Primary care doctors deliver 75 percent of all mental health care in this country, and most of us were never trained to do it. Internal medicine physician Robert Smith, author of Has Medicine Lost Its Mind, walks the full 2,500-year arc that explains why: from Hippocrates and bloodletting through the scientific revolution that built modern medicine, and the same disease-focused mindset that made physical medicine triumphant is now blocking the mental health crisis from getting better.

⏱️ Chapters:
0:00 Introduction
0:24 What medicine actually got right
1:19 Why primary care delivers 75 percent of mental health care untrained
2:13 Why bloodletting lasted 2,500 years
3:54 The Pope, the church, and the 1537 turning point
5:57 The autopsy room where modern medicine was born
8:21 Osler was still prescribing bloodletting in 1912
9:26 The cornucopia that doubled human lifespan
11:23 What physicians should still be proud of
12:13 The crisis psychiatry has not solved in 25 years
14:38 Why 2 percent of medical school is all the mental health training you got
15:23 What has to change next
16:30 Take home messages

About this episode:
Robert Smith, an internal medicine physician and author of Has Medicine Lost Its Mind, returns to the show to argue that the modern mental health crisis is not a recent failure but the late bill on a 400-year decision. He traces medicine back to Hippocrates and the four humors, the 2,500 years of bloodletting that killed millions including several U.S. presidents, the 1537 papal permission to dissect human bodies, Morgagni's 700 autopsies that gave us clinical pathological correlation, and Osler still recommending 20 to 30 ounces of blood for pneumonia in 1912. He then walks the 20th-century cornucopia, anesthesia, antibiotics, statins, MRIs, organ transplants, that doubled life expectancy from 40 to 80. The same disease-focused mindset that delivered all of that, he argues, is now exactly what has psychiatry stuck. He cites Thomas Insel, former NIMH director, on 25 years of no significant improvement in mental health care, points to the Flexner report locking medical education into 2 percent teaching time on mental and social factors, and lands on what has to change: bringing psychologists into medicine, training vastly more psychiatrists, and actually preparing the primary care physicians who deliver three quarters of mental health care for the work they are already doing.

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