June 24, 2025 • 52 mins
In this powerful and enlightening episode of Next Steps Forward, Dr. Chris Meek welcomes psychiatrist and author Dr. Steve Lesk, a 40-year veteran of the mental health field and author of Footprints of Schizophrenia: The Evolutionary Roots of Mental Illness. With decades of experience treating patients and mentoring professionals, Dr. Lesk brings a groundbreaking perspective to one of the most misunderstood mental illnesses: schizophrenia.
Dr. Lesk explores his pioneering “primitive organization” theory, which draws from evolutionary biology, neurochemistry, and psychology to offer a new understanding of schizophrenia - not as a broken system, but as a reflection of ancient brain structures. He tackles some of the biggest myths surrounding the illness, addresses the stigma and misconceptions, and offers compelling arguments for empathy, early intervention, and a shift in how psychiatry approaches diagnosis and treatment. Whether you're a healthcare professional, a caregiver, or someone curious about the human mind, this episode offers critical takeaways and a hopeful vision for the future of mental health care.
About Dr. Steven Lesk: Dr. Steven Lesk is the author of Footprints of Schizophrenia: The Evolutionary Roots of Mental Illness. He became a practicing, board-certified psychiatrist in 1984 and he’s treated thousands of adult patients as he has conducted research, written articles, and mentored students. He served as Chairman of the Department of Inpatient Psychiatric Services at the Brooklyn Veterans Administration Hospital and was an assistant professor at the hospital’s affiliated medical school. He is pioneering new theories in hopes of improving our understanding of the illnesses that patients endure and reducing stigma while surging empathy.
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Episode Transcript
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Speaker 1 (00:00):
There are few things that make people successful. Taking a step forward to change their lives is one successful trait, but it takes some time to get there. How do you move forward to greet the success that awaits you? Welcome to Next Steps Forward with host Chris Meek. Each week, Chris brings on another guest who has successfully taken the next steps forward. Now, here is Chris Meek.
Speaker 2 (00:34):
Hello, you've been in this week's episode of Next Steps Forward, and I'm your host, Chris Meek. As always, it's a pleasure to have you with us. Next Steps Forward is committed to helping others achieve more than ever while experiencing greater personal empowerment and well-being. Our guest today is Dr. Stephen Lesk. He's the author of Footprints of Schizophrenia, the Evolutionary Roots of Mental Illness. Dr. Lesk became a practicing board-certified psychiatrist in 1984, and he's treated thousands of people. of adult patients as he has conducted research, written articles, and mentored students. He served as chairman of the Department of Inpatient Psychiatric Services at the Brooklyn Veterans Administration Hospital, and was an assistant professor at the hospital's affiliated medical school. He is pioneering new theories in hopes of improving our understanding of the illnesses that patients endure and reducing stigma while urging empathy. Dr. Stephen Lesk, welcome to Next Steps Forward.
Speaker 3 (01:24):
Well, thanks a lot. I'm looking forward to getting a chance to explain my theory. I'm going to take a few minutes and let people know where I'm coming from.
Speaker 2 (01:33):
Likewise. Before we start, I've done a lot of work in the veteran space, and so I appreciate your time working with the VA, so thank you for that. Now, let's begin with your journey. What drew you to study schizophrenia?
Speaker 3 (01:45):
Well, actually, I've studied all mental illnesses as a psychiatrist, and I've always been interested in what makes people tick. I have a bachelor's in psychology, a master's degree in psychology. I have a medical degree, and then I did my psychiatric residency on Long Island. But I've always been fascinated by what makes all of us tick, and I've always found myself drawn to reading about it and theorizing about it. And, of course, my profession fit in perfectly with that.
Speaker 2 (02:20):
Is schizophrenia a single illness, or is it better understood as a spectrum or collection of related disorders?
Speaker 3 (02:27):
I see it as a single illness. And, you know, for most people, it's pretty easy to diagnose eventually, and there's a pretty strictly defined time period of onset between about 16 and 25. If you're older than 25, you're probably not going to get schizophrenia. So it has very specific symptoms, years of onset, and we know a lot about it. So I see it as one disease and a very specific. But even though my book mentions schizophrenia, it's really about all mental illness, because they're all interrelated, both emotionally and biochemically, as one sort of phenomenon with varying degrees.
Speaker 2 (03:16):
And you mentioned the age of 16 to 25. Does it tend to affect men or women more, or is it an equal opportunity disease?
Speaker 3 (03:23):
It's about equal, 50-50. It's 1% of the population worldwide. No matter where you go, it's 1%.
Speaker 2 (03:33):
And as we come out the other side of what I'm calling the mental health tsunami from COVID, are you seeing an increase? I mean, we know generically we've seen an increase in mental health troubles, if you will, with individuals. Is schizophrenia kind of in line with that overarching theme, or is it higher or lower?
Speaker 3 (03:51):
No, that's one of the interesting things about schizophrenia. It remains about the same all the time, all over. And that's one thing. You have to explain. Any theory of schizophrenia has to explain why is that, that it's this 1% worldwide. It doesn't, like some illnesses that are genetic, like Tay-Sachs tend to hover in Ashkenazi Jews, or sickle cell tend to hover in black people. Schizophrenia does not do that. It's all across the board. Socioeconomic, political boundaries, 1%. And you've got to explain that. And my theory does.
Speaker 2 (04:32):
And we'll get to that shortly. Are there any early warning signs that families, friends, or physicians should be watching for?
Speaker 3 (04:39):
Well, very often you'll notice changes in the individual, but they will not notice them, but other people will. So you might notice that your son or daughter is not taking as great care about their appearance, that they're kind of withdrawing from people, that they, they may start to say unusual things like you know, the government is following me or people have hacked my computer, or I'm hearing a voice coming out of the vents. And once you start hearing things like that, it's important to take them to a psychiatrist for assessment. Doesn't mean they absolutely have schizophrenia, but once they start talking in ways that don't seem too rational, that's when you have to investigate further.
Speaker 2 (05:29):
You know, and as you're talking about that, I'm reminded a good friend and former roommate of mine, his brother swore he was being followed by the government and then started banging holes in the wall in their house and then ultimately was diagnosed with schizophrenia. And so are those typical signs that are pretty common across the disease?
Speaker 1 (05:48):
Yeah.
Speaker 3 (05:49):
I mean, the paranoia is very common in schizophrenics. They may believe, you know, they're being followed or satellites are monitoring them or their food is poisoned. And then they start acting on these delusions like patients who will only eat peanut butter because that's the only thing that isn't poisoned or they will not go to certain parts of town because they know that's where the government is. So it starts to get more and more rigid and confining. And eventually they may just withdraw totally from people, stop caring about their appearance, start talking very strangely. And it becomes pretty obvious that something, something has changed in them, but they are not aware of it. It's called anastomosis. If you ask them, you know, why are you so different? They'll say, I'm not different. Other people are treating me differently, but I'm not different. That's how they view it.
Speaker 2 (06:44):
And as the conditions worsen, do they lose faith or trust in people that are close to them?
Speaker 3 (06:51):
They might start to be suspicious of people close to them, although tends to be people. They know less well that they're more suspicious. So, but eventually they could become suspicious of people close to them. There's something called Capgrass syndrome where they suddenly believe that their loved ones that they live with have been replaced by doubles. It's a very unusual thing and they're absolutely convinced of it and they don't want to live with those people and they're afraid of them and they may run away. They may assault them, but by and large, schizophrenics are not assaultive or murderous or, or anything like that, but they have had a change in their thinking.
Speaker 2 (07:35):
Is schizophrenia hereditary or random, biological or environmental? And what do you know about the causes of schizophrenia?
Speaker 3 (07:42):
Well, that's where my theory comes in. Most psychiatrists will tell you that it's genetic and we do know that there is increased vulnerability. If you have a parent or brother or sister with schizophrenia, your risk goes up, but that's, as far as we know. And to say that that makes it a genetic illness, I think is false. There are lots of things that increase your risk. If you have a head injury as a child that increases your risk. If you have abusive parents, if you have an elderly father, if you grow up in an urban area, as opposed to rural, that increases your risk. If you're born in winter months, that increases your risk. So a whole lot of things may increase your risk, including genetics. That doesn't mean it's a, it's a genetic illness. The central paradox of schizophrenia is if schizophrenia is genetic, why isn't it extinct by now? Because it reduces your ability to reproduce. It reduces your ability to function. It's not showing any signs of extinction. So I'm personally believe it is not a genetic illness, even though it can increase your risk. It's kind of like when your engine light comes on, you don't go. And you have your engine light fixed. That means you've got a problem with your engine. So yes, you may have a genetic risk. That doesn't mean schizophrenia is genetic. And I'll talk more about exactly what I think it is. And the problem is we don't know what it is until now. I think now I've come up with the answer.
Speaker 2 (09:19):
And we will get to that answer shortly. I promise. Can people recover from schizophrenia to the point where it completely goes away? Or is this a lifelong condition?
Speaker 3 (09:27):
Well, it's considered a life, lifelong condition. The the outcome is variable for the vast majority. Once you're diagnosed with schizophrenia, the expectation is that you will function on a lower level. And a lot of schizophrenics don't hold a job. Don't get married, have to live in a group home where they're given their meals and their medications. And it usually means that you're on medication for the rest of your life. Now, there are some high functioning, schizophrenia, and if you remember the movie, a beautiful mind, that person got a Nobel prize in mathematics. Many others, Ellen Sachs, who wrote the book, the center cannot hold was a high functioning lawyer who went to Oxford and Yale and was clearly schizophrenic. So there are exceptions, but for the most part, your functioning is expected to diminish. I mean, there are doctors and lawyers who are schizophrenic, but generally your function, your condition goes down.
Speaker 2 (10:30):
I know you mentioned earlier that it's pretty much 1% of the population. Is that across the board by country? You know, how many people in America today have been diagnosed with schizophrenia and how many people do you believe actually have it?
Speaker 3 (10:42):
Oh, about 3.5 million in this country alone. And it's, it's across the board and it's across all geopolitical boundaries. I can socioeconomic boundaries. And that, like I said, is one of the primary issues of schizophrenia that has to be, that has to be explained. So, you know, the numbers are massive. Think of all the patients, their families, caregivers, but it's entirely under the radar. No one wants to talk about it. Why? Because of stigma and stigma comes from ignorance. When we don't understand something, we develop all kinds of crazy theories about it. And that's unfortunate. I mean, we can change that.
Speaker 2 (11:24):
Now you mentioned stigma and I mentioned my work in the veteran space, and it's been a focus. It's been a focus on mental health and PTSD and TBI going back to COVID in the post COVID era. Do you feel, you know, I've been saying for about a year, if not two now that the one positive thing of COVID was to put up a spotlight on mental health broadly. Do you feel that that stigma is being softened now, as we come through COVID and people are facing more challenges?
Speaker 3 (11:50):
Unfortunately, I don't see it softening. I think that even though there's some more light being shown on mental illness, especially among youth, and there's a lot of looking into the fact that depression, suicide, anxiety has increased in the youth youth even before COVID, starting around 2010. And some people blame this on cell phones. I think it's more complicated than that, but no, I don't see the stigma reducing. And I think again, it's because we don't understand it well enough yet.
Speaker 2 (12:27):
In terms of diagnosis, how is schizophrenia diagnosed and are we getting any better at early and accurate diagnosis?
Speaker 3 (12:35):
Well, we look for the, those cardinal symptoms that I mentioned, the withdrawal from others talking illogically bizarre behavior, you know, like they're avoiding all you know people who have two pays because they're dangerous saying strange things, hearing voices, things like that. And you know, downturn in functioning social withdrawal. So those are some of the cardinal symptoms, paranoia that lead us to a diagnosis. That's pretty certain with schizophrenia. Eventually it may take some time. Now we're trying to identify schizophrenia before it's onset, which would be great. We're looking at what we call ultra high risk for schizophrenia people, but we haven't identified. Identified them with such certainty that we can start medicating them before they even get the schizophrenia. So we're not there yet. And it's a shame, but it's worth the effort.
Speaker 2 (13:42):
You're a lifetime member of the American psychiatric association, but even back when you're resident, you felt the psychiatrists were attributing schizophrenia to the wrong factors. What did they blame it on? And why do you believe the profession got it so wrong?
Speaker 3 (13:55):
Well, when you don't really understand something, you, you grasp it at the obvious. So when I was a resident, I would hear the attending psychiatrist talking to families of schizophrenics and they would say, well, what is this schizophrenia that my cousin or son or uncle has? And they would say, well, it's genetic or it's a chemical imbalance or it's a connectivity problem, miswiring vague generalities that really meant nothing. And, you know, left families very unsatisfied, but that's all they had. That's all we knew. And, uh, eventually I got so tired of hearing that and, and having no better answer to offer that I decided that I would be the one to come up with something better. So I started broadening my knowledge base. I read books on anthropology, um, Darwinian evolution, uh, language learning theory. And I think what I've come up with is, is much deeper and more explanatory than anything I heard as a resident. And, uh, that's why I'm promoting it so much because I think we can do so much better in psychiatry than we have been.
Speaker 2 (15:14):
What treatment options are available today? And what are the biggest challenges in treating schizophrenia effectively?
Speaker 3 (15:21):
Well, once you get the diagnosis of schizophrenia, you probably need to be on medication the rest of your life. And we use medications that we call antipsychotics and all the antipsychotics do one thing. They block dopamine receptors. Even the new one, there's a brand new one that came out, but it reduces dopamine indirectly. So it's, it's not that different, but it's just a different kind of way of going about it. So we know that schizophrenia involves a surge or excess of dopamine, and that you should be on one of those medications. The rest of your life. Problem is those medications have horrible side effects. They cause weight gain, which can lead to type two diabetes and other things. Um, what we call metabolic syndrome, they cause drooling constipation, uh, if in high doses, they could cause a seizure. They cause something called tardive dyskinesia, which is a permanent movement disorder of the limbs. Usually starting in the mouth, so you'll see people going like this and this, um, they cause something called a neuroleptic malignant syndrome, which is kind of an allergic reaction, which can be fatal. So we have all of these very difficult side effects. And imagine you're giving this medication to patients who don't really believe they have an illness. They're getting all these side effects. And we as psychiatrists can offer very good explanations for what we have. So we're treating patients. Patients. We don't understand with medications. We don't understand to patients who don't believe they have an illness. And of course, a lot of patients are going to go off their medications time. And again, even Ellen Sacks, who, like I said, went to Oxford and Yale, she went off her medications 10 times or more to prove to herself. She was not schizophrenic. And every single time she relapsed, you mentioned dopamine a few times.
Speaker 2 (17:23):
Why is dopamine such an important ingredient in our mental health? It's absent such a big factor in the development or presence of mental illness.
Speaker 3 (17:31):
Well, I'm going to say a few things that may surprise you or shock you, but let's start with this. Number one, schizophrenia is entirely due to the evolutionary moment that we're in. What does that mean? 50,000 years ago, there was no mental illness, 20,000 years in the future. There will be no mental illness, but because we're, in this unique transition evolutionarily, we are seeing mental illness. And I can elaborate a lot further on that, but all of this has to do with dopamine. And the way we use dopamine mentally changed once we've started to use language, which was only 50,000 years ago, human like animals have been around for six, 7 million years. It's only been 50,000 years. That we've had language. That is a drop in the evolutionary bucket. And for something that radically changed how we use our minds and how we process dopamine, obviously not everyone is going to be on board with it yet. 10, 20,000 years from now, we all will. But right now we're in this transition and 1% of us have schizophrenia. Another 15 to 20% have other mental illnesses. And it's due to the fact that, that we changed how we process dopamine once we got language a mere 50,000 years ago. And it's not just mental illness. We have physical illnesses that are related to dopamine, Parkinson's Tourette's Alzheimer's Huntington's, Korea restless legs and many others that are a legacy of this change and how we process dopamine.
Speaker 2 (19:25):
How do medications therapy and community support each play a role?
Speaker 3 (19:30):
Well, the medication is a must and what it does is block dopamine receptors. So what happens is as we're in adolescence, as we mature and learn language, we learn to suppress dopamine and certain tracks. And we never could before language, the mesolimbic mesocortical tracks. We suppress dopamine effectively for 80% of us. And that's what we do. And that's what we do for 90% of us. But for 20% and 1% are schizophrenic. There's a resurgence of dopamine and that resurgence throws everything off and brings our thinking back to the type of primitive thinking. What I call the primitive organization that we had prior to language. Once that happens, the schizophrenic starts to think in more primitive ways and they can't cope with a modern, modern civilization where you have to be able to think abstractly. So we give medications that block the receptors of dopamine and tone down this surge that we're seeing. And that's very, very effective. It's not a cure, but it very much can reduce the symptoms that we see in schizophrenia. And we use similar types of meds in other diagnoses as well.
Speaker 2 (20:51):
Why are some people unable to process dopamine? Well, most of us apparently process it without any problems.
Speaker 3 (20:57):
Well, the issue is that it's so new. And, you know, when you say it's new, we're talking about 50,000 years. We don't look at, you know, evolution. You know, most of us don't think, well, you know, humans have been around for millions of years and language started 50,000 years ago. And what are we going to be like 10,000 years from now? We focus on our little corner of the globe and our tiny little life. Time, which evolutionarily it is minuscule. But we have to look back at the trajectory of where we've been 50,000 years ago. We were living in the jungle. We had no transportation. We woke up every day. And if we were hungry, we ran out of our cave and we tried to find some berries or roots or nuts or kill a small animal and pray that we wouldn't get eaten because we were not at the top of the food chain. So now, a mere 50,000 years later, everything has changed. We live a lifestyle that is utterly different from what we evolved in, which is why we have so many of these mismatched diseases. But the change in terms of mental illness has to do with language causing a change in our processing of dopamine. And most of us, 80% of us handle that. Well, we suppress dopamine over time as we grow up and adolescent. But there's still a 20% that aren't there yet. And because it's so new, they're still in the transition process. I call them evolutions dispossessed. They're still a victim of the fact that this is so new that not everyone, not everyone's brain is on board with it.
Speaker 2 (22:43):
You've said that schizophrenia is quote everybody's problem. Make that case for us, please.
Speaker 3 (22:49):
Well, if you take an illness, that's 1% of the, of the population is very hard to find someone who doesn't even either have a relative, a friend or no people who have relatives or friends with the illness or no caregivers of those people. This is a massive problem. And the monetary cost is huge, not just in treating them, but in loss of productivity, it's massive. So this is everybody's problem. And if we could fix it a lot better than we do now, uh, the whole world would be better off every country, every nationality, every geopolitical area. So it's everybody's issue. And the fact that we don't understand it well enough brings on the stigma and then it goes underground. No one wants to talk about it. No one wants to admit my cousin is schizophrenic. My, my uncle, whatever an interesting fact is that, you know, you talk about genetics. Uh, if you have identical twins, two of the identical twins have the exact same genes. If one of them has schizophrenia and the illness was genetic, you would say, well, a hundred percent of the time, the other one will have schizophrenia. No, it's less than 50%. So genes play a role, but it is not a genetic illness. It's an evolutionary glitch that we're in and that we're going to get through, uh, you know, 10,000, 20,000 years from now. Well, how does that help us? Now, if we can understand an illness better, we can refocus our whole research protocols so that we can do much better in terms of understanding it, researching it and coming up with cures that maybe prevent this resurgence of dopamine from happening. That's why I say psychiatry is in the dark ages. Do you know any specialty of medicine where there's not a single blood test, a single x-ray, a single CAT scan that can give you a diagnosis? No, only psychiatry. We totally rely on what the patient tells us. And as you know, a lot of patients are not in the best position to relate what's going on with them. They were embarrassed and they're, they're not the greatest, not the most expressive people. So it's, it's sad. And I'm trying to promote this theory, which I think will move us farther ahead in our understanding. And shift our research protocols. You know, a lot of the young psychiatrists that I meet are very dissatisfied with their profession. You know, it's a wonderful profession and I've helped lots of people, but we're not where we should be. And if you talk to them about this idea of evolution and how this is affecting mental illness, they're, they're fascinated by it. But when you talk to the older psychiatrists, they just want, oh, you know, yeah, that's kind of interesting. They, they shrug it off and walk away. Why should they get involved with something totally brand new? They've never heard of when some guy was, you know, not famous or anything. But the truth is, if it's the truth, you want to know about it and you want to think about it. Even if you reject it, at least think about it, give it some thought. It's like buying a car. You know, you got to kick the tires, you got to drive it around a little, and suddenly you realize this is very comfortable. Same thing with this theory. It fits the data better than anything else that I've ever heard. And I've read a lot. I've read a lot.
Speaker 2 (26:27):
Schizophrenia is one of the most misunderstood mental illnesses, if not the most misunderstood illness out that's out there. Let's tackle one of the most persistent myths right off the bat. Many people believe schizophrenia means having a split personality. Where did that idea come from and how is it incorrect?
Speaker 3 (26:45):
Well, there another diagnosis is called multiple personality, and this is, usually in people who have suffered trauma as a child, and they have different personalities within them. So one minute they'll be talking as Alice and then 10 minutes later, they'll say, oh, I'm not Alice, I'm Jennifer. And they'll have a different personality. That's multiple personality. I think the problem came with that term schizo, you know, which is like schizoid, which means division. But, you know, uh, it's just not, uh, split personality. That's something else. And unfortunately, a schizo that term as has stuck and been misinterpreted.
Speaker 2 (27:31):
Some people hear the word schizophrenia and immediately picture someone violent or out of control. How often is violence actually associated with schizophrenia? And why is that stereotype so harmful?
Speaker 3 (27:42):
Well, it's minimal. A schizophrenics tend to be kind of meek, withdrawn people who are, uh, passive. And, uh, if they hurt anyone, they're much more likely to hurt themselves than anyone else. So, um, most of the people who are like mass murderers and things like that fall under the diagnosis of sociopath or antisocial, but not schizophrenic. Schizophrenics are not violent. They're not contagious. They're not possessed by the devil. They're not, uh, you know, all of these things that come from ignorance. And the more we truly understand an illness, the less the ignorance will be and the less the stigma will be. And that's what I'm fighting to try to improve our real understanding of what this illness is.
Speaker 2 (28:32):
Law enforcement is often the first point of contact for people with mental illnesses, including schizophrenia. How would you assess most law enforcement personnel's training and capacity to properly interact with people with mental illness? And again, especially schizophrenia.
Speaker 3 (28:46):
Well, I think it's getting better. I think that, you know, law enforcement has been made aware that you have to differentiate between someone who's mentally ill and someone who's a criminal. And once you do that, the whole scheme of changes and you may bring them to a hospital, not a prison. You know, there's still a problem that a lot of mentally ill are thrown into prisons and it doesn't help them or anybody else and costs a lot of money and they don't get better. So we do want to differentiate mental illness from criminality. And I think policemen are trained in that, some better than others. And it's an ongoing problem. But, you know, a lot of times that is the first contact. You know, if a schizophrenic sits quietly in their room and acts crazy, nothing's going to happen to them. Even if you call the police, they will say, well, until they get violent or dangerous, I can't bring them in. But if they start running down the street, flapping their arms like a bird and saying, you know, I'm an eagle and I'm going to take off and it looks like they're going to jump off a building. Then the police can be called, bring them in to an emergency room and get them assessed and even medicated against their will. So, you know, it's difficult. There are laws that protect, you know, mentally ill, but they sometimes protect them. From getting the help they need. Sometimes that is the very first time that a schizophrenic will be medicated when they're dragged into an emergency room involuntarily.
Speaker 2 (30:29):
What role do language and labels play in our attitudes about people with mental illnesses? And by that I mean, for example, should we be saying quote a person with schizophrenia rather than a schizophrenic?
Speaker 3 (30:40):
Well, I'm not sure if there's a huge difference there. You know, you could use either term, you know, you don't want to use pejorative terms like a nut job or he's a crazy person or a whack job, something like that. But schizophrenia is a diagnosis. It's in the DSM five and you know, schizophrenic is someone with schizophrenia, which is fine. So I think the real problem is the stigma that nobody wants to talk about it, even though it's a massive issue. You know what? What? What if everyone said, Oh, I have diabetes. I don't want to talk about it. The whole treatment and drug manufacturer for, for them would be reduced. But diabetes is nothing to be ashamed of. And neither is schizophrenia, but because it has the stigma, it's too much under the radar and it's got to be brought out, you know, into the open and dealt with as, as an illness, like everything.
Speaker 2 (31:45):
All right, let's get into your book. The book title Footprints of Schizophrenia is very compelling. What does that metaphor of the footprint mean to you and what are schizophrenia's footprints?
Speaker 3 (31:57):
Well, the footprint means that this is an evolutionary illness. This is an illness that comes about because we have made a recent change in evolution that is massive and very much affects the brain. So until you look at it that way, all you see is this, this person who's acting weirdly and then you have no frame of reference and what is it all about? Well, there's gotta be miswiring or, you know, genetic or this way. But if you look at the history of homo sapiens, we have made massive changes in the past 50,000 years. And I like to use the analogy. If you take three yardsticks, each one's represents 2 million years, put them end to end. So that's 6 million years. Language has been around for less than the last inch. And for something that radically changed how we use our minds. Of course, they're going to be people who are not on board with it yet. Another analogy I like to use, I don't know how good it is. Let's say the government said everyone must learn to play chess. You know, from now on, although be some people who are really great at it, some people who can kind of limp along and others who can barely do it at all. Well, we can barely do it at all. And that's just because of the nature of people's minds. And that's the situation. We're in our minds. I have not totally adjusted to this new way of utilizing them. That happened with language and language changed everything. It brought us to what Freud called the reality principle to the point where we now, instead of running out of our cave and finding a chicken to try to kill, we get in our Lexus and we drive to the supermarket and get a chicken breast in a plastic, you know, container and take it home and cook it. So much has happened even in my lifetime. I'm pretty old, but you know, when I was a kid, the TV was this clunky box with a flickering circle in the middle. Now, it's this thin, you know, color thing on the wall. That's, you know, an inch deep and sharp, beautiful colors. So much has changed when I was in college, in the 70s, there were no computers yet. It was just barely starting. So this radical change is new for everyone. And what we call mismatch diseases has to do with the mismatch between our current lifestyle and the lifestyle we evolved in and evolution is very important. When you evolve in a life lifestyle that is predatory, where a lot of your friends, get killed by wild hyenas and lions, the average lifespan was 30 back in the cave man here. I mean, so much has changed so fast that obviously not all of us are going to be there yet. And that is what mental illness is. Evolution is dispossessed. And if we can start seeing it that way, suddenly your whole view of what's going on changes and you get a whole other idea of where this is at, where it's coming from. The geneticist, T Dubzansky said, nothing in biology can be understood except in light of its evolution. And he was right. If you leave that out, it's like putting a bicycle together without the pedals. You know, it may look good, but it's not going to get you anywhere. And that's the problem in psychiatry. We're in the Dark Ages. We have to broaden our viewpoint and allow ourselves to take in, in other ideas, other viewpoints that may seem foreign to you. But when you think about them, offer a tremendous amount of insight.
Speaker 2 (35:53):
Let's talk about other ideas. You developed what you call the primitive organization theory to explain schizophrenia. Would you share a layperson friendly overview of your theory?
Speaker 3 (36:03):
Well, when we got language, our thinking progressed from primitive to modern. Now we think in a modern way. We have, we can distinguish reality from fantasy and truth from fiction, but primitives couldn't. And that was just 50,000 years ago. So when I say primitive organization, when a schizophrenic suddenly regresses to schizophrenia, and they have this surge of dopamine, their thinking goes with it. And I realized at one point, this was kind of an aha moment for me that schizophrenia isn't just some crazy, LSD manufactured in your brain or miswiring. It's a return to a previous way of thinking, a way of thinking that we all had as children, that we all have. If you take mushrooms, you start thinking that way. And we all have during sleep. We all think in this very primitive way, but since language, we've learned to think in a modern, realistic way. So what happens in schizophrenia is that when they regret, they go back to the primitive organization that we all had for millions of years before language. So that's why it's called the primitive organization. And it's a regression to something that you hear in children. Children don't think the way we do. I just listen to them. You know, they say things like, you know, the moon is a big fat man is going to eat you. And you know, things that are funny, but you'll make not a lot of sense. And they grow out of that. As they grow, they learn language and they suppress dopamine and schizophrenics do too. But what happens is it doesn't hold, it slips and slips back and they regress to the primitive organization that we all had. And we all have it at night when we're sleeping.
Speaker 2 (38:00):
For someone without a science background, how do you describe the concept of the mind being, quote, organized in primitive versus more evolved ways?
Speaker 3 (38:08):
Primitive simply means, you know, ways that aren't, necessarily logical. Uh, you know, if you look at like, I don't know if people know what petroglyphs are, you know, these rock carvings, they're very primitive. They're like a five year old. You ask a five year old, draw a picture of mommy and it's a little stick figure. It's very undifferentiated. Whereas you, if you ask Leonardo da Vinci, you get the Mona Lisa, uh, you know, primitive is, is everyone knows what primitive is. It's, it's a childish, it's very undifferentiated. And it doesn't, it doesn't always make sense. Whereas modern is realistic. It makes sense. It's, it's accurate. And that's the legacy of language that we all inherited 50,000 years ago. And we each learn in adolescence as we're growing up, we go from, you know, childlike speech to adult speech. You know, kids say things that we wouldn't say as adults, because we know that they're funny and they don't make sense. So that's really the whole thing. They're primitive versus, uh, modern and, and realistic.
Speaker 2 (39:17):
What led you to formulate and pursue the primate organization theory? Was a particular patient, a kernel of information in your research, or an intellectual spark that brought it into focus for you?
Speaker 3 (39:27):
Well, it was partially, it was a lot of things, you know, I read a lot of books about, um, Darwinian evolution, developmental psychology, uh, and, you know, how we were 50,000 years ago, our behavior. Um, but, you know, it was experiences like I mentioned, like once I asked the schizophrenic, you know, and I like to ask just questions, uh, that are sort of out of left field, just to see what kind of answer I would get. I said to the schizophrenic, you know, why does the sun come up in the morning? So he thought about it for a minute and then he said, uh, tomorrow. So I kind of scratched my head and I said, well, could you explain that a little? He said, didn't you ever see any, the sun will come up tomorrow and he burst into song. And it dawned on me that schizophrenic thinking is very idiosyncratic. You know, whatever occurs to them about your question is the answer, not what a realist would say, you know, something like, well, you know, the earth spins and as it spins, we start pointing toward the sun and it looks like it comes up. You know, he, he just said, Oh, you know, the sun will come up tomorrow. It's in the song. You know what? It's, it's idiosyncratic. It's whatever occurs to them. So that made me think that schizophrenics are using a kind of thought process that we all have had. And this is a regression. This isn't just some guy whose brain is sending out LSD or there's a miswiring and we need to cross the wires. This is a return to something in our past, both, individually and as a species, it goes back in time. So that's what struck me. That's when I started looking at books on anthropology and getting a clearer idea of what happened. And if you read those books, you'll see that within the past 50,000 years, we start seeing more advanced art, more advanced tools, things like coins and monetary devices. And eventually civilization, civilization resulted from language ultimately and required massive changes in how we behave and use our minds.
Speaker 2 (41:52):
You mentioned Darwin a moment ago in terms of bringing that into your theory. You also referenced Freudian psychology. What's the connection between that famous Austrian neurologist, the founder of psychoanalysis and schizophrenia?
Speaker 3 (42:05):
Well, Freud talked about, as I said, what we call the reality principle. And he was aware that kids, you know, think differently than adults. And his daughter, Anna Freud, was a child psychoanalyst. But Freud was really the first one who paid attention to what we call metapsychology. The fact that the mind is divided up into parts, one of which is the unconscious. A lot of what we do mentally, we're not even aware of, you know, our minds have a mind of their own. They think in ways, you know, the mind thinks in ways that will help the individual, but doesn't necessarily let us in on what it's doing. There are parts of our mentation that we're not aware of, and that's good. You know, they can go on without us. At night, you know, we kind of let everything flood in. You know, we let our guard down and everything can flood into our brain in dreams. And Freud was a master of figuring out that dreams were disguised, but what they really were, were very primitive messages, you know, disguised when we wake up. So he was the one who really probed the mind in a way that, you know, led us to understood what's going on there, you know, in terms of primitive versus modern thinking.
Speaker 2 (43:30):
Does the primitive organization model challenge or expand conventional medical models? And how does it influence the way medical profession should approach treatment, or even how lay people should empathize with those who experience schizophrenia?
Speaker 3 (43:44):
Well, the primitive organization model doesn't really challenge what we're seeing as, you know, scientific theories of schizophrenia, so much as expand on it and bring an entirely different dimension to it. So to just say, as a lot of psychiatric scientists would, that it's a genetic, illness, or a chemical imbalance, it means nothing. We have to understand it on a much deeper level. And I think my theory does that if people will pay attention to it. I recently went to a Minnesota Psychiatric Society meeting and presented a poster about my theories. And the people who were most interested were the young psychiatrists who hadn't been, you know, indoctrinated yet and fixed in their ways. The older, psychiatrists would come and look at it. That's interesting and walk away. So we have to find a way to present to psychiatry. Let's look at something different and really consider it, even if you reject it, because it's too easy to just shrug and say, oh, I don't have to deal with that. So it doesn't necessarily contradict so much as expand and deepen our understanding.
Speaker 2 (45:06):
How can a primitive organization, theory helps someone better understand a loved one who's living with schizophrenia?
Speaker 3 (45:13):
Well, you can think of your relative as someone whose thought process, unbeknownst to them, has gone back to a childlike kind of thought process. And that's what they're dealing with in trying to cope with the modern world, a very kind of primitive way of thinking that they're stuck with. And they don't understand it. They don't. They haven't felt any change. All they see is that other people treat them very differently so that when they go, if they're mad and maybe they resort to drug use because they're so upset about things and trying to cope with these delusional thoughts and the inability to relate to others, try not to abandon them. Try to remember that this is something that's utterly not their fault. It's not your fault. It's entirely due to the fact that we're in. In a specific unique evolutionary time, and that is unfortunately what they're suffering with. And if you can hang in there, studies show that the schizophrenics who do best are the ones whose families are able to hang in there despite all the difficulties. And they're very difficult. Sometimes, you know, I will be the first to admit that they'll go off their meds. They'll use drugs. They'll do bizarre things, even though they've been told a thousand times. You can't do that. So hang in there with them, encourage them to take their meds, make sure they see a psychiatrist that they can relate to a little bit and who they feel, you know, some connection with if possible. It's not always easy, but that's the best way for them to progress and encourage them to be involved with other people on some level, could be in a group or a group home, but not to withdraw totally if at all possible.
Speaker 2 (47:07):
You mentioned a moment ago about your presentation of your theory and the older and the folks in the profession kind of shrugged it off. And the younger ones were like, this is very interesting. You continue your book. The psychiatry is in the Dark Ages. What do you mean by that?
Speaker 3 (47:22):
Well, as I said, I cannot think of any other specialty in medicine where there's not a single blood test or x-ray or cat scan that helps you make a diagnosis. You go to any other specialty, you sit down, you say, here are my symptoms. They say, okay, they examine you. They do some tests. They say, well, you've got diabetes or the x-ray shows you have cancer or you know, you have gout or whatever it is. We don't have that. We would love to have it and psychiatry is desperate for that kind of thing. And we're so desperate for cures and diagnoses that we're looking to psychedelics to give to people who are mentally ill. Psychedelics cause mental illness. They don't cure it. You know, we should learn from psychedelics and then create medicines that really help but to run to psychedelics and hope that they're going to be, you know, something better than what we've had. It's because we're desperate and that's what I mean by in the Dark Ages. We have to expand our view of what mental illness is and then we can start fixing psychiatry. And a lot of my peers are frustrated with where psychiatry is at.
Speaker 2 (48:37):
You've recently retired from a 40-year medical career dedicated to caring for those affected by schizophrenia. What's next for you?
Speaker 3 (48:44):
Well, I'm writing another book. I've written a book on entropy, but my newer book is called The Predator Factor, which focuses on this idea that's been expressed by the book The Anxious Generation and others that the youth are experiencing tremendous increase in depression, suicide and anxiety and we're seeing low birth rates, withdrawal from social roles, blurring of gender boundaries with rise in transsexuality and things like that. And I think all of that can be explained by the fact that we are now living in a period where all of the predators, or most of them that we experienced as we evolved in the jungle, have been neutralized and that puts evolution in a free fall. And when that happens, people start questioning things they never questioned before, like am I a boy or a girl? Do I grow up with a profession or just not bother? Do I marry and have a family or not bother? I never thought about anything like this when I was growing up. I never had to, but now so many things are different. Our life expectancy is now 80, can be 90, 100 when just, you know, in 1950, when I was born, it was only 47, our life expectancy. We were never designed to live that long. We were designed to live to about age 30 and then either get eaten or just die if we broke our leg or anything else. So all of this is new and that's why we're seeing all of these phenomenon. And I'm hoping that that book, you know, the Predator Factor will add to our understanding of what we're seeing around us. We have to look back through time to understand it.
Speaker 2 (50:45):
And where can people find your book and learn more about your work?
Speaker 3 (50:50):
The Footprints of Schizophrenia, The Evolutionary Roots of Mental Illness is on Amazon. You can order it through Barnes and Noble and other book outlets. I have a website, stephenleskmd.com, which gives a lot of explanations for my theory. I put things on YouTube. I put more recently, I put things on TikTok, which have gotten thousands of views. One of them got 5,000 views and it's under the heading published author. If you look on TikTok under published author, you'll see that. So I'm trying to get the word out there and I'm kind of fighting alone in the wilderness here, but I appreciate the people like you, who let me come on and explain my theories.
Speaker 2 (51:38):
Now, I appreciate your time and the work that you do. And now that you're on TikTok, you're officially an influencer. So congratulations with that. Dr. Stephen Lesk, thank you so much for being with us today. I appreciate your time. I'm Chris Meek, run of time. We'll see you next week. Same time, same place. Until then, stay safe and keep taking your next steps forward.
There are few things that make people successful. Taking a step forward to change their lives is one successful trait, but it takes some time to get there. How do you move forward to greet the success that awaits you? Welcome to Next Steps Forward with host Chris Meek. Each week, Chris brings on another guest who has successfully taken the next steps forward. Now, here is Chris Meek.
Speaker 2 (00:34):
Hello, you've been in this week's episode of Next Steps Forward, and I'm your host, Chris Meek. As always, it's a pleasure to have you with us. Next Steps Forward is committed to helping others achieve more than ever while experiencing greater personal empowerment and well-being. Our guest today is Dr. Stephen Lesk. He's the author of Footprints of Schizophrenia, the Evolutionary Roots of Mental Illness. Dr. Lesk became a practicing board-certified psychiatrist in 1984, and he's treated thousands of people. of adult patients as he has conducted research, written articles, and mentored students. He served as chairman of the Department of Inpatient Psychiatric Services at the Brooklyn Veterans Administration Hospital, and was an assistant professor at the hospital's affiliated medical school. He is pioneering new theories in hopes of improving our understanding of the illnesses that patients endure and reducing stigma while urging empathy. Dr. Stephen Lesk, welcome to Next Steps Forward.
Speaker 3 (01:24):
Well, thanks a lot. I'm looking forward to getting a chance to explain my theory. I'm going to take a few minutes and let people know where I'm coming from.
Speaker 2 (01:33):
Likewise. Before we start, I've done a lot of work in the veteran space, and so I appreciate your time working with the VA, so thank you for that. Now, let's begin with your journey. What drew you to study schizophrenia?
Speaker 3 (01:45):
Well, actually, I've studied all mental illnesses as a psychiatrist, and I've always been interested in what makes people tick. I have a bachelor's in psychology, a master's degree in psychology. I have a medical degree, and then I did my psychiatric residency on Long Island. But I've always been fascinated by what makes all of us tick, and I've always found myself drawn to reading about it and theorizing about it. And, of course, my profession fit in perfectly with that.
Speaker 2 (02:20):
Is schizophrenia a single illness, or is it better understood as a spectrum or collection of related disorders?
Speaker 3 (02:27):
I see it as a single illness. And, you know, for most people, it's pretty easy to diagnose eventually, and there's a pretty strictly defined time period of onset between about 16 and 25. If you're older than 25, you're probably not going to get schizophrenia. So it has very specific symptoms, years of onset, and we know a lot about it. So I see it as one disease and a very specific. But even though my book mentions schizophrenia, it's really about all mental illness, because they're all interrelated, both emotionally and biochemically, as one sort of phenomenon with varying degrees.
Speaker 2 (03:16):
And you mentioned the age of 16 to 25. Does it tend to affect men or women more, or is it an equal opportunity disease?
Speaker 3 (03:23):
It's about equal, 50-50. It's 1% of the population worldwide. No matter where you go, it's 1%.
Speaker 2 (03:33):
And as we come out the other side of what I'm calling the mental health tsunami from COVID, are you seeing an increase? I mean, we know generically we've seen an increase in mental health troubles, if you will, with individuals. Is schizophrenia kind of in line with that overarching theme, or is it higher or lower?
Speaker 3 (03:51):
No, that's one of the interesting things about schizophrenia. It remains about the same all the time, all over. And that's one thing. You have to explain. Any theory of schizophrenia has to explain why is that, that it's this 1% worldwide. It doesn't, like some illnesses that are genetic, like Tay-Sachs tend to hover in Ashkenazi Jews, or sickle cell tend to hover in black people. Schizophrenia does not do that. It's all across the board. Socioeconomic, political boundaries, 1%. And you've got to explain that. And my theory does.
Speaker 2 (04:32):
And we'll get to that shortly. Are there any early warning signs that families, friends, or physicians should be watching for?
Speaker 3 (04:39):
Well, very often you'll notice changes in the individual, but they will not notice them, but other people will. So you might notice that your son or daughter is not taking as great care about their appearance, that they're kind of withdrawing from people, that they, they may start to say unusual things like you know, the government is following me or people have hacked my computer, or I'm hearing a voice coming out of the vents. And once you start hearing things like that, it's important to take them to a psychiatrist for assessment. Doesn't mean they absolutely have schizophrenia, but once they start talking in ways that don't seem too rational, that's when you have to investigate further.
Speaker 2 (05:29):
You know, and as you're talking about that, I'm reminded a good friend and former roommate of mine, his brother swore he was being followed by the government and then started banging holes in the wall in their house and then ultimately was diagnosed with schizophrenia. And so are those typical signs that are pretty common across the disease?
Speaker 1 (05:48):
Yeah.
Speaker 3 (05:49):
I mean, the paranoia is very common in schizophrenics. They may believe, you know, they're being followed or satellites are monitoring them or their food is poisoned. And then they start acting on these delusions like patients who will only eat peanut butter because that's the only thing that isn't poisoned or they will not go to certain parts of town because they know that's where the government is. So it starts to get more and more rigid and confining. And eventually they may just withdraw totally from people, stop caring about their appearance, start talking very strangely. And it becomes pretty obvious that something, something has changed in them, but they are not aware of it. It's called anastomosis. If you ask them, you know, why are you so different? They'll say, I'm not different. Other people are treating me differently, but I'm not different. That's how they view it.
Speaker 2 (06:44):
And as the conditions worsen, do they lose faith or trust in people that are close to them?
Speaker 3 (06:51):
They might start to be suspicious of people close to them, although tends to be people. They know less well that they're more suspicious. So, but eventually they could become suspicious of people close to them. There's something called Capgrass syndrome where they suddenly believe that their loved ones that they live with have been replaced by doubles. It's a very unusual thing and they're absolutely convinced of it and they don't want to live with those people and they're afraid of them and they may run away. They may assault them, but by and large, schizophrenics are not assaultive or murderous or, or anything like that, but they have had a change in their thinking.
Speaker 2 (07:35):
Is schizophrenia hereditary or random, biological or environmental? And what do you know about the causes of schizophrenia?
Speaker 3 (07:42):
Well, that's where my theory comes in. Most psychiatrists will tell you that it's genetic and we do know that there is increased vulnerability. If you have a parent or brother or sister with schizophrenia, your risk goes up, but that's, as far as we know. And to say that that makes it a genetic illness, I think is false. There are lots of things that increase your risk. If you have a head injury as a child that increases your risk. If you have abusive parents, if you have an elderly father, if you grow up in an urban area, as opposed to rural, that increases your risk. If you're born in winter months, that increases your risk. So a whole lot of things may increase your risk, including genetics. That doesn't mean it's a, it's a genetic illness. The central paradox of schizophrenia is if schizophrenia is genetic, why isn't it extinct by now? Because it reduces your ability to reproduce. It reduces your ability to function. It's not showing any signs of extinction. So I'm personally believe it is not a genetic illness, even though it can increase your risk. It's kind of like when your engine light comes on, you don't go. And you have your engine light fixed. That means you've got a problem with your engine. So yes, you may have a genetic risk. That doesn't mean schizophrenia is genetic. And I'll talk more about exactly what I think it is. And the problem is we don't know what it is until now. I think now I've come up with the answer.
Speaker 2 (09:19):
And we will get to that answer shortly. I promise. Can people recover from schizophrenia to the point where it completely goes away? Or is this a lifelong condition?
Speaker 3 (09:27):
Well, it's considered a life, lifelong condition. The the outcome is variable for the vast majority. Once you're diagnosed with schizophrenia, the expectation is that you will function on a lower level. And a lot of schizophrenics don't hold a job. Don't get married, have to live in a group home where they're given their meals and their medications. And it usually means that you're on medication for the rest of your life. Now, there are some high functioning, schizophrenia, and if you remember the movie, a beautiful mind, that person got a Nobel prize in mathematics. Many others, Ellen Sachs, who wrote the book, the center cannot hold was a high functioning lawyer who went to Oxford and Yale and was clearly schizophrenic. So there are exceptions, but for the most part, your functioning is expected to diminish. I mean, there are doctors and lawyers who are schizophrenic, but generally your function, your condition goes down.
Speaker 2 (10:30):
I know you mentioned earlier that it's pretty much 1% of the population. Is that across the board by country? You know, how many people in America today have been diagnosed with schizophrenia and how many people do you believe actually have it?
Speaker 3 (10:42):
Oh, about 3.5 million in this country alone. And it's, it's across the board and it's across all geopolitical boundaries. I can socioeconomic boundaries. And that, like I said, is one of the primary issues of schizophrenia that has to be, that has to be explained. So, you know, the numbers are massive. Think of all the patients, their families, caregivers, but it's entirely under the radar. No one wants to talk about it. Why? Because of stigma and stigma comes from ignorance. When we don't understand something, we develop all kinds of crazy theories about it. And that's unfortunate. I mean, we can change that.
Speaker 2 (11:24):
Now you mentioned stigma and I mentioned my work in the veteran space, and it's been a focus. It's been a focus on mental health and PTSD and TBI going back to COVID in the post COVID era. Do you feel, you know, I've been saying for about a year, if not two now that the one positive thing of COVID was to put up a spotlight on mental health broadly. Do you feel that that stigma is being softened now, as we come through COVID and people are facing more challenges?
Speaker 3 (11:50):
Unfortunately, I don't see it softening. I think that even though there's some more light being shown on mental illness, especially among youth, and there's a lot of looking into the fact that depression, suicide, anxiety has increased in the youth youth even before COVID, starting around 2010. And some people blame this on cell phones. I think it's more complicated than that, but no, I don't see the stigma reducing. And I think again, it's because we don't understand it well enough yet.
Speaker 2 (12:27):
In terms of diagnosis, how is schizophrenia diagnosed and are we getting any better at early and accurate diagnosis?
Speaker 3 (12:35):
Well, we look for the, those cardinal symptoms that I mentioned, the withdrawal from others talking illogically bizarre behavior, you know, like they're avoiding all you know people who have two pays because they're dangerous saying strange things, hearing voices, things like that. And you know, downturn in functioning social withdrawal. So those are some of the cardinal symptoms, paranoia that lead us to a diagnosis. That's pretty certain with schizophrenia. Eventually it may take some time. Now we're trying to identify schizophrenia before it's onset, which would be great. We're looking at what we call ultra high risk for schizophrenia people, but we haven't identified. Identified them with such certainty that we can start medicating them before they even get the schizophrenia. So we're not there yet. And it's a shame, but it's worth the effort.
Speaker 2 (13:42):
You're a lifetime member of the American psychiatric association, but even back when you're resident, you felt the psychiatrists were attributing schizophrenia to the wrong factors. What did they blame it on? And why do you believe the profession got it so wrong?
Speaker 3 (13:55):
Well, when you don't really understand something, you, you grasp it at the obvious. So when I was a resident, I would hear the attending psychiatrist talking to families of schizophrenics and they would say, well, what is this schizophrenia that my cousin or son or uncle has? And they would say, well, it's genetic or it's a chemical imbalance or it's a connectivity problem, miswiring vague generalities that really meant nothing. And, you know, left families very unsatisfied, but that's all they had. That's all we knew. And, uh, eventually I got so tired of hearing that and, and having no better answer to offer that I decided that I would be the one to come up with something better. So I started broadening my knowledge base. I read books on anthropology, um, Darwinian evolution, uh, language learning theory. And I think what I've come up with is, is much deeper and more explanatory than anything I heard as a resident. And, uh, that's why I'm promoting it so much because I think we can do so much better in psychiatry than we have been.
Speaker 2 (15:14):
What treatment options are available today? And what are the biggest challenges in treating schizophrenia effectively?
Speaker 3 (15:21):
Well, once you get the diagnosis of schizophrenia, you probably need to be on medication the rest of your life. And we use medications that we call antipsychotics and all the antipsychotics do one thing. They block dopamine receptors. Even the new one, there's a brand new one that came out, but it reduces dopamine indirectly. So it's, it's not that different, but it's just a different kind of way of going about it. So we know that schizophrenia involves a surge or excess of dopamine, and that you should be on one of those medications. The rest of your life. Problem is those medications have horrible side effects. They cause weight gain, which can lead to type two diabetes and other things. Um, what we call metabolic syndrome, they cause drooling constipation, uh, if in high doses, they could cause a seizure. They cause something called tardive dyskinesia, which is a permanent movement disorder of the limbs. Usually starting in the mouth, so you'll see people going like this and this, um, they cause something called a neuroleptic malignant syndrome, which is kind of an allergic reaction, which can be fatal. So we have all of these very difficult side effects. And imagine you're giving this medication to patients who don't really believe they have an illness. They're getting all these side effects. And we as psychiatrists can offer very good explanations for what we have. So we're treating patients. Patients. We don't understand with medications. We don't understand to patients who don't believe they have an illness. And of course, a lot of patients are going to go off their medications time. And again, even Ellen Sacks, who, like I said, went to Oxford and Yale, she went off her medications 10 times or more to prove to herself. She was not schizophrenic. And every single time she relapsed, you mentioned dopamine a few times.
Speaker 2 (17:23):
Why is dopamine such an important ingredient in our mental health? It's absent such a big factor in the development or presence of mental illness.
Speaker 3 (17:31):
Well, I'm going to say a few things that may surprise you or shock you, but let's start with this. Number one, schizophrenia is entirely due to the evolutionary moment that we're in. What does that mean? 50,000 years ago, there was no mental illness, 20,000 years in the future. There will be no mental illness, but because we're, in this unique transition evolutionarily, we are seeing mental illness. And I can elaborate a lot further on that, but all of this has to do with dopamine. And the way we use dopamine mentally changed once we've started to use language, which was only 50,000 years ago, human like animals have been around for six, 7 million years. It's only been 50,000 years. That we've had language. That is a drop in the evolutionary bucket. And for something that radically changed how we use our minds and how we process dopamine, obviously not everyone is going to be on board with it yet. 10, 20,000 years from now, we all will. But right now we're in this transition and 1% of us have schizophrenia. Another 15 to 20% have other mental illnesses. And it's due to the fact that, that we changed how we process dopamine once we got language a mere 50,000 years ago. And it's not just mental illness. We have physical illnesses that are related to dopamine, Parkinson's Tourette's Alzheimer's Huntington's, Korea restless legs and many others that are a legacy of this change and how we process dopamine.
Speaker 2 (19:25):
How do medications therapy and community support each play a role?
Speaker 3 (19:30):
Well, the medication is a must and what it does is block dopamine receptors. So what happens is as we're in adolescence, as we mature and learn language, we learn to suppress dopamine and certain tracks. And we never could before language, the mesolimbic mesocortical tracks. We suppress dopamine effectively for 80% of us. And that's what we do. And that's what we do for 90% of us. But for 20% and 1% are schizophrenic. There's a resurgence of dopamine and that resurgence throws everything off and brings our thinking back to the type of primitive thinking. What I call the primitive organization that we had prior to language. Once that happens, the schizophrenic starts to think in more primitive ways and they can't cope with a modern, modern civilization where you have to be able to think abstractly. So we give medications that block the receptors of dopamine and tone down this surge that we're seeing. And that's very, very effective. It's not a cure, but it very much can reduce the symptoms that we see in schizophrenia. And we use similar types of meds in other diagnoses as well.
Speaker 2 (20:51):
Why are some people unable to process dopamine? Well, most of us apparently process it without any problems.
Speaker 3 (20:57):
Well, the issue is that it's so new. And, you know, when you say it's new, we're talking about 50,000 years. We don't look at, you know, evolution. You know, most of us don't think, well, you know, humans have been around for millions of years and language started 50,000 years ago. And what are we going to be like 10,000 years from now? We focus on our little corner of the globe and our tiny little life. Time, which evolutionarily it is minuscule. But we have to look back at the trajectory of where we've been 50,000 years ago. We were living in the jungle. We had no transportation. We woke up every day. And if we were hungry, we ran out of our cave and we tried to find some berries or roots or nuts or kill a small animal and pray that we wouldn't get eaten because we were not at the top of the food chain. So now, a mere 50,000 years later, everything has changed. We live a lifestyle that is utterly different from what we evolved in, which is why we have so many of these mismatched diseases. But the change in terms of mental illness has to do with language causing a change in our processing of dopamine. And most of us, 80% of us handle that. Well, we suppress dopamine over time as we grow up and adolescent. But there's still a 20% that aren't there yet. And because it's so new, they're still in the transition process. I call them evolutions dispossessed. They're still a victim of the fact that this is so new that not everyone, not everyone's brain is on board with it.
Speaker 2 (22:43):
You've said that schizophrenia is quote everybody's problem. Make that case for us, please.
Speaker 3 (22:49):
Well, if you take an illness, that's 1% of the, of the population is very hard to find someone who doesn't even either have a relative, a friend or no people who have relatives or friends with the illness or no caregivers of those people. This is a massive problem. And the monetary cost is huge, not just in treating them, but in loss of productivity, it's massive. So this is everybody's problem. And if we could fix it a lot better than we do now, uh, the whole world would be better off every country, every nationality, every geopolitical area. So it's everybody's issue. And the fact that we don't understand it well enough brings on the stigma and then it goes underground. No one wants to talk about it. No one wants to admit my cousin is schizophrenic. My, my uncle, whatever an interesting fact is that, you know, you talk about genetics. Uh, if you have identical twins, two of the identical twins have the exact same genes. If one of them has schizophrenia and the illness was genetic, you would say, well, a hundred percent of the time, the other one will have schizophrenia. No, it's less than 50%. So genes play a role, but it is not a genetic illness. It's an evolutionary glitch that we're in and that we're going to get through, uh, you know, 10,000, 20,000 years from now. Well, how does that help us? Now, if we can understand an illness better, we can refocus our whole research protocols so that we can do much better in terms of understanding it, researching it and coming up with cures that maybe prevent this resurgence of dopamine from happening. That's why I say psychiatry is in the dark ages. Do you know any specialty of medicine where there's not a single blood test, a single x-ray, a single CAT scan that can give you a diagnosis? No, only psychiatry. We totally rely on what the patient tells us. And as you know, a lot of patients are not in the best position to relate what's going on with them. They were embarrassed and they're, they're not the greatest, not the most expressive people. So it's, it's sad. And I'm trying to promote this theory, which I think will move us farther ahead in our understanding. And shift our research protocols. You know, a lot of the young psychiatrists that I meet are very dissatisfied with their profession. You know, it's a wonderful profession and I've helped lots of people, but we're not where we should be. And if you talk to them about this idea of evolution and how this is affecting mental illness, they're, they're fascinated by it. But when you talk to the older psychiatrists, they just want, oh, you know, yeah, that's kind of interesting. They, they shrug it off and walk away. Why should they get involved with something totally brand new? They've never heard of when some guy was, you know, not famous or anything. But the truth is, if it's the truth, you want to know about it and you want to think about it. Even if you reject it, at least think about it, give it some thought. It's like buying a car. You know, you got to kick the tires, you got to drive it around a little, and suddenly you realize this is very comfortable. Same thing with this theory. It fits the data better than anything else that I've ever heard. And I've read a lot. I've read a lot.
Speaker 2 (26:27):
Schizophrenia is one of the most misunderstood mental illnesses, if not the most misunderstood illness out that's out there. Let's tackle one of the most persistent myths right off the bat. Many people believe schizophrenia means having a split personality. Where did that idea come from and how is it incorrect?
Speaker 3 (26:45):
Well, there another diagnosis is called multiple personality, and this is, usually in people who have suffered trauma as a child, and they have different personalities within them. So one minute they'll be talking as Alice and then 10 minutes later, they'll say, oh, I'm not Alice, I'm Jennifer. And they'll have a different personality. That's multiple personality. I think the problem came with that term schizo, you know, which is like schizoid, which means division. But, you know, uh, it's just not, uh, split personality. That's something else. And unfortunately, a schizo that term as has stuck and been misinterpreted.
Speaker 2 (27:31):
Some people hear the word schizophrenia and immediately picture someone violent or out of control. How often is violence actually associated with schizophrenia? And why is that stereotype so harmful?
Speaker 3 (27:42):
Well, it's minimal. A schizophrenics tend to be kind of meek, withdrawn people who are, uh, passive. And, uh, if they hurt anyone, they're much more likely to hurt themselves than anyone else. So, um, most of the people who are like mass murderers and things like that fall under the diagnosis of sociopath or antisocial, but not schizophrenic. Schizophrenics are not violent. They're not contagious. They're not possessed by the devil. They're not, uh, you know, all of these things that come from ignorance. And the more we truly understand an illness, the less the ignorance will be and the less the stigma will be. And that's what I'm fighting to try to improve our real understanding of what this illness is.
Speaker 2 (28:32):
Law enforcement is often the first point of contact for people with mental illnesses, including schizophrenia. How would you assess most law enforcement personnel's training and capacity to properly interact with people with mental illness? And again, especially schizophrenia.
Speaker 3 (28:46):
Well, I think it's getting better. I think that, you know, law enforcement has been made aware that you have to differentiate between someone who's mentally ill and someone who's a criminal. And once you do that, the whole scheme of changes and you may bring them to a hospital, not a prison. You know, there's still a problem that a lot of mentally ill are thrown into prisons and it doesn't help them or anybody else and costs a lot of money and they don't get better. So we do want to differentiate mental illness from criminality. And I think policemen are trained in that, some better than others. And it's an ongoing problem. But, you know, a lot of times that is the first contact. You know, if a schizophrenic sits quietly in their room and acts crazy, nothing's going to happen to them. Even if you call the police, they will say, well, until they get violent or dangerous, I can't bring them in. But if they start running down the street, flapping their arms like a bird and saying, you know, I'm an eagle and I'm going to take off and it looks like they're going to jump off a building. Then the police can be called, bring them in to an emergency room and get them assessed and even medicated against their will. So, you know, it's difficult. There are laws that protect, you know, mentally ill, but they sometimes protect them. From getting the help they need. Sometimes that is the very first time that a schizophrenic will be medicated when they're dragged into an emergency room involuntarily.
Speaker 2 (30:29):
What role do language and labels play in our attitudes about people with mental illnesses? And by that I mean, for example, should we be saying quote a person with schizophrenia rather than a schizophrenic?
Speaker 3 (30:40):
Well, I'm not sure if there's a huge difference there. You know, you could use either term, you know, you don't want to use pejorative terms like a nut job or he's a crazy person or a whack job, something like that. But schizophrenia is a diagnosis. It's in the DSM five and you know, schizophrenic is someone with schizophrenia, which is fine. So I think the real problem is the stigma that nobody wants to talk about it, even though it's a massive issue. You know what? What? What if everyone said, Oh, I have diabetes. I don't want to talk about it. The whole treatment and drug manufacturer for, for them would be reduced. But diabetes is nothing to be ashamed of. And neither is schizophrenia, but because it has the stigma, it's too much under the radar and it's got to be brought out, you know, into the open and dealt with as, as an illness, like everything.
Speaker 2 (31:45):
All right, let's get into your book. The book title Footprints of Schizophrenia is very compelling. What does that metaphor of the footprint mean to you and what are schizophrenia's footprints?
Speaker 3 (31:57):
Well, the footprint means that this is an evolutionary illness. This is an illness that comes about because we have made a recent change in evolution that is massive and very much affects the brain. So until you look at it that way, all you see is this, this person who's acting weirdly and then you have no frame of reference and what is it all about? Well, there's gotta be miswiring or, you know, genetic or this way. But if you look at the history of homo sapiens, we have made massive changes in the past 50,000 years. And I like to use the analogy. If you take three yardsticks, each one's represents 2 million years, put them end to end. So that's 6 million years. Language has been around for less than the last inch. And for something that radically changed how we use our minds. Of course, they're going to be people who are not on board with it yet. Another analogy I like to use, I don't know how good it is. Let's say the government said everyone must learn to play chess. You know, from now on, although be some people who are really great at it, some people who can kind of limp along and others who can barely do it at all. Well, we can barely do it at all. And that's just because of the nature of people's minds. And that's the situation. We're in our minds. I have not totally adjusted to this new way of utilizing them. That happened with language and language changed everything. It brought us to what Freud called the reality principle to the point where we now, instead of running out of our cave and finding a chicken to try to kill, we get in our Lexus and we drive to the supermarket and get a chicken breast in a plastic, you know, container and take it home and cook it. So much has happened even in my lifetime. I'm pretty old, but you know, when I was a kid, the TV was this clunky box with a flickering circle in the middle. Now, it's this thin, you know, color thing on the wall. That's, you know, an inch deep and sharp, beautiful colors. So much has changed when I was in college, in the 70s, there were no computers yet. It was just barely starting. So this radical change is new for everyone. And what we call mismatch diseases has to do with the mismatch between our current lifestyle and the lifestyle we evolved in and evolution is very important. When you evolve in a life lifestyle that is predatory, where a lot of your friends, get killed by wild hyenas and lions, the average lifespan was 30 back in the cave man here. I mean, so much has changed so fast that obviously not all of us are going to be there yet. And that is what mental illness is. Evolution is dispossessed. And if we can start seeing it that way, suddenly your whole view of what's going on changes and you get a whole other idea of where this is at, where it's coming from. The geneticist, T Dubzansky said, nothing in biology can be understood except in light of its evolution. And he was right. If you leave that out, it's like putting a bicycle together without the pedals. You know, it may look good, but it's not going to get you anywhere. And that's the problem in psychiatry. We're in the Dark Ages. We have to broaden our viewpoint and allow ourselves to take in, in other ideas, other viewpoints that may seem foreign to you. But when you think about them, offer a tremendous amount of insight.
Speaker 2 (35:53):
Let's talk about other ideas. You developed what you call the primitive organization theory to explain schizophrenia. Would you share a layperson friendly overview of your theory?
Speaker 3 (36:03):
Well, when we got language, our thinking progressed from primitive to modern. Now we think in a modern way. We have, we can distinguish reality from fantasy and truth from fiction, but primitives couldn't. And that was just 50,000 years ago. So when I say primitive organization, when a schizophrenic suddenly regresses to schizophrenia, and they have this surge of dopamine, their thinking goes with it. And I realized at one point, this was kind of an aha moment for me that schizophrenia isn't just some crazy, LSD manufactured in your brain or miswiring. It's a return to a previous way of thinking, a way of thinking that we all had as children, that we all have. If you take mushrooms, you start thinking that way. And we all have during sleep. We all think in this very primitive way, but since language, we've learned to think in a modern, realistic way. So what happens in schizophrenia is that when they regret, they go back to the primitive organization that we all had for millions of years before language. So that's why it's called the primitive organization. And it's a regression to something that you hear in children. Children don't think the way we do. I just listen to them. You know, they say things like, you know, the moon is a big fat man is going to eat you. And you know, things that are funny, but you'll make not a lot of sense. And they grow out of that. As they grow, they learn language and they suppress dopamine and schizophrenics do too. But what happens is it doesn't hold, it slips and slips back and they regress to the primitive organization that we all had. And we all have it at night when we're sleeping.
Speaker 2 (38:00):
For someone without a science background, how do you describe the concept of the mind being, quote, organized in primitive versus more evolved ways?
Speaker 3 (38:08):
Primitive simply means, you know, ways that aren't, necessarily logical. Uh, you know, if you look at like, I don't know if people know what petroglyphs are, you know, these rock carvings, they're very primitive. They're like a five year old. You ask a five year old, draw a picture of mommy and it's a little stick figure. It's very undifferentiated. Whereas you, if you ask Leonardo da Vinci, you get the Mona Lisa, uh, you know, primitive is, is everyone knows what primitive is. It's, it's a childish, it's very undifferentiated. And it doesn't, it doesn't always make sense. Whereas modern is realistic. It makes sense. It's, it's accurate. And that's the legacy of language that we all inherited 50,000 years ago. And we each learn in adolescence as we're growing up, we go from, you know, childlike speech to adult speech. You know, kids say things that we wouldn't say as adults, because we know that they're funny and they don't make sense. So that's really the whole thing. They're primitive versus, uh, modern and, and realistic.
Speaker 2 (39:17):
What led you to formulate and pursue the primate organization theory? Was a particular patient, a kernel of information in your research, or an intellectual spark that brought it into focus for you?
Speaker 3 (39:27):
Well, it was partially, it was a lot of things, you know, I read a lot of books about, um, Darwinian evolution, developmental psychology, uh, and, you know, how we were 50,000 years ago, our behavior. Um, but, you know, it was experiences like I mentioned, like once I asked the schizophrenic, you know, and I like to ask just questions, uh, that are sort of out of left field, just to see what kind of answer I would get. I said to the schizophrenic, you know, why does the sun come up in the morning? So he thought about it for a minute and then he said, uh, tomorrow. So I kind of scratched my head and I said, well, could you explain that a little? He said, didn't you ever see any, the sun will come up tomorrow and he burst into song. And it dawned on me that schizophrenic thinking is very idiosyncratic. You know, whatever occurs to them about your question is the answer, not what a realist would say, you know, something like, well, you know, the earth spins and as it spins, we start pointing toward the sun and it looks like it comes up. You know, he, he just said, Oh, you know, the sun will come up tomorrow. It's in the song. You know what? It's, it's idiosyncratic. It's whatever occurs to them. So that made me think that schizophrenics are using a kind of thought process that we all have had. And this is a regression. This isn't just some guy whose brain is sending out LSD or there's a miswiring and we need to cross the wires. This is a return to something in our past, both, individually and as a species, it goes back in time. So that's what struck me. That's when I started looking at books on anthropology and getting a clearer idea of what happened. And if you read those books, you'll see that within the past 50,000 years, we start seeing more advanced art, more advanced tools, things like coins and monetary devices. And eventually civilization, civilization resulted from language ultimately and required massive changes in how we behave and use our minds.
Speaker 2 (41:52):
You mentioned Darwin a moment ago in terms of bringing that into your theory. You also referenced Freudian psychology. What's the connection between that famous Austrian neurologist, the founder of psychoanalysis and schizophrenia?
Speaker 3 (42:05):
Well, Freud talked about, as I said, what we call the reality principle. And he was aware that kids, you know, think differently than adults. And his daughter, Anna Freud, was a child psychoanalyst. But Freud was really the first one who paid attention to what we call metapsychology. The fact that the mind is divided up into parts, one of which is the unconscious. A lot of what we do mentally, we're not even aware of, you know, our minds have a mind of their own. They think in ways, you know, the mind thinks in ways that will help the individual, but doesn't necessarily let us in on what it's doing. There are parts of our mentation that we're not aware of, and that's good. You know, they can go on without us. At night, you know, we kind of let everything flood in. You know, we let our guard down and everything can flood into our brain in dreams. And Freud was a master of figuring out that dreams were disguised, but what they really were, were very primitive messages, you know, disguised when we wake up. So he was the one who really probed the mind in a way that, you know, led us to understood what's going on there, you know, in terms of primitive versus modern thinking.
Speaker 2 (43:30):
Does the primitive organization model challenge or expand conventional medical models? And how does it influence the way medical profession should approach treatment, or even how lay people should empathize with those who experience schizophrenia?
Speaker 3 (43:44):
Well, the primitive organization model doesn't really challenge what we're seeing as, you know, scientific theories of schizophrenia, so much as expand on it and bring an entirely different dimension to it. So to just say, as a lot of psychiatric scientists would, that it's a genetic, illness, or a chemical imbalance, it means nothing. We have to understand it on a much deeper level. And I think my theory does that if people will pay attention to it. I recently went to a Minnesota Psychiatric Society meeting and presented a poster about my theories. And the people who were most interested were the young psychiatrists who hadn't been, you know, indoctrinated yet and fixed in their ways. The older, psychiatrists would come and look at it. That's interesting and walk away. So we have to find a way to present to psychiatry. Let's look at something different and really consider it, even if you reject it, because it's too easy to just shrug and say, oh, I don't have to deal with that. So it doesn't necessarily contradict so much as expand and deepen our understanding.
Speaker 2 (45:06):
How can a primitive organization, theory helps someone better understand a loved one who's living with schizophrenia?
Speaker 3 (45:13):
Well, you can think of your relative as someone whose thought process, unbeknownst to them, has gone back to a childlike kind of thought process. And that's what they're dealing with in trying to cope with the modern world, a very kind of primitive way of thinking that they're stuck with. And they don't understand it. They don't. They haven't felt any change. All they see is that other people treat them very differently so that when they go, if they're mad and maybe they resort to drug use because they're so upset about things and trying to cope with these delusional thoughts and the inability to relate to others, try not to abandon them. Try to remember that this is something that's utterly not their fault. It's not your fault. It's entirely due to the fact that we're in. In a specific unique evolutionary time, and that is unfortunately what they're suffering with. And if you can hang in there, studies show that the schizophrenics who do best are the ones whose families are able to hang in there despite all the difficulties. And they're very difficult. Sometimes, you know, I will be the first to admit that they'll go off their meds. They'll use drugs. They'll do bizarre things, even though they've been told a thousand times. You can't do that. So hang in there with them, encourage them to take their meds, make sure they see a psychiatrist that they can relate to a little bit and who they feel, you know, some connection with if possible. It's not always easy, but that's the best way for them to progress and encourage them to be involved with other people on some level, could be in a group or a group home, but not to withdraw totally if at all possible.
Speaker 2 (47:07):
You mentioned a moment ago about your presentation of your theory and the older and the folks in the profession kind of shrugged it off. And the younger ones were like, this is very interesting. You continue your book. The psychiatry is in the Dark Ages. What do you mean by that?
Speaker 3 (47:22):
Well, as I said, I cannot think of any other specialty in medicine where there's not a single blood test or x-ray or cat scan that helps you make a diagnosis. You go to any other specialty, you sit down, you say, here are my symptoms. They say, okay, they examine you. They do some tests. They say, well, you've got diabetes or the x-ray shows you have cancer or you know, you have gout or whatever it is. We don't have that. We would love to have it and psychiatry is desperate for that kind of thing. And we're so desperate for cures and diagnoses that we're looking to psychedelics to give to people who are mentally ill. Psychedelics cause mental illness. They don't cure it. You know, we should learn from psychedelics and then create medicines that really help but to run to psychedelics and hope that they're going to be, you know, something better than what we've had. It's because we're desperate and that's what I mean by in the Dark Ages. We have to expand our view of what mental illness is and then we can start fixing psychiatry. And a lot of my peers are frustrated with where psychiatry is at.
Speaker 2 (48:37):
You've recently retired from a 40-year medical career dedicated to caring for those affected by schizophrenia. What's next for you?
Speaker 3 (48:44):
Well, I'm writing another book. I've written a book on entropy, but my newer book is called The Predator Factor, which focuses on this idea that's been expressed by the book The Anxious Generation and others that the youth are experiencing tremendous increase in depression, suicide and anxiety and we're seeing low birth rates, withdrawal from social roles, blurring of gender boundaries with rise in transsexuality and things like that. And I think all of that can be explained by the fact that we are now living in a period where all of the predators, or most of them that we experienced as we evolved in the jungle, have been neutralized and that puts evolution in a free fall. And when that happens, people start questioning things they never questioned before, like am I a boy or a girl? Do I grow up with a profession or just not bother? Do I marry and have a family or not bother? I never thought about anything like this when I was growing up. I never had to, but now so many things are different. Our life expectancy is now 80, can be 90, 100 when just, you know, in 1950, when I was born, it was only 47, our life expectancy. We were never designed to live that long. We were designed to live to about age 30 and then either get eaten or just die if we broke our leg or anything else. So all of this is new and that's why we're seeing all of these phenomenon. And I'm hoping that that book, you know, the Predator Factor will add to our understanding of what we're seeing around us. We have to look back through time to understand it.
Speaker 2 (50:45):
And where can people find your book and learn more about your work?
Speaker 3 (50:50):
The Footprints of Schizophrenia, The Evolutionary Roots of Mental Illness is on Amazon. You can order it through Barnes and Noble and other book outlets. I have a website, stephenleskmd.com, which gives a lot of explanations for my theory. I put things on YouTube. I put more recently, I put things on TikTok, which have gotten thousands of views. One of them got 5,000 views and it's under the heading published author. If you look on TikTok under published author, you'll see that. So I'm trying to get the word out there and I'm kind of fighting alone in the wilderness here, but I appreciate the people like you, who let me come on and explain my theories.
Speaker 2 (51:38):
Now, I appreciate your time and the work that you do. And now that you're on TikTok, you're officially an influencer. So congratulations with that. Dr. Stephen Lesk, thank you so much for being with us today. I appreciate your time. I'm Chris Meek, run of time. We'll see you next week. Same time, same place. Until then, stay safe and keep taking your next steps forward.
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