In this episode, I speak with Eric Mathison, a philosopher and bioethicist at the University of Toronto Scarborough and a former clinical ethicist who worked in hospitals in Alberta and Texas. The conversation covers what medicine is actually for, how psychiatric systems treat people in crisis, and why the answers to those questions matter for anyone who has ever felt that the system saw their diagnosis before it saw them.
Eric argues that the dominant view of medicine, that its purpose is to heal, is false. There are many things medicine already does that have nothing to do with healing, from vasectomies to sports surgery, and nobody objects to them. The problem is that when healing is the only legitimate purpose, anyone who wants help from the system first has to be classified as sick or disordered. Eric’s alternative is that medicine should be organised around promoting patient values: helping people live according to what they actually care about, rather than returning them to a norm that someone else has defined.
The conversation turns to mental health, where Eric presents research showing that for conditions like depression and anxiety, the majority of people who receive treatment see little or no improvement. For anorexia, the numbers are even worse. Treatment does work for some people and that research should continue, but he challenges the story that patients just need to keep trying and they will eventually get better. For many, that story is not supported by the evidence.
We discuss what happens when the system has to decide whether someone is disordered before it can help them. The removal of homosexuality from the DSM is a key example: it was taken out not because of any scientific discovery but because the normative understanding of whether it was harmful changed. The same tension runs through current debates about ADHD, autism, and obesity. Eric walks through the ethics of diagnostic labelling, including research from addiction studies showing that framing a condition as a brain disease does not reduce stigma the way people expect, and can actually undermine a person’s sense of their own agency.
The episode closes with a conversation about the philosophy of death. Eric walks through the Epicurean argument that death cannot be bad for us, the Lucretian symmetry argument comparing pre-birth and post-death nonexistence, and Thomas Nagel’s deprivation account. We discuss whether it is possible to take death seriously as a genuine harm without being consumed by the anxiety of it, and Eric describes his university course in which students are assigned to find their own ways of confronting mortality. He finishes by introducing Tiller Labs, a tool he is developing that uses conversational AI to help people complete advance care directives.
Eric’s website: https://www.ericmathison.ca/
Substack: https://valuejudgments.substack.com/
Imi Lo is a psychotherapist and consultant who has dedicated her career to helping emotionally and intellectually intense people turn their depth into strength. She has written three books with Hachette: Emotional Sensitivity and Intensity, The Gift of Intensity, and The Gift of Empathy.
Imi has over fifteen years of clinical experience, including roles with Médecins Sans Frontières and the NHS (UK), and holds three master's degrees in Mental Health, Buddhist Studies, and Global Cultures. Her training includes art therapy, philosophical counselling, Jungian psychology, mentalization-based treatment, EMDR, Schema Therapy, mindfulness-based and trauma-informed modalities, and she works integratively with psychodynamic, philosophical, and creative methods.
You can contact Imi for a one-to-one session tailored to your specific needs.