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so drugs are in some ways the modern day equivalent of the magic devotions of the fairy tales and wednesday novels they have the power to change the way we think and feel and behave to alter our very consciousness so it's no surprise that many of us have strong opinions about how they should be used and regulated the way we go about pursuing our opinions about these practices is pretty contradictory the way that we decide which drugs we should promote and celebrate and which ones to condemn and prohibit is not your cut many people have strong motivations and influences to to decide what we think about these motivating them to tell narratives that influence us one way or the other and the way that the present law is formulated it's not the way it has been in the past and not the way that it could be in the future uh and it is constantly subject to revision and change right now is by no means absolutely correct and there is a number there are numbers of different viewpoints that are vying for credibility and attention um so the subject of today's discussion will be between the drug war and elicit drugs and illicit drugs which we are in the habit of prescribing widely to children and adults um so just how these issues relate to each other and overlap and conflict uh to our panelists and discuss a discussion ahead to illuminate so um i will now introduce our speakers so sitting to is a clinical psychologist and associate professor at the school of professional and psychology prior to entering academia he was a clinician and administrator in residential treatment centers working with the severely disturbed youth for over 15 years he has multiple publications and on the use and misuse of psychotrophies of youth and is coordinating the adolescent subjective experience of treatment study examining youth's perspective on what works and what doesn't in multiple multi-disciplinary residential care next we have thomas barrett his phd who is a psychologist psychologist and professor of the department professor and department chair of the clinical psyche at the chicago school of professional psychology from 2001 to 2010 he was associate professor and director of the center for psychoanalytic child development at case western reserve university school of medicine from 1990 to 2010 he directed the hannah perkins center for child development in cleveland a therapeutic preschool mental health clinic and training center that treated children with the use of psychopharmaceuticals without without chase demons is a poet historian and journalist with a special interest in states of consciousness he is the author of storming heaven lsd in the american dream and co-author of drumming at the edge of magic with grateful dead percussionist mickey heart and ethnomusicologist brendan i'll now hand over the mic to jay stevens all right um i'm not going to speak you know for the drug war for exactly illicit drugs but i'm going to try to give some context i think of this sort of subject here is the prescribe and the proscribe and that sort of sums it up i'm also going to try to give what i might think of as a poetics of the topic and you know in appreciation of the freudians and the psychoanalytic movement i'm going to try to come you know i'm not going to really do boots on the ground i understand that you people would be very much that but sort of be up there with the metaphysical drones and hitting some of the higher higher topics but incidentally the whole the whole the whole description came from the pagans that where they got it they got it off the pagan website i used to give talks with the pagans and that's where special interests and states of consciousness and all of that that's in the wikipedia page and it's an interesting thing that you can't change even though you're the subject of a wikipedia page you can't change it it's an extraordinary process to move in and sort of add any caveats you may want to what appears there and it's defeated me many attempts early on so i've just given up dude in an attempt to change the wiki thing i'd like to start with a poetic moment an epiphany that i think sort of sums up what we're going to be talking about here and to me it's the uh any school nurses office at eight o'clock in the morning i think where where if you stand and you look down the hallway the hall is lined with with anti-drug posters about what those substances will do to you and there's usually a line of kids waiting to receive their drugs from the nurse their ssis their you know whatever they're on the ritalin the adderall the oxies and that to me is the prescribed and the proscribed years ago after storming heaven came out a very a woman contacted me from rhode island and um she was looking for someone to help with she had collected a lot of data and her thesis was that many of many of in in case the most creative boys so she was looking at eight nine ten-year-olds in the schools that she was seeing were being drugged into a type of facility if she will because they wouldn't sit in their seats they were exhibiting the wrong sort of attention for the society and she said something that always stayed with me she said why is it wrong for the soviet union to give a poet thorazine so he cannot create his anti-social images but it's okay and then of course our psychiatric and psychological associations back 20 years ago were horrified by this and saying what an appalling practice and she said why is it okay for us to be doing this with these kids isn't there isn't there a similarity here let me now go back having given you that poetic moment let me go back to the start of the drug war because there is an actual just i'm essentially one of the hats i wear as a historian there is an actual moment in the nixon white house where a sort of moral a program that actually goes back to the beginning of the 20th century you know with the first the the opiates and then the chinese and then then marijuana and the mexicans and the you know if you ever look at some of the reefer madness is a good example of the sort of harry anslinger 1930s anti-drug thing but there was a moment in history so we're talking about late 1969 richard nixon is in the white house when all these forces sort of come together and we have the launching of what we now think of as the war on drugs whereas some people said the war on some drugs um so it's 1969 nixon is in late 1969 nixon is the white house we're talking september you know you have a vigorous anti-war movement sds coming out of 1968 is exploding you have charles manson has just killed you know the sharon tate family so that is in the headlines you have the black panthers that are at perhaps their most vibrant and jayco hoover has said he's going to shut them down by the end of the year richard nixon is always trying to get his message out that was one of his things and he has a lot of hollywood producers in you know they've been brought into the white house g gordon lydia who's going to show up as a watergate burglar is you know in the room a number of other people that are gonna who are part of the whole watergate are in the room and they're trying to get the hollywood producers interested in the nixon message and what they discover is they really love drugs that the idea of the heroin addict that they this actually has mileage and from this little moment the war on drugs will sort of take off and grow into this extraordinary so i think if a martian historian comes down in two or three hundred years and looks at this period this is going to be one of the real anomalous things why we're billions and billions and billions of dollars millions of people incarcerated why did this happen over really an argument that's what states of consciousness are permissible or is i'm going to say what really molecular densities on the walls of your cells and it's a body-wide system not just in your head are permissible now the important thing about this moment in the nixon white house really from what we're all three going to be talking about is that money is released into the giant the giant brick building that represents nih and nimh sitting out there in bethesda where they're saying can you find us the point of action of any of these substances why is marijuana doing what's it's doing cocaine heroin et cetera et cetera and sol snyder who's up at johns hopkins and his undergraduate his fierce graduate student candace pert discover the opiate receptor this is the first receptor found in the brain okay and this is the point where heroin is acting and what's a receptor a receptor is just a long string of amino acids we're actually just a giant amino acid city if you will that sits on the walls of cells and everyone has everyone has all these receptors and and everyone has different densities you know you may have three fat you know ten thousand i may have only 5 000 it's why we have different propensities to experience these drugs but a whole lot of other things the whole lot of the sensing system so with the discovery of this receptor a whole second nervous system is discovered and basically what they discovered what they found is there's last time i looked it was 86 of what they called messenger molecules you know the the heroin going in is basically a messenger molecule that's hitting the receptor um moving in the body and almost all of the drugs that we were talking about at the nurses thing the posters on the wall and the ones that are handing out are manipulating this system these messenger molecules they're they have various names their hormones peptides factors i mean various various various disciplines all named them different things but essentially they're carrying information telling your body how to how to do things they're making food digest they're making you know new cells they're also telling you how you feel about what the body is doing so they're they're often referred to as the molecules of emotion candice spurgeon discovered the opioid receptor that's her word for what these are doing so you have an information body if you will and this war from the war on drugs is really about what information if you want to look at that is permissible so i'd like you to think about some of what we're going to talk about as sort of almost an in-frame almost not a censorship thing but move it into that domain where you're looking at information and you're looking at the the long history of that we have as a species of controlling information and what information is permissible and what information can lead you to do so that's really how i see the whole war on drugs is is really who's going to control these molecular densities etc um that's really i think to to this point um you know what what would be useful for me to say i think it could be useful now to jump into your thing and then let's bat it around you know rather than me going on and walk onto my thing so let's you're basically dealing with almost the legal psychotropics what's come out of the corporate so in some sense we have two cartels you have an illegal cartel if you will and legal cartel you know and both are producing psychotropics that change molecular densities on the walls of cells and predispose you to certain informational body states one the culture finds you know useful and one they find completely non-useful and so gone to war with and imprisoned people et cetera so everyone gathered huge gallons of fluids to detect if you're doing it so gentlemen let's bang it over to you and then we'll pick this what i'm going to give us is a snapshot of the use of psychiatric medications in kids part of where my interest as was mentioned i spent a lot of years working in residential treatment centers and those kids have really been bounced through the systems they've been in and out of psychiatric hospitals usually through the foster care system as well and then the treatment of last resort is residential treatment where they're given kind of the shotgun approach of multi-disciplinary care they receive everything all at once which isn't really a great use of resources but that's what they do and in my work and i should say prior to getting into residential treatment i spent a good number of years working on inpatient settings with adults primarily those diagnosed with schizophrenia so i did that about five years and then went into residential treatment so my dissertation was on the experience of being medicated in schizophrenia so i interviewed 45 adults diagnosed with schizophrenia on what that experience was and that i kind of parlayed into the current research i'm doing interviewing adolescence and residential care about their experience of treatment a component of that is with the medication piece so if we hit the next one um i just saw these the last couple of days the next couple i've got all these kind of on a staggered thing so this headline a three-year-old prescribes six psychotropic drugs while in care in cps care six psychiatric meds three and one of the medications they were prescribed was risperdal which is a pretty potent antipsychotic and these numbers just came out but the cdc is really confirming numbers that we've had for about eight years i think there was a 2005 study indicating that 20 of america's youth qualify for a psychiatric disturbance right now and the way the statistics go at least before the new dsm-5 came out which i guess was just yesterday or this week whatever that 50 of us would have a diagnosable psychiatric condition at some point in their lives so let's assume it's that half of the room since i'm over here but um regardless we all it's become part of our culture now right um and obviously we're spending a tremendous amount of money on that care and i don't know how many of you are following this the dsm-5 just came out um and with it they are making some significant changes one of them is getting rid of the five-axis diagnosis system which is curious i'm not quite sure why they're doing that but now the national institute of mental health is pushing back saying you know what we're not big fans of the dsm-5 in fact we're not fans of it because while it may offer reliability you know like when we talk about an adhd kid we kind of know what we're talking about and and i have to say the reliability numbers aside from autism and adhd the reliability numbers and the rate of reliability are incredibly poor for the dsm-4 in particular it's actually gone down schizophrenia for example has gone down with each edition of the dsm the reliability but the national institute of mental health says great it gives us reliability it doesn't offer us validity so they're challenging the dsm five on its lack of politics now think about the impact of that we are giving people diagnoses all the time that aren't valid they're not real things they can't be demonstrated scientifically but think of what their presence is in our society um okay you can hit the next one um and i should add too the national institute of mental health now is devoting considerable resources to their new project called the rdoc the research domain criteria and in that they're trying to gather data on genetics molecular structures neural chemistry subjective experience all sorts of different domains for different symptom clusters rather than disorders so they're going to be looking at attention for example and looking at the continuum of attention on all those different domains rather than saying let's study adhd because adhd isn't really a real thing but let's look at break it up into its components and study it that way actually i think that pursuit of science is going to be pretty fruitful either it's going to tell us oh look we found something or it's going to say oh look there's nothing to be found and either way it's going to be useful information but over the years i mean especially when i was working in residential treatment a lot of the people were believing in the use of psychiatric medications because of these assumptions that they're chemical imbalances that there's some brain abnormality abnormality that's been determined or that these things are genetic right and now we know well i'm a huge fan of neural imaging but we are still behind the eight ball and trying to really find anything specific my rule is always the universal and exclusive so if an abnormality is found in fact i just was reading an oxytocin article for autism recently and what they found were certain changes in the brain but not across all kids with autism so that's not universal so they found some improvement but not across all kids and if it's if it's not universal then we still have a lot of questions to answer and if it's not exclusive if that change is not unique to that condition like frontal lobe problems depression adhd schizophrenia they all have bipolar disorder they all the frontal lobe is implicated in all of these things slightly different regions but regardless of the literature you're reading frontal lobe isn't indicated but that's not exclusive now we're just chasing you know something that could apply to all these different diagnoses so but we just generally make the assumptions about these general things we're giving medications because they correct something and we'd like to believe that they correct something that we've already found to be out of balance or abnormal right that would be a nice general conclusion to make but it is without scientific basis so this is something i like to ask people as well what do we believe medications can do and this is a great audience to ask this question to what do we believe medications can do that relationships cannot do now usually when that topic comes up people resort to psychosis but i'm guessing a good number of you are fans of burke karen's work gary prouty's work possibly there is some fascinating work on the treatment of psychosis without the use of medications and i think it deserves tremendous consideration when we're thinking about our treatments for example the meta guidelines for the treatment of schizophrenia just came out like two days ago they were announced on medscape now the lead author on that is a guy named steven stahl who writes the what is it called the essential fundamentals of psychopharmacology writes this giant book it comes out a new edition every two years but he's clearly going down a different road of study right he hasn't he's probably never even heard of bird caring but um but we need to really consider this when we are in practice when we are working with people struggling that come to us in distress we need to be asking ourselves that question because when we come when we hit the dead end of what we're what we feel like we're capable of doing that's when we shift into well you know maybe their depression is just so refractory they're going to need ect or an ssri or whatever the intervention is but that may be a limitation of ours not of theirs so i always like to challenge people with that question so here are some current trends i'm going to hit these quickly just to be mindful of time but there is no doubt that we are using increasingly large amounts of medication on younger and younger kids that top bullet point is very concerning um in that eight year span of time the use of antipsychotics in two to five year olds double that two to five year olds on an antipsychotic really pushes the bounds of what i would consider rational treatment um obviously we don't have an evidence base for that and and regarding the the use of diagnoses this is an interesting this came out in 2003 and it's a great analysis the same could be true for most of these diagnoses with all the bullet points in our checklist of arriving at a diagnosis there are 1750 ways a child can look symptomatically using only the basic criteria for post-traumatic stress disorder that is an impressive bit of analysis and now how many of you have heard of disruptive mood dysregulation disorder dmdd the next epidemic children in adolescence really well they're just remained bipolar it well bipolar is still in there and applicable to youth but they realized that this pediatric bipolar disorder was a disaster you know it all started with joseph biederman so it had a lot of clout behind it years ago but it really did some damage so now they went back to the drawing board and said no you know what i think we've identified something else and let's call it disruptive movement tribulation disorder so that's going to be our next epidemic and if you read the criteria for this diagnosis it's pretty embarrassing i mean it's it's like really inappropriate temper tantrums but i would say what is the appropriate hunger cancer you know like usually anyway so so this one's going to be pretty bad and let me also add that the issue of trauma is still not adequately addressed in the dsm i've got a dissertation student working right now and the sample of we're about 85 kids we've interviewed so far so it's a relatively small sample but what she what she's pulling out of the data and what she's pulling from additional published literature is that there is no reliable way to differentiate pediatric bipolar disorder from trauma exposure now the sample that we've got is extraordinarily traumatized kids in residential care we're using the aces questionnaire the adverse childhood experiences questionnaire and in the in the full study that was done by um what's his name anda and felide a group of people looked at over 17 000 adults asking them did this ever happen before the age of 18 10 different areas of trauma what they found in their 17 000 sample was that 12 and a half percent of that sample had four or more aces now in residential care 60 have four or more aces so and what the implications of that as you know trauma is a bad thing and it has implications um psychologically in terms of reckless behavior physical health mental health substance abuse all of those things are impacted it's life expectancy all of it's impacted by exposure to trauma and the more trauma you have exposure to it goes up exponentially so it is a it is a powerful force but back to what we're considering disruptive behavior in youth we've got a lot of questions to answer as well in terms of how are we assessing these kids are we just going down the checklist of a diagnosis and then what assumptions do we make with that we've included their pediatric bipolar disorder the silver bullet is lithium or depakote or now the antipsychotics but even the pragmatics yeah i feel myself getting on the subconscious even the journal of child adolescent psychiatrist practice guidelines for the treatment of pediatric bipolar disorder recommends depakote now i have to say to their credit their guidelines came out before the study i'm about to talk about but they recommend the use of papa code in the treatment of pediatric bipolar disorder well stanford did a study a couple years after those guidelines came out and demonstrated depakote is no better than placebo in the acute treatment of pediatric bipolar disorder so they studied these kids i think for a month no difference between that and a sugar pill except when you look at the side effect profile that is dramatic okay here are some more bullet points for all of us the use of antipsychotic drugs has gone up you can keep hitting these we'll just let everybody see them as i mentioned kids in foster care are increasingly medicated that first one the three-year-old that was on six medications they were in the foster care system and texas is notorious for overuse of medications the use of multiple medications is also of great concern and you know i have to say i work with some excellent psychiatrists i'm also in private practice and i have really teased out in my community or in the neighboring communities as well psychiatrists that i can rely on for a nice thoughtful conservative use of their intervention because i have tremendous respect for what they bring to the table but i think we as we as a society place incredible pressure on them to do something i was in a discussion panel i think about a year ago and we were talking about the treatment of psychosis when somebody is flooredly psychotic it's scary it's uncomfortable it feels out of control and psychiatrists are the ones in the position where everybody they're at the top of that pyramid that everybody goes to and says you better do something so what do they do they pull out the big guns of helldoll thorazine risperdal abilify whatever it is because it does something it slows that person down now does it really treat psychosis as they would the antipsychotic label would suggest i got to tell you in the study i did again 45 adults is not a huge study but only one of them said their voices went away everybody else continued to hear their auditory hallucinations they just didn't react to them as much so so it makes it comfortable for us but they were still psychotic so they aren't anti-psychotics in that way now i also have to say i was working in state psychiatric hospitals and in the continuum those are probably the least responsive to treatments right but it's it is again what conclusions do we draw are they just the ones that can't be treated or are our treatments questionable okay okay okay just one or three of these um oh yeah i've just got a couple slides left increasing numbers of medications for kids for example how good is the american education system would we just say it's top of the heap we know that's not true right um 75 of the world's ritalin is used in the united states 75 it fluctuates between 75 and 80 a couple european countries are starting to use it a bit more but 75 percent of the world's riddles that is a it's ridiculous and as you mentioned referring back to the medic the money aspect of this look at these numbers billions upon billions of dollars are being spent every year on psychiatric medications and i always like to ask a question about billions because when we talk about the brain it's got over 100 billion neurons 500 plus billion glial cells it's just an amazing and we hear billions all the time we're talking about finances and everything else but what year was it a billion seconds ago just one billion what year was it anybody guess 32 years ago and they're ticking off and that's just a billion seconds right billion hours the year was like eight that was the year um okay you can hit the next one so here that this is um just uh total prescriptions of different antipsychotics and i pulled this out so this green line in the middle that's abilify and you can see it's making steady progress and the one up at the top is cyrille both of these are very popular medications right um and the red one well this bright red one is latuta it's relatively new risperdal came out of nowhere and started making its impression um so then if you go to the next slide so jump in here sure absolutely i just i just want to point out here if you go to if you go to the illicit ones ecstasy adam and eve you know the names that that the things that get the new the new psychotropics with geodan and vegas you know to me to me there's a poetic congruence between how the legal cartel and the illegal cartel are coming up with their new psychotropics anyway so it cracks up yeah absolutely so here's the money devoted to advertising for these abilify and syrup well make up what two-thirds of it and they're the biggest you saw the abilify line progressively getting higher and circles leading the pack now call me a skeptic but we can say that's not the result of effective science it's the result of good marketing right now on the next slide yeah on the next slide okay so now keep it right there um you can hit the next one but not the following okay so if we were investing our money what's a good rate of return on a mutual fund would we go for ten percent now the market's a little better so now maybe a few years ago we would hope for six percent but if we're investing in a mutual fund 10 would be like okay we're hanging in there this ratio you can hit the next one is every dollar they invest they get 27 dollars back now that's a good investment right um and then the next one is a little spinning dollar or something so i think there's a tremendous influence that we can't ignore in the use of these medications now as you can tell i'm pretty skeptical of the use of medications and i work with people all the time that would say my kid wouldn't have made it through college without their ritalin i wouldn't have made it through my depression without my prozac and i believe those cases are out there but they are not representative of the large-scale studies for example the mta study on ritalin really showed that all treatments end up at the same spot all of it it's in the tad study treatment of adolescent depression study you get your biggest bang for the buck in the first few months with combined treatment psychotherapy and medications that diminishes after a few months everybody ends up at the same spot so we have to really step back and and i'll end on this the impact of these in children and adolescents is virtually unknown neurologically there are situations called up regulation and down regulation a medication like ritalin dramatically increases the availability of dopamine and norepinephrine in the brain but the brain adapts to that it down regulates because it's getting saturated with these neural chemicals the brain says wait we're getting way too much of this and it allocates resources elsewhere but then when somebody goes off it now they've actually got physiological changes as a result of medication exposure the same is true across the board that's where they found the increased receptor density in schizophrenia they only found it in patients that were exposed to medications this was years ago because the medications block a transmission of several neurotransmitters so the brain started sending more receptors over there to get as much as they could they thought oh we found the holy grail of schizophrenia increased receptor density and it proved not to be true it was iatrogenic it was caused by the treatment so so that sets the context and then we can go from a whole bunch of other directions and just to kind of pick up where bob was leaving off with the point about um you know we all know somebody who fared well on medication and uh and and i think it's that person or a few patients that people have had that convinces us that it must all be correct but and what i'm going to show you and talk to you about i want to guess i want to ask the question is the social cost worth what we're seeing in those uh individual cases so the first thing i'm going to talk about and the slide i'll be up in a minute is uh i want to go back to something that jay was saying i kind of want to think about you know why do people want to feel differently and and i and i guess both from the standpoint of whether we're talking about illicit drugs or the so-called illicit drugs are we fleeing into these uh because there's some social reason or individual reason that we have we know that that as a society and especially as a site from the standpoint of the impact of psychiatry on our society what we've what we've begun to do is is i would say pathologize affects so that you know we've taken things like anxiety and depression that we used to think about as moods and we've called them disorders and uh we we've also then even taken fear and worry on the one hand and sadness on the other and we've called those anxiety and depression as well just so that we can medicate them what i would argue and suggest is that kind of in the midst of all of this there's another affect or or feeling experience that is an important one and that is the ability to bear loneliness and and i would argue that it is a developmental accomplishment it is a step in mastery as a human being to be able to bear loneliness and i think that many people who flee into the medications whether they be listed ones or illicit ones are um running away from this challenge of trying to compare these speeches let me jump in here yeah what we're talking about here both the prescribed and the proscribe is this almost metaphysical thing of normality what is it you know what is a social normality that we seem to be driving people into or imprisoning them incarcerating or punishing them if they move outside it so we almost have this mystical body that we're attempting to inculcate here i think in advanced industry you know in our crazy complex rhythmically driven say that we're calling normal and you're dealing with it you're saying you know and you're looking at even three-year-old kids now are being seen as somehow they're abnormal in these giant transformations of their body chemistry being brought to them so that that's something we get in what is this thing that we're calling a normal body state and is the dsm-3 4-5-6 however this thing came out of the military at the end of world war ii a reflection of you know what normality is and what society is willing to tolerate as well because even as clinicians as we train those coming up if we as a society grow into the intolerance of anger or sadness or loneliness that then goes to a more advanced or extreme condition when in fact it's part of the human condition you know it's one thing when that when adults make decisions to use recreational drugs or even to use psychiatric drugs but i think some points you know bob that you were making about what's happening to children even infants and toddlers uh is remarkable because of the the inability to have any control over that from from the perspective of the person that's involved one thing i often tell my students is i ask them to speculate what is the subset of the culture that is most disproportionately medicated with antipsychotics anybody want to hazard a guess department prisoner prisoners yeah probably perhaps but they're not the ones that are i mean they're right up there but they too are ones without agency right kids foster kids which type of foster kids boys which type of boys black right adolescent african-american males are the most disproportionately medicated segment of this population when it comes to the use of antipsychotics sure so does that speak of racism as well you might wonder or or does it speak to to the the the drivenness that we have to do something to people that make us feel uncomfortable you know it's the same it's the same thing that i would argue we do with people who are psychotic we do things to them because we are made anxious and we are made uncomfortable by the manifestations of their psychosis you know we because of this this uh this wish not to feel uncomfortable we seek out quick fixes and i i would suggest that what we seek is quick but it's really not a fix the research increasingly demonstrates that really nothing is fixed and in fact matters are made much worse um there's a slide that i prepared that that talked about the soaring costs of psychiatric care in 2001 the u.s spent 85 billion dollars on mental health services in 2008 the u.s spent 170 billion and in 2015 it's expected that we'll spend 280 billion so going back to the uh the numbers of billions it's pretty remarkable and public medicaid and medicare uh covers the cost of about 60 percent of those expenses and these figures do not include costs of ssdi and ssdi disability programs lifetime costs for caring for one 18 year old who goes on disability for mental illness can be expected to exceed two million dollars so that's per per 18 year old over a 20 year span starting when prozac came on the market in 1987 the number of people on government disability due to mental illness just due to mental illness went from 1.25 million to more than 4 million there has been a 35-fold increase in the number of children disabled by mental illness who received federal disability payments rising from sixteen thousand two hundred to sixteen thousand two hundred in 1987 to 561 569 in 2007. so you can probably see my little graph here this is kind of to show you the exponential leaping forward that's going so this is this is 1955 people on uh uh disabled people disabled mentally ill people in the united states this is 1987. there when it went from 100 from 213 people per thousand to 543 per thousand in 2007 it was 1315 for a hundred thousand hundred thousand percent but you can just see it's an exponential increase now this spans the period of time during which we have been using psychotropic medication so if if that is so effective and things are getting so much better for those individual patients that we all know why is this also happening to such large segments of our population um the whole question about brought up about chemical imbalances that's been tatted with regard to depression with regard to schizophrenia and really all others and i won't repeat it but simply every study that looks at things long term finds there's no evidence of of chemical imbalances or any really any proof that that there is something organic in the brain that's causing these things to happen um in the interest of time i'll just skip over some of that i want to talk about a reality concealed by manipulated data so although psychiatric medications may be effective over the short term the reality is that they increase the likelihood that a person will become chronically ill over the long term and i'll show you just one study that talks about this this was a xanax study that was published in 1988 the blue line in my graph is xanax and the red line is um placebo so at baseline when these people with anxiety panic attacks and anxiety services began to take the drug and the placebo the the rate of impact was um at 6.2 per well i can't remember what the total number was i've got to put that on but but the point is that as as as you went through the first weeks of the program the first nine weeks both groups really got better you can see that the xanax treated group and the placebo treaty group both both got better but then they gradually took the patients off xanax and off the placebo over the next five weeks of the study from nine weeks to 14 weeks as the patients were taken off those on xanax got worse again significantly while those who had been on placebo um you know stay stayed about the same level of feeling better what this really demonstrates is that there was uh an effect an iatrogenic effect of having taken the drug and it did cause the brain to begin to want more of what had been you know suppressed through the use of the drug now it's interesting to know that in the study that was published about this by um the company that was the maker of xanax uh they only talked about this first part of the study and they did that to demonstrate the effectiveness of damage and that's why xanax then became as popular as it was this is just one study you can really look at many that that had this same type of experience the last thing i want to close with is just a few words about the military because i think this is another interesting subset of the population that is impacted by psychotropic medications uh in march on march 17 2010 the navy times published an article that was titled medicating the military it found that one in six service members at that time were on some form of psychiatric drug so one in six members of the military and many troops were taking more than one kind mixing several pills in daily cocktails for example an antidepressant with an antipsychotic to prevent nightmares plus an anti-epileptic to reduce headaches the the article continued to point out uh records obtained from the defense logistics agency which showed that 1.1 billion was spent on common psychiatric and pain medications by the military between 2001 and 2009. this represented a 76 increase in the use of psychiatric drugs over those eight years a 200 percent increase in the use of antipsychotics during those eight years and 170 percent increase of anti-anxiety drugs and sedatives during those eight years uh antidepressants only increased by 40 during that time but let's think for a minute about what is the collateral damage of this happening the army's suicide rate increased more than 150 percent from nine soldiers per 1000 in 2001 to 23 per 1000 in 2009 the marine suicide rate increased about 50 percent from 16.7 per 100 000 in 2001 to 24 for 100 000 marines in 2009 remarkably and interestingly and i think sadly and importantly the number of suicide deaths in the u.s military surged to a record of 349 in 2012 which was more than the 295 americans who died fighting in afghanistan that same year so suicides became the main cause of death for persons in the military now what what wants to be said is that this is happening because the war and the war experiences that these people were in was somehow worse but i think if you go back and you think about vietnam or you think about world war one for example especially i think we'd have to say that's not necessarily so and it and i think it really is worth asking ourselves what is the impact of these soldiers being drugged to the degree to which they've been drugged in terms of what is happening in the military there's a sizable portion of people committing suicide that we're not exposed to combat exactly so let me just go close by going back to this point about uh an iatrogenic epidemic you know the termitic means of or relating to illness caused by medical examination or treatment and i think we're trying to make the case that we have an iathrogenic epidemic on our hands it is a common belief that psychiatric medications have led to a revolutionary advance in the treatment of mental disorders but i would like to suggest that we're going to have an epidemic of in fact i want a quote from dr joseph taratolo who is the board chairperson of the international center for the study of psychiatry psychology he said well we are going to have an epidemic of young adults with yet to be determined neurological problems due to the long-term use of psychotropic drugs an epidemic is technically defined as one percent of the population being impacted but he points out that he believes that it will affect far more than one percent all right um you guys just um start talking if you have something to say about psychoanalysis psychoanalysis was not basically really talking cure something different so i just wonder if you guys wanted to offer general comments or address or other people in the audience address how you think um like this medical epidemic relates to psychoanalysis whether psychoanalysis is something that's always held another viewpoint if we're talking about a a system that's taking information to the cells and we've discovered we can manipulate it talking does that too i mean you can have a you know somebody says they love you or let me give a good example you know you you walk into a party and you see somebody you haven't seen for a while right by you right and and and your your excitement and joy which you're feeling that's a genuine emotion these are your emotions in some sense these are the molecules of emotion that we're talking about manipulating when we talk about receptors and all of that these ligands that we either you know you either have in your body these things only work because they're manipulating a body system either enhancing it or diminishing it often in very crude ways i mean it's oftentimes they're just blocking a door saying hey the body system can't get in the door anymore you know but anyways you know you're filled with excitement and and and they rush by you and you're filled with anger you almost go 180 degrees these are intense body states you know that have just been gender no drug has generated them you've generated them right so the talking cure yeah you can you can create i mean not as powerfully i mean certainly when these are powerful substances that are you know if you if you you know you're you know if you have an you're lighting your endorphin system up pretty significantly if you shoot heroin you're going that significantly more i mean you're you're you know you're maxing out you're tweaking the level way up which would you rather do well i can answer that unfortunately you know what they discover on that hair on that is you're tweaking your system way up you'll never get that high again i mean you know the heroin attitude that is always you know it's always a diminishing return that's how all peak experiences work though all peak experiences so what is it about the that it's not exactly a peak extreme you're always looking for the peak experience perhaps because you go back it's usually pretty much the same that's my experience i don't want to speak for anything else but uh gentlemen you know i would just add i think psychotherapy in general and psychoanalysis takes a really heavy hit on this i think it's another um i would say fatality maybe that's too strong of a word but it's it's been impacted dramatically by incredible healthcare costs so as a clinician that takes insurance i'm on the phone every few months with insurance companies to justify more sessions and that then there's a ripple effect in society that expects big results quicker so oh my gosh nine months of therapy i don't have time for that and i think it's that's a cultural piece but i think it's also supported by just the financial structures that are imposed on us i have colleagues that don't use diagnoses they don't take insurance but i think in that way they also kind of pigeonhole themselves into not working with certain people that really need this level of care i've always loved working with the more severely troubled people and you know they it's hard for them to get care without without funding in place unless they're getting pro bono services and they're just aren't enough of those out there so i think in general psychotherapy we need to really go back and re-examine our values around that because it's it's a you know i'm probably being too fatalistic about it but i think we have to fight to keep it in it in its existence because um there are a lot of forces working against us as you see this whole discussion is rimmed around with politics and economics you know you're you're looking at both both the legal cartel and the illegal cartel you're generating hundreds of billions of dollars of profits and they said you know you profit margins like you can't believe uh you know these are powerful powerful things that you know that are driving the whole discussion really you know i mean you you know you have to have to get to get reimbursed by your insurance company you have to have a dsm diagnosis you know and so it's the whole circle of things that you know that that move it away from the sort of philosophical discussion we might have i mean you know what is loneliness you know how does one treat that what is you know what is the search for ecstasy you know do you use illegitimate means if you want to use that or whatever to get it but you know driving this whole discussion are just powerful economic forces that you know that have corrupted science in some sense as you're saying the discussion we just heard was the discussion of science being corrupted in some sense by by the corporate agenda well one of the other things that gets said as i'm sure all of us know is that we have to we have it's not practical to think that we could make talking therapy available to everyone because if they couldn't afford it and we don't have clinicians and so on and so forth so that's an argument that is made to support the use of psychopharmaceuticals but i hope that what we what we've tried to at least get you interested in if not convinced of is that there are there are such remarkable consequences of the use of psychopharmaceuticals that i would argue that it really begs what's more cost effective in the long term because the cost that our society is going to have to bear for these remarkable increases in in the persons on disability over the course of the next several decades uh that that's going to be worn by all of us and you know you i made sure that you knew that we worked without medications and hannah perkins what the children worked with there i would just like to say a little bit about that these were children who were in therapeutic school and many of them were where we worked with their parents on their behalf therapeutically as they got older some of these children went into therapy and many into psychoanalysis these children their diagnoses would have placed them on pervasive developmental disorder autistic spectrum disorder and a whole range of other developmental interferences but we we never prescribed medications and more than 95 percent of the children who left our our preschool in kindergarten went on to regular classrooms in public schools or private schools without medication treatments so it's possible to work in relationship-based therapies without medication and have effects but it's it's challenging to try to uh to convince parents and even to convince insurance companies that that's possible i would add related to that when i was working in residential care i've heard it's recently changed a little bit but when i was working in residential we could not keep the child placed in care if they were not on medications because i was always championing come on let's reduce these come on they're on five meds let's reduce them blah blah blah but if we got to a point of them being ready to go off their medications the funding source would say well then they don't need residential care and my thinking is residential care would be that's the perfect place to do that kind of work because they're surrounded by relationships it's a very safe environment and if they're going to get impulsive and aggressive off their medications let it happen there at least everyone you know there are enough resources there but yeah we would get mailed by the funding sources you know will then discharge them if they're not ready or if they're coming off their heads there's something really wrong about that because right now in the state of illinois if you are on medicaid and you have more than four medicines you have to get sort of basically your doctor to fill out a special form to get approval which in my line of work means that a lot of people decide you know what it's not worth it to go to the doctor try and get that so they say skip it i'll just miss my risperdal my blood pressure medicine whatever um it seems to me that feeling better being medication and feeling better via psychoanalysis or psychotherapy are very very different kinds of experiences and the experience of psychotherapy is an experience of getting to know oneself or coming to understand ourselves and that there's a whole implication of you know these aren't just equivalent ways of feeling better or different modes of arriving at some point of feeling better they're very very different kinds of life experiences and they sort of set a particular kind of trajectory for the way somebody understands and experiences their life and i think you know it seems to me absolutely yeah i think that has to be part i think in some sense the medical intervention these drug interventions we have are extremely improved as i say it's like just you know as opposed to the psychoanalysis which is pretty you know it's a pretty sophisticated you know in in some sense you know it's i can't think of a good analogy to what i would call the drop you know i'll think of one as i think here how you know sort of simple it is to like get the effect it wants um what would be good as as opposed to uh well i don't know maybe it's dieting maybe it's dieting and then just going and having the operation that removes the you know i mean in the course of dieting you learn all there's a lot of dead self-discipline and there's a time that passes yeah a sense of mastery all the stuff is coming in there as opposed to if you just go to you know one of the things where they shrink your stomach you know i think the risk that comes with it when somebody's achieving being content with their life through analysis or psychotherapy versus taking prozac and then just kind of relinquishing the stress to the pill people come to the conclusion or could come to the conclusion that feeling okay on prozac is the way i'm supposed to feel when there are dramatic qualitative differences by doing it through therapy versus the medication so um but then we are as a society i just started working with a woman who um marital problems started taking prozac and she herself often packed and she um she feels like well you know it feels better now and maybe i'll just hang in there when in fact all the marital problems still exist but she's now just you know she's become tolerant more tolerant of them instead of activated to make a change or to get her spouse to make a change so go ahead yeah i don't know if you need an analogy it seems to me that when you medicate something you're just simply suppressing the pain and you black out a lot of other things at the same time if you're in a position to relieve the pressure of conflictual circumstances then you feel more alive and you're growing towards something completely different you know shut up and sit down over here and so on and the other one is go someplace i think that also involves the meaning we place on symptoms because your comment made me think of what i've heard before of using medications is like taking the batteries out of a smoke detector like the smoke detector exists to provide warning and if we see symptoms as those indicators of warning but there are a lot of people that don't you know they see it as a misfiring of the limbic system or you know i i also wonder how much the drug companies and the whole zeitgeist of current system has to do with the fact that even though you could show that all kinds of psychological human interventions much lesser even than full psychoanalysis but maybe coming from psychoanalysis in a way segmentation principles you could show that it really in the long run the short run here there and so on it's going to be cheaper but it doesn't make a profit it's not something you can sell so on the one hand you have people who want to make a killing uh in the drug market and so on and then they you know whatever they can sell and then on the other hand you have the the health debt the cost of the health system and the two are not put together i mean a lot of what what the pressure is coming from the fact that corporations want to make money that's what i'm wondering about if you put those straws i think that's true numbers together i wonder what you would find i think what you're speaking to as well is this whole climate of evidence-based care that we've been in for years now and your numbers reveal that despite our evidence-based treatments and all the rigor of science that we've thrown at them our outcomes are not necessarily better now when you look at these even psychotherapy strategies which are very difficult to measure in the first place analysis being one of them right i mean to quantify analysis and stuff but like the people that are really real geniuses at marketing their approach like the dbt marshall monahan dbt approach there are studies out there that demonstrate dbt doesn't get any better or worse results than standard psychiatric care for borderline personality disorder let's do this uh dialectical behavioral therapy well it's modified into it but but there is a whole industry of milky t out there i mean there's certification courses i mean it is like the treatment of choice for borderline personality but when you compare them against standard psychiatric care outcomes are basically the same but it's been marketed really well but the evidence just isn't there what does it mean outcome everybody says that outcome over what period of time and and ends with one criteria right there's no outcome what does that mean outcome person's no longer a pain in the neck well it depends on who's measuring and who you're asking that's the project i'm doing we're going right to the teenagers in residential care saying tell me what you think works and doesn't work what do you think of therapy what do you think about what do you think of the mill you the relationships you have here because nobody's ever asked them and i think that's a pretty important outcome so but it depends on you know if you're using the brief psychiatric rating scale for symptom response if you're using the pans the positive and negative symptoms scale for medication studies all sorts of different measures but are they good is it better to just go ask the patient like do you feel better now did you keep taking this thing you know okay one thing that sometimes gets left out with the idea of like emphasizing corporate profits is the like dimension of social control and like of behavior especially so it struck me when all you guys were talking that something happened at the same time as all this pharmacologicalization which was the massive reduction of street crime and it turns out that at the same time you know the like the start of this is also at the same time mass incarceration american society so i mean i wanted to put this exactly so before this mass incarceration happened the 60s was like it's sort of like difficult to explain but one way to understand is that that's the first period when like mass prosperity was available it's like after you know like a lot of humans who sort of like didn't feel the need for wage waiver people experimenting in like you know the drugs with different modes of living and then you start to see in the 70s a very aggressive sort of like attack back on that and i wonder given that there seems to be some sort of movement away from this model of social control you know like the decriminalization here is one good example is there something that the like people within the medical community and mental health community how do they like what's your perspective on like the criminalization of drugs on like like should like in a democratic society should i be able to walk into a pharmacy and buy real one take that little into the library use the rhythm to read you know a lot more than i could read otherwise this is for example how kroy wrote an interpretation of dreams except it was cocaine about rhythm well you know tim larry said it was the fifth freedom the freedom to control your own nervous system okay and i mean that's not a freedom we acknowledge you but yeah that's certainly been a philosophy out there do you have the right to control your own nervous system we live in a culture this is absolutely not you know on both sides of this question i mean that seems to me obvious we don't you do not have the right to do that um the decriminalization of marijuana and the state things you see that's yeah i mean in some ways you could say the taking of illegal drugs represents an enormous social dissidence movement perhaps the biggest one we've had because people keep doing it despite the federal laws certainly all the state you know the feds are very clear on decriminalization they're not going to support it they're looking at what's happening in california you know and that really and closing down that much of the dispensaries i mean there's certainly a push back against what's happened powerfully on the fed level the stakes of course are going along so what will happen down the road with this state federal confrontation is going to be very interesting um also what happens to the millions of people who are like there's 2.2 million people who are incarcerated right now of those i would say at least 50 percent in some relationships to the criminalization of drugs so it's a million human beings right yeah about 50 percent have been in there since the 80s that's pretty much a solid number just as you know when they do the high school survey about 12 percent of each graduating class is taking the psychedelic well much of this stuff has remained remarkably stable except these numbers these numbers are going through the roof you know over here to go to your point one thing that i'd like to just throw in the next is it's one thing when people eat whether it's via civil disobedience or personal independence they make a choice to use products because they want to use that and we can even look at alcohol which is legal but you know if you've had a family member that was killed by a drunk driver you have a different opinion about that kind of freedom right so it's when it's when the freedom crosses over and has a negative impact you know i think we could also agree that someone who's not impaired by alcohol might have a better chance of using that dangerous vehicle than someone else there's there's an attempt by a woman named elaine pringle to follow what's happened to all of the mass killings what's happening what's what's been behind the various mass killings and i came across a podcast of hers the other day where she was reflecting upon the aftermath of what happened in newtown and she had right after within a few days after the tragedy there she was getting email messages from people around the country who had heard reports that the uncle of the young man that did the killing was saying that he had been in the past had been treated with antipsychotics and other psychotropic medications so she went trying to find this news story and within a few days if it's having been released though it was it had been redacted so that part of that message was no longer available for people to really find and discover so the question that i think we would have to ask is is is there something so consequential about the use of these drugs that cause people to not have the ability to maintain the controls that we would hope that they could maintain and what if what happens when those people are children to whom those drugs were given without any uh you know abolition theirs being involved in the process and so i think to go back to your questions i would just ask us to put those factors into your mix you know just to try to connect a few dots um go back to the issue of social control to start you know it was uh her first uh all sorts of drugs into watts in the 60s there was a great fear about what might happen to the black panthers exploded then there's gary webb's work on the cia drug connection the cia needs the drugs in order to prop up its reason for being now we fast forward to um um the relationship that's that the recent recent studies have shown the relationship between suicide rates and economic inequalities in in greece and italy suicide rates have gone up since the austerity programs have been implemented in iceland and germany where they're slowing down the australian social services budget cuts to a minimum in terms of the harm that they bring on population the suicide rates and alcoholisms and other social indicators of distress other social indicators that distress are our not as severe i think one of the things we have to consider is that in the larger cultural context when you see the economic inequality in this country booming that not just the rich getting richer but everybody else going down that the median income of the family of four now is about fifty thousand dollars twenty years ago it's about seventy thousand so it's getting worse across the population we see indicators of uh high obesity rates going up to the third of the population by sleep um there's you can see all the matter of social indicators that put stress on people and in fact result in the united states being at the low end of healthcare outcomes of all the industrialized countries not just because of the healthcare system but because of these other social factors so in a certain sense what i what i like to think of in terms of connecting the dots is that we see a an economic system that is oppressing people to such a degree you know the drugs become a sort of a palliative or some effort force stall wider um uh uh uh more revolutionary more more um efforts towards social protest and change it's almost like if we would let them go back to the white house we're gonna stop the revolutionary kind of spirit with the drugs except we do it on a mass level psychiatrist huge amount of drugs which keeps them down on the farm in some sense well sure absolutely i mean what was a more political subject than you know the prozac and the huge anti-compression thing what do you say the country's depressed i mean or look at simply the sales of painkillers you say what are we looking in late industrially during a great deal of pain you know i mean clearly the body's in enormous amounts of pain just look at how many painkillers we're taking you know one piece one piece of that big picture is this new field of epigenetics that's been approaching um there's a study from two or an article from 2012 that talked about the impact of ssris and and one little column of the article talked about the epigenetic influence an example of this being african-american women that take ssris their male children have a higher likelihood of two very specific aggressive types of cancer but that yo