For the majority of patients, their primary care physician is the one who will address their mental health issues...even though they aren't trained for it. But shouldn't they be? The medical profession has separated mental health from physical health, creating two separate streams of care and separate medical practitioners for mind and body - leaving patients without access to proper care. Dr. Robert C. Smith, author of the new book Has Medicine Lost Its Mind? talks to Liana about how to fix the shortcomings of mental health care.
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Episode Transcript
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Speaker 1 (00:00):
The views expressed in the following program are those of
the participants and do not necessarily reflect the views of
SAGA nine sixty AM or its management.
Speaker 2 (00:09):
The following program is a peer to peer advice show
and does not diagnose mental health conditions. If you're seeking
social services, please call or text two to one one
or go to two one one dot CA. Hello listeners
around the world on radio, streaming and podcast services. This
is its own therapy. I'm Leanna Kerzner, and I am
(00:30):
not a therapist, but I am your source for navigating
the madness of mental health using my Coppen sayings for
going good crazy. This week, we're going to talk about
the problems with mental health and the medical system. My
guest this week is doctor Robert C. Smith, a medical
doctor and author of has Medicine Lost Its Mind. Robert
is in the US, but I hear plenty of stuff
(00:52):
up here in Canada as well about humiliating and degrading
treatment when people seek help. I personally got it from
both ends and the there's nothing wrong with you. You're depressed,
when I actually had a rare autoimmune disease and you're
functioning reasonably well. The product is your environment. When I
sought mental health treatment, everybody was pushing me somewhere else,
(01:13):
So I was somebody else's problem. So when I saw
treatment for my body, people told me it was in
my head. When I saw treatment for my head, I
was told the problem was my environment, and that was true.
But it wasn't until I reported being stalked and got
put in touch with York Region Victim Services that anyone
(01:34):
took the time to tell me what the actual problems
were in my environment. But I ended up getting yelled
at by a cop too. So we have a systemic
problem here. And obviously, you know, focusing on one part
of it at the time is like looking through a
pinhole with one eye. But the medical system is a
(01:56):
snapshot of the system isn't set up to do that right.
Since I was fifteen years old, I've had doctors telling
me to reduce stress. G Thanks, that's so easy when
you know, if you're a teenager, you're not in control
of your environment. Really, when you're an adult, you can
(02:20):
barely pay your bills. Thanks doc. In a perfect world, schools, churches, employers,
and yes, medical doctors would be routinely on the lookout
for signs of acute stress and not just teach healthy skills,
but actively create healthy, emotionally safe environments. But classes are
(02:43):
too big to start doing that in most schools now,
and everyone is just trying not to get yelled at.
My parents are even sued. Teacher burnout is a serious problem.
We've done past episodes on that program, on our program
about that. So we end up by the time some
(03:03):
people are teenagers, they have physical symptoms caused by stress,
but they're not taken seriously by well doctors. Yeah, but
also by anyone. We have this cultural stigma that teaches
us that if it's all in your head, then it's
a weakness of character as opposed to something you deserve
(03:25):
help improving. And that's not true that it's a weakness
of character. But there's also a continuing stigma against things
like antidepressants, which means that a lot of people are
suffering needlessly and struggling through lower quality of life than
they deserve. You don't have to be on antidepressants forever
(03:48):
just because you take them to stabilize in the short term,
but the idea of seeing four different doctors over a
period of six months to get a single prescription, that's
nobody's idea of a good time, and anyone who's dealing
with a relative who's addicted to a prescription drug like
xanx is a common one. They can tell you that
(04:10):
this addiction is facilitated by medical neglect, not from doctors
who pay attention. Again, however, just because some people get
addicted to a drug doesn't mean it isn't safe used
as directed on a temporary or occasional basis while you're
(04:31):
working on those other lifestyle changes that do take time.
A fourteen day prescription for xanax isn't going to get
you hooked, especially when you're not taking it every day.
But drugs aren't the permanent solution to our mental health crisis.
Those lifestyle changes are. We have to stop killing ourselves
(04:52):
through our jobs, repeatedly pushing ourselves past the breaking point
in school and at the gym, and learning realistic goals,
setting and health your mental habits. These are essential to
living a healthy and productive life. Easier said than done right.
More on that next week. Like it or not, your
(05:13):
family doctor is often the first person with any sort
of authority in a position to tell the people around
you the conditions like anxiety and depression affect the body
as well as the mind. But that conversation often doesn't happen.
You'll dutifully go to the doctor be told to reduce stress,
work less, sleep, exercise, and relax more, and the people
(05:37):
around you will say that's nonsense. You have to work harder,
you have to stop being so annoying, you have to
stop being so weak. You have to get tougher, stronger, faster.
And this is why you're seeing doctors write prescriptions for
things like walks and nature, because if a doctor writes
a prescription, people see it as more real. We can
(06:01):
do something to change all of this mess, but that
only happens if collective mental health becomes everyone's collective responsibility.
And after the break, we'll talk to a medical doctor
who is on a campaign to try to change the
healthcare part of the system. Doctor Robert C. Smith, author
(06:21):
of Has Medicines Lost Its Mind, will join me after
the break to talk about what he's seen from his
end of the story. Do you have a story you
think would be good for the show? Are you interested
in sponsoring the show? Leanna at not Therapyshow dot com.
At show dot com is the website at not therapy
show on social media's Leanna at Nottherapyshow dot com is
(06:42):
my direct email. By the way, should have made that
clear when we come back, Doctor Robert C. Smith Has
Medicine Lost Its Mind on It's Not Therapy.
Speaker 1 (06:55):
No Radio, No Problem stream is live on SAGA nine C.
Speaker 2 (07:03):
The following program is a peer to peer advice show
and does not diagnose mental health conditions. If you're seeking
social services, please call or text two one one or
go to two one one dot CA. We're back in
this a therapy I'm still iana curser. I'm still not
a therapist, and it is time for the interview. I
(07:25):
have doctor Robert Smith. He is a physician. Robert internal
medicine correct in primary care.
Speaker 3 (07:33):
That's correct is your specialty.
Speaker 2 (07:34):
And Robert is here to promote his new book, Has
Medicine Lost Its Mind? Why our mental health system is
failing us and what should be done to cure it?
Came out on March fourth, so you can get it
right away. Robert, I want to start with something you
talk about that I think is important to find before
we dig in, the idea of the mind body split
(07:58):
in modern medicine. Like to start there, explain to listeners
what that is and why it's relevant to the issues
with the system.
Speaker 3 (08:08):
Yeah, it's a critical question. Thanks for inviting him, honored
to be here. The mind body split basically means that
medicine has separated, split away the mind from the physical body,
and that it focuses then just on the physical body
(08:31):
and its diseases and excludes the mind. And medicine didn't
always do this. From the fifth century time of Apocrates,
fifth century BC, you know, up until the Scientific Revolution
in the sixteenth and seventeenth century, medicine united the bind
(08:52):
and the body. People with bipolar disorder what they call
then melancholia, we're seen in everyday physician, just as where
people always say diarrhea or headaches or something. But at
this point in the Scientific Revolution, scientists, and this wasn't
(09:12):
just in medicine, it was in physics and in mathematics
and a host of places. Science was beginning to get
much much stronger and more assertive. The Church had ruled
everything for the preceding millennium up until that point, but
at this point medicine became much more assertive and wanted
(09:36):
to start doing dissections of the human body. Of course,
that's the basic science back at that time, but the
Church had always prohibited that from the time immemorial, and
so physicians had always dissected goats, pot cow's, pigs and
the like and inferred that what they found there was
(09:59):
like humans, which of course is grossly wrong. Well, in
fifteen thirty seven, Pope Clement allowed the section of the
human body for educational purposes, but with one proviso, the
head must first be decapitated and turned over to church authorities.
(10:21):
It's kind of grizzly, and who would then bury it
and provide the right services. Medicine got the body from
the neck down, and that launched it. A century later,
came along all the philosophers you've heard of, from Descartes
to Locke to Hobbes. They then cemented this idea that
(10:46):
the church would handle mind spirit issues. That's why the
church wanted that, and that's why they insisted on that.
And so these philosophers, in a sense compromised with the
church so that the church got the mind, spirit soul.
(11:06):
Medicine got the rest from the neck down, all the
physical diseases, and from there on through the ensuing centuries,
medicine focused entirely on the physical body and its diseases,
and so that in essence is the mind body split
and how it's happened in medicine. It was incredibly effective
(11:31):
in the last century. From nineteen hundred, the life survival
at that point was forty years. By the end of
the century it was almost eighty years. That's a doubling
of life survival. This is a dramatic change. There have
been no improvement in life survival from the fifth century
BC on. This is the first time medicine had really
(11:52):
had any impact, and so it's highly effected. The problem, however,
is that medicine did not grow and mature and include
the previously excluded psychological and social and mental and emotional
(12:13):
aspects of medicine, and this became a terrible problem because
of all the acute diseases that medicine had cured that
led to improved life survival. Now we're faced mental illnesses
is becoming prominent, and also chronic diseases are becoming prominent.
(12:35):
These of course require attention to this psychological, social, emotional
factories that medicine excludes, and so it has proven as
it led to a terrible mental health crisis. I'm sure everybody,
your listeners are aware of this, especially since COVID. Here's
(12:56):
the problem, and this is what medicine is not doing.
Medicine has not grown and matured as it should right now.
The mental health crisis. Many people don't understand this, and
it's kind of scary when you think of it, But
the mental health crisis is due to the fact that
primary care physicians like myself, I'm certainly no exception like myself,
(13:22):
conducts seventy five to eighty percent of all mental health care.
Here's the problem, Leenna, Medicine didn't train them for this.
Medicine ignores the mental health aspect and so hasn't trained
them for this. And the downside of this is incredibly bad.
(13:47):
Unrecognized problems with suicidal patients medicine and trained them in
that many of these could be prevented. They see the
doctor in the month or so before that most of them.
There were two hundred thousand deaths from physician prescribed opioids.
Physicians aren't trained in using opioids. This could all be prevented.
(14:09):
And the downside is even greater. There's something like ninety
to one hundred million people with major mental disorders at
any one time. Most of these people are not even recognized.
When they're recognized and treated, it's usually wrong. So what
happens with unrecognized and poorly managed mental health care. The
(14:31):
depression is overlooked, anxiety is overlooked, addiction problems are overlooked.
This results in divorce, school failure, job loss, addiction, incarceration, homelessness,
and on and on it going. But don't blame the doctors.
It's not their fault. They haven't been trained. They're not trained.
(14:54):
And in fact, I've talked to them all the time,
and they'll tell you, bob up and said, there's no
psychiatrist in my town. What am I supposed to do?
Speaker 2 (15:04):
Yeah?
Speaker 3 (15:05):
Yeah, And another one says there's two psychiatrists in my town,
but it takes nine months to get a patient in
and see them.
Speaker 2 (15:12):
Yeah.
Speaker 3 (15:13):
And So the point here is psychiatry sees no more
than twelve percent of all patients in the US. Psychology
sees another twelve percent. That's why the remaining seventy five
percent are seen by untrained primary care physicians. Now, the
solution to this problem must be obvious. Train the doctors
(15:38):
who provide the care. But medicine refuses to do this.
And you asked, rhetorically, has medicine lost its mind? I mean,
why does not Why does medicine not trained it's doctors
to care for the most common health condition they'll see
in practice. Has medicine lost his mind? Is crazy?
Speaker 2 (16:01):
Yeah, And this is true not just of doctors. It's
true of police officers. It's true of firefighters. It's true
of paramatics, it's true of teachers, you know, it's true
of managers. There's all these single these primary you know,
it's called primary care because you're the primary contact, right
And doctors are in this double bind because when finally
someone decides to go to the doctor, they think there's
(16:23):
something real with them. And when you suggest, like hey,
maybe your stomach ache is caused by depression, or maybe
your chronic headaches are tied to anxiety or burnout or
over work, they feel dismissed.
Speaker 3 (16:38):
Right.
Speaker 2 (16:39):
They feel like you're saying it's all in your head.
But these are physiological processes that happen with you know,
our body, chemistry, our nervous system. You can't just as
you said, cut a person off the head and only
treat that and not treat that. Most of the people
I see as a peer counselor one of the fundamentals
(17:00):
at sleep exercise, something is compromised and they've told their
doctor this, and well, something's breaking down at some point.
I mean, you talk about the importance of integrating mindfulness
and exercise into treatment. What does mindfulness mean to you?
(17:23):
Because that's a term. You ask twelve people, you'll get
fourteen definitions, right.
Speaker 3 (17:28):
Yeah, I mean it's an important term. And have some
good friends who work in the area. Mindfulness just in
a general sense relates to meditation practices that raise one's
(17:48):
self awareness to what they're doing. There's also a tremendous benefit.
I mean, Herbert Benson demonstrated that simple mindfulness techniques lead
to reduction in blood pressure and then so on. But
it is a powerful thing that people can do on
(18:10):
their own or which doctors, if they're aware of it,
can prescribe for patients, and it advise they use it.
And so I think it's a tremendous thing that some
of these things you're mentioning, Leanna, diet, cigarette, smoking, alcohol use,
(18:31):
all of these things are implicated in causing most heart attacks, strokes, diabetes, cancer,
and yet medicine does not train its graduates in these
lifestyle factors because they're all psychological and social people drink
(18:56):
for psychosocial reasons, eat too much, we don't exercise, so
on and so forth, smoke too much for example. And
all of these things can be addressed by the medical
profession to prevent all these physical diseases. We see all
the heart attacks, strokes, diabetes, eighty percent of those could
(19:20):
be prevented if medicine addressed prevention. Now, how bad does
medicine do on prevention. In nineteen seventy fifteen percent of
the US population was obese. It's fifty percent today. That
is a terrible condemnation of medicine for not paying attention
(19:44):
to prevention. Instead, what medicine does is let the disease happen,
then it treats it after the fact, and just it's
a disaster that just goes on and on. It is
incredibly expensive. Our hospitals are filled with people with chronic
(20:07):
physical diseases in this day and age. What if you
prevented half of those, you would save tons of money.
Insurance companies would save tons of money, pharmaceutical houses, I mean,
and the whole thing goes on. And so there is
a tremendous not only health downside to this, but also
(20:32):
the financial side.
Speaker 2 (20:35):
All right, Doctor Robert Smith, author of has Medicine Lost
Its Mind? Why our mental health system is failing us?
And what should be done to cure He's a primary
care physician, internal medicine. Robert, can you stay with me
over the break? We can come back talk some solutions
for Berkeley. All right? When we come back, like I said,
solutions too, how to fix this really messed up system
(20:57):
where physical health and mental health are separated with doctor
Robert Smith talking what doctors miss about medical linless. When
we come back on It's Not Therapy.
Speaker 1 (21:09):
Stream us live at SAGA nine six am dot C.
Speaker 2 (21:15):
The following program is a peer to peer advice show
and does not diagnose mental health conditions. If you're seeking
social services, please call or text two to one one
or go to two one one dot CA. We're back
on It's not Therapy. I'm still yet a cursoner. I'm
still not a therapist. We're stalking, still talking to doctor
(21:35):
Robert Smith about what doctors miss about mental illness. And
before the break, Robert took us through this amazing history
and I love this stuff. So I was like, oh,
keep going about sort of how we got here, how
how physical medicine and mental health got split, and some
of the benefits to that in terms of things like lifecancy, longevity,
(22:02):
the stuff we can treat. But Robert, you were saying
the downside is we are very much a sickness based system.
We are not a health based system. As you said,
prevention is not taught. I was just talking to my
husband last night. We just watched All Creatures, Great and Small,
which is a show about a bunch of country vets, right,
(22:22):
but they were they deal with a lot of the
psychology we're dealing with the people who they have to
get through to treat the animals. And it's taken place
during World War two right now, And they were showing,
like how much it took to prepare food back then,
even when I was in middle school, in high school,
(22:43):
we learned how to cook, we learned nutrition, we learned
what went into our food. And a lot of these
programs now are cut. So I want to start here
when we talk about prevention. My god, we could talk
for four hours and barely scratch the surface. So where
do you want to begin in terms of prevention and
(23:05):
mental health.
Speaker 3 (23:06):
Yeah, the first place what we need to begin is
the system itself is not working right, and prevention efforts
and so on will have to come after medicine makes
a fundamental change. Right now, medicine provides no more than
(23:29):
two percent of all training time. It's about fifteen thousand
hours of training over four years of medical school and
three to five years of residency. Only two percent of
that is devoted to mental health care. That's a five
week experience usually in the third year of medical school
on psychiatry. And most of those patients are not like
(23:52):
the patient you'd see in practice. You know, they're very
severely disturbed, not like the garden variety depression, anxiety you
might see in practice. And so only two percent of
time is devoted to training for the most common health
condition they'll see in practice. Medicine has known this and
(24:15):
known the problem since at least the nineteen seventies. I'm
certainly not the first one to talk about this, and
prestigious groups like the Institute of Medicine later the National
Academy of Medicine have said medicine needs to train primary
care doctors in mental health. In fact, the primary care
(24:38):
system has been called the de facto mental health care
system in the US, and people have been saying this
since I think that paper came out in two thousand
and so. Medicine has known this for a long long
time but done absolutely nothing. It's training and mental health
and the other psychological and social aspects of META has
(25:00):
not changed in one hundred years, and quite frankly, they're
not going to change if they're left to their own devices.
This is why I'm getting out and going to the public,
as it were. The public needs to get involved. The
public needs to get angry and say you are not
(25:21):
meeting our needs. Now, you might say, how's the public
going to do this? How will they be a thing? Well,
there's an ample recedent for just this. Ralph Nader came
out with a book you're nodding, you know, with a
book called Unsafe at Any Speed. This book. At the time,
(25:47):
the auto industry didn't put seat belts in cars. It
was too expensive and they were afraid people wouldn't use
them and wouldn't buy cars. And they also had gearshifts
were misaligned, so people went forward when they thought they
were going backwards, and just a host of things. The
auto industry knew it, but they just didn't do anything
about it. Nighbor's book, Unsafety Speed came out and forced
(26:11):
the public forced its politicians to do something about this,
and this is why you today wear a seat belt
in your car and why it drives safely in so
many other respects. Rachel Carson, who I'm sure you've heard of,
also in Silent Spring. Same thing with the chemical industry.
They were polluting everything they stood on. There was DDT
(26:33):
and the water that you and I drank. They knew it,
they didn't do anything about it. Too expensive to fix it.
Rachel Carson's book comes out, the public gets inflamed. They
forced their politicians to do something. This is why in
the US we have the Environmental Protection Agency today. That's
why we drink clean water instead of water with DDT
(26:56):
in it. Has medicine lost its mind, can do the
same thing for the medical profession. Inflame, the public get
its politicians in gear and do something. And you might
ask what would they do once they get in gear,
And my recommendation is that they conduct set up a commission,
(27:20):
be a presidential commission, congressional commission, national Academy of Medicine,
somebody set up a commission that does an investigation of
modern medical education, and they will find it wanting yeah,
and they find that medicine is not training as practitioners
(27:41):
in the most common health condition they will face in practice.
And there's also a scientific basis for this. Medicine is
the only profession only science that does not follow a
modern systems perspective basically means a systems per second, you
(28:02):
mean you cannsider all parts of a problem and how
they interact, not just one part. Medicine considers just the
physical disease part, not the psychological, mental, social part. And
all other sciences have made this transition. Physics everybody's familiar
with went from Newtonian physics to quantity theory relativity theory
(28:27):
and with tremendous advances. Medicine can have the same advances
if it matures into a system's perspective of medicine. But
it has not done this on its own. Even though
it has been aware of a system's perspective for medicine
since the nineteen seventies, it just doesn't do anything with it.
(28:51):
And so medicine needs help. Now.
Speaker 2 (28:54):
I want to go back to something you said before
the break don't blame the doctors because you're speaking to
It's a perfect audience up here in Canada for yell
at the politicians about healthcare, because healthcare is always a
top three voting issue up here. We love our healthcare right.
But going from yelling at the politicians to effectively not
(29:17):
letting them off the hook for the problem, I think
that's something we can talk about with our remaining time,
because what do they do. They blame the doctors here.
We don't have enough primary care physicians, that's the big deal.
So people are lining up for hours when a new
clinic opens up. I saw here. I was one of
(29:37):
the first people in the door at my clinic up here.
I'm a semi rural. It's jumping now, it's super busy,
and they complain about how long it takes to train
doctors and how expensive it is to train doctors. And
so you go in there and you say, well, we
need a mental health component and all these things. They
just go can't afford it. Now, that's nonsense, right, because
(30:01):
they're paying more for our existing system than they would
for a prevention basis.
Speaker 3 (30:07):
Oh, you're right on, yeah.
Speaker 2 (30:10):
So what's some language that people can use when they're
dealing with this, because people go, oh, that makes sense.
Can't afford it? People now with inflation, they understand not
being able to afford eggs, for instance, But how do
you counter that while we can't afford it in a
system that you know is spending a ton of unnecessary
(30:32):
money treating something that could be prevented.
Speaker 3 (30:35):
You nailed it right there. They they can't afford to
not afford it. Is the tremendous savings that will come
from addressing the psychological and social aspects of medicine are
just out of sight. In the US, the healthcare expenditure
(30:56):
is roughly five trillion dollars a year. If and most hospitals,
for example, are full of people with chronic diseases. Okay,
I told you earlier you can present eighty percent of that.
If you prevented eighty percent of that, you would save
(31:18):
all of that money. If from a pharmaceutical houses, if
you prevented that, you would save all that money that
now goes to expenditures. These new drugs for obesity are
costing what one thousand dollars a month, You would be
saving all of that money. All of these people who
(31:38):
from say obesity end up with severe arthritis and have
joint replacements. You'd be saving all of that. And the
savings and just in prevention are in the range. You know,
if you presented prevented eighty percent of this, you cut
to five trillion dollars down to two trillion. It's just
(32:00):
it's unbelievable how much can be saved, and in people
right now. I mean this as just a specific example,
but people with chronic diseases diabetes, heart attacks, heart failure, strokes,
seventeen percent of them are also depressed. Yeah, if you
(32:23):
treat the depression, the physical disease gets better. If you don't,
the physical disease does not get better and costs two
to three times as much to take care of. And
this has been looked at just this specific population. Has
been shown that if we addressed the co occurring mental disorder,
(32:46):
he would save from twenty six to forty eight billion
dollars every year. These are that's enough the money to
support the National Institute of Health. I mean these these
are humongous figures that can be saved. And so the
argument is change the system. Medicine needs to start training
(33:12):
and medical education is the centerpiece of curing all of
this because it is through medical education only two percent
of time to mental health, that doctors get brainwashed into
isolated physical disease medicine. And this is why they need
help to get out of it, because we just keep
(33:33):
training in the same way and they keep doing the
same thing over and over, and so the public has
to get involved. My website, let me tell you this.
There's a way the public can get involved is Robert C.
SMITHMD dot com. And don't forget the MD, because there's
so many Smiths that you will never find it otherwise.
(33:54):
So it's Robert CSMITHMD dot com. Okay, the very first
page you go there will be something that says act now.
This will take you to a sample letter you can
send to the President, the Surgeon General, the National Academy
(34:16):
of Medicine, you're congressperson, and your senator. The email addresses
for them are all can all be found right there
on the same place. You can even add an own
paragraph of your own issues, say ADHD that you've had
and where you've had bad care. But the paragraph in
their advice is just when I'm talking about set up
(34:39):
a federal commission to investigate medical education.
Speaker 2 (34:45):
Yeah, and if you're going to send a letter to
your member of parliament or senator or whoever. People listening,
please customize the letter. It matters. They look for form letters.
I always rewrite it myself in my own words, because
it means more. One letter written by an individual to
(35:07):
your primary care contact person in your government means more
than a protest means more than you know tweeting angrily.
These letters do matter. Phone calls do matter. The entire
purpose of our system is so that there's someone to
yell at about stuff like this. So it's Robert C.
SMITHMD dot com. I checked it out. It works Robert
(35:31):
as in Robert C. Smith like the singer from the
Cure MD dot com. Robert, thanks so much for coming
on it. It's not therapy and sharing your wisdom with us.
Robert's book is has Medicine Lost Its Mind? Why our
mental health system is failing us? And what should be
done to cure. I'm halfway through it. It's fantastic, Robert.
(35:52):
Thank you for writing the book, thank you for coming
on here, and thank you so much for your passion
on this issue. It's really really great.
Speaker 3 (35:59):
Thanks. Ray, appreciate the chance to talk to you.
Speaker 2 (36:02):
All right, when we come back more things you can
do to help encourage change and keep going because change
is slow to com questions, comments, concerns. Leana at not
Therapyshow dot com. Not Therapyshow dot com is my website
at not Therapy Show on socials More. We come back
(36:24):
on what you can do to make change, and it's
not therapy.
Speaker 1 (36:33):
No Radio, No Problem stream is live on SAGA ninety
six am dot C.
Speaker 2 (36:40):
The following program is a peer to peer advice show
and does not diagnose mental health conditions. If you're seeking
social services, please call or text two to one one
or go to two one one dot CA. We're back
in it's not therapy. I'm still at a cursoner. I'm
still not a therapist. We're still talking about mental health
(37:01):
and the medical system, and I want to take the
remaining time to talk about what else you can do
to help encourage change, because, like we said multiple times
during the interview with doctor Robert Smith, it's not the
fault of doctors or first responders that they're not trained
or you know, they have minimal training in mental health practices.
(37:24):
With the shortage in family doctors here in Ontario, and
I know We're not the only jurisdiction in the world
that has a shortage of family doctors, nurses, et cetera.
There's going to be pressure to pump out primary care
doctors as quickly as possible instead of a focus on
additional mandatory training in things like mental health for primary
(37:46):
care physicians. So it's going to be an uphill battle
to advocate for this additional mandatory training, which is why
it's important to speak to local officials in charge of funding.
Just yell at doctors in paramedics or claim all cops
or something or other catchy slogan not really effective in
(38:08):
enacting change. When you're told the mental health system is overburdened,
it's true. When you hear that first responders are under
intense stress and suffer from mental health conditions themselves. It's
true when you hear that our physical healthcare system is overloaded.
That is also true, As Robert said, if you're not
(38:30):
in a major city, services are even more stretched. In
some areas. In Canada, the weight liss wit list excuse
me for mental health services is up to two and
a half years. Two and a half year waitlist now
the first place to look up support services is the
two to one one service that I talk about at
(38:51):
the beginning of every break on this show. Put in
your location on the website and search for mental health.
There are usually more community services and people are aware
of because they're poorly advertised. Using these services helps them
maintain their funding because undersubscribed programs tend to get cut. Now,
if you go on to two one one and you
(39:14):
find that the in person services are quite far away
from you, that's very cobbin, especially if you're on the
boundary of an area. Look up the TELL or internet
services as are there and they're usually marked on the calendars.
Another source of information regarding mental health supports in your
(39:35):
area is your local crisis line. They can inform you
of where the nearest drop in counseling center is if
you don't get very far with two one one, or
you can call the numbers on the two one one
website instead of you know, doing a search looking it
up yourself. Now, sometimes the people on these lines can
(39:59):
be a bit well, rude and dismissive, sometimes condescending, but
your goal is to get the information and their rudeness
is on them. I know, it's bizarre that somebody staffing.
A mental health line would behave this way. But it
(40:19):
is true. I don't get it. I'm just saying it's so.
All you're trying to do is get the information so
you can take that next step. Another next step is
that your local officials put on community events. Find out
where and when they are, and show up. If you
(40:40):
can eat the free hot dog, drink the lousy coffee.
I just drink the lousy coffee because the hot dogs
usually meat, and I don't eat meat. The point is,
the more that local representatives see you as a regular
person out in the community and not just a partisan activist,
the more active you'll be in persuading them that your
(41:03):
issue matters. Talk to other people, not just politicians, about
the importance of community involvement that doesn't involve protests. Politicians
have tuned out protest. Real lasting change is slow, but
it doesn't take a lot of time to send a
letter and make your concerns felt. If you've donated to
(41:26):
political parties in the past, they occasionally send out surveys.
Fill them out. Political parties tend to be laser focused
on top three voting issues. Contact the local political parties
and ask them where they stand on better mental health
primary care. They should have a clearly stated policy in
their platform. If they don't get back to you, as
(41:49):
the Liberal Party did not get back to me before
the last provincial election, well that may affect your vote. Yeah.
Now give all of this ten years of ongoing effort
to work. That's right, at least a decade. This stuff
changes slow. This is why participating in ways you can
(42:12):
sustain is important. Manage your frustration, manage your disappointment. Pay
attention to your own mental health in this process. If
you're getting overwhelmed, step back, just be a person. You're
not required to advocate. The issue will be there when
(42:34):
you're feeling more balanced again. Trust me, the way you
care isn't an indication of how much you care. Trying
to get politicians to spend money on anything that isn't
an immediate crisis is nearly impossible and way well, we
currently don't have the most informed provincial government in this province.
(42:55):
Our premier still thanks you apply for jobs by dropping
off a paper resume at a local business. An area
that we can get more traction on faster is at
your direct community level. Committing to make to taking mental
health seriously in the clubs and groups we participate in,
including online is essential. Don't participate in online pylons, don't
(43:21):
use social media at a fling abuseic strangers, make behavior matter,
and if someone seems to be struggling top ten phrase,
listen twice before you talk once. And if you're wondering,
I'm laughing. My cat's scout is here purring right into
the microphone. So that is a strange noise you may
be hearing on the radio. It is a cat. It's okay,
(43:43):
it's good for your mental health. Cats are good, right, scout. Yeah. Now,
in Canada here there's a bit of you know, people
see it as the Promised Land because it doesn't cost
many to go to the doctor. Okay. In Canada, a
lot of people don't access mental health services because of shame.
(44:08):
They go, they have bad experiences either with the doctor,
with the mental health system, or with the people around
them while they're going through the mental health system, and
they just stop because it's too hard, it's too humiliating.
I share my own experiences with the mental health care
(44:29):
system and my own mental health issues to reduce the
stigma for other people. And let me tell you, it's tough.
People paint me is bad crazy at the drop of
a hat, and they think it has more teeth because
I sought help, and I talk about getting help instead
(44:50):
of recognizing that I'm only good crazy because I got help,
and the people accuse me of being unhinged or have
anger problems or whatever. The latest claim is, Well, there
are people I said no to at least once because
they didn't respect the things I have to do to
(45:11):
maintain my mental health. When I was in intense therapy,
it was hard because my family didn't accept the things
that the therapist said needed to change, and I was
caught between those two pressures. Therapists will drop you if
they think you're not doing the work, but it's very
(45:33):
hard to do the work if your family is referring
to the professional advice as crap before they even try it. Now,
it's trust me, it's tough when you go in and
the therapist just like, do these things, and you're like,
I'm trying to, but it's my family, and the therapist say, well,
cut anybody out who isn't supporting you, and they're right.
(45:55):
But unless you've gone through it, you have no idea
how hard it is getting healthy by changing your environment
can sometimes be the most painful thing you will ever
do in your entire life. I can tell you it's
worth it, but it's hard. Now you can choose to
(46:19):
not be one of the people who makes it harder.
Another person's mental health is not your responsibility, but if
you want them to stay in your life, you need
to work with their recovery, not against it. The most
tragic thing I see on a regular basis is the
family of a person who is struggling keeping them down
because they're demanding quick fixes via some magical medication instead
(46:44):
of helping with those environmental changes at the person's own
pace that lead to the lasting improvements. The mentally ill
person in your family is not broken. You don't send
them to a mechanic for repair, and even if you
could do that, it doesn't last long if you send
them top speed into another crash the minute they get
(47:05):
home again. Conversely, if you're treating them as sick and helpless,
they're going to internalize that message and believe they're helpless
that it's never going to get better. Navigating the current
medical system is extremely difficult, and it's important to reward
efforts going to the appointments, saying what the problem is?
(47:26):
Stuff like that, Trying, really trying, even when the outcomes
are frustrating, disappointing, or even an outright set back, They're
going to happen. Healthy goals are based on things you
can control, and it often takes multiple attempts to get
connected to the right treatment or the right therapist. It's
very rarely. Take a pill and your better, and you
(47:47):
can help with the journey, even if you can't force
the destination. Questions, comments, concerns Leanna at not Therapyshow dot com.
Not Therapy Show is the website not Therapy Show dot
com as the website at not Therapy Show on socials.
Change is hard and it's slow, but if we never start,
(48:07):
it never comes. And as slow and hard as it is,
change is possible if we keep at it. These things
gain momentum with time. You're probably feeling like it's enormous
right now. Welcome to the last you know, ten fifteen
years of my life. But I am out of time
with you. You're crazy is only a problem if it's hurting you.
(48:30):
Talk next time.
Speaker 1 (48:32):
Stream us live at SAGA nine sixty am dot CA.
The views expressed in the following program are those of
the participants and do not necessarily reflect the views of
SAGA nine sixty AM or its management.
Speaker 2 (00:09):
The following program is a peer to peer advice show
and does not diagnose mental health conditions. If you're seeking
social services, please call or text two to one one
or go to two one one dot CA. Hello listeners
around the world on radio, streaming and podcast services. This
is its own therapy. I'm Leanna Kerzner, and I am
(00:30):
not a therapist, but I am your source for navigating
the madness of mental health using my Coppen sayings for
going good crazy. This week, we're going to talk about
the problems with mental health and the medical system. My
guest this week is doctor Robert C. Smith, a medical
doctor and author of has Medicine Lost Its Mind. Robert
is in the US, but I hear plenty of stuff
(00:52):
up here in Canada as well about humiliating and degrading
treatment when people seek help. I personally got it from
both ends and the there's nothing wrong with you. You're depressed,
when I actually had a rare autoimmune disease and you're
functioning reasonably well. The product is your environment. When I
sought mental health treatment, everybody was pushing me somewhere else,
(01:13):
So I was somebody else's problem. So when I saw
treatment for my body, people told me it was in
my head. When I saw treatment for my head, I
was told the problem was my environment, and that was true.
But it wasn't until I reported being stalked and got
put in touch with York Region Victim Services that anyone
(01:34):
took the time to tell me what the actual problems
were in my environment. But I ended up getting yelled
at by a cop too. So we have a systemic
problem here. And obviously, you know, focusing on one part
of it at the time is like looking through a
pinhole with one eye. But the medical system is a
(01:56):
snapshot of the system isn't set up to do that right.
Since I was fifteen years old, I've had doctors telling
me to reduce stress. G Thanks, that's so easy when
you know, if you're a teenager, you're not in control
of your environment. Really, when you're an adult, you can
(02:20):
barely pay your bills. Thanks doc. In a perfect world, schools, churches, employers,
and yes, medical doctors would be routinely on the lookout
for signs of acute stress and not just teach healthy skills,
but actively create healthy, emotionally safe environments. But classes are
(02:43):
too big to start doing that in most schools now,
and everyone is just trying not to get yelled at.
My parents are even sued. Teacher burnout is a serious problem.
We've done past episodes on that program, on our program
about that. So we end up by the time some
(03:03):
people are teenagers, they have physical symptoms caused by stress,
but they're not taken seriously by well doctors. Yeah, but
also by anyone. We have this cultural stigma that teaches
us that if it's all in your head, then it's
a weakness of character as opposed to something you deserve
(03:25):
help improving. And that's not true that it's a weakness
of character. But there's also a continuing stigma against things
like antidepressants, which means that a lot of people are
suffering needlessly and struggling through lower quality of life than
they deserve. You don't have to be on antidepressants forever
(03:48):
just because you take them to stabilize in the short term,
but the idea of seeing four different doctors over a
period of six months to get a single prescription, that's
nobody's idea of a good time, and anyone who's dealing
with a relative who's addicted to a prescription drug like
xanx is a common one. They can tell you that
(04:10):
this addiction is facilitated by medical neglect, not from doctors
who pay attention. Again, however, just because some people get
addicted to a drug doesn't mean it isn't safe used
as directed on a temporary or occasional basis while you're
(04:31):
working on those other lifestyle changes that do take time.
A fourteen day prescription for xanax isn't going to get
you hooked, especially when you're not taking it every day.
But drugs aren't the permanent solution to our mental health crisis.
Those lifestyle changes are. We have to stop killing ourselves
(04:52):
through our jobs, repeatedly pushing ourselves past the breaking point
in school and at the gym, and learning realistic goals,
setting and health your mental habits. These are essential to
living a healthy and productive life. Easier said than done right.
More on that next week. Like it or not, your
(05:13):
family doctor is often the first person with any sort
of authority in a position to tell the people around
you the conditions like anxiety and depression affect the body
as well as the mind. But that conversation often doesn't happen.
You'll dutifully go to the doctor be told to reduce stress,
work less, sleep, exercise, and relax more, and the people
(05:37):
around you will say that's nonsense. You have to work harder,
you have to stop being so annoying, you have to
stop being so weak. You have to get tougher, stronger, faster.
And this is why you're seeing doctors write prescriptions for
things like walks and nature, because if a doctor writes
a prescription, people see it as more real. We can
(06:01):
do something to change all of this mess, but that
only happens if collective mental health becomes everyone's collective responsibility.
And after the break, we'll talk to a medical doctor
who is on a campaign to try to change the
healthcare part of the system. Doctor Robert C. Smith, author
(06:21):
of Has Medicines Lost Its Mind, will join me after
the break to talk about what he's seen from his
end of the story. Do you have a story you
think would be good for the show? Are you interested
in sponsoring the show? Leanna at not Therapyshow dot com.
At show dot com is the website at not therapy
show on social media's Leanna at Nottherapyshow dot com is
(06:42):
my direct email. By the way, should have made that
clear when we come back, Doctor Robert C. Smith Has
Medicine Lost Its Mind on It's Not Therapy.
Speaker 1 (06:55):
No Radio, No Problem stream is live on SAGA nine C.
Speaker 2 (07:03):
The following program is a peer to peer advice show
and does not diagnose mental health conditions. If you're seeking
social services, please call or text two one one or
go to two one one dot CA. We're back in
this a therapy I'm still iana curser. I'm still not
a therapist, and it is time for the interview. I
(07:25):
have doctor Robert Smith. He is a physician. Robert internal
medicine correct in primary care.
Speaker 3 (07:33):
That's correct is your specialty.
Speaker 2 (07:34):
And Robert is here to promote his new book, Has
Medicine Lost Its Mind? Why our mental health system is
failing us and what should be done to cure it?
Came out on March fourth, so you can get it
right away. Robert, I want to start with something you
talk about that I think is important to find before
we dig in, the idea of the mind body split
(07:58):
in modern medicine. Like to start there, explain to listeners
what that is and why it's relevant to the issues
with the system.
Speaker 3 (08:08):
Yeah, it's a critical question. Thanks for inviting him, honored
to be here. The mind body split basically means that
medicine has separated, split away the mind from the physical body,
and that it focuses then just on the physical body
(08:31):
and its diseases and excludes the mind. And medicine didn't
always do this. From the fifth century time of Apocrates,
fifth century BC, you know, up until the Scientific Revolution
in the sixteenth and seventeenth century, medicine united the bind
(08:52):
and the body. People with bipolar disorder what they call
then melancholia, we're seen in everyday physician, just as where
people always say diarrhea or headaches or something. But at
this point in the Scientific Revolution, scientists, and this wasn't
(09:12):
just in medicine, it was in physics and in mathematics
and a host of places. Science was beginning to get
much much stronger and more assertive. The Church had ruled
everything for the preceding millennium up until that point, but
at this point medicine became much more assertive and wanted
(09:36):
to start doing dissections of the human body. Of course,
that's the basic science back at that time, but the
Church had always prohibited that from the time immemorial, and
so physicians had always dissected goats, pot cow's, pigs and
the like and inferred that what they found there was
(09:59):
like humans, which of course is grossly wrong. Well, in
fifteen thirty seven, Pope Clement allowed the section of the
human body for educational purposes, but with one proviso, the
head must first be decapitated and turned over to church authorities.
(10:21):
It's kind of grizzly, and who would then bury it
and provide the right services. Medicine got the body from
the neck down, and that launched it. A century later,
came along all the philosophers you've heard of, from Descartes
to Locke to Hobbes. They then cemented this idea that
(10:46):
the church would handle mind spirit issues. That's why the
church wanted that, and that's why they insisted on that.
And so these philosophers, in a sense compromised with the
church so that the church got the mind, spirit soul.
(11:06):
Medicine got the rest from the neck down, all the
physical diseases, and from there on through the ensuing centuries,
medicine focused entirely on the physical body and its diseases,
and so that in essence is the mind body split
and how it's happened in medicine. It was incredibly effective
(11:31):
in the last century. From nineteen hundred, the life survival
at that point was forty years. By the end of
the century it was almost eighty years. That's a doubling
of life survival. This is a dramatic change. There have
been no improvement in life survival from the fifth century
BC on. This is the first time medicine had really
(11:52):
had any impact, and so it's highly effected. The problem, however,
is that medicine did not grow and mature and include
the previously excluded psychological and social and mental and emotional
(12:13):
aspects of medicine, and this became a terrible problem because
of all the acute diseases that medicine had cured that
led to improved life survival. Now we're faced mental illnesses
is becoming prominent, and also chronic diseases are becoming prominent.
(12:35):
These of course require attention to this psychological, social, emotional
factories that medicine excludes, and so it has proven as
it led to a terrible mental health crisis. I'm sure everybody,
your listeners are aware of this, especially since COVID. Here's
(12:56):
the problem, and this is what medicine is not doing.
Medicine has not grown and matured as it should right now.
The mental health crisis. Many people don't understand this, and
it's kind of scary when you think of it, But
the mental health crisis is due to the fact that
primary care physicians like myself, I'm certainly no exception like myself,
(13:22):
conducts seventy five to eighty percent of all mental health care.
Here's the problem, Leenna, Medicine didn't train them for this.
Medicine ignores the mental health aspect and so hasn't trained
them for this. And the downside of this is incredibly bad.
(13:47):
Unrecognized problems with suicidal patients medicine and trained them in
that many of these could be prevented. They see the
doctor in the month or so before that most of them.
There were two hundred thousand deaths from physician prescribed opioids.
Physicians aren't trained in using opioids. This could all be prevented.
(14:09):
And the downside is even greater. There's something like ninety
to one hundred million people with major mental disorders at
any one time. Most of these people are not even recognized.
When they're recognized and treated, it's usually wrong. So what
happens with unrecognized and poorly managed mental health care. The
(14:31):
depression is overlooked, anxiety is overlooked, addiction problems are overlooked.
This results in divorce, school failure, job loss, addiction, incarceration, homelessness,
and on and on it going. But don't blame the doctors.
It's not their fault. They haven't been trained. They're not trained.
(14:54):
And in fact, I've talked to them all the time,
and they'll tell you, bob up and said, there's no
psychiatrist in my town. What am I supposed to do?
Speaker 2 (15:04):
Yeah?
Speaker 3 (15:05):
Yeah, And another one says there's two psychiatrists in my town,
but it takes nine months to get a patient in
and see them.
Speaker 2 (15:12):
Yeah.
Speaker 3 (15:13):
And So the point here is psychiatry sees no more
than twelve percent of all patients in the US. Psychology
sees another twelve percent. That's why the remaining seventy five
percent are seen by untrained primary care physicians. Now, the
solution to this problem must be obvious. Train the doctors
(15:38):
who provide the care. But medicine refuses to do this.
And you asked, rhetorically, has medicine lost its mind? I mean,
why does not Why does medicine not trained it's doctors
to care for the most common health condition they'll see
in practice. Has medicine lost his mind? Is crazy?
Speaker 2 (16:01):
Yeah, And this is true not just of doctors. It's
true of police officers. It's true of firefighters. It's true
of paramatics, it's true of teachers, you know, it's true
of managers. There's all these single these primary you know,
it's called primary care because you're the primary contact, right
And doctors are in this double bind because when finally
someone decides to go to the doctor, they think there's
(16:23):
something real with them. And when you suggest, like hey,
maybe your stomach ache is caused by depression, or maybe
your chronic headaches are tied to anxiety or burnout or
over work, they feel dismissed.
Speaker 3 (16:38):
Right.
Speaker 2 (16:39):
They feel like you're saying it's all in your head.
But these are physiological processes that happen with you know,
our body, chemistry, our nervous system. You can't just as
you said, cut a person off the head and only
treat that and not treat that. Most of the people
I see as a peer counselor one of the fundamentals
(17:00):
at sleep exercise, something is compromised and they've told their
doctor this, and well, something's breaking down at some point.
I mean, you talk about the importance of integrating mindfulness
and exercise into treatment. What does mindfulness mean to you?
(17:23):
Because that's a term. You ask twelve people, you'll get
fourteen definitions, right.
Speaker 3 (17:28):
Yeah, I mean it's an important term. And have some
good friends who work in the area. Mindfulness just in
a general sense relates to meditation practices that raise one's
(17:48):
self awareness to what they're doing. There's also a tremendous benefit.
I mean, Herbert Benson demonstrated that simple mindfulness techniques lead
to reduction in blood pressure and then so on. But
it is a powerful thing that people can do on
(18:10):
their own or which doctors, if they're aware of it,
can prescribe for patients, and it advise they use it.
And so I think it's a tremendous thing that some
of these things you're mentioning, Leanna, diet, cigarette, smoking, alcohol use,
(18:31):
all of these things are implicated in causing most heart attacks, strokes, diabetes, cancer,
and yet medicine does not train its graduates in these
lifestyle factors because they're all psychological and social people drink
(18:56):
for psychosocial reasons, eat too much, we don't exercise, so
on and so forth, smoke too much for example. And
all of these things can be addressed by the medical
profession to prevent all these physical diseases. We see all
the heart attacks, strokes, diabetes, eighty percent of those could
(19:20):
be prevented if medicine addressed prevention. Now, how bad does
medicine do on prevention. In nineteen seventy fifteen percent of
the US population was obese. It's fifty percent today. That
is a terrible condemnation of medicine for not paying attention
(19:44):
to prevention. Instead, what medicine does is let the disease happen,
then it treats it after the fact, and just it's
a disaster that just goes on and on. It is
incredibly expensive. Our hospitals are filled with people with chronic
(20:07):
physical diseases in this day and age. What if you
prevented half of those, you would save tons of money.
Insurance companies would save tons of money, pharmaceutical houses, I mean,
and the whole thing goes on. And so there is
a tremendous not only health downside to this, but also
(20:32):
the financial side.
Speaker 2 (20:35):
All right, Doctor Robert Smith, author of has Medicine Lost
Its Mind? Why our mental health system is failing us?
And what should be done to cure He's a primary
care physician, internal medicine. Robert, can you stay with me
over the break? We can come back talk some solutions
for Berkeley. All right? When we come back, like I said,
solutions too, how to fix this really messed up system
(20:57):
where physical health and mental health are separated with doctor
Robert Smith talking what doctors miss about medical linless. When
we come back on It's Not Therapy.
Speaker 1 (21:09):
Stream us live at SAGA nine six am dot C.
Speaker 2 (21:15):
The following program is a peer to peer advice show
and does not diagnose mental health conditions. If you're seeking
social services, please call or text two to one one
or go to two one one dot CA. We're back
on It's not Therapy. I'm still yet a cursoner. I'm
still not a therapist. We're stalking, still talking to doctor
(21:35):
Robert Smith about what doctors miss about mental illness. And
before the break, Robert took us through this amazing history
and I love this stuff. So I was like, oh,
keep going about sort of how we got here, how
how physical medicine and mental health got split, and some
of the benefits to that in terms of things like lifecancy, longevity,
(22:02):
the stuff we can treat. But Robert, you were saying
the downside is we are very much a sickness based system.
We are not a health based system. As you said,
prevention is not taught. I was just talking to my
husband last night. We just watched All Creatures, Great and Small,
which is a show about a bunch of country vets, right,
(22:22):
but they were they deal with a lot of the
psychology we're dealing with the people who they have to
get through to treat the animals. And it's taken place
during World War two right now, And they were showing,
like how much it took to prepare food back then,
even when I was in middle school, in high school,
(22:43):
we learned how to cook, we learned nutrition, we learned
what went into our food. And a lot of these
programs now are cut. So I want to start here
when we talk about prevention. My god, we could talk
for four hours and barely scratch the surface. So where
do you want to begin in terms of prevention and
(23:05):
mental health.
Speaker 3 (23:06):
Yeah, the first place what we need to begin is
the system itself is not working right, and prevention efforts
and so on will have to come after medicine makes
a fundamental change. Right now, medicine provides no more than
(23:29):
two percent of all training time. It's about fifteen thousand
hours of training over four years of medical school and
three to five years of residency. Only two percent of
that is devoted to mental health care. That's a five
week experience usually in the third year of medical school
on psychiatry. And most of those patients are not like
(23:52):
the patient you'd see in practice. You know, they're very
severely disturbed, not like the garden variety depression, anxiety you
might see in practice. And so only two percent of
time is devoted to training for the most common health
condition they'll see in practice. Medicine has known this and
(24:15):
known the problem since at least the nineteen seventies. I'm
certainly not the first one to talk about this, and
prestigious groups like the Institute of Medicine later the National
Academy of Medicine have said medicine needs to train primary
care doctors in mental health. In fact, the primary care
(24:38):
system has been called the de facto mental health care
system in the US, and people have been saying this
since I think that paper came out in two thousand
and so. Medicine has known this for a long long
time but done absolutely nothing. It's training and mental health
and the other psychological and social aspects of META has
(25:00):
not changed in one hundred years, and quite frankly, they're
not going to change if they're left to their own devices.
This is why I'm getting out and going to the public,
as it were. The public needs to get involved. The
public needs to get angry and say you are not
(25:21):
meeting our needs. Now, you might say, how's the public
going to do this? How will they be a thing? Well,
there's an ample recedent for just this. Ralph Nader came
out with a book you're nodding, you know, with a
book called Unsafe at Any Speed. This book. At the time,
(25:47):
the auto industry didn't put seat belts in cars. It
was too expensive and they were afraid people wouldn't use
them and wouldn't buy cars. And they also had gearshifts
were misaligned, so people went forward when they thought they
were going backwards, and just a host of things. The
auto industry knew it, but they just didn't do anything
about it. Nighbor's book, Unsafety Speed came out and forced
(26:11):
the public forced its politicians to do something about this,
and this is why you today wear a seat belt
in your car and why it drives safely in so
many other respects. Rachel Carson, who I'm sure you've heard of,
also in Silent Spring. Same thing with the chemical industry.
They were polluting everything they stood on. There was DDT
(26:33):
and the water that you and I drank. They knew it,
they didn't do anything about it. Too expensive to fix it.
Rachel Carson's book comes out, the public gets inflamed. They
forced their politicians to do something. This is why in
the US we have the Environmental Protection Agency today. That's
why we drink clean water instead of water with DDT
(26:56):
in it. Has medicine lost its mind, can do the
same thing for the medical profession. Inflame, the public get
its politicians in gear and do something. And you might
ask what would they do once they get in gear,
And my recommendation is that they conduct set up a commission,
(27:20):
be a presidential commission, congressional commission, national Academy of Medicine,
somebody set up a commission that does an investigation of
modern medical education, and they will find it wanting yeah,
and they find that medicine is not training as practitioners
(27:41):
in the most common health condition they will face in practice.
And there's also a scientific basis for this. Medicine is
the only profession only science that does not follow a
modern systems perspective basically means a systems per second, you
(28:02):
mean you cannsider all parts of a problem and how
they interact, not just one part. Medicine considers just the
physical disease part, not the psychological, mental, social part. And
all other sciences have made this transition. Physics everybody's familiar
with went from Newtonian physics to quantity theory relativity theory
(28:27):
and with tremendous advances. Medicine can have the same advances
if it matures into a system's perspective of medicine. But
it has not done this on its own. Even though
it has been aware of a system's perspective for medicine
since the nineteen seventies, it just doesn't do anything with it.
(28:51):
And so medicine needs help. Now.
Speaker 2 (28:54):
I want to go back to something you said before
the break don't blame the doctors because you're speaking to
It's a perfect audience up here in Canada for yell
at the politicians about healthcare, because healthcare is always a
top three voting issue up here. We love our healthcare right.
But going from yelling at the politicians to effectively not
(29:17):
letting them off the hook for the problem, I think
that's something we can talk about with our remaining time,
because what do they do. They blame the doctors here.
We don't have enough primary care physicians, that's the big deal.
So people are lining up for hours when a new
clinic opens up. I saw here. I was one of
(29:37):
the first people in the door at my clinic up here.
I'm a semi rural. It's jumping now, it's super busy,
and they complain about how long it takes to train
doctors and how expensive it is to train doctors. And
so you go in there and you say, well, we
need a mental health component and all these things. They
just go can't afford it. Now, that's nonsense, right, because
(30:01):
they're paying more for our existing system than they would
for a prevention basis.
Speaker 3 (30:07):
Oh, you're right on, yeah.
Speaker 2 (30:10):
So what's some language that people can use when they're
dealing with this, because people go, oh, that makes sense.
Can't afford it? People now with inflation, they understand not
being able to afford eggs, for instance, But how do
you counter that while we can't afford it in a
system that you know is spending a ton of unnecessary
(30:32):
money treating something that could be prevented.
Speaker 3 (30:35):
You nailed it right there. They they can't afford to
not afford it. Is the tremendous savings that will come
from addressing the psychological and social aspects of medicine are
just out of sight. In the US, the healthcare expenditure
(30:56):
is roughly five trillion dollars a year. If and most hospitals,
for example, are full of people with chronic diseases. Okay,
I told you earlier you can present eighty percent of that.
If you prevented eighty percent of that, you would save
(31:18):
all of that money. If from a pharmaceutical houses, if
you prevented that, you would save all that money that
now goes to expenditures. These new drugs for obesity are
costing what one thousand dollars a month, You would be
saving all of that money. All of these people who
(31:38):
from say obesity end up with severe arthritis and have
joint replacements. You'd be saving all of that. And the
savings and just in prevention are in the range. You know,
if you presented prevented eighty percent of this, you cut
to five trillion dollars down to two trillion. It's just
(32:00):
it's unbelievable how much can be saved, and in people
right now. I mean this as just a specific example,
but people with chronic diseases diabetes, heart attacks, heart failure, strokes,
seventeen percent of them are also depressed. Yeah, if you
(32:23):
treat the depression, the physical disease gets better. If you don't,
the physical disease does not get better and costs two
to three times as much to take care of. And
this has been looked at just this specific population. Has
been shown that if we addressed the co occurring mental disorder,
(32:46):
he would save from twenty six to forty eight billion
dollars every year. These are that's enough the money to
support the National Institute of Health. I mean these these
are humongous figures that can be saved. And so the
argument is change the system. Medicine needs to start training
(33:12):
and medical education is the centerpiece of curing all of
this because it is through medical education only two percent
of time to mental health, that doctors get brainwashed into
isolated physical disease medicine. And this is why they need
help to get out of it, because we just keep
(33:33):
training in the same way and they keep doing the
same thing over and over, and so the public has
to get involved. My website, let me tell you this.
There's a way the public can get involved is Robert C.
SMITHMD dot com. And don't forget the MD, because there's
so many Smiths that you will never find it otherwise.
(33:54):
So it's Robert CSMITHMD dot com. Okay, the very first
page you go there will be something that says act now.
This will take you to a sample letter you can
send to the President, the Surgeon General, the National Academy
(34:16):
of Medicine, you're congressperson, and your senator. The email addresses
for them are all can all be found right there
on the same place. You can even add an own
paragraph of your own issues, say ADHD that you've had
and where you've had bad care. But the paragraph in
their advice is just when I'm talking about set up
(34:39):
a federal commission to investigate medical education.
Speaker 2 (34:45):
Yeah, and if you're going to send a letter to
your member of parliament or senator or whoever. People listening,
please customize the letter. It matters. They look for form letters.
I always rewrite it myself in my own words, because
it means more. One letter written by an individual to
(35:07):
your primary care contact person in your government means more
than a protest means more than you know tweeting angrily.
These letters do matter. Phone calls do matter. The entire
purpose of our system is so that there's someone to
yell at about stuff like this. So it's Robert C.
SMITHMD dot com. I checked it out. It works Robert
(35:31):
as in Robert C. Smith like the singer from the
Cure MD dot com. Robert, thanks so much for coming
on it. It's not therapy and sharing your wisdom with us.
Robert's book is has Medicine Lost Its Mind? Why our
mental health system is failing us? And what should be
done to cure. I'm halfway through it. It's fantastic, Robert.
(35:52):
Thank you for writing the book, thank you for coming
on here, and thank you so much for your passion
on this issue. It's really really great.
Speaker 3 (35:59):
Thanks. Ray, appreciate the chance to talk to you.
Speaker 2 (36:02):
All right, when we come back more things you can
do to help encourage change and keep going because change
is slow to com questions, comments, concerns. Leana at not
Therapyshow dot com. Not Therapyshow dot com is my website
at not Therapy Show on socials More. We come back
(36:24):
on what you can do to make change, and it's
not therapy.
Speaker 1 (36:33):
No Radio, No Problem stream is live on SAGA ninety
six am dot C.
Speaker 2 (36:40):
The following program is a peer to peer advice show
and does not diagnose mental health conditions. If you're seeking
social services, please call or text two to one one
or go to two one one dot CA. We're back
in it's not therapy. I'm still at a cursoner. I'm
still not a therapist. We're still talking about mental health
(37:01):
and the medical system, and I want to take the
remaining time to talk about what else you can do
to help encourage change, because, like we said multiple times
during the interview with doctor Robert Smith, it's not the
fault of doctors or first responders that they're not trained
or you know, they have minimal training in mental health practices.
(37:24):
With the shortage in family doctors here in Ontario, and
I know We're not the only jurisdiction in the world
that has a shortage of family doctors, nurses, et cetera.
There's going to be pressure to pump out primary care
doctors as quickly as possible instead of a focus on
additional mandatory training in things like mental health for primary
(37:46):
care physicians. So it's going to be an uphill battle
to advocate for this additional mandatory training, which is why
it's important to speak to local officials in charge of funding.
Just yell at doctors in paramedics or claim all cops
or something or other catchy slogan not really effective in
(38:08):
enacting change. When you're told the mental health system is overburdened,
it's true. When you hear that first responders are under
intense stress and suffer from mental health conditions themselves. It's
true when you hear that our physical healthcare system is overloaded.
That is also true, As Robert said, if you're not
(38:30):
in a major city, services are even more stretched. In
some areas. In Canada, the weight liss wit list excuse
me for mental health services is up to two and
a half years. Two and a half year waitlist now
the first place to look up support services is the
two to one one service that I talk about at
(38:51):
the beginning of every break on this show. Put in
your location on the website and search for mental health.
There are usually more community services and people are aware
of because they're poorly advertised. Using these services helps them
maintain their funding because undersubscribed programs tend to get cut. Now,
if you go on to two one one and you
(39:14):
find that the in person services are quite far away
from you, that's very cobbin, especially if you're on the
boundary of an area. Look up the TELL or internet
services as are there and they're usually marked on the calendars.
Another source of information regarding mental health supports in your
(39:35):
area is your local crisis line. They can inform you
of where the nearest drop in counseling center is if
you don't get very far with two one one, or
you can call the numbers on the two one one
website instead of you know, doing a search looking it
up yourself. Now, sometimes the people on these lines can
(39:59):
be a bit well, rude and dismissive, sometimes condescending, but
your goal is to get the information and their rudeness
is on them. I know, it's bizarre that somebody staffing.
A mental health line would behave this way. But it
(40:19):
is true. I don't get it. I'm just saying it's so.
All you're trying to do is get the information so
you can take that next step. Another next step is
that your local officials put on community events. Find out
where and when they are, and show up. If you
(40:40):
can eat the free hot dog, drink the lousy coffee.
I just drink the lousy coffee because the hot dogs
usually meat, and I don't eat meat. The point is,
the more that local representatives see you as a regular
person out in the community and not just a partisan activist,
the more active you'll be in persuading them that your
(41:03):
issue matters. Talk to other people, not just politicians, about
the importance of community involvement that doesn't involve protests. Politicians
have tuned out protest. Real lasting change is slow, but
it doesn't take a lot of time to send a
letter and make your concerns felt. If you've donated to
(41:26):
political parties in the past, they occasionally send out surveys.
Fill them out. Political parties tend to be laser focused
on top three voting issues. Contact the local political parties
and ask them where they stand on better mental health
primary care. They should have a clearly stated policy in
their platform. If they don't get back to you, as
(41:49):
the Liberal Party did not get back to me before
the last provincial election, well that may affect your vote. Yeah.
Now give all of this ten years of ongoing effort
to work. That's right, at least a decade. This stuff
changes slow. This is why participating in ways you can
(42:12):
sustain is important. Manage your frustration, manage your disappointment. Pay
attention to your own mental health in this process. If
you're getting overwhelmed, step back, just be a person. You're
not required to advocate. The issue will be there when
(42:34):
you're feeling more balanced again. Trust me, the way you
care isn't an indication of how much you care. Trying
to get politicians to spend money on anything that isn't
an immediate crisis is nearly impossible and way well, we
currently don't have the most informed provincial government in this province.
(42:55):
Our premier still thanks you apply for jobs by dropping
off a paper resume at a local business. An area
that we can get more traction on faster is at
your direct community level. Committing to make to taking mental
health seriously in the clubs and groups we participate in,
including online is essential. Don't participate in online pylons, don't
(43:21):
use social media at a fling abuseic strangers, make behavior matter,
and if someone seems to be struggling top ten phrase,
listen twice before you talk once. And if you're wondering,
I'm laughing. My cat's scout is here purring right into
the microphone. So that is a strange noise you may
be hearing on the radio. It is a cat. It's okay,
(43:43):
it's good for your mental health. Cats are good, right, scout. Yeah. Now,
in Canada here there's a bit of you know, people
see it as the Promised Land because it doesn't cost
many to go to the doctor. Okay. In Canada, a
lot of people don't access mental health services because of shame.
(44:08):
They go, they have bad experiences either with the doctor,
with the mental health system, or with the people around
them while they're going through the mental health system, and
they just stop because it's too hard, it's too humiliating.
I share my own experiences with the mental health care
(44:29):
system and my own mental health issues to reduce the
stigma for other people. And let me tell you, it's tough.
People paint me is bad crazy at the drop of
a hat, and they think it has more teeth because
I sought help, and I talk about getting help instead
(44:50):
of recognizing that I'm only good crazy because I got help,
and the people accuse me of being unhinged or have
anger problems or whatever. The latest claim is, Well, there
are people I said no to at least once because
they didn't respect the things I have to do to
(45:11):
maintain my mental health. When I was in intense therapy,
it was hard because my family didn't accept the things
that the therapist said needed to change, and I was
caught between those two pressures. Therapists will drop you if
they think you're not doing the work, but it's very
(45:33):
hard to do the work if your family is referring
to the professional advice as crap before they even try it. Now,
it's trust me, it's tough when you go in and
the therapist just like, do these things, and you're like,
I'm trying to, but it's my family, and the therapist say, well,
cut anybody out who isn't supporting you, and they're right.
(45:55):
But unless you've gone through it, you have no idea
how hard it is getting healthy by changing your environment
can sometimes be the most painful thing you will ever
do in your entire life. I can tell you it's
worth it, but it's hard. Now you can choose to
(46:19):
not be one of the people who makes it harder.
Another person's mental health is not your responsibility, but if
you want them to stay in your life, you need
to work with their recovery, not against it. The most
tragic thing I see on a regular basis is the
family of a person who is struggling keeping them down
because they're demanding quick fixes via some magical medication instead
(46:44):
of helping with those environmental changes at the person's own
pace that lead to the lasting improvements. The mentally ill
person in your family is not broken. You don't send
them to a mechanic for repair, and even if you
could do that, it doesn't last long if you send
them top speed into another crash the minute they get
(47:05):
home again. Conversely, if you're treating them as sick and helpless,
they're going to internalize that message and believe they're helpless
that it's never going to get better. Navigating the current
medical system is extremely difficult, and it's important to reward
efforts going to the appointments, saying what the problem is?
(47:26):
Stuff like that, Trying, really trying, even when the outcomes
are frustrating, disappointing, or even an outright set back, They're
going to happen. Healthy goals are based on things you
can control, and it often takes multiple attempts to get
connected to the right treatment or the right therapist. It's
very rarely. Take a pill and your better, and you
(47:47):
can help with the journey, even if you can't force
the destination. Questions, comments, concerns Leanna at not Therapyshow dot com.
Not Therapy Show is the website not Therapy Show dot
com as the website at not Therapy Show on socials.
Change is hard and it's slow, but if we never start,
(48:07):
it never comes. And as slow and hard as it is,
change is possible if we keep at it. These things
gain momentum with time. You're probably feeling like it's enormous
right now. Welcome to the last you know, ten fifteen
years of my life. But I am out of time
with you. You're crazy is only a problem if it's hurting you.
(48:30):
Talk next time.
Speaker 1 (48:32):
Stream us live at SAGA nine sixty am dot CA.
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