As mentioned in my last issue, I’m taking the time to dive into how food and diet affect mental, physical, and frankly, spiritual performance.

Though this newsletter and most of my public-facing work is dedicated to all things psychiatric drug withdrawal education, I’ve spent my career in food and now work as a private performance chef to pro athletes. This is a rare, specific niche that requires a different skill set from those with nutrition degrees and career restaurant chefs. Restaurant chefs, Michelin-worthy or otherwise, have zero understanding of nutrition, elite sports, or performance. They are all physically falling apart and are usually miserable humans. Meanwhile, macro and micronutrient nerds can’t cook. They might be able to char a steak and flex in the mirror, but they can’t execute meal plans without extreme repetition or build flavor and texture in a way that makes you want to eat.

Meanwhile, I’ve got just the right history and education to make me perfect for the job:

But here’s the thing: my experience left me deeply disturbed. For so long, I thought I was doing everything right, yet I was still sick. And when I look around, everyone is sick. The reasons, of course, are complex. Some of it comes down to individual choices, but the more I learn, the more I argue that it’s rooted in forces well beyond the individual’s control.

So, I set out to figure out why.

Before I get into my actual food philosophy, it’s vital to understand how we got here. I’d go as far as to say that to make meaningful nutritional change, it’s required that you understand how we got here. Learning this history should permanently and irrevocably change the way you view food, which will in turn affect what restaurants you frequent, how you grocery shop, and who you listen to in the nutrition space. We will come back to it again and again.

Within the confines of this medium and in the absence of a PhD dissertation, I cannot explore every angle. But to understand why what you put in your mouth and why you’re (probably) always just a little bit sick has, in some ways, already been determined for you by the past. To me, there are four key historical points: World War I, 1937, World War II, and 1985.

Let’s go back.

The story of how the American diet came to be shaped by external forces begins with World War I. Before the war, food in the United States was relatively unregulated. Farmers grew a variety of crops, and diets were more closely tied to the seasons and what was locally available.

But as the United States entered the war in 1917, the need for food to support both troops and war-torn Europe became a critical national security issue. The government created the U.S. Food Administration, an independent federal agency that controlled the production, distribution, and conservation of food in the U.S. during the war. Future president Herbert Hoover was appointed as the director.

One of the agency’s tasks was to stabilize the price of wheat in the U.S. market. Hoover introduced concepts such as “meatless Mondays” and “wheatless Wednesdays” which were also implemented to help ration food, so that the government could prioritize the war effort by urging citizens to forgo certain foods so that they could be redirected to the front lines. This was an appeal to the American public asking for voluntary compliance in the formal absence of rationing. For the first time, the American public was asked to think about food not just as sustenance, but as a patriotic duty.

After World War I but just before World War II, a little known law passed during the Great Depression: the Agricultural Marketing Agreement Act (AMAA) of 1937.

The AMAA was originally designed to help farmers during the economic turmoil of the 1930s. It allowed producers of certain commodities—such as milk, eggs, and beef—to create “marketing orders” and “checkoff programs,” a complex aspect of U.S. agricultural policy with the overarching goal of ensuring fair marketing conditions for specific commodities by regulating quality standards, packaging, production, and advertising. It is the advertising angle of marketing orders that would go on to bite us all in the ass.

Marketing orders are only applicable to eligible commodities that tend to have perishable qualities or are produced in large quantities. Commodities aren’t “brands” in the way that “Pepsi” is a brand. Brands have companies, marketing departments, researchers, and lawyers to strategize advertising campaigns to set them apart from competitors, i.e., “Coke.”

But beef is beef regardless of the rancher who raises the cattle. A cattleman in Texas can’t really say his beef is better than Nebraska cattle. A steak to steak comparison only makes them compete with each other. Thus, marketing orders and checkoff programs were created to ensure the programs were fair to all producers.

The USDA oversees marketing orders for over 30 different commodities, including:

Some meats (California beef and lamb) are governed by marketing orders, while the rest fall under what’s called checkoff programs.

Checkoff programs originated alongside marketing orders in 1937, but they really took off in the 1950s and 60s. The specifics are irrelevant to this argument, but the point is that they are commodity-specific programs funded by mandatory contributions from producers. For example, cattle producers pay a mandatory assessment of $1 per head of cattle sold. The Cattleman’s Beef Promotion and Research Board receives about $42 million of the approximately $75 million in assessments collected, and that money is used for advertising, research, and promotion of beef.

However, the rules governing advertisements are incredibly restrictive. Checkoff-funded campaigns are prohibited from making comparative claims or disparaging other foods. Originally intended to keep the Texas cattleman from disparaging the Nebraska cattleman, these restrictions have only handcuffed the industry producing the food that actually keeps humans healthy.

For example, a campaign funded by the dairy checkoff program can say, “Milk is high in calcium,” but it cannot say, “Milk has more calcium than almond milk.” Similarly, beef producers can promote beef’s protein content, but they cannot compare it to chicken or plant-based meat substitutes.

You can probably see where this is going…

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On the heels of the Agricultural Marketing Agreement Act came World War II. By the time World War II began, the lessons of World War I and The Great Depression had been well learned. Food was a crucial element of the war effort. This time, instead of encouraging voluntary conservation, the government implemented strict rationing systems and sent nutrient-dense food and protein overseas. Sugar, butter, meat, and coffee were all rationed.

In 1943, our old friend Herbert Hoover famously declared to the public that “meats and fats are just as much munitions in this war as are tanks and aeroplanes…the same spirit in the household that we had in the last war can solve this problem.” His words reflected the reality that, during war, food was a strategic resource, one that was just as important as weapons and ammunition. Red meat, a staple in the American diet, hit the black market.

As Dr. Gabriel Lyon said in her book, Forever Strong, with less nutrient-dense food available for the general public, government research turned toward “preventing deficiencies and focused explicitly on boosting short-term performance rather than optimizing long-term health.”

In 1941, the National Research Council developed the first set of Recommended Dietary Allowances (RDAs). These were the precursors to today’s nutritional guidelines and were created with a very specific goal in mind: to establish minimum intake levels to prevent nutrient deficiencies in both troops and civilians during times of scarcity.

It’s crucial to understand the purpose of these early RDAs. They were never intended to guide people toward optimal health. Instead, they were designed to establish a baseline—just enough nutrients to keep the population from getting sick with diseases like scurvy (vitamin C deficiency), pellagra (niacin deficiency), or rickets (vitamin D deficiency).

This focus on preventing deficiency rather than promoting health would become a recurring theme in American nutritional policy. Even as the war ended and rationing disappeared, the emphasis on meeting minimum nutritional standards remained embedded in federal dietary guidelines. This foundational philosophy would have profound effects on how nutrition was communicated to the public and would shape future food policies.

Furthermore, with the end of World War II, the U.S. entered an era of economic prosperity. Food production ramped up to meet the needs of a booming population. Women entered the workforce and farming became more industrialized, leading to an abundance of cheap food that was easy to prepare.

Processed foods, which had been developed during the war to feed soldiers, found new markets among busy families. Canned soups, boxed cereals, and frozen dinners quickly became staples of the American diet. The government, meanwhile, continued to promote minimum nutritional standards rather than focusing on the potential health implications of these emerging food products.

Fast forward to the 1980s. The 1980s were a rough time for cigarette manufacturers. With increasing regulation, the rise of anti-smoking campaigns, and mounting legal challenges, companies like Philip Morris and R.J. Reynolds were looking for ways to diversify their portfolios. Their solution was to invest heavily in the food industry.

In 1985, R.J. Reynolds—maker of Camel cigarettes—acquired Nabisco for $4.9 billion. Nabisco’s brands, which included Oreos, Ritz crackers, and Chips Ahoy!, were already household names, so the merger of R.J. Reynolds and Nabisco created a behemoth in both tobacco and snack foods.

At the same time, also in 1985, Philip Morris—the maker of Marlboro cigarettes—purchased General Foods for $5.75 billion. General Foods was one of America’s largest food manufacturers, responsible for brands like Kool-Aid, Jell-O, Maxwell House, and Post cereals. But Philip Morris wasn’t done. In 1988, it acquired Kraft Foods for $12.9 billion, making it the largest food company in the United States.

These acquisitions weren’t just about expanding into food—they were about applying the tobacco playbook to a new product line. Tobacco companies already had a deep understanding of advertising, consumer psychology, and addictive products, and knew how to manipulate consumer behavior. They also had the best scientists in the world, and moved the cigarette scientists—the world’s leading addiction scientists— to the food world by the thousands. Those scientists weaponized processed food and turned it into ultra-processed food, intentionally creating it to be addictive.

Then, Philip Morris and R.J. Reynolds mobilized the cigarette lobbyists, giving processed food manufacturers both the resources and the motivation to reshape American eating habits. But they needed a little help from the government to give their products a stamp of nutritional legitimacy. Enter the Food Pyramid.

The Food Pyramid was introduced by the USDA in 1992 as a visual guide to healthy eating. At first glance, it seemed innocuous enough, with its broad base of grains and its recommendation for moderate consumption of proteins, dairy, and fats. But the pyramid was the result of intense lobbying by the food industry, particularly grain and processed food manufacturers. Its recommendations to consume 6-11 servings of bread, pasta, and cereals every day were not backed by independent scientific evidence. Instead, they reflected the interests of powerful agricultural and food processing lobbies.

This high-carb, grain-heavy diet stood in stark contrast to the American diet from 50 years before, when red meat was so prized as a source of nutrition that it was traded on the black market. We knew, during wartime, that meat and butter was key to keeping soldiers strong. Why would it be any different for the average American? And yet, in the 1990s, the government began promoting foods that, half a century earlier, were eaten in sacrifice to the war effort.

Of course, this just so happened to align perfectly with the product lines of Philip Morris’s new acquisitions, such as Post cereals and Kraft mac & cheese. Similarly, R.J. Reynolds’s Nabisco brands benefited from recommendations that emphasized carbohydrates as the foundation of a healthy diet.

The introduction of the Food Pyramid was followed by a massive marketing push. Processed food companies jumped at the chance to label their products as “part of a healthy diet,” thanks to the pyramid’s emphasis on grains. This led to an explosion of “low-fat” and “high-fiber” claims on everything from breakfast cereals to snack foods.

But while the pyramid was supposedly about nutrition, its real impact was to validate the consumption of ultra-processed foods. Companies like Kraft, General Foods, and Nabisco spent billions on advertising to reinforce the message that their products were not only convenient but also healthy. The pyramid, which was supposed to guide Americans toward balanced nutrition, ended up serving as a marketing tool for some of the least nutritious foods in the American diet.

As Calley Means, former Big Food and Big Pharma lobbyist, said in his recent talk at the U.S. Senate, “The Food Pyramid was created by the cigarette industry through complete corporate capture and was an ultra processed food marketing document saying we need to eat carbs and sugar. We listen to medical experts in this country, so parents started giving their kids ultra-processed food. Carbohydrate consumption went up over 20% in the next 10 years.”

And because of the Agricultural Marketing Agreement Act of 1937, commodities could not advertise against it.

The restrictions placed on commodities beginning in 1937 stand in stark contrast to the free-for-all enjoyed by processed food manufacturers in 2024. Companies like PepsiCo, Nestlé, and General Mills spend hundreds of millions to billions of dollars each year marketing their products. For example, in 2018:

In contrast, when the dairy industry launched the “Got Milk” campaign in 1993, all of $23 million was allocated from checkoff programs for advertising. That number increased over the years, but in 2016, the government contributed $562 million total to dairy, beef, pork, and lamb checkoffs.

Because commodities like beef, milk, and eggs are legally barred from making comparative claims and there is so much less money involved, they have virtually no way to compete with the marketing power of ultra-processed food companies. The folks who passed the 1937 Agricultural Marketing Agreement Act could not see far enough ahead to anticipate how this law would negatively impact the health of the most powerful nation on Earth, but we have all become victims of it. Today, the average American is bombarded with messages promoting artificially dyed cereals, “fortified” processed grains, and high fructose corn syrup laden beverages, while fresh, whole foods are conspicuously absent from the conversation.

Now you know why.

There is, of course, more to the story. But at a high level, the Standard American Diet is a story of war, corporate strategy, and regulatory oversight. It began with the food rationing campaigns of the World Wars, which emphasized patriotism and minimum nutrition rather than optimal health. It continued through the rise of tobacco companies in the 1980s, which applied their expertise in addiction and marketing to create a new generation of ultra-processed foods. And it is sustained today by an obscure 1937 law that limits the ability of whole foods to compete on a level playing field.

So the next time you’re grocery shopping and you’re bombarded by bright packaging and health claims, remember: the food products that dominate the shelves are there not because they’re healthy or nutritious, but because they have the deep pockets and regulatory freedom to out-market the actual food that keeps you healthy.

What you put in your mouth isn’t just a personal choice—it’s the result of a century of strategic decisions made by governments, corporations, and lobbyists, all vying to shape what’s on your plate. Understanding this history is the first step to taking back control of your diet and making choices based on nutrition rather than manipulation.

“What do all fat, sick, unhealthy people have in common? At least this: they all eat.”

Jordan Peterson at the American Health & Nutrition: A Second Opinion roundtable held at the U.S. Senate on September 23, 2024

I have been staring at a blinking cursor and a blank page for far too long, unsure of how to begin an issue about diet. Because of my work in the performance nutrition space—49ers linebacker Fred Warner and defensive tackle Kevin Givens are my two main clients—people ask me about diet all the time. They ask me about collagen, creatine, and keto. They want to know how to drop their belly fat and why I think they should stop eating oatmeal. They bitch about how their kid will only eat processed food and scratch their head over why Weight Watchers didn’t stick. They tell me about some health scare and ask me what to do about it.

And then they immediately reject whatever I say.

Just a few days ago, someone asked me about sugar and seed oils (canola, sunflower, soy, grapeseed, cottonseed, corn, vegetable, etc.) I gave a quick answer, which boiled down to:

The response, to the question this person took the time to ask?

“Fuck it, I guess I’m just going to get cancer.”

What the hell am I supposed to do with that? Why bother getting worked up if you’re not going to make change? Why waste my time? Why waste your time? What do you need that I can’t seem to give you?

This is why I rarely talk about diet or diet philosophy. It’s not enough that I spend as much of my time in the world of performance nutrition as I do in the world of psychiatric drug withdrawal. It’s not enough that I feed some of the world’s best athletes. It’s not enough that I put these strategies into practice and prove it works by learning stupid human tricks like standing backflips and bench-pressing my body weight for reps while maintaining a bloodwork panel that makes my doctors ask me what in the hell I’m doing to get such remarkable numbers.

Lest you think I’m fishing for kudos, I assure you it wasn’t always this way. I may have higher than average kinesthetic awareness but when I started down this road in my late 20s, I was eating tons of processed food, drinking way more than I should, taking a handful of prescription drugs every morning, carrying extra squish, couldn’t do a single pull-up or run a mile, and generally felt like shit.

All that changed when I was forced to change what I put in my mouth.

In 2021, five years after taking my last antidepressant, I was still struggling horribly with gut health. It was so bad I didn’t want to be around anyone, and none of my interventions seemed to help. First, I cut eggs. When that didn’t work, I cut gluten. When that failed, I cut dairy. I tried celery juice, fennel tea, and peppermint capsules given to me by a gastroenterology nurse practitioner whose only other suggestion was to “get a colonoscopy.” I added and subtracted psyllium husk, went vegan when possible, and cut coffee for a year. Nothing helped.

Finally, I called Andy Galpin, PhD, an old friend who agreed to let me run through a performance program designed for elite athletes. Over the course of a month, we measured and tested everything that came out of me: blood, spit, urine, hair, stool.

For the first time in my life, I had a comprehensive picture of what was happening in my body. Turns out my gut was boasting a staph infection, strep infection, h. pylori, and giardia—none of which would have shown up in colonoscopy results. An MRT blood test also showed I had a severe intolerance to both gluten and dairy, which would explain why cutting one or the other never worked. I was prescribed a crapton of supplements to deal with the infections and put on a strict diet of eggs, oatmeal (more coming on this), chicken breast, meat, white rice, carrots, broccoli, and macadamia nuts. The diet was brutal, but it worked. My gut symptoms cleared up, my sleep improved, I stopped needing a nap at 3pm, and the black circles under my eyes went away. For the first time in my adult life, I could honestly report that I felt good.

Still, I didn’t understand why this made such a difference when I thought I’d been doing everything “right” for so long. Thus began an extension of my obsession with food, this time focusing on performance nutrition and how it intersects with athletics and psychiatric drug withdrawal and recovery.

Just like how I do not hold an MD or PhD and still manage to be an influential figure in the psychiatric withdrawal space (check out my recent lecture at Grand Rounds at the University of Nevada, Reno Medical School), I do not hold a degree in nutrition or dietetics. But to paraphrase something someone recently told me, “What made John Wooden qualified to coach basketball? He didn’t get a degree in coaching, but he put in the work and immersed himself in the knowledge to become the best coach of all time. This is what good teachers do. They gather the work of others and present it in a digestible way.”

So, over the next few issues, I am going to tackle the world of diet as seen through the lens of what I’ve learned. Apologies in advance for my curt tone on the matter. What I want to do is just tell you what to eat followed by a diatribe culminating in “Quit your bitching and either do it or shut up about it.”

Alas, that is not how humans work. So I am going to try a different strategy: explaining why.

When it comes to diet, I know three things for sure:

We are going to dive into all three of these topics, and I will provide as much research and guidance as possible. I hope, by the end of however long this ends up being, we will have changed the lens with which you view food and cooking.

It is going to take time to compile all this, so bear with me if it comes in spurts. In the meantime, I suggest listening to literally any part of the American Health & Nutrition: A Second Opinion round table that happened at the U.S. Senate on September 23, 2024. A few quotes from the stream:

“While gen x, millenials, and gen z have our problems, 75% of us are not stupid, weak or lazy. So hopefully you are wondering what has happened to us.”- @JillianMichaels

“We are mass poisoning all of our children, and all of our adults.” – Robert F. Kennedy Jr.

“Treating chronic disease, which we now know is caused by the environment and our diet, without looking at diet as the treatment, should be considered malpractice.”- @MikhailaFuller“

“We could replace that miserable future with something much brighter and healthier if we had the moral and political will to do so.” – @jordanbpeterson

“This is why America is facing an obesity epidemic. That’s not about will power. It’s about the food system.”- @maxlugavere

“Life expectancy has not increased in the last 100 years. We spend 90-95% of all medical spending on chronic issues, and it’s done nothing.”- @calleymeans

“… who are the constituents of the American government? Is it industry or is it the American people?”- @ChrisPalmerMD

“If the current trends continue… At best, we’re going to face profound societal instability and decreased American competitiveness, and at worst, we’re going to be looking at a genocidal level health collapse…” – @CaseyMeansMD

“Our healthcare system is playing Whac-A-Mole on the backend and we are not talking about the root causes.” – @MartyMakary

“How is it that Americans are so chronically ill despite spending more on healthcare than any other nation. … the focus has shifted away from patient care, to corporate gain.” – Brigham Buhler

“Ultra-processed foods are the new cigarette for my generation.”- @travelingenes

“Over the last 60 years, almost all food additives were being created for one sole purpose. To improve the bottom line of the food industry, and not improve our health.” – @thefoodbabe

“So, of course, Kellogg and other food companies will argue children prefer [bright, artificial colors] over [natural, less bright colors]. Just as they would prefer cocaine over sugar. That doesn’t make it okay.” – @humankarp

After years of speaking publicly on the topic of antidepressant withdrawal and overmedicating children, I’ve learned that meaningful change is going to come from two directions: patients and new prescribers.

I’m not going to say I’ve lost hope in existing clinicians, but it’s more difficult to treat Stockholm syndrome than it is to prevent abduction in the first place. Paraphrasing from the former Big Pharma and Big Food lobbyist Calley Means, who now spends his life whistleblowing the playbook of Big Pharma and Big Food: “It’s difficult to change your actions when your beach house depends on it.”

Thus, I’m working to get my work in front of residents who have yet to begin their practice, hoping a seed of my message will be buried into their fertile little brains. Nevermind the fact that research shows medical students’ empathy erodes in year three—the year in which they begin seeing patients.

Alas, we must press on, which is why I was thrilled to lecture at Psychiatry Grand Rounds and the University of Nevada, Reno, where all psychiatric residents are required to attend. This wasn’t just a talk about my story. Instead, I focused on the language of withdrawal, the theory of serotonin occupancy and how it lines up with hyperbolic tapering, and genetic pathways and their role in drug-drug interaction and metabolism. While there wasn’t a ton of time for questions or feedback, I was pleased when a room full of residents raised their phones to take photos of my slides. That told me this was new information and that maybe it will make a difference.

I also got a little heated at the end when I was gently pushed by one of the UNR professors who wanted to “get clear” and reiterate that the problem wasn’t actually psychiatrists, because it’s primary care practitioners who prescribe most antidepressants. I couldn’t let that slide, especially knowing that one of their psychiatrists had a 7-year-old on 5 different psychiatric drugs. Off I went.

Football season is almost here, so my kitchen work is ramping up. I have two new clients, Fred Warner and Kevin Givens, both 49ers looking for another Super Bowl ring. My job is to feed them the food that will get them there, which means I’m elbow-deep in grass-fed bison and venison and gelatinous stock made with chicken feet.

Follow along with that work @chefbrookesiem.

I’m also prepping to lecture at Grand Rounds at the University of Nevada, Reno Medical School. This won’t be my first time speaking in front of a room full of doctors, but it will be my first time speaking in front of a room full of doctors who might not agree with me.

The Reno-Tahoe area is perpetually behind the times from a cultural, educational, and health standpoint. Our restaurants are straight out of 1989, our psychiatry is stuck in the 90s, and the definition of health in this town is to park at the far end of the parking lot before getting day drunk at all-you-can-eat sushi which, in a landlocked city, is just as disgusting as it sounds.

Thus, I have been brushing up on my science and communication skills (shoutout to the book Supercommunicators) in hopes of planting seeds in a few medical minds. Turns out, it’s been an interesting few weeks in the world of bad medicine and bad journalism. So for this issue, I’m sharing a little of what I’ve been reading this week, because sometimes, shutting up is the most effective strategy.

This week, I’m traveling to Los Angeles for a round table discussion with a small group of wildly successful people who all have one thing in common: we were medicated with psychiatric drugs when we were kids.

We connected through a private WhatsApp chat hosted by a megawatt podcaster. Around 800 of us are in the group, all of whom have either guested or will be guesting on this podcast (my episode should be released by the end of the year.) Amid the usual chatter about sales funnels and product launches, the conversation turned to medicating kids. Multiple people chimed in about how a childhood spent on Adderal, benzos, and antidepressants derailed the first third of their lives and led to addiction, psych wards, and prison.

Though all of us are lucky to have come through it, one person put it best:

“After years of struggle, I’ve finally overcome the battle but not without an immense cost to my sanity, family, and friends.”

All of us were minors when we were medicated, so all of our parents signed off on the treatment. I can’t speak for anyone else’s parents, but my mom maintains that had she known what she knows now, she would have at least gotten a second and third opinion before filling my scripts.

Though most of my focus is on psych drug withdrawal and how to find yourself in the aftermath of long-term psych drug use, I always hope my work makes people think twice about starting a psychiatric drug in the first place. And I especially hope it stops parents from drugging their kids just because it’s the easy way out and every other parent is doing it. The costs of this choice are incalculable. I cannot overstress that there is zero scientific backing or research exploring the effects of psychiatric drugs on developing minds and bodies. To drug your kid with stimulants, antidepressants, or antianxiety drugs takes away their agency, turns them into an experiment, and can irrevocably change their system and perception of the world for the rest of their life.

And if you don’t believe me, maybe the work of Robert Whitaker, a Pulitzer prize finalist, or Dr. David Healy, former Secretary of the British Association for Psychopharmacology can sway you.

With that, here are five books I think every parent should read before medicating their kid or taking their kid to a psychiatrist.

Share widely.

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By Robert Whitaker

There is an uncomfortable question in the world of mental health and treatment that everyone thinks about, but no one says out loud: If medicating mental illness with psychiatric drugs was working, why are people getting worse?

This book examines over fifty years of research to find the answer and comes to a startling conclusion. I think it is the single most comprehensive and explanatory book on the market about the true nature and outcomes of psychiatric drugs and that it should be required reading in all medical schools.

It is also divided into multiple diagnoses (schizophrenia, bipolar, depression, and ADHD), which I found particularly useful as someone who focuses mostly on the history and treatment of depression.

By Ethan Watters

To understand why mental illness has such a strong pull in American culture, it is important to understand how mental illness is created in the first place. Yes, created.

When I was depressed and taking antidepressants, I thought my depression was caused by a chemical imbalance and that it was just who I was. After all, that’s what the doctors told me. We now know the chemical imbalance theory is unsubstantiated, and yet the narrative remains.

Watters’ book blew my mind by showing exactly how the false chemical imbalance theory was exported all over the world and why this has fundamentally affected recovery rates—for the worse—all over the globe. 

By David Healy

Though this is technically an academic book, it is extremely readable and the best account of the manipulative marketing, hidden court cases, and corruption that occurred during the development of Prozac and Zoloft.

It’s one of those books where, if my mother or I had read it before I was medicated at 15, I’m quite sure we would not have made the same choices. 

By Ben Goldacre

A book about pharmaceutical corruption and manipulative science can rarely make me laugh out loud, but Bad Science does just that.

Not only did the book make me a better advocate for my health by teaching me what red flags to look out for in research and shady science journalism, but it kept me consistently entertained to the point where I was disappointed when the book ended. It should be required reading in all high school science classes. 

By Abigail Shrier

It took me a long time to understand how my mother’s well-intentioned decision to send me to a child psychologist derailed my whole life, but Bad Therapy finally put the pieces together. In being diagnosed with depression and anxiety as a teen—and consequently medicated for it—a message was sent by the adults around me: I did not have the capacity to help myself.  

That unspoken message haunted me for the next fifteen years, leading me down a path of self-induced victimhood, fragility, and, paradoxically, more depression. I see this happening with an entire generation, and this book explains why—a must-read for every parent or medicated kid. 

In the eight years (!) since my last antidepressant, the majority of my free time has been dedicated to healing and supporting my physical and emotional body. Though the majority of the Happiness Is A Skill archive focuses on psycho-emotional tools and philosophy, most of my day to day work is rooted in the physical.

The marketing around mental and physical health focuses on things companies can sell to consumers: supplements, diets and specific manufactured foods for that diet, and pharmaceutical drugs. This leads people to think that some random supplement, the keto diet, or a new drug will be the answer. Sometimes, these things help. But more often than not, it’s a futile experiment that results in wasted money at best and iatrogenic harm from misprescribed pharmaceuticals at worst.

This isn’t to say that physical interventions don’t matter. They absolutely do—and we’ll get to what I’m experimenting with these days—but people have it backward. They think if they get the physical nailed down, the psycho-emotional mind will follow. Instead, they end up building a backward, ineffective pyramid of healing that teeters on an unsupported base:

Here’s how this plays out:

Someone is having a rough time. Maybe they have their basic physiological needs covered, maybe they don’t. Let’s assume they do, because not having your basic needs covered is a different issue.

Instead of looking at their actions or their life situation, this person throws a bunch of money at some random wellness trend, hack, or drug. When that doesn’t work, maybe they try a new diet or sign up for an exercise class. But because the root issues haven’t been addressed, they can’t stick to those changes. At this point, whatever issue is going on in someone’s life is likely intensifying. Basic needs, whether financial, interpersonal, or health-related, are likely starting to crack. This is scary enough that maybe they try therapy, but there’s no foundation to support it, so it doesn’t “work,” leading to more destruction that will eventually topple the whole thing over.

In reality, the mind leads and the body follows. It’s as if you are tending a garden and strategizing the best way to grow a bounty. Sure, you can plant healthy seeds in parched, malnourished soil. Something will grow (maybe), but it’s not going to thrive. Or, you can take the time to regenerate the soil—which means a fallow harvest while the soil is healing—knowing next year’s crops will be set up to thrive.

This pyramid plays out in a different way:

This person has their basic psychological needs covered. It may not be the highest quality food, shelter, or security, but there’s enough of it to put focus elsewhere. Instead of scattering their energy across unsubstantiated wellness trends, they commit to emotional work. This could be through formal therapy, meditation, inner child work, hypnotherapy, spiritual counseling—whatever, as long as it resonates and doesn’t result in a bullshit DSM label/diagnosis. As the emotional work settles in, avenues of physical change emerge. It becomes easier to eat the way the body needs, because the desire to self destruct or self-soothe with food is lessened. When the body gets the right nutrients, sleep improves. When sleep improves, energy goes up and exercise is more sustainable. Now, this person has a frame of reference for how shitty they felt and how much better they feel. They are motivated to keep it up, to hone in on specifics, and get nerdy with it. They have earned the right to tinker with supplement stacks because, as one of my mentors once put it, “They are no longer eating, sleeping, and thinking like an asshole.”

I say all this because, inevitably, someone is going to read this issue, cherry pick a few things, and bitch when it doesn’t work. I’ll ask them about their diet or what action they’re taking in their emotional life, and they’ll tell me they’re eating lots of low fat muffins and haven’t fired their therapist, even though they haven’t made progress in years.

If that’s you, then you’re doing it wrong. Feel free to follow what calls to you and make many changes at once, but know that without the right base, it’s unlikely anything else will have a major impact.

With that said, I know so many of you are ready to level up. So here are all the things I’ve been experimenting with in 2024 to support my physical health.

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My foray into fixing my physical health after 15 years of antidepressants began in 2021 under the eye of an old friend and human performance expert Andy Galpin, PhD, and performance bloodwork specialist Dan Garner. Andy and Dan were quietly working with professional athletes, using biomarkers from an extensive series of lab tests to hone in and eradicate issues. After getting nowhere with traditional doctors, I reached out to Andy and Dan and they took me through their program.

Andy and Dan have now exploded in the performance space. Their R.A.P.I.D. program is the gold standard, but it is financially prohibitive for those of us who aren’t on multi-million dollar contracts.

To reach more of us normal folk, Andy and Dan created Vitality Blueprint, one of the world’s most in-depth blood tests on the market. Vitality’s bloodwork system measures over 100 biomarkers (your standard bloodwork from a doctor only measures 10), analyzes over 20,000 biomarker calculations, and breaks down the results into 13 categories including micronutrients, hormone profile, sleep, toxic load, and gut health.

Furthermore, results come with personalized programs that explain exactly how to eat, what lifestyle changes to make, and what supplements to take that will enhance and repair your unique physiology.

It’s not covered by insurance, but it’s no more expensive than throwing out hundreds of dollars a month on supplements you don’t need. And as a longtime supporter of Dan and Andy’s work, they have graciously offered HIAS subscribers 10% off any of their programs using the code VITALITYSIEM. I highly, highly recommend it.

Not to be confused with a carnivore diet, which is based exclusively on meat, or a ketogenic diet which severely restricts carbohydrates and relies on fat as fuel, the animal-based diet consists primarily of high-quality meat, organs, fruit (and fruits mistaken as vegetables), honey, raw dairy (if tolerated) and eggs.

A typical day for me includes:

Breakfast: coffee with collagen and coconut milk, 3 eggs fried in raw butter and 3 medjool dates with macadamia nut or raw almond butter.

Lunch: some sort of grass-fed/organic/pasture-raised protein (beef, bison, or chicken), some sort of fat like full-fat kefir or yogurt, raw cheese, or nuts, and carbohydrates from fruits like berries, citrus, apples, and dried mango.

Dinner: some sort of grass-fed/organic/pasture-raised protein or wild fish, light greens or a fruit masking as a vegetable (cucumbers, peppers, tomatoes, squash, etc—anything with seeds), fat from avocados, raw butter, or macadamia nut oil, and carbohydrates from sweet potatoes or white rice. Occasionally, I’ll incorporate vegetables I know I can tolerate like light greens (arugula, spring mix), broccoli, cabbage, or green beans. Most days, I have some high-quality dark chocolate for dessert.

I rarely snack, but if I do, it’s nuts and fruit, minimally processed meat sticks or jerky, or some whey protein.

I avoid seed oils (canola, safflower, grapeseed, peanut, etc.), anything fried, alcohol, gluten, grains, white sugar, beans, and most vegetables.

This diet has taken me years to dial in, but now it’s so second nature that I don’t even think about it. My bloodwork is pristine and my body composition remains steady at 15% body fat, even after major knee surgery.

This is also very close to what I feed my pro athletes, though they get a bit more variety. I am convinced that if everyone ate the way I and my athletes do, most health issues would be eradicated.

I don’t really believe in supplementation, at least not in the way that supports a multi-billion dollar industry. There is no one supplement I’d recommend to everyone, and I especially don’t recommend supplements without first doing extensive bloodwork. I just don’t see the point of throwing money at a problem when you have no idea what the problem actually is.

However, I have done extensive bloodwork, so I know what my issues are and what supplements can be used to optimize.

For example, my sex hormones and DHEA levels are low and have remained low despite massive dietary changes and getting off birth control. This has been determined through multiple Dutch Tests, which measure hormone levels in saliva and urine. The whole thing is a mystery, but we’re starting by addressing it with maca and DHEA supplements. I expect to retest by the end of the year, and if things are still wonky, we’ll go into the world of gentle hormone replacement.

Additionally, my ferritin (iron) levels run low despite eating a lot of red meat, so I supplement with high quality, grassfed, dessicated beef liver which is one of the most nutrient dense foods on the planet. I also combine my red meat and liver supplements with vitamin C-rich foods like citrus and mango, because vitamin C enhances iron absorption. Remember, it’s not about the micronutrients you eat. It’s about the micronutrients you absorb.

Because I’m recovering from knee surgery, I’ve also incorporated extra supplements known to support ligament and tendon recovery, including collagen, creatine, and C:15 (brand name Fatty15), an odd chain amino acid that strengthens cell membranes and aids mitochondrial function. C:15 is an amino acid primarily found in fish skin and full fat dairy, two things humans don’t eat much of anymore. The science around C:15 is new, but in my recovery, I’m happy to throw everything at it.

Much of my 2024 health rabbit holes have revolved around how light affects the body and, therefore, unlearning all the crap about how sunlight is bad for the body. Much like nutrition and mental health, once you start pulling at the thread around the narrative of sunlight, the whole paradigm falls apart. I’ve stopped slathering myself in sunscreen, stopped wearing sunglasses unnecessarily, and invested in a large red light panel that hangs in my bathroom.

I’m not going to go into the details, because there are plenty of more researched folks who write about this. For a taste, check out Dermatology’s Disastrous War Against The Sun and Natural Light is An Essential Nutrient.

Red light therapy (RLT) works by exposing the skin to low levels of red or near-infrared light, which penetrates tissues to varying depths. This light is absorbed by chromophores in cells, particularly within mitochondria. The absorption boosts mitochondrial function, leading to increased production of adenosine triphosphate (ATP), the energy currency of cells. Elevated ATP levels enhance cellular processes, promoting repair, regeneration, and overall health. RLT also stimulates the production of collagen, a key protein for skin structure, which improves skin texture and elasticity. Additionally, it is thought to reduce oxidative stress and inflammation by increasing antioxidant defense mechanisms. All of these effects collectively accelerate healing, reduce pain and inflammation, and improve skin health.

I bought my red light panel post surgery to help heal my scars and give my body a boost. While I don’t have any control to compare, I can tell you that I’ve seen massive improvement in the skin on my face, and my surgeon looked at my 8 week old scars and said, “What’s your secret sauce that’s made those scars look so good?”

Finally, I’m deep in the world of peptides. Again, this came about as part of my surgery recovery strategy.

Peptide therapy involves using specific peptides, which are short chains of amino acids, to target various health conditions and enhance physiological functions. These peptides can mimic or influence naturally occurring peptides in the body, thereby modulating specific biological processes and improve hormone regulation, immune function, and tissue repair.

Specifically, I’m using injectible variations of the peptides BPC-157 and TB-500, which accelerate muscle and tendon repair, reduce inflammation, and enhance recovery from injuries.

The catch with peptides is that there aren’t any randomized clinical trials in humans, but there is a mountain of anectodal evidence and animal studies. Also, it can be tricky to find American-made, third party tested peptides that are 99% pure. I’m working with a specialist, so I trust where the peptides are coming from and know the exact dose I need for my body, but there is still a slight element of risk. So far, though, I’m having no issues, and think that the peptides are part of the reason why my knee recovery is going so well.

Today’s issue is a little different.

I am sharing a short essay I wrote sometime last year, that has yet to see formal publication. It comes in anticipation of my least favorite day of the year, July 3, the anniversary of my father’s death. Like all things grief, the intensity of the day itself is unpredictable. Some years, I forget about it entirely. Other years, I fall into a funk around Father’s Day and stew there until Fourth of July celebrations end. Last year, a wave of grief hit me in a coffee shop in Milwaukee, followed by a rush of excitement over the circumstances that brought me to Wisconsin in the first place.

This year…well…jury’s still out. It’s been six weeks since my knee surgery, and in between the stretches where it feels like a bulldozer is running over my psyche, the liminal space in between emotion and response has forced radical acceptance of whatever or whoever shows up.

The who of all this? My goodness. Both personally and professionally, a few extraordinary beings arrived without fanfare. When they came into my awareness, my first thought was: There you are. And a beat later: But why did you show up now?

There’s a sense of being out of time and place, of both the familiar and unfamiliar, of tying up loose ends while unraveling a new story. There is the distinct knowing that everything is linked, without any conscious understanding of how. There is a sort of energetic collision, a string of connection transforming from invisible to undeniable. An unspoken agreement, a heartbridge to another realm. Steady and beating, stirring up all that is unknown.

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Recently, while reading a memoir by a dear friend, Y-Dang Troeung, I turned the page and was greeted by a demure, black and white photo. I brought my right thumb and forefinger together and placed my fingers on her body, attempting to zoom in on the static, paper image. It was only after a few attempts that I realized what I was doing, and I burst into tears. 

On November 27, 2022, at the age of 42, Y-Dang died of pancreatic cancer—the same disease that took my father when I was fifteen. In the photo, Y-Dang is standing in front of “The Killing Tree” at Choeung Ek in Cambodia, where Cambodian infants were killed at the hands of Pol Pot and his genocidal regime in the 1970s. Her right side body faces the camera, small enough to fit within the center third of the photo, barely distinguishable from the bridge she stands on and the tree still caked with dried blood. 

A Canadian national bestseller, her book Landbridge: Life In Fragments, depicts snippets of Y-Dang’s life as the literal poster child for Cambodian refugees in Canada, all of it written during precious waking hours during the last year of her life. A career academic specializing in refugee studies, the work is all at once an elegy to the freedom and imprisonment of political asylum, a reflection of the Cambodian genocide told through her family’s lens, and a series of love letters to her young son, Kai. 

As is with all art, we view it through the lens of our experience. I cannot read Y-Dang’s words without stirring the ghost of my father, a man who—other than a loose connection to the same general war (my father fought in Vietnam) and cancer of the same name—bears no ties to the woman in the photo. Yet it is through Y-Dang that I have been turned to face the dregs of grief, and through her that I have found fragmented answers to hanging questions about my father’s death.

Did he know what was happening? Was there pain? What kind of pain? What would he have said if he could speak?

I can’t say for sure what I was looking for when I tried to zoom into Y-Dang. It is something I do with digital photos of those who matter to me, in moments of loneliness. The act of bringing their face toward me is comforting, somehow, and seems to strengthen the invisible string that tethers us together. But something is lost in images of those who are gone. In death, that string releases, replaced by a nebula of energy that is no longer linear, but everywhere all at once. Not being able to zoom in, not being able to see the image clearly, is the ever present unease of living. 

In the beginning of Y-Dang’s book, she quotes Michael Allaby’s definition of land bridge: a connection between two land masses, especially continents, that allows the migration of plants and animals from one land mass to the other. 

I would like to add a new word to the lexicon: heartbridge. A connection between two souls, seemingly distant from one another, who provide a path of release and understanding both to each other, and for those who stay behind. 

There are a handful of events in human existence that, when encountered, fundamentally shift perspective by connecting you to the greater experience of the human race. Having children (or so I hear), is one example. Falling in love, another. Grief. Wonder.

And pain. Physical pain.

Until a few days ago, I would have told you I’d experienced a few bouts of 10/10 physical pain in my lifetime. A serious ballet dancer in another life, I broke both my feet when I was 18, which I thought was a 10/10 until, at 25, a gynecologist hit my cervix during an IUD insertion. That oopsie led to two extra hours in the doctor’s office, curled and crying in the fetal position because I was in too much pain to walk. No migraine, no cut or burn in the kitchen, not even the aftermath of a car accident has come close to the agony of that IUD mishap.

When I blew out my knee on April 2, I remember thinking about how little it hurt compared to the damage I knew I’d done. An MRI confirmed the carnage: a full ACL tear, meniscus tear, burst Baker’s cyst, and a collection of Grade 2 sprains, bone bruises, and “marrow leakage.”

Still, when people asked if it hurt, I shrugged and answered, “Sort of?” I was in pain, sure. But it was manageable, tolerable. I thought of a 1995 study that found that ballet dancers have a significantly higher pain tolerance than non-dancers and figured my blasé attitude toward my knee pain (and kitchen burns, lost toenails, and cold water tolerance) had something to do with spending my youth dealing with the discomfort of pointe shoes filled with my own blood.

I rehabbed my knee for six weeks before my ACL surgery, ensuring that the leg was as strong as possible going into it. I figured the post-operative pain would be worse than the injury itself, but not so much that I couldn’t handle it. Around 175,000 ACL surgeries are performed every year. On average, that’s 480 people per day. I was going to be fine.

In times of injury, the body can go into shock. A drop in blood pressure reduces the flow of oxygen and causes blood vessels to constrict. Adrenaline is released which increases the body’s pain threshold. In some scenarios, shock is life-threatening. In others, like when I was in a car accident in 2014, shock simply delayed the pain.

The threshold of shock varies from person to person, scenario to scenario. Based on anecdotes and brief research, it seems most likely to happen during a sudden trauma as opposed to, say, a mixup with post-operative drugs, leading to anesthesia gradually wearing off without any painkillers in my system.

When I was 25 and curled up on my gynecologist’s medical table, I didn’t think it was possible for the body to feel that much pain without going into shock. That pain has been seared in my mind for thirteen years, mentally helping me through pesky accidents and injuries because as bad as whatever it was, it wasn’t like that.

And this wasn’t like that either. This was worse.

This was four deep cuts into skin, muscle, and bone being lit up by a femoral nerve that was coming back online. This was a quadriceps muscle paralyzed both by the nerve blocker and the missing quad tendon harvested for my ACL. This was modern Frankenstein, butchery in the name of medicine. This was the part you’re supposed to do with opioids, acetaminophen, and ibuprofen.

Instead, I rode out the night without the right painkillers, feeling the entirety of what it’s like to be sliced open and sewed back up. Though my mother was a phone call away, I didn’t yet know what went wrong and figured there was nothing she could do. I didn’t want her to see me in the state I was in, anyway. The sounds someone makes in that level of pain are different than your standard cry. It is guttural, more of a wail than a sob, laced with desperation and a wordless beg for mercy.

At one point I was sitting up, leg hanging off the side of the bed, attempting to move myself counterclockwise so I could lie down again. But the pain was too great to get the leg over the bed.

My mind jumped to the battlefields of the Revolutionary War. I saw a field, with soldiers in red coats fighting the Patriots, bayonets perched on the ends of muskets. I saw the blood-soaked ground, scattered with bodies sliced through the abdomen, the shoulders, the legs. I thought: this is what it’s like to be maimed in battle. Even amid the greatest pain I’d ever experienced, I felt a connection to the human race I’d never felt before. Since the dawn of humanity, how many people have felt this pain? Were they in shock, or did they endure every cut?

I eventually got myself prone, and then, into some variation of a side sleeping position that provided a minuscule level of relief. I remembered Ekhart Tolle’s directives on pain from The Power of Now, and how he said that in times of pain—including physical pain—be the one who observes.

“Focus attention on the feeling inside you. Know that it is the pain-body. Accept that it is there. Don’t think about it – don’t let the feeling turn into thinking. Don’t judge or analyze it. Don’t make an identity for yourself out of it. Stay present, and continue to be the observer of what is happening inside you. Become aware not only of the emotional pain but also of ‘the one who observes’, the silent watcher. This is the Power of Now, the power of your own conscious presence. Then see what happens.”

— The Power of Now, page 40

I also remembered how, when I was a little girl, my mother would walk me through meditations to lessen the pain of migraines. With my head on her lap, she would ask me to focus on the pain in my head and imagine it as a ball of light. Then, in a soothing voice, she said to imagine the ball getting smaller and smaller. Sometimes the ball would dissolve into a pinprick, other times she would have me give it away to an angel. It always made me feel better, at least until we got to a bottle of Advil.

This time, I had no physical ability to get to the collection of painkillers on my kitchen counter and hours to wait before I could call my doctor. I certainly couldn’t ignore the pain, but I could pay even more attention to it.

I closed my eyes and looked at the pain. In my mind’s eye it was a blue and black inkspot, morphing from my knee, up through my hip, and back down to my toes. The more I watched it, the less it felt like pain and the more it felt like experiencing pain. It is difficult to articulate the difference, but it’s like there was a beat in between the observation of pain and the feeling of pain. That beat provided just enough relief to get through to the next moment.

My heart rate began to slow and the wails quieted down. I struggled to keep concentration on watching rather than feeling, but when I noticed myself straying, I brought my awareness back to the blue and black inkspot. Eventually, I locked in enough to try another visualization. I thought of a glowing white IV bag filled with painkillers, floating above my body. I watched as the white liquid came toward me in a thin intravenous line, entering my body and flowing through my bloodstream. I watched it take over the inkspot, infiltrating the sludge.

I woke up in blinding pain some time later. I don’t know if two minutes or two hours had passed, but the fact that I had managed to doze off at all seemed like a minor miracle.

A few days later, at my first physical therapy appointment, my PT kept apologizing as he was examining my wounds, changing the dressings, and causing minor amounts of sting as he did his job. I brushed him off, assuring him that I had a new ceiling of pain thanks to my first night after surgery.

I know it was bad—and worse than the IUD—because my body has flooded itself with hormones to make me forget the extent of it. I don’t so much remember the pain as much as I remember the sounds of my cries, the way my dog ran into the closet, and the helplessness of not being able to move. I hope I never have to go through something like that again and yet, I feel an odd sense of camaraderie towards the millions of people throughout history who endured unimaginable physical pain without anesthetics.

And, despite the damage I think much of Big Pharma has done to the world, I know how grateful I was when the right painkillers finally worked their way into my system. The right tool for the right job does wonders. But the wrong tool for the wrong job?

Chaos.

“I too, feel depressed,” I texted my mother from an island rock perched in crystalline Lake Tahoe.

My mother’s passing feeling of depression was referring to two suitcases in the back of a storage closet. They hadn’t been used in twenty-three years, relics from the trip she and I were on when my father died. My feeling of depression wasn’t so much wrapped up in luggage, although the reminder didn’t help. Instead, it was—is—caught in the tendrils of a long, ongoing list of personal and professional misfires capped off with a full ACL tear. (I am in surgery as we speak. Or as you read, rather.)

Although nothing about my career, relationships, or general life satisfaction is thriving, most of my inner torture is attached to the actions of someone else. Without getting into specifics, I am waiting on a response to an inquiry that could change my entire life. I have formally been waiting since March, but really, I’ve been waiting for a year and a half. What began as a zygote of an idea grew into curiosity and was then fed with just enough fodder and uncertainty to create a perfect storm of compulsion, passion, and confusion. The torture is less about what answer comes from the inquiry and more about the insanity over why this is happening in the first place. Is it destiny? Life purpose? Misguided desperation? I fixate on concrete interactions that brought me here and then fight the delusion that comes from dreaming so big in the first place. I search Twitter and Google News for updates and extrapolate data from folks who have no idea they’re supplying breadcrumbs to someone desperate for a nourishing meal. The whole thing has pulled a melancholic veil over my world, something that even a Wednesday lounge by the blue waters of Tahoe couldn’t lift.

I came home from the lake and turned to my coping mechanism—oil painting—until it got dark. Mid brushstroke, egged on by the minor chords of Shane Smith and the Saints’ “Little Bird,” I failed to fight back tears of exhaustion, longing, and frustration. While chewing on a (bad) idea I thought might take the edge off the ache, I remembered an old journal scribbled with something relevant to the bad idea and, upon cleaning my brushes, went looking for whatever I’d written down.

In big letters, I’d written a word I’d never heard of and had never bothered to look up: limerence.

A quick Google took me to The Attachment Project’s definition of limerence:

The experience of having an uncontrollable desire for someone – an obsession that consumes the limerent person’s thoughts, feelings, and behaviors. It usually involves two people: the person who desires the other (the limerent) and the desired person (the limerence object or LO).

Essentially, limerance is a state of being stuck between uncertainty and hope: will they or won’t they return the sentiment? For instance, perhaps this person hasn’t rejected them entirely, but they haven’t confessed their love either. 

This state of irresolution causes the limerent to become preoccupied with the LO, closely analyzing their behavior and body language to look for signs of reciprocation. They may also ruminate about past encounters with the LO and fantasize about what might happen between them in the future. The key feature of limerence is that these thoughts and yearnings are uncontrollable and all-consuming. 

As I went down a limerence rabbit hole, I wondered how I’d gone 38 years without learning this word. Limerence is usually associated with romantic love, but it doesn’t have to be. Friendship, family, mentor/mentee—any relationship involving two people can go wayward with limerence. For me, it explained everything.

Instantly, I felt better. I even looked dog and said, “Holy shit, that’s it!” How good it felt to be seen, to have the irrationality explained, to read accounts of other folks on r/limerence whose crazy was just as bad (and worse) than my own.

The epiphany gave me odd permission to do all the things I knew I needed to do but couldn’t quit. I unsubscribed from news platforms that might carry a snippet of information, unfollowed a few players in the space, and muted decision-makers. I will get an answer this year. Everyone involved has each other’s phone numbers. That was true before and is still true now. The difference is that in putting a name to the crazy, I am now able to shift into waiting without being consumed by thoughts.

It didn’t take long for me to draw a parallel between my elation over having a name for my distress and the (sometimes literal) party people throw for themselves when, after years of suffering, they get a formal mental disorder diagnosis. Twitter is full of tweets (and arguments) over adults to celebrate the ADHD, AuADHD (Autism/ADHD), or bipolar diagnosis they receive in midlife. People become so enmeshed with their diagnosis that it ends up in their bio, right next to their other primary descriptors: proud mom of 3, chemist, AuADHD.

I am, admittedly, quite judgemental over this kind of behavior. I can’t pinpoint exactly what bothers me, but it lies somewhere in the space of over-medicalization + over identification + taking resources away from folks who actually need it. Marcia, the offbeat, fiftysomething part-time jewelry maker may feel quirky and “off” in the world, but if she lives independently, pays her bills on time, and contributes to society, is she really “disordered”?

Hell, my sensory issues, mood swings, and general frustration with people land me on the spectrum of high-functioning autism. More than one person has asked me if I’m neurodivergent, which pisses me off. Again, I can’t pinpoint exactly why. Perhaps it’s because the suggestion itself indicates that someone wants to force me into a box, which, if you know me even a little bit, is the quickest way to make sure we never speak again. My gut reaction to the question is even less attractive. It’s something along the lines of: Who gives a shit? Stop searching for trendy explanations and go create something with your life.

And yet, learning the meaning limerence was like someone taking off mental handcuffs.

I am well aware of my bias. After seven years in the antidepressant withdrawal and overmedicalization space, the three words most likely trigger an eye roll are stigma, treatment, and validation. Drug makers are advocacy groups biggest donors, which puts a damper on “awareness” and “anti-stigma” campaigns. May may be “Mental Health Awareness Month” but if it were honest, it would be called “Psych Drug Advertisement Month.”

Treatment is a sneaky little way of using common languange to medicalizing a psycho/social/emotional issues. Just like Eli-Lilly’s clever 2023 tagline rebrand from “Powered by Purpose” to “A Medicine Company,” it’s about treating the patient, or ensuring access to treatment. What sort of monster wouldn’t want someone suffering to get the treatment they deserve? “Treatment” is medical care for an injury or illness, synonomous with drugs and diagnosis. It is not healing, building resilience, facing issues, making difficult decisions, or daring to accept that sometimes you are the problem.

And then there’s validation, both a powerful force for positive change and destruction. Validation when it comes to sorting out an issue and being understood by another human? Good. Validation from external sources and the constant need to have feelings recognized? Not so good.

The difference, I think, is what happens after validation is received. Productive validation identifies an issue and, through the act of recognition, diffuses its intensity. I recognized myself in the definition of limerence and used the tools provided to quiet the symptoms. Unproductive validation is righteous and only intensifies the feedback loop. Had I seen the definition of limerence, felt seen but not taken action, all I’d be doing is shifting the blame. A lightbulb that illuminates the whole picture versus a spotlight that blinds everything outside a defined edge.

Or, as Oxford researcher Lucy Foulkes recenty said in her New York Times opinion piece, “High-Functioning Anxiety isn’t a Medical Diagnosis. It’s a hashtag” :

All this awareness oversimplifies and maybe even popularizes mental disorder…and over interpretation can become a self-fulfilling prophecy…if everyone is ill, no one is.

Ever since MAY CAUSE SIDE EFFECTS was published in 2022, I’ve done as much press as I can without bankrupting my savings account or my soul. Podcasts are my favorite outlet, and after years of refusing, I finally caved and got on TikTok with the intent of reaching a withdrawal-specific audience. 

A few weeks ago, I shared a clip from my episode of Relatable with Allie Beth Stuckey, a massive podcast with loyal listeners. On both Instagram and TikTok, the post blew up, launching me into the weird world of internet virality. In many ways, I’ve been training for this since I started speaking publicly on antidepressant withdrawal in 2018. I’ve honed my message, backed up my personal story with research, and learned how to talk about it without treading into the litigious world of formal medical advice.

Still, nothing quite prepares you for the onslaught of notifications when a post goes viral. Instagram has a short half-life. Viral posts die within a week or so. TikTok is different. The algorithm keeps feeding it back into the funnel, like riding the same ride at the carnival over and over again. Combined, the clip has over half a million views with around two thousand comments. 

What I am most surprised by is the lack of pushback compared to the volume of psychiatric horror stories. Typically, anti-antidepressant content generates a decent amount of criticism. Whether it’s my work or someone else’s, you see a lot of, “Antidepressants save lives!” and “Stop shaming people for seeking the treatment they need.” Point out the FDA-supported data suggesting that antidepressants actually take lives in people under 24 and have no effect on suicidality for those 24-65, and I’m usually met by a reductionist, personal anecdote that culminates in, “What you’re doing is DANGEROUS.”

Sometimes people get cranky because I’m not a doctor or researcher, to which they say, “and what are ur credentials?” Unbeknownst to them, this is the one line that makes me doubt what I’m doing, so much so that after some rando made this comment I started researching online masters programs to see if I could get a quickie degree. I’m not bothered because I don’t have letters after my name. I’m bothered because I don’t know what I don’t know. I wonder if my bias is causing me to miss something that could hurt someone. Somehow, my lizard brain thinks having an advanced degree would protect me from that bias, which is ironic because the whole problem with the current standard of care in mental health is that clinicians are blind to the pharma/diagnostic bias programmed into them during their advanced degrees. 

Credentials buy you an expensive certificate that says, “I’m good at memorizing the stuff required to pass a test.” The art of medicine or therapy—and the critical thinking required to question why people aren’t getting better despite more intervention—only comes with time and practice. And after 10+ years of by-the-book education, very few practitioners have the self-awareness or balls to say, “I don’t know what I don’t know. I wonder if my bias is causing me to miss something that could hurt someone?” 

Thus, millions of people around the world are being hurt by people with letters after their names, yet somehow I’m the problem. 

When these comments get to me, I try to remember that being an MD doesn’t shield you from bullshit. Dr. Will Cole, a major player in the functional medicine space, recently shared a post on Instagram about the evidenced-based placebo effect with antidepressants. It garnered so many negative comments that the post is now deleted. Will told me in a podcast we did together that the response made him not want to talk about the topic at all. 

For my posts that went viral, the ratio of positive/like minded comments to nasty ones is about 100:1. Whether it’s sample bias from the algorithm or people finally feeling safe to air their grievances about shit doctors and bad drugs, I don’t know. But in the comments of one video, there are over 1600 horror stories just about Effexor. If this were in a specialty that uses lab tests to determine disease, that would be a class action lawsuit. It’s not a class action lawsuit in psychiatry because there aren’t any empirical tests to measure mental and emotional symptoms. A group of people claiming Effexor-induced suicidality cannot prove that Effexor was at fault, and all the pharmaceutical lawyers have to do is point to the patients’ clinical history and blame their suicidality on the depression diagnosis the patient inevitably received. Clever, innit?

The deluge of comments does inspire me to keep chugging along, though. Many folks talk about how they thought they were alone until they stumbled upon my post. This work can feel meaningless because it feels like the needle isn’t moving, and I often wonder if I’m wasting my time. I needed this boost as much as the folks in the comments did. 

So, if you’re new to my substack from one of these podcasts, thank you for being here. I’ll keep doing the work if you do. 

The title, basically, which is why this issue is a day late.

Last week, I tore my ACL after taking a bad landing during practice for a gymnastics meet I was supposed to compete in this week. Everyone who hears about it wants to tilt their head and make some comment about getting older, which pisses me off because this injury was the result of gravity and physics, not age. The only time I’ve been feeling my age is when I look around at the world and simultaneously think, my god, I’ve been around long enough to see the bullshit double back on itself and come back again and also I’ve still got a lot more of this left to go.

In theory, anyway.

I can’t say I’ve been thriving over the past eight months, and this injury and its long road to recovery isn’t exactly righting me on the road to flourishing. I’m not looking to beleaguer you for pity or words of encouragement. They’ll roll right off me and I don’t want to hear it. I only bring it up to convey the state of mind I’m in, which is probably why I’m purposely picking a public fight with Harvard psychiatrist Roy Perlis, who with all his Ivy League wisdom, truly thinks it’s a good idea to make antidepressants available over the counter.

On April 8, Stat News posted an opinion piece by Perlis titled, “The time has come for over-the-counter antidepressants,” wherein Perlis argues that antidepressants should be available without a prescription, just like ibuprofen or laxatives. (Don’t bother rewarding Stat with views by clicking the link. I’m going to break it down below.)

As sure as I am about the overall harm caused by casual, mass psychiatric drugging of the human psyche, I still leave the door open for counterarguments. I consider it part of my duty to stick to my guns only if they’re loaded, which means forcing myself to get out of the echo chamber and hear opposing opinions. So I read the piece, expecting a Harvard professor to at least make a well-substantiated argument, even if I didn’t agree with it.

Instead, it’s 900 words of one of the dumbest, most poorly cited pieces of “journalism” I have ever read in the mental health space. And that’s saying a lot, given the drivel that comes from pop-wellness websites.

Let’s take a look, paragraph by paragraph. Perlis begins:

Anyone can now walk into a pharmacy in the United States and buy oral contraceptives over the counter without a prescription, thanks to the FDA’s approval of norgestrel (Opill). This change reflects the drug’s safety and the public health imperative to ensure wider access to birth control. But another safe class of medicine that addresses a massive public health need remains unavailable except by prescription: the antidepressants known as selective serotonin reuptake inhibitors (SSRIs).

Let’s start with the immediate oddity. Why in the world is Perlis comparing an SSRI to hormonal birth control? What do these things have in common other than being a political football? If he’d instead compared an SSRI to over-the-counter supplements that act on the serotonin system, like St. Johns Wort or tryptophan, then maybe we have the basis for a relevant argument. Instead, he chooses birth control (in all likelihood to signal that he is not one of the Bad Men who took women’s rights away) and throws the word “safe” in front of both of them, as if there is any 100% safe medication. All interventions carry risk, and half the point of a doctor is to assess whether the risk of treatment outweighs the risk of the illness. Perlis sort of addresses this later in the article, but even by using the word “safe” in such a casual way, he is grossly generalizing while also patronizing readers.

These medications, which have been used in the U.S. for three decades, have repeatedly been shown to be safe and effective for treating major depression and anxiety disorders.

There’s that word again, right above the fold. Note how there is zero reference to support this. We are supposed to take his word because of the letters after his name. When someone else on Twitter pushed back against the safety claim with a study questioning antidepressant safety, Perlis chastised the user for “spreading misinformation” and then linked a meta-analysis he co-wrote along with a dozen others as evidence for antidepressant safety. I looked that paper over and noticed that at least half of the authors had declared conflict of interest statements. I responded to the tweet, asking Perlis why he would use a paper with so much declared conflict of interest to support a pro-pharma argument. Perlis blocked me along with the original user who called him out, and his response with the problematic paper is now deleted.

Perlis goes on to list the usual mental health woes including increasing rates of depression, long wait times for mental health services, and oddly, telehealth services whose quality of care is “difficult to measure.” He does not elaborate on how removing any clinical professional from the equation would improve measurement, but that’s par for the course for this dialogue, so I’m going to blow past it and focus on more egregious issues.

In reality, many OTC products treat symptoms or rely on consumers to diagnose themselves — think yeast infections, acid reflux, or respiratory infections. In the case of major depression or generalized anxiety, screening surveys have been developed for primary care that could help people determine their likely diagnosis with at least the degree of confidence of many OTC applications.

Ah yes, the screening survey. In no other area of medicine does a doctor make full diagnoses and prescribe solely based on a patient’s answers to a handful of leading questions. It’s working so well, too! People are thriving after being asked if, in the past two weeks, they’ve felt hopeless. Please circle “a little, sometimes, a lot of the time, or all the time.” And after you do that, we’ll give you a drug for the despair we can’t measure and convince you it’s your brain chemicals, stupid.

What about use or misuse? Depression is associated with increased risk for suicide, and medication overdose is among the most common methods of suicide. But walk through the aisles at your local pharmacy and pick any given medicine off the shelf: the odds are good it is more dangerous in overdose than an SSRI. Fatal overdoses are far more likely to involve drugs other than antidepressants.

Here’s where he really starts to lose me. Perlis uses overdose to defend his reasoning for the safety of SSRIs, claiming that it is more likely to overdose on other OTC drugs rather than SSRIs. This is bizarre because a Harvard psychiatrist should know that most people commit suicide by firearms or hanging and that even amongst poisonings or overdoses, people aren’t using their bottle of Zoloft to do it.

I’m unclear if Perlis was trying to make the argument that antidepressants are less fatally toxic at high levels than other OTC drugs, or if he’s trying to create a red herring that distracts people from the fact that suicidality and suicidal thoughts can be induced by antidepressants. I initially thought it was a poorly constructed argument for the former, but the next paragraph muddles it.

Among people age 25 and older, there is clear evidence that taking antidepressants does not increase the risk for suicide — in fact, the risk of suicidal thoughts or acts is reduced in this group, particularly among those 65 and older. For those younger than 25, the risk for suicidal behaviors or thoughts in clinical trials was modestly greater than that of placebo. So buying SSRIs over the counter could be restricted to people 25 and older, at least at first, just as some states restrict OTC pseudoephedrine (Sudafed) purchases to people age 18 or older.

Perlis is pulling data from a review by the FDA that examined the effects of black box warnings on antidepressants. Thanks to this study and others, it is well known that antidepressants increase suicidality significantly in younger populations. (A recent study used to approve the use of Lexapro for 7 to 12-year-olds documented a 6x increase in suicidality among kids who were put on the drug…and yet it was still approved by the FDA. See Dr. Roger McFillin’s take on that absurdity, here.)

It is incomprehensible to me that a psychiatrist in good standing would not only suggest a drug with a black box warning should be available over the counter, but that we can mitigate that risk by simply ID’ing whoever is buying it, as if the drug couldn’t then just be given to those under 25 as soon as the buyer walks out the door.

If Perlis ever grants me the interview I asked of him on Twitter**, my first question would be this: If some fifteen-year-old hangs themselves two weeks after starting OTC sertraline bought for them by their parents, who is responsible? The kid? The parents? Or the teller ID’ing folks at CVS?

Another objection to over-the-counter SSRIs is that not everyone believes in pills for depression. Some still question the biological basis of this disorder, despite the identification of more than 100 genes that increase depression risk and neuroimaging studies showing differences in the brains of people with depression.

Perlis goes on to draw an odd line between people not “believing” in the biological basis for depression and a study that looks at neuroimaging biomarkers as well as a Scottish study that concluded that people who “carried over 100 [changes to their DNA] were much more likely to develop the disorder in future.”

First off, the neuroimaging study he linked was connected to identifying the individuals who are most likely to benefit from targeted neurostimulation therapies, NOT antidepressants, which makes that reference null. Second, even if we did have the ability to easily test for these 100 or so mystery genes that cause depression (according to one study), does Perlis expect every person who walks into a CVS to have completed a full neuroimaging evaluation or DNA test before purchasing their sertraline with their toilet paper? If not, then how can you argue that this would be a broadly effective strategy?

To be sure, there are alternatives to pills. Certain talk therapies, like cognitive behavioral therapy, can be as effective as antidepressants, and some people prefer talking with a therapist to taking a medicine. But not everyone: weekly visits for eight to 12 sessions or more can entail substantial time and money. Here too, access to psychotherapists is a massive problem, particularly for individuals who seek to use insurance, or have none.

What this is saying is that Perlis is perfectly okay mass drugging lower-income folks under the guise of do-gooder benevolence. Please refer to the rise of Nazis for historical precedence on how that works out.

No treatment works for everyone, but around one in three people with depression get well with an initial antidepressant medication. Allowing over-the-counter access is not a panacea, but could open the door to a safe, effective, and inexpensive treatment for many who need it.

Perlis uses the STAR*D trial to report that one in three people who take antidepressants get well. Putting aside the recent calls to retract the STAR*D trial results due to significant violations of the originally submitted research protocol, Perlis’ own argument still suggests that the majority of people do not improve on antidepressants. Yet his strategy would expose 2 out of 3 people to iatrogenic risks and side effects of these “safe” drugs including but limited to suicidality, violent aggression, irreversible sexual dysfunction, mania, and damage to fetal development.

What’s needed to make this happen? An SSRI manufacturer with the courage to engage with the FDA and invest the necessary resources for a prescription-to-OTC switch, a well-trod path that has previously included medicines for allergies, acid reflux, and emergency contraception, among others. This process would primarily involve studies to prove that consumers can understand and follow the medication label, not new clinical trials, because more than three decades of evidence shows that SSRI antidepressants are safe and effective.

Perlis closes with a call to action from pharmaceutical companies, convenient because it absolves him of any downstream responsibility. He also continues to push the thread that depression is just as simple as contraception or acid reflux, even though those ailments occur due to a single, easy-to-explain mechanism. The same cannot be said of depression. Even in a world where biology was the sole explanation, it involves various processes (and apparently, over 100 genes) which means no single antidepressant would be suitable for all.

**Since Monday, this article is making its way around Twitter and I’m now not the only one picking a fight with him. However, in an odd twist, Perlis agreed to an interview with me. We’ll see if that materializes.

On March 8, 2017, I published a post on Medium entitled, “Finding Happiness Through Factual Optimism (Even When Life Goes Sideways.)”

The essay, even with its amateur prose that now makes me cringe, explained the system I created for myself to objectively track my progress when I was healing from antidepressant withdrawal and fifteen years of chronic depression.

At the time, I recognized two things:

So I did what I do best—go in a completely different direction and find a way to quantify the shit out of my feelings, then measure them against a very low bar of success! Because fuck gratitude, right? To quote myself from my book, on page 100 of MAY CAUSE SIDE EFFECTS: Gratitude is the bow we tie around our brand of shit to convince ourselves our particular pile of shit is a pretty pile of shit.

My feelings have changed on this, as I’ll address later, but at the time, rejecting gratitude was a form of taking back my power. I was just trying to survive. Gratitude was too advanced, and I needed to aim lower.

The lowest bar, I reasoned through a black and white lens, was that life would be worth living if it trended positive 51% of the time. That’s 2.6 “good” days per week, where “good” is defined by having the day itself trend 51% positive. String enough 51% days together, and you’ve got a 51% life objectively worth living. How’s that for data you can’t argue?

With a yardstick in place, I set about tracking and quantifying the data with the objective of a 51% Lifetime Happiness Average, whereby my choices were validated by default. My goal was never to reach a Utopic level of constant joy. I knew 100% Lifetime Happiness was impossible, but even 80% felt like a stretch. The gratitude gurus lived at 80. I just wanted to dig myself out of 20.

So, at the end of each day, I opened a journal and assigned myself a Daily Happiness Rating based on how the hell I was feeling at that moment. I used a 0-100 scale to allow for nuance. The difference between 49 and 51 was monumental, so it seemed right to give respect to the weight of each integer. Still, knowing that feelings aren’t facts, I didn’t overthink the number. Good morning, bad evening? Give it a 48. Horrific day filled with intrusive thoughts? It gets a 10. A window in the world of withdrawal, in which I didn’t break down in tears? Assign the day a 60 and hope for a 61 tomorrow.

Then, I plotted it all on a line graph.

The drop in February occurred when I went into antidepressant withdrawal. The uptick in August happened when I boarded a one-way plane to Malaysia and was temporarily spellbound by the thrill of a new place. Then, predictably, the high wore off leading to a September crash, followed by an uptick.

When zoomed out, this looks like a person healing. Which, it was. But zoomed in, the day-to-day felt volatile because it was:

My monthly charts from 2016 would reflect a much lower day to day experience, but in February 2017, nearly a year into withdrawal, I was having more 51% days than not. Still, when I went down, I went down hard.

Plotting this over a lifetime, as defined from the year my father died when I was 15 up until the end of 2017:

This is how I proved to myself that I was, objectively, getting better. I could not argue with the system I put in place. The only metric was how I felt, and I didn’t need to rationalize why I felt one day was a 38 while another was a 64. They just were, and that was good enough.

This process allowed me to have bad days, even bad weeks, while knowing that the only goal was a 51% lifetime average. This low bar both took all the pressure off and allowed me to look at individual decisions and determine how they’d affect my overall happiness average. Some decisions were easy. Making my bed certainly contributed to increasing my chances of a 51% day, and so would going to the gym rather than getting ice cream.

Other decisions were more nebulous or didn’t seem to have a clear upside. When those choices came up, I trusted that I’d banked enough smaller 51% decisions (like making the bed) to make up for a choice that might lower the overall average. Over time, I became better at recognizing when a choice was good for me while also forgiving myself for the days when things just fucking sucked.

I stopped tracking in early 2018, when I stabilized enough for the graphs to get boring. When the graphs got boring, something magical happened: I recognized gratitude.

What I’d missed about gratitude is that it is a feeling, not a thought. You cannot think yourself into it, which is why gratitude journals never worked for me. I was too full of muck for the feeling to appear, but once I cleared enough of the muck and analyzed all my little day-to-day choices, I began to notice the little spark of gratitude—a lazy moment in the sun with my dog, the smell of coffee, the color of a flower—all of which eventually grew into a campfire.

That is when I finally understood that gratitude is the way out of suffering. Because once you build that campfire, the world is filled with logs to keep it burning. Even in during painful experiences or crushing, a strong fire stays lit.

It is this duality that makes for a life truly lived at 100. For a long time, I thought a Lifetime Happiness Average of 100 was unattainable because no one can be happy all the time. This is true, of course, but what I know now is that the 100 contains within it all human emotions and experiences. To live at 100 is to experience the full depth of despair and uncertainty because it is matched by intense awe and love.

I know this because I now know love in a way I didn’t before. I know how love is all at once the most painful and beautiful experience, one that simultaneously makes you want to hold on to every moment and also die immediately, just to stop the ache of losing it. It is extreme and all-encompassing, encasing all the meaning of 0-100 within it.

What a gift it is to feel it, to not only want to live in a world bigger than 51%, but to welcome the extremes on either end. Where black and white, dark and light, good and bad are no longer opposites, but integrated expressions of a life well lived.