 All right, welcome everyone and thank you for joining the New America Fellows program for this discussion of Daniel Berger's excellent book, The Mind and the Moon, My Brother's Story, The Science of our Brains and the Search for our Psychees. I'm Katie Engelhardt, a 2018 New America Fellow and author of The Inevitable. Before we start, a few housekeeping notes. If you have questions during the event, please submit them through the Q&A function and we'll get to them in the second half of the event. Most importantly, copies of The Mind and the Moon are available for purchase through our books that link partners, solid state books. You can find a link to buy the book on this page, just click buy the book. Daniel Berger is, as many of you know, a contributing writer for the New York Times Magazine. The Mind and the Moon is his sixth book of narrative nonfiction. His last book, Sing for Your Life, was a New York Times bestseller and his book about Sierra Leone Civil War and the land of magic soldiers won an overseas press club award. And I think to start, Daniel, you were going to read a short excerpt from the introduction of your book to set the stage. So I'll turn it over to you. Thanks so much, Katie, and thanks to the New America Foundation and thanks to all of you for being here. So, yeah, this book is both an intellectual exploration about mental health but also a very, very personal narrative that starts with my brother, and we were in our early 20s was diagnosed as quite severely manic depressive. So I'm going to read just a little bit from the opening little section of the book. All you really need to know is that he's on a ferry crossing Puget Sound. He's wearing a military jumpsuit with little black dance shoes. And this is the scene. The impact of the rough water against the bow created a steady emphatic beat. And above that the engine delivered not only a churning rhythm, but something bordering on a melody, deep and ancient, like a Gregorian chant. It was a small part of my brother's gift that he both heard at swelling intensity, this music of water and machinery. He allowed himself to be inspired and electrified by it. His body responded with a physical visceral version of a child's wonder as she holds a conch shell to her ear and listens to its elemental communications for the first time. He stood on the lowest deck near the front of the cars and the slung chains as the boats combination of Gregorian choir and pounding drum surged through him. He lifted one foot to knee height, then left high off the other and landed on the first foot so that there was a simultaneous vaulting and transferring of weight, followed by a reversal and more repetition back and forth melded with the strivings of his torso and arms, amounting to movements at once airborne and sinuous. A few passengers who watch from their cars, his mix of military jumpsuit and elephant shoes may have looked odd, compounding the oddity of his dancing, but all of this strangeness was countered by the broad solidity of his body and by his resistance to the sporadic boat, which should have pitched him off balance and made him grab as the chain poles or brace himself against a car, but never did. He hung in the air, stomped his heels on the steel deck, spraying from side to side, spun and elevated again, athletic, animalistic, ethereal, impelled by the pulse of the water and the echoes of medieval worship. Soon, he was on a psychiatric ward with a heavy dose of Haldol seeping into his brain. This is his book, and it is the story of a few of the many who, over the past several years, his story sent me out to find. And then just for a moment more I want to flash forward. I want to take off medication against psychiatric advice because as a musician, particularly as a pianist, he couldn't perform and play because of the side effects of medication. And to arrest and a further hospitalization later, I, he was homeless. And this is his voice describing that experience. On the days I didn't work, I lined up for dinner outside a church across from the shelter. That was something. The guys who slept next to me, who spent their days in the park, they wandered over, and we all waited on the street to get in, waited to be fed. We filed into the church basement and took plates of spaghetti and chunks of bread. I wasn't was too crowded for anyone to sit alone, but I didn't talk to anyone while I ate. Most of the guys didn't. For those men, there was a lot of solitude. Afterward, I sometimes watch TV. But mostly I read a biography of Dwight Eisenhower that I found in the nursing home library where I was working. I loved that book. The idea that Eisenhower knew D-Day would probably be a calamity, but that he went ahead with it because he had no other choice. There was a quote of Pizz that I've never forgotten. This probably isn't exactly it. But for me, it became sort of like a cradle. We did what we could with what we had when we had it. That's how anyone would see me. I was a guy lining up on the street for my dinner. I was a guy taking my wrinkly white button down shirt into the shower with me to wash it at night. I was one more homeless person hard on his luck, but I didn't feel hard on my luck. I felt like I was escaping from this crushing fate and that whatever happened was going to be better than what I was leaving behind. The idea that there was something wrong with me, that I needed to take drugs, that even with the drugs, I couldn't trust my own judgment that I was broken. That you're fucked, you're fucked, you're fucked, you're fucked. I thought, not for the first time, but this time it was a clear calculation. I'd rather be dead than be a broken person. And even though I had just been arrested, and even though I had just spent weeks on a psych ward for the second time, and even though I was going to be living indefinitely in a homeless shelter, this was better than the other narrative. That was a life I just did not want to live. Thank you. I'd love to start broadly for those who haven't had a chance to read the book yet and pick up on the first part of your reading. Your brother, as you write, has had a decades long struggle with his mind. The struggle deepens in the 1980s. He as you read is eventually institutionalized. I'm hoping, could you talk about what was happening at that time in the 80s in American psychiatry and how your brother's experience started to shape what became your understanding of the psychiatric profession. So there was a real convergence, personal and public psychiatric. So around the early 80s, psychiatry made a concerted effort to claim scientific objectivity. It was losing ground in various ways and in disarray in various ways, and it decided that to claim hard science as its approach was going to be, in a sense, salvation. Meanwhile, there have been developments on the pharmaceutical side, some of them going back to the 50s, but culminating around the same time and allowing psychiatry to prescribe medicines and to claim that these medicines could cure. I want to be careful. There is nothing in this book that proclaims medications are invaluable. Put your medications behind you. That would be grossly irresponsible and fully arrogant of me to maintain. But what happened was, my brother was having these struggles and he would I should say now after decades of a really flourishing life which we should get to my brother was having these struggles being diagnosed in a way he would reject my parents. My dad was a public health physician, my mom a medical sociologist so utterly rationalistic in their views and terrified as all parents are in this situation. Clung to what they knew and what they were told and what they were told is if your son doesn't adhere to a heavy medication regimen is likely to take his own life. So your parents, as you write were great believers early on in what you call biological psychiatry. But you describe as the idea that the mind like the body can be broken in certain ways and that this brokenness can be repaired with pharmaceutical drugs. And that you were always skeptical. And as someone who's interested in reading about mental health but not an expert I mean it seems to me like skepticism of the biological model, even hostility towards psychiatry is sort of having a moment you know there's your book there's a few others. It seems like that moment sort of mirrors the turn against Freudianism that preceded it at the same time of course more and more people are being prescribed psychiatric drugs so I'm wondering how you understand that kind of tension. I think there really is a paradox at this moment. I do think we might be at a turning point so a couple of indications as I began this project at the New England Journal of Medicine published a lead opinion piece, which declared as a crisis in both clinical and academic that is research psychiatry just saying we don't know how these drugs work. We're making a progress in our medications. This can't be the only way to go we need other approaches. Interestingly, as I set out and unexpectedly to me, the people I was learning the brain science from and who spent their entire careers multiple decades searching for better pharmaceuticals were consistently saying, we haven't made progress in 50 to 70 years, in antidepressants anti psychotics and the anxiety medication. So, there's that side of things that does suggest we might be at a turning point or at least at a deeply reflective point. On the other hand, you're absolutely right. I mean we are prescribing more and more. We are diagnosing more and more and just for one glaring example of that, that number of young people being diagnosed with bipolar over one recent decade increase by 40 times. It's worth just pausing on that 40 fold increase in the diagnosis of bipolar disease. So, again, even the most hardcore scientists who devoted their lives to this biomedical mission, we're saying there's something going awry here. I mean, certainly one of the shocking conclusions I came to reading your book was, you know, there is just very little evidence for the efficacy of a lot of the drugs that are commonly prescribed for some of the basic models of psychiatry. You interviewed Mark Stone, who was a deputy director of the FDA's division of psychiatric products. He did a meta analysis that covered tens of thousands of subjects. He found that SSRIs used to treat depression do very close to compared to a placebo. How is it, do you think that these models have been able to persist in this field supposedly devoted to science? How is it that these drugs that seem to work so poorly have become so popular? Right. So, it's, on the one hand, the smartest thing to say is it's a mystery. On the other hand, it's worth acknowledging there are people who argue fiercely the other side of this. But yes, Mark's study, tens of thousands of subjects from within the FDA would say that SSRIs outperformed placebo for about 15% of people. And here's the new sort of revelation out of that research. We had thought that at least we could pinpoint who those limited people are who really do genuinely benefit and that it would be the severely depressed. That had been kind of the common wisdom, but his research calls even that into doubt so that yes 15%, but it's very difficult to pinpoint or predict who that 15% will be. And yeah, here's, you know, what my New York Times magazine editor has always asked me, she's like, how do you reconcile that data, which is pretty solid, but with the anecdotal data that we all know that our friend, our family member, was helped. I have family members who say, you know, I've gotten off it now, but that drug helped just lift up the bottom as the one person I'm thinking of. And to it just of my psyche just kept me from going lower than I was able to cope with. I don't have the answer but the scientific answers are fairly consistent. So do you have a long discussion of the placebo effect and you talk about how culture sort of contributes to it. I mean despite some very good evidence to the contrary and obviously there's there's evidence on both sides we collectively believe that drugs like SSRI work and so it seems they they work. I mean is that is that how you understand it as well. That's a variety of factors so hope is a big factor that we're all subject to. Another one that's in Calculable is just the attention of a practitioner or even a nurse who might be administering to subjects in a study that is so powerful and that brings us to a bigger, you know, theme in the book which is whether you're in a serious set of conditions, those that tend towards psychosis or severe bipolar, or whether you're dealing with a much more common set of conditions like depression that I won't say we all but many, many of us are reckoned with and deal with. And B connection can have a tremendous value, I mean human connection. And so it may be that in those studies. What we're seeing is the effect of just even a brief doctor patient nurse patient relationship. And Mark Stone the FDA director, we just discussed he, you're right that he worried when he published this, his findings that they wouldn't be well received, presumably not just by drug companies but by other psychiatrists. I see psychiatry as a self critical profession I mean the researchers you interviewed, certainly have pointed to problems with the evidence but does that trickle down to clinicians do you think. I wonder. So I think many of us had the experience of a clinician the 15 minute visit the walk away with your psychotropic medication for whatever the condition may be and that's not a great indication of nuance, attention, individual thinking, etc. I'm somewhat hopeful just because the level of deep reflection itself criticism was so powerful among a range of researchers that I spoke to so again when you think about turning points. We may well be at one. I mean one of the really powerful moments for me as I spoke to one of the preeminent researchers into depression research who was now and for the past decade looking at this fascinating question of, I think we all know there seems so resilient against depression like nothing gets to them and sometimes that's just so frustrating like how, how can he be so impervious to, you know anything that the rest of us, you know the darkness of the rest of us kind of at least touch upon if not sometimes get submerged by something that for brain mechanisms at the molecular level inside the neurons that might determine that kind of buoyancy so he's a hard hard core scientist, but what he said to me is look when I started out my career in the early 80s. What about cancer would be solved, and I thought psychiatric issues solve right behind it. Well, cancer is so dumb as simple he said compared to the issues we're dealing with. Of course, we haven't come too close to solving cancer we've made progress. Another thing he taught me is this from the 80s onward, and we're still living with this idea. We equated the brain with the mind. The brain is not just another organ. So you take any other organ in the body you said and I can cut out a tiny piece of it and I can even take its individual cells and they're generally doing what the organ does so if you go Google a heart cell it will be pumping. Neurons brain cells are not thinking. There are 100 billion 100 trillion connections, and somehow they are creating consciousness, the psyche, the self but we have no idea how and so to equate these things is just to merge to some other two things that are in completely different orders of magnitude he would say, and it sort of led me to think about our minds in totally different ways, led me and has led scientists to think in spiritual terms that made some of the scientists but nevertheless, they pursue those ideas. But it's something to keep in mind brain and mind just aren't the same. Your book obviously looks at this, maybe turn within psychiatry but but a lot of the book is devoted to patients to people who have been treated by psychiatrists for a long time and who eventually struggle against their diagnoses or the treatment recommended for them. And presumably patients now have a lot more access to information about the drugs are on about side effects there's the internet. Do you feel like that's another kind of movement. People who are diagnosed who are recommended really serious drug regimens, challenging their doctors, or is that something that's always existed. I think it's always existed nearly as much on one evidence bit of evidence for that is the peer support movement where people with lived experience are involved in the treatment process and in meetings and in determining the causes of treatment, but that's still fairly marginal I think that more typical approaches, you're in crisis, and the psychiatrist comes in and says this is the way to go and partly the reason for that is we as a culture are so concerned with managing risk. I do want to talk directly about this but you know, death. And it's good that you're my interlocutor because you thought a lot about this, but death, the possibility of death however slim overtakes the calculation. So, the idea is, I'm going to medicate you. The calculation may severely sedate you it may cause debilitating side effects but it may help to simply keep you alive it will may raise the odds of that now there's debate, even about whether that's true whether the long term outcomes, just in terms of life or death are proved, but that's the idea, and I think that really still determines the course that's taken, just to give you a sense of how problematic some of these drugs are I mean we know the SSRIs have problematic side effects, particularly with drug companies and people like to talk about which is about 50% of people are affected sexually by the SSRIs in one way or another. But okay, we can say that's a calculation that people make and live with her just to center on the anti psychotic side, and often bipolar kind of brings us toward anti psychotic drugs, even though it's a somewhat not to blurry distinction. On the anti psychotic side, those side effects can really really really be debilitating massive weight gain uncontrollable ticks there's a billion dollar industry now drugs to address those ticks even that only works, you know some fraction of the time. And just as evidence that this is problematic 30 to 60% of patients will abandon their anti psychotics now some would argue that's because those patients can't make decisions for themselves. They have no insight they're denying their illness, as my brother did and we can come back to that. My experience is that much more often than not if you sit there and listen long enough people are more living in two worlds and living in an entirely in an alternate world. So there are moments of crisis that are exceptions to that. So that 30 to 60% are probably voting with their feet and we should pay attention we can affirm all those decisions but a lot of them are really worth listening to. Well, I wonder to what extent the health care infrastructure dictates treatment, as in, I would imagine in many situations and insurance company will cover a prescribed medication but not, you know extensive talk therapy and inpatient treatment is that what you were finding to I mean, as you say it's hard to let let someone live in two worlds if they potentially pose a risk but there are places where they could probably do that safely. Safely as always, like what is safe I mean hospitalization is safe for the two weeks you're there, you're unlikely to have the wherewithal to do damage in that hospital, but is there anywhere near decent research say that the outcomes are better after hospitalization than if you hadn't been asked bless there certainly is not. And yes this insurance question is a big one so insurance will cover those prescription drugs will it cover a program like turning to the second major character book Caroline, who's suffered every imaginable onslaught of voices that you can think of including very violent ones. Hearing voices movement and alternatives to thinking about suicide prevention movement. And does that movement get support from either conventional psychiatry or the insurance industry, no it doesn't I don't know that that's a matter of being profit oriented that certainly pharmaceutical industry comes into play here, but it's a matter of this is a really different way of thinking. I'll give you a quick example it's easier to talk about the suicide prevention movement, because it's more straightforward so. And caveat, I'm not speaking against calling a suicide hotline if you need help. I'm not not not doing that. But if you call a suicide hotline the most heavily funded federally funded one. I will think it's confidential but in fact someone is scoring your risk and if you score high you police car and ambulance will be sent to your door and that happens about 20,000 times per year. The idea being we are going to move in coercively as a society in order and and impose involuntary care to prevent death. Caroline's approach this other movement completely different. She's setting up groups across the country where the pact is no matter what you say you intend to do no one will call 911 or or a clinician for that matter. And the idea is that the more candid. The sharing is and the more connected and the more understood you feel the less likely you will be to take your own life and the calculation is, is isolation that finally leads often to suicide, rather than, you know, well, that. And what we need to do is to counter that isolation with a deep kind of connection. I want to talk about pick up on that idea of involuntary care. So in the context of legal decisions, all the time someone is forced to receive psychiatric treatment, maybe in a hospital, or in the context of a legal system someone's declared, medical, legally incapable of making decisions. So in our understanding of, you know, capacity in, in psychiatric patients or patients receiving psychiatric care how's that changed in over time. In what context can someone be forced to take pharmaceutical drugs for mental illness at this point. The last question is easiest to answer so once you're out of the hospital of course it's very difficult to force to you can't there are means to monitor there's a program called AOT assisted outpatient treatment here in New York that tries to monitor that and empowers family members to monitor it, but it's difficult. I'm not sure that ideas of involuntary care really have changed that much there are legal protections that set limits on it, but for instance, in New York and Cisco with the recent crises of violence that's attributed to the mentally I want to be a little careful there. The response has been more psychiatric beds, more avenues for involuntary care on those approaches will run into court problems for obvious reasons, there can, it can be argued they're really impingements on human rights, but that's been the response I'm not sure our culture has shifted that much except that what we're seeing with movements like Caroline's what we're seeing with peer movements. I went to Israel and visited a place called a site. So Terry house that can, you know, takes it also very progressive approach. When we're thinking about mental health in terms of the neuro diversity movement, which it does have some convergence with. We're starting I think to see signs of reconceiving and we're starting to see, for instance, former head for 13 years of the National Institute for mental health Thomas in so has been widely quoted as saying, you know I spent $20 billion on all this amazing research to move the needle one bit in terms of suicide and hospitalizations, we have not so that's one indication that people at the forefront of science are saying, we need to rethink. Right. Sounds like a move away from suicide prevention at all costs. Move away from let me hold on to you. I mean one of Caroline's models is if I'm controlling I'm not connecting. And that's the problem like go back to the parents go back to my parents. They needed to control how could you need to do it and want to do anything else when your child is at risk. But the minute you're doing that and Caroline's been through this I mean as I said she's, you know suffered. You know the symptoms that we would consider fearful, the minute you're doing that you're unable to fully hears, you know she would say take your cape off, you cannot fix this, but you can listen, and in that process. You can help to bring someone back. I'm going to keep going here but just a reminder to everyone that you can submit questions we've had a few come in already. In your book talks about this push to prescribe medication. I'm wondering, to what extent is what what some people would refer to as an over prescribing problem to what extent is that an American problem. So, I mean, you give a really interesting example, looking back to the 1950s you're talking about the growth of a market for so called minor tranquilizers in the US this was initially an American phenomenon. You talk about the introduction of Thorazine as psychiatry's, you know for big pharmaceutical breakthrough in the 50s. What's fascinating was that in the United States the drug was marketed as a treatment for mania was understood as something that would make patients more relaxed in Canada, it was understood as a chemical lobotomy as something, you know, far more serious. So yeah I'm wondering to what extent this this is a problem in the United States compared to other countries. So, again, I just want to say, since the publication of the book and excerpt in the New York Times magazine received a lot of nice comments but also some comments which we need to note from people who've really suffered and really stand by medication. To answer your question, there does seem to be a particular American hunger for the quick fix that pharmaceuticals professed to supply dosages have been particularly high here particularly of anti psychotics. And there's some indication that even rates of diagnosis and rates of prescription are higher so there's interesting study showing, you know, same after sent out same symptoms across several countries, receiving much higher rates of diagnosis and prescription here that in countries in Europe. ADHD to just take a quick detour, depending on the study up to 10 times more prevalently prescribed here than in a country like France, other studies have it at two to one but no one has it at at an equal rate. Yeah, there seems to be something about us. There's also side note here in the early studies particularly of authority, which was the first anti psychotic in the 50s. There were just wild claims, but those claims emerged from seemingly rigorous studies such that 90% of subjects were either completely cured, or almost fully cure. And no one would claim that now for any anti psychotic whether the old form, which is Thursday and held all of the newer forms known as second generation anti psychotics, no one would claim anything except but somehow that study, which sort of held the argument for quite a while, and was able to make that claim and was also reported to found side effects that were fairly minimal bad dreams nasal congestion now this has nothing to do with, and I mean, really emphatic tech so you feel Caroline felt like she was losing control everybody so there was a dissonance there that's hard to explain. I mean, we've talked already about the faith that clinical psychiatrists have had in some of these in drugs and how have some researchers are starting to question that faith. You know about the consumer side of things, you write that in the 1980s federal laws were loosened they let drug companies advertise drugs directly to consumers something that only one other nation New Zealand allows. I mean I worked for a few years in American broadcast television, I would memorize different advertisements for diabetes drugs and whatever it was I mean they're on all the time. They're marketing directly to patients. Do you think that has contributed in a significant way to the popularity of some of these drugs is it that American consumers are demanding them more maybe than in other places. I think there's possibly a kind of circularity that is psychiatrists are diagnosing and prescribing with maybe unwanted unwarranted emphasis but certainly that then there's a demand and drug companies have known this certainly since the 50s when they started marketing some of those quote mild tranquilizers. Yeah, and on the unnamed morning news show that I tend to watch there are an inevitable stream of drugs, both marketed for primarily bipolar. Because those bipolar drugs often cause movement disorders ticks etc. There's a steady stream of advertising for drugs that can in some cases counter those movement disorders. So yeah, and that's prime time so there's you can imagine how much money is being spent on those campaigns. Yeah. I want to ask you about de institutionalization so then move away from offering in treatment, you know from in treatment psychiatric facilities I mean de institutionalization is seen as by many people is a successful movement in the United States that you know patients prefer to be treated in community. And then reporting for my book I went to a few countries in Europe like Belgium and was surprised to find that the institution I mean they're moving away from institutionalization but but still these institutions are common I met young people in their 20s and 30s who'd spent time as children in psychiatric facilities. How do you understand that the institutionalization trend in the US is it all positive have we lost something. I didn't have a chance to spend time as you did in European institutions. Like I said I did think a lot about it alternative institutions but those are really experimental open door. So, I don't think anyone really argues that de institutionalization itself which happened in the wake of thorazine and held also 60s up till kind of the Reagan era was in itself a mistake what people do argue is that there wasn't the funding to build the community level services that were supposed to come in and take the place of those institutions. So I don't think we should have a rush back to institutions I know we're in fear I mean shootings yesterday I mean shootings on the subway in San Francisco that kind of anarchy. All that raises questions I don't think the answer is re institutionalization I think it is though, and even fairly mainstream people to say this so I spent some time talking to the new head of the Department of Health here in New York and I think that our background is in mental health. And even he though he's a relatively centrist mayors Department of Health director was saying we really need to think upstream we need to think not about the crisis moment at that point we're dealing with a criminal situation. We need to think way upstream about why people are abandoning their medication that's number one, and number two is how can we whether on medication or not, how can we battle the isolation, which is really haunting you can imagine if you're hearing this, you're I mean I, for me I'm careful I mean, many people just call these alternate realities and I'm drawn to that idea, but whatever we want to call them psychosis, you know, non consensus realities. There are situations that since childhood have brought shame, isolation, self laceration, etc, and you can imagine what years and years and years of that does. And his point doctor for science point was look we just need to focus on the beginnings if we're going to avert the terrible endings. I'm about to throw up into questions from the audience, but as my concluding question. Daniel and we spoke on the phone last week you talked about an earlier New America meeting. At which you were asked you know what would you do as a parent if your child was diagnosed with a mental illness and strong psychiatric drugs were were recommended I mean your book with a lot of caveats with a lot of people there is skeptical of biological psychiatry. But you know as you write that you know some of your characters they started hearing voices and dealing with psychosis at you know as children. So I, you told me that at that time you didn't really have an answer to the question. That's fair it's a really hard question but I wonder if you have a more concrete idea now of what you might do. Yeah, the question that stump me actually raised the stakes even further what, what would you do if you had a child who was talking about suicide. And for good reason, and have an answer. But I think what I've learned here is maybe to advise against all the terror that I know from my parents and from parents who've written me since I was to advise for at least sort of metaphoric moment, taking a breath. What's being said to you. Can you afford to just listen would listening just listening help. I know this sounds trite and simplistic, but I can say from my brother's experience, and it's an end of one but it's, but I've done enough research over the last several years to have an end far beyond that. The minute, especially with a relatively grown child teen, the young adult, the minute you put that person on a locked war, you are communicating something that might be damaging. And I think for my brother tries he did tries we all did that relationship with our parents was never quite healed. It's an entirely different thing I should say if that child. People like this asks him or her themselves for that respite of hospitalization. I think that's an entirely different script with an entirely different I would guess outcomes. Yeah, I would go back to what Carolina has so much experience with this says and people can read she's now so involved with outreach the book contains a lot of her conversations with parents. The more we control the less we connect. Just, I would say to parents just at least keep that in mind. Right I'm going to turn now to some of the questions we've been getting from audience members. An anonymous viewer asked, how do psychedelic treatments for various mental health problems fit into the landscape, you describe. Yeah. And it's true. And it's really interesting and it's going to bring us trigger warning of people are really, really adamantly atheistic that's going to bring us into some spiritual territory so there have the New York Times, my paper recently published the psychedelic revolution and it, and it fascinatingly linked to two major studies, saying that both have been successful that is not true and if you just go to the conclusion sections you'll see it one of them was not successful and one of them personally was, and I really borrowed deep a clear difference between the two is that the successful study offered, I want to say 30 but it may have been way more than that hours of therapy, and that therapy, as you can learn if you read that therapy manual is very particular. And this is where we get in the spiritual. It talks about guiding the person toward a sense of self within one surroundings and a sense of quote oneness. It is all about using the psychedelic as an opportunity to position oneself within something larger or whatever we want to call that something larger the cosmos. And that power, you know we can go to Eastern or Western terms here. But it's fascinating to me that I think that is one of the places that psychiatric researchers student and moving in. One of the key researchers in that area apologize to me she's like, again it's hardcore as it gets in her background. I'm about to get woo woo on you. And she spoke about this spiritual aspect. So did the research I mentioned earlier that the depression researcher he's, he would never say is religious he draws a clear line between science and what he just said. I'm fascinated by what it is what's the ingredient for religious people that seems to help them and he just said it may be the ability to find order, or the ability to find meaning, because one is placing oneself within something larger. Oh, Katie, I'm not hearing you now. Oh, yeah. There we go. Okay. I have a question from another anonymous viewer. Have there been advancements in the prevention of mental health problems and crises as opposed to diagnosis and treatment. Wait, so what was the first part before the diagnosis and treatment and the prevention of mental problems as opposed to diagnosing. I mean, I would say again these are not rigorously studied but I would say that, you know, this whole idea about finding ways to connect. I'd say this idea that I just referred to about finding meaning and something larger. And there's a little bit of research about things like diet that might help certainly for my brother and this is important to note, you know, he adheres to a pretty strict regimen of meditation prayer exercise and for him because he's a musician music. When things begin his day, and it would be difficult to sway him from that that is a really centering or those are really centering forces in his life and I think if you think about those four things, you'll find, you know, at least one of them as themes in ideas about prevention. And kind of going off that point, Kelvin asks, what structural changes within our health care system today are important for us to address in order to support a relationship based approach to psychiatry. Right. So, I might not be smart enough structurally to answer that question, but I will say that humility would be a substructural element so I'm thinking of Steve Hyman, who I arguably is one of maybe the leading scientists and in psychiatric research he's a psychiatric physicist he ran the National Institute of Mental Health for many years he's now head of psych research at the Broad Institute, Harvard MIT organization. And what he called for after years and years and years of research was epistemological humility. We don't know, we don't know, and that can sound like a nihilistic starting point he didn't mean it that way at all he's a scientist he's going to continue to pursue the science of psychiatry. But he felt like starting from not knowing, rather than an assertion of expertise might be the way to go it allows that doctor patient relationship to be individualized in a way that we just haven't really done institutionally systematically. I'll just add one caveat to that. Of course science can't institutionalized to a complete degree science classifies right and without classifications and categorizations, it's lost, you can't study anything. I think Hyman's idea, the idea of others was, if you can push back toward the individualization of clinical practice, and perhaps even there's a way to do this at the level of research, we might find new and better methods. David Rubin's question kind of follows off that point he would like to know. You talked about Carolyn who said that we cannot connect and we are trying to control. Are you optimistic that more people will learn the skill I guess you optimistic that they'll be this turn towards more of a relationship based model. Right, so people hear about what I'm writing about and this happens not only with Facebook, but with others and think I'm a really dark person I'd say more that I'm just comfortable in dark places. And that's different than being terribly pessimistic. I actually do think so. And that's been affirmed. So the recent excerpt in the New York Times magazine has drawn just a huge amount of traffic and some of it's been very critical and some of it's been wrenchingly critical like I've watched one particular video I'll tell everyone, if you Google Freddie DeBoer, you will hear everything that is wrong with the story I've told and it is worth listening to. But that said, there have been a lot of people who've written back in very, very thoughtful ways so yes. I'm optimistic. Another anonymous reader had asked if any of the responses to your book or I guess to that to the Times excerpt surprised you. Yeah, the fierceness of Freddie divorce response caught me by surprise, even though I knew that sort of thinking was out there. He's someone who's really suffered and is clearly in pain right now and who I'd love to connect with but want to connect with me. So that took me by surprise. No, I'd say after all the years of doing this and then all the years decades of thinking about it ever since the early 80s. So I wouldn't say surprise it's not surprise it's more like each response just deepens my understanding so I love getting those responses I hope readers will just go to my website get my email and send me their thoughts that's a kind of connecting I love that deepens my experience as a writer. Another question just came in which I think I'd like to ask and and you touched on it earlier but the anonymous viewer would like to know, can you tell us the rest of your brother's story as he thought better. You know I'm always torn, because I like people to read the book. I just say my brother's story. I think is both a lesson and really really moving. Sometimes when I read that passage that is being homeless. I get choked up because at that point in our lives so we maintained a lot of close contact I kind of checked out maybe it was too much for me to deal with. It's a lot of transformative story that follows and I'm going to leave it at that for now. We are approaching the end of our time here. You know your book charts these these different sort of revolutions and psychiatry from pre Freudian times Freud it's biological model. It's not an optimistic person, but of course, the brain is a complex organ I'm wondering do you feel like we're, you know psychiatry will kind of crack it or at least make significant advances in our lifetimes, or do you feel like the move forward is to become as it earlier more humble with the limitations of the profession. So look my mind's reeling back to the enlightenment, and we don't have enough time for that lecture but ever since the enlightenment it's interesting we've thought that we could somehow excise mental illness from the brain, or rebalance the brain and current terms and think about, you know, balancing out chemical imbalances and rectifying them. And in many ways the enlightenment created the world we live in it created checks and balances it created the country we live in. Hasn't its faith in rationalistic materialistic science hasn't fully been born out and that's not to say that that science isn't fascinating. I can sit all day and did many days with those scientists who are looking at how our realities are created. I mean, Don Goff who's ultimately he and I, you know, kind of agree to disagree but I mean he was an amazing teacher showing me that it's not the frontal areas of the brain alone that create consciousness it's the hippocampus and just leading me deep into the brain primitive areas of the brain absolutely fascinating. But in answer your question Katie I, I, I'm not sure we can crack it there's not, you know, we've been trying to crack it for a very, very, very long time I think we will make incremental process, but I guess I find something affirming and knowing that the self is beyond cracking. I think that's a nice note for us to end on Daniel it was a pleasure to speak a real pleasure to read your book, I'll remind everyone watching that there should be a link at the bottom of your screen. That will allow you to buy the book, understand what all the controversies about. Thank you Daniel thank you to New America, and I will throw this back to the organizers. Thank you Katie.