’re saying? Like, why are we teaching an eight-year-old that they have anxiety and depression versus teaching an eight-year-old that they’re uncomfortable, or that maybe this is something that they don’t enjoy or. But but it’s in. Do you feel like we’ve gone to a place where we’ve taken a reasonable band of emotions and medicalized it?

Brooke Siem: Oh, 100%. You know, not only I mean, look, we keep using depression, anxiety as if they’re emotions, but they’re not singular emotions. They are a representation of a great many things. And so we certainly don’t know like people, if you one of the things that I like to do a lot is, you know, people will come to me and they’ll say, I’ve been depressed or whatever, anxiety, anxiety for how many years? And I asked them to explain what’s going on without using the word anxiety or depression. And the first thing they do is like short circuit because they don’t actually know. And then when they start thinking about it, it all comes out. It’s like, oh, well, I’m getting a divorce. And my dog died and my kid and I are fighting and it’s, like I’m overweight. I, you know, I’m unhealthy, right? It just it all starts coming out and then it’s like, well, there’s your roadmap. I really struggle with. The idea that mental illness is singular in the way that we attribute liver disease to a disease of the liver, because organs don’t fail that often, they certainly don’t fail at the rate of mental illness diagnoses around the world. 25% of people aren’t walking around with a brain that’s malfunctioning. If that was happening in livers or hearts or something, can you imagine what the what the cry would be? So anxiety and depression are normal reactions to crappy states of life, and we have just strayed so far in dealing with that and that it’s hugely systemic. And, you know, we’re not going to solve institutional racism and poverty and work stress and rising cost of living the rising cost of living crisis in a podcast. But.

Gabe Howard: Not even my podcast, Brooke? I mean, I’m very charming. [Laughter]

Dr. Raghu Kiran Appasani: Well, yeah, I mean, that’s why I’m here today, actually, to

Brooke Siem: Yeah. Yes.

Dr. Raghu Kiran Appasani: Solve all these issues, guys.

Brooke Siem: We’re not going to we’re not going to be able to address all these issues. And really no one is going to be able to. And I think if, if, if nothing else, that should actually empower the individual. I think if it makes a lot of people feel like they have no power, but for me it does the exact opposite. It basically says, all right, well, this is the world I’m living in. How am I going to figure it out and make it work for me? And and we all have that power. And I think that that’s what all of this is asking us to do. And, you know, our phones are a huge problem and we’re all in control of that. The amount of time we spend reading things on the internet is a huge problem, and we’re all in control of that. Making healthier food choices. Maybe not. Maybe not everyone has the ability to make the healthiest food choices, but we all have the ability to make a healthier choice. And we have the entire internet as resources and libraries that are free. So I just kind of struggle when people really end up in the state of I can’t help myself because it’s expensive to live in the city I live in or whatever it is, because there’s so much out there. And what this is asking you to do is to reach inside, find your own inner compass, and make changes in your life. That is what it is to be alive, and that is what it is to figure out how to human. And we’re not teaching people that.

Gabe Howard: Dr. Raghu, do you see people coming to you, to doctors to solve just routine, mundane issues with psychiatric medications or psychiatric care? Is this an epidemic in in your community, being the medical community?

Dr. Raghu Kiran Appasani: Of course, but one thing might seem mundane to us and not to them, right? But but yes, to the general point of what you’re asking. Yes, I do, and a lot of the work that I do, honestly, is and I had to do this for myself too, is like slowing it down. And remembering. Wait, like, am I actually breathing right now? And then where is this discomfort? Where am I physically feeling discomfort? And going to Brooke’s point about like when someone says anxiety, what is that like, how are you experiencing that? And when you start to slow people down, to start to get more embodied, they can start to recognize a situation or the things that are causing them to feel that discomfort and anxiety and then actually take action. So a lot of the work that I try to do is not to medicate, but to actually give them back agency and empowerment and control of their own bodies and emotions again. And that’s what people have lost when they get kind of stuck in this momentum of the mundane or the rat race, and it becomes this like snake eating its tail type of situation. What we really need to do as a society is slow that down and we can do this for each other as well. You don’t need to go to a health care provider to do this, right. So if we can start to do that, then people will start to feel empowered in themselves. And I just want to say one more thing. I feel like Brooke’s next book should be called How To Be Human or sorry, How To Human, just How To Human.

Brooke Siem: [Laughter]

Gabe Howard: I would read that book.

Dr. Raghu Kiran Appasani: Yeah. And here’s the thing. I think that we have to really think about, like, what is the word resilience really mean? And are we losing touch with that?

Brooke Siem: Yeah, Well, I mean, we don’t really for the most part, most of us don’t have a lot of institutional resilience opportunities anymore. Right? I mean, yes, I know that if you go online, the world is a horrible place, but if you actually look at what’s going on in your backyard, a great majority of people don’t have to worry where their next meal is coming from. They have a roof over their head. They’ve never experienced war. We we’re fat and happy compared to what was happening, you know? I mean, even like the way the world was affected during World War two, the Vietnam War. You know, our kids aren’t being drafted right now. I think that, you know, it’s kind of fascinating that we are, you know, in an objectively the most peaceful time and people are doing worse. I think that resilience is really important. I think it’s Tribe by Sebastian Junger, if I’m getting it right, who you know, he was looking in that book and people report the greatest instances of happiness and satisfaction during wartime. And it’s because they have purpose, because they’re aware of the gift of being alive. And every day is no longer guaranteed.

Dr. Raghu Kiran Appasani: It is the overflow of information though. It is.

Brooke Siem: Yeah.

Dr. Raghu Kiran Appasani: You know, I really believe that a lot of this is, is caused by the overflow of information.

Brooke Siem: Yeah. Yeah.

Dr. Raghu Kiran Appasani: And if you look at to Brooke’s point Steven Pinker as well, who’s this linguist out of Harvard. Right. And his book Enlightenment Now, he talks about how we’ve the world feels like it’s going in a negative direction, but we’ve actually come a long way and made a lot of advancements.

Brooke Siem: Yep.

Gabe Howard: Brooke, Dr. Raghu, thank you both so much for being here. Before we leave, I want to give you each an opportunity to say whatever you want. Closing remarks, if you will. And Brooke, would you like to go first?

Brooke Siem: I think with any major decision or any analysis, in order to be truly honest with yourself or in this case, with a patient, with a parent, you cannot consider one quality of a treatment without considering all the other qualities. It’s not fair. You have to give people the full spectrum and let them make the choice for themselves. Even if you don’t agree with it, or even if you, you know, maybe don’t respect it. And I believe that there are a lot of people who come to me and they say, I’m going to choose to stay on my medication or whatever it is. And I say, look, that’s your choice. But you have the information now, and so you can always change your mind. That is what I would say is that we need to be honest about what we’re doing. We need to give people the full spectrum of information, and we cannot look at the possible positive qualities without considering the negative qualities as well.

Gabe Howard: Brooke, thank you so much. And Dr. Ragu, final thoughts?

Dr. Raghu Kiran Appasani: Yeah. Thanks again for having me, Gabe. You know, from a from a medical provider standpoint, what I’ll say is two things. One is challenging providers to continuously educate themselves and actually reading the literature that’s unbiased so that you actually feel comfortable and confident in what you’re delivering to your patients and to patients and to caregivers to challenge your providers to actually have a dialog, make sure you’re getting all the information that you need to make an informed decision. It doesn’t have to be at war with your provider. It should actually be in collaboration. And together continuously monitor progress and what that looks like. And don’t just start something like a medication or any kind of intervention, even if it’s a diet and just let it go on, you have to continue to have the conversation. And it’s okay if you want to see multiple providers and get different opinions and, you know, be your own advocate as well.

Gabe Howard: All right, everyone, that is our show. If you want to learn more about Dr. Raghu, head over to his website, RaghuAppasani.com, or you can follow him on Instagram @rappasani. Brooke’s website is BrookeSiem.com and her book, “May Cause Side Effects” is available everywhere. Once again to both of you, thank you so much for being here. It was a great conversation and I’m positive that our listeners got a lot out of it.

Brooke Siem: Thanks, Gabe.

Dr. Raghu Kiran Appasani: Thanks, Gabe.

Gabe Howard: Oh, you are both so very, very welcome. And I want to give a great 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 also wrote the book “Mental Illness Is an Asshole and Other Observations,” which you can get on Amazon because, well, everything’s on Amazon. However, you can get a signed copy with some free swag or learn more about me just by heading over to my website, 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 listen up. I need a huge favor. Recommend the show to people, share it on social media. Send somebody a text message, mention it in a support group because sharing the show is how we grow. I will see everybody next Thursday on Inside Mental Health.

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