Is the DSM...BS?

first I read Sarah's book. I loved it. And you know, at first, if you just said to me on paper, you know, hey, there's a book out on this person says that the d s M, which is how all um mental health diagnosis is, they come from the d s M, and it stands for the Diagnostic and Statistical Manual of Mental Disorders. And I've known of the d s M my my whole adult life, that have been

in therapy. It's what therapist used to diagnose you. So you may say I have this symptom of that, they may look it up in their little book the d s M and say, oh, well that's a clinical depression or that's a generalized anxiety disorder. A lot of times a talk therapist will use it because there are codes in the book. So they'll say, okay, so you're coming into talk about your family, now would you say that

that's causing you more depression anxiety? You know, And then they'll put the code for your diagnosis on some kind of super bill and it gets sent to insurance, and if your insurance covers you to see a therapist for anxiety and depression, then there you go. You're going to be covered. So it originally came about as a way for doctors to communicate with each other, and then it sort of became the the manual for how to diagnose people.

And I've heard comments here and there from professionals that like the d s M. You know, it's just it's not the dictionary, if that makes sense. It's not totally accurate, it's not set in stone. It's it's it's guesswork, and there are a lot of diagnoses that could fit you. You can have a bunch of symptoms from different things.

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

a name for something. I think it's so helpful. You go, well, there's a name for this, then other people must have experienced it, and there's experts out there who can help me. But then as you get a little more practiced or grown up, or further along in your recovery from whatever mental disorder you're going through, you might start to think this seems like a very narrow definition. I don't do I really have this? Or is it more this? Or

is it you know that kind of thing. And so that's why I sometimes get nervous thinking about doing episodes like this. When I when I decided to do this episode, I thought, I hope I do this right, because I don't want to sound like good conspiracy theorists or make Sarah sound like one, because nobody is saying, oh, mental health issues, they're not real. That's literally not what anyone is saying. But I know, if you're doing the dishes or driving and sort of half listening to this, who

knows what you might hear. But I just want to make sure on my end that I've been very clear that what we're talking about in this episode, there is this manual called the d s M. And while mental health illnesses are real, the way that many things in the book are diagnosed maybe sometimes inaccurate. You may get an inaccurate diagnosis. It doesn't mean that like all doctors are bullshit. That's not what I'm saying. And Sarah and I very much believe in mental illness. We've both had it.

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

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

some dark, shadowy group. It's like, it's just not accurate. And so I talked to Sarah today about her new book, which, by the way, again is called Pathological. It is out right now. You can get it wherever you get books. It's been called a powerful memoir, a deeply compelling person and a fantastic writer. Pathological will make you passionate about improving the way we handle mental health. And again you can get it wherever you get books. A little bit

about Sarah Fay, the author. She is an author and an activist. Her writing appears in many publications, including The New York Times, The Atlantic Time Magazine, The New Republic, McSweeney's, The Believer, and The Paris Review, where she has served as an advisory editor. She's currently on the faculty at

Northwestern University in DePaul University. She's the founder of Pathological, the movement of public awareness campaign devoted to making people aware that mental health diagnoses are invalid and largely unreliable, and a full recovery from mental illness is possible. So I will link to Sarah's website and her book in the show notes, and I hope you enjoy our very nuanced and rather how do you conversation about this thing

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

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

diagnoses that you've had in your life? As you write in your book pathological, that you said you have received since you were twelve years old or beginning at the age of twelve. Yeah, So I was first diagnosed with anorexia, and then it progressed. I had a little break um in terms of diagnosis, so I was basically was out of danger in terms of anorexia, no longer going to

the hospital by the time I was about sixteen. But then I had kind of that lag in college that a lot of women have, which is you're you're eating horribly, but enough that you're gaining weight anyway, So you know, so I had that and then UM, and then in my twenties, I was in a relationship that was just really positive and I did really well there for a while. And I talked about this in my book. He's now a chef and was a fantastic cook, and he really

taught me to love food. UM. A lot of people who read my books say the second chapter is a relief, because the first chapter is so you know, dramatic with my anorexia, and then the second chapter is all about this boyfriend, Chris, and how great our life was together. It didn't last, and so I then went into sort of a lot of anxiety, a lot of UM, definitely dipping into hypochondria, relying on alcohol to self medicate, and

I talked about that in the book. But finally when I moved to New York, it really started to uh reach more of an acute phase. And so I was diagnosed at generalized anxiety disorder by my primary care physician in New York and given valium, which I quickly became I wouldn't say addicted, but I was definitely relying on it um. And then when I was in New York as well, my cat passed away. My cat died. Cat people out there will be able to relate to this,

but I was devastated. She had been mine for sixteen years. And so I really went into a very deep depression. And I had been battling with depression anyway, but turned to exercise UM to try to relieve it. And I was running so much in New York and running over what we called the five Bridges, so we would do all the bridges in you know, in Manhattan and Brooklyn and Queens and so anyway, So I was running to

such a degree and I went to a therapist. A friend insisted that I go, and I received the diagnosis of major depressive disorder after the thirty minute consult, and she said I should be on antidepressants right away. I resisted. I was the kind of person who wouldn't take aspirin.

I mean, I was just like, no, no, no, no, no, I'm natural, and so I YO good and I meditated my Chinese herb and I just kept getting worse and I kept getting worse, and so eventually I went to get my PhD in Iowa, and I ended up going to my primary care physician there. He diagnosed me first with a d h D, then obsessive compulsive disorder, and then obsessive compulsive disorder and a d h D with anxiety and depressive elements, which sounds like a nice cocktail

or something. I don't even know what that is. And it got it got quite bad at that point, and then I started to become suicidal and was really just went into crisis phase for about I guess it would be nine years. And then I was diagnosed with bipolar disorder. And so that's where my final diagnosis ended up. And I mean, it's a much longer story obviously it's a book. But so finally I was extremely suicidal. I had been

put on and taken off so many medications. Um antipsychotics had terrible AVer's reactions, including a caathesia, which is this terrible side effect where you feel like you're calling out of your skin. You can't stop moving. It's it was awful. And so I had a falling out with my psychiatrist at the time, and I went to a new psychiatrist that my sister found. My sister and my mother and my whole family. They're the heroes of this book, no question.

I was so lucky to have them. And I went to this new psychiatrist and he we had our quick, you know, back and forth twenty seven minutes, and I waited for him to proclaim whatever he thought my diagnosis was, or give me a new diagnosis. And he looked at me and he said, I don't know what you have. And my whole world changed. And I was walking down Chicago Avenue in Chicago, and it was winter, it was really cold, and I just thought, no one knows what

I have, none of you do. And so then I took it on myself and I just said, I'm going to find out everything about mental health diagnoses, their history. Who thought of these where did they come from? What lab were they discovered in? And so I just wanted to know everything. So I ended up going into this deep research phase and that's what my book is. It's my story, but I also bring in all the information that I want other people to know to save them

from going through what I went through. So I have two quick follow up questions. One is was it because you had been diagnosed so many times? Was it weirdly freeing to have someone say I don't know what's wrong with you? And secondly, normally I would do this like kind of at the end of the episode, but tell us now how you would diagnose yourself, Like what do you have now and how do you handle it now?

I'm glad we're talking about it now because I always want to preface that even though and we'll talk more about this, but the diagnoses we receive, all the mental health diagnoses, and when we talk about the d s M, that's just the manual they come from. It's just a book and that's where everything we're given, you know, originates we talk about those are invented categories. And I didn't say that actually, but Thomas Insel, who the former head of the end I'm and i m H, which is

the National Institute of Mental Health. He said that, so a lot of sort of our most prominent psychiatrists and researchers have been warning us about the invalidity of these diagnoses. So even though I say that and I agree with them, not that they need me to agree with them, but that mental illness is very, very real. I had one, There's no question. I used to say I have or had one. UM. But they are no D S M diagnosis, No mental health diagnosis has been proven to be chronic.

Mental illness is not chronic. UM. And that same Thomas in Soul, who is someone I really really admire. Um, he just came out with a book that basically says, UM, it's kind of an apology for focusing so much on the biomedical model or this idea that our mental health diagnoses are biological and therefore chronic. UM. When he was during his time at the n I m H and instead of really providing for people and providing care for

those especially most in need with serious mental illness. UM. But he's now come out and said, no, mental illness is chronic. We can fully recover. And so I see myself as an example of someone who had a serious mental illness. UM. I had to three technically UM, and I have fully recovered. And I want other people to know that they and their children and their teenagers can fully recover too. So that's where I am. Now we'll

be right back. The d s M is the Diagnostic and Statistical Manual of Mental disorders, and it does exist and it is a thing. But your book is about how we need to take another look at that because it's used to diagnose patients. And you know, there's psychiatry and their psychology, right, so I see a talk there fist they do not prescribe medication. I do have a

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

I mean, it's almost this kind of it's like the least healthcare it's like the least mental health care thing, right, It's not um ooei gooey and some kind of like loving warm blanket of a book. It's just codes and things. And so in your book you're talking about how it's not fully accurate and it's just kind of made up. But that can be challenging, I'm sure for people to hear you say no, but I have this, and it's like,

we're not saying you don't have a thing. Can you tell us just you know, we'll get into it deeper and deeper, but like overview, what is it? What is the d s M, what's it supposed to be for? And what is it really? You know, the underbellue of it? You know you asked this is This was all incredibly threatening to me. So it was a relief in some ways. But I would if you had taken away some of my diagnoses, I would have wrestled due to the ground. I mean, I was so identified with them and I

thought that they helped. I've since read, you know, and looked at studies, and they've actually found that people who believe there's a biological cause to their diagnoses have more stigma, more self stigma, mor shame and are more hopeless about their diagnoses. So that's kind of interesting just to keep in mind. But not everybody is, and I respect that. I mean, there are some communities that are really um

emboldened by their diagnoses, that really come together. The autism community is a great example, and that's a diagnosis that to me is like you know, mean, there's complications with the Aspergers and all of that, but we won't go into that, but the and what I really do want to explain to all your listeners and thank you again for having me on. This is such a great opportunity that all I want is not to take away anyone's diagnosis, because that felt right for me, not to identify with one.

Though I still very much identify with having a mental illness. I still take meds, I still see a psychiatrist. I will always take meds because I'm pretty sure my body is dependent on them. And I have no shame about that. There's no I don't need to be psychopharmacologically pure to be well. Um, that's just how you know, it's complicated. We're kind of in a sticky thing. So for me, I think everyone has to make their own decision. Do they want to keep their diagnosis. Do they want to

identify with it completely? Do they want to take it with a grain of salt, use it for what it's worth. And I'll explain why. So the reason is that, you know, we really have this luxury right now because the d s M has in some ways. As I said, it's a book, that's all it is. When someone said to me, you have bipolar disorder, I imagined, you know, microscopes and people in lab coats making tests and deciding who has

bipolar disorder. The problem with d s M diagnoses is that there is no biological marker for any of them. What that means is there's no test. So we often like to say mental illness is the same as physical illness, and that comes from a really good place, which is we need to respect it the same, we need to honor it the same. We need to have mental health days if we need them, absolutely, but they aren't the same.

With the exception of dementia and rare chromosomal disorders that are in the d s M, no single diagnosis can has an objective reality. They're dependent completely on self reported symptoms, totally subjective, and a clinician's opinion totally subjective. And that's the that's the issue with the d A SUM. It started in nineteen fifty two that doctors came together, Um well, I should say members of the American Psychiatric Association came together to create a manual that doctors could use to

better communicate with each other. And what's kind of fascinating. You talked about therapy and psychology versus psychiatry. So once medical, the d s M became away. In the third edition, it's had seven editions where it gets revised and more diagnoses are included. Never are they taken out, but more and they're were fined and the wording has changed. The third edition was really the turning point, and that was when a guy named Robert Spitzer, who again was very

well intended. I'm totally pro psychiatry, by the way, so so everybody knows um. And so he was a psychiatrist and was just bent on making psychiatry a respected medical field. And it wasn't because they didn't have the proof. Again, and so he's the one who came up with the symptom lists. So when you get depression, you have to

have five of nine of these symptoms. Now when I got the major depressive disorder uh, you know diagnosis, I thought, okay, well this is scientific, like this is medical, you know, of course, and then in my research as I went through, UM, it was it's completely arbitrary. So Robert S. Fitzer has quoted it's a it's a fascinating and penetrating and frightening quote. But he was asked why you have to have five of nine symptoms to receive a major depression diagnosis, and

he said, well, we were sitting around the table. We went around and we said how many do you think we should have? And six just seem like too many and four too few. They were completely arbitrary. Yeah, and we still have the five. Um. Now again, you know, the d s M is useful. We use it so you mentioned to get you know, so therapists can be reimbursed. We use those diagnostic codes and we use we use it for legal matters. We use it for when we're

trying to when people need educational services. You needed to file for disability. I don't want to throw it out the window. I mean, I don't think it's totally useless. What I'm really hoping for is full transparency. I just want everyone to know what they're really getting and then we can make more informed decisions about our mental health and decide because I think there were times, like you said, there were times in my life where for me, the

diagnosis tended to become self fulfilling prophecies. Um. And so I see where they were very unhelpful, but they were also helpful. Ultimately I did get well, and I couldn't have done that without the doctors I saw. Um. But just going to another point about the d s M. Psychiatrists aren't the only ones who use it. And this is what's really different and kind of fascinating too, in that of antidepressant prescriptions are coming from primary care physicians.

Five of my six diagnoses. Yeah, I didn't love reading that because I think that's five of my sixth name from primary care physicians. And what's what's really needs to be noted about that is they came from men in white coats in hospitals, so wearing. I mean, I had every reason to believe that it was as valid as a cancer diagnosis. Um. But again this this sort of you know, the and then the other thing about it is we use the terminology. So this one theorist has

called it the psychiatrization of language and of culture. Like the d s M is a really powerful work of culture. We diagnose each other, teenagers are diagnosing themselves on social media. We're really we use it even more perhaps than physicians. I mean, it's just such a huge part of our world that I just want everyone to know what these

things really are. Right in describing things, I always get, Okay, I really want to be sure that this isn't coming off as like, you know, secretly occult like and like scientology, like anti Zechia drine like that DSM all bullshit. It's like no, no, no, we're just literally telling you they're kind of guessing at stuff. And if a diagnosis doesn't feel right to you or you don't want to identify by it, just no the truth behind it, which is

it's not chronic. And I all this to say that when I first I went to therapy for depression, and I believe at that time all the undiagnosed, all the all the moods and behaviors I had from childhood to teenagehood with undiagnosed panic disorder and anxiety put me into a depression because I was so confused and so lonely about it, and then I just, you know, had feelings like a person. And I do believe there was depression.

I do believe my chemicals in my brain were altered because of the way I was behaving and thinking for years and in order to start exploring that. It was so overwhelming that I'm glad I had talked therapy and my first Prozact prescription. But I'm saying all that to say when I first went to get diagnosed and I went to a psychiatrist who prescribes my talk therapist, I said,

you probably have a chemical imbalance. And I remember thinking, oh my god, Like that's a big That is like someone saying you cancer, right, or not even cancer, because cancer can go away with chemo, Like, but someone saying you have an enlarged heart, or you know, you're one of your kidneys is failing, you need it removed, You're gonna have one kidney. I mean, it was like a

chemical imbalance that that sounds very final. And so then when I went to the psychiatrist, I honestly thought, I think I went on a lunch hour at my day job when I was just twenty one, and I I remember saying to my boss, I don't know if I'll be back today because I have this appointment. How long it's going to be. I thought I had to go through all this testing. I thought I'd be hooked up to monitors my brain and taking my blood and were they going to have to shave part of my head

to get in there? I mean, why would I not think that, you know? And when it's fifteen minutes later, I'm out of the office with a prescription and I was told I had a chemical imbalance? How how did they know? And then and I went, Okay, I guess I must be so obviously depressed that they can see through my eyes that I I mean, I I didn't go that's weird. Why did how did they know? It's one? And the calcal imbalance theory, which is now the chemical

imbalanced myth, has been disproven. It's been debunked, and so there are some things to keep in mind. And I know this gets so confusing, which is why this is great to talk about. And I none of this, by the way, none of it. I mean one reason I went along with so much for thirty years was that I believed in the chemical imbalance theory. The media reported it, celebrities talked about it. My therapist told me that was true. My doctor has mentioned it. I mean, why wouldn't we

believe it. They used to say, you know that it was you know, you have two low levels of something, right, so dopamine serotonin, as you said. And they found no consistency among people with depression or schizophrenia with any of the neurotransmitters or any of that. So the chemical imbalance theory has been debunked. Now does that mean that it isn't something going on in your brain? Probably not. We

don't know. And so what has happened Thomas insul I just interviewed him, So that's why I keep referring to him. I had that honor. So I'm like star struck. Some people, it's the card actions. For me, it's like the former. But he his new book is really great, and he's he's thinking of it as a researcher and researchers are an out trying to think of it more as a circuit board, like a computer circuit board. That's the metaphor

they're using now. And so but none of that has been proven either, And so what I think that does for us. Where that leaves us is we don't know. And when my psychiatrist said to me, I don't know, it was just then it was my choice. I wasn't forced to believe something that wasn't true. What bothered me was the I don't want to call it lying, because I don't know if those people didn't know the truth, they didn't do their research, they weren't up to date,

or if they were actually wanted to believe it. I don't know, but certainly there are a lot of people still talking about the chemical imbalanced myth and using that to really get people to take their mental health seriously. And what I love about your show that you do is you just investigate. You just ask questions and try to get at anxiety as a disorder versus anxiety as an emotion. And I didn't. I couldn't have told you. I couldn't have identified any of my emotions for the

thirty years. I don't know. I mean I could have hit happy, and I probably could have hit sad, But other than that, I mean, I did not. And I went into I was in a partial hospitalization program and we were in a group therapy session and we got an a motion wheel with all the colors. You know, it's got a hundred emotions around it. I was stunned. I was like, there are all of these. I mean,

how could you possibly know any of these? So, going back to what you were saying, I think it's really important. I would have been very well served. And I did do cognitive behavior behavioral therapy and dialectical behavioral therapy. As I said, I meditated, but it would have been very helpful for me to learn about emotions, like what are they, what do they feel like? How do I process that? Well? Kay, tinue the interview on the flip side of a quick

message from our sponsors. Where my anxiety began was really a phobia flying, and then it became a phobia of heights, and then kind of fear or fear of panicking and all that. But I didn't have the luxury of having too many emotions when I was going through all of that, so I didn't really learn how to emotionally regulate. So as I got older and the phobias went away, I wasn't very regulated emotionally, and sometimes getting a diagnosis of a d H D. Oh, well, I'm not hyperactive and

I can I can pay attention. Oh well, no, it's different new women. It's more about emotional regulation. And then it leads me to read about that, and then I think, yeah, I just I do identify with this. Okay, great, what can I do but it? And then I do something about it. With each thing I've conquered, I get to say I don't really have that thing anymore or you know. And then because it's just the kind of person I am, I'm just kind of always seeking joy and so nothing

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

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

to figure things out, and it was very overwhelmed. And uh, but it's just been it's been fun to take a ride and and just sort of be I have the luxury of being able to look at things differently, and you know, and so that's what I liked about your book is that it's really just about you finding yourself amidst all these diagnosis that you received. And my favorite part of your book and I'm going to have to

now read this person's books. I've never heard of him, but um, I'm just reading from a quote that I wrote down Randolph. Ness is good reasons for bad feelings. Insights from the frontier of evolutionary psychiatry. Um that anxiety was necessary, you know, dating back to our primitive selves. But we don't live in a state of threat all the time, and so those thoughts are natural, but they're no longer useful. But they're not a sign of a disorder or a disease. And you know, I think what

we need to get to. So if we look at the d s M and how like you mentioned a d D. Well, first of all, I just wanted to say, listening to you and my own experience being given so many different diagnoses, there's something wrong with the diagnostic tool that we're using. It shouldn't be that easy to slap. I don't go to the diet you know. I don't go to my yearly, my annual exam physical and get like cancer and then be told, now you got tuberculosis,

you know. I mean, it just doesn't right. You know, there's something wrong with the diagnostic tool that we're using. And part of it is that is again why it's not valid. The d s M DSM diagnoses. They overlap, so the diagnoses are not what's called discrete disease entities fancy word for just saying that they don't exist by themselves. So you can see a d h D in this person, and you can see, you know, anxiety in the same person.

In one study of um or half of the people who had been diagnosed with schizophrenia were reassessed and given diagnoses of anxiety and mood disorders. Those are incredibly different diagnoses. They should not be that easy to reassess and just be doing that and and so the problem is that these are really invented symptom lists and they're doing the best that they can. And I am getting to the evolutionary psychiatry. But the other problem is with that we

have an imperfect tool. So you have clinicians and mental health professionals trying to diagnose. But the reliability of these diagnoses is also very very low. So like generalized anxiety disorder has a reliability score of point two on his scale of zero to one. Like that's really bad, So like you've got a chance of actually having him. But all this is to say that doesn't mean anxiety isn't real. Again, it's just that the labels that they're using don't hold

up um. And so there's the validity factor and then the reliability factor. And so where that left me was, Okay, how am I going to think about my emotional life? How I going to think about my mental and emotional life? And then I read in this book and my father and I read it together, and um, my dad is eighty and he's just very funny. Now he's like being in a book club with him is takes like two sentences. You know that. That's a long we talked about the book,

but it stayed with me for a long time. And what I loved about what he was saying is my brain wasn't some dark, mysterious land of freud where everything was beyond my ability to understand it and I had to go to a therapist to understand myself and they knew me better than I knew myself. And but it also wasn't some horrible like chemical craziness where things were going off and misfiring and I couldn't control it. It was just that I have this really powerful primitive part

of my brain. I have crippling anxiety still and I feel it. And I think, first of all, I think those of us with anxiety really badly. We are the people you wanted on your team in the on the belt, like we were the people who were seeing lions everywhere. We're just like lions. We're looking ahead. We're like, even if it's not there, what if it were, Let's let's role play what to do. Exactly like I am, I am fully the person you wanted in your primitive clan. I just was, and so I kind of take solace

in that. And I just realized, Okay, we're answering email. It's okay, we're not on the belt. There isn't a lion. And I also love his his description I didn't understand. Anxiety made a lot of sense and the evolutionary model, but depression was like, well, what's the advantage of that, because remember, evolution is designed to keep you alive, not to make you happy. It's not what's best ran. It's just to keep us going. So that's why we're not

happy the time. We're not designed to find happiness. We're designed to survive. The human condition is not happiness. It's yeah, it's just it's just being here. Yeah, that's it, and it serves so. Yeah, and depression, he says that there's some belief that that depression is actually just the body's way of resetting from being high high, high on you know,

ratcheted up on anxiety. And that made a lot of sense to me, having been diagnosed with manic depression or what's called bipolar um that you know, I had very you know, I had high highs and low lows, and that when someone said, oh, that could have been a cycle, that was just natural or part of the way we function. That is interesting to me because I didn't want to see everything as being the result of my diagnosis anymore.

I really think at one point my body was like, please, we I don't know how to stop you from panicking, m because you're not doing anything about it. So I think I'm just gonna depress you physically, you know, And I just I couldn't get out of bed. And once I handled my anxiety and like got tools, the depression didn't come back. And I've always said, I really think it was like a respite, my body just saying time to sleep now, because you've just been so jacked up.

And I think also when you look at it that way in terms of serious mental illness, so there's any mental illness, and then there's serious mental illness and an am I versus an SMI, So s m I S are basically defined as they're not any disorder, but it's essentially bipolar schizophrenia, major depression with suicidality, sometimes severe PTSD, but anything that really um you are at the point where you cannot function or live independently. And so I

couldn't live independently for five years. I was living with my mother, and I was very lucky to have that resource, because that's why people are on the street and in jail, because they don't have a resource like that where they can go. And any mental illness is the rest of it. And it's not that that's any less important, but it

is a very those are very different. But when you think of someone in crisis, someone with a serious mental illness, you think about your brain as being programmed to just look for danger. That's just gonna it's just gonna keep going and keep piling on itself and and creating more and more of that and entrenching the person. And so it's it doesn't surprise me that I got worse and worse and worse and really just eventually couldn't come out

of it. But I did well. I really did love that story you told about um autism and then as Burgers being entered into the d s M and then taken away and the community the aspiece were like, excuse me, you know, and I actually do know people with autism and with Asperger's. To me, it's two totally different things. I can I can tell I mean, I really I was shocked to see that and the reasons for it were kind of ridiculous. Can you can you tell us

about that? Feel like that really illustrates this D s M. Yeah.

I mean part of my experience, uh, what I talked about in the book and just my life is that while I was going through all this, I also was encountering and I've always been, you know, taught, and so i was a writer and residence in the New York City public schools and I ended up being assigned off into special education classrooms and then suddenly I was the autism go to person, and so I was always going into classrooms with students with severe autism, and I mean

severe autism. So these are classes with about maybe six to eight children, many of them have a private nurse that you know, not private, and that they're wealthy. These were in very very marginalized communities in South Bronx and the South Brooklyn, and so I really got to know what that what that type of autism is. And as

you're saying, Asperger's is a totally different thing. So when we had the two diagnoses of autism and Aspergers, what they found was that a lot of the resources that we're going to people with Asperger's, which this isn't a very thorough definition of it, but Asperger's is slightly more high functioning than autism, and I should define what autism is.

So autism literally means interiority, like a loneness and when there's a kind of cut off from not necessarily reality in the sense of hallucinating, but there's a kind of separation with the world. And so autism was in the d s M. It was defined by mutism, so it was people who were non verbal. And then the diagnosis just what they call loosened, and so suddenly mutism was dropped from it, and then all that allowed for all

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

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

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

M had a hundred and twenty eight diagnoses. We now have five hundred and forty one if you count sub types, and um, every kind of avenue to get the diagnosis, and so you'd be hard pressed to go into any clinicians or mental health professionals office and talk about your fears or your deepest even desires and not get a

diagnosis at this point. Um, So it's just and again it's this idea of like you talked about a d h D or what they did was they dropped the H from a d h D, and you'll notice sometimes it's called a d D and sometimes it's called a d h D. But what they do is they dropped hyperactivity as a criteria, so you could be inattentive type and that created what was called the false epidemic of a d h D. Then they also included adult a d h D, which had never existed before, so they

just created it. It was not a real thing. So basically you have all you had was a d h D and you had to be hyperactive. Suddenly they dropped the H and you can be hyperactive, but you don't have to be. That doesn't quite make sense, but you can just be unattentive and then you suddenly have and before you had to be, you know, you had to be in childhood. It was a child you know, childhood disorder.

And then suddenly adults can get it too. So that's the kind of thing that happens in the revisions of the d s M and why it's so heavily criticized, but also why it's so problematic for all of us. I mean, we're all in this together. I don't think any psychiatrists, well there's hubrists and kind of you know, arrogance certainly out there, but I don't think any psychiatrist is around walking walking around. Well there is one I know that is, but walking around like you know, we're

doing a great job. This is great. I mean what someone asked me if I've gotten a lot of pushback from psychiatry, and I've gotten none. I have gotten Actually everyone has said yeah, we know, and thank you. Like that's that's all I've received. And it feels great. I mean, it's wonderful because it gives me a lot of hope. Anxiety bites will be right back. After a quick little

message from one of our sponsors. You said, you know, according to the d s M, if grief lasted more than two months in quotes called uncomplicated bereavement, it became a major depressive disorder despite no changes to the grief symptoms. So suddenly it's like, now, just because it's been two months, you've major depressive disorder, but you don't have any new symptoms. And and then you said the bereavement really only seemed

to count the loss of human death. I mean, it wasn't your house burned down, you lost your job, you had to break up, not even a pet dying, And so that's where I've heard a mythology. I've heard it from psychiatrists that oh, yeah, so if you're going through a grieving of any kind, if it lasts more than six weeks, you have tipped over into depressive disorder. Now you have depression. Yeah, looking back, it doesn't make sense because, first of all, our culture isn't set up to have

any time for grieving. So if we had to grief and it did last longer than six weeks, maybe I don't know, but it just seems so arbitrary. Well who does that help, though, Like, who is this helping? Well, the grief disorder it's now called prolonged grief disorder. They have a new the newest revision of the d s M came out this month. I'm not sure if they've released it yet, but it's out in March and the

UM So they've now created prolonged grief disorder. So basically, people have been working for many, many years, for decades to try to get the berieve Man exclusion removed because they want everyone to be able to get a depression diagnosis now to take out the criminal like evil element. Why do they want that I believe the people doing this. First of all, the d s M has been designed to diagnose as many people as possible. That's what it's

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

what losses they're experiencing. And and again, like you said, we're totally disregarding the problem with the d s M is it disregards context. So if my house is burned down and I am grieving, I have depression. I mean that's you know, or if I lose my job or

whatever it might be. But they've created prolonged grief disorder and that says that if you grieve longer than one year, you have a mental illness um and that and what's what's really too bad about this is that in their press releases, the American Psychiatric Association, which if you want to talk about benefiting. They make hundreds of millions of dollars off the d s M. It is in their best interest for it to be a cultural, you know, kind of presence among us and for us to use

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

that drug companies have done for a long time. And so and this is anxiety is really interesting in this respect. Anxiety has been kind of I don't know, victim of this, I almost want to say, because it's obviously not anxiety's fault. But when so a drug company creates Glaxo Smith Klein, the drug company creates Paxel, the antidepressant and s SR and they did it. They actually came up with it in so it was after the Prozac had made a

splash and they just Prozac stole its thunder. So basically what they had to do was find something else to say that Paxel could fix. And so what they did is they went through the pages of the d s M and they found an obscure diagnosis called generalized anxiety disorder. One percent of the population that was obscure. Yeah, one percent of the population had it. It was like, you know,

no one really you know, it was basically insignificant. And what they did, and this is actually brilliant, they marketed the diagnosis of generalized anxiety disorder, not Paxel, And so they hired a PR firm. They also create fake at patient advocacy groups UM and they also fund patient advocacy groups.

So basically, then the media is reporting on it, and they get some sort of prominent doctor from Columbia University or wherever to say, yes, this is a terrible diagnosis and all these people have it but they don't know it.

And then what happens is once they've got the approval, Glaxo Smith Klein swoops in and says, hey, Pexel can cure generalized anxiety disorder that now eight or fifteen or eighteen percent of the American public has, depending on the statistic you believe, and the same thing happened with social anxiety disorder, and it was also Glaxo Smith Klein. I mean they're not the only ones. Other pharmaceutical companies like

up John and Fiser have done the same thing. Fiser did it with PTSD and up John did it with O c D. So this idea of marketing the diagnosis again, it's it's a little bit wrong to say that pharma creates diagnoses in the sense of they don't actually stand at the door and pay the people writing the d s M to create a diagnosis. And it's not made up. There is anxiety either, is PTSD. Yeah, but they're just

saying it's like they're finding their brand. You know, the d s M is such a weak diagnostic tool that it can be used for all these terrible purposes and in all these terms, in all these sort of really dangerous way. This is the problem, um and sadly I don't think it's hopeless. But the new edition of the d s M that's just come out, they had a decade the last edition came out in so nearly a decade to fix the problems that were with the d s M. Controversies had erupted a lot of attention was

paid to it, and they haven't fixed one. And so I really feel like the reason why I wrote the book was it's not going to come. Change won't come from psychiatry, it won't come from the A p A. And it won't come from the d s M. It has to come from us. And that's why I wrote Pathological and why I want everyone. I want us to be empowered. I want us to be able to say, hey, I know about the d s M, and now let's talk about the diagnosis you're giving me and what that

means and what treatment I should have. Well example, this whole notion like we are having a mental health crisis in this country, and honestly, just on I can't explain it on a bizarre level in my body. When I hear that, I go, We're not. And I and I see people having to get duct tape on airplanes. I I see more insanity than I've ever seen in my life. Um, and so it's wild that I'm not running around going we're having a major mental health moment in this country.

It's something, but it's not all these undiagnosed people. And I interviewed this professor about trauma, and he said, we're not having a mental health crisis, we're having a chronic stress. And I there was this, even though I agree with him, there was this like, oh, don't say that, you know, I don't want anyone to get mad because we've all kind of bought into it. And I'm like, well, you

know that. But I it's like, well, if we understood what chronic stress really did to people, we wouldn't be so offended that we're calling it that instead of mental health crisis. Like chronic stress is not we're not meant to deal with it, and we don't deal with it well. But it is like, I do not think there's millions of people with undiagnosed this or that. I think I don't know what it is, Like, what do you think

is happening? Well, it's such an interesting phrase. And I really do blame the media a lot, so I I say in my book, I don't blame anyone except the d s M. I blame a book, but I and I do, but the media. I'm just I'm a writer, so I think about words and the power of words, especially the written word. And so what's interesting about what you're saying is we do have a mental health crisis in the sense that people with serious mental illness are ending up on the streets and in jails. Cook County

is our largest. Cook County Jail, which is not far from where I live, is the largest mental health facility in the country. That's a crisis. That is absolutely a mental health crisis. What's happening otherwise really isn't like you're saying. I mean, what's interesting about the diagnosis of anxiety and how it changed over the additions of the d s M. Is it used to be in the third edition you

had to have unrealistic and excessive worry. They removed unrealistic the word unrealistic in the next adition and in the subsequent editions, and excessive, So all you have to do is worry. I mean, think about what that changes. And when we think about the pandemic. None of what's going on is unrealistic or excessive given what we've just been through. Is it ideal? No? Do we want it? No? I mean,

and I do think that. You know, we don't know what stresses or what the relationship of it is to mental illness, but I mean, there's certainly could be points at which stress can drive you too, you know, an extreme of mental illness. We don't know so that that is possible. But really, I think we're all coping with

this very extreme, excessive somewhat. You know, it is realistic to be terrified that you're going to get you know, to be terrified of journs, and to be you know, hear annoid of the government, given what's going around and how you know, in the silos of social media and that sort of thing. You know, it's not actually I mean, this is what we're living in and we aren't making things up. How did you get yourself out of the situation where you're you're living with your mom? You've got

all these diagnoses, What did you do? I mean, I was extremely suicidal? Um I really did you know? At one point? I definitely was a lot. My mother was on suicide watch for four years. I mean, it was a lot to ask of her. So I did end up moving out and I got much much worse before I got better, and my sister. Again, my family was just a lifeline for me. So I cannot imagine someone who doesn't have that support system. But I had, you know, a place, and I had people to support me. And

I had a purpose, and so I started writing this book. Um, and I don't really look at writing is healing, but it gave me a purpose, and all right, as a writer, I do not either, so it's not healing. But so I did have those things. I say in my book that it's not a typical mental health memoir mainly because I'm questioning a lot of what we take for granted in terms of what mental health diagnoses are, but also

because I don't have the answer. And so all I know is that we don't We don't tell people that they can fully recover. We tell them they the best they can hope for is remission and managing their symptoms. And that is simply wrong. And my you know, I have no data to back this up. But if we want to lower the suicide rate, start being honest with people that not that mental illness isn't chronic and that

there's hope. Because when I was suicidal, I had no hope, I had no future, and so someone had no one had told me. Everyone told me they were chronic. Until I saw the I don't know psychiatrist Dr Are. He was the only one who was allowed me to think of the future. So that really helped. I suddenly started

thinking of the future. Once I stopped identifying with the diagnosis, then I stopped attributing all my really low lows and anxiety and you know, everything that I was feeling to a diagnosis, and instead it was just what I had to manage um. And then, to be honest, I mean up until Thomas Insel's book came out, and he is a man with so much authority and has my total respect. When he said mental illness isn't chronic, I felt like, oh my god, I can now really say it, and

I can say it to other people. I feel comfortable, you know, for me to say, I couldn't tell other people, yes, it's not chronic without you know, anything to back it up. But although there's no proof that they are chronic, but there's At the time, there was nothing there for me to really rely on. So that has helped tremendously. But I don't think we know what healing looks like yet. We don't know what recovery looks like because we haven't given it a chance, and that hasn't been our priority.

Our priority has been looking at trying to prove that their brain diseases quote unquote and trying to prove this and prove that, and what we need to start doing is healing and caring for people and getting them full recovery and to know that. And that's pathological the Movement. That's why I started it. UM. My book, you know, gives readers everything they need to know wrapped up in

a really good story. But I wanted also kind of actionable steps because I can't offer an elixir, I can't offer you a magic bullet, and so Pathological the Movement is just a public awareness campaign to let people know that mental illness is not chronic and you can fully recover, and that D s M diagnoses are not valid and largely unreliable. And all this is as I said, the

exception is dementia and rare chromosomal disorders. But and what I asked, or not what I asked, but what I hope we can do is ask three questions when we or someone we love receives a diagnosis, which is of the mental health professional or clinician, is this diagnosis valid and or unreliable? Um. The answer to the first one is no, it's not valid. And the answer the second one is it depends in terms of reliability, um, and then has this diagnosis been proven to be chronic? And

the answer is no? And then what does that mean in terms of the treatment that you're suggesting. Now, I'm not good about asking my doctor's questions. I'm very medical professionals have great authority over me, so I don't really I'm not really assuming people will actually ask these questions.

But we'll ask them of ourselves and we'll think about them, and that will walk into physicians offices and mental health professionals offices with power and they will have to kind of rise to the occasion and be more transparent with us. Do you have your to go box with you? Are you ready for the takeaways? If you want to read the takeaways or look at takeaways from past episodes, you may go to Jen Kirkman dot com and then click where you see that it says anxiety Bites. Will also

put the link directly in the show notes. But here are the takeaways from this episode. The word pathologize means to medicalize a condition, any condition, and not just a psychiatric one. All mental health diagnoses come from the manual known as the d s M, the Diagnostic and Statistical Manual of mental disorders. Many prominent psychiatrists and researchers have warned about the invalid diagnoses in the d s M.

Even though mental illness is very real. Mental health diagnoses in the d s M are focused on the biomedical model, or the idea that mental health diagnoses are biological and therefore chronic. But no DSM mental health diagnosis has proven to be chronic. Studies have shown that the people who believe there is a biological cause to their diagnosis have more self stigma, more shame, and are more hopeless about

their diagnosis. The problem with d s M diagnoses is that there is no biological marker for any of them, which means there is no test saying that mental illness is the same as physical illness comes from a well meaning place, meaning that we need to respect it the same.

But with the exception of dementia and rare chromosomal disorders that are in the d s M, no single mental health diagnosis has an objective reality like a physical illness in members of the American Psychiatric Association came together to create the d s M, which is the manual that doctors could use to better communicate with each other. The d s M has had seven editions where it gets

revised and more diagnoses are included. Sara Pha's goal is not to throw out the d s M, but to have more transparency around this manual so that people can make more informed decisions about their mental health. Sometimes agnosis can be helpful, but other times they can lead to self fulfilling prophecies of antidepressant prescriptions are coming from primary care physicians and not psychiatrists who prescribe medication. The d s M has been designed to diagnose as many people

as possible. It's designed to be doing a service, but the problem can be that doctors are now over diagnosing, which ultimately does people a disservice. Thanks for listening to this podcast. If you would like to give it a five star review, and please do, I would like you to. I don't care what you like. I want you to um go on over to Apple Podcasts or Spotify. Those are two places that allow you to leave reviews. The more reviews I get, the more people find this podcast.

It's a very simple algorithm, So do that for me and send me an email Anxiety Bites Weekly at gmail dot com. Tell me what you love about the show. You can give some anxiety tips that you have that you use that you want to share with your fellow listeners, And you can ask me any questions that you want and I may answer it on an upcoming listener email episode. Thanks again for listening and remember anxiety bites, but you're

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