 So I never watched the TV show Hill Street Blues, but I just finally watched the first episode last week, and it debuted January 15, 1981, and it ran until May 12, 1987, 146 episodes. It's a cop drama, one of the top five cop dramas of all time. And so you can look at Hill Street Blues, and you can interrogate it for its eternal messages of right and wrong, and wisdom, and to inform us about what matters now, all right. But I was kind of looking at it primarily as a time capsule. It's like, oh, whoa, I remember this time period, so January 15, 1981, I was six months into ninth grade. We'd just moved to Auburn, California. So it just reminds me of the power of historicism and how it's inevitable. Like when you watch I Love Lucy or any old TV show, you can watch it both for its inherent entertainment and cultural and wisdom and moral value, or you can look at it primarily through the lens. Oh, so this is what life was like back then. So I recently rewatched The Shield, another top five or time cop drama. And this was the era just before smartphones. So people didn't have smartphones with The Shield. So those are kind of the two ways that you can look at literature or culture or artifacts. You can see them as embodying timeless values, or you can look at them as the product of a particular time of place. And so we're increasingly educated to take it for granted that we see things as a product of a particular time of place. Like I am speaking to you August 22nd, 2021. And for all I know, there may be a major earthquake in an hour. And so, yeah, I've watched every episode of Bosch on Amazon, I thought that was good. But we can't help in our modern sensibility, we see things as a product of a particular time and place. Well, I can put on my headphones and I can listen to myself just with about 5, 10 seconds of delay. So that's what historicism is so powerful, we take it for granted. We take it for granted that we understand everything as the product of a particular time and place. So traditionally, we would look at, say, the Bible, scripture, Torah, as God's revelation to humanity. And so it was a divine revelation that transcends time. And so various Jewish apologists have tried to make the argument that the Jewish people transcend time, right? And so they're like an eternal people embodying certain, you know, essential, essential essence to the Jews that have an extra soul, a special soul, that they embody certain spiritual values or they embody compassion or whatever you want to attribute to them. So that's kind of the traditional way to approach sacred texts. But living in 2021, we have so imbibed historicism. So I'm watching Hill Street Blues and I'm not primarily watching it for the characters or the drama. I realize I'm watching it to China as a time capsule to take me back what life was like in January 1981. So in January 1981, I was 14 years of age and I remember I had that combination of overconfidence and overestimation of my own abilities along with, you know, huge anxiety and doubt and fear. But I watched that whole show and I felt a sense of calm afterwards that I hadn't experienced in weeks or months. It's like stepping back into that time capsule and looking at the show and recognizing that I don't think any of the actors on that show became big stars. Like I didn't recognize any of the actors. And so I'm watching this show and I realize this was a huge deal in 1981 up through 1987. And I'm just realizing that life is, you know, a river and it flows and you can never step into the same river twice because you've changed and the river's changed. You can never go home again because you've changed and home's changed. And so I'm watching Hill Street Blues realizing I can never go home again. And these things that are such a big deal in 1981, they mean almost nothing now. And so too, the things that we think are, you know, of primo importance, they'll mean 99% likely they'll mean nothing in 30 years. So for example, medical treatments, medical diagnoses from 50 years ago. Well, anyway, the treatments, 98% of them, we don't employ anymore, right? Only about 2%, 5% of the medical therapies, treatments, diagnoses that we employed 50 years ago, do we still see as valid? And you realize now that the medical diagnoses, treatments and our beliefs about the causes of things like, you know, what causes heart disease? It's too much saturated fat or what causes cancer? It's, you know, whatever, 95% of how we diagnose and treat things now. We will not be doing it 50 years. We'll look back on this as primitive and as misguided as we look back 50 years ago. But we're in a certain mindset where medical advances, they're always like super hyped. Like, oh, wow, we've got this new medication. All right, we've got this new approach. We finally understand the etiology. That means the causes, the causes of a certain disease. And so now we realize that we need more saturated fat and less unsaturated fat. So it used to be Americans ate a diet that had the calories came much more from fat. And then the Association of Heart Doctors said, no, no, no, that's wrong. That's bad. You must cut back on fat. So Americans started getting far more of their carbohydrates, far more of their calories from carbohydrates. And as a result, Americans suddenly became fat and they came down with diabetes and increased rates. So I'm reading this book on diagnoses, therapies, conundrums in American medicine. And it's just amazing to see like everything that was taken for granted 50 years ago, 95% of it's rejected now, which can only make me think that 95% of what we take for granted in medical diagnoses and treatments and therapies now are gonna be obsolete and ludicrous 50 years from now. And so I've also been rewatching Friday Night Lights. Just God, I love that show Friday Night Lights, but no smartphones in the show. So I'm primarily watching for that just experience of like that Texas, Christian, small town, heartland of America ethos, I love that. But I also like to step back into that time period and just experience, you know, what it's like. Whoa. Whoa. Whoa. Whoa. So Josh Randall says, I added my crypto Visa card to Super Chat payment methods, bro. PS, the food pyramid kills. Yeah. So all the things we were told about food, like the leading health authorities or the doctor said, saturated fats really bad. Americans followed that advice and it's been horrible. It's been absolutely horrible. No. No. Alternative is not to automatically distrust everything that authority say, right? The alternative is to stand in the middle between automatic trust and automatic distrust. You should not automatically trust anything I say. And I don't think you should automatically distrust anything I say. There's no alternative but to stand and deliver your keenest insights, to put your weight on what you think are the best or most accurate or most reliable sources of information. We have no alternative but to make decisions based on incomplete information. Like I'm a fallible human being. Like I not believe nothing, but just have a sense of humility. Like I think I put more of an emphasis on my own lack of expertise in things that I'm talking about than any other live streamer of which I'm aware. You know that I read a book and then I come on here and I talk about the book that I've read. I mean, that's kind of how the show works. And so I read some book buying an academic and I get all excited about some new perspective on life. But there are plenty of people who have devoted an entire lifetime to the topic that I'm just suddenly, you know, all up about. So there's a terrific essay in the Wall Street Journal. Why do we shout when we argue, right? My mother would catch this. My father had a PhD in rhetoric, okay? My father was a very accomplished speaker, very accomplished rhetorician. And he would always squash me in arguments. He would always get the best of me in arguments. My father, frankly, any conflicts, disagreements, debates that we had, he always won. He was like, he was pretty much always right. And he was almost always smarter, sharper, better read, better educated. He would just like get to the nub of things, you know, more quickly and effectively and more efficiently than I did. And so how would I react? I would react by shouting. And my stepmother would notice, hey, if you're shouting, it means that you're losing. Robert Prosper says, take heart in your falsity of yours. Jesus had few more than you at times. So how old were you when I was having these debates? So I think I probably started debating my father probably about age 11. That was also the age we moved to California. And so that was the age when both my teachers no longer hit me. California teachers don't corporately punish their students. And that's when my parents no longer hit me. So maybe that was the age that I started arguing back with my parents. But I always lost my arguments with my dad. And I would start shouting, which was clear that I was losing. It was obvious to everyone, so why do we shout? Because when we shout, it doesn't persuade anyone. So do you know why we shout? Because we have a lack of confidence. So we tend to be overconfident in our beliefs. We tend to believe that we're sharper, smarter, more accurate, have better sources of information than we really do. So I come on here and I do all these livestreams because I have unwarranted confidence in my own opinions. I think I'm smarter and sharper and wiser and finer than I am. OK, so we tend to have both simultaneously overconfidence in our own beliefs. And we also tend to have underconfidence in our ability to convince others. And so we shout as a compensation. I think that's classic. So we tend to think that we have better vocabularies and other people that were better drivers. But in social items, we tend to believe that we have fewer friends, smaller social circles, narrower social networks, and get less sacks than other people. So there are certain domains where we tend to feel unduly confident. And then there are other domains of life where we tend to feel less confident than we should. So we tend towards underconfidence in the social domain. So when we leave a public space, we believe that other people are less interested in us than is really the fact. So we believe ourselves simultaneously to be more moral, to be more objective, to have more of the facts, to be less biased than other people. So that makes us overconfident in the things we believe. So in general, I am overconfident in the things I believe. Like, I have far more confidence in my own wisdom and sagacity than is warranted. At the same time, others don't pay a sufficient attention. And they don't listen to what we have to say. And so this makes us underconfident in our ability to get our opinions out there and to convince others of them. So we shout. Why do we shout? Because we feel as if we're shouting into the void. So we overcompensate for our lack of confidence in our proficiency as influences. And that leads us to shout, to use overly assertive language. And these are both very ineffective tools for persuasion. So our pessimism about our ability to influence others quickly becomes self-fulfilling, leading to a downward spiral of dwindling influence as we shout louder and louder to be heard. So the more assertive we get, the louder we talk, the more shouty we get, the less effective we get. So assertive messages tend to backfire in reality. Softer persuasion is far more effective but because we don't have much confidence in our ability to persuade other people, we make fools of ourselves. I love this 2016 book on medical diagnosis. What's the name of the book here? It's called, I love this book. It's called Diagnosis Therapy and Evidence. Conundrums in Modern American Medicine. When you just see, when you see how medicine is shot through with self-interest, with the desire to maximize not just your income, but your authority. Now people love to be in charge of other people. And so much of what people do, which they frame and present as operating in the public interest, they're just trying to assert themselves to have more social capital, to get more women into bed, to make more money, but they will freeze things as, oh, I'm doing this for the public interest. Robert says, Luke loves showing off his teeth, no stains, no misalignments, no gaps, just white perfection. If that phrase may still be used in describing teeth. Josh Randall says, I only shout at women, they love it. Well, I'd like to interview the women and see if they truly love it. Well, Luke captured by cannibals, likely arguments would ensue over who would get Tim's on his jaw. How did I get such perfect teeth? I haven't had any special dental work. I mean, I do have a good dentist too. Every six months I check with him and he gets rid of any stains and any little nicks and nags, but I've never had any major dental work. So I've got dental insurance. So I just go in there. Like sometimes there'll be like three cavities. I think once I had five cavities repaired, little gaps or just any imperfections, they just polish it up. Avoid soy and sourdough. Okay, I love this 2016 book. So on medical diagnosis, when you just see how subjective they are, right? So for example, take psychiatry. There are no physical tests for any psychiatric diagnosis. It's entirely based upon people reporting their symptoms and maybe a small bit where the doctor is seeing what he sees as symptoms. But people are not reliable, all right? Generally speaking, when people tell you they're smart, they're only 50% likely to be accurate. Many stupid people think they're smart. Many smart people think they're stupid. Many funny people think they're not funny. Many unfunny people think they're funny. So there are no physical tests for psychiatric psychological diagnosis. So it depends upon individual self-reported symptoms which are incredibly, incredibly subjective, right? The whole field of personality psychology is just based upon people reporting their symptoms. Like, you know, people reporting, yes, I feel outgoing or no, I feel shy or I feel, I think I'm very conscientious or I feel very neurotic. All right, the whole field of personality psychology is just based on people self-reporting their symptoms. And the whole field of psychiatry basically depends upon people reporting their symptoms and then psychiatrists go, okay, you've got five of the symptoms for MDD. Do you know what MDD is? It's major depressive disorder. It's the dominant psychiatric diagnosis and it didn't exist prior to 1980. So the dominant psychiatric diagnosis didn't exist prior to DSM-3. I mean, this is just how incredibly subjective and socially creative and created and these diagnoses are created so that psychiatrists can prescribe medication and not get sued for it and they can bill insurance companies. And I'm not saying that there's a better alternative, right? Obviously, I don't know very much about this topic. Let's have a look at the chart. Luke's teeth put sunspots in my vision. Crazy people are pretty free in sharing their crazy talk. Serious mental disease that pretty much screams its presence for every subway platform in New York. People with dumb and stupid, totally unreliable, crazy cannot hide it. Never mind the DSM, whatever. Batshit people are easy to spot. I used to have one in my building, one in nightmare. But it's interesting. It used to be that anxiety was the number one psychiatric diagnosis. Like during the 1950s, 60s, 70s, anxiety. That was the number one psychiatric diagnosis. But since the 1980s, the number one psychiatric diagnosis has been depression. Now, did Americans change from being racked by anxiety to being racked by depression? No, it's just a matter of insurance billing codes and the pharmaceutical industry. So 130 years ago, the number one psychiatric diagnosis was hysteria. Nobody gets diagnosed with hysteria anymore. So people come down with illnesses that they believe are socially acceptable, even socially prestigious. So like PTSD, right? People love to be diagnosed with PTSD. That's like one of the few psychiatric diagnoses that people love to get. It's like, oh yeah, I got PTSD. Look, are you kidnapped by the Taliban? Think twice if you're okay. Isn't that funny how people are just going crazy about, oh my God, the Taliban have overrun Afghanistan. And what's this doing to American prestige? What's this doing to American stature in the world? Boy, Joe Biden looks really bad. What a mess of things. None of that has any importance. When it's the right decision to leave, you should leave. Whether it's a crazy girlfriend, a bad job, a bad social situation, or being in Afghanistan, getting out is the right thing to do. That it's a little bit messy, quitting a job, quitting a girlfriend, quitting a spouse, moving out of a community, leaving us a bad dinner party. All right, if it's messy, that's far less significant than in bad situations, you need to get the hell out. Joe Biden invites weakness. I don't know, Joe Biden did the right thing. He stood tall and said, we're getting the hell out of there. If the Afghanistan army is not up to snuff, like why should American boys die? So American prestige and stature in the world depends upon the strength of the American economy and the strength of the American military. There's nothing to do with whether or not we're in Afghanistan and how smoothly we exit from Afghanistan. So all these things in the news, like I was talking to a friend in Australia days, like he was saying in Australia, it's like, oh, how are people in America dealing with what's going on in Afghanistan? I'm saying, yeah, it dominates the news and has absolutely no significance. He left all our gear in place, big deal. It's not particularly important. I mean, I guess it makes him look bad and he's down in the polls, but we had to get out of that sandbox. We would have been much better off if we'd never gone in and we should have gotten out 20 years ago, 15 years ago. They're good on us for finally getting out and if it's a bit messy. Trump would have pulled it out and our human assets out before pulling the plug on our involvement. By human assets, do you mean that we need to bring in hundreds of thousands of Afghan refugees? Is that what you're saying? We need more Afghan refugees. Very disturbing article I read. Wife of the US Ambassador to Afghanistan. She says, Europe's Afghan crime wave is mind-boggling. I got a disavow. So Cheryl Bernard, wife of the US Ambassador to Afghanistan, says, I've worked with refugees for decades. Europe's Afghan crime wave is mind-boggling. Afghans stand out among refugees committing crimes in Austria and elsewhere. Why? In 2014, when waves of refugees began flooding into Western Europe, Europeans responded with generosity and openness. They were met with crowds bearing gifts of clothing and food and holding up placards, reading welcome refugees. Well, that welcome did not last. There's one development that had not been expected. The large and growing incidents of sexual assaults committed by refugees against local women. These were not of the cultural misunderstanding date rape saw. These were vicious, no preamble attacks on random girls and women committed by gangs and packs of young men. First, the incidents were downplayed or hushed up. No one wanted to provide the right wing with fodder for nationalist agitation. And the hope was that these were just isolated instances caused by a small group of outliers as well. As the incidents increased and even took place in public because the public became involved in trying to stop the attacks or in aiding the victim afterwards because the courts began issuing sentences as the cases came to trial. The matter could no longer be swept under the carpet of political correctness. And with the official acknowledgement of public reporting, a weird, weird and puzzling footnote emerged. Most of these sexual assaults were being committed by refugees of one particular nationality by Afghans. Now, Afghans should not even being part of the refugee tide. Like the Syrians who were expected, Afghanistan is not on the official refugee roster. But Europeans were sympathetic. They could understand why Afghans would want to leave a country rife with suicide bombing and empty of opportunity. And Europeans held a baseline positive sentiment towards Afghanistan. So the author of this, she's the wife of the US ambassador to Afghanistan, says, this is not an article that's fun for me to write. I've worked on issues related to refugees for much of my professional life. But nowhere had I encountered a phenomenon like this one. I've seen refugees trapped in circumstances that made them vulnerable to rape. But for refugees to become perpetrators of rape of this crime in the place that had given them asylum, this was something new. And she says, my personal professional life has endowed me with many wonderful Afghans. Now there's nothing collectively wrong with them. You know, there are Afghans who are doctors, shopkeepers, owners of Japanese restaurants, airports, sedan drivers, entrepreneurs, IT, experts, sales ladies at Macy's, they're like everyone else. It's impossible to imagine any of them engaging in this bizarre and primitive sexual aggression. They're young compatriots are becoming infamous for it, yet here we are. So a few weeks ago, the Austrian city of Tullan declared a full stop to any further refugee admissions. Decision was aimed at Afghans. But for legal administrative reasons, it could only be promulgated in a global way. This had not been the city's intention, all right? It had just completed the construction of an expensive brand new facility for incoming asylum seekers. In the mayor's words, we've had it. The tipping point after a series of disturbing incidents all emanating from Afghans was the brutal gang rape of a 15-year-old girl snatched from the street on a way home, dragged away in serially abused by Afghan refugees. And this is from an essay published in the nationalinterest.org. This is not me, Luke, just extrapolating this. I'm reading from an essay published in a prestigious magazine. In Vienna, young female Turkish-Exteen student had been pursued into a public restroom by three Afghan refugees. They jammed the door shut, proceeded to savagely attack her, grabbing her by the neck. They struck her head repeatedly against the porcelain toilet bowl to knock her out. And that failed to break her desperate resistance. They took turns hoarding her down and raping her. Young woman required a hospital stay after which she fled home to Turkey. So it took a while for this pattern of Afghan assaults to be recognized because until recently, Western European media deliberately refrained from identifying an assailant's refugee or asylum status for his country of origin. It was only when the correlation became so dramatic that it was newsworthy did this policy change. It became clear that the authorities that long known about and for political reasons had deliberately covered up large-scale incidences of sexual assaults by migrants. For example, a gang of 50 Afghans who terrorized women in the neighborhood of the Linz train station had been brushed off by a government official that remarked this was an unfortunate consequence of bad weather. But once summer came, the young men would disperse in the public parks and would no longer move in such a large menacing pack. And this woman says I could write the same report about Sweden, Germany, or any other country of asylum in Europe. But I'm focusing on examples from Austria because that's European country I come from. So this is from the Daily Newspaper in Austria front page Afghan 18 attacks young woman at Danube Festival. Once again, there has been an attempted rape by an Afghan, a 21-year-old Slovak tourist was mobbed and grope by a group of men. She managed to get away but was pursued by one of them an Afghan asylum seeker recorder and dragged her into the bushes. Nearby, planes closed, policemen noticed the struggle and attempted to prevent the rape at the last moment. Page 10, 25-year-old Afghan attempted to rape a young woman who was sitting in the sun in the park. Four courageous passers-by dragged the man off the victim and held him until the police arrived. Page 12, two Afghans have been sentenced for attempting to rape a woman on a train in Graz. The men live in an asylum seeker's residence, first insulted the young woman with obscene verbal remarks before attacking her. When she screamed for help, passengers from other parts of the train came to her aid. So why would the men do this? Do they expect their attempts to be successful? Do they think that they'd be able to rape a woman on the main street of a town in the middle of the day? Do they think they could rape a woman on a train filled with other passengers? They think they can just rape women in a public park in the early afternoon. Are they incapable of logical thought? They merely want to cause momentary female hysteria and touch some forbidden places of the strangest body. I mean, is it so gratifying to do that once that they will jeopardize their future and be hauled off to jail? And why Afghans? According to Austrian police statistics, Syrian refugees cause fewer than 10% of sexual assault cases. Afghans whose numbers are comparable to Syrian refugees are responsible for half of all rape cases in Syria. So type two words into Google Afghan and rape and a cornucopia of appalling incidents on Fords Before You. A mentally retarded woman in Linn's kidnapped, dragged to an Afghan refugee's apartment and raped until she was finally able to escape into his bathroom, locked herself in and as he batted to the door, crank open the window and screamed for help. So why are some Afghan refugees doing this? Why do Afghan stand out among refugees committing these crimes? Like public swimming pools are confronted with epidemics of young Afghan men, think it is a good idea to have sexual emergencies. Why do they do these horrible things? Oh, I had a sexual emergency. They think it's a good idea to expose themselves, to whip off their pants and stand there until tackled by the lifeguards removed from the premises with orders never to return. So why in a foreign country where your legal standing is tenuous would you engage in this behavior? I mean, within hours of their arrival, refugees are educated as to what you can and cannot do, ins and outs of navigating the country, what officers to go to, what to say when you get there, how to apply for aid, where to find free housing, they can learn all that, they can figure out that they should keep their pants on in a public swimming pool. What's going on? So one explanation is that they get drunk. Second theory hypothesizes that they are confused by a clash in cultural values. So they come from a country where women are merely dark silhouettes completely hidden under burkas. Now confronted with girls in tank tops and shorts, they lose their grip on sanity and their hormones run away with them. But this does not happen to other young men from similarly strict Islamic societies. Why are any Afghans reacting this way in such dominant numbers? I mean, why do we have like a 72 year old pensioner walking her dog when she's attacked, beaten and raped by a young Afghan? Or why do you have schoolboys kidnapped and gang raped in Sweden by a group of Afghans? So typically the preferred targets of their sexual aggression are not attractive, provocatively dressed young women. Now often their targets are mothers with small children. There's a woman who is out for a walk in a park on an elevation above the Danube River. She had two children with her, a toddler plus her infant in a baby carriage. Out of the blue, an Afghan refugee leapt at her, threw her down, bit her, strangled her and attempted to rape her. In the struggle, the baby carriage went careening towards the embankment and the infant almost plunged into the river below. With a second child looking on a gas, the woman valiantly fought off her assailant, ripped the hood off his jacket, later made it possible for an Austrian police dog to track him down. Another incident, two young women were on a midday stroll in the pedestrian zone of a small Austrian town, pushing their babies in prams before them and they were abruptly attacked by several Afghan refugees who launched at them, ripped off their clothing. So here's a third theory. So one Afghan translator says he believes to have discovered that they are motivated by a deep and abiding contempt for Western civilization. So Europeans are the enemy, their women are legitimate spoils and so are all the other things that one can take from them such as housing, money, passports. So European laws don't matter, their culture is boring, their civilizations can't fall any way to the hoard of which one is the spearhead. So there's no need to assimilate, there's no need to work hard, there's no need to try to build a decent life for yourself. These Europeans are too soft to seriously punish you for transgression, their days are numbered. So essentially this theory argued that Afghans are acting as triumphant conquerors of Western civilization. And it's not just the sex crimes but there is the deliberate insidious abuse of the welfare system. So Afghan refugees, according to this article had a particular proclivity to play the system, to lie about their age, to lie about their circumstances, to pretend to be younger, to pretend to be handicapped, to pretend to belong to an ethnic minority. So they get free housing, free money and quote unquote, some of them are smug parasites leaching off the gullibility of Sweden's taxpayers. Western legal systems are meticulous and procedural. They operate on the basis of rules and rights and forms and documents and you can sit innocent until you're proven guilty. So the refugees have figured out how to leverage this to their advantage. They'll lose their documents, they'll lie, they'll assert anything and then just lean back and wait for the system to try to prove otherwise. And if they reject it, no problem, they just launch multiple appeals. So once you've set foot in Europe, it's almost impossible to get rid of you. You can literally commit murder. If a court found finds you guilty of rape, you need to only argue that if you were sent home, your conservative society will kill you for the dishonorable act. Therefore you can't be shipped out because EU law forbids extradition of doing so, puts the individual's life at risk. Murders cannot be sent back to countries that have the death penalty or a judicial system known to be harsh. So why is this current cohort of Afghan refugees making its mark as sexual predators, committing massive welfare fraud and how can they be so inept and stupid at it? So one word comes to mind is an explanation for fulfillment. So this argument says that these young men feel like losers which inspires them to become social terrorists. So the young Afghan attackers are saying, yes, we have no impulse control. Our hormones are raging. We hate ourselves and we hate the world and we will not tolerate women who are happy, confident and feel safe in public spaces. They're saying they have no intention of respecting law, custom, public opinion, local values, common decency, all of which they hate so much they're ready to put their own lives in danger. Now, middle class diaspora Afghans are of course appalled by this behavior. They're upset, but many of their actions and reactions are essentially complicity. They cover up, they make excuses for, they advise on best ways to wriggle out of consequences and even directly about the deception, the illegal acts and disgraceful manners of friends, relatives of random unknown fellow Afghans. So they wanna be loyal to their friends, their relatives and their countrymen. They then identify with Western civilization, Western notions of bureaucratic and biographical fat. So the Afghan diaspora community doesn't feel much allegiance to the Western countries that have taken them in. Now, they don't endorse rape, but they're embarrassed and they wanna make excuses for these young men's behavior. They're young, they're confused, they grew up in Iran where one learns bad behavior. So this should concern Americans because these young men, to an extent, are ours. When we go into Afghanistan and we break the country, we then become responsible. You break it, you buy it, right? So these young men grew up during the years in which America was the dominant influence and primary source of funds in Afghan society that we have spent about $2 trillion on Afghanistan. We spent billions on the Afghan school system. We like to cite that as one of our greatest accomplishment. But these young men, they attended these schools that we created, we invested millions of dollars on gender programs, on rule of law programs. We spent billions of dollars trying to teach female equality and human value and being tolerant towards gays. And we try to teach them to have regard for law and order. We funded radio programs, entire TV stations devoted to this. We launched poster campaigns. We sponsored a large number of civil society groups to disseminate these values. And now here are our graduates rampaging across Europe like the worst sort of federal beasts. So US refugee policy must have rigorous vetting to weed out such deeply disturbed degenerate young males whose willingness to be deceptive is so pronounced and whose motives are so irrational. Here's a final theory that's being shared in Austria. These destructive, crazed young men are being intentionally infiltrated into Western Europe to wreak havoc. To take away the freedom and security of women, to change patterns of behavior, to deepen the risk between liberals who defend and excuse and the right wing that calls for harsh measures and violent responses to inflict high costs and aggravation on courts and judicial systems and make a mess of things. So the left might need to do a bit of hard thinking. It's fine to be warm, fuzzy and sentimental about strangers arriving on your shores, but let's also spare some warm, fuzzy and sentimental thoughts for our own values, our own freedoms, our own life and lifestyle. Girls and women should feel safe in public spaces. They should be able to attend festivals where clothing appropriate to the weather and to their own liking. They should be able to travel on trains, go to the park, walk their dogs and live their lives without being subjected to gang rape. So the author of this article is not some right wing nationalist. It's Dr. Cheryl Bernard, Program Director of the Initiative for Middle Eastern Youth within the Rand Corporation. It's published a lot of books. And one of her books, Civil Democratic Islam was one of the books found in Osama bin Laden's library during the raid on his compound. All right, let's get back to this terrific book. Diagnosis. Therapy and Evidence. Conundrums in Modern American Medicine. So good. I have to turn off the air conditioning in here to give you this high quality oral experience. So sweating it here. Okay, so we only got major depressive disorder in 1980. It's found in the third version of the diagnostic and statistical manual of the American Psychiatric Association. So diagnosis of major depressive disorder requires five symptoms of the following nine to be present during a two week period. One of which must be either depressed mood or diminished interest or pleasure. So one, depressed mood, diminished interest or pleasure in activities. Three, weight gain or weight loss or change in appetite. Four, insomnia or excessive sleep. Five, psycho motor agitation or retardation. Six, fatigue or loss of energy. Seven, feelings of worthlessness or excessive or inappropriate guilt. Diminished ability to think or concentrate or indecisiveness, recurrent thoughts of death or suicidal ideation. So if you have five of those symptoms guys, you have major depressive disorder. Now there's no physical tests. There's no blood tests. There's no objective tests for these things. This is just based on self-reported data and we know individual self-reported data is not terribly reliable. But at least psychiatrists get to prescribe pharmacological medication in this system. Now, there's an exception. If patients are exempt from this diagnosis, if they are sad about the death of a loved one, that the sadness lasts no more than two months and is not extreme. So what if you lost your job? All right, there's no other exception. It's just the death of a loved one. But what if you got a divorce? What if you lost a civil lawsuit? What if you fell out with your best friend? What if you were ejected from your synagogue? Like any other loss, that doesn't count. There's only one loss, which is the death of a loved one. But there are plenty of other losses which are equally severe. The depression is now the most important condition in the psychiatric profession. Far more people receive a diagnosis of depression than any other mental disorder. So 40% of psychiatric outpatients receive major depressive disorder diagnosis. And since 1990, antidepressant medications in particular, selective serotonin reuptake inhibitors, SSRIs, being the most widely prescribed drugs for mental disorder. So in the 50s, 60s, and 70s, the most widely prescribed drugs were value and it's equivalent for anxiety. But hardly anyone gets diagnosed with anxiety anymore. And nation building makes women safer. And posters, posters are so important. Did you know that by 2020, the World Health Organization estimates that depression is the second leading cause of worldwide disability behind any heart disease? Depression, man, it's an epidemic of depression, bro. How do you get an epidemic of depression? You offer subjective symptoms and you can get more depression if you say, oh, you only need four of these nine, right? You're gonna have more depressed people. If you say you count as depressed, if you have four of these nine symptoms as opposed to five of nine or six of nine. So we have an epidemic of depression since 1980. But prior to 1980, hardly anyone was diagnosed with depression. I mean, we've had sadness, right? We've had sadness for thousands and thousands of years. And Freud talked about depression, says it's a result of neuroses, it's a result of things that happen in childhood. So there was no consensus though on how to either diagnose it, what causes it, and how to fix it. And this is true for virtually all psychiatric conditions. There's very little consensus on what causes the problem and how to define the problem and how to classify the problem. Thank you so much, Josh Randall, throwing down the super charts, bro. Thank you so much, get a 12er of a censure. Thank you, cheers mate. I really appreciate your generosity. Okay, so Freudian analysis dominated psychiatry until the 1970s. So that it was these unresolved neurotic impulses. So do you know the difference between neurotic and psychotic? I just looked that up today. But I wanna know the difference here. So neurotic versus psychotic. So neurosis refers to inner struggles and mental and physical disturbances. Psychosis is a immediate personality disorder marked by gross mental and emotional disturbance. So neurosis is mild mental disorder and psychosis refers to insanity or madness. So neurosis is a milder, less intense form of psychosis. So Freudians dominated the American psychiatric profession until the 1970s. Then there were these biologically minded psychiatrists at Washington University in St. Louis. And that's where a famous sex researcher was, it wasn't Kinsey, he was at Indiana. But, oh, something in Johnson, William Masters and Johnson. Yeah, they came out of Washington University as well in St. Louis. But there were just a handful of psychiatrists at Washington University in St. Louis who wanted to develop something that was easily measurable symptom-based criteria. And they scorned the Freudian approach that assumed that unconscious anxiety was at the root of our psychiatric neuroses. So this small group of biologically minded psychiatrists at Washington University essentially shaped DSM-3 and on DSM since then. So it just shows what a tiny group of people can do. So they realized that the causes of mental disorders are not known. So they said, we've got to stop focusing on etiology. Let's ignore etiology. Etiology means the causes of the reasons for a disease. They said, let's just have a focus on symptoms. And these are the symptoms that individuals report to their psychiatrist. So if you want a medication, you can just Google the symptoms that this medication treats and then you go to your doctor and you present symptoms in line with what will enable you to get the medication that you want to get. So they developed criteria for a small number of mental disorders, 15 in all, that are solely based on symptoms. So there was little consensus on how to build empirical criteria to replace the very vague definitions of depression in the DSM-2. So they completely ignored previous research on the topic of depression. So one of them said, no evidence has been offered to suggest that depression is anything more than a convenient strategy. So they allowed for a diagnosis of probable depression when four instead of five symptoms were present. And their criteria or categorical meaning you either have depression or you don't. So that's categorical rather than dimensional. So dimensional is like, let's say this is happy and this is really, really depressed. So dimensional analysis understands that we're all on this spectrum. But a categorical analysis says, look, you're either depressed or you're not depressed. It's either or. So that's categorical versus dimensional analysis. Dimension, right? Or up and down, we're all somewhere on this chart. Either closer or further in depression. But categorical says we're either depressed or we're not depressed. So they didn't worry about causes. They used a purely symptom-based analysis. So anyone who showed up with these symptoms would get the diagnosis of depression. So even bereaved people who satisfied the symptom criteria were now viewed as suffering from a depressive disorder. So they considered all depressive conditions falling under a single category. So they did not take that dimensional view of depression. They did not consider psychotic depression to be distinct from less serious forms of the condition. So you no longer got diagnoses like psychotic, unipolar depression. Like all these previous diagnoses for depression are put in the trash can with DSM-3. So prior to DSM-3 in 1979, you had psychiatrists noting that research on depression just gives us a hodgepodge of competing and overlapping systems, right? There's no physical test for virtually any mental disorder. There's no objective test meaning for any mental disorder. So I was diagnosed with narcissistic personality disorder but other psychiatrists and therapists I've had did not think I had narcissistic personality disorder. I had one therapist on and off for 10 years and did not regard me as a sex and love addict. So the DSM-3 was a revolution in psychiatric classification and we're still living in a world of DSM-3. So DSM-4 and 5 are simply continuing on the approach of DSM-3. So this document defines what counts as a mental disorder and how you get to bill for it and how you get reimbursement from insurance companies. And the DSM-3, DSM-4 and DSM-5 diagnoses of depression basically are all grounded in the criteria of these biologically based psychiatrists at Washington University in St. Louis who got together in the 1970s to decide to shake things up. So prior to 1980 there hadn't been any single paradigm that dominated the practice of psychiatry. But now DSM-3 and this symptom-based approach would dominate the profession. So why did psychiatrists rally behind this new approach? Well, they saw the DSM-3 and this new approach as solving the reliability problem that the B-devil of their profession, right? There are no objective physical tests for a psychiatric diagnosis. And so other doctors look at psychiatrists as pretty shaky with regard to being doctors or with being scientists. So psychiatrists have very little prestige generally speaking with their other doctors. They're like personal injury lawyers with other attorneys. So the new criteria would simply consider symptoms and remember which are self-reported and hence not particularly objective. And so they didn't need to rely on tricky judgments of whether or not this particular manifestation of symptoms was a natural response to a given context. So this made it easier to generate agreement whether a given patient had a depressive condition. And they didn't care about etiology, the causes of depression. So they didn't need to worry about what was causing the symptoms. So psychiatrists of all theoretical persuasions could use this new symptom-based criteria. So for the first time, the psychiatric professionals come together with one way of classifying depressive disorder. And DSM-3 then lowered the duration of the required symptoms from a month to just two weeks so that greatly modified the number of people you could classify as having major depressive disorder. Now, of course, many people who are depressed for two weeks, they're not gonna be depressed a month from then or two months from then. So many of these symptoms of major depressive disorder, they simply disappear in a few weeks. But if you can just say, hey, you've got these symptoms for two weeks, then you can classify people as having a medical diagnosis. You've got an illness, you've got major depressive disorder. Here, take these pills. So they've got all these symptoms that classify you for major depressive disorder unless you suffer the loss of the loved one. So there are all sorts of other bad things in life, loss of a job, loss of a civil lawsuit, loss of a friend that could plunge you into these symptoms. These symptoms would be a normal natural response to life, but there's only the bereavement exclusion. So prior to 1980, a major approach in the psychiatric profession was asking, do you have these depressive symptoms with cause or without cause? It's like in the Victorian era, there was the deserving poor, people who were poor for no fault of their own, and then there were the undeserving poor, those who were alcoholics and drug addicts and lazy. And then what about people who simply have a melancholy disposition? So essentially we've taken sadness in many cases and made it an illness. We made it a disease that can be treated by medication. And so I've often thought that I've suffered from dysthymia. So that's low-grade depression. So when they were assembling DSM-3, they had to deal with the traditional category of neurotic depression. So neurosis, remember that's a lower key version of psychosis. So it's just some sort of low key mental disturbance. So DSM-3 was not interested in diagnoses of neurosis, which is a Freudian approach. You're unable to resolve certain anxieties and tensions inside of you. So the biologically-based psychiatrist didn't want anything to do with neurosis. That's rooted in unconscious psychological conflicts. But the psychoanalysts bitterly contested attempts to completely abolish a concept that had been the bread and butter of their discipline for the past half century. So DSM compromised, they introduced this new category of dysthymia, right? And they made it interchangeable with the term neurotic depression. So the final wording in DSM-3 was dysthymic disorder, parenthesis or neurotic depression. So many of these medical diagnosis, psychiatric diagnoses, they come about as a way to reconcile conflicts of interest between different parts of the profession. Wow, super chat from Josh. I find it odd that my best friend was diagnosed with depression until he entered Ironman and Tough Mudder. Suddenly he was completely normal, exactly. Highly, highly, highly subjective. And I know someone who was feeling pretty crappy for most of his life because he was a lifelong vegetarian and he was only able to turn things around when he started taking beef organ supplements from ancestral supplements. So a few weeks of taking these beef organ supplements, just swallowing down beef organ supplements, he feels like a new man. Like he's got vigor, he's got strength. Like he's working out in a way he hasn't been able to work out in his entire adult life. He's doing push-ups to a degree. He's never been able to do push-ups before. He's riding his bike to a degree he's not ridden before. He's riding his bike at a speed he has not ridden before. He just feels like a completely new man and he attributes it at all to ancestral supplements, beef organ supplements. He just takes these supplements as a lifelong vegetarian. He's not able to actually ingest meat directly. So he just takes these supplements. He feels like a completely new man. Just finally getting some beef organs into him. So yeah, I think like being a vegetarian sucks. It's really stupid. It's bad for your health. Like obviously our teeth are structured in a way to eat meat. Like our body craves meat. Unfortunately, cause I'm a lifelong vegetarian. I can't get over my phobia of eating meat. I wish I could eat meat. And it's incredibly antisocial. Like people grown when they're hosting a vegetarian or they have people over for a barbecue and it's like, oh, what are we gonna do about the vegetarian? Like people generally speaking have more negative views of vegetarians than they do of homosexuals. So raising your child vegetarian is just a terrible disservice to that child's health, to their mental wellbeing, to their social wellbeing, to their happiness, to their competence at dealing with life. I wish I was not a vegetarian. Thank God that there are now supplements that you can take to try to overcome this. Okay, DSM-3, the symptom requirements as dysthymia had no resemblance to any previous use of the term. So it was kind of an amalgam of low grade but long lasting low level depression that seems much more similar to simply having a melancholy disposition. Just start cooking with grass-fed butter. That's all you need. Interesting. Well, if you should be eating beef organs and you're unable to stomach it, well, there are supplements that you can take from ancestral supplements where you can get all those beef organs that are so necessary for your wellbeing. So DSM-3 was a huge success. Why? Because it resolved the problems of psychiatric legitimacy. So in the general public and among doctors as a whole, psychiatry has not seemed terribly legitimate because there's no empirical objective physical test for these disorders. But DSM-3 gave psychiatry a sense of legitimacy and reliability and it took away the theoretical confusion and it set out these diagnostic categories on the basis of symptoms and then these diagnostic categories became taken for granted. So now we all talk, oh, that person's got depression, that person's got PTSD, that person's got anxiety or narcissistic personality disorder. We just take these for granted as though they're real things. So depression is one of those small number of diagnoses that have been continually described throughout psychiatric history. But prior to 1980, depression was not a particularly significant diagnosis. So 120 years ago, people would get diagnosed with hysteria and with nerves and with tension and with stress. And then it was anxiety. But since 1980, depression has replaced, since the 1990s, depression has replaced anxiety as the core condition experienced by typical clients of outpatient psychiatry in general medical practice. So the proportion of patients receiving diagnoses of depression has doubled from 20% in 1987% in 1987 to 40% in 97, right? Percentage of patients diagnosed as depressed went from 20% to 40% in a decade, from 1987 to 1997. And so prior to 1980, people would go to a psychiatrist and they'd primarily get prescribed things like volume. But since the 1980s, people have been primarily prescribed things like SSRIs or antidepressants. And images of depressed people were completely transformed. So during the 1960s, portrayals of depression was these old women who used to be hospitalized. But by the end of the 1990s, you got all these advertisements featuring attractive young women who are restored to exceptional health after treatment with antidepressant medications like SSRIs. So what led to the sudden emergence of depression at the top of the hierarchy, at the top of the psychiatric hierarchy and how did this all happen in the 1980s? And I really wanna tell you that, but first of all, I need to take a break. So I better find something to play you while I just take a really short break. Okay. Come on, give me, okay. Welcome to 12 Steps Spirituality. No, no, that's not, that's not my, stop it, stop it, stop it, stop it, stop it. Okay. Okay. Be back in 30 seconds. People need me to go. It's trying to find that middle page and be patient. Whether you are the fast person or the slow person, it's your path and I have no rules about that and you'll see that emerge. As we move forward over the next three or four months, different people will be at different places in the step work and that's especially true when we get to the fourth step. It is obviously in your best interest, certainly in the first three steps to stay apace with us. The way to do that is to determine what the benefit is to you. What is the value to you? When I have a benefit or a value that I have personalized rather than have it put on me from the outside, then I make time for and I make sure that I incorporate that benefit or value into my life. And sometimes we need to actually make a formal commitment in our calendar. Okay. Thank you, Hope Kang. So just because I'm saying that psychiatrists are fallible, just because I'm saying that psychiatry is subjective, just because I'm saying that psychiatrists are self-interested, just because I'm saying that psychiatrists respond to incentives, is not a damning indictment. They have, they're human just like you and me. I'm subjective. I'm fallible. I respond to incentives and I'm self-interested. So I'm not damning psychiatry by simply pointing out the fallibility, the subjectivity and the way it asserts itself to have more prestige and why it wants to sound as more scientific than it really is. Like we all have illusions and delusions of grandeur. So I'm not condemning psychiatry as a whole when I'm pointing out simply that it's fallible. Luke is getting to disassemble and reassemble an AR-15 several times until he comes back. Not exercising destroys what little is left of a person's mental health. Okay. So why did depression become the number one psychiatric diagnosis? So much of it just has to do with the DSM classification system. So prior to DSM three, you had all these conditions that were considered to be neurotic or nerves or anxiety, now they're called depression, right? So prior to 1980, there wasn't major depressive disorder and not many people were diagnosed with depression. Major factor for this change was the development of SSRIs. So tranquilizing drugs, the anti-anxiety drugs dominated the treatment of non-psychotic conditions from the 1950s until 1980s. But beginning in 1962, the FDA required that medications could only be approved, marketed and advertised for the treatment of specific disease conditions, not for general psychosocial problems like anxiety. So the dominance of the anxiety conditions at the time ensured these medications would be promoted as treatments for anxiety rather than for depression. So the specificity requirement by the FDA led to a major search for specific diseases that existing medication could treat. So they wanted to try to link disease states to places in the brain where these drugs were biologically active. So SSRIs raise levels of serotonin in the brain and so these SSRIs treat depressive and anxious conditions. Now SSRIs could have just as easily been marketed as anti-anxiety as anti-depressive medications. So why would they advertise as anti-depression rather than anti-anxiety? Well, by the 1980s, anti-anxiety medications had a bad name, right? The media was on a jihad against volume and its equivalents, right? So the media turned sharply against the use of volume and broadcast all these stories featuring the potential for addiction with volume, how it was used in suicide attempts and all the destructive consequences of using medications like volume. So anti-anxiety medication developed a really bad name thanks to this media fixation on portraying negative consequences for the use of volume. And then you had patients with the backing of organized groups of lawyers filing all these lawsuits against drug companies that manufactured tranquilizers. And government agencies attempted to restrict the use of tranquilizers. It's not easy to get a prescription for volume and government agencies adopted an openly adversarial stance toward pharmaceutical industry anti-anxiety medication. So sales of anti-anxiety drugs plunged from their peak use in 1975 and then continued to plummet all through the 1980s. So pharmaceutical companies faced a tough situation trying to sell and market anti-anxiety drugs. So by the mid-1980s, it essentially became impossible to write good news stories about anti-anxiety medication, meaning chiefly benzodiazepines like volume. At the same time, the media is embracing SSRIs. So the media condemns volume, condemns benzodiazepines, but praises to the sky SSRIs. So psychiatrists shift and instead of diagnosing people with anxiety, they're now diagnosing them with depression so that they can prescribe them SSRIs. So until the late 1980s, anti-depressant medication was mainly associated with severe depression, not common psychosocial problems treated in general medical practice around patient psychiatry. So anti-depressants were not connected in the public mind with addiction and dependencies. So SSRIs came under the market late 1980s and it made more marketing sense to promote them as anti-depressants, not as anti-anxiety agents. Then you had the publication of Peter Kramer's widely popular book, Listening to Prozac. A psychiatrist explores anti-depressant drugs and the remaking of the self. So that came out in 1993. And so now you have all these network TV shows and national news magazines and best-selling books. Now widely featuring and promoting anti-depressant medication and condemning anti-anxiety medication. So depression became the disease that the new drugs would treat. So SSRI use increased spectacularly over the 1990s growing by 1300%. So between 1996 and 2001 alone, overall spending on anti-depressants rose from 3 billion to 8 billion. So by 2003 SSRIs, Prozac, Zoloft and Paxil were among the eight most prescribed drugs of any sort. These anti-depressants were the best selling category of drugs in the United States. So the development of a treatment SSRIs shaped the nature of the illness for which the treatment was supposed to be a response. So the drug was called an anti-depressant. So therefore, depression must be the condition that was being treated. So now we've got these great anti-depression drugs and therefore all sorts of things that used to be classified as anxiety that now called depression. So between 1987 and 1997, the proportion of people getting treated for depression increased by more than three-fold, right? In just 10 years, he suddenly had more than three times as many depressed people. At the same time, people being treated for depression receiving psychiatric medication doubled from 44% to 80%. So treatment of depression was about five times as likely to involve medication in 1987 as opposed to in 1997 as opposed to 1987. And then the FDA approved direct-to-consumer DTC, direct-to-consumer drug advertisements in the late 1990s. So that enhanced the popularity of SSRIs and reinforced their links to depression. So you had all this advertising, not just to market a drug, but to reshape the potential patients' understanding and presentation of their condition to their doctor in the form of a particular DDSM disorder for which a specific drug has been licensed to market it. So people see the advertisement, they want the drug and they learn from the advertisement what symptoms they need to exhibit to get the drug. Have you taken these drugs? Yes, I've taken Zoloft, did nothing for me. I've not taken Paxil and have not taken Prozac. I have taken Viagra at work. And I'm not condemning psychiatric medication. I'm just discussing with you this wonderful book. So you had all these ads, right? So for the first time, the FDA was approving direct-to-consumer advertising and you had all these ads linking common daily problems like sadness, fatigue, sleeplessness and the like and saying, oh, you've now got a major mental illness, bro. You've got now a major medical problem and there's a solution. So these ads link common symptoms of depression from the DDSM diagnosis, sadness, fatigue, sleeplessness with common normal psychosocial situations involving problems with relationships, problems with employment, problems with achieving your goals. So essentially, normal levels of life frustration and sadness have now been classified as a medical illness for which there is medication. So there was this one famous ad for Paxil featured a woman on one side of a room and her husband and son on the other side. And then there was a list of symptoms drawn from the major depressive diagnosis from the DDSM separating the two sides. So the ad was saying that the symptoms of depression of the cause rather than the result of the family's problems. So SSRIs were presented as a solution to family work and motivational problems. So all these ads direct to the consumer changed the conditions that the general medical sector treated from anxiety to depression. So anxiety, very common diagnosis, but now since the 1980s, increasingly less common, depression has replaced anxiety. So you also now have all sorts of people going to the doctor to get pills for these normal life problems, normal problems of family, work, fulfillment, happiness. So people see the ads, they watch TV, they see the ads, say, ah, I need that drug, right? I'm feeling a little frustrated, a little sad. So it used to be that people seeking help for emotional disorders, they only accounted about one third of medical patients that increased to one half during the 1990s, from one third to one half during the 1990s. And these conditions are now considered depression, not anxiety. So depression has now been called the central problem of the modern age. Now, prior to 1980, rates of depression were rarely studied, but now it's widely studied and the symptoms are so vague that about 80% of the American population can be diagnosed as depressed, which then makes them potential customers for your medication. So the WHO projected by 2020, depression would be the second leading cause of worldwide disability behind early heart disease and depression is the single leading cause of disability for people in midlife and for women of all ages. So how did the psychiatric profession react to this news? Satisfaction, the discipline was now the second most important in medicine after cardiology. So they've got to increase their stature, increase their earning opportunities, increase their authority by saying that depression is this worldwide huge problem. Now, if you had the emergence of any comparable epidemic like the epidemic of depression would have led to serious questioning of what the hell is going on, but there was no such questioning in the case of depression. Now, the WHO, the World Health Organization solidified the appearance of we're in a dire social situation because of all this widespread depression. So NIMH, National Institute of Mental Health, NIMH. So since the 1980s, the NIMH has promoted depression as the mental disorder. So they've been pushing that depression is really prevalent and it has terrible consequences. And they are promoting that we have this major depression threat to public health. So the National Institute of Mental Health is the major sponsor of research about depression because the more people have depression, the more power and authority and funding that this institution can get. And they have promoted all these widespread public education campaigns with the aim of raising awareness, raising public consciousness about this condition and promoting professional help-seeking among untreated people with ordinary life problems that can now be caused a major medical illness. So the National Institute of Mental Health became heavily invested in promoting the benefits of pharmacological treatments for this grave disorder. So National Institute of Mental Health is the most credible, respected, prestigious source of information about mental disorders. It has enormous cultural capital. It's been a leading force in changing public discourse about the nature of mental illness. And this symptom-based criteria from the DSM-3 onward generated these huge estimates of the extent of the population that suffers from major depression. These estimates of much of the population suffering from major depressive disorder, then allows the National Institute of Mental Health to expand its mandate, to make claims that mental illness is rampant in the population and they get to protect and to expand their budget. So they create these ubiquitous depressive disease states and it's a win-win for them. So they used to be concerned with poverty and discrimination and racism, but you're gonna get far more political support for your agency if you're preventing and curing a widespread disease rather than one that confronts controversial social problems. So consequences of chronic states of social deprivation and life stress are now viewed as diseases that require pharmacological intervention. So all these interprofessional, economic, political and cultural reasons all coalesced to make depression the central diagnosis to emerge from the DSM-3 revolution. Luke, can you see a new specialized branch of mental health dedicated to some sort of COVID specific trauma depression? Sure, I'm sure there's prestige and money to be made from it. So prior to 1980, there was a major controversy within the psychiatric profession about whether depression was categorical or continuous. So categorical means you either have it or you don't or continuous, it refers to a degree. We all have sadness. To what extent are we disabled by sadness? So the DSM-3 arbitrarily resolved this controversy required that a diagnosis of major depressive disorder required at least five symptoms and people who had four or fewer symptoms, they would not meet this diagnosis. But then a lot of psychiatrists realized, hey, there are people with three symptoms or two symptoms or even one symptom. These are proto-depressed people. We better get in there and treat the disease early. So just like I get from my doctor every year, I get a test in the mail. They want a little bit of my fecal matter to determine if I've got bowel cancer, right? Like early detection, right? That's what the medical profession is talking about, early detection of bowel cancer and breast cancer. Well, there's not much empirical evidence that this is doing any good. Fact is it creates a lot of problems with false diagnoses and over-treatment. But it's the conventional reigning wisdom. So we're doing a lot of this early prevention stuff. And this is how psychiatrists are looking at people with just like one symptom of sadness. It's like, oh bro, you're on your way to major depressive disorder. Now obviously having four or five symptoms in this nine-symptom list is not a major difference. So these DSM diagnostic conventions are arbitrary. They don't reflect any natural discontinuity in depressive symptoms. So we've got a continuous nature of depression that's created a movement to establish considerably lower cup points than those of the MDD, a major depressive disorder diagnosis. And the result of that is a tremendous expansion of depressive disorder. If you even have one or two or three or four symptoms, now you're on your road to major depressive disorder. So using this way of thinking, the best known community study found that only 20% of the population of Midtown Manhattan was well, meaning symptom-free, not depressed. Only 20% of Midtown Manhattan are free of depression from this way of thinking. So the arbitrary nature of the major depressive disorder diagnosis led to a flood of studies about minor or sub-threshold conditions that have fewer than five symptoms of depression. So the DSM definition of depression is symptom-based. And so the sub-threshold movement gets to pathologize a whole bunch of extremely ordinary behavior like a little bit of sadness or problem sleeping. So the most common depressive symptoms, trouble falling asleep, trouble staying asleep, waking up early, being tired all the time and thinking about death. So people who worry about an important event, people who must work overtime, or people simply taking these surveys around the death of some famous person are much more likely to experience these symptoms and therefore they're medically ill and need pharmaceutical intervention. So there's no context in these DSM diagnoses. You're gonna respond to these diagnoses very differently if you've just broken up with a girlfriend, you've just lost a lawsuit or you've just been the victim of some financial scam or something's gone wrong in your life. So sadness has become medicalized as pathology as an illness that needs pharmacological intervention. So there's no clear separation between natural sadness and depressive disorder. And most symptoms of depression that we experience are transitory. They disappear in a few weeks, but the more people who have this illness, the more funding they can get, the more prestige they can get at addressing this major social health problem and the more prestige of money they can get. And so people like prestige and people like money. So we've now pathologized, I mean diagnosed as ill, a huge segment of the population. We've extended mental health services to many non-disorder people who simply have ordinary sadness and ordinary problems of living and we're not directing treatment resources to people with serious mental health disorders. So by pathologizing minor depression, we're wasting resources and not helping people. So the mental health field has coalesced around the DSM and the DSM-3 and onward with its major depressive disorder has become firmly institutionalized in mental health practice because it's explicit, it's clear, it has ease of measurement. So it's become the standard for diagnoses research and treatment. It has become the common language for discussion of depression not only in the United States, but worldwide. So it appears as if DSM-3 definition has solved the perennial problems of defining and classifying depression, but this appearance is deceptive. So under the surface lies a host of unanswered questions. So for millennia, doctors would try to separate depression disorders from ordinary sadness. So it was feeling sad for no reason and feeling sad for good reason. But the DSM-3 has blurred this distinction. So symptom-based criteria considers all depressive emotions, essentially as signs of mental illness. And then by requiring fewer symptoms, you greatly expand the range of conditions that can be treated as pathological, meaning ill. Pathological means ill. So we've had a vast expansion of people who have a major depressive disorder according to this way of thinking. So essentially half the population could qualify for major depressive disorder. So how useful is it? So we get these unrealistic estimates of rates of depression resulting from a definition that does not distinguish natural unhappiness from mental illness. And then what about people who simply have a melancholy disposition? So there are no discrete empirical differences between someone with four of the symptoms and five of the symptoms. But you get five of the symptoms and you're diagnosed with major depressive disorder. And how these depressive disorders relate to depressive temperaments remains uncertain. So the dysthymia category in DSM-3 was a political compromise with the psychoanalyst. But it provides no guidance on how to distinguish long-term but low-grade depressive disorders from those with simply a melancholy natural personality disposition. So the DSM created a professional consensus among mental health professionals about what is depression, but it hasn't resolved any of the issues of classification that have surrounded depression throughout history. Whether depression is continuous or categorical, meaning either raw or varying degrees of intensity. What is the relationship of depression to a melancholy personality? How can depression as mental illness be distinguished from natural sadness? So an accurate classification of depression remains as elusive as ever. The depressive disorders have none of the characteristics of diseases. They remain without well-defined phenotypes. So you're saying 40, what is a phenotype? So a phenotype is a set of observable characteristics of an individual resulting from the interaction of its genotype with the environment. So major depressive disorder has none of the characteristics of disease. There are no well-defined phenotypes. There are no identifiable etiological factors, meaning cause. There's no predictable course of progression and there's no prediction for a response to any particular type of treatment. There's no biological marker. There's no objectivity. There's no gene. It is helpful for making a diagnosis of major depression or that predicts a response to any specific treatment. So this diagnosis emerged because of social and political pressures facing psychiatry during the 1970s as opposed to something that is objectively real. And then we can talk about post-traumatic stress disorder. Is post-traumatic stress disorder, is that the result of abnormal situation? Or is that the result of abnormal individuals? So the basic tenet of PTSD is that some traumatic event in the external environment outside of you can lead to lasting psychopathological consequences in previously normal people. Well, this does not easily fit into psychiatry's traditional focus on the biological or psychological roots of mental illness, right? So psychiatry is focused on either coming out with biological or psychological roots for mental illness, but PTSD says that there are external environmental causes that lead to mental illness. So you have psychiatric explanations that at different times emphasize social, moral, lifestyle factors that can influence who becomes mentally ill, but generally these environmental forces that lead to mental disorder only lead to mental disorder in already disposed individuals. But the view of trauma found in the PTSD diagnosis considers external events as necessary and often a sufficient cause for mental illness, which is completely different from how psychiatry normally operates. Yes, phenotype is an outward manifestation, genotype is the genetics. So outside of PTSD, psychiatry does not focus on social and external and environmental causes for mental illness. So PTSD is completely different from how psychiatry normally works. So PTSD focuses attention on how exposure to trauma can itself cause mental illness. Now you think that would threaten the profession's core assumption that it's internal vulnerability that leads to pathology. So the environmental focus, the social and world focus of the PTSD diagnosis completely challenges psychiatry's usual therapeutic focus on changing disordered brains. So psychiatry faces an impossible task integrating PTSD into the paradigms that have guided the profession since its inception in the 19th century. Bye-bye.