pbs. today understanding the america of today by understanding the america from the past. pulitzer prize winner historian john mitch shum on the polarizing politics of trump. are they really knew? plus listing mental health, the growing number of people dependent on anti-depressants and what the drug companies don't want you to know.

good evening everyone and welcome to the program. i'm christiane amanpour in london. it's a speech torn from today's headlines. build a wall of steel as high as heaven to keep problematic immigrants out of the united states. but in fact the year was 19 caller: 24. the immigrants were coming from italy. and the speaker was georgia governor clifford walker an addressing a national convention of the ku klux klan. in his new book author explores racial strive called the soul of america, the battle for our better angels with whole world trying to figure out trump era. not only does niche chum see how it's lit and how america has come through the darkness every occasion. and joining me now from raleigh, north carolina. welcome to the program.

>> thank you. >> good to have you. so the subtitle of your book, are better angels refers to abraham lincoln first inaugural address, and at that time america stood on the brink of civil war. how to you does that resonate now? why did you choose that title? >> well, every era in american life has been shaped by the battle between our best instincts and our worst instincts. uniquely among nations we were founded in more or less the modern era coming out of the european enlightenment and scientific revolution, behind it reason would stand against passion in the a roon a. we were founded on that idea. but at every point from the very beginning, 1790 all the way until our conversation now, we have had this struggle. and my view is that as lincoln put it, at that perilous hour,

600, 700,000 americans about to die in the civil war, he said he hoped the better angels of our nature would in fact prevail. and i think this is not a whom lithic point or fourth of july point, it's not a narcotic one, basically our better angels have managed to continue to make us a country that people want to come to as opposed to fleeing. and i think that's an important thing for us to remember as we try to figure out how do we survive clearly the most unconventional presidency in our history. >> well, you say that about coming rather than fleeing. i mean, certainly some people are leaving. some under duress, others are just leaving, because they can't deal with it, frankly. and the particularly sharp point pointed sphere leveled at the immigrants that made america what it is. so how dark is today's era, in your, you know, construction and narrative, compared to some of those other past issues that you

highlight? >> i think this is a lot like the 1920s. i think it's a lot like the second half of the 19th century when we decided to focus quite firmly in discriminatory way against immigrants. the chinese exclusion antibiotic. there were enormous fears in the late 19th century that, see if this sounds familiar, the white working class of america was worried as we moved to industrialized economy, a great of economic upheaval that foreign workers would come in and take jobs that americans should do. what we are living through now is the latest manifestation of a perennial tension, perennial fear in the american soul. and what we have to do is what theodore roosevelt called upon us to do is we had to embrace diversity, we had to open our arms more widely than clen

itching our fists. but every era as you know is imperfect. theodore roosevelt who called for a melting pot, who called for a new kind of americanism also believed in la discredited genetic theory about white superiority. so i don't think we can roman taize size the fact. i think there is a tendency right new in many places for americans to see that everything before trump was somehow better. and ever since then we have descended into this uniquely dark place. my argument is not let's relax because we've been through this before, it's that let's get to work to figure out what it was about the constitutional and cultural inclinations of the past that got us through these dark moments before. and essentially the answer is a historically based realization that the free movement of idea, free movements of free trade,

pure adam smith has been what's made us truly great. and if we want to make america great again, let's embrace that openness and continue to go from strength to strength. >> except of course as you rightly say that pressure point is it right on that openness right now, and on the diversity that has made america so great. i wonder what you think of this new sort of study seeping into the political arena, if you like, that was done to explain the trump vote and the trump voters? because many of the mainstream press, of course, conservative press as well, and all the talk after the election was that it was all about the left behind, it was all about the middle states, the fly over states, it was all about those who, you know, under going severe economic disenfranchisement and anxiety. and yet the stanford university study suggested it is actually about racial anxiety much more

than economic. they look at the economics of those who voted and they see that it's actually racial anxiety, what van jones said on election night, sort of a white lash. >> oh, i don't think there is any doubt that race is at the heart of this chapter of american history. because race has been in the heart of every chapter of american history. it is our original sin. our constitution was created to deny the full implications of what declaration of independence has said we were supposed to be about at every point race has been a difficult, difficult fault line in american life. i come from the american south. 50 years ago, we had functional apartheid in our politics here. american women voted 98 years shifted from race to gender. and of course marriage equality on the question of gay rights is not quite three years old.

and so the story of the country, again, without sent men lysing it has been moving from -- has been pro grgressive. basically i think president trump is president trump because of anxiety and all rolled up with racial fears, a fear that a certain way of life is under assault from immigrants, from people of color, and that some howl or another, this happened in the 1920s in the same kind of period, 5 million clans man, oregon, indiana, colorado were all taken over in many ways politically by the include clue claks, 50,000 clans man marched out in 1925 without their masks on. so we have been here before. in times of stress. and certainly race will forever it be a factor. my own view, to go to van's point, is that in 20 years the united states is going to look a lot more like barack obama era

than donald trump. and the reason that it is people know that in their bones and last gap of older vanishing order. >> university of pence study. so to that end, describe what led you to write this book. it was i think the events of charlottesville, right? >> it was last august, yeah, neo nazis and clans man were marching to defend robert e. lee statue and two troopers were killed as part of the operation. and president of the united states had difficult time deciding which side he was on. and i spent most of my time reading and thinking about the american presidency. and we have had some terrible moments before but that was right up there, or down there. >> well, indeed. i wonder if you can talk about, you know, you talk about these different eras, the dark devils and the better angels sort in

constitution. i was struck this week by two major commencement addresses as this cast of graduates go forth, one by mayor bloomberg of new york and today rex tillerson. both of them spoke about the fundamental need to recognize truth and facts over lies and dis torsion. the fundamental need for honesty in our public space. to protect the very democracy and the constitution of the united states. and i wonder if you can comment on how that is sort of whittling away at the soul of america and the better angels? >> it is. and as john adams said facts are stubborn things. we are testing stubbornness. we are in a timly tribal moment in american politics. there are 35, 40% on each side that believe their view of the world is absolute.

they believe that any con trary fact is somehow or another dismissible because it doesn't fit in with their pre-existing world view. to me, that's among the most unamerican. and i don't use that phrase much. but unamerican views to take largely because the founding of the country and this is going to appeal to political conservatives as well as classical. the founding of the country was clearest manifestation of the enlightenment idea that reason should be an organizing principle in human affairs. what is the american revolution, if not, the political undertaking that comes at the end of an era of gutenberg, rise of type, protestant reformations, entire shift from popes and kings to either by an accident of birth or instant of

election have authority over other people. to a more horizontal understanding that we are all created equal. we have the capacity in ourselves to determine our destiny. it's a great western idea. and america was the embodiment of that. if we continue to think ideologically as opposed to rationally, we are not being true to the american problem. >> you know the european president tonight addressed that kind of question that you just raised, and remember european is closest ally, and trading partner. this is what trump said at a speech just now. >> we are witnessing today a new phenomenon. the capriciousness of the american administration. looking at the latest decisions of president trump, someone could see them think with friends like that who needs enemies. >> i mean, you know, i haven't

heard that recently from european ally to the united states president. that's quite harsh. >> it is. and one of the things we are dealing with, and obviously on the global stage, is trying to separate to what extent is president trump's showmanship and bullying and ill considered it seems social media postings, to what extent does that shape our policy? and basically we made things as difficult for ourselves as possible. which is kind of a classically american thing to do when you think about it. churchill is reputed to have said you can always count on us to do the right thing after every other possibility. and we are certainly testing that at the moment. this is a very perilous moment in the life. country because the conventions that have died are at best vulnerable and that at worst are already gone.

the question is we know that the president has not changed donald trump. the question is whether donald trump changed the presidency going forward. >> i want to put fort your eulogy at barbara bush funeral and you talked about public service as you would like to remember it. >> barbara and george bush, the country of the party, the common good above political gain, and service to others above the settling of scores. >> you know, that whole principle of again the better angels, national service, you know, above individuals, you know, ego. just very quickly, because we are out of time, what does that mean to you right now, their administration? >> i think that we have to look back in order to find a way forward. and right now the president is about settling scores. but we've had presidents who have been erratic, not quite

this erratic, and i think we have to ultimately hope that through protest, and through resistance and these kinds of conversations, through the bearing of witness we shall get through this. >> john niche chan, thank you so much. highly politics, on saute of bad news, perfect instagram life, all taking a toll on our mind. staggering new physicians show 15.5 million americans have been taking anti-depressants for at least five years. the rate has tripled in the last 18 years. and there is similar statistics in the u.k. and women are twice as likely to take these anti-depressants. so what is going on? dr. allen france helped write one of the go to manuals for diagnosing mental illness. and ringing the alarm bells, they are destroying our own faith in our own human

resilience. his book, "saving normal" explains how we fix this broken system. he jind me earlier this week from san diego. dr. fan cyst, welcome to the program. >> thank you very much. >> so i wanted to start by saying who knew that anti-depressants were addictive? it's not what you associate with things like anti-depressants. you think of pain killers and obviously drugs and alcohol and cigarettes. >> well, they are not really addictive in the sense that ben's a pianos are addictive or alcohol. they don't cause the same degree of functional impairment when you are taking them. but they definitely do have a withdrawal syndrome. and that withdrawal syndrome traps people. it's so easy to start an anti-depressant and sometimes very difficult to stop it. >> and how did you find that out? how much science is there on the difficulties? and how do people know when they've been on it too long? it's such a fluid area of

medication of prescription. >> well, it's very deeply held secret. there's been almost no research on the withdrawal syndrome. there is absolutely no interest on the part of the pharmaceutical companies in advertising the fact that getting on an anti-depressant may trap you for years or maybe for life. so they have discouraged research. they don't report adverse findings. pharmaceutical industry is it slightly less ruthless than the drug cartel and not in their interests to advertise this. so very little research. and we really don't know how the long-term use of these medications may affect the brain. we are doing a kind of public health experiment on hundreds of millions of people around the world without really understanding long-term effects. >> new figures from the new york times show that 15.5 million americans have been taking anti-depressants for at least five years and that rate is almost double since 2010 and more than tripled since 2000.

how easy is it to actually get the prescription in the first place? >> there is nothing easier in the world than starting an anti-depressant. primary care doctors are given far too little time with their patients. and only way they can get a patient out of the office satisfied after self inminute visit is to write a prescription. 80% of the anti-depressants are prescribed by primary care doctors, usually after self inminutes under heavy pressure from both the patient and from the drug company to prescribe the medication. on the other hand, stopping the medicine can take years. it requires for some people a very, very slow taper. and without that, they'll have symptoms of return of anxiety, of depression, flu like physical symptoms, and often miss attribute these return of sip

tom symptoms thinking they are getting depressed again and it's the result of side effects. >> and symptoms while on these can vary as well. potentially lack of sex drive and other such side effects. what are some of the side effects, weight gain? >> yeah. the anti-depressants cause almost ubiquitous changes in sexual interest and performance. and this can result in serious relationship problems. they frequently cause weight gain. and sometimes it's very dramatic weight gain. anti-depressants can cause less motivation. and in a deeper sense they reduce the person's pride in their own resiliency. >> i'm fascinated you talked about many some of the demographics. so from some of the studies in "the new york times" research and articles it seems that some of the majority of these anti-depressant pill poppers are

women over the age of 40 or 45 or so. is that correct? >> it's become absolutely ridiculous. one in every four women in america after the age of 40 is taking anti-depressants on a regular basis. the use is ubiquitous so in younger women one in eight. and even among teenagers where they have no proven value except for classic severe depression in teenagers, they shouldn't be used in teenagers, no proven value, and increased risk of suicidal ideation, even in teenagers 4%. so they have made ubiquitous part of our society. and that's very good for their profits, very good for the executives, for the shareholders. it's not good for most of the people involved. >> well, in fact, there is one woman who is one of the people

who you focus on in your book, and it's sarah, and just to remind again that 80% of anti-depressants you say are prescribed loosely by gps after interview that usually lasts less than ten minutes. so this sara says she was misdiagnosed using depress sifs when she was really very sad and grie grief stricken about the suicide of her son. and she told you, quote, that doctor was clinical brushing a side my fears. i needed someone who would understand and share the pain that i was going through, not for a cold medical label on it. how much of that kind of situation and diagnosis did you see as you were doing your book? >> well, i think she's particularly poignant heartbreaking case, because her son actually himself been mistreated, over prescribed medication, caused side effects, and he actually ki8d himself with medication he was

prescribed. she is feeling grief. and after a few minutes the drr over prescribes medication for her. this is a very common story. i think people have to become educated for themselves, their family members, and particularly their children. not to accept a quick diagnosis of depression. not to accept a pill. the diagnosis of depression should take not just one session, but normally weeks and sometimes even months. most people come to a doctor on the worst day of their life. if nothing is done except watch full waiting, support, advice, most of those people get better in the short run. what's happening now is they get a very quick prescription of a pill, and then there may not be an end point shs, because stopping the pill will be difficult, and the person will assume that the pill is keeping them well. >> well, let's say a little bit of devils advocate. because you make a bit of a distinction between situational

grief and feeling really low. and then proper depression. i mean, there is some benefit, isn't there, to be treated, potentially with medication, even for a situational amount of feeling low, is there, or not? can one sort of micro target like that? >> let's be very clear. there is accrual paradox that we are over treating the worried well and terribly neglecting the really ill. and medications are absolutely essential for people with severe depression. there is no one size fits all. it's not that med stins are good or bad. medicines are very effective for the few become harmful only when they are misused with the many. so i think in terms of situational depressions, short-term reactions to job loss, divorce, financial troubles, it's always better to

watch fully wait. and psychotherapy is preferably first line treatment instead of medication. it's also cheaper. >> is it cheaper? really? >> it's a lot cheaper if insurance companies would let primary care doctors have time to talk to their patients. because most of those patients will not need medication on a second or after a third visit. instead, they are rushed, easiest thing they can do is prescribe a pill, and a lifetime of medication is far more expensive than short-term psychotherapy or watch full waiting. >> wow. >> insurance companies are making a bad financial decision, not just clinical but bad financial decision. >> what is your solution to this crisis? not just doctors having polar time, but people how should individuals be sensitized and made aware of this problem? >> well, i think you are doing

that, and i'm trying to do that with this program. i think there are several things that need to be done. the first and most obvious is that we need to tighten the diagnostic criteria for how physicians and people regard clinical depression. we need to tame the pharmaceutical industry. they should not be advertising directly to con supervisors. that happens only in the u.s. and new zealand and most countries have high use. we need to convince the insurance companies to allow primary care doctors to get to know their patients so only recourse is not writing a prescription. and most of all we need to inform the public to be more afraid of medication and less afraid of their emotions and of illnesses. i think that the overwhelming clinical experience and research finding is that most people with transient mild depression will do very well on their own and

people should trust to their own resources, get support from their family. get psychotherapy before they consider medication. medication should be the last resort for people who have severe chronic depression. it shouldn't be a means of treating the aches and pains of every day life. >> really fascinating. dr. allen francis, thank you so much indeed. >> dr. francis was joining me earlier this week with that very timely warning. and that is for our program tonight. thank you for watching ta "amanpour" on pbs and join us again tomorrow night.

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