The Art of Manliness - Skills Over Pills

00:00:00.000 Brett McKay here, and welcome to another edition of the Art of Manliness podcast.

00:00:11.460 Over the last decade, there's been an increase in the number of people, particularly young

00:00:15.480 adults who struggle with low moods, distractibility, and anxiety, and consequent difficulties with

00:00:21.180 getting their life on track and making progress in work, friendship, and romance. In addressing

00:00:26.020 these difficulties, people are often given or adopt a mental health diagnosis and look

00:00:30.500 for a solution in therapy and or medication. My guest isn't opposed to these remedies.

00:00:35.380 She is herself a clinical psychologist who's maintained a practice for a quarter century

00:00:39.000 that specializes in treating clients in their 20s. But Dr. Meg Jay, who's also the author

00:00:44.160 of the 20-something treatment, believes that a lot of what young adults, and in fact, adults

00:00:48.220 of all ages struggle with, aren't disorders that need to be treated, but problems that

00:00:52.360 can be solved. In the first half of our conversation, Meg explains what's behind the decline in

00:00:57.100 mental health for young adults and how it's bigger than just smartphones. We discuss the

00:01:01.100 dangers of self-diagnosis, the potential downsides of using medications to treat mental health

00:01:05.420 issues, and why she advocates for skills over pills. In the second half of our conversation,

00:01:10.560 we talk about how mental health gets better when we get better at life and what skills 20-somethings

00:01:15.000 and many older adults need to develop, including the skills of thinking, feeling, working, socializing,

00:01:21.360 and even cooking. We also discuss how porn is affecting the young men in her practice,

00:01:25.820 an alternative to being a self-assurance junkie. Out of the show's over, check out our show notes

00:01:30.100 at awim.is slash Meg Jay. All right, Meg Jay, welcome back to the show.

00:01:47.860 Oh, it's so great to be here, Brett.

00:01:49.980 So I was looking, the last time we talked to you was 2013. You're one of our first podcast guests.

00:01:56.120 You're in episode number 51.

00:01:57.900 Oh, I love it. Well, I said, I feel like we're old friends. I've always had a special place in

00:02:02.420 my heart for the art of manliness.

00:02:04.160 Well, thank you so much. We talked about your book the last time, The Defining Decades, about your 20s.

00:02:09.080 When that book actually inspired a few articles that we wrote on the site, and it really resonated

00:02:13.220 with me at the time because I was in my 20s when I first came across that book.

00:02:18.100 And you got a new book out. It's called The 20-Something Treatment, A Revolutionary Remedy

00:02:23.860 for an Uncertain Age. So background on you, you are a clinical psychologist who specializes

00:02:29.180 in working with 20-somethings, young people. And one thing we've been seeing in the zeitgeist a lot

00:02:36.300 recently in blog post articles, news articles, et cetera, is that young people today, we're talking

00:02:42.420 teens, people in their 20s, are in the midst of a mental health crisis. What do the statistics say

00:02:49.240 about the mental health of young people today? And what are you seeing with the patients you are

00:02:54.420 encountering?

00:02:55.720 Yeah, well, I've been specializing in 20-somethings for 25 years, believe it or not. And you might

00:03:01.740 remember from your 20s, it's a tough time. So I think people hear, oh, these are going to be the

00:03:06.220 best years of your life. Really, I'm sorry to say they're actually, empirically speaking,

00:03:11.020 a mental health low point. That has been the case for a while. I think now, I mean, that's why I've

00:03:17.380 always been working in the space. I think people are talking about it more now, which is potentially

00:03:22.380 a good thing. But I think part of the conversation about young adult mental health too quickly becomes

00:03:28.620 what's my diagnosis? What's the medication that I need? So a lot of what I do is really normalize a lot

00:03:34.760 of the problems that 20-somethings and adults of all ages have and talk about strategies for

00:03:40.920 looking at those that aren't just necessarily therapy or medication.

00:03:45.860 So yeah, we're seeing a lot of young people and a lot of people, just even older people,

00:03:49.560 talking about anxiety, depression, ADHD, things like that. When psychologists try to explain what's

00:03:57.700 behind this uptick in mental health, what are the reasons they give?

00:04:02.960 I mean, I think what you hear people saying a lot is phones and the pandemic, and those certainly

00:04:08.540 played a role. I think what I see a lot with young adults and adults of all ages, but everything that

00:04:15.260 I see is just sort of more acute with young adults, is just how uncertain 21st century life is. The brain

00:04:22.220 really doesn't like uncertainty. So in your 20s, everything is uncertain all at the same time. You're

00:04:27.780 uncertain about work and love and friends and where you're going to live and who you're going to be. And

00:04:32.080 that's a lot. The brain doesn't like that, and it tends to respond to uncertainty by perceiving it as

00:04:38.940 danger and then therefore feeling stressed and anxious. But that doesn't mean that you have an anxiety

00:04:43.720 disorder. It means you're feeling anxious. There's a lot in your life that's uncertain. So let's help you

00:04:49.240 sort of pin some things down and feel more sure of yourself.

00:04:52.940 Yeah, you call uncertainty a transdiagnostic stressor.

00:04:57.660 Yep, that's a mouthful of a word and maybe a boring label. But in the research, that's what

00:05:03.720 uncertainty is known as. And what that means is that it's a stressor that shows up differently in

00:05:09.120 different people. So when people are feeling overwhelmed by uncertainty, some people get anxious,

00:05:13.800 some people feel hopeless and lay in their bed and feel depressed. Other people reach for substances,

00:05:18.700 other people eat too much or eat too little. So it's definitely a stressor for most human beings

00:05:25.760 and how it manifests depends on the individual.

00:05:29.220 Yeah, I can see that in my own life. Uncertainty causes so much stress.

00:05:34.040 When I remember when I was in my 20s, one stressor that I had that was caused by uncertainty

00:05:38.040 was when I was in law school and I took my final exam. Because your whole grade depended on one exam

00:05:43.860 for the semester.

00:05:45.260 No stress.

00:05:46.040 No stress. So you took the test. And then after you were done, you do these postmortems in your

00:05:49.740 head because you didn't know how you did.

00:05:51.720 Right.

00:05:52.240 And then you'd go down this spiral where you're just like, oh my gosh, I probably...

00:05:56.720 What is this? What is that?

00:05:59.220 Basically, it all led to like, I'm going to... We're going to end up... I tell my wife,

00:06:02.600 we're going to end up homeless.

00:06:04.000 Yes. Of course.

00:06:04.900 And bankrupt.

00:06:06.080 Yes, of course. And that's really, I mean, that's such a great example of really the big

00:06:12.580 picture of the 20s is that people don't, like, it probably took you a week or two to find out the

00:06:17.800 results of that exam. But in your 20s, in terms of what am I going to be? Is my life going to work

00:06:23.160 out? Will I be happy? Will anyone love me? Will I be successful? Can I pay my bills? Those are

00:06:28.840 things that remain uncertain for a good five to 10 years of time. And so that's a lot to cope with.

00:06:37.240 And it does tend to make people feel anxious and stressed until they have those data points that

00:06:42.080 give the feedback that, okay, you're going to work this out. This is moving in the right direction.

00:06:46.920 But the brain just doesn't like that.

00:06:49.400 Yeah. And this uncertainty that causes things like anxiety or feeling depressed and just down,

00:06:55.320 this can happen, you know, later on in life when you're in your 30s, 40s, 50s, when you have those

00:07:00.960 moments of uncertainty in your life, maybe you get laid off from your job and you think, oh my gosh,

00:07:05.120 what's going to happen to my family? Or maybe there's something with your kids you're worried

00:07:08.720 about. Same sort of thing can happen to you.

00:07:11.800 Yes. I mean, I actually, I had a health issue last year and I was really feeling for my 20

00:07:17.920 somethings because suddenly there was this new piece of uncertainty in my life. And, you know,

00:07:22.440 at this point in my life, my career is pretty sorted and my love life is sorted and I have kids and I

00:07:27.900 know where I'm going to live. So there's not a ton of uncertainty in my life anymore, but I had this

00:07:32.620 health issue come up and suddenly there was all this uncertainty and it was really difficult until

00:07:38.720 I got some information of, okay, this is the deal and this is what we do. And then I noticed how,

00:07:44.400 you know, sort of like with your law school exam, suddenly I was like, great, I know what to do now.

00:07:48.880 And I know what this means. So you're going to have those periods again and again throughout life,

00:07:54.280 whether it's health or changes in work or changes in your relationship. We usually get better at

00:07:59.380 handling them over time because we have more experience of, okay, I've been here before.

00:08:03.960 I've gotten through this. I'll find a way. You feel like you can count on yourself.

00:08:08.680 The hard part about being in your twenties is you don't feel like you can count on yourself yet.

00:08:12.360 And you don't have a lot of data points for how this works.

00:08:15.780 And I can see this idea of uncertainty causing all this distress. I can see why the pandemic would

00:08:22.340 exacerbate that. You're just like, oh my gosh, what's going to happen? I don't know if I'm going

00:08:26.580 to have a job. Is this ever going to end? And I can also see how smartphones can exacerbate that

00:08:31.560 because you're just constantly plugged into this thing that's showing you all sorts of different

00:08:35.920 information. You're not exactly sure like, what should I act on? What's the good stuff?

00:08:40.860 That can probably just cause even more uncertainty.

00:08:42.820 Right. And we've all heard by now the social comparisons that phones induce. We're always

00:08:50.200 looking at people on vacation or skydiving in Dubai. I mean, they're having amazing time and

00:08:55.940 amazing lives and amazing relationships. And so it's hard when you feel like, I don't really know

00:09:01.700 if my life is going to work out, but look at all these other people's lives who are working out

00:09:06.220 beautifully. Your brain knows that this is not a fair fight in terms of the data being presented,

00:09:13.200 but it still has to go through that process of, ugh, you can't believe everything you see. And

00:09:19.160 maybe I'm not doing as badly as I think. And that's a lot. So I think people of all ages have to decide

00:09:26.340 what platforms they're going to use, what makes them feel happy, what makes them feel unhappy,

00:09:31.680 or how they use them and how much they use them. Okay. So uncertainty, we don't like uncertainty.

00:09:36.960 It can cause us to get anxious, feel just low and depressed. It can even cause us or nudge us

00:09:43.860 towards using substances to alleviate some of the bad feelings we have when we're facing uncertainty.

00:09:49.280 We experience a lot of uncertainty in our twenties because we're figuring life out,

00:09:53.360 but people in their thirties, forties, fifties can also experience this. And one way people have

00:09:59.240 tried to cope with the feelings of angst that come with uncertainty is they turn to psychology,

00:10:04.360 which makes sense, right? Psychology is there to help you deal with those sort of things.

00:10:08.260 But you note in your book that there's been a trend of young people, and I've seen this not just

00:10:13.980 with young people, but even people my age in their late thirties, forties, people self-diagnosing

00:10:20.080 themselves with mental health disorders. What are the dangers of self-diagnosing?

00:10:26.880 Yeah. I mean, I think when we're feeling uncertain, we're, you know, casting about for,

00:10:31.640 give me something I can act on. I mean, it was, you know, a bit like what I was talking about with

00:10:35.620 my health issue last year of, you know, let me understand what this is and what we do. So

00:10:39.760 I think it's very tempting to say, what's wrong with me? What's my diagnosis? What's the three-point

00:10:46.100 plan? Although, you know, most mental health problems don't have a three-point plan or what's

00:10:51.460 the medication required. And, you know, the truth of the matter is most young adults, most adults of

00:10:57.040 all ages don't have diagnoses. They have problems they're trying to solve. They have changes they

00:11:01.920 need to make. They have skills they need to build. And I think one of the drawbacks of looking for

00:11:08.680 certainty in a diagnosis is that, you know, your identity can become pretty wrapped up in that. And then

00:11:14.180 you see everything through that lens rather than through the lens of, hey, I'm in a transition or

00:11:19.540 this is a tough time. And what are the skills I need to build? What are the changes I need to make

00:11:23.800 rather than looking for, you know, what's the medication I need to take?

00:11:27.820 Yeah. You talk about, you know, giving yourself a diagnosis can cause a nocebo effect in you. What

00:11:32.760 do you mean by that?

00:11:33.760 Yeah. The nocebo effect is the opposite of the placebo effect, which of course is if you think you're

00:11:39.100 going to get better, you're more likely to get better. The nocebo effect is really the power of

00:11:43.860 negative expectations. So I have a lot of people come in my office and they say, I have this and

00:11:50.500 I'm going to have this all my life. And I've read this as a lifelong problem and they see everything

00:11:55.640 through that lens. And so it can get in the way of people actually getting better or having hope that,

00:12:02.360 you know, there's nothing wrong with me. I'm not doing something wrong. I'm just having a hard time.

00:12:06.600 So what is it I need to do to move forward? And people who have hope are more likely to

00:12:12.340 take action, to, you know, kind of move their lives ahead. They're less likely to feel anxious

00:12:17.860 and depressed, less likely to think about ending their lives. So I think sometimes people look for

00:12:23.120 certainty in diagnoses and which they may not really have. And believe it or not, that can actually

00:12:29.840 get in the way of finding hope that life could be better six months or a year from now.

00:12:34.940 Yeah. Cause you, you take on that, like you said, you take on that identity. I'm depressed. I'm a

00:12:39.600 depressed person. I'm always going to be depressed. And yeah, you might, like you said, you might be

00:12:44.220 feeling low because you're going through a hard time in college or you just had a breakup, a lot

00:12:49.920 of uncertainty. So, you know, if you open up the, the DMS five, you know, the diagnostic tool and you

00:12:55.480 look at the symptoms for depression and you say, well, I got that. Um, now like, yeah, you just kind of

00:13:01.220 look at everything as like, well, I'm depressed and there's nothing I can do about it.

00:13:04.960 Right. Or great. Now on top of, you know, being laid off now, I'm also depressed rather than saying

00:13:10.760 after loss, whether it's loss of a job, loss of a relationship, loss of, you know, anything,

00:13:16.900 it's normal to feel sad and depressed. It doesn't mean you have a disorder. I mean, that's grieving.

00:13:24.200 And so it helps often to say, this isn't a normal reaction to a loss in your life. And what does

00:13:31.800 that tell you about what it is that you value that you want to get back in your life? Meaningful work,

00:13:37.840 close connections, you know, what did you lose that you want to get back rather than let's just

00:13:43.340 alleviate the symptoms? How has social media exacerbated the problems of self-diagnosing?

00:13:49.320 Well, you know, when I first started doing this 25 years ago, for better or for worse,

00:13:57.380 the DSM, the kind of psychiatrist Bible you were talking about a minute ago, that, that was only

00:14:02.600 available or, you know, no one would go out and purchase that. It was a hundred dollar doorstop

00:14:07.100 of a book and extremely boring and dry. So no one really had access to what are these mental health

00:14:13.980 disorders and how do you diagnose them? And now, you know, for a lot of reasons that are good,

00:14:19.320 that information is widely available on the internet or in on social media and quick little

00:14:25.600 tidbits and quick videos. And it's actually what we used to call medical student syndrome that people

00:14:31.480 would go into medical school and they would read about illnesses and disorders and decide they had

00:14:35.900 all of them because, you know, they could see themselves in so many. So something similar happens

00:14:41.020 on social media. People hear about anxious attachment style and they decide they have it or,

00:14:47.260 you know, panic disorder and they decide they have it or bipolar disorder or borderline personality

00:14:53.460 disorder, which it's very rare, but people decide they have it. And so then, you know,

00:14:59.640 it's sort of a misunderstanding of what's going on. They're locating the problem in their brain

00:15:04.160 rather than in their everyday life.

00:15:07.340 Yeah. You say about the social media, mental health stuff that goes on on TikTok and Instagram

00:15:12.880 reels or whatever, there's a fine line between social awareness and social contagion.

00:15:19.140 What do you mean by that?

00:15:21.100 Yeah. I mean, I think it's cool that people are becoming more aware of, hey, you know,

00:15:28.240 the twenties or many points in adulthood are difficult and people have these struggles and this is very

00:15:33.600 normal, but it's not so great when everybody decides that, oh, you know, I have this disorder

00:15:41.060 or we've even seen how quote unquote disorders can literally spread on social media. There was a lot

00:15:47.440 of research done around during the pandemic around these ticks like, you know, that people were developing

00:15:53.920 in terms of, you know, squinting or saying words over and over again that young adults or teenagers

00:15:59.580 would see these videos of people saying, I can't stop doing this. And then they started doing it.

00:16:04.080 And so there was this unprecedented number of people going into neurology clinics with ticks that

00:16:10.380 were specifically the ones that were circulating on TikTok. So that was a very concrete example,

00:16:15.500 but I see the same thing with right now. I can't tell you the number of people who keep coming in

00:16:20.720 and telling me they have anxious attachment style and they don't. They're just feeling,

00:16:27.360 you know, uncertain about, gosh, I don't know if this person likes me or I'm not sure who my friends

00:16:33.320 are. And that's a pretty normal way to feel in your twenties. It doesn't mean that you have anxious

00:16:38.740 attachment style. Yeah. I've seen, you know, I get this like mental health stuff that pops up in my

00:16:45.480 Instagram feed. And when I look at this, cause I've read, I've talked to enough psychologists and I've

00:16:50.240 read enough books about this because of the podcast. I can look at some of the stuff like this is not

00:16:54.100 legit. Like this is just some person who maybe had some problems and now they're trying to like

00:16:58.900 help other people, whatever. One thing I've seen is like this idea that procrastination is a trauma

00:17:04.860 response. And I'm like, ah, I don't maybe, but probably not. You're probably just, you know,

00:17:11.660 you're like anybody who procrastinates. It's just, you don't like doing the thing. It's not pleasant to

00:17:15.500 do. So you're putting it off. Right. And I think, you know, I actually haven't even seen that,

00:17:21.260 Brett. So I'm curious of a, what's the connection and B how is that helping people to say, oh, great.

00:17:27.720 Not only do I procrastinate, but I'm also traumatized. So I'm not sure what's going on

00:17:32.720 there, but yes, I see procrastination in my office all the time. And I think sometimes people panic

00:17:39.200 and say, oh no, that means I have ADHD or that means I have, you know, fill in the blank. And often,

00:17:45.940 like you're saying, it's young adults and adults of all ages trying to grapple with the reality that

00:17:52.060 they have to do things they don't want to do. And the brain would like to avoid that as long as

00:17:56.980 possible. But eventually, hopefully we learn through experience, much of it painful, that it's actually

00:18:03.280 just easier to not procrastinate, to do stuff in small bits, starting sooner rather than later,

00:18:09.960 that this is part of, you know, growth and development. Okay. So instead of being quick

00:18:15.420 to take on a mental health diagnosis, if you're feeling anxiety, just feeling depressed, maybe

00:18:20.920 scattered brain, et cetera, you try to help people figure out that come to you, you know, whether

00:18:27.120 those feelings they're having can be attributed to some situational stressor. Like maybe you're not

00:18:31.360 depressed. Maybe, you know, you're just, you're feeling low because you got a bad grade this semester

00:18:36.060 in college, or maybe you lost your job, or maybe you're having some problems in your relationship.

00:18:41.620 How do you, I mean, one thing I've noticed when it comes to mental health, people can get really

00:18:46.480 touchy about questioning diagnostic labels they've given themselves because it's like tied up with

00:18:52.280 their identity. So how do you do this as a practitioner, help them maybe look at things

00:18:57.700 differently and kind of nudge them to look at maybe the feelings or problems they're having

00:19:03.520 can be attributed to a situational thing and not to a disorder?

00:19:07.640 Yeah. Well, I mean, it may be because I do this day in and day out. So I usually just very, you know,

00:19:13.960 matter of factly with a smile say, well, I'm not so sure this is a disorder. Maybe this is something

00:19:18.460 going on in your day to day. So let's talk about your day to day. And I usually ask people to tell me

00:19:23.320 a lot of detail about their work and love and life and health and sleeping and substances and porn

00:19:30.160 and everything. I get real familiar with the details of people's lives. And then I start to

00:19:35.740 maybe help them connect the dots between what's going on day to day and how they're feeling. And

00:19:42.140 then, you know, obviously only can go off of what clients tell me, but you'd be amazed. Most people

00:19:47.560 tell you what their problem is, even if they don't realize they're telling you that they tell you,

00:19:53.000 you know, where the gaps are, where things are going sideways. And then they're, you know,

00:19:57.380 end up basically suggesting their own solutions. And so you say, well, why don't we start there?

00:20:02.660 Why don't we start by addressing this issue or having this or that conversation or changing who

00:20:07.840 you live with or talking to your boss at work? And then just sort of work on it on the ground

00:20:14.280 through a life intervention rather than through a medical intervention.

00:20:18.460 And you make clear in the book, you're not against mental health diagnoses, but you're only

00:20:23.500 going to provide one if you think it's going to be useful for the person.

00:20:27.760 Yeah. Yep.

00:20:28.420 You're going to try these life interventions first.

00:20:31.380 Yeah. I mean, I'm thinking, I'm always thinking with a client, do I need to diagnose this person

00:20:37.120 in order to help them? Because oftentimes, what difference does it make? You know, what you do

00:20:41.480 or don't call it. The question is what you do about it is really the important thing. So, you know,

00:20:46.300 I'm thinking, do I need to diagnose this person in order to help them? How could a diagnosis

00:20:50.780 help them understand what's going on? Or how could a diagnosis limit their understanding

00:20:56.200 of what's going on? And I mean, you know, these are not black and white issues. I mean,

00:21:02.200 I've been doing this 20 years. So, there's some finesse involved in trying to decide when

00:21:06.280 is a diagnosis helpful? When might it be limiting? And I'm also not for or against medication.

00:21:12.520 I'm just for people understanding that medication has upsides and it has downsides. And I like for

00:21:18.480 people to be educated about what those are when they make decisions about whether to start or

00:21:23.760 continue or to stop a medication for a mental health problem.

00:21:27.620 Well, let's talk about mental health medication because that's another thing you're seeing an 0.99

00:21:30.940 uptick in. People turning to psychoactive medication to relieve feelings of sadness, angst,

00:21:37.740 feeling scattered brain. Do we know how many people are taking psychoactive medication today?

00:21:42.700 Yeah, about one in five are taking a mental health medication. And actually, among adults of all ages,

00:21:50.660 antidepressants, this is a kind of a shocker of a data point, are the most likely prescription

00:21:57.080 medication to be in your medicine cabinet from the age of, you know, 20 to 60. If you've got a

00:22:03.240 medication in your medicine cabinet from age 20 to 60, it's most likely to be an antidepressant. So,

00:22:09.120 they're quite widespread. They have upsides and they have downsides. And I think about 80% of

00:22:15.400 prescriptions for mental health meds are made by general practitioners. And I don't have anything

00:22:21.400 against general practitioners either, but they don't specialize in these medications. They don't

00:22:26.800 specialize in young adults. And often, because of, you know, no fault of their own, they're limited to

00:22:31.900 15-minute appointments. And so, oftentimes, young adults and adults of all ages are given medication

00:22:38.760 after very brief conversations where you're not able to get a lot of context of, hey, what's going

00:22:44.200 on in your life? Is there something we might want to work on there before we give you medications that

00:22:50.520 do have side effects?

00:22:52.640 What does the research say about the efficacy of these drugs, like the upsides and the downsides of it?

00:22:57.680 Yeah. So, antidepressants are not a silver bullet. They're estimated to work about 50% of the times.

00:23:04.740 And by work, I mean, the effects that people appreciate, so the upsides of them is they can

00:23:11.900 make people feel less sad. They make kind of the lows less low and the anxiety less intense. So,

00:23:18.800 that's why people take them. I think what many people don't realize is that they don't just work

00:23:24.400 on one end of the emotional spectrum, that they basically kind of turn down the volume on emotions

00:23:29.320 in general. So, they make the lows less low, but they make the highs less high. So, you'll hear

00:23:34.660 people say, yeah, I'm less depressed and anxious than I used to be, but I'm also, I don't really

00:23:38.940 enjoy my life much. I'm also not that happy, don't have a lot of motivation. They can really cause a lot

00:23:44.840 of sexual side effects. So, people just aren't that interested in sex or don't feel like they could get

00:23:49.580 much pleasure out of it. They can also cause some weight gain, which is, you know, a big issue,

00:23:54.520 especially for young adults while they're trying to kind of start their life and have relationships.

00:23:58.900 So, most young adults don't know about the negative side effects when they go on the medications.

00:24:05.820 And often, there isn't a plan for, well, how long am I going to be on this? So, most people go on

00:24:12.340 mental health medications thinking like, you know, maybe I'll do this six months to a year.

00:24:16.460 Whereas, in the end, the majority of people end up staying on these medications for five to 10 years.

00:24:22.980 It's okay. So, antidepressants work 50% of the time, like it's 50-50 chance that it could work.

00:24:28.380 Yeah, it's not, they're not a silver bullet. They're absolutely not. You know, some people find

00:24:32.640 that they are somewhat helpful and just as many people find that the side effects really outweigh

00:24:39.580 the positive effects. So, you know, I think people have heard or imagine there's this kind of like,

00:24:45.380 well, why not? We know it'll work. We know it'll help. There's no downsides, but none of what I just

00:24:50.300 said is the case. So, we don't know they're going to be that helpful and there are downsides.

00:24:55.460 Yeah, we had a podcast guest a few weeks ago who said that antidepressants don't work much better

00:25:00.660 than a placebo. And I got a couple comments from some listeners who said something like,

00:25:05.640 hey, you shouldn't have let them say that. You know, that was misinformation. But that's what the

00:25:09.680 evidence shows. I mean, you can Google, are antidepressants more effective than a placebo?

00:25:14.800 And you'll find articles on it. And in a recent study, this was a re-analysis of a meta-analysis

00:25:20.900 on the effectiveness of antidepressants. And I'm going to link to it in the show notes.

00:25:25.660 This study concluded, it is unclear whether antidepressants are more efficacious than placebo.

00:25:32.120 And as you said, it works for some people. What I've read, and correct me if I'm wrong,

00:25:36.660 is that antidepressants, they particularly work well for people who have severe depression.

00:25:40.080 Like, they can't even get out of bed depression. And then you take the antidepressant,

00:25:44.760 they'll hopefully get you going. So, you start doing the things like exercising, socializing,

00:25:49.180 doing those things that will help you start alleviating your depressive symptoms.

00:25:53.700 Right. Yes. I mean, I think at this point, physicians who really know what they're doing,

00:25:59.260 that is the suggestion. However, I mean, I see all the time that the first hint of,

00:26:05.960 I feel anxious, I feel depressed, physicians saying, well, try this. Why not? I mean,

00:26:10.660 that is the medical model. If you diagnose something and you give someone medication. I

00:26:15.280 mean, it is not their model to say, let's talk about lifestyle interventions or what's

00:26:19.740 happening in your relationship or what's going on at work. That is not what they're trained to do.

00:26:23.720 That is not what they have time to do in 15 minutes. But I am not a anti-medication person.

00:26:30.380 And it's not misinformation. The data is there that if you look at all the studies that have

00:26:36.140 been done on antidepressants, they work about half the time. And it's very unclear who they're

00:26:42.040 going to help and who they're not going to help. So, they're just, they're really not a silver 0.82

00:26:46.780 bullet. So, I think at this point, people who are careful and really know what they're doing,

00:26:52.320 they reserve them for those at whom you feel like we've got to really try everything.

00:26:56.440 For me, I mean, I'm a psychologist. So, prescribing meds is not my lane in the first place. But I'm

00:27:02.540 looking at what else, you know, I'm looking at skills over pills. What are the skills this person

00:27:07.700 needs? What are the experiences they need to be having, the changes they need to make? Because

00:27:12.260 oftentimes, there's plenty to work with there. And those sorts of interventions have no negative side

00:27:18.580 effects. Okay. So, there's downsides to things like antidepressants. You also talk about other

00:27:23.740 drugs, benzos for anti-anxiety, but those are extremely addictive. And you said, yeah,

00:27:29.480 the group most likely to wind up in a hospital, emergency department, young adults, because they

00:27:34.220 took too many benzos. Another one I've been reading about is stimulants, like Ritalin and Adderall for

00:27:40.680 ADHD. I guess there's like a shortage in the country because everyone wants these things. What's going on

00:27:46.640 there? I mean, there's no question. I have worked with so many ADHD folks over the years. And

00:27:52.720 college, young adulthood, very difficult time for people with ADHD. And there's no question if you

00:27:58.460 have a real diagnosis of ADHD, stimulant medication will help you. And I will, I'm the first person to

00:28:05.200 say, let's do skills plus pills in this situation for students, especially with ADHD. College is very

00:28:11.680 difficult to get through without stimulant medication if you're neurodivergent. However, there's some really

00:28:18.360 interesting research just very recently about when you're a neurotypical person and you take

00:28:24.480 stimulants. They found that people will work harder and longer. So there is that feeling of, oh, if I

00:28:30.320 take stimulants, I can pull an all-nighter, I can study more, I can, you know, really lean into my paper

00:28:35.900 or my test more. You will study or work longer and harder, but the quality will be lower. It's like going

00:28:43.820 to the SAT, you know, jacked up on too much caffeine if you don't usually drink caffeine. It's just, it's

00:28:49.100 not actually what the neurotypical brain needs. So, you know, this article is talking about how smart

00:28:55.540 drugs aren't that smart for people who have neurotypical brains. It's not what your brain

00:29:00.840 needs. And so you're not probably going to get the results you're going for.

00:29:05.500 Okay. So medications, not always the best medicine. They can be useful in certain circumstances,

00:29:09.700 but you'd be working with a trained practitioner with this. And again, you talk about how social

00:29:15.340 media has exacerbated the problem of people relying on medications to treat these underlying mental

00:29:23.060 health disorders because of uncertainty, not even disorders, just feeling not great, you know,

00:29:28.320 because with this, again, like on my, I don't know what my, I don't know what my Instagram feed

00:29:32.740 thinks about me, the algorithm thinks about me, but I get these ads for like ADHD medication and like,

00:29:37.820 you just got to have like a 15 minute consult online. And then in a few days you get and pick

00:29:43.660 up a prescription at Walgreens. Yeah. It's a big problem. You know, we talk about social media as

00:29:49.040 not being great for mental health in terms of, you know, all the comparisons and looking at other

00:29:53.200 people's lives, but not enough is said about how much it's really funneling people into diagnoses and

00:30:00.220 medications where, you know, they're really not getting the best information about whether that's

00:30:06.040 really the right treatment for them. Okay. So instead of spending time diagnosing themselves

00:30:11.580 or looking for a doctor to give them a prescription or even spending lots of time in therapy, you

00:30:18.280 mentioned this phrase earlier, you recommend skills before pills. And you argue that people who are

00:30:24.340 feeling distressed might be better served in developing skills. Why is that?

00:30:29.080 Yeah. Well, you know, like I said, I specialize in young adults. So, you know, they still have a lot

00:30:35.140 to learn. A lot is new. People are in their first jobs, first relationships, first apartments, first,

00:30:41.640 you know, conflict resolution. So there's a lot that 20 somethings don't yet know how to do. And

00:30:47.320 that's okay. This is not a judgment. This is just developmentally normal. So when you ask people

00:30:53.860 what's going on in your life, they often can point to areas where they're struggling, areas where

00:30:59.920 they're not feeling confident or competent, or where they're not sort of feeling able to gain

00:31:04.540 ground. And usually if you take on those areas, then people start to feel better without medications

00:31:12.000 that, you know, you ask people about the ins and outs of their lives and what does a day look like?

00:31:17.640 What does a week look like? What's going on? And you can see that there are areas for growth.

00:31:22.000 Okay. So when you develop skills, you're able to reduce the uncertainty in your life. It's like,

00:31:27.120 well, I know how to handle this because I got the, I know how to make a decision. I know how,

00:31:31.400 I know what I need to do to fix the problem that I encounter at school or my relationship.

00:31:36.460 Yeah, that it's, you know, I say a lot to my clients, mental health gets better when life gets

00:31:41.780 better. And, you know, also when we get better at life. And so, you know, I try to work with people

00:31:47.620 to help them improve their situation and or improve how they're handling their situation.

00:31:52.960 That, you know, if there's a lot of uncertainty out in the world that you can't change,

00:31:57.260 one thing you can change is feeling more sure of yourself, of saying, well, I can count on myself

00:32:02.640 that I know I can get through this or find another job or have a better relationship next time or handle

00:32:09.480 this distressing situation. That you start to feel just more sure and more certain of yourself.

00:32:15.060 And that's a normal thing to be developing in your 20s. I mean, I would say by the time you're

00:32:21.480 where you are in life, Brett, you probably feel like you can't control everything that happens in

00:32:26.660 the world, but you probably feel pretty confident that you'll manage, you'll figure it out, you can

00:32:31.160 handle it. And that is amazing. And that's not the way 20-somethings feel. So they feel like they

00:32:37.120 can't control anything out in the world and they have very little confidence that they can handle

00:32:42.180 anything from, I don't know how to ask my boss for, you know, time off to go to a wedding to,

00:32:49.560 I don't know how to find love or make friends. I mean, there's just a lot they're learning.

00:32:54.820 They're on a very steep learning curve.

00:32:57.660 Is this, you know, this idea, this confidence, is this identity capital? You've written a lot

00:33:01.560 about identity capital.

00:33:02.580 That certainly helps. So in my previous book, in The Defining Decade, I talked about identity capital

00:33:08.680 as, you know, a lot of 20-somethings talk about they're having an identity crisis. They need to

00:33:14.660 figure out who they are and who they're going to be and, you know, what life is going to be like.

00:33:18.500 You really can't, you can't really forecast that. But one thing you can do in your 20s is

00:33:23.400 get out there and have experiences, you know, especially at work as the leading driver of positive

00:33:31.080 personality change in the 20s because, you know, there's so much skill building that goes on at

00:33:35.860 work. And so a lot of those skills that we gain, not just at work, but also in experiences, life,

00:33:42.800 hobbies, etc., is what's called identity capital. And it's just this feeling of, okay, I know how to do

00:33:48.720 things. I feel confident. I feel competent. You know, my job can go sideways, but I'll find another

00:33:54.200 one or this relationship may not work out. But, you know, there are other people in the world that

00:33:59.800 might love me. It's that sense of that I know how to do things.

00:34:04.220 We're going to take a quick break for your word from our sponsors.

00:34:11.340 And now back to the show. Okay. So in your book, you talk about various skills that 20-somethings

00:34:18.360 need to develop. But as I was reading it, I thought, man, these are skills all people need

00:34:22.700 to keep working on even as they get older. And the first skill is how to think. How do people mess up

00:34:28.180 their thinking? Yeah. So, you know, people may hear that and think, well, I know how to think.

00:34:33.820 I think all the time. But, you know, if you really dig into it, thinking is complicated that when we're

00:34:41.060 in an uncertain situation, the brain is wired to think negatively. So, you know, your brain is wired

00:34:47.220 to keep you alive, not happy. So if it's not sure what to think about a job interview or, like you said,

00:34:53.820 the law school exam you took or a first date that you're going on, it's going to assume the worst.

00:35:00.660 And that's kind of the better safe than sorry approach to life, which we really can't stop our

00:35:05.720 brains from doing. It's evolutionarily programmed to do so to keep us alive. But what you have to do

00:35:12.680 after that is to say, okay, I see how my brain just did that. Those are my fears. Those are my what ifs.

00:35:19.700 But can I spend some time thinking about some facts, some what is? So what do I actually know

00:35:25.240 about this situation? Have I ever been in a situation like this before? What happened last

00:35:30.320 time? You know, what if this difficult thing came to pass? What would I do about it? How could

00:35:35.440 I solve that problem? So it's really helping our brains not just get stuck on the catastrophic what

00:35:43.200 ifs, which is the first place they're going to go, but to say I'm going to force my brain to spend

00:35:48.160 some time also thinking about what is happening in this situation or what else? What else might be

00:35:54.700 happening besides the worst case scenario? But that takes work. Your brain is not going to want to do

00:35:59.460 that naturally. The older you get, the more data points and experience you have, the more your brain

00:36:04.560 will feel like, yes, I can think more flexibly about this situation. But when people are younger,

00:36:11.220 it's very difficult. They have a lot of negative thoughts and feelings.

00:36:14.360 Yeah. And you gave a lot of examples of patients you've worked with and you change the names or

00:36:18.980 maybe these are an amalgamation of different people. But what you do is when they come in

00:36:23.560 with the problem, they're like, oh my gosh, I'm depressed. And here's this thing. And then you

00:36:28.220 just, what you do is you just walk them through. Well, let's find out the situation. What's going on

00:36:31.740 in your life? And then you help them just by asking questions. Like, are you just getting stuck in

00:36:37.720 creating these hypotheticals in your head that aren't going to happen? Let's just focus on what,

00:36:41.940 what are the facts on the ground? Exactly. And that is, it's something that I'm helping someone

00:36:49.040 do, but something that you don't need a therapist to do that. You just need to recognize that as a

00:36:55.740 good, you know, coping mechanism or a good skill to practice of, okay, I often jump to the worst case

00:37:02.240 scenario and I cause myself a lot of stress and anxiety hanging out there. So what else could I be

00:37:10.620 saying about this situation? And sometimes people, you know, thumb type that onto their phone. Sometimes

00:37:16.180 they write it down on a piece of paper or in a journal or talk it through with a friend who can

00:37:20.600 often help you say, well, okay, that's one possibility. What are the other possibilities? And just to sort of

00:37:26.520 let, let it be a little bit more open until we find out what is actually going on.

00:37:33.220 Yeah. You know, one thing you try to do, another tactic you use to help people when they get stuck

00:37:37.860 in this, you know, catastrophic thinking, because that usually happens when we're in our default

00:37:42.020 mode network, when it's kind of like more mind wandering. And that's why at night, that's what

00:37:46.360 you usually feel like the most angsty and existential, existentially angst is at nighttime, you're laying

00:37:51.400 in bed and you're like, oh my gosh, what am I doing with my life? That even happens to me still

00:37:55.600 because you're in that default mode network. But one thing you try to do is you help people shift over

00:38:00.540 to the task positive network where it's basically your brain's, it's focused on something and you're

00:38:06.420 not mind wandering. Exactly. Well, that is, you know, so one thing you can be focused on in the

00:38:12.400 task positive network or okay, what are other possibilities? You're giving your brain a job,

00:38:17.020 which is let me think about something else other than the worst case scenario. Sometimes the task

00:38:21.900 positive network can be distraction by focusing on something else of, you know, I'm going to go run an

00:38:27.180 errand. I'm going to watch something on Netflix. I'm going to call a friend on the phone. You just

00:38:32.980 want to give your brain something else to do besides just going down the rabbit hole of the worst case

00:38:38.480 scenario and hanging out in that default mode network. Your brain's default mode is to imagine

00:38:43.180 the worst. And then, you know, even better is when the task positive network is focusing on, well,

00:38:50.020 what else could be happening here? What are the facts? How can I problem solve? And so you give your

00:38:55.700 brain something to do that's constructive rather than just imagining the worst.

00:39:00.480 Okay. So another skill people need to develop is how to feel, how do people mess up managing their

00:39:06.480 emotions? Yeah. So when we're feeling uncertain, not surprisingly, because we tend to think negatively,

00:39:13.720 we very, I mean, this happens in a nanosecond. We also feel negatively. So we feel anxious or stressed

00:39:20.160 or overwhelmed or depressed. That's normal. I think oftentimes when young adults are struggling,

00:39:28.440 they panic of, I shouldn't feel this bad. Something is wrong. I need to, you know, like these sort of

00:39:34.940 feelings shouldn't exist. And oftentimes you see that their parents panic of my kids crying. This is

00:39:41.060 terrible. Something bad's going to happen. And so, you know, just helping people understand that

00:39:46.300 emotions are a part of life and, you know, so-called negative emotions, you know, aren't necessarily

00:39:52.500 negative. They're sources of information. So they're telling us this is something you're worried

00:39:56.840 about. This is something that's important to you, or this is something you're sad that you've lost in

00:40:01.760 your life. And so helping people just accept even the negative emotions in their life as sources of

00:40:07.720 information, not as something they need to panic about, actually paradoxically helps emotions pass

00:40:14.640 more quickly. So it's, you know, when we stop kind of wrestling with our negative emotions and say,

00:40:21.340 okay, part of life, what is there for me to learn here? Those negative emotions tend to move on along.

00:40:27.140 Whereas if we get into this fight with them where we panic and keep trying to get rid of them,

00:40:32.060 they actually tend to hang around longer. Yeah. You call this, you know, just kind of being

00:40:36.020 comfortable with the negative emotions, paradoxical intervention.

00:40:41.040 Mm-hmm. Yep. Because it's, you know, when you say, I don't need to get rid of this feeling,

00:40:47.240 it actually tends to pass more quickly. So you're sort of doing a, you know, mind trick on negative

00:40:54.120 emotions. But it really is just about not being upset about being upset or anxious about being

00:41:00.020 anxious or sad about being sad or stressed about being stressed. But just to say, okay, you are not

00:41:05.520 going to get through your life and certainly not through your 20s without having these emotions.

00:41:10.920 Quite often, that's normal. 20-somethings have more negative emotions than older adults.

00:41:17.400 And so it's really about understanding what are they trying to tell me? What am I worried about?

00:41:22.080 Where do I need to gain competence? Or what am I sad about? What do I need to get more of into my life?

00:41:28.520 Yeah. And again, you're also trying to normalize these feelings.

00:41:30.680 Mm-hmm. Instead of saying, well, this is a diagnosis because I'm feeling anxious, depressed,

00:41:34.420 whatever. It's like, well, no. Congratulations, you're a human being. You're feeling things that

00:41:39.060 all human beings feel and have felt. Well, right. And, you know, really everything that I do with

00:41:44.360 20-somethings, like you've said, it's adult development. It's relevant to us at all ages. I just

00:41:49.540 am the kind of person that, you know, I try to get in there as early as possible in that trajectory.

00:41:55.480 But if you think about going to the doctor for something, you know, in your 30s or 40s,

00:41:59.980 and you're having a pain here or a, you know, flutter there, and the doctor says, oh, yeah,

00:42:05.560 that's normal. It's this thing that happens when, you know, X, Y, Z. It doesn't mean anything or it'll

00:42:10.320 pass. I mean, we forget how helpful that is. That is very helpful when someone says, oh, yeah,

00:42:17.600 I know it hurts, but it's normal. Nothing to be worried about. That also has a function.

00:42:22.880 My daughter actually had a sports injury a couple years ago, and it really persisted.

00:42:27.640 So I took her to a specialist, and the guy said, oh, yeah, I've worked with big,

00:42:31.820 tough ice hockey players, and this can hurt for months, but trust, it will get better.

00:42:37.180 And I thought, great, that's all I needed to know. And I think we forget the value of telling

00:42:42.960 someone. I believe that what you're experiencing is real. I know it hurts. I know it's difficult,

00:42:47.820 but I have every confidence that things are going to get better.

00:42:51.820 You also talk about the skill of working. How can work help us become emotionally healthy?

00:42:57.640 Yeah, well, work actually is the number one driver of positive personality change in your

00:43:05.160 20s. And, you know, I think if we think about it at any age, it's a pretty important source

00:43:09.880 of confidence and competence. So, you know, it's probably what we spend more hours doing

00:43:15.660 per week than anything else. So there are lots of opportunities to learn new skills and gain

00:43:21.980 new competencies, become more confident. You know, everything from the concrete skills you need

00:43:26.960 for work to the social skills of dealing with bosses or interns or co-workers. I mean, there's just so

00:43:33.040 much growth happening on the job when you're in your 20s, or it should be. And if there isn't,

00:43:38.360 you need to go find a job where you feel like you're going to have those growth opportunities.

00:43:42.300 I know from the research, it's the number one leading source of stress and anxiety in the 20s,

00:43:47.440 but it's also the number one source of growth and change. And those two things go together,

00:43:51.580 obviously, because if you're going to be growing and changing, you're going to be putting yourself

00:43:55.220 into situations that are new and uncomfortable and that you don't know how to do.

00:43:59.340 Yeah, I think all of us have this idea like, man, I wish I didn't have to work. But then when you look

00:44:04.060 at the studies of people who, you know, get laid off from a job, they're unemployed for a while,

00:44:09.820 this happened in middle age, like depression, just it's off the chart. It's one of the most

00:44:14.340 debilitating things that can happen to someone when they're unemployed.

00:44:17.700 Yeah, I mean, there was a lot of talk a couple of years ago about, you know,

00:44:21.420 young adults are quiet quitting. And what did I think about that? And what I thought is,

00:44:25.200 I want to help them find jobs, they don't want to quiet quit. Because, you know, maybe people

00:44:31.080 imagine, oh, my life would be so great if I didn't work. But like you said, it actually usually isn't

00:44:36.460 people feel, you know, quite bored and under stimulated. And so I think the idea is to find work

00:44:43.340 that you feel good about. And, you know, now with hybrid possibilities, you know, I think that's

00:44:48.840 more possible than ever that people can find work that really works for them.

00:44:53.700 Okay, so another skill that you think people need to develop is how to be social. And that's,

00:44:59.300 this is another thing we've been hearing a lot about that might be contributing to the mental

00:45:03.060 health crisis in the United States, is people are lonely, they're isolated. Why do you think we're

00:45:08.840 having such a hard time making friends and socializing these days?

00:45:14.040 Yeah, I mean, I think that, you know, it's a little bit like working from home, it has upsides

00:45:19.340 and has downsides of that when people feel like they can sort of semi scratch the itch of connecting

00:45:25.900 with people over their phones or on their screens, then they're less likely to get out there and do that

00:45:31.620 in person, even though we know that in person interactions are different than interactions

00:45:36.860 that we're having on screens. And so I think a lot of young adults, they move to new cities,

00:45:42.280 they need to meet new people. And that's a different skill set than picking up your phone

00:45:47.180 and texting someone or DMing someone on Instagram, you've got to sort of get out there and figure out

00:45:52.180 where are my people and how do I make conversations with them. But that that, you know, most people

00:45:57.740 don't realize this, but your 20s are actually the loneliest decade of life. We know we imagine 20

00:46:03.960 some things are they're having so much fun, they have so many friends are just out and about all

00:46:08.060 the time. It's really not true. You know, you're most likely in that age group to be quote, between

00:46:13.480 families. So you know, you wake up in the morning alone in an apartment or in an apartment with people

00:46:18.960 that you may not know well or may not get along with that great. And it's a lot of work to be

00:46:23.980 constantly trying to find someone to go out with on Friday night or find somebody to go, you know,

00:46:28.720 shopping with on a Saturday. So you know, most young adults are actually quite lonely.

00:46:32.960 Yeah. And I think part of the problem is when you're in high school, your friends are just

00:46:37.960 pretty much given to you. Like you show up to school every day and they're right there. And

00:46:41.980 then when you're an adult on your own, it's up to you. Like you have to make it happen.

00:46:46.440 Right. And that's, you know, same for college. You have people in the hall, you have people in

00:46:50.660 your classes, but then you may go to a workplace where there aren't that many young adults, or you

00:46:55.660 may be working from home where you really aren't interacting with anyone. And so people have to sort of

00:47:01.940 figure out how do I meet people? You know, is it okay? What if it's through, you know, joining a

00:47:08.080 gym? Well, that's one step, but then you have to figure out how do I talk to people or say, hey,

00:47:12.740 do you want to get coffee or let me give me my number? That there's a lot of steps in there and

00:47:18.340 it requires, there's a lot of uncertainty involved in that and it requires a lot of courage.

00:47:23.280 So yeah, it's something, one of the things you do is you do social prescribing. So if you have

00:47:27.120 patients that come in saying, I'm feeling anxious, I'm feeling depressed, one thing you might turn

00:47:32.380 to is like, hey, why don't you go out and try to make some friends? Like what kind of things do

00:47:35.900 you tell them to do, like a recommend that they try doing? Yeah. I mean, this probably just sounds so

00:47:41.600 obvious or so basic to someone listening, but you would be surprised at how many people will say,

00:47:48.520 I'm so lonely. And then you ask about their day and it's, you can easily see, you know,

00:47:53.240 some relatively low hanging fruit of, well, why don't you try this? But I think I write in the

00:47:57.580 book about a guy who came in my office who I really liked a lot. He was a great guy and he had

00:48:03.320 a steady girlfriend, but she had moved states for like a job or something. And so ever since she left,

00:48:12.540 I think she was sort of his leading form of social interaction, which often happens with young males.

00:48:18.160 So she left and he was spending a lot of time on his phone. So I said, well, let's pull it up. Let's see

00:48:23.660 how much on his screen time. I believe it was 10 hours a day because he was eating all of his meals in

00:48:29.400 front of his phone. He was lying in bed on his phone. I mean, that was, that's where everything was

00:48:32.780 happening. I said, well, what are you doing on your phone? And he said, oh, I like sports. I'm watching

00:48:37.360 this, this game, those stats, whatever. And I said, well, what sports do you like to do? He said, I like

00:48:42.860 to play basketball. So I said, okay, I prescribe your homework between now and the next time I see you

00:48:48.080 is to get out and go play basketball with other people. And so it wasn't very long that he was

00:48:54.200 doing that, that he said, yeah, I feel better now. I think I just needed to adjust better and

00:49:00.680 differently to my girlfriend leaving and find healthier ways to get through my day. So it may

00:49:06.480 seem pretty obvious and pretty basic, but you would be surprised how many people aren't sort of trying

00:49:11.860 the solutions right in front of them.

00:49:13.940 And another thing you point out is that young people and even adults need to realize that making

00:49:19.080 friends, it's going to take a long time. You cite research from Jeffrey Hall. We've had him on the

00:49:24.420 podcast. And yeah, he talks about, it takes like about, you have to spend 50 hours with somebody to

00:49:30.720 be considered as kind of a casual friend. And then it takes about 150 hours or more to make that person

00:49:37.520 a best friend. And when you're in high school and college, that was easy to do. Cause you're probably,

00:49:42.600 you know, you get those 50 hours in a few weeks, right?

00:49:45.740 Right. You're, you know, you might get five hours a day with somebody.

00:49:49.380 And when you're an adult, you might just get like an hour a week with somebody. So it's going to take,

00:49:55.480 it could take a year or two to make a really good friend. So you got to be patient.

00:49:59.900 Right. And people are often saying, how do I make friends? And, you know, the best way to make

00:50:06.960 friends is to go out and live your life. I mean, outside of your house, whenever possible that you

00:50:12.520 usually make friends over something, you know, so friends from grad school or friends from the

00:50:18.360 playground when you had little kids or friends at your job or friends in the wine tasting class that

00:50:24.440 you decided to take or in the running club. So rather than people imagining there's some

00:50:29.580 separate program of things they need to do to make friends, the best way to make friends is to

00:50:35.100 get out and do you. And you will meet people who are interested in the same things, have the same

00:50:41.420 values, have the same interests. That's where friends come from. But to your point, it takes a

00:50:45.840 while. Yeah. And one of the side effects of getting out there and making friends is it can actually help

00:50:52.200 you find love. You talk about a lot of young people you're seeing, they want to get married,

00:50:55.880 but they can't find having a hard time dating. But what the research shows, and people know this

00:51:01.180 anecdotally, if you hang out with lots of different people, you're going to be put in the path of

00:51:06.200 people who might be a potential partner for you. Right. Friends are great practice for being

00:51:12.180 partners. If you don't know how to be a good friend, I find it hard to imagine how you could

00:51:17.200 possibly be a good partner. So it's great practice because you start to think about, hey, it's not just

00:51:23.860 about me. It's about this is a two-way street here and I need to think about another person.

00:51:28.360 Sometimes I need to resolve issues. So friends are great practice for being partners. And they're

00:51:34.400 also a great way to meet partners that, you know, the more you're getting out and interacting with

00:51:38.780 people. And again, I think I don't have anything against online dating. I've had plenty of clients

00:51:44.200 meet people online. But it's a little bit to what I said about making friends is that,

00:51:49.380 you know, rather than imagining there's like a separate program or a separate app or avenue for

00:51:54.840 finding a partner, often get out and live your life, spend time with friends, and you're likely

00:52:00.860 to meet people who are interested in the same life and the same future that you are.

00:52:05.940 Okay. So making friends can help you practice the skill of love, of romantic relationships.

00:52:11.840 Related to this idea in these chapters on the skills of love, and you also have the skill of sex,

00:52:17.580 you devote a lot of time to an issue you've seen more and more in your patients in the past 15

00:52:23.040 years. And I think this is really relevant to men, porn use. How have you seen porn use

00:52:28.280 change in your 20 plus years of working with young people?

00:52:33.220 Yeah. People always ask me, how are young adults of now different than when you started 25 years ago?

00:52:39.200 I would say as human beings, they aren't very different. What's different is the technology

00:52:43.520 available to them? And so that's created situations and problems maybe we didn't have

00:52:48.380 25 years ago. But a couple of decades ago, you know, everybody had seen porn, but it was harder

00:52:54.860 to come by. You had to sort of have a Playboy or a penthouse or see a movie on Cinemax. I mean,

00:53:00.800 it just wasn't that available. So watching porn was not something that came up a lot in sessions

00:53:07.260 on either side of the room. Now it's actually a routine intake or screening question that I have

00:53:13.760 for all my clients. Young males are more likely than females to say, yes, I watch porn and probably

00:53:20.040 too much. But I ask every client how much porn they're watching and whether that's working for

00:53:26.200 them, not working for them to kind of take a look at that. And what I've really learned from listening

00:53:32.040 to my clients, especially to my young male clients is that, you know, what kind of started as a

00:53:37.200 curiosity or as entertainment kind of became more consuming and maybe even a compulsion and that

00:53:44.580 people spend a lot more time watching porn than maybe they really want to. And that it kind of has

00:53:49.540 created for a lot of young men this anxiety about getting out and, you know, being intimate with

00:53:56.420 someone in person, having sex with a real person, because, you know, watching porn doesn't

00:54:01.620 necessarily translate to dating or to starting an intimate relationship with someone.

00:54:07.440 Yeah. You talk about some of the issues that they're seeing amongst young men who are habitual 1.00

00:54:11.300 porn users, erectile dysfunction, performance issues, and also a lot of the patients you talk to

00:54:16.660 who have a porn addiction or just use porn too much, depression and anxiety. What do you think is going

00:54:23.540 on there? Why is there a connection between depression, anxiety, and habitual porn use?

00:54:28.020 Yeah. I mean, that's really, to me, the biggest connection because whether people can be addicted

00:54:33.700 to porn or not is up for debate. But what I definitely see is that people will say,

00:54:40.400 I'm watching porn every day and I don't want to be, so it makes me feel depressed about myself.

00:54:47.520 You know, why am I doing this? What's wrong with me? I feel weird walking around knowing that I'm

00:54:52.700 doing this thing that I wish I wasn't doing. It makes me feel bad about myself that I'm,

00:54:56.980 you know, kind of watching other people have sex rather than figuring out how to go out there and

00:55:01.720 have it myself. And then there's the anxiety piece where, whether consciously or unconsciously,

00:55:07.840 people imagine, well, I'm supposed to know how to do all that. I'm supposed to be able to perform

00:55:13.980 like that. And the longer you spend, you know, kind of watching sex rather than trying to

00:55:18.820 participate in having sex, the more likely you are to have that sort of stage fright or performance

00:55:24.580 anxiety. So I'll have young male clients say, well, I just don't even know how to start. You

00:55:29.800 know, what if I go out with someone and I can't perform? And I say, well, let's, let's like take

00:55:34.620 it back a few steps. What if you just, you know, go out with someone and get to know them or go out

00:55:39.600 with someone and make out and don't worry about sort of performing, not to mention, you know, 0.95

00:55:45.100 performing like a porn star. Don't worry about that on the first date. Let's just spend some 0.97

00:55:49.500 time with someone and see what happens. Yeah. You talk about how porn use can get in

00:55:53.420 the way of a healthy sexual relationship once that's, you know, part of your life with somebody

00:55:57.560 is that you have these like weird expectations of what sex is supposed to be like, because you're

00:56:01.460 trying to perform, right? You're trying to mimic what you're seeing there. And I've also, I've seen

00:56:06.460 surveys with young people where it's a lot of young people who are doing things in the bed

00:56:12.620 because they saw it on their TV screen or their computer screen, but they're actually not

00:56:17.840 comfortable with it. But they think, well, this is what I'm supposed to do is what I see. And you

00:56:21.600 argue, instead of trying to like perform and trying to mimic what you see in this, these videos or

00:56:27.580 whatever, sex and love should be like a jazz collaboration. You're working with the other

00:56:32.180 person to figure out what works for you too. Right. That it's, you know, don't try to imitate

00:56:37.640 something you've seen other people do. Just be in the moment with the person you're with and

00:56:42.240 figure out what that person wants to do and what you want to do. You know, the best metaphor

00:56:46.940 comparison I ever heard, I think I heard it on NPR was someone, and I wish I could credit

00:56:52.700 them because I don't remember who said it, but they said learning how to have sex from 0.56

00:56:56.340 watching porn is like learning how to drive by watching fast and furious movies. That it's 0.83

00:57:01.480 just not, it's not going to give you the best sort of scripts or, you know, playbook in

00:57:07.480 terms of how most people actually want a sexual relationship to go.

00:57:12.180 Do you have any advice on, you know, say there's someone's listening, like I got, I'm watching

00:57:16.520 more porn than I want. Any advice on helping them stop?

00:57:19.620 Yeah. I mean, well, that's a spectrum. So, you know, I'm hearing more and more from men

00:57:24.160 who are saying, I have a hardcore porn addiction, like I'm in deep. And so I think if you're feeling

00:57:30.720 that that's your situation, that I think people are treating that the way they treat other

00:57:35.740 addiction. So look for addiction resources that specifically geared to this. But, you

00:57:43.320 know, what is more common is young males, and I see this all the time, who are just saying,

00:57:48.360 you know, I don't think I'm addicted to porn, but I'm really watching it too much. And so

00:57:51.960 we come up with solutions together. You know, when you're leaning on a substance too much,

00:57:56.580 no matter what it is, the first sort of line of defense is to figure out, well, how can we

00:58:02.480 make this a little less available and how can we do something else? And so that may be,

00:58:09.120 I don't bring my phone in the bedroom or I got rid of my desktop. I mean, depends on, you know,

00:58:14.620 where are you accessing this? When are you most likely to look at it? And can you kind of busy

00:58:20.100 yourself at other times? And that may sound like not big interventions, but that's the great thing about

00:58:26.660 working with young adults is that these are when difficult habits tend to crop up, but they also

00:58:32.860 haven't often been around all that long in that they can be easy to shift. And so sometimes,

00:58:39.800 you know, you make some lifestyle adjustments and, you know, they're able to act on that pretty

00:58:45.880 quickly. I have a client right now who came in a month ago and said he was getting high half the day,

00:58:51.840 you know, noon to midnight. And I was like, well, that's probably a problem. So can we reduce that?

00:58:57.760 And so he was, you know, has already been able to say, okay, I'm going to get my day done. I'm going

00:59:03.020 to get my work done and maybe I'll just be a nighttime smoker. And, you know, for now that's where

00:59:08.900 he is. Will he eventually become, well, actually he said over the long haul, you know, three to five

00:59:14.780 years from now, he would rather be a weekend smoker or a not at all smoker. And he's moving in that

00:59:19.720 direction quite quickly and effectively without much intervention on my part, except saying,

00:59:25.700 I think you can do this. Let's talk about how.

00:59:28.360 Two other skills that I was surprised to see pop up in the book was the skill to move,

00:59:33.540 exercise, and the skill to cook. Why those skills? How do they help our mental health?

00:59:39.220 Well, I mean, I think, I hope everybody's heard by now that exercise is always great for mental health

00:59:46.700 and there aren't really aren't any downsides. So unlike medications, which can be a mixed bag,

00:59:51.760 getting out and moving more, it's good for our physical health. It's good for our mental health.

00:59:55.840 It's, you know, can be good for our social lives, can be good for our work lives and creativity.

01:00:00.400 There's really no downside to moving more. And about a third to a half of doctors will

01:00:06.380 prescribe movement for mental health struggles. But that also means a half to two thirds don't.

01:00:13.580 And they should be because oftentimes clients are coming in and they're saying,

01:00:17.100 I want to feel better right now, immediately. And that makes people think, oh, well, maybe

01:00:22.000 medication. But if you want to feel better right now, probably the quickest thing you could do to

01:00:26.240 feel a little bit better is to move a little bit more. You don't have to exercise. You don't even

01:00:31.580 have to play a sport. It's just whatever you're going to do and enjoy. So maybe you walk your dog

01:00:37.220 more. Maybe you play Frisbee. Maybe you play pickleball. Maybe you go for a hike. Maybe you do salsa

01:00:42.120 dancing on the weekend. The best kind of, quote, exercise is whatever it is you're going to do.

01:00:48.500 Yeah. And we've had people on the podcast talk about that exercise as effective or even more

01:00:52.980 effective than antidepressants without the downsides, without the side effects. Cooking. Why cooking?

01:00:59.620 That might sound like a funny. Everybody's commented on that, that I've got cooking in my book.

01:01:04.360 A couple of reasons I do. One is young adults, they just eat like crap. Pardon my French. They 1.00

01:01:11.480 really do not eat well. And so that's not helping that we're learning more about how processed foods,

01:01:19.080 junk foods are not great for your mental health, not great for your brain. The gut is called the

01:01:25.400 second brain because it's second only to the brain in terms of the number of neurons that it contains.

01:01:30.780 So, you know, what you put in your body matters. There's also the issue of, I think, just,

01:01:38.380 and, you know, people who cook are more likely to eat more healthily, but just knowing how to cook,

01:01:43.620 I think, helps people feel more competent and more confident rather than, you know, feeling like

01:01:49.620 they're running around trying to get some of their most basic needs met by another person or that they

01:01:54.640 don't know how to do it. You know, knowing how to, you know, make a breakfast smoothie in the

01:01:59.180 morning or pack a sandwich or make a meal at night really does help people feel like there's

01:02:04.000 something that I can, you know, follow the instructions on and have a win on today. It

01:02:09.420 also helps your social life because you're more likely to have people over or have a barbecue or

01:02:13.400 a potluck. So again, no downsides to learning how to cook. And it can be incredibly grounding.

01:02:21.240 Okay. So another skill, last skill I want to talk about is the skill of how to decide.

01:02:24.900 Your 20s are filled with lots of big, important decisions. How do 20-somethings and maybe even

01:02:31.880 people beyond 20-somethings, how do they get decision-making wrong?

01:02:36.180 Well, you know, your 20s are when you move from what are called small world problems to big world

01:02:40.820 problems because it's when you sort of move from school of there are right answers and, you know,

01:02:47.580 clear ways to get an A or a B to life after school where there isn't a right answer to who should I

01:02:54.640 partner with? What should I do? Should I take this job or that job? Where should I live?

01:02:58.820 There aren't any right answers. There's no algorithm. There's no way you're going to be

01:03:02.660 able to sort of game this or find out from another person what you should do. The good news is there

01:03:08.740 aren't any wrong answers. It's really just what's right or wrong for you. And, you know, I think when

01:03:14.040 we're looking for that answer, that's where the asking your therapist or asking your parents,

01:03:17.960 what should I do? When really only you can decide. And, you know, I think that can be freeing when

01:03:25.020 people recognize that there isn't a wrong choice to make here. There's only your choice. So, you

01:03:32.400 gather the best information that you can and you make it based on like your own values and priorities.

01:03:38.740 Yeah. You talk about one problem that 20-somethings have is constantly looking for reassurance and that

01:03:42.980 can actually get in the way of making progress in life. Yeah. Actually, in the psychology world,

01:03:49.140 they have seminars now about reassurance junkies, people who sort of always want to know,

01:03:55.380 am I doing the right thing? Is this going to work out? Am I okay? And when you reassure people,

01:03:59.980 it's actually a little bit like a drug that you're giving them a hit of something that makes them feel

01:04:05.380 better for about five minutes and then they come back and they want more. So, rather than reassure

01:04:11.480 people, I actually recently, and I think I wrote about it in the book, but this happens to me all

01:04:16.860 the time, I will say something that is meant to inspire confidence and people will say, well,

01:04:23.120 that's very reassuring. And I said, no, no, I'm not trying to reassure you. I'm trying to say,

01:04:28.120 based on the evidence, I believe in you. You've gotten through this situation before. I think you

01:04:32.540 can do it again. Recently, I was on a podcast and someone said, my life has been okay in my 20s,

01:04:38.680 but what if it all goes sideways in my 30s? And I said, well, why would that happen? And we talked

01:04:43.860 about how she had already made progress at work and was in a healthy relationship and had some nice

01:04:49.280 friends. So, she clearly had the skills to be off to a great start. So, I really couldn't understand

01:04:54.720 why everything would just go to pot in her 30s. And she said, oh, that's so reassuring. And I said,

01:05:01.140 no, I'm not trying to reassure you. I'm trying to give you confidence that based on the data,

01:05:07.320 on the evidence, there's no reason to believe your life is going to go sideways. And that's

01:05:11.220 different from saying, oh, everything will be fine. But that's just sort of empty.

01:05:16.120 Well, Meg, this has been a great conversation. Where can people go to learn more about the book

01:05:19.720 and your work? Let's see. The book is sold everywhere, I hope. And on socials, I'm at Dr. Meg J.

01:05:28.340 And then my website is megj.com. Fantastic. Well, Meg J., thanks for your time. It's been a pleasure.

01:05:34.280 You too, Brett. Always great to talk to you.

01:05:37.320 My guest here is Dr. Meg J. She's the author of the book, The 20-something Treatment. It's

01:05:41.200 available on Amazon.com and bookstores everywhere. You can find more information about her work at

01:05:44.880 our website, megj.com. Also, check out our show notes at aom.is slash megj, where you can find

01:05:49.460 links to resources. We delve deeper into this topic. Well, that wraps up another edition of the AOM

01:06:01.200 podcast. Make sure to check out our website at artofmanliness.com, where you can find our podcast

01:06:04.640 archives, as well as thousands of articles that we've written over the years about pretty much

01:06:08.200 anything you think of. And while you're there, sign up for our email newsletter. It's completely

01:06:11.980 free, and there's both a daily and weekly option. As always, thank you for the continued support.

01:06:16.720 And until next time, this is Brett McKay, reminding you to not listen to AOM podcast,

01:06:20.180 but put what you've heard into action.

The Art of Manliness - April 15, 2024

Skills Over Pills

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