The Peter Attia Drive - #105 - Paul Conti, M.D.： The psychological toll of a pandemic, and the societal problems it has highlighted

00:00:00.000 Hey, everyone. Welcome to the drive podcast. I'm your host, Peter Atiyah. This podcast,

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00:00:41.720 head over to peteratiyahmd.com forward slash subscribe. Now, without further delay, here's

00:00:48.080 today's episode. Welcome back to another COVID-19 episode of the drive podcast. My guest this week

00:00:56.420 is Dr. Paul Conte. Some of you may recognize that name as Paul was a previous guest on the show

00:01:01.840 about a year and a half ago when we spoke about mental health, depression, trauma, and a number

00:01:06.220 of other things. On this episode, we kind of pick up a little bit of that thread, but obviously talk

00:01:10.620 much more specifically through the lens of the anxiety, trauma, uncertainty that many people are

00:01:17.160 experiencing in the midst of the pandemic, the quarantine itself, the isolation, the uncertainty

00:01:25.620 that comes from it, both economically, socially, politically, et cetera. Paul and I go off on a

00:01:31.620 number of tangents here that I think, you know, on some level speak to societal problems, on other

00:01:39.000 levels speak to challenges that we all have at the individual level. So I hope you'll enjoy this as a

00:01:45.500 bit of a deviation from the normal flow of information as it pertains to some of the more

00:01:51.360 technical aspects of this, which we'll obviously continue to return to. But I found this to be a

00:01:56.220 very helpful discussion. And frankly, the type of discussion that Paul and I will often find

00:01:59.980 ourselves having in the midst of situations like this, but hopefully by being able to have this

00:02:04.780 discussion and share it with you, some of you may find value in this. So without further delay,

00:02:08.120 please enjoy my discussion today with Dr. Paul Conte.

00:02:15.500 Hey Paul, thank you so much for making time to talk this afternoon. I know you're even busier than

00:02:21.220 you normally are, but I know you appreciate that some good can probably come of us setting some time

00:02:26.960 aside to talk. Thank you very much. And I so appreciate you having me back on. It's such an

00:02:32.960 important time and there's so much to think about and talk about. And thank you for taking the time to

00:02:38.460 have me on. So Paul, before we jump into some of the stuff I really wanted to talk about, it's probably

00:02:43.500 worth you sharing with people your own experience with what has to be believed as a presumptive

00:02:49.300 diagnosis of COVID-19. You got sicker than hell about a month ago, as did one of your children.

00:02:57.340 And as you've described those symptoms to me, they are very classic for the diagnosis here. And you're

00:03:03.420 no stranger to getting the flu and things like that. But tell folks a little bit about what you

00:03:07.340 experienced. My wife and my two-year-old both just had malaise, mild symptoms, but my six-year-old

00:03:15.380 who is, we're kind of like carbon copies of one another. She had pretty significant symptoms by

00:03:21.100 pediatric standards. So I kind of knew it was coming and I had the malaise and just generally not

00:03:27.440 feeling good. And that was there for a couple of days. And then I very rapidly got very, very sick

00:03:34.040 in a way that felt different than flus or food poisonings or other illnesses. We felt extremely

00:03:41.540 hot alternating with really terrible chills that kind of took over along with like an awful headache

00:03:49.000 and this just deep nausea, not like I've experienced before. And interestingly, I wasn't congested. It was

00:03:56.320 strange to start to have a feeling of shortness of breath, really having to catch my breath and start

00:04:02.760 taking deep breaths and to be that sick, but to not have any congestion. And it was scary. I mean,

00:04:08.520 I remember at one point I was in the shower and I had the water turned up high enough to scald me,

00:04:13.640 like it should have been really painful. And I was just shivering and I had goosebumps and just things

00:04:19.720 that haven't happened before. And I could really see the lethality in someone who has some of the medical

00:04:27.000 comorbidities I'm fortunate not to have or is older. And it was scary. It was scary.

00:04:33.960 Well, I think it also kind of gives you an interesting perspective to be able to talk about

00:04:37.600 the stuff I want to talk about with you today. As you know, I've been spending the past month trying

00:04:43.860 to figure out how to be useful. And that's required more starts and stops and fits and starts than normal

00:04:49.600 because there is this feeling of helplessness. You and I were talking about this earlier, which is like

00:04:54.000 that you have this desire to do something, but at the same time, you feel like you can't really do

00:04:58.740 anything. And there are days when I just wake up and all I want to do is watch Netflix and play in

00:05:04.320 my simulator and literally have nothing to just forget that this is all happening. But then there's

00:05:09.880 days when I wake up and I feel really motivated and I think, how can I help? And I haven't figured

00:05:13.900 the answer to that. I suspect doing these podcasts is helpful. The feedback has been great. And I also

00:05:19.380 think that people are probably at least as interested, if not more interested in the kind

00:05:24.900 of stuff we're going to talk about today as they are on the nuances of this type of RNA virus versus

00:05:31.100 that type of virus versus this drug and that drug. And while those things matter, I get a very vague

00:05:36.860 sense that there's a coming fatigue around the uncertainty of when are the cases going to peak and

00:05:43.540 what all these things. And there's a little bit more of a sense of, okay, well, what does this mean

00:05:47.180 for me as a person? And how have you been sort of struggling with the role that you play as an

00:05:52.440 individual to your family and then the role that you're trying to play with your patients and then

00:05:57.440 maybe even thinking more broadly? As I know that you know, and you and I have talked about on your

00:06:03.040 podcast, I see the world through the lens of trauma. And I think part of what just frustrates me at

00:06:11.400 times to just utter exasperation is I think the predictability of so much that has gone on around

00:06:20.320 us. And I think we've had an explosion of so much technology, so much increase in capability.

00:06:28.480 And I think we've made errors as a society in how we're utilizing that technology. And we've

00:06:34.920 really paved the way, I think, for deeply traumatizing ourselves as a society, as a country,

00:06:44.960 and also just as species. And I think, obviously, I'm a psychiatrist. And one of the principles that's

00:06:52.580 at times used in psychotherapy is this idea that everything is as it should be, which does not mean

00:06:59.980 morally right. It means that the vast majority of things that ail us, I mean, some of them befall us.

00:07:09.120 But so often, there's a predictability that we've gone 19 steps down a 20-step path,

00:07:16.400 and then are surprised when we get to the 20th step. And I think that we have been paving the way

00:07:23.740 for terrible trauma to happen both medically and also socioeconomically. And what so disturbs me is

00:07:33.560 that as the virus itself recedes, in whatever way that ends up happening, we're going to have to make

00:07:40.440 decisions. And I think that those decisions have tremendous gravity to them. I mean, I try not to be

00:07:47.200 inclined to hyperbole, but I think that they are as serious as you and I have discussed in other venues.

00:07:53.520 I mean, is it America passing the torch as really no longer being the world leader that we have been

00:08:00.280 since the Second World War? Are we setting the planet on a reckless course that we can't recover

00:08:06.380 from? And I think we have to learn from this. And I think where I wring my hands and gnash my teeth

00:08:13.320 is the idea that maybe we won't learn from this. And I'm worried that we could then sort of

00:08:21.220 traumatize ourselves out of existence. What do we know about how humans internalize

00:08:28.680 this type of stress versus other types of stress that are more potentially uniting? So I know that

00:08:37.040 there's a body of literature that would say, look, pandemics do different things to the human psyche

00:08:43.320 than most other things like war, terrorist attack, even natural disaster, because by their very nature,

00:08:50.180 they are isolating. Sebastian Younger has written very eloquently in his book, Tribe, about how post

00:08:56.140 9-11 suicide rates actually went down. People united. There was a common enemy, and then there was

00:09:03.260 something we could all do to stand together. But the literature on pandemics actually doesn't suggest

00:09:07.640 that to be the case. What is your take on these sort of differences in the psychology and psyche

00:09:12.900 of us when confronted with these different external stresses? I think on the one hand, it creates

00:09:19.100 tremendous feelings of loss of control and tremendous vulnerability. And it also creates suspicion.

00:09:28.520 We know that viruses are real, but there's still that part of human beings that we can't see it.

00:09:34.980 We can't just stop it, no matter what we're doing. It can be lurking around invisibly.

00:09:40.100 And those are things really that terrify us, the idea of an invisible enemy. And we internalize this

00:09:47.380 in a way that is more and more isolating. And I think historically, it just makes people very suspicious

00:09:52.720 of one another. I don't know, like the idea that, hey, if I meet you on the street, I don't know if you're going

00:09:56.920 to accidentally kill me. And I can't read, I can't use what I would do to read safety, to read control

00:10:03.440 in order to keep myself safe. And I think in addition to that, we have a very big added problem,

00:10:11.060 which is that that feeling of vulnerability, that feeling of loss of control is looking for an enemy.

00:10:18.720 I mean, after 9-11, whether we ultimately were targeting the right enemy or not, there was an attack.

00:10:26.100 There was an enemy. And here, I am very, very worried that the social structure we have allowed

00:10:33.420 to arise is a social structure that searches for an enemy. And I see the xenophobia, the racism that

00:10:43.960 then makes us feel that there's an enemy that actually isn't our enemy. Instead of seeing, look,

00:10:51.380 this is a human ailment. And people who are suffering are suffering in the same way. I mean,

00:10:56.960 as you and I know, as physicians, when you see someone who's really suffering, nothing else

00:11:01.840 matters. And we're not thinking about like, what's the color of that person's skin? And how much

00:11:06.460 education or money do they have? It makes us all the same. But we lose that perception of people who

00:11:13.140 are suffering in China, suffering in Iran, suffering in America, suffering in Europe, suffering in Africa

00:11:18.960 and South America. We lose that. And we start to, I fear, further the processes that are separating us

00:11:29.740 already to such a dangerous degree.

00:11:33.800 Paul, if you could wind back the clock to January 12th, so the virus has been now identified,

00:11:39.980 the scientists in China have sequenced it. If you had mind control over world leaders at that moment in

00:11:46.780 time, and you could have programmed everyone in such a way that there would have been complete cooperation

00:11:53.260 and borders would have effectively dissolved, not from the standpoint of interstate travel and things

00:11:59.480 like that, but in terms of nationalism, everyone said, hey, you know what? We're all in this together.

00:12:04.260 This thing's going to be a potential disaster. Let's completely share every piece of information

00:12:09.820 we have. And we're all part of the same country. So whether you're our enemy in Iran from a

00:12:15.700 political standpoint or not, no, no, no, we're all going to share resources of testing, of data,

00:12:21.020 of medication, et cetera. Is there any precedent for the world being cooperative and productive

00:12:27.440 in a manner like that? Because I got to be honest with you, the only thing that comes to my mind is

00:12:31.980 these goofy sci-fi movies where the aliens come to invade and all of a sudden the Russians and the

00:12:37.100 Americans are friends because they have to sort of fight the alien. So outside of goofy sci-fi,

00:12:42.340 is there any reason to believe we even possess the ability for that degree of cooperation?

00:12:48.820 I don't think we do right now. I think we can, but I don't think we do. And this is because it is

00:12:55.920 much, much easier to ally around a common enemy. How long has the expression, you know, my enemy's

00:13:03.880 enemy is my friend. I mean, that's probably been around since people develop language in some form

00:13:09.100 or another. It's very easy to identify that is my enemy. So now you are my friend, hence the alien

00:13:14.680 invasion. Even you look during the second world war nations that had a lot of adversity, there were

00:13:20.440 examples of unification around fighting the common enemy that the problem is what is becomes much,

00:13:26.340 much, much harder and requires different elements of the human being's ability to call upon the deeper

00:13:35.540 parts of our brain. The parts that don't just react with what I think of as traumatic aggression in

00:13:42.020 order to ally around something that really isn't an enemy. The virus isn't plotting against us. It

00:13:48.900 doesn't have intelligence. It's invisible. In order to unite, we have to recognize our shared humanity

00:13:55.860 ability. And our ability to, for people to cross borders, our ability to destroy one another with

00:14:03.840 weapons has so far exceeded our ability to do that. I mean, if you look at the reactions in various

00:14:10.280 countries, it's been the same reaction. I mean, I think to me, core principles here are the everything

00:14:16.400 is as it should be. If we make decisions one through 19, we're going to end up at decision point 20.

00:14:21.800 And the other point is how much the middle school playground plays into all of this. Even it was

00:14:28.480 three, four weeks ago, around maybe three weeks ago, my father, who's in his eighties, his girlfriend

00:14:34.980 who's in her eighties, we're going to go out to an event with like 500 people. My response is,

00:14:39.540 oh my God, stay home. And then he responds, why would I stay home? There are no cases of the virus in

00:14:45.500 New Jersey where my father lives, right? Sure. If you don't test people, then you don't know that

00:14:51.680 there are cases. And I think this is so part of the problem that we've reacted in this, hey,

00:14:58.360 I don't have the cooties. It's not mine. It's a middle school playground reaction. And when you

00:15:04.100 combine that with how easy it is to just blame somebody, it's someone else's fault. And that

00:15:10.420 we've, I think, socialized ourselves through how media in general, let alone the subcomponent of

00:15:17.620 media, that social media has grown up around us to self-indulge to that appeal. It's not me. It's

00:15:24.960 somebody else's fault. Somebody's my enemy. Can't land here. And then it's a combination of misguided

00:15:30.560 aggression and sticking our heads in the sand. And then look where this leads us. I mean, the scenario

00:15:37.800 that you cited shouldn't have to be science fiction. We should be able to collaborate in ways

00:15:44.740 that recognize common threats to us. But we don't do that. We so quickly devolve into the first part

00:15:53.520 of what we were talking about, which is, I feel insecure. I feel vulnerable. Are you my enemy?

00:15:58.340 And I certainly don't want you to think that there's something wrong with me. Maybe you'll

00:16:01.520 think I'm your enemy. And then we all put our heads in the sand and look what happens down the road.

00:16:07.400 It's so clear how preventable this was and also how inevitable it was given that we did not

00:16:17.680 set the groundwork in place to prevent something like this.

00:16:23.740 So you've been very busy, obviously, in the last month. You're as busy as I am, if not more busy

00:16:29.020 generally. But my guess is that the people you help have found themselves relying on you perhaps

00:16:37.120 even more than normal. Is that a fair assumption?

00:16:40.520 In some ways. I mean, it's been interesting. That has been the case for some people. For other people,

00:16:47.800 there is some sense of safety in sort of hunkering down at home and that idea of circling the wagons.

00:16:54.700 So it's interesting how much it has really dichotomized in that way. And also, what I'm not

00:17:03.640 seeing nearly as much of are the people who were so at risk socioeconomically before this. A lot of

00:17:13.400 what I do bifurcates. I'm the medical director at a place that provides drug and alcohol treatment

00:17:19.780 for mostly an indigent population. That's part of the work I do. And the other part tends to be

00:17:25.960 with people with more resources. What I'm not seeing is the gigantic, and I mean gigantic,

00:17:32.240 swath of most of the country that were on a socioeconomic precipice before this. So then not

00:17:40.940 only do they have the medical risk, the fears that I do think are pervasive and are perhaps temporarily

00:17:47.420 soothed by holing up at home, but they're not soothed by holing up at home if you don't know what

00:17:54.620 you're coming out to. We've known for a long time that the specific numbers vary by study, but the idea

00:18:03.760 that half the population in this country couldn't survive and move forward from $500 unexpected cost

00:18:12.140 or a $500 shortfall. So on the one hand, we've talked about, oh, look how great the economy is

00:18:16.700 doing because employment rates are high. But so many people are living either in desperation or one

00:18:23.740 step away from desperation. And I think what we are doing is, yes, a lot of people are traumatized,

00:18:30.280 absolutely. But that gigantic swath of the population that is most of us are traumatized

00:18:38.460 disproportionately because they don't know what they're emerging to because we've set up a system

00:18:44.800 that has essentially made that inevitable. I mean, how long was it going to be if half or more of the

00:18:50.860 population can't survive through a $500 need or $500 shortfall? Something is going to trigger that.

00:18:58.540 And it's not a surprise that something triggers it en masse. And I think that's where this is a gigantic

00:19:04.440 medical problem. It is a social problem. It is an economic problem. When you add those things

00:19:10.500 together, those things synergize and it becomes a societally threatening medical socioeconomic problem.

00:19:21.160 And we haven't had that before. So let's take both extremes of the types of patients that you're most

00:19:27.860 working with, most commonly working with. In the first group you said is the indigent population who

00:19:33.860 you're helping with substance abuse, presumably many other medical and psychiatric problems that

00:19:39.840 accompany those. How is that population doing in the presence of what's happened in the past

00:19:45.980 four to six weeks? I think it's added desperation on top of desperation, which is obviously not a good

00:19:54.280 thing. It's an element of the population that, I mean, I think in large part we've left behind.

00:20:00.700 Because I see the world through the lens of trauma, I see part of my reason for existing and fighting

00:20:06.040 the shame that's created by trauma. But there are ways in which shame is called for. And I think as

00:20:13.420 a society, there are things that we really should feel ashamed of. The ways we don't give people

00:20:19.460 chances to get back on their feet. And then we have a populace that there's just so much desperation

00:20:25.420 in that part of the population that, yes, this makes things worse. But it's not a change in how

00:20:31.980 a lot of people in that situation are living day-to-day life. And I think that's lamentable.

00:20:37.260 Which is a sad statement.

00:20:38.660 Yeah. It's a terrible thing to say. But that's even in the 20 years or so that I've been doing this,

00:20:44.080 which is it's not a gigantic amount of time. It's not a small amount of time. But the change

00:20:49.340 has been dramatic, where there is a part of the population that we just leave behind.

00:20:55.660 They need more resources than we're willing to put towards them. So we check a few boxes and

00:21:01.320 we say we're doing things that we're not really doing as a society. And we've written people off

00:21:08.380 en masse. Now, that is not true of everyone. And there are people who, of course, work so hard and

00:21:13.900 selflessly to help other people. But as a society, we've sort of decided that it's okay

00:21:20.020 if you can't navigate complex systems, or if a couple of bad things happen, either things happen

00:21:26.960 to you or you make bad choices, that as a society, I don't think it's subtle that we've written people

00:21:32.820 off that way.

00:21:35.020 And then what about the patient population you take care of for whom the economic stress of this

00:21:40.380 is not nearly as it is for perhaps the majority of people, but who still have their own demons,

00:21:46.440 their own neuroses, their own stresses? What are you seeing that is unique to this environment

00:21:52.080 that is maybe either similar to or even distinct from other things that you have been in the capacity

00:22:01.620 of being a therapist? For example, during the economic catastrophe of 2008, 2009, again,

00:22:09.600 post 9-11, any other sort of external stressor, how does this stack up and what is it that you see

00:22:16.480 that's maybe unique about it? I think I've never seen something that just supercharges this idea

00:22:25.360 that if I fear enough, then I'll be safe, which I believe is an impact of the insecurity that many,

00:22:36.420 many people, if not certainly most people I encounter, I believe, feel about the world.

00:22:44.300 This idea that our biological drive to recognize threats so that we can stay alive and pass on our

00:22:50.800 genes has in so many people mutated to where we're essentially living in a state of constant

00:22:58.280 hypervigilant discomfort. There's always something else to do. It's never enough for us to be safe and

00:23:05.240 secure. I think the society is always telling us that. The news has mutated from providing news

00:23:14.040 to grasping people's attention, grabbing people's attention in a way that says, look at that news

00:23:20.140 again because you're going to see something else bad. All the anecdotes of he got up at nine and felt

00:23:25.500 healthy and by noon was in the intensive care unit. It's like we know this. We don't need to be

00:23:33.140 assailed every moment by every threat to us. We have become prisoners of the insecurity that we

00:23:41.440 have generated. I think that comes through these biological drives that have led us to a place that

00:23:48.940 is no longer keeping us safe. If you think of the biological drives and psychological drives to

00:23:55.400 increase our safety by participating in social systems and economic systems, a lot of that has

00:24:03.400 mutated into strivings that make no individual sense within systems that make no group sense.

00:24:11.000 So people that are working and working and putting money away for retirement, but the vehicles that

00:24:16.440 they're in aren't safe vehicles anymore. We've created so much insecurity that it affects people even

00:24:24.240 who have enough economic means, but still have this pervasive feeling that there's always, always,

00:24:31.960 always something to fear. And then this idea that if I fear enough, I'll be safe, then starts to spiral

00:24:38.700 out of control and people get obsessive and people get ruminative. The negative thoughts go over and

00:24:45.220 over and over. What if something happened to my kids? And like, okay, what if we all get sick? Or what if we

00:24:50.660 don't get sick? But there's a terrorist attack? Or what if, what if, what if, what if? And become so

00:24:56.060 pervasive that what's fascinating to me is that I don't see peace in any demographic. Does it matter if

00:25:03.740 people have tremendous amounts of money or have no money? I just don't see peace anywhere. And I think

00:25:10.600 I am trying to scientifically ascertain for it, right? I mean, I'm trying to listen to people, talk to

00:25:16.700 people, learn what's going on inside of them. And sort of what is uniting us is this pervasive

00:25:23.400 insecurity. And then these parts of our brain that want to keep us safe, go into overdrive and

00:25:30.440 inadvertently make us feel so much more vulnerable. What do you think is actually happening from a

00:25:36.340 neurobiology standpoint? I mean, we're now over a month into our quarantine here and spoken about this

00:25:43.200 on the podcast before. I'm pretty fortunate. There are people who are quarantining inside tiny

00:25:48.720 apartments and they don't have the luxury of being able to go outside in their yard and things like

00:25:52.740 that. So I want to be clear that I'm not for a second lamenting the quarantine I'm in because I feel

00:25:57.600 really, really lucky. But I can't for the life of me understand the degree of irritability that I've

00:26:03.700 experienced over the past month. And I've done a little bit of a better job in the past few weeks,

00:26:08.800 at least not lashing out. But there's no denying internally a feeling that I have that is,

00:26:16.820 well, frankly, I don't know how to explain it. I'll tell you because I mean, it's so frequent.

00:26:20.960 I can tell you how I felt this morning. So this morning I was, I was exercising. So I'm lucky to

00:26:27.540 have a gym at home so I can exercise. So, and again, intellectually, it's not lost on me. What a

00:26:32.980 privilege. Like I think of all the people who can't go to the gym now and their best thing they can do is

00:26:38.320 pushups and sit-ups in their apartment. So intellectually, I get that, right? But I'm

00:26:42.860 sitting there thinking, I don't really feel like doing this. And frankly, if this quarantine ended

00:26:48.320 tomorrow, I don't feel like going anywhere. There's this weird feeling of, I don't know what I want,

00:26:54.280 but I don't want this. I have a lack of interest in anything, but of course I'm as busy as I've ever

00:27:01.880 been. So there's this very difficult feeling of every minute I'm moving, I'm hustling. I mean,

00:27:09.440 even my exercise is scheduled and between calls and this thing, the other thing. But if you told

00:27:15.080 me, Hey, I could wave a magic wand and make the coronavirus go away tomorrow and everything would

00:27:18.860 be back to normal. I didn't even have a sense of joy over that. I was just like, Oh, well, what would

00:27:24.140 I do? I don't know how to describe this, Paul. It's like, I'm sure there's a word for this sort of

00:27:28.340 overall just lack of interest in life. Maybe that's too broad a way to explain it, but it's

00:27:34.520 this really weird oscillating feeling of sort of sadness and irritability and almost wishing I

00:27:43.040 could just escape something, but not sure what I want to escape. Does any of that make sense?

00:27:47.700 Absolutely. And then I am finding there are more people who are escaping through say drugs and alcohol

00:27:54.460 and other really unhealthy things through that sense of desperation. And I think what you are

00:28:01.420 describing is demoralization. And you can tell me if this resonates with you. You and I haven't talked

00:28:06.720 about this before. So you tell me if this resonates that, that I think somewhere in there is a sense of

00:28:12.680 futility that says, Hey, if you look on two different levels run on a personal level, you've worked

00:28:18.640 very, very hard to better yourself, better your situation in the world, take care of your family.

00:28:25.420 And there's something that speaks to, okay, there's a roof over our heads and we're sheltered here, but

00:28:31.500 have I succeeded in doing that? Or have those efforts been futile? Because I can't protect the

00:28:37.440 people around me. I can't make things okay. That my personal efforts to make life okay have come to

00:28:43.840 not. I mean, obviously not saying these things are true, but this is what goes on inside of us

00:28:47.500 because you feel that, okay, you can shelter everybody for now, but what does it say about

00:28:53.060 the world around us? And what does it say about the next threat that maybe you won't be able to

00:28:57.640 shelter from? That's one aspect of how we become demoralized. The idea that, Hey, no matter what

00:29:03.160 you do and how hard you work, you can't make a difference because you can be vulnerable anyway.

00:29:07.980 And I think it brings that home to a lot of us because I think I'm not saying that we should be

00:29:13.700 demoralized, but I'm saying, I believe there's truth to that because I think the world around us,

00:29:19.660 the world around us leads to that. The everything as it should be says the world is such that we're

00:29:24.660 not safe. On the other hand, there are things that you've done on a broader level that are about

00:29:31.600 trying to contribute to the world in a bigger way around you.

00:29:35.800 I think what you said is incredibly spot on. And of course, that's part of what makes you who you

00:29:40.760 are is your ability to sort of see things I would never see. I've never thought of this as being

00:29:46.660 demoralized, but I think you're absolutely right. And I think you're right that I'm not alone.

00:29:51.560 I suspect people in 2008, 2009 were demoralized for a different reason, which is if you're that person

00:29:58.560 who did everything right and found themselves on the wrong side of a mortgage because the value of

00:30:06.700 their home came crashing down and they were not sophisticated enough to know that, hey,

00:30:11.980 these types of loans have these hard, nasty resets on interest rates, et cetera, et cetera.

00:30:16.840 You could very easily say, hey, I did everything right and look what happened, right? And now I think

00:30:24.420 you're seeing that same thing all over again, but with far less economic stratification. The economic

00:30:33.740 stratification plays probably a broader role in your resilience to this, but it probably doesn't play as

00:30:42.280 much of a role in what you just described, which is whether you're the wealthiest person in the world

00:30:47.880 or the least wealthy person in the world, there's still sort of a view that you should live in a

00:30:54.160 world where you have some ability to control your health if you do the right thing. If you take

00:31:01.540 care of yourself, if you eat, sleep correctly, exercise correctly, you shouldn't be afraid for

00:31:07.640 your life. And I'm not saying that that fear is rational, by the way, because as we've discussed,

00:31:13.000 the majority of healthy people who get this virus are going to be totally fine, but there is a degree of

00:31:19.000 fear that says that that might not be true. I think that's right. And that's where I'm sort

00:31:25.100 of fond of saying it's the soup that we're all swimming in. And I think that's the commonality,

00:31:30.120 wealth status, social standing, like those things don't matter when we're swimming around in the same

00:31:36.200 soup. And neither you nor I, we're not political animals and we don't have political discussions in

00:31:42.200 that way. And this isn't about politics. I mean, I'm a believer that many things in the world are

00:31:48.460 driven by strong individual people, good, bad, or otherwise. But I do believe that that's not always

00:31:56.540 the case. There are cases when social forces evolve and then they produce something that's going to be a

00:32:03.560 certain way, regardless of the specifics about it. So this isn't Republican, Democrat, like it's so

00:32:10.100 far from that. But the idea that the importance of expertise actually has become less and less and

00:32:16.700 less and less important because everybody can have an opinion and can just yell that opinion louder.

00:32:22.880 And then what we get is an erosion of expertise, where it doesn't so much matter anymore. What does

00:32:29.320 somebody know or not know? Because, well, everybody's got an opinion. And I think we've seen that evolve.

00:32:35.100 And my thesis is that the inevitable outcome, where the basics that we think of about the state around

00:32:42.800 us, the government, right, keeping us safe, like just isn't true. And we do expect that. We live in

00:32:49.360 this society. We participate in it. We vote. We pay taxes. Like I expect that if I'm driving down the

00:32:54.860 highway, there's not going to be like 20 foot long hole that's 20 foot deep that my car falls in.

00:33:01.400 Like I expect that's not going to happen, but that's not the only expectations we have. We expect

00:33:07.320 that there's something going on that's providing us with some sense of protection, that there's some

00:33:14.440 foresight to the world around us, that everything isn't just based upon opinions and opinions that

00:33:22.060 then justify whatever the person expressing them wants to justify. And I think what we're seeing here

00:33:28.780 is like truly that the emperor has no clothes. And again, I'm not speaking, this is not me trying

00:33:34.200 to be political about the president. I mean like the emperor of the society we live in. It's not

00:33:39.980 adorned with the splendor that we think will protect us. There's a truth here that there can be hurricanes

00:33:46.640 that devastate individual places and people don't come to help. I mean, look, some people go to help,

00:33:52.920 but not in a way that says, look, let's make sure that this doesn't devolve into complete

00:33:58.080 lawlessness. Like we haven't been able to pull that off in focal settings. How are we going to

00:34:04.880 pull that off on a national setting where there has to be acumen and resolve to decide what tests

00:34:10.880 should we deploy to have the willpower to deploy? I mean, it's not that long ago where people were

00:34:16.220 still saying, oh, some person somewhere in this place had the coronavirus. Oh my gosh. Oh my gosh.

00:34:22.720 And we look at that person had it. We now know there's probably half a million people who have it.

00:34:27.480 There's a seduction of like, let's look at that person and look at that bad thing. And then we can

00:34:32.820 posit that we're other than that. And the truth is that that never made any sense. That never made any

00:34:38.740 sense. That example you gave where everybody's cooperating, we would identify who's been exposed,

00:34:44.060 know who those people are, test those people, protect their contacts. We could have done so

00:34:49.720 much better containment, but instead there really hasn't been that much going on to protect us.

00:34:57.580 And I think this lays that bare in a way that the hurricane showed us in a focal way,

00:35:02.660 but it's not just about health. I think it's about socioeconomic risk.

00:35:07.680 Paul, I want to shift gears for a minute and talk a little bit about healthcare workers. I don't know

00:35:11.380 how much time you've spent thinking about that in this setting, but do you have any thoughts about

00:35:19.780 sort of the lingering effects of this on that population, which has a couple of things working

00:35:28.660 against it? One, they're on the front line. So while people like you and I have the luxury of working

00:35:34.880 remotely with people we care about during a time like this, they don't. The doctors and nurses that

00:35:40.460 take care of these patients don't get to do so remotely. So now they're at this increased physical

00:35:45.980 risk. And there's, you know, still some evidence to suggest that the risk that they face is even

00:35:52.060 greater just based on potentially the viral loads they're encountering and things like that. So this is

00:35:56.880 real risk. Secondly, you have the sort of the morale insult that comes with seeing their own

00:36:06.500 colleagues also become patients. So when they start to have to care for each other,

00:36:12.180 do you have any thoughts about sort of the PTSD that comes to this population in the months that

00:36:18.140 follow this or in potentially even longer? I think it's going to be so pervasive. I think the trauma

00:36:25.420 is going to be pervasive and even generational. I think that family members, children of people in that

00:36:33.540 situation will be affected by it and potentially deeply affected by it going forward. I think we

00:36:41.960 are facing the, what I think of as the appalling consequences of compounded ignorance. I mean,

00:36:48.320 look at what we have done in our health system. Like you and I have both been in it in a whole bunch of

00:36:54.540 different ways. And I think people in it can see how little it makes sense that we're trying to run

00:37:02.920 our healthcare system in a way that is sort of pushing people to the limits and extracting

00:37:10.040 profit and reducing costs wherever possible. And then ultimately everything is running in a way

00:37:17.740 that stretches people to the limit, stretches people to the limit. And how much have we seen of

00:37:26.500 that in anyone, doctors, nurses, social workers, respiratory therapists? I mean, everybody is pushed to

00:37:34.300 the limit in systems that have, in a sense, abdicated their intelligence. They're not being run with

00:37:41.220 intelligence. They're being run by rules that no one is looking at whether they make sense or whether

00:37:46.740 they keep people safe or whether they make the people who are doing the work in that system feel

00:37:53.780 so disempowered and so devalued. How many times have we heard, I mean, you must, I guess you can hear

00:37:59.980 this the way I do of healthcare workers, just talk about the feeling of their own expendability.

00:38:05.480 They're working in a system that doesn't know them, care about them, value them. And again, I'm not

00:38:10.680 trying to criticize individual people. There's so many people trying to do their best, but we've allowed

00:38:16.480 the systems evolve into this compounded ignorance where we can't take care of the people who are

00:38:24.040 supposed to take care of us. And they know that, and they've known that for a long time,

00:38:29.720 and they're seeing it come to the forefront. So what's a path forward, either in the scenario where

00:38:37.520 this just lingers on longer than any of us would like to imagine, or where it becomes sort of a

00:38:44.600 vacillating, ebbing, flowing pandemic, or even under the scenario where, look, six months from now,

00:38:52.480 everything is back to normal. This virus is squarely in the rear view mirror. We have effective

00:38:58.560 treatments, and the healthcare system is back on its feet. In either situation, how would you think

00:39:07.040 about managing the long-term toxicity of this? Because especially if it's sort of smoldering,

00:39:14.940 but not resolved. I mean that from a psychological trauma perspective.

00:39:19.900 I think the first thing we have to do, which is by no means a given, is acknowledge the trauma.

00:39:25.480 When a person has been through trauma, there is a strong and reflexive impulse to keep that inside.

00:39:34.500 We don't understand it. We feel ashamed of it. It's so threatening, and we push it down,

00:39:39.640 and we need it to be validated. I think we need to validate as a society that we set ourselves up for

00:39:48.940 this, that we set the healthcare systems up to be overwhelmed, to not have the protection mechanisms

00:39:56.940 and the testing that they needed. Now, we need to essentially acknowledge and atone. I don't mean

00:40:04.720 in some way that's atonement in some abstract way, but we actually need to make things different.

00:40:10.960 I mean, I think you would agree. And again, you're the master of what data tells us, right? I think

00:40:16.180 we can look at data and see how we can and should be doing things better. There's not a tremendous

00:40:24.060 mystery to that. I mean, there are places that are doing it better. There are paradigms that we could

00:40:30.560 utilize more that don't reduce people to cogs in a system. And I think we need to, number one,

00:40:38.620 acknowledge that to the people who have felt like just things in the system. And you can throw away

00:40:44.520 a mask, just like you can throw away a gown, just like you can throw away a person. We have to get

00:40:49.740 out of the interchangeability of employment in the modern world, in healthcare as well. And we have to

00:40:56.660 look at what are we doing with our resources? And we have to make it different so people feel like

00:41:01.940 you understand me and what has happened to me, and you are trying to make it better. The you being all

00:41:07.980 of us as a society. If we don't do that, just like with any other trauma, if no one acknowledges it,

00:41:13.680 and there's nothing being done to try and make it better, then it will stay with that person and

00:41:18.060 fester. And it will lead to all sorts of bad outcomes that we'll see years down the road.

00:41:22.940 We'll look in retrospect, and we'll see rises in rates of alcoholism. We'll see rises in rates of

00:41:27.880 domestic violence. We'll see rises in rates of suicide. We'll see rises in rates of people just

00:41:33.640 giving up and walking away from important things to them. We'll see all of this. We will see all

00:41:39.280 of this. Because if we demoralize the population and we don't rectify that, it's not going to be

00:41:44.980 okay. And if somehow it seems to be in six months, that will be a deceit, that it will be tempting to

00:41:51.600 just believe that and go on. But we have to have the courage of our convictions to know that that's

00:41:58.540 not okay. Let's look at, is it true that everything is as it should be? Meaning we let

00:42:02.420 ourselves here. If it's not, let's argue about that and prove that it's not. If it is, let's

00:42:07.580 look at it and change it. And I think it involves people standing up and saying, look, this needs to

00:42:13.140 change. There needs to be not, how do we make the systems better? How do we fine tune this or that,

00:42:17.280 or give this to this population that really suffered? No, no. It's how do we acknowledge the

00:42:23.380 need for change? And that's the hardest thing to do is not that we're going to make systems better.

00:42:28.960 We're going to look at systems and we're going to bring change to them.

00:42:32.240 What does that look like? I mean, I understand what you're saying in the abstract. I don't think

00:42:38.160 I understand what it means. I don't think I know what that looks like five years from now,

00:42:44.400 when this is long forgotten. How does a society from a mental health perspective

00:42:49.420 look, if they are going to be resilient to the next pandemic? So if there's a SARS-CoV-3

00:42:57.320 that's coming in 2030, what does a national psyche, what does the mental health of a population need

00:43:04.060 to look like the year before that hits to do a better job than we might be doing today and to do

00:43:09.940 maybe the best job that can be done given the circumstances? What has to be true of that population?

00:43:14.600 I think what we need is what I would call an alliance of common sense. And I was talking

00:43:23.220 about this earlier this morning with our friend and colleague, Jim Kochalka, about the ideas of how

00:43:29.300 would one, how would we work towards an alliance of common sense where people would say, I can't

00:43:37.920 pretend that something is okay just because it suits my interests, even if I know it is

00:43:44.400 false. I have to first prioritize looking at truth. And can we, the people who would do this,

00:43:53.020 which ideally could be a growing movement led by people with influence and with the ability

00:43:58.680 to say, we have to put aside whatever our wishes might be, whatever our animosities might be,

00:44:06.200 that we actually do have to treat this like post 9-11 or like the second world war and say,

00:44:10.860 what we need to look at now is truth. What are the failings in our public health system as a planet

00:44:19.940 and also as a nation? They stretch people to the limit. They stretch resources to the limit.

00:44:27.800 When do we pretend that lies are truth? And how can we say that that's okay? Republican, Democrat or

00:44:35.100 other, who cares? And again, this gets contentious because as soon as you get political and you can't

00:44:40.960 talk about change without treading into the political, then there's such bitter and brutal

00:44:47.360 animosity that it tells all of us. I mean, part of me, I want to have this conversation because I care

00:44:53.060 about the world. Even if I didn't have children, I would care about the world, I hope. But the fact

00:44:57.180 that I have children is I want to have this conversation. But there's a part of me that says,

00:45:01.820 hey, put your head down and go back home. Because ultimately, whatever you say is going to make some

00:45:08.720 people really, really angry. And people get angry and bitter and vindictive. What we need is something

00:45:17.100 that fights against that, that says we are going to ally around truth in our medical system, in our

00:45:24.360 social systems, in our economic systems. We have to look at this. And if people start allying

00:45:31.700 in that way, then we have all the expertise that we need. Medically, social systems, public health,

00:45:39.160 economically, whether it's economic on a local or on an international commerce system, we absolutely

00:45:46.180 have every single bit of expertise we need. What we do not have is an alliance of common sense

00:45:54.900 of people who say, I will stand by that. Come hell or high water, I will not give into lies.

00:46:01.780 I will stand by that. Then we can start making the world better. If half the population can't survive

00:46:07.760 a $500 shortfall, I am not going to pretend that the economy is okay, or that our social systems are

00:46:13.460 okay. Or if the healthcare choices that people are facing are too complicated for them to understand,

00:46:18.680 and then people ultimately don't get the care that they need. They show up at emergency rooms for

00:46:23.180 their primary care, demoralizing the emergency room staff that wants to take care of people who

00:46:27.180 have emergencies. There's so many thousands and thousands of examples, and we just need people

00:46:32.240 to say it's enough. Do you think that this event is potentially a catalyst for changing the way people

00:46:41.080 think about science and truth? And again, I use those two in the same sentence, because when you

00:46:49.380 take a step back and think about what the truth means, I think we have to differentiate between personal

00:46:54.780 truths and absolute truths. I think it's true that Formula One is amazing, but I also recognize that

00:47:01.960 that's a personal truth. It's shared by you, but it's not necessarily shared by everybody else,

00:47:07.240 and that's okay. If you and I believe it, that doesn't make it true?

00:47:09.540 Yeah. I believe Ayrton Senna is the greatest Formula One driver of all time. Again, I think

00:47:17.460 that verges on being an absolute truth, but I'll leave it in the category of a personal truth.

00:47:22.880 Yes.

00:47:23.820 But when you start to get into things that are absolute truths, that's really where

00:47:27.880 science comes in. Science is a toolkit that allows us to test hypotheses. It's a methodology that

00:47:35.220 allows us to examine absolute truths. And do you think there's a chance that what we're seeing here

00:47:43.860 could ever be a catalyst for allowing that distinction to be made in broader society?

00:47:52.920 Because it's not clear to me that it does. I think that for the majority of society,

00:47:58.140 there's a blurred line between absolute truth and personal truth or relative truth.

00:48:02.700 Peter, I think you're striking to the heart of the matter because absolute truth operates through

00:48:10.380 logic systems in our brain. Ultimately, this does relate to brain biology. Absolute truth resonates with

00:48:20.060 logical systems in our brain. Relative truth resonates with emotional or what's called affective or limbic

00:48:28.980 systems in our brain. When we engage effectively in the world around us, and again, I have a thesis

00:48:36.140 that says we as a society are not engaging effectively because we have lost the distinction between those

00:48:43.660 two that lets us make the personal truth secondary to the absolute truth. So the idea is there's a strong

00:48:54.300 resonance if I feel something to be true. I mean, there are social issues I feel very strongly about.

00:49:00.780 That resonates with me emotionally because I'm a human being and says, because I believe that,

00:49:06.060 that makes it true. That's my belief. So that's how I want it to be. So that's true. But then the other

00:49:11.900 systems in my brain say, there are absolutes that I want to hold up and against that. And I want to

00:49:20.620 have those absolutes govern my own personal feelings. So I may feel just as rabidly that Formula One is

00:49:27.660 the greatest sport ever. I want everybody to believe that. And if I let my emotion run away with me,

00:49:33.260 where do I end up? I end up thinking everybody who doesn't believe that is an idiot, as opposed to

00:49:37.980 saying, look, I feel that way. But hey, look at all these other sports. And there are people who

00:49:43.020 really love those other sports. And they see the excitement and the personal strivings that I see in

00:49:48.220 Formula One. So the reflex in us is to elevate the personal truth, the emotional, to supremacy. And we

00:49:56.620 need to overcome that so that logic wins the day because logic is not charged the way that emotion is.

00:50:02.700 And I think media, social media, I mean, this is the heart of the matter, have made it very easy

00:50:09.260 to elevate personal truths. You believe A, I believe B. Instead of having a conversation about

00:50:14.940 it, isn't it just easier? And in some ways, doesn't it feel better for each to say the other one's an

00:50:19.740 idiot and that's that? We're indulging that in a way that then starts making logic subservient.

00:50:27.340 It makes the absolute truth subservient to the emotions, to the personal truths. And if you look

00:50:33.020 at how change happens, the concept of a dialectic where you have something and you have something

00:50:38.060 different from it, right? You have two different things and they become something that's different

00:50:41.980 from both of them, I think is where we're at. This is going to be a catalyst to something. And the

00:50:48.860 something on the other side of it, I strongly believe is going to look differently than what it looks

00:50:54.220 like now. If it's not after this and things seem to be back to normal, this will just be one of steps

00:50:59.740 that lead us to things being different. And one way things could be different is that absolute truths

00:51:06.060 really do go out the window. We very much come back to superstitions and we're really kind of not that

00:51:13.020 far away from it now. And we could very, very easily get there. Or this will be a catalyst for us

00:51:21.660 writing ourselves and saying, look, we must prioritize logic, whether I like what it says

00:51:28.940 or not. And there I think, how do we make the catalyst, the resolution of that dialectic go one

00:51:35.580 way and not the other, is we need people to make this, I'm just calling, it's no magic to the words,

00:51:42.860 but an alliance of common sense that says, hey, if you think A, or you feel A, and I feel B,

00:51:49.900 that's the words, if you feel A and I feel B, that instead of immediately being at each other's

00:51:55.340 throats, let's stop and look at the facts. Let's stop and look at logic. Otherwise, I mean, how far,

00:52:02.940 again, I'm not trying to be overly dramatic, but look, when the Khmer Rouge took control in Cambodia,

00:52:08.540 right, one thing they did away with was doctors, right? This is very easy to put one person's blood

00:52:13.020 into another. We can teach people to do that. Okay. What about blood types? You didn't have any

00:52:18.540 doctors or science or hospitals, and then they just started randomly transfusing people and either

00:52:23.980 making hemorrhages or putting one type of blood into another. I mean, that was an utter human

00:52:29.340 catastrophe there, but there are whiffs of that going on now. Who cares what the science says about

00:52:34.620 hydroxychloroquine? Try it. I mean, this is emblematic of us leading ourselves away from

00:52:41.500 logic. I don't see how we're not heading towards destruction. Everything is as it should be.

00:52:46.780 It tells me, we can't let that happen because it ends at destruction. There's nowhere else it ends.

00:52:50.940 So we need this alliance of common sense of people who will stand up and say,

00:52:55.340 if I disagree with you because I feel differently, I'm going to look at the logic. And if the logic tells

00:53:00.300 me that what you're saying is right, what I'm saying is wrong, then dammit, I'm going to go

00:53:05.180 forward with your way of seeing it, no matter how I feel. We need more of that.

00:53:09.020 I mean, do you worry, Paul, that we have spent such a scant period of our evolutionary history

00:53:17.820 with any formal language around logic and science? I mean, for all intents and purposes,

00:53:23.580 it's about one-tenth of one percent of our evolutionary history has operated with even

00:53:30.380 the nomenclature of science. The skill set and the tools for logical thought, the reason that

00:53:37.340 I think religions exist and the reason that mythology exists and superstitions exist is they

00:53:43.420 became ways to explain things prior to a nomenclature that could describe things. The sun went up on this

00:53:51.740 side and the sun went down on that side. And before you understand that the earth is spinning around

00:53:56.220 the sun, you have to concoct another explanation. And so we're not hardwired to think critically.

00:54:04.940 Our limbic system has literally billions of years of repetition and maybe not our limbic system

00:54:13.580 exclusively, but say from amygdala up, right? In other words, the most primitive part of our brains

00:54:18.780 have billions of reps in them. And as you point out, the brainstem, the amygdala, the limbic system

00:54:25.980 are generally driving us now, when in reality, this would be the time to have higher cortical

00:54:31.740 functioning take over. But that is such a recent, recent development, not just evolutionarily, where

00:54:38.540 maybe for the past 50,000 years, we've had those structures of our brain and I could be off by

00:54:42.780 some magnitude there, but directionally, but really only about 500 years in terms of formal structure

00:54:48.860 of scientific methodology. Is this just not even a fair fight? I mean, we're sitting here having this

00:54:54.620 philosophical discussion about logic, but I mean, in times like this, when we recede to our lowest common

00:55:01.980 denominator, how in the world can we expect those systems of logic and science to prevail?

00:55:07.980 So on the one hand, you're speaking to a very powerful truth, which is we are driven to be

00:55:15.020 driven by the limbic system, by emotion. It is always held the upper hand. So it's not a fair fight,

00:55:23.100 but it's a fight we can win. You know what I mean? The odds may be stacked against us, but we can win

00:55:27.980 that fight as evidenced by the fact that we have evolved in a way that the scientific method became

00:55:34.540 understood. And then we learned, oh, wait a second, the earth does revolve around the sun.

00:55:38.540 We can fight that just because the odds are against us. This is because we're swimming

00:55:41.660 against a strong current. It doesn't mean that we can't with the right preparation and cooperation

00:55:47.500 successfully swim against that current. What has happened, and I think my amateur read of the

00:55:53.820 sociological data is that what has happened is our ability to unleash emotion has way outpaced our

00:56:03.820 ability for our logical processes to keep up with that. The explosion of social media, of people being

00:56:12.540 able to communicate with one another so rapidly about what they feel, our control mechanisms haven't

00:56:19.580 kept up with that. I mean, the fact that the lead physician in charge of fighting this virus has to

00:56:26.780 have bodyguards, right? I mean, whether he does or whether it's been talked about, I don't know.

00:56:32.060 It's part of this anger that that person said something I don't like, so stone him, right? I mean,

00:56:39.180 these emotional responses are in us. And what we need to do is be adults and not be children. We're being

00:56:46.300 children and we need to be adults and we need to say, look, we need to hone our control mechanisms.

00:56:52.460 But what we're not doing is saying we can't have systems around us that propagate just how someone

00:56:59.100 feels about something and then stokes the emotion of everyone else who feels the same way. I don't like

00:57:05.420 this. That person is bad. I like this political opinion. I don't like whatever it is I don't like.

00:57:10.060 That spreads like wildfire. I think in a way, I don't know if it's happenstance or not,

00:57:14.780 but I think the wildfires that are plaguing us in California and Australia, right? These are far

00:57:20.940 flung events that I think mirror the wildfires of emotion that go on. And it doesn't matter

00:57:27.020 what's true. People's emotion runs wild. And what we need to do is to step up to the plate and develop

00:57:32.380 greater control mechanisms and look at how do we stop misinformation? How do we establish sources

00:57:38.460 that are arbiters of truth outside of politics that are arbiters of what's actually true? And we don't

00:57:45.020 have that. We need more of the things that aren't sexy and aren't glamorous. Otherwise,

00:57:49.580 this emotion you're talking about is running wildly ahead of us and it's going to metaphorically make

00:57:56.620 wildfire that consumes us. And I don't think that's catastrophizing.

00:58:01.180 Do you think part of it is we're also not very well equipped genetically to understand uncertainty?

00:58:10.540 So in what we're talking about of sort of absolute truth versus personal truth, there's another layer

00:58:16.820 of complexity. So if the personal truth is that formula one is the most exciting thing on the face

00:58:22.920 of the earth, I think most people, if they're being intellectually honest, can come to an understanding

00:58:29.040 that that's a personal truth, no matter how strongly one feels about it. But let's use the example

00:58:36.520 you've brought up, the example of hydroxychloroquine as a potential treatment for this. To say that

00:58:42.780 hydroxychloroquine is an effective treatment for COVID-19 doesn't really fit in either of those

00:58:50.940 categories. It depends on how it's expressed. It could be expressed as, hey, it's my opinion that looking at

00:58:58.180 the scant data to date, the risk of this is lower than a certain threshold, which deems it an effective

00:59:08.720 treatment in someone whose risk is high enough. That level of nuance to something kind of straddles

00:59:17.000 both personal and absolute truth. Another example is climate change. Part of the struggle with climate

00:59:23.500 change is nobody can really talk about it in terms of probabilities and with error

00:59:27.960 bars. And so you basically get polarized arguments that both sort of have their own flaws. So on the

00:59:36.360 one hand, you have people that just completely deny it, or if they don't deny climate change,

00:59:41.280 they're sort of adamant that man can play no role in it. And on the other end of the spectrum, you have

00:59:46.920 these extreme hyperbolic estimates that might represent a scenario, but not necessarily the most likely

00:59:55.760 scenario or not necessarily a complete picture of the plausible scenarios. In other words, again,

01:00:01.480 it comes down to uncertainty and probabilities. And I think that something like this, this experience

01:00:09.300 that we're dealing with makes it very complicated for our little plebeian brains, our little reptile brains

01:00:19.420 to deal with. And I'm struggling with it. And I'm someone who understands probability and I understand

01:00:25.080 logic and I understand science, but I have to be honest with you. I am tired of saying, I don't know.

01:00:31.240 And yet it is the only answer I have to give a hundred times a day. I get asked a question and it can be my

01:00:38.520 daughter saying, dad, when do we get to go out and have dinner? And it can be one of my patients. And he was

01:00:44.680 asking me, let me ask you your opinion, Peter, what do you think is going to be happening in six months? And

01:00:50.660 again, all I can say is, I don't know. I can give you five different scenarios of maybe this, maybe this,

01:00:57.840 maybe this, maybe this, but there is no absolute truth that I can offer that person. So I could give a

01:01:04.660 personal truth, which is, this is my opinion, but science rarely proves anything. It's not like

01:01:12.780 mathematics, right? In mathematics, we have proofs, but in science, we just have high degrees of

01:01:18.800 certainty. And again, I just, I worry that this introduces a new layer of complexity to a discussion

01:01:24.780 that already makes it impossible to sort of cope with a lot of signal, a reasonable amount of signal,

01:01:34.640 an extraordinary amount of noise, and then a supercharged emotional swamp that

01:01:42.500 dilutes and amplifies the wrong things, if that makes sense. I'm rambling a little bit. I think my

01:01:47.720 point is, I'm generally pessimistic, Paul, I guess is my point.

01:01:51.500 Yes. Peter, of course, I don't know, right, for sure. But I see it maybe in a more simplistic way.

01:02:00.480 I don't think there's another level on top of it, because I think that I don't know is actually a

01:02:09.960 beautiful answer. If you don't know, what do we really know, right? You see, we know so little

01:02:16.920 that admitting that we don't know engenders humility. It engenders the humility that makes

01:02:23.260 us careful. I don't know if a pandemic is coming. Let's have some preparedness to it. I don't know if

01:02:30.380 this is helpful or not. Let's learn more about it. There's a caution that then leads to alliance.

01:02:36.100 I mean, we started early on talking about how can people, countries, nations, ally. It's through a

01:02:42.700 sense of humility that, you know what? I don't know, and I'm not ashamed of not knowing. I mean,

01:02:48.580 think about in medical school. I think part of the myths of medical education, right, is that you

01:02:53.200 never say you don't know. I think that's the worst thing ever. I think, why would you ever say you know

01:03:00.200 when you don't know, and we're talking about somebody's health? There's a humility in I don't

01:03:06.020 know that leads to collaboration, that pushes against aggression. It pushes against that middle

01:03:12.860 school playground of, oh, I don't know, and now I'm ashamed. And it leads towards progress. The other

01:03:19.380 side of that coin is what I see as the hubris that leads people to just declare that they know.

01:03:27.040 And there's a recklessness to that, right? I mean, I think we're a society of angry,

01:03:33.540 frustrated people, and we're getting angrier. You think we're not going to come out of this with

01:03:37.960 more of that? I mean, people already were feeling insecure, traumatized by the systems that we live

01:03:44.860 in, the insecurity about where my healthcare is coming from, or people's fear of that $500 that's

01:03:49.980 going to sink them. We're not going to come out of this angrier, and the anger is what fuels the

01:03:55.940 emotion. And then it's the emotion that then falls into the political spectrum.

01:04:01.880 So if that's the case, then whether you agree with something or not, it becomes a mechanism of

01:04:07.680 your allegiance. We start to look more like systems that say, it doesn't matter what's right or wrong,

01:04:12.580 do you agree with me? Because if not, you're bad. And we're doing that all the time. Why is the

01:04:19.440 efficacy of hydroxychloroquine a politically charged question? That's insurmountable then.

01:04:25.960 We need to make it not a politically charged question. There are political issues. Taxation

01:04:31.040 rates, social equality, value systems we're deploying. There are lots and lots of political

01:04:36.260 questions. But because we are so angry and I think so traumatized and desperate as a population,

01:04:43.320 we make everything a political question. And then that adds to that emotion side of things. I think

01:04:48.800 it is just the real truth versus personal truth, logic versus emotion. It is that. But it's become

01:04:55.200 so convoluted because the emotion is so high and it gets attached to things as vehicles for that

01:05:01.240 emotion. And that's what we have to work against. That's where this alliance of common sense would say,

01:05:08.580 look, we have to not be children. We have to be adults and we have to look at what is it that I

01:05:13.680 don't know. And if there are 20 questions and I don't know the answer to any of them,

01:05:18.220 well, at a minimum, I hope that that engenders humility in me and ability to work together with

01:05:24.420 other people and listen to their opinions. Even if I have a say, if I have a strong personal opinion

01:05:29.480 about 15 of those questions, but actually there's no logic to know any of the 20 of them,

01:05:34.980 can I find it in myself to have the humility to admit that and to say that? And to say that to you

01:05:40.380 and know that you're okay with that. You're not going to humiliate me for it and embarrass me for

01:05:45.220 it, right? And that's what people are afraid of is you have to know because you have to fight with

01:05:49.220 what you're going to say you know. We need to stop that. And we don't have to be, look, I'm

01:05:54.060 pessimistic too, but that doesn't mean that I feel hopeless. I am pessimistic, but not nihilistic

01:05:59.560 because I think the wake up call, what this can catalyze is people who are trying to do good

01:06:06.180 things, but may be hesitant to step into what seems like a political arena. I don't mean run

01:06:12.820 for office, right? I'm just saying that truth, personal truth versus real truth just has to

01:06:18.400 stand aside from politics. And our economic system, our social system, these are systems

01:06:23.380 tied in politics. And we have to look at the truth of those systems because they are not serving

01:06:28.520 us well. We have to separate ourselves, our trauma and our anger and our shame and our frustration

01:06:34.520 from what is logical truth or not. And I think, again, I think you and I between us,

01:06:40.940 it's what I was talking to Jim about this morning. There are enough people who could step up to this

01:06:45.380 plate, but boy, it's a thing people are least inclined to do because it's a thing that draws

01:06:50.600 the most flack and the most personal animosity. Paul, I want to shift back from the macro to the

01:06:57.400 micro now. You and I have spent a lot of time over the years talking about something that I think

01:07:02.840 you're better at than I am, but I think we both struggle with. What has been your recipe in the

01:07:09.500 past month for self-care? I don't know how you do what you do. I mean, I think, and I don't just mean

01:07:16.160 you, I mean, people like you, right? People whose job it is to take on sort of the burden of other

01:07:23.400 people's pain and suffering, and then to be able to do it in a manner that's not detached, but rather to

01:07:29.320 be fully involved and invested in whatever crisis, whatever struggle, whatever turmoil that person

01:07:35.800 exists and how you then manage to buffer yourself from that without being detached, take care of

01:07:43.040 yourself so that you can continue to take care of people, take care of your family. Again, you and I

01:07:47.880 have had endless discussions on the types of things that one can do here. I just wonder if there's

01:07:53.100 something that you can teach listeners about how you've done that and what can somebody take away

01:07:58.380 from this when they're feeling, going back to where we were a while ago, back to that feeling of

01:08:02.900 sort of low in morale. I forget how you described it. The way you very aptly described how I was sort

01:08:09.720 of feeling. Demoralized, right? Yeah, demoralized I think is the word you use. Yeah. So let's assume

01:08:14.320 that this quarantine is going to continue in the weeks and even months that follow, and people are going

01:08:21.640 to be in their routines that are full of stresses and stressors that they might normally be able to

01:08:30.740 escape from, and they don't have the luxury of picking up the phone and speaking with you or Jim or

01:08:37.260 some of the other amazing people out there who are really just sort of a godsend to folks who have

01:08:44.160 access to you. Is there something that they can do to ease the suffering? And I mean the suffering in

01:08:52.920 their mind, which is of course the worst kind, I think. I think the answer to that is finding one's way

01:09:00.860 to the lowest common denominator of what matters. And I think if people are experiencing the truth now

01:09:12.440 that they're, say, with their family, the realization that that is what matters the most now, and it's

01:09:20.140 also what's going to matter the most tomorrow. And I'd rather be with my family in a lean-to out in

01:09:26.240 the middle of nowhere than any luxurious living situation alone. And part of that realization that

01:09:34.280 I think I can sustain that. If everything else went away, I could probably, I don't know, put some

01:09:40.060 sticks together, give us some shelter, right? Like it gives me a feeling that what matters is care and

01:09:45.900 concern between people, being with the people we care about. And look, I'm hearing that from people

01:09:52.160 too. I'm hearing a lot about the silver lining of this, which is more time with family. I talked to

01:10:00.060 almost nobody who say purchased anything in the last month other than necessities. I don't care.

01:10:06.140 So much that I think matter, matters, doesn't matter. And look, I'm not advocating, like I'm

01:10:12.640 not a Luddite or raising, let's go back to just living like we did a thousand years ago or a hundred

01:10:17.800 years ago or whatever. But it is meaningful to realize that the things I care about most are

01:10:24.780 actually more immediately accessible to me in the moment. And I think that's still going to be the

01:10:30.280 case tomorrow. Hopefully everyone's staying safe and we're trying to ensure that. That's what most

01:10:36.260 matters. And it's a good place to start from. I think it engenders practicality. It engenders

01:10:41.100 humility. It engenders a sense that everything is okay. I've sat at home with my family for periods

01:10:48.020 of time I wouldn't have before. And I have a very strong sense that everything is okay. Sit around with

01:10:54.120 my family because I have a six-year-old and a two-year-old and we blew up six balloons and we're just

01:10:58.800 throwing these balloons between the two of us. I mean, and we're happy, right? And I think we need

01:11:04.040 more of that because it works against the trauma. There's a realness and a connectedness to that that

01:11:09.640 works against the trauma. Now, look, I think we need to change the social systems where we are not

01:11:15.680 going to change the trauma and things are not going to be okay. If I might ask you to your question, you're

01:11:19.400 not saying how do we fix this on an individual level of people in their homes? I think the answer is we

01:11:23.440 don't. But how do we feel better? How do we let ourselves find some peace? I think that is the

01:11:30.300 answer. My daughter, who's turning six this coming weekend, said to me, she said, Daddy, with you at

01:11:37.060 home more, it's like spring has come, but inside of me. And my thought was, oh, I'm not sure what else

01:11:44.140 really matters. And that doesn't mean I don't want to go to work and do my job. But when I'm talking with

01:11:48.960 people on the phone, I'm looking more through that lens of what else really matters to that person

01:11:53.520 that I'm talking to than the people that they love. And I think we need more of that. We need

01:11:58.700 to fix our social systems, but we need more of that. And that's something that each of us can do

01:12:02.860 at home, right? Because it's really our interpretation of things. Are things not okay

01:12:07.000 because I don't know what's going to be like when it boots back up? That's true too. But I don't have

01:12:10.680 to live in that every moment. And I can live in more time with my kids. That's real and that's

01:12:17.540 tangible. And that's going to mean something to me this evening and tomorrow. And that can be real

01:12:22.240 for everybody and people who don't get to be with people that they love and that love them.

01:12:27.080 So thinking of how do we make more of that in our life? The idea that we all need love and we need

01:12:31.620 things that are generative, that make where there wasn't before, does not just have to apply to human

01:12:36.640 relationships. It can apply to nurturing a pet or nurturing a garden, to making a poem where there

01:12:42.340 wasn't before. It's kind of strange, but our needs are not that complicated. But I'll be

01:12:47.420 damned if they aren't hard to meet in the system that we've set up around us. We need to change

01:12:52.540 it. We need to change the systems. But part of how we change the systems is to change how we're

01:12:56.720 looking at them as individual people. What am I valuing?

01:13:01.240 So if I'm hearing what you're saying, it sounds like you think that this sort of

01:13:05.100 attachment to others or connection to others is sort of an antidote to this trauma?

01:13:12.480 Put more broadly, I think the attachment to things that are meaningful.

01:13:15.920 Yeah. Yeah. Sorry. Not to, yeah. I'm meaning to other people in relationships that matter,

01:13:21.360 to our kids, to our friends, to our spouses.

01:13:24.900 Right. Right. Right. Because for all the money, success, prestige, world mastery, I mean,

01:13:32.660 if you could have all of it, I mean, you wouldn't sacrifice the ability to be with one of your

01:13:37.740 children. That stuff matters the most to us. And it's also where we generate our own meaning.

01:13:43.120 That's where I don't feel demoralized. That's where I don't feel demoralized. Because I know

01:13:49.260 that I have meaning to people and people have meaning to me. And then I can find within myself

01:13:55.460 the strength to put one foot in front of the other, keep doing what needs to be done, even

01:14:00.680 though I sure do feel demoralized often. I mean, the reason why I think I can project and guess how

01:14:06.180 you were feeling is because, well, you and I know each other very, very well. And I'm feeling the

01:14:10.660 same way that you are. Has whatever I contributed to the world made a difference or whatever I've

01:14:15.360 done for myself and my family made a difference? I mean, the answers to those questions are yes,

01:14:20.280 but we feel that they're no when we're confronted with the state of the world around us. And again,

01:14:27.160 it just brings me back to that something more is called from us. I mean, there's a little bit of,

01:14:31.540 again, I'm not trying to be political, but when John F. Kennedy said, like, ask not what your

01:14:35.780 country can do for you, but what you can do for your country. And yes, he was speaking about

01:14:40.560 difficult things. He wasn't just say, do more of what you're good at doing, or what's easier for

01:14:45.000 you to do, or even things that are hard for you to do. But you may need to do some things that are

01:14:49.620 very, very difficult. Do you see people having a difficulty reintegrating back into the world when

01:14:55.940 the quarantines lift? Do you see lingering fears? I mean, fears literally of infection,

01:15:03.740 recurrence of pandemic, other forms of phobias that might not even seem logical or rational. I

01:15:10.500 mean, do we have any insight into what people do after quarantines and what their psyches are left

01:15:17.620 with? This idea that if I am more afraid, I will be safer is going to precedence. We're going to see

01:15:26.620 more anxiety, more obsessiveness, more panic, more agoraphobia, right? Fear of being outside of the

01:15:34.860 home. We're going to see more and more of that. And we're going to see more of the unhealthy coping

01:15:38.740 mechanisms to that, more drugs and alcohol. We're going to see more of the unintended results of that,

01:15:45.080 like depression and accidents. We're going to see more of all of those things because there's

01:15:50.520 nothing to prove to you that you're not safe, like a period of time in which you were very clearly not

01:15:57.080 safe. And I think if we reintegrate into the previous lies, then underneath that is the knowledge

01:16:03.400 that this is not okay. It wasn't okay before. So if we're now back to it, it's not okay now either,

01:16:10.220 which is why we need to make change. Ultimately, yes, this is about trauma and how this pandemic is

01:16:18.420 traumatizing us and how we paved the way for the trauma of it to be so bad. And we need to change

01:16:26.000 that just like we need to change what traumatizes people individually. If someone has been traumatized

01:16:31.600 individually, someone has been attacked and hurt, and that person knows that there are people around

01:16:40.300 them that care about that, that care about them, that care about what happened to them, and that are

01:16:45.180 working for change in the systems that allowed the trauma to happen in the first place, then we help

01:16:52.860 move that person towards healing. And yes, we need to do that for individual people in their trauma

01:16:58.940 treatment. And we need to do that as a society. Otherwise, we will be no more successful as a

01:17:04.680 society than will be the individual sufferer from trauma who is trying to deal with that trauma by

01:17:10.840 pretending everything is okay, which is a natural response because we're afraid of it and we're

01:17:15.220 ashamed of it and we don't know how to deal with it. And there aren't the systems around us to say,

01:17:19.320 you can come and talk about that and you don't have to be ashamed of it. And you know what? I have that

01:17:24.120 too. Maybe I have a different flavor from you, but I have what you have. And you and I know this.

01:17:29.860 I mean, part of the reasons I think we've survived our own traumas is because we have not gone through

01:17:34.480 them alone and we've had them validated and we ourselves have been validated. And then we look

01:17:39.860 to ways to make the world better. And that's part of our demoralization that it kind of hasn't had as

01:17:45.420 much of an effect as we might've wanted. So let's start doing something new about it because it does not

01:17:51.860 have to be this way. Say rape cultures on college campuses. You know what? Doesn't have to be that

01:17:57.800 way. And we start making changes. My good is not that we've made the changes we need to, but we start

01:18:03.280 looking at that, looking at what it really is and looking at the lies that said, oh, it's all okay.

01:18:08.880 And people are consenting and everybody who's drinking is de facto giving consent. We look at those

01:18:14.940 lies and we start making change and we start making less trauma and we start better being able to help

01:18:21.680 the people who have suffered trauma. That is a very real and tangible example that we are going to

01:18:28.100 need to do on an individual basis, whether it's healthcare workers who are afraid to go back in the

01:18:33.020 hospital, or it's people who are afraid to try and go find the next job, or it's our society as a whole.

01:18:39.440 We have to change those things. There's nothing else that makes it better.

01:18:44.160 I think it's worth pointing out for listeners. You and I have known each other for 25 years. We're pretty much

01:18:48.080 inseparable. In fact, this is probably the longest we haven't seen each other in person because the

01:18:52.360 last time we were together in person was January. So that's for us, that's an eternity. I think it's

01:18:57.900 worth the listener knowing you and I have never once talked about politics except in the context of

01:19:03.360 history. In other words, you and I together, we are not the type of people that sit here and wax on

01:19:08.520 about current political affairs. We over a meal, we'll sit here and discuss the Cuban missile crisis

01:19:14.200 ad nauseum and talk about Nixon and all these things. We love to talk about the history of

01:19:18.420 politics. We're not political people. And I think it's important that people who are listening to

01:19:23.380 this don't take this to be a political rant. Everything we've talked about today seems to come

01:19:28.160 down to a common theme, which is those of us who sit here in the peanut gallery who are not in a

01:19:33.720 position of leadership are going to have to sort of become the movement of change. In other words,

01:19:41.420 it's not enough to just sit around and pontificate about this stuff. We are going to at some point

01:19:46.560 have to do something about it. We're going to have to take some sort of action. It's not going to be

01:19:50.820 enough to just think about this, lament this, talk about this with our friends. That won't change

01:19:57.840 the system. Everything you've talked about from this most recent example, which I think is a great one

01:20:03.080 of sort of date rape culture on college campuses to social support network. I mean,

01:20:09.480 all of these things in the end come down to not just being open about what we think is right and

01:20:16.580 not right, but it's also taking some sort of action. It is going to come down to that. And

01:20:20.700 I don't know, you know, it's funny. I didn't come into this discussion with any sense of what we were

01:20:24.680 really going to talk about. I just knew it was going to be something sort of interesting and not

01:20:28.580 sort of the, how does this drug work versus that drug work. But I don't know that I really thought

01:20:33.660 about it as broadly as you've been thinking about it. It sounds to me like this experience,

01:20:37.720 you've made good use of your time, your forced exile from the busy travel schedule. And you've

01:20:45.220 thought even more broadly and deeply about some of these problems that we've thought about and

01:20:49.860 talked about in the past together. But I don't think, I think you've coalesced a broader mission

01:20:55.580 urgency around this.

01:20:57.680 I think so, Peter, because I've just felt it. These are not foreign concepts to me,

01:21:02.700 and these are things I have been afraid of. But really seeing it play out, it becomes so

01:21:07.740 compelling. And you talked about, we're all going to have to do things. Those of us in the peanut

01:21:13.060 gallery, we're going to have to do things. And it's not just that, it's we're going to have to do

01:21:17.760 things that are unpalatable. And that's what I've really come to realize. It's like a couple of weeks

01:21:23.900 ago, garbage disposal, whatever gets kind of clogged. And like, there's a whole bunch of strategies I

01:21:28.760 have to try and fix that. I mean, I pour a bunch of water down and I've got a butter knife and I'm

01:21:32.580 trying to do things with it, right? And like, I'm doing things, but ultimately what I had to do to

01:21:37.560 make it better was the thing that was unpalatable. I had to stick my hand down there into a bunch of

01:21:42.100 gross stuff and unclog something. And now everything is okay. Like I have a willingness to do things and

01:21:48.500 you do too. And lots and lots of people do, right? But what we shy away from is doing the thing that's

01:21:54.960 unpalatable. And the way society has developed, I don't think we can get around the political

01:22:00.440 flavor of this, right? Because if you want to set up, like, look, if I had my way, there would be

01:22:05.480 committees of people with expertise that would look into these different areas. But what they have to

01:22:11.140 do is really unpalatable things. Stand against the status quo. Enter into areas, arenas that are

01:22:18.180 politically charged. Enter into minefields knowing there's something unpleasant is going to happen,

01:22:23.380 right? I'm going to try not to get myself killed doing it, but something unpleasant is going to

01:22:27.960 come of it. And I think those are the things we shy away from. And I have the privilege of knowing

01:22:33.640 and interacting with lots and lots of people who are helping and God bless that people are helping.

01:22:39.180 But there's a difficult message for all of us here that says, yes, help in the ways that you're

01:22:43.160 built to help and comfortable helping, but you got to help in the, I'm sticking my hand in the

01:22:47.580 garbage disposal way too, which is why when Chowka calls and talks about this, and he's

01:22:53.360 starts talking about leadership in ways that come through humility, that come through marshalling

01:22:59.760 people to do unpleasant or unpalatable things to really look at this, it resonates with me in part

01:23:05.900 because like you and I, I mean, he and I have an ongoing dialogue about life, but because I just,

01:23:11.360 I can't not believe that's what's necessary. I try and do thought experiments where I come at a

01:23:18.340 position that's diametrically opposed to mine. It's different from mine. I feel differently. I have a

01:23:22.920 different personal truth and I can't but come to this conclusion, which obviously doesn't mean that

01:23:29.120 it's right, but I'm using all the due diligence I can inside of myself and I can't but come to any

01:23:37.100 other conclusion. Well, Paul, on that note, I want to thank you for this discussion today.

01:23:44.120 I look forward to continuing our discussions over the coming weeks. I rely on them heavily.

01:23:49.460 Thank you so much. As always, Peter, I appreciate your trust in me and my opinions to have me on and

01:23:56.300 as always, I deeply appreciate your friendship. Thank you, Peter.

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The Peter Attia Drive - April 10, 2020

#105 - Paul Conti, M.D.： The psychological toll of a pandemic, and the societal problems it has highlighted

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