>> good evening everyone and welcome. thank you all very much for coming. on behalf of warwick's i want to thank you for your support. just an aside last year were rick celebrated 125 years is the oldest continuously family-owned bookstore in the united states so thankin you very much. hopefully next year wewe will he our 126 the year. this evening warwick's is pleased to welcome andrew scull who will discuss his newest book "desperate remedies" psychiatry's turbulent quest to cure mental illness and he will be in conversation with dr. david lehman. andrew scull received his b.a. from oxford university and his

ph.d. from princeton university and is currently distinguished professor of sociologyhe at meredith at the university of california san diego. in 2015 he received the report or medal for lifetime contribution to the history of medicine and in 2016 the air carlson award for lifetime contributions to the history of psychiatry. his previous books include madness and civilization, hysteria, the disturbing history and madhouse, a tragic tale of bedlam, mania and modern medicine but he is contributed toic many documentaries including the pbs series mysteries of mental illness and also below bottom is.

andrew scull does blogs for psychology today and met an american he has written for the atlantic, scientific american, the paris review, "the wall street journal" and the nation among many others. dr. david lehman received his medical degree from washingtonee university st. louis medical school and completed his psychiatry residency at university of california san diego. he is currently chief of cognitive disorders clinic at the va medical center in san diego as well as the medical director of the inpatient unit. dr. lehman is heavily involved in education at the university of california san diego medical school and the residency training program and he is the

recipient of teaching affords in both departments. in addition is the associate director for the third year medical student psychiatry clerkship and the coordinator of the fourth-year medical student psychiatry sub internship. please give a very warm autumn to andrew scull with david lehman. [applause] >> thank you very much for that introduction. it's a real pleasure to be here. i hadn't realized that warwick's was quite that ancient and that's a remarkable comp which meant and i'm so pleased that we have a bookstore of this quality in our community. so i'm very pleased to be with you tonight. the book that i just completed i actually envisioned if you can

believe it in the early 1980s. it would have been a very different book had i published itn back down. i had my early part of my career first of all looking and the emergence of psychiatry and the rights of the asylums in england and before i publishan that book i tired of it because it was my doctoral thesis when i went around talking to those people they asked me what about the shutting down of the asylums and will do you think that's a good thing and why is it happening? and i said i didn't live in a 19th century, i don't know. i knew how much money and intellectual capitol was invested in the idea that the mental hospital was the solution to mental illness. anyway i thought that would be an interesting topic and one

more continuing for mike colleagues. so i wrote a book on deinstitutionalization very early in the mid-70s when it was still being hailed as grand reform and my book suggested perhaps all was not quite what it seemed. in many ways like to thank a prescient book anticipated what we lived with -- live with today and the abandonment of people with serious mental almost and the great problems that has resulted in. later on i moved into the 18th century and they did books that spanned vast areas and i started to work on the 20th century and the period i was initially working on was the 1920s and 30s which was the period of

extraordinary therapeutic experimentation and psychiatry. mental patients were locked away in their voices were stifled and anything they have to say was a product of their mental illness. that meant given the desperation of the times they were very vulnerable and the option was a series of interventions some of which i talk about in this book. psychiatry's turbulent quest to cure mental illness occurred to me in 1981. as time went on i wrote many other books and went back and forth. i always had this project in the back of my head. finally i said to myself i have to write these things.

i wanted to put american psychiatryri and a long historil context. where did it come from and how did it come to be? how did the above in 19th century and the initial utopian hopes that wee could cure mentl illness began to subside into a climate of hopelessness and the period presented a 19th century where psychiatrist in the culture at large dismissed people as degenerate and people who had suffered evolution in rivers were no longer fully human and needed to w be locked away so they would more of their kind. that was the state at the end of the 19th century a heavy biological account of mental illness but one imbued with a sense of hope in what would you do? one ofof the things we did and when i say we california was the

leader in the united states as we started involuntarily sterilizing the mentally ill. california didn't stop doing that until about 1960. it is a very long history and that legislation with was the model for the in germany and they a sterilization lacking the restraint of our political system. they exterminated en masse and then they decided that these people were as they called them so they killed them. the final solution was first started on mental patients he was there that the technology of the gas chamber was developed. quartere million patients were killed with the active participation of the leading german psychiatrist and that was one possible response to this.

in other respects psychiatrists who weren't satisfied with just being boarding housekeepers running an asylum and keeping the population under wraps they wanted to be healers. they looked for various ways to intervene and unfortunately that some pretty results. and at this point i will point i was will shut up for a few minutes and let david who i know has read the book talk about those middle chapters right talk about that experimentation as i call it. >> first of all let me thank you for inviting me. you have been training me since i was a resident in psychiatry and probably more than anyone else introduced me to the

unpalatable nature of the history of psychiatry. and that unpalatable history really has had a dramatic and in the end very positive effect on my psychiatric career and i would thinkrr it's sad and perhs amiss if a resident were to graduate from a psychiatry program and really not be familiar with these warnings that you do so well in reporting on the history of psychiatry. >> i think one of the things that's very important to understand there was a strain in my disciplines and among some renegade psychiatrist in the

1960s to dismiss mental illness, to claim it was a myth were to claim it was a matter of social label and that's never been my point of view. i understand how deeply distressing and disturbing and disruptive mental illnesses in people's lives. i've seen a close-up with closest friends one of them committed suicide after depression. i'm not in any sense anti-psychiatry. i'm very much somebody who thinks we need to face up straightforwardly to the truth of what we can and cannot do what we understand of what we don't understand the limitations and the kinds of things that we ought to be doing and are not. while the book is heavily critical inay many ways of psychiatry it's not meant to be and the critics have responded

to it so far has not seen it as an attack on the field. more of an attempt to analyze ways in which it's gone wrong, ways in which it has made limited progress in the last 60 or 70 years with the limits of that and the ways in whichan i think and the national institute of mental health has been captured by the very monochromatic view of mental illness. so we concentrate on genetics and we concentrate on neuroscience and the upshot of that for patients who are actually sick has been basically nothing. you think that's me speaking as an outsider so i will just say thomas and full saran inh when he stepped down said well you know over the last period i've

a lot of money, about $20 billion he said we funded some really cool neuroscience and some really cool genetics and the payoff for patient has been zero. actually he was being too kind. if you look at people with serious mental illness as some of the audience will know the life expectancy of those people is 15 to 25 years less than the rest of us and that gap is growing. that's not purely psychiatry's fault but the result of publicic policy. it is a sobering reminder that we have a very long way to go. >> i thought a lot about his comments. and the way i think about it is

psychiatry is concerned with the mind. the mind is an obstruction of the brain and the brain is by far the most complex organ in the body. the question psychiatry asks are vastly orders of magnitude more difficult than other branches of medicine. what is consciousness is among the most difficult questions that scientists ever posed and so i don't think it should be a surprise that psychiatry has not come up with many answers very quickly. it will take time. as you point out in the book in the 1990s there was some exuberance, the decade when they made all kinds of promises that have not yet been delivered. but from my perspective what i would say to thomasi in full asi see no reason why science given

the time cannot address these very difficult questions in psychiatryth the same way that it's addressed in other branches of medicine. it's not going to happen in the i next decade but i don't see why it cannot happen. >> i guess what i would add david it seems to me the distinction is often made between the biological and the social in this wholele dichotom. our brains are for years and decades after we are born they hentare the joint product of the brain we are born within the brain that develops and patents are developed within the brain are caught up within the cultural and social environment in which the t brain matures ana person matures. one of the problems i have and i'm not trying to say there should not be narrow scientific

research and there should not be research into genetics although so far that has proven to bet a dead-end what i would like to see his research as well that deals with the other dimensions of mental illness and is a clinician you were only too well aware of that. we need research on how best to give families some relief. we need research on how we provide suitable housing and social support for people with serious illness. and we have that for two decades now. stenga yeah but i think that it seems biological psychiatry was the way to go and you mention in your book of the rockefellertr institute really struggled with this question. what should they find given all this money to research and who o

should they trust in terms of recommendation and there were so many advances that weree happening so quickly with medical technology at the time that seemed reasonable to place a bet on the exciting stuff rather than the less fun and exciting questions of how you house people and how you address loneliness and how you minimize the suffering associated with the human condition. >> i would agree. what many people may not realize and that's why it's important i think to have a historical perspective is that before the second world war there was essentially no federal involvement in mental illness other than running one mental hospital in washington d.c. without federal funding or medical resource let alone psychiatric research in the major actor in and filling that gapar was in fact the rockefeller

foundation which made the rather brave and unorthodox decision in the early 1930s that was going to fund psychiatry the least developed part of medicine and the one that they thought could make the most difference in the dead spread its net quite widely. some of the directions and which it seem reasonable and others in the light of later development seemed rather problematic. for example rockefeller founded, funded the german psychiatrists and continue to do so up to the outbreak of world war ii. and was heavily involved. on the other hand rockefeller also provided funds to rescue many cycle analysts who were jewish from the and bring them to america and that proved to be

a very difficult exercise. at about double the number of cycle analysts here and it was one of the preconditions for something that happened in america after the war which had really no counterpart that i'm aware of other than the merchants and the dominance for a period of a quarter-century of psychoanalysis in american psychiatry. understand in 1950 there were a half million people in america's mental hospitals and that continued to grow for another 45 years. those psychiatrist obviously could didn't practice psychoanalysis and that environment the drug revolution emerged sort of behind psychoanalyzing. .. basis, that was

heavily psychoanalytic. and that was not just a matter of the profession. the whole of american culture, especially high culture, but also popular culture, was saturated with psychoanalytic ideas. freud was seen as the equivalent of darwin. >> we sort of race is a smile these days but intellectual things, all disciplines, humanities and social conscious particular flock to 40 ideas and the movie, spellbound, when of alfred hitchcock's films and i think 1948, you will see that is propaganda, psychiatry so there is that into random where peoplesoft meeting and that madness they try to understand it a psychological level. they try to treated with some

american analyst so far as to say but they could treat schizophrenia with cycle knowledges which 40 himself had not thought possible. so other than washington saying look at, other than that virtually every other department was headed by somebody either a psychoanalyst were sympathetic to it in the best recruits the profession, went away this with the reports were ms patients invasions when money and also more interesting on the backwards and so is curious in a way that the thing the market real revolution and psychiatry emerged not there and not inth universities the mental hospitals which is where the

drugs the antipsychotic in particular, is copycat drugs, first emerge and what happened, for many years is like a building this meeting in a way by termites of the structure look solid the psychoanalyst we were in the settle and then with remarkable rapidity, the shifted we can dated almost precisely 1980, and fueled by problems that emerged about psychiatric diagnosis and the factst that psychiatrist could not great with what was wrong any given case and there was a sustained effort to create diagnostic system that at least was reliable which meant, this doctor here in this doctor there that it would produce the same diagnosis and it was an approach

that was a theoretical by's nature but in fact, underneath that was fueled by hostility to psychoanalysis and it helped into the profession and i think that's a complicated question and so psychiatrist of the generation who trained in the 60s, were all encountering the psychological ideas think david could. amy: that. >> if you that i had anything to do about it with this, let you know, that i had criticized about psychoanalytic psychiatry, what is important to recognize that what ever the flaws in the doctrine and or ideas and whatever the flaws in the rigidity that were produced in so many practitioners would you bring out, that in many ways,

they sowed the seeds of their own demise through their rigidity. but they were and they are the humanists in the story. and rather than re- correcting redirecting some of the rigidity in the psychoanalyst bosley ended up throwing the baby out with the bathwater and also the site i entered dynamics i can't psychiatry with biological psychiatry. indicated previously, there would be a dead-end as of our biological is only part of the absurd. needs to be recognized and is not always recognized. >> that's something i absolutely concur with my of my own quarrels with her rigidity it

with freudian but, listening to the patients and giving the patient's a voice is in this role he lost now was very interesting there was a study done in the 60s what patents psychiatric practice was like at the time and outside the institution the average length of time the 70s meant when they went to consult a psychiatrist was between 45 minutes and one hour, almost a difficult psychoanalytic a 55 minute in and out, and so meant there was a lot exploration into or where iss now, partly because of the pressures of the insurance companies importantly the needs clip psychiatry is not the best paid medical specialties and sorta become a pill mill and you the psychiatrist for ten minutes and

maybe different but a lot of research has suggested that is real decline on the professions part of delivering psychotherapy as well as the cycle - when they have come to turn with us and indeed one of the stories in this book is the emergence of other professions in the psychological and many patients with other kinds of disordersit end up with clinical psychologist and psychological social workers getting some of the psychotherapy that they don't get to go to cedar indy. md. >> these are economic forces

that are drivingng this rather than theoretical courses and rather than ideas about what is possibly the best way to treat mental illness. so in my mind, i separate out the mistakes made for theoretical science and other reasons from just the sheer marketet forces that every industry is going to respond to producing either favorable or unfavorable results because of thosee incentives. >> one of the things that happens when the mental hospitals impede out, is there had been it was mixed is my history shows, the event long tradition mental illness unlike physical illness, in this country. the estate responsibility being something that was funded publicly was a very strong

public psychiatric going to the profession. it wasbl a blue braided really n it was not the profession did not protest i would say or in some did but not enough protested about what was happening it was not the produce psychiatrist deciding that this was the way forward coming really was on the that you were talking about unconscious public policy choices, pressures from the insuranceom industry, the availability of the technology in the form of the drugs that looks like conventional medicine and to be dispensed pretty quickly and the insurance company were not willing to pay decently to the other kinds of cares and they still aren't. >> yes unfortunately, that is the place that we find ourselves and right now.

i think that one has to recognize if you are going to promote improved treatment for the severely mentally oh, you're going to have to recognize it is phenomenally expensive and i think that your book comments that that when the asylums were opening, the single biggest line item on the budgets of most states and that is jaw dropping and that was crappy care, that was snake for care so you can imagine the cost that would be involved in providing beautiful state-of-the-artar care the severely mentally ill and it brings of the very difficult question that most people do not want to look in the face which is, should the people with the

severe mental illness, or marginalize, and do notot vote, get the majority of the resources thatrc otherwise going to people withes mental illness but not asylum level mental illness. >> i think that's right and i think that one of the other things that i would say, confined to the history that i review here for h the last 200 years or so, that it extends much while of all recorded history i am aware of that mental illness is something that ist constantly associated with stigma and fear and rejection and so, this is a population of stephen said they don't outcome up so this is the are not going to be responsive to them. but much of the problems are kind of hidden away.

i think that one of the things that i saw in the years, a lot of the burden originally phone families will they were still intact and vertically on the women are often pulled out of the workforce to care for full-time for the patient. eventually, families crumble very oftenof noted that, it's jt too much and you know those families reluctant to make a lot of noise the reason for that is obviously didn't want people to know that in the domestic bliss, actually was something else happening. it is amazing how when you become aware of this problem, sometimes people will open up and you realize what they been going through the breaks down in

effect, the welfare reform is worsen the situation for the mental patience is hard for a harder for them to get help save have not replaced monies thatys used to use with wells fargo must been on the mental health in new york state in 1950, was b30 percent of the state budget was a state hospital, an extraordinary number and so when i see as a result, we see the worst of it living here in california where the weather your downtown san francisco, la, san diego, the problem of homelessness which is not only a problem mental illness is a subset an important subset of what is in fact people with serious psychiatric problems who just cycle from god to the jail with an occasional stop off in the psychiatrist office to get a

prescription back into the cycle all oregon is a dismal part of life in a country as rich as ours. >> i would suspect that you and i differ politically on this issue. when i read the book, one of the things that jumps out at me is how many off the devastatingly bad ideas promoted by progressive ideas so much of psychiatry involved in scrupulous people more of it, was well meaning people who did usually in school is think of a jaw-dropping in the name of the unjustified reason they were so enamored with her do good -ism, their ideas that they lost the

boundaries of western civilization and i think that eugenics courses as an example that and so i do worry quite a bit that the idea that we just sit down and come up with yet another program, to help the severely mentally ill and spent a lot of money on it, that will then be the panacea i am adults i see these patients in the emergency room basis and i know thatie the solution this would e much more difficult and subtle and challenging than convincing the state of california to spend more money. >> i don't disagree at all david actually, i mean, one of the great messages i think of the book is psychiatry, the

hippocratic injunction first do no harm cover that jumping into enthusiasm and refusing to see the evidence that is contrary to one's enthusiasm in seeking thinking that you have a magic wand that will solve the problem come that strategically happen over the last 200 years and the results have almost been uniformly disastrous and indeed some of these people were perhaps while many of them were absolutely sincere in their belief that they had discovered the royal road to intervening. one of the figures in this ♪ ♪ also in my book that has come as a gentleman named henry around the new jersey sales ottoman trenton for, from about 191908 until he dies a lead

1933, encarta decided that it was an idea that he may well have picked up from another who arguably major figure at the tie mental illness was a result of infections. looking the body they were poisoning the rain and pre- antibiotic order, the only solution to that was to surgically eliminate them so you started the first targets were a lot of people of rotten teeth. and tonsillectomy's but when people don't get better, instead of thinking, perhaps i'm on the wrong tracker, sourcing, will they have to be other areas of infection in the body and encarta and starts eliminating stomachs and spleens and colons and uterus assist, another pattern that reoccurs again and

again were the extremist that work women were disproportionally targeted for some reason i can talk about some of thetr reason but trust , about 70 percent of the patients were female operated on wednesday that was sincere, he decided any teeth or potential menace we had his wife teeth in his children's teeth prophylactically removed and one of his sons seem to be masturbating he removed his part of his. when he felt mentally ill under the pressures, human off to arkansas and had his own teeth pulled so he believed what he was doing, what he was doing was an absolute travesty. unit was not unique it to him to be was praised when he went to london in 1937, and psychiatry

in the equivalence of as introducing antiseptic surgery and that by the most prominent figures,fi felt that they were sincere walter freeman was sincere, he was a moral monster in my eyes. absolutely, he lobotomized kids as young as four pretty and he busted the braind to tolerate more damage than adults. and actually when i took part in the pbs documentary, i think you can still see it on my call the lobotomized which is about his career, pathetic in my view to freeman but nonetheless, two of his children took part but so did one of his last lobotomy patients amending our dolly, it was lobotomized since 11, after his parents marriage broke up at his new stepmother decided that he was acting out too much and he needed to have his brain

operatedra on. so there's a lot of sincerity but sincerity does not cut it in my book. and yes,ok they often lean of te asylum experiment when it was launched it, it was small this into an intimate's effusions and i do think the early years, they did a lot of good and they had charismatic figures that h they had in the dedicated staff but to try to do that on a routine basis, with the hordes of patients who did into the state hospital score that just was not possible as i don't think we are that far apart. >> you know, it's weird to note the two of the nobel prizes given out and psychiatry were given out to really horrific treatments. it was - governor bill price rejecting mentally oh patients

with likely general paresis of the insane with malaria and yes malaria, to use as a treatment for see if syphilis and then of course, the great portuguese nero's shirt under surgeon of the prize for the invention the frontal lobotomy. >> i should add that that was 14 years after the first lobotomy someone might have thought that these times were accumulating enough contrary evidence within but no, the really was not into the 50s, the operation continued in some instances even into the 60s, there were a couple of in england and yale as well. in the other thing to bear in mind as they were not necessarily patients visited on

the poorest we often think will please fermentation would've taken place on the most vulnerable in the poorest of the lot but inn fact, this most famous case of a botched lobotomy's if they were all a about just as far as i'm concerned, one of the worst outcomes was john kennedy's sister which her father had her lobotomized in the early 1940s. she barely walk and she was incontinent and she had to be trained to speak again it she walked wainer kennedy family kept her out of sight and mind and i don't think they ever visited. so again the earliest lobotomy patients were all outpatient there were with money that came because they heard about this miracle cure. they volunteered for you to do

and living in connecticut was and probably still is a prominent psychiatric facility was the first mental hospital to build a special surgical suite to perform lobotomy's. the planes, which is probably still the most extensive psychiatric hospital in the country also lobotomized substantial number of patients particularly women. sooner the narrative, is very complicated. i think mental illness brings with it a great deal of auditability, enormous amount ou suffering. and is oneri of my fellow historians that was most solitary reflections in the most social of now this was mentally a person is often very solitary nightmare place to be in for everybody around them come is profoundly disruptive it is

serving and threatening and all that. >> like to highlight the word desperate in the title of your book and this is no march 2 doctor steve who is a narrative psychiatrist in san diego who is trained hundreds and hundreds of psychiatrists over his career and what is so purported to learn and psychiatric training is the experience off desperatin that you have coming up patients that are suffering in the most horrible ways, some of them are violent and when we have one violent patient on our 30 bed inpatient psychiatric unit, that is very destructive and i think about asylums, and hundreds of violencepa destructive patients with no thorazine, there was

what what could you do and it is very scary to go to work and being afraid that you might be assaulted, that is very real. that is not an excuse in any way, for putting in i speak and 70s brain. but unfortunately, it helps me understand how people got such a desperate place and what the doctor has taught me, is that many feel that desperation, the part of your brain should be turning on, saying, i know what happens next and whatever think imported next i'm going to observe maybe get a second opinion and spend time thinking about this before i would often try to save the world. >> i think that is very right in precisely the desperation which is the desperation itselfti by e patient by the family and by the

therapist to do something that sometimes it's worse than not doing anything at all and thus the history we see again and again is the desperation that makes up possible for people to conceive the right idea to come down on hold persuades families and patients to accompany him down the rabbit hole so the title to have multiple meetings if not just again, it is hard to avoid despair when is writing the book, my editor kept saying can you say more positive things. >> this is so depressing your cconclusion and the drugs are better than not having the drugs

but the drug for some people probably create - causes illness better worse than the disease they're treating. as i look at this i see patients falling into three groups, part of the problem, forgive me for suggesting it is that we do not know in advance when the patient presents i shouldn't say we, they know in advance that i don't like to pretend. they do not know which group 70s going to fall into for some of patients on antidepressants and antipsychotics make a radical difference in positive direction they transform somebody was raving when somebody who's hallucinating and delusional, they given that down the make possible some contact with with

the rest of us like to call reality. and then there's group of patients in the middle, that there is no free lunch and there's always side effects and things that we do not want to come with the things that we do with psychiatric medications of the side effects are often very severe and sometimes lifelong winter contracted them to visit with the middle group of patients, you're trying to way because they're experiencing the side effects more thanor the fit group in the way the benefits of the drug perhaps another group of patients, who just do not respond and who will forget anything public at the side effects that's not quite what we were supposed to be about the dimensions of this problem ares really very great, and in 2005,

the research on the drugs being funded by the drug companies and unfortunately, deeply contaminated by that it looks like evidence-based evidence and buys medicine could suppress the data they don't like but in 2005, there was a very large study club kitty, which appeared new england journal of medicine led by jeffrey lieberman who recently was forced to step out as a chair this columbia psychiatry department after he made some rather unfortunate public remarks but with a study showed is that it looked out and original antipsychotic, when is the first generation from the 50s and three so-called atypical modernn drugs, and he said is the old drug inferior to the current to drug and how well doru these work. any answers on both fronts were not very reassuring.

then the new drugs did not perform better than the old drugs and the cost a lot more money because they were patented but they were not to better come they hadth a different side efft profile but it was equally a serious one the other thing that i found striking ring study, depending on which drug comes in four of them in the trial, between 67 and 82 percent of the patients, dropped out either because the druged wasn't workig because they cannot stand theec side effects. so we don't have psychiatric medicine, we have pills that help some people and if god for bid,if and relative who needed psychiatric care, i would not stand in the way of a trial a careful trial drug treatment bud it would be very aware that the odds were mixed about whether it was going to work in that particular case and i would be delighted if it did. but not surprised if it didn't.

... big pro forma. i don't know if it is unexpected given this discussion, but i would be so sad to think of a career in psychiatry without the benefits of modern chemistry that the pharmaceutical companies have provided. lord knows they have been naughty at times in their marketing styles, brushing things under the rug. it's true. big pharma big pharma has really provided release for so many. and i am so thankful for that. x on the other hand i agree with that. it's very important to

understand. many ways can be tied this people working by no means. farmer has pulled out. no longer looking for new drugs. it took a reputation of the knot is that david was talking about and described in the book. they could not see to make a profit. there is no obvious new avenue to explore psychedelic treatments, advocating for deep brain stimulation toe depressi. we know where depression resides

in the brain. we don't. the companies 60 years were heavily involved research on formal logical treatments for mental illness have gone away. they have found other areas that are more profitable. at leastic it might be if we had public funding of that kind of research. that's another facet of our contemporary situation just like the scientologists dismisses psychiatric medication as

poisons. can't see that as a positive development.st >> should be take questions? i would love to respond. >> you talked about the issue of the homeless and the mentally ill. evaluate running from into anything you can think of the ohmic reference to but i wish to solve the problems of the homeless. can you share your thoughts what possibly might be effective?n

well, and simply throwing money out it is not going to resolve it. san francisco sends spends $35000 per head for anyone spends time in that city as i do realizing they're not getting much value for their money. it is a mess. one of the issues and it's when we have sort of skirted around, back inop the days of the old mental hospital most people got into a mental hospital forcibly so to speak. they were certified as insane and if necessary the cops showed up and tookk them.t so there is compulsion and they could not leave even if they wanted too. is that whole situation is very tricky and it is one of those political minefields newsom has

some new ideas about this, which potentially involve some degree of compulsion and civil libertarians up in arms about that. and i get that having seen what it was like when people work shut up in both senses of the term, it is a very dangerous situation. on the other hand many of those people are very resistant to getting treatment. the texture of life in our cities is being undermined by their presence. and so think politicians are responding to the fact, when it wrote my first book about institutionalization i said these people were largely being returned to ihe the poorest most deprived areas of the cities.

this had no political voice numbers have multiplied they are everywhere. we used to be wheat respectable folks used to shut our eyes to what's going on unless you're in the biz. and nowen it is inescapable and provoking a backlash even in cities that think of themselves as progressives like san francisco. and i think san francisco's politics, oh my goodness do not get mee started. that city is in a really strange place. i do not know, do you have anything to add onto that davids what's my perspective is psychiatrists are not the people to solve the housing problem. i think economist would be a much better place toch start.

and so many mental health practitioners who weigh in on this question have absolutely no training in economics. which to me seems bordering on fraudulent. milton freedman had a lot to sap on the issues of supply and demand. if you do not have enough supply and how to address it. and may be a way to start would be to look at those questions. >> i agree substantially there. i think nimby is him in california and the overload of regulation which has really stymied the supply of housing at the level that is needed contribute to this. a bite no means are all the people you see in s the street e people who are mentally ill or

drug addicted or alcoholic. many of them are people who can literally no longer afford a roof over their heads. and anybody who has watched what happens to california housing prices it is no surprise. how anybody with an ordinary job manages to put a roof over their head. feed and clothe themselves and their kids and have in the margin be on them. it just gets worse and worse. it is a supply and demand a problem if you have millions of people and youu do not build enough houses you are going to face exactly that problem. not always what's going on. in england for example in london the housing stock is being bought up by corrupt money. it's russian, it's chinese, it's arab, it's dirty money from all over the world. many of those houses sit empty. therefore she place for ill-gotten gains.

i think in new york there's a bit of that phenomenon too. here it not so much. here we really have created a problem for ourselves. it's also people's expectation houses get bigger and bigger they get more and more complicated more expensive repair and what that loses sight of is for ordinary people that is not something they could ever afford. they need a decent place to live and we don't have i agree withhi you that is not a psychiatric problem, not at all. in fact the whole institutionalization has created problems that in some ways are psychiatric in psychiatry tries to cope with. it is the product of much larger social movements and social forces. so to look to psychiatry to solve those problems seems to be mistake.y >> category mistake.

>> you made a reference to the psychedelic thinking about the remedy. >> is a little early to tell but it has some of the signs of it. and actually i was reading a couple papers this afternoon just before he came down about the emergence of a number of huge i startups, billion-dollar companies who are investing in this thing. once that genie is out of the bottle it's going to be very hard to put back in. and look at things the survival of interest in lsd, magic mushrooms, same thing with ketamine. any changes in mood. we know that, for years it was a party drug it was special k.

it also produces hallucinations relations. it can produce damage to the bladder it has a lot of potential. once it's given some sort of life there will be unscrupulous companies and people who will set up shop. i've been hearing about this people who are giving infusions for other medical things here's a great new source of revenue. unregulated, there we are going to go. and so yes i do think both of those things have the potential to be ato new desperate remedy. people used to always say to me while it could happen now. and it wouldn't happen exactly that way. but it could happen. you could have some damaging remedy a cold and then be out of control and hard to stop.

figures like michael cohen forhi example was become a cult figure because is very interesting writings on the food chain. it sounds like timothy leary reborn and it is very dangerous i think. i do worry about exactly those developments very much so. ask if you have any idea how it compares to canada or europe with regard to the treatment of the mentally ill and so forth? especially socialized medicine are they worse off than us are they better than us? accent most familiar with the english situation. i know a little bit about things in europe and i was just there. helplessness was somewhat less

visible in london within the last time i visited. i was a little bitpr surprised. out of blue have british psychiatrist who i knew as the house of the lord's, elaine murphy wrote to me and said one of the artifacts of the covid epidemic was the government swept those people off the streets they saw them as reservoirs of infection for covid. so they moved them into sheltered housing in a hurry. but she said now they are leaking back out. and so on the whole i argue one of the things that really drove the institutionalization was states were able to move patients off the state budget and onto the federalth budget. medicare prompted a flood of people, old people being moved out of the asylum into nursing homes. when ssi came in supplemental security income which provided some support regardless of youro

work history, then that young people started to be moved out. so it was possible here it was eight shell game you removing the resources in different places. and then as the feds cut back on some forms of welfare that was not replaced and so the situation in some ways got worse. written, like most of europe has a more developed a welfare statw than we ever did. butt nonetheless i will tell you in talking with a well-informed and well-intentioned british psychiatrist whom i trust,, psychiatry is always got the short end of the stick. and even when the health service was funded better under tony blair very few of those new resources trickle into psychiatry. it was always the stepchild. partly as david was saying earlier, this is not a politically power constituency.

there is no one arguing for them for it if we are seeing arguments now about homelessness and is not because we have sympathy for the people in the streets. it is because they are affecting our quality of life and we do not like it. that is the honest truth. so a little bit better, there is more developed. but in the last dozen years under first the coalition and the conservative government and now with brexit public services have been slashed in britain. and are probably going to be/some more because their economy is going down the toilet. it is hard to fund things when you are not getting the revenues. that is one of the things politically you have to understand. the productive part of the economys is not thriving you

cannot afford to do all these nice things you think you would like to do. and as we move towards potential recession it's a very worrisome time. i have seen mental health budgets are there one consider prime candidates to be cut. texas cut its mental health budget for all their prattling in the last dreadful week. and they redirected it we are going to control the border. inbecause the feds are not doing it. then there is a shooting. instead of saying we have a problem with the guns, it is blamed on mental illness. the problem is not that we have too many crazy people it's that we have in my view absolutely crazy gun laws. that i do not see any fix for. in a 400 million "guns out" there it is hard. but maybe you don't allow 18 years old on their birthday by

two high-powered rifles and three to 50 rounds of ammunition and body armor. maybe you have some sensible restriction that says we do not do that. rather than thoughts and prayers after the slaughter of the innocents, sorry to be onon a soapbox that went really, really angers me. mental illness being blamed all the time. and what that does as well as exacerbate something i talked about earlier irl this evening naming the stigma that attaches to the mentally ill people. mental illness sometimes produces violence. by no means as of the case everybody was mentally ill turns violent. and so to the extent we encourage that equation of mental illness and violence we make that population fearsome, something we want to lock away rather than deal humanely with.

it's her questions? >> i get the last question? i've got a question for you. it's his favorite topic of mind which is involving site psychiatric and alan francis the editor of the dsm for us but moaned allowing the explosion of psychiatric diagnoses in dsm for. and of course expanding to dsm-v. he fought a losing battle trying to prevent the dsm-v from growing even bigger. where do you stand on that? >> i think allhr through the 200 years i have looked up and the problem somele is called diagnostic can be seen. i think it happened lots of people got scooped up probably

could have been coped with in other ways. but the solution was to institutionalize them so that is where they went. and yes, i do think, it's a very controversial topic. esm said diagnostic statistical manual. it creates all the diagnoses that you have to have to get insurance reimbursement or to be really diagnosed as mentally ill. there've been several additions. alan francis was the editor-in-chief of the fourth edition and later i created a nightmaree here. particularly with respect to autism which exploded in numbers. that was a very controversial thing to say. as for parents with a difficult child and sometimes difficult is putting it very mildly. access to that diagnosis waso actually something they sought

because it brought with it both social supports and educational things that otherwise they would not have got. and when it was late that the dsm-v task force was considering changing the boundaries there was a fearsome backlash. it's easy to think this is all the product of an imperialistic profession. but it is also public demands. i'll be thinking of the next couple of months of thee whole issue which has become a huge thing in a huge industry now. the one exception in dsm three which is a revolutionary document to taking no stance on where it mental illness came from was ptsd. because ptsd had a very clear ideology and it was not brain disease. it was the product of a

traumatic experience. that first emerged among vietnam veterans against the war. they allied themselves with two harvard psychiatrist who were sympathetic to them. and they browbeat spitzer and they browbeat spitzer an adventure they succeeded to appoint. but they wanted to call it post- vietnam syndrome, wasn't having any of that. so it became posttraumatic stress disorder. and over time it expanded in ways that make sense to me intellectually. for example women who have been victimized by rape and sexual assault, very profound change in their identity, their lives, their being. people the aftermath of texas, right? but pretty soon it was my college student is upset what he

or she is being asked to read in class we need to trigger warnings. if we don't get trigger warnings we are going to suffer from posttraumatic stress disorder. that diagnostic is veryng dangerous. and there always will be people willing to pander to that because those people will then want treatment. if we supply it publicly there will be even more of them. what do you say david? >> ditto. [laughter] alright, thank you all for being such a patient audience. i hope we have imparted something and i would like to thank david who i have known on and off for a lot of years now. [laughter] thanks to steve grove in. david knows from time to time when i have had a student either with serious problems themselves or with family issues he is

someone i trust and i refer people too. and it is a sign i wish i knew more clinicians like david, let me say that. >> think you vote both very much think you and your, thank you david spent a very enlightening evening. the next time you write a book i hope you will come back up. and i invite you back. thank you all very much for coming, enjoy the evening. [applause] if you are enjoying book tv then sign up for our newsletter using the qr code to receive a scheduled upcoming programs, author discussions, folk festivals and more. book tv every sunday on cspan2 or any time online at booktv.org. television for serious readers. ♪ sunday on q&a accommodated

journalist shares his book strength in numbers which examines a history of public opinion polling going back to the 19th century accurate post today. >> predicting donald trump has a 30% chance of victory in this 2016 election. because national polls are going to be wrong but every race is close and key states. i do wonder if every person in the media understood that 30% as a 30% meaning these bowls, if you've had three elections, three going to be wrong if your sample size is 18 elections you have a pretty good chance the polls are going to miss enough losing a presidential candidate. i wonder how the tone of the campaign would have been different and with the people would have thought would happen. >> strength in numbers sunday

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