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bookstore in the t united states so thank you. hopefully next year we will have ourll 126 year this learning we are pleased to welcome andrew call will discuss his newest book desperate remedies, psychiatry, driven quest to cure mental illness and he will be in conversation with doctor david lehman. andrew received a ca from oxford university and phd from princeton university and currently is distinguished professor of sociology macros at the diversity of california san diego. in 2015, he received the roy pearl metal for contribution to the history of medicine. in 2016 the carlson award for

lifetime contributions to the history of psychiatry. his previous books include madness and civilization, hysteria, disturbing history and madhouse, a tragic tale of modern medicine. his contributed to many documentaries including the pbs series mystery of mental illness and the phlebotomist. andrew blocks for psychology hetoday and met in america and he's written for the atlantic, scientific american, paris review, the "wall street journal" and the nation among many others. doctor david received hisis medical degree froml washington university lewis medical school

and completed his psychiatry residency at university of california san diego. currently chief of disorders clinic at the va medical center in san diego as well as the medical director of the inpatient unit. his heavily involved in education at the university california medical school and the training program. a recipient of teaching awards in both departments. in addition, associate director for the third year medical student psychiatry clerkship and coordinator of the fourth year medical student psychiatry sub internship. give a warm welcome to andrew with david lehman,.

>> thank you for the introduction, it is a pleasure to be here. i hadn't realized like that ancient, that's a remarkable accomplishment and i'm pleased we have a bookstore of this quality in our community, very few places these days sad to say, have a place like this. i am pleased to be with you tonight. the book of just completed i first envisioned in the early 1980s. it would have been a different book had i published it back then. i spent the early part of my career looking at the emergence of psychiatry and a silent in victoria, england. before i published that book because i was tired of it, when

i went around doing job interviews, they asked what about the shutting down of asylums? why is that happening? i i thought i've been there in e 19th century, i don't know. [laughter] i thought that is a big surprise. i knew how much money intellectual capitol have been invested in the idea the mental hospital wasta the solution too much on this so i thought that would be an interesting topic continual for those who went about in victoria, england went about strange so i wrote a book very early, mid 70s when it was hailed as a grand reform and my book suggested but perhaps not always what light seemed. in many ways, i like to think was a book that anticipated what

we live-- with today, abandonmet really of people with serious mental illness and the problems it has resulted in so bitter i moved into the 18th century and that i did books that spanned vast regions of history and iry started to work on the k 20th century and the. i was initially working on was the 20s and 30s, a period of extraordinary therapeutic experimentation, mental patients were shut up with double fencing, walked away and was stifled. anything they had to say was a product of their mental illness so given the desperation of the time, it meant they were vulnerable and it was a series of intervention, some of which i

discussed in this book so desperate remedies is a title that occurred to me in 1981 in london but as time went on, i wrote many of the books and went back and forth. i always have this project in madison civilization in the back of my head. finally i said to myself i have to write these things but i wanted to put american psychiatry in a long historical context. ... how did it evolve as the hops that we could cure mental illness start to decline into hopelessness toward the end of the 19th century were

psychiatrists and the culture dismissed mentally ill people as degenerates? >> very heavily biological. and one with all the hopelessness. what would you do? california was the leader in the united states since we started to voluntarily sterilize. california did not stop until 1960. that was the model for the nazis in germany when they

produce one from the political system that they exterminated en masse and then then they killed them so the final solution the technology of the gas chamber was developed for the active participation and that was one possible. but in other respects psychiatrist to were satisfied they wanted to be healers so they look for ways to intervene so that produce some

pretty terrible results so that david talk about those middle chapters a joke about that orgy of and experimentation. >> first of all thank you for inviting me. you have been training me since i was a resident in psychiatry and probably more than anyone else to introduce me to the unpalatable nature of the history of psychiatry. and that had a dramatic and positive effect on my career and i think it's bad and

horribly remiss from a psychiatry program not be familiar with the's warnings that you do so well to report on the history of psychiatry. >> oneve of the things that's very important to understand that among some renegade psychiatrist in the 1960s to claim it was a myth that has never been my point of view i understand how deeply distressing and disruptive mental illnesses in people's lives may have seen a close-up even with the suicide after postpartum depression so i am

not in any sense anti- psychiatry but i am somebody who thinks we need to face of straightforward to what we can and cannot do and what we understand and do not the limitations of our knowledge that in the present we ought to be doing and so while the book is heavily critical it is not meant to be in the critics have responded have not seen as an attack on the field but the attempt to analyze ways it has made some limited progress but the limits of that and the way to which the national institute of mental health has been captured a very

monochromatic view and that's all that needs to be said to concentrate on genetics and neuroscience the upshot of that has been basically nothing. and when he h stepped down, you know over the last. i have spent a lot of money. about $20 billion from the payoff for patients has been zero and he was being too kind if you look at serious mental illness the life expectancy is

between 15 and 20 years less and that gap is growing. not diminishing but it is a sobering reminder. >> i thought a lot about the comments and the way i think about it is this way. psychiatry is concerned with the mind. it is an abstraction of the brain and it is by far the most complex organ in the body but the questions psychiatry ask our vastly more difficult than other branches of medicine.

consciousness is among one of the most difficult questions that science has ever posed. so i s don't think it should be a surprise psychiatry not, but very many winters very quickly. it will take time progressed he point out in the book in the 1990s there was irrational exuberance where we made all kinds of promises that have not yet been delivered. but from my perspective i see no reason why science, given the time cannot address these very difficult questions in psychiatry the way it's another branches of medicine over the next decade. but i don't see why. >> it seems to me that

distinction between that dichotomy we have very plastic organs it isy the joint product of the green we are born with and what develops and those patterns in the brain are very much a product of social and cultural environments. one of the problems that i have come i'm not trying to say there shouldgh not be research into genetics although that is a dead end. i would like to see the deals of the other dimensions and you are only too well aware of that. we need researches on how best to givee some relief and

provide suitable housing and social support for those during a mental illness. >> yes. but i think it seems biological psychiatry was the wayy to go so the rockefeller institute really struggled with this question so given that they have funded research and who should we trust? and they were so many advances happening so quickly with medical technology at the time it seems reasonable to place a bet rather than the less fun and exciting questions of how you address loneliness and

advise the suffering. >> i agree with many people mayit not realize it's important to have a historical perspective because there was no federal involvement other than running one mental hospital that no federal funding of medical research let alone psychiatric research. g so to fill the gap was the rockefeller foundation which made the unorthodox decision that they would find psychiatry is the least developed part of medicine and it could make the most different and did spread the net quite widely some of those directions that seemed

reasonable but those later development seem problematic the german nazis psychiatrist and continued to do so with the outbreak of world war ii on the other hand rockefeller also provided funds to rescue many psychoanalysts and bring gthem to america but that doubled the number and one of the preconditions for what happened in america after the war that is the emergence and the dominance for psychoanalysis in american psychiatry.

understand in 1850 there were half a million people and that continued to grow. those but it was in that environment it emerged behind the backs of the psychoanalysts but if you look to the high status growth of psychiatry on the outpatient basis that was heavily psychoanalytic and then it was saturated. and freud wasof seen the equivalent.

and intellectuals in all disciplines with the humanities and social sciences. look at the movie spellbound. one of alfred hitchcock's films. i think 1948. so it is that where people's sought meaning in madness to understand that a psychological level to say that they could treat schizophrenia with analysis but freud himself. >> other than washington using st. louis. [laughter] other than that virtually

every other department was headed of psychoanalysis in the best recruit went that way that isth the root words and those who had money and also who were more interesting a marked a real revolution emerged not only from the university but from where the drugs and the antipsychotics in particular first emerged in what happened for many years is like building structure looks solid and they said that we are in the saddle with that

remarkable rapidity that shifted some in 1980 fueled by problems emerged the fact that the site cages could not agree with a sustained effort to create at diagnostic system to look at the same patient and produce the same diagnosis. it was an approach that was theoretical in nature but fueled by hostility of p the psychoanalysis and i think that's a complicated question. psychiatrist to word trained on —- trained and sixties that

could speak to that. >> if i have anything to do about it, but i have lots to criticize of psychoanalytic psychiatry but it's important to recognize that whatever the doctrine and ideas and rigidity to some practitioners,t in many ways so the seeds of their own demise. but they were and are the humanist in the story and rather than re- correcting or redirecting some of the

rigidity they ended up throwing the baby out with the bathwater with biological psychiatry and then to point out decades previously that would be a dead end so that's only part of the answer. >> that's something we concur with. that is very important but it is very interesting there's a a study done in the sixties of what happened in the psychiatric practice and the average length of time what

went to psychiatrist is 45 minutes and an hour. that is partly because of the pressures and the needs of psychiatry got the best paid medical specialty. it is not a pill know that then you see the psychiatrist for ten minutes and that is barely time to really penetrate. maybe it's different but a lot of research has suggested that. on the person professions part. and then the emergence of

other professions in the psychological realm. so very many patients with other kinds of disorders and up with clinical psychology. getting that psychotherapy they don't get when they see the md. and those economic forces driving this rather than theoretical forces rather than ideas what is possibly the best way so in my mind i separate out the mistakes made from the sheerce market forces

that every industry will respond to producing favorable or unfavorable results because of those incentives. >> when the mental hospitals emptied out. >> so to be a responsibility or something that was funded publicly is a very strong public side to the profession and it wasas obliterated the profession did not something that what was going on is not the product psychiatrist deciding this is the way

forward it really was r other forces conscious public policy choices and pressures and the availability of technology in the form of the drugs that worked that could be dispensed pretty quickly and the insurance companies were not willing to pay decently. >> and that's the place we find ourselves right now. and one has to recognize if you promote improved treatment then you have to recognize phenomenally expensive hoping

it was the single biggest line item on the budget. it is john dropping that was make pit caree. see you can imagine the cost of providing beautiful state-of-the-art care for the severely mentally ill. and it brings up a very difficult question that most people don't want to look in space should people with severe mental illness get the majority of the resources for people with mental illness? >> one of the other things i would say over the last 200

years that extend much through all of recorded history, mental thomas is something that is constantly associated with statement in fear of rejection. so the politicians are responsive. and those are hidden away and one of the things i saw those who are pulled out full-time and then eventually it is just

too much. but those families were very reluctant to make a lot of noise. the reason is obvious. they didn't want people to know that in their domestic bliss where something else is happening. you become aware of the problem to not realize that they areou going through someone that breaks down in welfare reform has worsened the hsituation and states have not replaced the money it was 30 percent of the state budget was mental hospitals.

>> as a result living here in california and downtown san francisco l.a. and san diego it's not only a problem with mental illness but that is people with serious psychiatric problems that just cycle and then back into the cycle. the dismal part of life as rich as ours. >> i would suspect we differ politically but when i read the book, one of the things that jumps out at me is how

many of the devastatingly bad ideas were promoted and that has unscrupulous people and well-meaning people who days usually unscrupulous things. where the ends justify the so enamoredere that they lost the boundaries of western civilization and i think eugenics of courses an example of that in the institution as an example. so i do worry quite a bit if we just sit down and come up with another program to help

the severely mentally ill than that will be the panacea i have my doubts. and then to be challenging. >> and then to take that jumping into enthusiasm and refusing to see the evidence and then thinking you have a magic want to solve the problem.

and indeed some of these people and then to discover the railroad. and henry cut for the new jersey status island. but then died suddenly in 1933. and cotton decided that major figure at the time and in the pre- into biotic quarter.

and then to have his first targets. and then when people don't get better. and then to have other areas of infection. and another that occurred that women are disproportionately targeted. but 60 percent were female that i operated on. so now he decided any seat for a menace. he had his wife but then one

son removed part of his : when he felt mentally all the pressure investigation he had his own teeth pulled. he believed he w was doing and with the travesty. and he was praised when he went to london in 1927. with those british medicine. so yes f they were sincere. amoral monster in my eyes absolutely. he lobotomized and to say

their brains could do more damage than adults when i took part in the pbs documentary and maybe you could even still see it online it was too sympathetic in my view. but so did one of the last lobotomy patience. after the parentsis marriage broke up deciding he was acting out too much. and sincerity does not cut it. and then addsxp a silent experiment with a small intimate institution. and then to have a dedicated

start but if you do that on a routine basis but that just was not possible. >> it's weird to note to the nobel prizes given out in psychiatry were given to horrific treatments. to inject patience with malaria to be used as a treatment for tertiary syphilis. and then the nobel prize for they. invention. >> and that was 14 years.

on the time to accumulate and then the operation continued. so than the other thing to bear in mind and that they visited. we often think the experimentation with the most vulnerable. but one of the worst outcomes was rosemary kennedy and then

she could barelyy walk. so that she was locked away and then kennedy kept her out oft sight. and again the earliest lobotomy patience where people with money because they came in and heard about the miracle cure and they v volunteered. the institute of living and that was the first surgical suite to perform lobotomies and also to be lobotomized.

and then mental illness brings with it the great vulnerabilityam and it is as one of mine put it. for the mentally ill person a nightmarish place to be and then everyone around them. and to be disruptive and disturbing a threat and. >> i like to highlight the word desperate this is the only to have had the good fortune of having today the emeritus psychologist here in san diego treating hundreds of psychiatrist. over his career.

and what is so important to learn with psychiatric training is the experience of d desperation. you have patients that are suffering in the most horrible way. some of them are violent. but and that is very disruptive i think of hundred of violent disruptive patients and then it's very scary to go to work. is very real. it's not an excuse in any way to put the i.c.e. pick and somebody's brain but unfortunately it helps me understand how people got to such a just place and a part

ofe my brain. so what happens next. [laughter] o so then to spend some time thinking about it before i run off and try to save the world. >> you think that's right. >> by the therapist. do something, something surely to show that it is worse than anything at all history we see again and again and the desperation makes it possible for people to conceive a bright idea to go down the

rabbit hole to persuade families and patients of coming down the rabbit hole and they have multiple meanings. it is hard to avoid despair when i was writing the book this is so depressing. but your conclusion yes drugs are better than not that to some peoplee they are repositively that is bad or worse. as i look at it for pharmacology that part of the problem is that we don't know

in advance. i shouldn't say we but they don't know. i like to pretend. but they don't know and for some of the patient's. iand then to transform for someone that is delusional. so than thosehe group of patients in the middle there are always side effects things we don't want to come with what we, do. often they are very severe for lifelong once you have contracted them. so the middle group of

patients you try to weigh because they experience these more so they try to weigh the benefits against the problems that it creates so then you have another group of patients who just don't respond and if anything they get the side effects for what we are supposed to be about. and the dimensions and in 2005 a lot of the research but in 2005 a veryst large study appeared in the new england journal of medicine and was

recently forced to step down but it looked at the original antipsychotic one of the first generation and three so-called a typical modern drugs and said it is inferior to the current drug and how well does it work? the answers on both fronts were not very reassuring. but then the other thing that i found striking in the study depending on which drug between 67 and it is on —- 82 percent dropped out because

they could not stand the side iceffects. we have pills that help some people and if god for bid i would not stand in the way of. >> im big pro forma. i don't know that is unexpected with thatcu discussion but i would be so sad to thinka of a career as psychiatry without the benefits of modern chemistry p that the pharmaceutical companies have provided.

bit big pharma has permanent one —- provided the possibility for so many patients and i am so thankful for that. >> on the other hand, i agree, it is very important to understand that we have had some progress in many ways have been tied to the drug and that is a substantial number of the people suffering. that the other sad thing is big pharma has pulled out.

and so then it takes a batteringht to talk about it as i describe in the book. they cannot see a way to make a profit. now talking about operations with ketamine and there are some people advocating. and then maybe that solution to depression we know where it resides in the brain. we don't. there are those things but to be heavily involved in the process of pharmacological agents have disbanded their

department and found other areas that are more profitable and research follows profit. it's not enough or maybe it is with public funded research but there's probably enough of that around. that is another facet of our contemporaryou situation. and less you are somebody like scientologist and dismisses, there is no there a pet on —- therapeutic value for all of the last things that the drug companies did. >> let's take questions.e

>> to be mentally ill and homeless but also think anybody running from the civilization to stop america or anything that you can think of the director of finance and they wish to solve the problems of the homeless. so what possibly could be effective? >> i don't think anybody has a good solution to that. and simply throwing money at it san francisco spends on average $35000 per hand per year.

sms. back in the days it would be an old mental hospital. most people died and forcibly so to speak and they were certified as insane. so these days the whole situation is tricky and it's a political minefield with some ideas about this which potentiallyol involve some degree of compulsion. and having seen what it is like it is a very dangerous situation on the t other hand

and they arein very resistant to getting treatment and the texture of life in our cities is being undermined by their presence. so ire think politicians are responding to the fact that when i wrote my first book they are largely being returned to the most private areas of the cities. and those people that have no political voice or clout. the numbers have multiplied. and so we used to be able to shut our eyesey to the world.

so then to talk about politics. my goodness. >> so my perspective is that psychiatrist are not the people to solve. economist would be a much better place to start in many mental health practitioners who weigh in on the question have absolutely no training in economics which to me is bordering on —- bordering on fraudulent.

and the end and without level that is needed to contribute by no means other people dc are people who are mentally ill or drug addicted or alcoholic. many cannot afford a roof over their heads. if anybody wants to watch what happened to california housing prices is no surprise. you wonder how anybody with an ordinary job manages to put a roof over their head, feeding forr themselves and it just

gets if you have millions of people and don't build enough houses you will face exactly that problem. but it is russian and chinese and arab and there are parking places for ill-gotten gains. but then people get more and more complicated. and with that loses sight is for ordinary people that's not something that the could

afford but they needed decent place. i agree that is not a psychiatric problem at all. in fact the whole institutional problem is created that in some ways but it is the product of much larger social movements and forces. so to look to psychiatry. >> you may reference the psychedelics suggest that concern you as desperate remedy? >> it's a little earlyly to tell but has signs. and actually i was reading a couple of papers this afternoon just before i came down about the emergence and

startup billion dollar companieses who are investing once the genie t is out of the bottle it's hard to put back i look at things that has been a survival of interest make a magic mushroom. thee same thing. we have known that for years it was special k. it also produces hallucinations and damage to the latter and has a lot of potential. given license, there will be unscrupulous companies of people who will set up shop and i have been hearing about this infusion they were giving infusions for other medical

things saying here's a great new source of revenue and unregulated that potential to be a new desperate remedy and it couldn't happen now or exactly that way. but it could see you see people like michael poland who is very interesting writing well on the food chain is touting it sounds like timothy reborn. and they do worry exactly but

are they better off than us? i know a little bit and i was just there homelessness was a little less visible but then out of the blue a member of the house of lords evening murphy said because it took people off the streets because it's other reservoirs of

infection so they lived a housing in a hurry. as a holy argue one of the things that drove the institutionalization that were able to move them off the state budget onto the federal budget. medicare there was a flood of old people being moved out of the asylum and that provided some y support regardless of work history. but then young people started to move out. it was impossible it was a shell game. and then as the fence cap back on forms ofth welfare. and so that situation got worse.

and like most of europe as it on developed welfare state. talking to well-informed and intention years on —- better society. so even when the health service was better than those that trickled into psychiatry but as david said earlier there's no one arguing for you. they see them before to have e sympathy for the people in the street that because they are affecting our quality-of-life and we don't like it. that ish. the honest truth. so a little bit better.

one dozen on the coalition and now with brexit the public service they probably will be slashed somewhere because the economy goes down the toilet. it's hard to find things and you have time to do what you would like to do. so if we move towards a potential recession i have seen it and mental health budgets. and texas cut its mental health budget and redirected

it to the shell game every will control the border. and then there is a shooting in's dad. i don't see any fix for that. would you 400 million out there? it is hard. that maybe you don't allow 18 -year-olds on the belt who can buy two high powered rifles and body armor and ammunition and then to say we don't do that.

that mainly this statement that attaches to people that mental illness by no means is that the case but then we make that population not something we wantth to lock away and deal l with humanely.

and where do you stand on that? >> i think that. >> i can. it happened in the era that people are being cooped up in so the solution was institutionalism. and yes it is a controversial topic so that diagnostic statisticall manual but creates a diagnosis that you have to have to get insurance

reimbursement. and there have been several additions alan francis was the editor in chief of the fourth edition and later particularly with respect to autism which excluded. that was a very controversial thing to say because for parents with a difficult child and sometimes that put that mildly. that is something that they sought. with that educational that they would have not have gotten. but when it was the that there is another example to think it's all the product of the imperialistic profession but it's also public demand.

i will be thinking the next couple of months which has become a huge thing and industry. and then to be a theoretical to take no stands was ptsd. thater had been to have a very

profound change in their identity. and then the aftermath the texas. but pretty soon play college student is upset. plus we need trigger warnings and if we don't get that then all my god we will suffer from ptsd. that diagnostic creep is very dangerous and there always will be people willing to pander to that if we supply it publicly then there's even

more. >> did a. [laughter] >> thank you all for being patient i hope we have imparted something i have known david a lot of years on and on and he knows sometimes time i have a student was serious problems that had issues he is somebody a trusted me for people to pick i wish a new were clinicians like david. say that. >> thank you this is been a very enlightening evening but you back and thank you for

coming. [applause] programs anytime

booktv.work. >> in this week public affairs virtual event we bring you a conversation with the washington post national politics columnist