I am not myself lately. Then again, was I ever? I'm not the self I was a year ago, or the one I will be in five minutes. My sense of reality is ephemeral, and my circumstances are constantly rewriting the narrative. My brain wants to make sense of all that, though, so it keeps trying to find order and actualization. But what it keeps writing, as Emory University psychology professor Gregory Berns puts it, is its own "historical fiction."

In his apt and timely new book, "The Self Delusion: The New Neuroscience of How We Invent — and Reinvent — Our Identities," Berns, author of "How Dogs Love Us," explores the neuroscience of self perception and the clever, confounding ways we attempt to tell the stories of our lives.

Along the way, Berns explains the newest science of how memory, perception and influence play upon our pliable minds, and offers insights into better understanding who we are — and who can be.

Salon spoke to Berns recently about how our brains prime us to create stories — and superstitions, how COVID drove us into a "collective existential crisis" and the secret to shifting the tales we tell ourselves.

This conversation has been edited and condensed for clarity.

I was a newcomer to the concept of computational neuroscience. For those who have not yet read the book, what is this discipline and why is it significant in our understanding of the brain?

Computational neuroscience has been around, in some form or another, probably for fifty years. It used to go by different names. It first started out as AI, artificial intelligence, back in the sixties, then went through various iterations. By the time I was in training in the nineties, it was equivalent to what then was called neural networks, which now underlie everything in AI.

AI has evolved from the fifties and sixties style of AI, where people were hopeful that computers could be trained to do things that humans do. It evolved into this area where neural nets were discovered. Originally, these neural nets were based on what we knew about the brain, but then they went off on their own. As we have them today, they underlie what we now know is AI. That's everything from image recognition to self-driving cars.

Computational neuroscience is an umbrella term that covers all of these things, but with a little more emphasis on the neuroscience side, so understanding how the human brain does computations. Then all the AI people take that and put their twist on it and make computer algorithms.

We think of computers as operating like brains, but also our brains work like computers.

That's right. A computer's obviously man made, but it's an analogy. The brain is a type of computer. In particular, I think, along with a lot of neuroscientists, that it's fundamentally a prediction computer or a prediction engine. That what brains evolve to do, which is try to make internal models of how the world works so the owner of that brain can survive and outwit competitors. Or if they're prey, to avoid predators, always just staying one step ahead of things.

The better prediction that the brain does, the better the person or the animal will do. There's been a strong evolutionary pressure to make brains very good at anticipating things that might happen in the future.

We now live in a world where anticipating things has bitten us in the butt, because we also live in this state of heightened anxiety. You open the book by talking about the self that is, at its simplest terms, our past self, our perceived current self and our future self.

What you just described is the beauty of what the brain does. I don't think this is necessarily specific to humans, I think all animals do this to varying degree. It's just that humans overlay it with a narrative on top so that we have a way of putting meaning on things, if you will.

The anticipation bit is not just about what's going to happen. It's the consideration of the world of things that might happen. And not only that. We also have the capacity to look back in time and imagine things that might have been, the what-if scenarios. These are all various forms of predictions that the brain has evolved to do, to help humans in particular flourish in this world.

It feels like the past few years, there has been a deeper understanding interest in this study of the self and self-perception.

Our anticipation is different from the experience, which is different from the memory. Why do we need to have that understanding of that truth and those subtleties of our perception?

I think COVID has put everyone into a collective existential crisis. The last few years has been somewhat excessive navel-gazing about why we're here. Each of us comes to that individually and we each have our own idiosyncratic ways of dealing with that, but the whole conundrum is the curse and the benefit of the human condition.

However it is that we ended up the way we are, we have the skill of conceptualizing ourselves in the past, present and future. It's not clear that any other animal can do that, not in any substantial way. I look at my dogs, and they're clearly conscious and sentient, but I am not sure that they have a conception like we do, that they existed yesterday and they're going to exist tomorrow.

Most other animals don't have the need for this. If you know that you existed in the past and you know that you're going to exist tomorrow, how do you make sense of that? If you think about it, that is a pretty awesome understanding. It requires time shifting, it requires a huge cognitive apparatus to do that.

As I maintain in the book, you also have to contend with the fact that we physically change. Not so much day-to-day, but certainly over the years. If you look back at your childhood pictures, for all intents and purposes, those are different people. They're not the same person you are today. Physically, there may be some resemblance, but the molecules have been rearranged so many times in your body and your brain that it's just not the same person.

So, we have this realization that somehow that person was us at a different time, but they're not us now, and we're going to be different in a year or ten years. We have to construct some mechanism to link all these together. The way we do that is through narrative and storytelling. We have to, just for our own psychological health, construct something that links all these versions of ourselves together. Otherwise, the alternative is completely existential, that there is nothing unifying past, present and future, and the universe is random. Psychologically, we can't handle that.

As you point out, while there are distinct cultural and individual differences, there are also some universal ground rules to the ways we construct these narratives. One we can all relate to is, for the most part, that episodic aspect of it. I don't know any other way to really make sense of my life, but then COVID put us in a very nonlinear narrative.

The analogy I used was like being on a train, where you think of a train ride as a journey between stations, or stops, where not much happens in between. The way you encode it then is the stops, or as you say, episodic.

I think there's a couple of reasons for that. Probably the most important is that our brains do not appear designed or evolved for continuous recording, or at least recalling things in kind of a continuous fashion. Our brains are not video recorders in the sense that a camera is. It seems as if the memories themselves are laid down in an episodic fashion and those episodes are defined by when things happen.

Most of the day, nothing happens. I don't think it's been calculated, but we go through the day, probably 90% of the day is pretty static, and then the other 10% is just stuff happening. That's going to vary from day to day. When stuff happens, when something in the world changes or something changes in you, those are the things that we encode in memory and those are the things that get stored.

When you recall a memory, you can't call up the exact recording of what happened. You have these sparse instances that you can call up. But you still have to fill in the gaps somehow, because they're not just still images, they're highlights. It's the highlight reel of the day, or of your life.

The brain has to fill in those gaps. The thing I've become fascinated about is, how do you fill in those gaps? The best answer I have is that they're built on what psychologists call schemas. Or if we want to be mathematical about it, I call them basis functions. These are the templates that get laid down early in life as children. These are the stories that we hear when we're young, because those are the stories where the child doesn't have many of their own experiences. Not much has happened. Those are the templates for understanding the world, when the parents tell their kids stories.

These are fairy tales and fables and simple stories, good versus evil. These are going to be culturally different depending on where you grew up, but there are some common themes. Importantly, those are the templates that stay with us throughout our lives and help us interpret these episodic events as they happen to us. They provide a ready framework for slotting things into as they come.

One of the things that is universal also is that fine line between superstition and myth-making and straight-up delusion. It's a way of creating pattern more than anything else, looking for explanations and answers in things that might otherwise seem random. Is that another aspect of just our brains needing to create order?

It is. And that's part of the prediction engine that's baked into all animals' brains. The brain is a prediction engine. It's that way because there was, at some point in time, a survival advantage to that, and there still is.

If you think about the alternative, let's say that life is just a series of random events that are completely unconnected to each other. If that were the case, then there really wouldn't be any survival advantage to having a predictive brain, because if things were random, then there's nothing to predict.

The fact that we can predict things is also a reflection of the world that we've evolved in, that there is some amount of order there, certainly not 100%, but there's enough order that brains can extract it. That drives things, even when there is no predictability or causality. It's not like you can turn off the prediction engine; it's always going.

That's where superstitions come from. It's like if two events happen in close proximity to each other, then the brain's naturally going to equate them in some causal way, even if they're not. That's how superstitions arise. Then you can consider superstitions the building blocks of storytelling or fables.

It doesn't take much to spin up a superstition into something quite elaborate. Whether you call it a delusion or to talk about conspiracy theories, it doesn't take much.

That leads us into groupthink and the double-edged sword of living in a social environment, because we need each other, we take our cues from each other. We are impacted in our morality by each other. Looking at this country today, do we seem more polarized, or are we actually more polarized? And what is that in our brains that we can learn from?

We're definitely polarized. I think the question then is why. It comes back to, okay, we humans have to ascribe meaning to events because that is the nature of being human. We tell stories. In this country, we've basically got a series of events have happened. Whether it's COVID, climate change, politics, you can pick any one of those things.

Some things happen, and we can agree on specific events that happened probably because they've been recorded in various forms from the media. But the interpretation of them is vastly different. The thing that's fascinating about all of this is, how can two people have completely diametrically opposite views of what happened? How does that come about? The answer is because they have different basis functions to interpret the events. They have different schemas.

You take January 6th. Perfect example. You've got a sizable portion of the country that looked at those events and interpret it in one narrative framework, one schema. Then you've got a whole bunch of other people who interpret it entirely different, and they're operating on different schemes. They're different narrative basis functions.

The book is called "The Self Delusion," but you later more deeply describe it as the "self historical fiction." What does that mean when you say that our concept of the self is historical fiction?

It means that the interpretation of our past. Self-identity comes from the story that you tell about your life, which is the historical part. But it is a story. I hope to convince the reader there isn't just one story for anything. That story is one that you choose, and you have the capability of telling in different ways.

In that sense, it is fiction. The story you tell yourself is a sort of fiction. It's almost a delusion. The story you tell about yourself to other people is probably a slightly different version, so that's a different fiction. This goes on and on.

I hope to convey in the book that the stories you choose to tell, we have control over that to some degree. Actually, the best way to shift your storytelling, if that's what you want to do, is by controlling what you consume. Because as we were just talking about, a lot of this is influenced by what other people say. Our brains are very good at mixing up things that happen to us versus things that happen to other people. The provenance of our memories gets all muddled.

And it's harder to be that selective when the algorithm is constantly guiding us and pushing us. We are very vulnerable to influence.

That's right, we are. And so, if you want to be a good curator, then you need to be careful about the types of things that you consume from other people, because that will heavily influence your own thought processes.

"I'm obsessed now with just hearing women's doctor stories," says Anushay Hossain. "Everyone has one."

The author of "The Pain Gap: How Sexism and Racism in Healthcare Kill Women" definitely has her own. After growing up in Bangladesh, the writer, podcaster and policy analyst felt "relieved" to be delivering her baby in the nation with "the best healthcare in the world." Instead, she almost died in childbirth, an experience that left her shocked at how ineptly her medical team had handled her pain and symptoms — and how uncharacteristically compliant she'd been in her vulnerability.

It was an ordeal that led Hossain to delve into the ways in which women are treated (and mistreated) in the American health care system, and "how misogyny in medical practice profoundly impacts women's health."

As she reveals, it's not about that one insensitive, inattentive doctor here and there. It's about the institutionalized forces that deeply influence how we treat heart disease, chronic pain, COVID, and every other physical condition that impacts women's health.

Salon talked to Hossain recently about why these inequities persist, why they're even more glaring for women of color — and what we can do, systemically and individually — to close the pain gap.

This conversation has been lightly edited and condensed for clarity.

We cannot ever truly know what someone else's pain is. But you start out very early talking about pain that is unique to women.

Gabrielle Jackson, the author of "Pain and Prejudice," said something so true, which is women's that pain is at once expected and denied. It's like they expect us to have this really high threshold, but then they don't believe us when we say that we're in pain. What else is really interesting is that in addition to the pain gap, there's a credibility gap. There's a knowledge gap. Women don't have any credibility, and it's not just about pain. It's about our health. It's about our bodies. It's amazing what women don't talk about, and the stories they keep to themselves.

Where does that come from? Does it come from the fact that we're just so used to dealing with a patriarchal system regardless of who is working in healthcare, regardless of the number of women who are doctors, because the system is still patriarchal inherently?

I don't feel like the onus should be on women, obviously. But then there is a lot that we can do and a lot of things that are changing. I grew up in Bangladesh and I was just taught, you just never question the doctor. You definitely don't question a white man. Even after 25 years in America, the power balance is so off. This is not an anti-doctor, anti-medical establishment book. But I never knew that you have choices and that you can literally deny anything, refuse anything that you want, and you can switch doctors. You don't have to stick with them.

Another interesting thing that I've seen with women is we really do try to be the perfect patient. A good student, the perfect mother.

We want to be good at being sick.

We approach our healthcare as though the most important person in that team is the doctor. But your healthcare is actually a team effort, and the most important member of that team is you. And we never give ourselves that authority. We will say, "I feel like this," and the doctor will be like, "Oh, it's probably in your head." And most women are like, "okay, maybe."

Almost every woman has been told that it's all in her head or she's imagining it, and almost every woman was never imagining it. It was almost always something like endometriosis or cancer. This is another thing I would really like to just make as a public service announcement. Women are not going to the hospital or to the doctor and just making stuff up. I'm sure there's the odd one off, but most of the time, by the time we're at the hospital or at the doctor's office, we're not there to just make crap up and waste everyone's time. We have a lot to do. We're really busy. We really don't have the time to just like go to the hospital, make some s**t up. It's so offensive. It's so offensive and condescending.

I wonder if part of that is because our bodies are not well studied. They are not as well documented.

It's infuriating to me, the standard of health in America is a middle-aged white man. And it hasn't improved. We have studies showing that women are still not being included in trials. It's dangerous. When they released Ambien, everything was great, and then women started having a lot of side effects, getting in to car crashes, and they found out that women take longer to digest the medicine.

About like 75% of people who suffer from chronic pain are women. But the tests are done overwhelmingly on male mice. There's even a mice patriarchy. My favorite example is heart disease, because we really think of that as a male disease, and it's actually one of the leading killers of women in America, and black women especially. We imagine heart attacks as a man holding his chest like this dramatic heart attack in a movie, but women experience it really differently. We get nauseous, we get pain in our necks. If you have in pain in your neck and if you're 55 and older, you're actually seven times more likely in America to be dismissed from the hospital mid-heart attack.

Tara Robinson works for the American Heart Association now. She's an advocate for them. She had three heart attacks in 48 hours, and the third time she went to the hospital, she was like, "I am not leaving." They kept sending her home like, "You're fine." Then she was like, "You don't understand the pain that I am in."

You also talk about violence in the book. Violence is a health issue. I am constantly amazed, when we talk about healthcare, that we talk almost exclusively about sickness.

We never ever think about violence against women. It is a healthcare issue. They're calling it the shadow pandemic, because obviously it's just skyrocketing. Everything we do to isolate for COVID, self isolation, social isolation, lockdown . . . Imagine for a woman in a domestic violence situation or in an abusive relationship. Those stories stayed with me the most. Some nights I just couldn't go to sleep because it just made me think that there's such a gendered impact of COVID. It's also how intimately women experience the pandemic. So intimately, you couldn't even imagine.

I just can't imagine being beaten, abused, then isolated from your family. Wherever you go in the world, still it's happening. Domestic violence, forget that it's not being treated as a health issue. We still don't think that it's an issue that should be public. I feel like that silence is the biggest thing. We don't see it as a health issue, but also people are still hesitant to get involved.

Women are scared to ask for help. One woman I interviewed was like, "I was so scared," because any time she coughed or anything, her abuser would get really, really mad. He wouldn't let her out of the house. She was so scared that he was either going to kick her out or he was going to beat her to death. At the peak of lockdown, people thought that if you were just out on the street, you would die. There was a period where people were just not leaving their house.

A big thing around violence is more women have to say it. It is a health issue because the people who are killed the most in America through domestic violence are women and pregnant women.

I interviewed Shannon Watts from Moms Demand Gun Action, and she said what makes it so dangerous in America, more than any other country, is the access to guns. At one point in the pandemic, when they started opening things up, guns were deemed essential businesses. Gun stores opened up. I still can't believe that. And then of course these men are already under financial stress of the pandemic. They're buying guns, they're going home, taking it on their victims, on their partners. So many experts also said in the book that they're seeing more extreme wounds in domestic violence victims during COVID. Gun wounds, cigarette burns, all these things. It's a health issue, and we need to say that. We need to say that more.

Violence doesn't exist in its own lane. We think of violence as existing purely within the legal system and the judicial system and the justice system. We don't discuss it as within the medical system.

And violence against women, domestic violence, even rape, even today, is seen as the woman's fault. Rape culture is real. And what is rape culture? Every time I say this, people think I'm talking about like a culture that endorses rape. That's not what it is. Rape culture is when we blame women for men's sexual violence. We still do it. We might not say, "What were you wearing?" anymore, but we'll be like, "Oh, she was drunk." Or, you know, this, "What did you do to put yourself in that situation?" And women do this, too.

That's another thing that the book calls for. It's a cultural shift that we need. And one of the most radical proposals in the book is, can we believe women? Believe women.

You discuss in the book a new Marshall Plan. Tell me what that means.

Reshma Saujani, who founded Girls Who Code, has a whole movement around it, The Marshall Plan for Moms. We should give moms like $2,400. We should build back moms until they can rejoin the workplace. They can be at home, but they need money. 875,000 moms left the workforce summer of 2020.

America's fallback is women, unpaid labor, overworked women. The moms are not okay, and nobody gives a s__t. No one is coming to save us. It's crazy. We're burned out. We're overworked. It's going on and on. And nobody cares. It's so traumatic, and people don't realize what we're going through. I was just thinking about how we keep framing this in the news as a pandemic of the unvaccinated. Well, what about these kids? We're all like, "Oh, we have a vaccine for everyone," but it doesn't include the youngest children and pregnant women. Who are we? I just think it's crazy that nobody wants to know about it. And it's the moms' problem. Can you imagine what it's like when you know you can't protect your child, and then they get sick? I feel like it's because America doesn't value caretaking, and everything is falling on unpaid labor of women.

Meanwhile, we're getting sick.

That's another thing. Women's health is not an enigma. Where the F is the research? We have the money, we have the resources. Look at the controversy around insurance coverage for birth control and whatnot. We won't even get in to abortion. But do you know that insurance covers Viagra? Penis pumps?

There's the idea that our bodies are public property and are up for discussion, which is why then when we enter a healthcare situation, of course we feel disempowered. Of course we don't feel any agency, because we're used to having people who have opinions about our bodies tell us those opinions all the time.

All the time. Without bringing the whole abortion thing in, but just look what's happening with abortion. In the year 2022 It might be overturned. How is this happening in America? In the '60s and '70s, what were women saying? We can't be free without reproductive freedom. Reproductive justice. Reproductive control. Now it's happening again.

What really bothers me is that America was so instrumental in bringing these choices to women around the world. The UN Conference on Population and Development in the 1990's, initially started out very racist about population control. How did they intervene? They were like, "Oh, if you give women access to contraceptives and high paying jobs, guess what? They don't want to have 10, 12 kids and die by the time they're 20. They will actually choose to have smaller families themselves. Everybody benefits." We already have the data on this, and America's going to go backwards.

Tell me what we can do as patients in those dynamics that we are dealing with. How do we have that agency for ourselves as patients? We have to change ourselves.

We can change ourselves. The default now is not believing women, immediately. So I just ask to flip that. Just give her the benefit of the doubt and see where we go. That's the cultural shift that I'm asking for. Not only to believe women, but believing women of color who really have even less credibility. The other thing, and I really hate recommending this, but apparently it's very effective. Even Maya Dusenbery in her book "Doing Harm" said — women have said that when they bring in a male friend with them. The doctor is more likely to believe you. I wanted to say, bring a girlfriend with you, bring somebody with you. But apparently if he has a penis, it's more effective.

Because people, not just men, but women, hear men's voices.

And also do a lot of research. I think we also expect doctors to be magicians. Now you can be like, "No, this is my blood work. This is my family history." Research the provider. Read the reviews. Just like for everything else, when you're prepared and you've done your homework, you're more confident. You can ask more informed questions, and everybody benefits.

Something happened with my dad's endocrinologist, where he was like, "Oh, I don't know the answer to that." He had to do a little Google, too. I never thought about how hard it is for doctors to say, "I don't know." I don't think they're allowed to say that or encouraged to ever say that, and that freaks everybody out. But it's been happening a lot in the pandemic because nobody knows. We're all learning. I never even thought about that, because they just have so much power.

"I own me." This sentence, comprised of three short words, seems inarguable. But when attorney and author Faith Jones says them aloud, as she does in her 2019 TED Talk and in her new book, "Sex Cult Nun: Breaking Away from the Children of God, a Wild, Radical Religious Cult," they symbolize a lifetime of experience, learning and healing.

Jones was born into and raised within the powerful Children of God, later known as the Family, a religious group founded by her grandfather David Berg. She, like her parents and everyone else in their peripatetic community, was expected to be obedient and to distrust outsiders. It was, perhaps inevitably, a climate rife with abuse and exploitation. That Jones struck out on her own, attending Georgetown University and eventually becoming an attorney, is a testament to her internal strength and resolve. That she has since made it her mission to empower other women to similarly claim ownership of their lives is remarkable.

Salon spoke to Jones recently about her memoir, and her lessons in creating healthy boundaries and recovering from the unimaginable.

This conversation has been edited and condensed for clarity.

I want to start with this mantra of yours, this mission of yours, that you discuss in the book. What does it mean when you say, "I own me?"

"I own me" is recognizing that I have a property right in my body. My body is my sole property, which means like other property, nobody gets to tell me what to do with it. Without my express permission, nobody gets to access it. Nobody gets to enforce their will on me without my willing, free, unpressured permission. To me, that was such a revolutionary concept because I had grown up being told directly my whole life that my body was not my own. That it belonged to God, but really they meant it belonged to the group, and they got to tell me what to do with it. When I figured this out, that was the key for me to understand what had gone wrong in this group and in so many of these organizations, whether religious or family or governmental, where they try to take away our right of ownership in our body.

The way that you discuss the difference between what you were told but what your gut was telling you is something that not just people who grew up in cults can relate to. Being told that what you feel is not right. "Don't trust yourself, we're going to tell you what you feel." Talk to me about how you came to that understanding, and the people along the way who helped you trust yourself.

Learning to trust yourself is a continuing journey for all of us, especially for people who've experienced abuse and exploitation. That's one of the hardest lessons that we have to come to terms with, trusting ourselves. That is one of the reasons why this framework is so powerful because I believe it gives us the tools to understand and to trust that, if I'm feeling pressured, if I'm feeling a certain way, then I already know that's a red flag, that this is a violation. Something is happening here.

That's critical, because we're so used to being told that what we feel isn't true. So we try to keep trying to dismiss it instead of accepting it. One of the biggest issues we have is creating healthy boundaries when you've grown up without having boundaries, or when those boundaries have been violated. That's really what this framework is about — helping us who are recovering, but helping society in general, because these are the foundational principles of all society.

Later on in the book, you step back and look at your parents to get clarity on where they were coming from — because of what they brought to their parenting experience in this really, really strange environment. To see these patterns and where they come from, and to know that they don't come out of nowhere is important. How do you get to that place, though? Particularly for those who are survivors — to distinguish between understanding and distancing — because you've had to set those boundaries.

I've been on this journey of healing for many years, and there were certain things that were key turning points for me in that. One of the things that I read was Alice Miller. She's a psychologist, and she wrote a great book called "The Drama of The Gifted Child" and other work like that, where she looks at the effects of this type of abuse and where it comes from and how it persists generationally. Oftentimes abusers are people who have also been abused. That enabled me to take a step back and look at that, and say, "I can see where they're coming from, but I don't want to continue that pattern." That is the key responsibility of each of us, to step up and say, "Okay, I see what happened. I see my parents and the maybe abusive patterns that they had. It probably came from their parents and so on, but I am my own person and I get to step forward and say, it stops here. I get to work on the change in myself."

Writing this book, I spent hours interviewing my parents and other people to make sure my memories were accurate and details were correct. That was one of the interesting things I learned writing this book, just hearing more of the background stories to some of these things that happened. It gave me an even clearer understanding of things that I didn't really understand about them, their past experiences, what it was like for them in the moment they were going through. For instance, with my mother had basically left me for two months when I was a baby.

I was like, "How could you do that? How could anyone do that to their baby?" Understanding what had happened to her and how she had been threatened she could lose me if she didn't submit to this helped shift my mindset. Oftentimes, we're trapped in the narrative we know. Taking that time to explore it more can also bring us a kind of release because our reality is our story, the story we tell ourselves.

Your story is so unique, and yet, the scale was shocking to me. The number of people involved, the global scope of it, was huge.

Yes. Something like over 10,000 members, but thousands more moved in and out of the group over forty, fifty years. But it's much bigger than that. I talked to so many of my friends, men and women, who grew up in normal society and many, many have experienced child sexual abuse. Many have experienced some form of sexual assault, rape, sexual harassment, control. So many have experienced abusive beatings from their fathers or father figures.

The cult didn't start this. The cult took things that existed in society and it created a microcosm and an isolation and a validation that allow people to take it more to an extreme. But this stuff exists throughout society, which is why I'm so passionate about saying these are the principles we need to get really clear on and understand. That's the only way we can kind of inoculate people against these type of cults and anywhere in society where we say, "Hey, are they trying to get you to give over your body, your free will? Are they using manipulation? Are they trying to get you to give over your creations and saying you don't own this? Are they violating these principles?" Red flag, right?

People involved in these cults at the higher levels, or involved in these power dynamics in abusive relationships as the antagonists, don't see themselves as villains. The question that a lot of people reflexively ask of the victims or of the survivors is, "Well, why did you stay?" without understanding the escalation. Without understanding, "This was also the person who was caring for me. This is also the person who I was dependent upon." That's a crucial element, whether it's a cult or a marriage or a job.

You said something really important. These people don't see themselves as that. In fact, they see themselves as very, very good. "I am this great, good person. I am this prophet. I am hearing from God." They have this vision of themselves. Most people in the world, they don't see themselves as bad or evil, even murderers and serial killers have this vision of somehow, "I'm doing this for a greater, a better, higher purpose." Which is why you need a standard and principles. Because when you can take it, you can say, "Hey, I'm hearing from God, and God tells me to do this thing." If it's a violation of one of these principles, you already know, I'm in the wrong boat right away.

What happened to my mother, for instance. She joined this group. It wasn't a sex cult when she joined. It was this biblical missionary group that was out to save the world. It demanded extreme sacrifice and loyalty from its followers. But the sex stuff came in quite a few years later. It was seeded in slowly into the indoctrination of the people by my grandfather. He didn't just change overnight. He presented all of these letters, preparing his followers' minds over a year to get them into a place, prepping them for this.

I interviewed cult survivor Daniel Barban Levin recently, and he said, "Nobody joins a cult. They join a group of friends." Nobody signs up for an abusive relationship either. Nobody says, "I'm going to start a relationship with this person because this seems like someone who will really, really hurt me."

So let's talk about those principles. Whether you are in a group or in a one-on-one relationship, there are some of these red flags that you need to be thinking about and have top of mind.

It's first stating, "I own my body. It's my sole property." Therefore I own what I create with it, whether it's my services or products or invention. And then once I create something — and this is a constitutional right — I have the right to contract. I have the right to make a deal to exchange.

I think one of the main things that gets violated is there are five elements of any good exchange or contract. One of the main elements of this is something called no undue pressure. Because what is blackmail? It's blackmail when you apply undue pressure to somebody. For instance, in the group, I was subjected to pressure to have to have sex with other members where I really didn't want to, but I was told that I had to for God, or to avoid punishment basically.

When you coerce somebody into doing something through either implicit or direct threats, that is not a free choice. That is not a free exchange. You violated one of those principles. In that particular case that could even be considered rape. And then the final element is the effect. What is the impact? How much responsibility do I bear for impact beyond my direct control? My grandfather, how much responsibility does he bear, not just for the children that he molested himself, but for espousing those ideas in such a way that other people did that as well.

So that principles, and the red flags are: They put it always in very noble terms, that your body is for service or instead of saying, "You own you. You get to choose. You have free choice, and as long as your choice is not violating other people's rights, that's fine." Nobody gets to tell you who you are and what you need to do. That is your choice.

There's another thing, how vulnerable you make yourself in this story and your realization that, "What happened to me, that's called rape." For a lot of people, when they have that dawning, it's not necessarily because someone has jumped out of a bush in a dark alley. It's well after the fact. It's so important for someone reading that to understand that's often what it's like.

I think that's true. I think people who experienced child abuse are the same, they don't realize it until much later what happened to them and what was taken from them. As to how I get through it, there's a few resilience techniques which really helped me to come through it in a different way, that I used without realizing what I was doing. But also I didn't just sit around. I went after healing and happiness like a bulldog.

I was like, "I'm not going to suffer. This is not what life is for. Life is to grow." So yeah, bad stuff happened to me and I'm going to figure out how to heal in myself. That's what I did. I talk about some of the most powerful techniques that I used to heal and to recover. I wrote a guide for women called, "I Own Me." Talking about those experiences, talking about this framework and how learning to see ourselves and our bodies in a different way, really helps. There are certain psychological techniques that I used. I was helped with therapy to do certain healing processes that really helped to clear out I think some of the residual trauma locks that were in there.

Even after recognizing what had happened to me, I did not think of myself as a victim. That wasn't the role I wanted. That wasn't the part I wanted to play. I could say, "This bad thing happened to me, but here I am taking control of my life. This is my life now." I wasn't going to live in that story. I didn't talk about it all the time. In a healing process, it's one thing to bring it up and go through it, which you need to do, to access it. Some people don't do the healing because they're too afraid to access it, but you don't have to keep living in that story. You get to write a new story. And that's what I decided.

Going back and writing this book was tough, because you don't only have to write your most painful experiences once. You go over them a hundred times because you edit them and then edit them again and then edit them again. Every time I was like, "Oh no, I do not want to read that chapter again." I wouldn't have done it if it wasn't that I had a bigger purpose in this. This is really just a vehicle to express what happens when we, as a society, as a group, as individuals don't have clarity on what are these fundamental principles of human integrity.

What's the phrase you used? "Twenty-three years of in indoctrination doesn't disappear in an instance." I love that line, because it's true. Tell me a little bit about what it looks like now that you're doing this work and you're living within your own identity now.

The thing is, I think we get to change identities. I've done it a number of times in my life. We get to write our own story and our identity. When I initially thought about writing the story, I had thought, "We just had such a crazy life, it would be kind of interesting to write the story." I was more thinking of it from a perspective of wanting to show people who didn't have much that they could still achieve and do well. I became a lawyer and I work for some of the top law firms, and I wanted them to show them that path didn't have to be their story.

But as I grew and developed and healed and learned, I created the framework and began this journey of writing this book. All of these stories that I didn't think I was going to tell or write, especially not in such detail, were really the story that needed to be told. Even now, it's daunting because I've always been a very private person. But I think if it can help people to reconcile some of their own experiences, then it's worth it to me.

At the end, you make it clear that the other members of your family have made different choices and gone on very different paths. There isn't just one story from an experience like this, you can go in so many different directions from it.

That was why I tried to really stick to my story and my experiences, because each person who goes through this is affected differently. Each person has their own journey, their own story. My own family members, fortunately are all in their own stages of recovery from this, but they have learned and grown. My parents have as well. My mother, when I taught her this framework, had a lot of really good conversations. It gave her a lot more clarity on what had happened to her in the family. what some of those practices were, clearly defining what was wrong with them. When you don't have that framework in your mind, it's going to be hard to define exactly what was wrong.

Until you have the language to really articulate your experience, it is very, very hard to identify it. That's what this book is about. It's a very personal story, but it is also a guide for other people who are looking at their experiences and going, what is the word for this? What is the language for it?

This is why I want to get these principles taught in schools and to young people and in colleges and to people who've experienced abuse, because it does give them the language to express themselves. To say, "No, this is not what I want." To have a conviction that they are right. And also to say, "Well, this happened to me and it was wrong because..." It gives us the language to communicate about these topics and even gives us the language between men and women to communicate about these topics in a way that men appreciate. It allows us to talk about it. I think that's very important, whether it's in the corporate environment, talking about sexual harassment, but also in our schools, to teach children these principles so that they have the words.

What do you hope now for this book? Where do you want to see this book go in terms of who's going to read it and who's going to learn from it?

I hope that each person who reads it, if there's somebody who suffered some kind of abuse like this, that it can give them strength and insight. And if they haven't, that it will give them insight into what other people go through and then understanding perhaps things that have happened to friends or relatives. I hope that this is a door and a gateway to helping us to have bigger conversations about this stuff, particularly things like child abuse.

I think women and sexual harassment, while this is not solved, it's been brought much more to the forefront of human consciousness. But still a lot of stuff about children and how they are treated as property is not really discussed I think in the way it could be. My own personal work I'm doing now is both to help people achieve emotional independence and freedom through understanding these principles and other types of techniques.

A big part of what I am teaching now as well is, how do we create economic stability and freedom? My mother left the group for a while when I was a child and we were basically homeless for some time. She couldn't support us. So often the reason that people stay in bad environments, relationships, controlling groups, is they don't have a way economically to care for themselves outside. You both need to have the emotional freedom and understanding of what is true, and then you need to have the economic tools to be able to take care of yourself. Those are the two pillars that I'm working on, helping to share with people who are coming out of experiences like this.

"Some diseases are immutable facts," says Suzanne O'Sullivan. But from there, it gets complicated.

The Irish neurologist has spent a good portion of her career exploring the confounding and often controversial terrain of physical symptoms that seem to defy explanation. In her previous book, "Is It All in Your Head? True Stories of Imaginary Illness" she looked at psychosomatic illness through the lens of individual cases. Now, in the fascinating follow-up, "The Sleeping Beauties: And Other Stories of Mystery Illness," O'Sullivan travels around the world to explore mass cases. From a group of near-catatonic refugee children in Sweden to an upstate New York town besieged by a media-labeled "mass hysteria," O'Sullivan looks at the political, social and cultural contexts of these apparent "outbreaks," and asks what we can learn from them about how we talk about illness.

During a recent Zoom chat, Salon spoke to O'Sullivan about the liminal enigma of the mind and body connection, and why getting a diagnosis is vastly different from truly understanding — and treating — what's going on inside. As always, this conversation has been lightly edited and condensed for print.

Tell me first, what is a psychosomatic illness, and what does that term mean? There's a lot of stigma and confusion and apprehension around giving certain symptoms or conditions that designation.

Labels and names are a real problem here, because we all mean different things by them. Psychosomatic disorders traditionally defined as real physical symptoms that are thought to have a psychological cause, or at the very least, are not known to have an organic cause.

A lot of people have the sense that "psychosomatic" means that every symptom must be due to psychological distress or this Freudian idea that it all dates back to a single moment of horrible trauma in your life or to your childhood. I certainly, when I use it, do not mean it in that way.
I'm talking about physical symptoms that arise because of some sort of glitch in the cognitive processes that make up the mind, and that can sometimes occur through trauma and childhood things, but can also happen for hundreds of other reasons. I'm not talking about, necessarily, stress or psychological trauma-induced symptoms, but rather, symptoms that arise mostly in the cognitive processes of the mind. I think most people now dispense with "psychosomatic" because it's so prone to being misunderstood.

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There's a misunderstanding that it means it's, quote-unquote, "all in your head."

Precisely, or that you're making it up. Even worse, that you're making it up or that you're faking it. The point about psychosomatic conditions is they are biological conditions, like anything else. If you have a symptom that shouldn't be there, if you have a disability that shouldn't be there, it's biological. The distinction we make between a psychosomatic disorder, due to real biological changes, and a disease, is due to pathological. So psychosomatic conditions arise out of physiological changes and diseases arise out of a pathological changes.

That gets complicated because there is a sense, certainly in the Western world, that there has to be a very clear-cut designation between something as physical or as psychological. There's very little space in between. Yet you found things that dispute this. There's a phrase you used, that the presence or absence of disease are not immutable ideas.

Some diseases are immutable facts. If you have diabetes, if no one ever finds out, or if no one ever measures it, you will still get sick with it. Some diseases are facts and, at present, you don't have to describe them or name them for them to have an effect.

Illnesses are different. Illnesses are, to a certain degree, cultural constructs. An illness is a perception of how one feels. And to a certain degree, around the edges of illness in particular, your society and your culture tells you what is an illness and what is not. If we use the example of depression, some cultures would consider depression not a medical disorder, but a situational phenomenon. In Western medical cultures, we might be more inclined to label someone as having a brain-related problem causing depression, or we will equate depression with hormonal or with neuro chemical changes in the brain, for example, whereas another community might prefer to consider it situational.

I feel that in Western medicine, we think because we write all these things down in big books and give them technical names, that we have superiority in that, of medicalizing bodily changes. It's very difficult for a doctor to say when high blood pressure becomes pathological. Obviously, high blood pressure is a disease, dangerous, needs to be treated. But in a room somewhere, a group of doctors are deciding whether you have normal blood pressure or high blood pressure and they're picking the number — not arbitrarily, but a little bit arbitrarily.

If that's what they have to do with diseases like high blood pressure or kidney disease or osteoporosis, imagine how hard that is to do in the field of mental health sciences, to decide what behavior we're willing to accept as normal, what behavior we think is too much and we're going to give a disease name to. I fear that in cultures that rely on Western medicine, we're pushed very strongly in the direction of over-diagnosing disease, for many social cultural, practical reasons. I'm not sure that we are superior to other cultures in the way we deal with mental health problems.

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There are a couple of things that I think of when you talk about that. One of that is over-diagnosis can lead to over-prescribing, medicalizing. And then what happens, in particular, to our younger and more vulnerable?

Much is said about pharmaceutical industries and over-prescribing and people making money out of illness. I suppose I'm worried about something that people talk about a lot less, and that's the way that people embody disease labels when you give them to them.
If we decide that something has passed from being within acceptable, normal limits into being a medical problem that deserves the attention of a doctor, then a person becomes a patient. And what do they do? They begin looking for other features of the label that they have been given. People can begin to then take on features of that label by searching for them. Our bodies are a mass of change and white noise, and we all have good days and bad days. If we're given a label through which we can explain these things, we can begin accumulating new symptoms by paying extra attention to our bodies.

I'm a neurologist, I run straightforward clinics for things like epilepsy, brain diseases. But a huge number of people who come to see me will have what would have once been called hysterical seizures, now are called dissociative seizures, but they're psychosomatic.

What's happened to these people is something like, for example, they're on a very busy train and they faint. What happens in a lot of faints is people shake. The other thing that happens in faints is that someone nearby is a first-aider, and says you had a seizure. Suddenly this young person has been told they had a seizure on the train, then they go to a casualty department for a very junior doctor who doesn't know anything about seizures, tells them they think they have epilepsy. Then what happens before they make it to my epilepsy clinic is that they begin embodying the epilepsy diagnosis by looking on the internet, to see what else is associated with epilepsy, by joining communities who are affected by this. They begin with one symptom, which is dizziness and collapse on the train, and they've accumulated ten more symptoms by the time they get to my clinic.

I'm not saying everyone does this. This is just something that some people do. And it' effect of labeling is that we embody the identity of that diagnosis and take on new features, which can lead us into chronic disability. I think people don't realize how dangerous labeling can be.

Let's get into this. For instance, let's say you are a woman and you have pain within a medical system in the West that doesn't understand women's pain, doesn't take it seriously, or then immediately says that it's psychiatric. We can see how this culture, then, of people who are eager to create a diagnosis and then eager to, well-meaning or not, exploit that can arise.

I think people like to blame pharmaceutical industries, but we should all be looking a bit at ourselves — me as a doctor, but also me as a patient, because a successful consultation for me is one where the patient leaves with a diagnosis, with a treatment and they're delighted with exactly what I've offered them.

A difficult consultation is one where you have to say, "Well, I don't think this is actually necessarily a medical problem." People like to be told a specific diagnosis so that they have information that allows them to know about prognosis and where they should go for help. It's easier for me to give a diagnosis. So we've entered into this collusion between patient and doctor where it is in everybody's favor to label things. Unfortunately that has long-term consequences that we don't properly think through.

When you have an answer, you have a path forward, you have a potential remedy, as opposed to, "Maybe I can work on my symptoms without ever getting a diagnosis."

It's important for me to say that I'm probably more than anything here talking about the fringes of some of these diagnoses. I want people with severe depression to get a diagnosis of depression, get the appropriate treatment. I'm really talking about where it's all a bit more uncertain, and it's much easier for a doctor to over-diagnose and under-diagnose. No one can argue severe depression is extremely serious and needs medical help. But it's in that very borderline area, over-diagnosing depression can have long-term implications for a person, first in the embodiment of the identity of being a depressed person. It'll never leave your records and it will never probably leave your unconscious identity, either.

One of the things that you were speaking to in this book that I think is important, is this idea of, instead of just embodying a diagnosis as a permanent state, can we think of some of these things as transitory?

I don't want to be depriving people of help. That's what we use labels for, is we use them to help, so people know where to go to for help. What we should be able to do is to develop strategies for helping people that don't require us to give people chronic disease labels. It should be possible for someone who's depressed or feeling very low, without being told that they're depressed, to have a place to go where they can talk and get support without necessarily needing the label.

Again, this doesn't apply to everyone. Some people are greatly helped by understanding the biology of what's happening to them and getting a disease label. But there is undoubtedly a segment of people who are made worse by being given a chronic disease label.

I think in Western societies, where we're very individualistic. We're expected to support ourselves, we don't live in big family groups like other cultures, we're less spiritual than we used to be, people are less inclined to turn to a spiritual leader for help. Again, I'm not advocating that these are the right ways, there's no right way or wrong way. But one caring institution that's always there is your doctor. If they are our caring institutions and we have to have a disease label to be allowed to go there, then this is what happens. There should really be methods of caring for people and giving them support that doesn't require us to give them chronic disease labels. Because unfortunately I think medicalization is not always very good for people's identities.

Looking at this book, you explore these serious physical manifestations of intense experiences happening across the world and how differently they are looked at and approached. What do you wish that doctors in the West knew about what you've seen traveling around the world?

One of the conditions that I came across that I just thought, really found very inspiring, was a condition called Grisi Siknis. This affects the Miskito People or indigenous people of the Mosquito Coast in Nicaragua. It doesn't exist anywhere else in the world, it's specific to this group of people. It manifests seizures and manic behavior; its literal translation is, crazy sickness.

People who exhibited these exact symptoms in the West would probably find themselves referred to a psychiatrist, which isn't necessarily a route that works for everyone with these symptoms. In fact, these symptoms only get better about 30% of the time in the West with psychiatry, 70% remain chronic.

But what happened within the Miskito Community is, developing these symptoms, there was a sophisticated language that said to the community, "I need help." What happened was that the community rallied round. If you had these symptoms in the UK or the US, you'd probably stay at home all day and you wouldn't want to be seen, and there'd be no community response. So this was a way for people to ask for help and to get community and support. Then there was a ritualized treatment involving a traditional healer. It was highly successful treatment, and it is understood by the Miskito Community that this disorder is caused by a demon or a bad spirit. The ritual drives away the bad spirit. I think a lot of Western people hearing that will say, "Oh, superstition," negative things like that.

Actually, when anthropologists and people who have lived in these communities have examined it more closely, they can see that it's, in fact, a highly, highly sophisticated, complex, problem-solving strategy used by the community. It's a way for young women to say that they need support and that they have a problem without having to be explicit about what the problem is. They're just able to ask for help without facing judgment, without having to be specific. It guarantees a nonjudgmental community response. That's beautiful, really, because they get better, whereas people with these sorts of problems in Western communities who are medicalized struggle to get better.
I don't know yet how to translate that into my own medical practice. I'm not a spiritual person, but I'm traveling around the world, meeting spiritual communities who are doing a great job of supporting each other and actually making people better. I have to consider how I can incorporate that into a scientific medical practice.

I think part of it is understanding the language of the symptoms. What is this person trying to say by expressing it in this way? What does this person want? And responding to the symptoms in that way, but also encouraging this idea of the community response, rather than shutting people away when something distressing and potentially strange is happening to them. I think there's something in the ritual to getting better, to be understood. It may be right for some people that we take a really Western medical approach of physiotherapies, psychological therapies, psychoanalysis, whatever it might be, a Western medical approach. It may be however that, for some people, we need to understand, communicate through the metaphor of their symptoms, figure out what it is they want and try and help them to get it.

What do you hope for the future of medicine?

What I hope is that it is possible for someone to ask for help without being categorized in a particular way.

I think it's particularly problematic in schools now because, it's very easy for a child to take on a label when they're in school. There are very many advantages to it, because people get help in exams or the school gets more funding or they get more teachers. It is very easy for us now to label our children who are struggling.

I would want a child to be able to say, "I'm finding it really difficult to get help," and we should be able to give the funding and give the help and support without giving the medical diagnosis. I'd really love to see us cutting down on our need to medicalize and biologize every human experience.

"Some diseases are immutable facts," says Suzanne O'Sullivan. But from there, it gets complicated.

The Irish neurologist has spent a good portion of her career exploring the confounding and often controversial terrain of physical symptoms that seem to defy explanation. In her previous book, "Is It All in Your Head? True Stories of Imaginary Illness" she looked at psychosomatic illness through the lens of individual cases. Now, in the fascinating follow-up, "The Sleeping Beauties: And Other Stories of Mystery Illness," O'Sullivan travels around the world to explore mass cases. From a group of near-catatonic refugee children in Sweden to an upstate New York town besieged by a media-labeled "mass hysteria," O'Sullivan looks at the political, social and cultural contexts of these apparent "outbreaks," and asks what we can learn from them about how we talk about illness.

During a recent Zoom chat, Salon spoke to O'Sullivan about the liminal enigma of the mind and body connection, and why getting a diagnosis is vastly different from truly understanding — and treating — what's going on inside. As always, this conversation has been lightly edited and condensed for print.

Tell me first, what is a psychosomatic illness, and what does that term mean? There's a lot of stigma and confusion and apprehension around giving certain symptoms or conditions that designation.

Labels and names are a real problem here, because we all mean different things by them. Psychosomatic disorders traditionally defined as real physical symptoms that are thought to have a psychological cause, or at the very least, are not known to have an organic cause.

A lot of people have the sense that "psychosomatic" means that every symptom must be due to psychological distress or this Freudian idea that it all dates back to a single moment of horrible trauma in your life or to your childhood. I certainly, when I use it, do not mean it in that way.
I'm talking about physical symptoms that arise because of some sort of glitch in the cognitive processes that make up the mind, and that can sometimes occur through trauma and childhood things, but can also happen for hundreds of other reasons. I'm not talking about, necessarily, stress or psychological trauma-induced symptoms, but rather, symptoms that arise mostly in the cognitive processes of the mind. I think most people now dispense with "psychosomatic" because it's so prone to being misunderstood.

There's a misunderstanding that it means it's, quote-unquote, "all in your head."

Precisely, or that you're making it up. Even worse, that you're making it up or that you're faking it. The point about psychosomatic conditions is they are biological conditions, like anything else. If you have a symptom that shouldn't be there, if you have a disability that shouldn't be there, it's biological. The distinction we make between a psychosomatic disorder, due to real biological changes, and a disease, is due to pathological. So psychosomatic conditions arise out of physiological changes and diseases arise out of a pathological changes.

That gets complicated because there is a sense, certainly in the Western world, that there has to be a very clear-cut designation between something as physical or as psychological. There's very little space in between. Yet you found things that dispute this. There's a phrase you used, that the presence or absence of disease are not immutable ideas.

Some diseases are immutable facts. If you have diabetes, if no one ever finds out, or if no one ever measures it, you will still get sick with it. Some diseases are facts and, at present, you don't have to describe them or name them for them to have an effect.

Illnesses are different. Illnesses are, to a certain degree, cultural constructs. An illness is a perception of how one feels. And to a certain degree, around the edges of illness in particular, your society and your culture tells you what is an illness and what is not. If we use the example of depression, some cultures would consider depression not a medical disorder, but a situational phenomenon. In Western medical cultures, we might be more inclined to label someone as having a brain-related problem causing depression, or we will equate depression with hormonal or with neuro chemical changes in the brain, for example, whereas another community might prefer to consider it situational.

I feel that in Western medicine, we think because we write all these things down in big books and give them technical names, that we have superiority in that, of medicalizing bodily changes. It's very difficult for a doctor to say when high blood pressure becomes pathological. Obviously, high blood pressure is a disease, dangerous, needs to be treated. But in a room somewhere, a group of doctors are deciding whether you have normal blood pressure or high blood pressure and they're picking the number — not arbitrarily, but a little bit arbitrarily.

If that's what they have to do with diseases like high blood pressure or kidney disease or osteoporosis, imagine how hard that is to do in the field of mental health sciences, to decide what behavior we're willing to accept as normal, what behavior we think is too much and we're going to give a disease name to. I fear that in cultures that rely on Western medicine, we're pushed very strongly in the direction of over-diagnosing disease, for many social cultural, practical reasons. I'm not sure that we are superior to other cultures in the way we deal with mental health problems.

There are a couple of things that I think of when you talk about that. One of that is over-diagnosis can lead to over-prescribing, medicalizing. And then what happens, in particular, to our younger and more vulnerable?

Much is said about pharmaceutical industries and over-prescribing and people making money out of illness. I suppose I'm worried about something that people talk about a lot less, and that's the way that people embody disease labels when you give them to them.
If we decide that something has passed from being within acceptable, normal limits into being a medical problem that deserves the attention of a doctor, then a person becomes a patient. And what do they do? They begin looking for other features of the label that they have been given. People can begin to then take on features of that label by searching for them. Our bodies are a mass of change and white noise, and we all have good days and bad days. If we're given a label through which we can explain these things, we can begin accumulating new symptoms by paying extra attention to our bodies.

I'm a neurologist, I run straightforward clinics for things like epilepsy, brain diseases. But a huge number of people who come to see me will have what would have once been called hysterical seizures, now are called dissociative seizures, but they're psychosomatic.

What's happened to these people is something like, for example, they're on a very busy train and they faint. What happens in a lot of faints is people shake. The other thing that happens in faints is that someone nearby is a first-aider, and says you had a seizure. Suddenly this young person has been told they had a seizure on the train, then they go to a casualty department for a very junior doctor who doesn't know anything about seizures, tells them they think they have epilepsy. Then what happens before they make it to my epilepsy clinic is that they begin embodying the epilepsy diagnosis by looking on the internet, to see what else is associated with epilepsy, by joining communities who are affected by this. They begin with one symptom, which is dizziness and collapse on the train, and they've accumulated ten more symptoms by the time they get to my clinic.

I'm not saying everyone does this. This is just something that some people do. And it' effect of labeling is that we embody the identity of that diagnosis and take on new features, which can lead us into chronic disability. I think people don't realize how dangerous labeling can be.

Let's get into this. For instance, let's say you are a woman and you have pain within a medical system in the West that doesn't understand women's pain, doesn't take it seriously, or then immediately says that it's psychiatric. We can see how this culture, then, of people who are eager to create a diagnosis and then eager to, well-meaning or not, exploit that can arise.

I think people like to blame pharmaceutical industries, but we should all be looking a bit at ourselves — me as a doctor, but also me as a patient, because a successful consultation for me is one where the patient leaves with a diagnosis, with a treatment and they're delighted with exactly what I've offered them.

A difficult consultation is one where you have to say, "Well, I don't think this is actually necessarily a medical problem." People like to be told a specific diagnosis so that they have information that allows them to know about prognosis and where they should go for help. It's easier for me to give a diagnosis. So we've entered into this collusion between patient and doctor where it is in everybody's favor to label things. Unfortunately that has long-term consequences that we don't properly think through.

When you have an answer, you have a path forward, you have a potential remedy, as opposed to, "Maybe I can work on my symptoms without ever getting a diagnosis."

It's important for me to say that I'm probably more than anything here talking about the fringes of some of these diagnoses. I want people with severe depression to get a diagnosis of depression, get the appropriate treatment. I'm really talking about where it's all a bit more uncertain, and it's much easier for a doctor to over-diagnose and under-diagnose. No one can argue severe depression is extremely serious and needs medical help. But it's in that very borderline area, over-diagnosing depression can have long-term implications for a person, first in the embodiment of the identity of being a depressed person. It'll never leave your records and it will never probably leave your unconscious identity, either.

One of the things that you were speaking to in this book that I think is important, is this idea of, instead of just embodying a diagnosis as a permanent state, can we think of some of these things as transitory?

I don't want to be depriving people of help. That's what we use labels for, is we use them to help, so people know where to go to for help. What we should be able to do is to develop strategies for helping people that don't require us to give people chronic disease labels. It should be possible for someone who's depressed or feeling very low, without being told that they're depressed, to have a place to go where they can talk and get support without necessarily needing the label.

Again, this doesn't apply to everyone. Some people are greatly helped by understanding the biology of what's happening to them and getting a disease label. But there is undoubtedly a segment of people who are made worse by being given a chronic disease label.

I think in Western societies, where we're very individualistic. We're expected to support ourselves, we don't live in big family groups like other cultures, we're less spiritual than we used to be, people are less inclined to turn to a spiritual leader for help. Again, I'm not advocating that these are the right ways, there's no right way or wrong way. But one caring institution that's always there is your doctor. If they are our caring institutions and we have to have a disease label to be allowed to go there, then this is what happens. There should really be methods of caring for people and giving them support that doesn't require us to give them chronic disease labels. Because unfortunately I think medicalization is not always very good for people's identities.

Looking at this book, you explore these serious physical manifestations of intense experiences happening across the world and how differently they are looked at and approached. What do you wish that doctors in the West knew about what you've seen traveling around the world?

One of the conditions that I came across that I just thought, really found very inspiring, was a condition called Grisi Siknis. This affects the Miskito People or indigenous people of the Mosquito Coast in Nicaragua. It doesn't exist anywhere else in the world, it's specific to this group of people. It manifests seizures and manic behavior; its literal translation is, crazy sickness.

People who exhibited these exact symptoms in the West would probably find themselves referred to a psychiatrist, which isn't necessarily a route that works for everyone with these symptoms. In fact, these symptoms only get better about 30% of the time in the West with psychiatry, 70% remain chronic.

But what happened within the Miskito Community is, developing these symptoms, there was a sophisticated language that said to the community, "I need help." What happened was that the community rallied round. If you had these symptoms in the UK or the US, you'd probably stay at home all day and you wouldn't want to be seen, and there'd be no community response. So this was a way for people to ask for help and to get community and support. Then there was a ritualized treatment involving a traditional healer. It was highly successful treatment, and it is understood by the Miskito Community that this disorder is caused by a demon or a bad spirit. The ritual drives away the bad spirit. I think a lot of Western people hearing that will say, "Oh, superstition," negative things like that.

Actually, when anthropologists and people who have lived in these communities have examined it more closely, they can see that it's, in fact, a highly, highly sophisticated, complex, problem-solving strategy used by the community. It's a way for young women to say that they need support and that they have a problem without having to be explicit about what the problem is. They're just able to ask for help without facing judgment, without having to be specific. It guarantees a nonjudgmental community response. That's beautiful, really, because they get better, whereas people with these sorts of problems in Western communities who are medicalized struggle to get better.

I don't know yet how to translate that into my own medical practice. I'm not a spiritual person, but I'm traveling around the world, meeting spiritual communities who are doing a great job of supporting each other and actually making people better. I have to consider how I can incorporate that into a scientific medical practice.

I think part of it is understanding the language of the symptoms. What is this person trying to say by expressing it in this way? What does this person want? And responding to the symptoms in that way, but also encouraging this idea of the community response, rather than shutting people away when something distressing and potentially strange is happening to them. I think there's something in the ritual to getting better, to be understood. It may be right for some people that we take a really Western medical approach of physiotherapies, psychological therapies, psychoanalysis, whatever it might be, a Western medical approach. It may be however that, for some people, we need to understand, communicate through the metaphor of their symptoms, figure out what it is they want and try and help them to get it.

What do you hope for the future of medicine?

What I hope is that it is possible for someone to ask for help without being categorized in a particular way.

I think it's particularly problematic in schools now because, it's very easy for a child to take on a label when they're in school. There are very many advantages to it, because people get help in exams or the school gets more funding or they get more teachers. It is very easy for us now to label our children who are struggling.

I would want a child to be able to say, "I'm finding it really difficult to get help," and we should be able to give the funding and give the help and support without giving the medical diagnosis. I'd really love to see us cutting down on our need to medicalize and biologize every human experience.

Twenty-five years ago, the best news show on television debuted — on Comedy Central.

From its beginning, "The Daily Show" distinguished itself with its combination of brutally funny cynicism and furious hope, a balance refined when Jon Stewart became host in early 1999, and maintained today with Trevor Noah behind the desk. And from its beginning, it's been a show much about the news media as the news itself.

The endurance of "The Daily Show" remains a testament to its creators, Madeline Smithberg and Lizz Winstead, who helped set the show's meticulously crafted tone. Salon spoke to Winstead recently via phone about the show's genesis, the grueling, pre-Google days of newsgathering and the "Daily Show" reunion benefit livestreaming this week.

This conversation has been lightly edited for length and clarity.

It's not like there'd never been satire. It's not like there'd never been parody of the news. What made "The Daily Show" unique?

I think what made this different is that we didn't lampoon it; we became it. We really gave the audience credit. We didn't want to be cartoons. We wanted to, by being as realistic as possible, by looking like and having their same tone, by using the same bullsh*t that the media focused on, really shine a light on what it was that wrong with the media.

A lot of times, in previous iterations where there was a news desk, it was snarky commentary about the news. For us, we felt like the media itself needed to be a character. Back in 1996 when we launched, there was only CNN. We launched in mid-July. MSNBC launched a couple weeks later. [Note: MSNBC launched July 15, 1996]. Fox News launched in October. All of that happened in 1996.

When we started, we were really satirizing the whole if "If bleeds, it leads" local news stories, and also the fear-based news magazines. There were 17 news magazines on network television when we launched. They would all do,"Will your pasta kill you?" You know, everything was about terrifying the viewer and then finding obscure ways to tie it into a think piece and then put it out there in this supposition language. That was happening all over. You would look at the cover of a magazine and it would say, "Do you have AIDS?" Then there would be an article and it was just, "Of course you don't have AIDS." But they would just try to scare you. We really followed that trajectory. The show, when we launched it, was actually more like Colbert in the sense that every single person on the show was in character. We just took the audience on this newscast full of people who were utterly reprehensible on some level. You could see the essence of what you knew and what you saw every night in real news.

One of the reasons "The Daily Show" is 25 years old and has been going strong is because Brian Unger came from news, and trained every correspondent. He was the first correspondent we hired. He was a producer and he was an on-camera person. He trained everybody on how to light a shot, how to shoot to create a mood, how to deliver your lines. He really helped all of us learn how to go straight with the ridiculousness, so it sounded like you were delivering the news.

Was the show a hard sell to the public, as female creators?

To create a news show back in the day, and to do good satire, you had to satirize the existing thing. And the existing thing was full of white men. So as two women, the one thing we did know was that if we wanted to blow the lid off the news, it had to look like the news. That meant that the spaces that needed to get occupied needed to be white dudes, right? To this day — and this part is frustrating —I don't think a lot of people know that two women created that show.

I think that they also don't know that our two co-creators, executive producer, head writer, executive in charge of production, senior producer, all of field producers except for one, were all women. It was a bummer because we got over 150 writing submissions, and only two from women, when we launched.

It was a lot of fun, but it was also really challenging. Madeleine and I had to fight a lot of battles with the network because they didn't want this to be a news show. I think they wanted it to be wackier, and more pop culturey. I'm not sure that "The Daily Show" would have lasted 25 years if Madeleine and I would have acquiesced to turn it into some kind of "Entertainment Tonight" kind of comedy show.

When did you know that this was something? That this was a thing that people were paying attention to and that it was having an impact?

The second the show went on the air, I had a feeling. Then we got flooded with fan mail. Then there were so many requests that it was almost a year in advance to get tickets. That happened within like the first week. And that audience wanting to be part of it thing was really cool.

There was nothing else really quite like that out there to pin your conversations around, that was reflecting the way that we were talking about the news.

What gave us a great boost was broadcast news had just really done a disservice around real news. CNN was like "the trial of the century of the week." A lot of people were really wondering what the hell was going on in the world and not seeing it, and then watching the news. They knew the conventions.They knew the local news guy. They knew that scary story. They knew Stone Phillips. They had a working knowledge of the conventions. Within the subtleties of how we did our characters, we still made sure that the audience was with us on how we satirized the people and the genres and the type of stories that we did. So we didn't try to be too inside baseball. And you know, print journalists were so excited that we were sh*tting all over television journalism. They were writing glowing, glowing stories.

Was there a moment early on in it, where you had a story where you thought, "We're doing this story in a way that nobody else has looked at it?"

I think everything we did was sort of that. I mean, even "Weekend Update" never used footage. There was never a lot of designing over-the-shoulder graphics that looked like how they did on the news. We were the first to do that. Taking the trends of news genres, like, "When animals attack," then we did "When the elderly attack."

We really just satirized how they did the coverage, the terms, and how many times they're just throwing to somebody to say, "Over to you," when there was nothing going on there. Car chases. Storm watch. We were the first people to really take it to the next level and out into the field, and bring it back into the studio. Instead of it being skits, it was actually a fully formed show that had to operate like a newsroom, because we were making a news show, but we were satirizing it.

And remember, without Google. I think we stole a LexisNexis login. We had like 45 newspapers delivered to the office. People split up the country in regions, and they would just find stories. I think we had the AP wire. But it was digging around, and then just watching, and observing what the trends were, and then satirizing it.

The show came at a moment in the midst of the Clinton administration and post O.J., all these media circuses. Do you think that that was part of what made us ripe for the show, or was the show ripe for America?

I think it's what made the show ripe for America. The media had set the agenda for the circus. We didn't have to point out there was a circus; the circus was self-evident. The circus started after the first Gulf War. People forget that right when it was winding down, and everybody was panicking about how they were going to keep ratings going, Rodney King happened. So they were able to keep their media jones going, and then that just keeps perpetuating itself.They didn't even really learn good lessons in that. They just amplified the furious nature of the rage, instead of examining the rage. That should have been our reckoning.

Instead of what it's become, which is the model.

Then you had the baby-shaking nanny, and then the Menendez brothers, and then Anna Nicole Smith. It just became this furious churn factory. We just followed it. It was like, that's how you're going to help people? That's insanity to me. Part of what was fun was by holding a light up and becoming them, without having to hit somebody over the head to say, "Careful who you trust when you get information."

You've got a reunion event with Madeline Smithberg, Brian Unger and other "The Daily Show" originals. Tell me about the show.

The good news is, I really want to promote this special, because it's also benefiting Abortion Access Front, which is really cool. All these people are getting together to support us.

I really would love to make sure that people know that they can watch all these cool people get back together and tell the original story with stories they've never heard before. I'm really excited that this fall, we are launching a YouTube talk show — a 30-minute weekly hilarious feminist comedy talk show that's going to talk about all the issues that don't get talked about, and that is really doing deep dives into all these laws that are happening around reproductive access, and just patriarchy, and white supremacy, and with comedy and fun. That's called Feminist Buzzkills Live, and that's launching in October. That's one of the projects that we're working on with Abortion Access Front as well. I'm also going back out on the road to do a bunch of touring. People really need a catharsis and to gather. We need a 12-step program to get off Nextdoor. Just stop going online and getting weird information from your vaguely racist neighbors. Like, we need to regroup.

So, all eyes on the prize and in Washington, D.C. in the fall, on the Supreme Court, when they're going to decide the fate of abortion access as we know it in the United States. And that is pretty intense.

The last five years have been a master class in gaslighting. For those of us who came into the Trump Era with some personal experience with narcissists, emotional abusers and flat out liars, it has been a jarringly familiar time.

For those who previously had the luxury of expecting honesty of others, this has been a sharp learning curve. We all now know exactly what it feels like to be on the receiving end of untruth so blatant and shameless it makes us question ourselves. We know what it's like to hear a falsehood repeated so insistently it almost becomes convincing. We get it from the highest levels of government, from cable news networks, from our radicalized relatives and neighbors. And we know the confusion, self-doubt and fear that come with long term exposure to what liars like to call "alternative facts."

It feels pretty crappy. But what does it feel like for the liars? How can they keep spinning their BS with such shocking ease and conviction?

As with all things, it's a matter of practice. We all bend the truth with some regularity — a 2003 University of California study found that participants reported lying on average twice a day. If "I'm fine" counts, the number must surely be higher. White lies are a social lubricant and a "get out complicated explanations" card. Dinner was delicious. I'm five minutes away. I wish I could help.

But toxic people, people with antisocial personality disorder, people with pseudologia fantastica (a.k.a. pathological liars) lie for other reasons, and they do it a lot. They lie to gain control in their relationships. They lie to self exonerate and to justify their behavior. And the more they do it, the better they get at it, and the bigger their lies can become.

A 2016 study published in Nature Neuroscience found that "Signal reduction in the amygdala," the part of the brain associated with emotion, "is sensitive to the history of dishonest behavior, consistent with adaptation. . . . the extent of reduced amygdala sensitivity to dishonesty on a present decision relative to the previous one predicts the magnitude of escalation of self-serving dishonesty on the next decision."

In other words, "What begins as small deviations from a moral code could escalate to large deviations with potentially harmful consequences." Hence, you can seemingly desensitize yourself to your own dishonesty.

This is especially handy for a narcissist, who, as psychiatrist Dr. Bandy X. Lee explained to Salon recently, perpetually "must overcompensate, creating for himself a self-image where he is the best at everything, never wrong, better than all the experts, and a 'stable genius.'"

It's not just the amygdala that gets a workout from lying: other parts of the brain get in on the act as well. A 2009 Harvard University study of volunteers — some of whom cheated on a simple coin toss game and some who didn't — found that while the honest players had "no increased activity in certain areas of the prefrontal cortex known to be involved in self-control… those control regions did become perfused with blood when the cheaters responded." And it happened even when the cheaters were telling the truth. Keeping your story straight takes work.

If you're capable of knowing right from wrong, lying and cheating make you feel bad. And even if you don't puke like Marta in "Knives Out," you may have a "tell" — fidgeting, averting your gaze — that communicates that. But habitual liars don't feel bad. This is why lie detector tests are such unreliable tools. The autonomic nervous system of a somewhat average person, with an average person's anxiety about being caught in wrongdoing, will respond differently when telling the truth and when not. Their breath, blood pressure and heart rate may change. They may get sweaty. If you're someone like Gary Ridgway or Ted Bundy, two of the most prolific and vicious serial killers in American history, you can pass a polygraph with ease.

The other key component of chronic lying is that it often resides in the same neighborhood as delusion. Individuals with delusional disorders have "fixed beliefs that do not change, even when presented with conflicting evidence," and oh boy, there is no shortage of a spectrum of unchanging fixed beliefs here in our country right now. This is why gaslighting is so persuasive. It's the blatant, brazen confidence that only people who really put in their ten thousand hours of bald faced lying and genuine dissociation from reality can deliver that sells it.

Can habitual liars change? Dr. Robert Feldman, who wrote "The Liar in Your Life: The Way to Truthful Relationships," told Everyday Health in 2016 not to hold your breath, because they usually don't want to. The only path forward is escaping their grip — and keeping our own amygdalas honest.

After Donald Trump was hospitalized last week following a positive test for COVID-19, he emerged from Walter Reed with all the "Scarface" energy of one of his sons, declaring that, after "some really great drugs" he felt better than he did twenty years ago. Those drugs include Regeneron's REGN-COV2, a monoclonal antibody cocktail that is not approved by the FDA but was administered through a process known as compassionate use. (Regeneron's CEO, Dr. Leonard S. Schleifer, is also a friend of the Trump family.) Mainstream and social media quickly lit up over Trump's revelations, especially when he declared that the treatment "wasn't just therapeutic, it made me better. I call that a cure."

But is it?

If you've ever seen television ads for drugs with names like Opdivo (nivolumab) or Keytruda (pembrolizumab), you may notice a common denominator in their nomenclature. That "mab" — usually written as "mAb" — at the end is short for "monoclonal antibodies," antibodies engineered in a lab.

Nine years ago, when I was diagnosed with metastatic melanoma, I got a front row education in how they work when I became one of the first patients in the world in a groundbreaking immunotherapy clinical trial. While I did not have the same condition or treatment that Trump did, I did receive a cocktail of two mAbs and I do feel confident saying that the experience did not give me super strength nor make me feel twenty years younger. In fact, it seems to have been at the root of a thyroid dysfunction that actually aged me! But hey, I'm not a self-proclaimed "perfect physical specimen," like an obese 74 year-old man who is renowned for not eating vegetables would be.

Trump can cavalierly — and surprise, inaccurately — describe his treatments as "miracles coming down from God," but understanding and engineering the human immune system has been the complicated work of decades of research, failed experiments and heartbreak.

You have no doubt heard more about antibodies in the past few months than you have since that long ago high school science class you barely passed. The simplest way to understand them is they're proteins that help the body fight invaders and, significantly, remember them to keep them at bay. When you feel flu-like systems after getting a flu shot, that's the antibodies you've developed doing their thing in there. This is why we get vaccinations, and also why I have only had chicken pox once. When the immune system has confronted certain kinds of threats in the past, it can, like an efficient bouncer, fend them off in the future in most cases.

But antibodies can't fight everything; if they did we'd never get sick. They also aren't an ironclad guarantee of immunity — some people do get chicken pox twice, and plenty more get shingles when the dormant virus wakes up many years later. Trump may boast that "Maybe I'm immune" now to future infection, but there are confirmed cases of patients getting COVID-19 more than once, and the duration of immunity for everyone who's experienced it is still unknown but may not be longer than a year.

And antibodies aren't always the good guys; when they go rogue they can cause a world of harm. Autoimmune disorders like lupus, multiple sclerosis, and rheumatoid arthritis all stem from overactive immune system. Similarly, organ transplant patients are often given immunosuppressants to prevent the body from rejecting the new organ as an invader.

Getting the immune system to effectively go after the right targets in the right way has been a long-standing scientific challenge. That's where these laboratory created antibodies come in. In early oncology research, the thinking was that antibodies could be developed in animals and transferred humans. By the late eighties the process was being refined to create human antibodies in genetically modified rodents, so the risk of rejection would be lessened. As pioneering scientist Nils Lonbergonce explained to me, "You don't really want to put a mouse antibody into patients. You want to put a human antibody into patients."

When they work, MaBs can work quickly and durably, because the immune system learns and remembers. But they don't work all the time or for everybody, nor are they casually dispensed. My mAb combo is considered a rousing success; the 5 year survival rate is about 52%. And these therapies can produce vicious side effects as the immune system revs up. I was fortunate in my experience; my rashes, dizziness and fatigue were tolerable, but I had an adverse event where my temperature shot up and I felt like hell for a day. Other people on cancer immunotherapy develop colitis so severe it's debilitating. I've been on panels with doctors who've presented photos of what immunotherapy can do to the human colon, and the phrase "hellmouth" comes to mind.

So far, the side effects for the Regeneron treatment appear to be well tolerated in COVID-19 patients. Late last month, the company reported that with "more than 2,000 people enrolled across the overall REGN-COV2 development program, no unexpected safety findings have been reported." Speaking with MSNBC recently about Trump's recent hospital regimen, company co-founder Dr. George Yancopoulos' said that the cocktail "mimics the normal immune system," and said, "theoretically there should not be any additional interactions with any… other medications with our very natural antibody cocktail than you would normally have with your own antibodies." But the pool of patients is still very small.

We all want a vaccine and we all want a cure. We want to send our kids to school and hug our old friends and go to the movies and, most of all, for people to stop getting sick and dying. The way forward is through smart science and practical, equitable distribution, not empty promises of "miracles." The monoclonal antibody cocktail that saved my life currently has a six figure price tag. As Vox put it two years ago, "The average cost of cancer drugs today is four times the median household income." (Because I was in a clinical trial, the pharmaceutical company paid the costs related to my treatment.) Who's going to pick up the check when and if these types of therapies are available for COVID-19? There have been 7.6 million cases in the US already and that number is currently on an uptick — who will receive treatments that are approved, and how will hospitals handle the influx? What happens to patients who don't golf with the president of the United States?

Monoclonal antibody treatments have saved countless lives over the last several years. Harnessing the human immune system to fight disease and infection is among the most promising scientific breakthroughs of any of our lifetimes. But right now, there is no cure for COVID-19. There is only recovery, hope and a lot more research to be done.