Inevitably, when you write a book about a growing global concern like antidepressant withdrawal, people reach out with questions. And even though I’ve received hundreds of inquiries in the year and a half since MAY CAUSE SIDE EFFECTS came out, I haven’t bothered to create an FAQ. As much as general themes repeat, people’s stories are unique, and canned answers rarely come in handy.

Instead, I try to answer each person individually and at the very least, ensure that they feel heard for a moment. In most cases—80%—this is all that’s needed. When people have been gaslit by doctors or have spent the majority of their lives under the influence of powerful psychiatric drugs, sometimes the difference maker is nothing more than someone validating their experience. That little bit of encouragement is enough to keep them on course and usually, I never hear from them again.

The remaining 20%, like all 80/20 relationships, take up most of my correspondence time. Typically these are the more complicated cases, usually from folks whose friends likely describe them as “a little neurotic.” These are the overachievers, the philosophers, the Type-As control freaks who did not schedule antidepressant withdrawal into their five-year plan.

This phenotype wants to do everything in their power to make withdrawal go away as fast as possible and can be found furiously googling and going down unhelpful rabbit holes on withdrawal forums. They also usually have money—depression is a privilege as it turns out—and are willing to spend it if they only knew what tests to get.

Of course, their doctor doesn’t have a clue, so when a basic blood panel comes out clean, the prescriber dismisses the idea of running more tests. The patient, though, knows something is amiss. Inn googling, these people find me and fill my DMs, which leads me the meandering point of this issue: every medical test I’ve been through to heal myself after fifteen years of antidepressants.

I took my last antidepressant in 2016, considered myself fully through antidepressant withdrawal in 2018, and spent the better part of 2021 – 2023 healing my body from the ordeal. I spent 2019 and 2020 tinkering with my diet in hopes of figuring out what was causing my gut issues and general I-feel-like-shit issues. I cut gluten or dairy or coffee. I ate less protein. I ate more protein. I juiced celery and drank fennel tea. I went to gastroenterologists who looked at me over a clipboard and said, “We can schedule a colonoscopy?”

Finally, in 2021, I called Andy Galpin, PhD., an old friend who, along with nutrition savant Dan Garner, was working with professional athletes to heal their lingering issues and improve their physical performance. Dan & Andy let me go through their program, which kicked off a two years of lab work and serious dietary changes that have finally allowed my body to heal and perform its best.

(I’ll cover my diet and the results of these tests in another issue. I’m on the road doing press for the paperback release of MAY CAUSE SIDE EFFECTS.)

Over a two year period, I’ve spent well over $10,000 out of pocket on lab tests. It is no small amount of money, especially given my super-lucrative career as a freelance writer and chef. (I recently received a royalty check for the amount of thirteen cents!)

Insurance hasn’t covered a dime, and still, it’s the best money I’ve ever spent on myself because I actually feel better. The key is to get all the testing done in a 1-2 week time period so you have a full picture of your health, all at once. This allows for the Dan Garners of the world to connect the dots between the body’s different systems, rather than isolating the endocrine/gut/blood labs in a vacuum and assuming nothing is connected, like allopathic medicine likes to do.

So, have at it folks. Go forth and figure out your shit. Literally.

Food Sensitivity:

MRT test

Hormones:

Dutch Test

Gut/GI:

GI Map

Heavy Metals:

Doctor’s Data Toxic & Essential Elements: Hair

Genetic:

GeneSight

Blood:

Complete metabolic blood panel

HNK1 (CD57) panel

Microscopic examination

Urinalysis, complete

C-Reactive Protein, Cardiac

Ferritin

Fibrinogen Activity

GGT

Hemoglobin A1C

Homocyst(e)I’ve

LDH

Lipid Panel with Chol/HDL Ratio

Magnesium

Phosphorus

Reverse T3, serum

Thyrogobulin Antibody

Thyroid Peroxidase TPO Ab

Thyroid Profile II

Thyroxine (T4) Free, Direct

Triiodothyronine (T3), Free

Uric Acid

Vitamin D, 25-Hydroxy

For months, I’ve felt like I just got on one of those carnival rides where you sit down, strap in, and let a rusty elevator take you to the top of a tower. Even though the elevator is gently taking you away from familiar ground, you know that at some point, the elevator will stop, open its doors, and give you a view of the world you’re about to drop into. And then, just as you relax into the view, the floor will fall away and gravity will take over, leaving you with no option other than to feel the rush.

I keep waiting for the elevator doors to open and show me a new world. It is coming. I can feel it and I’ve been feeling it for months. In October, I lost my main client and most of my work evaporated overnight. I challenged myself to simply wait, as itchy as it was because I could feel this something coming. I could feel myself standing in line, putting on a seatbelt, and waiting to move.

Every few years I seem to come back here, to a place of uncomfortably long stagnancy with no clear direction. The last time this happened was in August 2017. I was at the tail end of both a year of international travel and a year and some months of antidepressant withdrawal. I didn’t have a job or an address, but I had signed a flimsy book deal for a book called LADYBALLS. Though I still love the title, that book never came to be, but its existence contained the zygote of what would eventually become MAY CAUSE SIDE EFFECTS.

On a rooftop in Buenos Aires, I wrote myself a letter and dated it January 1, 2018. Why I thought six months was an appropriate open date, I don’t remember. But I do remember that when the new year rolled around, I looked at the unopened letter and knew it wasn’t time to read it. Days before, the book deal for LADYBALLS fell apart. I fired my agent and my publisher in a blind move that turned out to be the best career decision I’ve ever made. I couldn’t remember the specifics of the letter, but I knew if I opened it, I would only feel frustration and shame. So I stuffed it in a folder and forgot about it.

Until yesterday.

My strategy for dealing with general overwhelm is to spontaneously deep clean my home. Typically, a stressor appears—good, bad, doesn’t matter—and within a day, I decide my house is unacceptable. I am already known to vacuum in the middle of a dinner party, but this takes it to another level. In the words of Monica Gellar, the compulsive chef on Friends: “Not just health department clean. Monica clean.”

Yesterday, I signed a contract with a new client, thereby imbuing me with all sorts of problems to solve. After attempting—and failing—to solve all those problems in one morning, I came home and began scrubbing the screws on my toilet. Which led to re-lining drawers. And going through my closet. And cleaning out my desk, where I found a brittle, unopened yellow envelope dated January 1, 2018.

I smiled, sure that inside the letter was something about a $50,000 book deal that never materialized. Enough time had passed and I figured I could handle whatever was in there, even if what was in there was nothing but disappointment.

The back side:

I chuckled at the line, “By the time you read this, you’ll know where you’re going to live.” That is the only bit in there that isn’t quite settled. Something on the carnival ride feels like I’m not staying put much longer.

Everything else, though, has manifested. I wrote the book. And it’s good. And I finished on time, and I am happy with the words I wrote and the things I believe. The money came, too. And that independence. Real independence, because that year and these years gave me the gift of confidence and a voice—a true voice.

By the time I opened this, I had an address to come home to. And I can pay for it. And I am surrounded by people who love me. The negativity that followed me is a distant memory. I am me. And I am paid to be me. I am content, happy, full, and free.

I can’t remember if, when I wrote the letter, I really believed any of it would come true. I knew I wanted to believe, and that I’d seen glimpses of light during antidepressant withdrawal that at least taught me I was capable of experiencing a life I never imagined.

I share this with you because I can feel that I’m reaching the top of the elevator and that when it opens up and the ride truly begins, I know my story is going to reach even more people. So far, I’ve been able to keep up with the amount of correspondence I receive from people suffering from antidepressant withdrawal. Sometimes it takes a while, but I get there. I don’t know how much longer I’m going to be able to respond to everyone.

So, for everyone who is suffering, let this letter serve as an example of possibility. This can be your future if you keep the course and keep doing the work. Most times, the hard way is actually the easy way. Let it be hard. Feel it. Process it. Because at the other end is light.

Light

Light

Light

Light

Light

Light

Light

Joy

Love

Acceptance.

Hi friends,

When you’re reading this, I will be on my way to another continent to celebrate both my mom’s and my birthdays. And on the day of my birthday—February 1—I will have 16,715 more days to live. 

Maybe. Hopefully.

My father died suddenly when he was 54. That means he was halfway through at 27 and still had 13 years of living before I came along. I don’t have the vocabulary to express how much that twists my mind, and yet it’s been a constant thought over this year. I don’t know if it’s because 54 no longer feels all that old or far away, or because no one ever knows when they’re halfway done. 

I turn to numbers for comfort. Always have. Even as a girl, when I felt overwhelmed, I would quietly calm myself by counting ceiling tiles or cars passing in the other direction. 

In the depths of depression—despite years of antidepressants—I took a dozen life expectancy tests, sourced from life insurance companies and accounting firms. I averaged the results for a total of 83 years, 9 months, and 6 days on this planet. Or 30,595 sunsets.

I didn’t want those sunsets until I got off all the antidepressants and came out of a year of severe antidepressant withdrawal. But after all the suffering and all the deep work, finally, I want time. I want all the days I never thought I’d have. 

If I am so lucky to see them all, that means I get to watch the leaves turn 46 more times. 

And read just 920 more books. 

And watch 11 more Summer Olympics. 

There will be maybe 138 more pizzas and 33,430 cups of coffee. Assuming there’s always a canine by my side, I’ll take 66,860 more walks with 4 more dogs. 

I’ll hug that friend I only see once every few years about 15 more times. 

And feel lucky if I laugh until I cry 92 more times. 

Maybe I get half a dozen moments of complete and utter awe. 

And one great love. 

Maybe. Hopefully. 

All this to say: 

I don’t know how many more mother/daughter trips I have left, especially grand international ones. I will be happily unavailable for a few weeks and want to make sure you have your fill of the latest news on antidepressant withdrawal, so I have compiled a bunch of recent articles below.

There was a time when maybe one article was written on the topic every three months, and now I’m starting to see weekly (and even daily) headlines. Something is shifting. I can feel it, and I welcome it.

The STAR*D trial, once considered a landmark study in psychiatry, is now mired in controversy due to findings of protocol violations, inflated remission rates, and a general lack of accountability from its investigators.

One of the largest and longest studies on antidepressants, the trial initially reported a 67% effectiveness rate for antidepressants, which became the basis for the pharmaceutical focus that has shaped much of modern psychiatric “care.” However, the trial has come under scrutiny for several reasons, revealing a far different picture of its findings:

Recently, through a text message from a mutual friend, lifestyle design guru Tim Ferriss asked me a question:

“Could you ask her, if she has time, what the TL;DR (too long; didn’t read) is for the book explanation of why we’ve had such an astonishing rise in mental illness?”

Tim was referring to the book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker. I’d recommended the book to him by way of said mutual friend after Tim and one of his recent podcast guests, psychiatrist and Stanford researcher Nolan Williams, got the history of antidepressants wrong during the interview. Already annoyed by the proselytizing and arrogance that comes with elite academia, it pissed me off that Williams didn’t know the basic history of the field he’s trying to revolutionize.

William’s research, which focuses on a non-invasive, rapid-acting form of transcranial magnetic stimulation (TMS) called Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT), is reported to reduce severe depression symptoms in 90% of participants. Though I admit this is intriguing if replicable (and a good 5-10 years away from mainstream adoption), it would do Williams some good to remember George Santayana’s prophetic quote:

“Those who cannot remember the past are condemned to repeat it.”

And so, from a parking lot in a strip mall, I texted a friend to ask him to pass the book title along to Tim, given that it corrects the error and was then asked to summarize the book’s thesis. Here’s what I sent back:

The hypothesis of the book asks exactly that question. Why, despite billions of dollars invested in research, has the number of disabled mentally ill in the United States tripled (as of 2011) over the past two decades? Whitaker uses disability rates as a measurement, since there aren’t any practical biological markers/blood tests/or scans to identify or diagnose mental illness, and self-reported surveys aren’t the hallmark of anything resembling good science.

The TL;DR of it all: over long periods—longer than your average 4-12 week study—the drugs (which have been our only real strategy since the 90s), across the board, create changes in the brain/body to cause denigration to the psyche, which results in a mental illness diagnosis and more drugs. And of the long-term studies that do exist, they all point to this same conclusion. In schizophrenics, for example, long-term use of antipsychotics reduces grey matter. So not only is there a reduction of brain volume, but there’s the physical dependence on the drugs which, when they’re taken away, causes withdrawal…but withdrawal symptoms haven’t historically been considered in the research, leading to both misdiagnosis and sixty years of science confusing relapse with withdrawal and more people permanently disabled.

When you combine this with some of what’s come out recently about the shit science in psychiatry—notably, the publication bias in the original Xanax trials (four of the five original studies on the effectiveness of alprazolam found it to be no better than a placebo or a negative result, but the data was cooked and now we have an opioid crisis), the call to retract the STAR*D trial due to protocol violations that grossly inflated the announced remission rate (not to mention there wasn’t was a placebo control group which is baffling), broadening diagnosis + patents expiring on hallmark drugs, and the anti-stigma campaigns (many of which are funded and created by pharmaceutical companies), and you’ve built yourself a lucrative, psychiatric bomb where individuals suffer at every step.

It’s also interesting because years ago when I was researching an op-ed I wrote for The Washington Post, I spent time with Fidel Vida Rodriguez in his lab at the University of British Columbia. His lab does TMS-fMRI and tDCS-fMRIs. It’s interesting to watch technological progress meet the same mistakes we made in the past, and I’ll be curious to see if this stuff can escape the problematic structural issues in psychiatry.

To which, Tim responded: “Smart woman! Pls extend my thanks.”

Who am I to argue with Tim Ferriss? Perhaps I should add “Tim Ferriss says I’m smart” to my LinkedIn Profile.

Though I stand by my stance of this psychiatric bomb being made up of a collection of ingredients, perhaps the most influential propellant was the National Institute of Mental Health’s 1988 Depression Awareness, Recognition and Treatment campaign (DART) that was “designed to alert health professionals and the general public to the fact that depressive disorders are common, serious, and treatable” and “change public attitudes so that there is greater acceptance of depression as a disorder rather than a weakness.”

(Note: the research is normally behind an academic paywall, but I got a hold of it and uploaded it to a Google Drive for you to view. Yet another reason why it’s impossible for the average person to “do their own research.”)

My god, the language used here is brilliant. In 37 words, a previously unknown problem is revealed, the public is shamed for viewing this unknown problem as personal weakness, and a treatment is teased for the disorder so many people don’t know they have. And it’s all couched in subtle influence that says we’re here to protect you.

But here’s the thing. The DART campaign launched five months after Prozac, made by Eli Lilly, hit the market. And prior to the release of Prozac, a NIMH survey found that only 12% of American adults would take a pill to treat depression. The rest said they “would live with it until it passed.” And as much as it would be nice to believe that the NIMH was truly acting in the public’s best interest, even if they came to that conclusion through cooked research, that argument quickly falls apart given that the program and clinical training were funded by pharmaceutical companies.

The document continues, emphasis my own:

“With pharmaceutical company support, APA [American Psychological Assotiation] also has sponsored a series of training sessions for primary care physicians. Particular emphases for nonmedical mental health providers have been on biological and pharmacological treatments; for medical specialists, diagnoses and a full range of treatments have been emphasized.”

Read that again. Part of the program involved going to mental health providers who legally can’t prescribe (and therefore remained employed by using non-pharmaceutical therapies) and “educating” them on the wonders of drugs.

A wide variety of “public education materials” were also developed, including “radio and television public service announcements, posters, flyers, print advertisements, bus cards, bookmarks, and educational brochures at various age and education levels in English and Spanish.”

Furthermore, Eli Lilly helped fund the printing and distribution of 8 million DART brochures titled “Depression: What You Need to Know,” which wound up in physician’s offices all over the country.

The pamphlet explained the merits of “serotonergic” drugs that acted specifically on the serotonin system, which was extremely convenient given Eli Lilly’s concurrent Prozac promotion, which garnered major media profiles and landed the drug on the cover of Time Magazine.

In one 1990 New York Times feature—which in some ways, is more concerned with the negative effects of antidepressants than most reporting from the past 10 years—readers are told that Prozac works because of its “novel biochemical nature” that “is believed to zero in on serotonin, blocking the removal of the important signal from the neurochemical loop in the brain and thus allowing serotonin to remain operative on neurons for a longer time. That blockage seems to restore overall serotonin activity to a more normal state, which somehow helps alleviate many cases of depression.”

All of this, from the prescriber training programs to the Spanish bus cards to the cover of Time, is a lesson in the power of guerilla marketing. I don’t remember the early 90s well, but I imagine it was impossible to get away from this campaign. No matter where you went, the marketing was there to get you to do one thing: talk to your doctor, nurse, occupational therapist, or social worker who, unbeknownst to you, had received “short-term training in the diagnosis and treatment of depressive disorders” that from 1987 to 1988, had “been offered somewhere in the United States every week over the past year.”

Let’s break down the timeline and look at the financials:

1975: American revenue from antidepressant sales valued at less than $200 million

December 1987: The FDA approves Prozac.

January 1988: Prozac hits the market.

May 1988: DART campaign is launched, pamphlets distributed to physicians, the word “serotonergic” introduced to the public

1990: Projected Prozac Sales: $700 million

1991: Zoloft approved by the FDA.

1992: Prozac graces the cover of Time Magazine.

1993: Annual Prozac sales: $1.2 billion

1994: Zoloft sales $638.4 million

1998: Annual Prozac sales peaked at $2.8 billion

2001: Zoloft’s “sad blob” ad launches, cementing the chemical imbalance theory in the zeitgeist.

2005: Zoloft sales $3 billion.

2023: Total antidepressant market size: $17.41 billion—one hell of a return on investment.

I awoke this morning, on New Year’s Day 2024, from one of those deep sleeps that makes you wonder if you ever really sleep at all. I have been sick for the better part of the holiday season, in every sense of the word—physically sick, heartsick, lovesick, grief sick, job sick—and most of my nights have been fitful, either because of a hacking cough or the prickly agitation that comes with the sort of longing that NyQuil can’t shake off.

The chest infection combined with other people’s holiday obligations meant that I spent most of the back half of December alone, an experience I am deeply familiar with after years of working in the Manhattan restaurant industry. In food service, someone has to work the Christmas Eve rush, frost New Year’s cupcakes, and cater Thanksgiving dinner to folks who don’t cook. Even if the business is closed on the actual holiday, someone has to work the day before and after, rendering cross-country travel impossible.

Thus, my clearest holiday memories are not of cozy, matching pajama-clad mornings, but of a Christmas dinner of Caesar salad and buffalo chicken wings at the Jewish diner underneath my apartment, long walks with my dog down silent Manhattan streets, the deep sense of toska pulling at my heart.

Goddamned toska.

A Russian word with no English equivalent, Vladimir Nabokov said it best: “At its deepest and most painful, it is a sensation of great spiritual anguish, often without any specific cause. At less morbid levels it is a dull ache of the soul, a longing with nothing to long for, a sick pining, a vague restlessness, mental throes, yearning. In particular cases it may be the desire for somebody of something specific, nostalgia, love-sickness. At the lowest level it grades into ennui, boredom.”

Perhaps, given my pockmarked history of holiday experiences, I am primed to feel the weight of toska each year. Or, perhaps this is something experienced by those who have lost a core member of the family. The holidays, for all their cheer, will always be a quiet reminder that my father is not around to throw a tantrum over tangled Christmas lights. Or maybe it is the mark of adulthood, when the magic of the morning is tempered by all the work it took to create it, and all the impending work it’s going to take to erase it.

But the stupid heart always has hope.

This year, while a campy holiday Hallmark movie chirped in the background as I loafed prone and achy on my mother’s couch, we talked about uncertainty. My illness, it seemed, was the physical manifestation of everything I don’t know going into the new year. And I don’t know anything right now.

I have had a sense, for months, that big change is coming to my world. And yet, there is no indication of what that might be or where it might take place. All I know is that in October, my income evaporated when a client’s situation changed, and since then I have watched lead after lead dry up while I anxiously monitor my bank accounts.

My heart, too, is searching for a signal, but the frequency I put out keeps getting lost in static. And yet I cannot shake the situation, the person, and how their existence in my life has fundamentally altered my perception of myself, my abilities, and what I want to experience in the world.

Meanwhile, in my Instagram DMs, a woman reached out to tell me that after 16 months of tapering, the last night of the year would also be her last time taking an SSRI. I reposted this on my Instagram stories, thrilled to get a bit of good news given that most of the messages I receive are of the opposite ilk.

The post gained attention, at soon folks were messaging me with other antidepressant withdrawal wins. One woman went to her first concert in four years, armed with earplugs to combat withdrawal-induced noise sensitivity. Another shared a story about her first trip to the grocery store after coming out of Zoloft withdrawal. Another recently gave birth to a healthy baby fourteen months after horrific Effexor withdrawal.

These little messages, most from folks who’d contacted me in the depths of suffering, lifted me not because of any hand my work may or may not have had in their healing, but because it reminded me that blind conviction is a requirement during fallow seasons. The other side of toska is hope. It is hope that lets us endure the pining, restlessness, and yearning for the magic to return, for the static to clear, and for the body to find health and equilibrium.

And so I awoke lighter this morning, the pull of toska not quite as heavy, the phlegmy cough a little less rough, with a little more patience to let the signal of work and love travel to their receivers.

Bestill the stupid, stupid heart.

Earlier this year, in Issue 107, I wrote about a two-month-long experiment where I drastically distanced myself from all current events and news media. Though I’ve never been a news junkie and loath all politics, I am curious and want to learn, so I spent a few years attempting to balance the wave of fear and doom by listening to science-education podcasts like Huberman Lab, following good news Instagram accounts, and subscribing to Wired magazine.

Just before starting this experiment, I’d also come off a long stretch of health-related inquiry after learning I carry the BRCA gene. In my spare time, I was reading books on longevity, distilling the pros and cons of preventative mastectomies, and annoying the hell out of a genetic counselor by asking who funds the institution that recommends annual mammograms and MRIs for folks with BRCA, despite conflicting research that indicates excessive radiation from mammograms could actually be harmful for BRCA carriers because “Women who carry deleterious BRCA mutations have an impaired ability to repair damage that arises in the DNA that makes up genes…the small amount of radiation exposure due to a mammogram – essentially an X-ray – can contribute to DNA damage.”

The National Cancer Institute is government-funded by the way, which is a benign way of saying it’s run by lobbyists. This isn’t necessarily bad—most research is publicly funded—but let’s not pretend we’re frolicking in a field of altruism. Cancer is big business. My experience in the world of mental health x pharmaceutical influence means I cannot approach a health issue without looking to see who is pulling the narrative strings. A guideline is never just a guideline. It always comes from somewhere. Typically, the end point is a multinational organization that oh so coincidentally makes a lot of money off of the story being told (Coca Cola funding, influencing, and owning the URLs of anti-obesity groups) or a wartime guideline that no one ever bothered to dig into. The Recommended Dietary Allowances of nutrients, for example, were introduced during World War II in order to advise “on nutrition problems in connection with national defense.” This was about the minimum required to survive another day of battle. Yet, every nutrition label and marketing scheme still reflects these antiquated numbers.

Knowing how all this works, my personality left me with only one choice: go HAM on my own reading and research.

I found a functional medicine doctor and ran dozens of labs, listened to health and longevity podcasts while driving, and read the latest books on preventative medicine and mind-body health. My diet, which already underwent a big overhaul in 2021, tightened up in the most unexpected of ways: more red meat, fewer vegetables, no seed oils, and little to no alcohol.

I’ll never know how, or if, these changes actually prevent or delay a cellular oopsie. Carrying the BRCA gene does not guarantee mutation. But all the research and changes gave me a sense of control over the situation…until it didn’t.

We glorify learning, as if knowing more information is always the right call. But knowledge has diminishing returns; there comes a point where you know what you need to know, and knowing more actually causes more issues because it interferes with your intuition. Yes, I had gained a rudimentary understanding of one possible health future. But I was also fried, anxious, and no closer to figuring out what in the hell to do about it.

So I decided to stop learning.

Midway through the year, fresh off the unexpected glory of staying away from all news and current events, I put myself on a learning embargo for an undetermined amount of time. No more doctor’s appointments. No more medical books. No more podcasts. No more fear-based learning. I was to be purposefully dumb!

My god, what freedom. Between no current events and no learning, all my free time went to reading fiction, painting, and running in the hills. I listened to music while driving, found a group of old men to play chess with on Saturday afternoons, and used up all the hot water during daily, mind-wandering showers.

In time, I came to find a sense of peace around my persnickety genetics. If it becomes something I need to deal with, I trust myself to deal with it. In the meantime, I know I’ve made the best changes with the information I have in order to give myself the best shot of never having to deal with it. Really, what more is there to do?

All this to say, look at your life. Where might it be beneficial for you to actually learn less? Consider it addition by subtraction. In going on a learning embargo, I wasn’t practicing denial. Instead, I was making room for integration, understanding, and the quiet voice that always knows.

The act of reading—specifically sitting down with a physical book or Kindle—tells me a person has the ability to focus, slow down, and live life with intention and curiosity. Whether they read fiction or nonfiction, sci-fi or biographies, they are likely to contribute to conversations and process ideas that may not be in line with their own beliefs. In short, it demonstrates that they are open and capable of growth.

Books are also the fastest and cheapest way to change your life. I have little patience for people who can’t solve their own problems when there are literal libraries filled with free resources to address your exact issue.

This year’s roundup of books is very much focused on troubleshooting existence. From breathing to protein to getting what you want from others, here are the 10 books I read that will make for a happier life.

Landbridge: A Life in Fragments by Y-Dang Troeung

This is the best, most impactful book I read all year. It earned rare display status in my living room, and I tear up just looking at it. It’s also written by a friend who died a year ago this week, so I’m feeling especially tender.

Though you can get creative and get this book in the US by following my link, it’s currently only available in Canada. The US release date is set for later this year.

“In 1980, Y-Dang Troeung and her family were among the last of the 60,000 refugees from Cambodia that then-Prime Minister Pierre Trudeau pledged to relocate to Canada. As the final arrivals, their landing was widely documented in newspapers, with photographs of the PM shaking Y-Dang’s father’s hand, reaching out to pat baby Y-Dang’s head. Forty years later, in her brilliant, astonishing book, Y-Dang returns to this moment, and to many others before and after, to explore the tension between that public narrative of happy ‘arrival,’ and the multiple, often hidden truths of what happened to the people in her family.

In precise, beautiful prose accompanied by moving black-and-white visuals, Y-Dang weaves back and forth in time to tell stories about her parents and two brothers who lived through the Cambodian genocide, about the lives of her grandparents and extended family, about her own childhood in the refugee camps and in rural Ontario, and eventually about her young son’s illness and her own diagnosis with a terminal disease. Through it all, Y-Dang looks with bracing clarity at refugee existence, refusal of gratitude, becoming a scholar, and love.”

Breath: The New Science of a Lost Art by James Nestor

In the realm of books that will solve most of your problems, Breath is #1 on the list. Told with a journalistic flair that keeps you reading, Breath explores the most basic, common thing humans do—breathing—and explains exactly why you’re doing it wrong, how it’s creating your physical problems, and how to fix it with a quick trip to the drug store.

The Medium is the Massage by Marshall McLuhan

It’s been six months since I stopped consuming any news or current events, and I cannot overemphasize how much this choice has positively affected my life. McLuhan’s book is a meta, visual explanation of why this occured, showing how we are unconsciously influenced by media through brilliant illustration.

And lest you think this book falls into the camp of “dangerous alternative media,” know that it was first published in 1967, establishing it as one of the rare works that stands the test of time.

Forever Strong: A New Science Based Strategy for Aging Well by Dr. Gabrielle Lyon

Much of my year has been focused on understanding how nutrition affects mental and physical performance. I’ve ditched dozens of foods I thought were helping but turned out to be hurting—oats, kale, and seed oils to name a few—and am focusing on a more primal, stripped back diet that leans more into red meat.

An easy read with a focus on unraveling the false narrative surrounding meat, Lyon touches on the history of our bogus food pyramid, why so many people are physcially weak and overweight, and how more muscle means better health and longevity.

Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen by Christopher McDougall

I picked this book off a friend’s shelf when I was too jetlagged to function, and it changed my entire perspective on what my body was capable of doing.

In less than three months, I went from someone who hated running and thought I wasn’t “built” for it to someone who is excited to spend an hour in the woods, running six miles with 2000 feet of elevation.

Plus, it’s a damn good story that will speak to anyone with any inclination towards physical activity.

Walking in Wonder: Eternal Wisdon for a Modern World by John O’Donohue

I like to read philosophy or poetry before bed, and John O’Donohue is the perfect lullaby.

“Widley recognized as one of the most charismatic and inspirational enduring voices on the subjects of spirituality and Celtic mysticism, these timeless exchanges span a number of years and explore themes such as imagination, landscape, the medieval mystic Meister Eckhart, aging, and death. Presented in O’Donohue’s inimitable lyrical style, and filled with rich insights that will feed the ‘unprecedented spiritual hunger’ he observed in modern society, Walking in Wonder is a welcome tribute to a much-loved author whose work still touches the lives of millions around the world.”

The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture by Gabor Mate

Read this book. Just do it. Listen to it on audiobook if that’s what you need to do. Make it the only book you read if you only choose one.

“Over four decades of clinical experience, Maté has come to recognize the prevailing understanding of “normal” as false, neglecting the roles that trauma and stress, and the pressures of modern-day living, exert on our bodies and our minds at the expense of good health. For all our expertise and technological sophistication, Western medicine often fails to treat the whole person, ignoring how today’s culture stresses the body, burdens the immune system, and undermines emotional balance. Now Maté brings his perspective to the great untangling of common myths about what makes us sick, connects the dots between the maladies of individuals and the declining soundness of society—and offers a compassionate guide for health and healing.”

Crazy Like Us: The Globalization of the American Psyche by Ethan Watters

If you’re a regular reader of HIAS, you’ll recognize this book from several of this year’s issues. This book should be required reading for anyone in the mental health field, becuase it’s going to force you to re-evaluate what you think mental illness is.

A Walk in the Physical: Understanding the Human Experience Within the Larger Spiritual Context by Christian Sundberg

By far the most out-there reccomendation on this list, A Walk in the Physical is the account of a man who was born with the spiritual veil “half open.” He remembers life before life, and attempts to explain what happens to souls before we come into human form—and after we leave through death.

Though the writing isn’t going to win any awards, it’s worth reading simply for the premise. Whether you belive what he’s saying or not, its sure to make you think.

How to Win Friends and Influence People by Dale Carnegie

“Why are you reading Dale Carnegie? He was old when I was your age.”

This is what said to me when she saw this book on my coffee table, indicating just low long this book has been around. Classics are classics for good reason, though, and there are plenty of nuggets in Carnegie’s book that are still relevant today.

The trick I use the most: Using people’s name to get what I want.

When you’re interacting with people, whether it’s a cashier or someone you know personally, play around with saying their name when making a request or giving a complement. We are conditioned to respond to our name, and assuming the tone is in kind, you’ll be shocked at how much easier it is to get people to help or respond to you.

A new study on publication bias of the benzodiazepine Xanax has been released. According to researchers from Harvard, Massachusetts General Hospital, McLean Hospital, and former FDA reviewer Eric Turner, four of the five original studies on the effectiveness of alprazolam (Xanax) found it to be no better than a placebo. Furthermore, only one of the five studies reviewed by the FDA showed a positive result. It is curious when you consider that the FDA “expects that the drug maker will submit results from two well-designed clinical trials to be sure that the findings from the first trial are not the result of chance or bias.”

Publication bias is the practice of picking and choosing what gets published and how it gets published. This is extremely common across all hard and soft scientific disciplines, and it’s a big reason why relying on published, peer-reviewed research should not be the be-all, end-all of human existence.

Negative and neutral trials, for example, often don’t make it into literature. Not only do the researchers not want to draw attention to a failed hypothesis, but journals don’t want to waste space on science that doesn’t work. Furthermore, the media rewards breakthroughs, not duds. Thus, an unknown amount of research is left on the cutting room floor.

The problem with this is that when you look at the body of research that does get published, it tells a very different story. British physician Ben Goldacre explains it well. I’ve fast-forwarded to the most relevant part for your convenience:

This is exactly what happened in the Xanax approval process. The FDA received data on five Phase 2 and Phase 3 trials. They considered four of them to be negative but approved the drug due to the strength of Study 2. Furthermore, the results of Study 1 were spun to look positive, despite the FDA statistician determining the study failed because improvement was not noted in all seven primary endpoints (the FDA deems “studies positive only if all primary endpoints achieve statistical significance”).

Studies 3, 4, and 5 failed or were nonsignificant, and none of these studies were published.

Thus, the published literature reflected that Xanax was a successful intervention for panic disorder, which led to a frenzy of prescriptions thanks to media and marketing departments that use published literature for headlines and campaigns.

And here we are, thirty years later, with a raging global opioid crisis, in part thanks to the misuse of benzodiazepines.

You know Big Pharma is prepping to push a new class of drugs when the narrative starts changing around the golden pharmaceutical children of yore.

Drug patents in the United States typically last 20 years, and given that there’s been no meaningful pharmacological advance in the mechanism of antidepressants during that time, most SSRIs and SNRIs have fallen off the patent cliff and are available in generic form. Generics, of course, don’t bring in the dough. So, pharmaceutical companies use a variety of tactics to bury generic competition, including but not limited to:

Two themes are appearing in the media that make me think we’re heading for a classic shift. First, we’re seeing headlines about new antidepressants, specifically Zurzuvae (zuranolone) and Zulresso (brexanolone), both of which act on GABA receptors (like benzodiazepines) and are being targeted at vulnerable new mothers with postpartum depression.

Zulresso, by the way, costs $34,000.

The New York Times reported on these new drugs on August 4, 2023. On November 9, 2023, the New York Times also reported on Post SSRI Sexual Dysfunction, a devastating and often permanent side-effect of antidepressants that can rob people not their libdo, function, and feeling in their genitals. Chemical castration, effectively.

Both articles include a pithy offer of journalistic objectivity, adding a quote or two from the “opposition” to satisfy the reader with an attempt at balance. But the tone of each article is clear: New shiny drugs, good! Old generic drugs, beware!

Curioser and curioser.

In good news, SNOMED (Systematized Nomenclature of Medicine Clinical Terms) has created code 1285639002 for “Protracted antidepressant withdrawal syndrome (disorder).”

SNOMED is a non-profit organization responsible for determining global standards for health terminology. It is designed to support a wide range of healthcare processes, including clinical documentation, decision support, and data analysis. It encompasses a broad spectrum of clinical concepts, relationships between them, and associated terms. This standardized terminology helps ensure consistency and interoperability in health information systems.

Without a formal code, an ailment essentially doesn’t exist. That means that prior to code 1285639002, precisely 0 cases of protracted withdrawal have been formally recorded because there wasn’t a way to do it.

In the UK, doctors have to activate the code in order to use it. Once that happens, researchers will be able to start tracking case rates. In the US, it’s irrelevant because of our dumbass system. I’m told that we likely won’t have a code until the DSM recognizes it, which would lead to a bit of the emperor has no clothes situation. But SNOMED is a start, and I’ll take it.

On October 9, 2023, the United Nations and World Health Organization jointly released a 184 page report addressing the massive human rights violations that occur in mental health “care” all over the world—including the United States and Canada.

After looking through the document, I’m at a loss for words. I’ve spent years speaking alongside other titans, all of us trying to blow the whistle on the corrupt, evidence-less, biomedical model of mental illness that leads to detrimental over prescription, forced institutionalization, and “treatment” without consent. This work has opened all of us up to a special portal of hell, where defamation, academic mobbing, death threats, and the constant risk of getting sued is always on the mind.

(Never have I been so happy to not be associated with an institution. I have a lot more latitute to speak freely when I am not at risk of losing a license or my job with a University.)

And yet, this is a 184 page report effectively says we were right all along. Addressing the harm of the biomedical model, it proposes new legal objectives and a clear mandate for mental health systems to adopt a rights-based approach as opposed to a containment-based approach. It also admits:

Mental health and well-being are strongly associated with social, economic, and physical environments, as well as poverty, violence, and discrimination. However, most mental health systems focus on diagnosis, medication, and symptom reduction, neglecting the social determinants that affect people’s mental health.

Imagine that! Living under constant threat, whether familial or political, isn’t the way to health and wellness. Whoda thunk?

Furthermore, the document goes into considerable detail on informed consent in psychiatric care, which is generally nonexistent in current practice. This manifests in a variety of ways, from involuntary psychiatric holds to general practioners handing out antidepressants after five minute appointments to psychiatrists refusing to support their patients in tapering from psychiatric drugs.

The document says, specifically:

Countries should adopt a higher standard for the free and informed consent to psychotropic drugs given their potential risks of harm in the short and long term. . . . Legislation can require medical staff to inform service users about their right to discontinue treatment and to receive support in this. Support should be provided to help people safely withdraw from treatment with drugs.

More than anything, though, I am shocked and impressed that the WHO and UN admitted the following:

An additional concern is the explicit use of a reductionist Western biomedical model in mental health law, which works to the detriment of other holistic, person-centred and human rights-based approaches and strategies for understanding and addressing distress, trauma, and unusual perceptions or beliefs (2, 86).

Reductionist Western biomedical model! My god, if this was a snark Substack, that statement would come with a dramatic reaction gif.

Actually, fuck it. My filters are gone.

It’ll be interesting to see how—and if—this document has any real impact on legistlation and operating procedure. I doubt there will be a rush to change any laws any time soon, at least in the United States, as long as Big Pharma continues to hold their lobbying power.

However, one major change is that for those branded with scarlet letters ranging from “dangerous” to “anti-medicine” to “anti-science” we can now point to this report for hard-to-argue-with evidence and support. As I’ve said all along, change on this front is not going to come from the top down. It’s going to start with each individual taking control of their own care, and finally, there’s a document to support it.

Download the report.

How small a thought it takes to fill a whole life. – Steve Reich

I have spent the last year bewitched by a singular thought. It began as a wonder, planted unintentionally by multiple people who independently came to the same conclusion, well before the idea ever dawned on me. There was—is—an energy behind the idea. Though it was slow to root, once it took hold, its vines tangled itself in every corner. The details are ever changing based on how the scenario is or isn’t playing out in my reality, taking me on a wild ride of highs and lows. As my mother put it, “It’s like you are on a river, rafting through rapids, completely unaware if you are heading towards a cliff.”

Another person is involved, of course. Isn’t that always how it is with these sorts of things. And they have no idea what I’m experiencing, of course. Because isn’t that always how it is with these sorts of things? And now is not the time to say anything, of course, because when it comes to these sorts of things, timing is everything.

So I sit. And think. And try not to think. And push it away and watch it come roaring back again.

It manifests in my body, sinusitis combined with a heaviness that creeps through my limbs. I cut through it by watching my dog frolick on a dirt path behind my home, willing myself to hear the birds while I observe her canine joy and force myself to think, “If this is my last moment on Earth, my God, it is beautiful.”

Another thought: Don’t decide your failures in advance.

There are two forces at work here. First, a lesson on perception. Due to the nature of the situation, most of it is playing out in my own mind. Over the past month, new information has come in that has me questioning my interperetation of the last year. My mental and emotional assumption of What Is has taken a sharp turn, veering away from one of hope and possibility to one of frustration and stupidity.

And yet, objectively, the situation has not changed. It is identical to what it was six months ago. All that has shifted is the story I tell myself. Still, it is maddening that I can’t find the line between intuition, instinct, and fantasy. That is not often a line I struggle to walk.

Which leads me to the second lesson, a perennial lesson it seems I am constantly forced to learn: the art of waiting.

Back in Issue 22, I wrote: We have conditioned ourselves to think that when we are presented with a choice, our only options are to pick one or the other and to do it fast. But there is an ever-present third choice that often holds the most power — the choice to wait.

I am fighting a sinking feeling telling me that I was wrong, that what I thought this was, isn’t. I want to chastize myself for being so foolish, box up the embarrassment of ever mentioning it at all, and pretend it never happened by engaging in whatever or whoever pulls me in to break up the thought pattern. But even if this path turns out to be true, it is too early to decide my failure. Frankly, there is little evidence to support the Stupidity Theory. But there is some evidence, albeit not an overwleming amount, to support the Original Theory. The truth is likely somewhere in between. I am sure I have overcorrected on both ends.

So I must wait and find a way to tend to the roots without letting the vine suffocate its host, one thought at a time.

When we left off in the early 20th century in the last issue of HIAS, A Brief History of Psychiatric Diagnosis, Part I, a few themes had emerged:

Keep these themes in mind as we explore the origin story of the Diagnostic Statistical Manual of Mental Disorders.

Though it was Richard von Krafft-Ebing and Josef Adolf Hirschl who propagated the biological model of mental illness thanks to their work with syphilis, it is German psychiatrist Emil Kraepelin who is most responsible for the genesis of the DSM and its stronghold over our modern psychiatric system.

Born in 1856, Kraepelin’s work began to attract attention in 1893. Kraepelin ran a clinic at the University of Dorpat and determined that because patients often showed similar symptom patterns, he could use those patterns to classify psychiatric disorders. For example, he observed that manic-depressive insanity did not deteriorate into dementia praecox (what we now call “schizophrenia.”) Dementia praecox, on the other hand, appeared in adolescence and progressed to dementia and institutionalization. One did not morph into another, indicating to Kraepelin that despite some similar symptoms, they were two separate ailments.

Kraepelin took this theory and applied it to all expressions of psychiatric distress that existed at the time. He coined the term “depression”, distinguishing it from the melancholia umbrella that had described human suffering for centuries, and separated the “paranoid thinking of schizophrenia” from “paranoia.” He was fixated on objectivity and measurability, eschewing notions of stress, environment, personality, and their potential impact on mental illness.

He was also a rampant eugenicist. A letter to the editor published in the American Journal of Psychiatry put it bluntly:

In a 1919 paper titled “Psychiatric Observations on Contemporary Issues,” Kraepelin proclaimed that “dreamers, poets, swindlers and Jews” possess “distinctly hysterical traits” and fall outside the bounds of normality, adding that Jews exhibit “frequent psychopathic disposition.”

Kraepelin died in 1926, but his belief that “reasonable policies of racial hygiene” were the solution to Germany’s “degeneration” problem deeply influenced Nazi ideology and the rise of the Third Reich.

While an obvious display of eugenics was playing out in Europe during the first half of the 20th century, the American Psychiatric Association (APA) was busy with a more inconspicuous systemization. In 1913, the APA set up a statistics committee that eventually took responsibility for classifying psychiatric diseases. Combining American observation with Kraepelin’s work, these publications ruled American psychiatry through World War II.

We need to pause for a moment in order to highlight an oft-ignored aspect of this early American classification. It must be noted that as reported by the American Psychiatric Association itself, “Between 1892 and 1947, 31 presidents of APA acted in leadership positions in eugenics organizations, during their time as president, but also in the years surrounding their presidencies.”

Let that sink in for a minute. During the time in which the foundation for all modern psychiatric diagnostic strategies was built, the people in charge of creating that system held the same beliefs as Hitler. Literally, your kid’s ADHD diagnosis or your bipolar diagnosis is rooted in the same categorization and rationale that led the Nazis to exterminate six million Jews.

Combine this with the Social Darwinist movement pervading white-collar industries at the time, and it’s no surprise that the intellectual elite worked to sort folks into acceptable and flawed stock. And don’t think this was an act of good intentions gone awry. Even the modern IQ test that we still use today, which was developed around the same time, is rooted in eugenics. Developed by noted American eugenicist Henry H. Goddard, the IQ test ranked those he considered “feebleminded” into three categories of perceived incompetence: pre-verbal “idiots” illiterate “imbeciles,” and high-functioning “morons.” According to a law review of the landmark murder trail Atkins vs. Virginia, which hinged on the definition of mental retardation, Goddard “found morons wherever he looked: criminals, alcoholics, prostitutes, and anyone ‘incapable of adapting themselves to their environment and living up to the conventions of society or acting sensibly.’”

But by 1948, though the foundation for systemization was already laid, German eugenic sentiments weren’t exactly popular among the collective. Thus, the APA asked its Committee on Statistics to rewrite the diagnostic system. A rebranding, if you will.

Spearheaded by George Raines, the first edition of the Diagnostic Statistical Manual of Mental Disorders pulled away from German language and theories, instead drawing from the en-vogue influences of Sigmund Freud and Swiss psychiatrist Adolf Meyer. Both Freud and Meyer attributed psychological distress to childhood experiences and in Freud’s case, sexual repression. Kraepelin’s symptom-based sorting system still remained, but because of this shift, psychotherapy dominated psychiatric thinking for a short time.

Right around the time the DSM-I was making its way into clinical practice, psychopharmacology was on the rise after the first mood-altering drug, iproniazid, was accidentally discovered in a tuberculosis ward in 1952. Iproniazid induced euphoria in terminal tuberculosis patients and phenomena so profound, the drug was given to 400,000 depressed people to see if it would have the same effect. It did, but it also caused the blood vessels to constrict to dangerous levels, and administration of the drug was stopped. However, its brief existence brought the chemical imbalance theory of mental illness back to the forefront, and the DSM-II was written with this in mind.

It is at this point that the “pill for every ill” strategy leaves psychiatric wards and enters the homes of everyday folks, in part due to the introduction of tranquilizers and benzodiazepines aimed at women in the early 1960s.

In the early 1970s, after the US/UK Diagnostic Project determined that American psychiatrists and British psychiatrists operated by wildly different criteria for diagnosing schizophrenia (a not-so-surprising twist given that there wasn’t and still isn’t any medical test for schizophrenia or any other mental illness), American psychiatry determined it needed to tighten up its diagnostic strategy.

Robert Spitzer, a biometrician at Columbia University, was assigned the task. It is Spitzer who came up with the checklist, in that in order to meet the criteria for a certain mental illness, the patient had to experience X symptoms out of a list of Y.

The DSM-III also introduced bipolar disorder, borrowing the term from yet another set of World War II-era German psychiatrists, Karl Kleist and his student Karl Leonhard. We all know where this leads. According to Edward Shorter, PhD., “The term went on to become among the most popular diagnoses in psychiatry, as well as the foundation of pharmaceutical fortunes selling ‘mood stabilizers.’”

The DSM-III also added attention deficit disorder to the lexicon, as well as post-traumatic stress disorder and a variety of anxiety disorders.

Shorter continues, “What psychopharmacology had begun, DSM-III finished off; the [psycho]analysts were shown the exit sign from the field, or at least from its commanding heights…the DSM-III began a rapprochement between psychiatry and the rest of medicine.”

Since the publication of the DSM-III in 1980, the “bible” of psychiatric diagnosis has been revised three times, with the DSM-V appearing in 2013. From a clinical level, little has changed in the world of diagnoses since the DSM-III appeared. Patients are still judged by a checklist of diagnostic criteria, psychotherapy and root cause are generally ignored, and no test, scan, or lab exists to confirm or refute a biological or chemical cause for mental illness.

One thing, though, is noticeably different. The size of the Diagnostic Statistical Manual of Mental Disorders has swelled with each edition.

The DSM-III registers at 494 pages and weighs 1.9 pounds.

The DSM-IV is 886 pages and 3.4 pounds.

The updated DSM-V, published in 2022, is 1050 pages and weighs 4.6 pounds.

He who knows syphilis knows medicine.

—William Osler, co-founding physician of Johns Hopkins Hospital

In 1885, the Boston Medical and Surgical Journal made an observation: mental asylums in the United States were full. The journal noted that the number of patients had risen dramatically, with people wandering the halls of asylums with a jerky gait, grandiose illusions, and dementia—a collection of symptoms deemed “general paralysis of the insane.”

On the rise, too, was syphilis. In its late stages, syphilis also creates a jerky gait, grandiose illusions, and dementia. In 1885, it was unclear whether the rise in the insane was due to pathological disease or other influences. But in 1897, a causal link between these symptoms and syphilis was found thanks to German psychiatrists Richard von Krafft-Ebing and Josef Adolf Hirschl.

Krafft-Ebing and Hirschl knew that syphilis could only be contracted once, so they created an experiment where they injected the pus from sores of syphilictics into people suffering from general paralysis of the insane. If the patient became infected, they could say with certainty that the patient had not had syphilis before. However, none of the subjects became infected with the disease, leading Krafft-Ebing and Hirschil to conclude that not only had all of their patients’ been previously infected by syphilis, but that it was a disease that caused their psychiatric symptoms.

Thus, the biological theory of mental illness was born. The connection between the biological nature of syphilis and the undesirable psychological side effects of that illness led researchers to assume that all expressions of mental illness boiled down to a biological malfunction. Given the first neurotransmitter wasn’t discovered until 1921, and more robust science on the matter didn’t appear until the mid 1950s, neurologists at the turn of the century instead focused on what could be observed in autopsies. However, little progress was made. Common psychological ailments of the time, like hysteria and shell shock, left no visible sign of brain tissue damage. This lack of biological evidence bolstered the theories of Sigmund Freud, the father of modern psychology, to say: “The case histories I write should read like short stories and that, as one might say, they lack the serious stamp of science.”

The link between syphilis and mental distress came at a time when a concept called Social Darwinism was hitting its stride. Rooted in Charles Darwin’s theories—though he himself was not directly connected to the movement—Social Darwinists believed that human groups were subject to the same evolutionary principles as plants and animals. Natural selection and survival of the fittest could be applied to sociology, economics, and politics because, in their view, sociocultural ideals were inherently biological. Said another way, it was biology that determined if you were white, male, and physically fit, so therefore, natural selection should be applied. Practically, this meant that Social Darwinists believed the strong should see their wealth and power increase, while the weak should see their wealth and power decrease.

The connection between Social Darwinism and the rise of the global eugenics movement of the late 19th century and the first half of the 20th century is obvious: a group of intellectual white men decided the human race was “de-evolving,” and wielded their power and influence to reverse this perceived course by professing who should and should not bear children. This influence stretched into all white-collar industries, from major businessmen like the Carnegie’s and Rockefeller’s to legal theorists, academics, criminologists, and of course, psychiatrists.

The science—although “science” is a loose term given not a shred of evidence existed then or now to back up the theory—became so pervasive, that by 1914, 44 American colleges had introduced eugenics into their curriculum. Rooted in the language of protecting the average citizen from those who threaten the fabric of society thanks to inferior genes and beliefs (note the connection between the language being used at this time and the language surrounding both sides of modern American political movements), Social Darwinists pushed the idea that the species could not evolve if people of good stock mingled or procreated with undesirables. The undesirables, as you’ll remember from high school World War II history lessons, included everyone from Jews to Blacks to the “feeble-minded” and physically disabled.

As Dr. Boonie Burstow, Canadian feminist professor and psychotherapist wrote of the Social Darwinists a few months before her death in early 2020, “While they saw themselves as progressive and as following the dictates of modern science, what they were wrapping themselves in was a combination of hatred and pseudo-science for there was not a shred of credible evidence supporting their position.”

Again, note the connection between Burstow’s commentary on Social Darwinists of the early 20th century and the mental illness propaganda being pushed into the zeitgeist today.

It is at this time in history when the open practice of eugenics simultaneously becomes both obvious and insidious. In 1920, German psychiatrist and eugenicist Alfred Eric Koch and German jurist Karl Binding penned Die Friegabe der lernichtung Lebensunwerten Lebens, which translates to “Permitting the Destruction of Life Unworthy of Life.” This work directly led to the German T4 program, which allowed for the killing of disabled patients in institutions under the guise of mercy. In 1939, Hitler secretly signed an authorization protecting physicians and administration from any prosecution associated with the program. It was also this program that would develop the gassing chamber used throughout World War II.

To help identify who “qualified” for the T4 program, planners developed questionnaires that were distributed to patients in hospitals, old folks homes, and institutions. Worded and formatted in a way that appeared like a simple census to the average citizen, these forms were actually designed to parse out ancestry not of German blood, those suffering from schizophrenia, epilepsy, dementia, encephalitis, and other chronic psychiatric or neurological disorders, criminals, and those who had previously been institutionalized.

A group of prestigious physicians evaluated the forms and identified those deemed undesirable. After their identification, they were coerced from their institution and transported to their death in a gassing chamber. The families of the victims received an urn and death certificate noting a fictitious cause of death.

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In the next installment of A Brief History of Psychiatric Diagnosis, we’ll look at how the eugenics movement influenced the bible of all psychiatric diagnosis, the Diagnostic and Statistical Manual of Mental Disorders (DSM).