The Peter Attia Drive - #15 - Paul Conti, M.D.： trauma, suicide, community, and self-compassion

00:00:00.000 Hey everyone, welcome to the Peter Atiyah Drive. I'm your host, Peter Atiyah.

00:00:10.140 The Drive is a result of my hunger for optimizing performance, health, longevity, critical thinking,

00:00:15.600 along with a few other obsessions along the way. I've spent the last several years working with

00:00:19.840 some of the most successful, top-performing individuals in the world, and this podcast

00:00:23.600 is my attempt to synthesize what I've learned along the way to help you live a higher quality,

00:00:28.360 more fulfilling life. If you enjoy this podcast, you can find more information on today's episode

00:00:33.000 and other topics at peteratiyahmd.com.

00:00:41.340 Welcome to this week's episode of The Drive. My guest this week is one of my dearest friends,

00:00:47.700 Dr. Paul Conti. Paul is a brilliant psychiatrist. In fact, I often refer to him as the single best

00:00:55.060 psychiatrist I've ever come in contact with, and I've met some many very sharp people over the

00:01:00.780 years. I've long wanted to have Paul on the podcast. I've always wanted to interview Paul

00:01:06.200 just in general because there's not that many people who I find myself having discussions with,

00:01:11.440 and I think to myself, how can this discussion be shared with others? And throughout this interview,

00:01:17.220 you'll hear us even comment to that effect, which is God. It's almost like we're not even talking in

00:01:21.980 front of microphones. This is exactly the kind of conversation we find ourselves having so often.

00:01:27.900 Paul's a very special person. He doesn't get into great detail, but his life has been shaped

00:01:32.180 by a number of really, really tragic events, a couple of which he alludes to here, many of which

00:01:38.140 he does not. In fact, some of the most tragic events in Paul's life, he does not allude to. But

00:01:42.500 I think the point that comes across here is that Paul is one of the most empathetic,

00:01:46.640 kind, giving individuals. And his understanding of the human condition is really unparalleled. So

00:01:52.700 in keeping with one of the general themes here, which is longevity, of which health span and

00:01:58.220 happiness are important components, we go really deep on this topic. We talk about what is meant by

00:02:04.800 trauma. Many people just think of trauma as, you know, he got hit by a car or something like that.

00:02:09.660 But we get really into emotional trauma. We talk a lot about shame, which is the result of trauma and

00:02:16.320 what it ends up doing. We talk a lot about depression, suicide, and a number of other

00:02:22.260 topics that are closely related to this. I do think at times this is a little bit heavy, but

00:02:27.860 you know, we really don't get into any of the technical stuff that I thought we might get into

00:02:32.200 in large part, just because I think there was so much to talk about without getting into the

00:02:36.080 neurobiology. I do think that Paul and I will need to sit down again in the future and get a lot deeper

00:02:42.500 on some of those other topics that I also thought, you know, would be interesting. And I suspect a

00:02:46.820 number of you will find very interesting. So again, this is not a deep podcast from a technical

00:02:51.940 standpoint, though we do get into some of the heavier stuff. Unfortunately, Paul is not someone

00:02:56.720 you're really going to find much about on social media. Paul is someone whom can be contacted

00:03:02.920 through his office, of course, and we'll provide that contact information for folks who do want to

00:03:08.440 reach out to his office. But the good news is Paul is really considering writing a book. And after we

00:03:14.020 finished recording this podcast, we spent another 20 minutes talking about the book he wants to write.

00:03:19.700 And the gist of it is the book is exactly about the stuff we talked about today. So I couldn't be

00:03:24.740 more encouraging of Paul doing this. And I think that the world will be a better place for that.

00:03:30.780 So I hope you enjoy this episode half as much as I enjoyed listening to Paul talk about all of

00:03:39.780 these things. And I think almost anybody will find something of a great value in this episode.

00:03:49.040 Hey, Paul, how are you, man? I'm doing well, Peter. Thank you for having me.

00:03:52.680 You're a super trooper here. You have laryngitis. I do indeed have laryngitis. I am persevering

00:03:58.100 and I appreciate your patience in persevering with me.

00:04:01.320 Well, luckily, I guess luckily is the wrong word, but most people here don't know what you sound

00:04:05.740 like normally. So they probably won't even know that you're that. I'm only bringing it up because

00:04:09.220 I know you're straining a lot to speak, but this is such an important topic. We didn't really want

00:04:14.060 to put it off, but you know, the two of us were so busy, even though we're in New York often,

00:04:17.940 that we could both have a night when we don't have something else to do, I think makes this worth it.

00:04:22.400 So thank you. It's my pleasure. And even though I sound like the godfather, I'm still going to do

00:04:26.440 my best to come across as open and honest in a way that's not quite consistent with the godfather.

00:04:32.780 Although you did pull one old school Italian trick a moment ago, which was as you came in my

00:04:38.480 apartment, you beelined for the kitchen. What did you do with the aspirin? I gargled with hot water

00:04:43.780 and aspirin, just like my grandmother taught me to do. She gets credit. If people can understand me,

00:04:49.520 credit goes to my grandmother. All right. So there you have it. Your first old Italian old

00:04:54.100 school trick on what to do with laryngitis to take some boiling water, smash some baby aspirin

00:04:59.300 into it and gargle it. They didn't teach us that in medical school, but I'm still doing it.

00:05:04.360 All right. So speaking of medical school, you and I have now known each other for 21 years.

00:05:09.200 Amazing. Yeah, almost exactly 21 years. And I think, uh, the relationship that you, me and the other

00:05:16.520 five coconuts had in our med school class, the seven of us probably in some ways really annoyed

00:05:21.700 most of our med school classmates because we were, we became close, like within the first week of

00:05:26.640 school and never separated. We were just, we were an inseparable group of knuckleheads that I strongly

00:05:31.700 agree that that annoyed people. Yes. Yeah. Yeah. Yeah. Yes. But we're fortunate and I feel blessed

00:05:37.700 to, to have met all of you guys. And in particular, probably all of the seven of us now, I think you and

00:05:43.460 I by far spend the most time together because so much of our work clinically overlaps. I don't want

00:05:48.900 to go deep so soon, but I think, I feel like I have to. So I'll never forget the first day we met

00:05:55.080 all med students on day one are sort of nervously talking about why they're here and blah, blah, blah.

00:06:00.020 And truthfully, most med students don't really know what they want to be when they grow up. They

00:06:03.740 have sort of figured out they want to be doctors and that's about it. But there were some of us that

00:06:07.840 knew I wasn't really one of them. I kind of knew I wanted to do something in oncology.

00:06:11.400 I thought at the time, pediatric oncology, one of our buddies decided on day one, he was a plastic

00:06:17.200 surgeon and that is exactly what he is today. You said the most interesting thing I'd ever heard,

00:06:22.680 which was that you wanted to be a psychiatrist. And I just remember thinking, I didn't know people

00:06:27.340 went to med school to become psychiatrists. I thought that was sort of a lifestyle choice that

00:06:31.960 they made later on or something like that. But, but you were adamant about it. Why was that the case?

00:06:37.520 I think it represented a search for truth. I think it represented a search for truth

00:06:42.260 and probably a response to some of the difficult things in my life and to a lot of the dissatisfaction

00:06:48.940 that I was feeling with achievement, with my personal life, my professional life from top to

00:06:56.540 bottom. There was a sense of wanting to understand things more. And I think it's interesting, you know,

00:07:01.380 you talk about how quickly, you know, this group of us became really fast friends. And I think

00:07:06.380 there was a commonality there that we'd all had some life experience and in different ways as we

00:07:12.060 came to learn, we'd all really been through a lot. And I think we were coming into medical school

00:07:17.480 searching for something and trying to find that something for ourselves through doing things

00:07:24.940 that are good for other people. And I understand that the idea is that's why people go to medical

00:07:29.820 school. And I'm not saying other people weren't doing that, right? But we'd all been through a fair

00:07:34.860 amount. And I think it's the suffering component that drove the ability to maybe be open and honest

00:07:42.460 earlier with one another and to form bonds that were based upon the searching that we were all doing

00:07:49.460 that drove all of us, right, to change career, to do something different than what we might have

00:07:54.660 thought we were doing as a response to an internal need. And I think ultimately as a response to trauma.

00:08:01.100 Yeah. It's interesting you bring that up. I mean, I always knew this, but I guess I sort of forgot

00:08:05.140 until you reprimed it. None of us were pre-meds and all of us were a little older. We were all a

00:08:11.200 couple of years older because we'd all, in some cases, like, you know, in Bobby's case, I mean,

00:08:16.600 Christ, he'd been a mountaineering instructor for a decade or something like that. You know,

00:08:21.780 Zolly had been in the army for four years. Same with Jason, all these guys. Sorry to be calling all

00:08:26.860 our boys out here on the show. But yeah, none of us had just come through.

00:08:31.480 Right. Right. And, you know, certainly people can go through a lot by the time they're, you know,

00:08:37.520 out of infancy, right? So it's not as if people need to be out of school, do different things

00:08:42.460 in order to really gain life experience. But I think the choices that each of us made were choices

00:08:50.240 that came from a place of drive and ambition, but ultimately that were colored by very personal

00:08:55.580 things. And I think led each of us to really want something more. And I think we came to medical

00:09:03.980 school in part to find that. And I don't think that there's a distinction between what are the

00:09:08.440 things that we do for other people and the things that we do for ourselves. I think that that's a

00:09:12.700 false dichotomy that follows through sort of Western logic, that things have to be one thing or

00:09:18.720 another. And I think often the best things that we do for others, we do in a search for some

00:09:25.220 healing or soothing in ourselves. And I think that that was part and parcel of all of us was part

00:09:31.160 and parcel of many people that you and I went to medical school with trained with, but I think

00:09:36.140 it's what made the seven of us fast friends. And I think it's why there's, there's remained a strong

00:09:41.460 bond in part because that searching and that desire to do for self through doing for others,

00:09:46.880 I think really hasn't changed.

00:09:48.660 So what were you doing before medical school? In other words, you studied, you were an undergrad and

00:09:53.880 you went to Penn, you studied math and then you can, you moved to New York, you were working in

00:09:58.320 finance, right?

00:09:58.940 Yeah. I minored in math. I majored in political science and I studied a lot of history and a lot

00:10:04.780 of literature. And what I didn't realize was that the attraction to me of everything that I was

00:10:10.520 studying was, was, was really the, the allure of people. You know, like I studied World War II a lot.

00:10:16.400 And for a while I thought I wanted to go to grad school and be a World War II historian. And at some

00:10:20.660 point I realized what fascinated me was the, the people, right? The, the people who are driving

00:10:26.220 the action, good, bad, or otherwise, you know, the people who are caught in the crossfires, you know,

00:10:29.960 the millions of people who were part of that event. And, and what I realized over time was it,

00:10:36.740 that there was a commonality of drive about understanding what was leading people to do

00:10:42.780 things or how people were responding to things. And oddly enough, it may seem odd, but I think math is

00:10:48.060 kind of part of that too, right? That, that there are things that happen inside of people and there

00:10:53.660 are aspects of our choice, our choices that we, we design with a certain linearity, but ultimately,

00:11:00.380 you know, the, the complex functions in all of us that make things that we might think are predictable,

00:11:05.180 very unpredictable. And, and I only kind of realized that in retrospect. I mean, when I graduated from

00:11:10.720 school, I really wanted a good job and I came out in 1991 and there was a little bit of an economic

00:11:15.600 downturn and I was fortunate to get a job with a good consulting firm. And, you know, I just thought,

00:11:21.460 okay, that's where I'm going to go. You know, that I'm going to have this business career. And

00:11:24.700 if it's with my father having been entrepreneurial and had a business career, and I just thought like,

00:11:29.640 okay, that's for me and I'm going to make my way doing that. So then what changed?

00:11:33.960 What changed is it, it really, really did not make me happy. And I say that with no criticism or

00:11:40.640 dispersion whatsoever to people for whom it doesn't make happy, but there was something very much

00:11:46.760 missing from it for me. And, and I think that was the intensity of human interaction. And so the

00:11:52.660 intensity of human struggle and what I found is, you know, I did that for four years and I took some

00:12:00.140 time in the middle and I traveled for, for several months because I was kind of trying to figure

00:12:05.180 something out. Like, why am I not happy? Right. And I came back and I took a better job with the

00:12:10.020 same company. Right. So as time went on, you know, I had more authority. I was making more money. I was

00:12:14.800 doing more interesting things and I was less happy. And it really became quite stark to me that, um,

00:12:21.000 unless I was delving into like the intensity of what's going on inside of people, I wasn't going to

00:12:26.240 be happy. And I think, you know, what I didn't really fully realize was that that was going to be a way

00:12:32.740 of kind of delving into the things going on inside of me. And I mean, as you know, and you and I've

00:12:38.020 talked about many, many times, there were some traumatic things that happened during that time

00:12:42.620 that really just brought to the fore to me, I want to understand better and I want to be able to help

00:12:48.380 soothe things in other people. And what I didn't realize at the time was that wasn't a way of saying,

00:12:53.240 oh, I'll be selfless and, you know, and altruistic. Right. And like, that's going to save the day for me.

00:13:00.200 But, but really, you know, that also what I didn't realize at the time was the mirror that it would

00:13:05.560 put up that would allow me to like, just get access to help that I didn't have before, be open and

00:13:11.260 communicative and understand myself in ways that it wasn't necessarily programmed to do. Right. I mean,

00:13:16.640 I was programmed to like work hard, achieve, um, not be weak. Right. And that inability to express,

00:13:24.760 right. Even to myself, let alone to other people, you know, was ultimately draining the life

00:13:29.180 from me and actually did, you know, drain the life in terms of like actual death from some people

00:13:35.080 around me that I, I very much cared about. And in some ways I was rebelling away, rebelling against

00:13:41.080 that way of being in the world and that way of teaching people to be in the world. And I had some,

00:13:47.280 I think, inkling of understanding of that, but it more came through anger and, and rejection of things.

00:13:52.660 And it came through an understanding, uh, through the lens of compassion that, you know, we've kind

00:13:58.000 of structured our society in a way that makes it very, very difficult to live in that. I think

00:14:02.020 you're alluding to, um, obviously something I know is very difficult and we've talked about it a lot.

00:14:07.000 Uh, I don't know that we need to necessarily go into great detail here, but in the span of a year,

00:14:12.340 if I recall, you lost your brother and your best friend. Yeah. My, my brother, my brother died by

00:14:17.460 suicide. And, uh, about a year later, one of my closest friends, so the same, a close group of

00:14:24.500 friends growing up, like sort of like we had in medical school, but there were a group of us and

00:14:29.120 one of those very, very close friends from childhood also died and he didn't die by suicide,

00:14:34.040 but there was sort of that same kind of desperate recklessness that I saw this common root in those

00:14:42.620 two deaths. And, you know, they confused me and, and infuriated me and, you know, made me feel very

00:14:51.240 helpless and vulnerable and wanting to be able to understand better and to kind of fight against this

00:14:58.200 thing that made it so hard for people to really, to get help, right. And to be vulnerable. And that was

00:15:05.720 really the commonality is like both of the people who died had real and significant needs inside of

00:15:12.180 them that came about naturally, right. And like something you, one would never criticize a person

00:15:18.080 for having those needs, right. Or those struggles, but there just wasn't a venue of, of getting real

00:15:24.880 acknowledgement and help for any of that. So that kind of silent bravado and silent struggle,

00:15:30.000 you know, became very real to me that like, oh, that leads to death, right. I mean, it doesn't all

00:15:35.240 the time lead to death, but it leads to death, you know, way more often than is even remotely

00:15:40.560 acceptable. I mean, I think as we've discussed it, sometimes it can lead to death immediately,

00:15:45.200 like in these cases, and sometimes it can lead to a functional death, which is you're still

00:15:50.660 technically alive, you know, you still respire, but you're effectively dead. In many ways, that's

00:15:56.360 probably the more endemic, more sinister, more destructive over the longterm, given its sheer

00:16:04.100 volume problem, right? Oh, absolutely. I think the deaths that we see in front of us as like,

00:16:10.440 actually, okay, that person is not breathing anymore. Are there a viscerally moving hallmark

00:16:18.000 of what is so pervasive in our society? And, and I do think that I didn't understand that then,

00:16:24.760 that in many ways, the way our society is structured and the way our matrices of achievement

00:16:31.960 are structured really beckons us to death in life, to losing touch with the basics of our own value

00:16:40.040 system. And essentially to incessant striving, and not incessant striving to achieve, although we may

00:16:47.360 see it that way, but incessant striving to not pause, and to not feel the vulnerability that I

00:16:55.100 think is so pervasive now. I mean, even in the 20 years, you know, since we went to medical school,

00:17:01.220 I mean, you think about how pervasive media is, right? I mean, how there's just marker after marker

00:17:06.880 after marker after marker that says that you're not good enough. You don't have enough. You're too

00:17:11.020 vulnerable. You know, there could be terrorist attack anytime your kids could be killed. Uh,

00:17:14.800 we could die. I mean, it's one stimulus after another that tells us not to stop and to, to really

00:17:24.220 value ourselves by the things that we really value. We get through med school and true to your word,

00:17:32.040 you get a psychiatry residency spot. You decide to stay at Stanford in part because your wife was

00:17:38.600 still your soon to be wife. You guys weren't married yet, but your girlfriend was a couple

00:17:42.340 of years behind us in med school. And you end up spending half your time at Stanford and then

00:17:48.520 your wife matches at Harvard. So you go and finish your residency at Harvard. So whenever I'm telling

00:17:53.900 patients about you and I'm probably bastardizing all of my knowledge, which is so limited in this

00:17:59.500 field, but I say, you know, one of the things about Paul that's so unique is he did half of his

00:18:03.500 training at Stanford, which is probably one of the foremost institutions when it comes to

00:18:08.000 understanding the neurobiology and the pharmaconeurobiology and the pharmacology of

00:18:13.960 psychiatry. And then does the other half at Harvard, which is sort of a more old school,

00:18:18.020 but you know, a place that specializes so much in the, in the psychotherapy. Is that an act? Am I,

00:18:23.620 am I making that up when I say that? Cause I've just decided to take the liberty and say that about you.

00:18:27.880 It sounds good. So please keep saying it. No, no, actually I think that there is truth to that.

00:18:33.460 And there's even more, there's more truth to that. The longer I get from it and the more I reflect

00:18:39.100 on it. I think that, you know, I'm not a very positive or hopeful person about the state of the

00:18:45.480 field that I'm in, which I think does not broadly enough train people in brain biology, not just in

00:18:55.260 the use of medicines, but in what does medicines actually do. And on a very real level, what are

00:19:03.200 those medicines doing as interventions in the brain, in the many, many systems of the brain,

00:19:09.380 in the cascade of effects that occur in the brain. And we don't think about structural neurobiology.

00:19:14.840 We don't think about neurochemistry in general. So there's that part of the field that often gets

00:19:20.940 ignored. And then the other side is the psychology. There has been a debate of, should psychiatrists

00:19:28.440 still be trained in psychotherapy? I mean, I see this come up and, and I just think that it's

00:19:33.480 putting it crazy to consider having people that are, that are schlepping medicines to other people that

00:19:40.240 aren't thinking about what it's like to really try and understand someone. And what are the paradigms of

00:19:46.060 understanding other humans, right? The kind of things that are valid and have a scientific basis

00:19:50.800 for them, but that are not hardcore brain biology. And I was very, very fortunate to learn so much

00:19:57.300 neurobiology at Stanford and to have that integrated into my training. But when I got to Harvard, I was

00:20:02.620 struck by that several very like prominent influential people there who like were influential

00:20:08.460 over like, for example, whether I graduated, right, were like really shocked at how much brain biology I

00:20:14.060 knew, and really shocked at how much psychology I didn't know. And even though I had sought out some

00:20:19.460 of this on my own, being in a place that was kind of steeped in an older analytic tradition, really

00:20:25.280 helped me kind of embrace this belief that understanding psychology, and certainly from the perspective of

00:20:32.280 what's psychodynamic, right, the things that influence and motivate us that are in our unconscious,

00:20:38.000 you know, the gigantic part of the iceberg that's underneath the water, but that is most deterministic

00:20:42.800 of our behaviors and our choices and our feelings. And being able to integrate that with the brain biology

00:20:50.100 upon which it rests, I think is, I think it's the way to at least try and have the most broad set of abilities

00:20:58.040 to try and help people. And in some ways, it was very fortuitous for me to split my time between those two

00:21:04.100 places and to find a couple very, very good people who took it upon themselves to try and teach me in a short period

00:21:10.100 of time what maybe I should have learned over a longer period of time.

00:21:14.520 When those of us who are not trained in this discipline think back to, you know, our psych 101

00:21:19.060 class or something as undergrads in college, you get introduced to all of the luminaries in the field.

00:21:26.000 And one of the things I still remember was sort of the id, ego, superego stuff. How much of that stuff

00:21:31.200 is still relevant today? I mean, even sometimes when you and I talk, we still, I think when we talk about

00:21:35.880 personal things, this idea of ego still comes up. I mean, you and I both completely separate to all

00:21:42.460 of this discussion because we won't go down this path. It just takes too long, but we share an

00:21:46.020 enormous interest in psychedelics and the promise that they hold for people. And of course, one of

00:21:51.000 the hallmarks of this is dissolution of ego. So when you think about what someone like me or someone

00:21:56.920 who's listening to this who doesn't have the training thinks at a very crude level of, you know,

00:22:01.140 the id, ego, superego, how much does that still apply to how you think about these problems?

00:22:06.300 I think it applies tremendously on a foundational level. And the problems we often run into are often

00:22:13.280 about semantics. And even among experienced psychiatrists, the definition of words and terms

00:22:19.620 can obscure any understanding. So for example, in the Freudian concept of the ego, it's much more

00:22:26.800 the whole self. It's the part of self that one can bring in a conscious way to bear on the questions

00:22:34.880 and issues at hand. It's the part of self that can mediate between the different pools, right?

00:22:40.380 So the id may be about gratification, the superego may be about what you should or shouldn't do,

00:22:45.540 but ideally it's the ego, the whole self that pulls that together. And that's a very different use of the

00:22:51.040 term ego than how it often is used these days, where ego is a sense of self that essentially

00:22:57.720 indicates a defense mechanism. And the idea of dissolution of the ego through the use of

00:23:03.900 psychedelics is not dissolution of the classic psychodynamic or Freudian ego, which is like the

00:23:10.820 whole self at its most poised and comprehensively aware and empowered. It's more the dissolution of ego

00:23:18.660 as defense that we build up over time. I think a shocking number of defense mechanisms that serve

00:23:27.840 us well at the time, but that ultimately are an unhealthy part of the foundation that then gets

00:23:35.000 built upon. So for example, a sense of insecurity in childhood and I'm not good enough and I need to

00:23:40.160 achieve more and I need to please people. You know, we build so much around that, that defines us in a

00:23:46.800 certain way, for example, right? That tells us that we must be perfect and we beat up on ourselves if

00:23:52.100 we're less than perfect because that's how we're going to make ourselves perfect, right? And then

00:23:55.640 you can think of all the things that build on top of that, which could be maladaptive friendships,

00:24:00.260 maladaptive romantic relationships, maladaptive career choices, right? There's so much that we can

00:24:05.780 build on top of that. And then in a very strong sense, it's almost as if like the true us,

00:24:13.280 the Freudian ego is surrounded by, you know, 90 story high walls that are built to protect us,

00:24:22.380 but actually protect us from real connection with self and others and real understanding. And

00:24:27.180 some of what the psychedelics, it seems through the phenomenology, the people's experiences,

00:24:34.180 the research, right? When you put all of that together and you look at it with the brain imaging

00:24:38.740 and, and the knowledge we have about brain biology is, is in an amazing way, they can take down those

00:24:45.260 defenses, which if not done in, you know, a therapeutic and a controlled setting, obviously

00:24:50.660 can be dangerous, but in the right setting opens one up to an experience of self and an experience of

00:24:58.380 the truth of self that is no longer walled off by all of these unhealthy defenses. So, I mean,

00:25:06.500 it's a long answer to the question, but yes, what's going on in our unconscious, what's going on deep

00:25:12.060 in our brain, the things that we're not consciously aware of are so deeply impactful. So, Freud certainly

00:25:18.500 didn't get everything right, but, but this concept of the unconscious pulls on us and the ability to

00:25:24.300 integrate those things in a healthy ego that can actually decide and choose, I think is as relevant

00:25:29.680 or more so than ever when there's so many pulls away from authenticity of the self. And then the,

00:25:36.900 the hope of psychotherapy, just shared human experience and psychedelics is to be able to take

00:25:42.800 those defenses down so we can have an experience of self that reflects who we truly are, which the vast

00:25:50.460 majority of the time involves acknowledgement of the things that we're ashamed of, the vulnerabilities,

00:25:55.880 the things that we've insured ourselves against, which are often the very things that, that keep

00:26:01.260 us away from happiness. You know, I'm, uh, as you know, I'm writing a book now and it's not a

00:26:07.820 particularly easy thing to do. I think it's probably hard even for someone who's a natural writer, but

00:26:12.500 certainly for someone like me, it's very difficult. And I'm toying with a chapter that I've been

00:26:17.020 really, really flailing with for the past three weeks. It may not end up in the book because I just

00:26:23.740 don't know how to, how to write it, but it's a chapter that centers around the experience I had

00:26:28.560 in Kentucky, which might seem like an obscure thing to write about in a book about longevity.

00:26:32.580 But of course, as I've become very, um, you know, clear on lately, I don't think all of this

00:26:39.580 obsession with longevity and living longer and living better means a lick if you're miserable.

00:26:44.480 And so much of our misery is self-imposed. And I think obviously I, I, you are the reason I went

00:26:52.120 there. I would never have done what was required to go through that experience were it not for you

00:26:57.780 insisting on it. And frankly, even had you insisted on it, you know, at a different time without the

00:27:03.640 confluence of events that led to it, I probably could never have done that because the, the

00:27:08.360 vulnerability that's required to do and to go there. And you even put me in touch with another

00:27:12.020 patient who you had sent, who had gone again. The thing that amazed me about that was how long I had

00:27:19.100 lived my life, never even considering the idea that there can be a child that gets wounded,

00:27:25.840 that wounded child develops in an adoptive child. And sometimes that adoptive child is the one that

00:27:32.880 shows up in the adult body and not as opposed to a functional adult. Yes. Yes. And I guess I just

00:27:40.180 sort of feel like I'm Neo in the matrix. And after I've gone through this whole experience,

00:27:45.300 I see my life in a totally different way. And I realize, Oh my God, like all of that achievement,

00:27:52.380 all of that perfectionism, all of those things I was chasing, it's basically a kid trying to protect

00:27:58.740 you. And I've certainly not held out any hope that it's going to be ever fully resolved. I mean,

00:28:04.740 I'm not, I don't know, maybe I'm just too pessimistic. It's going to get better. I'm absolutely

00:28:08.740 confident because it has gotten better, but it's just strikes me as so hardwired that it kind of

00:28:16.220 makes me wonder, like, is this something that's getting worse or is this something that has always

00:28:21.660 existed in our civilizations, in our societies? And only now, because so many of our other needs are

00:28:29.300 being met, you know, no, none of us that are list. If you're listening to this podcast, you're probably

00:28:33.880 not worried about where your next meal is going to come from. You're probably not worried about a

00:28:37.180 plague. You're probably not worried about, hopefully you're not worried about a civil war

00:28:41.760 or something like that. So is it just that our basic needs, you know, of Maslow's hierarchy of

00:28:49.020 needs, they've been met. And so now we, we have the quote unquote luxury of worrying about self

00:28:54.540 actualization and, and, and what does happiness mean? And what does it mean to be fulfilled and

00:28:58.740 content that we're now realizing this? Or do you think there are things that are actually making it

00:29:03.060 worse today? And there are more wounded kids out there and more adults that are effectively

00:29:08.520 nothing more than adoptive kids. It's such a fascinating question. And I mean, of course,

00:29:13.580 I don't know the answer, but I do suspect that we are making it worse for ourselves in ways that we

00:29:21.540 haven't intended. So of course, look, I'm all for opportunity. Meaning like we are numbing ours. We

00:29:27.080 have more net agents to numb and soothe ourselves. No, we've made more opportunity for ourselves in

00:29:33.580 certain ways, right? And that opportunity is a wonderful thing in many ways, but every good thing

00:29:41.560 has its potential for a downside and something that can work against or even negate the good thing. So

00:29:49.520 for example, as far as I know, for generations, you know, the people in my family lived, you know,

00:29:55.240 up in the hills of central Italy and, and, and, and, and as far as I can tell, most of them were

00:29:59.780 shepherds, right? And we could look at that and say, look, there's a, there's, there's a limitation

00:30:04.740 to what they could achieve. And how fortunate am I that people sailed across the Atlantic and now

00:30:11.280 I go to college and I have a business career and then I go back to school and I take undergraduate

00:30:16.420 classes and I apply to medical school after all of that. And I get in and you could like, you could,

00:30:21.640 you could list forever the additional opportunities that I have that people didn't have before.

00:30:27.000 And that's wonderful. And I, and I certainly would not argue against opportunity, right?

00:30:32.020 But it also brings greater opportunity to run away from the things that plague us. So for example,

00:30:39.320 you and I, and probably many, many, if not most of the people listening to this podcast are driven to

00:30:44.180 be powerful. So, okay. Some of the motivation for what I do or what you do is intellectual curiosity,

00:30:51.020 the desire to help others, the desire to learn about self, right? But a significant aspect of

00:30:57.360 the strength of the fuel in the tank, right? Is running from something, right? It's running from

00:31:02.900 vulnerability because there's more opportunity. There are higher expectations. And I think there

00:31:07.580 are high expectations for both of us. Not that I am arguing against, you know, the fact that our

00:31:12.520 families instilled in us conscientiousness and ambition, but I think we internalize that as must be

00:31:19.580 perfect, must achieve more. Like when is, you know, when is enough, enough? And it becomes very,

00:31:25.540 very unclear and it becomes very easy to run from things. And, you know, it's that, that I think

00:31:32.320 that the modern world doesn't actually help us define what we are striving for. So more striving,

00:31:39.600 more power, whatever that means, right? And it could mean money. It could mean prestige and titles,

00:31:44.680 influence, whatever it means, like more of that by definition becomes better. And we live in a world

00:31:50.420 that constantly reminds us of our vulnerability. So there's never a time. I mean, my guess is

00:31:56.340 having spent time, you know, in places where like people are shepherds, right? And people do have these

00:32:01.760 simpler lives. And sure, they don't have the opportunities we have, but there are ways that I

00:32:07.560 often can see them at the end of the day, feel a sense that the day is over and that what's the day's

00:32:14.500 exigencies are over. The day's ambitions are over, right? They're like, things are okay and it's time

00:32:19.680 to rest and there'll be tomorrow. And I think most of us don't have that feeling. You know, most of my

00:32:24.920 life when I fall asleep, I'm exhausted and I have a sense that, well, now I need to sleep for a little

00:32:30.100 bit so that I can get up and strive more. And I don't think there's any way, if we're honest with

00:32:35.560 ourselves, that we can frame that as, oh, that's a drive to something. No, that's a drive away from

00:32:41.460 something, right? And it's running away from ourselves and it's running away from our problems

00:32:45.740 and we don't even know what those problems are. And the fact that, as you know, I have a pretty

00:32:50.920 diverse practice, right? That like really, I think spans the spectrum of psychiatric and

00:32:57.200 neuropsychiatric things. And I absolutely believe, and I've come to believe more and more and more and

00:33:04.020 more as time goes on, that 80% of what I treat is trauma. 80% of what ails me, 80% of what ails you,

00:33:12.100 80% of what ails the world around us is all trauma. There's another 20% that might be a head injury,

00:33:19.160 schizophrenia, you know, the complications of physical injuries, biological determinants of

00:33:24.400 addiction. I mean, but none of those things, even those things that seem and are very biologically

00:33:31.060 determined, are free of the impact of trauma. And the rest of it, I think, is purely trauma.

00:33:36.840 Its manifestation is anxiety, depression, panic attacks, choices to abuse substances, choices to do

00:33:43.360 things that are unhealthy, whether it's overeating or it's cutting or it's gambling or whatever it is

00:33:48.720 that we're doing. So much of that is driven by trauma. And I think that, you know, yes, it's an

00:33:55.500 opinion, right? It's not something I can prove that you can prove like a, you know, like a math

00:33:59.480 problem, right? But I think if you really look at it and you look at what's going on at the root of

00:34:05.520 what ails people, I think it becomes self-evident that I think there actually is a way of proving

00:34:10.400 that, which is just look at what's really going on in people instead of categorizing them. You know,

00:34:15.140 there's a DSM-5 that's a half a city block long that just looks to like, look, if we flip through it,

00:34:21.040 I don't know how many diagnoses you and I would have between us, right? Because it's designed to

00:34:24.920 capture everybody multiple times over. But categorizing what ails somebody and putting a

00:34:29.920 number on it is not understanding them. That is not synonymous with understanding them.

00:34:35.420 This is the tragedy of your profession, right?

00:34:37.160 Yes.

00:34:37.340 Is that the direction it's going in?

00:34:39.240 It's designed to categorize. If you categorize something, you can put a number on it, right?

00:34:44.080 And then you can get 20 bucks through insurance and you haven't actually understood people. I think

00:34:49.300 that both the practitioners in my field and the people who come to care deserve better than what

00:34:55.800 the field gives them. And we've stepped away from really trying to understand people. And I'll give

00:35:00.940 you an anecdote. I was very, very fortunate when I was interviewed for Stanford. I was interviewed by

00:35:05.800 Peter Rosenbaum, who was an emeritus professor of psychiatry.

00:35:09.980 This was in medical school or for residency?

00:35:12.060 No, for medical school.

00:35:12.920 For medical school.

00:35:13.220 Yeah. And we got along really, really well. And he's a wonderful person.

00:35:17.640 And later on, when I decided to become a psychiatrist, I told him, you know, I got his

00:35:23.280 email out of the archives and I told him and he sent me some redacted histories, right, of patients.

00:35:30.400 And he wanted me to understand that, yes, there have been so many biological advances. There's

00:35:36.240 space age neuroimaging. There's an understanding of brain biology that was unimaginable 30, 40 years

00:35:42.320 ago. But if you look at what they were writing about people, it really evokes a human being.

00:35:48.780 Whereas very often now, when I look at reports of people, I can't tell anything, right? It's just,

00:35:54.180 it's an inventory of signs and symptoms that you could conclude anything from. And then a number

00:35:58.520 gets put on top of it. And, and yes, I'm, I mean, I'm being critical of the field as I'm saying this,

00:36:04.240 but in many ways, it's a societal criticism, right? It's a criticism of a society that dumbs things

00:36:10.080 down and that doesn't respond to the individual, whether it's the, the incessant phone trees that

00:36:15.720 prevent us from ever solving any problems, right? No matter what it is, whether it's my bank or it's

00:36:20.420 the phone company. I mean, when do you actually connect, right? And, and I think it's that isolation

00:36:26.440 that is a societal malady and it affects psychiatry, which is a very bad thing because psychiatry is

00:36:32.920 trying to help us have better mental health. And we're kind of disarming its ability to do that,

00:36:37.260 I think. And then it pervades our society in a way that leads to isolation and desperation. And,

00:36:44.020 you know, if I think if you look at suicide rates and, and just levels of general misery,

00:36:48.620 I mean, I don't want to glorify the past, including the recent past, but it's pretty hard to look at

00:36:54.340 that and to think that, no, there's not, that there's not something here that's getting worse.

00:36:58.280 Yeah. Well, I mean, touching on that, there was an article in the wall street journal recently after

00:37:02.200 the sort of very close to back-to-back suicides of Kate Spade and Anthony Bourdain, and it showed

00:37:08.880 some stats from the CDC. So these are obviously US-based statistics, but when you looked at men

00:37:14.940 and women between the ages of 40 and 60 across the board, there was about a 30% increase in the rate

00:37:20.920 of suicide over, I don't want to be misquoted on this. So I, it was either a decade or two decades,

00:37:26.680 but it was a relatively recent period of time. And in my, my approach to longevity is very,

00:37:32.020 it's very kludgy, right? I mean, I'm kind of a hack if you really stop to think about it. I don't have

00:37:35.560 like some single magic pill that I think can make you live longer. Instead, it's like a whole bunch

00:37:40.440 of reverse engineered problems. And one of them is, you know, it's, it's, you figure out what it,

00:37:45.920 what it is that's going to kill you and start to back out of that. And so I spend a lot of time

00:37:49.980 poring over actuarial tables and looking over mortality trends and trying to understand how they're

00:37:55.740 shifting, where are we quote unquote winning and where are we losing? And it seems to me that,

00:38:00.840 you know, even though most of my energy focuses on three things, atherosclerotic disease, cancer,

00:38:05.180 and neurodegenerative disease, the only disease that shows up in every single decade as a top 10

00:38:12.020 cause of death outside of the first decade. So birth to nine is suicide. Accidents do as well. And, but,

00:38:18.400 but I think the suicide thing, but, but the nature of accidents, by the way, changes so much from

00:38:23.660 beginning to end, that it's a very different, you know, in other words, the accidents that kill,

00:38:27.540 you know, 30 year olds and 40 year olds are quite different from the accidents that kill

00:38:30.480 80 year olds and 90 year olds. And sorry to interrupt, but how many of those accidents,

00:38:35.160 especially ones that are killing younger people are what we might call parasuicidal, right? It's

00:38:40.540 people being reckless and getting killed because their mental state is such that they're not invested

00:38:45.260 in staying alive. Not only that. So that's a great point. The other point is when you look at the top

00:38:50.380 three causes of accidental death, it is automotive accident, falling, and accidental ingestion,

00:38:57.240 which of course begs the question, how many accidental ingestions are not accidental?

00:39:02.000 When I was in college, a friend that I grew up with, his dad shot himself in the head. I remember

00:39:08.760 the Sunday afternoon that it happened. He literally, they all went out to church like a normal day,

00:39:14.240 went out for lunch after. And then when they got back home, his dad went out to the shed and shot

00:39:18.120 himself in the head. Probably one of the saddest lessons I ever learned was maybe two months later

00:39:24.960 during finals, my mom said, so-and-so, my friend is not doing well. He's really down in the dumps.

00:39:32.280 You ought to come home and see him this weekend. And I still to this day just cannot, I can't believe

00:39:37.800 what I'm admitting and acknowledging now. It's so embarrassing and painful to say this, but I said,

00:39:42.080 mom, look, I'm in the middle of finals here. You know, I got to graduate first in my class,

00:39:46.860 right? I have to be the best engineer that ever lived. I'll be done in two weeks. I'll see him

00:39:51.840 then. A week later, he was dead. Oh my gosh, I'm so sorry. Now we don't know, you know, I don't know

00:39:58.520 that he'll get counted as a quote unquote suicide because it was alcohol, barbiturate, you know,

00:40:03.440 it was like a cocktail of drugs in his system and he just never woke up. And again, I only tell that

00:40:09.840 story, not because it's, you know, it's just such a sad, it's a sad reminder to me to how to

00:40:15.380 prioritize. It's, it's that overnight changed the way I prioritize things in life, but it also begs

00:40:22.060 the question, you know, his death might not be one that actually gets counted as a suicide, but I

00:40:26.280 would call it a suicide. Absolutely. I mean, the deaths by suicide are in general, the ones that

00:40:31.420 are just very clearly suicide, right? Yeah. But if you, if there's a note written that the gunpowder's

00:40:37.480 on the hand as the gun points at the head, yeah. Right. But so many deaths that are not labeled

00:40:43.340 as suicides actually are suicide. And so many that aren't someone saying I'm going to kill myself now

00:40:49.920 are the result of an approach to one's life that doesn't value it and wants it to end what gets

00:40:55.460 called parasuicide. When, when you, when you add those things together, those numbers, it just

00:41:01.160 undoubtedly are strikingly higher than the shockingly high numbers that we're reading now.

00:41:07.480 And I've, I've always kept a mental note of if someone I know, you know, which includes,

00:41:13.300 again, I don't make much of a distinction in people, my personal life, my patients, people I

00:41:17.360 consult to, I mean, just humans, right. Of what they died of on the death certificate versus what

00:41:23.800 they really died of. Right. And it might be auto accident, accidental overdose fall. Right. And I'm

00:41:30.480 looking at them saying, no, that person died of Madoff, that they're so ashamed of what happened

00:41:35.520 to them when they were swindled and humiliated. Right. That person died of rape that was never

00:41:41.320 adequately addressed. And the, the sense of shame and the sense of misery that was imparted on them

00:41:47.980 was never addressed. That person died of childhood bullying. Right. That was so intense. They, they,

00:41:53.000 they decided that they were this awful reprehensible person in sixth grade. And that never changed. I

00:41:58.720 mean, every now and then the actual cause of death matches what, what is, is, you know, my brain

00:42:03.820 registers as the real cause of death, but very, very often there's a difference there. And, and the

00:42:09.360 difference I account for by the role of trauma, right. The role of trauma that pushes people to either end

00:42:16.520 their life or to move towards the end of their life, even if they're not overtly acknowledging

00:42:22.840 that they're doing that, which can be a clever way of not having to feel accountable. Right.

00:42:27.520 If the religion says don't commit suicide, well, let's say ultimately it was an accident or, well,

00:42:32.540 I don't want to leave my kids. Ultimately it's an accident. I mean, you know, I'm not saying that in

00:42:36.420 any negative way, but we, we don't help people to understand what's going on inside of them. Right.

00:42:43.940 And, you know, you're talking about like how you run your practice and how you try and understand

00:42:48.440 the, the routes to not just to longevity, but to healthy longevity. And, you know, and I would

00:42:53.780 argue, I mean, my take on that is that you actually have become the best engineer because what you're

00:42:58.660 doing is, as you said, you're reverse engineering to ways of living longer and being healthier. And

00:43:04.620 with so many complex variables, I'm not so sure if it's possible to figure that out without

00:43:10.840 reverse engineering. And I view it as a marker of your, I truly mean this, your intense and

00:43:17.420 incredible thoroughness that you look beyond the factors and the reasons for the factors and the

00:43:23.340 reasons that underlie the factors and the reasons. And it's, you know, I think what leads you to have

00:43:28.180 me here instead of someone who could talk more about oncology or cardiovascular pathology, right?

00:43:34.660 The realization that what undergirds a tremendous amount of the things that actually take someone's

00:43:42.800 quality of life or take their life ultimately has a root in, in mental health, right? That people

00:43:49.480 who are depressed are more likely to die of cardiovascular disease, are more likely to die

00:43:52.600 of accidents, are more likely to become addicted, right? People who've been through terrible trauma

00:43:56.640 are more likely for all of those things to happen. The role of stress in its impact on the immune

00:44:01.620 system and the growth of cancer cells, right? There's a level underneath the things to which

00:44:07.040 we attribute morbidity and mortality that strongly influence morbidity and mortality. And I believe

00:44:13.500 that's true. I mean, I think that 80% of what I treat is trauma, but I actually think, I don't know

00:44:19.040 what the numbers are, but I think more than 50% of what everyone treats, any doctor, more than 50% of

00:44:25.840 what walks through that door is ultimately resting in misery inside of that person that I would

00:44:32.380 attribute to trauma. And again, it's not my way of saying, oh, we're all suffering and in some way

00:44:38.620 that it just kind of denigrates, you know, like when really awful things happen to people. I mean,

00:44:44.000 the problem is we don't take stock of really awful things that happen to people like most of the time.

00:44:49.120 And even when those things are something so overt as, you know, an assault, a terrible loss,

00:44:55.580 right? We can ignore even those things, let alone the impact of, you know, loss of a parent as a

00:45:02.420 child, loss of a friend who moves away, loss of a pet. I mean, like these are things sometimes that

00:45:06.840 you ask somebody what their inner life is like 20, 25 years later, and that thing may go through their

00:45:12.840 head a thousand times. And it may be that the loss of the pet is symbolic of they will have no

00:45:18.400 stability, no peace, no freedom. So then it becomes, you know, becomes the internal symbol

00:45:24.720 of their, their sense of hopelessness in life or their sense of infinite striving with no hope of

00:45:29.840 getting where they want to go. So, so I don't mean to say that in some, I don't know, trite way,

00:45:36.800 but I mean to say it in a way that I do think if you sit with individual people, you see the depth

00:45:44.380 of that and you see the pervasiveness of it. When you recommended that I needed to go to

00:45:50.460 Kentucky, needed to go to this place, the bridge to recovery, which we'll be sure to link to in the

00:45:55.160 show notes here, because I really think if anybody takes anything away from this and they even have a

00:46:01.520 suspicion that they're, some of their actions, some of their pain could be sort of driven by trauma

00:46:07.300 that had occurred earlier in life, I want to make sure that people at least pick up the phone,

00:46:10.480 give them a call and at least commit the time to doing an intake interview with them. But I mean,

00:46:15.360 I was so incredibly resistant to this idea, right? It was this idea that how could there really be

00:46:21.640 anything wrong with me? Look at how hard I work, look at how quote unquote successful I am. And by

00:46:26.640 that I just meant like, I'm not an alcoholic. I don't have a drug problem. I'm not a gambler. Like

00:46:32.260 I don't have any of these overt signs of pathology. Yeah. I've got these other things that are kind of

00:46:40.020 pathologic, but I can mostly keep them in check. But I kind of remember when I did my intake call

00:46:48.120 with them, how pissed off I got. And that to me, there was, there was two things, right? So the

00:46:54.560 first is I'm talking to this poor woman whose job it is, is to just do a basic screening call.

00:46:59.560 But she's asking me a lot of questions nobody's ever asked me and questions I don't want to answer.

00:47:04.640 And at one point she asked me a question. I won't tell you what the question was,

00:47:09.440 but my answer was, fuck you. Like that was just my answer, right? Like, and when I later told that

00:47:17.500 story, once I finally got there, everybody thought that was so funny because they're like, wow,

00:47:20.940 she asked you a question about X and she found out you have X and a bad temper. It's like,

00:47:26.640 it's really great. Anger management and this other thing, check. But that was also kind of the reason

00:47:31.480 one. That was certainly one of the things that made me think, because as you recall,

00:47:35.480 you know, you wanted me to go and I agreed to go and then I backed out and you know,

00:47:39.580 it was just like, this had been something that had been on the table for years and I just refused

00:47:43.840 to acknowledge this needed to be done. And I think part of it was the semantics, right? It's like,

00:47:48.520 what does trauma mean? We get so far in our lives, our skin gets so thick that I think people get into

00:47:55.740 different patterns. And for me, I know the pattern was minimization. You know, I didn't forget any of

00:48:03.440 the stuff that got me there. I just didn't think it mattered. You know, when they talk about trauma

00:48:09.200 at the bridge, they really refer to it in five routes. So the first route is abuse, which can be

00:48:14.840 physical, emotional, sexual, spiritual. They talk about neglect, abandonment, enmeshment, and the

00:48:22.260 witnessing of tragic events. And so I think it'd be impossible to think that somebody listening to

00:48:28.760 this hasn't experienced at least some of one of those branches and many of us more than one.

00:48:35.520 For me, the single most powerful way to let my guard down was because we're now what, three or four

00:48:45.360 days into the most intense experience of my life, which is 13 hours a day of group, you know, therapy.

00:48:51.180 And I had still sort of, I mean, I was there, so I'd shown up, but I wasn't happy. But I'd refused to

00:48:57.580 sort of even have a discussion about any of this stuff. I was happy to listen to other people, but I

00:49:01.980 wasn't going to get into it. And one of the counselors, and I had these two amazing counselors,

00:49:07.240 Jeff and Julie. I can't remember if it was Jeff or Julie, but one of them said something to the effect

00:49:11.260 of, you know, if such and such, because we were talking about an event in my life, if such and such

00:49:16.500 occurred to your son, Reese, because Reese is four, about the age that, you know, I was,

00:49:22.900 would you think that was okay? It's a very different question, right? It's one thing when

00:49:28.760 it's like, look, that happened. What the, you know, I'm over it. Come on. Look at, you know,

00:49:32.320 blah, blah, blah. You could, I could even rationalize. Look, these things have made me more resilient.

00:49:36.960 This has given me a chip on my shoulder. This has given me an edge. But when they turn it into,

00:49:42.560 you have a kid and that, and it's so interesting because just last week I was having dinner with a

00:49:48.580 friend in, um, in Malibu and he opened up to me about something incredibly personal and private

00:49:54.860 that I'd never known, which was that his wife had had a really difficult year. She'd relapsed in her

00:50:01.600 smoking. A whole bunch of other stuff had completely fallen off the rails in her, in their lives,

00:50:06.200 but in particular in her life, we get through the whole dinner and he tells me everything about the

00:50:11.360 story. And it's just a heartbreaking story. And then he alludes to a fact that was clearly the

00:50:18.400 trigger, which was his, his wife had been abused very badly by her stepfather had been sexually

00:50:23.860 abused nonstop. It started when she was seven years old earlier this year, their daughter turned seven

00:50:31.180 and it completely triggered this because, and again, if I'd heard that before, I would have been like,

00:50:37.940 come on, that sounds like sort of psychobabble nonsense. How is it that seeing your daughter

00:50:43.320 at the same age that you were at when something happened could do that? I mean, do you see this

00:50:47.240 often? Oh, sure. Yeah, absolutely. And, and to kind of lead up to addressing that, I want to comment on

00:50:54.300 a couple of things, right? One, you said that the woman who was asking you the questions, okay, she

00:50:58.260 learned, okay, this, there's this issue. And then she learns about anger, right? I would frame that a

00:51:03.380 little differently. I would say that, that there's a very skilled clinician that is doing the same

00:51:08.260 thing over the telephone that we might do physically examining a patient, right? Any touch, does it

00:51:12.860 hurt here? Does it hurt there? Right? I mean, if you get where it hurts and you know, we're not, even if

00:51:18.600 we're very gentle about it, right? At times the person has a reaction, right? And then you learn like, oh, you

00:51:23.840 hurt there, right? And that's why you reacted that way. And I think that's what she learned. Jesus, it hurt

00:51:29.860 here. Does it hurt here? And then she'll go, shit, it really hurts there. And, you know, it tells us

00:51:35.280 something, right? And, and what it tells a good mental health clinician is where there's shame and

00:51:41.980 fear, right? And, you know, shame is extremely powerful. And it's, it's, it's technically it's

00:51:48.780 an aroused affect. I mean, the word aroused, you know, it doesn't, it's not purely a sexual word. I

00:51:54.800 mean, it often gets used in that way, because the idea is that something can turn a person on that you

00:51:59.220 didn't choose to have turn you on, right? But the idea of aroused affect is something that's

00:52:05.540 created in you without your volition. Someone shoves you, you get angry, right? Someone shows

00:52:10.100 you really hard, you might get afraid, right? There are things that make a certain, what gets

00:52:15.420 called affect, but colloquially a feeling inside of us that we don't have a choice over. And

00:52:20.080 there's an incredible automaticity to that. And, and that's like, what, what's, what you're

00:52:25.840 talking about with, okay, like, what, what is this trauma thing? And what is it doing?

00:52:30.360 Right? It's not necessarily what happens. It's what does it make you feel? And my guess

00:52:36.260 is, and again, I don't know, I don't know the person you're talking about, but probably

00:52:40.280 that person is carrying some sense of shame over what happened to her. Because, you know,

00:52:45.220 at the age of seven, you know, that there's not the cognitive capacity of deciding, look,

00:52:49.700 what's going on to me, happening to me is wrong. You know, the child needs to make sense

00:52:53.720 of it, right? And often how the child makes sense of it is to decide somehow that it makes

00:52:57.280 sense, or what's happening to them is deserved, or it's their fault, right? Or it's the way

00:53:01.700 it should be, right? And that evolves into a sense of shame that the problem here is me.

00:53:07.040 Someone's hurting me in some way, whatever's happening to me doesn't feel good. And it's

00:53:10.640 my fault. And then it creates a sense of shame that does not give a damn about the clock or

00:53:17.700 the calendar or levels of achievement. You have a trillion dollars and 15 PhDs, right?

00:53:23.160 It does not make a difference unless that shame is directly addressed. So that's really the

00:53:29.960 answer, right? Is what has happened to a person and what is it triggering inside of them? The

00:53:34.360 same way there's pretty good literature that talks about, you know, someone is shot, right? How

00:53:40.160 much does it hurt? And like, clearly it hurts more if there's no damn reason to have been

00:53:43.640 shot, right? Like if you try to save somebody and, you know, and you get shot, then people tend

00:53:47.980 to feel less pain because there's, there's a sense that, that it makes sense in some way

00:53:54.520 that, that this bad thing has happened, but something good has covered, or I was trying

00:53:58.700 to do something good, right? It doesn't seem senseless and sadistic. And, you know, that

00:54:04.200 sense of absurdity, the sense of, of evoked shame or aroused affect of shame, the sense of an

00:54:12.080 aroused affect of fear, the sense of absurdity and meaninglessness is what then creates the

00:54:19.040 trauma that stays with someone. And kind of like, it's not even like a ghost shadowing,

00:54:23.980 you know, it's like, you know, just imagine someone who like, can't stand you that just

00:54:28.680 shadows you all the time and says awful things. And that's essentially what this kind of thing

00:54:34.300 evolves into. And it's, it's that, that, you know, that raises that triggering that if there's

00:54:39.920 still a sense of shame, and now the daughter is seven years old, you know, what does that

00:54:43.560 make the person feel like, right? The person identifies with the daughter, they still identify

00:54:47.940 as the hurt child, but now they're supposed to take care of a child who's vulnerable because

00:54:52.220 that child has reached the age at which they were hurt. I mean, it's very, very triggering

00:54:56.240 for reasons that make damn good sense.

00:54:58.420 So you've seen this where people's trigger is a child that reaches an age at which some traumatic

00:55:04.620 event occurred.

00:55:05.460 Yes, it's very common because that is a trigger that they say, okay,

00:55:09.560 it's my job to make sure that does not happen to them, but I am still in the throes of

00:55:15.420 it, right? So then while I am the traumatized seven-year-old child who is supposed to protect

00:55:21.500 the seven-year-old child, that's terrifying, right? It's terrifying. And then the part of

00:55:26.640 the brain that is terrified says, look, this absolutely could happen to your child and you

00:55:31.840 can't protect them. And then, you know, the brain, again, the brain doesn't care about the

00:55:36.080 clock and the calendar. So that trauma is very, very, very real to the person and it's very

00:55:41.340 immediate. It doesn't matter if it was two days ago or if it was 30 years ago. It's just as

00:55:46.320 immediate. And we also lose sight of that. And many times I hear people say, well, I couldn't

00:55:50.800 still be bothering me. It was, what, two months ago, two years ago, 50 years ago. And the answer

00:55:56.380 to that is it does not matter one bit how long ago it was. If it instilled terror, shame,

00:56:03.960 a sense of responsibility for something that wasn't the person's responsibility, then, you

00:56:09.440 know, my guess is we could probably live to be a thousand years old and that would still

00:56:13.600 be with us. And again, very germane to what, to your practice is that's one of the things

00:56:19.140 that often prevents us from living longer, right? It's that kind of internal stress that leads

00:56:23.480 not only to suicide and para-suicide, but also to the kind of strength, sorry, the kind

00:56:28.700 of stress that contributes to cardiovascular disease, to cancer, to autoimmune problems,

00:56:33.400 right? To all the things that ultimately, you know, if you look at the population as a whole

00:56:38.220 that chips away at our health, at our healthy lifespan and at our lifespan.

00:56:42.800 I still remember to this day, the very, very first patient we ever collaborated on, which

00:56:47.040 of course was such an interesting experience for me that it's what basically led to you and

00:56:52.380 I being so close at the hip in terms of like how many patients we overlap with. But I

00:56:58.060 obviously won't use her name, but the woman in San Diego that I was taking care of, very

00:57:01.840 interesting case. I think most of my patients are incredibly nice people, but she would certainly

00:57:06.500 be on the short list of like the nicest, just a very, very special woman. And there were

00:57:12.980 a lot of things that didn't look metabolically right. Frankly, her chief complaint when she came

00:57:16.860 to me was, you know, she just wanted to have more energy. She wanted to, to feel better.

00:57:21.240 Her father had died prematurely of heart disease. She wanted to make sure that was not going to

00:57:25.860 be her. And we got to it. We changed her nutrition and we fixed her hypothyroidism and we tweaked

00:57:34.280 a bunch of things and everything on paper looked right, but we couldn't eradicate certain things.

00:57:41.000 There was still a degree of inflammation in her body. There was still a degree of insulin resistance.

00:57:44.800 I probably hadn't seen a patient who could be so compliant with her nutritional plan as she was.

00:57:51.860 And the only one of her meds I couldn't really offer any input on was she was on an SSRI. I think,

00:57:57.800 I don't remember which one as well, butrin if I can remember actually. And, you know, I think this

00:58:02.620 had been prescribed by her family doctor like 10 years earlier or something like that. But

00:58:06.240 I remember one day thinking about what she talked about when her dad died, when she was in medical

00:58:12.860 school, she was a physician. And it cleared me on this particular day, which was like a year after

00:58:18.580 the first time I'd heard this story that like that had, that I didn't know to use the word trauma,

00:58:23.620 but that was clearly a traumatizing event in her life. And my first thought was actually,

00:58:29.800 I thought of these Zucker rats, right? Which I thought of these experiments that occurred.

00:58:33.400 Cause, cause what I couldn't understand was why in the world is this woman who's doing everything

00:58:37.800 right seemingly have a metabolic rate of a slug, right? It was like, she's doing everything by

00:58:44.360 the book. And the only way that we could infer what's going on with her is that her metabolic

00:58:49.600 rate has shut down because she's no longer hypothyroid. All these other things have been

00:58:53.540 fixed. And I thought about these Zucker rats where they, you know, they sustain certain lesions

00:58:58.280 into parts of the hypothalamus and they can alter the metabolic rate. And so I floated the idea by

00:59:04.800 you and you said, look, anything is plausible. And to make a long story short, I introduced the

00:59:09.880 patient to you. She came up, she saw you. And over the course of the next six months without making

00:59:16.020 any change in the thyroid meds, in the nutrition, in the exercise, she probably lost 30 pounds and she

00:59:23.400 looked like a different person. In fact, I remember when I got her Christmas card with her and her

00:59:30.400 family. At first I thought, I don't know who this is. Why am I getting a Christmas card

00:59:34.660 from a random person? And I mean, what do you remember about that case? Maybe not even the

00:59:42.040 specifics, but just like, were you as surprised by that as I was?

00:59:46.120 You know, I think the fact that I wasn't is, is just indicative of, it's not indicative of like

00:59:54.240 some genius that I figured things out that other people haven't. It's just indicative of things that

00:59:59.120 I have witnessed that utterly shocked me at the time that lead to what I would describe as more

01:00:06.580 than a healthy respect, but an utter reverence for the impact of what the brain can do to the body.

01:00:16.320 And, you know, a couple of examples are like paralysis of a limb. I mean, I've seen people,

01:00:21.040 seen cases in my training and subsequently taken care of people who do something that they find

01:00:28.540 reprehensible or almost do something that could have been disastrous. And then the limb that they

01:00:35.080 did it with is paralyzed, right? And now it's like, it's 10 years later and the limb hasn't moved in 10

01:00:40.440 years. I mean, the nerves haven't been severed, but they may as well have been. There's contractures and

01:00:44.900 everything else. I mean, when you see that the brain can like shut off vision, right? The brain can shut off

01:00:51.860 movement to a limb. You know, these are really shocking things. And, and I think that we, as a

01:00:58.360 society, like we, we, we just don't appreciate how much impact over all aspects of our functioning,

01:01:06.860 some of the things that torment us inside can have. So, so there was something tormenting this

01:01:13.720 lovely woman that was like shutting her metabolism off. And in many ways I get it. It's like,

01:01:18.820 it's a shocking thing. And, and it would have like, you know, knocked me off my feet if I hadn't been

01:01:23.340 like seen paralyzed limbs before. And, you know, things that, that, that really kind of told me

01:01:29.440 things that to be honest, really made me angry. And I thought like, how is it that I consider myself

01:01:36.500 to be a curious person? I mean, even before psychiatric training, right? And I'm a well-read

01:01:42.180 person. I'm a well-traveled person. I'm interested in other people. I took a broad curriculum in college.

01:01:46.940 I was like, how is it that I didn't understand these things of what our brain and, and what does

01:01:53.160 that mean? It means what our brain in the context of trauma, which, which is about evoke shame,

01:01:57.940 fear. Think about things we're talking about in the patients where we've had these kind of,

01:02:01.720 you know, these kinds of experiences, right? And even in ourselves, think about the impact of shame

01:02:06.960 and fear and what it does to us. And, and people don't tell us that. So then a person feels ashamed,

01:02:13.700 right? That they're eating less and they can't lose weight. They feel ashamed that they're sleeping,

01:02:19.860 but they're not well rested. They feel ashamed that they want to be patient with their kids and

01:02:23.880 they can't be as patient as they want. I mean, I could go on and list thousands and thousands of

01:02:29.020 things. And what we often don't, again, don't appreciate is where's all that coming from? And

01:02:36.580 has anyone ever asked about it? I'll give you a very quick aside that I saw a person in my practice

01:02:42.220 several years, maybe five years ago or so. Very, very intelligent person, very capable,

01:02:48.100 academically accomplished, who was working many, many, many levels underneath where

01:02:53.440 he could, would have been operating in a $10 an hour job and somebody, you know, who should be

01:02:58.980 running a company that dramatic. And, you know, I was, I don't know how many people had seen and

01:03:05.920 talked to this person before. Right. And I asked him a question and, you know, we had been talking,

01:03:10.920 so it's not like it came out of the blue, but, but I asked him, you know, how many times a day

01:03:16.740 do you say something to yourself inside that's some version of like, I suck? And this response

01:03:25.760 was, oh, I'm a piece of shit. And his answer was like, he stopped. He says hundreds, hundreds of

01:03:32.100 times, all the way to the job, all the way back in the shower before he goes, when he's back at home

01:03:37.440 with his kids, nonstop, you know, that was all trauma-based and it was based upon belittling,

01:03:44.460 bullying, all things that had happened. I mean, you could take a trauma history from this person

01:03:47.680 and not like, no one's ever shot him. No one's ever sexually assaulted him. Like it'd be, oh,

01:03:51.420 there's no trauma. Oh no. There was gigantic trauma. And if you're saying something to yourself

01:03:58.660 over and over and over again, that is, that is profoundly negative. And that makes you feel

01:04:04.400 vulnerable, ashamed, inadequate. How are you supposed to be at your best? How does it affect

01:04:09.400 your brain? How does it affect your endocrine system? How does it affect your immune system?

01:04:13.280 How does it affect your vasculature? The answer is dramatically. And then you look at this person

01:04:18.060 who now was aware of substandard role performance and now he feels worse about himself. And by going

01:04:23.640 after that, we were actually able to like change everything. I mean, that the person's life is

01:04:27.420 dramatically different. If you look at what he's doing for a living now, you'd be like, okay,

01:04:30.560 that's, you know, that's something that seems more commensurate. And in this person, it doesn't

01:04:35.800 represent the endless striving of you. You could never, you know, achieve enough, right? In this

01:04:40.300 person, it represents something that makes him feel whole, that this wasn't, you know, his ability

01:04:45.560 to be something he could feel proud of, to support his family in a way he could feel proud of. It wasn't

01:04:51.500 taken away from him. But if you looked at what was the ideology of that problem, it absolutely wasn't

01:04:56.260 single digit ages. And it doesn't matter that this was like three or more decades along,

01:05:01.360 right? It was with him hundreds of times a day. And that's why these things don't surprise me.

01:05:08.740 And, you know, I've had an increased awareness over time of my own inner voice that, you know,

01:05:12.720 I may as well have somebody, you know, behind me all the time. I mean, I've been trying to alter

01:05:16.920 this and some, when someone's with your help and a couple of other people around us, you know,

01:05:21.420 it's kind of gotten better. And the realization that I carry around with me a voice that tells

01:05:26.680 me how shitty I am for everything that's not utterly perfect from the moment I wake up to the

01:05:30.940 moment I go to sleep has created a lot of misery in my life and has created unhealthy situations. And,

01:05:36.800 you know, at times real risk to my, to life and limb for me. So, you know, I'm a huge believer that

01:05:43.800 the reality and the truth that we're living, and I say that the reality and what we view as truth,

01:05:49.700 that, that we're living in is often not apparent to anyone around us and nor is it apparent to

01:05:56.680 ourselves. And if we make that apparent, then we can make some decisions about it,

01:06:00.540 which is why that woman was able to lose weight is because we, we started talking about like what

01:06:04.860 was actually going on inside of her. And, you know, in a certain person, if you are intensely ashamed

01:06:11.680 and feel inadequate from the moment you wake up to the moment you fall asleep, you probably eat 20

01:06:16.140 calories a day and you're going to gain weight.

01:06:17.460 Yeah. That's the part that just blows my mind in her case. The other thing with this stuff that I

01:06:22.900 think it's worth people who are listening, understanding, and it's, it's so important.

01:06:27.560 I certainly didn't understand it until the past year. I think I wasn't so naive to know that I wasn't

01:06:35.000 so, so, so maybe naive is the wrong word. I wasn't so ignorant to think that, look, bad things happen.

01:06:40.720 I got it. But my sort of blinder based mentality was I can prevent that exact set of things from

01:06:49.560 happening to the next generation, to my kids. And of course the irony of it is you learn that

01:06:55.300 trauma almost always comes out in some orthogonal way. And so it's not necessarily that the child of

01:07:02.980 the alcoholic becomes the alcoholic. In the case of the woman that I was just talking about earlier,

01:07:08.280 who, when she saw her daughter turned seven, triggered all these flashbacks of the sexual

01:07:13.040 abuse. I don't think that, I think the probability that that mother is going to go ahead and like

01:07:18.720 sexually abuse her daughter because she was sexually abused by her stepfather. I think the

01:07:22.680 probability of that is like close to zero. That is not how the shame will be transferred to the next

01:07:27.520 generation. It will not be through the same root cause. It will come out in something different.

01:07:33.800 And, and to me, that's the part of this thing that is so, is such an epidemic, you know, Terrence

01:07:40.620 real who we've talked about a lot in his book, which I've talked about on other podcasts, one of the

01:07:45.060 most important books I've ever read. I don't want to talk about it. He talks about this, the number of

01:07:50.760 generations it takes for shame to sort of work itself out. And it's like, you know, this happened to the

01:07:58.400 grandfather, this happened to the, to the mother, this happened to the child. And, um, this idea of

01:08:05.480 shame transference through trauma is, I don't know, I guess, like I said, even though I don't do this for

01:08:12.220 a living, it occupies more and more of my time because I spend more and more of my time thinking

01:08:18.100 about it with, with the patients that I'm lucky enough to get this close to. And truthfully, there

01:08:22.800 are some of my patients I just don't get close enough to, to understand this part of their lives,

01:08:26.800 but I want to, because I realize so much of what we do without knowing this becomes quite futile.

01:08:33.020 Absolutely. If, I mean, if the manifest, if the only thing we were guarding against was the

01:08:37.100 manifestation of something that we recognize, things would be different. I mean, I think the

01:08:41.920 number of generations to get rid of shame without intervention, you know, is either infinite or

01:08:48.820 there's just some, you know, it's practically infinite, right? Because why would something like

01:08:54.280 that change unless it's understood? Now people at times can intuitively understand. I mean,

01:08:59.300 there are things that can intervene, but otherwise you're absolutely right. I mean, it finds a way

01:09:06.100 out, right? So the person who was sheltered and over-controlled as a child, and that led to say,

01:09:13.960 you know, big problems of rebellion, and then something traumatic happens. Maybe if they don't

01:09:18.820 understand it, they may overcompensate with the sort of freedom and what seems like opportunity for

01:09:23.620 their own kids, but what actually, you know, puts them inadvertently in danger. Just as the person

01:09:29.940 who was neglected and was then left in a situation of danger may over-control their kids, and then

01:09:35.180 the kids rebel and the same thing happens. I mean, if we don't understand it, there's a very good chance

01:09:40.700 that it will find a way to get us. And, you know, sometimes that's something dramatic. And, you know,

01:09:46.120 I see these cases like, oh my gosh, like this person did the opposite thing. Their parent didn't look.

01:09:49.980 The same thing happens, right? But a lot of times, you know, I think most human suffering and most

01:09:56.380 bad outcomes, you know, happen with a fizzle, not a bang. And I think that's part of the really the

01:10:01.600 biggest sadness of it. It's the things that we don't know are the person who just languishes, who doesn't

01:10:06.320 have a strong sense of self and is burdened with regret. And that's the story. I mean, there's so much

01:10:13.060 about this that because we don't talk about it, we don't educate ourselves about it, we just let

01:10:20.140 be perpetuated. And in many ways, like I'm not trying to say, oh, this is all easy to address,

01:10:25.880 right? But some of this, I think, is low-hanging fruit of, look, why are we not talking about these

01:10:30.660 things, right? Why is it that we enter medical school and you have all these like overly powerful

01:10:35.620 guys? And, you know, we don't think of it like, what are we all defending against? Like, why do we have

01:10:40.320 to be so powerful all the time? What are we guarding against? Why is it that we feel ashamed

01:10:45.420 if we're not powerful, right? If we're not, you know, I mean, if we're not perfect, if we're not

01:10:50.580 the best, right? Why is it? And, you know, I'm not saying, gee, let's have some like soft wave going

01:10:58.320 about life and then people aren't driven to achieve things. But it's a lot of it is based on this lie

01:11:03.580 that like, what doesn't kill us makes us stronger. Okay. That is a lie. Sometimes something doesn't

01:11:11.680 kill us and makes us stronger. You know, we can get an infection. It doesn't kill us. We develop

01:11:15.840 antibodies, right? It can happen on a biological level. It can happen with a life tribulation.

01:11:21.440 But my experience in my own life and in the people around me that I take care of, or my friends,

01:11:28.220 family, patients, like the humans in my life, is that bad things that don't kill us often make us

01:11:33.380 weaker, right? They hurt us. And if we don't acknowledge that, what has this thing done to me,

01:11:40.220 right? Then we put it onto the surface and we soldier forward, right? And for a lot of people,

01:11:46.700 you know, what does that mean? I mean, it does mean languishing. And oftentimes for people who maybe are

01:11:51.580 blessed with more drive and perseverance, sure, it means we drive ourselves to achievement. But amidst all

01:11:57.740 that achievement, we remain miserable. Because the hurt part of us is like still what we're living in

01:12:04.840 every moment. Most of the time we're living in that hurt person. But that hurt person is festooned

01:12:13.000 in a way that doesn't look like that. And if you think about very powerful things in culture,

01:12:17.740 you know, the Wizard of Oz, you know, like such a cultural touchstone across generations, even the

01:12:24.020 Emperor's new clothes. I mean, we're infatuated with things looking some way, but being another way,

01:12:31.560 you know, things looking strong and powerful, but being weak and vulnerable. And part of our infatuation

01:12:37.520 with that is it can take the fear out of some of the things that scare us. But I think an even bigger

01:12:43.420 part of that is that we often identify with that, right? We identify with, you know, festooning

01:12:49.620 ourselves, look how great I am. And like, you know, really, I'm not festooned in anything, right? I

01:12:54.260 mean, there's like a, there's a pathetic nakedness to some of it, right? But, but we sort of posture

01:12:59.220 that way, right? And we posture that way, in order to show ourselves up. And if I see a commonality

01:13:06.020 between like how you and I practice medicine, and how the vast majority of I think good doctors

01:13:11.280 practice medicine is, is it's with not hiding vulnerability. I do not feel in any way, shape,

01:13:16.860 or form healthier than the vast majority of my patients. I mean, some people, yes, I've had a

01:13:21.440 bad head injury, have schizophrenia. Okay. I don't feel any better, necessarily healthier to them a lot

01:13:27.360 of the time. But there's an identified problem that we want to address and treat that can let the person

01:13:33.760 feel a greater sense of wholeness. Okay, that's valid. But most of the people that I encounter

01:13:39.360 are just struggling the same way that I am. And, you know, there really is no difference except that

01:13:45.240 person may do something, maybe someday I need an architect, a financial manager, you know, a lawyer,

01:13:50.860 whatever it is that they're doing. But we're no different. It just happens to be like, okay,

01:13:55.400 this thing I do brings them to come to me for help about this certain thing. But we're all people

01:14:00.960 trying to make our way and survive in the world. And often, some of the people who I feel are most put

01:14:07.540 together are not the people that you might think, right? They're the people who, if you look at their

01:14:12.220 achievements, you know, you're not going to, like, be wowed by it, necessarily. But they're people who

01:14:18.060 have a greater sense of wholeness. They're people who have maybe spent more time and effort on

01:14:23.640 themselves. And again, this is not an anti-ambition agenda that I have here. But what I absolutely am

01:14:31.460 saying is that very, very high levels of achievement are a marker in my brain for suspicion that this

01:14:37.640 person is defending against something. And, you know, that's the reason why I thought that you

01:14:41.900 should go to the bridge. It's a reason why trauma therapy is part of my psychotherapy. It's a reason

01:14:47.760 why at some point, I should go to the bridge too, right? I mean, this, this...

01:14:52.600 You know what the nickname for that place is?

01:14:54.420 You, you're that first person who told me I send a bunch of people there and no one tells me this

01:14:58.300 and then you do, right? Do you want to...

01:14:59.680 His two nicknames, Camp Misery and The Crying Factory.

01:15:03.880 Yeah, can you tell me The Crying Factory, right? And, you know, it, it points out that making

01:15:10.960 ourselves healthier often is difficult. It does involve misery, right? It involves tears and

01:15:18.220 exposure of things we're ashamed of. And, you know, of all the places that I have sent people in,

01:15:24.480 you know, at this point in almost two decade career, you know, I think that they are the most

01:15:29.320 effective or among the most effective of places. And I think part of it is because they don't shy

01:15:34.980 away from that.

01:15:35.720 I remember something you said to me because you suggested, look, there are two or three places

01:15:39.600 where I think you could go. Here's why I think the bridge is the best for you. And one of the

01:15:43.920 reasons was, oh, I'm almost embarrassed to admit live, you know, to people, to so many people what I

01:15:51.760 asked you. But I said, you know, Paul, when I looked at these other places, the bridge seems

01:15:56.660 unique in that the socioeconomics of it look very different from where I've come from, meaning

01:16:01.960 I'm not going to be there with other people who have gone to medical school or gone to law school

01:16:07.380 or whatever. Will I have enough in common with the other people there? And you said, that's exactly

01:16:13.000 why I think you should go there. And I didn't understand that. So I go there. And of course,

01:16:17.720 the first rule is everybody has a roommate. Well, I don't want a goddamn roommate. I'm 45 years old.

01:16:23.200 I, I'm, I've passed that course, right? I did that. I did summer camp already. I don't want a

01:16:27.180 roommate. So I, you know, have my assistant call over and say, Hey, we'll pay extra, but he needs a

01:16:32.400 solo room to which they sort of said, thanks for telling us how to do our job. That ain't the way it

01:16:37.540 works. He gets a roommate. Right. Again, everything that they did that I thought was pure torture turned

01:16:43.740 out to be perfect. There was exact, and it's exactly what you said. I had to be around people

01:16:50.720 who I could relate to intellectually, who I couldn't relate to intellectually, who I had a

01:16:55.080 similar education to, to whom I did not. But in the end, what I realized was we are all the same.

01:17:01.460 And again, that is such a banal, glib, idiotic statement, but it's fucking true. We are all the

01:17:08.360 same. My roommate, I swear for the first three days, I thought I don't have one thing in common with

01:17:13.600 this guy. I loved him out of the gate. I mean, he was just an amazing guy, but it's like, we don't

01:17:17.320 have anything in common. And that's fine. I mean, I didn't make me like him any less, but two weeks

01:17:22.420 later I realized, Oh, actually we have more in common than I would have ever dreamed. We have

01:17:27.640 the, the reason we look like we have nothing in common is perhaps some innate wiring, perhaps some

01:17:34.240 stochastic events. But in the end we took very different divergent paths. You know, mine led me to

01:17:39.040 college. His did not. My weaknesses led me in a different area than his did. One of the things

01:17:44.580 that I found most powerful, and I'm bringing this back to a point you made earlier was in addition

01:17:50.380 to 13 hours of camp misery every day, seven days a week, you get to go to a 12 step meeting every

01:17:57.140 single night and you get to pick what it is. So they're not going to tell you which one you're

01:18:01.460 going to, but you're either going to AA or Al-Anon or CODA or NA or SA or SLA. You're going. I think

01:18:09.400 you got one night off a week. I think Sunday night you got spared the meeting. And I remember thinking

01:18:14.180 the first few times, like, I'm so tired. I'm just so emotionally exhausted that, you know, it's 7 PM

01:18:21.680 or 8 PM. All I want to do is go lay on my shitty bunk bed and sleep. But they were like, Nope, you got

01:18:28.500 to go. And you're a guy, by the way, who could work what, how many hours constantly as a surgical

01:18:34.760 resident, right? Yeah. This was a different level of fatigue. So the fact that you're that exhausted

01:18:40.460 speaks to like what's going on, the magnitude of what's going on inside of you. I find that to be

01:18:45.660 like, like fascinating and a great proof of concept. Yeah. This in many ways hurt more than swimming the

01:18:52.640 Catalina channel every day. Wow. Okay. That's saying something, right? So, but what's

01:18:58.500 what I realized when it was all said and done, cause I, I ended up being quite surprised at how

01:19:03.880 much I really got out of being in these 12 step meetings. And I wasn't a participant. Every

01:19:08.380 meeting I went to was an open meeting. I never once spoke never once, but I was so moved by

01:19:14.920 the vulnerability of these people. Now, again, part of that might be an artifact of the fact

01:19:18.780 that we were two hours outside of the nearest civilization. I mean, we're an hour outside of Bowling

01:19:24.280 Green, Kentucky. Like we were in a place that I don't even, I wouldn't know how to find

01:19:27.820 on a map if my life depended on it, but I couldn't believe the vulnerability in these meetings. And

01:19:34.320 I think in many ways that is an antidote to shame. It is the beginning of it. And fast forward five

01:19:41.720 months, I'm back. I'm in, I'm back into my life. And, and obviously much of my life has changed a

01:19:46.260 result of this, but look, we still struggle, right? We're still always thinking about these

01:19:49.480 things. And I remember my therapist in San Diego said something that I thought was so profound.

01:19:54.300 She goes, you know, Peter, part of the problem with you is you're always the smartest guy in the

01:19:58.540 room. Now she didn't, she was sort of mocking me. She wasn't like actually telling me I'm the

01:20:02.400 smartest guy in the room. She's like, you basically are always the one on point. You're the one talking.

01:20:07.000 You're the one giving the advice. You're the one who everyone's looking to for the answer.

01:20:11.440 And the problem with that is like, you never get the chance to listen and not say a word and not

01:20:17.640 have anybody even give a shit that you're in the room. And I was like, you know, that's the key.

01:20:22.760 That's the thing I miss about the 12 step meeting was nobody gave a shit that I was in the room.

01:20:28.000 And even if I was, and I said, yeah, my name is Peter. It's like, great. Thanks for being here,

01:20:32.320 Peter. You were no better or no worse than anybody else in this room. And so in me, in many ways,

01:20:38.240 I feel like, and again, I don't think it has to be the 12 step stuff. I know people are going to

01:20:41.880 listen to this and say, oh, 12 steps, a bunch of nonsense, whatever, you know, what works for you

01:20:46.380 works for you. But the point is there is really something to be said for that type of vulnerability

01:20:51.440 in a group where nothing else matters. It doesn't matter how much money you have. It doesn't matter

01:20:56.320 how many degrees you have. It doesn't matter what you've done. I mean, none of those things

01:21:00.640 matter. And of course, the next place where that became the most riveting to me was on this prison

01:21:05.020 visit that I went to, which we've talked about as well. And again, just another great example of how

01:21:10.540 in that moment, in a moment of redemption, all that matters is where it was, where you are in that,

01:21:15.300 in that moment. And I just find that again, as I, as I'm sitting here and listening to all of the

01:21:19.700 things you're saying, of course, my, my mind is immediately going to, okay, what can we do?

01:21:24.400 What can we do? What can we do? What can someone listening to this do? What can someone listening

01:21:28.140 to this, who's identifying with this saying, you know what, like maybe that thing that happened to

01:21:34.460 me when I was 10 or, or maybe this behavior that I have, that's on the surface reasonable, but

01:21:40.900 underneath the surface is maladaptive. Maybe that needs to be revisited. And again, if the answer is

01:21:46.500 they need to seek therapy, fine, but what else can people do? I think that it's, it's so important

01:21:51.440 to, to try and take stock of how are we trying to separate ourselves from other people? I mean,

01:21:59.600 think about the things you're saying. It's, it's, it's very interesting. And people listening to this

01:22:03.440 who know you will know that this is true. And for the people who don't know you, please, I would ask,

01:22:08.060 take my word for this. I mean, you are, you know, the least entitled condescending human being,

01:22:13.660 right? I mean, you do not feel superior to other people. I don't think I've seen one wit of that in

01:22:18.900 the two decades I've known you. So why is it that you want a private room and that you want to be

01:22:24.580 different? It's a reflex. And the reflex is like, I've got to stand out in some way because that's

01:22:31.280 what allows me not to feel superior, but to not feel ashamed. And that's often what is driving us and

01:22:39.040 it drives good things, right? I mean, your expertise and, and often being the focus in the

01:22:43.780 room because you have, you know, things to say to ought to offer is like, these are good things,

01:22:47.960 but they're also driven by the need to separate ourselves. And, you know, we, it's not that both

01:22:54.300 of those sides of the coin have to come together, but if we're not aware, they do come together.

01:22:59.160 And then you're doing something by reflex that is the exact opposite of what you need. What you need

01:23:06.400 is to be part of the humanity around you, right? What you need is to relate to people. What you

01:23:12.480 need is to feel that, my God, I mean, I'm a human who suffers from human things like these people

01:23:19.340 around me, some of whom are nothing like me, some of whom may be like me, but like none of that

01:23:24.160 matters. We're all people and our suffering is shared. That takes away the unique stigma of the

01:23:31.100 things that you are suffering from. But your reflex, as mine has been, and as is the case in many

01:23:36.940 people who are sort of driven to differentiate themselves, is to differentiate yourself so that

01:23:42.060 you guarantee loneliness. And, you know, that's what people, I think, really should try and be aware

01:23:48.300 of is when are we differentiating ourselves from the world around us because we are trying to escape

01:23:58.240 from something. But in doing so, we isolate ourselves and we don't, we don't get a chance

01:24:04.260 to just be human. We don't get a chance to just be people. Like, you know, the people who were there

01:24:09.860 at the bridge with you had trauma and suffering and they needed to express emotions and they needed

01:24:16.760 to cry and they need to get angry. And, and you did too, right? And, and I have too. And so many

01:24:23.360 people need that to heal, but we work so hard to separate ourselves from that. And that's what I

01:24:32.020 think, you know, if there's one thing like some, a person is going to be attuned to is how much are

01:24:36.660 you separating yourself from, from the, the humanity around you? You know, groups of people, when people

01:24:44.080 have agendas or angry can feel threatening and intimidating, but there are many places that people

01:24:49.880 gather in order to feel some sense of openness and shared humanity. And that's really what we're all

01:24:55.980 seeking. You know, I know you, you know this, but seven, eight years ago, and I had a clinic that

01:25:01.140 myself and my practice partner built, you know, to be relatively sizable. And we were doing a lot of

01:25:08.120 individualized treatment and we were running groups and the groups we were running were around addiction.

01:25:12.500 And we were absolutely adamant that we did not stratify people by what they were addicted to. So gambling,

01:25:21.340 cutting, sex, cocaine, it doesn't matter. Nor did we stratify people by age, socioeconomic status. And it was

01:25:28.000 a pressure to do that because certain of the people who had more resources, right? Like wanted that, not

01:25:34.660 realizing that what they were asking for was, it was the very thing that was going to stand in the way of their

01:25:41.600 ability to get help. That's exactly, I see, you told me this exact story when I called you up to say,

01:25:47.320 wait a minute, I don't think the bridge is the place for me and I should be going to this place

01:25:51.680 or that place. And you, you said, no, what you're missing is you absolutely need to be around people

01:25:58.520 who on the surface you think you're different from to realize that you're not. Right. And it's an

01:26:04.420 advantage that people have if they're at a stage of life or for whatever reason, they're,

01:26:09.820 they're not in a socioeconomic class that allows them to differentiate because then they don't

01:26:15.100 strive for something that stands in their way. And, you know, and I think back on that venture,

01:26:20.860 which over about five years, you know, my partner and I, and, you know, we had 30 people or so in

01:26:27.520 some way, shape or form were working for us by the end. We all like really slaved away to make that

01:26:33.360 place as good as it could be. And when I think back on it, you know, I think the proudest moment,

01:26:38.560 people have asked me this, like, oh, it was so difficult. And so some people who know me and

01:26:42.300 kind of know what we struggled through. And like, some of the people ask, what do you feel good

01:26:46.020 about? Right. And, and the same image comes to mind is I remember, you know, a young woman who I

01:26:51.180 think she was 19, who really had struggled and was trying to find her way and had been on the streets

01:26:55.920 and, you know, to the outward look of things, you know, as piercings and tattoos and all the kind of

01:27:01.380 things that kind of mark her attempts to differentiate herself to say, okay, stay away from me

01:27:07.260 in a way that she was using to separate herself. And God, she had made so much progress, so much

01:27:14.740 progress in embracing who she was and not feeling ashamed of who she was and not feeling responsible

01:27:21.080 for things that happened to her that she had no control over. And I remember her, I walked by kind

01:27:26.540 of late one day after groups had let out and she was having this like really intense conversation with

01:27:31.320 a neurosurgeon. And it was so clear that she was teaching him a lot of things. And, you know,

01:27:38.060 and he was in sort of wrapped attention. And it's a marker for me of like our shared humanness is like,

01:27:44.820 you know, if you look at him and you look at her, you say, okay, the things they've achieved,

01:27:49.060 clearly he's the authority. He's got a CV a half a, you know, half a mile long. Right. And,

01:27:53.880 you know, this woman has been struggling to stay off the streets. She had done more work on

01:27:59.120 herself. So she had a lot to teach him. And I have found that again, it sounds trite,

01:28:04.000 but the things that I have learned, uh, through the course of my work, uh, so much of them have

01:28:12.580 just come from people who have been through such difficulties and have learned things about

01:28:21.080 themselves that I hadn't yet learned, uh, not at all tied to any metric other than that. And I think

01:28:27.940 that's part of the secret of it. And we don't do these things anymore. We don't have places

01:28:32.520 where people can come and even get some mental health education, some idea of like what ails them

01:28:38.300 in terms of trauma. Like we don't as a society acknowledge this. So then it becomes some like

01:28:43.200 shocking rarity when somebody finds their way to it. And I just, I, I'm astounded by that,

01:28:49.660 that we should be like setting a roadmap with like really gigantic arrows for all of us.

01:28:54.060 But you know, a person has to stumble upon it or come across it inadvertently.

01:28:59.780 And in many ways, I think I'll forever be grateful. I mean, forever be grateful to you

01:29:04.160 for making this happen because I guess some people just can't, they need a greater degree

01:29:11.600 of immersion to finally break down. I think I could have spent two hours a week in therapy for

01:29:16.260 the rest of my life and never, never come close to what finally takes place when you're doing 13

01:29:23.840 hours a day plus 12 step meetings. And, and, and not only that, it's like every meal you're sitting

01:29:29.740 there with this same group of people. We only got coffee once a day, 7am was coffee time. And it was

01:29:35.840 like, I would get up at four and work out and then I'd be, you know, waiting to have my coffee at

01:29:40.420 seven. And there were like six of us that showed up for coffee every morning. And the other thing about

01:29:44.660 this place that was so amazing, which it really ties into what you're saying is everyone who works

01:29:49.900 there, obviously not just the counselors and the therapists, but the kitchen staff, the custodial

01:29:55.760 staff, the people that worked at the barn where we did equine therapy, every one of them had

01:30:01.020 themselves been a client there. Wow. I didn't, I didn't know that. Unbelievable shared experience.

01:30:06.580 Like we are all the same at this place. Wow. And isn't there comfort in that, right?

01:30:12.300 Absolutely. How can you be some exception who deserves shame for being something less than

01:30:17.980 perfect when you fully apprehend that reality? It can't be right.

01:30:24.480 You know, you said something a moment ago that made me think of one of my favorite talks. So,

01:30:27.820 you know, you and I, you know, that I'm the biggest fan of David Foster Wallace, this person

01:30:32.100 who I've just, I've just always been kind of so amazed by his insight. I just, you know,

01:30:39.640 here's a guy who was not a trained psychiatrist. He's a writer. And yet his insights into humanity

01:30:46.220 go beyond almost anything. I think you couldn't learn this stuff in a textbook. And, um, you know,

01:30:52.180 I've been asked before, like if you could bring anybody back from the dead, you know, of recent

01:30:56.020 era, right. Who would it be? And I think it would be him. You know, if I could, if I could go back in

01:31:00.500 time and spend a day with anybody, it would probably be with David Foster Wallace. He has a very famous

01:31:06.940 commencement speech from 2005 that he delivered at Kenyon college, uh, titled this is water. And in

01:31:12.800 it, he talks about the fact that we're, I think he, the way he describes it is there's no such thing

01:31:19.060 as atheism. We are all worshiping some God. Do you worship money, power, your body, you know, your

01:31:26.760 physical allure. And he almost makes the case that at least if you pick a God to worship, the harm to

01:31:35.720 you might be less because if it is money you worship, you'll never have enough. If it's power,

01:31:41.360 you worship, you'll never feel strong enough. If it's intellect that you worship, you'll always

01:31:46.760 feel like a fraud. And I remember listening to this for the very first time, which was many years

01:31:52.320 ago and thinking, yeah, I get that. Like, I really get that. Like I, I, I, I know I'm not alone,

01:31:59.820 but I think a lot of people who place their self-worth and their intellect, you think, what if people

01:32:05.480 find out I'm not that smart? Like I'm just a fraud. And you know, it's again, it's just,

01:32:11.720 it just speaks to this entire nature of humanity. And of course the tragedy in the case of David

01:32:17.060 Foster Wallace is that he ends up taking his own life by suicide three years after he gave

01:32:21.700 that talk. Now, totally unrelated. I want to play something for you. So I was actually just

01:32:26.900 listening to this today. I'd know I hadn't come across this before, but this is an interview

01:32:29.980 with David Foster Wallace and Terry Gross from NPR. I believe it was 97. So it was like a year or

01:32:36.740 two after Infinite Jest came out. So I want to play this for you if I can cue it up on my phone

01:32:41.520 here. Cause I thought of you as soon as I heard this, right? Okay, here we go. You know, I really

01:32:45.860 like the way you talk, you write about a pleasure and how difficult it can be to, to really achieve.

01:32:53.740 Um, you write about pleasure in the Infinite Jest, your, your, your latest novel. And I'm thinking,

01:33:01.260 you know, one of the things relating to that in Infinite Jest, uh, one of the characters finds

01:33:05.920 that, that marijuana is marijuana is no longer a pleasurable experience. It just makes them terribly

01:33:10.560 self-conscious and therefore anxious. And I'm wondering what happens to you when you do something

01:33:15.880 that's supposed to give you pleasure and that just makes you uncomfortable or anxious.

01:33:20.400 Boy, I'm not really even sure how to respond to that. Look, a lot of the impetus for writing

01:33:27.680 Infinite Jest was just the fact that, that I was about 30 and I had a lot of friends who

01:33:32.280 were about 30 and we'd all, you know, been grotesquely overeducated and privileged our whole

01:33:37.200 lives and had better healthcare and more money than our parents did. And we were all extraordinarily

01:33:43.460 sad. I think it has something to do with, with being raised in an era when really, um,

01:33:50.400 the ultimate value seems to be, I mean, a successful life is, let's see, you make a lot

01:33:55.440 of money, um, and you have a really attractive spouse, uh, or you get, um, you get infamous

01:34:01.660 or famous in some way so that it's a life where you basically experience as much pleasure as

01:34:06.380 possible, which ends up, which ends up being sort of empty and low calorie. But the reason

01:34:11.900 I don't like talking about it discursively is it sounds very banal and cliche, you know,

01:34:16.420 when you say it out loud that way, believe it or not, this was, this came as something

01:34:20.240 of an epiphany to us at around age 30, sitting around talking about why on earth we were so

01:34:24.740 miserable when we've been so lucky. Well, when did you realize that, uh, all the, all the

01:34:30.620 benefits you had in an educated middle-class life weren't bringing you happiness?

01:34:34.560 Well, look, I guess it, I guess it sort of depends on what, what you mean by happiness. I mean,

01:34:40.860 it's not like we were walking around fingering razor blades or anything like that, but it just

01:34:44.460 sort of seems as if we, we sort of knew how happy our parents were and we would compare our lives

01:34:50.520 with our parents and see that at least on the surface, we're according to the criteria that

01:34:54.400 the culture lays down for a successful, happy life. We were actually doing better than a lot of

01:34:58.480 them were. And so why on earth were we so miserable? I don't think I, you know, I don't

01:35:04.220 mean to suggest that, that it was, you know, a state of constant clinical depression or that we all

01:35:08.560 felt that we were supposed to be blissfully happy all the time. There was just, um, I have a very

01:35:13.700 weird and amateur sense that, that an enormous part of like my generation and the generation right

01:35:18.760 after mine is just an extremely sad sort of lost generation, which when you think about the material

01:35:24.460 comforts and the political freedoms that we enjoy is just strange. I could listen to interviews with

01:35:29.980 David, well, indefinitely, but it's interesting that I came across that today for the first time.

01:35:35.100 Again, I don't know how I missed it today, just, just literally today. And, um, you know, I knew that

01:35:41.140 we were going to be speaking this evening and I thought, you know, I'm going to put Paul on the spot

01:35:44.600 and play that for him and ask him not just to explain that, but even more broadly, what the heck is

01:35:51.840 going on? Right? Why? I mean, let's take a step back. It would seem to me that suicide is the least

01:36:00.740 likely cause of demise for our species, just given our evolution. I mean, it seems to me that we are

01:36:06.860 wired to survive. So in other words, and again, I'm certainly not being critical of suicide. I'm,

01:36:13.060 I have nothing but empathy for obviously anyone who commits suicide. It strikes me as the saddest thing

01:36:19.220 ever, but I don't understand it. Like I don't, I don't understand how it can be so prevalent

01:36:23.620 when we must be so wired to not want it, when we must be so wired to want to survive. And it,

01:36:32.620 I remember very recently, I remember having this thought probably in the wake of, of the, you know,

01:36:38.160 these high profile suicides, which, you know, I remember when Robin Williams killed himself,

01:36:42.500 the same sort of thoughts go through my mind, which is, did our ancestors do this? Is suicide

01:36:48.080 a symptom of our civilization? Is what David Foster Wallace is talking about here, even comparing

01:36:54.720 ourselves to one generation ago, are we less happy or do we just have greater expectations?

01:37:00.980 And those expectations being unmet is what makes us feel unhappier.

01:37:05.040 Again, it's, I mean, it's so complicated and I want to start off by saying like, by, by no means do I,

01:37:12.500 attest to any expertise, right? Or, or a right to offer an opinion that's more valuable than anyone

01:37:19.840 else's. But the thoughts that occur to me is, you know, we're wired to survive as long as we see

01:37:27.120 meaning in survival. And I am not here trying to glorify struggle, but there is something around

01:37:34.840 struggle that gives meaning. You know, people who struggle to survive in war zones, you know,

01:37:40.760 are people who see meaning in survival. They see meaning in what they're fighting for. You know,

01:37:47.240 Viktor Frankl writing an immense search for meaning, right? It's like, if you don't have meaning,

01:37:52.940 then why would you struggle to survive? And it's not a lengthy extrapolation of that to say,

01:38:00.080 if you don't have meaning, why are you interested in surviving?

01:38:03.860 Have you read Tribe by Sebastian Younger?

01:38:06.740 I have not. I probably should. And I've been told several times I should. I just haven't

01:38:10.800 gotten to it yet. But I, but I, I mean, I understand, I think something,

01:38:13.840 I think this is sort of part of what he's getting at. Yeah.

01:38:16.180 Yeah. That, that, that we like, okay. For example, like I really, I mean, it's interesting,

01:38:21.400 right? Given what I do for a living that like, I don't know how I value myself. I don't know how to

01:38:27.500 value myself and whether I'm succeeding or not. I mean, is that what my family of origin thinks of

01:38:34.220 me? How much time I spend with them? I've certainly ranged far afield and left the place I grew up in

01:38:41.000 order to achieve things and do things. Like, should I be proud of that? If I, have I, you know, not been

01:38:47.200 a good friend or family member to the people I grew up with? Do I value myself by what other people

01:38:53.980 think of me? How many patients I feel I can help? The health of my relationship with the people I

01:39:00.300 love as adults, the kind of parent I am, kind of husband I am, how much money I have, how many,

01:39:07.180 you know, people want me to offer some expert opinion on something. It's like, I have no idea.

01:39:11.320 I have no idea whatsoever. And it occurs to me sometimes that I'll bet all those ancestors of

01:39:17.580 mine really knew how to value themselves. Like, are the sheep safe? Is there a roof over our heads?

01:39:21.940 Yes. And again, I mean, I'm not glorifying the lack of opportunity, you know, the lack of like

01:39:27.040 basic medical care, right? In generations past. But there is something very, very concrete about

01:39:33.180 that. And when people go through struggle, when we often most worry about them is when the struggle

01:39:38.980 is over. When people feel like, oh, I made it through that. You know, whatever that was, maybe that

01:39:44.040 was chemotherapy. Maybe that was the death of someone close to them. Maybe it was a particularly

01:39:50.200 trying time at home or in their career. You know, people will persevere when they see meaning in

01:39:55.640 their struggle. But when there's not a struggle, the struggle is over, or we're not particularly

01:40:00.980 struggling for something, what does, how do you value yourself? And I think often we don't even know

01:40:06.440 enough to answer the question. I mean, like you and I have never sat down and talked about this.

01:40:11.140 We spent a lot of time together. We've been close for two decades. Like, why do we not talk about

01:40:14.860 this? In part because we don't understand how meaningful it is, right? So we value ourselves

01:40:20.380 by persevering. But that's endless, right? I mean, as you said, there's always more of things to have.

01:40:27.140 So at a certain point, that can seem very, very hollow. And I think that in many ways,

01:40:33.100 that's the disease of the modern civilization. I mean, even when we grew up, the time of the Cold

01:40:38.100 War, I mean, I grew up with this very like clear idea. And I get that, you know, it was a simplistic

01:40:42.960 idea, right? The West is good. And, you know, we fight for democracy. And, you know, the Soviets

01:40:48.680 are bad. And look, I get that this is not the case. I mean, I've spent time in Russia and in

01:40:53.340 Eastern Europe. And like, I get like, the people are people. But it was an easy, it was an easier

01:40:58.340 algorithm to grow up in. And it instilled faith in America and faith in what we stood for. And as we

01:41:06.600 get older and wiser, we all learn about the hypocrisy of life and the truths of life and, you know,

01:41:12.600 learning of, you know, I remember learning about like things that America had done in Central

01:41:16.840 America, right? And, you know, and feeling a sense of like, oh, my God, like, we are not this force

01:41:20.860 of good. And it doesn't mean that we were a force of evil. It means that the situation was far more

01:41:26.000 complicated. But it provided a heuristic. And even that was something that kind of made sense. I mean,

01:41:31.100 I can remember the Olympics coming around and like feeling this sense of, okay, like it's, are we going

01:41:37.160 to beat the East Germans and the Russians? And, you know, there was just a sense of dichotomization,

01:41:41.520 which is why people who want to control other people know to make struggle, right? You make an

01:41:47.440 enemy. So this is all a double edged sword. And you can make meaning in ways that is not valid,

01:41:53.940 right? You say, okay, those people are bad, let's go kill them. I mean, that's a way of making meaning

01:41:58.020 for people. It's not an honest or a moral way. But what I'm trying to point out is that we see value to

01:42:05.340 our struggle if we see meaning. And I think that for a long time, even as people got wisdom and

01:42:12.740 greater knowledge of things like hypocrisy, and they're really the truth of the world,

01:42:17.040 I think we still saw greater meaning. And I'm not so sure that we do as much now. You know, I think

01:42:23.380 that things are much more nebulous. And then it's hard to get around the idea of, well, do I really

01:42:28.900 matter? You know, what am I doing? What am I standing for? What's really the difference? And I just

01:42:34.580 think, look, that can happen at any time. And probably it did happen, you know, back, you

01:42:39.260 know, when everybody lived in caves. But I think we're much, much more susceptible to it because

01:42:43.640 we don't have some sense of community, right? We don't have a sense of community. I mean,

01:42:47.940 it's interesting, right? People have written about why do human beings, when we're so focused

01:42:52.960 on survival, right? There's a lot of people that will spontaneously risk their life for somebody

01:42:57.840 else, jump into the river, right? Try and rescue somebody. Why do we do that? I think the answer

01:43:03.100 is because in that moment, we see very clearly defined, a very lucid meaning to our actions.

01:43:08.920 And I think that that's, like, very, very profound. And I think it's the opposite. I see that as the

01:43:15.420 opposite of suicide, which is, I mean, it can happen for a lot of reasons, right? People can be very

01:43:20.720 depressed and, you know, the delusions of lack of worth. I mean, again, it's very complicated. I'm not

01:43:25.640 trying to trivialize it. But I think a lot of what promotes suicide is the absence of meaning,

01:43:31.460 which I see as the opposite of someone who's taking good care of themselves and maybe wants

01:43:35.960 to stay alive, very much so, but will risk their life to help someone else. That's a focus of

01:43:41.780 meaning, that there's a compelling meaning right now.

01:43:44.040 Right. What parent wouldn't jump in front of a car to push their child out of the way?

01:43:49.280 Right. And a lot of those parents who want to be there for their child would jump in a river for

01:43:53.420 someone else, like, as they see a child. So, you know, it's that just capturing of the attention,

01:43:58.200 like, this is meaningful. Look at this. I will make a difference now, right? And I'm willing

01:44:02.920 to take a chance to do that. And I think it's very, very different than how a lot of people feel,

01:44:08.740 I think, but all socioeconomic demographics. I mean, if you think that, I don't know what the

01:44:13.740 exact numbers are, but, you know, what percentage of people in this country, you know, I was sort of

01:44:19.180 reading the reports around like a $500 unexpected bill, right? And like, just people can't survive that,

01:44:25.580 right? Like, they're not going to get medical care. They're not going to, you know, service the

01:44:29.220 car, and then they can't get to work, or they're not going to, you know, they can't live a life that

01:44:34.160 we would consider acceptable, you know, with an unexpected, in the grand scheme of things,

01:44:39.520 otherwise surmountable amount of money that's needed. And, you know, I think that's a very,

01:44:45.040 very hard way to live that, that, you know, a lot of what we're talking about is,

01:44:50.000 Foster Wallace was talking about of like, well, we have so much opportunity, we don't have to

01:44:53.300 struggle, right? But if you're struggling to put food on the table, and, you know, you know that if

01:44:58.620 somebody needs to go to the emergency room, how the hell are you going to get enough food?

01:45:02.840 That's a struggle, it's very hard to see meaning in. That's a struggle that seems like denigration.

01:45:08.020 I mean, it's, you're going to struggle.

01:45:10.280 Whereas it's different, our ancestors, if they had to struggle through a famine or drought,

01:45:15.100 I mean, it was just, that was just, that was the gods, right? That was nature, that was the season,

01:45:19.960 and they were in it together. Right. And it's not like you were struggling because of the drought,

01:45:24.240 but your neighbor was, you know, rolling around in a, you know, whatever the equivalent of the

01:45:29.180 Ferrari would be. Right. And I think, I mean, it's so, you know, it's so in a way baffling,

01:45:35.040 right? That, look, I hate the thought that how many people are there that a 500 yard medical bill,

01:45:39.460 and they can't put food on the table. You know, yet, you know, I'm fortunate to live in relative

01:45:44.500 plenty compared to that, but I don't know how to bridge that gap. There's not a sense of,

01:45:49.960 community, and sure, like, we can donate, and we can do things for free, and all of this, but,

01:45:54.120 but, like, we don't have a sense of what does that mean, and how do we change that, and how do we make

01:45:59.160 that better? And my sense is that I actually feel quite insecure. Do I have enough if my kids need

01:46:04.160 something, right? Do I have enough if, you know, things really go south, and it becomes unsafe to

01:46:10.020 live here? I have a sense of vulnerability. What does someone feel like who has the same sense of

01:46:16.800 conscientiousness towards the people that they love through $500 can sink? So, I'm not trying to

01:46:22.740 make specific points about that, but really to point out what I view as just a tremendous sense

01:46:29.160 of isolation, and it's not a disease of plenty. I mean, I think it's a disease that affect people

01:46:34.340 who have enough, and that affects people who don't have enough even worse, and that lack of shared sense

01:46:39.880 of community, a lack of being in it together, you know, it may sound hokey, but, but through most of

01:46:45.140 life, that's how people lived. I mean, unfortunately, Paul, everything you just said doesn't really seem

01:46:49.580 to offer a foreseeable remedy to this, and if today we're seeing 30% more suicide, or thereabouts, than we

01:46:59.420 were a couple of decades ago, is there anything on the horizon that's going to curb that trend, or is

01:47:07.180 suicide going to become an increasingly greater part of our humanity, and perhaps worse yet, for every

01:47:17.040 person who actually kills themselves, what if there's nine people who are in that category we

01:47:22.640 described earlier as basically functionally dead? And then you think of the effect of the suicide.

01:47:27.160 Exactly. What's the trickle-down effect of that on the next generation? I do think that there are ways

01:47:32.500 to make this better, and I feel strongly and passionately about them. You and I have talked

01:47:37.560 about some of them, and I'm fortunate to have dialogues with people who can really kind of help

01:47:43.720 make a difference in this way. Again, do I know that it's the right way? No, I don't, but it's the best I

01:47:48.180 can think of, which is, you know, it's a simplification, right? We don't have places where people can come

01:47:56.180 together and have shared experience and have a sense of community. Like, what about places where

01:48:04.380 there are people to facilitate human connection and education, even about the basics of what's

01:48:09.560 going on inside of people, and there's a couple comfortable couches and a pot of coffee. These are

01:48:14.060 not expensive things. I mean, you think about in this country, what things cost. Go get an x-ray,

01:48:19.920 it's $700, right? I mean, we've built up so much cost around things, so much liability, so much

01:48:27.480 that prevents really basic, simple things from happening, and we've lost the basics of community

01:48:33.980 support. I mean, there was an era before you and I were practicing medicine, certainly before I was

01:48:39.700 a psychiatrist, right, where there were community support centers, and they were publicly funded, and

01:48:45.000 they didn't cost very much money in the grand scheme of things, and there were places where people

01:48:49.460 who are pretty mentally ill could go for support. Not only do we not have places like that for you

01:48:54.360 and me and the other people who are managing to function, we don't even have those places for

01:48:59.340 people who are really mentally ill. So we don't provide a nidus in the community for the basics of

01:49:05.780 what I would call psychoeducation, and for the ability to do that in a way that really links human

01:49:11.660 beings and looks at what their needs are. You know, how many times have I seen where a person who, if

01:49:18.700 they overdose or they slit their wrists, right, that the world will pay a million dollars for their

01:49:24.840 intensive care unit stay. But what we will not do is buy them the $300 alternator that could fix the

01:49:33.960 car that allows them to not have to go back to the abusive household situation that leads to the

01:49:39.840 suicide attempt that society pays a million dollars for. Like, a lot of what we do is utterly absurd

01:49:47.120 as a society. It's not even cost efficient. If you took out care and concern for human beings and

01:49:53.960 said, look, let's factor that out, it's absurd. You know, it's like, you know, you'll throw away

01:49:59.140 $10,000 to get a dollar. And that's how we operate as a society. And I think that if we're going to

01:50:06.380 survive our own progress, you know, as a species or certainly in this country, we're going to do

01:50:12.260 things that are around mutuality and community support. And we're going to do things where

01:50:17.120 people who have something can help people who don't. And maybe that's $300 to buy an alternator.

01:50:23.720 You know, maybe it's not that. Maybe it's somebody who doesn't have the education or resources that you

01:50:30.200 or I might have who share some wisdom that they've learned. I mean, it's not just, oh, the people who

01:50:36.440 have do things for the people who haven't. I mean, we all have and we all don't have. And I'm not trying

01:50:41.640 to trivialize the struggles of people who can't put food on the table. Like, we need to work so that

01:50:48.460 that's not the case. And it's actually not that hard to do. But at the same time, we need to recognize

01:50:53.880 that some of the things that we've done through Drive to separate us make us lonely and isolate

01:51:00.560 us. And I think you and I have as many emotional needs and as many struggles that can be soothed by

01:51:07.640 other people as somebody does who might identify as underprivileged or ill, right? Like I said,

01:51:14.400 we're all in it together. But we work so damn hard to separate ourselves. And you end up with

01:51:21.200 maybe not everybody, but most people feeling some sense of loneliness and isolation.

01:51:27.340 It's, uh, there's no easy antidote. You and I have spoken a lot about

01:51:31.060 the idea of creating a tribe. We, we, we think about the seven of us from medical school and it was

01:51:39.500 like, we had this fantasy, like, what if we all could get jobs, not only in the same city, but like

01:51:46.140 we could all live on the same block and we could all just sort of be one family. The kids could go

01:51:53.700 between the homes interchangeably. Meals were consumed interchangeably. Like it was just, you

01:52:00.640 know, creating a tribe in the way that it would have existed 10,000 years ago. But, you know, we

01:52:06.220 still put our shirts and ties on in the morning and go to work, but you, but there's this closeness

01:52:10.900 that seems so distant right now. I mean, you and I are so fortunate because of the geography in which

01:52:17.520 we work that at least a few times a month, we get to have a meal together, but that is harder and

01:52:23.660 harder to do with friends. And I suspect that there are many people who go months, if not years,

01:52:30.040 without really getting to do that because it's just too busy. There's just too much to do. That's

01:52:36.140 mission critical. Right. And there again is the automaticity of a value system that, you know,

01:52:41.440 I struggle very much with how many people do I care about who've been really important in my life.

01:52:46.760 And I think an eye in there is that we exchange two emails a year. I mean, why, right? Why is,

01:52:54.580 why do I not take two weeks every three months and go around and see people I care about? Like,

01:53:00.720 why don't we do that? And I think, again, I think I do think that all paths, I mean,

01:53:05.620 even not all paths, but I think the majority of these paths lead back to trauma, that there's a

01:53:10.700 way in which I feel too insecure to do that. I'll step away from my work and maybe I won't be as good

01:53:16.020 at my work or opportunities will pass me by and I'll earn less. And all these things that actually

01:53:22.480 make no sense whatsoever, but it's not as if I can stop them from driving me. And, and, and I don't want

01:53:29.500 to sound futile about that. I mean, I think like there are things that we can do. Right. And I

01:53:34.500 think like you and I do some things, um, that we might not have done even a couple of years ago.

01:53:40.120 Right. But do I think that we do enough of it? No, I don't. And you think about those other people

01:53:44.860 that, you know, we were in school with and care very much about, and then think about people who

01:53:49.440 weren't like sort of in that group that we know well and knew well and care very much about how much do

01:53:55.240 we really see of them. Right. Almost nothing. Right. And, you know, it's a strange thing to,

01:54:01.920 to have so much automaticity to our value system. And we might think, well, I never decided I don't

01:54:08.000 value that. And I value, you know, another day of work overseeing those people. Okay. I never

01:54:12.980 actually put words to it, but I've decided it right because I act in accordance with that decision.

01:54:17.620 And yes, I'd like to be healthier about those things. Um, but I think the answer is as a,

01:54:24.380 is as a community that we start teaching ourselves and teaching people how to be healthier about those

01:54:29.660 things, because you can still be very good at what you do. Very successful move society ahead. All

01:54:34.580 these things that we want to do if we achieve and have a better sense of balance and mutuality,

01:54:39.180 which is why a lot of these fantasies, and it's what kids say in kindergarten to their best friend,

01:54:44.620 we're going to live next door to one another, right? Okay. We're still saying that in medical

01:54:48.140 school after we're fricking 45 year old dudes. And we still say the same thing, right? Because

01:54:53.880 I think we still have the same needs within us and we still have the same fears of loneliness and

01:54:59.580 isolation and struggle in isolation. So the fantasy is still there. I think because there's meaning to

01:55:06.000 the fantasy, it's a recurrent fantasy in a lot of people that tells us something about our

01:55:11.520 desperate sense of isolation. And I have no basis to back this up and it probably is politically

01:55:16.340 incorrect to say this, but I actually don't give a shit. You can be married. You can have the perfect

01:55:21.340 spouse. You can have all that stuff going on. But, and I say this only being able to speak from my

01:55:25.860 vantage point, which is as a male, I think that there are certain needs that can't be met by your spouse.

01:55:33.060 There are certain needs that like, and again, I think my wife doesn't even like hearing that.

01:55:37.020 Like she'd like to believe understandably that every problem I have emotionally can be rectified

01:55:45.500 by discussing it with her. But I do think there's something different that I think there's a,

01:55:51.440 maybe even a degree of vulnerability that exists outside of that relationship. And, or

01:55:55.460 maybe even there's just something gender specific, like a guy needs to be with a guy. Sometimes a girl

01:56:02.300 needs to be with a girl sometimes as far as like truly talking about some of these things. And I,

01:56:07.940 and I think that for many people as they get older, as they have families, as they have kids,

01:56:12.680 as they have careers, they lose sight with those other people. Meaning the woman loses touch with her

01:56:18.820 female friends who I think can offer her something that her husband cannot, even if they're the most

01:56:24.420 well-adjusted couple. And similarly, I mean, I can't tell you the premium I place and the time I get to

01:56:31.500 spend with my male friends. And it's hard because as you said, it often comes at the expense of time

01:56:36.820 with your family. I mean, every minute I'm here in New York right now, you and I are here, we're not

01:56:40.740 with our families. Right. I mean, I, I, I think that that is a human problem. I mean, I think that we,

01:56:47.880 you know, we can, we see it through our own lens, right? But I don't think it's based upon gender,

01:56:53.680 gender, socioeconomic class, sexual orientation. I mean, I think it's a human problem

01:56:58.000 that, that there's a fallacy that says that we're supposed to enter, you know, a committed

01:57:04.860 relationship, which already think about what there are people who, you know, might not be able to do

01:57:11.500 that, right? Might not want to do this. So we're already saying de facto that that's not okay. So

01:57:15.720 think how many people were invalidating already. Then we say, okay, even if you do that, we're going to

01:57:21.280 put so much pressure to be everything to one another, that, that we guarantee almost a sense

01:57:28.780 of a failure or of inadequacy. Why should your lovely, wonderful wife think that she can be

01:57:36.600 everything to you, right? Like that's just not how humans work, but somehow society has told her that.

01:57:41.960 And then it engenders some negative feeling because both you and she being healthy people need

01:57:48.460 a broader set of connections, but we're taught to kind of hunker down and that's what we're supposed

01:57:53.420 to do. And then when we're getting away and we're doing these things with our friends, that there's,

01:57:58.960 there's something about that that seems kind of trivialized because we don't, we don't live in

01:58:05.280 communities where, and look, think about it. I haven't thought about this before. We think about in

01:58:09.600 medical school when we were kind of living in a community and we did spend time, like if we were

01:58:15.820 friends, then I spent time with Jill and you spent time with Brooke. We were in a community. So there

01:58:22.400 was more of a sense of communality. And now we don't have that as much, like that's not the way

01:58:28.840 it's supposed to be in a sense. And then it engenders these unrealistic expectations of self

01:58:34.660 and others. And the question I would most ask about that, I don't know the answer to is like,

01:58:39.340 why don't we continue to live in a, in a communal way? And, and I think that that's some of what,

01:58:45.500 you know, communities offer people, right? Communities that are based around religion or

01:58:50.200 based around shared interests. Those can be very, very good things for people. Of course,

01:58:54.340 like anything else, the other side of that sword is they can, you know, that's, they can be used to

01:58:58.340 create cults and how about like affiliate, right? And people are desperate to affiliate. So, you know,

01:59:03.860 I think if there isn't health and balance, then, you know, we see more of the negative side of

01:59:09.060 things. We don't have enough community affiliation. So there are a lot of people who get caught up in

01:59:13.900 cults or cult-like things, you know, more than we would, more than we necessarily know on the

01:59:19.760 surface, because there are a lot of things like that, that don't get defined as such, or don't get,

01:59:23.640 you know, acknowledged as such. They just don't come to attention, but there's a desperation for

01:59:28.640 connection and for a multiplicity of connection and a variety of connection. And we live in a way

01:59:35.420 often that really makes no sense. There's no reason. Why should one person be everything to

01:59:40.600 one other person? You know, life is more complicated and more interesting and richer than that.

01:59:46.060 Are there any books that you would recommend people read? I mean, I have my sort of list of go-to books

01:59:51.660 that I've suggested to people over time. I certainly hope that anybody who's listening to this that thinks

01:59:57.600 that some trauma in their life has continued to sort of yield its grip around their neck will look

02:00:04.800 into some of these trauma-based treatment facilities and ultimately seek out therapists who themselves

02:00:09.840 are, are well-versed in trauma-based therapy. Again, you don't have to go to an inpatient place to start,

02:00:15.760 but I've since learned the importance of trying to vet therapists to find out who truly understands

02:00:21.840 this. But what other resources, whether it be books or facilities or anything like, I mean,

02:00:27.420 what, what kind of things can we, can we leave people with to think about as they begin to

02:00:32.140 navigate their own path? I mean, like I said, I suspect there's going to be some people for whom

02:00:36.000 this episode scratches a scab a little bit, creates a little bit of bleeding. What do they do now?

02:00:42.340 I think it's so important to take stock of one's inner dialogue. We can say things to ourselves

02:00:49.080 hundreds and hundreds and thousands of times over and never stop and reflect that we're saying it to

02:00:53.580 ourselves. So I think thinking about what's going on inside of us and talking to people that are close

02:01:00.520 to us. I mean, most people have people that they can talk to more openly than they're talking to,

02:01:06.980 and that can be complemented with professionals. I mean, I think anyone who has no problems or issues

02:01:12.580 whatsoever should never have psychotherapy, right? Which is, you know, my way of trying to be clever and

02:01:18.100 saying every damn human on the planet should have psychotherapy, right? Because it's a way of

02:01:23.400 understanding ourselves better. It's a way of being able to commune with someone without feeling

02:01:30.020 the pressure that we're burdening them. Like, you know, personal and professional relationships help

02:01:33.700 us understand each other better. Go to a 12-step meeting helps a person understand oneself better,

02:01:39.120 even for no other reason by the feeling of shared humanity. Some of those things,

02:01:43.360 which may sound kind of basic, I think are just of inordinate importance, inordinate importance of

02:01:49.800 take stock of what's inside of you, connect with people around you. That may sound trite,

02:01:54.560 but most of us are not doing it or not doing nearly enough of it. And in terms of literature

02:01:59.860 or books, I mean, I tend to have very, very few book recommendations. I'll say a couple of the

02:02:06.680 standards that I say when people ask me, I would consider reading Camus' The Plague. You know,

02:02:12.360 the plague is about a city that is afflicted by the plague, but it is also about the afflictions of

02:02:18.340 all of us, that are we all living amidst the plague? And are we all living amidst threat to

02:02:23.280 our life and health and safety? Yes, we are. And I think it's a way of potentially thinking about

02:02:33.000 and framing things inside of us, this feeling often of being beset upon and needing a sense of

02:02:39.020 community and a sense of mutuality that we often don't acknowledge. And I think for that reason,

02:02:43.880 the book is of tremendous value. Somewhat of a very different recommendation is read some short

02:02:49.540 stories by Catherine Mansfield. I think that, yes, Chekhov was a wonderful, brilliant short story

02:02:56.880 writer. But my favorite in terms of evoking the realness of being human, the subtle nuances of

02:03:04.560 human interaction, I think is actually best evoked by Mansfield. And I think if we're searching for

02:03:11.620 a way of identifying with our own humanity, I think those two authors can help us get there.

02:03:17.960 So it's not the most typical literature to recommend. But I think exploring things that great

02:03:24.660 writers have written that help elucidate our humanity is a good thing. If one is trying to gain

02:03:30.880 a greater grasp on what's going on inside of us and what may be really driving us to misery. And I

02:03:37.360 think those things engender compassion. And compassion for self is what can ultimately lead

02:03:42.280 somebody to take that step of getting help, right? As we have to feel like, hey, there's something going

02:03:47.800 on inside of me that I've been hiding and that I feel really ashamed of, that I don't want to feel

02:03:52.500 ashamed of anymore. I don't want to hide anymore. And in general, people won't take that step unless

02:03:57.380 they've engendered some compassion for themselves. Paul, there are so many other things I want to

02:04:03.460 talk about. I'm looking at my little notepad here where I had just scribbled down other things to talk

02:04:08.520 about that. Amazingly, we literally did not get through half of what I wanted to talk about.

02:04:14.940 We didn't get into, you know, the real understanding of distressed tolerance, the completely nuanced,

02:04:21.660 geeky discussions that we have over dinner about all of the different pharmacokinetics of every

02:04:27.080 class of drug and every neurotransmitter. I think the only real remedy for this is we have to do

02:04:33.060 this again. So I think there needs to be a part two of this discussion where we can get into all

02:04:39.220 of these other things. And perhaps between now and then I could try and become less annoyingly

02:04:43.960 long-winded. No, no, no, no, no. So I will all work on that before our next one. Despite the short tenure

02:04:49.440 of this podcast, I've already been given feedback by a few friends who have said, Peter, we are really

02:04:54.640 loving your podcast, but can you shorten it? I would really like to just have a 30-minute podcast.

02:04:59.880 And I've said, honestly, I appreciate your feedback, but that's not what I'm trying to do here.

02:05:05.480 One is I want these conversations to be the conversations that we have. And what we just

02:05:10.760 discussed tonight, the only thing that separates it from a normal discussion is we have these

02:05:15.520 microphones in front of us and we're not eating a meal. Right. I mean, it's very similar to a

02:05:20.400 conversation you and I had three weeks ago while we were sitting around the same table eating really

02:05:25.060 good Indian food. Right. Now, the fact that I'm in the middle of a one-week fast makes that image

02:05:29.300 particularly distressing to me right now. I don't appreciate that, but thank you.

02:05:32.600 Look, I just see part of how I keep myself in business is by causing trauma.

02:05:36.260 Yeah, yeah. You just caused a shit ton of trauma in me by reminding me of that incredible

02:05:41.260 lamb vindaloo that I was eating sitting right where you're sitting now.

02:05:45.660 And I'm not going to have any of it tonight because I'm going to live in sympathy. I'm going to.

02:05:51.860 Well, Paul, I can't thank you enough for all of the insights you've brought to all of these topics

02:05:57.860 from depression, suicide, trauma, shame, all of these things that are, I think, near and dear to

02:06:04.760 our hearts, but more importantly, kind of near and dear to the hearts of pretty much everyone who's

02:06:09.120 listening. I know I said there's a lot more I'd like to get into. I think we should certainly plan to

02:06:15.120 sit down again and talk more about this stuff. I believe that there's a lot here that people can

02:06:20.860 take with them and hopefully at least take some steps that kind of improve the quality of their

02:06:25.880 lives. I've said it before. I will continue to say it. I don't think it makes much sense to fixate on

02:06:33.360 living longer if you can't on some level rectify being happier. And that seems to be, you know,

02:06:41.200 if we talk about diabetes and all these other things being diseases of civilization, there may

02:06:45.280 be no greater disease of civilization than our unhappiness. Yeah. It's probably a good time for

02:06:51.620 me to say, you know, what I truly believe, which is I'm honored that you have had me on here. And I

02:06:57.200 really do mean that. I do think that the things that I have to say from the mental health perspective,

02:07:02.180 not because I'm saying them, but because mental health undergirds, you know, our ability to live good

02:07:08.000 lives are so important. And I think it's a testament to, you know, your sort of relentless

02:07:14.260 drive to understand things better that make a difference to the lives of the people that you

02:07:19.760 take care of, that has you looking at elements of the substructure that people often ignore.

02:07:26.080 So I consider it an honor and a privilege to be on your podcast and to be able to talk about things

02:07:32.720 that I think are really are so important and that are just so often overlooked. So I thank you for

02:07:38.440 the opportunity to get the word out in a way that I hope ultimately helps some people. Thank you.

02:07:44.720 Paul, I have no doubt that it will. Thank you for your generosity of time and insight.

02:07:49.280 You're welcome.

02:07:51.980 You can find all of this information and more at peteratiamd.com forward slash podcast.

02:07:57.080 There you'll find the show notes, readings and links related to this episode. You can also find

02:08:02.340 my blog and the nerd safari at peteratiamd.com. What's a nerd safari you ask? Just click on the

02:08:08.360 link at the top of the site to learn more. Maybe the simplest thing to do is to sign up for my

02:08:12.360 subjectively non lame once a week email, where I'll update you on what I've been up to the most

02:08:17.060 interesting papers I've read and all things related to longevity, science, performance, sleep,

02:08:21.900 etc. On social, you can find me on Twitter, Instagram, and Facebook, all with the ID peteratiamd. But

02:08:28.700 usually Twitter is the best way to reach me to share your questions and comments. Now for the

02:08:32.820 obligatory disclaimer, this podcast is for general informational purposes only and does not constitute

02:08:37.460 the practice of medicine, nursing, or other professional healthcare services, including the

02:08:42.360 giving of medical advice. And note, no doctor patient relationship is formed. The use of this

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02:09:02.460 they have, and should seek the assistance of their healthcare professionals for any such conditions.

02:09:08.040 Lastly, and perhaps most importantly, I take conflicts of interest very seriously. For all of my

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The Peter Attia Drive - September 17, 2018

#15 - Paul Conti, M.D.： trauma, suicide, community, and self-compassion

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