Whether they come up with ways of when we call it and when we dont but then we give medications for it. So if you get it wrong it upsets people. Does that make sense . What percentage of americans have a diagnosed or undiagnosed Mental Illness . And Community Studies with people went up to five when people went knocking door to door what they came up with this 56 percent of americans at some. At some point had an episode. Because that does not seem right. The figures that the National Alliance for Mental Illness. Out that Mental Illness point out is that one in five have a mental disorder at any given time. How many of those people are being treated and how are they being treated . I dont have an exact answer to that. The thinking is that a lot are not being treated for all sorts of reasons. Some dont want to go because they dont want to see themselves as having a problem. Many people dont have access to care. Access to care is a big issue these days. How is Mental Health treated with regard to Insurance Companies medicare, medicaid . That is such a complicated question, peter. You know so much of it depends on where you are. And cities it is easier to get help. Some people see psychiatrists. Some people see therapists. Usually medication and psychotherapy. There are things for more extreme conditions but these are just out wires of treatment p or counseling is used more and more for group therapies. What is the approach you took in your book with your coauthors . To you want to here the story . Okay. In 2,006 one day i decided that i want to the blog. I did not no what it was. It it was a fairly impulsive thing and within a couple of hours i set up a blog that i impulsively called. I am not all that great with technology and so i called two friends who are very good and asked if it would help me. They did and became sucked into it. I dont no if you ever had a have a blog but it is something that can get very consuming. We started having meetings occasionally. And and after a number of months steve suddenly comes up with we need a a podcast. I did not no what it was and did not really everyone how but i showed up. Actually, i made the chile. So how they ended up magically on itunes. At at some back i started saying we need a book. I dont know how many posts we had done by this time. April of 2006 that we started, so it is years old well over 2000 posts, night to have not quite going with this team that it did early on but i still make posts. The training director for the university of maryland forensics as active as psychiatry program. And that is how it came to be. What do you post on . Well, it is lot of psychology psychology related stuff. For the layman . It started with if you go it we will say on the introduction or the banner a blog by psychiatrists for psychiatrists. What was interesting was that psychiatrists did comment comment, but so did other Mental Health professionals Health Professionals who were not necessarily in Mental Health. For a number of years we had a pediatrician who commented on every single post and patience. Well, this is why i like my psychotherapist. So we changed to talking to the general public and are pretty good at describing a work in terms that others can understand and i think that is what as part of the book. There seems be a need for an understanding of psychiatry command people just dont really understand what we do. Well, what well what do you do . Have you read the book . It is a broad question, and the book is of Clinical Psychology because their are those who are administrators or researchers. The book is about the clinical practice. We put in fictional characters because this is dry stuff. If you have a fake person to walk through the process that holds the readers attention more. So we added people in. You dont want to write about your own and you want to write about specific things and cannot come up with people who have done the things that you want them to do. If they are fake and fictional you can make their lives go a certain way. We stuck by actually having a pediatrician who gets episode of major depression an electrician who becomes depressed after his wife leaves him and he ends up going to the jail system because he is arrested for driving laws intoxicated. Look at how the system accesses health. Then we assume why people go to reason to seek help, and then we go through what kind of help their is, someone is someone getting psychotherapy, how we think about what to prescribe medication and there are a couple of chapters on specifically forensic issues one on civil and one criminal. A troubled child who grew up to become a criminal and does well. That is a better word. If you read the New York Times or follow the New York Times you will read the stories asserted antidepressants are little better than placebos for security depression but that for mild and mild to moderate depression they are not much better than casinos thirty to 40 percent effective. What they do not tell you is this is a study who looks at people given a sugar pill versus a single antidepressant and i say that is about right. With the study does not go on to say is by the time someone gets to a psychiatrist they have had to try another. You pick up 30 to 40 percent but a little more. Europe tried to her three start adding to each other. Lets go to trying different medications and combinations so how effective, very effective, very effective. Are most Mental Illness is biological, environmental lately bradley we have come to see most is biological a lot of people who criticize psychiatry say we have a lot of reasons to think that they are biological. That is environment. But they run in families looking at children who are separated by adoption. We dont think it is all biology. Certainly predisposed. I think people like the term because we do assume something is wrong with the chemistry in your brain, but we dont no what it is. It takes away the blame from the patient. He takes away the blame the family. It is not that you are a horrible mother it is that something is wrong with the chemistry. You can take something to make it better. On the other hand, people who object to using medication or who have you know, they dont work for everyone and certainly a lot of them have side effects. In the best of all world worlds someone takes medicine, feel better and has no side effects. The worst and is all sorts of side effects and dont get better so critics of psychiatry like to say you dont no what the chemical imbalances. You have sold us a lousy bill of goods. I dont actually use that term for much. Us president s. Do you read my blog . It is a funny a funny question to ask. There are historians that have gone through and look at the behavior of us president s and have come up with like half of all president s had a mental almonds. You. You know i think so. I dont know. I think i think the screening nowadays for the medical background of president ial candidates is such that i do not think it is as likely now as it was many years ago when people did not go through the records will worry about someone. If you have a physical health problem. A lot of armchair psychiatrists have diagnosed Abraham Lincoln is having depression. I never examined him, so if you are going to ask me there is a rule of psychiatry that you do not diagnose people your government. I tried talking to question lincoln but he just would have nothing to do with me. Im not going to what you think . Does not matter what i think. I believe they have changed at now. I believe they have made it that if you have gone for 12 months without an episode of depression that you can fly. It is not an issue that the medication impairs your ability to fly. You would think that an Pain Medicine or muscle relaxants as well i think the fear is if someone could be potentially mentally unstable they should not be flying an airplane. Is addiction and Mental Illness to back. It depends on whether you are an Insurance Company. If you are the diagnostic statistical manual of Mental Illnesses, yes. If you are an Insurance Company somehow treatment of addiction has been pushed out separately so you cannot be admitted to the psychiatric unit with a primary diagnosis of an addiction a Substance Abuse disorder typically goes to someone, a detox unit or rehab unit. You have you have to have another illness like depression or bipolar disorder or some type of anxiety. Do you personally think that addiction is a Mental Illness next . Yes. It is some type of illness. I do not think that it is i i mean obviously there is some issues of control but certainly some people seem to be more driven to crave certain things. Some people dont drink at all because they dont like the taste of all call or how it makes them feel and others who just really struggles about have a drink i think their are biological underpinnings. Over the years there has been legislation passed or debated to bring Mental Health into and to parity with physical health. Has that happened your perspective . Quex think it is trying to get there. I may be the wrong person to ask. I am i am not that familiar with the daytoday insurance issues because it is an insurance question. Mental illness, we we embrace of the same way as physical illnesses are and there are people who have concerns about it, but it gets funny and technical because it we will be things like, you know one of the ways the Insurance Companies get around it is a reimbursable percentage of the usual and customary rates. I think they reimburse the same way they reimburse medical illness. However the usual and customary rates they just pay less. They set a rate rate that is not reasonable and then pay the same amount believes patients sometimes to flounder if they go out of network with that the rate is not good they dont have people in network. Some of the stigmas . People are worried about being seen as crazy loving thoughts and feelings dismissed because, zero, you must be manic again. No, im just excited. At at times it just leaves people feeling discredited and people worry about what if i do want to be a pilot have to worry about what if your pilot is depressed. Psychiatry is this enormous doubleedged sword. We want people to get help when they are ill but it is hard to sometimes guarantee that they wont have consequences that are troubling. This is his 1st job costing, costing and it has gotten worshipers. The comprehensive legislation. Report to an fbi registry if you might be a danger to someone else. Inpatient, involuntarily committed. So there is the doubleedged sword tell somebody that you are feeling suicidal. Most states do not have that requirement and i think the hospitals after a report. Im not aware of individual therapists but it is a funny issue. From your perspective as a private psychotherapist do you think that you have a duty to report your patients to the fbi if they are danger to somebody . Why have not had that happen. So if you think that there is to father is lot called terra soft. If you believe someone has expressed an intent that based on somebody, and intention to harm a specific named victim you are obligated to do one of three things hospitalized to protect everyone involved or call the police were called the victim, the intended intended victim but there is not a provision to call an fbi registry and have begun ticking away. Confidentially. It is it is never in my patients best interest to have them kill somebody. I am just looking at my patients best interest. I dont want them killing myself. Doesnt make my life unfold in a happy way. Glazer focused lately has been very biological very much on brain initiatives. I dont have a lot of contact. The director has a blog that i occasionally. Not necessarily something and follow closely. Is all with all the information i am out there people self diagnosing. Of course. Why wouldnt they be . Sometimes they are correct. I dont think it is bad. It has said the. When it is interfering with my life. At is within their rights. This, this command this. rightguillemet talking about your visit to new orleans after katrina. Why . I think it started there. It is not really so much that clothing. Video through worldwide it reduces. We all take a moment to talk about how i got sucked into this project. I think it started with katrina. Steve started his with diana called me with problems and they became my. A volunteer mission to help people. It was striking. You have other national disasters. People were killed and horrible things happened but by and large they were not pharmacies all these people who could not get help because the psychiatrist of flooded Mental Health centers were closed from us pharmacies cannot get people medicines for preexisting Mental Health conditions it could no longer access care because they had nowhere to be in know where to get help from and all the people who were stressed and traumatized. So i went for two weeks and came back feeling restless. One of the things i do is write. Part of that restlessness the spring of 2,006 i felt like i was having some restlessness and that this was my way of dealing with it. We have been talking with doctor diana miller coauthor of. Book tv is on location in john hopkins university. And now joining us is benjamin ginsberg. His book is called the worth of work. You write that the unpleasant fact is that although war is terrible and brutal we should not ashamed to have assumed that all its consequences are important. What does that mean . War and violence it is the nature. War is a major force in building modern society has answered three of the main questions of politics statehood, territoriality and power in every state that exists is the product of war. They they did not debate with the british. They fought very few exceptions. Territoriality. Every piece of territory on the face of the earth used to belong to someone else. As i recall, the native americans did not trade north america. The white settlers seized and finally. Someday it we will be taken from us. Us. It is the nature of history. And finally power within any nation is often settled by violence blood by the ballot box. The broad contours of who holds power come about because of violence