WEBVTT 1 00:00:00.760 --> 00:00:03.680 You're listening to an airwave media podcast. 2 00:00:04.719 --> 00:00:08.000 Monster Talk is supported by listeners like you. Find out 3 00:00:08.080 --> 00:00:10.679 how you can contribute via Patreon or with reviews at 4 00:00:10.720 --> 00:00:14.960 monster talk dot org, forge slash support. Your contributions, large 5 00:00:15.039 --> 00:00:18.679 or small, make a huge difference. Thanks. Hey, they're monster 6 00:00:18.719 --> 00:00:20.640 Talk listeners. Karen and I are getting ready to head 7 00:00:20.679 --> 00:00:23.079 to Texas for Lubbocon this weekend. If you're in the area, 8 00:00:23.480 --> 00:00:26.440 stop buy and see us in Lubbock, Texas, Saturday, February 9 00:00:26.480 --> 00:00:29.920 twenty third, twenty nineteen, at lubbocn at two pm in 10 00:00:29.960 --> 00:00:35.880 the Civic Center, Room one oh one. Okay, it's actually 11 00:00:35.960 --> 00:00:38.079 quite unlike anything we've ever seen before. 12 00:00:40.240 --> 00:00:43.759 A giant, hairy preacher park ape part mats. 13 00:00:44.880 --> 00:00:47.920 In Larkness, a twenty four mile long bottomless lake in 14 00:00:48.000 --> 00:00:50.600 the highlands of Scotland, if a creature known as the 15 00:00:50.679 --> 00:00:51.560 Luckness Monster. 16 00:01:13.840 --> 00:01:18.519 Monster tal Welcome to Monster Talk, the science show about monsters. 17 00:01:18.799 --> 00:01:19.920 I'm Blake Smith. 18 00:01:19.920 --> 00:01:21.120 And I'm Karen Stolsner. 19 00:01:21.480 --> 00:01:23.879 In this episode, we begin an intermittent series on what 20 00:01:23.920 --> 00:01:26.640 I'm calling monstrous medicine. I think we're going to have 21 00:01:26.680 --> 00:01:29.200 some interesting in macab topics to cover around the history 22 00:01:29.239 --> 00:01:31.120 of medicine as it evolved over the past couple of 23 00:01:31.120 --> 00:01:34.480 thousand years. Up first in this series, we welcome Australian 24 00:01:34.519 --> 00:01:37.280 author Mike McCrae, who's going to talk with us about 25 00:01:37.319 --> 00:01:40.200 his new book Unwell, which looks at the meaning of 26 00:01:40.239 --> 00:01:44.359 the entire concepts of disease. I wouldn't give this episode 27 00:01:44.400 --> 00:01:46.359 an explicit tag, but we do talk a good bit 28 00:01:46.359 --> 00:01:49.519 about some disturbing terms and ideas, and we talk about 29 00:01:49.599 --> 00:01:52.519 human sexuality. So if you've got kids who listen, you 30 00:01:52.560 --> 00:01:54.079 just need to be aware of that. As a parent, 31 00:01:54.159 --> 00:01:56.840 I like to be forewarned, although to be honest, my 32 00:01:56.959 --> 00:01:58.680 kids have reached the age where they're more likely to 33 00:01:58.680 --> 00:02:04.079 shock me than vice versa more instrutal Off the air, 34 00:02:04.159 --> 00:02:06.159 Karen introduced me a little bit to who you are, 35 00:02:06.239 --> 00:02:08.759 But could you give a bio for the listeners who 36 00:02:08.800 --> 00:02:09.560 won't know who you are? 37 00:02:10.319 --> 00:02:14.000 Yeah? Sure. So I'm an Australian based science writer. 38 00:02:15.199 --> 00:02:17.879 I write for a science news service called Science Alert, 39 00:02:18.240 --> 00:02:22.319 which some readers might know of. My background is all 40 00:02:22.360 --> 00:02:25.840 over the place, so I started in pathology many years ago. 41 00:02:26.000 --> 00:02:29.319 I used to test bloods and urines and any other 42 00:02:29.360 --> 00:02:32.120 body fluid you can name, and I worked in a 43 00:02:32.120 --> 00:02:34.680 hospital doing that I moved from that into teaching, so 44 00:02:34.719 --> 00:02:38.800 I've taught in the UK, I've taught in various places 45 00:02:38.840 --> 00:02:42.159 over Australia, and I moved from that then into writing 46 00:02:42.319 --> 00:02:47.039 and developing educational resources. So I've written for children's magazines, 47 00:02:47.159 --> 00:02:52.159 I've developed various educational programs, and I kind of do 48 00:02:52.199 --> 00:02:54.719 a mix of things these days. So an additional science alert, 49 00:02:54.759 --> 00:02:59.000 I write books such as Unwell, and I also freelance 50 00:02:59.120 --> 00:03:01.560 for educational groups and other news services. 51 00:03:02.319 --> 00:03:05.240 So Kierra mentioned that you had met through the Australian Skeptics. 52 00:03:05.439 --> 00:03:08.599 How were they doing as an organization lately? 53 00:03:08.680 --> 00:03:09.280 Couldn't tell you. 54 00:03:09.560 --> 00:03:13.080 I have had very little to do with skepticism over 55 00:03:13.120 --> 00:03:16.800 the past say five years or so, largely because I 56 00:03:16.919 --> 00:03:20.319 found a lot of the values that I hold in 57 00:03:20.360 --> 00:03:24.319 that I can apply directly into science, communication and education, 58 00:03:24.479 --> 00:03:28.319 So that hasn't changed. But I think as a community, 59 00:03:29.560 --> 00:03:31.680 I sort of found there were two types of people 60 00:03:31.719 --> 00:03:33.879 in the community. There are those people who are practically 61 00:03:33.960 --> 00:03:37.680 minded and those people are morally minded. Moral skeptics tend 62 00:03:37.719 --> 00:03:40.240 to be the ones who get quite upset and angry 63 00:03:40.280 --> 00:03:42.639 when somebody doesn't share their views, and they tend to 64 00:03:42.840 --> 00:03:46.080 isolate and ostracize those people and almost vilify them in 65 00:03:46.120 --> 00:03:49.360 a way. I prefer the more practical side, which says, 66 00:03:49.479 --> 00:03:51.159 how do we change the world, how do we actually 67 00:03:51.639 --> 00:03:55.000 help people understand things differently? And that often requires you 68 00:03:55.039 --> 00:03:57.439 stepping into their shoes and understanding how they got there, 69 00:03:57.439 --> 00:03:59.759 and that could be quite uncomfortable for people who don't 70 00:03:59.800 --> 00:04:01.080 have that moral mindset. 71 00:04:01.879 --> 00:04:03.560 So I find it easier just to kind of go 72 00:04:03.639 --> 00:04:04.240 on alone. 73 00:04:04.479 --> 00:04:06.400 I was going to say, recently, seen the same thing 74 00:04:06.439 --> 00:04:09.360 here in the the US, with not only the organizations 75 00:04:09.360 --> 00:04:10.599 but the community itself. 76 00:04:11.520 --> 00:04:11.719 Yeah. 77 00:04:11.759 --> 00:04:14.240 Absolutely, and you see it also in science communication to 78 00:04:14.280 --> 00:04:15.680 a part, I think it's all over the place. It's 79 00:04:15.680 --> 00:04:18.160 a human thing to do. So it's not like, you know, 80 00:04:18.240 --> 00:04:21.079 I get frustrated. It's more just it's just easier sometimes 81 00:04:21.120 --> 00:04:23.399 I think buying those people who share a practical goal 82 00:04:23.480 --> 00:04:26.480 and say how do we work towards actually changing things 83 00:04:26.519 --> 00:04:28.639 without seeing them as the enemy. 84 00:04:29.079 --> 00:04:32.319 Yeah. I have a tremendous amount of empathy, and that's 85 00:04:32.360 --> 00:04:37.800 not always appreciate it, I think maybe in the hyper 86 00:04:37.879 --> 00:04:38.639 rational world. 87 00:04:38.759 --> 00:04:42.480 So yeah, yeah, empathy, it's a place you kin'd have 88 00:04:42.560 --> 00:04:44.120 to start in a way. I mean, I think that's 89 00:04:44.120 --> 00:04:47.000 one of the things in education I found over the 90 00:04:47.079 --> 00:04:49.639 years is if you're teaching students and you're wanting to 91 00:04:49.680 --> 00:04:52.399 actually give them the skills and the knowledge and the 92 00:04:52.439 --> 00:04:55.519 ability to think critically, the first thing that you need 93 00:04:55.519 --> 00:04:58.040 to give them is the ability to empathize with how 94 00:04:58.079 --> 00:04:59.839 did somebody else come to that belief? 95 00:05:00.240 --> 00:05:02.240 You know, you can't just reduce it to stupidity. 96 00:05:02.240 --> 00:05:04.399 You can't reduce it down to what they call an 97 00:05:04.480 --> 00:05:07.959 education the deficit model, which says you don't have this information, 98 00:05:08.079 --> 00:05:10.240 I'll give it to you. Now you have it, and 99 00:05:10.279 --> 00:05:12.120 it's just it's not how it works. And so you 100 00:05:12.240 --> 00:05:14.120 kind of have to say, well, how did you get there? 101 00:05:14.439 --> 00:05:16.199 How do I put my brain into it and go right, 102 00:05:16.319 --> 00:05:18.120 I see the steps you made, and how do I 103 00:05:18.199 --> 00:05:20.639 use your values to kind of try to help you 104 00:05:21.079 --> 00:05:22.600 arrive at a conclusion that's going to help you. And 105 00:05:22.639 --> 00:05:25.439 it's not always possible, but it's the most practical way 106 00:05:25.439 --> 00:05:26.600 to actually change your minds. 107 00:05:26.639 --> 00:05:29.360 It sounds very pragmatic, Well, yeah, I. 108 00:05:29.279 --> 00:05:31.160 Mean with it, it's a practical problem. In the end, 109 00:05:31.519 --> 00:05:34.360 education is a practical thing. You get so many teachers 110 00:05:34.399 --> 00:05:38.000 that are so upset with students. You know, you're not 111 00:05:38.079 --> 00:05:40.839 trying hard enough, You're being lazy and it's like, you know, 112 00:05:41.000 --> 00:05:44.240 it's I had an interview with the newspaper here recently 113 00:05:44.519 --> 00:05:48.720 and the conversation sort of found all these overlaps between 114 00:05:48.839 --> 00:05:53.040 medicine and education. Both of them are practically minded things 115 00:05:53.079 --> 00:05:56.839 to say, how do we take something that is not good? 116 00:05:57.000 --> 00:05:58.800 You don't value it, I don't value it, And how 117 00:05:58.800 --> 00:06:01.319 do we advance to a place that we all appreciate 118 00:06:01.360 --> 00:06:03.680 and like? And that means it's a practical problem. How 119 00:06:03.720 --> 00:06:05.480 do we change things? How do we actually move things 120 00:06:05.519 --> 00:06:08.040 along to a practical outcome? Otherwise it's just about you 121 00:06:08.120 --> 00:06:09.720 being angry that the world isn't the way that you 122 00:06:09.759 --> 00:06:12.839 want it, which we all get. But that's a discussion 123 00:06:12.839 --> 00:06:15.079 down the pub where you vent it's not a practical 124 00:06:15.120 --> 00:06:16.000 way to change the world. 125 00:06:17.040 --> 00:06:17.519 True enough. 126 00:06:19.319 --> 00:06:22.279 So, Mike, you've mentioned one well and we invited you 127 00:06:22.319 --> 00:06:24.240 on the show today to talk about Unwell, which is 128 00:06:24.279 --> 00:06:26.399 your latest book, and I believe it's published through the 129 00:06:26.519 --> 00:06:27.639 University of Queensland. 130 00:06:29.160 --> 00:06:32.279 That's right, So what can. 131 00:06:32.199 --> 00:06:33.439 You tell us a little bit about the book and 132 00:06:33.519 --> 00:06:35.079 what inspires you to write unwell? 133 00:06:35.800 --> 00:06:35.879 So? 134 00:06:36.000 --> 00:06:39.600 Unwell is an exploration of what makes one thing a 135 00:06:39.600 --> 00:06:43.279 disease and something just simply an undesirable trait or something 136 00:06:43.279 --> 00:06:48.600 we don't like. I think it goes back to many 137 00:06:48.639 --> 00:06:50.480 parts of my life. I keep trying to find the 138 00:06:50.480 --> 00:06:52.959 starting point. Part of it, I think might have been 139 00:06:53.000 --> 00:06:56.800 that I grew up with a father who battled with alcoholism, 140 00:06:57.439 --> 00:07:00.600 and one of the things he quite often said was, 141 00:07:00.879 --> 00:07:03.279 you know, some you have to understand, this is a disease. 142 00:07:03.360 --> 00:07:07.560 And I couldn't comprehend, you know, the difference between somebody 143 00:07:07.639 --> 00:07:10.839 choosing to put a drink in their mouth and be 144 00:07:11.000 --> 00:07:13.439 this way and somebody with a disease, you know, and 145 00:07:13.519 --> 00:07:16.879 how we dealt with that. I then went into pathology, 146 00:07:17.279 --> 00:07:22.560 and that's very much a clear clinical process. You know, 147 00:07:22.639 --> 00:07:26.040 you get in body of fluids and you test them 148 00:07:26.279 --> 00:07:28.199 and you get a number, and that number will tell 149 00:07:28.240 --> 00:07:30.199 you something and either you're close to that number, you're 150 00:07:30.199 --> 00:07:32.480 on that number, or you're over it, and that. 151 00:07:32.680 --> 00:07:35.600 Gives you a diagnosis. This person now has a disease. 152 00:07:35.680 --> 00:07:38.040 And you go back to the care provider and you 153 00:07:38.079 --> 00:07:40.959 give them the information and then they provide a plan. 154 00:07:41.560 --> 00:07:43.720 But in your mind it's still this is a clear line. 155 00:07:43.759 --> 00:07:46.439 We have diseases or we don't have diseases. And I 156 00:07:46.439 --> 00:07:50.360 think I've always kind of struggled with this concept of like, well, 157 00:07:50.600 --> 00:07:52.959 who gets to determine what this disease is? How do 158 00:07:53.040 --> 00:07:56.120 we find them? Is it like you have dinosaur bones, 159 00:07:56.160 --> 00:07:58.079 you dig them up, and you go, here is a disease. 160 00:07:58.120 --> 00:08:00.279 We didn't know this existed? What do we kind of 161 00:08:00.279 --> 00:08:04.240 invented as we go along. My previous book was Tribal Science, 162 00:08:04.240 --> 00:08:06.879 and that have a lot to do with this fuzzy 163 00:08:06.920 --> 00:08:09.360 line between what is science and what's not science and 164 00:08:09.399 --> 00:08:12.199 how do we communicate that? How do we think scientifically? 165 00:08:12.519 --> 00:08:14.399 So this was almost the next step on it was, well, 166 00:08:14.439 --> 00:08:17.000 how do we think about our health? You know, where 167 00:08:17.079 --> 00:08:19.800 is that fuzzy line between somebody feeling healthy and on 168 00:08:19.839 --> 00:08:22.680 top of things and somebody having a disease? And I 169 00:08:22.759 --> 00:08:25.120 love the history and the culture that goes into that. 170 00:08:25.240 --> 00:08:27.879 So that kind of culminated in writing Unwell. 171 00:08:28.040 --> 00:08:32.240 So how do you define a disease as opposed to say, 172 00:08:32.279 --> 00:08:35.159 a condition or a disorder, at least within the context 173 00:08:35.159 --> 00:08:35.679 of your book. 174 00:08:36.559 --> 00:08:38.759 Well, I don't go into too much detail about what 175 00:08:38.840 --> 00:08:43.840 defines say, syndrome from condition, disease disorder, because it's kind 176 00:08:43.879 --> 00:08:46.600 of a fuzzy mix of things as it is. With that, 177 00:08:47.159 --> 00:08:48.759 I kind of stand back and just kind of say, well, 178 00:08:48.799 --> 00:08:53.720 what really separates this disease concept from health? And there's 179 00:08:53.759 --> 00:08:56.120 kind of two answers to that. One's a bit more 180 00:08:56.159 --> 00:08:58.919 trite than the other one. The simple answer is, there 181 00:08:58.960 --> 00:09:01.600 is a group of people who decide for us. So 182 00:09:01.639 --> 00:09:05.879 you'll have authorities in the world who will have debates 183 00:09:05.879 --> 00:09:08.559 and discussions about this, and every now and then they'll 184 00:09:08.559 --> 00:09:11.120 put out big books, and those books will have whole 185 00:09:11.159 --> 00:09:12.799 lists of diseases in them. 186 00:09:13.799 --> 00:09:14.039 You know. 187 00:09:14.120 --> 00:09:16.919 One of them is the Diagnostic and Statistical Manual, which 188 00:09:16.960 --> 00:09:19.679 looks at mental health. Another one is the International Classification 189 00:09:19.720 --> 00:09:22.720 of Diseases. But they're both made by groups of people 190 00:09:22.759 --> 00:09:27.039 who put these out every now and then, and that 191 00:09:27.200 --> 00:09:29.759 if you're a care provider, you turn to that book 192 00:09:29.799 --> 00:09:32.080 and you find a code and it breaks everything down 193 00:09:32.120 --> 00:09:35.200 in a very methodical way. So for most of us 194 00:09:35.960 --> 00:09:39.200 it is an authority based decision. The thing is, there's 195 00:09:39.200 --> 00:09:42.840 also a philosophical conversation behind that. People who make these 196 00:09:42.879 --> 00:09:44.759 big books and kind of determine what is and is 197 00:09:44.799 --> 00:09:47.279 not a disease have a debate about these things and 198 00:09:47.279 --> 00:09:47.759 the lead up. 199 00:09:47.799 --> 00:09:48.960 So a recent. 200 00:09:50.159 --> 00:09:53.440 Edition of the ICD came out at number eleven, or 201 00:09:53.440 --> 00:09:56.279 at least the draft version has, and. 202 00:09:56.200 --> 00:09:57.799 That has changes in it. 203 00:09:57.919 --> 00:10:01.159 So an example of that is game disorder is now 204 00:10:01.200 --> 00:10:05.200 considered a bonifie disease. It wasn't previously before if you 205 00:10:05.240 --> 00:10:08.080 played too much computer games, then you know, that was 206 00:10:08.200 --> 00:10:10.159 just an issue you had to deal with, whereas now 207 00:10:10.200 --> 00:10:11.720 you can actually go along and have a talk to 208 00:10:11.759 --> 00:10:14.159 your doctor, you can talk to your psychologist and they 209 00:10:14.159 --> 00:10:17.480 have a code that they can go to to provide 210 00:10:17.480 --> 00:10:21.720 certain benefits because you now have a disease. But that 211 00:10:21.759 --> 00:10:23.759 didn't come out of nowhere. There was a big conversation 212 00:10:23.840 --> 00:10:26.080 that went into that, and that meant that they looked 213 00:10:26.120 --> 00:10:29.039 at the literature, they looked at petitions, they looked at 214 00:10:30.159 --> 00:10:33.519 discussions that are happening out there in conferences, and it's 215 00:10:33.519 --> 00:10:35.200 a slow build up to say, you know, maybe this 216 00:10:35.279 --> 00:10:35.720 thing we've. 217 00:10:35.600 --> 00:10:37.720 Been talking about should be considered disease. 218 00:10:37.799 --> 00:10:39.879 You know, we can label it certain ways, we can 219 00:10:39.919 --> 00:10:44.240 look at certain physiologies, and there's a lot that informs that. Now, 220 00:10:44.759 --> 00:10:48.159 what that philosophy is actually determined by is what I 221 00:10:48.240 --> 00:10:50.480 kind of explore in the book, and it sort of 222 00:10:50.480 --> 00:10:52.960 comes down to three things. So our culture of disease 223 00:10:53.320 --> 00:10:57.399 is informed by looking at what we consider to be 224 00:10:57.679 --> 00:11:00.799 biological normality. So you know, we look around us and 225 00:11:00.799 --> 00:11:03.960 there's variation, but if you have a disease, you're different 226 00:11:04.080 --> 00:11:06.600 to most of those variations in some way. You know, 227 00:11:06.679 --> 00:11:08.320 I've got a lot of gray hair, but no one's 228 00:11:08.320 --> 00:11:10.519 going to tell me that I've got a disease unless 229 00:11:10.519 --> 00:11:13.279 that gray hair actually happened, you know, when I was five. 230 00:11:13.399 --> 00:11:15.320 And then someone says, well, that's not a normality we're 231 00:11:15.399 --> 00:11:19.600 used to. So you're different, But that difference alone doesn't 232 00:11:19.600 --> 00:11:21.919 give you a disease. So the next step is does 233 00:11:21.960 --> 00:11:26.039 that difference actually interfere with how you engage with a 234 00:11:26.159 --> 00:11:30.120 responsibility in society. So all of us have certain expectations. 235 00:11:30.440 --> 00:11:32.840 That expectation might be that you have to work. You know, 236 00:11:32.919 --> 00:11:34.519 you have to get up out of bed each day 237 00:11:34.759 --> 00:11:37.080 and go and contribute. Maybe you're in part of a 238 00:11:37.080 --> 00:11:40.279 culture that doesn't have a capitalistic way of seeing things, 239 00:11:40.399 --> 00:11:42.440 but you still engage in another way. You might need 240 00:11:42.480 --> 00:11:45.559 to do some hunting or gathering or bringing food into 241 00:11:45.559 --> 00:11:49.080 the community. There's other expectations. You can't sit in a 242 00:11:49.120 --> 00:11:52.480 bus and talk to yourself. People expect something of you, 243 00:11:52.559 --> 00:11:56.399 a certain cordiality, or they expect, you know, for you 244 00:11:56.480 --> 00:11:59.519 to not inspire fear in others, so you have to 245 00:11:59.519 --> 00:12:01.600 behave in a certain way. There's also a look. You know, 246 00:12:01.679 --> 00:12:04.200 you have to look a particular way because otherwise people 247 00:12:04.240 --> 00:12:06.159 might be a bit comfortable. You're expected to be of 248 00:12:06.200 --> 00:12:08.600 a certain ways. You know, you're expected to look a 249 00:12:08.639 --> 00:12:12.639 certain way, or you're not fulfilling the obligations and the 250 00:12:12.679 --> 00:12:15.960 requirements of society. But there's a third one we don't 251 00:12:16.000 --> 00:12:18.399 think too much about, and that is you can be 252 00:12:18.440 --> 00:12:22.039 different and you won't fit certain social norms, but it 253 00:12:22.080 --> 00:12:25.240 has to not be your fault. You know, you have 254 00:12:25.320 --> 00:12:30.000 to kind of not have responsibility of this state if 255 00:12:30.039 --> 00:12:32.720 you do. If you chose to be this way, then 256 00:12:32.840 --> 00:12:34.759 you might not have a disease or an illness. So 257 00:12:34.840 --> 00:12:37.759 you can take a hangover, for instance, you can ring 258 00:12:37.840 --> 00:12:39.120 up and say, look, I'm feel a bit ill, But 259 00:12:39.120 --> 00:12:40.799 no one's going to say you have a disease because 260 00:12:40.840 --> 00:12:43.600 you've got up one morning and said I'm hungover because 261 00:12:43.639 --> 00:12:45.919 you put that alcohol into your system the night before. 262 00:12:46.320 --> 00:12:50.000 But if you wake up and say, look, i've food poisoning. 263 00:12:50.080 --> 00:12:52.200 You know I didn't mean to, then people are going 264 00:12:52.240 --> 00:12:54.600 to start thinking of that more of a disease like fashion, 265 00:12:54.679 --> 00:12:56.960 and the way we behave towards a hangover is going 266 00:12:57.000 --> 00:13:00.159 to be very different to the way we behave towards that, 267 00:13:00.279 --> 00:13:04.679 you know, having food poisoning. So again it's a bit 268 00:13:04.679 --> 00:13:06.440 of a fuzzy line, and that's why we have debates 269 00:13:06.440 --> 00:13:08.519 about this, But there's a lot of this philosophy that 270 00:13:08.559 --> 00:13:11.559 goes into what do we determine is the difference between 271 00:13:11.559 --> 00:13:14.559 you having a disease and you simply not feeling well 272 00:13:14.759 --> 00:13:16.679 or simply not fitting a certain obligation. 273 00:13:18.320 --> 00:13:21.360 So a little while ago you mentioned alcoholism, So how 274 00:13:21.440 --> 00:13:24.720 is that classified today because you were talking in terms 275 00:13:24.759 --> 00:13:29.679 of responsibility and blame is seen as an addiction or 276 00:13:29.759 --> 00:13:31.559 is it seen as more of a disease or a 277 00:13:31.600 --> 00:13:33.080 mental illness nowadays? 278 00:13:33.639 --> 00:13:36.480 Well, I mean the simple answer again it's yes. 279 00:13:36.600 --> 00:13:38.600 So you know, you can be seen as an alcoholic 280 00:13:38.600 --> 00:13:40.480 can have a disease, But I mean the history behind 281 00:13:40.519 --> 00:13:43.000 that is actually what you know, it's almost a focal 282 00:13:43.080 --> 00:13:45.360 point for this. So you can go back a good 283 00:13:45.440 --> 00:13:49.000 centrist to looking at the history of alcoholism, which was 284 00:13:49.039 --> 00:13:51.120 one of the first debates on is this a disease 285 00:13:51.240 --> 00:13:53.480 or not? So you had a lot of medical professionals 286 00:13:53.480 --> 00:13:56.840 to be looking at this question, and you know, the 287 00:13:56.840 --> 00:14:01.960 origins of alcoholics alcohol anonymous, for instance, is wrapped up 288 00:14:01.960 --> 00:14:03.480 in this question where we had somebody who didn't have 289 00:14:03.519 --> 00:14:05.960 a medical background, who did a lot of pseudo science. 290 00:14:06.000 --> 00:14:08.759 You know, they sort of went out and interviewed people 291 00:14:08.759 --> 00:14:11.039 and came up with this categorization, the steps that you 292 00:14:11.399 --> 00:14:14.919 went through to classify you as being an alcoholic, and 293 00:14:14.960 --> 00:14:17.279 it looked quite rigorous, but really when you pull it apart, 294 00:14:17.320 --> 00:14:19.600 there wasn't a lot of riger to it. So there's 295 00:14:19.639 --> 00:14:21.639 been this debate to kind of say, well, is it 296 00:14:21.759 --> 00:14:24.240 your fault? Are you going out and your drinking and 297 00:14:24.679 --> 00:14:27.080 you know, where does the youth start and stop? Or 298 00:14:27.159 --> 00:14:30.639 is it your physiology? And it's still a debate today. 299 00:14:30.679 --> 00:14:32.720 You know, we still debate about addiction and we still say, 300 00:14:32.759 --> 00:14:35.720 well where do you stop in your body start? And 301 00:14:36.200 --> 00:14:39.639 you know, the interesting thing is the conversation is shifting slowly. 302 00:14:39.759 --> 00:14:42.000 So this whole disease model that we've had for the 303 00:14:42.000 --> 00:14:44.279 past one hundred, one hundred and fifty two hundred years 304 00:14:44.799 --> 00:14:46.840 is gradually evolving to where we're kind of saying, well, 305 00:14:46.879 --> 00:14:49.600 where does that matter? You know, the practicality of it 306 00:14:49.679 --> 00:14:52.080 kind of says, we don't want you to suffer, and 307 00:14:52.080 --> 00:14:54.399 we don't want socide to suffer. How do we change that? 308 00:14:54.759 --> 00:14:57.759 So psychology is starting to blend more with neurology and 309 00:14:57.799 --> 00:15:01.759 psychiatry and medicine starting to blurt together to kind of say, 310 00:15:01.840 --> 00:15:04.320 you're an individual, how do we help you? But this 311 00:15:04.399 --> 00:15:07.080 is a slow process, so we may see in years 312 00:15:07.120 --> 00:15:10.080 to come, this whole disease model, these great big books 313 00:15:10.120 --> 00:15:12.440 of disease are getting more and more complicated kind of 314 00:15:12.440 --> 00:15:14.679 fall apart, and we'll look at medicine in a completely 315 00:15:14.679 --> 00:15:15.200 different way. 316 00:15:16.759 --> 00:15:20.600 That would be really interesting. It sounds like, you know, 317 00:15:20.639 --> 00:15:23.000 there's a couple of components going on. You've got the 318 00:15:23.799 --> 00:15:30.480 medical oversight sort of view, but you also have society 319 00:15:30.799 --> 00:15:34.399 sort of defining how diseases are perceived. I'm thinking here 320 00:15:34.399 --> 00:15:37.919 about not only new things like the video game addiction, 321 00:15:38.000 --> 00:15:41.519 but you know how alcoholism, where society gets to say, 322 00:15:42.679 --> 00:15:48.240 for right or wrong, that they think about an individual's 323 00:15:48.320 --> 00:15:51.440 ability to control their own behavior, you know, the self 324 00:15:51.440 --> 00:15:57.360 determination factor. And when you're dealing with something that is 325 00:15:57.799 --> 00:16:02.879 potentially like it has a moral stigma associated, like when 326 00:16:02.879 --> 00:16:05.559 AIDS happen, a lot of people felt like, well, AIDS 327 00:16:05.720 --> 00:16:09.519 was tied to morality, like if people hadn't have had 328 00:16:09.600 --> 00:16:12.559 the sort of behaviors that would lead to contamination with 329 00:16:12.639 --> 00:16:16.080 the virus, then they wouldn't have gotten the disease. And 330 00:16:16.240 --> 00:16:18.600 that in some way, because they were behaving in a 331 00:16:18.639 --> 00:16:21.519 way that they felt was immoral, that they somehow deserved 332 00:16:21.559 --> 00:16:23.679 the disease. Is did you do you cover that in 333 00:16:23.679 --> 00:16:24.120 the book? 334 00:16:24.759 --> 00:16:25.320 Absolutely? 335 00:16:25.399 --> 00:16:27.120 In fact, it's one of the core themes in the 336 00:16:27.159 --> 00:16:29.519 book that I keep going back to is the fact 337 00:16:29.519 --> 00:16:32.759 that diseases, really it's hard a moral concept. In many ways, 338 00:16:32.879 --> 00:16:35.320 you can't pull apart in the morality from the disease. 339 00:16:35.799 --> 00:16:38.759 You know, nature doesn't give what your variation is. 340 00:16:38.879 --> 00:16:40.080 You know, you you're. 341 00:16:39.960 --> 00:16:42.360 Sort of you're different in some way, and nature provides 342 00:16:42.440 --> 00:16:44.879 variation because well, you know, that's how we evolve. We 343 00:16:44.960 --> 00:16:48.320 have variation within a species, variation in a genetic level, 344 00:16:48.360 --> 00:16:51.480 you know, the environment shifts, there's difference. But as we 345 00:16:51.639 --> 00:16:54.000 humans who then kind of say what do we value 346 00:16:54.000 --> 00:16:56.759 as a community and what's important to us? Some things 347 00:16:56.759 --> 00:16:58.399 are going to be important in one culture that are 348 00:16:58.399 --> 00:17:01.080 not important in another. And so a variation of what 349 00:17:01.080 --> 00:17:04.359 we consider to be that defining line of disease, the 350 00:17:04.400 --> 00:17:07.920 other point that you made was to do with, you know, 351 00:17:08.200 --> 00:17:11.319 that that whole volition thing, that culpability. Where do you 352 00:17:11.400 --> 00:17:15.039 start and stop? And interestingly, science doesn't really have an 353 00:17:15.039 --> 00:17:17.480 answer to say, well, where does your free will start? 354 00:17:17.559 --> 00:17:19.160 You know, where does it stop. We sort of treat 355 00:17:19.160 --> 00:17:21.200 the whole consciousness free will thing as a little bit 356 00:17:21.200 --> 00:17:25.200 of a first year philosophy student type discussion. You know, yeah, 357 00:17:25.480 --> 00:17:27.960 it's in the two hard basket and it's something that 358 00:17:28.079 --> 00:17:31.240 young students debating. We don't talk about anymore because it 359 00:17:31.279 --> 00:17:35.039 is quite hard to kind of discuss any scientific way. 360 00:17:35.200 --> 00:17:38.160 We don't even have a philosophical definition of it. So 361 00:17:38.200 --> 00:17:40.319 when we then look at it in terms of not 362 00:17:40.440 --> 00:17:44.079 just health and medicine, but in law other a society 363 00:17:44.119 --> 00:17:46.319 that kind of say, you know, who are you and 364 00:17:46.400 --> 00:17:50.160 how much influence do you have over your biology? We've 365 00:17:50.240 --> 00:17:51.920 drawn a line. We kind of say, well, on one 366 00:17:52.000 --> 00:17:54.240 side you do have control and the other you don't. 367 00:17:54.680 --> 00:17:57.119 But we don't know what that line looks like yet. 368 00:17:57.119 --> 00:17:59.799 There is so much that does depend on it. So 369 00:18:00.119 --> 00:18:01.799 you know, one area I do go into in the 370 00:18:01.799 --> 00:18:04.519 book is with mental health and the legal system. So 371 00:18:04.559 --> 00:18:07.519 you know, we have things like the insanity plea for instance, 372 00:18:07.519 --> 00:18:09.200 which kind of says, look, I wasn't in my right 373 00:18:09.240 --> 00:18:11.920 mind or I didn't have control over what I was doing. 374 00:18:12.400 --> 00:18:14.880 And the courts debate this, but there is nothing in 375 00:18:14.920 --> 00:18:16.839 science that kind of says, oh, hang on a second, 376 00:18:16.880 --> 00:18:19.119 yeah you didn't have that line look at Yeah, let's 377 00:18:19.119 --> 00:18:20.240 look aside your brain. 378 00:18:20.079 --> 00:18:22.759 And find where volitions start and stop. Where is your agency? 379 00:18:23.279 --> 00:18:25.920 So we've got these big things, these big definitions that 380 00:18:26.000 --> 00:18:29.200 sort of rely very heavily on something we don't even 381 00:18:29.240 --> 00:18:32.240 have a definition for, let alone understand. And there's lots 382 00:18:32.240 --> 00:18:35.119 of consequences to that. It's not an easy thing to do, 383 00:18:35.240 --> 00:18:37.799 but you know, in the end we then need to ask, well, 384 00:18:37.839 --> 00:18:41.119 where are our definitions? You know, what points can we 385 00:18:41.160 --> 00:18:43.160 actually affect? What do we have control over and what 386 00:18:43.240 --> 00:18:46.440 we don't. And when it comes to disease, we've had 387 00:18:46.440 --> 00:18:48.480 a century or so of being so clear on it 388 00:18:48.519 --> 00:18:51.759 being a medical scientific problem, we don't stop to think 389 00:18:52.400 --> 00:18:53.400 what can society do? 390 00:18:53.720 --> 00:18:54.920 You know, we're so clear on kind. 391 00:18:54.839 --> 00:18:56.680 Of saying well, if your legs don't work, we can 392 00:18:56.680 --> 00:18:59.400 build your wheelchair, we can build you an extra skeleton, 393 00:18:59.440 --> 00:19:01.480 we can fix your you know, we don't often then 394 00:19:01.559 --> 00:19:02.079 say well. 395 00:19:01.960 --> 00:19:02.839 Can we build a ramp. 396 00:19:03.400 --> 00:19:06.200 Can we change society in ways to kind of deal 397 00:19:06.279 --> 00:19:09.440 with disability and disease as if you know, it's a 398 00:19:09.559 --> 00:19:12.000 variation and there are many things that we can do 399 00:19:12.480 --> 00:19:13.599 to try to address that. 400 00:19:13.759 --> 00:19:16.200 In your book, you talk about some really interesting phenomena 401 00:19:16.240 --> 00:19:20.640