EP8 | Trends & New Treatments in Mental Health | Guest: Paul Blavin, Social Venture Entrepreneur, Philanthropist
Download MP3Alright. Welcome to another brain hope reality. PTSD, not PTSD. PTSD. Bad.
Dr. Lipov:Bad. Anyway, I have a pleasure of my great excellent, amazing friend Paul, mister Blevin, here. And I thought we can have a great conversation, and we'll see where we go.
Paul Blavin:Alright. Thanks for having me, Gene.
Dr. Lipov:Thanks for coming and bringing your loved ones here. I appreciate it. So one of the I have I believe in pretty loose format in a sense. I don't have any specific things. We've known each other relatively short amount of time, but we certainly spend a lot of time chatting.
Paul Blavin:We've covered a lot of ground in a short period of time.
Dr. Lipov:We're doing some crazy, crazy things. So very rapidly, so we met through a mutual acquaintance, and I think we had a really good discussion. And then you and I have, I think, a very similar perspective on mental health. So maybe you can kind of summarize what you think mental health is all about, and what can you and I together do about it?
Paul Blavin:Well, I think that mental health is, from my layman's perspective, the greatest opportunity that exists in health care today. Because there's obviously a huge need for mental health treatment, for healing. We live in a very traumatized society that's only getting worse. And we could see that with the divisiveness that goes on and the lack there's been a lot of talk about lack of civility in dialogues. This all relates to trauma.
Paul Blavin:Having a background, a little bit of a background from the biotech industry and the health care field as a result of that, it was shocking to me that less than 2% of the research budget in medicine is devoted to mental health. Have you thought about why? Yeah, I have well, first of all, I think because, yeah, but I, you know I can
Dr. Lipov:give you my answer.
Paul Blavin:Okay, yeah, I'd love to hear your answer.
Dr. Lipov:So I'll tell you my answer to that. So psychiatry has been the best of child of medicine forever. The problem with psychiatry is difficult. We don't have really good biomarkers. We don't have really good, highly effective therapeutics.
Dr. Lipov:There are some new ones coming along and I've been extremely fortunate introducing my partner, which is Stella Gangnam Blog for Sympathetics. So I think one of the big things is people are starting to finally look at mental health as a physiologic change in the brain. So if you look at it like that, instead of like PTSD, people talked about it's a weakness of the soul, any of that. But what do you do about that? Snap out of it?
Dr. Lipov:It's very difficult to do because there's a physiologic change. Another thing people don't think about, but I think about it a lot, mental health leads to aging. It leads to heart attacks, sexual dysfunction. Eighty five percent of men with PTSD have sexual dysfunction. That's a horrible number.
Dr. Lipov:And it leads to other problems, obviously.
Paul Blavin:Well, it's interesting you say that physiologically because we've stumbled upon just modern day, extremely recently, these GLP-one drugs, these diet drugs, an unanticipated but profound side effect is all of a sudden you're finding people who are labeled alcoholics completely losing the desire or the craving to drink. And that was also considered a spiritual deficit. Alcoholics Anonymous has been phenomenal for certain people and so on, in trying to fill that spiritual deficit. But boy, it's striking how people can start taking Mounjourno, Wegovy, Ozempic, and all of a sudden they lose their craving for alcohol without going to an AA meeting, by the way.
Dr. Lipov:Yeah, exactly. So if you think about to me, that has been the huge push for PTASI term. If you think of a broken leg, so in the olden days before cast, before doctors, before x rays, they know they're walking and it looks weird. Something is wrong, but they don't know what to do about it. You can do a shaving thing, you can do leaves on it, but until they straighten it out, it ain't gonna work.
Dr. Lipov:So to me, when somebody has, like, example, one of the things that's still being used, which I'm totally against, is called exposure therapy. So the idea there, you have gone through, let's say, battle. And let's say we're in a tank. So they put a VR helmet on. So it's like reliving the battle.
Dr. Lipov:And they burn flesh, like chicken flesh, it smells like that, and this cordite smell. So you're like reliving this. And shockingly, only five percent Yeah. People complete that. I don't know why that is.
Dr. Lipov:Right. So physiologically So I've talked to the person who started that. I said, that makes no sense physiologically. It's like, you have broken leg, you know, so go up the heel a few times and come back. Fix the leg.
Dr. Lipov:So to me, fight and flight system is clearly highly involved. That's how Stellar Gaming works.
Paul Blavin:Yeah. Well, you and I have had this conversation very recently about how we as a society in The United States, and I can't speak for other societies, is a punitive society.
Dr. Lipov:No
Paul Blavin:question. So the way we have chosen in our crazy thinking is that we're gonna punish traumatized people. We're going to punish the trauma out of traumatized people.
Dr. Lipov:Yeah, absolutely. And incarceration, we've talked about how the rate of incarceration is so much higher here. We have more prisoners than anybody else in the globe, only five percent of the population.
Paul Blavin:And a terrible recidivism rate. Shockingly. When you go to
Dr. Lipov:jail, PTSD doesn't just melt away.
Paul Blavin:No, it gets worse. Flu. Right. And then we release even more highly traumatized people who are being policed And or more traumatized they're entering societies that are traumatized. And it's like rushing to a fire with kerosene.
Dr. Lipov:So I'll tell you an interesting story. So I was I had an honor to be exec medical director or CFO or whatever for my wife in Englewood, where a lot of murders happen and stuff. So a lot of times when you have two people who are traumatized, like, typically a lot of Half of the police force used to be deployed overseas. And now they're police in the very rough area. And now you have the guys who are really traumatized.
Dr. Lipov:They have high ACEs, all of that. So I've treated both of them, both groups. And sometimes when they get together and they talk to each other, they can actually have a civil conversation. So instead of when somebody has a comb, they're put in comb and they get shot, think about why that happens. Because the guy on the other side, who's the gun, who's a policeman, is so traumatized he expects all this horrible trauma.
Dr. Lipov:So your primitive brain, like the amygdala, goes, this is danger. Do something about it right now. So you haven't even thought about it. And they go, oh, that was the wrong target.
Paul Blavin:Well, you know, I've had the privilege of sitting in San Quentin Prison with the groups of men who are all murderers. And one of the exercises they do in their healing is to go around the room and estimate how much premeditation, how much time went in premeditation into the murder. You know what they asked, so I sat with a group of 29 men who collectively had served over seven hundred years in prison for murder. Unbelievable. And the average was six seconds.
Paul Blavin:That's fascinating. That's the premeditation. That makes perfect sense. Well, makes complete sense. These are traumatized people, it's just a volcano erupting.
Dr. Lipov:Has that been published before?
Paul Blavin:I don't know. You know
Dr. Lipov:You and I should publish that. I've never heard of that. That's fascinating because complete sense. Yeah. Because if you think about it, the reflex Right.
Dr. Lipov:When somebody is throwing a punch, you go, that's that's about that order of magnitude. But in order to get it through your eyes, put it in the prefrontal cortex and go, well, what should I do about it? Yeah. That's wow. Yeah.
Dr. Lipov:That's fascinating.
Paul Blavin:I mean, very few murders are committed with any type of premeditation that It's just traumatized people who And if you go through those 29 people that were sitting in that room, they've all had violent crimes, violence committed against them so I mean, we're so traumatized.
Dr. Lipov:So it's interesting. So let's look at it from my perspective of these eligible things. So when you have let's say if you're a child. Let's say your child hangs over. It's a lower amount of resources.
Dr. Lipov:So you're always in a position to either you have food insecurity, you have housing insecurity, you have all those insecurities. And then you see trauma or people being placed in jails, all of that happening, right, continuously. So that activates fight and flight system now. They're more likely to develop further. So that increases norepinephrine level.
Dr. Lipov:Norepinephrine level is the main transmitter in the brain for trauma. So if you jump in front of the bus and you don't get hit, hopefully, your norepinephrine goes up. You think how you feel. You're disoriented, you're shaky, anything that bothers you, right? You're hypervigilant.
Dr. Lipov:That's what PTSD is. It continues. So if you have PTSD, you have one person on one side, has PTSD. The second one saying hello could be interpreted or looking at somebody's eye, interpreted as a threat. And then you have to eliminate threat.
Dr. Lipov:And that's why you get to meet them. Wow. That's It's
Paul Blavin:physiologically driven. It's not a psychological problem. Totally agree with that. Now, you know, an interesting thing about society is we'll look at serial murderers, you know, who may very well be sociopathic, obviously, but that's not the typical person that's incarcerated. No.
Paul Blavin:You know, those are the rarities.
Dr. Lipov:Not exactly. So like there was one forgot the name. So there were two brothers. They came from a very, very wealthy family, I think, England, and they figured out how to kill, torture and kill a postman. That's like 1905 or something like that.
Dr. Lipov:So that trial was a big deal because it was highly permitted. That was just fun stuff. That's not what you describe. No, you're describing like moments of passion or anger or something like that.
Paul Blavin:Yeah, totally physiological.
Dr. Lipov:I love it. So to that, so one of the things we were just talking about, how can we spread the word that PTSD is real and it's physiologic. So I'm working very hard on changing the name because So this was originally designated in 1980, DSM III. So I sent a letter, an official request, name changed to American Sikhetic Association, and they said no. So we're working right now to try to get testimony in front of the subcommittee in Congress and the committee in Senate.
Dr. Lipov:Yeah. Because a four star general, General Schirale, was very big into trying to change that in 2013. And APA told them no. I said, no, it doesn't cause any stigma. I did the study showing show stigma, but it's the battle continues anyway.
Dr. Lipov:So I think
Paul Blavin:they should revisit the Hippocratic oath. Because, you know, what are they trying to what's their is it their ego or are they trying to actually help people? Clearly it's stigmatized. It's stigmatized.
Dr. Lipov:But they disagree with It's not a matter
Paul Blavin:of how they agree or disagree. There's data.
Dr. Lipov:Know. I have the
Paul Blavin:Doctors are supposed to be, I know they're not scientists, they ought to be, but they ought to at least be able to understand. I assume they teach you in medical school how to read studies and understand data. And if the data is saying that it's stigmatizing
Dr. Lipov:Well, they said that there's not an update. There's never an update. But think about DSM, what it stands for, Diagnostic Statistical Manual. It was originally designed in 1950s. Statistical Manual means a scientific study thereof.
Paul Blavin:Well, I'm curious, isn't part of the Hippocratic Oath do no harm?
Dr. Lipov:That is the number one rule.
Paul Blavin:That's number one rule. So what would be the harm of change if there is data? They're saying there's not enough data, but there is data that's already showing that people could kill themselves literally because of this stigma, because they're not getting treatment. There's data that shows that people do not get treatment because of
Dr. Lipov:So the
Paul Blavin:they aren't doing no harm by them digging in their heels with their ego to say, it's a disorder gene, not an injury. And we don't think there's enough data to show it's stigmatized, but we know it's stigmatizing. So why not change the name?
Dr. Lipov:So exactly. So then there is no
Paul Blavin:What's the downside?
Dr. Lipov:Well, I've heard some interesting ones, but nothing. Nothing meaningful, shall we say. I can't really defend myself.
Paul Blavin:In terms of saving lives, what's the downside? In terms of doing no harm, what's the downside of calling it Nothing. Right.
Dr. Lipov:Nothing. But let me give you an example. It's kind of interesting. So in my you need to justify a name change for APA, which is a formal thing. You need to prove basic thing.
Dr. Lipov:If it causes harm, they will change the name. But if you look at the history of it, which is really interesting. So between DSM four, DSM five, they changed the name learning disability. They felt it causes stigma. Now it's learning differences.
Paul Blavin:Yep.
Dr. Lipov:They could change that. There's many more people with PTSD than learning difference or disabilities, like factors of magnitude difference. Yet they were able to change that, but they are not changing that. So that's why I continue the battle. Anyway, so one of the things I thought we can strategize, what can unite it together?
Dr. Lipov:So one of the things we were talking about potentially is coming up with maybe social campaign And pull in whoever can, because I think it's a simple message. And there's so many celebrities and well known people who talked about from Mick Jagger, for example, talked about his trauma and his PTSD and goes down the line. One of my favorite ones is what's her name? Adriana Grande. Mhmm.
Dr. Lipov:So remember she was involved in that there was a bomb explosion that she had. Yeah. Chesser. Now seven years ago. So since then, had a brain scan and it showed PTSD in a brain scan.
Dr. Lipov:Which is kind of interesting. So people are starting to talk about brain change that happens with it. And that's why I've been a big proponent of people starting to talk about that. That is physiologic. Because people would say, well, that's your opinion.
Dr. Lipov:My opinion, it's the weakness of the soul, let's say. But with advanced scanners, you actually see the difference in the brain. So, you know, there's a change in the brain. It was a study done by Doctor. Alkire in Irvine, and they found that you can see the brain change from PTSD.
Dr. Lipov:They did stell it and deactivate the amygdala which controls PTSD. So the point is, we know what it looks like. We know they can do something about it. And we also know very clearly when I deal with a lot of special forces guys and every one of them says, if you change the name, more of my brothers and sisters are going to be seeking care. It's not a complicated concept.
Dr. Lipov:It is so simple. No.
Paul Blavin:And the data argument is just people's ego. Pushing it back.
Dr. Lipov:Yeah, it's basically Well, you prove it.
Paul Blavin:Yeah, exactly. And to say there's not enough data when we're losing 35 to 40 veterans a day.
Dr. Lipov:45 now.
Paul Blavin:Right. So it's going up. We have an epidemic. We have a highly I don't think I assume the APA the people in power at the APA realize we have a crisis in mental health.
Dr. Lipov:Well, they clearly care about.
Paul Blavin:It. And they clearly care about It
Dr. Lipov:just gets me right there. Care. So you know the other part that just came out? There was a study that came it was published in the American Psychological Association, that 2024, the highest suicide rate since 1941. Wow.
Dr. Lipov:World War II started in 1941. That was a little stressed then.
Paul Blavin:Right? Mhmm.
Dr. Lipov:But now we're at that level of suicide, which is mind boggling.
Paul Blavin:Yeah.
Dr. Lipov:So I think the need is to well, the other thing that's cool that I want to kind of view with you is so current diagnostics for suicide is you come I used to be an ER doc, Say, Okay, are you suicidal? They go, no. Okay, we're done. So I'm working on physiologic devices to be able to predict who's going be suicidal. But regardless, the question is if somebody does say they're suicidal, What people, I think, need to know is that their current treatments today, yes, they can do something rapidly.
Dr. Lipov:Yes. Like ketamine has been shown to reduce suicide. Yes. We actually have a paper in submitted for publication that Stella can reverse suicidal thoughts.
Paul Blavin:Yeah,
Dr. Lipov:there are other things potentially can do it, but I know those two can do it. Yeah. So the point is, there is hope.
Paul Blavin:Yes, there is.
Dr. Lipov:As I was telling my mother took her life, and I think one of the things that I've learned about it. You have no hope. Much easier to take your life.
Paul Blavin:Yeah.
Dr. Lipov:At least I've never met anyone who was hopeful and being really suicidal. Right? So getting the hope back
Paul Blavin:Mhmm.
Dr. Lipov:I think if I was gonna name a movement, that would be get your hope back.
Paul Blavin:Yeah, I agree with you. And you haven't even mentioned psychedelics, and we know there's incredible data already. Oh, it's the best. Incredible data.
Dr. Lipov:I think it's great.
Paul Blavin:And it's an example of how regulation has stifled an extraordinary opportunity for the last sixty years.
Dr. Lipov:I think longer And than
Paul Blavin:now it's coming forward. It's bubbling up. And we'll have MDMA assisted therapy, God willing, FDA approved this year.
Dr. Lipov:Solasitabine is not far from LSD Right. Is moving
Paul Blavin:And there was the great study at NYU that had It was a very well structured case controlled study. It had people who were given death sentences. Effectively, were told you have terminal cancer, you're going to be dead in a certain number of weeks or months. And I think close to eighty percent of the cases where they were given proper psychedelic assisted therapy with psilocybin had a dramatic reduction in anxiety. And they're probably
Dr. Lipov:they're going to live longer because
Paul Blavin:Probably, but they also came to grips with the reality of their situation and were able to They reported living much fuller lives for the remainder of
Dr. Lipov:their And impact on the families would be huge.
Paul Blavin:Everywhere, the ripple effect.
Dr. Lipov:No, I agree. And like psilocybin, for example, has no side.
Paul Blavin:And you talk about hope. So like for me, it's very hard to structure a study to show hope better than that study, because you're told like your situation most people's eyes is hopeless. You're gonna be dead in a few And yet with the help of these psychedelics with psilocybin, these people were okay with it. And they came to grips with that. And that is a pretty good canary in the coal mine
Dr. Lipov:for
Paul Blavin:everybody else who hasn't been given the death sentence. But in their mind, they've been told, you've got a death sentence because the pain is so hard. There's no
Dr. Lipov:Emotional pain and physical pain is very hard to separate. It's kind of interesting. So I read the study where they gave people who had a breakup, pain of breakup, emotional, not physical. They gave Tylenol and that helped them.
Paul Blavin:Yeah.
Dr. Lipov:It's like the point is the separation of mental and physical. So I have to tell you one of the books I read.
Paul Blavin:And there is no
Dr. Lipov:story. They're all mixed. It's all mixed.
Paul Blavin:They're connected. Highly. There's a great book called Back in Control. It was written by a really successful spinal surgeon. And he had said that he figured it out, that eventually that there's a direct connection between your mind and your back pain.
Paul Blavin:And so what he told his patients is, Okay, yeah, I can do the surgery, but I know that I need you to do one thing before I do the surgery. So go home, and for the next thirty days, ten minutes in the morning, ten minutes at night, just write. Write anything that's on your mind.
Dr. Lipov:Simple, okay.
Paul Blavin:Rip it up, throw it away. Come back to me in thirty days. If you still have the back pain that you think you need, seventy plus percent of them didn't need the surgery after thirty days.
Dr. Lipov:No, I know that, as a pain guy I knew that. Right. Yep, agree.
Paul Blavin:Yeah, so it's obvious and we could have fear of change and that's costing people's lives.
Dr. Lipov:What's interesting, so back to the APA meeting. So the person who came up with the term PTSD was Frank Hogberg. He came up with the term Stockholm Syndrome, very famous psychiatrist. He's 87 now. So he and General Scharrelli, or Sargent General, in 2013 went to the APA when they were changing between DSM IV, DSM V.
Dr. Lipov:So General Scharrelli was a line officer. He's not medical at all. He was placed in charge of suicide prevention for the US Army. That was a little bit. He and Agberg testified.
Dr. Lipov:They said this causes stigma that kills people. You know what the response was? It does not. And won't change it. You have a four star journal in charge of suicide prevention for the army tells you this.
Dr. Lipov:What kind of data do we need?
Paul Blavin:Well, more importantly, how are you doing no harm? How how
Dr. Lipov:Doesn't matter to them.
Paul Blavin:Well, yeah.
Dr. Lipov:So anyway, so I got to tell you one last thing to close-up on. So I read this book. It's called the the the the it's called desperate measures. There was a history of psychiatry in The United States and global for 200. So my favorite one just shows how crazy we have been.
Dr. Lipov:It was biological or surgical psychiatry, they called it. So it started in 1907 and ended, thankfully, in 1924. So they figured out, so one man figures out that when somebody has a high fever, they see things and hallucinate. And then, so his idea was when somebody does not have a fever, they doesn't have mental health things because there is an infection somewhere. So subclinical infection.
Dr. Lipov:So two places he thought the bugs can hide. Number one, they can hide in, sorry about that, they can hide in the teeth. Number two, in the colon. So when people who were sick, he got they would take out the teeth. And if that didn't work, they would take out the colon.
Dr. Lipov:And he described his son who was depressed, took out the teeth, and it didn't make him feel better. So keep in mind, at that time, colectomy order, taking out the colon, fifty percent fatality rate. And they did it from 02/2007, 02/2024. No. 02/2007 to 1924.
Dr. Lipov:So my point is, psychiatrists had, unfortunately, a very complex history. So I think it's gonna be in this everything happening like physiological monitoring, psychedelics, stellate TMS, all this more physiological measures. I think we actually have got in the prep of a major change in a very positive direction. So back to hence the name, hope. Yeah.
Paul Blavin:There's a lot of hope. There's a lot of opportunity. And we're only gonna be going positively, not negatively. It's can't you can't keep these.
Dr. Lipov:No. We can't continue. It's stupid. Cool. Great to see you.
Paul Blavin:Great to see you. Thank you. Thank you.
