A Harvard Neuroscientist Says We’re Medicating Normal Human Behavior | Dr. Adam Omary EP 237
In a Nutshell
Dr. Adam Omary argues that the massive rise in gender dysphoria—especially among teenage girls—and mental health diagnoses stems from overdiagnosis, social contagion, and financial incentives created by expanded DSM criteria and insurance mandates around 2010, rather than genuine epidemics. He contends that puberty blockers, cross-sex hormones, and widespread SSRI use medicalize normal developmental distress and often worsen outcomes, with weak evidence supporting their benefits and growing evidence of harm including permanent side effects for detransitioners. The solution involves rejecting reflexive medicalization of ordinary behavior, preserving bodily autonomy for informed adults, and prioritizing resilience and addressing root causes over pharmacological intervention.
These notes were generated by AI and may contain inaccuracies.
Dr. Adam Omary is a psychologist and neuroscientist who studied at Harvard, focusing initially on gender dysphoria. Prior to that research, he studied hormones and brain development with emphasis on sex differences during puberty and intersex conditions. His earlier work examined rare intersex conditions, which are mostly genetic anomalies and endocrine disorders resulting in hormone imbalances that can lead to personality differences and, in extreme cases, gender dysphoria.
Intersex conditions exist but occur at very low rates—one in 100,000 people or fewer for any particular condition. These conditions do not represent a third sex; individuals remain genetically male or female with specific anomalies leading to intersex phenotypes. Historically, transgender individuals likely had rare genetic conditions causing them to feel they were in the wrong body. Omary expresses sympathy for these rare cases.
There has been an explosion in gender dysphoria cases over the last decade or two, especially among teenage girls. The gender affirming care protocol involving hormonal and surgical intervention has been a disaster. Omary warned about this outcome during a previous podcast two years prior.
Omary completed his dissertation on what is driving the surge in gender dysphoria cases, particularly among teenage girls. At Harvard, Steven Pinker was the only adviser willing to support this research topic, requiring Omary to switch advisers from his original neuroscience lab.
Puberty blockers were first administered in animal research. Adolescence represents a sensitive window for higher-order cortical development, particularly prefrontal cortex regions involved in emotion regulation. The theory behind puberty blockers was that blocking secondary sex characteristics would reduce distress from the felt mismatch between biological sex and gender identity, thereby reducing depression, anxiety, and suicidality.
The common argument was framed as choosing between having a trans kid or a dead kid, citing high suicide rates among transgender people. However, correlation with suicide rates differs from proving causation—that withholding puberty blockers, hormones, or surgery increases suicide likelihood.
Normal hormone fluctuations, such as across the menstrual cycle or from birth control use, can massively impact mood. Administering cross-sex hormones far outside normal developmental ranges is much more likely to destabilize mood and can paradoxically worsen the suicide outcomes the treatment aimed to prevent.
More robust longitudinal evidence now exists on the first cohort of children who received puberty blockers and cross-sex hormones. The majority, who already had very high rates of depression, anxiety, and suicidality, experienced worsening symptoms. Because puberty represents a sensitive period for brain development, the long-term side effects remain unknown. Many detransitioners, including individuals like Chloe Cole, experience lifelong side effects including impacts on fertility.
Omary suggests the term "gender affirming care" should instead be called "dysphoria enabling interventions" or DEI. Many lawsuits are being filed by detransitioners for medical malpractice. Most psychiatrists involved acted in good faith under a reasonable hypothesis that intervening on distressing bodily features would help, though Omary compares this to treating anorexia with weight loss pills or surgery.
For transgender adults, Omary takes a libertarian position supporting bodily autonomy for elective procedures while advocating for greater openness about potential side effects. Many gender clinics are shutting down as evidence shows interventions either failed to help or worsened underlying symptoms.
Omary argues against defunding research into side effects, stating government research funding should not be tied to political agendas. He notes irony that conservatives who accepted social contagion explanations for gender dysphoria also pulled funding for side effect research. Europe is conducting longitudinal follow-up on the first cohort of treated children.
Thirty percent of American college students, mostly from Gen Z, are on psych meds, primarily SSRIs. Across the general population the rate is approximately 20%, with a large sex difference: closer to 30% for females and 10% for males. College student rates are notably higher, partly because college populations are now majority female.
A study of people taking SSRIs for more than two years found 78% experienced some type of withdrawal, with 30% unable to discontinue due to withdrawal severity. The APA does not recognize SSRI withdrawal, instead calling it "discontinuation syndrome." Omary expresses concern about long-term side effects given limited understanding of how hormones, drugs, diet, and even gut microbiome interact to affect mood.
Updated tapering guidelines emphasize hyperbolic tapering rather than abrupt cessation, recognizing that psych meds are not casual medications like a "serotonin vitamin." RFK's initiative to create billing codes for deprescribing medication represents progress. The focus on Medicaid financial incentives highlights how providers who diagnose conditions also benefit financially from increased diagnoses.
The DSM has expanded significantly across revisions. The original manual over 60 years ago was approximately 130 pages; the current edition is 1,130 pages. Successive revisions have broadened diagnostic criteria. Omary argues this expansion reflects both greater awareness and incentive structures favoring overdiagnosis.
A sharp increase in depression and anxiety diagnoses, especially among young people, occurred around 2010. Jonathan Haidt and others attribute this to smartphones and social media. Omary critiques this explanation, noting that while correlations exist between social media use and negative mental health outcomes, meta-analyses controlling for personality traits like introversion show effects largely disappear. Self-selection plays a major role—individuals already depressed, anxious, or lonely seek online connection.
The Affordable Care Act's mental health parity provision in 2010 made mental health care an essential health service, legally requiring insurance coverage. This created supplier-induced demand by opening insurance funding to a previously uncovered service. The DSM-5, released in 2013, contained the most expansive and loosest diagnostic criteria to date. Omary views this timing as a striking coincidence more causally plausible than social media correlations.
The most robust effects of screen use appear on attention span rather than mental health. Quasi-randomized control trials comparing schools with and without smartphone bans within the same district show significant differences in standardized test scores, with better performance in schools banning smartphones. No significant differences appear in mental health outcomes or bullying rates.
Omary interprets attention effects through neuroplasticity principles. Developing brains have finite computational capacity that can be redirected. Slow, traditional learning (critical thinking, reading long passages) competes with fast-paced multitasking optimized by video games and social media. Research shows individuals become worse at long-term critical thinking tasks but better at multitasking, representing specialization rather than overall decline in intelligence.
Omary references his own experience as a homeschooled child spending over 10 hours daily on screens, noting that online connection may have mitigated worse outcomes despite personal struggles with weight and loneliness.
Psychology connects to policy, technology, AI, and mental health topics including chatbots, AI therapy, and extreme cases like AI psychosis and AI-driven suicide. Discussions around AI, social media, diet, and elective procedures highlight real potential harms. Government regulation is often proposed as a solution, but regulation itself creates harm, and diagnosis also creates harm.
The DSM has broadened, which some view negatively, but the counterargument is that expanded access to care is preferable to underdiagnosis. Labeling someone, especially a child, with a diagnosis carries consequences. According to the CDC, there was a 70% increase in autism in the three years post-COVID. Autism is described as a rare genetic neurological disorder characterized by social difficulties. The increase followed a pandemic that removed children from normal social environments.
Social contagion spreads easily on social media through support groups and algorithms that connect people with similar symptoms. This effect may be stronger than screen time alone. Jonathan Haidt's work focuses on homophily—what people hear and who they interact with—rather than screen time directly. This includes cyberbullying and phenomena like the gender dysphoria epidemic, eating disorders such as anorexia, and self-harm like cutting.
Australia implemented a ban on social media for kids under 16, but teenagers bypass it using VPNs and the dark web, potentially moving them from regulated platforms with safety checks to less regulated spaces. Age verification mandates for all users introduce unconstitutional privacy risks for adults. The question arises whether responsibility lies with parents rather than companies, similar to how parents are held accountable when children access firearms or drugs.
An evolutionary mismatch exists between ancestral environments and modern life. In ancestral settings, preference for high-calorie foods and threat detection (mistaking a stick for a snake) were adaptive. Media exploits negativity bias because negative information naturally captures attention. Marcus Aurelius in Meditations described first-world problems 2,000 years ago as emperor—avoiding gluttony, laziness, and outsourcing responsibilities—mirroring current abundance challenges.
The current crisis of meaning represents "emperor world problems at scale" due to unprecedented wealth and safety. Responsibility and agency become harder to cultivate in environments of extreme ease. This difficulty is worthwhile, as it replaces historical struggles with starvation and shelter with opportunities for self-created meaning.
Personality traits like conscientiousness and neuroticism follow a bell curve distribution. Individuals lower in conscientiousness and higher in neuroticism face greater challenges adopting responsibility, but the solutions remain fundamentally the same and become more urgent for them.
Mindset around responsibility can be taught. No truly unmotivated people exist because humans possess inherited biological motives: avoiding pain, starvation, and boredom. Even doom scrolling reflects an intrinsic drive to escape boredom. Boredom itself supports creativity. The goal of progress psychology is to understand evolutionary psychology and optimize it, similar to Maslow's hierarchy of needs.
When uncertain about life's direction, identify problems and work to fix them. Starting with personal issues like autoimmune disorders provides direction and applies universally: examine what part of life is suffering and address it.
Dostoevsky's Notes from Underground illustrates that complete absence of problems leads to boredom, depression, and nihilism. Every era has unique challenges, but the existence of problems does not negate overall progress.
Progress psychology aims to become its own subfield within psychology, akin to social, developmental, cognitive, evolutionary, and clinical psychology. It connects to progress studies, which optimize human existence through health, AI alignment, and institutional reform. The field examines psychological traits that enable progress (mental health, fulfillment, creativity, purpose) versus those that hinder it (tribalism, zero-sum thinking, negativity bias).
Marian Tupy runs HumanProgress.org, which presents open-source data from sources like OECD and Our World in Data. The data shows broad improvements, though mental health outcomes appear worse. Skepticism remains about whether this reflects actual deterioration or shifts in diagnostic standards. Agency is viewed as both affected by and a solution to nihilism. The fertility crisis is linked to the meaning crisis, as having children represents a long-term optimistic bet that fewer young people are making.
Rising rates of conditions like juvenile rheumatoid arthritis and obesity suggest something physiological may be increasing sensitivity to depression beyond a meaning crisis alone. Proposed factors include vaccines, processed foods, and reduced physical activity. Life expectancy remains near historic highs, and infant and childbirth mortality are at all-time lows compared to a historical median age of around 40.
Sarah Hill contributes on birth control's psychological and institutional trade-offs. Expanded agency and women's rights come alongside potential hormone disruption and shifts in institutional culture, such as women now earning the majority of degrees, which may relate to changes like increased cancel culture. Smartphones trade long-term focused thinking for multitasking and rapid information processing. Free markets are supported because data shows they drive innovation and prosperity, while anti-free-market systems, particularly communist regimes, have caused hundreds of millions of deaths.
More freedom is generally positive. Adults should make their own choices about smoking, diet, or medications without being lied to about consequences. Society is not starting from zero; it is already addicted to certain foods and medications due to prior misleading information. This makes questions about government intervention more complex. Institutional trust is at historic lows, partly due to COVID-era overreach, lockdowns, and information manipulation, with long-term ripple effects on younger generations and future parenting.
The KO Institute runs studies through the human progress team and operates a polling center. Think tanks function similarly to research universities, covering policy areas including health, economics, foreign policy, and defense. The organization employs experts across disciplines with true diversity of thought, despite self-selection bias toward libertarian or libertarian-leaning free market thinkers. Historical patterns show that free markets correlate with greater freedom, attracting talent through brain drain effects and creating a Matthew principle phenomenon where success compounds. This represents an evolutionary dynamic rather than a flaw in free market systems.
The KO Institute is commissioning studies on social media polarization and misinformation through the broader psychology of progress project. Existing research shows that social media trolls are disproportionately high in dark triad traits, particularly during anonymous online interactions. The goal is understanding problems accurately as the first step toward solutions, recognizing that while progress occurs on average, real challenges remain.
Adam Omary serves as the only psychologist at KO, functioning as a generalist while evaluating study methods across disciplines using biostatistics expertise. The four main organizational taglines are advancing limited government, individual liberty, free markets, and peace. Most think tanks are more explicitly partisan, with examples including the Heritage Foundation's involvement with Project 2025, Brookings and Centers for American Progress on the left, AEI where Carol Hooven works, and the Manhattan Institute where Rob Henderson is based.
Think tank work operates at a faster pace than academic publishing, with one or two op-eds per week or month reaching larger audiences compared to one or two peer-reviewed articles annually. In-depth policy analyses are produced that function as peer-reviewed academic papers, though these receive limited readership. Content gets condensed into outlets like the Washington Post or Wall Street Journal for broader reach. KO stands out as the largest libertarian think tank that remains nonpartisan, allowing principled rather than partisan positions that support certain policies while critiquing others.
KO operates as a nonprofit relying on individual donors who support advancing individual liberty. Think tanks recruit through two main streams: policy analysts and economists for behind-the-scenes research, and notable public figures whose philosophy aligns with the organization's mission. Rob Henderson's association with the Manhattan Institute serves as an example of the latter approach.
KO takes no particular stance on gender dysphoria, exemplifying diversity of thought. Libertarian arguments exist on both sides: one holding that children cannot consent, making medical interventions unethical, and another holding that parental liberty includes decisions about children. Most concern centers on children rather than transgender adults. A shared position is the need for more openness about harms and what interventions actually accomplish.
Adam Omary's position combines early career researcher and policy analyst work with a public intellectual role through podcasts and writing. His public speaking on gender dysphoria in a data-driven manner attracted KO's attention. Committing to truth-seeking despite potential pushback from Harvard peers led to this opportunity through connections including Marian Tupi. KO circles overlap with ARC (Alliance for Responsible Citizenship) circles.
An article in The Dispatch addresses ADHD overdiagnosis. Diagnostic criteria have broadened across successive DSM revisions with increasing financial incentives. The school structure requiring children to sit still for eight hours conflicts with evolutionary psychology expectations, particularly for young boys. Pathologizing ordinary human behavior raises concerns. The NIH reports that 50% of American adolescents have met criteria for mental illness at least once, with approximately 30% meeting criteria at any given time.
From a personality and clinical psychology perspective, 30 to 50% prevalence represents ordinary human behavior by definition. Clinical psychopathology concerns extreme tails of distributions. The distinction between ordinary and pathological exists within the definition of psychopathology itself. When prevalence reaches these levels, ordinary distress has been medicalized.
Multiple pregnancies involve extreme psychological destabilization through hormonal changes and postpartum effects, compounded by family health stressors. Normal human stress responses to difficult circumstances like cancer diagnoses in loved ones produce expected distress that should not be medicated, as this prevents emotional processing. Trauma survivors who receive medication may not process emotions, creating long-term issues.
Therapists and psychiatrists navigate insurance systems requiring diagnoses for reimbursement. Adjustment disorders serve as a catchall term for people going through difficult times with the understanding that no clinical disorder exists, yet coverage requires treating situations as medical disorders. This represents an open secret within the therapeutic industry. The term adjustment disorder itself carries problematic implications by pathologizing normal responses to life circumstances.
Historically, community and family provided support that has since fragmented. A fine line exists between medical problems, mental health problems, and adjustment problems requiring advice and support. People internalize diagnoses as indicating something wrong with themselves when life challenges require social support. Jordan Peterson assessed clients by examining friendships, work, love life, and recent losses before diagnosing major depressive disorder.
Psychiatrists may rely on Beck questionnaires without thorough exploration of trauma or life circumstances. Population-level prevalence data from CDC and NIH primarily use surveys rather than in-depth psychiatric interviews. These surveys correlate with conditions but produce false positives, as autism-related items like struggling with eye contact or preferring to be alone also characterize social anxiety or ordinary shyness.
Psychiatrists receive payment for more diagnoses, with financial incentives favoring four 15-minute prescription sessions over hour-long therapy. A shortage of psychiatrists means most therapy comes from master's level counselors. Medication makes sense only after thorough evaluation rules out obvious causes, rather than serving as first-line treatment or a crutch that prevents addressing root problems.
Pregnancy involves distinguishing between optimal decision-making capacity and pregnancy brain states. Philosophical libertarianism in the free will debate contrasts with determinism, acknowledging agency where it exists. Developmental psychologists often hold implicit or explicit determinist positions in nature-nurture debates. Acting as though free will does not exist leads to bitterness and resentment, with free will exercised unproductively. Recognizing pregnancy-related mood changes reflects a libertarian approach acknowledging voluntary choices while maintaining mindfulness about current states.
Everything is trade-offs. A libertarian philosophy recognizes ahead of time that certain outcomes are predictable results rather than diagnosing something as wrong with you. Instead of viewing yourself as a victim of your hormones, you can recognize situations in advance and navigate around them with free will and agency.
One benefit from being miserably depressed for so long and then going through antidepressant withdrawal and being completely batshit for 2 years was figuring out when thoughts didn't make sense. The distinction became clear between "there's me" and "these thoughts I have that don't make sense, but that's not me."
Pregnancy makes people dumber with increased use of filler words like "like," causes short-term memory issues, tiredness, nausea, meat aversions, and physical discomfort. It's an unpleasant experience, but unpleasant experiences can be endured for a period of time if they pay off, especially when the payoff is having kids.
A good approach for people going through unpleasant experiences is to stay hopeful for a window at the end and for things to get better. Learning that you can be resilient through these things makes them not as anxiety-provoking. You can frame it as "This is a bad year. This is a period of suffering. I'm going to do as well as I can. I'm not going to be as productive as I normally am, but I've done this before and I can do it again." This prevents adding existential horror on top of whatever you're experiencing.
Resiliency is important for people to learn. Otherwise, how are you supposed to stay mentally healthy and be a human? This represents human progress at the individual level.
People can learn more at psychology.humanprogress.org. There's discussion about getting Adam on PA to teach a course on the Psychology of Human Progress.
Keep Mikhaila Peterson in your library
Save the videos and channels worth coming back to, and find them again in one place.
