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Jon Meacham on "The Soul of America"; Dark Side of Antidepressants. Aired 2-2:30p ET

Aired May 16, 2018 - 14:00   ET


CHRISTIANE AMANPOUR, CNN HOST, AMANPOUR: Tonight, understanding the America of today by understanding the America of the past. Pulitzer Prize

winning author and presidential historian Jon Meacham on the polarizing politics of Donald Trump. But are the current divisions over race,

religion and identity really new?

Plus, lifting the lid on mental health. The eminent doctor Allen Frances on the growing number of people dependent on anti-depressants and what the

drug companies don't want you to know.

Good evening, everyone, and welcome to the program. I'm Christiane Amanpour in London.

It's a speech that sounds torn from today's headlines. Build a wall of steel as high as heaven to keep problematic immigrants out of the United

States. But the year was 1924. The immigrants were from Italy and the speaker was Georgia Governor Clifford Walker. And he was addressing a

national convention of the Ku Klux Klan.

In his new book, the Pulitzer Prize winning historian Jon Meacham explores America's vulnerability to fear, bitterness and racial strife. It's called

"The Soul of America: The Battle for our Better Angels".

With literally the whole world trying to figure out the Trump era, not only does Meacham help us see how the fires of fear are lit, he shows us how

America has come through the darkness on every occasion.

And Jon Meacham is joining me now from Raleigh, North Carolina. Welcome to the program.


AMANPOUR: Good to have you. So, the subtitle of your book, "Our Better Angels", it refers to Abraham Lincoln's first inaugural address. And, of

course, at that time, America stood on the brink of a civil war.

How, to you, does that resonate now? Why did you choose that title?

MEACHAM: Well, every era in American life has been shaped by the battle between our best instincts and our worst instincts. Uniquely among

nations, we were founded in more or less the modern era, coming out of the European enlightenment, coming out of the scientific revolution, the idea

behind the Constitution was that reason would have a chance to stand against passion in the arena.

We were founded on that idea. But at every point, from the very beginning, 1790s, all the way into our conversation now, we've had this struggle. And

my view is that, as Lincoln put it, at that perilous, perilous hour of 600,000, 700,000 Americans about to die in a Civil War, he said that he

hoped that the better angels of our nature would, in fact, prevail.

And I think - and this is not a homiletic point. It's not a Fourth of July point. It's not a narcotic one. Basically, our better angels have managed

to continue to make us a country that people want to come to as opposed to flee.

And I think that's an important thing for us to remember as we try to figure out how do we survive clearly the most unconventional presidency in

our history.

AMANPOUR: Well, you say that about coming rather than fleeing. I mean, certainly some people are leaving. Some under duress. Others are just

leaving because they can't deal with it, frankly, and the particularly sharp, pointed spear leveled at the immigrants that have made America what

it is.

So, how dark is today's era in your construction and your narrative compared to some of those other past issues that you highlight?

MEACHAM: I think this is a lot like the 1920s. I think it's a lot like the second half of the 19th century when we decided to focus quite firmly,

in a discriminatory way, against immigrants.

The Chinese Exclusion Act. There were enormous fears in the late 19th century that - see if this sounds familiar - the white working class of

America was worried as we moved from an agrarian to an industrialized economy, a time of great economic and cultural upheaval that foreign

workers would come in and take jobs that Americans should do that.

So, what we're living through now is the latest manifestation of a perennial tension, a perennial fear in the American soul. And what we have

to do is what Theodore Roosevelt called upon us to do in that era, which was we had to embrace diversity, we had to open our arms more widely than

clinching our fist.

[14:05:08] But every era, as you know, is imperfect. Theodore Roosevelt who called for a melting pot, who called for a new kind of Americanism also

believed in a discredited genetics theory about white superiority.

So, I don't think we can romanticize the past. And I think there is a tendency right now in many places for Americans to see that everything

before Trump was somehow better and ever since then we've descended into this uniquely dark place.

My argument is not let's relaxed because we've been through this before, it's that let's get to work and figure out what it was about the

constitutional and cultural inclinations of the past that got us through these dark moments before.

And essentially the answer is, a historically-based realization that the free movement of ideas, the free movement of people, free trade,

competition, pure Adam Smith, has been what's made us truly great.

And if we want to make America great again, let's embrace that openness and continue to go from strength to strength.

AMANPOUR: Except, of course, as you rightly say, that pressure point is right on that openness right now and on the diversity that has made America

so great.

I wonder what you think of this new sort of study seeping into the political arena, if you like, that was done to explain the Trump vote and

the Trump voters because many of the mainstream press, of course, the conservative press as well and all the talk after the election, was that it

was all about the left behind. It was all about the middle states, the flyover states. It was all about those who were undergoing severe economic

disenfranchisement and anxiety.

And yet, the Stanford University study has suggested that it's actually about racial anxiety, almost much more than economic. They look at the

economics of those who voted and they see that it's actually racial anxiety, what Van Jones said on election night, sort of a "white lash."

MEACHAM: I don't think there is any doubt that race is at the heart of this chapter of American history because race has been at the heart of

every chapter of American history.

It is our original sin. Our Constitution was created to deny the full implications of what the Declaration of Independence had said we were

supposed to be about.

At every point, race has been a difficult, difficult fault line in American life. I come from the American south. Fifty years ago, we had functional

apartheid in our politics here.

American women have only voted for 98 years, shifting from race to gender. And, of course, marriage equality, on the question of gay rights, is not

quite three years old.

And so, the story of the country, again, without sentimentalizing it, has been moving from - it has been progressive. Basically, I think President

Trump is President Trump because of economic anxiety and that is all rolled up with these racial fears.

I fear that a certain way of life is under assault from immigrants, from people of color and that somehow or another - this happened in the 1920s in

the same kind of period. Five million Klansmen, Oregon, Indiana, Colorado, all were taken over in many ways politically by the Klu Klux Klan. Fifty

thousand Klansmen marched down Pennsylvania Avenue in 1925 without their masks on.

So, we have been here before in times of stress and certainly race will forever be a factor.

My own view, to go to Van's point, is that, in 20 years, the United States is going to look a lot more like Barack Obama's America than it is Donald

Trump's. And I think one of the reasons Donald Trump is president is because people know that in their bones and that this was one last gasp of

an older banishing order.

AMANPOUR: And I misspoke, it's the University of Pennsylvania study. So, to that end, describe what led you to write this book. It was, I think,

the events of Charlottesville, right?

MEACHAM: It was last August, yes, when the neo-Nazis and Klansmen were marching to defend a Robert E. Lee statue and a young counter-protester

was killed, two Virginia state troopers were killed as part of the operation and the president of United States had a difficult time deciding

which side he was on.

And I spend most of my time thinking about and reading about the American presidency. And we've had some terrible moments before, but that was that

was right up there or down there.

AMANPOUR: Well, indeed. I wonder if you can talk about - you talk about these different eras, the dark devils and the better angels sort of in

competition. I was struck this week by two major commencement addresses as this class of graduates go for, one by Mayor Bloomberg of New York and then

today former Secretary of State Rex Tillerson.

Both of them spoke about the fundamental need to recognize truth and facts over lies and distortion, the fundamental need for honesty in our public

space, to protect the very democracy and the Constitution of the United States.

And I wonder if you can comment on how that is sort of whittling away at the soul of America and even the better angels.

MEACHAM: It is. And, yes, John Adams once said facts are stubborn things. We're testing that. We're testing their stubbornness.

We are in a particularly fraught tribal moment in American politics. There are 35, 40 percent on each side that believe their view of the world is

absolute. They believe that any contrary fact is somehow or another just dismissible because it doesn't fit in with their preexisting worldview.

To me, that's among the most un-American - and I don't use that phrase much - but un-American views to take, largely because the founding of the

country - and this is (INAUDIBLE 1:30) cultural and political conservatives as well as more classical liberals.

The founding of the country was the clearest political manifestation of the enlightenment idea that reason should be an organizing principle in human


What is the American Revolution if not the political undertaking that comes at the end of an era of Gutenberg, the rise of moveable type, the

democratization of information, the Protestant Reformations, the entire shift from popes and prelates and princes and kings who either by an

accident of birth or an incident of election have authority over other people to a more horizontal understanding that we're all created equal. We

have the capacity in our ourselves to determine our destiny.

It's a great Western idea. And America was the embodiment of that. If we continue to think ideologically as opposed to rationally, we're not being

true to the American problem.

AMANPOUR: Well, the European Commission president tonight addressed that kind of question that you just raised. And remember, Europe is America's

closest alliance block. It's its biggest trading partner. This is what Donald Tusk said at a speech just now.


DONALD TUSK, EUROPEAN COUNCIL PRESIDENT: We are witnessing today a new phenomenon, the capricious assertiveness of the American administration.

Looking at the latest decisions of President Trump, someone could see them think with friends like that, who needs enemies.


AMANPOUR: I mean, I haven't actually heard that recently from a European ally towards an American president. That's quite harsh.

MEACHAM: It is. And one of the things we're dealing with and, obviously, on the global stage, is trying to separate to what extent is the President

Trump's showmanship and bullying and ill-considered, it seems, social media postings, to what extent does that affect, shape our policy.

And, basically, we made things as difficult for ourselves as possible, which is kind of a classically American thing to do when you think about


Churchill is reputed to have said you could always count on us to do the right thing after we've exhausted every other possibility. And we're

certainly testing that at the moment.

This is a very perilous moment in the life of the country because the conventions that have guided us are at best vulnerable and at worst are

already gone.

The question is, we know that the presidency has not changed Donald Trump. The question ultimately will be whether Donald Trump has changed the

presidency going forward.

AMANPOUR: So, I want to put forth your eulogy at Barbara Bush's funeral and you spoke about public service as you would like to remember it.


MEACHAM: Barbara and George Bush put country above party, the common good above political gain and service to others above the settling of scores.


AMANPOUR: That whole principle of, again, the better angels, national service above individual ego, just very quickly because we're out of time,

what does that mean to you right now, their administration?

[14:15:00] MEACHAM: I think that we have to look back in order to find a way forward. And right now, the president is about the settling of scores.

But we've had presidents who have been erratic, not quite this erratic, and I think we have to ultimately hope that through protests, through

resistance, through these kinds of conversations, through the bearing of witness that we will get through this.

AMANPOUR: All right. Jon Meacham, thank you so much.

And now, highly divisive politics, the onslaught of perilous news, the pressure to live a life perfect like Instagram, it's all taking a toll on

our minds.

Staggering new figures show 15.5 million Americans have been taking antidepressants for at least five years. The rate has tripled in the last

18 years. And women are twice as likely to take them. So, what is going on?

Dr. Allen Frances helped write one of the go-to manuals for diagnosing mental illness and now he is ringing alarm bells, warning us that these

pills are not only hard to quit, but they are destroying faith in our own human resilience.

His book "Saving Normal" explains how we fix our broken system and he joined earlier this week from San Diego.

Dr. Frances, welcome to the program.


AMANPOUR: So, I just wanted to start by saying, who knew that antidepressants were addictive. It's not what you associate with things

like antidepressants. You think of painkillers and, obviously, drugs and alcohol and cigarettes?

FRANCES: Well, they're not really addictive in the sense that benzodiazepines were addictive or cocaine or alcohol. They don't cause the

same degree of functional impairment when you're taking them, but they definitely do have a withdrawal syndrome. And that withdrawal syndrome

traps people. It's so easy to start an antidepressant and sometimes so very difficult to stop it.

AMANPOUR: And how did you find that out? I mean, how much science is there on the difficulties? And how do people know when they've been on it

too long? It seems such a fluid area of medication and prescription.

FRANCES: Well, it's a deeply-held secret. There's been almost no research on the withdrawal syndrome. There is absolutely no interest on the part of

the pharmaceutical companies in advertising the fact that getting on an antidepressant may trap you for years and maybe for life. So, they

discourage research. They don't report adverse findings.

The pharmaceutical industry is only marginally less ruthless than the drug cartels. And it's not in their interest to advertise this. So, there's

been very, very little research.

And we really don't know how long-term use of these medications may affect the brain. We're doing a kind of public health experiment on hundreds of

millions of people around the world without really understanding the long- term effects.

AMANPOUR: New figures from "The New York Times" show that 15.5 million Americans have been taking antidepressants for at least five years. And

that rate is almost double since 2010 and more than triple since 2000. How easy is it to actually get the prescription in the first place?

FRANCES: There's nothing easier in the world than starting an antidepressant. Primary care doctors are given far too little time with

their patients. And the only way they can get a patient out of the office satisfied after a seven-minute visit is to write a prescription.

Eighty percent of the antidepressants are prescribed by primary care doctors usually after seven minutes, under heavy pressure from both the

patient and from the drug company to prescribe the medication.

On the other hand, stopping the medicine can take years. It requires for some people a very, very slow taper. And without that, they'll have

symptoms of return of anxiety, of depression, flu-like physical symptoms, and often they will misattribute these return of symptoms to thinking that

they're getting depressed again when, in fact, it's just the result of withdrawal side effects.

AMANPOUR: And the actual symptoms while one is on these antidepressants can vary as well. There's potentially a lack of sex drive and other such

side effects. What are some of the side effects? Weight gain?

FRANCES: The antidepressants cause almost ubiquitous changes in sexual interest and performance. And this can result in serious relationship


They frequently cause weight gain and sometimes very dramatic weight gain. The antidepressants can cause apathy, less motivation. And in a deeper

sense, they reduce the person's pride in their own resiliency.

AMANPOUR: I'm fascinated. You talked about some of the demographics. So, from some of the studies in "The New York Times" research and articles, it

seems that some of the majority of these antidepressant pill poppers are women over the age of 40 or 45 or so, is that correct?

[14:20:12] FRANCES: It's become absolutely ridiculous. One in every four women in America after the age of 40 is taking an antidepressant on a

regular basis.

The use now is ubiquitous, so that amongst younger women, it's something like one in eight. And even amongst teenagers, where the antidepressants

have no proven value except for very classic severe depression in a teenager, they shouldn't be used in teenagers. No proven value. And

there's a risk of increased agitation, increased suicidal ideation. Even in teenagers, the rate is 4 percent.

So, the drug companies have made antidepressant use a ubiquitous part of our society and that's very good for their profits, very good for the

executives, for the shareholders. It's not good for most of the people involved.

AMANPOUR: Well, in fact, there is one woman who is one of the people who you focus on in your book. And it's Sarah. And just to remind again that

80 percent of antidepressants, you say, are prescribed loosely by GPs after an interview that usually lasts less than about 10 minutes.

So, this Sarah says she was diagnosed as being a depressive when she was really just very sad and grief stricken about the suicide of her son. And

she told you, "the doctor was clinical, brushing aside my fears and my loss. I needed someone who would understand and share the pain that I was

going through, not put a cold medical label on it."

How much of that kind of situation and diagnosis did you see as you were doing your book?

FRANCES: Well, I think she is a particularly, poignant, heartbreaking case because her son actually himself had been mistreated, over-prescribed

medication. It caused side effects. He actually killed himself with a medication he was prescribed.

She's feeling grief. And after a few minutes, the doctor over prescribes medication for her. This is a very common story. I think people have to

become educated for themselves, their family members and particularly their children. Not to accept a quick diagnosis of depression, not to accept the


The diagnosis with depression should take not just one session, but normally weeks and sometimes even months.

Most people come to a doctor on the worst day of their life. If nothing is done, except watchful waiting, support, advice, most of those people will

get better in the short run.

What's happening now is they get a very quick prescription of a pill and then there may not be an endpoint because stopping the pill will be so

difficult and the person will assume that the pill is keeping them well.

AMANPOUR: Well, let's play a little bit of devil's advocate because you make a bit of a distinction between situational grief and feeling really

low and then proper depression.

I mean, there are - there is some benefit, isn't there, to be treated potentially with medication even for a situational amount of feeling low.

Is there or not? I mean, can one sort of micro target like that?

FRANCES: Let's be very clear. There is a cruel paradox that we're over- treating the worried well and we're terribly neglecting the really ill. And the medications are absolutely essential for people with severe


There is no one size fits all. It's not that medicines are good or bad. Medicines are very effective for the few, become harmful only when their

misused with the many.

But I think in terms of situational depressions, short-term reactions to a job loss, divorce, financial troubles, it's always better to watchfully

wait and psychotherapy is by far the preferable first-line treatment instead of medication. The pills are cheaper.

AMANPOUR: Is it? Is it cheaper? Really?

FRANCES: It's a lot cheaper. If insurance companies would let primary care doctors have time to talk to their patients because most of those

patients will not need medication on a second or after a third visit.

Instead they're rushed. The easiest thing they can do is prescribe a pill and a lifetime of medication is far more expensive than short-term

psychotherapy or watchful waiting.


FRANCES: The insurance companies are making a terrible financial decision. It is not just a bad clinical decision. It's a terrible financial


AMANPOUR: So, what is your solution then to this overdiagnosis crisis. I don't just mean from the doctors to have more time, but people. How should

individuals be sensitized and made aware of this problem?

[14:25:07] FRANCES: Well, I think you're doing that and I'm trying to do that with this program. I think that there are several things that need to

be done.

The first and most obvious is that we need to tighten the diagnostic criteria for how physicians and people regard clinical depression.

We need to tame the pharmaceutical industry. They should not be advertising directly to consumer. That happens only in the US and New

Zealand. And both countries have remarkably high rates of antidepressant use.

We need to convince the insurance companies to allow primary care doctors to get to know their patients, so that their only recourse is not writing a


And most of all, we need to inform the public to be more afraid of medication and less afraid of their emotions and of illnesses. I think

that the overwhelming clinical experience and research finding is that most people with transient mild depressions will do very well on their own and

people should trust to their own resources, get support from their families, get psychotherapy way before they consider medication.

The medication should be the last resort for people who have severe chronic depression. It shouldn't be a means of treating the aches and pains of

everyday life.

AMANPOUR: Really fascinating. Dr. Allen Frances, thank you so much indeed.


AMANPOUR: A timely warning indeed.

And that is it for our program tonight. Remember, you can always listen to our podcast and see us online at And you can follow me on

Facebook and Twitter.

Thanks for watching. And goodbye from London.