Skills Over Pills
Episode Stats
Summary
Meg Jay is a clinical psychologist who specializes in working with 20-somethings and young people. She's also the author of The 20-Something Treatment, a new book about mental health for an uncertain age. In this episode, Dr. Jay discusses the decline in mental health among young people, the dangers of self-diagnosis, the potential downsides of meds, and why she advocates skills over pills.
Transcript
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Brett McKay here, and welcome to another edition of the Art of Manliness podcast.
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Over the last decade, there's been an increase in the number of people, particularly young
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adults who struggle with low moods, distractibility, and anxiety, and consequent difficulties with
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getting their life on track and making progress in work, friendship, and romance. In addressing
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these difficulties, people are often given or adopt a mental health diagnosis and look
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for a solution in therapy and or medication. My guest isn't opposed to these remedies.
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She is herself a clinical psychologist who's maintained a practice for a quarter century
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that specializes in treating clients in their 20s. But Dr. Meg Jay, who's also the author
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of the 20-something treatment, believes that a lot of what young adults, and in fact, adults
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of all ages struggle with, aren't disorders that need to be treated, but problems that
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can be solved. In the first half of our conversation, Meg explains what's behind the decline in
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mental health for young adults and how it's bigger than just smartphones. We discuss the
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dangers of self-diagnosis, the potential downsides of using medications to treat mental health
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issues, and why she advocates for skills over pills. In the second half of our conversation,
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we talk about how mental health gets better when we get better at life and what skills 20-somethings
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and many older adults need to develop, including the skills of thinking, feeling, working, socializing,
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and even cooking. We also discuss how porn is affecting the young men in her practice,
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an alternative to being a self-assurance junkie. Out of the show's over, check out our show notes
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at awim.is slash Meg Jay. All right, Meg Jay, welcome back to the show.
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So I was looking, the last time we talked to you was 2013. You're one of our first podcast guests.
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Oh, I love it. Well, I said, I feel like we're old friends. I've always had a special place in
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Well, thank you so much. We talked about your book the last time, The Defining Decades, about your 20s.
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When that book actually inspired a few articles that we wrote on the site, and it really resonated
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with me at the time because I was in my 20s when I first came across that book.
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And you got a new book out. It's called The 20-Something Treatment, A Revolutionary Remedy
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for an Uncertain Age. So background on you, you are a clinical psychologist who specializes
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in working with 20-somethings, young people. And one thing we've been seeing in the zeitgeist a lot
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recently in blog post articles, news articles, et cetera, is that young people today, we're talking
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teens, people in their 20s, are in the midst of a mental health crisis. What do the statistics say
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about the mental health of young people today? And what are you seeing with the patients you are
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Yeah, well, I've been specializing in 20-somethings for 25 years, believe it or not. And you might
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remember from your 20s, it's a tough time. So I think people hear, oh, these are going to be the
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best years of your life. Really, I'm sorry to say they're actually, empirically speaking,
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a mental health low point. That has been the case for a while. I think now, I mean, that's why I've
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always been working in the space. I think people are talking about it more now, which is potentially
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a good thing. But I think part of the conversation about young adult mental health too quickly becomes
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what's my diagnosis? What's the medication that I need? So a lot of what I do is really normalize a lot
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of the problems that 20-somethings and adults of all ages have and talk about strategies for
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looking at those that aren't just necessarily therapy or medication.
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So yeah, we're seeing a lot of young people and a lot of people, just even older people,
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talking about anxiety, depression, ADHD, things like that. When psychologists try to explain what's
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behind this uptick in mental health, what are the reasons they give?
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I mean, I think what you hear people saying a lot is phones and the pandemic, and those certainly
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played a role. I think what I see a lot with young adults and adults of all ages, but everything that
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I see is just sort of more acute with young adults, is just how uncertain 21st century life is. The brain
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really doesn't like uncertainty. So in your 20s, everything is uncertain all at the same time. You're
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uncertain about work and love and friends and where you're going to live and who you're going to be. And
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that's a lot. The brain doesn't like that, and it tends to respond to uncertainty by perceiving it as
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danger and then therefore feeling stressed and anxious. But that doesn't mean that you have an anxiety
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disorder. It means you're feeling anxious. There's a lot in your life that's uncertain. So let's help you
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sort of pin some things down and feel more sure of yourself.
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Yeah, you call uncertainty a transdiagnostic stressor.
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Yep, that's a mouthful of a word and maybe a boring label. But in the research, that's what
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uncertainty is known as. And what that means is that it's a stressor that shows up differently in
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different people. So when people are feeling overwhelmed by uncertainty, some people get anxious,
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some people feel hopeless and lay in their bed and feel depressed. Other people reach for substances,
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other people eat too much or eat too little. So it's definitely a stressor for most human beings
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and how it manifests depends on the individual.
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Yeah, I can see that in my own life. Uncertainty causes so much stress.
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When I remember when I was in my 20s, one stressor that I had that was caused by uncertainty
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was when I was in law school and I took my final exam. Because your whole grade depended on one exam
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No stress. So you took the test. And then after you were done, you do these postmortems in your
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And then you'd go down this spiral where you're just like, oh my gosh, I probably...
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Basically, it all led to like, I'm going to... We're going to end up... I tell my wife,
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Yes, of course. And that's really, I mean, that's such a great example of really the big
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picture of the 20s is that people don't, like, it probably took you a week or two to find out the
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results of that exam. But in your 20s, in terms of what am I going to be? Is my life going to work
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out? Will I be happy? Will anyone love me? Will I be successful? Can I pay my bills? Those are
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things that remain uncertain for a good five to 10 years of time. And so that's a lot to cope with.
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And it does tend to make people feel anxious and stressed until they have those data points that
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give the feedback that, okay, you're going to work this out. This is moving in the right direction.
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Yeah. And this uncertainty that causes things like anxiety or feeling depressed and just down,
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this can happen, you know, later on in life when you're in your 30s, 40s, 50s, when you have those
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moments of uncertainty in your life, maybe you get laid off from your job and you think, oh my gosh,
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what's going to happen to my family? Or maybe there's something with your kids you're worried
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Yes. I mean, I actually, I had a health issue last year and I was really feeling for my 20
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somethings because suddenly there was this new piece of uncertainty in my life. And, you know,
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at this point in my life, my career is pretty sorted and my love life is sorted and I have kids and I
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know where I'm going to live. So there's not a ton of uncertainty in my life anymore, but I had this
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health issue come up and suddenly there was all this uncertainty and it was really difficult until
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I got some information of, okay, this is the deal and this is what we do. And then I noticed how,
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you know, sort of like with your law school exam, suddenly I was like, great, I know what to do now.
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And I know what this means. So you're going to have those periods again and again throughout life,
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whether it's health or changes in work or changes in your relationship. We usually get better at
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handling them over time because we have more experience of, okay, I've been here before.
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I've gotten through this. I'll find a way. You feel like you can count on yourself.
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The hard part about being in your twenties is you don't feel like you can count on yourself yet.
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And you don't have a lot of data points for how this works.
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And I can see this idea of uncertainty causing all this distress. I can see why the pandemic would
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exacerbate that. You're just like, oh my gosh, what's going to happen? I don't know if I'm going
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to have a job. Is this ever going to end? And I can also see how smartphones can exacerbate that
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because you're just constantly plugged into this thing that's showing you all sorts of different
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information. You're not exactly sure like, what should I act on? What's the good stuff?
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That can probably just cause even more uncertainty.
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Right. And we've all heard by now the social comparisons that phones induce. We're always
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looking at people on vacation or skydiving in Dubai. I mean, they're having amazing time and
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amazing lives and amazing relationships. And so it's hard when you feel like, I don't really know
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if my life is going to work out, but look at all these other people's lives who are working out
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beautifully. Your brain knows that this is not a fair fight in terms of the data being presented,
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but it still has to go through that process of, ugh, you can't believe everything you see. And
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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
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what platforms they're going to use, what makes them feel happy, what makes them feel unhappy,
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or how they use them and how much they use them. Okay. So uncertainty, we don't like uncertainty.
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It can cause us to get anxious, feel just low and depressed. It can even cause us or nudge us
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towards using substances to alleviate some of the bad feelings we have when we're facing uncertainty.
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We experience a lot of uncertainty in our twenties because we're figuring life out,
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but people in their thirties, forties, fifties can also experience this. And one way people have
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tried to cope with the feelings of angst that come with uncertainty is they turn to psychology,
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which makes sense, right? Psychology is there to help you deal with those sort of things.
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But you note in your book that there's been a trend of young people, and I've seen this not just
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with young people, but even people my age in their late thirties, forties, people self-diagnosing
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themselves with mental health disorders. What are the dangers of self-diagnosing?
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Yeah. I mean, I think when we're feeling uncertain, we're, you know, casting about for,
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give me something I can act on. I mean, it was, you know, a bit like what I was talking about with
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my health issue last year of, you know, let me understand what this is and what we do. So
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I think it's very tempting to say, what's wrong with me? What's my diagnosis? What's the three-point
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plan? Although, you know, most mental health problems don't have a three-point plan or what's
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the medication required. And, you know, the truth of the matter is most young adults, most adults of
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all ages don't have diagnoses. They have problems they're trying to solve. They have changes they
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need to make. They have skills they need to build. And I think one of the drawbacks of looking for
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certainty in a diagnosis is that, you know, your identity can become pretty wrapped up in that. And then
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you see everything through that lens rather than through the lens of, hey, I'm in a transition or
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this is a tough time. And what are the skills I need to build? What are the changes I need to make
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rather than looking for, you know, what's the medication I need to take?
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Yeah. You talk about, you know, giving yourself a diagnosis can cause a nocebo effect in you. What
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Yeah. The nocebo effect is the opposite of the placebo effect, which of course is if you think you're
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going to get better, you're more likely to get better. The nocebo effect is really the power of
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negative expectations. So I have a lot of people come in my office and they say, I have this and
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I'm going to have this all my life. And I've read this as a lifelong problem and they see everything
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through that lens. And so it can get in the way of people actually getting better or having hope that,
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you know, there's nothing wrong with me. I'm not doing something wrong. I'm just having a hard time.
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So what is it I need to do to move forward? And people who have hope are more likely to
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take action, to, you know, kind of move their lives ahead. They're less likely to feel anxious
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and depressed, less likely to think about ending their lives. So I think sometimes people look for
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certainty in diagnoses and which they may not really have. And believe it or not, that can actually
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get in the way of finding hope that life could be better six months or a year from now.
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Yeah. Cause you, you take on that, like you said, you take on that identity. I'm depressed. I'm a
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depressed person. I'm always going to be depressed. And yeah, you might, like you said, you might be
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feeling low because you're going through a hard time in college or you just had a breakup, a lot
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of uncertainty. So, you know, if you open up the, the DMS five, you know, the diagnostic tool and you
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look at the symptoms for depression and you say, well, I got that. Um, now like, yeah, you just kind of
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look at everything as like, well, I'm depressed and there's nothing I can do about it.
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Right. Or great. Now on top of, you know, being laid off now, I'm also depressed rather than saying
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after loss, whether it's loss of a job, loss of a relationship, loss of, you know, anything,
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it's normal to feel sad and depressed. It doesn't mean you have a disorder. I mean, that's grieving.
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And so it helps often to say, this isn't a normal reaction to a loss in your life. And what does
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that tell you about what it is that you value that you want to get back in your life? Meaningful work,
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close connections, you know, what did you lose that you want to get back rather than let's just
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alleviate the symptoms? How has social media exacerbated the problems of self-diagnosing?
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Well, you know, when I first started doing this 25 years ago, for better or for worse,
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the DSM, the kind of psychiatrist Bible you were talking about a minute ago, that, that was only
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available or, you know, no one would go out and purchase that. It was a hundred dollar doorstop
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of a book and extremely boring and dry. So no one really had access to what are these mental health
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disorders and how do you diagnose them? And now, you know, for a lot of reasons that are good,
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that information is widely available on the internet or in on social media and quick little
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tidbits and quick videos. And it's actually what we used to call medical student syndrome that people
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would go into medical school and they would read about illnesses and disorders and decide they had
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all of them because, you know, they could see themselves in so many. So something similar happens
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on social media. People hear about anxious attachment style and they decide they have it or,
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you know, panic disorder and they decide they have it or bipolar disorder or borderline personality
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disorder, which it's very rare, but people decide they have it. And so then, you know,
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it's sort of a misunderstanding of what's going on. They're locating the problem in their brain
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Yeah. You say about the social media, mental health stuff that goes on on TikTok and Instagram
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reels or whatever, there's a fine line between social awareness and social contagion.
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Yeah. I mean, I think it's cool that people are becoming more aware of, hey, you know,
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the twenties or many points in adulthood are difficult and people have these struggles and this is very
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normal, but it's not so great when everybody decides that, oh, you know, I have this disorder
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or we've even seen how quote unquote disorders can literally spread on social media. There was a lot
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of research done around during the pandemic around these ticks like, you know, that people were developing
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in terms of, you know, squinting or saying words over and over again that young adults or teenagers
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would see these videos of people saying, I can't stop doing this. And then they started doing it.
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And so there was this unprecedented number of people going into neurology clinics with ticks that
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were specifically the ones that were circulating on TikTok. So that was a very concrete example,
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but I see the same thing with right now. I can't tell you the number of people who keep coming in
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and telling me they have anxious attachment style and they don't. They're just feeling,
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you know, uncertain about, gosh, I don't know if this person likes me or I'm not sure who my friends
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are. And that's a pretty normal way to feel in your twenties. It doesn't mean that you have anxious
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attachment style. Yeah. I've seen, you know, I get this like mental health stuff that pops up in my
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Instagram feed. And when I look at this, cause I've read, I've talked to enough psychologists and I've
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read enough books about this because of the podcast. I can look at some of the stuff like this is not
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legit. Like this is just some person who maybe had some problems and now they're trying to like
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help other people, whatever. One thing I've seen is like this idea that procrastination is a trauma
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response. And I'm like, ah, I don't maybe, but probably not. You're probably just, you know,
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you're like anybody who procrastinates. It's just, you don't like doing the thing. It's not pleasant to
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do. So you're putting it off. Right. And I think, you know, I actually haven't even seen that,
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Brett. So I'm curious of a, what's the connection and B how is that helping people to say, oh, great.
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Not only do I procrastinate, but I'm also traumatized. So I'm not sure what's going on
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there, but yes, I see procrastination in my office all the time. And I think sometimes people panic
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and say, oh no, that means I have ADHD or that means I have, you know, fill in the blank. And often,
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like you're saying, it's young adults and adults of all ages trying to grapple with the reality that
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they have to do things they don't want to do. And the brain would like to avoid that as long as
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possible. But eventually, hopefully we learn through experience, much of it painful, that it's actually
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just easier to not procrastinate, to do stuff in small bits, starting sooner rather than later,
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that this is part of, you know, growth and development. Okay. So instead of being quick
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to take on a mental health diagnosis, if you're feeling anxiety, just feeling depressed, maybe
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scattered brain, et cetera, you try to help people figure out that come to you, you know, whether
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those feelings they're having can be attributed to some situational stressor. Like maybe you're not
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depressed. Maybe, you know, you're just, you're feeling low because you got a bad grade this semester
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in college, or maybe you lost your job, or maybe you're having some problems in your relationship.
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How do you, I mean, one thing I've noticed when it comes to mental health, people can get really
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touchy about questioning diagnostic labels they've given themselves because it's like tied up with
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their identity. So how do you do this as a practitioner, help them maybe look at things
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differently and kind of nudge them to look at maybe the feelings or problems they're having
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can be attributed to a situational thing and not to a disorder?
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Yeah. Well, I mean, it may be because I do this day in and day out. So I usually just very, you know,
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matter of factly with a smile say, well, I'm not so sure this is a disorder. Maybe this is something
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going on in your day to day. So let's talk about your day to day. And I usually ask people to tell me
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a lot of detail about their work and love and life and health and sleeping and substances and porn
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and everything. I get real familiar with the details of people's lives. And then I start to
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maybe help them connect the dots between what's going on day to day and how they're feeling. And
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then, you know, obviously only can go off of what clients tell me, but you'd be amazed. Most people
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tell you what their problem is, even if they don't realize they're telling you that they tell you,
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you know, where the gaps are, where things are going sideways. And then they're, you know,
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end up basically suggesting their own solutions. And so you say, well, why don't we start there?
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Why don't we start by addressing this issue or having this or that conversation or changing who
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you live with or talking to your boss at work? And then just sort of work on it on the ground
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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.
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You're going to try these life interventions first.
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Yeah. I mean, I'm thinking, I'm always thinking with a client, do I need to diagnose this person
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in order to help them? Because oftentimes, what difference does it make? You know, what you do
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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
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of what's going on? And I mean, you know, these are not black and white issues. I mean,
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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
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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.
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Well, let's talk about mental health medication because that's another thing you're seeing an
00:21:30.940
uptick in. People turning to psychoactive medication to relieve feelings of sadness, angst,
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feeling scattered brain. Do we know how many people are taking psychoactive medication today?
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Yeah, about one in five are taking a mental health medication. And actually, among adults of all ages,
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antidepressants, this is a kind of a shocker of a data point, are the most likely prescription
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medication to be in your medicine cabinet from the age of, you know, 20 to 60. If you've got a
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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
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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
00:22:52.640
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
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.
00:32:57.660
Is this, you know, this idea, this confidence, is this identity capital? You've written a lot
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
00:49:13.940
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
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,
00:55:45.100
performing like a porn star. Don't worry about that on the first date. Let's just spend some
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
00:56:56.340
watching porn is like learning how to drive by watching fast and furious movies. That it's
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,
00:59:28.360
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
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.
01:05:37.320
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
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01:06:08.200
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01:06:16.720
And until next time, this is Brett McKay, reminding you to not listen to AOM podcast,