In this episode, we're joined by the author of the new book, "Depression and Psychedelics: How to Overcome It: The Truth About Depression and the Drugs That Helped and Didn't Help It, Dr. Gavin McElroy. Dr. McElory is a leading expert in the field of anti-depression and psychedelic therapy, and he has written a book on the subject. He's also a regular contributor to the New York Times and the BBC, and is one of the few people in the world with a PhD in psychology.
Transcript
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00:06:15.000in baltimore where they were giving people psychedelic drugs to see if that would work and i learned loads of things but i think you've gone to the part that's been to my surprise most controversial because i think in a way it's the most banal part of the book so one of the things i learned is uh it's simply not true that depression is caused by a spontaneous chemical imbalance in people's brains um that's not my doctor said that to you as a fact.
00:06:39.000It wasn't like, here's what I think it might be.
00:06:41.000It was just a fact that you were lacking serotonin and we needed to increase the serotonin.
00:06:47.000And people all over the world were being told that in the 90s.
00:06:49.000They're still being told that now it's shifted to other chemicals mostly, but they're still being told it's due to a spontaneous chemical imbalance in people's brains.
00:06:58.000And yeah, it was really striking to me to learn that the leading experts on this say that's just not true, right?
00:07:04.000Professor Andrew Scull at Princeton University says it is deeply misleading and unscientific, that's his phrase, to say depression is just by chemical imbalance.
00:07:13.000Dr. David Healy, one of the leading experts in Britain, said you can't even say that story was discredited because it was never really credited.
00:07:20.000There was never a time when half of the scientists in the field would have told you that.
00:07:24.000That what happened, that story was promoted to us because it was the most congenial to the drug company PRs.
00:07:31.000Now it's important to say the fact that depression isn't caused by a chemical imbalance, and in fact there are nine causes of it that I write about in the book, for which there is scientific evidence, none of which is a chemical imbalance, doesn't mean there's no value to chemical antidepressants.
00:07:44.000And I think this is where some people have kind of willfully misunderstood what I was saying.
00:07:48.000So we know the effects of chemical antidepressants.
00:07:52.000So depression is measured by something called the Hamilton scale, right?
00:07:57.000And I've always felt sorry for whoever Hamilton was because he's only remembered for how miserable he makes everyone.
00:08:02.000But anyway, the Hamilton scale goes from zero, where you'd be like dancing around after taking ecstasy, to 51 where you would be acutely suicidal, right?
00:08:11.000And to give you a sense of movement on the Hamilton scale, if you improve your sleep patterns, you will move six points up the Hamilton scale, right?
00:08:24.000And if your sleep patterns get a lot worse, you would go six points down the Hamilton scale.
00:08:28.000The average effect of chemical antidepressants, according to the best research by Professor Irving Kirsch at Harvard University, is they move you 1.8 points on the Hamilton scale, right?
00:08:38.000So it's important to say that's an average.
00:08:40.000So some people will have less, some people will have more.
00:09:45.000And part of that is about redefining what an antidepressant is.
00:09:47.000So just to tell that cow story a little bit closer to the way it was told, but just closer to the way it was told to me, is, and this is something that really helped me to think differently about this.
00:09:58.000So I spoke to this South African psychiatrist called Derek Sommerfeld.
00:10:02.000And he was in Cambodia when chemical antidepressants were first introduced there, and I think it was 2001.
00:10:08.000And the Cambodian doctors didn't know what they were, right?
00:10:12.000So they asked him, and he explained, and they said, oh, we don't need them.
00:10:25.000They told him, like you said, there was a rice farmer in the fields that they knew who one day had stood on a landmine, had his leg blown off.
00:10:55.000And they said, well, they basically described going and sitting with this guy, listening to him, realizing his pain made sense.
00:11:03.000And they figured, well, if they bought him a cow, he could become a dairy farmer.
00:11:08.000He wouldn't have to go into these fields where it was such a nightmare for him.
00:11:10.000So they bought him a cow, and within a few weeks, his depression went away.
00:11:12.000And they said to Derek, so you see, doctor, that cow was an antidepressant.
00:11:18.000Now, if you've been raised to think about depression the way we have, that it's due to a chemical imbalance in the brain, for which there was never a scientific consensus, and there certainly isn't now, that just sounds like a joke, right?
00:11:29.000But what those Cambodian doctors knew intuitively is what has subsequently been discovered by a huge number of scientists.
00:11:34.000It's now the position of the World Health Organization, the leading medical body in the world, which is if you're depressed and anxious, your pain makes sense, right?
00:11:42.000You're not crazy, you're not biologically broken, you're not a machine with broken parts, you're a human being with unmet needs, right?
00:11:49.000Everyone listening to this knows you have innate physical needs, right?
00:11:54.000You need food and water and shelter and clean air.
00:11:57.000And if I took that away from you, you would be really f ⁇ ed up really fast, right?
00:12:01.000There's equally strong evidence that human beings have natural psychological needs, right?
00:12:20.000But our culture has got less good at meeting a lot, not all, but a lot of these underlying psychological needs that people have.
00:12:27.000And that is the main reason why we have a rising depression and anxiety epidemic.
00:12:31.000Could it be that big pharma has too much of a financial incentive to allow any criticism?
00:12:37.000I mean, you're watching Fox News and MSNBC and CNN, and they're taking pot shots at every corporation and everyone in society with, you know, the left is obviously biased to the left, the right's obviously biased to the right.
00:12:50.000But one thing you don't see on the news is someone crapping on the family who is responsible for OxyContin.
00:12:58.000And you go, there's an opioid epidemic.
00:13:01.000Then it cuts to the commercial and it says, Valototrex is please talk to your doctor, side effects include.
00:13:08.000And you realize these guys aren't discussing big pharma because they don't want to bite the hand that feeds them.
00:13:14.000I think there might be something in that.
00:13:15.000I wouldn't want to go too far with it, but I think the it's not the only reason why this has happened, but I do think, look, it was established in court.
00:13:25.000Elliot Spitzer, when he was the AG of New York State, took a case against the pharmaceutical companies for the way they had massively exaggerated the claims about the benefits of antidepressants.
00:13:36.000And it was established in the court beyond doubt they had, and there was a massive payout as a result.
00:13:40.000So I think the fact that they exaggerated the claims is really not beyond dispute now.
00:13:45.000Now, I just want to stress that doesn't mean there's no value.
00:13:49.000But if you want to really think, now, it's important to say to people, we need antidepressants.
00:13:53.000If you understand antidepressants as something that reduces depression, right?
00:13:57.000We have got a real depression and anxiety crisis.
00:14:02.000It's a really deep form of despair that's spreading across the culture.
00:14:06.000And we do need things that deal with that.
00:14:08.000Now, I think alongside chemical anti-depressants, we need things that more learn, like the lesson of the cow.
00:14:13.000And I'll give you an example of something that, because all this can sound a bit weird and abstract to people if you don't apply it something very direct to them.
00:14:19.000So I want to give a very direct example, as Muggle at Lost Connections does.
00:14:23.000So I noticed that lots of the people I know who are depressed and anxious, their depression and their anxiety focuses around their work.
00:14:32.000So I thought, well, let's start looking at the evidence about work.
00:14:35.000Gallup did the most detailed study that's ever been done of how people in the United States and Britain think about their work.
00:14:42.000And what it found was kind of striking.
00:14:44.00013% of us like our work most of the time.
00:14:49.00063% of people are what they called sleepwalking through their work, so they don't like it, they don't hate it, they kind of tolerate it.
00:14:55.000And 24% of people hate their work, right?
00:15:31.000So I can tell you how if you want, but just to give you the headline, he discovered the key factor in work that makes people depressed.
00:15:38.000The key factor is if you feel controlled at work.
00:15:42.000If you go into work and you feel you can't use your mind, you can't use your creativity, you're just doing what you're told, and you're like the equivalent of on a kind of conveyor belt, right?
00:15:50.000The more you feel controlled, the more likely you are to become depressed.
00:15:54.000Actually, the more you feel controlled, the more likely you are to have a stress-related heart attack as well.
00:15:58.000Now, we all know that when we think about other societies, right?
00:16:00.000It's one of the reasons why we know people in the Soviet Union were the most miserable people you can ever imagine, because they were controlled all the time, right?
00:16:12.000And I actually misunderstood what Michael Marmot was saying when I first met him.
00:16:17.000Because I thought he was saying, okay, so some people are going to get to have fancy jobs like you and me do, and then everyone else is going to be condemned to be miserable because there are going to be jobs, like, you know, my dad was a bus driver, my brother's a delivery guy, my sister's a nurse.
00:16:29.000Is he just saying, but I kept going back to him, and it was only quite a while into it, I realized I was completely misunderstanding what he was saying.
00:16:37.000It's not the work that makes you depressed.
00:16:43.000So I went to Baltimore, met this woman called Meredith Keogh, who's part of this movement that's a really interesting experiment in how we do this differently.
00:16:50.000So Meredith used to go to bed every Sunday night, just sick with anxiety, right?
00:17:54.000And one of the things that was so fascinating going there, it's a really successful business, and speaking to them, which is completely compatible with what Professor Michael Marmot found, is how many of them talked about having been depressed and anxious before in their previous controlled work and not being depressed and anxious now.
00:18:10.000And it's important to say, they fixed bikes before, they fixed bikes now.
00:18:13.000It's not like they left their jobs and became Beyoncé's backing singers.
00:18:18.000But what had changed was not the work, it was whether they were controlled in a kind of humiliating way at their work.
00:18:24.000And as Josh put it to me, there's no reason why any business should work this way, should work in this depressing, controlled-down way, right?
00:18:31.000How many people do you know who would feel better if they knew that tomorrow they were going into a workplace where they set the priorities with their colleagues, where the boss was accountable to them, where the boss was elected if there has to be a boss?
00:18:51.000Now, I would say that is an antidepressant, right?
00:18:55.000That's dealing with the reason why people are depressed.
00:19:32.000And that rubs me the wrong way as a free market capitalist because I honestly believe, I agree with you, that you need to be empowered to be happy.
00:19:40.000And I honestly believe that that happens more in capitalism than any other system.
00:19:47.000And by you focusing on like an American bike shop, where, by the way, this guy had amassed all these bicycle mechanics, and then they leave.
00:19:56.000I mean, we have non-competes to avoid this ripoff, and they start their own.
00:20:02.000And it looks like a utopia at first glance.
00:20:04.000But I think big business is, in its ideal form, and that's usually what it is, or I shouldn't say usually, but that's often what it is, is a self-empowerment.
00:20:13.000And we talked about this before, Frank Mars, he has a big banner at Mars Bars.
00:20:22.000So I feel like when you're going into corporate America and saying, oh, it's the corporate system, I feel like you're looking at supermodels and you're saying, a lot of these supermodels look like crap because they let their bangs get sweaty and they get matted to their forehead.
00:20:36.000And I'm sitting here going, yeah, but they're supermodels.
00:20:40.000Like, there's a lot of uglier people out there.
00:20:42.000And the reason I bring this up is to say, I think Brits are more depressed.
00:20:48.000I think Canadians are more depressed than Americans.
00:20:51.000And I think it's because they have a more socialist system.
00:21:53.000I can't remember the figures off the top of my head, but it was pretty similar.
00:21:56.000The attitude towards work is pretty similar across the Western world.
00:21:58.000I think there was kind of mild, but I haven't looked at it in a while, so I don't want to get it wrong, but I don't think there was a huge variation.
00:22:07.000I think the important thing to say about that is you're absolutely right to put a very high premium on freedom, but I think you're putting the locus of freedom on the wrong institution.
00:22:16.000The locus of freedom should be on the individual and the group, not on the corporation, right?
00:22:20.000Freedom for corporations is what we have now, and particularly in the United States where there are basically no labor unions.
00:22:28.000And actually, that's created a system where you have 87% of people not liking the thing they're doing most of the time.
00:22:34.000But it's important to also say, democratic cooperatives are part of market competition, right?
00:22:44.000I believe, I'm not a communist, right?
00:22:47.000I think there should be market competition.
00:22:49.000I don't think it should be everything in the economy.
00:22:52.000I think there should be state provision of certain things.
00:22:55.000We probably disagree on the ratio that should be provided by the state.
00:22:58.000But I believe very strongly that market competition should exist.
00:23:01.000But the question is, what should the market competition be between?
00:23:04.000Should it be between this institution, between corporations, which happen to make people really miserable and unhappy?
00:23:11.000Or should it be between democratic cooperatives, which are a different form of providing market competition?
00:23:19.000Democratic cooperatives are cute and they're fun for a little soup shop or a cafe, but when you're trying to sequence the genome and accrue data of an entire nation's DNA, you need big corporations for better or for worse.
00:23:35.000Cornell University did a really good study of this that found that the more democratic an institution was, the faster it grew.
00:23:42.000Actually, the more democratic corporations they looked at grew four times faster than the kind of top-down ones.
00:23:49.000People are much more committed to democratic institutions.
00:23:54.000I mean, you know, for such obvious reasons, it hardly needs to be said.
00:23:57.000People at Baltimore Bicycle Works are much more motivated than they were in their previous store.
00:24:02.000And I think this comes back to this question about underlying needs and how they cause depression, right?
00:24:12.000I don't think the isolated, and this is something where we probably would disagree, I want to say it as fairly as I can because I don't want to mischaracterize anything.
00:24:23.000I don't, so systems, how would I put it?
00:24:27.000Our societies are the loneliest societies that have ever existed.
00:25:50.000And I go, yeah, but they don't have shoes.
00:25:53.000So please acknowledge that the West is the best.
00:25:57.000Just because there's one worst thing, like our supermodels have matted bangs, doesn't mean that the third world or anywhere in the East can hold a candle to the West.
00:26:27.000I think there is good evidence that, so we know the more individualistic and lonely a society becomes, the higher its rates of depression become.
00:27:18.000I mean, look at, if you explain, speak to any immigrant to the United States and ask them about retirement homes and what people in their home country think of retirement homes.
00:27:29.000When someone they love becomes old, they look after them.
00:27:32.000They don't abandon them in a fucking literally piss and sh ⁇ filled place where I forget the figure, but something like half of elderly people in retirement homes in Britain are drugged with antipsychotics to shut them up, right?
00:27:49.000The idea that what we do to elderly people is we shunt them away and then they express their distress.
00:27:58.000And there's been studies with these centenarians where they say when these grandfathers around their grandkids, not only does it thwart senility and Alzheimer's, but there's cases where they had Alzheimer's or dementia and they were pulled out of it by being around their grandkids.
00:28:15.000Yeah, so this comes back to depression in a really good way, actually.
00:28:18.000One of the things we know is human beings are social animals.
00:28:22.000The reason why you and I are alive is because our ancestors on the savannas of Africa were really good at one thing.
00:28:28.000They were really good at cooperating, right?
00:28:31.000They weren't bigger than the animals they took down.
00:28:33.000They were much better at working together.
00:28:36.000Every instinct human beings have is to be part of a tribe.
00:28:40.000Just like bees need a hive, humans need a tribe.
00:28:43.000We are the first humans ever to try to live without tribes, right?
00:28:51.000Professor John Cassioppo, the loneliness expert at the University of Chicago, is an amazing neuroscientist.
00:28:57.000You know, explained to me, think about in the circumstances where human beings evolved, if you were separated from the group, you were anxious and depressed for a really fucking good reason.
00:29:42.000He ran a doctor's surgery, co-ran a doctor's surgery, and patients kept coming to him who were depressed and anxious.
00:29:48.000And he felt really bad because he'd been told in his medical training, even though he knew the science doesn't say this, to tell them you've got a chemical imbalance in your brain and just drug them.
00:29:57.000Like me, he's not opposed to chemical antidepressants, but he just thought this is inadequate to the scale of, this is not dealing with the problem in front of me, right?
00:30:05.000This is blunting some of the symptoms.
00:30:15.000She'd been shut away in her home, crippled with depression and anxiety for seven years.
00:30:21.000And Sam said to her, look, I'll carry on giving you these drugs if you want.
00:30:24.000I'm also going to prescribe for you to take part in a group.
00:30:27.000So there was an area behind the doctor's surgery that they called Dog Sh ⁇ Alley, which gives you a sense of what it was like.
00:30:32.000It was a bit of scrub land where dogs used to sh ⁇ .
00:30:35.000He said to Lisa, what I'm going to do, we're going to support you.
00:30:38.000I want you to come twice a week and you, with a group of other depressed and anxious people, we're going to find a way to turn this alley into something beautiful, right?
00:30:46.000First meeting, Lisa was literally physically sick with anxiety.
00:30:49.000She turns up, all these jangly, anxious, depressed, depressed and anxious people, and they start talking over the weeks.
00:30:58.000They have something to talk about that's not how shit they feel.
00:31:02.000And they started to teach themselves gardening.
00:31:04.000They didn't know anything about gardening.
00:31:20.000This approach is called social prescribing.
00:31:22.000There was a study in Norway that found it was more than twice as effective on the Hamilton scale for depressed and anxious people as chemical antidepressants.
00:31:33.000It was dealing with the actual reason why they were depressed in the first place, right?
00:31:37.000It's a very different way of thinking about depression and anxiety because what we do is we tell depressed and anxious people, this is a pathology in your brain.
00:32:40.000and it seems like the more we adhere to tradition and sort of our caveman values and keep grandpa around, the more we benefit, the less depressed we are.
00:32:48.000You ready for the awkward elephant in the room?
00:32:52.000Homosexuals don't get married and have kids.
00:32:56.000And you said Mormons have a disproportionately high thing, high level of joy.
00:33:03.000I've noticed, and I'm not one of them, but young Catholic Christians who get married when they're 20 and just have a brood, they seem to be the happiest people I've met.
00:33:12.000So is it possible, and believe me, I think you're born gay.
00:33:46.000But also, I think what that misses is, so huge numbers of gay people have children, but more importantly, the idea that I want to just say something about social media as well, don't let me forget, but the idea that gay people who don't have children are not involved in the raising of children, I think is crazy.
00:34:02.000We are the first people ever to try to raise children in human history as isolated individuals, right?
00:36:11.000These things are separating us from each other, and they're turning us into these isolated, depressed people, and then we're medicating and getting back on our fucking phones.
00:36:21.000I think you're onto something, but I think it's a bit more complicated than that.
00:36:25.000So the woman who runs this rehab center is called Hilary Cash, amazing person, doctor.
00:36:30.000And I spent a lot of time there with her and with these patients there.
00:36:33.000And one of the things I thought was so interesting that emerged from kind of talking to her and thinking about it, you've got to think at the moment in history the internet arrives, right?
00:36:41.000So it starts, comes along the late 90s, early 2000s for most of us, right?
00:36:46.000And what's interesting is a lot of the trends we're talking about, like massive increase in loneliness, for example, had already massively been in place for several decades before.
00:36:56.000They've been rising and rising and rising.
00:36:58.000But what happens is the internet arrives in the middle of this disconnection and it looks like the things we've lost, right?
00:37:07.000It gives you Facebook friends in place of.
00:37:31.000But if all of your sex life was porn, you would be constantly frustrated and angry because your deeper needs would not be being met.
00:37:38.000In the same way, social media does not meet your deeper needs, right?
00:37:42.000In the same way, you know, you spend an hour looking at porn, you don't feel sated and valued the way you do after sex, right?
00:37:48.000You spend an hour on Facebook, you don't feel like you've been seen and heard and you've seen and heard someone else that you do if you sit with someone for an hour.
00:37:58.000We're playing the music at the Academy Awards.
00:38:01.000Well, people can read the fucking book then.
00:38:04.000Anyone who wants any more information about it can go to www.thelostconnections.com where they can figure out where to buy the book, the audio book.
00:38:12.000They can hear what loads of people have said about it.
00:38:14.000We'll have the URL at the bottom of the screen.
00:38:16.000Congratulations on being the only guest in the history of the show that dominated the entire show.