Dec 13, 2022 • 55M

Interview: Dr Thomas Cook

Speaking with Dr Cook, psychiatrist on his practice, marijuana, ketamine, psychadelics and alternative modalities, societal breakdown, parenting and the role of technology in mental health

 
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Dr Cook is a board certified psychiatrist in private practice. He is the founding director of Beyond Mental Health, a Honolulu, Hawaii practice combining traditional psychiatry with alternative care models using nutritional supplements, nootropics, TMS therapy, medical cannabis, ketamine, to empower patients. Dr Cook is also and advisor to the Clarity Project, a lobbying effort to improve medical access to psychadelics in the state.

We spoke in detail about his general practice, marijuana, ketamine, psychadelics and alternative modalities, societal breakdown, parenting and the role of technology in today’s mental health climate.

Leafbox:

So why don't we just dive in. Dr. Cook, before we start, how do you describe yourself in a quick bio and who you are?

Dr Cook:

I would describe myself as a quirky psychiatrist, but that's a kind of redundant thing I guess nowadays. But I'm an alternative psychiatrist.

Leafbox:

And where was your medical training from?

Dr Cook:

I went to Northwestern University Feinberg School of Medicine, and that's where I went to undergrad too in Chicago.

Leafbox:

And you've had your practice in Hawaii for how many years?

Dr Cook:

I've been in private practice for seven years and I completed my residency here in 2013.

Leafbox:

And what made you stay in Hawaii?

Dr Cook:

My ex is from here, I've got three kids and just rooted. I'm rooted here. I've been here long enough to know everybody here, everybody in the mental health system and around the hospitals. So it was natural to open my practice after I worked at the state hospital for two years and got a dabbled in forensics work and some work with the circuit court in terms of dealing with the criminal side of psychiatry.

Leafbox:

Maybe that will, before we talk yesterday, we talked about some of the criminal aspects in medicine, but one of the first questions I had actually before we dive into that is since you're from the mainland and you did your original medical training there, what are some of the major differences in the medical health kind of environment between Hawaii and the mainland? I'm just curious what you see there or if they're the same.

Dr Cook:

Well, in the Midwest, Chicago's a pretty diverse place, but not as diverse as Honolulu. Here you see such a menagerie of cultural psychiatry cuz psychosis looks different in a Filipino than it does in a white waspy Anglo person. And depression looks different in a Japanese older gentleman than it does in a young Portuguese, Hawaiian kind of person. Just it's really interesting here, the intersection of culture and mental illness and it's I've always wanted to be kind of a renaissance doctor, that's why I went into psychiatry so I wouldn't lose the flavor and taste of reading novels and studying humans. Human behavior from a fuzzy perspective, liberal arts. And here in Psychiatry, Hawaii, you've got that to the max.

Leafbox:

And then what made you open your own practice versus continuing the work in the kind of clinical criminal settings? For instance,

Dr Cook:

I found the state bureaucracy a criminal system here where they send people into Kaneohe to the state hospital for evals to be just a mess. And they had people who were obviously dangerous, sociopaths, intermixing with vulnerable schizophrenics. And I came up against the hospital for segregating them. They had somebody from OSHA and those kinds of people talking to me about, oh you can't segregate and you can't cuz they're all considered patients. So we had this basic philosophical disagreement about free will and well who's a patient and who's none. How do you become a patient? Do you become a patient just presumptively. And so I was having to basically manage prisoners and extremely vulnerable people simultaneously on the same ward. And I found it unethical and I think it stems largely from a unexamined philosophy, which the state system has where they can't easily decide when someone is a bad actor and when someone is sick.

Leafbox:

And then what are some of those unquestioned philosophy that made you, what would be the ideal then for you?

Dr Cook:

Well, people are smarter than we give 'em credit for. And people play the system all the time and say they have symptoms and try to get exculpatory interpretations made on their crime. I was once telling a story about a Midwest, a Chicago story of a criminal who said I had two personalities and the person's obviously a sociopath and is feigning this and faking it. So this humorous judge said, well, I'm in a sentence both of you to prison, you're going to do 30 years instead of 15 <laugh>. Cause he's going to, he the judge sentenced both personalities.

Leafbox:

And how did the prisoner take that decision? He was cured.

Dr Cook:

Yeah, I guess so. I think in another instance that same prisoner had said actually Victor, this next one's from Victor Frankel and I think he's describing a situation in the east coast in the sixties when person said, my illness made me do it, judge, I can't help it. I can't help it at all. And the judge said, well, I understand, I sympathize with you, but I can't help dropping this gavel either. So sorry. And I think the tone of irresponsibility is so high in state hospital systems there's just a culture of irresponsibility and the nanny state, the kind of the nanny state and caring for people that kind of need a swift kick in the rear, which may leave us into the discussion of parenting at some point.

Leafbox:

Maybe you can expand a little bit on free will and what you think that applies to in psychiatry. I'm curious what just individual action or what do you mean by free will?

Dr Cook:

Well, it's not just free will, but reason liberal art that just what does it mean to be a liberal? It means to do things for no other reason than the pure intellectual enjoyment. That's why the arts, history and poetry were always considered liberal arts. They're not utilitarian arts, they are liberal arts, they're not trades, they're not for anything. And that's what humans are in our very nature. We're quirky. We like to just cut the grass as we walk by our cane or grab a flower and put in our do things for no apparent reason. A hoon, this is part of being happy and that's what psychedelics get people back towards is always a spontaneous quirkiness which is I think core essence of being human. And that is partly also related to being rebellious too.

But psychiatry has had a philosophical problem for a long time and that is not approaching a human from the point of view of free will and reason and always looking at the things they say as motivated by some irrational instinct and something that's below reason or behind reason or underneath reason. And usually those instincts are things that can be studied in small animals and rats. And so there's been this behaviorist trend in psychiatry which has reduced people to stimulus and response. And you see a lot of that philosophy today in social media programming of algorithms and the gambling kind of Facebook, Instagram kind of reinforcement stuff. And it's very, very, very saturated in the coding, the world of software and coding and all that and behaviorism. But we also have the freudianism where you just see through everything and reduce the people down to something else.

Says this joke about two psychiatrists that meet in the hallway and one says good morning. And the other one thinks, I wonder what he means by that. And that's kind of ridiculous. But that is you can take the interpretive, reductive aspects of psychiatry to such an extreme that you just lose the capacity to be liberal, to talk to people in a fun, creative, spontaneous way. And I see that in my field it's a problem in my field. And so I think that's part of the reason I needed to practice on my own. So philosophically I can protect myself from these errors, which are I think so pervasive, not just in psychiatry but in society in general. I also just couldn't handle the bureaucracy of the legal system, but a lot of it, can you hear me still?

Leafbox:

Yeah, perfect.

Dr Cook:

Lot. A lot of it I enjoyed. I liked writing conditional release letters and making predictions whether people will be violent, but there's obvious limits to that.

Leafbox:

Expanding on that then what you set up your own clinic and then tell me about your evolution into alternative psychiatry with psychedelics. Mainly ketamine,

Dr Cook:

It all started with marijuana, I was as straight laced as anybody. I never smoked pot. I was the kid in high school that kind of was med school bound and judged my friends for it. And I never tried marijuana. It's on my thirties and it was actually right around the same time that I was leaving the state hospital system and opening my private practice. And I got really interested in medical pot from my patients, a lot of whom were combat vets. And they gave me books to read and started reading academic cannabinoid medicine articles and was as of that time not into psychedelics at all. And I just listen to my patients. I see a lot of doctors just don't learn from their patients, but patients have time to read and a lot of 'em are really smart and then wonderful. They're driven to by their suffering, suffering produces wisdom and people who have suffered a lot for a long time, they really have looked into things and they are wise.

And so I saw a lot of combat vet patients getting off of antipsychotics, respiral, Klonopin, Seroquel, the VA's prescribing and with marijuana they're doing so much better. And I saw it, I saw so many patients that I became convinced empirically and clinically into the efficacy of marijuana for P T S D symptoms. And it rattled my philosophy of being skeptical of mind altering substance as possibly being useful in healing and having an intoxicated mind state as being part of healing. And I also became more sensitively aware over time of the fact that ordinary medications that we don't consider intoxicating like say Lyrica or even SSRIs, do induce an altered mind state. I started to really listen, not just the way my training told me to, but really ask questions in people. When you started this s sri, did you ever feel like as if things were a little silly or not quite real or in terms of your seriousness in your attitude towards stressful situations, what did the S S R I do for you?

And I started to hear all kinds of subtle differences. And so it opened my eyes that even pharmaceuticals can be more psychoactive in terms of not just these flat two-dimensional symptom categories that we talk about mood or ruminations or guilt or this kind of flat behavioristic way of looking at patients. If you look at it in more of a phenomenological way, a more subjectively sensitive way, you realize a lot of these pharmaceuticals we're giving are very psychoactive but not necessarily in a way that's healing. I realize SSRIs have a lot of numbing effects and I didn't see that with cannabis. I just saw only benefits. There are problems with cannabis and there's problems with any new psychedelic, but I found that the problems with cannabis are really insignificant compared to pharmaceuticals. So my practice trended towards getting people off of pharmaceuticals.

Leafbox:

When you discussed the risks of cannabis did you see an evolution? Many doctors are concerned about the high T H C cannabis, kind of the evolution of a corporate cannabis that keeps pushing THC higher and higher and higher. Did you have any response to that or what's your ideal, just, I'm curious about more thoughts on cannabis in terms of the risks.

Dr Cook:

Well, I do agree with the risk of paranoia, psychosis, short-term memory problems. And these are all products of pushing the THC level too high. It's frustrating to have a dispensary system where all the THC percentages are 20% and above. How do I induce a grandma who's never used it into teaching her how to vape? How do you tell someone what a small puff is versus a medium puff versus a large? And edibles really are better. Low dose micro-dose edibles are wonderful, like Aloha Green here has these mints that are two and a half milligrams, which are great for new people to carefully titrate their dose. But Willie Nelson would say that back in the sixties, Woodstock era, you could smoke a whole joint and be moderately high. And today that's impossible for most people. Two hits and they're high. And so it doesn't lend credibility of the medical marijuana industry that we don't allow the newbies, so to speak, or the people that are new to it, to find ways to dose themselves slowly and carefully.

And I think it's due to selective breeding. It's just like in the world of dogs, you have these French bulldogs that can't even go into labor, they have to have C-sections cuz these things have been unnaturally bred. And cannabis has to be meticulously bred for a lot of reproductive cycles. And the pollen, the certain types of plants have to be kept apart, strictly separated. It's not natural to have THC percent that high. So I do agree with a lot of the criticism and there will be, as marijuana gets more popularized, there are going to be a slight uptick in some of the adverse effects overall. And its benefit on society in reducing liquor abuse, opioid abuse, opioid overdoses, and its detoxification from pesticides. And overall cannabis is going to have a beneficial effect on society. But I think the criticisms are valid and for recreational pot we should limit the THC to 12% or 10%. And I think medical you can go higher. Some people need extreme high doses of R S O for their cancer, but I think that recreational marijuana should be generally low T hc cuz it's where the risk lies or the risks will be minimized that way.

Leafbox:

Do you think maybe pushing into fraud or the corporate culture, what are some of the parallels you see with that intensification of the THC in cannabis with the intensification of the medicalization of psychiatry? Is there a parallel there or not in terms of, I mean I read some statistic that one in I think five under 18 are on some psychotropic pharmaceutical product. I'm just curious if you see what your thoughts are on the industry aspect of mental health and how that plays into just improvement.

Dr Cook:

Well, because cannabis hasn't been absorbed into mainstream medical culture unregulated, it also has a high placebo response. Cuz any medicine that's got of a lot of cultural trappings, it's going to have high placebo associations. Kind of like in the ancient world, you've had different doctors and ancient Greece and Hippocrates and these people had reputations, they had almost a culture surrounding them, a cult if you will. So cannabis has a cult surrounding it and that includes some false expectations, false advertising, C B D will do this, it'll do that. No it won't. I tried it didn't do this. And then all the Rastafari cultural connotations widget wi with it, which are largely wonderful but that has kept the world of cannabis separate from mainstream medicine and has subjected it to some criticisms because it has so much culture attached to it.

The cannabis industry is largely regulated because it's left up to states. And so it has attracted quite a few douche bags that want to sell as much CBD as they can and make false claims and hide its adverse effects. And if you're trying to make that connection with big pharma, I do see where you're going with that because I think you can loosely compare the fact that for other reasons, big pharma is largely unregulated in terms of vaccines today. I think in pharmaceuticals you still have pretty high standards at the F D A, but what we're seeing with Pfizer right now is lack of safety data amongst pregnant women. And yet we have Pfizer working with the feds to promote it at the American College of Obstetrics and Gynecology and American Academy Pediatrics. Despite really safety data, you can kind of see an industry that's a very unregulated making excessive claims.

Leafbox:

So those excessive claims aren't done by Pfizer for Prozac and other kind of S S R I products and other, I mean pushing new and new mental health products.

Dr Cook:

I think what we've seen with big pharma and antidepressants is that the Y-axis is always manipulated. They'll say, oh, 10 point reduction in HAMD or pH HQ score this or that, or whatever an psychometric test there is for a mood symptom or a P T S D symptom. And then they take that number and then say, oh, effective. And then they bamboozle the, the fda who has FDAs full of people that used to work at the top executive positions at these drug companies and vice versa they'll leave the F D A and go work. So when they're talking, when the FDA is talking to big pharma, they are talking to their colleagues who used to work at the F D A, these, they have their numbers on speed dial they used said God for dinner and they know, they all know each other. So it's a incestuous, the regulatory agencies are all captured and it's an incestuous kind of situation.

You saw that with Scott Gottlieb. You only have to look up who Scott Gottlieb, g o t t l i e b is to understand why the F D A very has been very compromised in terms of its interactions with Pfizer all throughout 2021. And but what big pharma does with antidepressants, which are, which blockbusters three out of the top 10 grossing meds are all antidepressants is they will manipulate the definitions of efficacy. And so people will, you know, got statisticians and wow impressive reduction in this scale of this or whatever. And then that's defined as effective. A lot of it's hand and it's not that effective. SSRIs are about 40% effective for depression as opposed to T M s being 60% and ketamine being around 70 and psilocybin being around 80. In terms of a rough comparison, and you can quote me on that, but

Leafbox:

T M s being a trans

Dr Cook:

Yes, transcranial magnetic stimulation, is it outperforms, SSRIs - And when I compare all those things, my definition of efficacy are more than half of the patients satisfied with their symptom reduction. And do they say, this worked for me? That's my definition. You'll never have a drug company define a drug to the F D A in terms of are more than half the people content with the reduction in their symptoms. They will never ever define efficacy in those terms. It's always a reductive status, statistical definition based on some kind of questionnaire. They love to hide in statistics and hide in the metric. For instance this is a common thing, Pfizer, when the Covid vaccine came out, their study was they tested two groups of 22,000 people and you had to vaccinate all 22,000 in one of those groups and then none of the other group.

And in the one that you vaccinate, you reduce the COVID P C R Inc numbers by about a hundred and you reduced the number of covid deaths about by one. So there was two covid deaths in the unvaccinated group and one death in the vaccinated group. Now that's to vaccinate 22,000, you reduced the death by one. Now Pfizer declared in the media that their efficacy was 100% because to reduce the number from two to one is two is 100% of one. So that's all the public knew was 100% effective. And so that's presenting relative risk as if it is absolute risk. So that's an old slight of hand if you gotta be really gullible to believe that they don't know what they're doing and they don't know that they're presenting stats.

Leafbox:

So are they presenting, focusing on the psychotropic drugs? Are they presenting the SSRIs more effective than tms for instance? Or they never compare the two, they'll just compare Prozac to another SSRI on correct or

Dr Cook:

A correct? Correct. TMS is threatening to big pharma. They've never been in the business of T M s and I don't think they're ever going to try to be, it's always, excuse me, to be an alternative. When they compare new antidepressants, they will not necessarily compare them to old antidepressants because they'll do as good as sometimes. But generally they will use psychometric questionnaires and then they'll exaggerate the Y axis in terms of the amount of symptom reduction that's obtained.

Leafbox:

So moving into ketamine since that's a schedule two drug and it's generic, I know Johnson and Johnson, the ketamine how are they responding to the effectiveness that you're seeing in depression and rapid onset suicidal depression treatment and things like that? Are you seeing favor or how are you interacting with the traditional pharma companies and things?

Dr Cook:

Well, two drug reps approached my office a few years ago with when S Provato was coming out, which is basically just Johnson Johnson's attempt to patent one of the enums of ketamine. It's got a left-handed and a right-handed much in the way that amphetamines do you know Dexedrine is the right-handed one and Adderall is a mixed left. So they tried to pull that slide of hand of assuming that the left sided one is more effective. It was based on some spurious reports and they marketed as a purified patented thing when you're getting the same thing from any generic ketamine provided through by a doctor like myself at a ketamine clinic. They did an additional slide of hand by researching depressed individuals with suicidal ideation and then when they couldn't prove that it reduced suicidal ideation, it did improve mood cuz ketamine tends to improve mood, but because it's a nasal spray, it's a microdose, it's not a real dose.

They wanted to compare the nasal spray dose, which is less bioavailable to the intramuscular or to the IV because they couldn't find a way to patent that. And so they wanted this nasal spray to get a piece of the action, a piece of the market. But they marketed as if it improves suicidal features knowing that intramuscular or IV ketamine or have been documented to reduce suicide, one of the first psych drugs ever to do so other than clozapine and maybe lithium but none of the SSRIs have reduced suicide. They actually increase as we found out with Eli Lilly and the black box warning with Prozac. But what Johnson and Johnson did was bravado was another slide of hand where they

Study a patient population, which has some suicidal features, they reduced their mood problems, didn't change the suicidal ideation, and then marketed it as if it's effective for suicidal ideation, just as effective as the psychedelic dose that's given in a clinical like mine. And so it's caused tremendous confusion in the world of ketamine. People are thinking that bravado gives the same results they were having. Insurances pay $600 or more per little spray bottle. So they're trying to force the F D A or to try to have the F D A excuse insurances to cover ketamine for a similar price that you would pay in a psychedelic clinic and with less efficacy. So it's disappointing.

Leafbox:

Is the, aside from the IV dosing, is part of the effectiveness of the ketamine treatment the spa like and psycho psychotherapy aspect as well? Or do you believe it just to be the drug?

Dr Cook:

No integration with either a guide, an experienced guide or a sitter or following up in that afterglow period when you're more malleable, a little more regressed, a little more childlike the week after any psychedelic do, ketamine always provides better results. And the idea you can just put 10 people in a room snorting Sprovato from a plastic can and they just kind of wait two hours and then go home. And that that's equivalent to psychedelic informed guide guided experience or with a little bit of integration at the end. The idea that those are equivalent is just crazy. Now, just clinically speaking, you always get better results when you get a controlled regression. You get a little bit of a transference effect towards the person who's the guide, just like you'd expect in an ayahuasca ceremony. You know go back into your child and the person is there to protect you and hold you in space and provide you holding space where you can recode your childhood and reparent yourself. That's the whole point. So the relational aspect of it is very, very important.

Leafbox:

Is that your belief on how the ketamine is functioning on the depression aspect, that's the regression or is there something else?

Dr Cook:

I think you can look at it in so many ways from a fuzzy liberal arts perspective, you could say that it's a controlled regression can say that there's a third person where you see yourself, you almost see your parents as children. You almost see your family system as if you are an ancestor of your own family and you kind of step outside time, step outside yourself. And there can be kind of a flow of self-compassion and self-love with that. You see that with a lot of psychedelics. But the third person effect is I believe, strongest with ketamine. That's why it's so effective for certain types of depression.

Leafbox:

What are your thoughts on the telehealth ketamine clinics? Have you heard of these?

Dr Cook:

How is the ketamine administered in those clinics?

Leafbox:

Well now that because of the Covid regulations, they expanded cross state telehealth rules. Basically they mail people the Johnson and Johnson product and then do a zoom call where they kind of snort the ketamine and do some type of integration on a zoom call.

Dr Cook:

I think if it's an online business and you don't have much rapport or transference or feelings towards the person on the other end, I don't think it's that useful. I think if it's done with a talk therapist who and who knows you and who they know you. So there's some of that bond that mirroring that contagious kind of mental health is contagious, just like hysteria contagious. So that's what we get from a relationship of healing. You get a contagious modeling effect like you would from a friend or sibling. And I think psychedelics can amplify that. But I think if you don't know the person that very well on the other end and it's just not that useful. I am realistic however, that micro doses of ketamine are pretty useful for people who ruminate and brood and have trouble letting go of things. And if they form a bond with a person through an online business, I think it's great.

I think it does overall increase access, but the quality goes down. So maybe the incident inequality's way harder to control. I do know for instance, I have a patient in my practice who I obviously won't, will not give any identifiers for, but who would make an awful therapist, but who wants to be a therapist and I can't tell this guy that, but let's say a therapist, a patient of mine that wants to be a therapist and who tells me that they're going to be hired by one of these online businesses and I ask, what's the hiring process? And they tell me and he tells me, well they just wanna see that I did this training or that and went to, they did a quick five minute talk interview and then they hire me. So these are businesses which are basically not engaging in very much quality control at all.

Leafbox:

My fear with ketamine, it's that there's a gold rush behind the psychedelics and you have the same aspect that you would have with pharma or the cannabis industry being kind of corporatized. And then that has obviously the pros and cons, like you said, expanded access but then quality control issues.

Dr Cook:

Yes sir. Absolutely. Yeah, it's exactly that. I think I worry about the psilocybin. I think it's good what's done in Oregon. I'm part of the Clarity Project, the lobbying activist group here in Hawaii. And I think the laws as they change in Oregon for access are great. The pitfall that I worry about is that when you have a lot of unlicensed people serving as guides, which is what's going to happen in Oregon the fear of losing your license is no longer a stoppage towards boundary crossing and people having sex with their patients. The vast majority, that's not an issue, but maybe for the 5%, the risk of losing your license is what holds is stops you. When you get rid of that, you get a lot of these problems that you've seen in ayahuasca gurus and young women getting taken advantage of. And we tend to blame Nixon too much. We forget that what Tim Leary and Albert and what was happening at Harvard was they were having sex with female students, grad students, and boasting that L S D made them more seductive as men and doing all these workshops with getting, putting everybody in L S D. And I don't think it was necessarily all just an anti-drug attitude that was reactionary to Timothy Leary, I think it was.

They were partly reacting to the sexual boundaries violations that which would influence the Department of psychology at Harvard. And so I think we need to own that and I think we need to prevent that from happening again. And so we need to have a high degree of professionalism as this industry kind of goes off to the races and it's going to be like horses just unbridled, just going. I think we do need people who have an unfettered optimism, but it really does need, and Michael Poll has been very right about we need to do counterbalance that with being as buttoned up as we can and careful there will be harms with any paradigm shift. If there's a new class of pharmaceutical, there's going to be a shift in the types of harms and there's going to be tremendous benefit too. But these modalities healing are so important that we need to not everybody would agree with me. Maybe Rick Doublin would disagree with me and he'd be more of the

Leafbox:

Libertarian model, I guess.

Dr Cook:

You're an optimist. Yeah. But I do think we need to be careful. I would rather these substances be recreational if I knew that they would never be incorporated into the medical mainstream. But what I've seen in psychiatry in the past 10 years is psychiatry is it allowing them? And it is struggling with how to mainstream psychiatry is as it's been dominated by big pharma for 25 years, academic psychiatrists are accepting cannabis and they are accepting psilocybin if stubbornly but they are and they will. And I think eventually we'll get back to psychiatry where it was when drug assisted therapy was a thing in the fifties but we're kind of having to walk back rather than walk forward in order to I don't think history moves in a progressive direction necessarily at all. It devolves and then people need to rewind and go back. That's what revolutions are all about. So I think we're seeing that now. And you're going to have the die hards and the Tories and whatnot and that's really the big pharma of people at this point.

Leafbox:

How do you manage your clinic then to maintain that professionalism or at least aim to do that with your patients, your other colleagues? I mean, I'm just curious how you protect, not yourself, but also your patients from...

Dr Cook:

Screen any talk therapists that are going to work with ketamine in a higher dose setting in my office or work with my patients who have just come outta my office and then see their therapist. I want to know who they are. My assistant who sits in and guides patients is someone I have profound trust in and gotten to know her over the years and she's very professional. I think just as a profession, psychiatry needs to be a bit buttoned up a bit on the conservative side because we're dealing with emotions and traumas and people are messes, they're impulsive and they can't control themselves. And patients fall in love with their doctor and doctors hear all kinds of things about their patients, A lot of intimate things. And we need to counterbalance that with as much professionalism as we can. I

Leafbox:

Keep it, it's funny that you keep mentioning that professionalism, but at the same time they're so willing to almost over-prescribed for ordinary life events sometimes the general assumption, I mean if you look at the number of people on, I don't know if people are just getting mentally worse or they're just taking more substances, it's hard to know. Maybe it's both.

Dr Cook:

I think people are taking more substances now, but we've seen alcohol and opioids go down a little bit lately. But yeah, people are moving generally away from taking a antidepressant every day and they're kind of pursuing a different treatment model, a sporadic treatment model where, but yeah, as a society I think stressors are way up and people are more lonely and stressed out than ever largely due to the political climate and big tech and the excessive incursion on our lives from technology.

Leafbox:

Do you have any thoughts on, I'm just curious about homelessness and psychosis and what is driving that? I mean there's mention of designer spice or synthetic Cannabinoids or the math. I'm just curious what you think as a psychiatrist aside from

Dr Cook:

Well spice, synthetic cannabinoids are a product of big pharma. They were in invented by big pharma chemists in the early two thousands as an attempt to make money off what was viewed as a potentially lucrative cannabis industry. Spice as we know it, like synthetic T h C was. And it can cause psychosis. Yeah, it was invented, but I don't know which drug company, you'd have to look that up your listeners, but it was an, it's a invention of big pharma just as heroin was. Heroin was made by IG Farbin and Bayer and so, and it probably has its proper use, but there was an attempt to make a blockbuster weight loss drug in two thousands when I was in med school called Dronabinol. And it got pulled cuz it made people suicidal, another synthetic cannabinoid that could make people unstable. And I think big pharma kind of stepped away from the cannabis development world cuz they've had some failures, but they always keep someone in the back. All the cannabinoid research conferences always be a representative from big farm in the back, just sitting quietly with a laptop taking notes. So they follow everything thinking that they throw a billion dollars, they can beat someone else to the punch.

But Spice escaped the lab, so to speak, and became a thing on the streets. And I don't think drugs are the primary driving force in homelessness though. I think it's the brokenness of the family structure in the us credible high rates of divorce and single parents and broken families, estrangement, unreconcilable, estrangement differences. And I think that's what drives homelessness.

Leafbox:

So Dr. Cook, now that you've been a therapist or not therapist, a doctor for so many years, how does that play into your own personal parenting kind of life and what you see and how that affects how you are as a person?

Dr Cook:

How does my work in psychiatry affect how I parent my kids?

Leafbox:

Well now that you're seeing one of the causes of maybe the mental health issue being divorce or trauma, intergenerational child trauma or societal technology and all these issues you mentioned, I'm just curious how you live your life differently or reaction to that or how you apply to that.

Dr Cook:

I think one of the main things we've seen since 2006 when Tinder came out is we've seen sexual chaos amongst the millennial generation. We've had a generation of people that don't know how to handle jealousy feelings and the self-esteem problems that come from that from a more sexually liber kind of hookup culture. And so I think it's incumbent on anybody parenting today to view the iPhone like plutonium. It's quite possibly one of the most powerful things on earth. It's incredibly useful, but it can radiate you, it can hurt you and it needs to be regulated. We need to regulate technologies to the extent that they wield power over us and allow one human to wield an oligarchic like power over another human. And you see that sexually with a lot of emasculated men addicted to porn and just kind of sipping on beautiful women who have an only fan's account.

Now these men are lacking the development that their grandfathers got in the fifties and sixties of trying to seduce a real woman. And the impact of that on their development as young men is unfathomable. I do agree with some of the social critics like Jordan Peterson who have stated that there will be an uptick in depression and violence and men because of the effects of sexual over availability on young people. There's a wonderful article, I don't remember where it was written, which periodical, but I think it's a fairly moderate period article that says that men did greater things when it was harder to see boobs. And I agree with it, if it puts me people categorize me as a prude or as a whatever, that's fine. But I think that tech and the ready availability of porn has created a generation of young people that have trouble falling in love and are quite bitter.

So with our children, we need to be aware of that. I'm not a Luddite, I'm not totally anti-tech, but we need to realize that the tech unleashes all kinds of things that we can't regulate it ourselves. We need to regulate the tech. And I see technology leading us into irrational actions. For instance, let's just get away from the iPhone and look at hand sanitizer. Anybody who goes up to a hand sanitizer machine during covid and no sanitizer comes out bathroom and wash their hands, or do they just shrug their shoulders and get in the elevator or go in the building and do whatever they were going to do? They don't go to the bathroom. So why were you going to the hand sanitizer then? Why are people doing an action, which if it fails, there's nothing else there. There's no bottom, it's underneath. It's just pure irrationality.

And I see that with iPhone checks of people obsessively at the dinner table. Kids do this, teenagers check my email, did I get a text? Did I get a text? Did I get a text? Well, if you didn't, you're kind of disappointed. Well cuz the, they've designed it that way, at least on social media. But the texting is not, I don't think it's any kind of nefarious coders behind it, but it leads to actions which are really socially disruptive. And so as a family man and having family life for my kids teaching kids that this tech is incredibly powerful but also can be incredibly harmful. It's something needs to be handled with care like plutonium. It's like chest x-rays. We used to have 'em at the carnival and they'd cause cancer. We'd play, it was cool to see your skeleton at the carnival and the continuous livestream, but we had to get rid of that. Technology is always exciting and fun and sexy until it wreaks havoc. And that's the lesson of Jurassic Park. And Michael Kreton was saying that all his life until day he died.

And we also need to know that science and technology are immoral. They're not immoral, they're immoral. They have nothing to do with morality. In fact, you could be a better criminal the more science. That was the lesson of Breaking Bad. And the story that Vince Gilligan told was story of Walter White, a chemistry teacher who became the biggest drug kingpin in the southwest. And why that show was so interesting was that the science, him having a PhD in chemistry didn't stop him. It enabled him to do it. And I think this idea that, oh, if you go to college you get disagree. Oh, you're a better person or whatever. No, no. All the dictators have had PhDs in world history and they've all been very, very, very highly educated people at the top education whatnot, doesn't protect you from, and science certainly above all, doesn't protect you from developing in a wrong way as a child or as an adult.

And so we need to view science that way. Science doesn't have some kind of flavor or moral cultural flavor of its own. It's totally a moral. So when Pfizer says, we're moving at the speed of science or we're doing this, or when Fauci says, you're criticizing me, you're criticizing science with this kind of moral high tone, it really just make any sense because science is a utilitarian tool. It's not, certainly doesn't make anybody better. I'm not aware that doctors are above reproach on their tax returns. I'm not aware that the i r s looks at somebody that works at N I H and says, well, we don't need to audit them. They work at N nih. Why are we auditing their taxes? I mean, they're a scientist. I'm, I'm not aware that the I r S thinks this and they don't because nobody with common sense thinks that.

So kids need to know morals don't come automatically. They don't come from science, they don't come from mainstream culture. I think you need to find them on their own and you need to delve into religion and mystery and the primitive things in order to develop fully as a human being. I don't think being what today's considered mainstream is going to give you any kind of good moral development's going to, if anything, just give you kind of platitudes and a kind of veneer of being upstanding. And that's a lot of people that work for the state today.

Leafbox:

Dr. Cook, I know your time is limited. I think we should do a second one. Maybe talking about morality, psychedelics. I have a lot of questions about spiritualism and what you see sometimes in psychedelic trips and I would like your opinion on that. So if you're open to it we do a second or another recording in the future,

Dr Cook:

I would love it. Let's do a focus talk on people who go into psychedelics as agnostics and they come out convinced that they talk to their ancestors. We see that. I see that in my clinic all the time and it's fascinating.

Leafbox:

Great. Well, Dr. Cook, I really appreciate your time and we'll talk soon.

Dr Cook:

Sounds good. Appreciate it. I had a fun time. Thanks Rob.