Mental health crisis is exploding. You can help fix it. Watch this video!

Hi, thanks for joining us for episode #107 of the Doctor Podcast, Sicard File Show. And I'm your host, as usual, Doctor Robert Sicard. And please subscribe and follow Doctor Podcasts and like and share and repost this episode so we can get more great guests like we have today. Now, Doctor Podcast is now ranked in the top 20% of all video podcasts on Spotify, according to a message I got from Spotify. So we need your help to get to #1 And I know Joe Rogan watches Doctor Podcast, so please click on the like button.

Also, Joe, we'd really appreciate it. Now, in addition to Spotify, by the way, you can watch or listen to Doctor Podcasts, episodes on the X platform, on YouTube, on LinkedIn, on Apple Podcasts, Amazon podcasts, Instagram, Facebook, and TikTok. So whatever you prefer, we're there. Now today we have a great guest, it's Doctor Robert Smith. Doctor Smith is a physician and is a University Distinguished Professor Emeritus of Medicine and psychiatry at Michigan State University and the Master in the American College of Physicians.

And he's also a trailblazer in patient centered care and mental health education, which we're going to discuss in detail today. He recently wrote a ground breaking book, which also has an awesome title. I love it. It's called Has Medicine Lost Its Mind? What a perfect title coming from a psychiatrist. In the book, Doctor Smith explains how our mental health system is unfortunately failing us and what should be done to cure that problem now. The book also exposes the critical gap in mental health training for physicians and offers a bold road map for reform.

Doctor Smith has been featured in lots of media in New York Times, a Wall Street Journal, a Today Show, and is a frequent columnist for Psychology Today. Which is the most popular journal for psychology and also psychiatry? Doctor Smith brings decades of clinical experience and evidence based research to the conversation. He joins us today to share powerful stories from the front lines, unpacking the devastating consequences of the mind body split, which we'll talk about in medicine and inspires us with practical solutions to transform mental health care for millions of people in the USA and around the world.

So thanks very much, Doctor Smith, for taking the time and your busy day to join us to talk about this very, very important topic. I appreciate it. Pleased to be here. Thanks for inviting me. Sure. So tell us first how you became interested in psychiatry and and mental health years ago. Sure. I'm an internist and did primary care and I trained in your typical university institution where my training, and this is 4 years of medical school and three years of residency, all had to do with people with physical diseases.

And I'm just well supervised, well trained. I mean, I must have been supervised on 100 people with heart attacks and strokes and cancer and the various things well trained. So I go into practice and it wasn't like what I saw in the University Hospital. People there had many emotional and personal issues and even more troublesome for me was mental disorders. I mean, I and I had some sense of what was going on, but I, I couldn't really pinpoint anything and had tremendous difficulties with them. There was one woman in particular who came to me just after I'd gone into practice metastatic breast cancer.

And at the time there was no other treatment for her. And she'd come from out of town and I became her doctor and I and she would cry and say, what are you going to do for me? Why am I crying all the time? She crying all the time asking. I feel so down. I have no hope. And and I was just frozen Robert just frozen. I had no clue of what to do. And and long and short, I would order a lab test, I'd get an X-ray or something and I knew it wouldn't do any good but it bought me some time. And Long story short, she after multiple visits like this and I really liked her.

She was a nice person. And as we got off of some of the panic she had around her problem, we had a nice conversation. I really liked her, but I was must confess I was relieved when she died. The pressure was off, at least so I thought. Two weeks after she died, her husband hurried into my office. So all of a sudden came in and dropped a book on my desk and said here's a diary she kept. I thought you might want to see this. And he beat out quickly and I couldn't figure out why he came and went so quickly.

Then I read the book, it was just replete with comments about the young doctor doesn't seem to know what to do with me. The young doctor doesn't seem to care about me. I wish the young doctor would answer my emotions. I wonder why he just gets tests all the time. And Robert, there was page after page after page of this and it in more graphic detail than that. And that, that that really shook me to the core. I mean, I could barely concentrate on patients the rest of the day having this in, in my psyche.

And it, it lasted. I mean, the visceral reaction to this lasted for 07 to 10 days. And it was during that time I, I started kind of self assessing and started listening better to patients over the next couple years, listening to them, talking to them. And it in fact seemed to help some people. But I, I still couldn't diagnose depression, all the major mental problems in primary care, depression, addiction, anxiety, panic disorders, stuff like this. I just didn't have a clue, much less to treat them.

And there were lots of them. And so I then decided and to to go back and get additional training and I went to University of Rochester where Doctor George Engel who, who, who identified the biopsychosocial model and I trained there in fellowship for two years on learning some of these things, including inpatient psychiatry, psychotherapy and, and the like. And it was at that point that I committed myself to primary care mental health and to better doctor patient communication and establishing a good strong doctor patient relationship.

And so that's how I got into this business. That's an incredible story that that woman or her husband changed your entire year in life. And, and, and there were, we don't have time, but it's, it's in. Has medicine lost its mind? There are many other stories. There was one in residency which troubled me a great deal, and several others that I recount in the book. Right now, you said that about one in four Americans, about 25%, face a major mental illness problem each year. Yet only about 7075% get no treatment for it at all.

So only 1/4 of those people are are getting treatment. That's right. What makes this issue so urgent right now, especially after the pandemic? I'm an ophthalmologist and I I see it in my practice. Patients are more anxious, nervous, depressed, more panic disorders, OCD problems and I try to help them as much as I can. But I also I don't have training as a psychiatrist so but what's going on now and why is does it seem to be getting much worse? Yeah, I mean, the things you're pointing out, psychiatric care, mental health care has been a disaster from the get go.

It has never been good. And right now something like one of every four of us will have a major mental disorder in any given time. One in two of us, we'll have 1 / a lifetime. So it's the most common health condition doctors face. Right. But medicine Only 25% of the nearly 100 million people with a mental disorder receive any treatment at all. Most of that. In turn, the story gets worse is by untrained primary care doctors like I was when I was in practice, which I was telling you about, right? And so that that's the problem with this crisis.

Now compare this to 70 to 80% of people with physical disorders, heart attacks, strokes, eye problems, receive quality care because they've been trained in these physical disease problems that they see. And so it's that dramatic disparity. And that's where the mental health crisis comes from. Primary care doctors, like untrained, like myself, are conducting 75% of all mental health care without training. And it is just a disaster, Robert. I mean there are, these are there are 17,000 opioid over deaths per year still 200,000 since the opioid epidemic began.

These are all prescribed by untrained doctors who not trained in opioid use and they're not trained in pain, right? Suicide is another problem. There are 48,000 suicides a year. Half of those people see their primary care doctor in the month beforehand, some as recent as two weeks beforehand. Doctors are doctors are not trained in suicide, right? They, they don't recognize it and they would have no clue what to do with it. I mean, if they did recognize it, they said something, refer it, right? And so we're talking there in the 10s of thousands, 48,000, 17,000, whichever focus.

Now let's talk in terms of 100 million people in the US with a mental disorder when these diagnosis are not made and treatment, effective treatment and we have effective treatments. And if effective treatment is not given, 100 million people are risking divorce, school failure, job failure, addiction, homelessness, incarceration. Now I'm not saying that it would cure all of that, but it would cure a vast majority of that. These people are simply aren't being treated. Somebody gets depressed, they end up taking drugs, they get divorced, da, da, da, and then go on and go.

And so these unrecognized mental disorders are a disaster for this society. And don't blame the primary care doctors. It's not their fault they've not been trained and in in talking to them. I'm sure you have yourself, but I was just at a meeting recently and one of them said, Bob, there's no psychiatrist in my town. What am I supposed to do? And, and, and so the point of that is, and this is a long term problem, Robert, psychiatry sees no more than 10 to 12% of all mental health patients. It's long been viewed in medical circles that somehow, inexplicably, somehow, they thought psychiatry would take care of the mental health issues.

And you and I would focus just on the important, what was viewed as more important physical disease issues. That's it's never worked and it's always been like this with untrained primary care docs providing care, but in effective care. And so the solution in my mind is quite straightforward. Train the doctors who provide the care. But medicine refuses to do it and so. They they should be anyone going to primary care or internal medicine should have a rotation in psychiatrist significant rotation and and trained by psychiatrists and can recognize these conditions, treat them if they can or refer them if.

Exactly. Doctors just aren't trained. You, you've been through it four years at medical school. I was three years in residency. You were probably 5. And through all that time, on average, it's about 15,000 hours. Only 2% of that training time is devoted to mental health problems. It's a psychiatry rotation on an inpatient ward in the third year of medical school at last five weeks on average. Now, these patients are completely unlike doctors. See, in practice, they're psychotic, they're severely drug addicted, they're personality disorders, not the kind of patient doctor would see in practice.

OK, that's third year of medical school. Residencies provide no training. And so these people, even if that did any good in that third year of medical school, it's washed out over the next three to five years. And so only 2% and and a question comes up. This is actually where the title of the book comes from. And this, this paradox is medicine is failing to train its graduates for the most common health condition they see in practice. Has medicine lost its mind that that's where the title comes from?

Perfect title. Yeah, I went to medical school. We had about 2 1/2 months in a psychiatry rotation and that that was it. During my internal medicine year, which I had to do as an intern, we got zero training. And then I did four years further of residency and fellowship and ophthalmology. Now many people are anxious about their loss of vision. It's a major fear for people. But I received no training during residency and how to handle the emotional issues arising from loss of vision. So I've had to train myself to do that and I do the best I can.

Yeah, and there's even another downside. Physical disease is medicine Forte, OK? That's what everybody's trained in. Even physical disease it now the predominant physical disease problem are chronic physical diseases, right? Diabetes, heart attack, cancer, stroke, emphysema, so on all these chronic diseases, 17% of them are so severe that the people become depressed, drug addicted, anxious or a combination of those. To help this person with emphysema or a heart attack, you have to treat the Co occurring mental disorder.

But doctors don't do that, right? And This is why you see all this stuff of these people. There's a big thing in the literature. People with heart failure and other chronic problems get admitted to the hospital. Doctors tune them up, as they say, quickly and they send them out. They went, they're right back in three weeks. And the problem is it's not recognized. These people are depressed. They don't take their medications. They don't follow a low salt diet. And so they come back to the hospital and, but, but doctors, they can't put that together because they're not trained in it right The.

Major problem now your book has Has Medicine Lost its mind? It traces the historical mind body split back to the scientific revolution and figures like Rene Descartes. How has this, the philosophical divide shaped modern medicine's failure to address mental health? And why is it still so pervasive? Why haven't we learned over the decades or hundreds of years to fix that problem? Yeah, yeah, I mean the title of the book. Now, asking it more seriously than I did before. Has medicine lost its mind?

Yes, it has. It lost it in what you're talking about, the mind body split of the 16th and 17th centuries, scientific revolution. And it was at this time, the Catholic Church up until that time, for over a Millennium had ruled medicine and education and all facets of society with an iron hand. But come the scientific revolution, it wasn't just medicine, it was mathematics and physics and so on. Scientists were gaining some traction and wanting to get involved, and we're getting new ideas. And in medicine, the compromise was made that the church, and this came from Rene Descartes, Locke, Hobbes, these philosophers of the 17th century, they compromised with the church.

The church said, OK, you guys can take over medicine except for one part, the head. That's the source of the mind, the spirit and the soul. We keep the head. You guys get medicine from my neck on down. And that launched the mind body split. And it's a it, it's a basic medical theory or philosophy. It then took hold doctors in anatomy and pathology and chemistry and Physiology focused on non mind issues to focus just on physical disease. In the middle of the 1700s, late 1700s, turn of the 1800s, this got translated into clinical medicine where doctors, then the clinicians now started focusing just on physical symptoms because it pointed to an underlying physical disease.

Makes sense. It's what we do. Yet today, it's what you and I do. And even then, treatment was still not effective. Treatment actually did not become effective until about the 1900s, a little over 100 years ago. And we all know of the dramatic changes that happened in the last century. I mean, it started with penicillin, sulfa ether, chloroform. All of these acute disease problems were were cured. They've been lethal 10 years before that. But all of a sudden it's being cured. You move up. Polio was controlled.

Smallpox was controlled by public health and medical measures. Moving even farther, cholesterol drugs were discovered, Mris were discovered. We're now probing into genes and and artificial intelligence is now helping. And so the long and short of this mind body split culminated in the last century in a prolongation of life survival from 40 years in 1900 to nearly 80 years by the end of the century. That's doubling. That is a dramatic improvement and benefit of the mind body split of this isolated physical disease focus.

The problem that has arisen. But we do need to recognize it's been very effective. That's why you and I have been trained just in physical diseases because it worked and it helped. But what has happened, Robert, is that as we got rid of all the acute problems and controlled some of the other ones, the always ignored mental health problems have surfaced to become the most common health condition there is, right. Concurrent with that, acute diseases have been replaced by chronic diseases. And so the exclusion It's obvious how excluding psychosocial and mental factors harms mental illness.

It's not so obvious how it harms physical illness. And here's how. In brief, medicine excludes all psychosocial emotional factors, not just mental disease. And so look at heart attacks, strokes, diabetes, 80% of those can be prevented. If medicine were to address the excluded psychosocial factors that lead to lifestyle habits that 'cause these diseases, right? Too much drinking, too much smoking, not enough exercise, too much eating, stress, and all of these things, 80% of that could be prevented.

Well, medicine doesn't do any prevention. It doesn't even treat these factors. And the patient who comes in who's now had a heart attack and a stroke, they still don't know what to do to control the because they're not taught these things in medical school. Now, of course, doctors know to say you should quit smoking or get more exercise. That doesn't work. It requires supervised training in in depth, difficult to learn and difficult to deploy skills. They're called motivational interviewing skills.

You don't just tell someone to quit smoking and expect that it's going to do what he could. And. Everybody knows that, but that's that's the only thing doctors do. And and so think now what could happen. We've got a $5 trillion healthcare budget, right? Not a budget, I guess, but it's expenditures. Growing rapidly. And growing, what if we remember you can prevent 80% of all heart attacks, strokes, diabetes? What if we prevented all of those you could save? I mean, those are the main populations of hospitals today.

That's the main recipients of medications today. I mean, this new anti obesity drug which costs $1300 a month, all of these drugs, you would not need all of that. You could save one to two to $3 trillion every year. That's enough to start addressing the deficit. Right. I mean, but medicine does not do that. Medicine, I mean just an example, 15% prevalence of obesity and I think it was 1970, it's now 50%. If medicine was doing anything from a prevention standpoint, that would never have happened.

If they do it, medicine just lets it happen but they have the heart attack then they treat it and that it's so backwards you need to you can prevent it. I hope Robert Kennedy Junior is watching this episode because. He I actually, I don't want to get into politics and I know you don't, but Kennedy's idea of being interested in chronic disease, chronic disease will never be effectively managed until medicine embraces the psychosocial lifestyle factors and also the Co occurring mental health disorders that occur in 30 million people.

Right. I hope he's watching. I hope he's watching. I'll send him an e-mail, let him know I'm getting a link to the episode. Now, you mentioned a few 100 years ago that part of this was just the church wanting to control the the head and the brain and, you know, the rest of the body you guys can take care of as you want. That explains how this started. But why haven't we been able to fix it in a few 100 years? What are the biggest barriers now to integrating mental health into medical curricula? Why haven't all the Deans and the doctors and the professor has done anything about this?

And there's two explanations for them. One is the mind body split, remembering it's four years of medical school, three to five to seven years of residency with isolated physical disease entrance. You and I and everybody else have basically been brainwashed. That's a harsh term, but I, it's, I emphasize it is accurate. We have been brainwashed in the physical disease only approach, excluding the psychologic, social, emotional and mental health problems. That's just, and that is part of why this persists.

We take these new students coming in, brainwash them through 7 to 10 years, and they come out, they become our leaders, they become our Deans, our program directors, art researchers, and so on. That's all they know. If they're like a fish in water, they just know water. And so they can't help it. That's all they know. They've never been taught anything else. Plus, and I'm sure you experienced this, it's not only that they don't teach mental health and other psychosocial issues. There is a culture of medicine that disdains these things.

You'll hear somebody say, oh, psychiatry's over there across the street. I think the psychiatrist are as crazy as their patients sometimes. And you'll you'll hear comments from faculty with stuff like that. I'm sure you've heard that. Oh. Yeah. And so it's just rampant. I'll tell you another example. This is from I think what was it, The British Journal of Psychiatry, 49% of beginning medical students are interested in psychiatry. Strong interest, you know, on a 5 or 7 point scale, strong interest by the end of training, four years later, only 4% are interested.

We're doing something during that time to discourage these people's healthy psychiatric psychological interest. And it's this brainwashing that goes on. You're. Right. I was interested in psychiatry when I started, but then, you know, I kind of lost interest as time went on, part of it due to what I heard from doctors and and leaders at the time. Yeah, yeah. And it's, it's no different today. And so that's one phase. That's why I mean medicine is just brainwashed completely. Yeah. No. And so they can't intrinsically change what's happened that then fosters, this is the medical industrial complex, hospitals, insurance companies, drug houses, equipment companies.

These people have loved physical disease, only medicine. Right. This is where they make their money. It's profitable. Yeah, and what has happened is people like you and I and other doctors, Deans, heads of the AMA, we've lost control of medicine. In my opinion, this medical industrial complex now runs medicine and we of course have some input, but it's often overridden. In other words, your and my interest and all other doctors interest. We're not mercenary. We still think primarily of the patient and their well-being.

The medical industrial complex does not. Their interest is the bottom line first and foremost. Now they will give lip service to patient care of course, but first and foremost this is where you get all these pre authorizations and CEO's making $24 million a year and so on. You know what as well as I do. And and so this medical industrial complex has piggybacked onto an already brainwashed medicine in physical disease. And This is why change is not happening. And this is what medicine, Robert, what you and I are talking about today, they've known this since the 1970s, that there's a mental health care problem and that they're doing nothing about it.

Medicine and the medical industrial complex are not going to change of their own accord and in my opinion this is going to take some top down influence from the government to insist on what needs to be done. Right, but let me ask you this. This is a controversial question based on what you just said. Is is part of the problem though, is that we don't have good ways to treat a lot of the mental illness issues and problems. So maybe doctors do try to help, but they get frustrated because it's difficult to get results.

Yeah, it's it's it's doubly difficult for a primary care doctor because they're not trained right. In fact, mental health care lags behind physical disease care, but for obvious reasons, I mean, the NIH budget, even though mental disorder is the most common health condition there are, is less than 10% devoted to mental health. I mean, it's just that's that unrecognized mind body split philosophy that just permeates everything we do. It's the same reason only 2% get trained in it. And So what? What has happened there is that no training at all is is is taking place of.

Now you're you're a pioneer in this patient centered care and you're also also the author of Smith's Patient Centered Interviewing, which can teach doctors how to listen to patients better about mental health concerns like anxiety and depression. What should patients say to ensure their concerns are are taken seriously? Maybe patients need to take a more proactive role in getting the doctors involved and interested. Yeah, no, I think so. And nothing I'm saying is critical of primary care doctors.

I'm one of them. They're doing the best they can. Quite frankly, many of them are trying to learn on their own and are somewhat effective in doing it. And many of them are very humane, humanely oriented, other directed and interested in helping people. They just haven't had the training to do it. But they will be open to people's concerns. For example, I'm worried because I'm drinking too much or I'm really feeling down. I can't sleep at night. I think I might be depressed. My mother had depression once and she was just like this.

Or they might, they might say, you know, I'm getting these strange panic. They said, oh, they were panic attacks in the emergency room and others. What these people would do with with symptoms of this sort is go to their primary care doctor, be upfront. Don't don't just kind of keep it in the background or allude to it. Just say I'm worried that I may be depressed like my mother. I think something needs to be done about it. And could you refer me to a mental health professional now? We haven't mentioned psychology.

They, they see another probably 1215% of all mental health patients, they are very good. They don't use medications, but psychotherapy they do is just as effective as the medications. And so that and they would also know when somebody needed to be be referred to psychiatry. They would also work in conjunction with the primary care doc. The primary care doc should not get out of the loop, but should get help from psychology and psychiatry. And that that is what what I would advise someone to do. But be very careful.

If people are starting to give you antipsychotic medications or antidepressants and they don't advise follow up, they don't see how you're doing. And this is unfortunately what happens. Doctors will prescribe say an antidepressant, but they don't follow up. They don't see if it works. They they just haven't been taught that. Seems like if we're just waiting for the government to do this, we may be waiting a long time and they've got lots of other issues and problems going on. Seems like, I think what you're saying, the best approach is for patients to actually ask their doctors for this and it'll be sort of a a grassroots effort from patients and if there's pressure applied from patients to their doctors and it'll eventually get up.

I I like that idea of the public Robert, but and and has medicine lost its mind. I actually go through how we can get to this what what needs to happen. And you remember Ralph Nader wrote Unsafe at Any Speed, Rachel Carson wrote Silent Spring. Both of those people blew the whistle on industries Nader pointed out to the public in his book and got them terribly angry. That automobile industry had seatbelts, but they weren't putting them in cars because they were afraid people wouldn't buy the cars.

It was a financial interest. And there were a host of other unsafe attributes of all my views. They don't want to change them because it would not cost too much. They'd lose money. Well, Nader quote blew the whistle on the auto industry that led the feds then to implement through the politicians the Motor Trafficking and Safety Act. It's something like that. That's why you have seatbelts today. Rachel Carson's book Blew the Whistle, and I like that term, blew the whistle on the chemical industry.

They were polluting everything they touched. There was DDT in the water that you and I drank and a host of other unhealthy things. Carson's book came out, was read widely. The public was furious about what the chemical industry was doing to make money or to save money, Right. And her efforts got the politicians in gear. They formed. What today we have is the Environmental Protection Agency. That's why you don't drink DDT in your water and you have 1001 other protections from derelict industries that are financially oriented.

Now Has medicine lost its mind? Seeks to similarly blow the whistle on the medical industrial complex and enrage the populace. They will get their politicians in gear. The politicians will then, and here's the specific thing that needs to happen, Robert, in my opinion, the politicians will require and in a federal investigation could be a presidential Commission, congressional Commission, National Academy of Medicine. But some independent Commission will investigate all medical schools and all medical education and residencies to see if they are A scientific and B managing and producing doctors who can take care of common health conditions.

Well, you know, the latter will not be held because they're not taking care of mental health crisis, is there. But they will also find, Robert, that modern medicine is to some extent at least not fully scientific. And that's because this mind body split philosophy, it is a what's called a reductionistic philosophy, which means looking at just one part out of a part of a problem with multiple parts. OK. And all sciences began that way back in the scientific revolution. They just look at one part.

But all sciences come the 1900s and since then, Biology, chemistry, physics, anthropology, all of them. Have adopted a systems approach which means that you look at all parts of the problem and how they interact, rather than just one part only. Medicine continues to look at just one part of the problem, the physical disease part. They exclude you and I, the mental part, our environmental part where we exist in relationship to other people. Medicine is not interested in that, and so this Commission will find that medicine is not only risking the health of the most common problem, its doctors say in practice mental disorder, but that it is functioning in a not fully scientific way that matches all other sciences.

With that finding, this commission's finding, there will be an outcry to change medical education. We haven't even addressed medical industrial complex or anything yet. But this is the most proximate, the most fundamental or root cause of this entire problem. And once you can then start training that in medical schools, you will start training you and I will be trained in all of these psychological things that come out. These graduates now become the Deans of the medical schools and the heads of the AMA and the heads the American College of Physicians and all of these people that run medical aspects of medicine.

So and it will then boil up from there. And so that will train all doctors, all students in all years, all residents in all years, not to be psychiatrists, but to graduate as competent in mental health and other psychosocial issues as they are in medical issues. They will still fit into the common model today. Doctors will know primary care docs like me when I was in practice, will know how to take care of the common mental disorders. I'll know how to treat depression. I'll know how to treat anxiety and panic disorders.

I'll know how to approach addiction patients. And when I'm not successful, I'll refer to psychiatry. There are enough, there are enough psychiatrists and psychologists to fulfill this purely consultative rule. And along with this, we do need to train more psychiatrists and more psychologists. There's no question about that, right? Now, until we can fulfill this and and follow your strategy and get things fixed, how can people help themselves? You talk about mindfulness. You also talk about exercise.

Can you tell us about that? I, I am a avid fan of exercise mindfulness. Another one that I think is tremendously helpful for people is journaling it. It used to be called Diaries and, and, and in doing that, you write down what you've done that day and focus on what was the best thing that happened to me today and what was the emotion and what did that emotion lead me to do? And then what's the worst thing that happened? Focus on that emotion and what did that lead me to do? And in doing that, people start to get some self-awareness of themselves of what's of what's going on.

And I one of the other problems is loneliness. And so people, and especially since COVID, Robert, as you know, but it's but another factor in this, in my opinion, are these cell phones. Yeah. I, I was out to dinner, just lunch, just as noon. There were four people sitting at a table. They were all looking at their cell phone. They weren't talking to each other. And the cell phone is tremendously isolating. Those are not strong relationships that you're developing on the cell phone. People need to talk to each other.

They need to talk to their family. They need to let them know what's going on and let them know that they need support. Be open about it. And, and part and parcel of what you talk about then is being aware of the emotions. I'm feeling down, I'm feeling angry, feeling happy, whatever it is, but talk about one's emotions and, and making sure that you've got support in your social network. Make an effort, join with other people and, and it's critical to do this. And, and so these are, these are things I think everybody should be doing.

And it's not just mental health problem. Now, what about exercise? I have several patients who are psychiatrists and I talked to them frequently about exercise and psychiatry, psychology, and they all tell me that exercise is better than most of the pills that they're prescribing. Why is exercise so helpful? Why do you think and and how much exercise should people be doing? I, I don't really know the Physiology of it or anybody knows it for sure, but I think it induces an endorphin rush and you and and and it and, but it does something.

I do it myself. I've had this cold recently and I have been unable to do it. I miss it, but I'm now back into it and I feel better and but yeah. The exercise somehow stimulates the brain to release some chemicals that make you feel better. Yeah, I think endorphins are probably just one part of it, right? And what, what pathways and so on are involved? I I I quite frankly don't know, but. Yeah, no, nobody seems to know, but we know it definitely works and not only it also helps with all the chronic diseases that you mentioned as well.

Oh, yeah, yeah. Oh, yeah. The data are strongly, excuse me, supportive of this. People who exercise live longer. I mean, there's no question about it. Right, Yeah. So it's important to keep doing that. Now you touched on this briefly, but I want to talk about it some more. You mentioned AI, you mentioned loneliness. I've read recently in the last few weeks that the most usage that people are using AI for things like ChatGPT and Grok from the X platform. X platform is to keep the people company and about 30% of people use AI for psychological advice and emotional support.

I was very surprised to hear that, but what do you think is going on there? And is it possible that in the future people are going to have humanoid robots like Musk is smoking, run by AI as their psychiatrists and companions? Yeah, I, I mean, I think the role of AI in medicine is going to be more in diagnostics. It's more somebody comes in with chest pain and a swollen leg and short of breath, it's more going to be in something like that. And the hope there, and I think the real hope for AI and what you and I are talking about is it will give the doctor more time to deal with the patient on a personal emotional level.

It certainly is not AI. To your question specifically about what amounts of psychotherapy or at least support it, it's not at that point yet. It conceivably could get to that point, but it the risk is there is still not a relationship to another human being. And that's what billions of years of evolution have shown. We are from the lowest animal on up are social beings. And that's a relationship that will not occur with AOI or with ChatGPT or whatever. Yeah, No, I, I, I'm very hopeful about it. Robert Pearl has written extensively about this and it I think it has great potential, but it certainly isn't ready for prime time and and counseling people.

You know what? I think we're pretty close because sometimes when I communicate with Grok, I feel like there's a real person there and I'd have trouble telling the difference. And now you can have grok with a voice response, so it actually talks to you and has intonations. It has some humor, it makes some jokes, all appropriate. And it's, it's pretty impressive, you know? So I was I was playing with ChatGPT the other day and, and challenged it with being patient centered and, and and and of of using so-called person centered skills and it did not do very well with it.

Well, apparently this just came out of news. In the last couple of days. ChatGPT has had some problems. Apparently they've trained it to be sycophantic and just kind of go along with what the person. It was kind of like that, I must say. Right. So actually Musk has made fun of that in the last few days and in his post because his Grok AI doesn't do that. And it's, it's more truthful. But we'll we'll see where that goes. It's it's interesting. We're in in the infancy of that and we'll see where what develops.

No, I think I'm curious an issue. Yeah, I'm curious, what keeps you driven and and keeps you fighting for this change? You've obviously been doing this for decades. What motivates you to keep fighting for this? I, I think it's a very real unrecognized problem. People, by and large, I think most people know there's a mental health crisis, but I don't think they know how derelict medicine is in a creating it and B doing nothing about it. That's what people don't know. And I think most people assume there and people don't really separate the mind and body like medicine does.

They go to their primary care doctor and assume that their mental health care is probably as good as their physical health care. I don't think they make that distinction. And so that's a trust in you and me that we're not able to fulfill. And the medicine is terribly derelict in this and and more so in refusing to do anything about it. They are so encumbered in this mind body split, they can't get out of it. This is why there's going to have to be changed from the top down. And so that that's that's what motivates me is here is such an obvious problem, Robert, and we're doing nothing about it.

And so I mean, I, I, I quit writing grants and stuff and writing papers which would go to medicine. I mean, we did good evidence based work. We developed methods for primary care, mental health and write about it and they're well published and so on. Nobody listens. Nobody. Medicine has not changed in the last 25 years and all the work I've ever done and then everybody else is doing this is going nowhere as far as mental health care is concerned. It's because of this mind body split. They just can't get out of it.

And so that has to change. And I'm, I'm actually inspired by people I mentioned like Ralph Nader and Rachel Carson. They blew the whistle on recalcitrant industries and it worked. And that's, that's what I'm trying to do. And I'm, I'm motivated by that. That's great. I hope you're successful. It'll be beneficial to all of humanity. Now, if people are interested in in what you're doing, is there a website they can go to? And I'll, I'll put that on the the video podcast so they can go. Yeah, it's Robert C smithmd.com.

And don't don't forget the MD, because there are too many Smiths. You'll never find me. Really. I thought it was only like 1 Robert Smith. All right, I'll look that up and make sure I spell it correctly. Robert C smithmd.com Now when you go to that, there is a on the landing page. Once you click on that, you'll go right to it. There's a box on it that says Act Now there in contained is a sample letter to an e-mail addresses for the president, the surgeon general, the National Academy of Medicine, the congressperson and their senator.

And all you have to do is plug that into that and send it this request that you and I were talking about the formation of a federal Commission to investigate medical education. And so people this, this is, this gives people something they can do. It's, it's, it's not enough just to complain about a problem. Here's something people can physically do and have an impact in changing mental health care. So they should write to Congress and and the president and political leaders. And it's right there.

They don't even have to write anything. They've just got to cut and paste. That's great, made it very convenient. Is there? I'm pretty sure there is, but is there a link to your book there also so they can purchase? The book, it comes, it comes right up on the same landing page. There is the book and then there's Act Now. But the book is right there also, yeah. I assume it's also available on Amazon and online. It's yeah. And it, it's got links there to Amazon books-a-million Bookshop, Barnes and Noble.

Where, where you can get it there, Yeah. That's great, I'll make sure that I post that. So. This is, yeah, my pleasure. This has been very educational, informative and also entertaining. I learned a lot from you. I like your your stamina and your go and your ambition in doing this. And I hope you'll really be successful. And I'll do my best to help out as well. So I want to thank you again for taking the time from your busy day to join us today and talk about this. Robert, thank you for having me.

I've enjoyed it. Thanks.

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