Demedicalizing Depression: An Interview with Milutin Kostić

Milutin Kostić is a practicing Serbian psychiatrist trained in the tradition of biological psychiatry who has become a new figure in the critical psychiatry movement. Affiliated with the Institute of Mental Health in Belgrade, Serbia, he is currently a Fulbright scholar working alongside Lisa Cosgrove in Boston to challenge established norms in psychiatry and psychology. Kostić utilizes his extensive training and traditional research methods to question the fundamental assumptions of his field. For example, Kostić critiques the flawed premises of genetics research in depression, arguing that it overlooks the heterogeneity of human experience. He uses analogies to illustrate how psychiatry often pathologizes normal human emotions, drawing parallels to how medical conditions are misunderstood when the context is ignored, like trying to treat the lungs alone in a society overrun by air pollution. We will also discuss his latest study, which emphasizes the benefits of de-medicalizing experiences of depression rather than quickly resorting to diagnoses and subsequent treatments with medication or psychotherapy. His research also sheds light on the effects of biological narratives on patient perspectives, the complexities of drug dependency, and the profound impact of psychiatric diagnoses on individual identity. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. To find the Mad in America podcast on your preferred podcast player, click here © Mad in America 2024. Produced by James Moore

Rodrigo Nardi is a psychiatrist and psychologist. He obtained his psychology degree in the year 2000, and following that, he obtained a certificate in CBT, and a Master’s Degree in Clinical Psychology at Universidade Evangélica de Paraná. He obtained his M.D. degree in 2010, and in 2016, he completed his psychiatry residency at Penn State. Altogether, Dr. Nardi has worked as a Mental Health Professional for more than 20 years, covering from individual psychotherapy to inpatient and outpatient psychiatry, substance use treatment, and interventional psychiatry. His passion for teaching and learning has led to the creation of the True Psychiatry Network and the development of a mentoring program designed to address the most frequent challenges related to psychiatric training. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. To find the Mad in America podcast on your preferred podcast player, click here © Mad in America 2024. Produced by James Moore

Arthur Kleinman is a towering figure in psychiatry and medical anthropology. He has made substantial contributions to both fields over his illustrious career spanning more than five decades. As a Professor of Medical Anthropology at Harvard University's Department of Global Health and Social Medicine and a Professor of Psychiatry at Harvard Medical School, Kleinman has profoundly influenced how medical professionals understand the interplay between culture, illness, and healing. His extensive body of work includes seminal books and numerous articles that have become foundational texts in medical anthropology. These writings explore the crucial role of personal and cultural narratives in shaping medical practices and patient care. In recent years, Kleinman has increasingly focused on critiquing the prevailing practices within psychiatry, particularly the over-medicalization of mental health issues and the neglect of broader social and personal contexts that significantly impact patient care. His critiques advocate for a more nuanced and compassionate approach to psychiatry, one that recognizes the importance of individual patient stories and the socio-cultural dimensions of mental health. In this interview, Kleinman explores critical issues facing modern healthcare. He discusses the often-overlooked narrative of patient experiences, critiques the mechanistic approaches that dominate U.S. healthcare, and offers insightful reflections on the global mental health movement. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. To find the Mad in America podcast on your preferred podcast player, click here

On the MIA podcast this week we turn our attention to conflicts of interest (COIs) and new research from the British Medical Journal (BMJ). Mad in America has previously examined the problems with conflicts of interest in research but this time we extend that to look at the potential effect of COIs on diagnostic tools such as the Diagnostic and Statistical Manual of Mental Disorders (DSM). Joining me today are Lisa Cosgrove and Brian Piper, two of the authors of a paper which appeared in the BMJ. The paper is entitled “Undisclosed Financial Conflicts of Interest in the DSM-5 TR: Cross-Sectional Analysis,” and it was published in January 2024. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. To find the Mad in America podcast on your preferred podcast player, click here

Swapnil Gupta is an Associate Professor and Medical Director of Ambulatory Psychiatry at Mount Sinai Morningside Hospital. She was trained as a psychiatrist in India and the United States, at SUNY Downstate Medical Center and Yale University, and PGI Chandigarh in India. She is known for her work on deprescribing from and discontinuation of psychiatric drugs. Dr. Gupta’s career began with research on the role of the endocannabinoid system in the pathophysiology of schizophrenia as an academic psychiatrist. Her subsequent scholarship has focused on applying deprescribing, the systematic reduction of unnecessary medications, to psychiatry by rooting it in the principles of recovery-oriented care. She has authored several peer-reviewed papers on deprescribing and co-authored a book with Rebecca Miller and John Cahill. She is an active member of two organizations that aim to enhance stakeholder engagement in psychiatric research. She is also a part of the editorial board of the Community Mental Health Journal. Currently, she is working on creating educational resources to help people discontinue psychiatric medications and gathering information on the knowledge and opinions of psychiatrists regarding the discontinuation of such drugs. In this interview, we discuss deprescribing from psychiatric drugs, the difficult decisions faced by patients, the importance of psychosocial support during withdrawal, and how deprescribing is central to recovery-oriented practices such as shared decision and patient choice. We will also tackle the complex issue of whether the recurrence of symptoms once a drug is tapered is a mark of relapse or withdrawal caused by the psychiatric medication. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. To find the Mad in America podcast on your preferred podcast player, click here

Justin Garson is a Professor of Philosophy at Hunter College and The Graduate Center, City University of New York, and a contributor for Psychology Today and Aeon. He writes on the philosophy of madness, the evolution of the mind and purpose in nature. His most recent book is Madness: A Philosophical Exploration, published by Oxford University Press in 2022. He is also the author of the forthcoming The Madness Pill: The Quest to Create Insanity and One Doctor’s Discovery that Transformed Psychiatry, which will be published by St. Martin’s Press. In this interview, Justin joins us to talk about the ways in which society has attempted to explain or categorize madness over the years. We also discuss the value of looking at madness, not as disease or defect, but as a designed feature. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. To find the Mad in America podcast on your preferred podcast player, click here

Deborah Kasdan is author of Roll Back The World: A Sister’s Memoir, in which she describes her extraordinary late sister Rachel–poet, musician, free spirit–and her decades-long journey through psychiatric treatment until, finally, she found a place of peace and community.  Kasdan is a longtime business and technology writer who pivoted to memoir writing on a quest to tell her sister’s story, joining the Westport Writers’ Workshop. Her book, published in October by She Writes Press, is a moving and nuanced portrait filled with love and grief, candor, and complexity.  *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. To find the Mad in America podcast on your preferred podcast player, click here

Hello and welcome to the Mad in America: Rethinking Mental Health podcast. If you are new here, hello. My name is James and I will be your host as we ask critical questions about the state of psychiatry and psychology in the 21st Century. In this podcast, we examine mental health with a critical eye by speaking with psychologists, psychiatrists, researchers, journalists and people with lived experience. When you hear such conversations, you realise that much of what is believed to be settled in mental health is actually up for debate. Is mental health a matter of faulty biology or is there more to it? Are the treatments used in psychiatry helpful or harmful in the long term? Are psychiatric diagnoses reliable? With the help of our guests, we examine these questions and so much more. I think you will find the podcast insightful, informative, and, most of all, thought-provoking. It’s available on all major podcast platforms like Spotify, Apple or Google podcasts and YouTube. Just search for Mad in America: Rethinking Mental Health. Please join us for these important conversations. *** Mad in America is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. To find the Mad in America podcast on your preferred podcast player, click here

Mark Freeman is a renowned author and a pioneering voice in the emerging field of the psychological humanities. He serves as Distinguished Professor of Ethics and Society in the Department of Psychology at the College of the Holy Cross. His body of work, including the critically acclaimed Toward the Psychological Humanities: A Modest Manifesto for the Future of Psychology (Routledge, 2023), offers a profound reimagining of psychology, interweaving it with the arts and humanities to better understand the human condition. He is the author of numerous additional works, virtually all of which, in one way or another, speak to the emerging field of the psychological humanities. These include Rewriting the Self: History, Memory, Narrative (Routledge, 1993); Finding the Muse: A Sociopsychological Inquiry into the Conditions of Artistic Creativity (Cambridge, 1994); Hindsight: The Promise and Peril of Looking Backward (Oxford, 2010); The Priority of the Other: Thinking and Living Beyond the Self (Oxford, 2014); and Do I Look at You with Love? Reimagining the Story of Dementia (Brill | Sense). Along with David Goodman, he has also co-edited Psychology and the Other (Oxford, 2015) and, with Hanna Meretoja, has co-edited the recently published The Use and Abuse of Stories: New Directions in Narrative Hermeneutics (Oxford, 2023). He also serves as Editor for the Oxford University Press series “Explorations in Narrative Psychology.” In this interview, we'll explore his personal journey toward the psychological humanities, delve into his work in narrative psychology, and discuss his approach to the concepts of 'self' and the 'Other.' We'll also touch upon how his perspectives guided him as he navigated his mother's journey through dementia, a deeply personal narrative shared in his book. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. To find the Mad in America podcast on your preferred podcast player, click here

On the Mad in America podcast this week, we continue our reader Q&A with Mad in America founder Robert Whitaker. In Part 1, we discussed Mad in America, the biopsychosocial model and the history of psychiatry. For Part 2, we will be covering reader questions on pharmaceutical marketing and issues with psychiatric treatments including psychiatric drugs and electroconvulsive therapy. Thank you to all of you who took the time and trouble to send in your questions. *** Thank you for being with us to listen to the podcast and read our articles this year. MIA is funded entirely by reader donations. If you value MIA, please help us continue to survive and grow. To find the Mad in America podcast on your preferred podcast player, click here