In this episode, Dr. Larry Peterson joins me to talk about his views on mental illness and therapy. Dr. Peterson is a professor of psychology at the University of Southern California, specializing in the treatment of depression and anxiety. He is also the author of the book, "Depression and Anxiety: A Handbook."
00:00:00.000So there's an idea, for example, that's central to the Christian worldview that wherever two people are together, the spirit of God himself is present.
00:00:15.480And a secular interpretation of that is that it's therapeutic.
00:00:30.000Dr. Peterson, thanks for taking the time to talk to me today.
00:01:02.220But I think that a lot of people in the audience are expecting or maybe hoping that this will be kind of a debate between us.
00:01:12.660And I don't want to disappoint anyone, but that's not exactly my plan.
00:01:15.340I actually just wanted to talk to you and get your insight into a lot of these issues having to do with mental illness and therapy.
00:01:23.660And I'll admit up front that I have a lot of doubts and a lot of questions on this topic, but my mind is not totally made up.
00:01:33.920So you might even change my mind, which doesn't happen very often, but it could happen today.
00:01:37.940So let me just, I guess, set this up a little bit, what started all this.
00:01:45.360I tweeted something a couple of weeks ago about therapy, and I expressed my view that I've said several times publicly that I think therapy is very often a waste of time.
00:01:56.120It's very often something that does more harm than it does good.
00:02:01.640That turned into a conversation about mental illness and things like depression and anxiety, something I've also talked about quite a bit, and whether those things are really a disease or whether they've been miscategorized.
00:02:14.220And I think that they, that we have made sort of a category error with them that made people very upset.
00:02:21.060And that's when it was suggested that, that you and I should talk.
00:02:23.580And I think people are hoping that you'll set me straight on some of this.
00:02:26.240So I'm hoping that we could kind of start with the second thing, which is mental illness.
00:02:31.440And then I think that will lead more naturally into the conversation about therapy and what it is and what its purpose is.
00:02:37.360So my, again, my view, just to start things, is that I, it seems to me we've made a major mistake in treating things like depression as a disease.
00:02:52.000You know, as if having them, it's like having diabetes or malaria or something, treating it as a, as a totally physical phenomenon.
00:03:01.640And from that category error, a lot of negative consequences have followed.
00:03:09.180But what do you, what do you say to that?
00:03:11.320Well, I would say that within the broad and vague category of depression, there are many separate entities lurking and hiding.
00:03:22.000And that conflating them is problematic with regard to understanding and also with regard to treatment.
00:03:32.080And so depression per se is a secondary category.
00:03:38.580It's a secondary manifestation of proclivity to negative emotion.
00:03:42.880That's the broadest possible conceptualization.
00:03:45.940And that manifests itself in the personality structure as trait neuroticism.
00:03:49.980All of the negative emotions clump together, which means that if you're more likely to experience one, you're more likely to experience all of them.
00:04:00.800So you could think that there's a general emotional arousal capacity that typifies emotions,
00:04:10.240and it branches into two major subcategories, positive and negative emotion.
00:04:15.700And those are quite separate neurologically and psychopharmacologically, functionally, although they are to some degree mutually inhibitory.
00:04:25.780So there are chemicals that increase positive emotion, and there are chemicals that decrease negative emotion.
00:04:33.460The chemicals that decrease negative emotion can be subdivided into chemicals that decrease anxiety per se.
00:04:39.600That's benzodiazepines, barbiturates, and alcohol, and medications that decrease pain.
00:04:46.400And pain is frustration, disappointment, grief, shame, and physical pain.
00:04:54.460So that's the negative emotion side is where you have trait neuroticism, and then that can be subdivided.
00:05:03.040And by pathological, what is meant is something like either unbearable or interfering with functions associated with both basically survival and reproduction.
00:05:15.920And that's a judgment call when levels of negative emotion get so high that they now take on clinical significance.
00:05:23.160The way that well-trained clinicians determine that is that levels of negative emotion have risen to the point where, as I said,
00:05:30.900either the person finds it subjectively unbearable, or there's evidence that important domains of broad function have been compromised.
00:05:39.160Now, so, for example, if I was trying to determine if you abused alcohol, I would find out, first of all, how much you consumed.
00:05:50.240But then I would find out, is that causing you trouble with the police?
00:05:54.020Is it causing you trouble with yourself in terms of guilt and shame and regret?
00:05:58.700Is it causing trouble with your family?
00:06:00.540Is it interfering with your employment?
00:06:03.260Is it starting to take over your life?
00:06:05.080And you make the same kind of diagnostic judgment when you're evaluating someone who's suffering from an excess, let's say, of anxiety or an excess of pain,
00:06:16.300which would be more a depression-like phenomenon.
00:06:19.240Now, and so you have to do a very careful diagnosis to find out to what degree that's occurring,
00:06:26.700to what degree it can be attributed, let's say, to anxiety or to depression,
00:06:30.100how long-standing it is, and then there's the necessity for a detailed causal analysis.
00:06:36.800You made mention of the mistake of categorizing depression, for example,
00:06:44.140which is a pain-like phenomenon as an illness, and I would say,
00:06:48.500well, sometimes it is a consequence of a physical illness,
00:06:51.840and sometimes it's more psychological or functional,
00:06:55.260and you have to be very careful from a diagnostic perspective that you get that right.