The Saad Truth with Dr. Saad - Dr. Sally Satel - A Deep Dive into the Psychiatric Profession (The Saad Truth with Dr. Saad

00:00:00.000 I'm delighted to report that I have joined as a scholar the Declaration of Independence Center

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00:01:05.240 Hi everybody this is God Sad for the Sad Truth. Today I have another fantastic guest Dr. Sally Sattel

00:01:12.020 who is a psychiatrist. I'll shortly mention all of her great accomplishments. How are you doing Sally?

00:01:17.340 Good thank you. It's very nice to see you. We met for the first time ever I think a couple of weeks

00:01:24.480 ago at the University of Chicago at a conference you know dealing with freedom of speech and freedom

00:01:30.920 of inquiry and so it was lovely to meet you there. Let me just mention all of your not all of your

00:01:36.660 accolades a few of the important ones. So as I said you're a psychiatrist you're a lecturer at Yale

00:01:41.760 School of Medicine but I think much earlier in your career you had been on a tenure track position

00:01:47.200 as an assistant professor. You're a resident scholar at the American Enterprise Institute

00:01:52.600 Director of a Methadone Clinic in DC and some of your books include a few of which I have right here.

00:01:59.180 I think your first one Drug Treatment the Case for Coercion. This one I bought many many years ago

00:02:05.260 right here look at this beauty. DCMD How Political Correctness is Corrupting Medicine. You were one of the

00:02:11.880 early ones to say hey I think we have a problem. So this one. This one you were kind enough. Oh then

00:02:18.560 you have One Nation Under Therapy How the Helping Culture is Eroding Self-Reliance with a co-authored

00:02:24.280 with another Sad Truth guest Christina Huff Summers and you just sent me this one which we can talk about

00:02:31.080 Brainwashed The Seductive Appeal of Mindless Neuroscience and I only have one of your edited books.

00:02:39.160 This one right here which was sent to me by I don't know who sent it to me. The free inquiry papers.

00:02:46.620 Now here's the interesting thing Sally maybe you could explain this to me. I looked through the book

00:02:51.500 and I noticed a glaring omission of say oh a professor who for the past 30 years has been at the forefront

00:02:59.780 of speaking against the lunacy. His name escapes me. Do you know who I might be talking about?

00:03:04.920 That would be you. Well I apologize for the omission but I also have to say that was the

00:03:12.080 brain that that collection was a brainchild of Bob Maranto. Okay. But I'm just kidding. Don't worry

00:03:22.580 about it. Okay so I thought we'd start when we were scheduling our chat. We had a brief back and forth

00:03:29.900 about one of the or maybe the most recent article that you wrote. I think it was published in the

00:03:34.680 free press where you were arguing for the Carlos Brown Jr. who you know killed or allegedly killed

00:03:44.160 the Ukrainian woman on the on the tramway or subway and you were saying wait a minute I'm not sure that

00:03:49.740 it's a good idea to to kill him because he suffers from mental health issues and then you were accused of

00:03:55.800 the terrible affliction known as suicidal empathy. Walk us through that. Yeah that's something I've

00:04:02.840 been interested in for a long time. Actually schizophrenia, severe mental illness, happened to

00:04:09.580 be an addiction psychiatrist but but my real initial love was psychosis. I may sound strange to put it that

00:04:18.720 way but I just found it the most fascinating and and tragic and often uh treatable uh condition. So

00:04:25.780 any anyway um yeah this case was beyond horrific. It hasn't even had one day in court yet but it's

00:04:36.300 pretty clear from the history of this um man Mr. Brown that he is um you know severely mentally ill

00:04:44.280 probably schizophrenic but even in a way the diagnosis per se doesn't matter. The the point

00:04:49.940 is that he has a chronic psychotic illness that doesn't appear to be simply the product of like say

00:04:56.300 abusing drugs. In fact we're not even aware that there's a drug history. I think that would have come

00:05:01.220 up although I'm sure again more uh details will uh come forth about his history but the the point is

00:05:07.840 that he had uh for years he's 34 and for for many years he had this uh delusion this um constant

00:05:16.360 delusion that there were some he called it a dark material inside of him that that controlled him. So

00:05:23.320 these sort of kind of illusions of of control or delusions I should say of control and that is uh what

00:05:30.780 he uh said uh caused him to kill the young woman that uh he was uh he was commandeered by these dark

00:05:41.140 forces that control everything he did everything he ate everywhere he went everything he said

00:05:46.440 and um and as I said there's a long documentation of this he had been hospitalized before briefly

00:05:52.860 at one point really strikingly uh within a year or two before this horrific incident he called 9-1-1

00:06:00.760 over like 50 times this is in uh North Carolina uh Mecklenburg County that's where he lived and

00:06:08.540 called the police relentlessly to get them to take this this material out of his body uh any anyway so

00:06:17.740 that's in my view largely established that this man suffers from a severe chronic um psychotic illness

00:06:24.500 and so then the question becomes you know the large question is of course how do we think about

00:06:30.100 blame and uh in the case of someone who commits a murder uh in the grip of a psychosis where their

00:06:38.100 their moral reasoning is um annihilated by their delusions not necessarily their factual reasoning so

00:06:45.620 in other words I'm sure if you asked him is it illegal to kill people would you go to jail or

00:06:51.060 prison for killing a person I don't doubt that he would say yes in fact after the incident he talked to

00:06:57.700 his sister from jail and said well why would I do such a thing uh she didn't do anything to me you know

00:07:03.320 implying that you only hurt someone when they've they've hurt you uh so anyway what so what are the

00:07:11.040 options for someone like him a person who kills in the grip of a psychosis who is either commandeered by

00:07:17.840 hallucinations or delusions um it it's not guilty by reason of insanity that's that's and I'm sure

00:07:27.560 there will be that plea but uh very often people who are wildly psychotic um can give you two more

00:07:35.460 examples um and there are many more but two high profile examples who um are you know psychotic when

00:07:44.000 they kill they don't get not reason uh they don't get acquitted by um not guilty by reason of insanity

00:07:51.280 or the insanity defense and uh so what should we do with people like that because they can't be

00:07:58.740 adjudicated as if they had a kind of a normal intent and uh so I propose that they should not even be

00:08:07.700 eligible for the death penalty in the first place so can I go back and talk about another case to put

00:08:14.980 this please please okay before you do that can I just interject so let's suppose in the case of this

00:08:20.760 gentleman I don't know if that's the clinical diagnosis but let's say it's paranoid schizophrenia

00:08:25.500 and we know that if we you know administer a pharmacological intervention that can get rid of

00:08:32.100 all of the the you know the the neighbor's dog wants me to kill you and so on that he could

00:08:37.580 perfectly function now if he chooses as often happens the case with paranoid schizophrenics to not

00:08:44.100 take the drug and then he commits that act does that increase the the burden of blame onto him

00:08:52.740 because he willfully chose to not take an intervention that would have prevented him

00:08:58.220 from having to then plead insanity does that come into the yeah um in other cases it actually has um in

00:09:06.900 the cases of for example out of people who have um alcohol problems uh if they uh now once they are

00:09:15.220 intoxicated then you might not we don't expect them to make the kind of rational judgments that uh

00:09:23.300 they should but um but the point is they walked into the bar sober and uh they drove their car

00:09:32.300 dangerously um and they walked out but drove their car home in an intoxicated state and and that is

00:09:40.760 considered um frankly an agra could be considered an aggravating factor um same with people with bipolar

00:09:47.560 illness they know that um lithium or antipsychotics or what if some mood stabilizer does help them but

00:09:55.280 they don't like the side effects and this is a big problem with so many of these medications

00:09:59.120 um and these side effects are not just trivial and and remember you take these for life so it's not

00:10:04.980 just an antibiotic that might give you like the runs i mean you know it's over in five days or whatever

00:10:10.260 um and but in any case you know stop taking the medication and go on a manic spree um sometimes they

00:10:20.460 don't hurt anyone but they spend you know thousands and tens of thousands of dollars and um

00:10:26.260 neglect their children or even sometimes do become violent drive erratically um this could be considered

00:10:33.460 um you know an aggravating yeah factor it could be um now i don't know what i don't we don't have

00:10:39.460 enough history in his part it's not even clear that he was ever really treated um i think it's so common

00:10:45.600 for people with severe mental illness to fall through the cracks but remember the point is i'm not

00:10:50.720 talking about for a not for a minute uh letting this man go for heaven's sakes um we're talking about

00:10:58.440 either a not guilty by reason of insanity plea which he seems to be a good candidate for um in which case

00:11:05.580 he would spend um probably at least two decades in a psychiatric hospital uh there are data uh suggesting

00:11:14.720 that people who are um who get hospital excuse me get um incarcerated versus people with the same

00:11:25.680 let me back up again uh if you have a pool of people who are uh eligible for not guilty by reason of

00:11:33.280 insanity and but some lose and some succeed the people who have lost assuming they don't get the death

00:11:40.600 penalty stay incarcerated for a shorter period than those who go to a psychiatric forensic facility

00:11:47.800 so this man does not getting out anytime soon uh or he would get life in prison that would be

00:11:54.840 the alternative under this plan of making people um not eligible for the death penalty if they committed

00:12:02.440 while they were psychotic so in other words they could get not guilty by reason with sanity but if that

00:12:07.300 doesn't work then they would get life um in prison uh which you could argue um is unfair in a sense

00:12:15.220 because they really were not guilty in the classic sense of you know mansrea having that guilty intent

00:12:21.700 um but at least they don't get the death penalty well uh just to remind you you wanted to mention

00:12:27.540 some other cases so take it away yes thank you um there's one uh one that everyone is probably familiar

00:12:33.460 with um her name the andrea yates case this was a woman she killed her five children right is that the one

00:12:41.380 yeah um in 2001 houston texas and she was she was highly uh religious to begin with but the psychosis

00:12:51.540 which in her case was postpartum psychosis um because she had a little baby and she had developed uh

00:12:59.460 you know severe religious delusions um and she thought that her children were not um developing

00:13:07.700 properly in that they were uh vulnerable to satan and that if she did not kill them they would grow up

00:13:15.380 to be uh morally disfigured and and rock horrible acts on society so she thought to protect them uh she

00:13:26.340 she would have to kill them which she did systematically in the bathtub it's another

00:13:30.900 just nightmare story and um her first actually her first trial she she was actually convicted this

00:13:40.020 was texas um which is often is notoriously harsh about these things and also i have to say the insanity

00:13:47.380 defense has usually in most states has what's called two prongs the first is does someone know what

00:13:52.500 they're doing and almost everyone knows what they're doing unless they're delirious or demented

00:13:57.220 in other words if i were strangling you even if i were in the throes of psychosis i know i was

00:14:02.420 strangling a person as opposed to you know let's say a giant lemon um there was one case in arizona

00:14:09.620 where someone a young man thought he was actually killing an alien so i guess he would fit that criteria

00:14:16.180 um but the second prong is they know what they're doing but do they know what they're doing is wrong

00:14:22.900 and that wrongfulness concept is um you know it's hard to understand understandably it's hard to make

00:14:32.340 sense of because as i said before do they know it's wrong legally yes she knew it was wrong in fact she

00:14:39.060 called the police after she acted and um expected to go to jail and prison and even to be executed

00:14:46.180 now in her case there was an added benefit to that in her mind which is that satan would be benefit

00:14:50.900 would be killed along with her because he inhabited her but in any case um but her her moral reasoning

00:14:58.900 was so deranged that she felt she was actually saving her children right so she went to um a forensic

00:15:05.860 so first she she lost her first case and uh but that was uh because one of the expert witnesses um

00:15:13.300 psychiatrist actually had mistakenly said that there was a law and order of episode of a woman who faked

00:15:21.140 a psychosis to to kill her children and it turned out he probably he was an advisor to that show so he

00:15:28.580 probably kind of had a false memory almost you know that it happened or he had thought about having

00:15:33.380 an episode like suggesting it to them in any case she had a retrial and um and his his mistake was uh

00:15:42.180 made known and so now so then she went to uh a forensic hospital stayed for well it's 2025 right

00:15:51.140 she's been there i think 24 years and she doesn't want to leave um and which is interesting and so sad

00:15:56.980 you know i don't know why but you can imagine things she felt feels she deserves this

00:16:01.540 she's afraid of how society will respond to in any case so the point is these people aren't going

00:16:08.100 anywhere and i feel that is so important to make clear got it uh can i yes to just psychiatry in

00:16:15.540 general so let me give you a bit of a personal story so at one point when i was trying to decide what

00:16:21.780 i would study i was very much interested in uh so i'd done a undergraduate degree very technical

00:16:28.740 mathematics computer science and now i have to kind of decide what's my next step and for a short

00:16:33.380 period of time i was interested in maybe going into psychiatry so going to medical school and so on

00:16:38.900 what this several things dissuaded me and i discussed this in one of my books one was that i

00:16:44.420 felt that i didn't have the right personality to be able to actually probably not commit suicide after

00:16:51.700 a few years of hearing about children being abused by their uncle and neighbor that i would probably care

00:16:58.020 too much but the second reason and you'll forgive me if this sounds pejorative to the to the field

00:17:03.700 as being someone who was very scientifically minded and i don't mean scientifically in that i want to

00:17:09.380 take anatomy and physiology in the scientific method in rigorous thinking is this born by the data

00:17:16.340 by the theoretical framework uh you know i have a very here's here's a book that i wanted to show you

00:17:21.860 why freud was wrong okay we're going back a while here here's another one that you i don't know if you

00:17:26.660 know this one by an anthropologist right okay and i mean i've got an incredibly long big library of

00:17:32.820 books on you know psychiatry and probably the book that had most influenced me was i mean at that point

00:17:38.740 i'd already made my decision about house of cards by uh robin dawes who was trained as a clinical

00:17:45.300 psychologist if i'm not mistaken who said that look much of the stuff is pure quackery now doesn't mean

00:17:50.660 that of course the pharmacological intervention for paranoid schizophrenia is quackery but the history

00:17:57.460 of mental health profession is so filled with junk that uh i certainly decided it wasn't right for me

00:18:03.860 to to go into it as i say this what's your reaction do you agree with it do you feel that

00:18:10.740 it's a lot less quackery now where are we in the quack you can't offend me don't worry um no it's very i mean

00:18:17.780 we're still having we're still embroiled in the diagnosis wars um we don't even have a taxonomy i

00:18:24.340 mean we do have the dsm diagnostic statistical manual the first one came out i think in 1952

00:18:30.740 the first two editions were very freudian um and so to the point where it's almost symptoms didn't

00:18:36.260 matter it's really you know the underlying conflicts and and the derailed you know developmental

00:18:40.820 trajectories that's that was really where it was at the symptoms were almost irrelevant and then in dsm

00:18:45.940 three it became more scientific and and i i with all due respect to robert spitzer who um the late

00:18:53.460 bob spitzer who devoted his life to the manual uh in a sense and to diagnosis i mean it did become a lot

00:19:00.820 better and when it became much better and was reliability not validity but reliability so if two

00:19:06.980 people looked at the dsm and then interviewed a patient the odds were good that they both come up with

00:19:13.380 the same diagnosis right uh what that meant um i mean obviously there's a difference uh between you know

00:19:22.100 severe ocd and um ptsd and um you know manic depression i mean there are at there clearly are differences

00:19:33.300 in uh symptoms that you would uh you know group as um tending to occur together but but there's so much

00:19:42.980 overlap there's so much comorbidity people who have one diagnosis will have another the medications are

00:19:48.900 unlike the classic uh case of um infectious disease where you know they take a swab of or a sputum

00:19:57.380 sample or a urine sample and then they culture the bug and then they know the sensitivity of the

00:20:02.100 antibiotic and you know that kind of thing um you know we treat mainly not not true of all the

00:20:09.300 diagnosis but we treat mainly by symptom if you're depressed if that depression happens in the

00:20:14.820 context of ptsd in the context of drug addiction in the context of um um gosh i'm blocking now um

00:20:23.300 you know anxiety it's we'll use it so uh no it's very very i guess sloppy in a sense but everyone knows

00:20:32.420 it i give my profession credit for for knowing honest about it yeah yeah i'm trying to fix it

00:20:38.580 but so does that i mean having said that your daily sort of purpose and meaning can go in either

00:20:48.260 direction on the one hand it could validate that you know i i'm speaking as you as a psychiatrist you

00:20:54.180 know i am dealing with the most complicated organ or machine known in the universe and so it is

00:21:01.700 expected that i have a much harder job because it's i'm not an orthopedic surgeon who just has

00:21:08.420 to fix the ruptured achilles tendon on the other hand the orthopedic surgeon walks walks into that

00:21:16.180 intervention the the tendon is fixed they walk away feeling like they helped whereas you could be

00:21:23.060 intervening with someone for for three years never fully knowing how how well spent that time was so how

00:21:31.460 do you where do you fall on this are you walking yeah go ahead no no i think you do have a sense of

00:21:36.740 of where you've fallen you you don't have a good sense of certainly what the pathophysiology is for

00:21:43.060 heaven's sakes there are over 100 genes involved with schizophrenia and even then um so many of these

00:21:50.180 conditions have enormous uh relation to the context in which the person lives uh so that's what you often

00:21:58.900 work on you know you try to get the medication as well honed as you can um minimize the side effects

00:22:06.420 because you want the patient to take it um and but then so much of the effort really is on the

00:22:12.580 environment the person is living in and uh you know trying to get a sense of what what kind of life they

00:22:19.300 they want given the limitations uh and there's the and helping them socialize uh so you can tell if

00:22:26.980 someone has a happier life a better life a more content life and and that's the you know we have

00:22:32.900 a different measurement uh now we could certainly measure symptoms of course or you know how are your

00:22:39.060 hallucinations this is this is always found interesting to me when people were you know started

00:22:44.980 on let's say they have a very dense hallucination that they're like jesus christ and uh and we'd have

00:22:50.500 people in the va fight over it well no i'm jesus you know but um that's where i did my more general

00:22:56.580 psychiatry uh but as the medication will start to work the the delusion becomes uh weaker so first it's

00:23:06.340 i am jesus christ i think i'm jesus christ i used to think i was jesus christ my gosh that's deranged you

00:23:14.500 you know um and so you know these medications can help very much uh again with these hard symptoms

00:23:22.580 but then people who've been who've had these conditions especially if they've been untreated for

00:23:28.580 a while as you can imagine they they have a very they don't have a work history and they they don't

00:23:34.900 even know they've never even been in a workplace and luckily there are sheltered workshops for this kind

00:23:39.780 of stuff but the point is uh a lot of it really is um more psychological and social after a while

00:23:47.300 and i work um my job right now is in a methadone clinic so methadone is great is i still think it's

00:23:54.580 the best you know anti-addiction medication for opioids it's the only thing it works for

00:23:59.860 but you know it's really something to help a person stand still it's really uh its purpose is to help

00:24:06.820 control the withdrawal symptoms and to help control the craving and then nine-tenths of the recovery

00:24:13.220 so to speak is repairing your life and repairing what led you to use drugs in the first place because

00:24:18.500 there are always two layers of of turmoil you know it's a turmoil that led you to drugs because i'm a

00:24:24.180 big believer in the self-medication model of addiction and then there's the destruction you wrought

00:24:29.540 while you were addicted it's a miracle anyone ever stops i always think because once you do stop

00:24:34.340 then you have to face the life that you know depending on how severe your problem was you've

00:24:39.540 really not only destroyed a much of it but you've hurt so many people and there's a real moral injury

00:24:45.700 component to recovery because you violated many of your own principles about how to be a good person

00:24:53.300 so it uh this arises in many disciplines and certainly in psychiatry sort of the the old proverbial

00:25:00.420 nature nurture and i like to ask it on in two different contexts so we could talk about nature

00:25:06.020 nurture in terms of the etiology of the disease so if we go back to freud it would have been

00:25:12.660 all because of mommy and therefore yeah because he because he couldn't treat schizophrenia you know

00:25:18.100 he wanted to do that at first as you know and said that's too hard right so then that's the

00:25:22.500 schizophrenic mother that that oh that was brutal betelheim yeah fair enough but i mean same kind of

00:25:28.980 cycle battle yes true so okay so so at that time in terms of the etiology of the diseases more weighted

00:25:37.140 on nurture and then there was an auto correction maybe became too much based on nature that's so that's

00:25:43.060 one level the other level is in terms of the nature versus nurture of the therapeutic modality so now that

00:25:51.780 i come to you as your patient you're the psychiatrist if i were freud i'm all basing it on talk therapy

00:25:58.100 and let's discuss what mom did when you were three or whatever it was the irritable complex or whatever

00:26:03.620 and now we're very quick to give the drug so where are we in that whole debate if you were to assign

00:26:11.460 a hundred points to the nature versus nurture where are we right now well good psychiatrists that's

00:26:19.060 what makes a good psychiatrist someone who's aware that you know both are often operating not always

00:26:24.820 if you're just in there for psychoanalysis you know probably the oh i i guess i'm thinking in terms of

00:26:30.580 how you treat it in terms of medications we can do that if you want we can focus on that if you prefer

00:26:35.220 oh you know it's um i know what you're so you're getting back to kind of the psychopathology of it you

00:26:40.740 know or the the origins of the problem um well yeah sure i mean we're always aware of the fact that

00:26:49.060 you know people have different temperaments and temperaments are have a genetic component to

00:26:54.340 them um so um i'd say that a good psychiatrist is very much aware of all the limitations of the um

00:27:06.500 of the the bi-directionality of nature and nurture and how one influences the other and it's a circular

00:27:13.620 dimension um there's an interesting i think this is ian hacking um where he makes a distinction i hope

00:27:21.140 i have that right between um natural kinds and interactive kinds of uh psychiatric problems uh and

00:27:30.020 ptsd that's that's something i worked on for a long time because i worked at a va hospital that's a very

00:27:36.340 complicated um condition um condition so uh i mean just as a paradigm for for considering uh you know

00:27:44.260 these these dimensions so what's what's the core of ptsd it's it's it's a fear reaction that hasn't

00:27:51.620 extinguished after the stimulus has gone away and it's the essence of ptsd um how many uh i i could be

00:28:00.980 wrong i probably if you um well probably if you were someone born with a highly sensitized arousal

00:28:10.340 system it's possible that you could have chronic ptsd for forever i mean somehow between cognitive

00:28:17.060 behavioral therapy and medication you'll still always be you know highly sensitized uh very high

00:28:24.180 hyper vigilant highly reactive to things that go on in most cases i i think that is kind of short-lived

00:28:32.260 and could be very short-lived because we have really good cognitive behavioral work for that

00:28:37.380 and also some medication like you were in a car accident heaven forbid and um you know now you're

00:28:43.140 afraid to drive understandably anytime you kind of hear traffic going by you get very anxious but

00:28:49.940 there are desensitization kinds of things the ptsd of war uh or of situations where you have to be

00:28:57.380 the actor are very complicated uh the classic survivor guilt um i don't know if that term is still used

00:29:06.340 anymore but i think the meaning is still highly relevant the moral injury that i that i mentioned

00:29:11.940 before um heaven forbid you kill a kid you know unintentionally i mean but it happens um these kinds

00:29:19.460 of things just they torture people and uh often in in wartime there's a sense of at least this was

00:29:27.460 very true in vietnam which was the error of the veterans that i was treating when i was there a

00:29:32.180 real sense of disillusionment and betrayal you know why did i sacrifice so much for a war that was

00:29:39.220 yeah yeah whatever um and um towards the end of the war as you may know there was a very bad morale

00:29:47.860 a lot of the um the senior people and i mean on the ground forgetting washington were um just not

00:29:55.380 doing a good job they weren't protect they weren't watching out for their um troops they may have

00:30:01.300 gotten wrapped up in some sadistic acts themselves i mean it's it's just a the whole situation of course is

00:30:08.420 perverse as can be what it brings out in people but this is what you're dealing with this is what you're

00:30:14.900 dealing with you're not just dealing with a fear response that didn't you know um where you didn't

00:30:21.460 re-equilibrate when you once you came back home and on top of it we had we i know the va is and

00:30:29.060 the department of defense are much more attuned to this now but at the time there was very weak

00:30:34.660 transition you know when you come out of you come i mean you flew home 24 hours you're in the jungle and

00:30:41.700 honestly 28 hours later you are home for some of these guys and that is just uh the most existential

00:30:49.700 whiplash you you can imagine you need decompression you need to be with your the other guys in your

00:30:56.020 troop um and there needs to be a a real focus on this reintegration um and there wasn't and for a lot

00:31:05.540 of people that was just they basically never regained their civilian footing now i'm talking

00:31:12.020 i'm committing a little bit of what's called the clinician's illusion where you extrapolate too much

00:31:16.820 from the people you see in a clinic to the people in the world most veterans came back and they adjusted

00:31:22.900 and they were fine but um but we saw the people you know who weren't and um and so i guess that's my point

00:31:33.060 so that that condition to some extent had a natural dimension to it which is to say you put an organism

00:31:40.100 with a central nervous system in a situation where they're you know could be killed and that really

00:31:46.180 affects them um and sometimes in a prolonged way uh but now you have all this um elaborate and uh impactful

00:31:58.820 social and psychological um sequelae to it that will affect the course of that condition because

00:32:06.020 even the way you see um you see it like a situation a certain situations you can see it as a

00:32:14.740 a threat or a loss or a challenge and even the way you psychologically approach these things

00:32:20.340 has prognostic implications for the the symptoms and the residual that you experience interesting uh

00:32:30.740 have you been able to see in your career as a psychiatrist your ability to cope with the undoubtedly

00:32:39.220 harsh realities that you have to face have you become thicker skin has it uh you know nod at you and

00:32:46.180 you you you go home now you have to have three drinks to deal with what you just saw tell us

00:32:50.980 about the trajectory of your own psychological health being a psychiatrist for so many years

00:32:58.980 well you know i'll tell you ever since i left you mentioned i was on the tenure track um i haven't

00:33:06.020 heard that phrase in so long yeah i i was i did my residency there and then i um was on the faculty for

00:33:15.140 five years and then i did a health policy fellowship that was in washington dc and then i never went back

00:33:20.980 so um so i haven't been working with psychotic people if i were i always found that i always found

00:33:30.020 these patients um i found their situation very poignant and and and and very tragic and in some cases

00:33:37.620 they're very kind of um childlike in some ways and that would that would really affect me if i were

00:33:44.740 still seeing that patient population um i don't know i'm sure i would have built up better resistances

00:33:51.380 now now the patients i see i mean i can be felt philosophically i feel bad i mean so many of them

00:33:58.100 have had um these are inner inner city folks um this is washington dc uh actually the majority of the

00:34:07.220 the actual eight the average age of a person in our methadone clinic is 57 and and we have seven people in

00:34:14.260 their 70s and that a number of people in their 70s who are getting methadone how long the trajectory of

00:34:23.060 when they first became an addict would have been how how many years prior to seeing you is it 10 years

00:34:29.460 20 years yeah that's a good question um it can't it it varies some i you know that has said they haven't

00:34:36.820 it could be 20 years um and sometimes people i mean you don't hear this very often but people can

00:34:42.180 manage heroin addictions now we see fentanyl that's a little different um is but when heroin wasn't that

00:34:50.100 strong you could manage a heroin addiction for a long time uh and uh and norman zinberg has written

00:34:56.740 a lot about this drug drug set and setting and um chippers people who just they use but they don't

00:35:03.060 form they don't become addicted um and uh and even if you are you know this gets into the whole

00:35:09.460 question of what is addiction but if you're um let's say using heroin substitute what oxycodone

00:35:19.620 dilaudid uh morphine you know any opioid for you know months you'll probably be physiologically

00:35:25.780 addicted and all that means and then if you let's say god forbid you broke your back and you were on

00:35:30.740 these medications for months um you are physiologically dependent is really the proper

00:35:38.180 word meaning if i stop them tomorrow you would go through significant withdrawal symptoms extremely

00:35:44.980 unpleasant um that's not how we work we taper them off um a pain you know people in chronic pain if

00:35:52.900 they're lucky enough to be able to come off them so we taper them off slowly that taper can take a long

00:35:59.060 time and and a lot of doctors don't do it right but um in any case so there's that um but people who

00:36:07.780 are on let's say heroin for a long time um they will just come into a treatment program either when they

00:36:15.140 feel they've tipped some balance and i don't know what the physiology of this balance is between being

00:36:22.100 able to control their use and then not being able to control their use as much but uh so that's when

00:36:27.860 they feel they might need help but that tipping point can come years into into a chronic use of

00:36:34.900 these drugs it's really interesting uh it could come because you've suffered um some kind of emotional

00:36:40.660 loss uh uh or you've let's say retired for men retiring is very destabilizing uh for for a lot of them

00:36:50.020 they don't have good plans for afterwards if they got too much of their sense of identity and meaning from

00:36:54.580 their you know day-to-day work we saw that a lot in va patients would come in again after being

00:37:00.500 not being a patient for years they come in at retirement because that was so destabilizing to

00:37:05.540 them um and uh so so we'll have a patient come in after they've really managed to use their drugs in a

00:37:14.020 controlled way they had a reliable sample that was relatively um uncontaminated and then something

00:37:21.060 shifts in their life um and so the answer is a long time actually for some people others i mean we

00:37:28.980 have lots of trajectories in the clinic but some people have been in and out for decades and and

00:37:34.580 they stop for years and you would say well you've done it once you know why can't why can't you do it

00:37:39.620 again and um but and then some of them just need the methadone to get them back on track some need

00:37:46.660 the methadone simply to reduce how much they're using which in the old days we were very disapproving

00:37:52.820 of and now we have more of a harm reduction approach to it you know well it's better than using five

00:37:57.540 grams a day if you're going to use you know one gram a day is better than five so it's really it's not

00:38:02.900 a very compact answer but it's it's um it's it's every combination of permutation because addiction

00:38:09.860 and this is a a whole nother issue and um when i have this book coming out uh sometime i hope next

00:38:16.820 year where i i actually go i say i don't think of addiction as a disease um i don't debate people who

00:38:24.500 do and if that's you know if that's important to them especially if they're in recovery or whatever

00:38:28.740 that's fine that's fine um because i would treat them the same way and have the same conversations with

00:38:33.860 them about how to uh you know get better but um but addiction is um it's it's a it's a condition

00:38:42.500 it's a phenomenon it's a human drama i mean it's it's so much more complicated than just being on

00:38:48.100 methadone and i know politicians often you know they see it that way and just get you on methadone

00:38:53.220 you'll be fine no you'll be standing still because you won't be craving as much and you won't be

00:38:58.180 withdrawing and now you have to do the really hard work and it's hard and that's why people drop out

00:39:03.220 all the time how did you decide uh of all the possible the panoply of specialties that you

00:39:10.580 could have focused on walk us through why it was psychiatry and not radiology or oncology or one of

00:39:19.220 the endless and i asked this from the following uh perspective my original training was in psychology

00:39:25.620 of decision making specifically what i studied in my doctoral dissertation is when have we acquired

00:39:31.940 enough information to stop and make a choice so those are called stopping decisions and so i looked

00:39:37.940 at the cognitive mechanisms that lead to a stopping decision so you're finishing your uh you know your

00:39:45.300 md degree now there is 40 specialties walk us through why it's psychiatry not anything else

00:39:52.740 yeah actually uh in my case i finished college and then i went to grad school in evolutionary biology

00:39:59.540 at the university of chicago oh so that's why i loved being back in hyde park when we were there

00:40:04.980 um and uh your goal was to hopefully become an an academic evolutionist yeah it was although i i went

00:40:12.660 with the i kind of went with too many too much darwinian romance i mean by the time i was there it was

00:40:18.820 it was starting to get extreme i was gonna talk to you soon so get ready i'm gonna talk to you about

00:40:24.100 darwinian psychiatry shortly but go ahead okay um yeah so you wanted to go into evolutionary biology but

00:40:32.100 yeah yeah yeah and then while i was there my first year my first my first six months in the department

00:40:39.380 which i absolutely loved i loved being there um i developed um uh i got ill and i got developed

00:40:46.980 an inflammatory condition and the the classic treatment for it is high dose steroids you know

00:40:54.180 prednisone i'm sure you've heard of it yeah um and um so the real answer to your question is why

00:41:01.220 psychiatry i went to medical school to be a psychiatrist i didn't decide to become a psychiatrist

00:41:07.300 and i went because that medication i was one of the lucky ones um although it's not that uncommon i had um

00:41:14.260 um i i had a um i it wasn't a psychotic break but i i i got very very very depressed on um steroids i

00:41:25.620 mean like immobilized depressed and um it was high dose that's that's not it's not that common but it's

00:41:34.020 not it's not unheard of at all to have mental it was what we call mental status changes i also years later

00:41:41.300 when i had to be on a a much shorter course of it got kind of manic uh so in any case yeah so i was uh

00:41:50.740 just profoundly depressed uh and you you hear this kind of thing sometimes among really depressed

00:41:56.100 people they would have killed themselves but they didn't have the energy to do it which is why starting

00:42:01.620 people on antidepressants can be very tricky because sometimes they become more activated before

00:42:11.220 they become less depressed so if you get your energy back but you're still hopeless

00:42:18.500 and miserable the odds of committing suicide are higher actually but in any case um and

00:42:27.540 i couldn't i really i couldn't i like slept all day and i cried the rest of it and i thought i should

00:42:33.220 kill myself and um then i told this to my uh the doctor who was giving me the steroids uh about two

00:42:40.260 weeks three weeks into it he said oh my god that's the steroids you know he said that that's it um i had

00:42:47.060 another weird symptom that was very very unusual i've since found out i've spoken to some neurologists and

00:42:53.300 they've never heard of this really but i developed what's called um a receptive aphasia okay so most

00:43:02.500 people think of aphasia meaning like you can't really express yourself with words as expressive

00:43:08.660 aphasia that's what most people have heard about and that it's typically uh if you have it it's usually

00:43:13.940 because a person had a stroke i mean could have something else but that's you like you know what you

00:43:18.020 want to say you just can't even yeah there's before you go on forgive me there's a famous

00:43:22.820 case which i've cited in some of my writings uh mentioned by oliver sacks it's called the president's

00:43:29.700 speech in his book uh titled uh the man who mistook his wife for a hat whatever and in in the story what

00:43:38.660 he tells is that as he's walked he's doing his rounds he walks by the room where all the people who

00:43:44.660 are suffering from aphasia are housed and they're looking at the screen and they're all cracking up

00:43:50.820 while listening to the president's speech i don't remember if it was reagan or something and so he was

00:43:55.460 at first perplexed because he's thinking well why are they reacting to this to the speech if they no

00:44:01.860 longer are able to you know extract meaning from it or whatever and then apparently his explanation was

00:44:07.700 that they were laughing about the falsity of how it sounded in that while they could not

00:44:14.420 necessarily understand the words they were understanding the modality of how inauthentic

00:44:19.940 it was i just thought small intro but go on okay so i have to read that story um uh actually when a

00:44:26.180 person has expressive aphasia they can understand very well so obviously these folks were suffering

00:44:31.860 from some other thing but that's really interesting because yeah he always had these incredibly

00:44:36.740 microscopic deficits that he could elucidate um and so but i had receptive aphasia which meant i didn't

00:44:44.260 understand what you were saying to me i kind of didn't meaning what like if i'm talking to you

00:44:49.460 now you see my mouth moving yeah i can't process what i'm saying not really and i know that i can't

00:44:55.700 even kind of recreate it to explain to you how it worked how it felt but i just know i mean people

00:45:01.780 would say something and i go what what you know and then i remember reading the newspaper and um

00:45:09.620 there was an ad for um floor coverings and there was uh so it said carpets you know carpets reduce

00:45:17.620 carpet why would anyone need a pet in the car you know it's just weird stuff like that but it was all

00:45:25.060 the steroids thank god um and then you know uh as you know anyone who had to take them for at least

00:45:32.660 two weeks uh you have to taper steroids off you can't just stop them or get adrenal failure so um

00:45:40.980 so that took another four to five weeks so by the time the whole thing was over i'd basically been nuts

00:45:46.900 you know for six weeks and i remember thinking that um you know how lucky i was that it was due to some

00:45:54.500 exogenous influence you know i get the drug was gone and i was back to my old self um but there are

00:46:01.700 people who have these experiences and it's kind of their own neurochemistry revolting on them and they

00:46:08.020 never know when it could come back and or even if it could be treated and i just thought that's what

00:46:13.460 a horrible horrible thing and so that's that was my motivation for going into psychiatry very interesting

00:46:19.540 okay well now as promised you gave me the segue are you at all sally familiar with the field of

00:46:25.620 darwinian psychiatry i don't mean to put you on the spot you are a bit no i mean like a randy nessa you

00:46:31.060 know i mean yeah oh okay you know he's he's a good friend of mine he's been on the show twice but i don't

00:46:35.380 know as much as you do i'm sure so but from whatever you do know because i mean sure you may not be an

00:46:41.220 expert and you know evolutionary theory as applied to psychiatry you do know the landscape of how often

00:46:49.460 psychiatrists may or may not be informed via the evolutionary lens now i'm i'm expecting you to say

00:46:56.180 that very few are informed from the evolution via the evolutionary lens and if that's true why would it

00:47:02.900 be the case that as you're training as a psychiatrist you never study the ultimate causation that might

00:47:11.540 result in the mental breaks that we see well first off a lot of these people who've been pre-med when i

00:47:21.140 was in college i went to cornell it must have been the most competitive school you know that i went to cornell too

00:47:27.300 no yeah ms phd cornell go ahead okay um it was wildly competitive i wasn't even pre-med then i didn't

00:47:35.380 want to go to you know um and i just remember thinking thank god i'm not pre-med so part of it

00:47:41.540 is who comes to medical school or who at one time at least they were very you know focused on you know

00:47:47.700 organic chemistry and biology and microbiology and all this so these were people who were didn't even

00:47:54.260 think about those things i'm sure and then um okay so i'll say something that's pretty but i'm

00:48:00.500 probably gonna make your head explode which is not that you've done that to me but maybe you will in a

00:48:05.940 moment um i'm not sure i'm sure sometimes how much it would change what we would do um like let's say uh

00:48:18.740 you take anxieties like the classic right isn't that the the most paradigmatic case of yeah so

00:48:24.980 because the idea is that when you go for anxiety related phobias the typical structure of that

00:48:32.580 content of that phobia is stemming from an evolutionary signature people are not coming to

00:48:37.380 see you because they're afraid of moving cars but because they're afraid of spiders which would

00:48:41.940 have been something that we face in our evolutionary past is that where you're going with this oh no i was

00:48:46.660 just going with the idea that that being vigilant is just oh yes obviously it's good for survival and

00:48:52.980 then you can get in situations where people's vigilance is just too hyperactive yeah it's

00:49:00.820 dysfunctional what's the harmful dysfunction yeah well i mean i actually use exactly that framework if

00:49:06.660 you remember i mentioned it briefly at the university of chicago talk i i use the example of how ocd

00:49:13.060 is a maladaptive firing of an otherwise adaptive process right and that's how i think about okay i

00:49:20.020 see but so what you're saying is that from your perspective while yes it's great in terms of the

00:49:26.740 explanatory richness of understanding the etiology of mental health disorders pragmatically it's not

00:49:34.660 changing my intervention modalities as a psychiatrist that's what you're saying yeah yeah now if i'd be

00:49:40.340 very open to hearing how it would change it could change it improve it you know but i that's my

00:49:46.820 answer it's like yeah it's fascinating and i was just listening to someone talk about depression and

00:49:51.940 how maybe that well again we say depression depression is a very it's header you know it's

00:49:57.540 a heterogeneous state but in any case um or maybe a a state of withdrawal you know um that that may be an

00:50:05.780 important um adaptation for somehow recharging or making yourself less conspicuous if somehow

00:50:13.860 if somehow being more noticeable would be harmful you know would get you rejected from the group or

00:50:19.380 somehow attacked or whatever uh but it wouldn't change how i treat someone who's depressed well i so

00:50:26.580 i'm trying as you were saying i was trying to rise up to your challenge of having an example where

00:50:32.660 the therapeutic approach might be different i'm not sure if i have one but i what i could certainly

00:50:37.300 tell you is and again that may speak exactly to your point that the fact that i explain it via an

00:50:43.940 evolutionary lens doesn't mean that i might change how i treat it take for example anorexia nervosa

00:50:50.500 and i discussed this in some of my earlier books the the evolutionary argument is actually quite distinct

00:50:56.100 from uh some of the sort of social constructivist arguments which typically go as follows uh you

00:51:03.860 know young women see the thin ideal through social media that becomes an attack on their personhood and

00:51:10.260 then then sort of it misfires by wanting to become increasingly more skinny i mean in some small sense

00:51:16.580 that might be true but it turns out at least the best evolutionary argument that i've heard of is that

00:51:21.780 it is an instantiation of what's called the reproductive suppression model so if you look across

00:51:27.940 many female mammalian species when the environment is not conducive to me having a child there is an

00:51:35.700 innate mechanism that shuts off my reproductive potential so if i'm a cow and there is not enough

00:51:41.860 food well i don't go into estrus if i'm already pregnant i will then have a miscarriage because

00:51:49.380 there is a calculus that says it's not worthy worthwhile for me to carry it right viewed from

00:51:54.900 this perspective since since anorexia nervosa results in either primary or secondary amenorrhea

00:52:01.780 shutting off the demensis and so on the argument is that it is an instantiation of that mammalian

00:52:08.980 mechanism and so then the argument becomes so what is it that this woman rightly or wrongly so is viewing

00:52:16.100 as threatening in the environment that she should shut off her reproductive potential so there are

00:52:22.420 unique insights that i just now whether that changes the specific way by which dr satel would treat

00:52:31.060 the anorexic i'm not sure but isn't there some value to the fact that i didn't just rely on it's because

00:52:37.780 you saw it in vogue magazine that you became anorexic what are your thoughts on that uh well um

00:52:46.500 i would say that as an evolutionary i mean i could easily i mean this does happen in nature right

00:52:51.220 so it happens across populations not just to individuals i mean isolated individuals but um

00:52:57.700 i would say that um i would tell people to read hadley freeman's book which i loved it was called good

00:53:04.260 girls and it's about her i know there are a billion anorexia you know memoirs so this one was really

00:53:10.900 good and um so what was her reason what was her attribution because that's what you're going to get

00:53:16.100 from a human being a meaning making creature it's what why the hell is this happening to me or and or

00:53:21.540 why am i doing it and uh her explanation in some ways has maybe some relationship to your theory

00:53:28.900 um because she said not so much this had nothing to do with conserving resources of course but it had

00:53:35.860 to do with the fact that she was uh very reluctant to become a woman you know very reluctant to uh uh

00:53:46.100 leave childhood and take on the you know the burdens of of of adulthood and you know reproduct now she has

00:53:53.540 kids she's doing great she has three kids she's a journalist um but but that was her that was her

00:54:00.100 rationale which at least relates to some extent to the reproductive dimension exactly what you were

00:54:05.700 saying exactly so because then then if so if i were coming from an evolutionary perspective and you

00:54:12.100 just told me what you said my next probing questions would be what is it that's causing you to want to

00:54:20.260 delay you entering the reproductive window of motherhood well then you should be a psychiatrist

00:54:25.780 because that's what i would ask i mean that's the only rational question to ask um exactly and then

00:54:31.140 with all due respect to darwin that's what you would do anyway okay so so i haven't converted you into

00:54:37.060 becoming a darwinian psychiatrist um i i mean i mean i think it's interesting but it um so that's why it

00:54:43.300 doesn't get taught i guess that's why um although i wouldn't be surprised if some like i'm sure randy

00:54:48.900 you know has obsessions uh you know with some of the residents you know i do by the way not not that

00:54:55.620 we need to to to to stay on the point but i do i would be able to answer with a readily deployable

00:55:04.500 answer the therapy how the therapeutic thing would be different but not in psychiatry do you want to hear

00:55:10.820 it oh sure okay so pregnancy sickness is something of course that is universally

00:55:18.260 true happens to women from every culture throughout all eras if you're if you are

00:55:25.220 studying pregnancy sickness from a proximate perspective there's an endless number of

00:55:30.420 proximate causes uh how does fluctuations of my hormones affect the severity of my pregnancy sickness

00:55:36.620 okay that's approximate that's a how what the ultimate explanation is that pregnancy sickness very

00:55:44.180 very very predictably and reliably happens at an exact moment during the first trimester

00:55:48.900 where organogenesis is happening right and i don't want to be exposed to teratogen exactly

00:55:56.100 therefore i develop all the food aversions and food attractions that solve that problem

00:56:01.460 and if that were not to be solved by that then the ultimate insurance policy is to expel it and

00:56:07.380 therefore all of those symptoms now here's here comes the therapeutic part that you were asking for

00:56:12.340 when i go see my obgyn because i can't stand those symptoms he or she will give me a pill

00:56:19.380 that assuages those symptoms that is the perfectly incorrect thing to do from an evolutionary perspective

00:56:26.260 because the more pregnancy symptoms you have the better your trajectory during childbirth

00:56:34.260 including reducing the likelihood of having miscarriage so those ugly symptoms are actually

00:56:40.340 adaptive so yes i may take that pill that assuages the symptoms so that i can go do the exam tomorrow

00:56:46.740 because otherwise i don't want to be running and and and throwing up every second but from an

00:56:51.620 evolutionary perspective i shouldn't do that so there is an example of a different therapeutic

00:56:57.540 approach that is owned by evolutionary theory what's your thinking on that dr stelle

00:57:01.860 well i don't quite get how symptom you know so just because you control symptoms doesn't mean you control

00:57:08.340 the underlying um physiology of of the um of the reaction so to speak so maybe it's not

00:57:17.300 interfering with this better these these better outcomes you know maybe not have yeah all right

00:57:25.860 well we will have enough to study we could i mean you know you get up that pass an irb good luck but um

00:57:32.260 yeah so wait i don't know if we have to i know you usually chat for about an hour yeah yeah we could go

00:57:36.500 a few more minutes if you want i do because because i never really went full circle on the very first

00:57:41.540 question you asked me which one um oh about the um uh

00:57:45.540 uh you know the um not guilty by reason oh yeah let's go back to that sure so right the reason i

00:57:53.700 emailed you is is because um i was really i know that's controversial i certainly but first off the

00:58:01.380 death penalty is controversial i'm not against the death penalty um i'm not going to go to the mat for

00:58:07.220 it um but um i think there are people for whom it was made like timothy mcveigh yeah and i actually

00:58:14.900 think it's this is probably also you know somewhat one could debate but an expression of how much we do

00:58:23.060 value life but um but in any case if we abolish the death penalty tomorrow that would be fine um however

00:58:31.380 um and i knew that this idea of maybe not allowing this gentleman to be eligible for the death penalty

00:58:41.540 as a separate problem uh some people would disagree with but i was just unprepared for the vitriol with

00:58:49.220 which folks um disagreed and how they uh uh i just was i that just really surprised me so yeah but what so

00:58:59.700 i i wonder if if this is in part due to this i'm gonna plug a it's not this is not my study but there

00:59:05.540 was a few years ago a study looking at the extent to which medical specialists were woke as a function

00:59:16.340 of which specialty they're in and i actually discussed the study in the parasitic mind and it

00:59:22.020 turns out so so some of the least woke uh you know specialists would be urology orthopedic surgery

00:59:30.260 these kinds of guys the three most woke disciplines were pediatrics psychiatry psychiatry and infectious

00:59:39.700 disease and i've got although i don't think they had come up with uh an explanation for it i think

00:59:45.220 there are there are quite obvious reasons why one would think that those folks are more likely to be

00:59:52.100 woke so so i'm guessing and this is completely speculative a lot of the people who threw vitriol

00:59:57.540 at you saw psychiatrist sally satel therefore you're a bleeding heart liberal that's probably exactly

01:00:07.060 what gadsad is talking about with this that was some of it some of it was oh another you know crazed

01:00:13.940 left-wing jewish of course yes um psychiatrist um there was some of that uh and other uh some of

01:00:20.980 it also just had the quality of he killed someone how could you and and in this case oh my god was

01:00:28.340 almost just it couldn't have been more uh it couldn't have been more primed to just activate anyone's

01:00:36.740 sense of justice this uh you know on one hand this menacing looking individual and on the other

01:00:43.140 hand this angel you know i mean my god it was just a morality play just staring at you and but they

01:00:50.740 could not go that extra step to realize that you know he's just he's not your average you know killer

01:00:59.620 the average killer knows what they you know they deserve to be punished most likely unless again it's

01:01:05.380 self-defense um but you know that wasn't his motive his motive was deranged and because of that

01:01:12.580 he can't be held responsible in the way we would hold an intentional killer responsible we're not

01:01:19.460 going to free him uh hopefully he gets you know some some treatment he's not going to be freed uh it's a

01:01:26.660 horrible tragic thing but this this and i'm a retributivist of it i've got quite a streak of

01:01:31.620 retributivism in me but this is not the this is not the the the the this is the situation in which

01:01:40.980 those intuitions apply and so there were people who just they just could what do you mean he killed

01:01:48.260 her how can you not i mean the sense of fairness which is deeply ingrained in in our uh evolution

01:01:54.820 uh just yeah i was gonna say i wonder if there might be room for a follow-up article where you

01:02:05.140 actually address the the the animus that you obtain that itself is worthy of it i thought about that

01:02:13.460 i actually thought about that yeah um because and maybe i'm maybe i'm silly you know naive for being

01:02:19.860 a stun but but also it um you know i mean these are free press folks uh these these uh you have to

01:02:27.860 pay to get the free press um you know i think all these little barriers that that you know would select

01:02:34.100 for people who are kind of more thoughtful you know fans of barry weiss you know um and uh but um

01:02:41.700 um yeah obviously listen again who's who who carries on the most it's it's a it's a percentage

01:02:49.460 it's probably small but it gives you the impression that it's a why did it upset you i mean did it no

01:02:55.460 no it didn't oh my god we this is what we do you know is part of the job but uh but what i guess what

01:03:01.620 upset me was how how um immune to you know an argument that these folks were um and again being

01:03:11.940 being folks who were fans of that outlet i just i was just a little surprised got you well let me

01:03:18.740 put up the but we didn't we didn't speak about brainwashed which i sent you a couple of articles

01:03:24.580 where online where i did something similar to you talking about sort of the limitations of all this

01:03:31.060 brain imaging stuff people go out this book is now 2013 so it's a few years old but probably

01:03:36.500 as it hasn't i reread it to talk to you actually and it it's still everything as exactly exactly uh

01:03:44.260 so check out this book here's the other one i want to put up again this is from 25 years ago

01:03:50.100 yeah but it's still also it's still awesome you you're also not awesome but you can say that if

01:03:57.940 you want but both and the third one that i'm going to put up again but that's a bit more of it's less

01:04:03.460 likely to appeal to everybody it's an edited book a compendium of many people who are writing about

01:04:09.060 sort of free inquiry issues check that out anything else you want to maybe promote before we wrap this

01:04:15.780 up on a shabbat evening oh no except to thank you so much i'm so glad i met you and hopefully

01:04:23.540 we could do this again someday there's a lot more to talk about indeed thank you so much stay on the

01:04:27.940 line so we could say goodbye offline thank you so much for coming on sally and i'll talk to you soon

01:04:31.780 thank you cheers

The Saad Truth with Dr. Saad - November 28, 2025

Dr. Sally Satel - A Deep Dive into the Psychiatric Profession (The Saad Truth with Dr. Saad_923)

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