Transcription
20 years ago, Tom Cruise was mocked for criticizing psychiatry and the overuse of medications. The media called it a rant and doctors said he was frankly dangerous. But were they right?
So, I'm a board-certified psychiatrist and today I'm going to look back at what Tom said in the past and how well it's held up today.
I've never agreed with psychiatry ever. Uh, before I was a Scientologist, I never agreed with psychiatry. And then when I started studying the history of psychiatry, I started realizing more and more why I didn't agree with psychiatry. And as far as the Brook Shields thing is, look, you got to understand, I really care about Brook Shields.
For those of you who didn't follow this at the time, Brook Shields is a very attractive Hollywood celebrity and model. And she had said that she had taken an anti-depressant for postpartum depression. And Tom had commented on it at the time saying that there were problems with anti-depressants. I, I think here is a a wonderful and talented woman and uh, I want to see her do well and I know that uh, psychiatry is is a pseudoscience.
Okay, pseudoscience. So what he's talking about is that psychiatry is built on shaky ideas. I mean, that's his premise. And he's actually right about this because back in 2005, when this was filmed, doctors were telling the public that depression was caused by a chemical imbalance like low serotonin. We now know that idea is completely wrong. There was this huge research paper published in 2022 by Joanna Moncrieff and her team that looked at all of the data trying to find chemical imbalances and problems with serotonin in depression and they could not find it. So there was never any proof that this was real.
And this is a big deal because many people thought that psychiatric diagnoses were based in objective medical biology. But what many people now know today is that psychiatric diagnoses are not based in biology. They're in fact voted upon in the DSM. You know, a group of psychiatrists get together and they say, "Well, how many symptoms do we think qualifies for a major depressive disorder?" Well, I think you should have five of them. Okay. Well, you know, why not six and why not four? Well, you know, four seems a little too low and six seems a little too high. And that's essentially how it's done with all psychiatric conditions. They're not based on blood tests, brain scans, or anything like that.
Now, why is that a big deal? Well, it's a big deal because for decades, patients who were told to take the psychiatric drugs because they fixed these imbalances. Not because this was proven, but because it was just a reassuring way to get people to agree to take medications, which were really just masking symptoms. Anyway, let's go on. Tom's going to talk about ADHD in a moment. But Tom, if she said that this particular thing helped her feel better, whether it was the anti-depressant or going to a counselor or a psychiatrist, isn't that enough?
You have to understand this. Here we are today where I talk out against drugs and psychiatric abuses of electric shocking people, against their will of drugging children with them not knowing the effects of these drugs. Do you know what Adderall is? Do you know Ritalin? Do you know now that Ritalin is a street drug?
Well, this is a big deal because back in 2005, many parents were told that ADHD was a biological issue presumed to be caused by low dopamine. And that if you took drugs like Ritalin or uh Adderall that you're actually boosting these dopamine levels back up and that's why it's effective. And this simply isn't true because there's no chemical imbalance in ADHD. And essentially these drugs are used to mask the symptoms of ADHD. You know, it's not like insulin for diabetes where we where they're fixing an underlying problem.
And to be honest, his criticisms about the overuse of ADHD medications have aged quite well because here's what we know now. What we know now is that ADHD medications do not improve academic performance. Not in the short term, like right when you take the medications, and not in the long term either. But what they do do is they change how kids feel about their performance. So a kid who's on a stimulant medication will do a test and compared to a kid who was not on one of those medications, that kid on the stimulant medication will think that they performed better. This is a mood effect which is not really translating to you better grades.
But here's the real kicker. This is the thing that surprised a lot of people. For the parents out there who have kids on ADHD, without a doubt, they will know that these drugs improve behavior. If you have a kid running around a classroom, maybe hitting other kids, things like that, very distractible. Almost immediately, stimulant medications get the child very locked in and focused on their work, and they stay in their seat more. You know, parents and teachers see this a lot. But the biggest finding, and this came out about 3 years after this interview, in the largest and longest National Institute for Mental Health study ever done, the MTA trial, they found at 3 years, the kids who were on stimulants compared to the kids who were not on stimulants, there was no difference in their behavior. And so what that means is the behavioral effects, the biggest effects of these drugs do not stick around long term. They essentially wear off over time.
On top of that, a lot of side effects were found. Now, people knew that ADHD drugs suppressed appetite. But what they didn't know was that the suppression of appetite led to the kids on stimulants being about 1 inch shorter on average compared to the kids who were not on them. Now, this could be because of the appetite. It could also be because these stimulant medications disrupt sleep as well. But whatever was happening, they were leading to kids being shorter on average. We also learned eventually that some kids would go on to abuse these medications. Now, all of these risks are on the drug label now. There's no dispute about them. But I think parents, if they would have known this back in 2005, that the behavioral effects were off and there were all of these side effects, I think many of them would have been very worried about putting their kids on these meds. Let's keep on going.
Question, madam, asking a question. I understand there's abuse of all of these things.
No, you see, here's the problem. You don't know the history of psychiatry. I do.
Aren't there examples? And might not Brook Shields be an example of someone who benefited from one of those drugs?
All it does is mask the problem, Matt. And if you understand the history of it, it masks the problem. That's what it does. That's all it does.
Do you see that there's a big difference between, hey, this drug is fixing a chemical imbalance like insulin for diabetes, which is what doctors were telling patients, and oh, you're taking a drug that will mask the symptoms? Because one seems like you're fixing a medical problem. The other seems like you're avoiding issues in your life. And it doesn't matter whether it's ADHD or depression that we're talking about, especially with young kids. There's a million things you can do. There's parent-child behavioral therapy, there's dietary change, there's exercise. All of these approaches are proven to work in randomized control trials with kids and they don't wear off over time and they don't cause side effects. And I think if parents knew about how the drugs worked, they would have been steered to more non-drug interventions. Let's keep on going.
All it does, you're not getting to the reason why. There is no such thing as a chemical imbalance.
So postpartum depression to you is is kind of a little psychological gobbledygook?
No, no, I did not say that.
I'm just asking what you what would you call it? Perhaps that Matt that is.
So this is the whole idea that you know if someone gets so depressed that they need a medication it must be biological and Matt Laauo is trying to say oh it's just some gobbledygook as if uh Tom is trying to diminish the suffering because if there's severe suffering it must be biological and you must take a drug. I don't think that's what he's saying.
But that's what she went on the anti-depressant for. But what happens the anti-depressant all it does is mask the problem. There's ways of vitamins and through exercise and various things. I'm not saying that that isn't real. That's not what I'm saying. That's an alteration of what what I'm saying. I'm saying that drugs aren't the answer. That these these drugs are very dangerous. They're mind-altering antipsychotic drugs and there are ways of doing it without that so that we don't end up in a brave new world. The thing that I'm saying about Brooke is that there's misinformation. Okay. And she doesn't understand the history of psychiatry. She she doesn't understand in the same way that you don't understand it, man. But a little bit what you're saying, Tom, is you say you want people to do well, but you want them to do well by taking the road that you approve of as opposed to a road that may work for them.
No. No, I'm not.
Well, if if anti-depressants work for Brook Shields, why isn't that okay?
I, I disagree with it. And I think that there's a higher and better quality of life. And I think that promoting for me personally, so you're saying.
Okay, so Tom Cruise is doing pretty good for someone who's not a psychiatrist. I mean, he he's he's read into it, but what he didn't fully say here, which I wish he did, was that, you know, it's not a question of um preference, you know, what is my preference? What what do I approve of? It's actually a question of logic. Because when you know that the drugs aren't fixing an underlying problem, when you know that the drugs are masking them, all of a sudden a lot of things become very self-evident, you know, and they're troubling things. And the first thing is that the drugs wear off over time. Just if you take any drug that has a mood-altering effect, gradually tolerance will build up and that intervention will become less successful over time. So that's not a good long-term solution.
The second thing which is logical as well is that human brains are not designed to be in a drugged state their entire life. You know, as a psychiatrist who helps a lot of people with these side effects, some patients on them long term, they get worse over time. And when we're talking specifically about the SSRIs, these patients frequently report they start to feel more tired and they start to have cognitive problems gradually over time.
And the last thing that I wish he would have mentioned at the time is that these drugs can lead to a prescribing cascade. Now, what is a prescribing cascade? Well, it's when you have a kid who's, you know, maybe there's a parent at home with some mental illness and things are really difficult and they get an anxiety diagnosis, then they get put on Prozac and then they have a side effect from Prozac and the Prozac makes them really irritable and all of a sudden the the um the doctor diagnoses them with bipolar disorder and then now they're having like cognitive problems because they're on a more sedating medication and now they get diagnosed with ADHD. And this is quite common. You know, you see this sort of cycle where people will pick up these medications and diagnoses over time. And so, if you can avoid that by going in another direction with your treatment, then that's going to be a better long-term plan. And, you know, now things are a little bit better. But back in 2005, essentially all the doctors and the media were pretty much just exaggerating the benefits and downplaying any of these harms. And that was not only misleading parents, but it was also dangerous.
I can't discuss what I want to discuss.
No, you absolutely can't. But Matt, you're going in and saying that that I can't discuss that.
I'm only asking, isn't there a possibility that do do you examine the possibility that these things do work for some people that yes, there are abuses and yes, maybe they've gone too far in certain areas. Maybe there are too many kids on Ritalin, maybe electric shock.
Many kids on Ritalin.
You know, to give Matt Lowour his due here, these drugs can be effective for people and they can be used in the short term. Is that the ideal scenario that we need to rely on medications? It's not. But is that a practical reality? At times it is. And so for me personally, when when I use psychiatric meds in the past and when I tell people how to use them now, for severe cases, you can use them short term, yes, it is a drug effect, but it will make people feel a lot better um most of the time. And if you do use them short term before the effects wear off and all the other things happen, you have to pair them with non-drug approaches. And I actually think that's what happened in Brook Shields's case, that she was on it for a short period of time and then she tapered it off. But let's go on.
I'm just saying. But but aren't there examples where it works?
Matt. Matt, you don't even you're glib. You don't even know what Ritalin is. You start talking about chemical imbalance. You have to evaluate and read the research papers on how they came up with these theories. Matt, okay, that's what I've done. And you go and you say, "Where's where's the medical test? Where's the blood test that says how much Ritalin you're supposed to get?" You're you're it's very impressive to listen to you because clearly you've done the homework and and you know the subject.
And you should and you should do that also because just knowing people who are on Ritalin isn't enough. You should be a little bit more responsible in knowing.
Prescribing Ritalin. Tom and I'm not asking anyone else to do it.
You're saying I know some people who seem to have been helpful.
I but you're saying but it's like this is a very important issue.
I couldn't agree more. And you know what? And you're you're here on the Today Show and to talk about it in a way of saying, "Well, isn't it okay in being reasonable about it when you don't know?" And I do.
I think that you should be a little bit more responsible in knowing what it is because you you communicate to people.
I think we could wrap it up there. That's pretty much the end of it. You know, in hindsight, I look back on this and Tom is right about so many things. I mean, I think overly maybe a little too harsh on just saying there's never a use. Obviously, ideally, the the ideal scenario is that that people don't need these medications, but a practical reality is that, you know, for some people, especially in the short term, they can be helpful. And I just love that he just laid into them at the beginning because over the last 20 years, and particularly in the early 2000s, you could say, "These drugs are the greatest thing in the in the world. They make you better than well. Everyone's taking them. We should put Prozac in the water." And no one would bat an eyelid. They'd say, "Oh, that's that's a responsible thing to do. You're fighting stigma." But it's not. You know, these these are serious drugs. This is a serious topic. And changing your mood and personality and the way you feel chemically is a big deal, and it should not be diminished. And so, when Tom lays into him and is essentially just saying, "You need to be more responsible about this," I'm thinking, "Yes."
So, that's it for me today. I know I was talking about these medications sometimes making patients worse. If you want a deep dive in that, check out this video about how anti-depressants can make people worse long term.