WEBVTT 1 00:00:00.800 --> 00:00:06.980 This session of the 2013 Adelaide Festival of Ideas was recorded by Radio Adelaide, 2 00:00:07.020 --> 00:00:10.500 through the support of the Bar Smith Library, University of Adelaide, 3 00:00:10.600 --> 00:00:14.480 the University of South Australia Library and Flinders University Library. 4 00:00:15.020 --> 00:00:21.440 I thought I'd celebrate by having the most important person Australia could boast in science. 5 00:00:22.180 --> 00:00:27.820 Trouble is they'd been on recently already, Sir Macfarlane Burnett, a couple of other people, 6 00:00:27.820 --> 00:00:31.560 so I decided to invent one whom I called Sir Clarence Lovejoy, 7 00:00:31.760 --> 00:00:35.960 who got his Nobel Prizes for brain flux theory, 8 00:00:36.760 --> 00:00:42.960 where you could talk about manipulating the brain by putting various needles in, 9 00:00:43.000 --> 00:00:46.420 into the lobus levitatus, and the rat started to laugh. 10 00:00:47.680 --> 00:00:51.900 Or in the pons ponderosus, if you put the pin into the brain, 11 00:00:52.660 --> 00:00:54.720 it crossed its paws and started to ponder. 12 00:00:55.480 --> 00:00:56.760 And the main... 13 00:00:57.500 --> 00:01:01.520 You always have to have an application, and so I said that Sir Clarence invented 14 00:01:01.520 --> 00:01:05.600 a cerebral flange wick, which you could implant, 15 00:01:06.480 --> 00:01:11.620 and especially in politicians, it overcame deficiencies in megalomania. 16 00:01:13.300 --> 00:01:16.220 And we broadcast this, and people believed it. 17 00:01:16.540 --> 00:01:20.560 And we went on any number of television current affairs programs, 18 00:01:21.160 --> 00:01:23.200 and he was treated quite seriously. 19 00:01:23.360 --> 00:01:26.740 He was in fact an actor who was a professor of philosophy at the University of Sydney, 20 00:01:26.760 --> 00:01:28.000 Fred May, who's now deceased. 21 00:01:28.580 --> 00:01:31.500 And it was just incredible how you could invent a malady, 22 00:01:31.560 --> 00:01:32.720 and people would take it seriously. 23 00:01:32.880 --> 00:01:37.440 Now this is what, to some extent, Gary is talking about in his book, 24 00:01:37.560 --> 00:01:42.840 that you can actually place people as if they are in a box, 25 00:01:43.560 --> 00:01:47.880 which you can identify as a malady defined by science, 26 00:01:48.700 --> 00:01:52.380 when in fact there is a flux and a fashion that's quite... 27 00:01:52.380 --> 00:01:55.620 Now, I was reminded when I heard you on radio last night 28 00:01:55.620 --> 00:01:56.740 of Thomas and his book, The Melody of Science, 29 00:01:56.740 --> 00:01:57.460 and I was reminded of Thomas Satz, 30 00:01:57.600 --> 00:02:01.960 who was saying similar sorts of things a generation ago, 31 00:02:02.280 --> 00:02:05.860 and he wasn't really an anti-psychiatrist. 32 00:02:07.220 --> 00:02:09.960 He was someone who was suggesting 33 00:02:11.820 --> 00:02:15.680 that psychiatry was too ready-giving definitions, 34 00:02:15.840 --> 00:02:17.720 and there was not enough science behind it. 35 00:02:17.820 --> 00:02:18.880 That was the point. 36 00:02:19.480 --> 00:02:21.860 There was fashion behind it, but not enough science. 37 00:02:22.300 --> 00:02:23.680 And I asked him the question, 38 00:02:23.780 --> 00:02:26.320 how do you give therapy, because Gary gives therapy, 39 00:02:26.320 --> 00:02:28.920 how do you provide therapy for patients 40 00:02:29.560 --> 00:02:32.740 if you are, at the same time, in public, 41 00:02:32.960 --> 00:02:35.420 giving doubt about the entire field? 42 00:02:35.580 --> 00:02:37.500 So it's an intriguing situation. 43 00:02:38.920 --> 00:02:41.580 The Book of Woe, I don't know whether you... 44 00:02:42.140 --> 00:02:45.140 That is a title which instantly becomes a bestseller. 45 00:02:47.400 --> 00:02:50.180 But would you stand up and talk to us for 35 minutes? 46 00:02:50.200 --> 00:02:52.300 And then after that we'll have some Q&A. Thank you. 47 00:02:57.060 --> 00:02:59.720 Thank you, Robin, for that introduction, 48 00:02:59.920 --> 00:03:01.520 and for the watch. 49 00:03:02.340 --> 00:03:05.040 See, I've had all these troubles since I've been in your country. 50 00:03:05.120 --> 00:03:07.380 I've contributed greatly to your GDP. 51 00:03:07.540 --> 00:03:10.760 I have purchased a computer and a phone since I've been here. 52 00:03:10.960 --> 00:03:12.240 And anybody that wants to come up 53 00:03:12.240 --> 00:03:15.160 and show me how to get my phone to work right afterwards, 54 00:03:15.520 --> 00:03:16.620 I'm all for that. 55 00:03:18.060 --> 00:03:21.280 So I'm relying on Robin's watch to keep time, 56 00:03:21.440 --> 00:03:23.680 which is analog, I would note. 57 00:03:26.320 --> 00:03:28.740 So the answer to the question 58 00:03:28.740 --> 00:03:31.600 of how Tom Sotz would practice therapy 59 00:03:31.600 --> 00:03:34.380 is we have to remember psychoanalysis, 60 00:03:34.420 --> 00:03:37.720 which is sort of the background of psychotherapy in the Western world, 61 00:03:38.360 --> 00:03:39.880 was founded by Freud. 62 00:03:40.360 --> 00:03:41.840 Freud was a self-hating Jew. 63 00:03:42.420 --> 00:03:46.300 So what that means is that it's a practice 64 00:03:46.300 --> 00:03:48.540 that's always going to be, in some respects, 65 00:03:48.640 --> 00:03:50.520 in conflict with itself. 66 00:03:51.740 --> 00:03:55.660 Now that tendency to have a discipline 67 00:03:55.660 --> 00:03:56.840 that's in conflict with itself 68 00:03:56.840 --> 00:03:59.900 has, in recent years, begun to fall apart. 69 00:04:00.960 --> 00:04:03.880 The DSM, the Diagnostic and Statistical Manual, 70 00:04:04.140 --> 00:04:06.380 is an attempt to find certainty 71 00:04:06.980 --> 00:04:09.840 in a field which is inherently uncertain. 72 00:04:10.140 --> 00:04:11.420 That is the field of human behavior. 73 00:04:12.200 --> 00:04:14.880 I'm, for one, pleased to say 74 00:04:14.880 --> 00:04:16.960 that I think that until the end, 75 00:04:17.040 --> 00:04:19.120 we will defy our own understanding. 76 00:04:19.720 --> 00:04:21.480 I don't have any problem with that 77 00:04:21.480 --> 00:04:23.800 except for when I wake up at 2 o'clock in the morning 78 00:04:23.800 --> 00:04:25.580 with a sudden attack of dread. 79 00:04:25.660 --> 00:04:26.560 I'm going to be very upset and wish I knew why. 80 00:04:28.300 --> 00:04:30.580 But I want to start with that 81 00:04:30.580 --> 00:04:31.760 because I want to let you know 82 00:04:32.480 --> 00:04:35.340 that what I'm talking about is a highly contentious 83 00:04:35.340 --> 00:04:37.300 and strongly contended field. 84 00:04:37.660 --> 00:04:38.980 And since I've been in Australia, 85 00:04:39.160 --> 00:04:40.680 I've been exposed to something that, 86 00:04:40.720 --> 00:04:42.080 while I've heard in the States, 87 00:04:42.200 --> 00:04:44.000 it hasn't been quite so common, 88 00:04:44.220 --> 00:04:47.140 which is the radio and TV shows 89 00:04:47.140 --> 00:04:49.560 and the people that I've talked to in bookstores, 90 00:04:49.680 --> 00:04:52.200 they all seem to, at least one of them, 91 00:04:52.220 --> 00:04:54.660 in every situation, wants to ask me a question. 92 00:04:54.740 --> 00:04:55.400 They want to know, 93 00:04:55.400 --> 00:04:57.000 are you a Scientologist? 94 00:04:59.960 --> 00:05:02.400 Now, there's a reason for them to ask me that. 95 00:05:02.560 --> 00:05:04.400 You know, Scientologists believe that psychiatry 96 00:05:05.040 --> 00:05:06.120 is an evil cabal 97 00:05:06.800 --> 00:05:09.040 which is dedicated to preventing people 98 00:05:09.040 --> 00:05:10.400 from becoming Scientologists. 99 00:05:12.280 --> 00:05:15.140 And therefore thinks that everything that psychiatry does is evil. 100 00:05:15.620 --> 00:05:18.180 On the other hand, psychiatrists believe 101 00:05:18.180 --> 00:05:20.540 that Scientology is an evil cabal 102 00:05:20.540 --> 00:05:23.940 dedicated to preventing people from going to psychiatrists. 103 00:05:25.400 --> 00:05:28.460 And consequently, most criticisms of psychiatry 104 00:05:28.460 --> 00:05:31.100 fall into this category that Robin mentioned 105 00:05:31.100 --> 00:05:32.400 called anti-psychiatry. 106 00:05:32.640 --> 00:05:34.920 So I want to be really clear. 107 00:05:37.040 --> 00:05:40.200 Let me just add that this is what psychiatrists do, 108 00:05:40.360 --> 00:05:41.280 for better or for worse. 109 00:05:41.360 --> 00:05:42.420 They take something that's troublesome 110 00:05:42.420 --> 00:05:44.440 and they diagnose it. 111 00:05:44.500 --> 00:05:47.760 In this case, they diagnose me as an anti-psychiatrist. 112 00:05:48.060 --> 00:05:52.180 Well, actually, I'm neither a Scientologist nor a psychiatrist. 113 00:05:52.280 --> 00:05:55.260 I have a PhD in psychology, and I'm a lapsed, 114 00:05:55.400 --> 00:05:56.680 Jewish Jew, not a Scientologist. 115 00:05:57.440 --> 00:06:00.580 And in fact, I don't believe very much in conspiracies at all. 116 00:06:01.040 --> 00:06:04.380 I think that conspiracies probably exist, 117 00:06:04.760 --> 00:06:07.020 but they tend to require more competence 118 00:06:07.020 --> 00:06:09.320 than most people have. 119 00:06:11.240 --> 00:06:13.600 And especially about important things like 120 00:06:14.400 --> 00:06:16.340 naming the mental illnesses in the world, 121 00:06:16.400 --> 00:06:17.360 or to put it another way, 122 00:06:17.500 --> 00:06:19.840 trying to come to an understanding of our suffering. 123 00:06:21.080 --> 00:06:23.900 But I also don't believe very much in coincidences. 124 00:06:23.900 --> 00:06:26.640 And I think that when we have a phenomenon 125 00:06:26.640 --> 00:06:28.200 that's as pervasive and troubling 126 00:06:28.900 --> 00:06:31.620 in the jump in psychiatric diagnosis and treatment 127 00:06:31.620 --> 00:06:35.940 that we've seen in the last 15 or let's call it 25 years, 128 00:06:36.120 --> 00:06:39.380 I don't think we're in the presence of either conspiracy or coincidence. 129 00:06:39.900 --> 00:06:43.060 Which actually, they're not very interesting ways to tell a story anyway. 130 00:06:43.260 --> 00:06:47.080 I think what we are when we observe something like this 131 00:06:47.080 --> 00:06:49.720 is we're deep in the grips of history. 132 00:06:50.760 --> 00:06:53.700 Now, that doesn't mean that the DSM-5, 133 00:06:53.900 --> 00:06:56.160 the Diagnostic and Statistical Manual that I wrote about, 134 00:06:56.260 --> 00:06:59.680 isn't a problem, or that it is... 135 00:06:59.680 --> 00:07:01.640 It's just that it's no worse 136 00:07:01.640 --> 00:07:04.420 than any other diagnostic manual that's come along. 137 00:07:04.680 --> 00:07:06.720 It doesn't mean that it's 1,000 pages 138 00:07:06.720 --> 00:07:10.220 and 250 psychiatric diagnoses 139 00:07:10.900 --> 00:07:14.040 naming the suffering that people experience 140 00:07:14.040 --> 00:07:15.920 from everything from adjustment disorder, 141 00:07:16.180 --> 00:07:17.320 you can figure out what that is, 142 00:07:17.440 --> 00:07:19.940 to schizophrenia, aren't important. 143 00:07:20.480 --> 00:07:23.120 It's just to say that that book, 144 00:07:23.900 --> 00:07:26.860 is not the product of a conspiracy. 145 00:07:27.300 --> 00:07:30.560 It is the product of a lot of people who are trying to do good work, 146 00:07:30.720 --> 00:07:32.780 but are, just like everybody else, 147 00:07:32.980 --> 00:07:34.120 bounded by history. 148 00:07:35.300 --> 00:07:38.020 I think that there's an idea 149 00:07:38.020 --> 00:07:40.080 behind psychiatric diagnosis, 150 00:07:40.440 --> 00:07:41.900 and it's a fairly simple idea. 151 00:07:42.140 --> 00:07:45.340 The idea is that when... 152 00:07:45.340 --> 00:07:47.780 The idea is that craziness is illness. 153 00:07:48.660 --> 00:07:51.260 I don't mean to deny that craziness exists, 154 00:07:51.480 --> 00:07:53.040 or that it's important, 155 00:07:53.040 --> 00:07:54.960 or that it causes suffering, 156 00:07:55.620 --> 00:07:56.800 or that it's frightening. 157 00:07:57.760 --> 00:08:00.520 And I don't even know if I mean to deny that it's sickness. 158 00:08:00.820 --> 00:08:02.320 What I mean to say here today 159 00:08:02.320 --> 00:08:03.960 is that we don't know yet 160 00:08:05.540 --> 00:08:07.720 whether craziness is medical illness. 161 00:08:08.220 --> 00:08:10.200 And the medical establishment, 162 00:08:10.440 --> 00:08:11.640 particularly psychiatry, 163 00:08:11.760 --> 00:08:13.820 has spent the last 15 or 20 years 164 00:08:13.820 --> 00:08:16.380 acting as if, indeed, we do know that. 165 00:08:16.460 --> 00:08:17.380 It's actually more than that, 166 00:08:17.440 --> 00:08:19.660 but it's really come to a head in those years. 167 00:08:19.920 --> 00:08:22.060 Now, I think this reflexive notion 168 00:08:23.960 --> 00:08:25.060 that mental illness, 169 00:08:25.780 --> 00:08:27.560 that craziness is mental illness, 170 00:08:27.680 --> 00:08:29.680 I think, you know, you hear it all the time, right? 171 00:08:29.720 --> 00:08:30.600 Something terrible happens. 172 00:08:30.700 --> 00:08:31.880 Somebody does a mass murder. 173 00:08:32.180 --> 00:08:34.960 I wrote a story once about Ted Kaczynski, 174 00:08:35.060 --> 00:08:36.680 who was the Unabomber in the States, 175 00:08:36.820 --> 00:08:38.820 and he was diagnosed with paranoid schizophrenia. 176 00:08:38.960 --> 00:08:41.400 I spent two years in correspondence with Kaczynski. 177 00:08:41.520 --> 00:08:43.100 He was an evil guy. 178 00:08:43.920 --> 00:08:45.400 He had terrible ideas, 179 00:08:45.680 --> 00:08:47.140 but he wasn't sick. 180 00:08:47.500 --> 00:08:49.320 And yet our reflex is to think 181 00:08:49.320 --> 00:08:50.840 that whenever anything happens like that, 182 00:08:50.840 --> 00:08:52.040 the person is sick. 183 00:08:52.160 --> 00:08:54.060 I think that reflex needs to be questioned. 184 00:08:54.600 --> 00:08:55.740 And I'm a therapist, 185 00:08:56.020 --> 00:08:58.000 and the premise of therapy is that 186 00:08:58.000 --> 00:08:59.200 when you have a troublesome idea, 187 00:08:59.480 --> 00:09:01.520 one that's shaping your view of the world 188 00:09:01.520 --> 00:09:02.660 without you knowing why, 189 00:09:02.820 --> 00:09:04.440 or even that you're knowing that it's doing it, 190 00:09:04.500 --> 00:09:06.500 and when that idea is not quite working, 191 00:09:06.700 --> 00:09:09.100 you have to go on archaeological expeditions 192 00:09:09.100 --> 00:09:10.960 to figure out what's going on 193 00:09:10.960 --> 00:09:12.180 and to try to treat it. 194 00:09:12.640 --> 00:09:16.260 Now, my evidence that the idea isn't working 195 00:09:16.260 --> 00:09:17.320 is simply this. 196 00:09:18.180 --> 00:09:20.000 Psychiatry is in tremendous disarray 197 00:09:21.040 --> 00:09:21.520 and it's not a good idea. 198 00:09:21.520 --> 00:09:23.380 I'm sure that most of the people here 199 00:09:23.380 --> 00:09:26.160 are at least skeptical about psychiatric diagnosis 200 00:09:26.160 --> 00:09:27.300 and psychiatric treatment. 201 00:09:27.460 --> 00:09:29.240 I'm sure that most of the people here 202 00:09:29.240 --> 00:09:30.820 who happen to be on psychiatric drugs 203 00:09:30.820 --> 00:09:33.260 wonder why they're on them sometimes, 204 00:09:33.500 --> 00:09:35.720 wonder whether it's a good idea for them to be on them, 205 00:09:35.780 --> 00:09:38.500 or wonder whether they should give their children psychiatric drugs. 206 00:09:38.740 --> 00:09:39.600 And unfortunately, 207 00:09:40.160 --> 00:09:42.320 we don't have very good answers to that question. 208 00:09:42.980 --> 00:09:45.300 We're going along on empirical science, 209 00:09:45.680 --> 00:09:47.240 I'm sorry, on empirical observation 210 00:09:47.240 --> 00:09:49.100 and not on science. 211 00:09:50.840 --> 00:09:52.520 Because I want to give you some thoughts today 212 00:09:52.520 --> 00:09:55.400 about how we got to this strange point in history 213 00:09:55.400 --> 00:09:58.200 where craziness is considered a disease. 214 00:09:58.660 --> 00:10:00.120 You know, over the years, 215 00:10:00.200 --> 00:10:02.020 craziness has been considered sin, 216 00:10:03.420 --> 00:10:04.840 witchcraft, devil possession, 217 00:10:05.240 --> 00:10:06.680 the sign of divine inspiration, 218 00:10:07.200 --> 00:10:08.640 the sign of artistic inspiration, 219 00:10:09.060 --> 00:10:11.120 but now we think of it as a disease, 220 00:10:11.340 --> 00:10:14.140 which means, at least in capitalist societies, 221 00:10:14.280 --> 00:10:15.680 to get to the title of the talk, 222 00:10:15.980 --> 00:10:17.040 it means a market. 223 00:10:17.580 --> 00:10:19.540 Because every disease is a market. 224 00:10:19.980 --> 00:10:22.040 Not just for drug companies, and we'll get to that, 225 00:10:22.180 --> 00:10:23.680 but for practitioners like me. 226 00:10:24.320 --> 00:10:25.840 We treat diseases, 227 00:10:26.220 --> 00:10:28.060 and when we do, we get paid to do it. 228 00:10:28.960 --> 00:10:31.660 Now what I want to do is I want to give you a quick case history, 229 00:10:32.460 --> 00:10:34.340 but I don't want the case history to be of a person, 230 00:10:34.420 --> 00:10:36.960 I want the case history to be of a psychiatric disorder. 231 00:10:37.520 --> 00:10:40.980 This is a psychiatric disorder that arose in the 1990s, 232 00:10:40.980 --> 00:10:43.180 after those of you who were around then will remember 233 00:10:43.620 --> 00:10:46.060 that there was a great deal of cultural displacement 234 00:10:46.460 --> 00:10:48.540 in the 1980s and the 1990s, 235 00:10:48.540 --> 00:10:49.980 with the rise of the internet, 236 00:10:50.240 --> 00:10:52.080 it was the rise of many things, 237 00:10:52.240 --> 00:10:54.480 and what my experience was, I'm 56, 238 00:10:54.720 --> 00:10:57.500 so I was in my salad days in the 1980s, 239 00:10:57.520 --> 00:11:01.140 what I remember is that life got a whole lot faster, 240 00:11:01.380 --> 00:11:03.580 and there was a whole lot more distraction, 241 00:11:03.860 --> 00:11:05.880 and it was a whole lot harder to concentrate, 242 00:11:06.060 --> 00:11:08.160 to the point today where nobody can concentrate. 243 00:11:08.960 --> 00:11:12.000 Where they have to tell you to shut off your cell phones at the movie theater, 244 00:11:12.140 --> 00:11:15.260 because everybody will be on their cell phones while they're at the movie theater. 245 00:11:15.540 --> 00:11:18.200 So we've come a long way, I'm not sure it's a good way, 246 00:11:18.540 --> 00:11:20.920 but one of the things that happened at the same time 247 00:11:20.920 --> 00:11:23.140 that the speed of life was ramping up, 248 00:11:23.240 --> 00:11:25.580 and the number of distractions was multiplying exponentially, 249 00:11:26.180 --> 00:11:28.660 was that there was a rash, an epidemic, 250 00:11:29.100 --> 00:11:31.180 of a childhood psychiatric disorder, 251 00:11:31.320 --> 00:11:32.160 you all know what I'm going to say, 252 00:11:32.340 --> 00:11:34.300 attention deficit hyperactivity disorder, 253 00:11:34.480 --> 00:11:35.340 better known as ADHD. 254 00:11:36.440 --> 00:11:38.800 Now, I'm not trying to imply cause and effect, 255 00:11:38.960 --> 00:11:42.100 but those are two really interesting parallel occurrences. 256 00:11:42.400 --> 00:11:43.980 And one thing you need to know, 257 00:11:44.020 --> 00:11:45.880 from right off the bat in psychiatry, 258 00:11:45.880 --> 00:11:48.680 is that the focus has always been 259 00:11:48.680 --> 00:11:51.120 on what's wrong with the kid who can't concentrate. 260 00:11:51.580 --> 00:11:53.640 And in focusing there, 261 00:11:53.780 --> 00:11:56.480 the focus has been on what's going on inside his brain 262 00:11:56.480 --> 00:11:59.400 that makes him say he can't concentrate. 263 00:11:59.980 --> 00:12:03.600 That's why when the Ritalin or the Adderall work, 264 00:12:04.320 --> 00:12:05.860 the explanation is, 265 00:12:05.980 --> 00:12:09.100 well, it solved some kind of a chemical problem that the kid had. 266 00:12:09.440 --> 00:12:11.880 Now, anybody that's taken one of those stimulants knows, 267 00:12:12.040 --> 00:12:15.420 that if you take a stimulant, you suddenly become, 268 00:12:15.420 --> 00:12:17.340 I had a girl describe it to me the other day, 269 00:12:17.420 --> 00:12:19.020 like a horse with blinkers on. 270 00:12:19.460 --> 00:12:21.360 It's like your brain is a magnet 271 00:12:21.360 --> 00:12:23.120 and the work you're trying to work on is metal. 272 00:12:23.260 --> 00:12:25.580 That's why so many brain workers who don't have ADHD 273 00:12:26.160 --> 00:12:27.160 like to use it. 274 00:12:27.240 --> 00:12:29.280 It's like coffee, only it doesn't hurt your bladder. 275 00:12:31.440 --> 00:12:33.220 Now, the kids that we all know, 276 00:12:33.340 --> 00:12:34.300 I mean, this was infamous, 277 00:12:34.620 --> 00:12:39.700 the rates of diagnosis and treatment were helped. 278 00:12:40.420 --> 00:12:41.800 I'm not trying to advocate for it, 279 00:12:41.840 --> 00:12:43.980 but we have to at least acknowledge 280 00:12:43.980 --> 00:12:45.640 that some of these kids were helped, 281 00:12:45.720 --> 00:12:48.480 as is almost always the case with psychiatric drugs. 282 00:12:48.600 --> 00:12:49.360 The market decides. 283 00:12:49.540 --> 00:12:51.140 If they don't work, they don't stay. 284 00:12:52.440 --> 00:12:54.400 But there was a few kids, 285 00:12:54.520 --> 00:12:56.160 and actually an increasing number, 286 00:12:56.300 --> 00:12:59.740 who not only didn't respond well to stimulants, 287 00:12:59.800 --> 00:13:00.660 but got worse. 288 00:13:01.300 --> 00:13:03.480 And then when they weren't on any drugs at all, 289 00:13:03.560 --> 00:13:04.920 they got even worse. 290 00:13:05.160 --> 00:13:07.160 These were children who were explosive, 291 00:13:07.420 --> 00:13:10.380 who threw temper tantrums up through the age of 10 or 12. 292 00:13:10.580 --> 00:13:12.600 They were scary, violent, 293 00:13:12.600 --> 00:13:15.700 children who parents couldn't manage 294 00:13:15.700 --> 00:13:17.100 and teachers couldn't manage. 295 00:13:17.240 --> 00:13:19.740 And they worked their way through the mental health system 296 00:13:20.380 --> 00:13:23.520 until they finally got to the top tier. 297 00:13:23.960 --> 00:13:26.340 In the United States, that would be Harvard University. 298 00:13:28.480 --> 00:13:30.120 I got paid to say that. 299 00:13:32.200 --> 00:13:34.140 Now, we might think of these kids, 300 00:13:34.180 --> 00:13:35.160 I think of these kids, 301 00:13:35.280 --> 00:13:38.020 as sort of like your antibiotic-resistant bacteria. 302 00:13:38.260 --> 00:13:40.060 Not to call children bacteria or anything. 303 00:13:40.360 --> 00:13:41.640 There aren't any here, are there? 304 00:13:42.600 --> 00:13:48.560 Or your, you know, pesticide-resistant bugs. 305 00:13:49.180 --> 00:13:51.640 They somehow defied the treatment, 306 00:13:51.780 --> 00:13:53.340 and indeed got stronger. 307 00:13:53.800 --> 00:13:56.140 What we were seeing was a kind of super ADHD. 308 00:13:57.780 --> 00:14:00.360 And clinicians, unable to deal with it, 309 00:14:00.380 --> 00:14:01.520 having sent them to Harvard, 310 00:14:02.360 --> 00:14:05.020 the children were met by a team at Harvard, 311 00:14:05.240 --> 00:14:06.440 some of them anyway, 312 00:14:06.500 --> 00:14:07.460 were met by a team at Harvard 313 00:14:07.460 --> 00:14:09.580 led by a psychiatrist named Joseph Biederman. 314 00:14:10.360 --> 00:14:12.580 Now, Joseph Biederman was a prominent American, 315 00:14:12.600 --> 00:14:15.400 psychiatrist, he's what's called a key opinion leader, 316 00:14:15.560 --> 00:14:17.660 a KOL in the parlance. 317 00:14:18.060 --> 00:14:20.980 And Biederman decided that these children 318 00:14:20.980 --> 00:14:23.000 weren't suffering from ADHD at all. 319 00:14:23.180 --> 00:14:25.720 What they were suffering from, he said, 320 00:14:25.880 --> 00:14:27.480 was bipolar disorder. 321 00:14:28.800 --> 00:14:31.880 Now, no one knows exactly why Biederman came up with this. 322 00:14:32.000 --> 00:14:33.900 He came, there were some studies that he did 323 00:14:33.900 --> 00:14:35.340 that if you read them, if you can, 324 00:14:35.840 --> 00:14:37.360 I'm not gonna bother you with them, 325 00:14:37.420 --> 00:14:39.260 but if you penetrate through them, 326 00:14:39.320 --> 00:14:41.340 they sort of make it look like, 327 00:14:41.340 --> 00:14:43.480 it could be the case. 328 00:14:43.620 --> 00:14:46.560 But there was no reason to choose bipolar disorder. 329 00:14:46.820 --> 00:14:48.900 And for two reasons I say that. 330 00:14:48.960 --> 00:14:51.040 One of them is that bipolar disorder 331 00:14:51.040 --> 00:14:53.120 requires episodic mania. 332 00:14:53.200 --> 00:14:55.060 Bipolar disorder used to be called manic depression. 333 00:14:55.320 --> 00:14:57.380 From psychotic excitement 334 00:14:57.380 --> 00:15:00.320 to suicidal depression, back and forth. 335 00:15:01.360 --> 00:15:03.700 Episodic mania is unheard of in children. 336 00:15:04.200 --> 00:15:06.420 Unless you consider childhood to be 337 00:15:07.160 --> 00:15:08.920 one long manic episode. 338 00:15:09.620 --> 00:15:11.320 So there was no reason to choose 339 00:15:11.340 --> 00:15:11.500 bipolar disorder. 340 00:15:11.500 --> 00:15:12.480 There was no reason to diagnose, 341 00:15:12.600 --> 00:15:14.760 they were immediately excluded from the diagnosis. 342 00:15:15.700 --> 00:15:17.680 And interestingly, and this is the second reason 343 00:15:17.680 --> 00:15:18.620 I say there was no reason, 344 00:15:18.740 --> 00:15:21.800 there was a diagnosis in the Diagnostic and Statistical Manual 345 00:15:21.800 --> 00:15:23.340 that suited these children just fine. 346 00:15:23.520 --> 00:15:25.940 It was called oppositional defiant disorder. 347 00:15:26.940 --> 00:15:29.420 And, well, you can tell from the title, right? 348 00:15:29.580 --> 00:15:31.520 It's a great example of a description 349 00:15:31.520 --> 00:15:32.820 that's not really an explanation, 350 00:15:33.060 --> 00:15:34.240 but you take it up one notch, 351 00:15:34.420 --> 00:15:36.640 you say, well, that kid's oppositional, 352 00:15:36.740 --> 00:15:39.380 or you say, no, no, he's oppositional defiant disorder. 353 00:15:39.380 --> 00:15:42.660 And suddenly you've made it science, right? 354 00:15:43.040 --> 00:15:45.640 And the problem with ODD, 355 00:15:45.720 --> 00:15:47.380 as we call it in the trade, 356 00:15:47.720 --> 00:15:49.040 I'll let you in on that secret, 357 00:15:49.100 --> 00:15:50.680 and the secret handshake will be for sale 358 00:15:50.680 --> 00:15:52.600 at the end of this lecture. 359 00:15:53.560 --> 00:15:55.440 The reason that they didn't want 360 00:15:55.440 --> 00:15:57.740 to give these kids the diagnosis of ODD 361 00:15:57.740 --> 00:16:00.060 was as somebody who was close to these proceedings 362 00:16:00.060 --> 00:16:03.420 explained it, it has a bad reputation. 363 00:16:04.780 --> 00:16:06.580 The reason it has a bad reputation 364 00:16:06.580 --> 00:16:08.260 is exactly the reason that you, 365 00:16:08.260 --> 00:16:09.560 those of you who laughed 366 00:16:09.560 --> 00:16:11.760 when I said oppositional defiant disorder, laughed. 367 00:16:12.260 --> 00:16:13.600 Because it sounds ridiculous, 368 00:16:13.720 --> 00:16:14.520 and it sounds trivial, 369 00:16:14.700 --> 00:16:17.000 and it sounds like pathologizing normalcy, 370 00:16:17.060 --> 00:16:18.380 and it sounds like, well, 371 00:16:18.460 --> 00:16:20.340 let's just take any adolescent and diagnose him. 372 00:16:21.200 --> 00:16:24.420 So the impetus was, 373 00:16:24.580 --> 00:16:26.380 and by the way, it's not just a problem 374 00:16:26.380 --> 00:16:28.240 of not being taken seriously, 375 00:16:28.500 --> 00:16:30.800 you know, the people who are going to take these kids seriously 376 00:16:30.800 --> 00:16:32.980 were insurance companies, researchers, 377 00:16:34.280 --> 00:16:35.240 other pediatricians, 378 00:16:35.240 --> 00:16:38.160 the label wasn't going to attract any research. 379 00:16:38.260 --> 00:16:38.700 They were going to take them as a resource. 380 00:16:39.180 --> 00:16:40.520 And that was a problem. 381 00:16:40.800 --> 00:16:42.300 So these people were motivated 382 00:16:42.300 --> 00:16:43.820 to get these kids resources, 383 00:16:44.100 --> 00:16:46.220 and they seized on bipolar disorder, 384 00:16:46.380 --> 00:16:48.300 which is a very serious illness. 385 00:16:48.780 --> 00:16:50.740 In its pristine form, 386 00:16:50.900 --> 00:16:53.800 it's one of the most devastating mental illnesses. 387 00:16:53.880 --> 00:16:56.020 It's thought to be familial, if not genetic. 388 00:16:56.240 --> 00:16:57.540 It's thought to be biochemical 389 00:16:57.540 --> 00:16:59.040 and unresponsive to the environment. 390 00:16:59.240 --> 00:17:00.380 It's thought to be lifelong. 391 00:17:01.400 --> 00:17:04.300 And, of course, the treatment for bipolar disorder 392 00:17:05.540 --> 00:17:07.660 was, well, at the time, 393 00:17:07.660 --> 00:17:09.200 they were called antipsychotic drugs, 394 00:17:09.360 --> 00:17:11.860 but quickly, as the drug companies caught wind of this, 395 00:17:12.040 --> 00:17:14.500 they were called mood stabilizers. 396 00:17:14.540 --> 00:17:16.620 Same drugs, different brand. 397 00:17:19.760 --> 00:17:21.420 So, and Biederman said 398 00:17:21.980 --> 00:17:23.600 that childhood irritability, 399 00:17:23.680 --> 00:17:25.380 to get around the episodic mania problem, 400 00:17:25.580 --> 00:17:26.980 he said, childhood irritability 401 00:17:27.660 --> 00:17:30.500