Diagnoses: More Harm Than Good? With Dr. Stu Law pt. 1

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:03):
You're listening to Why We Do What We Do. Welcome
to Why We Do What We Do. I am your
questioning common practices host, Abraham.

Speaker 2 (00:22):
And I'm your potentially anti-DSM host, Shane.

Speaker 1 (00:26):
We are a psychology podcast. We talk about the things
that humans and non-human animals do, and sometimes we bring
people with us to help us on that journey to
talk about things that we maybe shouldn't do so much,
no mo. But if you're joining us for the first time,
then welcome. Hope that you enjoy what you hear in
this discussion. And if you're a returning person, then welcome back.

(00:47):
And thank you for finding your way to us once again.
And either way, if you'd like to support us, you
can do that by joining us on Patreon, leaving us
a rating and review, like, subscribe, and tell a friend.
I'll talk more about those things at the end of
this discussion.

Speaker 3 (00:59):
Hey.

Speaker 1 (01:00):
You could also name a diagnosis after us if you'd
like to. Don't do that, actually. That would not support us.
Take it back. Don't do that. Either way, hey, if
you are listening to this on the day that it publishes,
it is August 26th. So happy Congressional Startup Day. I'm
not sure I want to know what that means.

Speaker 3 (01:18):
Who knows?

Speaker 2 (01:19):
It's just start your own Congress, I guess.

Speaker 1 (01:20):
Okay.

Speaker 2 (01:21):
It is Make Your Own Luck Day.

Speaker 1 (01:23):
And you can do that by celebrating Musical Yoga Day.

Speaker 3 (01:28):
Sure.

Speaker 2 (01:29):
And then it's also National Cherry Popsicle Day.

Speaker 1 (01:32):
And maybe related, National Dog Day. Oh, those aren't related.
I'm sorry. Again, undue. I need to stop connecting dots
to things that should not be connected.

Speaker 2 (01:41):
It's like that scene in It's Always Sunny. It's you're
the Pepe de Silva. You're like the red yarn everywhere.
You're freaking out like Charlie Day. It's great. It's National
Toilet Paper Day. Also, don't connect that to Dog Day
or Cherry Popsicle Day.

Speaker 1 (01:55):
But you can use that toilet paper to celebrate Tug
of War Day because it's also that.

Speaker 3 (01:58):
Sure.

Speaker 1 (02:00):
Short game.

Speaker 3 (02:00):
Yeah, yeah, yeah.

Speaker 2 (02:01):
Real quick game. You can also tie Toilet Paper Day
to Willing to Lend a Hand Wednesday.

Speaker 3 (02:05):
Oh, no.

Speaker 1 (02:08):
Yikes.

Speaker 2 (02:09):
If you've ever been stuck, you know.

Speaker 1 (02:11):
Jeez. It is Women's Equality Day. Something to not make
jokes about, I guess.

Speaker 3 (02:17):
Yeah.

Speaker 2 (02:17):
It's also Be Kind to Humankind Week. Indeed.

Speaker 1 (02:21):
It's Break Safety Week, as in you can break something safely.
You can stop slowly to break safely. You can take
a break and do so safely. But it's spelled B-R-A-K-E,
so there's that.

Speaker 3 (02:32):
Yeah.

Speaker 2 (02:33):
It's National Safe at Home Week.

Speaker 1 (02:36):
Do not leave. Zombies will get you. It is World
Water Week or Water World Week. I think we just
got the words in the wrong order.

Speaker 2 (02:45):
Yeah, it's Waterworld Week. It's celebrating the masterpiece that is
Waterworld starring Kevin Costner and his gills.

Speaker 1 (02:54):
Oh, man. For those of you our age, that will
make sense. And for those of you younger than us,
unlikely you've seen that film. That's okay.

Speaker 2 (03:01):
Treat yourself.

Speaker 1 (03:02):
Treat yourself. Yeah, go check it out for a blast
of 90s. We don't need to keep talking about holidays, though,
because that's not why we're here. Instead, we're taking on
a different question, a different discussion, and introducing our guests today.
But before I do that... I'd like to do a
little bit more setup and intro here, but am I
missing anything or is there anything you'd like to add

(03:24):
before we begin our topic, Shane?

Speaker 2 (03:26):
No, I don't think so.

Speaker 1 (03:28):
Okay, let's start with the fact that a significant number
of professions, I don't know what proportion or anything, but
there are a lot of people. There's a lot of
people in a lot of jobs and a lot of
spaces who have as their primary or maybe secondary or
some part of the realm of things that they do,
they have an objective to solve problems. I would argue
that a lot of professions, that's kind of all they

(03:48):
do is solve problems. But that's okay. There's a lot
of solving problems is something that is part of work
that we do as people. And that usually means that
the first step is identify problem. Usually through some kind
of process of diagnosis. You can think of it like
a mechanic. They figure out what's wrong with your car.
They get a diagnosis first, and then they're going to
move forward with that afterwards. So there's a lot of

(04:09):
different spaces this shows up. But that is like step
one of problem solve maybe is identify problem.

Speaker 2 (04:15):
Yes, and diagnostics can help triage issues and direct treatment
or intervention in some way. Like that's usually what they're, it's,
you've got the diagnosis as a result of the diagnostics
that guide or give you guidance to where to go next.
But diagnoses can also be incorrect, misleading and create more problems.

Speaker 3 (04:32):
Yeah.

Speaker 1 (04:32):
So like there's, there are pros and cons here. There's
maybe there's, there's benefits in this system. And arguably some
of these, some of the systems that use the diagnostic
process use it to a greater effect than others. And
there's probably a spectrum around which this is there's use
utility in doing these kinds of things. That sort of
brings us to introducing our guest here. This is probably

(04:52):
our most frequently recurring guest. We're happy to have him back.
This is Dr. Stu Law, who's joined us in the
past in various episodes, as I just alluded to. You
can go check those out if you're particularly persuaded by
his charm and charisma today. But yeah, Dr. Stu Law,
tell us a little bit about yourself.

Speaker 3 (05:10):
I am a behavior analyst, kind of straddling the line
between behavior analysis and clinical psychology. So I spent a
good chunk of my training in a lab accompanied by
a bunch of very behavior analytically minded clinical psychologists. And
we studied things like something we're going to talk about

(05:32):
a little bit, I hope. Ideonomic analyses, ideo meaning starting
at the level of individual and then nomic meaning leading
to broad principles. And then I am the developer of
a behavioral assessment called Generate. which is like a skills
assessment or a skills inventory kind of approach to human wellness.

(05:55):
So we get a sense of what people can do,
and then we compare them to some outcome that they
tell us about. So that's one of the things that
kind of makes it a little different from other assessments.
We don't say like, here's normal kids and here's your kid.
Your kid wants to be normal, right?

Speaker 1 (06:11):
Right.

Speaker 3 (06:12):
There's a lot of talk in the field right now
about indistinguishability as a goal, ascent-based treatment, getting people generally
on board with the things that you're doing with and
to them. And we think we have some technological things
that can help practitioners support them in that journey.

Speaker 1 (06:30):
So this is kind of its own diagnostic tool.

Speaker 3 (06:34):
Yeah. I mean, in a sense, we're leading the way
as to like where we want this thing to go
and how we want psychology of the future to look
now that we have, again, as we'll talk about, like
a lot of new technologies and tools at our fingertips
that I think have historically been unavailable to us.

Speaker 1 (06:54):
And for those who are interested in looking it up,
it is not spelled the way you might look to
spell generate G E N A R E T E.

Speaker 3 (07:04):
Yeah.

Speaker 1 (07:05):
I'll say that one more time. G E N A
R E T E. And, and you have essentially rolled
this out. I'm understanding with there's like a website and
like a workbook that will guide you through conducting this
assessment and that sort of thing.

Speaker 3 (07:19):
Yeah, and our kooky name, we didn't reach the conclusion
that we needed a bad spelling of a real word, likely.
I think that's a term that I tend to try
to avoid. But the origin was just too good. We
couldn't help it. So our name comes from gen or
genesis or the origin of and then a rate. It's

(07:40):
pronounced other ways, but it's a Greek word that means
to reach self-fulfillment or like a metaphorical peak. So we
thought it was a really nice way to orient people
to like, hey, we're.

Speaker 4 (07:50):
Doing this as one a little bit differently.

Speaker 3 (07:52):
And it has to do with notions of self-fulfillment, reaching
purpose in life and those kinds of things.

Speaker 1 (07:59):
Nice. All right, well, we have a lot to unpack
in this discussion. So I'm sure there'll be opportunities to
continue to bring in what you have developed as it
relates to this type of assessment. And I think we've
more or less teed up our topic today. But I
want to make sure we're actually sort of setting the
stage here in a way that allows us to move

(08:21):
forward cogently with this conversation and not having people feel
particularly lost. Because I started this by talking about diagnoses.
And then we sort of talked about diagnoses. can sometimes
be not the most productive direction to go. And there's
a variety of reasons for that that we'll get into.
And so really the purpose of this discussion is as
it relates to diagnosis for things like mental health, you

(08:44):
can maybe make the argument that that could be a
separate category from like behavioral concerns or that maybe people
would think of those as being separate things. But the
point being that there is a diagnostic label, a diagnostic
system that is applied to behaviors of people, and that
that system has, while it has been around for the

(09:05):
better part of a century, what does it continue to
contribute to our understanding of human behavior? What pitfalls do
we see? And what can we do moving forward? thinking
about the impact that this has for humans, broadly speaking,
for our profession and other psychologists, maybe more specifically, the

(09:28):
sort of debate set up here is like, do diagnoses
do more harm than good?

Speaker 3 (09:34):
Yeah, that is the setup, I think. It's one that
you kind of baited me into.

Speaker 4 (09:39):
Yeah. A little bit.

Speaker 3 (09:42):
But it's noteworthy that, you know, it feels a little
anti-science to go against kind of this mainstream way of
looking at things. But hopefully we'll set forth some things
that don't feel like we're trying to take the like
anti-vax path.

Speaker 4 (09:59):
You know what I mean?

Speaker 3 (09:59):
Sure. This was kind of the focus of our lab
in the entirety of kind of my graduate career.

Speaker 4 (10:05):
And I think we make some good points.

Speaker 3 (10:08):
We try to back it up with good science and
point to very pragmatic solutions and where we can go
next and how we've maybe demonstrated that as much as
it Sounds really cool to apply medical models to psychological problems.

Speaker 4 (10:24):
That comes with some baggage.

Speaker 3 (10:26):
I think that's a fair stance to take. Maybe that
it didn't do more harm than good. That's a high bar,
but it definitely comes with some baggage. Okay. I agree.

Speaker 1 (10:39):
And I kind of want to try to, as much
as I can make myself do this, be the devil's advocate,
be the voice of the denier, the doubter, the skeptic
who might hear this and think like, I don't like
what this guy says. I don't like it. I think
he's wrong. Even though I think I'm probably not going
to feel that way internally, I want to try and
be the voice of the audience who might. So I'm

(11:00):
going to try and challenge you where I maybe see
opportunities for doing so.

Speaker 4 (11:04):
Okay.

Speaker 1 (11:05):
And not out of anything other than love, you know,
but for the purposes of this discussion. But let's go
ahead and start then with the first thing to make
sure we're all on the same page about is what
is the diagnostic system for mental health? A system, but
we also have a specific system that we can talk about. Yeah.

Speaker 3 (11:24):
So I think it generally is probably not going to
be surprising to people to hear that the prevailing strategy
in clinical psychology for the past couple of decades, maybe
since the 80s even, has been to take the medical
model and study psychology in the same way that we
tend to understand medical mysteries. So your job as a

(11:47):
psychologist is to identify syndromes. So step one is to
kind of identify some class of symptoms that hang together.
And then as scientists, what we've generally tried to do
is create protocolized treatment packages that then address those syndromes.
So step one, identify signs and symptoms that hang out together,

(12:11):
identify them as common sense syndromes. And then step two
is to identify packages, treatment packages that are evidence-based that
fit those syndromes.

Speaker 4 (12:22):
So the DSM is kind of the most common one that.

Speaker 3 (12:25):
Many are familiar with, but there are others that are
kind of competing it. So the World Health Organization has
the International Classification of Diseases, which is sort of a
competitor for the DSM that some people have turned towards,
in part because it's kind of an open secret, not
to get ahead of our skis, but it's kind of
an open secret that even people who've written the DSM

(12:46):
are terribly thrilled with some of the things that are
coming out of it.

Speaker 1 (12:50):
Very fair.

Speaker 4 (12:50):
But in short..

Speaker 3 (12:52):
In short, not to be demeaning to this approach, but
we've tended to call it protocols for syndromes.

Speaker 1 (12:58):
Very fair. I should have warned you ahead of time.
I'm going to intermittently and sneakily throw in some random
segue to an ad. So step one, step two, and
step three is ads. Sure. All right, we're back. We've
just started unpacking sort of what a diagnostic system is

(13:21):
with respect to understanding and talking about mental health, behavioral health,
those sorts of things. And as you said, essentially, just
saying this slightly differently, we actually did an episode a
long time ago. People could check out if they're interested
about diagnosing mental health conditions where we sort of just
walk through the history of systems that have attempted to

(13:43):
do something like this. And we talked about the ICD,
talked about the DSM, some of the iterations it's been
through and various approaches that have been taken to trying
to handle this. And there's also others in other parts
of the world that kind of do their own thing
with it. But yeah, it is like we observe a
thing that people are doing. We decide that's a thing
that they maybe shouldn't be doing in some capacity. And

(14:04):
then we say, we're going to call that something. There's
a problem here. That problem needs a label. I want
to call it the thing. And then, as you said,
from there, there's often... figuring out what we're going to
do about it becomes the protocol. But first we want
to call it something. So when someone does these behaviors
and someone else does some behaviors, I'm going to say
those look close enough that we're going to call those
the same type of things. We're going to call that

(14:24):
one bipolar and that one's bipolar or whatever. That's sort
of broadly how people have approached this idea of thinking
about classifying behaviors in a way that we would relate
them to this idea of mental health is just sort
of what do we see What do we call that
thing that we think we shouldn't be seeing that we
maybe should do something differently about? Because presumably those classes

(14:48):
of behaviors are– the concern is that they're pathological, that
they're adverse and that there's something wrong with them and
that that means something wrong for the individual. And I
think in many cases, you have a fairly strong case
for having said that because this is someone who might
be hurting themselves or hurting other people a lot. and
that they're doing things that are pretty unambiguously adverse to

(15:10):
their overall well-being. But other things, I think, much less
clear in the extent to which it's something that is pathological.
And maybe we don't need to go all the way
down that rabbit hole, but let's instead pivot to what
problems this system was supposed to address. Why would we
even want to develop this in the first place? Yeah.

Speaker 3 (15:30):
So one of the things that we commonly cite when
we're approaching this issue, this is I don't even know
if it's famous, but in my book, I've probably heard
this quote a thousand times.

Speaker 4 (15:41):
And it's Gordon Paul.

Speaker 3 (15:42):
He has this sort of infamous question. He says the
purpose of psychological treatment and the approach that we're taking
is to determine what treatment by whom is most effective
for this individual with that specific problem under which set
of circumstances and how does that come about? So all
of those questions are what we are trying to accomplish

(16:04):
when we take the syndromal approach to psychology. That is
the problem we're trying to solve. So what treatment should
we deliver? Who's going to deliver it? For what problem?
And then under what set of circumstances and who's allowed
to do it? So all of those kinds of questions
are the kinds of things that in psychology, I would

(16:24):
say we have spent years. the vast majority of our
time and effort trying to solve.

Speaker 1 (16:31):
Yeah. And yeah, thinking through the fact that this is,
as I was pointing out earlier, like there are people
who are doing things that are fairly unambiguously difficult. They're
maybe creating situations where they are not able to participate
very fully or meaningfully in whatever part of society they
find themselves in. It could be taking care of themselves.

(16:53):
It could be taking care of others. Again, there could
be active harm that's coming to them. Or they're like
struggling to participate in a way that we typically expect
that most people will be able to participate. And you
could certainly make the argument that this is a systems problem.
It's like we have systems that are just not designed
to accommodate a wide range of ways that different humans

(17:14):
show up in the world. And I think that's a
point that's very true. And then there's also like the
fact that people do legitimately experience distress. Like they're legitimately reporting,
I wish that I could think about this or handle this.
psychological experience I'm having in a more practical way.

Speaker 4 (17:31):
Yeah.

Speaker 3 (17:32):
I think one of the advantages of the system is
it's a really nice shortcut. I think there are other
ways to this solution, but you know, it's a really
nice way to create systems of care and identify the
need for care and identify the need for compassion. And
just like a understanding of where a person's coming from,
because if somebody is coming to you and saying, I

(17:54):
need help, And I recognize that I need help. And
there are times where I might not say that out loud,
but in my more sober and taking the sort of
broadest sense of the word in my more sober states
of mind, like I recognize that I'm not in a
good space and I need somebody to help intervene, even
if it's, you know, at times.

Speaker 4 (18:15):
Something that I might resist. And so, yeah, setting oneself
up for How.

Speaker 3 (18:21):
Do we identify a clinical threshold where those things happen?

Speaker 1 (18:28):
Okay. So I think, at least for me, this feels
like this has adequately set the stage for sort of
why the system began to exist in the first place.
Is there anything, Shane, that you feel like you'd like
to see that I maybe missed or would like to
add to this before we start talking about what issues
have maybe been created by this same system?

Speaker 3 (18:47):
No, no, no.

Speaker 2 (18:47):
I'm really excited to get into this because I feel
like as somebody who trained in a clinical psychology space
prior to behavior analysis, I'm really excited to kind of
get into this and like really unpack this a little
bit more. Cool.

Speaker 1 (19:01):
Anything else for you Stu in terms of unpacking like
the premise for the system existing to begin with?

Speaker 4 (19:08):
No, I don't think so. Yeah.

Speaker 1 (19:10):
Okay. All right, so let's start, I think, digging into
what kind of issues were going to be created by
such a system. And I think you could argue in
a lot of cases where there's any kind of diagnostic
system that there are some issues that are going to exist.
The medical model certainly has its own issues. and that
they've been Yeah, absolutely. Yeah.

Speaker 3 (20:03):
So one of the things that the system has struggled
to do is find specific syndromes. So identify syndromes, diseases, disorders,
things that are very orderly unto themselves. So one of
the things you might say is that the DSM has

(20:23):
suffered from underwhelming specificity. So kind of famously, PTSD can
be made up of any one of 636,120 symptom combinations.

Speaker 4 (20:36):
So if you were.

Speaker 3 (20:39):
To take things that are not psychologically medical, like the
flu or, you know, gout or something like that, signs
and symptoms tend to lump together in a much more
orderly fashion and with much more specificity such that when
you go to the doctor, they have a pretty good

(21:01):
sense of.

Speaker 4 (21:01):
Like, oh, that's X, Y, Z. So. this is not
the case.

Speaker 3 (21:06):
So like a sign or symptom might be like, you're
not eating, you're lethargic, right? Things like this, you know,
the signs and symptoms, the sheer number of possibilities and
combinations are dizzying. And that is problematic from a perspective
of trying to, you know, identify order in these spaces,

(21:27):
because if somebody comes to you and they say, I'm
not eating, I yelled at my kid the other day.

Speaker 4 (21:32):
I'm irritable. I'm not sleeping.

Speaker 3 (21:36):
And then you have somebody who has none of those
signs and symptoms and you're giving them the same diagnosis.
There is some degree to which that happens in medicine.
For example, you might have the flu and you might
have a kind of stomach issues, whereas somebody else might
have a really bad headache or something like that. But
generally speaking, When we are trying to diagnose the initial

(21:58):
onset of something for which we have a treatment, we're
doing so in a way where the signs and symptoms
hang together a lot better than they do in the
psychological world.

Speaker 1 (22:09):
You know what's wild about that number that you threw out?

Speaker 3 (22:11):
636,120.

Speaker 1 (22:11):
That's how many episodes we've got?

Speaker 4 (22:14):
Boy, that'd.

Speaker 1 (22:18):
Be quite the coincidence. If you were to just Google
how many words there are in the English language, the
estimates range from 170,000 to a million. And this is
like toward the million side of that. Like there are
more symptom combinations than one of the estimates for the
number of words in the English language. I was like,
I'm not sure that I know 636,120 words and I

(22:39):
have a pretty big vocabulary. So that's a lot. That's
a big number.

Speaker 4 (22:45):
Yeah.

Speaker 3 (22:46):
And, uh, you know, and it's noteworthy that This isn't
just like on paper. It's possible that people have different
signs and symptoms for the same diagnosed syndrome, right? So
it could be the case that there's a whole bunch
of them or a whole bunch of pathways that never
get used, but that we don't think is the case.

(23:08):
So there's examples where people with major depression... So they
did a study where they evaluated 3,700 of them, and
there were 1,030 unique pathways inside of that.

Speaker 4 (23:21):
So people are using all of the pathways.

Speaker 3 (23:24):
So it's not just that there's signs and symptoms that
could exist, but they seldom come up. All of those
different pathways are being used, and people are showing up
in many different ways.

Speaker 4 (23:36):
And it's being called the same thing.

Speaker 3 (23:38):
Right.

Speaker 4 (23:38):
You know, just in terms of trying to create a system,
it creates some problems.

Speaker 1 (23:43):
I would presume based on that, like, yeah, like over
a thousand people who have not one thing in common
with one another, who all have the same diagnoses, not
like symptomatically, not one thing in common, the exact same diagnoses.

Speaker 3 (23:57):
Yeah.

Speaker 1 (23:58):
And that sort of speaks to like, how descriptively accurate
or useful could this be if it is the case
that like, again, there's just no overlap with the things
we've used to identify a diagnosis, split that many different ways.
Is that really the same thing going on for each
person in that situation?

Speaker 2 (24:19):
It seems unlikely.

Speaker 1 (24:20):
Yeah.

Speaker 3 (24:21):
Well, and if you were to look at therapeutic approaches
as therapeutics, so think about medical interventions and these things
aren't designed to get rid of the virus or to
alleviate something correctly, but rather to provide some relief, right?
So put ice on your knees or take a warm

(24:44):
bath or put some vapor rub on your chest or whatever.
It's going to be really hard to recommend those things
if those signs and symptoms are very different, right? So
If somebody were to have an upset stomach and you're.

Speaker 4 (24:57):
Like, VapoRub, you have the flu, VapoRub, and that's going
to immediately make them hurl. Well, now you've got some problems.

Speaker 3 (25:06):
And I tend to think that a lot of psychological
signs and symptoms, we need specificity on the signs and symptoms.
And often we are looking at the signs and symptoms
and we're trying. So if somebody is not sleeping, it's
probably a good idea to get them some intervention or
some plan or some organizational things around like, okay, here's

(25:26):
how we get you to sleep. And here's how we,
you know, so it's, you know, it's, it's kind of
three things, right? One is these signs and symptoms don't
hang together. This is how it occurs in the real world.
And those signs and symptoms are the things that we generally.

Speaker 4 (25:44):
As psychological professionals are looking to treat on the forefront.
So that creates quite the headache. I tend to think.

Speaker 1 (25:53):
Ads create quite the headache.

Speaker 2 (26:02):
It's so funny because I was thinking about this from
just the idea and kind of thinking about the perspective
of what people generally do with the diagnosis, right? So
you've got all these symptoms and you've got all these
combinations of symptoms that make it kind of disorderly in
what is described as an orderly system. I'd be curious
about whether or not what people are doing is they're

(26:24):
not really looking at the symptoms and they're, or they're
not even looking at the title or the diagnosis. What
they're doing is they're going, the minute they get that label,
they're assuming that that's causal or they're, they're assuming that
there is like, oh, like that's where it's coming from. Like,
so when you hear major depression, you go, it's not
like what is happening. It is, oh, there it's major depression.

(26:46):
So now I know, I know where that's coming from.
I know the beginning stages are like the, you know,
the focal point of where to intervene. Which I'm sure
is happening, but I think that that's what I'm kind
of noticing is like people are going, they're conflating label
versus cause, I think, when they hear that.

Speaker 3 (27:01):
Yeah, and I think if, you know, eventually I'm going
to deviate from my receipts and that's one of the
ones that I have personally is.

Speaker 4 (27:09):
It tends to feel like.

Speaker 3 (27:11):
These things are treated as causal entities and that to me,
and just in pop psychology, that is a lot of damage.
Even if it doesn't trickle up to professionals and professionals
can identify, you know, hey, this is not a causal
entity and we still have.

Speaker 4 (27:27):
To ask good questions. If that were the case, then
I don't think that it is.

Speaker 3 (27:30):
I do think a lot of professionals take these as
causal entities rather than descriptive entities.

Speaker 4 (27:36):
Mm-hmm.

Speaker 3 (27:37):
Even if that were true at the level of the population,
that would create quite some headaches for us. But I
tend to think it's true both at the level of
the population and many, many practitioners take them as causal entities.
But disorder, which many of these things are, they're not
designed or intended to be causal structures. This just means

(27:58):
there's typically order, which I kind of disagree with that notion,
that there is order in people's lives. I think people
are different, and we'll talk about that more later. But
disorder just means we're finding that there's not a lot
of order. And that is not intended to be a

(28:20):
causal structure that moves and grooves things, that it doesn't
push and pull things.

Speaker 4 (28:26):
It's circular, right? I'm sure you guys have talked about.

Speaker 3 (28:28):
Things like that before, but I tend to think a
lot of diagnoses are treated circularly in that fashion. Mm-hmm.

Speaker 1 (28:36):
Yeah. Actually, maybe our second episode ever was about like
circular reasoning. I have to imagine, yeah.

Speaker 3 (28:43):
Yeah.

Speaker 1 (28:43):
I beat this drum many times and I will continue
to do so. And I'm realizing I'm doing a terrible
job disagreeing with you about things. I'll try to do better.
But it's like we see someone doing some behavior and
we're like, I'm going to call that behavior X. And
then someone's like, why is that behavior happening? Like, because
of X. I'm like, yeah, but you just You just
called it that. You just made up a name for it.
You're like, I'm going to call it X. And now

(29:04):
you're saying that's the reason they're doing it. That's not
the reason. They're just like, all you've done is call
it a thing. And now you're assuming that that has
some causal, that that name somehow is making that happen.

Speaker 3 (29:15):
Yeah.

Speaker 1 (29:15):
You can see the carryover from like medical where it's like,
why am I throwing up all over the place? Oh,
because you have cancer in your stomach. And like, oh,
so that's making me throw up everywhere.

Speaker 3 (29:24):
Yep.

Speaker 1 (29:25):
And so that diagnosis does tell you what the cause
of the symptom is. in those cases. But when we're
talking about the psychological things, again, you're just sort of
applying a name to a cluster of hundreds of thousands
of symptoms, apparently in some cases, and then saying that like...
that's the thing that we're observing. And then now also
assuming that that's the cause when all you've done is

(29:45):
label a cluster of symptoms. And that, yeah, that causal thing,
I agree, is it's a stick in the craw thing
for me where I'm just like, ugh, that's terrible.

Speaker 4 (29:55):
I'll be you for a minute and do your job
for you.

Speaker 3 (29:59):
And I would say, you know, like that label, despite
and that method and that way of doing things does
provide a way forward potentially.

Speaker 4 (30:09):
Right.

Speaker 3 (30:09):
Like it provides, I mean, one of the things that's
really kind of self-evident is that it generally provides a
sense of.

Speaker 4 (30:15):
Relief, right? Like at least I have a name for
this thing.

Speaker 3 (30:18):
Right.

Speaker 4 (30:19):
And that in the medical world is a very common experience. Like,
I went to.

Speaker 3 (30:23):
Doctor to doctor, and even if it's terminal cancer and
there's no way forward, at least I know what this
thing is, right? At least I have a word for it,
and at least I have some closure. I can find
communities of people who are experiencing similar things, and having
those words and labels, it's not entirely without utility, right?

(30:44):
you know, having words and labels for things can be
a tremendous relief. It can provide, you know, closure in
a sense, you know, and I think those things are useful,
useful elements of what we're doing here. It does have
the unfortunate side effect of some of the baggage that
comes with that, right. Of, you know, I can't because

(31:05):
I'm depressed.

Speaker 4 (31:06):
I can't because I have ADHD. I can't because, and.

Speaker 3 (31:10):
That fusion with that thing, can be problematic, but it
can also not be problematic.

Speaker 4 (31:16):
It can be part of your identity, part of how
you move forward.

Speaker 1 (31:19):
I'd argue that's problematic, but that's okay. I appreciate you
being your own devil's advocate when I wasn't going to be.

Speaker 2 (31:30):
I do appreciate him being the devil's advocate and then
you disagreeing with him while he was being the devil's advocate.
There's something really special about that. Yeah.

Speaker 3 (31:39):
True.

Speaker 4 (31:40):
We're role swapping. Yeah.

Speaker 1 (31:44):
Yeah. All right. I've been outlining again several of these issues,
which I think is great. And one of them being
the fact that there's this lack of specificity, which has
the fact that it is not a very reliable or
valid type of system. Like if we're talking about the
utility of some kind of assessment being reflected in its

(32:05):
ability to be reliable or valid. with that many issues already,
it lacks those two criteria for being useful. And in
addition to that, there's another one that definitely stands out
to me as a common thing that people have both
criticized about this, but also really latched onto as an
important feature of their diagnoses is this comorbidity. And for

(32:29):
those people who don't know that term, it means that
like this diagnosis tends to also happen more with this
other diagnosis. It's like, if you have autism, you probably
also have ADHD or something like that. You know, like the,
the things, or you might, there's like, there's a, there's
a rate at which they co-occur frequently enough with each other.
And I, and I sort of pointed out at one

(32:50):
point in, uh, in one of our discussions where I
was like, all right, if you've got 99% of your
people with dyslexia also have ADHD, let's say I'm like,
To what extent are those different things? I mean, if
you feel like there's that much overlap, where do you
draw the line? And obviously, most things aren't that high.

(33:10):
But the point being that it is the correspondence, the
rate at which two diagnoses tend to hang together, which
is surprisingly high in the diagnostic space with respect to
mental health and behavioral health specifically.

Speaker 3 (33:25):
Yeah. Yeah, I mean, if you just think about that
inside of the medical model again, it's something that doesn't
really happen.

Speaker 4 (33:32):
Unless there's like a mechanistic... If then, right? Like, so
if you're not eating, you might experience these other signs
and symptoms, but the notion that you have the flu
and therefore you have a 80% likelihood of being like
diagnosed with scurvy, right?

Speaker 3 (33:54):
Like that's not how diagnoses work in the medical world,
but I tend to think, and I think there's good
evidence to show that that is how things work.

Speaker 4 (34:03):
Inside of the psychological medical model.

Speaker 3 (34:06):
If you're diagnosed with one thing, the chances of being
able to, you go to a different psychologist and you
get diagnosed with something completely different or, or even just
people getting diagnosed with things in general. Like I think,
you know, there's kind of this general notion that at
some point in your lifetime, if you went into a psychologist,
you could get a diagnosis for some kind of thing. Yeah.

(34:28):
And these things also span these axes. So inside of
the DSM, there's this general notion of like, hype subtypes
of diagnoses. Right. And they fall upon one of, I
think three axes and that diagnoses span. So like if
I'm diagnosed with depression, severe depression, the chances that I

(34:50):
qualify for like severe psychosis and things like that is
like on the table.

Speaker 1 (34:54):
Right.

Speaker 3 (34:54):
And so these things span the axis. It's not just like,
If you're depressed, you might also be dysthymic. It's not
that kind of thing. It's a lot of other kinds
of things. We've seen evidence. I mean, it's not evidence,
but anecdotally, you watch TV and they go, were you
diagnosed with depression and you started taking an antidepressant and

(35:17):
then you started getting manic?

Speaker 4 (35:18):
Well, guess what? We just uncovered that you're actually bipolar.

Speaker 3 (35:22):
And this is a different thing and you need a
different medication that's going to help your medication not make
you bipolar. Right. And so these kinds of things are
very common in in this way of doing things. If
you have one thing, the chances of being able to
say you have something different is very high. The chances
of during your lifetime, us being able to slap some label,

(35:44):
if not multiple labels on you is very high. And
if these things are disorders in a medical sense, that
ought not be the case. It's at least inconvenient for
that to be the case inside of the system.

Speaker 2 (35:57):
To be fair, all those people in those commercials seem
to be really enjoying those concerts.

Speaker 4 (36:00):
That's true. That's true. They don't have anything.

Speaker 3 (36:03):
I mean, I think that speaks to the point that
those people have bipolar disorder.

Speaker 4 (36:06):
What the hell am I doing? Those people are having
a great time at a barbecue.

Speaker 1 (36:12):
I can't even enjoy a jazz routine. Speaking of which,
here's an ad for a jazz routine. I was trying
to do my job a little bit more as you
were talking through this and thinking through like, would someone

(36:33):
maybe have the thought that like, okay, but maybe it's
the case that just because people have these diagnoses, like
they're just more likely to also have these other problems.
And so it's good that the system does a good
job catching these other problems that these people like might
have because it's It just is the case that like
if you've got one that can spiral into others or

(36:54):
it might mean that you already have a sort of
pre– you're sort of already at a higher risk for
having more things. And so the system is working by
catching all the things you might have.

Speaker 4 (37:07):
Yeah, I think that's good. good idea, I guess.

Speaker 3 (37:11):
And I would tend to think that that's kind of true,
but I, my approach doesn't adhere to diagnostic systems more generally. Right.
So I think if that's the case, cool, we need
a new system because the purpose of this system is,
is to say you have X, therefore Y is the

(37:32):
specific treatment that fits this specific problem. And inside of
a system like that, Again, flu tends to lead to scurvy,
tends to lead to whatever, is not generally how these
things work outside of the psychological medical model. If that

(37:52):
is the case, psychological phenomena are weird, and we ought
not think of them like medical phenomena because they're different.
And this like use case of if you have one thing,
it can lead to something else and it can lead
to something else. And the dysfunction that you're experiencing in
one space leads to it.

Speaker 4 (38:12):
Then cool. Let's not call it one thing.

Speaker 3 (38:16):
And let's look at the processes of change that are
leading to those diagnostic systems.

Speaker 1 (38:23):
I do think one of the things that stands out
to me as a reason that the same model just
doesn't apply very well in the space of psychology is
the number of variables that contribute to a set of
symptoms medically. And I'm sure some medical doctor is going
to disagree with me, but I'm like, it seems vastly
smaller than the number of variables that contribute to a

(38:43):
psychological phenomenon. Because psychological phenomenon also includes medical phenomenon. It
also includes like basic health things, sleep, nutrition. If you
have actual like medical issues that might be causing you
distress or suffering in other ways. The social things going
on in your life, the entire history you have up
to that moment that you're in, the context of the
moment that you're in, like all these variables that is

(39:06):
just there are probably thousands, if not many, many hundreds
of times that number of variables all participating in sort
of an ongoing evolution of factors that contribute to your
experience in any given moment. versus with the medical thing,
I'm like, we got cells, we got parts of your
body that do stuff, we got diseases that exist, and

(39:28):
we can identify those things pretty clearly because we know
what they all are, and we can mostly observe them
empirically and objectively. And therefore, we can sort of rule
in and rule out and make clear delineations between Problem A,
problem B. And there's going to be a lot of
things that are still ambiguous. Obviously, if we had solved
all the medical things, there would be no more medical
research because we would have solved all medical things. We haven't.
That's still an ongoing thing. But the point being that

(39:52):
I don't even know if we'll ever be able to
enumerate the kind of variables that contribute to fully to
anyone's particular psychological experience in a moment because there's so many.
And at some point there's like diminishing returns on how
much you can get from that. But the sheer volume
of variables is vast, vast, vast. And the likelihood that

(40:12):
we can clearly identify what are the relevant contribute factors
for this person in this moment with respect to the
issue that they're facing seems like distilling that down into
any kind of useful label is We'll just never get there.
Like the variety of the complexity of variables that could
get you there are so huge that like what would

(40:34):
be relevant to identify for one person is not going
to be relevant to identify for the next person, even
if they're having the same experience.

Speaker 2 (40:40):
Yeah.

Speaker 3 (40:41):
And again, to your point, I think in the medical model,
if you were to see signs and symptoms hanging together
for different diagnoses, there's like a clear mechanistic explanation as
to why things might be cascading into another process.

Speaker 4 (40:55):
Into another diagnosis.

Speaker 3 (40:56):
Right.

Speaker 4 (40:56):
So sure.

Speaker 3 (40:57):
You know, your liver is failing because you had an
infection and the infection wouldn't like, there's like the doctors
will be able to describe like a mechanical process that
is occurring.

Speaker 1 (41:05):
Yeah.

Speaker 4 (41:06):
But in psychology, I don't think we have that level
of precision about.

Speaker 3 (41:09):
You know, neurochemicals or, or God forbid interactions with environmental conditions. Right. Like,
and I think that task becomes really challenging. Like, you know,
we can spin a yarn around like, The antidepressant uncovered
your bipolar disorder by suppressing one element of it, but

(41:32):
the mechanistic reasons for that are not well understood. They
don't have people doing neuro studies and looking at, oh, see,
since it suppressed the serotonin. it made this other neurochemical
shoot up and that's a marker of, it does not
work like that. It's just not the same game, but
we can spin a yarn around it being the same game.

(41:52):
But I think the realities are an organism is in
an environment is a complex system and it's really hard
to isolate variables in the way that you would need to,
that I think are a little more available to us in,
in the like medical medical world.

Speaker 1 (42:08):
Yeah.

Speaker 3 (42:09):
But those kinds of causal structures, I think I've interacted
with them enough and it's a little anecdotal to say,
but I'm just like not impressed with how those things
come to be. You know, I've studied like psychedelic stuff
and I've looked at some neuro correlate correlate stuff and
it's pretty crude or like, you know, like the, that

(42:32):
neuro chemicals.

Speaker 4 (42:33):
Do one thing.

Speaker 3 (42:34):
It, to begin with is a crude understanding of how
these things work. So there's a Ted talk. I typically
hate Ted talks, but there's a Ted talk by this lady,
Molly Crockett, and she talks about neurochemicals.

Speaker 4 (42:48):
And she talks about basically, she.

Speaker 3 (42:51):
Did a study looking at the impact of some neurochemical
on people's behavior in a very controlled situation. So she
made them drink this like orange juice that was filled
with neurochemical inducing stuff. And she was getting approached by
like chocolate companies, like, Oh, chocolate has tryptophan. And so,

(43:12):
and you showed that it makes people more cooperative. So
what if we said that our chocolate makes people cooperative
and she could not be more, not be more opposed
to that kind of thing. So, you know, one really
common one, what's the, not serotonin, but, um, dopamine, the
one that's supposed to make you moral and get along
with people. Oh, in a crude called the love acid

(43:34):
been called the it's been called the moral molecule and
there's a guy named dr love or something like that
who says that the cure for everything is a hug
oxytocin oxytocin yeah so oxytocin for example she provides this
example is like generally known to make people more agreeable
you feel a sense of closeness there's all the all

(43:55):
kinds of things like As you progress in your relationship
with a romantic partner, you experience less serotonin and more oxytocin.
So you feel a sense of closeness with them rather
than a sense of euphoria. There's these really crude ways
of describing what neurochemicals do, but they are crude. And
she uses the example like, actually, oxytocin is kind of

(44:17):
dangerous because one of the things that it predicts is
that if you have two groups, in-groups and out-groups, and
you pit those in-groups and out-groups against each other, and
you give one of them oxytocin, they tend towards jealousy
and foul tactics against the other, and they tend to
hate the out-group a little more. She argues that you

(44:39):
could just as easily make the argument that oxytocin is
an amoral molecule. There's a guy out there calling himself Dr.
Love who says that it's the cure for everything, and
it's going to make you fall in love with everybody.

Speaker 4 (44:54):
But it also makes you more jealous. It makes you
more likely to seek revenge.

Speaker 3 (44:57):
There are studies showing those things as well. These neurochemicals
are obviously important with regards to what we do, but
I don't think that we've done... the work of understanding
them in context to such a degree that we can
like prescribe labels as, as to what they do crudely, right?
Like they do a lot, they do a lot of

(45:18):
different things. And I think she does a really good job. Again,
Molly Crockett, uh, she does a really good job of demonstrating.
Like I know that's your chocolate will not make people
get along with, we're likely to share. Right.

Speaker 4 (45:32):
That's not what will happen.

Speaker 3 (45:33):
Yes, you'll have higher levels of oxytocin, but the impact
of that oxytocin is not that it may be, but it's,
it's probably not that you will share.

Speaker 1 (45:42):
I'm thinking about the fact that you could arrange any
kind of– if you narrow the scope of the question
you're asking, you could draw lots of correlations. I'm going
to make something up. So everyone who's listening, this is
not something– I'm not referencing a study or anything. But
let's just pretend you had a study. What if we
did a thing where people who had the option to

(46:02):
take drugs, first we give them– we just directly inject
some dopamine into their brains. And then we see that
when we do that, that they actually take fewer drugs.
And again, I'm not, I don't even think that's how
that would necessarily work, but let's just pretend that that
was the situation that like some groups like we don't
do anything. The other one, we like give them a
direct dopamine hit and then they actually sometimes choose to
not necessarily consume drugs. So maybe dopamine then has this

(46:25):
like inhibiting factor or this impulse control thing. We use it.
But that's just in that one scenario. Then in another scenario,
we take someone who's deprived of something or like maybe whatever,
we give them a doping hit and then they start
seeking out more of the thing. And I'm like, if
you ask the question, what happens in this particular case
when I manipulate this chemical? And then you broadly average
everybody and say like, well, we had a statistically significant

(46:48):
change in this group versus this group. You've also not
necessarily asked what does it do in a different situation,
in a thousand different situations with a variety of different
contextual variables. And like, If you're also just taking a
statistically significant difference between those things, it's probably not a
very powerful significance. It just happened to be the case

(47:09):
that they did something a little bit differently over here.
And I feel like they've done that similar with mice
with oxytocin. They're like, oh, in this particular situation, we
gave them more oxytocin, they groomed each other more. But
in this one, if we gave them more oxytocin and
then we introduced a strange rat, they attacked them more.
I'm like, again, I'm not saying that there's an actual experiment,
but it's just like if you narrow your scope to
just one type of question, you can probably identify some

(47:32):
mean some difference relative to another group that didn't have
the same variable. But that doesn't tell you very much
about any of that. And as much as I love
going down the rabbit hole of neurology and the issues
we have with the. reductive approach people have taken to
try to ask these questions. And not that it was
necessarily the wrong approach, but I think that the conclusions

(47:53):
are way overstated, particularly the way that they're reported in
news and stuff. Returning to the problem of the diagnostic
system and it being riddled with ads. All right, we're back.

(48:13):
Mostly the TV we watch and the games we play
on our phone are riddled with ads for treatments for
diagnostic things. All right, the other problem here is you
actually started talking about this already, but this is one
that I brought up as well that I think is
this idea that a diagnostic system... A lot of reason
for it to exist is because it'll inform what to
do about the problem that you've diagnosed. Like, if I identify, like, oh,

(48:37):
your car is not running, oh, well, you have to
put gas in it. Like, diagnostic system tells you treatment
is put gas in car. Like, whatever the problem is,
the diagnosis should... And the vast majority of circumstances, and
I'm not even sure I could come up with one
where this isn't the case, but it should inform what
do you do about this now that you have this label?
Like how do you change this moving forward? And that

(49:00):
is not a thing that you get with psychological diagnoses.

Speaker 4 (49:05):
Yeah, I tend to think that's true.

Speaker 3 (49:08):
And there's studies on it, but there's also a lot
of anecdotal evidence. If you stereotype a lot of clinical
psychological students' dissertations, what you'll find is like dozens.

Speaker 4 (49:20):
ACT work for XYZ, right?

Speaker 3 (49:22):
So I'm an acceptance and commitment person. Nobody has looked
at whether Acceptance and commitment therapy works for sibling distress, right?
And so I'm going to be the person who breaks
the mold and I'm going to go study. What if
we applied ACT for sibling distress? And sure as s
* * t, it works pretty good. Holy s *
* t.

Speaker 4 (49:42):
Cool.

Speaker 3 (49:44):
And this is like a stereotypical way of casting, but
you know, so that creates one problem, this problem, we
call it the billion year problem or purple hat.

Speaker 4 (49:55):
What is it? Dialectical behavior, DBT, purple hat, DBT.

Speaker 3 (49:59):
So this creates a problem where we feel like we're
trying to fit treatments to syndromes. And we have to
demonstrate empirically that every person, Every treatment package fits every syndrome,
and that's an unsolvable problem, right? So the idea of
purple hat DBT is what if we did DBT for depression,

(50:19):
but we all wore purple.

Speaker 4 (50:21):
Hats, right?

Speaker 3 (50:23):
And those kinds of questions are everywhere inside of psychological
science when we take this approach.

Speaker 1 (50:29):
So true.

Speaker 3 (50:30):
And, you know, like I'll walk by posters and read
articles and I'll be dismissive of purple hat DBT.

Speaker 4 (50:36):
Oftentimes, like, you know, you see like, does ACT work? Yeah,
it probably does.

Speaker 3 (50:41):
You know, like it helps a lot of these things,
which again, it doesn't bode well for a diagnostic syndrome.
It tends to be the case that when you ask
the question, does DBT, CBT work? ACT, PBT, FAP, does
this work for XYZ psychological problem?

Speaker 4 (50:59):
It tends to be the case that it does.

Speaker 3 (51:00):
And it becomes like a self-fulfilling prophecy. There's not a
lot of like, you know, there's not a lot of
negative findings in that world. And if that's true, that's weird.
It would, you know, it'd be like rep and tussin
on everything, solves everything, which may be true.

Speaker 1 (51:18):
That's like how the wellness industry operates. They're like, It's
just a new thing.

Speaker 4 (51:22):
Yeah, yeah, yeah.

Speaker 1 (51:23):
Yeah, it's like, go get milk thistle and put it
in your eyeball, and that will cure whatever ails you.

Speaker 4 (51:28):
Ginger, man. Ginger fixes everything.

Speaker 1 (51:30):
Is that the thing right now?

Speaker 4 (51:31):
Yeah, ginger and horse meat warmer.

Speaker 1 (51:34):
That's so 2020.

Speaker 2 (51:40):
And just listen, just to be clear about that, to
our folks that are advertisers that are really into ivermectin, listen.
We don't want to lose that sponsorship, so we've got
to keep the ivermectin sponsorship up. That's what keeps the
lights on.

Speaker 1 (51:54):
And also, f * * * you.

Speaker 4 (51:57):
Yeah. So, yeah.

Speaker 3 (52:04):
I mean, you take something as simple as an SSRI,
and this is the point where maybe you get to
the receipts, but SSRIs... have been demonstrated to have positive
impact on obsessive-compulsive disorder, panic disorder, social phobia, bulimia, generalized
anxiety disorder, post-traumatic stress disorder, premenstrual syndrome, alcoholism, obesity, aggressivity, dementia,

(52:28):
trickle-tail mania, headaches, and migraines.

Speaker 4 (52:31):
And that's one. Substance.

Speaker 3 (52:34):
And it's cool that it's having a moderate or mild
impact on those things, but it's also odd if those things.

Speaker 4 (52:43):
Are distinct entities as we might hope they are inside
of a syndromal system.

Speaker 1 (52:48):
Could the solution then be that those are not distinct entities?

Speaker 4 (52:52):
I tend to think that that's true.

Speaker 3 (52:54):
Okay.

Speaker 1 (52:54):
Yes.

Speaker 4 (52:55):
And I tend to think that we've been asking the
wrong question at the wrong level of analysis.

Speaker 1 (53:03):
Agreed. I mean, I disagree with you, but I don't
know why. It's just to do my job.

Speaker 2 (53:10):
There's something about what you're saying I just can't agree with.
I don't know what it is, and I don't have
a logical way of saying it, but you know, just, ooh.

Speaker 4 (53:16):
I don't want to.

Speaker 1 (53:24):
Yeah. And I mean, I think that makes a lot
of sense. Are you sure though, that like act works
with people with green eyes? Have you really isolated that variable?

Speaker 3 (53:31):
I think somebody has done that study. Some exciting student
definitely took that on and opened their talk with, but
nobody has looked at does act work.

Speaker 2 (53:42):
I did see that paper and my response was no.

Speaker 1 (53:48):
Yeah.

Speaker 3 (53:48):
Yeah. Yeah.

Speaker 1 (53:50):
No, I think the, to your point, I feel like
we're almost gearing up to getting to sort of what
do we do with this? How do we move forward?
And I don't want to jump the gun too much
because I think there are other problems I also want
to outline. But it does feel like we're sort of
getting at the point that because psychological phenomenon are processes...
and not necessarily causal discrete events, that a therapeutic approach

(54:15):
is also a process and not necessarily a discrete causal
one-time take this pill and call me in the morning solution.
It's more complex than that. The variables are ongoing. The
effects of treatment are probably cumulative and ongoing. and that
it requires a dynamic adjustment as things proceed versus like,
you've got worms, let's give you dewormer and get those

(54:37):
worms out of you. Problem solved. No more worms.

Speaker 4 (54:40):
Yeah. And I think, you know, this is a little
bit anecdotal.

Speaker 3 (54:44):
I think we brought some reviews to something so I
can speak out of experience at times, but having been
in the world of psychedelic assisted therapy and what people
are excited about, I think there's.

Speaker 4 (54:53):
Two sides to this, right?

Speaker 3 (54:54):
So I don't necessarily agree that that psychedelic assisted therapy
is like a revolution in the field right i think
it has some promise under some very specific sets of
circumstances with some very specific parameters given some very specific
sets of assumptions but i think people are really excited
about this notion of like i'm a little depressed it's

(55:15):
been treatment resistant not a lot of things have worked
what if i just go home and get up about
it right and i just like take a I'm worried
a little bit that the research is going to be
distilled to that, right? There's a lot of notions of like,
it makes your neuroplasticity more plasticky.

Speaker 4 (55:35):
So you, and the nodes that don't typically talk to
each other, talk to each other.

Speaker 2 (55:40):
Oops, got your notes.

Speaker 3 (55:41):
I think those are cool biological correlates, but they're not
going to lead you to the path of wellness very reliably.

Speaker 4 (55:50):
I'll call it right now.

Speaker 3 (55:52):
Take mushrooms and call me in the morning is not
a plan for psychological wellness.

Speaker 1 (55:58):
Somebody's plan. I mean, yeah.

Speaker 4 (56:00):
And you see talks like that. I went to a talk. recently.

Speaker 3 (56:03):
And it was basically like these four PhDs and they
all got up in Jamaica and they're like.

Speaker 4 (56:09):
And then you bark, remember that? And then you threw
yourself into the ocean. Like they were just talking about
their trip and what they learned and blah, blah, blah.

Speaker 1 (56:17):
Right.

Speaker 3 (56:18):
And so I think there's a real tendency to go
towards take X and call me in the morning, but
really I think it's evident that psychological assisted therapy or
psychedelic assisted therapy is much more of a like you're
working with your therapy for a long time they don't
really see a way forward you're kind of stuck on
some language there's something happening where they need you to

(56:40):
kind of make a leap right metaphorically speaking and they've
had a hard time doing that they're not really sure
what to do next and i'm like what if we
just get you really turnt up and then we you
know have you close your eyes and we prepare you
for what's coming so we're like hey i have this
idea i'm gonna get you you know to level 10
And like a snake might eat you and it's going

(57:01):
to be kind of crazy. And you're going to have
to like, then, you know, I'm going to give you
some tools to kind of like deal with this thing.
And then after that, we're going to debrief, we're going
to talk about it. We're going to like, yeah, remember
when that snake ate you, that was kind of crazy.
you know, and like you dealt with it though, you
faced it and you were like, it's actually pretty sick
inside the snake stomach. And you've, and, um, you know,

(57:24):
and that is like, that very much is a process
that I'm describing, right?

Speaker 4 (57:30):
Like it is not if treatment resistant.

Speaker 3 (57:34):
Depression, then, you know, micro dose or do a hero's
dose of some psychedelic substance.

Speaker 4 (57:42):
And I think, that's where we're going.

Speaker 3 (57:45):
I mean, I feel a little disheartened to say it,
but the tip of that spear is take mushrooms and
call me.

Speaker 4 (57:50):
And I think that sounds like an appealing treatment. Cause
I don't, I, the patient don't have to do anything.

Speaker 3 (57:56):
I just have like, I have a great time. And
then I'm going to feel amazing in the morning. And
like all the world will be through rose blood glasses.
And the reality is like, you know, if that treatment
is going to be effective, it's going to be effective
in a lot of the ways that other treatments are effective.
you have a person who's responsive to the kinds of individual-level.

Speaker 4 (58:18):
Processes that are occurring. Again, not to get ahead of ourselves,
but it's tricky.

Speaker 1 (58:24):
The way I see an application of something like psychedelic-assisted therapy,
which honestly is not fundamentally distinct from other things just
like systematic desensitization and exposure-based therapy, is the There's a
lot of rigidity. Let's see if we can flex that
up by just creating a very novel experience for you.
And I think, as you said, we're just sort of

(58:45):
the point where it's like, it feels like we're stuck.
It's like nothing we seem to be doing is really
moving the needle in any particular direction. Something we haven't
really done is like, let's just give you a wild
experience you've never had and see if that just helps
break up some of the stuckness and the rigidity and
gives you an opportunity to explore a new set of
behaviors that might be a little bit more productive moving forward.

(59:07):
That's sort of why I see like if there's utility here,
there might be multiple ways that there's utility here, but
like in that sort of context of like, let's just
get a little more flexible away from this stuckness that
you find yourself.

Speaker 3 (59:20):
Yeah, and I think it points to me to something
that is a little related and which is I have
higher hopes for psychological science and psychological intervention than we
are currently experiencing. I think one of the things that
has kind of gone unsaid is like, I'm not thrilled
with the state of psychological intervention. And one of the

(59:44):
things I would point to as evidence for that is
the fact that we're talking about psychedelic-assisted therapy as like
a revolution in psychological science, as something that can solve
problems that other things can't solve. Those things don't tend
to come about inside of intervention sciences that we're happy with.
You don't have like stark revolutions that can change how

(01:00:05):
we approach psychological phenomena forever inside. That doesn't happen a
lot in medicine. There are things that might, you know,
excite doctors like now I can do surgery with robots
and I can be more precise. But the notion that
like surgery, as you understand it.

Speaker 4 (01:00:20):
Is no more.

Speaker 3 (01:00:22):
And now this way, those kinds of revolutions don't come
about inside of successful intervention sciences. And I feel like
we talk about a lot of psycho and rediscover, right?
I mean, this isn't even something that we're discovering. This
is something that you're rediscovering. I mean, yes, you could
argue that this is that psychological, that psychedelic assisted therapy

(01:00:44):
was kind of strangled in its research crib a little bit,
but through the intervention of government entities and things like that.

Speaker 4 (01:00:52):
And I think that's the argument that's being made, but yeah,
But people kind of studied this before.

Speaker 3 (01:00:57):
And if it were a really, really effective approach for
these things, I think we might have detected it by now.
Because I'm sure that a lot of psychologists in their
basement were doing this kind of work.

Speaker 4 (01:01:09):
And it would have come out into.

Speaker 3 (01:01:10):
The forefront had it been just like a night and
day kind of experience. And I think it's sort of
bare saying that as behavior analysts, we expect night and
day results.

Speaker 4 (01:01:24):
We expect..

Speaker 3 (01:01:25):
You know, like this person will fundamentally changed in a
way that is detectable. And that is like, that is impressive.
You know, I, I, I don't, I don't think it's
too humble to say like.

Speaker 4 (01:01:37):
It's impressed.

Speaker 3 (01:01:38):
Like people, you know, when I debrief on cases that
I've worked on, they talk about how different this person
is and often positive ways. Right. And I don't think
we're seeing those kinds of results inside of the world
of psychology.

Speaker 4 (01:01:51):
I think that's what underlies some of this for me.

Speaker 3 (01:01:54):
And yeah, You know, you can point to other things
like how many people are disabled due to some kind
of psychological well-being problem? They're on Social Security disability. How
many people were doing that? What percentage of people were
on Social Security disability for some debilitating mental disorder?

Speaker 4 (01:02:14):
Back in the fifties and how many people are.

Speaker 3 (01:02:17):
On social security disabilities for some kind of psychological, you know,
there's other variables that enter the picture, but I tend
to think that it's not night and day. I tend
to think, you know, and there are books that you
can read that provide more clear evidence of that. One
of them is the emperor's new drug and then the
emperor's new drugs.

Speaker 4 (01:02:37):
And what's the other one? Oh, the anatomy of an epidemic.

Speaker 3 (01:02:41):
And they point to specific numbers that no, no, the
rates of social security disability, people who are cannot work
because of psychological distress, they've gone up. And if we
were in an effective science of intervening upon these things,
You could argue like maybe they've stayed the same or
maybe we're detecting problems that we didn't before. But I

(01:03:03):
hold our science to the standard of a stark difference.
Like this, it should be clear and obvious that we
are having an impact on the people that we're trying
to help.

Speaker 4 (01:03:13):
And I don't know that that's necessarily true.

Speaker 1 (01:03:16):
All right, Stu, we have talked about what the diagnostic
system is, some of the problems with it, including the
underwhelming specificity, the comorbidity, the lack of treatments, or maybe
the overgeneralization of treatment and sort of dipped our toes
into treatment. We talked about neurology. We talked about drugs.
We talked about ads. Okay, we're back. We have been

(01:03:46):
having this wonderful conversation here, and I think we're at
a great point now because there's a lot more I'd
actually like to continue to unpack. Both of the problems
of the diagnostic system, but also the future of where
we could potentially go, where we are going, where we
would maybe hopefully go instead is the way to put that. Stu,

(01:04:06):
can you come back for a second discussion about this
and talk more about those things?

Speaker 4 (01:04:10):
I'll check my calendar, but I think I like my chances.

Speaker 3 (01:04:13):
Yeah.

Speaker 4 (01:04:13):
Okay.

Speaker 3 (01:04:14):
All right.

Speaker 1 (01:04:14):
Very good. Well, let's pause here to come back for
a part two and continue to unpack this discussion that
will hopefully give a lot of people some new ways
to think about this. If you are enjoying this conversation
and you'd like to support us, you can head over
to Patreon. If you do that, then you'll get access
to bonus content, ad-free episodes, behind-the-scenes stuff, all kinds of
bonus goodies. And at the end of our full-length discussions,

(01:04:36):
I'll read the names of the people who have chosen
to support us as a special shout-out and thank you
to you because money makes me talk, and that's just
how it works. So a giant thank you to Mike M., Megan,
Mike T., Justin, Kim, Brad, Stephanie, Brian, Kiara, Charlie, and Michael.
We have a new person who joined us. Thank you.
Happy to have all these people with us. Thank you
for joining us. We have three Mike or Michaels in

(01:04:59):
our group, which is cool.

Speaker 2 (01:05:00):
Yeah, that's kind of fun.

Speaker 3 (01:05:02):
Yeah.

Speaker 2 (01:05:02):
It's almost like Michael's a common name.

Speaker 1 (01:05:05):
Almost like that. Almost like that. In addition, you can
support us by leaving us a rating. Just click the
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then say something nice. If you're feeling motivated to also
say something nice, you can just click stars, and that's
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we appreciate it, and it helps us do our thing,
so go do that. If you'd like to leave us
some corrective feedback, you can email us directly at info
at www.wwdpodcast.com or reach us on the social media platforms,

(01:05:29):
and someone will talk to you over there. Also... I
need to remember that I have a team of people
without whom I cannot make this podcast. Writing and fact-checking
from Shane and myself. Thank you for recording with me today, Shane.

Speaker 4 (01:05:39):
Hey, anytime.

Speaker 1 (01:05:40):
Our social media coordinator is Emma Wilson, and the person
who takes all of the sounds that they hear and
mixes them together into a delicious slurry that is this
podcast is our god emperor, Penguin Justin, producer extraordinaire. Of course,
a giant shout-out and thank you to Stu, Dr. Stu Law,
for coming on and talking to us about this, although
we'll have you back again for another one of these.
And then, of course, thank you all for listening. But

(01:06:01):
we're actually not done because we're going to recommend some
things because it's fun to do that. So anything that
I missed or anything you'd like to add before we
transition to recommendations, Shane?

Speaker 4 (01:06:09):
No. So I got a couple.

Speaker 3 (01:06:20):
One is the Emperor's New Drug that I mentioned, the
Emperor's New Drugs.

Speaker 4 (01:06:24):
Okay.

Speaker 3 (01:06:25):
And..

Speaker 4 (01:06:26):
The Anatomy of an Epidemic. Nice little airport books. Good reading.

Speaker 3 (01:06:32):
They talk about the first and second wave of psychotropics
that I think it's fair, but it paints a picture
of ineffectiveness, I tend to think.

Speaker 4 (01:06:45):
And if you'd like to.

Speaker 3 (01:06:46):
Read ahead for the next episode, there's a book called
called Beyond the DSM and then Learning Process-Based Therapy by
Hoffman and Hayes. Hoffman is a German psychologist. He's a
big deal over there. He gets a lot of big grants.

Speaker 4 (01:07:04):
And then Dr. Stephen Hayes is my former advisor.

Speaker 3 (01:07:08):
And those will prepare you for the discussion that we'll
have next week if you feel so inclined.

Speaker 1 (01:07:15):
Perfect. So that was learning process-based therapy, the anatomy of
an epidemic, and there was the end of the DSM.

Speaker 4 (01:07:23):
Beyond the DSM.

Speaker 1 (01:07:24):
Beyond the DSM. The end of the DSM.

Speaker 2 (01:07:29):
Or the index.

Speaker 4 (01:07:30):
And then The Emperor's New Drugs.

Speaker 1 (01:07:33):
Perfect. All right. Four books that you can read within
the next seven days to be prepared for this. And
then you're going to have to recommend some more things
next time. So... Could you add that list?

Speaker 4 (01:07:45):
I'll be prepared for that.

Speaker 3 (01:07:47):
All right.

Speaker 1 (01:07:47):
Very good. Shane, what are you recommending today?

Speaker 2 (01:07:50):
So I am right now obsessed with and maybe it's
maybe it's my midlife crisis. But, you know, originally I
was going to go to school to open a recording
studio and to be able to do that. And so
now I'm kind of leaning into like home studio production stuff.
And recently I got this like fun little toy. It's
the Akai Mini MK3 MIDI board. It's a little piano.

(01:08:12):
It's got like a drum pad on it. And it's
really a lot of fun to play around with, especially
if you have like the right software to plug it into.
If you've never played around with like a MIDI board,
it's just basically just like you can turn your typing
keyboard into a MIDI board. It's just basically like a
bunch of hotkeys that make different sounds and stuff like that.
And so this one's shaped like a tiny little piano.
It's super portable. I was able to pack it in

(01:08:33):
my suitcase and bring it with me to Denver recently
and then play around with it. And I use a
software called Ableton that allows you to plug in different sounds,
different noises, and then your keyboard does all the things
that you want it to do in all the different ways.
So it's a lot of fun to mess around with
and explore and just kind of like, just be goofy
with if you like to kind of record stuff at home.

(01:08:53):
So it's a lot of fun. Fun.

Speaker 3 (01:08:56):
Yeah.

Speaker 1 (01:08:57):
Very cool, all right, so this is the, uh, well,
actually I'm gonna go through and list all the things
after we've talked about them. So people remember I'm recommending
an album. We've been in this renaissance. I've mentioned this
a few times. I've just, like, all these bands that
I've loved for so long are just putting out new stuff,
and some of them at prolific rates. But a band
I like for a long time is called Protest the Hero.
They're a very technical, very fast, very... Technical and fast.

(01:09:24):
They're like kind of like vaguely in the middle punk ish.
There's a lot. It's mostly melodic. Like there's not a
lot of sort of the screaming vocals that some people
struggle with, but they're a Canadian based band. They just
recently put out an album maybe a month or so
ago called Within. And it's great. I mostly have enjoyed
everything they've put out. But this one actually did feel
like it had some kind of newer ways to approach

(01:09:46):
some of their stuff. Some of it felt like kind
of a return to form to older things. Some of
it felt totally fresh and new. All of it I liked.
So if you're into very fast, very technical sort of
virtuoso type music, then Within by Protest the Hero is
something I think most people will be able to get
on board with in some capacity. All right, so that's
the album Within by Protest the Hero, the AK, AKI, MPK, Mini, MK. Oh,

(01:10:09):
my God. When you were talking about MIDI things, I
think they just throw a bunch of letters and numbers
into a bowl and then just pull them out, and
then that's what they call it.

Speaker 2 (01:10:15):
Yeah, yeah, yeah, yeah, yeah. Especially AKI.

Speaker 1 (01:10:18):
AKI Pro.

Speaker 2 (01:10:18):
Yeah, but their stuff is cool, yeah.

Speaker 1 (01:10:20):
Okay, and then learning, so four books, Learning Process-Based Therapy,
The Anatomy of an Epidemic, Beyond the DSM, and The
Emperor's New Drug. Check those out if you are interested
in doing so. Otherwise, we'll catch you next week, hopefully,
and we will continue to follow up this discussion. Are
we good to wrap it up there, Shane?

Speaker 2 (01:10:37):
Yeah, that feels good.

Speaker 1 (01:10:38):
All right, see you all next week. Thank you for listening.
This is Abraham.

Speaker 2 (01:10:41):
And this is Shane.

Speaker 4 (01:10:42):
I'm Stu.

Speaker 2 (01:10:43):
We're out.

Speaker 3 (01:10:43):
Bye.

Speaker 4 (01:10:45):
You've been listening to Why We Do What We Do.

Speaker 3 (01:10:47):
You can learn more about this and other episodes by
going to www.wwdpodcast.com.

Speaker 2 (01:10:54):
Thanks for listening, and we hope you have an awesome day.

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