Is the DSM...BS?

Jen talks to author, Sarah Fay, about her new book "Pathological: The True Story of Six Misdiagnoses" and why the DSM (The Diagnostic & Statistical Manual of Mental Disorders) isn't always accurate.

Sarah Fay is an author and activist. Her writing has appeared in many publications, just to name a few, the New York Times, The Atlantic, and the Paris Review where she served as an advisory editor.

For more information on her book "Pathological..." and her work go to: https://sarahfay.org

For more information on Jen Kirkman, the host of Anxiety Bites, please go here: https://jenkirkman.bio.link

and to get the takeaways for this episode please visit: http://www.jenkirkman.com/anxietybitespodcast 

Anxiety Bites is distributed by the iHeartPodcast Network and co-produced by Dylan Fagan and JJ Posway.

See omnystudio.com/listener for privacy information.

Episode Transcript

Speaker 1 (00:08):
This is the Anxiety Bites podcast and I am your host,
Jen Kirkman. Welcome to another episode of Anxiety Bites. I
am your host, Jen Kirkman. Today my guest is Sarah Fay.
She has a new memoir art called Pathological The True
Story of Six Misdiagnoses. So today's I was a kind

(00:30):
of a thinker. Or maybe it's not. Maybe it was
just something for me to wrout my brain around. At
first I read Sarah's book. I loved it. And you know,
at first, if you just said to me on paper,
you know, hey, there's a book out on this person
says that the d s M, which is how all
um mental health diagnosis is, they come from the d

(00:53):
s M, and it stands for the Diagnostic and Statistical
Manual of Mental Disorders. And I've known of the d
s M my my whole adult life, that have been
in therapy. It's what therapist used to diagnose you. So
you may say I have this symptom of that, they
may look it up in their little book the d
s M and say, oh, well that's a clinical depression
or that's a generalized anxiety disorder. A lot of times

(01:16):
a talk therapist will use it because there are codes
in the book. So they'll say, okay, so you're coming
into talk about your family, now would you say that
that's causing you more depression anxiety? You know, And then
they'll put the code for your diagnosis on some kind
of super bill and it gets sent to insurance, and

(01:38):
if your insurance covers you to see a therapist for
anxiety and depression, then there you go. You're going to
be covered. So it originally came about as a way
for doctors to communicate with each other, and then it
sort of became the the manual for how to diagnose people.
And I've heard comments here and there from professionals that

(01:59):
like the d s M. You know, it's just it's
not the dictionary, if that makes sense. It's not totally accurate,
it's not set in stone. It's it's it's guesswork, and
there are a lot of diagnoses that could fit you.
You can have a bunch of symptoms from different things.

(02:21):
It doesn't mean you have that disorder per se. And
then it doesn't mean if you are diagnosed with one,
that that your doctor is right necessarily, and it doesn't
mean that you're going to have it your whole life.
So in a way, getting a diagnosis can be helpful
because you don't just feel like I'm just I guess crazy,
you know, and no help for me. I mean having

(02:43):
a name for something. I think it's so helpful. You go, well,
there's a name for this, then other people must have
experienced it, and there's experts out there who can help me.
But then as you get a little more practiced or
grown up, or further along in your recovery from whatever
mental disorder you're going through, you might start to think

(03:07):
this seems like a very narrow definition. I don't do
I really have this? Or is it more this? Or
is it you know that kind of thing. And so
that's why I sometimes get nervous thinking about doing episodes
like this. When I when I decided to do this episode,
I thought, I hope I do this right, because I
don't want to sound like good conspiracy theorists or make
Sarah sound like one, because nobody is saying, oh, mental

(03:30):
health issues, they're not real. That's literally not what anyone
is saying. But I know, if you're doing the dishes
or driving and sort of half listening to this, who
knows what you might hear. But I just want to
make sure on my end that I've been very clear
that what we're talking about in this episode, there is
this manual called the d s M. And while mental

(03:51):
health illnesses are real, the way that many things in
the book are diagnosed maybe sometimes inaccurate. You may get
an inaccurate diagnosis. It doesn't mean that like all doctors
are bullshit. That's not what I'm saying. And Sarah and
I very much believe in mental illness. We've both had it.

(04:12):
We very much believe in psychiatry. We both go to psychiatrists.
But we're just saying this book has its flaws, and
she just wants to bring that out into the open.
I mean, there are bigger issues at play. I means
sometimes people use the d s M two market their antidepressants,
you know, and sometimes the d s M maybe used
by well meaning people who may accidentally over diagnose someone.

(04:35):
So it's just kind of shining a light on this
thing that that if you're in therapy, you may have
heard referenced, oh, the d s M. And if you're
anything like me, sometimes you hear something and you might
not know a lot about something, and so you figure
out they know what they're talking about. The d s
M sounds pretty uh, you know, the Diagnostic and Statistical
Manual of Mental Disorder sounds pretty on the up and

(04:57):
up to me. And we're not saying it's a you know,
some dark, shadowy group. It's like, it's just not accurate.
And so I talked to Sarah today about her new book, which,
by the way, again is called Pathological. It is out
right now. You can get it wherever you get books.
It's been called a powerful memoir, a deeply compelling person

(05:18):
and a fantastic writer. Pathological will make you passionate about
improving the way we handle mental health. And again you
can get it wherever you get books. A little bit
about Sarah Fay, the author. She is an author and
an activist. Her writing appears in many publications, including The
New York Times, The Atlantic Time Magazine, The New Republic, McSweeney's,
The Believer, and The Paris Review, where she has served

(05:39):
as an advisory editor. She's currently on the faculty at
Northwestern University in DePaul University. She's the founder of Pathological,
the movement of public awareness campaign devoted to making people
aware that mental health diagnoses are invalid and largely unreliable,
and a full recovery from mental illness is possible. So

(06:00):
I will link to Sarah's website and her book in
the show notes, and I hope you enjoy our very
nuanced and rather how do you conversation about this thing
called the d s M? Before I ask you the

(06:20):
six diagnoses you've had in your lifetime, let's define pathological
or let you define it. I'll listen. So we were
worried about that, my editor and I actually just because
it's not that common of a word. It's used in
psychiatry circles a lot, but knots and medical circles. But
it's essentially medicalizing a condition, any condition. It doesn't have

(06:43):
to be psychiatric, it could be anything. So when we
pathologize the human condition is what psychiatry is often accused of.
We're talking about calling the emotion anxiety the disorder anxiety,
and it's confusing because they're the same name. And with depression,
so we're calling the disordered depression the same as the

(07:04):
emotion of depression. And so, what are the six diagnosis
diagnoses that you've had in your life? As you write
in your book pathological, that you said you have received
since you were twelve years old or beginning at the
age of twelve. Yeah, So I was first diagnosed with anorexia,
and then it progressed. I had a little break um

(07:27):
in terms of diagnosis, so I was basically was out
of danger in terms of anorexia, no longer going to
the hospital by the time I was about sixteen. But
then I had kind of that lag in college that
a lot of women have, which is you're you're eating horribly,
but enough that you're gaining weight anyway, So you know,

(07:48):
so I had that and then UM, and then in
my twenties, I was in a relationship that was just
really positive and I did really well there for a while.
And I talked about this in my book. He's now
a chef and was a fantastic cook, and he really
taught me to love food. UM. A lot of people
who read my books say the second chapter is a relief,

(08:10):
because the first chapter is so you know, dramatic with
my anorexia, and then the second chapter is all about
this boyfriend, Chris, and how great our life was together.
It didn't last, and so I then went into sort
of a lot of anxiety, a lot of UM, definitely
dipping into hypochondria, relying on alcohol to self medicate, and

(08:32):
I talked about that in the book. But finally when
I moved to New York, it really started to uh
reach more of an acute phase. And so I was
diagnosed at generalized anxiety disorder by my primary care physician
in New York and given valium, which I quickly became
I wouldn't say addicted, but I was definitely relying on

(08:52):
it um. And then when I was in New York
as well, my cat passed away. My cat died. Cat
people out there will be able to relate to this,
but I was devastated. She had been mine for sixteen years.
And so I really went into a very deep depression.
And I had been battling with depression anyway, but turned
to exercise UM to try to relieve it. And I

(09:15):
was running so much in New York and running over
what we called the five Bridges, so we would do
all the bridges in you know, in Manhattan and Brooklyn
and Queens and so anyway, So I was running to
such a degree and I went to a therapist. A
friend insisted that I go, and I received the diagnosis
of major depressive disorder after the thirty minute consult, and

(09:38):
she said I should be on antidepressants right away. I resisted.
I was the kind of person who wouldn't take aspirin.
I mean, I was just like, no, no, no, no, no,
I'm natural, and so I YO good and I meditated
my Chinese herb and I just kept getting worse and
I kept getting worse, and so eventually I went to
get my PhD in Iowa, and I ended up going

(10:01):
to my primary care physician there. He diagnosed me first
with a d h D, then obsessive compulsive disorder, and
then obsessive compulsive disorder and a d h D with
anxiety and depressive elements, which sounds like a nice cocktail
or something. I don't even know what that is. And
it got it got quite bad at that point, and

(10:23):
then I started to become suicidal and was really just
went into crisis phase for about I guess it would
be nine years. And then I was diagnosed with bipolar disorder.
And so that's where my final diagnosis ended up. And
I mean, it's a much longer story obviously it's a book.
But so finally I was extremely suicidal. I had been

(10:49):
put on and taken off so many medications. Um antipsychotics
had terrible AVer's reactions, including a caathesia, which is this
terrible side effect where you feel like you're calling out
of your skin. You can't stop moving. It's it was awful.
And so I had a falling out with my psychiatrist
at the time, and I went to a new psychiatrist

(11:10):
that my sister found. My sister and my mother and
my whole family. They're the heroes of this book, no question.
I was so lucky to have them. And I went
to this new psychiatrist and he we had our quick,
you know, back and forth twenty seven minutes, and I
waited for him to proclaim whatever he thought my diagnosis was,
or give me a new diagnosis. And he looked at

(11:30):
me and he said, I don't know what you have.
And my whole world changed. And I was walking down
Chicago Avenue in Chicago, and it was winter, it was
really cold, and I just thought, no one knows what
I have, none of you do. And so then I
took it on myself and I just said, I'm going
to find out everything about mental health diagnoses, their history.

(11:53):
Who thought of these where did they come from? What
lab were they discovered in? And so I just wanted
to know everything. So I ended up going into this
deep research phase and that's what my book is. It's
my story, but I also bring in all the information
that I want other people to know to save them
from going through what I went through. So I have
two quick follow up questions. One is was it because

(12:15):
you had been diagnosed so many times? Was it weirdly
freeing to have someone say I don't know what's wrong
with you? And secondly, normally I would do this like
kind of at the end of the episode, but tell
us now how you would diagnose yourself, Like what do
you have now and how do you handle it now?
I'm glad we're talking about it now because I always

(12:36):
want to preface that even though and we'll talk more
about this, but the diagnoses we receive, all the mental
health diagnoses, and when we talk about the d s M,
that's just the manual they come from. It's just a
book and that's where everything we're given, you know, originates
we talk about those are invented categories. And I didn't

(12:57):
say that actually, but Thomas Insel, who the former head
of the end I'm and i m H, which is
the National Institute of Mental Health. He said that, so
a lot of sort of our most prominent psychiatrists and
researchers have been warning us about the invalidity of these diagnoses.
So even though I say that and I agree with them,
not that they need me to agree with them, but

(13:17):
that mental illness is very, very real. I had one,
There's no question. I used to say I have or
had one. UM. But they are no D S M diagnosis,
No mental health diagnosis has been proven to be chronic.
Mental illness is not chronic. UM. And that same Thomas
in Soul, who is someone I really really admire. Um,

(13:38):
he just came out with a book that basically says, UM,
it's kind of an apology for focusing so much on
the biomedical model or this idea that our mental health
diagnoses are biological and therefore chronic. UM. When he was
during his time at the n I m H and
instead of really providing for people and providing care for

(14:00):
those especially most in need with serious mental illness. UM.
But he's now come out and said, no, mental illness
is chronic. We can fully recover. And so I see
myself as an example of someone who had a serious
mental illness. UM. I had to three technically UM, and
I have fully recovered. And I want other people to

(14:21):
know that they and their children and their teenagers can
fully recover too. So that's where I am. Now we'll
be right back. The d s M is the Diagnostic
and Statistical Manual of Mental disorders, and it does exist

(14:44):
and it is a thing. But your book is about
how we need to take another look at that because
it's used to diagnose patients. And you know, there's psychiatry
and their psychology, right, so I see a talk there
fist they do not prescribe medication. I do have a
psychiatrist who prescribes medication. So mostly it is the psychiatrist

(15:06):
who prescribe medication that use the d s M. My
talk therapist uses it to get a reimbursement on my
health insurance. You know, if if she doesn't indicate what
we're talking about, it's not considered something that my health
insurance would reimburse me for. So it's really about a
bunch of coding, right, so that payments can be handled.

(15:29):
I mean, it's almost this kind of it's like the
least healthcare it's like the least mental health care thing, right,
It's not um ooei gooey and some kind of like
loving warm blanket of a book. It's just codes and things.
And so in your book you're talking about how it's

(15:50):
not fully accurate and it's just kind of made up.
But that can be challenging, I'm sure for people to
hear you say no, but I have this, and it's like,
we're not saying you don't have a thing. Can you
tell us just you know, we'll get into it deeper
and deeper, but like overview, what is it? What is
the d s M, what's it supposed to be for?
And what is it really? You know, the underbellue of it?

(16:13):
You know you asked this is This was all incredibly
threatening to me. So it was a relief in some ways.
But I would if you had taken away some of
my diagnoses, I would have wrestled due to the ground.
I mean, I was so identified with them and I
thought that they helped. I've since read, you know, and
looked at studies, and they've actually found that people who

(16:33):
believe there's a biological cause to their diagnoses have more stigma,
more self stigma, mor shame and are more hopeless about
their diagnoses. So that's kind of interesting just to keep
in mind. But not everybody is, and I respect that.
I mean, there are some communities that are really um
emboldened by their diagnoses, that really come together. The autism

(16:54):
community is a great example, and that's a diagnosis that
to me is like you know, mean, there's complications with
the Aspergers and all of that, but we won't go
into that, but the and what I really do want
to explain to all your listeners and thank you again
for having me on. This is such a great opportunity
that all I want is not to take away anyone's diagnosis,

(17:16):
because that felt right for me, not to identify with one.
Though I still very much identify with having a mental illness.
I still take meds, I still see a psychiatrist. I
will always take meds because I'm pretty sure my body
is dependent on them. And I have no shame about that.
There's no I don't need to be psychopharmacologically pure to
be well. Um, that's just how you know, it's complicated.

(17:37):
We're kind of in a sticky thing. So for me,
I think everyone has to make their own decision. Do
they want to keep their diagnosis. Do they want to
identify with it completely? Do they want to take it
with a grain of salt, use it for what it's worth.
And I'll explain why. So the reason is that, you know,
we really have this luxury right now because the d

(18:00):
s M has in some ways. As I said, it's
a book, that's all it is. When someone said to me,
you have bipolar disorder, I imagined, you know, microscopes and
people in lab coats making tests and deciding who has
bipolar disorder. The problem with d s M diagnoses is
that there is no biological marker for any of them.
What that means is there's no test. So we often

(18:24):
like to say mental illness is the same as physical illness,
and that comes from a really good place, which is
we need to respect it the same, we need to
honor it the same. We need to have mental health
days if we need them, absolutely, but they aren't the same.
With the exception of dementia and rare chromosomal disorders that
are in the d s M, no single diagnosis can

(18:46):
has an objective reality. They're dependent completely on self reported symptoms,
totally subjective, and a clinician's opinion totally subjective. And that's
the that's the issue with the d A SUM. It
started in nineteen fifty two that doctors came together, Um well,
I should say members of the American Psychiatric Association came

(19:09):
together to create a manual that doctors could use to
better communicate with each other. And what's kind of fascinating.
You talked about therapy and psychology versus psychiatry. So once medical,
the d s M became away. In the third edition,
it's had seven editions where it gets revised and more
diagnoses are included. Never are they taken out, but more

(19:32):
and they're were fined and the wording has changed. The
third edition was really the turning point, and that was
when a guy named Robert Spitzer, who again was very
well intended. I'm totally pro psychiatry, by the way, so
so everybody knows um. And so he was a psychiatrist
and was just bent on making psychiatry a respected medical field.

(19:53):
And it wasn't because they didn't have the proof. Again,
and so he's the one who came up with the
symptom lists. So when you get depression, you have to
have five of nine of these symptoms. Now when I
got the major depressive disorder uh, you know diagnosis, I thought, okay,
well this is scientific, like this is medical, you know,

(20:13):
of course, and then in my research as I went through, UM,
it was it's completely arbitrary. So Robert S. Fitzer has
quoted it's a it's a fascinating and penetrating and frightening quote.
But he was asked why you have to have five
of nine symptoms to receive a major depression diagnosis, and
he said, well, we were sitting around the table. We

(20:35):
went around and we said how many do you think
we should have? And six just seem like too many
and four too few. They were completely arbitrary. Yeah, and
we still have the five. Um. Now again, you know,
the d s M is useful. We use it so
you mentioned to get you know, so therapists can be reimbursed.

(20:56):
We use those diagnostic codes and we use we use
it for legal matters. We use it for when we're
trying to when people need educational services. You needed to
file for disability. I don't want to throw it out
the window. I mean, I don't think it's totally useless.
What I'm really hoping for is full transparency. I just

(21:16):
want everyone to know what they're really getting and then
we can make more informed decisions about our mental health
and decide because I think there were times, like you said,
there were times in my life where for me, the
diagnosis tended to become self fulfilling prophecies. Um. And so
I see where they were very unhelpful, but they were

(21:36):
also helpful. Ultimately I did get well, and I couldn't
have done that without the doctors I saw. Um. But
just going to another point about the d s M.
Psychiatrists aren't the only ones who use it. And this
is what's really different and kind of fascinating too, in
that of antidepressant prescriptions are coming from primary care physicians.

(22:01):
Five of my six diagnoses. Yeah, I didn't love reading
that because I think that's five of my sixth name
from primary care physicians. And what's what's really needs to
be noted about that is they came from men in
white coats in hospitals, so wearing. I mean, I had

(22:24):
every reason to believe that it was as valid as
a cancer diagnosis. Um. But again this this sort of
you know, the and then the other thing about it
is we use the terminology. So this one theorist has
called it the psychiatrization of language and of culture. Like
the d s M is a really powerful work of culture.

(22:44):
We diagnose each other, teenagers are diagnosing themselves on social media.
We're really we use it even more perhaps than physicians.
I mean, it's just such a huge part of our
world that I just want everyone to know what these
things really are. Right in describing things, I always get, Okay,
I really want to be sure that this isn't coming

(23:06):
off as like, you know, secretly occult like and like scientology,
like anti Zechia drine like that DSM all bullshit. It's
like no, no, no, we're just literally telling you they're
kind of guessing at stuff. And if a diagnosis doesn't
feel right to you or you don't want to identify
by it, just no the truth behind it, which is

(23:26):
it's not chronic. And I all this to say that
when I first I went to therapy for depression, and
I believe at that time all the undiagnosed, all the
all the moods and behaviors I had from childhood to
teenagehood with undiagnosed panic disorder and anxiety put me into

(23:50):
a depression because I was so confused and so lonely
about it, and then I just, you know, had feelings
like a person. And I do believe there was depression.
I do believe my chemicals in my brain were altered
because of the way I was behaving and thinking for
years and in order to start exploring that. It was

(24:11):
so overwhelming that I'm glad I had talked therapy and
my first Prozact prescription. But I'm saying all that to
say when I first went to get diagnosed and I
went to a psychiatrist who prescribes my talk therapist, I said,
you probably have a chemical imbalance. And I remember thinking,
oh my god, Like that's a big That is like

(24:31):
someone saying you cancer, right, or not even cancer, because
cancer can go away with chemo, Like, but someone saying
you have an enlarged heart, or you know, you're one
of your kidneys is failing, you need it removed, You're
gonna have one kidney. I mean, it was like a
chemical imbalance that that sounds very final. And so then
when I went to the psychiatrist, I honestly thought, I

(24:55):
think I went on a lunch hour at my day
job when I was just twenty one, and I I
remember saying to my boss, I don't know if I'll
be back today because I have this appointment. How long
it's going to be. I thought I had to go
through all this testing. I thought I'd be hooked up
to monitors my brain and taking my blood and were
they going to have to shave part of my head
to get in there? I mean, why would I not

(25:16):
think that, you know? And when it's fifteen minutes later,
I'm out of the office with a prescription and I
was told I had a chemical imbalance? How how did
they know? And then and I went, Okay, I guess
I must be so obviously depressed that they can see

(25:37):
through my eyes that I I mean, I I didn't
go that's weird. Why did how did they know? It's one?
And the calcal imbalance theory, which is now the chemical
imbalanced myth, has been disproven. It's been debunked, and so
there are some things to keep in mind. And I
know this gets so confusing, which is why this is

(25:57):
great to talk about. And I none of this, by
the way, none of it. I mean one reason I
went along with so much for thirty years was that
I believed in the chemical imbalance theory. The media reported it,
celebrities talked about it. My therapist told me that was true.
My doctor has mentioned it. I mean, why wouldn't we
believe it. They used to say, you know that it
was you know, you have two low levels of something, right,

(26:21):
so dopamine serotonin, as you said. And they found no
consistency among people with depression or schizophrenia with any of
the neurotransmitters or any of that. So the chemical imbalance
theory has been debunked. Now does that mean that it
isn't something going on in your brain? Probably not. We
don't know. And so what has happened Thomas insul I

(26:44):
just interviewed him, So that's why I keep referring to him.
I had that honor. So I'm like star struck. Some people,
it's the card actions. For me, it's like the former.
But he his new book is really great, and he's
he's thinking of it as a researcher and researchers are
an out trying to think of it more as a
circuit board, like a computer circuit board. That's the metaphor

(27:04):
they're using now. And so but none of that has
been proven either, And so what I think that does
for us. Where that leaves us is we don't know.
And when my psychiatrist said to me, I don't know,
it was just then it was my choice. I wasn't
forced to believe something that wasn't true. What bothered me

(27:26):
was the I don't want to call it lying, because
I don't know if those people didn't know the truth,
they didn't do their research, they weren't up to date,
or if they were actually wanted to believe it. I
don't know, but certainly there are a lot of people
still talking about the chemical imbalanced myth and using that
to really get people to take their mental health seriously.

(27:51):
And what I love about your show that you do
is you just investigate. You just ask questions and try
to get at anxiety as a disorder versus anxiety as
an emotion. And I didn't. I couldn't have told you.
I couldn't have identified any of my emotions for the
thirty years. I don't know. I mean I could have
hit happy, and I probably could have hit sad, But

(28:13):
other than that, I mean, I did not. And I
went into I was in a partial hospitalization program and
we were in a group therapy session and we got
an a motion wheel with all the colors. You know,
it's got a hundred emotions around it. I was stunned.
I was like, there are all of these. I mean,
how could you possibly know any of these? So, going

(28:35):
back to what you were saying, I think it's really important.
I would have been very well served. And I did
do cognitive behavior behavioral therapy and dialectical behavioral therapy. As
I said, I meditated, but it would have been very
helpful for me to learn about emotions, like what are they,
what do they feel like? How do I process that? Well? Kay,

(29:00):
tinue the interview on the flip side of a quick
message from our sponsors. Where my anxiety began was really
a phobia flying, and then it became a phobia of heights,
and then kind of fear or fear of panicking and
all that. But I didn't have the luxury of having

(29:23):
too many emotions when I was going through all of that,
so I didn't really learn how to emotionally regulate. So
as I got older and the phobias went away, I
wasn't very regulated emotionally, and sometimes getting a diagnosis of
a d H D. Oh, well, I'm not hyperactive and
I can I can pay attention. Oh well, no, it's
different new women. It's more about emotional regulation. And then

(29:45):
it leads me to read about that, and then I think, yeah,
I just I do identify with this. Okay, great, what
can I do but it? And then I do something
about it. With each thing I've conquered, I get to
say I don't really have that thing anymore or you know.
And then because it's just the kind of person I am,
I'm just kind of always seeking joy and so nothing

(30:06):
gets in my way of that. And if I want
to take a day in lamb bad all day because
I just I don't know what's going on, but I can't.
I just can't whatever insert whatever I'm like, I can't
today I will do that. But I have, especially since
starting this podcast, been less I define things so that
people quickly understand what I'm saying. I've tendency towards a
d h D. You know, I didn't see towards anxiety

(30:28):
or panic. But in general, it's all just becoming one
big soup now, which is sometimes I'm having certain emotions,
and sometimes I have reactions about how I feel about
those emotions. They may not be reactions anyone can see,
but they may just really affect me that day. So
I'm looking back and going, I don't even think I
ever had depression. I just really don't, you know. Um,

(30:48):
I think I was just underwater for a while trying
to figure things out, and it was very overwhelmed. And uh,
but it's just been it's been fun to take a
ride and and just sort of be I have the
luxury of being able to look at things differently, and
you know, and so that's what I liked about your

(31:10):
book is that it's really just about you finding yourself
amidst all these diagnosis that you received. And my favorite
part of your book and I'm going to have to
now read this person's books. I've never heard of him,
but um, I'm just reading from a quote that I
wrote down Randolph. Ness is good reasons for bad feelings.
Insights from the frontier of evolutionary psychiatry. Um that anxiety

(31:34):
was necessary, you know, dating back to our primitive selves.
But we don't live in a state of threat all
the time, and so those thoughts are natural, but they're
no longer useful. But they're not a sign of a
disorder or a disease. And you know, I think what
we need to get to. So if we look at

(31:54):
the d s M and how like you mentioned a
d D. Well, first of all, I just wanted to say,
listening to you and my own experience being given so
many different diagnoses, there's something wrong with the diagnostic tool
that we're using. It shouldn't be that easy to slap.
I don't go to the diet you know. I don't
go to my yearly, my annual exam physical and get

(32:15):
like cancer and then be told, now you got tuberculosis,
you know. I mean, it just doesn't right. You know,
there's something wrong with the diagnostic tool that we're using.
And part of it is that is again why it's
not valid. The d s M DSM diagnoses. They overlap,
so the diagnoses are not what's called discrete disease entities

(32:35):
fancy word for just saying that they don't exist by themselves.
So you can see a d h D in this person,
and you can see, you know, anxiety in the same person.
In one study of um or half of the people
who had been diagnosed with schizophrenia were reassessed and given
diagnoses of anxiety and mood disorders. Those are incredibly different diagnoses.

(32:58):
They should not be that easy to reassess and just
be doing that and and so the problem is that
these are really invented symptom lists and they're doing the
best that they can. And I am getting to the
evolutionary psychiatry. But the other problem is with that we
have an imperfect tool. So you have clinicians and mental

(33:19):
health professionals trying to diagnose. But the reliability of these
diagnoses is also very very low. So like generalized anxiety
disorder has a reliability score of point two on his
scale of zero to one. Like that's really bad, So
like you've got a chance of actually having him. But

(33:42):
all this is to say that doesn't mean anxiety isn't real. Again,
it's just that the labels that they're using don't hold
up um. And so there's the validity factor and then
the reliability factor. And so where that left me was, Okay,
how am I going to think about my emotional life?
How I going to think about my mental and emotional life?
And then I read in this book and my father

(34:05):
and I read it together, and um, my dad is
eighty and he's just very funny. Now he's like being
in a book club with him is takes like two sentences.
You know that. That's a long we talked about the book,
but it stayed with me for a long time. And
what I loved about what he was saying is my
brain wasn't some dark, mysterious land of freud where everything

(34:27):
was beyond my ability to understand it and I had
to go to a therapist to understand myself and they
knew me better than I knew myself. And but it
also wasn't some horrible like chemical craziness where things were
going off and misfiring and I couldn't control it. It
was just that I have this really powerful primitive part
of my brain. I have crippling anxiety still and I

(34:52):
feel it. And I think, first of all, I think
those of us with anxiety really badly. We are the
people you wanted on your team in the on the belt,
like we were the people who were seeing lions everywhere.
We're just like lions. We're looking ahead. We're like, even
if it's not there, what if it were, Let's let's
role play what to do. Exactly like I am, I

(35:13):
am fully the person you wanted in your primitive clan.
I just was, and so I kind of take solace
in that. And I just realized, Okay, we're answering email.
It's okay, we're not on the belt. There isn't a lion.
And I also love his his description I didn't understand.
Anxiety made a lot of sense and the evolutionary model,

(35:33):
but depression was like, well, what's the advantage of that,
because remember, evolution is designed to keep you alive, not
to make you happy. It's not what's best ran. It's
just to keep us going. So that's why we're not
happy the time. We're not designed to find happiness. We're
designed to survive. The human condition is not happiness. It's yeah,

(35:56):
it's just it's just being here. Yeah, that's it, and
it serves so. Yeah, and depression, he says that there's
some belief that that depression is actually just the body's
way of resetting from being high high, high on you know,
ratcheted up on anxiety. And that made a lot of
sense to me, having been diagnosed with manic depression or

(36:17):
what's called bipolar um that you know, I had very
you know, I had high highs and low lows, and
that when someone said, oh, that could have been a cycle,
that was just natural or part of the way we function.
That is interesting to me because I didn't want to
see everything as being the result of my diagnosis anymore.

(36:39):
I really think at one point my body was like, please,
we I don't know how to stop you from panicking,
m because you're not doing anything about it. So I
think I'm just gonna depress you physically, you know, And
I just I couldn't get out of bed. And once
I handled my anxiety and like got tools, the depression
didn't come back. And I've always said, I really think

(36:59):
it was like a respite, my body just saying time
to sleep now, because you've just been so jacked up.
And I think also when you look at it that
way in terms of serious mental illness, so there's any
mental illness, and then there's serious mental illness and an
am I versus an SMI, So s m I S
are basically defined as they're not any disorder, but it's

(37:24):
essentially bipolar schizophrenia, major depression with suicidality, sometimes severe PTSD,
but anything that really um you are at the point
where you cannot function or live independently. And so I
couldn't live independently for five years. I was living with
my mother, and I was very lucky to have that resource,
because that's why people are on the street and in jail,

(37:46):
because they don't have a resource like that where they
can go. And any mental illness is the rest of it.
And it's not that that's any less important, but it
is a very those are very different. But when you
think of someone in crisis, someone with a serious mental illness,
you think about your brain as being programmed to just
look for danger. That's just gonna it's just gonna keep

(38:08):
going and keep piling on itself and and creating more
and more of that and entrenching the person. And so
it's it doesn't surprise me that I got worse and
worse and worse and really just eventually couldn't come out
of it. But I did well. I really did love
that story you told about um autism and then as

(38:31):
Burgers being entered into the d s M and then
taken away and the community the aspiece were like, excuse me,
you know, and I actually do know people with autism
and with Asperger's. To me, it's two totally different things.
I can I can tell I mean, I really I
was shocked to see that and the reasons for it
were kind of ridiculous. Can you can you tell us

(38:54):
about that? Feel like that really illustrates this D s M. Yeah.
I mean part of my experience, uh, what I talked
about in the book and just my life is that
while I was going through all this, I also was
encountering and I've always been, you know, taught, and so
i was a writer and residence in the New York
City public schools and I ended up being assigned off
into special education classrooms and then suddenly I was the

(39:17):
autism go to person, and so I was always going
into classrooms with students with severe autism, and I mean
severe autism. So these are classes with about maybe six
to eight children, many of them have a private nurse
that you know, not private, and that they're wealthy. These
were in very very marginalized communities in South Bronx and

(39:38):
the South Brooklyn, and so I really got to know
what that what that type of autism is. And as
you're saying, Asperger's is a totally different thing. So when
we had the two diagnoses of autism and Aspergers, what
they found was that a lot of the resources that
we're going to people with Asperger's, which this isn't a

(40:01):
very thorough definition of it, but Asperger's is slightly more
high functioning than autism, and I should define what autism is.
So autism literally means interiority, like a loneness and when
there's a kind of cut off from not necessarily reality
in the sense of hallucinating, but there's a kind of

(40:22):
separation with the world. And so autism was in the
d s M. It was defined by mutism, so it
was people who were non verbal. And then the diagnosis
just what they call loosened, and so suddenly mutism was
dropped from it, and then all that allowed for all
these other people to receive a diagnosis of autism. And

(40:44):
the way they tried to sort of counter that or
work with that was to create aspergers which was a
higher functioning if you want to call it, version of it,
although again that's you know, not a great way of
describing it because it's more complicated than that. But so
when they found that the sources were going to the
higher functioning students often it was educational services, uh, they

(41:05):
decided to they created the Autism spectrum. Now that was
also created, so Asperger's was dropped completely from the d
s M. That was also part of the d s
M is moving towards this idea of a spectrum. So
instead of having all these different like generalized anxiety disorder
and social anxiety disorder, they're trying to go toward a
spectrum of diagnosis that has its own problems. But so

(41:30):
that's what happened. But a lot of you know, the
people Asperger's, people with Aspergers, did find that they suddenly
did not have a diagnosis, and that was they really
there was an uproar about it. That's pretty rare though
that a d s M diagnosis has dropped more often
than not. I mean, when we started the d s
M had a hundred and twenty eight diagnoses. We now

(41:50):
have five hundred and forty one if you count sub types,
and um, every kind of avenue to get the diagnosis,
and so you'd be hard pressed to go into any
clinicians or mental health professionals office and talk about your
fears or your deepest even desires and not get a
diagnosis at this point. Um, So it's just and again

(42:12):
it's this idea of like you talked about a d
h D or what they did was they dropped the
H from a d h D, and you'll notice sometimes
it's called a d D and sometimes it's called a
d h D. But what they do is they dropped
hyperactivity as a criteria, so you could be inattentive type
and that created what was called the false epidemic of

(42:32):
a d h D. Then they also included adult a
d h D, which had never existed before, so they
just created it. It was not a real thing. So
basically you have all you had was a d h
D and you had to be hyperactive. Suddenly they dropped
the H and you can be hyperactive, but you don't
have to be. That doesn't quite make sense, but you

(42:53):
can just be unattentive and then you suddenly have and
before you had to be, you know, you had to
be in childhood. It was a child you know, childhood disorder.
And then suddenly adults can get it too. So that's
the kind of thing that happens in the revisions of
the d s M and why it's so heavily criticized,
but also why it's so problematic for all of us.

(43:13):
I mean, we're all in this together. I don't think
any psychiatrists, well there's hubrists and kind of you know,
arrogance certainly out there, but I don't think any psychiatrist
is around walking walking around. Well there is one I
know that is, but walking around like you know, we're
doing a great job. This is great. I mean what
someone asked me if I've gotten a lot of pushback

(43:33):
from psychiatry, and I've gotten none. I have gotten Actually
everyone has said yeah, we know, and thank you. Like
that's that's all I've received. And it feels great. I mean,
it's wonderful because it gives me a lot of hope.
Anxiety bites will be right back. After a quick little
message from one of our sponsors. You said, you know,

(44:00):
according to the d s M, if grief lasted more
than two months in quotes called uncomplicated bereavement, it became
a major depressive disorder despite no changes to the grief symptoms.
So suddenly it's like, now, just because it's been two months,
you've major depressive disorder, but you don't have any new symptoms.

(44:21):
And and then you said the bereavement really only seemed
to count the loss of human death. I mean, it
wasn't your house burned down, you lost your job, you
had to break up, not even a pet dying, And
so that's where I've heard a mythology. I've heard it
from psychiatrists that oh, yeah, so if you're going through
a grieving of any kind, if it lasts more than

(44:44):
six weeks, you have tipped over into depressive disorder. Now
you have depression. Yeah, looking back, it doesn't make sense because,
first of all, our culture isn't set up to have
any time for grieving. So if we had to grief
and it did last longer than six weeks, maybe I
don't know, but it just seems so arbitrary. Well who

(45:06):
does that help, though, Like, who is this helping? Well,
the grief disorder it's now called prolonged grief disorder. They
have a new the newest revision of the d s
M came out this month. I'm not sure if they've
released it yet, but it's out in March and the
UM So they've now created prolonged grief disorder. So basically,
people have been working for many, many years, for decades

(45:29):
to try to get the berieve Man exclusion removed because
they want everyone to be able to get a depression
diagnosis now to take out the criminal like evil element.
Why do they want that I believe the people doing this.
First of all, the d s M has been designed
to diagnose as many people as possible. That's what it's
designed for. That's what they want because they believe they're

(45:51):
doing a service. The problem is we're over diagnosing and
and they're they're not always doing a service. Now does
that mean someone doesn't meet the arapy? No, But do
they need a diagnosis. That's that's where we get into it.
So the brievement exclusion was dropped, and now they've created
so anyone can receive major depressive disorder diagnosis regardless of

(46:13):
what losses they're experiencing. And and again, like you said,
we're totally disregarding the problem with the d s M
is it disregards context. So if my house is burned
down and I am grieving, I have depression. I mean
that's you know, or if I lose my job or
whatever it might be. But they've created prolonged grief disorder
and that says that if you grieve longer than one year,

(46:36):
you have a mental illness um and that and what's
what's really too bad about this is that in their
press releases, the American Psychiatric Association, which if you want
to talk about benefiting. They make hundreds of millions of
dollars off the d s M. It is in their
best interest for it to be a cultural, you know,
kind of presence among us and for us to use

(46:57):
these diagnoses. And what they've done in their press releases
as they talked, they really have capitalized on um everything,
so meaning the pandemic, talking about how many people have
lost loved ones. They also talked about natural disasters, they
talk about you know, so they're really kind of what's
called and this is where it does get sinister, but

(47:19):
marketing the disorder is what it's called, and it's something
that drug companies have done for a long time. And
so and this is anxiety is really interesting in this respect.
Anxiety has been kind of I don't know, victim of this,
I almost want to say, because it's obviously not anxiety's fault.
But when so a drug company creates Glaxo Smith Klein,

(47:42):
the drug company creates Paxel, the antidepressant and s SR
and they did it. They actually came up with it
in so it was after the Prozac had made a
splash and they just Prozac stole its thunder. So basically
what they had to do was find something else to
say that Paxel could fix. And so what they did

(48:02):
is they went through the pages of the d s
M and they found an obscure diagnosis called generalized anxiety disorder.
One percent of the population that was obscure. Yeah, one
percent of the population had it. It was like, you know,
no one really you know, it was basically insignificant. And
what they did, and this is actually brilliant, they marketed

(48:25):
the diagnosis of generalized anxiety disorder, not Paxel, And so
they hired a PR firm. They also create fake at
patient advocacy groups UM and they also fund patient advocacy groups.
So basically, then the media is reporting on it, and
they get some sort of prominent doctor from Columbia University

(48:47):
or wherever to say, yes, this is a terrible diagnosis
and all these people have it but they don't know it.
And then what happens is once they've got the approval,
Glaxo Smith Klein swoops in and says, hey, Pexel can
cure generalized anxiety disorder that now eight or fifteen or
eighteen percent of the American public has, depending on the

(49:09):
statistic you believe, and the same thing happened with social
anxiety disorder, and it was also Glaxo Smith Klein. I
mean they're not the only ones. Other pharmaceutical companies like
up John and Fiser have done the same thing. Fiser
did it with PTSD and up John did it with
O c D. So this idea of marketing the diagnosis again,
it's it's a little bit wrong to say that pharma

(49:32):
creates diagnoses in the sense of they don't actually stand
at the door and pay the people writing the d
s M to create a diagnosis. And it's not made up.
There is anxiety either, is PTSD. Yeah, but they're just
saying it's like they're finding their brand. You know, the
d s M is such a weak diagnostic tool that

(49:53):
it can be used for all these terrible purposes and
in all these terms, in all these sort of really
dangerous way. This is the problem, um and sadly I
don't think it's hopeless. But the new edition of the
d s M that's just come out, they had a
decade the last edition came out in so nearly a
decade to fix the problems that were with the d

(50:15):
s M. Controversies had erupted a lot of attention was
paid to it, and they haven't fixed one. And so
I really feel like the reason why I wrote the
book was it's not going to come. Change won't come
from psychiatry, it won't come from the A p A.
And it won't come from the d s M. It
has to come from us. And that's why I wrote
Pathological and why I want everyone. I want us to

(50:36):
be empowered. I want us to be able to say, hey,
I know about the d s M, and now let's
talk about the diagnosis you're giving me and what that
means and what treatment I should have. Well example, this
whole notion like we are having a mental health crisis
in this country, and honestly, just on I can't explain
it on a bizarre level in my body. When I

(50:57):
hear that, I go, We're not. And I and I
see people having to get duct tape on airplanes. I
I see more insanity than I've ever seen in my life. Um,
and so it's wild that I'm not running around going
we're having a major mental health moment in this country.
It's something, but it's not all these undiagnosed people. And

(51:19):
I interviewed this professor about trauma, and he said, we're
not having a mental health crisis, we're having a chronic stress.
And I there was this, even though I agree with him,
there was this like, oh, don't say that, you know,
I don't want anyone to get mad because we've all
kind of bought into it. And I'm like, well, you
know that. But I it's like, well, if we understood
what chronic stress really did to people, we wouldn't be

(51:41):
so offended that we're calling it that instead of mental
health crisis. Like chronic stress is not we're not meant
to deal with it, and we don't deal with it well.
But it is like, I do not think there's millions
of people with undiagnosed this or that. I think I
don't know what it is, Like, what do you think
is happening? Well, it's such an interesting phrase. And I

(52:03):
really do blame the media a lot, so I I
say in my book, I don't blame anyone except the
d s M. I blame a book, but I and
I do, but the media. I'm just I'm a writer,
so I think about words and the power of words,
especially the written word. And so what's interesting about what
you're saying is we do have a mental health crisis
in the sense that people with serious mental illness are

(52:24):
ending up on the streets and in jails. Cook County
is our largest. Cook County Jail, which is not far
from where I live, is the largest mental health facility
in the country. That's a crisis. That is absolutely a
mental health crisis. What's happening otherwise really isn't like you're saying.
I mean, what's interesting about the diagnosis of anxiety and

(52:45):
how it changed over the additions of the d s M.
Is it used to be in the third edition you
had to have unrealistic and excessive worry. They removed unrealistic
the word unrealistic in the next adition and in the
subsequent editions, and excessive, So all you have to do
is worry. I mean, think about what that changes. And

(53:08):
when we think about the pandemic. None of what's going
on is unrealistic or excessive given what we've just been through.
Is it ideal? No? Do we want it? No? I mean,
and I do think that. You know, we don't know
what stresses or what the relationship of it is to
mental illness, but I mean, there's certainly could be points

(53:29):
at which stress can drive you too, you know, an
extreme of mental illness. We don't know so that that
is possible. But really, I think we're all coping with
this very extreme, excessive somewhat. You know, it is realistic
to be terrified that you're going to get you know,
to be terrified of journs, and to be you know,
hear annoid of the government, given what's going around and

(53:54):
how you know, in the silos of social media and
that sort of thing. You know, it's not actually I mean,
this is what we're living in and we aren't making
things up. How did you get yourself out of the
situation where you're you're living with your mom? You've got
all these diagnoses, What did you do? I mean, I
was extremely suicidal? Um I really did you know? At

(54:18):
one point? I definitely was a lot. My mother was
on suicide watch for four years. I mean, it was
a lot to ask of her. So I did end
up moving out and I got much much worse before
I got better, and my sister. Again, my family was
just a lifeline for me. So I cannot imagine someone
who doesn't have that support system. But I had, you know,

(54:40):
a place, and I had people to support me. And
I had a purpose, and so I started writing this book. Um,
and I don't really look at writing is healing, but
it gave me a purpose, and all right, as a writer,
I do not either, so it's not healing. But so
I did have those things. I say in my book

(55:01):
that it's not a typical mental health memoir mainly because
I'm questioning a lot of what we take for granted
in terms of what mental health diagnoses are, but also
because I don't have the answer. And so all I
know is that we don't We don't tell people that
they can fully recover. We tell them they the best
they can hope for is remission and managing their symptoms.

(55:23):
And that is simply wrong. And my you know, I
have no data to back this up. But if we
want to lower the suicide rate, start being honest with
people that not that mental illness isn't chronic and that
there's hope. Because when I was suicidal, I had no hope,
I had no future, and so someone had no one
had told me. Everyone told me they were chronic. Until

(55:43):
I saw the I don't know psychiatrist Dr Are. He
was the only one who was allowed me to think
of the future. So that really helped. I suddenly started
thinking of the future. Once I stopped identifying with the diagnosis,
then I stopped attributing all my really low lows and

(56:03):
anxiety and you know, everything that I was feeling to
a diagnosis, and instead it was just what I had
to manage um. And then, to be honest, I mean
up until Thomas Insel's book came out, and he is
a man with so much authority and has my total respect.

(56:24):
When he said mental illness isn't chronic, I felt like,
oh my god, I can now really say it, and
I can say it to other people. I feel comfortable,
you know, for me to say, I couldn't tell other people, yes,
it's not chronic without you know, anything to back it up.
But although there's no proof that they are chronic, but
there's At the time, there was nothing there for me

(56:46):
to really rely on. So that has helped tremendously. But
I don't think we know what healing looks like yet.
We don't know what recovery looks like because we haven't
given it a chance, and that hasn't been our priority.
Our priority has been looking at trying to prove that
their brain diseases quote unquote and trying to prove this
and prove that, and what we need to start doing
is healing and caring for people and getting them full

(57:10):
recovery and to know that. And that's pathological the Movement.
That's why I started it. UM. My book, you know,
gives readers everything they need to know wrapped up in
a really good story. But I wanted also kind of
actionable steps because I can't offer an elixir, I can't
offer you a magic bullet, and so Pathological the Movement

(57:32):
is just a public awareness campaign to let people know
that mental illness is not chronic and you can fully recover,
and that D s M diagnoses are not valid and
largely unreliable. And all this is as I said, the
exception is dementia and rare chromosomal disorders. But and what
I asked, or not what I asked, but what I

(57:54):
hope we can do is ask three questions when we
or someone we love receives a diagnosis, which is of
the mental health professional or clinician, is this diagnosis valid
and or unreliable? Um. The answer to the first one
is no, it's not valid. And the answer the second
one is it depends in terms of reliability, um, and

(58:16):
then has this diagnosis been proven to be chronic? And
the answer is no? And then what does that mean
in terms of the treatment that you're suggesting. Now, I'm
not good about asking my doctor's questions. I'm very medical
professionals have great authority over me, so I don't really
I'm not really assuming people will actually ask these questions.

(58:37):
But we'll ask them of ourselves and we'll think about them,
and that will walk into physicians offices and mental health
professionals offices with power and they will have to kind
of rise to the occasion and be more transparent with us.
Do you have your to go box with you? Are
you ready for the takeaways? If you want to read

(59:01):
the takeaways or look at takeaways from past episodes, you
may go to Jen Kirkman dot com and then click
where you see that it says anxiety Bites. Will also
put the link directly in the show notes. But here
are the takeaways from this episode. The word pathologize means
to medicalize a condition, any condition, and not just a
psychiatric one. All mental health diagnoses come from the manual

(59:25):
known as the d s M, the Diagnostic and Statistical
Manual of mental disorders. Many prominent psychiatrists and researchers have
warned about the invalid diagnoses in the d s M.
Even though mental illness is very real. Mental health diagnoses
in the d s M are focused on the biomedical model,

(59:46):
or the idea that mental health diagnoses are biological and
therefore chronic. But no DSM mental health diagnosis has proven
to be chronic. Studies have shown that the people who
believe there is a biological cause to their diagnosis have
more self stigma, more shame, and are more hopeless about
their diagnosis. The problem with d s M diagnoses is

(01:00:09):
that there is no biological marker for any of them,
which means there is no test saying that mental illness
is the same as physical illness comes from a well
meaning place, meaning that we need to respect it the same.
But with the exception of dementia and rare chromosomal disorders
that are in the d s M, no single mental

(01:00:30):
health diagnosis has an objective reality like a physical illness
in members of the American Psychiatric Association came together to
create the d s M, which is the manual that
doctors could use to better communicate with each other. The
d s M has had seven editions where it gets
revised and more diagnoses are included. Sara Pha's goal is

(01:00:51):
not to throw out the d s M, but to
have more transparency around this manual so that people can
make more informed decisions about their mental health. Sometimes agnosis
can be helpful, but other times they can lead to
self fulfilling prophecies of antidepressant prescriptions are coming from primary
care physicians and not psychiatrists who prescribe medication. The d

(01:01:15):
s M has been designed to diagnose as many people
as possible. It's designed to be doing a service, but
the problem can be that doctors are now over diagnosing,
which ultimately does people a disservice. Thanks for listening to
this podcast. If you would like to give it a
five star review, and please do, I would like you to.
I don't care what you like. I want you to

(01:01:36):
um go on over to Apple Podcasts or Spotify. Those
are two places that allow you to leave reviews. The
more reviews I get, the more people find this podcast.
It's a very simple algorithm, So do that for me
and send me an email Anxiety Bites Weekly at gmail
dot com. Tell me what you love about the show.
You can give some anxiety tips that you have that
you use that you want to share with your fellow listeners,

(01:01:58):
And you can ask me any questions that you want
and I may answer it on an upcoming listener email episode.
Thanks again for listening and remember anxiety bites, but you're
in control. For more podcasts from my heart Radio, visit
the I heart Radio app, Apple podcast, or wherever you

(01:02:20):
listen to your favorite shows.