 G'day, May 40 here. We love our doctors, don't we folks? I mean we have the best doctors. We have the best healthcare in the whole world, don't we folks? I mean the best. I mean we don't just love our doctors. We love our nurses too because they're important. We love our hospitals, our Medicare and our Medicaid. We love our public health professionals and for everything they do to keep us safe. Thank you. Thank you. Okay, I'm reading this terrific book, Diagnosis Therapy and Evidence, Conundrums in Modern American Medicine. This book came out in 2009 by a medical historian and a medical sociologist. Just such a fun read as you just go through all these fads in medicine. It reminds me of education. Like I didn't really know what was going on when I was a little kid but I did notice that every year there was like some new fad blowing through my education and so too with parenting. That you follow the news is like always some new fad of parenting but there's no style of parenting that's shown to have statistically significant outcomes and most of the things that we're told about oh this will reduce your cancer risk or this will reduce your heart attack risk. There's very little evidence for it too. Most of the etiology meaning the causes of chronic heart disease and cancer and almost all psychiatric medicine we don't really have a clue. We don't have a clue and yet there are all these authorities making great proclamations and Americans have so much faith that the medical establishment is just going to dramatically improve the quality of life and the length of life and now everything's getting medicalized so old age right that's now an illness so your bones they naturally lose minerals as you get older but now that's that's a disease it's it's osteoporosis right everything's become a disease you're feeling sad oh man you made you have major depressive disorder so we've got all these very specific categories of mental illness that've been the foundation of psychiatry since 1980 since the publication of dsm3 and we don't have a clue what causes these diseases and we have no objective tests for them because the the tests for whether or not you have narcissistic personality disorder or multiple personality disorder it largely relies on you know patient reported symptoms and individuals reporting their symptoms or other people observing individuals and and proclaiming that they have symptoms uh it's uh it's not so scientific not so scientific so yeah we've got a problem with afghan refugees they've uh they've been a bit naughty and uh frankly i feel like the problem's with us right i think that uh that that we failed like we must have gone wrong right we let down our afghan brothers and if they're behaving badly i think i think that's on us so here's an article in the national interest about the afghan crime wave all right we love we love our health professionals don't we folks we love our refugee resettlement agencies because they're important i i don't know about you i would love to have another 100 000 afghan refugees in this country as soon as possible that would be amazing so we have no objective tests we know i have no blood tests no no physical tests for for psychological illnesses or psychiatric illnesses so we have all sorts of widely deployed medical therapies for which there's very little evidence like we were this country and other countries were were conducting hundreds of thousands of tonsillectomies right but by 1935 or so there's an article in Scientific American saying there's no evidence that for the vast majority of tonsillectomies that uh that they're doing any good yes lord forgive our trespasses against our afghan brothers because any wrongs that they commit i'm sure it is our fault we must have gone over to afghanistan and been racist and bigoted and sexist and homophobic and islamophobic so yeah there are medicines that are effective but many medicines and therapies are widespread in use despite you know evidence demonstrating their efficacy now there are all sorts of drugs that have been introduced and approved by the FDA with considerable fanfare then subsequently withdrawn because of adverse reactions so over the past 50 years we've had a steady decline in the number of gps general practitioners or what PCPs that are now called in america primary care physicians and we've had this huge rise in specialists and internals so specialists tend to be oriented towards surgery right you go to a back surgeon he's going to look at your problems and he's going to say oh mate you need some surgery right so my father was a theologian so he saw everything through through a theological lens so most medical specialties tend towards either surgery use of fancy expensive technology and really dramatic interventions because dramatic interventions are more exciting and it gives you more prestige and it makes you more money so hysterectomies and uforectomies where they take out the ovaries all right causes decrease in lifespan but doctors are doing these in the hundreds of thousands these procedures even though the net results for people on average are not so good but doctors love getting into women's vaginas and ripping out ovaries we've got spinal fusion surgery very expensive for lower back pain no evidence this does any good lots of evidence that this does a lot of bad you know anyone who's just had one back surgery I think everyone I know who's had one back surgery has then had follow-up surgeries I didn't know anyone who just goes in get one back surgery one back surgery always leads to multiple surgeries it's like getting one tattoo how many people do you know who only have one tattoo rather than get that one tattoo and then they get more and more and more and like getting breast implants you know anyone who's just got like breast implants and that's it right they've never had go back in and touch things up so spinal fusion surgery we've had tens of thousands of spinal fusion surgeries there's no evidence it's good for you but it makes doctors lots of money it has huge complication rates much more than than other types of back surgery I'm reading from this terrific book diagnosis therapy and evidence conundrums in modern American medicine so this is funny so the federal agency for health care policy and research noted that the bad results that come from a lot of back surgeries in particular spinal fusion surgeries and so they develop these evidence-based guidelines for managing acute back problems and this panel recommended non-surgical approaches in most instances so what happened that what happened the North American spine society you know the union for spine doctors then launched a lobbying campaign against the recommendations because the guidelines as well as the research showed that the use of a particular type of screws for this spinal fusion surgery had really bad results but hey those screws make me money so because of the lobbying by spine surgeons and Medtronic Medtronic is the manufacturer of these really dangerous screws because of the lobbying by spine surgeons at Medtronic this federal agency received a 25 percent cut in its budget and congress removed its mandate to develop clinical guidelines so despite the despite the lack of evidence of efficacy you know spinal fusion operations increased 77 percent between 1996 and 2001 and the efficacy of therapies for the overwhelming majority of mental illnesses is really weak right we've got these huge rates of drug treatment all right just soaring while the rates of psychotherapy are steadily declined but there's no evidence that psychotropic medications are any more effective than interpersonal and cognitive psychotherapies but maybe cheaper and easier so what we have are changes in the organization and financing and mental health care that are dictating this massive amount of psych psychiatric drug what is it prescriptions it's not the success of the drug treatments that are dictating these changes so aside from the most serious types of mental illness the value of psychiatric medication does not much exceed the value of placebo's but now we've got like new classes of psychotropic drugs that are introduced with assertions that they are you know greatly superior to the old classes of psychotropic drugs now we've got like second generation anti-psychotic drugs they're supposed to be more effective and have fewer adverse effects than first generation drugs but there's no evidence for this and there's no evidence that SSRIs have any advantages over value over tranquilizers and order antidepressants the meds that they superseded so it's really the ability of a medication to generate profits that's a primary determinant for how frequently it is used rather than its therapeutic benefits so the lack of safe and effective treatments have not deterred the mental health industry from continually implementing new screening programs that strive to identify and then treat vast numbers of people who have not sought out mental health treatment on their own so in 2003 we had the president's new freedom commission recommended that every teenager in america should be screened for signs of mental illness and suicidal tendencies and then these screening programs were implemented in schools across you know across the country because the more people you can screen the more people you can diagnose and then the more people you can medicate and the more people you can make money off of and the more people that you can dominate and the more prestige you get yes defend the constitution it defends you so the rationale of these screening programs for suicidality among school kids is that like early detection of mental illness and early detection of depression and anxiety prevents not just impairment such as poor school performance and teenage pregnancy and substance abuse but it screens for the development of mental illness later in life but there's no evidence for this like there's no evidence that this widespread screening and subsequent treatment you know do anything towards these objectives in fact screening programs generate far more false positives than actual cases of mental disorders and what they do is they create a vast amount of pathologizing of natural distress and sadness so instead of people just being sad now they've got a mental illness that needs medication so this widespread enthusiasm for widespread screening programs for mental health for school kids completely exceeds the ability of detection and treatment to provide more benefits than problems for people identified with having these mental illnesses and and the same for screening for conditions such as prostate cancer right that's increasingly being questioned because a high proportion of detected tumors turn out to have benign outcomes even when they're not discovered so many of the etiological that means causes claims of medicine the proliferation of these therapies of dubious efficacy conceal an even more significant problem that is that we are medicalizing everyday life all sorts of normal forms of distress it's now being considered an illness so now we no longer define aging as just a normal part of the human condition guys aging is an illness it's a disease i think about osteoporosis i remember i went got checked out and like whoa in my in my 30s i had some osteoporosis well osteoporosis is a normal part of the human condition as you age right so once you hit a bone sees growing after puberty then they strengthen through a process of mineralization but by about 40 your bones begin a gradual process of deep mineralization and it lasts until you die it's a normal part of life and few people demineralize to the extent that fractures are unavoidable but osteoporosis and osteopenia scant bone right these are now a disease right i'm sure if you're if you're over 30 i'm sure you have osteoporosis dudes you have a disease and because you have disease now you've got a proliferation of therapies you've got all these dietary supplements hormone replacement therapy you've got drugs such as phosomax from merc and actinel from procter and gamble now how effective are these interventions not very right virtually not at all now what are the adverse side effects of these drugs pretty significant so osteopenia scant bone and things like osteoporosis they're essentially a new age social construction and they're propelled to the current status by aggressive marketing invested interests but people who can get status and authority and money from convincing you that you've got this terrible disease and now we've had a vast growth in the medicalizing of emotional life like have you heard about the five htt gene it's a it's a risk factor for depression guys you need to get screened right we may have like 20 of the population with the htt gene but uh there's there's there's not much evidence that you really need to get screened for these things we've got we've got we've got this massive proliferation of diagnoses and we've got the use of numerical scales to expand and expand and expand the number of people who are suffering from some grave illness and then we've got the medicalizing of all these normal phenomena of you know normal rates of sadness but hey at least there are vast entrepreneurial opportunities so the pharmaceutical industry essentially sponsors diseases and promotes drugs for diagnoses but at best a questionable and at worst you know non-existent and harmful so so the pharmaceutical industry promotes medical education there's essentially just a marketing strategy and the pharmaceutical industry of course it has got very close ties to the medical profession so doctors will prescribe drugs to a willing public you know eager to believe the ads right we the FDA now allows you know direct to consumer marketing of medications and people want to believe that you know taking this drug is just going to dramatically improve their life so academic medicine holds you know substantial financial interests in pharmaceutical companies that then sponsor research within the same institution so how do you get funding for science these days by producing the kind of results that the funders want right there's very little meta funding for people to just go out and explore right all the funding comes from interested entities who want certain results so that's why we can no longer trust science to govern itself and we can't trust medicine is there any profession that we can currently trust to govern itself so we have articles and medical journals typically prepared by drug company employees or by medical publishing companies hired by drug companies we've got the most famous medical researchers a paid huge amounts of money and get listed as authors even when they have little to do with with a study right faculty leading academic institutions generally have ties to pharmaceutical companies then fund their research and they receive compensation from pharmaceutical companies for consulting and for speaking and often get equity interests in these companies and this problem where is it most acute it's most acute in psychiatry all right so prominent psychiatric researchers frequently don't disclose millions of dollars that they get in payments from pharmaceutical companies so marsha angle the former editor of the new england journal of medicine notes it's absurd to look to investor owned pharmaceutical companies for unbiased evaluations of their own products but many academic investigators and their institutions pretend otherwise why because it is convenient and it is profitable for them to do so look forward live streams is becoming a living art piece 40 you need to interview somebody anybody i'm seriously worried about your mental state you shine and heal while talking to others thank you can 40 do this in an acrylic box in so-ho i'll charge a hundred thousand dollars per person i am not on locals not yet okay is it time to talk to talk about post traumatic stress do you guys have post traumatic stress disorder so post traumatic stress disorder is rooted in these like shocking horrifying events that take otherwise normal healthy people and turn them into people with mental health diseases right these just these events just come along and and turn you into a zombie broke and he don't even have to be there for the event you can just watch it on tv or you can just go on twitter and see a video of a beheading or a shooting of you know some kandace owens commentary and you can be traumatized bros and you might get ptsd right and then ptsd is like about the only psychiatric diagnosis that people want to have people love to have that diagnosis why because they're all sorts of secondary gains you know what secondary gains are those those are the benefits you get from claiming you know a certain illness so you can get monetary compensation for ptsd you can get status you can get extra special care now it was rare to find a psychiatric diagnosis that people like to have but ptsd is about the only one so then diagnoses like ptsd right you could join the bandwagon guys join the moral crusade right and sign up for demands for redress right and you may not have suffered but your ancestors suffered so now you've got ancestral ptsd so if you can claim that you've suffered from ptsd then you can claim you know compensation on the other side you've got claims of deception malingering and exploitation of the sick role so it's difficult for doctors to remain neutral in these controversies so where do they side well it depends on the benefits of disease status and the the sick role so ptsd as a diagnosis emerged in the late 19th century and since 1980 it has exploded in popularity so ptsd is probably the fastest growing and most influential diagnosis in american psychiatry so we've got this huge trauma industry you got to catch the wave guys i mean are you do you have stock in the trauma industry it's just going up up up up up up up all right you got to get on board with the trauma industry you've got medical and mental health professionals you've got grief counselors you've got lawyers you've got claimants you've got a whole subculture responding to traumatic events by peddling proprietary workshops and proprietary you know online programs you've got to sign up for there are trade magazines there are books there are books you know peddle to public safety military school hospital organizations so the rate of publications about ptsd between 1980 and 2005 exceeded that of any other anxiety diagnosis so trauma and the psychological consequences you know this is a major stuck in trade of daytime talk shows tv documentaries news programs like we're all talking about ptsd that's our reaction to trauma so we've got a whole court court of trauma so in human history we've all always had a lot of bad events like wars violence accidents plagues and victims have always you know suffered from intense psychic disturbances but until the latter decades of the 19th century mental illness was limited to conditions resembling insanity so when did we get ptsd essentially as a psychiatric diagnosis well essentially developed from train wrecks so once we started having train wrecks then railroad companies could be held liable for injuries resulting from the shock and the trauma of train wrecks so railway spine that was the first diagnosis that captured the psychic consequence of disasters and in the 1860s and 1870s when railway accidents became widespread so you know maybe you have railway spine bro so railway spine is characterized by patient reports of intense pain loss of muscular control paralysis neurological problems general health impairments without any discoverable physical pathology whiplash you look like you're suffering from whiplash young man so sufferers demand monetary compensation because their conditions have rendered them unable to resume their normal occupational familial and social activities they may even have loss of consortium right they may no longer be after makes sweet or savage love to their spouse so railway spine became a big issue in the 1860s and 70s and at the time most psychiatrists believed in hereditary hereditarian explanations so they thought that psychiatric disorders only emerged in individuals who had inherited predispositions towards them so after 1870 biological inheritance was widely accepted as the cause of mental illness and it was the central precondition that led to mind-breaking during accidental events so people without these pre-existing susceptibilities who then developed psychological problems well they did not fit psychiatric theories so they were to be regarded as malingerers it's just like the deserving and the undeserving poor that's the Victorian perspective on welfare now there is the deserving people who suffer from from trauma deserve to be compensated and then there are the undeserving so prior to 1870 there was no psychiatric conception that are explained why previously normal people who were not predisposed could then develop mental illness after a severe life experience so the initial debates over railway spine centered on whether physical trauma such as train wrecks could lead to a malfunctioning nervous system in the absence of any predisposition that was the debate so there are theories then that physical shocks could produce you know mental illness then there are these series are countered by other doctors to claim that personal vulnerabilities and desires for monetary compensation lay behind claims of railway spine so cynical so whenever individuals stood to gain from a medical diagnosis their motives became suspect so doctors had a keen awareness of the advantages and disadvantages of granting victims of psychic trauma the benefits of the sick role so many commentators said these injuries would remain chronic as long as they were reinforced by the possibility by the possibility in the reception of compensation so some claim the only differences between you know railway injuries and other injuries that railway injuries you can get a payoff so a man whose spine is concussed on a railway he brings illegal action against the company and may get you know heavy compensation but a man who falls from an apple tree and concusses his spine well there's no one that he can bring a lawsuit against so railway spine was unlike almost all other medical diagnoses in that it led to monetary rewards having PTSD it leads to sometimes monetary rewards and just you know cultural and life rewards so there are all these secondary gains accruing from acknowledging and rewarding victims and this has become a constant theme of our response to trauma related diagnoses so there are a lot of very cynical people who believe that psychic injuries stem chiefly from desires for compensation rather than from actual damage so that that cynical perspective is based on the argument that there's personal vulnerabilities and not traumatic events that are responsible for these problems so you have two sharply contrasting schools with regard to trauma so the first first says that these kind of traumas are the result of actual physical traumatic events leading to damaged nervous systems and then the second school says the injury lies in psychological susceptibilities to conditions such as hysteria and nervous weakness so then after world war one we've got you know widespread shell shock so there are many doctors and military officers and politicians who felt that shell shock was a product of cowardice and malingering and it could only be overcome by harsh discipline but military psychiatrists said no it was the triggering events themselves wartime experiences themselves that led soldiers to develop these hysterical symptoms and so there were some who say you know psychic weakness there's a desire to escape from the dangers of combat and the allure of a comfortable bed and a cushy pension you know creates and perpetuates these symptoms of trauma like shell shock so normal individuals naturally recover from trauma without long-term effects but you have a minority of people who develop chronic disorders like you know long-term covid right so most people who who have shell shock or ptsd they recover within a few weeks or a few months okay so psychiatric casualty rates in the vietnam war were remarkably low compared to previous conflicts so one thing that's clear the more time you spend in combat the more likely you are to develop shell shock or ptsd but most people recover naturally from this problem you know only a minority have ongoing ptsd or shell shock now generally speaking in the vietnam war psychiatric casualty rates were very low so overall rates of mental breakdowns during the vietnam war were only about five per thousand troops so this compares to 37 per thousand troops in the korean war and 70 per thousand troops during world war two so this may be due to improved medical treatment in combat zones maybe due to the expectations of quick recovery with better medical care maybe use of ready availability of alcohol and illegal drugs as a way of coping with the stresses of war maybe it's just the under reporting of psychiatric casualties so when vietnam veterans returned home to the united states united states had changed so we had this dramatic social change we've got much more distrust of authority we got widespread rejection of the war we've got a highly politicized anti-war atmosphere and it was a tiny group a strong vocal and well organized subculture of anti-war veterans emerged most notably the vietnam veterans against the war vva w and this small group completely transformed the way we regarded ptsd just like it was a tiny group of psychiatrists at washington university in st lewis who were behind the dsm3 which profoundly influenced all the succeeding dsm's so too it's just a small group of anti-war veterans who completely changed the way we understand ptsd so ptsd was a very stark exception to the data-driven causally agnostic descriptions of other diagnoses in the dsm3 so we don't have any empirical studies showing how traumas produce specific symptoms so the anti-war psychiatrist took advantage of the dsm3 the revision the diagnostic and statistical manual to aggressively promote veterans interests and that means promoting ptsd and so they say we need this category and so they were able to persuade the powers that be behind the dsm3 hey we got to we got to adopt post-traumatic stress disorder and so you had this new diagnosis in dsm3 it had none of the trappings of other diagnoses there were no field trials of criteria there were no tests of reliability there were no statistical analyses of data so veterans advocates relied on anecdotes and mainly moral arguments that said oh if we don't include a ptsd diagnosis in this new dsm3 that would be like blaming blaming the victims for their misfortunes would look forward to be refused at the australian border very possibly so the veterans advocates were trying to get ptsd into dsm3 and they had to persuade one other major psychiatrist to to join them then they'd have enough to get the diagnosis right so diagnosis aren't objective right they're not based on blood tests they're based on persuading your most important peers to get on board with this new diagnosis and so these veterans advocates persuaded nancy and rearson psychiatrists specializing in the treatment of burn victims and they persuaded her that ptsd you can't just limit it to war veterans we can just apply it to all sorts of stressful situations you know victims of sexual violence you know civilian disasters accidents survivors right anyone who survives something they may very well have ptsd so what you have are these very well organized politically active veterans advocates and and the the opposition to their theories was neither organized nor politically active so you get the dsm3 incorporating diagnosis of post-traumatic stress disorder that essentially just mirror the recommendations of the anti- vietnam war psychiatric group and so this diagnosis requires recognizing the existence of outside stress evokes significant mental illness in almost everyone right that's the criteria like there are so traumas out there that are so horrible that pretty much everyone who goes through this trauma is going to become mentally ill these traumas these external events are going to produce depression anxiety substance abuse so the the genesis of the ptsd diagnosis is political it was a group of anti- vietnam war advocates who pushed for inclusion of ptsd because they could use that as an authority to try to reduce the chances that america will will go to war anymore so then in the 1980s we got this social movement that emphasized the widespread prevalence of repressed memories of childhood sexual abuse so you had all these completely innocent people the mc martin school trial all these people running child care centers that got accused of sexual abuse and there was absolutely no no evidence for it but you had this widespread social movement saying oh people just have repressed memories of childhood sexual abuse and we can recover these memories so so this crowd would say well look the ordinary response to atrocities is to just banish them from our consciousness so this repression of traumatic experience you know is very different from the intense memories of vietnam veterans were able to easily recall their their problems so now you got the numbed responsiveness to the external world and the inability to recall important aspects of the trauma that now indicates you got a mental illness of ptsd so that means you know much of the population now has ptsd so according to one study 61 percent of men and 51 percent of women have experienced at least one traumatic event and so this study found that 10 percent of women and five percent of men have ptsd so everyone who you know saw 9 11 on tv or even heard about 9 11 they were widely expected that to have uh experienced you know trauma and and to need grief counseling we now throughout the english-speaking world we send out grief counselors whenever there's a traumatic event so apparently you know almost everyone was upset by by 9 11 they were so upset that they essentially had ptsd so if you had quite a bit of anger at a summer bin laden that that means you're ptsd bro if you fear future harm to your family or resort of terrorism you've got ptsd if you got a fear of future terrorism you got ptsd if you're afraid of having more afghan immigrants or more islamic refugee immigrants then bro you've got a mental illness you got ptsd so what exactly did it mean to be exposed to 9 11 so it's not just the actual experience of being in the world trade center at the time the attacks just watching events on tv is supposedly triggering ptsd so you know terrorist attacks school shootings natural disasters of the horrors are continually shared broadcast on tv social media so virtually everyone is confronted with traumatic events on a regular basis so the best indicator of getting ptsd from 9 11 was the extent that you watch tv news now there are all these dire predictions after 9 11 that the 9 11 event would result in an enormous amount of psychological disorders particularly ptsd but in fact these symptoms drop precipitously soon after the attacks so essentially you know only about one percent of people developed ptsd so by six months after the attack only 0.6 percent had had ptsd and these are the people who are you know immediately experiencing 9 11 so that 99.5 percent of people quickly recover from such a traumatic event now causing the question you know whether these these traumas cause ptsd in the first place so traumatic exposure right that recedes an importance if you focus on individual susceptibilities so the logic of the ptsd diagnosis you know it leaves a wide opening for those who want to emphasize individual vulnerability so you can compare rates of pathology in groups they're exposed or unexposed to trauma to try to show the massive role of traumatic exposure in causing ptsd but logically unexposed groups cannot develop ptsd trauma exposure is a constant it's not a variable so the only possible comparison lies within a group that is being exposed to trauma glib medley says god forbid the months after 9 11 in new york city were a good time to get laid because people are in survival mode so less than one percent of people exposed to traumatic events develop ptsd so why do some people develop ptsd and most people don't so two psychologists say ptsd is best understood as a periodic expression of long standing dispositions so it's it depends upon individual susceptibility so that's similar to earlier neurologists and psychiatrists who studied sufferers of railway spine shell shock combat neuroses and traumatic experiences the ptsd results from personal dispositions rather than from horrible external events so poor individual coping styles pre-existing anxiety mood disorders family histories of mental illness essentially predict who will develop ptsd so ptsd remains the big exception to the overwhelming dominance of biological and psychological approaches to mental illness so the core assumption of the trauma community is that there are these tragic events that can provoke ptsd in large proportions of the population now there's no evidence for this but there's a whole trauma industry pushing it so there's a trauma industry is essentially an autonomous profession that studies and treats trauma with its own ideology its own journals its own conferences its own training we've got grief and trauma counselors and they place their emphasis on exposure rather than vulnerability and this crowd is firmly institutionalized in schools and hospitals and disaster relief organizations and other establishments so focusing on the vulnerability of the minority of exposed people contradicts the basic principle of the trauma community which says that we must respond to catastrophes immediately and encompass entire populations or they may develop these dire symptoms so we've had this traumatic expansion of what situations count as traumatic so now virtually the entire population can be viewed as vulnerable to developing ptsd which means you know the entire population needs psychiatric help and medication so the trauma community says that much of the population is going to develop ptsd unless we have mental health interventions that implemented immediately after disasters occur so psychological debriefing is now mandatory in much of the english-speaking world after any disaster there's this whole industry of grief counselors that sends therapists to natural disasters to school shootings to workplaces wherever a stressful event has occurred because it's presumed that anyone who's experienced this disaster is going to be at risk so we need to treat as many people as quickly as possible now there's no evidence that this grief counseling and this treatment does any good in fact there's considerable evidence that it does more harm than good so there's no evidence that these interventions relieve stress or prevent the emergence of subsequent ptsd you know these single debriefing sessions the trauma and grief counselors provide have no efficacy and they often produce detrimental effects when compared to no interventions so generally speaking people are better off getting zero grief counseling so getting debriefed by mental health professionals tends to interfere with their own natural processing of traumatic events it suggests to us that we're not capable of handling tragedies on our own and and it implies that we're going to be at risk if we don't submit to these interventions and these prevention efforts often backfires so school children who are given prevention training for dealing with earthquakes or possible shootings they have much higher levels of distress than school children who don't have these kind of trainings so a a Cochrane review report concludes compulsory debriefing of victims of trauma should cease because there's no evidence that does any good and there's considerable evidence that does harm but even though the evidence is clear that widespread debriefing after trauma does more harm than good it's now mandatory in much of the english-speaking world so emergency personnel in new york city were required to participate in mental health treatment after 9-11 now for the collapse of the investment bank bare sterns company court and grief counselors now we've got the trauma industry it's embedded in schools and workplaces and hospitals and police and fire departments it's embedded in the military it's completely impervious to efforts to limit its intervention even though the evidence shows that it's doing far more harm than good so now the industry is spreading worldwide to dispense western style therapy to victims of natural disasters we've got the military has undergone a vast change so now it's expected by the veterans administration that veterans will will commonly get PTSD it's just inevitable after you've been in combat you'll get PTSD that all soldiers are potential victims and we need these short screening tools to indicate which which soldiers are going to suffer so there's the primary care PTSD screen uses just four items and ask you do you suffer from intrusive thoughts do you suffer from emotional avoidance are you easily startled and you feel detached right if you answer yes to any of those bro you've got PTSD so 27% of active soldiers 35% of the national guard and reserve soldiers are mental health risks now almost all the soldiers who report PTSD symptoms are remarkably improved six months later so for most people who go through trauma like being in combat coming home and getting a job and getting a girl is usually you know the most successful way of reintegrating into the community after military service get a job get a girl get a job get a girl so there's no evidence that PTSD treatment does much good and there's quite a bit of evidence PTSD treatment does does harm so it's social cultural and political factors that influence the degree of prominence given to the argument oh it's exposure to traumatic events or no it's the argument that's personal vulnerability that leads to two problem problems so ideologies that emphasize personal responsibility and individual agency you know these perspectives dominate some errors and other areas are dominated by explanations that focus on you know external events so environmental considerations dominate explanations at other times well alexander technique cure PTSD I'm sure that there are a thousand different things that may help PTSD including alexander technique and listening to the calming tones of my show is Luke still living off the apricot sky royalties yeah one day a real rain will wash the stinking streets look mate you have not read your Russian history Stalin use psychiatry to level political distances mentally ill the only way out of PTSD is learn sociopathy or secondary sociopathy bye bye