📺 Watch on YouTube and Spotify

"A lot of what we call disease is really just dis-ease with this mismatch of what we are designed for versus what we find ourselves in today," says Jeff Bohnen, psychiatry resident and holistic health practitioner, who joins Mental Health in a Modern World to illuminate why much of modern psychiatry misses the mark on both the root and treatment of mental illness.

Trained in both Western medicine and holistic health, Jeff Bohnen shares his inside perspective on the tension between pharmaceutical-driven psychiatric care and science-backed natural interventions like nutrition, movement, and spiritual health. He reveals why SSRI antidepressants (and the infamous "chemical imbalance" model) are far less effective than patients are led to believe—citing the real research numbers that pharmaceutical companies don't want you to know—and how vital factors such as vitamin D status, the gut-brain axis, and even daily sunlight are overlooked in mainstream mental health care.

Jeff Bohnen draws on both research and firsthand experience to explain how symptoms like depression and anxiety are the body’s intelligent but maladaptive attempts to cope with an artificial environment—akin to trying to swim a fish in sand. He outlines how common psychiatric diagnoses are often merely 'disorders of the human experience' calling for more than a pill or label, and offers a path forward for people and practitioners who are ready for a radically integrated approach.

Listen to this episode of Mental Health in a Modern World to discover what most psychiatrists never learned in med school, which interventions outperform antidepressants in clinical trials, and how the future of mental health will require us to reclaim ancient wisdom as much as cutting-edge science.

5 Key Takeaways

This episode is a wake-up call to approach mental health with greater depth, curiosity, and self-honesty—here are five powerful ways to take action starting today:

1. Address the Basics First: Prioritize quality sleep, reduce caffeine, eat whole foods, and establish a safe environment as the fundamental building blocks of mental well-being.

2. Embrace Holistic Tools: Integrate exercise, nutrition, meditation, breathwork, and time in nature into your daily routine—these accessible practices can outshine medications for many.

3. Question the Status Quo: Think critically about the effectiveness of psychiatric medications and explore evidence-based alternatives; don’t accept the "chemical imbalance" narrative at face value.

4. Personalize Your Healing: Align your approach to what resonates with your values and beliefs, whether it’s therapy, lifestyle changes, or spiritual exploration—your buy-in is essential for success.

5. Take Ownership and Get Curious: Don’t wait for the medical model to catch up; seek out research, question your symptoms, investigate micronutrient deficiencies, and become an advocate for your own health.

Start today—pick one small change from this list and make it yours.

Memorable Quotes

"I think a lot of what we call disease is really just dis-ease with this mismatch of what we are designed for versus what we find ourselves in today."

"If anything is not smart, honestly, it's our environment, our environmental structure. The body is doing what it's supposed to be doing for a lot of people, but we have removed ourselves from the state of optimal conditioning for that body."

"I think of mental illness in a lot of cases as being kind of the same thing as an autoimmune condition. The immune system is trying to help, trying to do its best to protect, and the symptoms are a casualty of that response. Often these mental disorders might reflect the body's attempts to stay safe more than something being 'wrong' with the individual."

Connect with Jeff

LinkedIn - https://www.linkedin.com/in/jeffbohnen

Resources Mentioned

Win Friends and Influence People by Dale Carnegie - https://amzn.to/3VE3Oro

Antifragile: Things That Gain from Disorder by Nassim Nicholas Taleb - https://amzn.to/3z6zmBo

Diagnostic and Statistical Manual of Mental Disorders (DSM) by American Psychiatric Association - https://amzn.to/4bte2E1

Connect with Greg

Website - https://www.healing4d.com/

Instagram - https://www.instagram.com/4d_healing/

YouTube - https://www.youtube.com/@gregschmaus

LinkedIn - https://www.linkedin.com/in/greg-schmaus-22929589/

🎙️🎙️🎙️

Podcast Production & Marketing by FullCast: https://fullcast.co

Discover the best podcast services in the world at The Podosphere: https://www.thepodosphere.com/

Mentioned in this episode:

Embark on The HTM Journey

MHMW - HTM

Embark on The HTM Journey

MHMW - HTM

The body is doing what it's supposed to be doing for a lot of people.

But if anything, we have sort of removed ourselves from the state of optimal conditioning

for that body. I mean, it'd be like if you took a fish out of

water and you blame the fish for not being able to swim in the sand,

right? The body is not designed for the current environment. And so I think a

lot of what we call disease, disease is really just dis-ease with

this mismatch of what we are designed for versus what we find ourselves in

today. In a world moving faster than our minds were designed to handle,

Mental health is becoming one of the defining challenges of our time. Welcome to

Mental Health in a Modern World with holistic health practitioner

Greg Schmaus. After overcoming severe anxiety and OCD

in his own life, Greg dedicated the past decade to helping others heal

through a fully integrated approach to mental health, combining lifestyle coaching,

psycho-emotional healing, mindfulness, and archetypal work.

Over the years, he's facilitated thousands of sessions, Guiding people back to

peace, clarity, and a deeper connection with themselves.

Each week, Greg shares powerful solo insights, conversations with leading

voices in holistic healing, and immersive live coaching sessions that take you

inside the healing process itself. New episodes every Friday.

Follow the show and start reclaiming sovereignty over your mind in a modern world.

Here's Greg. Jeff, welcome to the podcast, brother. Yeah,

thank you for having me, brother. Grateful to be here. Yeah. So I'm excited to

dive into this topic with you. You know, you and I have been doing some

work for a little while now, and you've been

kind of on a unique journey going through medical school and

residency in psychiatry, but also having like a,

a deep passion and background in holistic health. So I'd love to

start with just a little bit of, you know, brief overview of your

story, your background, and what brought you into this area of

study and line of work. the work that we've done together, I think when I

look at my story, I can recognize it doesn't start with me. You know, it's,

I guess I'll start with the layer of looking back at, you know,

transgenerationally some of those influences and then some of my own personal experiences. But

I decided when I was 14 that I was going to pursue

psychiatry, that that was what I was interested in. There were a couple of other

fields I thought were, you know, really, really interesting, like emergency medicine,

sports medicine, but I, you know, ultimately was drawn to mental healthcare. There were

themes in my own path that sort of

mirrored some of the things I later learned about my ancestors. You know, like for

example, I have a great-great-grandfather who

was very interested in understanding plant medicine as it

pertained to different disorders at the time. And he would

very deeply study some of the mechanisms, you know, involved in some of these

disorders. And he would come up with ways they could use plant compounds to create

novel treatments for this. And this way of thinking, the research that he was involved

with later became the foundation of what we now call clinical

pharmacology, you know, and I can see the parallels and the

curiosity, the intrigue, the appreciation for nature, some of the things that, you know,

I'm now very much also practicing in the path that I'm taking.

So I do think there's a strong transgenerational

thread that's sort of woven into my own story, so to speak, in terms of

just my predilections of how I think through things or

the things I find interesting or feel drawn to do, you know, in terms of

my own personal experiences. You know, I guess

suffice to say, I was no stranger to the impact of mental

health, right? I'm descended on my mom's side from Holocaust survivors. There's a

lot of transgenerational stuff there, to say the least.

Not that my father's side is, you know, a stranger either to, you know, having

afflictions of the mind. Witnessed some, some things pretty early on.

You know, it was very much one of those things where, you know, in

academia, the world I find myself in now for residency, right? Like, It's one

thing to sort of stand at a distance and understand intellectually,

oh, you know, this marker is involved in depression, or this brain network is

XYZ. It's a whole different thing to go through a lived experience and see

firsthand what that suffering looks and feels like. So,

you know, with me having such firsthand exposure to some of these things,

it was one of those things where I wasn't on the sideline. I saw how

much this could really influence your outcomes, you know, in life,

your trajectory that you take through life, your internal experience. And so.

I felt very drawn to understanding these conditions and doing what I

could to be a part of the solution. How do we treat these things knowing

that there is, you know, currently this epidemic of a need for mental

health and, you know, afflictions of the mind? Yeah, it's beautiful.

You know, there's a big difference between direct experience and just

theoretical knowledge. You know, one of the things I'd love to explore

is going into medical school and,

you know, psychiatry and in residency. You're going through

conventional medicine training and, you know, Western medicine

training, but you're also coming with a strong passion and

background, and you could say core values of holistic

health. And so what has it been like for you to

hold the tension of those opposing forces? And

I guess, how have they been opposing and how have they been able to

be complementary in any way? Yeah. And to, to the

point of the latter, I've found surprisingly there are ways that they align. That

being said, there is definitely a lot of tension. The way I would

describe it, sometimes I feel almost like a double agent. You know, I have these,

you know, spiritual inclinations or like, for example, I remember I had one

case where, um, this was second year of medical school

and someone had come into the emergency department. I was on a trauma surgery

rotation. This person had shot themselves through the heart with a shotgun.

So they were bleeding out in a pretty vivid, gruesome way.

Uh, they ended up getting, I wanna say it was anywhere from 4 to 6

liters of blood. The human body only contains roughly 4 liters to begin with.

So, I mean, this guy had lost multiple humans' worth of blood in front of

me. And I remember as all this was going on,

I had this sort of spiritual,

intuitive knowing. Hmm. And I just knew it. What was funny was actually even

before I saw the patient, I had never seen a patient die. My entire

experience in medical school up to that point. But as soon as the

pager went off, I hadn't even seen what the page said. I didn't know what

it was. We'd had plenty of pages all month, but I just knew instantly I

was about to watch someone die. Something told me that before we read the

page. And then I saw it was a gunshot wound. Go to the trauma bay.

And I remember There was something happening energetically as

this person was dying that was not necessarily

immediately evident in the physical manifestations of what was going on.

Like in, for example, in traditional Chinese medicine, they have this concept of, you know,

there is not just the rate of the heartbeat,

there's the quality of it. Like, you know, a depressed heart beats differently

from an excited or joyful heart. And there is, you know, a certain

type of heartbeat that sort of signifies resignation. You know, I'm no

expert in TCM, but that's my sort of high-level understanding that they have

this qualitative aspect of how they assess the bodily function that we don't

have in Western medicine. We just kind of say, okay, that's a regular rate and

rhythm. You know, the rate is X beats per minute. You know, but I remember

it was almost like the way I could describe it as like a pulsation in

the air that gave me a sense of resignation.

Like it felt like there was something letting go of life

in the room. And I remember feeling that just because something in

my body, in my field, whatever you call that, just feeling there's

something here that's moving on. And as soon as I felt

that, within the next 3 seconds, I saw on the

monitor that the person started to flatline. Mm-hmm. Um,

but it happened before I saw the vital sign changes. But of course I

kept that to myself. I didn't say anything because I'm in a room full of

of surgeons and doctors, and they're gonna think I'm crazy if I say something

like that. You know, I just share that to illustrate what this was like at

times for someone who might be more inclined to think

through things in a non-physical lens. Western medicine is

the most materialist paradigm essentially you can come up with. I mean, this is

all about materialism. It's all about empiricism. You know, we see it, we

measure it. If we don't see it, we don't measure it, it doesn't exist. So

I have felt at times, to answer your question, like I'm sort of,

you know, one foot in this world, one foot in that world, and trying to

balance as I'm sort of doing the splits. And then you bring up value systems

too. There are stark differences in terms of the value system

for allopathic medicine versus holistic ways of healing. Even the

word allopathic, the origin of that word means other,

opposing force, right? So the idea in allopathic medicine

is Your blood pressure is too high. We will push in

an opposing force with, you know, our drugs, our treatments, and we're going to

make the blood pressure lower, right? We'll cut the cancer out. Very different

way of thinking compared to some holistic paradigms where this, there's this

idea of alignment with the body, right? Yeah, I've definitely experienced

dissonance just from a value standpoint. I think there is

also a very stark irony in Western medicine that we call

this health. care, quote unquote, and the people practicing it are

often incredibly unhealthy. We're essentially not allowed to sleep for

long stretches of time. I've had to do 24-hour

shifts, you know, as part of residency training, which is completely not

compatible with human physiology, but it's just what we do.

80-hour work weeks, all of that stuff. I've gone 11 hours at a

time sometimes without even drinking water because of the demands of the hospital.

And to call that healthcare, I think, is such a ironic thing to say

if you think about it. So I think, you know, multiple levels of dissonance. In

terms of that being said, where is there

alignment? I do think there's a lot of value in having perspectives

to bring to the table beyond just the Western

scientific lens. For example, if a spirit, a spiritual

crisis is part of a patient's presentation, which sometimes it is,

to have a language To embody that, to have a

conversation about that with a patient, that can really be helpful for patients.

I think if you can bring those perspectives to the table, there's definitely demand

for it. Not to say that that is always

something that would be embodied by the people, you know, in terms of the

practitioners in the system. I think people in the Western medical

system tend to be more empiricism-focused,

more this idea of objectivity-focused. Um, which is kind of at

odds, you know, with non-material thinking or spiritual thinking. That can be

difficult, but I, the way that I see it is I think, you know, these

are just different ways of telling a story, right? The scientific model is

one way of telling a narrative, one way of seeking truth, and there are

also other forms of knowing. And I think it helps to

be able to go through both perspectives and, and see what

they can offer rather than limiting yourself to one or the other.

Yeah. You know, one thing I'm really curious about, you know, you

mentioned earlier how Western

medicine has really

divided, you could say, spirit and matter and

really focused more just on what's weighable and more like

scientific materialism. And

that might make sense if you're working with a bone,

like a broken femur or something. But in psychiatry, you're

working with the psyche. And so I'm curious, what

have you seen be the consequences

of that division of, you could say, soul

or psyche and physical matter in the

field of psychiatry? Oh yeah, that's a great question. There's a

lot there to unpack. Exactly to your point, The, the word root

for psychiatry comes from soul. You know, the organ system is

the souls, you know? Right. So it's so ironic that we take the

exact same model of this materialism-based model

and we try to just neatly fit that into psychiatry. You know, as you can

appreciate, there have been some issues with that. So I guess where to

start with that? Well, I guess the DSM is a good place to start. There

is a stark division, right? So we use the DSM, the Diagnostic and

Statistical Manual. Yeah. to classify disease states in

psychiatry, you know, and this is all in an effort to make

psychiatry objective and materialist-focused in

alignment with the rest of medicine. If you look in the DSM,

what's interesting is that there is not a single biomarker in any

of these descriptions. These are all constellations of

subjective elements of the human experience. And to date,

I mean, they're working on, this is a, you know, an evolving point of research.

They're working on, you know, what biomarkers can we use to understand Mental illness,

but for them to even operationalize mental illness, they

couldn't keep it within the bounds of a biomarker. They had to stay within this

sort of subjective way of thinking. But then what's ironic is

you look at all the treatments, right? So the diagnosis of mental illness is subjective,

right? All the treatments are biology-based, right? At least on

paper they are, right? You block the reuptake of the serotonin

transporter. So therefore you have more serotonin in the synapse and that

is thought to help depression, right? That's a very biological way of

treating something. So we use these non-biological

subjective categories to then apply these biological treatments

that often are really missing a big part of the picture. To your point,

which I think is what this boils down to, is a point of diminishing

returns and potential harm with being overly reductionist

of the human experience. When we're dealing with mental illness, we are dealing with

you know, disorders of the human experience, which may be in

their very nature, spiritual crises or whatever that might be, right? If we just

reduce that down to this, we are limited. Like even take for, for

example, depression. If we just take this model of, you know,

depression as a deficiency in serotonin, block the reuptake of

serotonin by blocking that transporter, you get more serotonin, depression's

fixed. I mean, this is even in mainstream scientific culture

is now within medicine, this is largely debunked that we think of depression this way.

It's not simply a deficiency in serotonin. It's a lot of,

you know, data that would indicate it's much more complicated than that. And there's much

more to depression than simply serotonin. You know, but even if you zoom

out beyond neurotransmitters, there's so much more to this, you know, so much more that

we're missing. And I think if we become too

rigid in the way that we think about some of these disorders, we're limited in

the treatment approaches. And I think that's ultimately reflected in

the limited efficacy of a lot of these treatments. You know, I think they're, depending

on who you ask, like there, there are cultural divisions. Some people are very

pro-psychiatry and they think this is, you know, like hope in a pill form,

essentially. Like if I take this pill, I'm going to fix my problem and I

can't wait for the chemical imbalance to be fixed. And for some people that works

great. You know, that being said, how much of that is their own expectancy

or their own belief in the treatment is a whole nother topic, but it does

work for certain people. And then there are people that just feel like this is

a scam. Keep me away from this. Don't mess with my brain. I just wanna

like meditate, go work out. And then, you know, I can empathize with that too.

Obviously there are people that are very anti-psychiatry. But anyways,

you know, I think you'll find that largely these, these

treatments have a limited window of efficacy and for a lot of people they are

not the answer. And so then the question becomes, where do we go from here?

Which I think comes full circle back to the question of how do we define

you know, the diagnostic and treatment paradigms for these disorders. And I think there's a

lot of room for growth beyond what we currently have. Yeah, it's

beautiful. A couple of things. Number one is

it sounds like the whole idea of mental

illness, let's take depression, for example, being a chemical

imbalance in the brain. Would you say that is

psychiatry's attempt to try and fit These

answers into the preexisting model?

That, and honestly, it's great marketing. I think when you're trying

to position this idea of giving an antidepressant, right, when this was

first coming out, how do you make that make sense to people? Sometimes we

oversimplify because that's how the message can catch on. You know, when you get

into the nitty-gritty, some of these research studies where they try to really quantify,

like, are we seeing deficits in serotonin? And there is data to

indicate that might be the case, there's also data to indicate that it may

not be. So I think there is this element of oversimplification.

You know, where does that come from? You know, this idea of fitting into the

mold of other fields of medicine. Honestly, I think part of that

too is that medicine has sometimes been a victim of its own

success. And we all are as human beings, sometimes victims of our own success, right?

We figure out this thing worked for this case. And so now I need to

use that, right? Like you take, for example, infectious disease, right?

Western medicine is largely not delivered on a lot of fronts. You

look at like chronic illness, there's an entire epidemic of chronic

illness that, you know, just giving pharmaceuticals, you can control symptoms, but we're not

reversing these disorders, right? We're often just kind of controlling them to an

extent. But infectious disease is an area where medicine has really

excelled, right? Vaccines eliminated certain

conditions. You had, you know, antibiotics that could cure

syphilis and cure all kinds of stuff, which were big deals back in the day.

You know, you could get rid of these disorders. You know, and the idea of

this, you know, foreign invader or some sort of imbalance in the system, right?

You have like a, you know, infectious pathogen, some sort of

virus or bacteria or whatever it is, right? And then you find some sort

of unique marker that thing has that the rest of the body doesn't have,

right? Like penicillin, you're targeting this specific binding protein that's

used to build the bacterial wall, for example. You have a drug that tries

to target that thing that destroys the bacteria with hopefully minimal

damage to your own tissues, right? And so you, you have a clear,

succinct mechanism of action that's targeted. Importantly, it's

patentable, right? That's important for the whole model of research. And then you

sell a drug that targets that one specific thing, and it worked for certain

diseases. So then they try to apply that to a whole bunch of other stuff,

you know, with mixed results in psychiatry, right? You know, like, um,

you have the antipsychotics, you know, which are targeting dopamine receptors in the brain.

Mood stabilizers are a bit more diverse as a class, but they're affecting

these sodium channels essentially that control excitability. Or

lithium is unique in its own way, to give some quick examples there. And you

have antidepressants, which are affecting serotonin. These are all

patentable compounds that are targeting these very specific

granular mechanisms in hopes that we can, the same way you can cure

syphilis, you can cure depression. Has not panned out to be the case.

And I think It's kind of that victim of your own success kind of

thing. Like you try to apply that model, doesn't fit clean. Dementia is

a great example. They thought, let's just find that one mechanism. If we find the

thing, we can cure dementia. I think the issue is when you're dealing

with more complex disorders of the brain and mind, these are

multi-mechanistic, multifactorial. You can't just hit that one thing and

think you're going to get lucky unless you do. Sometimes that happens, but it hasn't

panned out that way. You know, it reminds me of the old saying, when all

you have is a hammer, everything looks like a nail. Yeah. That's what I was

visualizing in my head as I was saying. Yeah. I'm

very curious also over the last probably

10, 15 years, the research on the

microbiome has, you know, blown up

in science and medicine, especially in holistic

health. And, you know, one of the

facts that we've all come to know is that over 70%

of our serotonin is made by our gut bacteria. And so when new

information like that comes into

the field of awareness and medicine, what do you

find? What have you experienced? Because I know you've had some personal experiences with

this, their capacity to accept and

integrate some of those new findings. Especially when

it might shift things in terms of their already

working model? Yeah. Yeah. Great question.

Capacity for change. Yeah. And it's one of those things. It is a

very delicate and tactful endeavor to partake in

because in medicine, right, you invest so heavily,

right? You give up your 20s, parts of your 30s often. You're, you're

so deep in it. You've been studying for years and years and years.

Um, it can attract people. I'm not saying this is across the board. You can

definitely see people in medicine where their identity gets attached

to this sense of power, knowledge being power,

right? I have the answers. So if someone else has an answer to

a question that I didn't have, there's another way of thinking about this, that can

be threatening and it may not be a conscious recognition, right? And so I'm

very wary of that if I'm navigating those conversations.

Kind of like how in the, that classic book, Win Friends and Influence People, you

know, one of the rules is never tell someone that they're wrong. You just don't

do it because they will just double down on why they're right. I'm wary of

that and just, just mindful of broaching conversations if there is

an additional piece of information. That being said, ethically, I mean, like

if you have a patient, for example, who has some, you know, maybe gut

dysbiosis or leaky gut syndrome that's probably affecting their depression or anxiety,

I mean, it would be— Yeah. Ethically wrong for me to not broach that

topic if it could be of benefit to that patient. I've been in situations

where I happen to know of research that could be beneficial to a patient, you

know, for this case, have we tried this? You know, like, and have had to

navigate those conversations. It's a very difficult thing to do, honestly.

I have definitely been in that situation. Well, and I'll at least try to offer

what I can, you know, in terms of how receptive are people to it. I

think it all depends on how you have that conversation and honestly who that person

is and their value system. Their relationship with these

themes of power, knowledge, hierarchy, those sorts of things. Some people

are super open-minded and they're just like, oh, that's so cool. Like, yeah, send me

the studies. That's great. Let's do it. You know? And so you do come across

those people. You also come across the opposite where even if you

show them the study, some people are just not going to be receptive to it

because it wasn't part of their conventional training. Right. And so they're just more

conservative with input of new knowledge. And my role being a

trainee, you know, I kind of have to draw the line, right? Like if they're

ultimately making the call, I can say, here's a study that showed this

patient profile that, you know, the population that matches that, and they saw this

benefit and, you know, with this intervention and the intervention is

extremely benign and it's cheap. So there are reasons to try it, but ultimately if

they don't want to try that, my hands are ultimately

tied until I'm practicing on my own outside of residency. Right. But. I will

say, generally speaking, if you have good research to back it up, people are receptive.

So I think, you know, most people end up kind of in that middle category

where they're not necessarily going to, you know, jump on board like, yes, let's do

it without ever reading, you know, reading the study. They're not necessarily completely closed

off. Generally speaking, people in the medical world

prescribe to the, you know, the scientific way of thinking, you know, which

is if you can show me, you know, with clear objective, or at

least quote unquote objective, I don't think anything's truly objective, evidence

as best as you can that there's a compelling case for this and that it's

effective and safe, then yeah, let's give it a shot. You know, and so that

is, you know, why me personally very drawn to research because you can

push the needle, you can change things. So I've, you know, got involved in my

own clinical trials and I've been able to, by sort of being that

translator, you know, of saying in the language of science and the language that this

is, you know, what we use in this culture, here are the ways we can

think about it. Here are objective biomarkers that we can use to gauge response. Here

are placebo-controlled trials that show this thing is clearly doing something. Here are the adverse

If I can speak that language, then I can maybe

sway some hearts and minds to consider ways of healing that they previously had

not. And I think much broadly, way more broadly beyond just my own

experience, you know, in the system, this is happening across the board. We

are now like adopting different types of therapies.

Meditation has become mainstream, right? Exercise is widely

recognized as being beneficial for mood. Yeah. You know, now they're looking at, you know,

ketogenic diet for bipolar disorder, you know, for, you know, mood

stability, that sort of thing, which would have been crazy to say even 10 years

ago as a result of research. And so I do think you can push the

needle. It's one of those things that can be very slow. And

I think you have to be very mindful of the psychological dynamics at play

because as much as people want to put on this idea of we're all

objective and we're just making clear, rational decisions, It's never that

simple. Yeah. And based on your research,

what have you found in terms of the effectiveness of

SSRIs and some of the kind of mainstream psychiatric meds?

Yeah. And with SSRIs, they're honestly, it's

a whole can of worms to get into. So I'll try to be as succinct

as I can. What I'll start with is what the classical teaching is, what

they'll tell you, or if you like look in the lay press, what people will

often say about antidepressants. They'll throw out this idea,

antidepressants work for about 2/3 of people, you know, 67 or 70%

of people. That's what people will often quote. I can tell you

that honestly, that is not accurate. Where that came from

was what was considered actually a landmark trial in

psychiatry called the STAR-D trial, the

Sequenced Treatment Alternatives to Relieve Depression trial.

This was a $35 million trial. that on paper was supposed to be

great. It was actually primarily funded by the government. So the

idea is that it was potentially more free from bias,

you know, and then you had thousands of people, they took a number of different

antidepressants. They were trying to compare, you know, which antidepressants

outperformed the others. Later, especially in recent years,

this was critiqued. There were a couple issues with it. The

principal investigators had a huge amount of financial ties

to different pharmaceutical companies. I've seen quoted

151 collective financial ties to different companies

amongst the 12 principal investigators. And I've seen

quoted 8 out of 12 had direct ties to the company that

manufactured citalopram, which was the primary SSRI that was

used in that study. Some of these financial ties included,

you know, speaker engagements, quote unquote, which means they would fly you

out to some tropical resort and pay you, you know, tens of thousands of dollars

to speak for like an hour, those sorts of things. And also holding stock in

some of the stocks that were involved in, you know, in these drugs.

You know, so anyways, there was a lot going on under the hood that would

indicate maybe this wasn't quite as unbiased as it might seem on paper.

And then when you actually got into the methods of how they reported this, you

know, where this idea of efficacy largely came from, there was a

lot of smoke and mirrors and a lot of things that are just not good

evidence-based medicine, right? This just wasn't good science. For

example, in that study, They had made up this new outcome

measure. They called it the QIDS-SR, and this is what they ended up

reporting. You know, when they reported their outcome measure of effectiveness

in their protocol, they had explicitly stated they would not use that measure

because it was unblinded and not intended to be used for research outcomes. They were

supposed to use what's considered the gold standard, the Hamilton Depression Rating

Scale. They also had done this thing where they would,

if someone went into remission, so it was stepwise, it's like if you didn't respond

to the first antidepressant trial, then you would go to the next step.

And sometimes people would've gone into remission for starting

that next step, but then they included them as being

responders or remitters, so to speak, to that antidepressant treatment they never

even got. So they did some statistical gymnastics, I guess you could say, to

sort of inflate some numbers. They, there were a lot of

dropouts in the study, huge amounts of people dropped out, and they actually

took a huge chunk of those people and just assumed that they went into remission

and included them in their reported remission rates, even though Scientifically,

we know that people who stay in clinical trials and people who drop out of

clinical trials are not equivalent. 2 most common reasons people drop out,

usually lack of efficacy and side effects. So to assume they're equivalent is a

big scientific no, you shouldn't do that, but they did. And also there was

no placebo control for the entire trial. And the placebo response

and remission rates for depression are quite profoundly high.

You know, like response rate, meaning an clarify, response typically means a

50% reduction in the severity of depression. So you

score the depression. If that score goes down by over 50%, you're a

responder. If it goes down so low, you no longer meet

criteria for depression. You are now in remission, so to speak. But

if you just give someone a sugar pill and watch them for 6 weeks,

35, 40% of those people will respond, you know? And so

anyways, they didn't control for that at all in this study. So with

all of those smoke and mirrors, You know, and changing their outcome measure, et

cetera, they came up with this number of, I think it was 66 or

67%, and then they just rounded it up and that's where the

70% came from. When you actually look at the numbers compared

to placebo, you know, which really in research should be the gold

standard, the numbers you end up with, there's this concept of number

needed to treat, you know, which I think is the simplest way to answer your

question of how effective are these drugs truly. Number needed to treat, it

depends what numbers you're looking at. It's one of those things where they say,

the idea is everyone can have their own opinion, you can't have

your own facts. That's no longer true. You can have your own facts. It just

depends where the numbers came from, where you're looking, what source. But at least from

what I've seen in the literature and what's often— Number needed to

treat just means if I give this many people a

drug, how many of them will have a response or

remission they would not have achieved With a placebo pill. That is to say,

how many people do I need to treat to just get one response to

remission I wouldn't have otherwise achieved? For response,

that number is about 1 in 7. And for remission, that number is

about 1 in 11. So that means if we're taking remission, meaning you

go out of depression, 10 out of 11 people are

going to get the same response with that antidepressant they would've had with

placebo. They're no better off with the antidepressant than they would've been with

placebo. 1 out of those 11 people will go into a remission they

wouldn't have otherwise achieved. So when you actually look at it that way, that's over

90% of people are not having a remission they wouldn't have otherwise achieved

with placebo. And then it, you know, is it a shock then that we

see so many patients come in and they've been

on 5 or 6 or 7 or even 10 drugs and they're, they're still

extremely depressed or extremely anxious, et cetera. So There are limitations.

Those are not astounding numbers. You can dress 'em up and you can do those

statistical tricks, you know, honestly, that have been, you know, employed by certain

researchers or companies to make things maybe appeal a little bit more. But this has

been a big area of criticism in more recent years in psychiatric research

that we need to be better scientists, you know, in how we're thinking about these

things and recognize the limitations of these treatments.

Yeah. Beautiful. Beautifully said. And I'm

curious how some of the alternative

therapies such as, you know, exercise, nutrition— it's funny that

those are considered alternative— exercise, nutrition,

meditation, breathwork, community, time in

nature. How do the efficacy of those

treatments compare based on what you just shared

statistically? That question I think is so

important, right? Because it informs everything, which to your point exactly, why do we

consider that alternative? You know, like, why is exercise or just

changing your diet or having a community considered edgy or like

rebellious, you know, but to take a patented pharmaceutical that probably

has limited efficacy for most people, that's considered normal. You know, this just

shows you the social conditioning, you know, how we can shape the way

culture thinks as a result of financial interests and marketing. But— Yeah.

Yeah. In terms of how they compare, to really answer that question,

we would need multi-arm randomized controlled trials.

Meaning, for example, if we were to compare like saffron, for

example, or like curcumin or different things that have been

tried for depression, for example, you would want head-to-head trials

where you have, you know, one group gets escitalopram, you know, an

antidepressant, and then this group gets, you know, the saffron

extract and this group gets the curcumin extract and this group gets the omega-3s or

whatever it might be. you know, Mediterranean diet, whatever you're trying

to compare it to, right? You want to compare things in that

format to really gauge how do these things compare

head to head. Yeah. Now, from the standpoint of funding those

trials, because most of the funding for phase 3 trials

comes from private companies that have a vested interest in

proving that their drug is effective, right? These are not

cheap. You know, average costs to, to bring a drug to market, I've seen

estimates as high as $2.8 billion. $1 billion is probably a good ballpark.

These numbers are inflated because they're also, they're writing off their

expenses from all their failed trials, you know, as well that are sort of wrapped

up in those projections. But suffice to say, I mean, it's hundreds of millions of

dollars if you want to do these trials. So if you're a drug company,

why would anyone pay to compare their drug to something

that is cheap, over-the-counter, potentially safer, and

might even outperform their drug? I mean, they're essentially buying their way out of

their own Profit margins. They're essentially paying to

research the competition. So, you know, as a result of the financial

structures and incentives at play, we just haven't seen many of those trials. When there

are head-to-head trials, these are few and far between. When I've seen them,

you kind of have to search the literature to even find them. And they're often

going to be small investigator-led studies, like maybe someone at a

university or an academic center wanted to, you know, study one

of those specific things. Let's say they wanted to compare the curcumin versus

antidepressants, whatever it might be. There's some studies on, um,

Selexin, which is a lavender extract where they compared it to an antidepressant,

for example. Um, and it, it actually did, did a bit better than the

antidepressant. These are hard to find, these studies. Mm-hmm. Um, and they're usually not going

to be large phase 3 trials. So to really answer that question of how do

they compare, you have to extrapolate or just throw up your hands and say, we

can't make a perfect comparison with the existing evidence.

One thing that you can do, which was a project that I took on myself

to try to get some sense of comparison, is you can turn

things into what we call standardized mean difference. And that's essentially a

standardized unit where you're comparing an outcome. And, you know, so

classically that should be reduction in symptoms with the

treatment versus reduction in symptoms with a

placebo, right? And so then compare these outcomes. You do this

You know, you use some statistics that spits out a number and it gives you

essentially a gauge of how effective that is. And we call that a standardized

effect size. Okay. And these are ways you can now compare things across studies.

You are extrapolating, right? Because now you're comparing the way that

said outcome was calculated in this study to this study, which might've had a

different population, you know, different investigators, different geographic location,

right? So this is not apples to apples, but if you try to do that,

Honestly, antidepressants end up being not that impressive. Like the

standardized effect size for antidepressants for depression,

accounting for publication bias, is roughly 0.31, which is

considered a mild, modest effect size. Then,

you know, you take, for example, they had a study on whole body hyperthermia for

depression. So this is essentially like a scientific version of a

sauna. You stick someone in a tube and they even had a sham

condition where they would turn some lights on and there'd be noises and the people

thought they were getting the treatment. Over 70% of the people thought they were getting

real hyperthermic treatment, even though it was a sham in that case. So it shows

you that they had actually effectively, for the most part, replicated

some sense of, I'm getting something, you know, replicated some of that placebo aspect.

Look at that study, small study, you know, again, not apples to apples, but the

effect size blows antidepressants out of the water, right? So I

believe that one was in the ballpark of 2-ish, you know, compared to

0.3. Mm-hmm. So direct, That being

said, yeah, there's, you can't

truly answer the question. If you're a devout scientist, you need to do those studies.

I just don't see them getting funded. But I do believe from what I've

seen that there is at least signal to suggest that we

really should not be ignoring some of these more ancient forms of healing, that

not only are they safer, but in many cases, they, at least from what

we're seeing, may even be more effective than conventional

Ultimately what it does hinge on though, you know, like I said, there was a

such, there's such a strong placebo piece for depression especially.

So belief, expectancy, what do they expect to happen?

That is such a core piece of healing. So I think what it still boils

down to is what is the patient invested in? What do they

believe in? What do they think they would be aligned with versus what they would

not be aligned with? And I think you kind of have to meet the patient

where they're at. You know, if I came across a patient that You know, was

like, nope, I don't wanna do any dietary changes, nothing. I'm not

interested in that. I don't even wanna do therapy. I just want an antidepressant.

Honestly, that person is the most likely to respond to an antidepressant, even if we're

mostly seeing a placebo effect because of their belief in the treatment.

So I still think there's something to be said for meeting people where they're at,

but I do think largely Western medicine has

underestimated some of the other forms of healing. Yeah.

And the Hippocratic oath, first, you know, do no harm.

Obviously, you know, like exercise, nutrition, you know, meditation,

breath, like these are free technologies for the most part that,

you know, have really no side effects. You know, I'd

love to get a sense of how

you perceive mental illness in

comparison to how mainstream or

conventional psychiatry and medicine perceives mental illness. So

what's the difference between how you

perceive, I guess, root cause, where some of

these, what we're calling pathologies come from versus kind of

what you learned in your education? Yeah, there's a lot there.

And it's one of those, it's one of those things where it depends

goes a long way, you know, as you appreciate nuance. To answer that,

I think of it almost like the immune system for the mind. And I'll explain

what I mean by that, right? Like drawing on this parallel, this idea of, can

we think about these things abstractly as having parallel themes?

You take an autoimmune condition, for example, right? Let's say you have a child

who eats a bunch of processed food or, you know, they get exposed to a

virus early in life. Their immune system gets angry

and it starts attacking some of their own organ systems, you know, or some of

their own tissue. Right? And they end up with an autoimmune condition. Okay.

The immune system is trying to help that child. The immune system is

trying to do its best to protect against said, you know,

invader of the system, right? It just so happens that the

inflammation or the symptoms are a casualty of that

response, right? The body, kind of like how in like IFS, you

know, this idea of there are no bad parts, these are benevolent processes.

At their core, right? You know, the immune system responding to said stimulus is

trying to help you. I think of mental illness in a lot of

cases as being kind of the same thing, right? Like you take, for

example, post-traumatic stress. You have a child that grows

up in an abusive home and they learn, I have to be

extremely aware of my environment because if I'm not, bad things can

happen. I have to be very attentive emotionally

to what my attachment figure is experiencing because they might explode

and abuse me or abuse my mom, whatever it might be, right? So Their nervous

system becomes hypervigilant, becomes hyper-aware, and they

learn to walk on eggshells, which makes sense in the context of that

environment. Right. You know, so you have this response, which is

benevolent in its intention, but then when they leave that environment,

they can't have normal relationship because they're just so on edge. Right. You know, so

you have this casualty of that response. I think a lot of mental

illness is, you know, essentially the bystander

effect. Mm-hmm. Well, not the classic psychological definition of that,

more just we're seeing casualties from what

underneath might actually be an attempt to keep the system safe.

Depression, anxiety, post-traumatic stress disorder. These are meant, at

least by the body, to be adaptive processes, but they can become

maladaptive depending on context. Depression as well,

I think, is an interesting example. There's a lot of

research that would indicate depression is meant to be more of an episodic

state. And also there's a strong link between inflammation and

depression, you know, sickness behavior, as they would call it. You can actually

create depression in animals by inducing inflammation. You'll create

behavior that looks a lot like depression. They'll sort of become socially withdrawn.

They won't expend as much energy. You're sort of reallocating metabolic

resources to fighting off the infection, not spreading the pathogen, which

is why it's theorized that maybe we see the social withdrawal as part of the

state, you know? And so that would be adaptive, right? That would be adaptive in

a tribal setting. Problem is, what if the inflammation is not

from, you know, an infectious disease? What if it's from our environment, from pollution,

from food, from chronic low-grade inflammation? And now this episodic

state is never turning off and you just get stuck in the state of depression.

Now it's a problem. All that is to say, you know, I do believe that

there is a benevolence, generally speaking, to the body, you know, and often

these, you know, mental disorders, as we call them, might reflect

that more so than, oh, there's something just so wrong with you as an individual,

you know, or Yeah, I guess that's how I think of it, at least. I'm

sure there are exceptions to everything, but. Yeah. So what I'm hearing is

that 2 things. Number one, that you see it more as an adaptive strategy

than a pathology. Well, I

guess I should, I see it as an attempt at being adaptive,

like the body's best attempt that can sometimes become

self-destructive or limiting. Yeah. Not coming. It's not like the body wants to

inflict suffering as its core motivation, so to speak. There's an

intelligence to the body, not perfect, but it's a very smart system,

you know? And that's how I think of it, that the body has good intentions

when it's creating a lot of these states. You know, what comes up for me

as you're sharing this is, you know, I'm of the belief

that the body is, and well, let's include the brain as

kind of part of the body, part of our physiology, our biology.

It's so intelligent and

it's never intentionally made a mistake.

And it has billions of years of biological

intelligence built into every cell. And so

what I have found in medicine, there's this perception that the

body or the brain, like, made a mistake in some way.

Like there was some like mishap or mistake that was

made rather than really understanding the

adaptive nature and how sometimes the adaptive

strategies end up expressing these symptomologies.

It sounds like you're kind of aligned with that as well. Yeah. And

if anything, I would think, you know, the other thing that's coming to mind, or

we, like you said, we've billions of years of intelligence in our bodies.

What's changed, if anything, is the environment. Yeah. You know, as human beings,

we've created this artificial environment, separated ourselves from

nature, created these boxes that we put ourselves in.

And meanwhile, the body hasn't caught up, you know, in

terms of our genes, right? You know, our genes are still built for an environment

that was much older than what we're living in now, was, you know, made for

resource scarcity, you know, food scarcity, entrainment to the

sun's natural rhythms. You know, like we didn't have artificial blue light, we didn't have

fridges, you know, we didn't have Addictive substances or

addictive devices, those sorts of things, right? And so

if anything is not smart, honestly, it's our environment, our environmental structure,

right? The body is doing what it's supposed to be doing for a lot of

people, right? But if anything, we have sort of removed ourselves from the state of

optimal conditioning for that body. I mean, it'd be like if you took a fish

out of water and you blamed the fish for not being able to swim in

the sand, right? The body is not designed for the current environment.

And so I think a lot of what we call disease is really just

dis-ease with this mismatch of what we are designed for versus what we find

ourselves in today. It's another layer I would add to that as well. Yeah.

Beautiful. That's why Gabor Maté talks so much about us

being biopsychosocial, you know, beings, and you can't

exclude any of those. I actually think we're biopsychosocial spirituals. I

think there's 4 dimensions to it, but I'm glad you really touched on

that. You know, I love the research that you do, and I'm very curious

what you have found in terms of some of the

metabolic, nutritional, and

inflammatory factors when it comes to

some of the mental illnesses, whether it's nutrient deficiencies,

chronic inflammation, or metabolic health?

Yeah, all, all of them play a role. I mean, I'll say one thing about

nutrients too. One thing is a lot of doctors won't even check

micronutrient levels, which to me blows my mind. Like for example,

you know, I mentioned trying to compare to the extent that we can,

some of these forms of healing or micronutrient nutraceutical strategies, et

cetera, to conventional treatments, the effect size for just

repleting someone's vitamin D is extremely high,

higher than the effect size versus placebo that we see for antidepressants. You know, so

you would think that's a pretty low-hanging fruit example, right? Just if someone's low vitamin

D, bring their vitamin D back up, right? Oftentimes what I've

seen is in psychiatry, we don't even check vitamin D levels. That was something that

I started encouraging In the context of my own program, it's such low-hanging

fruit. Largely, it's not even what you see. So, there's one, there's the issue of

do people even check for these things? 2, even if you check, you know,

if you want to incorporate some of these strategies, the normative

measures, so to speak, if you have a quote-unquote normal range for a lot of

these micronutrients, for like magnesium, for example, you know, for

vitamin D, we are extrapolating in the sense that what we consider a

normal vitamin D level Largely that research came from

osteoporosis in postmenopausal women. So how do we know that, okay, sure,

this vitamin D is optimal for preventing, you know, a bone fracture

with osteoporosis if you're postmenopausal, but that doesn't mean that's the right vitamin

D level for mental health. That could be a totally different measure. You know, take

magnesium. Magnesium, highly implicated in anxiety as

well as depression. But the normal measures, so to speak, if you look at the

lab ranges, are largely just based on how low can I

get in magnesium before I have Life-threatening arrhythmias and

cardiovascular complications, you know, so that level doesn't

mean that's optimal for your mental health, right? We're talking about different things. So

that's the next barrier in terms of how you incorporate those things is we probably

have to shift what we consider normal levels. And that requires more research

as well. Take magnesium, for example, less than 1% of your

magnesium is even floating around in your blood. Most of it is in your cells.

And we're not measuring intracellular magnesium when we get those labs. We're actually

measuring what's floating around in the blood, which may not give you an accurate sense

of what's going on in someone's body, right? So, but anyways, not to get too

tangential there, but if let's say you, you get past the first

barrier, you start actually thinking about these things, and then you have to

extrapolate or navigate some of the nuances, you know, what we consider normal

measures for micronutrients and all those things, then you can incorporate some of these

treatments, which can be quite effective, I think, if there is a

deficiency, you know, and sometimes, you know, people will have chronic

Migraines, muscle tension, anxiety, insomnia. Like when you hear those

constellations, that's telling me, you know, micronutrient deficiency. And there is

a feedback loop as well in the sense that people who are very depressed, very

anxious, may disrupt their eating patterns. This can become a cycle, you know, and

then that micronutrient deficiency as a result of reduced intake

can further worsen their mood state and they just end up in a loop. No

one's looking at that. But yeah, I do believe there is a lot of

value in trying to address those things. And then I just make sure I'm closing

out the original question, that is to say, what do I consider to be the

most effective forms of that? Or make sure I'm on track there. Sorry.

You answered all of it. Yeah. Yeah.

I do think that micronutrients, diet, nutrition, all of that stuff can go a

long way. Sorry if I rattled that. Beautiful. Beautiful.

And so if you were put in charge to

restructure the Medical school

and psychiatry education, how would you

start by restructuring it? I think nutrition is a

key piece. I had one week of nutrition training in medical school. It

was an open book test. I was grateful I had it, but I missed all

of this. And it was all about like, how many calories are

in 1 gram of fat? How many calories are in 1 gram of carbohydrates? But

it wasn't, how can we use micronutrients or nutrition to

heal? disease states. That wasn't really mentioned a whole lot.

Would've been good to know. You know, now with the research we have that ketogenic

diets, for example, can maybe stabilize bipolar disorder, that's

good information to have. That was never something that was taught to me in

medical school. I think incorporating nutraceuticals, I

think can be helpful at least to speak that language with patients. 'Cause often patients

will ask about this stuff, but it's not part of conventional training. I had to,

ended up taking 19 online courses during medical school. Um, so that I

could educate myself in these things and a lot of, you know, self-education that was

not something I ever learned through the conventional programming. I had, I

think, one, a 1-hour session where we talked to someone who was like a

homeopathic provider and they just gave us a little, you know, spiel about what they

did and that was it. And that was our entire integrative curriculum in med school.

You know, I think there's value in thinking through those things. Um, the pushback that

you often get with med school is, well, you know, it's such a traffic jam.

There's too much stuff that we have to know. You can't add anything. So I

think honestly, a lot of what I would do with medical education is taking stuff

out, you know, like trimming it up because I think there is a lot of

unnecessary education, you know, like, you know, and a lot of these

drugs that we're memorizing, we're memorizing all of these pharmacological

things. They're probably gonna be irrelevant in like 5 to 10 years anyways, if I

even practice them, you know, like I, as a psychiatrist, probably

do not need to know, you know, these extensive, you know, like

cardiovascular regimens or cancer regimens that really, People want that

care, they can go to those providers and get it. I do think there has

to be a little bit of room to breathe in the curriculum. And I

think rather than thinking so much about

what to think or what to know, I think we should be thinking more about

how to think, you know, like, right? Like, how should we be thinking

about disease states? What are different models through which we can do this? And if

we really understand what is going wrong in some of these conditions, approaching it from

multiple angles becomes a lot easier. So yeah, if anything, I would probably

decondense it and also give people more time to take care of themselves. I think

that's like largely lacking is your own health in medical school. And if our

providers are not healthy, how are they gonna help patients be healthy?

Yeah. Beautiful. And if some of our listeners are,

you know, struggling with some anxiety disorder,

depression, um,

what would your recommendation be for them as a starting point? Let's say

someone's just entering this territory. They thought about going to a

psychiatrist and getting put on a med, but they're possibly

entertaining— if they're listening to this show, they're probably entertaining

some different approaches. What would your initial recommendations

be? The first thing I would say is, right, we're

dealing with disorders of abstraction, disorders of the mind. I

think the first shift is just knowing that you are not alone,

that there are so many people suffering more than you could

imagine. Because this is not a broken bone, like you said, right? I'm

not walking around limping. You can't see those sorts of things. Just know that you

are not alone in your suffering. First, normalize the experience. I think

stigmatization is, you know, such a big piece of all of this that I think

needs to be reversed. And even within medical culture, there is

stigmatization of it, ironically. So I think that's really the first piece, you

know, like you're not alone in this and there are people who have gone through

this. There are ways that you can feel better. You know, like recognizing

that benevolence oftentimes, right? Like the anxiety disorder you're dealing with,

the depression you're dealing with, that is your body trying to rectify a situation.

How can we work with your body rather than trying to fight with your

body, right? I think that's a key mentality shift that I'm a big fan of

in the work that you've done. I think that's really crucial to the healing process.

And then I think come back to the basics, right? Think of Maslow's hierarchy of

needs, right? Nowhere in the hierarchy of needs is there SSRI,

right? You start with sleep. You start with, you know, having a roof over your

head, having safety, freedom from abuse. Like those are basic

things, right? Like if someone is homeless or in an abusive

relationship and not sleeping at all, you know, like how much help am I

going to offer them if all we have to give them is an SSRI, right?

So I think you first have to start at the base of that pyramid and

meet those basic needs of sleep, nutrition. I'll try to go through what is a

patient eating? Simple things. Oftentimes people will come in and say, I'm so

anxious. I don't know why. And they're drinking 5 liters of caffeinated soda

every day, wondering why their heart rate's over 100 in the waiting room. You know,

and so that's a quick thing. You know, if you're a responder to an SSRI,

that's if you're a responder, right? If you're a responder, you're typically waiting

6 weeks, maybe 8, 12 to see an effect. And you could

cut down your caffeine consumption and feel better in days. Why would we overlook that?

You know, sometimes it's the simplest things. And then I think the other key

shift, of course you could kind of do the laundry list of modalities. I think

going through the different ways of thinking is largely based on finding what aligns for

that patient. If it was like a former athlete, they really like working out, let's

do some activation therapy where they're working out. You know, if they

are a yoga teacher, maybe that's what they, you know, should be focusing on restoring

their practice in their life and just finding what aligns with them. Yeah, that's

kind of how I would think through those different pieces. You know, and then

aligning with that patient on what would resonate for them. Yeah.

Beautiful. If you looked into a crystal ball 10,

20, 30+ years from now, what does your

visionary see as an

integrated field of psychiatry? What would you

envision? I think to predict the future,

sometimes it helps to go back to the past. And an interesting

story about the guy who was considered the father, the founder of

germ theory. He was a physician. I believe he was Hungarian, if

I recall correctly, but he worked in this, this hospital where they

had a lot of babies being delivered and they also did autopsies. Like,

this was in the era when medicine was trying to become more objective and they

would do these anatomical dissections and the doctors

would do the dissections and then go deliver babies without washing their

hands. And they would find that a lot of these women who were giving birth

to children at this place They would become septic and die, and they didn't know

why. They thought it was just pure coincidence or just, you know, nothing was wrong.

It can never be us. The doctors could never do anything wrong. This guy, he

was one of the people there, and he thought, you know, I think there is

some sort of invisible thing that we're, you know,

tracking over from the dead bodies in the delivery room. And I

think that thing is making the women sick. And he made all of the people

who worked with them wash their hands. And then the rates of sepsis

dropped dramatically. People got better. And so he essentially discovered

what germs were. And you would think that people would be ecstatic, like, oh my

God, you took away the illness, you figured it out. He went around trying to

educate other providers on this idea of germ theory.

What was the response? He was absolutely vilified because doctors

said, how dare you think that I was the problem, that I was doing

something wrong? What happened to him? He died in an insane asylum

because he was— he ended up going crazy, essentially, from being ostracized. by his

own profession, I think, being a big part of it, at least my level of

understanding from the distance of his story. I think about that sometimes

and think a couple hundred years ago, it would've been absolute heresy

to say that germs were real, right? There's no evidence. You can't see them.

There are no studies. You're crazy for thinking that. And look at where we are

now, right? To think, hey, maybe there's more to

mental illness than just neurotransmitters. Like maybe neurotransmitters are a

part of the story or a way of thinking about things. But, you know, maybe

there is like an element of spiritual distress,

spiritual crisis. Maybe there's energy that our bodies are sort of conduits

for, whatever you would want to describe that. That's crazy to say in the Western

medical world. If I say that, I'm talking about something that has not been seen

or observed or empirically validated. Therefore, I'm crazy for even

thinking that. Fast forward 200 years, I wouldn't be

surprised, right? Because what's nice about the scientific model

is although it's very slow, It can catch up to the wisdom of

our ancestors in some. I wouldn't be surprised if 200 years from now,

there are ways of gauging or assessing

energetic or non-physical components of health that we are

just blissfully oblivious to right now. And learning that

really these do shape our human experience in ways that we just don't appreciate

right now. I think eventually the model will, will catch up.

I have hope for the future, you know, and seeing now the shift that we're

seeing in research that, you know, metabolism, nutrition, you know, meditation,

exercise, heat therapy, these are things that are scientifically validated and

under study, you know, as we speak. There are a lot of strides being made

in research. And I think Western psychiatry is

recognizing that we don't have all the answers as it is. If we did, we

wouldn't have so many people knocking at our door, depressed and anxious and traumatized.

Clearly we don't have all the answers, so we need to go beyond the current

model. And that's, I think, where I see things headed down the road.

Beautiful. And so what I'm hearing from you is in order to move

forward, we have to look back. Yeah. Antifragility.

There is a great book, Antifragile, that talks about it. You know, this concept of

neomania, um, just this idea that we're so fixated on

what is the next shiny new object that's going to deliver us from our

troubles. You know, when the irony is these longstanding

ancient ideas, they survived for a reason. They withstood the

test of time. So often rather than focusing on the shiny new

object of, oh, there's this new pharmaceutical compound that's under study and lo

and behold, it didn't work for dementia, but dietary changes might. I think sometimes

we have to look to the past to guide the future. Beautiful.

What an incredible conversation, Jeff. Thank you so much for everything that you shared.

Just a wealth of wisdom. If people want to either

reach out to you or maybe they're interested in some of the work that you're

doing or the research that you're doing, Would you like to send

anyone anywhere? Yeah, you can find me. So Jeff Bone, and

that's B as in boy, O-H, N as in Nancy, E-N as in Nancy for

the last name. You can find me on LinkedIn, might be the easiest. Feel free

to, you know, look up that name if you want to see some of the

publications I'm involved in, and always happy to connect. Thank you so much for having

me. It's been a great conversation. Really appreciate being here. Yeah, Jeff, thanks for

coming on the show, man.