A Harvard Neuroscientist Says We’re Medicating Normal Human Behavior | Dr. Adam Omary

Intro

Mikhaila Marcus Aurelius, he's an emperor 2,000 years ago and he writes about I don't want to get out of bed. I'm worried about gluttony because I have like literally all the best food in the world brought to me on a platter. So, he has extreme first world problems and what we're seeing now, this crisis of meaning is basically emperor world problems at scale because we're wealthier than any other time in human history.

Dr. Omary Adam Omari, welcome back to my podcast.

Mikhaila Glad to be back. As harmful as they've been, 30% of American college students are on psych meds, mostly SSRIs. And APA doesn't even recognize SSRI withdrawal. They call it discontinuation syndrome.

Dr. Omary I don't even know how to explain that.

Mikhaila In order to mandate age to prevent children from being able to access harmful content online, [music] it means that you have to have age checks for all users, including adults. that introduces unconstitutional privacy risks. [music]

Dr. Omary Dr. Adam Omari, welcome back to my podcast.

Mikhaila Glad to be back.

Dr. Omary You're a doctor now.

Mikhaila I I am. I managed to survive Harvard.

Dr. Omary That's amazing. You're alive. You look good. Okay. So, we want Well, first of all, if anyone hasn't seen the old episode, can you give a brief background about who you are and what it is you do?

Mikhaila I'm a psychologist and neuroscientist, and I was at Harvard studying gender dysphoria. But in the last episode, we didn't talk so much about that. We talked about hormones and brain development, sex differences in brain development, particularly during puberty, and interex conditions. And so I did a lot of research before I got to studying the transgender phenomenon. Research on very rare interex conditions, genetic anomalies, most of them endocrine disorders that result in hormone imbalances that result in personality differences including in extreme cases gender dysphoria and in even more extreme rare cases interex ambiguous phenotypes and genitalia which definitely connects to the transgender debate. And that's how I became dragged into this research. And what I tried to talk about in our last podcast is on both of these extremes of the transgender debate.

Mikhaila On the transgender activist side, you often hear these radical claims of sex is a social construct, sex is a spectrum, it's not binary. And often if you inquire what they mean, they'll say, "Well, look at all these interex conditions." And it's true they exist, but we're talking about one in a 100,000 people for any particular condition or fewer. So those exist, but it's not just that. It's not like interex is a third sex. It's they are genetically male or female and they have these specific anomalies that lead to these specific interex phenotypes and they can be much more likely to experience gender dysphoria. So, I made the case that historically transgender people very likely had some rare genetic condition that resulted in them feeling like they're in the wrong body.

Mikhaila And I have a lot of sympathy for those cases, but as we've seen in the last decade or two, there's been an explosion in gender dysphoria cases, especially in teenage girls.

Why 30% of Gen Z College Students Are Taking SSRIs

Mikhaila And the gender affirming care protocol, the hormonal and surgical intervention has been a disaster. I warned about that when we did this podcast two years ago. And I managed to do my dissertation on what is driving this surge in gender dysphoria cases, particularly among teenage girls.

Dr. Omary Wow. How was that dissertation received?

Mikhaila In different ways, better and worse than you would expect. So the better than you would expect is that as an institution, Harvard protected me and my adviser Steven Pinker made it possible. So on one hand, if there was not an adviser who was willing to support me doing the research, I wouldn't have been able to period. And at Harvard, Pinker was the only person. So I'm very grateful that I had his support. It is concerning that everyone else was not willing to do it and I ended up switching adviserss to be able to pursue this topic.

Dr. Omary Oh, I didn't realize that.

Mikhaila Yeah, cuz I was in the neuroscience lab studying hormones and sex differences. And in that lab, that's where I learned about mostly from animal research. It was animal research where puberty blockers were first administered. And you see the tragic part is that the the things that sex hormones do to the brain during puberty, people talk about adolescence as a sensitive window for higher order cortical development. The types of prefrontal cortex regions that help mature emotion regulation capability. So the theory for gender dysphoria is if you're prescribing puberty blockers because the secondary sex characteristics of puberty are distressing because you have this felt mismatch between your biological sex and your desired gender identity. And that's going to exacerbate depression, anxiety, and in extreme cases suicidality.

Mikhaila The strong argument was always would you rather have a trans kid or a dead kid? and they point towards the high suicide rate among transgender people, which is true. They do have among the highest suicide rate, but that's very different from a causal argument of if you don't give them puberty blockers or hormones or surgery, then they're going to be more likely to commit suicide. And the part that really disturbed me is that we know just from typical variation in hormone levels, especially across the menstrual cycle or on birth control, that hormones can massively impact your mood. And that's within normal smallcale fluctuations. So if you're talking about far outside the range of normal development cross- sex hormone and hormone administration that is much more likely to destabilize your mood in a way that can paradoxically make the very suicide outcomes that were tried to prevent much worse.

Dr. Omary Yeah.

Mikhaila And we didn't have the data at the time that we last spoke two years ago. Now we have more robust longitudinal evidence on this first cohort of kids that were on puberty blockers and cross sex hormones and it's exactly what you'd expect to find. Unfortunately, the majority of them which who already had very high rates of depression, anxiety, and suicidality, they get even worse. And again, the tragic part is it's a sensitive period for brain development. So we don't understand the long-term side effects of it. It's not just that they're worse, they come off of the hormones and then they're better. Hopefully, that's the case for many of them, but because you're messing with brain development during this sensitive window, we don't understand the long-term side effects.

Mikhaila Also, on fertility, many dransitioners, like I know you've interviewed Khloe Cole, they're going to have lifelong side effects from these protocols. So, I'm really concerned about that. I'm glad that the pendulum has shifted back. I joke that instead of gender affirming care, we should have called it dysphoria enabling interventions or DEI.

Dr. Omary Oh yeah, that's that's not bad. Dark, but but good. Oh, man. Okay. So, how do we want to start this? So, I like from my political position, I suppose, and what I'm exposed to, what I see is this huge push back against the transgender movement. um listing things like there's actually increased suicidality when you give gender dysphoric people these treatments. What are you seeing?

Dr. Omary Do you think that's representative of America? Are we moving away from it? Are hospitals starting to shut down uh these like transition clinics? Is that like are we actually going in the right direction now?

Mikhaila There are many lawsuits being filed by dransitioners for medical malpractice. And as we talked about last time, the whole thing was an experimental protocol to start. Now, I've met many of these psychiatrists and I I believe most of them are acting in good faith. And it's a reasonableish hypothesis that okay, if the gender dysphoria is caused by these bodily features that are causing such strong distress, then maybe if we intervene, then we can help them. It's about as reasonable sounding a theory to me as looking at someone who has anorexia and thinking, "Okay, maybe we'll help them if we give them weight loss pills or surgery." Like maybe, and academia at its best should be entertaining at times radical hypotheses and letting the data speak for itself. Now, it's very different when you're talking about vulnerable kids that

Mikhaila

Dr. Omary yeah,

Mikhaila can't consent to experimental treatments. When it comes to transgender adults, I'm a strong libertarian. I think they should be free to do what they want with their bodies, even elective harmful procedures. I think we should have more openness about the potential side effects. But I'm completely supportive of them. And in fact, though I'm optimistic about the direction that we're moving towards from a medical perspective that as you mentioned, many of these gender clinics are being shut shut down. It turned out that in most cases the interventions either weren't working or even making the underlying symptoms worse.

Mikhaila But at the same time, we shouldn't be defunding this type of research. If the government is going to fund research at all, it shouldn't be tied to any specific political agenda. What I found ironic, and I've written about this, is that the very conservatives that were most welcome to the idea that gender dysphoria is being driven by social contagion and that a lot of these treatments have harmful side effects. They were the same ones to pull the research funding into what the side effects would be. So, I think that Europe is doing this better. Even though I don't think these treatments ever should have been allowed to start with, they're doing longitudinal follow-up on this first cohort of kids because again, we have to understand the long-term side effects.

Dr. Omary Imagine your favorite lecture, dial that up on Max, put that on steroids, [music] and then add some cinematic elements to it. That's the best way I could describe a Peterson Academy lecture.

Mikhaila There's always that [music] one professor who's like, "Oh man, you know, you got to take this one professor. They're the best." But at Peterson Academy, it's all of those that one professor.

Dr. Omary I'm still paying off college from 10 years ago. And I'm also still questioning [music] the value that I got out of college.

Mikhaila It's very common nowadays for students to be in thousands and [music] thousands of dollars of debt. It breaks my heart the interest rates that are just going to keep on piling up on them for an education that doesn't entirely serve them.

Dr. Omary You are stuck in the room. You have to do a particular set of courses. And I have to [music] convince myself to stay focused. It's just pretty dry.

Mikhaila With Peterson Academy, it's a fraction of the cost and you get access to all these different topics.

Dr. Omary Goes anything from sciences, nutrition, why we get sick, all the way up to history.

The Mental Health Crisis: Overdiagnosis or Real Epidemic?

Dr. Omary Tons of courses, tons of [music] really good lectures.

Mikhaila I'm always looking for high-quality educational content. Peterson Academy provides it all.

Dr. Omary The instructors are amazing. They're so well known in their field that [music] you just want to pay attention.

Mikhaila The more I access, the more I listen, the more I learn, the more I want to learn. I just keep expanding and I just want more.

Dr. Omary Traditional university can sometimes ground you down. Peterson Academy will be able to [music] scratch that itch of you wanting to learn and continuing to grow as a person.

Mikhaila I can't wait to see where Peterson [music] Academy goes. There's just so much potential and it's just the beginning.

Dr. Omary I went to college [music] because I had to. I go to Peterson Academy because I want to.

Mikhaila You just kind of have to focus on what's going to actually change your life. stop paying attention to what things [music] are supposed to look like and actually aim for something and you might just stumble across something like Peterson Academy seems like a disaster. I'm also especially with dad being sick this year and like the impact of medication, long-term medications, the impact that had on me. I'm so and because I'm so pregnant I think I'm I'm so irritated at this idea of oh you have this really complicated issue here's the solution that we can provide you when it it's much more nuanced than that even in terms of mental health which is like yeah you're very depressed but here's a pill that just fixes the imbalance and it's like clearly that hasn't been working because our mental health issues are skyrocketing and you've done a bunch of research Actually, you know what? Let's start with KO. Let's start with KO and then get into that.

Dr. Omary You're at the KO Institute now, right?

Mikhaila Can you describe what that is, what that does?

Dr. Omary KO Institute is a libertarian think tank policy research organization and I'm on the humanprogress team. There's a great website, humanprogress.org. You can see all these great statistics about increase in lifespan, decrease in disease rates, increase in literacy worldwide, increase in economic productivity. Basically, human progress, more of everything good, less of everything bad. And we use global data, publicly available, everything you can check for yourself. Everything is replicable and open source. So, I'm doing mental health research because despite this robust evidence that by so many metrics, we're living in the best time in human history.

Dr. Omary You also look at psychiatric diagnoses and they're at all-time highs. And worse than that, it's in the wealthiest, freest countries that have the highest depression and anxiety rates. So, a lot of people look at that and they think there's some fundamental problem of progress, of modernity. There's evolutionary mismatch. We're experiencing a crisis of meaning. It's hard to get data on things like that. And I I try to be a data driven skeptic.

Dr. Omary So when I hear crisis of meaning driving an all-time mental health crisis, I think okay, that's one good hypothesis. On the other hand, maybe it's a sign of progress that we're seeing psychiatric diagnoses rise because there's less stigma, there's more mental health awareness, we have the resources to attend to mental health problems. I think all of that is part of progress and part of what's driving this. But I've also been writing a lot about KO. Now being a libertarian think tank were also extremely suspect about government overreach and the financial incentives that come into in this case a healthcare expansion. So when the very providers that diagnose the conditions are the ones that stand to benefit financially from seeing more psychiatric disorders, it's not surprising that there's an incentive to overdiagnose. And if you look at the DSM, the American Psychiatric Association's textbook manual that lists all of the mental health conditions and the criteria for diagnosing them, it's gotten bigger with every successive revision.

Dr. Omary The original one more than 60 years ago was about 130 pages and the new one is 1,130 pages.

Mikhaila Wow.

Dr. Omary So, it's expanded a lot. And people will say, well, it's expanded because we have again greater mental health awareness, better screening, there's more nuance in how we define the disorders. That's all true, but also across every successive revision, the criteria for diagnosis have gotten broader. So, what I've been writing a lot about recently is psychiatric overdiagnosis. And across virtually every condition, I think we're overdiagnosing. And as you mentioned, like forget about relatively rare interventions like puberty blockers, as harmful as they've been, 30% of American college students of Gen Z are on psych meds, mostly SSRIs, and I know you've been doing a lot of research into I personal experience.

Mikhaila The Yeah, like the stats I pulled because it they're kind of hard to pull, right? was 20% across the board, but I hadn't heard the 30% of Gen Z in universities.

Dr. Omary Yeah, my understanding is it's about 20% across the board, including for Gen Z, but there's also a large sex difference because it's mostly women who are diagnosed with depression and anxiety. So, it's closer to 30% for females, closer to 10% for males, and also across the board,

Mikhaila for whatever reason, 30% among college students. So, the college student rate is much higher. That could be in part because college students are now majority female.

Dr. Omary Yeah. Oh my gosh, that's wild.

Mikhaila And we don't understand the long-term side effects as you've been writing about.

Dr. Omary That's for sure. And it's looking it's seriously not looking good. I I read a study recently and it was people who'd taken I think they were specifically looking at SSRIs and it was people who'd been taking them for more than two years and 78% of them had some type of withdrawal and it was I think it was 30% out of the 100% of people couldn't get off them. So the withdrawal you could say was bad enough that they couldn't stop taking them.

Mikhaila And APA doesn't even recognize SSRI withdrawal. They call it discontinuation syndrome.

Dr. Omary Yeah. I don't even know how to explain that. It's so frustrating. I've been so frustrated by that. Do you know what? Have you seen any studies about what percentage of women who are on an SSRI started with birth control? Cuz I'm wondering if that's a huge trigger for depression and anxiety in the first place, but I haven't seen any research about it.

Dr. Omary

Mikhaila I have no idea. But to your point, our underlying biology is so complex and hormones and drugs interact in complex ways. Also, all your experience with diet, like again, we have we have very little understanding, although we're seeing emerging research that even like your gut microbiome can seriously impact your mood, let alone inter intervening with much more extreme pharmaceutical interventions. So, I'm I'm concerned about the long-term side effects of all of these, but I'm glad we're talking more openly about it.

Dr. Omary Yeah, I think we're headed in the right direction. And at least I think if people know I know that the guidelines are being changed, which the tapering guidelines, which is really important.

How the DSM Expanded From 130 Pages to 1,130 Pages

Dr. Omary And once the tapering guidelines change and people understand, oh, if you're on a psychmed hyperbolic tapering, they'll understand that this isn't such a casual medication. If you can't just suddenly stop taking it and revert back to normal, if you need this lengthy taper to have your brain adjust back to being normal, then you can infer, oh, this medication is actually quite quite intense. It's not just like a serotonin vitamin that you pop.

Mikhaila Mhm. Yeah. I think I think in RFK's recent initiative to create billing codes for not just prescribing, but deprescribing medication, that was a step in the right direction. And on on the subject of Medicaid and financial incentives, one of the strong arguments that you'll hear for this mental health crisis that supposedly young people in particular are living through is you see this hockey stick like phenomenon. So like slow increases in depression and anxiety and then right around 2010 like sharp increase especially in young people. So a lot of people Jonathan height a social psychologist being one of the most prominent examples attribute that right around 2010 this sharp increase to the advent of smartphones and social media. I've also been writing a lot about critiquing that underlying research.

Mikhaila So it's true that there are correlations between social media use and depression, anxiety, and loneliness. Kids who are most depressed, an anxious, and lonely are the most likely to use social media. You might also remember from our podcast, we talked about me being homeschooled and addicted to video games and spending like well over 10 hours a day on screens. So maybe there's a little bit of what Freud would call reaction formation, like a little bit of defensiveness and fighting against the thing uh that that that calls out your blind spots. But if you look at the actual data, there are lots of individual studies that show associations between social media use and these negative mental health outcomes. But they're mostly correlational. It's mostly self- selection that you have kids like me who are, you know, already overweight, lonely, depressed, homeschooled that are seeking out connection online.

Mikhaila And as poor as my childhood was, I think that it would have been even worse if I didn't have video games and if I didn't have online social connection. And if you look at metaanalyses, especially the ones that control for other personality traits that independently predict both negative mental health outcomes and increased screen usage like introversion, then you see that the effects disappear. So the largest meta analyses show that these social media effects are mostly correlational and mostly null when you control for other compounds. And the alternative explanation to this hockey stick phenomenon also in 2010 is when the affordable care act introduced this mental health parody provision. So before 2010, it was not legally required for insuranceances to cover mental health services. They weren't considered an essential service. The Mental Health Parody Act introduced mental health care as an essential health service.

Mikhaila So again, speaking in Kato language in terms of financial incentives, this opened the floodgates to what economists would call supplier induced demand. Here's a thing that previously wasn't eligible for insurance coverage and you need a diagnosis for insurance coverage. So after you open you legislate a requirement to open the floodgates to in insurance money, you create a strong incentive for diagnosis. And immediately after that in 2013 is when we have the most recent and also the largest and most expansive and loosest diagnostic criteria edition of the DSM. So I look at that and I think it's a striking coincidence and it seems more causally likely to me than these social media correlations.

Dr. Omary I I completely agree that like that makes perfect sense. I didn't realize that was exactly at the same time. And that and that does make sense to me that if you're introverted, you are going to spend more time online. And I can tell from like so my my 8-year-old, you can just tell that giving kids screens all the time, especially if this is a healthy kid, isn't good for the kid. But I would I would agree that it it's likely um it's not causal. It's likely correlation.

Mikhaila Right. The most robust effects aren't on mental health. The most robust effects of screen use are on attention span. And even when you look at attention span and education outcomes, the best studies on this are quasi randomized control trials looking at different schools within the same district. So they have similar demographics and you're more or less naturally controlling for those socioeconomic compounds. And you're looking at, okay, this school bans smartphones, this neighboring school doesn't. you don't see any significant differences on mental health outcomes or bullying. What you do see big effects is on standardized test scores.

Mikhaila So, kids do better with smartphone bands. Now, even there, I don't look at it and say social media or smartphones are so harmful to attention span that kids are literally getting dumber. I look at it as a neuroscientist and thinking about the first principles of brain development like it's it's the same brain matter. It's the same level of computational power. We can just specialize and redirect to different areas. So we talked about this last time actually in the context of sensitive windows for brain development. you have these heightened windows of plasticity and the extreme examples are both in animal studies where you experimentally manipulate say blinding certain animals. What you'll see is that the visual cortex will atrophy but then the other sensory cortices like the auditory cortex will grow in and start to fill that brain region and you see the animal develop more acute sense of hearing or of smell.

Mikhaila And we see the same thing in congenally blind or deaf humans. So that's neuroplasticity at work. So starting from those same principles, let's say you have a developing brain that has a finite amount of smarts or computational power and you can either specialize in slow traditional learning like the types of critical thinking and reading long text passages that you do in standardized testing and traditional education. or you specialize in fast-paced multitasking, the types that the types of intelligence that's optimized for with video games and social media. And indeed, that's what the research shows. It's not that you're getting dumber, it's that you're getting worse at a very specific type of long-term critical thinking task, but you also get better at multitasking. Now, I'm not to say that objectively one is better or worse, but again, thinking like an evolutionary psychologist and neuroscientist, there are different trade-offs, but you have the same level of brain power.

Dr. Omary That's cool. I don't know what to say to that. That's cool. I think that makes that makes sense to me. It's also hard to tell with the advent of AI and how the future is going to be exactly how humans need to adapt, right?

Mikhaila See, I've been writing about AI and mental health, too. Actually the fun thing about this role is because psychology connects to basically everything policy related and technology related. So I get to opine on all these different areas. So like in the context of AI people are talking about chat bots and AI therapy or in these extreme cases AI psychosis AIdriven suicide. So often times people point towards some potential for harm. And that's that's kind of what we're talking about in all these examples here. there are real potential harms say of AI of social media of diet of elective procedures then the question is what do we do about it and often people rush in for government solutions saying we need to regulate we need to prevent this harm but regulation creates harm too diagnosis creates harm too so also when people look at overdiagnosis and when they say well the DSM's been getting broader yes but worst case that just means we're generating some false positives, but we're expanding access to care. Wouldn't you rather do that than underdiagnose?

Mikhaila But people forget that when you label someone, especially a child with a diagnosis who's Okay, get this.

The Financial Incentives Driving Psychiatric Diagnoses

Mikhaila According to the CDC, there was a 70% increase in autism in the 3 years postco. Now, autism is a rare genetic neurological disorder that is characterized by social difficulties. Gee, I wonder why there is a 70% increase in social difficulties following a pandemic where we shut down the world and left kids outside of the normal social environment. [laughter]

Dr. Omary Yep. I was also going to say for for Jonathan Height's work on social media, what I do think is realistic is people are talking more about it. So you get social contagion really easy on social media. So perhaps around 2010, which isn't even I think when social media really took hold. I think it was a bit later than that at least for me. I was probably more involved in it in 2012, like quite a bit more than 2010. But you get support groups, you get people saying these are my symptoms or these your symptoms and then you can find all your people so easily because of the algorithm.

Dr. Omary And that I think would have more of a potential negative effect depending on what the contagion is than amount spent than just social media as a whole. Like the ideas that are in social media. Does Jonathan height talk about that? Is he talking about that causing mental health problems like what people are talking about on social media or literally just screen time?

Mikhaila Yeah, it's it's homopholy. We certainly see that with the gender dysphoria epidemic and also with eating disorders like anorexia, with self harm, like cutting. In all those cases, I agree with you. Social media, if it has any causal effect, it's not directly on mental health, but it's on who you're talking to and what you're hearing. So, that's where that's where most of Height's critique is. And, you know, he also pays a lot of attention to cyber bullying. Again, there's there's a completely separate policy question that we need to be having because a lot of people I mean, first the question is, is this thing harmful?

Mikhaila And what I've been calling attention to is often the harms are on a less robust evidence foundation than people would have you believe. But even where the harms are real, okay, what do we do about it? Do we ban social media for kids under 16 like Australia has just done? It's not working. Teenagers are smart. They know how to install a VPN and reroute their traffic through another country that doesn't have the ban. They know how to access the dark web.

Mikhaila So, in many cases, the bans, if anything, it just gets them off the big platforms like Instagram that have the most robust safety checks and they're exploring darker corners of the internet that don't have the same regulations. So that's again it's it's like the the hormones for gender dysphoric youth. It's well-intentioned and yet it might make the underlying problem worse. Not to mention that in order to mandate age to prevent children from being able to access harmful content online, it means that you have to have age checks for all users, including adults. And that introduces unconstitutional privacy risks. That makes sense.

Dr. Omary So, what do we do about it? Do we regulate or do we leave it like most forms of potential harm that children should be protected from and recognize it as a responsibility of the parents. So, in a lot of these big lawsuits that we're seeing against social media companies right now, they're claiming that there's an underlying harmful association, which again, I'm more skeptical about, but open to the possibility that it's there. Certainly in some minority cases there are direct causal harmful effects. What we can't say is that you know at the level of systematic reviews and meta analyses across the board we can say something is harmful. But there are definitely individualized cases of harm. Even in those cases is it the company that has been negligent or is it the parent that has been negligent?

Dr. Omary Because in any other case, a kid gets access to a firearm or drugs, then the parent will be charged with negligence. You don't go after the company that's produced it.

Mikhaila Yeah. Might be an unpopular opinion, but I I'm probably inclined to think it's the parents fault. Now, I don't have a teenager yet, so maybe my view will change once I have a teenager. But if you end up in a in a cycle of negative Reddit threads, probably not great for your for your mental health. But then maybe there needs to be some oversight by parents being like, are you in a chat room? Like, where are you on the internet? As opposed to just saying social media as a whole is bad.

Mikhaila Because I also don't see how you're going to avoid, especially in five or 10 years, how we're going to avoid the internet with the advent of advent of AI. Like it's going to be so ingrained in society, especially when there are robots walking around.

Dr. Omary Right. Right. What I've written a lot for human progress about recently is the fact that we have this innate negativity bias. There is uh an evolutionary mismatch. You know, like diet is the classic example. In an ancestral environment where fat and sugar and high calorie foods were rare, it's adaptive to develop a strong taste for it. But in a modern environment of industrial food production, overconumption is the greater risk.

Dr. Omary So there's all sorts of evolutionary mismatch. Negativity bias being a great example. You would rather mistake a stick for a snake than a snake for a stick. Evolution has selected for people to be a little bit neurotic, a little bit overly threatens. And media hijacks that negativity bias, not even because there's any perverse incentives. It's just a natural incentive. Like you want to get human attention, then anything negative is going to orient human attention. again because in an ancestral environment and even in a modern day environment it's adaptive but it's also even more adaptive to be mindful of the fact that we have this negativity bias and be selective about what information you allow into your life.

Dr. Omary So I think that this is a form of progress. And the interesting thing, if you've explored stoicism at all, Marcus Aurelius, former Roman emperor, he writes about in his meditations, in his diary, he basically has a whole bunch of first world problems. He's an emperor 2,000 years ago. And he writes about I don't want to get out of bed. I have all these servants that can do my job for me. Um I'm worried about gluttony because I have like literally all the best food in the world brought to me on a platter. I don't want to go outside and exercise, but I know it's good for my body.

Dr. Omary I don't really want to read because I can just have all these concubines brought into my bed chambers, and I don't have to do anything if I don't want to than like have sex and have grapes fed to me by these beautiful women, and other people, power- hungry people, would be glad to do my emperor job for me. I can outsource all of that. So, he has extreme first world problems. And what we're seeing now, this crisis of meaning that we're talking about is basically emperor world problems at scale because we're wealthier than any other time in human history. We are having to contend with the same problems that the founder of stoicism contended with. The fact that we would rather have to avoid gluttony or avoid sleeping in and being lazy because we're wealthy enough and safe enough that we can afford to. So that's difficult.

Dr. Omary Responsibility and agency is difficult. I think this is why your dad was such an influence on us, especially on young men like myself growing up in this environment of extreme abundance but also extreme ease and being able to take the easy way out and be lazy. But being able to instead, you know, rally for responsibility and create the own the meaning in your life as opposed to just having it handed to you in the daily struggle for survival. It's difficult, but it's worthwhile. And it's amazing to me from a human progress angle that now those are the problems that we have to face instead of the default problems of starvation and seeking out a safe shelter.

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Dr. Omary Do you think a percentage of people aren't going to make it? Not to be too dark about this, but like in in order to say you have everything and you're in this abundant society and you don't have any motivation, isn't that highly reliant on how conscientious you are? Isn't that a lot of that personality driven? And if so, then what are those people going to do?

Mikhaila It is. And I I like that you're thinking like a personality psychologist. I worry about the bell curve all the time. And I don't just mean about intelligence, but conscientiousness, like you said, neuroticism as well. So, there's always going to be some tale of a distribution of people that are going to have it easier and have it harder, but they still fundamentally have to deal with the same challenges, but I don't mean that in a pessimistic way like they have to deal with it. I mean it like the solutions are going to be the same even if they're harder to implement. As hard as it's going to be to adopt more responsibility if you're for biological reasons lower in conscientiousness and higher in neuroticism if anything all the more urgent it is for you to adopt that mindset.

Mikhaila

Dr. Omary Yeah. So do you think that can be taught? Do you have recommendations?

Mikhaila I think it can be taught and I'm optimistic as an evolutionary psychologist that you know you said for people that don't have any motivation. I don't believe such people exist because at the very least we have these inherited biological motives. You know, we want to avoid pain, avoid starvation, avoid boredom even. That's why that's why we talk about addiction and doom scrolling because people don't want to be bored. I mean, boredom is healthy for creativity to some degree. But even you say like someone who supposedly has no motivation, well they're doom scrolling because they're bored and that implies an intrinsic motivation to try to avoid boredom or they're overeating because again eating is just naturally pleasurable. We evolved that way.

Mikhaila So what I'm trying to do in this broader mission as a psychologist of human progress is to better understand our evolutionary psychology and try to gify it so we can optimize psychology. It's like Maslo's hierarchy of needs.

Dr. Omary Yeah. I had this conversation with dad about five years ago because we were talking about what what do people do when they can't figure out what to do with their lives? I was like, well, figure out where the problems are and then fix the problems.

Mikhaila Like everybody has some issue that they could probably work at. And and that's a place that's how I started where I was like, okay, this autoimmune disorder is a huge problem. It's ruining my entire life. I guess that's what I'll do with my life is figure out how to not have an autoimmune disorder and I think that applies to every human is like what part of your life is suffering and what can you do to fix it and there you have something to do

Dr. Omary right so it's like a fundamental is the glass half full or half empty I mean for every problem that's pointed out and like I mentioned one of the major critiques of the human progress narrative is well how can you say we're living in the best time in history when and then you know name all of these new problems that are unique to this time in history. But for every problem, I mean, if we didn't have any problems, your dad talks about this too in uh Dosstoyky's Notes from Underground, like if you had nothing to do but lay in bed and eat cake, you'd be bored, you'd be depressed, you'd be nihilistic. So, and a lot of people are again, it's the it's the stoicism emperor world problems.

Mikhaila That's cool. Okay. You talked about the meaning crisis and before we started talking, you mentioned a book. Can you describe this upcoming book?

Dr. Omary This is the long-term vision for psychology of human progress. So in the same way that there are many different disciplines within psychology, social, developmental, cognitive, evolutionary, clinical, we want progress psychology to be its own subfield. So if you've heard of this somewhat still niche world of progress studies, it's a lot of Silicon Valley techro libertarian types, not just you know startups, but this broader world of you know how do we optimize human existence? You hear a lot of it with AI too. So people are coming at it from different angles. There's progress studies in terms of optimizing health. So maybe I'd place you in there.

Dr. Omary There's progress studies in terms of AI alignment. There's progress studies in terms of our institutions. How can we remove a lot of the corruption and perverse incentives including the incentives the perverse incentives in our health care system like for over diagnosis like we were just talking about. And more importantly underlying all of this all of these different problems and potential solutions are psychological problems and solutions. So that's not just what are the psychological traits that we should try to optimize for in terms of mental health and fulfillment and creativity and purpose, but also what are the psychological traits that hinder progress, tribalism, zero suming, negativity bias, and how can we be more mindful of that and navigate around them?

Mikhaila That makes sense. And you mentioned you're working with Marian Tupi, Sarah Hill a bit. Who's in the KO Institute that people might know?

Dr. Omary Marian Tupi runs humanprogress.org.

Mikhaila Yeah, my dad has been such a fan of his for like 10 years. I remember before all all the like YouTube infamy and everything. Uh he was kind of obsessed with the X account, Human Progress, because I was always tweeting out. I was like, "Well, technically actually things are going in the right direction. and here are all the studies.

Dr. Omary Yeah. And it's funny. People don't like to hear it. They get weirdly defensive. Like they're clinging on to the to the narrative that the world is so bad. I don't know why, but yeah, you look at the data. Look at humanprogress.org and all of the data is open source from publicly available like OECD, our world and data, international data sets.

Dr. Omary So we're not creating the data. We're not spinning the narrative that things are better. We're just illuminating where it is. And again, we're willing to contend with where the data says that things are worse. And the main place that the data is worse is mental health outcomes. So, I'm looking at that still with a healthy view of skepticism of is it actually worse or could the data say it's worse because the diagnostic standards have shifted? And it's a combination of both.

Dr. Omary I think that there are real problems that are making people more nihilistic if they lack agency, but agency also seems to be the solution to this. And you know, there are other real pressing problems grounded in this type of international data like the fertility crisis. And I think that's fundamentally tied to this crisis of meaning. Like having a child is the most long-term optimistic bet on the world that you can take. And a lot of young people aren't taking that bet. This is true. Interesting.

Dr. Omary I'm probably more inclined to think that there's some that something has made people sick recently, you know, that it's not just But I mean, I come I come at this from more of a health perspective, but I can't imagine. For instance, one of the arguments when I was diagnosed with juvenile rheumatoid arthritis, it was unseen. I think that was 1999 when I was diagnosed and it took 5 years to diagnose because doctors hadn't seen it. And now it it's skyrocketed. I don't I don't want to give the stat, but it went from something like one in 10,000 to one in a 100red or something. It those numbers aren't right. They'd have to be double checked, but it it's way more prevalent.

Dr. Omary And one of the arguments is, well, that's because we can catch it faster. But I didn't know anybody in my school that had joint pain. You know, it it wasn't there. And so I'm more inclined to think that something uh recently has made people more sensitive physiologically to something that's causing depression rather than just a meaning crisis. But I think we're going to need a lot more data to figure out exactly what there is. There's theories. There's a vaccine theory.

Dr. Omary There's diet the diet theory of course like more processed foods causing chronic illness. But I think that plays a huge role.

Mikhaila I think you're right that certainly in terms of physical health and even mental health,

Dr. Omary obesity too, even just the rising obesity rate,

Mikhaila diet plays a whole a huge role, lifestyle plays a huge role because people are just less active. The fact that you don't really have to be physically active to survive or to put food on the table anymore in most industries of work in wealthy western democracies. So again, I look at that still as a sign of progress, like genuine problems we need to contend with. But let's say it's the case that because of food industrialization, there are all sorts of additives that turn out to have tiny harmful cumulative effects on physical and mental health that are impairing us from a optimal health standpoint. On the other hand, life expectancy is just about higher than ever. And if we think about the evolutionary and historical perspective, for most of human history, the median age was 40. Like most of human history, deaths in infancy and in childbirth were crazy high and now they're at all-time lows.

Mikhaila So the human progress angle is yes, we have real challenges to face, but on the other hand, we're able to acknowledge those because we have you know billions of people putting their minds together because we have these advancements in food production and technology and energy and so forth. So also on this point um you mentioned Marian Tupi so he's he's leading this whole human progress initiative. You also mentioned Sarah Hill who you had on your podcast Simon Peterson Academy birth control expert. So, she's writing a chapter for us in this book on the psychology of progress on the trade-offs of birth control.

Gender Dysphoria, Adolescence & The Challenges of Treatment

Mikhaila Like, it's great in terms of expanding agency and gender rights, women's rights. On the other hand, yeah, there are real meaningful challenges, whether that's the literal psychological side effects of disrupting hormones or even institutional side effects. Like when we see such a change as now a majority of people earning degrees are women, we see changes in institutional culture that probably contribute to the rise in cancel culture that we saw in the last decade.

Dr. Omary Adam pushed gently.

Mikhaila Yeah. So, that's not to say that we should regress, but it's to say that everything is trade-offs. Even, you know, smartphones and brain health, everything is trade-offs. We're not atrophying our brains, but we're trading off a type of long-term delayed thinking into a type of multitasking and fast-paced information processing. Everything is trade-offs. So, that's the central thesis of the book. I mentioned those two.

Mikhaila And we're going to have chapters from various experts in different fields, including hopefully on diet, on physical health. Again, not just thinking psychologically in terms of individuals and their personalities and mental health, but also psychologically in terms of tribalism and what types of people feed into what types of institutions and what type of institutional norms enable progress versus hinder progress. Now, on one hand, there is a strong bias. the free market bias. But the bias is not because we're libertarian. We're libertarian because we see that this is what the data shows enables progress. Free markets genuinely enable innovation and material prosperity. And anti- free market societies, especially communist regimes, are the exact opposite.

Mikhaila Hundreds of millions of deaths. And unfortunately, people, especially on the left, still have not gotten the picture. But that's why we're continually fighting for freedom and trying to do it not so much in a polarized way, but in a in a datadriven nuance. Just take a step back. Don't listen to us. Listen to the data.

Dr. Omary I like that. And I I can see that with abundance in food, even though there were some malevolent, I would say, players creating the food pyramid and putting chemicals into our food, you could see that if a society was to suddenly become abundant in food, there's going to be this kind of blip where people figure out what to eat when they're exposed to everything. And so maybe in the long term games like, well, at least we have an abundant amount of food compared to before, but we're in this intermediary period where we're not entirely sure what to eat because everything's been manufactured to taste so good,

Mikhaila right?

Dr. Omary But in the long run, maybe a good thing.

Mikhaila Yeah, I think more freedom is always good. And it it gets trickier, especially from a philosophical perspective. You know, what is what is the right amount of voluntary suffering? Not even the types of healthy sacrifice to develop yourself, but you know, some people really like smoking. Some people really like junk food. And they say, you know, I know this is going to shave years off my lifespan, but I would rather live 60 years as a smoking McDonald's eater than 80 years on a on a strict carnivore diet. Go for it.

Mikhaila I I I I have exa exactly that perspective is people should be able to do adults should be able to do basically whatever they want, but they shouldn't be lied to in order to come to the conclusions they're at. So like take psychiatric medications if you want to, but know what happens if you're on them long term. Like you should be told that and eat whatever you want, but know what the like potentially chronic disease is the outcome. like and it does get tricky from a philosophical perspective when you involve the government which I'm usually not interested in doing because I think usually that goes in the wrong direction but but then it's hard to say what to do with a society that's already addicted to all these things because they've been lied to for so long. So we're not starting at zero for like medication foods. We're not starting at zero and saying eat whatever you want. Here are all the ramifications if you decide to eat unhealthily. Here are all the ramifications if you decide to take medication long term.

Mikhaila We're starting with a society that's already in the midst of it. So then do you need government input? Probably. I I still don't know if it's useful or not, but it it becomes a much harder question. One of the questions that keeps coming up in this progress psychology project is what do we do about institutional trust which is at all-time lows and really deservingly so given how much people have been lied to especially like co really blew the roof off a lot of this not just because it was a strong example of government overreach and manipulating public information but also So again, the cumulative effects of years of lockdown and the psychological stress and handicapping an entire generation of young kids socially, I think a lot of the political polarization and craziness we're seeing are downstream ripple effects of that. And we're going to probably see it for generations to come because again, you know, psychologists overuse the term intergenerational trauma. But in subtle ways, you're going to not just see that young kids who grew up during the pandemic are going to change and they're going to influence our institutions, but they're going to parent in different ways.

Mikhaila And those children are going to grow up differently because that sort of parenting. So, I'm not trying to sound determinist or doomer. If anything, it's literally my job on human progress to be an optimist, and I am a datadriven optimist. But yeah, we need we need more transparency, more openness, more research, more data, and conversations like these are a step in that direction.

Dr. Omary Agreed. Does the KO Institute run studies as well?

Mikhaila We're running some studies on the human progress team. There's a whole polling center. I can't speak much to what other policy departments are doing. Think tanks are kind of like research universities. So, it's quite big. Basically, every policy area that you can think of, health, economics, foreign policy, defense, all sorts of things that I'm sorry for my colleagues for leaving out.

Dr. Omary We have experts on everything. And the people at KO are brilliant. And what I love about it is there's true diversity of thought like you're supposed to have in academia. I mean, there is a self- selection bias to the extent that we're all libertarian or libertarian leaning at least and free market thinkers, but there's so much diversity.

Mikhaila But you're right, so it's fine.

Dr. Omary And we're right. Yeah, I think we're right. And again, look at the data. Look at if you treat history as a set of quasi experiments well it's not an accident that we're having this conversation in America and you immigrated here because of the greater freedom right so you get these brain drain effects and your father as well and it's like a rich get-richer phenomenon it's like this Matthew principle that seems to be a natural law and that's why a lot of people critique free markets but it's not the free market. That's the problem. It's the underlying diversity of capability and value production. Like this is a far deeper evolutionary problem.

Dr. Omary Agreed. Do you guys do any studies on like tribalism particularly I guess on social media? I feel like just from what I've seen, it's skyrocketed since co. Uh, and there's got to be some I was talking to dad about this the other day actually was there's got to be some personality traits that are associated with people who end up leading kind of these fringe conspiratorial tribes. And he was assuming it has something to do with the dark triad. And I'm just wondering if there have been any studies on that at all, showing sociopaths, I guess, or psychopaths or whatever you want to call them, people high in the dark triad on social media amassing large followings. Have you do you guys look into that at all?

Dr. Omary

Mikhaila At KO, we're not looking into dark triad traits specifically. So the existing research literature certainly shows that that the types of social media trolls are disproportionately high in dark triad traits and especially when it's anonymous online interaction. You see the worst behavior brought out and we are commissioning studies for this broader psychology of progress project on social media polarization misinformation.

Autism Rates After COVID: What Explains the Surge?

Mikhaila What do we do about it? Because again, it we're not trying to say literally everything is getting better all the time. We're trying to say on average, if you could choose to be born in any time in human history, probably this is the time to be. And there are real challenges to face there. And the solution to those challenges or the first step to solutions is understanding what the problems really are. So yes, we're commissioning studies on that. And I'm relatively new here.

Mikhaila I'm the only psychologist at Kato which allows me to be much of a generalist but as I mentioned we're relying on outside expertise from others topic experts and I have a bioatistics background as well so I I feel that I'm particularly strong at evaluating study methods which across any discipline like the statistics are the statistics so I have a pretty good bullshit detector [laughter]

Dr. Omary that's so cool so what's the goal of the KO Institute is Is it kind of awareness and to try to help society stay positive? Is that the underlying goal or is there something else?

Mikhaila The the four main taglines are advancing limited government, individual liberty, free markets, and peace. And we could talk about how each of those lead to a more prosperous society. But also, I think it's useful to think about what think tanks do in the broader political ecosystem. And this is pretty new to me because the before deciding to cancel my academic career by pursuing literally the most controversial topic, although it worked out for me and I'm I'm really glad that I did. You know, your dad talks about when you commit to seeking the truth, your life becomes an adventure. So, I couldn't have predicted that I would have ended up in this great job at Human Progress and at KO, but it's worth it. So, most think tanks, as far as I understand it, are more explicitly partisan. like you have the Heritage Foundation that has contributed to the 20 project 2025 agenda.

Mikhaila On the left you have uh Brookings and Centers for American Progress. Very different definition of progress there. You have you have AEI where my friend Carol Hooven is. So think tanks are very friendly, especially on the more conservative libertarian side, very friendly to more of the heterodox thinkers. Uh Rob Henderson is at Manhattan Institute, which is also uh more conservative than KO, more conservative than libertarian. So they're all kind of like research universities, and they employ a lot of either concurrent or former academics to do policy research. What's really different from my perspective is the pace of the work.

Mikhaila So, you know, rather than writing one or two peer-reviewed academic journal articles per year, I'm doing like one or two or more op-eds per week or per month, and we're reaching larger audiences. So, again, everything is trade-offs like you at the cost of some depth. Even though we do great in-depth policy analyses that are basically peer-reviewed academic papers and many KO scholars and many think tank scholars generally remain active in publishing academic papers, no one reads them. So then you condense it into like a Washington Post or Wall Street Journal article and they get larger readership. So I'm basically doing both. I'm keeping up with the research in terms of these psychology studies that I'm commissioning. I'm also writing a lot basically every week about whatever is fashionable in terms of mental health or public policy.

Mikhaila So all think tanks do that. I think what's really unique about Kato aside from being the largest libertarian is that we're nonpartisan. Most are explicitly partisan. And that means again it contributes to this strong diversity of thought. It's like you can support Trump in his tax cuts one day and critique him on his immigration policy or on starting a war the next day. So there's a lot of true diversity and principled rather than partisan.

Dr. Omary Cool. I don't think I really knew what a think tank was other than knowing what the word think and tank was and then just assuming

Mikhaila I am now a professional overthinker. Before I was just a part-time overthinker.

Dr. Omary That's so funny. Okay, so just out of curiosity more about think tanks, are these are these nonprofits? Do people donate? How do they stay alive? Because you can't stay alive by by writing articles, right?

Mikhaila Yeah. KO is nonprofit. I think all tank think tanks are nonprofit, but I'm not entirely certain of that. Most of them probably are and rely on donations. The more partisan ones probably take direct political money, but I'm not sure of that. KO definitely doesn't. KO is individual donors, like people that believe in advancing individual liberty.

Mikhaila And again, lots of former academics or people that are just notable public figures like Rob Henderson is a good example ending up at Manhattan Institute. My understanding is that think tanks have kind of two main streams of recruitment. So there's like you're recruiting policy analysts and economists and people that are going to do research kind of behind the scenes and then you're recruiting people that are already notable public figures just because they align with your philosophy and it makes a lot of sense and it's advantageous to to have them on board and to put your branding on anything that they do. So like anytime Rob Henderson goes on your podcast now, like he's advertising Manhattan Institute. So to some extent I get to do that for KO. Mine is kind of a unique case because I'm doing both because I'm relatively early on in my career. Like you know during grad school I was doing a lot of writing and public speaking about in this case the controversial gender dysphoria debate.

Mikhaila I think that if anything KO well KO definitely doesn't take a particular stance on it and this is a good example of the diversity of thoughts. So I think everyone at KO and and really like Americans broadly are more supportive of what transgender adults want to do. Most of the concern is about children. So on one hand you can make a strong libertarian argument that children can't consent therefore it's unethical. On the other hand you could make a strong libertarian argument saying that well when children can't consent it falls onto the parents and it's within the realm of the parents liberty to decide what they want for their child. So most hopefully all libertarians would recognize that there's some level of extreme harm or neglect and there's some level of inherent rights and value to a child that if a parent is severely abusing them then they need to be protected and it makes sense to look towards the government for that. But where do you draw the line?

Mikhaila And particularly for experimental potentially harmful medical procedures, where do you draw the line? So there are some people, some libertarians even, who look at that and say, well, even children, especially, you know,

Dr. Omary where's the cut off for child? Like a 16, 17year-old has more agency and maybe they should have more say in what they do with their body even with harmful elective procedures. At the very least, I think what we agree about is we need to have more openness about what the harms are and what the interventions are actually doing. And we certainly have not had that from the people promoting gender affirming care.

Mikhaila Yeah, that's for sure.

Dr. Omary So, there's a lot of healthy diversity of thought there. And my case is unique again because I was speaking publicly about this issue. I think what they liked is that

Mikhaila I was doing it in a hopefully unbiased data driven way. I was certainly trying to do that and that it meant that I wasn't shy of talking about whatever the spotlight issues are. Like I didn't want to just remain in a narrow academic specialization where only me and my five colleagues would ever read each other's papers. Like I wanted to have more of an influence in public discourse. So, I get to have this somewhat unique role being both the early career researcher, policy analyst type, but also getting to have more of this public intellectual role doing podcasts like this.

Dr. Omary That's so fun.

Mikhaila Congratulations. That's amazing. I didn't even know that was a job really,

Dr. Omary but it sounds it sounds perfect. Yeah, it's a it's a great example again of, you know, just committing to trying to tell the truth and do good in the world and not be concerned about the long-term consequences, not holding your tongue.

Lockdowns, Development & Children's Mental Health

Dr. Omary I debated when you first invited me on your podcast two years ago whether to do it because I knew that I would get a lot of push back, particularly from my peers at Harvard who were already saying mean things about me. But it was worth it. And one indirect path that I couldn't have predicted and Marian Tupi who's been on your show and who's taught for Peterson Academy, he saw it, he liked it, he liked me. This opening

Mikhaila cool came up

Dr. Omary and it's a small world. Um, so a lot of the people that are in KO circles are also in ARC circles, the Alliance for Responsible Citizenship conference that your dad puts on.

Mikhaila Yeah. Weird. That's very, very cool though. Okay, let me see. I I have a a few more questions to ask you. Okay, we didn't talk about So, you've been writing these articles. I saw an article pop up and I don't think I even saw it cuz you shared it.

Mikhaila I think I saw it from somewhere else, but it was on the Wall Street Journal and I think it was ADHD.

Dr. Omary So, there's two separate ones you could be referring to. There's the Wall Street Journal one which is talking about RFK's recent psychmeds press conference and the financial incentives that go into that which I think we already covered both of those. And then separately there's ADHD. I wrote an article for the dispatch on ADHD over diagnosis. And again, this is continuing the broad theme of ADHD is yet another example that's being massively overdiagnosed in my opinion. And if you look at the diagnostic criteria within successive revisions of the DSM, they've gotten broader with time. There are more financial incentives.

Dr. Omary And just if you look at the structure of the school system, especially if you're thinking like an evolutionary psychologist, it's not surprising that young kids, especially young boys, don't sit still for eight hours a day in a classroom. And I don't think we should be medicating them if they can't do that. That's normal and healthy. what's abnormal but also remarkable that many kids can adapt to it. That's also neuroplasticity at work. I'm concerned about pathizing ordinary human behavior. And I think we ought to be

Mikhaila conservative in in the scientific sense and in the medical sense of where we draw the line. According to the NIH, according to the National Institute of Mental Health, 50% of American adolescents have met criteria for mental illness at least once in their lives.

Dr. Omary Yeah, of course.

Mikhaila At any given time, it's closer to 30%. Like we discussed, that's still insane. Again, if you're thinking about this like a personality psychologist and like a clinical psychologist, like this bell curve acknowledgement, well, 30 to 50% of the population is ordinary human behavior by definition. If we're talking about clinical psychopathology, you can debate about where to draw the line, but you're always talking about an extreme tale of a distribution. The distinction between ordinary and pathological, it's in the definition. It's in the word psychopathology. It has to be pathological to be diagnosible.

Mikhaila If it's 30 to 50% of the population, it's ordinary levels of distress and we've forgotten that.

Dr. Omary Yes. Yes. I know. I've been thinking about that quite a bit in terms of mental health because so o over the last couple of years I've had multiple pregnancies which are extremely destabilizing like psychologically because your hormones during pregnancy are insane and then postpartum are insane and then the stress of dad especially this year being so unbelievably sick that I've been like I don't feel good like if I was anyone realistically if I was anyone other than me I'd be like I need some sort of anti-depressant or something because I'm depressed. But I I've also seen people go through stressful situations, a relative gets cancer or like your close loved ones gets cancer, you're going to be depressed. You're not going to be the same person you were. There are periods throughout your life where you don't feel good and things are hard and you could be like, "This is not tolerable.

Dr. Omary I don't feel good." And that's normal human stress. And it's not supposed to feel good. And it shouldn't be it shouldn't be medicated for sure because then you don't even process the emotions you're going through. Like we we haven't even talked about that. What about the fact that people are going through trauma say and get medicated and then they don't process the emotions? That's got to be an issue long term,

Dr. Omary

Mikhaila right? I'm concerned about that as well. So this is another good example of the perverse financial incentives that come in in the way our healthare system currently operates. So most therapists and psychiatrists aren't deluded enough to believe that 30 to 50% of young people are mentally ill. They're navigating an insurance system and they're trying to provide care and they're thinking, "All right, if you've just gone through a breakup or the death of a loved one, you probably don't have major depressive disorder. You probably are in need of short-term support. And yet you still have to if the patient is going to receive any sort of insurance reimbursement and they probably won't go to therapy if they can't.

Mikhaila So there are adjustment disorders which is often the shorthand that's used uh which are temporary by definition but again depending on coverage and eligibility a lot of times you'll see overdiagnosis. So that you know let's say adjustment disorder is the diagnostic tag

Dr. Omary and is an adjustment disorder is that something that's something in your environment like cancer or divorce or something like that. Is that what what's an adjustment?

Mikhaila That's basically the catchall term for this person is going through a hard time and the unspoken awareness is this isn't really a clinical disorder but we have to treat it like a medical disorder otherwise there won't be coverage. So, it's like the open secret within the therapeutic industry. Talk to any therapist about it. They'll they'll be open about, yeah, adjustment disorder is what you do when you have to diagnose something, otherwise you won't receive coverage, but nothing's really wrong with them.

Dr. Omary That's not good. Even the term adjustment disorder is kind of pathological. What? Well, adjusting to this difficult life circumstance

Mikhaila like disorder sticking disorder in there that's manipulative.

Dr. Omary That's the point again. So, we need to have a conversation about what types of mental health services and support can you receive if you don't have a medical disorder? Because the therapeutic industry has expanded to fill the void. I think that historically you'd find in community and from family all of that has fragmented. So again, everything is trade-offs. I don't look at that and say it's an inherently bad thing. I look at it and think it's a predictable result that there's going to be a strong incentive to create or expand the closest existing support service.

Dr. Omary And there's a there's a fine line between what is a medical problem and what is a mental health problem and what is an adjustment problem that you really just need some advice and some support and someone to listen to. And you could get it from a friend, but if you can't, then it makes sense to pay for a therapist. I'm I think that's a good thing. The bad thing is that people internalize these diagnoses as though they have something wrong with them when really life is challenging and we need social support.

Mikhaila Yeah. Dad said when he had clients and I learned this from a long young age is before he said you're you know there seems to be a major depressive disorder or something going on here. He'd be like do you have friends? How is your work? How's your love life? like is anyone around you dying or hurt and go through all these elements of human life to make sure there wasn't something that was contributing to your stress levels that that would was making you depressed and I don't know how many specifically psychiatrists do.

Smartphone Bans: What the Evidence Actually Shows

Mikhaila I don't know how many psychologists do that, but I don't know how many psychiatrists actually do that rather than getting somebody to fill out a Beck questionnaire on depression and then just looking at that and saying, "Well, this looks like depression without delving into trauma or life situ life life circumstances." So hopefully, I guess hopefully with RFK kind of bringing awareness to psych meds that we'll get more clinicians doing that. But I don't even know what psychiatrists are taught, how they're taught to figure out how people are sick. Is it mostly based on questionnaires? Because that's how my experience went when I was a kid. It was like, yeah, you have arthritis, which is already reason enough to be depressed as a kid, but I was just diagnosed from a Beck Beck questionnaire. Do you have any idea what the norm is?

Mikhaila Like an ADHD test, I know that that's mostly questionnaires. So I can speak as a psychology researcher and I rely on public health data at population scales and certainly for these prevalence estimates for all disorders that you hear from CDC and NIH most of those use surveys because they're not able to do the types of in-depth psychiatric interviews that you would need for proper clinical assessment. So they use surveys that are typically correlated with depression, anxiety, autism, whatever it is, but they have major blind spots, especially the autism one like we talked about, which is surveys, oftent times parent reported surveys that ask items like my child struggles with eye contact, struggles making friends, prefers to be alone, things that are associated with autism, but are also associated with social anxiety or even ordinary shyness. So, it's easy to get false positives on surveys, but these are just the prevalence data. So, when you hear a suspect claim from NIH, 30 to 50% of young people have experienced mental illness, part of it is survey bias. Now, if we're talking about actual diagnosis and over diagnosis, then that's driven by the clinician themselves. I'm not a clinician.

Mikhaila I don't see patients. I'm not a psychiatrist. I can't prescribe medicine. So, I can only look at the population level numbers and guess what they're doing. But again, when you look at the incentive structure that they're paid more when they diagnose more, particularly psychiatrists, because you can do an hourlong therapy session or you can do four 15minute prescription writeups. So, psychiatrists have strong incentives to see more patients. Now, this isn't to say they're greedy and they're prescribing when they should be doing therapy.

Mikhaila There's also a strong short supply of psychiatrists. So, most of the time you're seeing a master's level counselor for therapy. And then if you need meds and if they're doing their job right, like you and your dad mentioned, if you've thoroughly evaluated all areas of your life that you can't find any obvious cause to your depression, maybe it makes sense to start exploring medication. But certainly if it's if it's viewed just as a crutch or viewed as the first solution, that's very likely to best case serve as a crutch that avoids you getting to the root of your problems. Worst case leads to long-term side effects and dependency and the things we were talking about earlier.

Dr. Omary Yeah. And that's a huge problem. Okay, Adam, my pregnancy brain is burning out. That was a lot of information.

Mikhaila One last thing relating to your pregnancy. So you were talking about basically the psychological concept would be how much agency you ascribe to yourself and how you navigate problems. So you could take this victim mindset of how difficult things are going for you and how you pathize it like something must be wrong with you or with the world. Or it sounds like you're recognizing, you know, my hormones are out of whack. This is impacting my mood. I'm gonna sort of take a step back kind of like the Alan Watts mindfulness perspective and recognize, you know, there's me at my optimal decision-making capacity and there's me in pregnancy brain. So, we've been talking about

Mikhaila

Dr. Omary political libertarianism, but there's another interesting definition of libertarianism. So, in the free will debate in philosophy, there's determinism. We hear a lot about that. The anti-determinist stance, the technical position is libertarianism. So this is related to philosophically the libertarian political movement that's all about individual freedom and agency but entirely separate philosophy literature on libertarianism. So I would say

Mikhaila this is determinism. Okay,

Dr. Omary versus determinism. So determinism would be this stripping you of your agency, your deterministic system. you're a byproduct whether it's genetic determinism like everything ultimately traces back to biochemistry you have no free will Robert Seapolski is a great example of this neuroscientist who doesn't believe in free will or even on the social constructivist determinism so the interesting thing and the sad thing a lot of developmental psychologists are implicitly or explicitly determinist so the nature or nurture debate and I host the nature and nurture podcast so I'm quite familiar with the debate territory, but it overlooks the libertarianism free will debate. It if if you have free will and agency, it doesn't much matter whether you're a byproduct of genes or environment. Genes is inherently reductionist and determinist. So what I like about the libertarian philosophy, not the political philosophy, but the free will philosophy is that it grants people agency or it acknowledges agency where it exists. Because as your dad talks a lot about, like if

Mikhaila if you act like you don't have free will, then all that happens is you get bitter and resentful and you use your free will in unproductive ways.

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Mikhaila So, what I really liked about you describing the challenges of pregnancy, you did it in a very libertarian way of acknowledging that this is a voluntary choice,

Dr. Omary presumably voluntary if you're mindful about when and when not to use protection and it's it's worthwhile and there are downsides, but it's obviously I mean you can speak to this. I don't have children yet, but probably the world's greatest blessing. So everything everything is trade-offs. And I like this libertarian philosophy of rather than you know you're a victim of your hormones and it needs to be diagnosed as something's wrong with you like you're recognizing ahead of time this is a predictable result and I'm entering into this and I'm just going to try to navigate around it with my free will and with my agency.

Mikhaila Well, thank you that this is me on a podcast though. This isn't the me that my husband sees. There's more victimhood there. But yeah, I I think from being one of the benefits from being miserably depressed for so long and then going through anti-depressant withdrawal and being completely batshit for 2 years was I figured out and this is one of the ways I survived honestly. I figured out when my thoughts didn't make sense, didn't quite make sense. And I was like, "Okay, there's me. Something in me is me."

Mikhaila And then there are these thoughts I have that don't make sense, but that's not me. And so, I can go through these periods of pregnancy cuz I hate being pregnant. It like it makes me dumber. I say like more. Uh I I can't I have short-term memory issues. You get tired. You get nauseous.

Mikhaila I have meat aversions. I'm physically uncomfortable. It's just an unpleasant experience. But you can have unpleasant experiences for a period of time if they pay off, especially if the payoff is obviously worth it, like having kids. But I think a really good thing to do for people is while they're going through unpleasant experiences to stay hopeful for a window at the end and for things to get better at the end and then learn that they can be resilient through these things and then it's not as anxietyprovoking. You can be like, "This is a bad year. This is a period of suffering.

Mikhaila I'm going to do as well as I can. I'm not going to be as productive as I normally am, but I've done this before and I can do it again." And then it's not some existential horror on top of whatever you're experiencing. So resiliency is important for people to learn for sure. Otherwise, how are you supposed to stay mentally healthy and be a human?

Dr. Omary That's human progress at the individual level.

Mikhaila Yeah. Cool. Okay, Adam, where should people go if they want to learn more?

Dr. Omary psychology.humanprogress.org.

Mikhaila Cool. Okay. And I think we should get you on PA if you want to teach a course.

Dr. Omary I would love to.

Mikhaila Okay. That's amazing.

Dr. Omary Psychology of human progress.

Mikhaila Yes, let's do it. That sounds great. Well, thank you so much for coming on again. That was amazing.

Dr. Omary Thank you, Michaela.

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