The Peter Attia Drive - #298 ‒ The impact of emotional health on longevity, self-audit strategies, improving well-being, and more

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

00:00:16.540 my website, and my weekly newsletter all focus on the goal of translating the science of longevity

00:00:21.520 into something accessible for everyone. Our goal is to provide the best content in health and

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00:00:53.200 of a subscription. If you want to learn more about the benefits of our premium membership,

00:00:58.020 head over to peteratiyahmd.com forward slash subscribe. My guest this week is Paul Conti.

00:01:06.400 This may be a familiar name to many of you as Paul has been on multiple times and was one of our first

00:01:12.360 guests way back in September 2018, back on episode 15. Paul is a practicing psychiatrist and author of

00:01:19.640 Trauma the Invisible Epidemic, How Trauma Works and How We Can Heal From It. He's a graduate of

00:01:25.100 Stanford University School of Medicine, and he completed his psychiatric training at both Stanford

00:01:30.380 and Harvard, where he was appointed chief resident. He then served on the medical faculty before moving

00:01:35.480 to Portland and founding Pacific Premier Group, a practice focusing on addressing mental health

00:01:40.500 from a trauma-based perspective. In this episode, we speak about emotional health and its

00:01:45.780 relationship to lifespan and health span. Through this, we try to look at the various ways listeners

00:01:52.280 can take an audit of their internal and emotional health, knowing that this is one compartment of

00:01:57.800 health span for which we don't have biomarkers and for which we don't expect an inevitable decline

00:02:03.220 as we age. We cover how emotional health can also increase with age, what drives people and their

00:02:09.440 motivations, happiness and satisfaction as it relates to material possessions, the connection between

00:02:14.980 physical and emotional health, negative self-talk, accepting death and more. We end this conversation

00:02:21.240 speaking about how people can take a first step in improving their emotional health and what people

00:02:27.000 can look for in a therapist if they deem it necessary. So without further delay, please enjoy my conversation

00:02:33.400 with Paul Conte. Paul, so great to see you again. It's never frequent enough. I agree. Thank you.

00:02:46.000 So I don't know, somehow the evolution of my thinking on longevity, I feel more and more drawn to health

00:02:52.020 span over lifespan. And again, not that these are ever mutually exclusive. They're not. And virtually without

00:02:57.620 exception, anything that's enhancing health span is enhancing lifespan. I think it's just a question

00:03:03.380 of focus. And I think when you focus more of your energy on health span, you're getting a lot of those

00:03:09.800 lifespan benefits for free. And you can clearly do a lot of the one-off stuff that is purely lifespan

00:03:16.880 related, like managing your APO-B and cancer screening and things like that. But it's this focus on

00:03:23.020 cognitive health and physical health that get you so much of that lifespan benefit. And of course,

00:03:29.820 you're enjoying the quality of your life. Those two decline quite predictably. And so really what

00:03:35.700 we're trying to do as we age is delay the rate of decline. But then there's this third component of

00:03:42.560 health span, which is emotional health, which is what obviously we're going to speak about in great

00:03:47.960 detail. And what I tell people and what I tell myself when I'm feeling a little depressed about

00:03:52.720 aging is that the thing we have going for us is that's the one that doesn't have to get worse

00:03:58.140 with age. Everything else gets worse with age. You can do quite a bit to mitigate that and reduce

00:04:05.500 the magnitude of the negative derivative, but you're not making it a positive derivative.

00:04:11.960 But this doesn't have to be true for emotional health. I want to ask you just to start in your

00:04:17.100 experience working with people. Is that what you see? Do you see that people generally become

00:04:24.060 happier, more satisfied as they age? Do you think that's the exception? Is it the rule? And I guess

00:04:29.660 as a follow-up to that, how deliberate does one need to be about emotional health to ensure that you

00:04:36.380 can reap what I just said, which is, hey, you could actually be on an increasing curve of emotional health

00:04:42.240 as you age?

00:04:43.280 I think, unfortunately, emotional health often declines as people get older. That is sort of

00:04:50.160 the rule, but it doesn't have to be. I think that that can be the exception and emotional health can

00:04:56.560 improve throughout the lifespan. But there's so many things that we have to be aware of. As you said,

00:05:02.020 does it take intention? Like, yes, we have to really think about how are we taking care of ourselves?

00:05:07.360 How is my emotional health setting the climate for my physical health, my cognitive health, for my

00:05:14.860 happiness? And very, very often we kind of get swept up in this idea that, oh, time is passing and we're

00:05:22.380 getting older and isn't that bad? There's a whole set of societal standards that bias us away from good

00:05:29.920 emotional health as we get older. And I think this idea that it's so sad that we're getting older and we

00:05:36.700 lamented and we talk about how fast time is going. I think that's really a societal construct. It's a

00:05:41.960 social construct that we can change because if we're actively taking care of ourselves, and this

00:05:47.620 means, yes, it means, of course, taking care of our bodies so that we can remain active. It means

00:05:52.640 remaining interested in new things. It means learning. It means keeping an expansive mindset that if we're

00:05:59.340 doing this, we're setting a climate inside of us that is conducive to all these other good things,

00:06:05.260 healthspan, lifespan, cognitive health. But so often we're sort of trying to do that, or we say

00:06:12.020 that we're trying to do that, but we're ignoring the climate that we're living in. And we do have so

00:06:18.420 much more control over that. And I think that's part of the message of healthspan and lifespan is

00:06:24.440 attend to our emotional health, take it very seriously because we're living in it day in, day out,

00:06:29.960 and we've got to step back from our lives often and look at what are we presuming,

00:06:35.260 are we thinking, oh, it's just bad to get older and the jokes and all the dialogue within us is

00:06:40.220 negative? Or can we feel good about getting older, that we have achievements under our belt and we

00:06:45.140 have learning and wisdom that we didn't have before, and we can continue to stay curious and

00:06:50.220 active and get happier and healthier across the lifespan? There's a demographic of people for

00:06:54.940 whom that's absolutely true, and it's wonderful to witness them. They're very, very different than

00:07:00.660 people who are not like that, where you see people aging and they're still bright-eyed engaged in the

00:07:07.040 world, and that doesn't happen by accident. Let's talk about emotional health in the sense of how it

00:07:14.060 fits into healthspan. So when someone asks me to explain what the cognitive component of healthspan is,

00:07:20.280 we can talk about executive function, we can talk about processing speed, we can talk about

00:07:25.520 recall memory. Of course, you can drill down further and further and further into these things,

00:07:30.500 and you can start to paint a pretty comprehensive picture of what cognitive health involves. And you

00:07:36.900 can also do that cognizant of the changes that occur. So Arthur Brooks has written quite eloquently

00:07:43.400 about the transition from fluid intelligence to crystallized intelligence. And so while our fluid

00:07:49.560 intelligence peaked when we met each other, and we've in that regard only become stupider,

00:07:54.920 we've gained other intelligence, this crystallized intelligence that's more experiential and more

00:07:59.900 about pattern recognition. And while we might not have the processing speed we once did, we're

00:08:04.840 intelligent in a different way. Similarly, on the physical side, and I should say one other thing,

00:08:09.300 Paul, we test these things. These are all testable. These are quantifiable things. And while most people

00:08:15.160 don't necessarily do it, it can be done. We do it with our patients. You go to the physical, it's the

00:08:20.240 same way. I could spend the next five hours talking about the nuances of strength, power,

00:08:27.780 explosiveness, cardiorespiratory efficiency, maximum cardiorespiratory, flexibility, balance, all of those

00:08:33.620 things. And yes, we can measure all of those things effectively, and we can track progress and things

00:08:38.300 like that. I kind of have a definition for how I think of emotional health, but I would much rather

00:08:42.880 hear yours. How would you explain the umbrella of a person's emotional health? And then I'll plant the

00:08:52.500 seed, which is where I want to go with that is given that we don't have biomarkers for these things

00:08:58.240 and necessarily tests that we can do. I want to talk about how we can evaluate it.

00:09:03.940 Sure. The way we evaluate it is by looking inside. So then what are we looking for inside? We're trying

00:09:10.640 to understand what's going on in us. You know, when we wake up in the morning, how do we feel about

00:09:16.800 ourselves? How do we feel about life? Are we low-grade afraid? Do we feel on the back foot?

00:09:23.960 There's so much of this going on in us, and then that impacts our self-talk, which is why we may not

00:09:28.580 have biomarkers, but we can look inside, so to speak, by asking the right questions. What do you say to

00:09:35.680 yourself when you're alone? What kind of phrases or mantras seem to repeat over and over? Do you

00:09:42.580 criticize yourself? Do you have a shadow voice within you that is oppressive or that is regretful

00:09:47.740 or that is ashamed? What is going on inside of us is often very opaque to us, even though we're living

00:09:55.600 through that when we then interface with the world. So this idea that if we inquire, if we become curious

00:10:03.400 about ourselves, we learn so much more about what is going on inside of us, and it can guide us towards

00:10:09.240 change. So if a person wakes up and doesn't feel good about waking up or feels afraid or feels ashamed,

00:10:16.060 why is that? What can be done to change that? Because very often the environments inside of us

00:10:21.900 we're not taking good care of. So we, for example, harbor traumas within us that we haven't talked about

00:10:27.940 or process. It's one example. Or we know that we don't feel great, we don't know quite why,

00:10:35.060 and then we're sort of afraid and confused and we move forward. This idea that we should be as

00:10:41.280 interested at what is going on inside of our minds, what is going on inside of us emotionally,

00:10:46.280 as we are about our bodies, even though we have many more markers, biomarkers internal and external to

00:10:52.220 look at physically. And sometimes what I'll see is a person is paying a lot of attention to that,

00:10:58.100 but it's all couched in an emotional climate that is not good and that at times becomes angry and

00:11:06.180 aggressive. Like I'm going to fight aging and I'm not going to let this get the best of me. And that's

00:11:10.940 not a recipe for happiness and health. There's so much acceptance called for. So acceptance of the

00:11:17.920 fact that we're aging. So you're right. When you and I met, we had much greater processing power.

00:11:22.800 That's great. We could sprint better, say. But life isn't a sprint. It was fun to be able to sprint

00:11:28.980 when we could sprint really, really well. But I hope and believe that we're both smarter now,

00:11:34.660 even though if we stop and look at our processing power, we can see the change for the negative.

00:11:40.200 But that's one factor that's negative. I mean, overall, I think and hope that we're wiser and

00:11:45.700 happier. But we have such a bias in us, a salience bias towards the negative.

00:11:50.820 So we look and say, oh, look, I could do so much more before. I could hold so much more in working

00:11:54.740 memory. I was so much faster. Look, I'm getting old. Okay. The trade-off for that of increased

00:11:59.560 intrinsic knowledge, things we know without having to think about it that reside in our unconscious mind,

00:12:04.580 we don't value that as much. And I think if we can get over some of the biases that come from

00:12:09.720 outside of us and then come inside of us, both that our emotional health maybe isn't so

00:12:15.060 important or that there's something that's not so high yield, paying attention to that,

00:12:19.800 or even that it's weak to pay attention to that, instead of seeing that's undergirding

00:12:24.400 everything else that we're doing on top of it, let's pay close attention to that and let's be

00:12:30.120 interested and curious about ourselves. Because that's where really it leads us is to be curious

00:12:35.140 at what is going on inside of me? How is it affecting me? How are all these things I do

00:12:39.700 from morning till night affecting what's inside? And how's what's inside affecting that?

00:12:43.940 Or things I want to change or do differently. Now we become curious and engaged and we want to

00:12:49.620 learn, which is a characteristic of being younger. Many people want to learn and think expansively

00:12:54.180 and are interested in new music and new sights and sounds. And if we can maintain that, that curiosity

00:13:00.080 about ourselves and about the world around us, then we change this really, really big factor that

00:13:05.920 often is working against us and we're not aware of it. By looking at it, we can control it and make it

00:13:11.340 work for us. Where do some of these other things that I think of at least, and certainly others

00:13:17.020 fit into the overall equation? So I'll give you three things that are probably subsets of that.

00:13:22.540 And I kind of want to think about how you integrate them. So one would be something that's talked about

00:13:26.460 a lot, which is sense of purpose. And I think there's so much literature on this in as much as

00:13:31.460 there's literature in this field, which is obviously harder to do this type of work. But you say to a

00:13:35.980 person who's working hard, but down and out, Hey, would your life be better if you won the Powerball

00:13:41.820 today and you never had to work again? And the data are pretty clear that the answer is no. If you

00:13:47.340 didn't have something to do, and it doesn't have to be the job, but if you don't have something to do,

00:13:54.140 if you don't have a purpose, it's very difficult to have an emotional keel that's adequate.

00:14:00.660 So sense of purpose would be something. Another thing would be kind of this idea of satisfaction.

00:14:06.300 So kind of achievement following struggle. And again, I think anybody listening to us right now

00:14:12.580 can relate to that. Achievement with no struggle is not particularly satisfying. Arthur Brooks,

00:14:18.940 again, has talked a lot about this idea that satisfaction is sadly fleeting, but nevertheless,

00:14:24.380 it temporarily provides a positive feeling that is worth reinforcing. And then obviously,

00:14:30.540 what you're, I think, talking a lot about is relationships too. So what is the nature of

00:14:35.060 our relationship to self and then the quality of our relationships with others? What else would

00:14:39.680 you add to this or would you subtract anything from it? I think the first thing I would do is

00:14:44.200 take the extremely important things that you just said and put them under the heading of a generative

00:14:50.360 drive. The field of mental health has long understood that we have drives within us and it has been

00:14:57.120 focused on an assertion or an aggression drive, which makes sense. We have to do things, right,

00:15:02.800 in order to survive, in order to achieve, in order to move ahead. So there's an assertion drive within

00:15:08.840 us. This must be highly, highly preserved. Natural selection must have been ruthlessly selecting for

00:15:17.020 this. The thought would be, and it would be very, very hard to survive without either one of these,

00:15:23.580 especially in an era of human development when one took a significant amount of responsibility for

00:15:29.300 one's own survival. That one had to be assertive. You had to want to impose yourself on the world

00:15:34.280 around you. So assertion or aggression, whatever we want to call that drive, it's a drive to do in the

00:15:40.920 world. And then there's a pleasure drive, which at times has been misunderstood that it's a drive for

00:15:45.920 hedonism. But pleasure comes in all sorts of ways. Pleasure comes from being inside out of the rain.

00:15:51.700 Pleasure comes from being warm and not cold. Pleasure comes from having enough to eat. So

00:15:56.560 pleasure drives us not just through sex and satisfactions that make it more attention, but

00:16:02.940 through relief of pain, through a sense of safety, a sense of security. So we're very, very focused on

00:16:08.420 humans in the field of mental health, which has guided much, not all, of course, of our understanding

00:16:13.460 and our beliefs about ourselves. So we see assertion, we see pleasure, but that ignores

00:16:20.020 the humanity inside of us. If that were true, how differently would we behave? People wouldn't create

00:16:26.900 for the satisfaction of creating something new, or go somewhere new because we don't know what is

00:16:33.780 there. This is humans going deep in the ocean, climbing mountains, going to the moon. There's

00:16:39.100 something else going on in us. And that other thing is the generative drive. And aspects of philosophy

00:16:45.940 and literature and religious studies and psychological studies point us in this direction. But the field of

00:16:52.220 mental health doesn't acknowledge. We want to live and create beyond ourselves. We, for example,

00:17:01.060 may have children, not just so someone may take care of us later on and we perpetuate our genes,

00:17:06.240 but how about for the joy of seeing the children learn and develop and be in the world and see them

00:17:12.860 grow. There are things inside of us that are about creation and are about growth. And when we are in

00:17:20.420 touch with that, when there is an active generative drive, then we are on this path to happiness. This is

00:17:27.280 the way to take care of everything. Emotional health, cognitive health, physical health. It all

00:17:31.540 comes together in some sense. It all naturally comes together if we're approaching life from a

00:17:36.680 healthy place. So to go back to your example of someone who is unhappy, say working, and feels like,

00:17:43.340 oh, I'll be happy if I win the lottery. Why does the data show us that that's not true? Because the

00:17:49.500 presumption there is the generative drive isn't satisfied by either scenario. So if the person is

00:17:55.140 working and they're not happy, then there's something there that could be, would be, probably

00:18:01.180 should be different. Are they enjoying the work that they're doing? Is this what's really inside

00:18:05.640 of them and what they value? Are they doing it just because they feel it pays them more money and they

00:18:09.820 have to make more money? Do they feel that they need to make more money than they're making and now

00:18:13.460 they're unhappy and disappointed? And there's something in their work that's not honoring this

00:18:19.100 ultimately, I believe, greatest human thing to make more than what we are. So the contrast to that

00:18:27.060 is not winning the Powerball. In fact, it's the same thing coming in a different disguise.

00:18:33.080 It is now not honoring the generative drive. There's enough money, but there's nothing coming

00:18:37.400 out of the person that's creative. If someone imagines winning the Powerball and then maybe they'll go

00:18:42.400 back to school and learn something they really wanted to learn, or they'll go do this thing they

00:18:45.700 really wanted to do, or they'll grow a giant garden. If having the money that would come from

00:18:50.340 the lottery win and having the time subserves the generative drive, then that is a good thing.

00:18:56.800 But money alone doesn't provide that. So that's where inquiry could come in. Like,

00:19:02.180 what is going on in this person's life? How are they working? What choices are they making and why?

00:19:06.920 What's inside of them? Do they feel good about what they're doing? Do they want to do something else?

00:19:10.300 We see examples of this so, so often where people are out of accord with themselves and they're

00:19:16.900 unhappy. And then there's a sense of futility about it. I'll get out of this if I win the lottery.

00:19:22.060 And that's not the answer. There are many, many things we can change in our lives. And

00:19:25.460 I mean, you and I know this. How many different things have we each done across the lifespan,

00:19:30.700 some of which we then incorporate going forward, and some of which each of us has decided to move

00:19:35.700 away from? And I think some of that is honoring the generative drive of if I'm not feeling a certain

00:19:42.000 way when I'm getting up in the morning, like, what is it that I need to do differently to feel that way?

00:19:46.900 Paul, do you believe, I know this is not knowable, but what is your belief around the innate nature of

00:19:53.040 the strength of the generative drive in an individual? So if you look at a thousand children

00:19:58.260 that are born across various cultures, socioeconomic status, different races, look at all factors,

00:20:05.620 and what is your view on the innate strength of that drive? Do you believe it's relatively preserved

00:20:12.500 and that early life experiences shape it as adults?

00:20:16.700 I think there's nature and nurture aspects. It's wide ranging across humans. But if we really step back

00:20:24.320 within a relatively narrow band, when we come in close, we see that the drive varies so much across

00:20:31.380 people. But how we see that is also a factor of what the person has been through. Has a person been

00:20:39.000 taught and told that their generative drive was worth something? Did their parents delight in things that

00:20:46.260 were of interest to them? Did they feel nurtured or did they feel denigrated? Did they feel

00:20:51.920 thought of as less than by the society around them for whatever reasons people do, whether it's race,

00:20:57.920 religion, gender identity, sexual orientation? They're things that push towards people feeling

00:21:02.700 less than or feeling less capable. The good things in the world aren't out there for them.

00:21:07.960 So one aspect is genetic, that we probably inherit a whole set of factors that we don't understand

00:21:13.500 that lead with a predisposition. Someone may be relatively satisfied with a level of life that might

00:21:20.680 make someone else bored and needing something very, very different. But then our life experience,

00:21:25.000 probably through psychological factors, epigenetic factors, even factors of inflammation running

00:21:30.260 around in us and how that makes us feel physically based upon what's going on in us emotionally.

00:21:35.020 Now we have a whole bunch of factors that feed back to the natural genetics and impact where am I at

00:21:40.860 any point in time? Which is why we can intervene and we can help people to feel more of a generative

00:21:47.320 drive. If a person feels disillusioned and disheartened, maybe there's some desire in me

00:21:51.860 to do something different or better, but why? It's not going to happen anyway, or I'll end up feeling

00:21:56.020 disappointed and worse afterwards. Can we help people be in the world in a way that better honors

00:22:01.680 what's inside of them and tells them they can understand and harness and change their lives in

00:22:07.120 ways that bring them greater happiness? So I think we all have a generative drive. It varies a lot

00:22:12.600 among humans, but if we really step back and we look, we're probably selected to be within a relatively

00:22:17.580 narrow range. Although as we get closer, that range seems wider and wider. And what we can do is

00:22:24.000 help ourselves to optimize whatever the range of genetic drive is within us, because it's not set at a

00:22:31.860 certain place. And through things like giving people opportunity or encouragement when there was none

00:22:37.200 before, helping people with their mental health or their physical health, helping people with basic

00:22:42.380 needs, basic needs of encouragement that often doesn't happen in, for example, our education

00:22:46.940 systems, then we can help people be at the best place they can be. And I think that's the leader of

00:22:53.600 all else. If we help the generative drive be as best it can be, where we want to be in the world and

00:22:59.560 we want to see and understand and create whatever that may be, whether it's a garden or it's a company or

00:23:06.380 it's a cure for cancer. If we help ourselves to live as best we can, then the rest of the aspects

00:23:13.860 of our health will follow. I don't know anyone with a really strong generative drive who's engaged in the

00:23:19.540 world who isn't also interested in taking care of themselves. This comes along with feeling that we

00:23:24.840 can be the best we can be in the world around us. Maybe I'm not understanding it correctly, but

00:23:29.520 sometimes when I think of a strong generative drive, I think of a person who is striving so much,

00:23:35.360 who is so productive in the eyes of the world. They're running three companies, they're successful

00:23:42.840 by every metric you would have, but they're actually not taking care of themselves. They're

00:23:47.780 working so hard that they're not taking care of themselves. That seems a little bit at odds with

00:23:51.520 what you just said. Or have I misunderstood generative drive and I'm now talking about a

00:23:57.180 pathologic state or a state that is harmful? Achievement is not the measure of the generative drive.

00:24:04.280 So there are people who are phenomenally successful in the eyes of the outside world and running three

00:24:09.200 companies and they feel great about what they're doing. They have great relationships with people

00:24:15.440 around them. They're thinking as they're doing. They're taking pride in moving forward businesses

00:24:22.140 or ideas in ways that wouldn't be happening without them. And there's an engagement in life and

00:24:26.700 they feel productive. They feel worthwhile. They wake up with a good feeling. But there are people

00:24:34.580 who look the same from the outside and are driven by shame or fear or previous deprivation that there

00:24:41.340 can never be enough so that what you have can't be taken away from you. There are people who are

00:24:47.000 laboring under those fears, often from early childhood experiences. And from the outside,

00:24:52.060 they look very, very productive and successful. But on the inside, things are very threadbare or

00:24:58.160 they're filled with fear. Whereas you can see a person who from the outside world is not doing very

00:25:03.660 much or coming and going from a routine job, but they're growing a beautiful garden in their backyard

00:25:08.680 and they are filled with the generative drive and they are happy. What we see from the outside tells us

00:25:15.440 something. But it's just data. It's like any other data. Data outside of context is not of value and in fact

00:25:22.760 becomes misleading. And I see this at times in people who are very successful who don't understand why they are

00:25:29.180 not happy because they are very successful. So it should back map that they must be successful. But what really

00:25:35.820 is going on, they may have a very strong assertion or aggression drive because they're running away from

00:25:41.320 something, their own fears about themselves or shame or prior poverty or whatever it may be.

00:25:46.260 That drive is very, very strong. Their enjoyment, their ability to take pleasure in all of it is very,

00:25:51.840 very low. And then the generative drive inside of them is at a much lower level than it seems to be

00:25:58.680 from the outside.

00:26:00.640 That's very helpful. And it actually, I think, probably answers part of my next question, which is,

00:26:06.900 would it be your belief, again, knowing that this is not knowable, that everyone is at least from a

00:26:13.760 nature perspective born with the capacity for enough generative drive to be happy later in life?

00:26:20.980 I think the answer to that is yes. I think, as you commented a little while ago, we're selected

00:26:25.660 for that because that is adaptive, high levels of generative drive. This is the person who in

00:26:32.220 hunter-gatherer days would say, the food is a little bit sparse. There's a mountain over there.

00:26:36.920 We don't know what's on the other side of it. Maybe we should check. Or maybe we should do things

00:26:42.320 differently so that we're better prepared for what may come next. The generative drive and the

00:26:49.220 enthusiasm and the joy inside people when that is being realized does pull humanity forward.

00:26:55.260 I think Leon Trotsky said that the locomotive of history is war. And I would beg to differ

00:27:01.860 with Trotsky. I think war and the aggression driven by human envy and destructive capacity

00:27:10.100 is the opposite. It's not the locomotive of history. It pushes history backwards.

00:27:15.760 And what is actually the locomotive of history is the generative drive within us as human beings

00:27:20.860 and our ability to realize it. This is why people learn and create.

00:27:23.840 Imagine Mendeleev in front of the periodic table and the joy of putting, wait a second,

00:27:29.060 I see a pattern here and figuring it all out. There is a joy in creation, whether it's watching

00:27:33.780 a child or they can be watching something grow or discovering something. This is the locomotive

00:27:39.140 of history. But we pay so little attention to it inside of us, even the idea of valuing ourselves

00:27:46.140 by what we see from the outside, by things that we feel bring us prestige. And we know that

00:27:52.460 that doesn't make happiness. So we've kind of gotten lost a little bit and a little bit away

00:27:58.000 from what our core humanity is telling us is we want to feel worthwhile. And we want to be interested

00:28:03.420 in things around us. And we want to be sort of delighted by new knowledge and new experience.

00:28:08.400 And when people carry this through the lifespan, going back to where we started, these are people

00:28:12.980 who are happy and who are taking care of themselves and who age well and who don't fear death.

00:28:19.440 That's also another part of it is when people are living through the generative drive, they're

00:28:24.240 taking care of themselves in mind and body and emotion. They don't find they're afraid

00:28:28.720 of death. It's not that people want to die, but they want to stay alive because they're

00:28:32.360 healthy and happy. But there's a difference between that kind of enthusiasm and fear.

00:28:37.600 And I think that is remarkable. We should look very closely at who are people who are not

00:28:41.580 fearing death. And we see that they are often in very good balance. The generative drive

00:28:46.960 is being honored and the assertion within them and the ability to feel pleasure and satisfaction,

00:28:52.140 these are all well-balanced. And then they're in places where they can find some peacefulness

00:28:56.560 and some reflective capacity and some ability to feel contentment and delight in the world

00:29:03.460 around them. I mean, we see this and these are happy people. And we know that is not tied

00:29:08.480 to the things we might think it's tied to, like wealth, for example.

00:29:13.540 So how can a person begin that examination? I think what you said is very insightful, which

00:29:19.680 is from the outside, these can be indistinguishable. You can have an individual who looks like they

00:29:27.840 are doing remarkably well. Again, by any metric, I don't just mean financially, but I mean in terms

00:29:34.860 of actual achievement, but it could be fueled by fear, by anger, by insecurity, by any of these

00:29:44.160 other things. And you can have an individual who's achieving the same things or frankly less,

00:29:50.440 but it's coming from this generative place. So if an individual listening says, hey, how can I

00:29:56.980 take this first diagnostic step and evaluate my own drive? What would you say to them?

00:30:05.320 The first thing to do is to look inside oneself. How do I feel? I talk a lot about a life narrative

00:30:12.020 and a person could just start writing. You can start talking with someone. You can start

00:30:15.880 introspecting that there are ways of taking stock of what is going on inside of me. Am I being kind

00:30:21.800 to myself? What's the voice inside of me saying to me? Do I feel good about any of this? Is any of

00:30:28.100 this what I want? Let's stop there for St. Paul, because that's not an easy question to necessarily

00:30:34.020 answer. I want to dig into this because it can be very difficult to answer that at a deep level

00:30:40.960 because sometimes the superficial answer is so obvious. If you have everything, if you have

00:30:46.120 material success, your knee-jerk answer would be, of course, this is what I want. How do you go

00:30:52.220 deeper into that question to what you're talking about, which is the look inside?

00:30:56.560 Use more specific tools. So what do you say to yourself when you're alone? Is there something

00:31:03.360 that you say to yourself over and over? If you make a mistake, what do you say to yourself

00:31:07.740 then? Is there an urge in you to be helpful to other people when you see them around you?

00:31:14.980 If someone stumbles in front of you, do you feel like you want to move forward to help that person?

00:31:19.220 These are the ways in. These are the ways to give us answers about how we feel about ourselves.

00:31:26.240 There was a period of time, seven, eight years ago, where I would, for some period, a week or so,

00:31:32.900 would see people who had very, very high levels of success, that from the outside looked as if they

00:31:39.200 must be happy. And when I would stop doing that, I came back and I would do clinical work on a unit

00:31:47.180 that takes care of people who don't have insurance, many of whom are indigent, not all,

00:31:53.140 who have drug and alcohol problems. So the opposite end of the socioeconomic spectrum,

00:31:59.260 I swear to you that this is true. I could find no difference in overall happiness between the two

00:32:06.760 groups. So someone who looked to have it all would feel, if I don't have that next achievement,

00:32:12.300 it all goes away. So the person isn't owning what they have earned for themselves. And this is a

00:32:17.660 theme inside of me. So the person may have made a lot of money and now they don't have to worry about

00:32:22.440 being in need, or they may have achieved at their chosen art form, but they're so afraid that if the

00:32:28.360 next thing doesn't go right, it'll all be taken away or they'll feel ashamed of themselves. This goes

00:32:33.280 on a lot in people who are high achieving. It's like, what have I done for myself lately? And if I

00:32:38.500 haven't done something good enough, I can't feel good enough about myself. There is so much of that.

00:32:44.240 Whereas I could see people who from the outside literally had nothing, who would be saying, you

00:32:50.040 know, when I get out of here, I'm going to do it differently. I'm going to do it better. I'm going

00:32:54.060 to go see this person I really miss who is helpful to me. I'm going to get a job. I'm going to keep

00:32:58.840 myself away from what got me in here in the first place. And they might have an enjoyable story or

00:33:04.260 memory to say. I remember one point meeting someone who was living behind a bush under bad

00:33:09.160 conditions, who was far, far happier than the vast majority of people I had seen over the previous

00:33:15.380 several days. The truth is, we are often running from something or trying to achieve something that

00:33:21.660 makes us safe in the world. And all of a sudden, we're going to feel better about ourselves. And what

00:33:25.660 we really need to do is honor that we are human. And what is going on inside of us is so important.

00:33:32.020 If we are willing to look at that, we're willing to ask the questions, what do I say to myself? How

00:33:36.480 do I feel about myself versus other people? Do I feel like a fraud? Am I afraid everything will be

00:33:40.720 taken away from me? Every time I drop something, do I say, what an idiot, you know, inside of myself,

00:33:45.900 like what is going on inside of me? Do I feel like I have an openness of spirit to new things or people

00:33:51.560 who are different from me? Like we can ask ourselves these questions, but we have to stop feeling that

00:33:58.460 what we adorn ourselves with is what brings us happiness. Then we can get to this owning what is

00:34:03.460 ours. So that person who is going to try and put a roof over their head when they leave can own what's

00:34:10.000 theirs, which is the tenacity to have what survived behind the bush, survived and lived in that way and

00:34:17.380 maintained a good spirit. And often these are people who are helpful to other people and are looking out

00:34:22.380 for people around them. Like that is something to feel so good about as you strive for what comes

00:34:28.420 next. Just as someone who has worked and learned and studied could feel good about the achievements

00:34:33.960 they have or someone who goes to a difficult job that doesn't provide them with satisfaction that they

00:34:39.840 feel is backbreaking labor and underpaid, but they go and do that and they take home a salary that

00:34:46.740 supports a family and puts a roof over people's heads. Feel proud of that. When we don't feel

00:34:52.220 good about ourselves, often we are out of kilter with the generative drive within us. That is

00:34:57.480 absolutely a part of what makes people unhappy. But also coming along with that is not owning

00:35:04.340 what is ours. And how many people who've raised families, done things that are so impressive from

00:35:10.120 the outside, have told me over the years that, oh, they're not worth anything. They didn't make

00:35:14.180 enough money. They didn't do this. They didn't do that. And it's not what matters. It is not what

00:35:18.900 matters within us. It is being the best that we can be in honoring the drive inside of us to live

00:35:25.880 and to create. How would you make the case to somebody who's listening to this and says,

00:35:30.900 Paul, I get what you're saying, but there's no way that if I had to choose between those two extremes,

00:35:37.520 meaning I live behind a bush, but I have some sort of happiness, but I have nothing,

00:35:43.740 no material possessions, no status in society versus I could be incredibly successful in the

00:35:51.180 eyes of society and with it have all of the comforts that come from that success, all of the

00:35:57.900 wealth. But you'll tell me that I'm unhappy. Someone listening to us might not be able to even wrap their

00:36:02.660 head around what you're saying because they might be right somewhere in the middle. They're not living

00:36:06.480 on the street, but they're struggling and they believe that their struggle is because they don't

00:36:12.220 have something greater or even they acknowledge it and say, yeah, but if I had to choose between

00:36:17.800 those two, I'd rather have all the comfort of the world materially and be miserable. It's a silly

00:36:24.120 question, but how would you make the case to them that a, it's not a zero sum game and that's a false

00:36:28.160 choice. So we'll come back to that. But more importantly, even in that extreme choice, why is that not the

00:36:32.900 wise choice? I would say get to know people in both categories better if you're in the middle,

00:36:39.000 because I know what I would choose. I mean, I would absolutely choose that person who doesn't

00:36:43.340 have any material possessions. If I were making the choice for myself, like the selfish choice

00:36:48.540 is to choose that person. I don't want to be the other person because I know that's not happy. I see

00:36:53.460 where that goes. I see where the dissatisfaction leads and I don't want that. I would much rather

00:36:59.720 have within me the spirit that makes me feel like I can do something. I can make some change because

00:37:06.440 we all need the basic minimum in order to have some safety and satisfaction, like a roof over our

00:37:13.100 head, enough to eat. But oftentimes if you give a person a little bit of help, they can go off and do

00:37:19.600 that. If I were that person getting some help so that maybe now I can move my life forward, I would

00:37:27.020 feel an enthusiasm about that. I can make things better. I can have the minimum that I need. And

00:37:33.200 from there, what is it that I choose to build? When we look at measures of satisfaction, societies

00:37:39.220 even today who are by and large hunter-gatherer societies or the societies that we from the outside

00:37:44.820 think have nothing are often happier than we are. So like there's your proof. There is your proof.

00:37:50.420 So I think as a society, we have so much plenty that we can look after people better. I always say

00:37:57.420 we live in a society that runs ahead so quickly that we're always trampling people along the way.

00:38:04.140 And one, it's just not right to do. And two, any of us can be in that group of people who

00:38:09.520 has something really difficult happen to them, was up against something really, really big,

00:38:14.520 and then something else really, really big, and gets to a place where like we need a helping hand

00:38:19.820 up. And any of us could be that person or someone we love could be that person. And even if that

00:38:26.520 weren't the case, it's just not right. And even if that weren't the case, it's not even economically

00:38:32.420 efficient. Help people to be productive members of society. That's important economically. And of

00:38:39.740 course, beyond economics is the human part that matters, but even just the dollars and cents of it

00:38:44.060 tells us, help people up when they need help. We can do more for people to give them an opportunity

00:38:51.940 to make a life for themselves that can feel productive and contain happiness within it.

00:38:57.840 And if we do this for all of us, we give all of us an opportunity to have the generative drive within

00:39:06.640 us realized, as that may be for us, someone who's very interested in academic learning and

00:39:13.580 success may think, look, I like that. I like when I get an accolade. I like when I learn something.

00:39:17.740 And then maybe they go off and they start building businesses and they feel great about that. Like,

00:39:21.680 that's wonderful. That is wonderful if that's what that person feels good about.

00:39:25.780 There are also people who live good, productive lives and they're good neighbors to the people

00:39:30.520 around them. And they take care of children if they've chosen to be responsible for children.

00:39:35.140 These aren't people who should feel any less good about themselves. And the irony in the world is

00:39:40.240 that often what I see are both groups of people are not feeling good about themselves. They're not

00:39:45.360 earning what is theirs. The person who went off and studied and created and can't feel good about

00:39:49.720 the wealth they generated that now may be good for people around them. And they don't feel good

00:39:53.940 about that. Or the people who struggled and worked and made good lives for themselves don't feel

00:39:59.140 that they have enough. I see this as coming along with this idea about aging, that, oh, we should feel

00:40:03.880 so bad about getting old. And, oh, we should feel so bad about whatever we can identify in ourselves

00:40:08.800 that isn't what we think it should be if we look from the outside. There is a real simplicity in just

00:40:15.820 sitting with ourselves and introspecting or sitting with someone that we're talking to or writing with

00:40:21.780 a pen or being in a therapy room of, let me think about me. Because the truth is, all of us are so

00:40:29.360 different as to be really and truly unique. So, if we take ourselves out of how we try and tether

00:40:35.840 ourselves to all the shoulds around us and say, let's talk about your life. And let's talk about

00:40:41.540 what your experience of life has been, your experience of being in the world and trying to

00:40:47.220 have some healthy control over a world that's difficult to control. Let's talk about that.

00:40:52.340 And it's those discussions that lead people to interesting decisions. Sometimes they're decisions to

00:40:56.820 leave a very high-paying job for a lower-paying job, but then the depression goes away or the

00:41:01.760 substance use goes away. Sometimes it's a decision to strive for more that leads a person ultimately

00:41:07.160 to achieve external measures of success. But we don't know what that is. We don't know what that is.

00:41:14.160 But if we start thinking about it and talking about it, we also go back to the basics of how are you

00:41:18.420 taking care of your body? It's going to be very difficult to feel good if one is not taking care of the

00:41:23.260 basics of their physical function. We get down to the first principles, physical health, the things

00:41:28.480 that contribute to lifespan, healthspan, cognitive health, and emotional health. But we have to go

00:41:34.140 back to the first principles of like, who are you? And let's talk about your story. Because that

00:41:39.060 understanding is what leads to the next decisions. And the next decisions are not obvious from where we

00:41:44.740 stand now.

00:41:46.240 How positive in terms of its predictive value would the following be? And again, I'm still thinking

00:41:50.620 through this as almost a self-audit tool. If a person ostensibly recognizes that they are not

00:41:56.980 taking care of their physical health, okay, they're drinking too much, smoking, using substances in an

00:42:04.300 unhealthy way, eating too much, not exercising, all of these things. If a person can recognize

00:42:10.520 objectively that those things are true, and that's a generally pretty easy thing to recognize,

00:42:15.440 what is the PPV, the positive predictive value of that sign that says there is something

00:42:19.960 unhealthy going on in me emotionally?

00:42:23.440 Recognizing the sign?

00:42:24.520 If those signs are present, the sort of physical, not doing the things to make yourself the best

00:42:30.920 version of yourself physically, let's assume that that's easy to recognize. How likely is it to then

00:42:36.700 be predictive of the fact that you're emotionally unhealthy?

00:42:42.140 Oh, very, very high. Very, very high predictive value. Because think about what's the link between

00:42:47.160 the two. It doesn't feel good to get up every day and not feel good. It doesn't feel good to know that

00:42:52.500 one is unhealthy and energy levels are low, or it doesn't feel good to look at oneself in the mirror

00:42:57.240 and say, I could, would, should be healthy, right? Or to not be able to keep up with one's kids or

00:43:02.600 whatever it is that goes on inside of us that makes us know that. If that's going on, something isn't

00:43:08.920 aligned well within us. What is the reason for that? Oh, I have to work to do this, this, and this,

00:43:13.320 so I don't have time to take care of myself. Or I've got to be in this job I hate. I'm so stressed.

00:43:18.420 We have all these reasons, but there aren't good reasons. This is what we have. Our bodies and our

00:43:24.020 minds are what we have. So the idea that we can just push that aside and not pay attention to it,

00:43:31.660 like can't be right. It cannot be right to not pay enough care and attention to everything that we

00:43:39.620 have as we move forward. So the key is the curiosity to link the two. So there's a high

00:43:47.300 positive predictive value that there is something emotionally then out of balance, if we want to

00:43:52.180 look at it that way, or something in the mental health realm, whatever it may be. But whether or

00:43:56.640 not good comes of that is the link of curiosity. It's amazing, Paul, because that's such a common

00:44:03.960 phenotype. For all of us, I include myself in this category. There are absolutely things that I do.

00:44:10.760 For me, it's clearly overindulging in food often. Even when I'm saying to myself, Peter, you don't need

00:44:17.040 to be eating this extra helping of dessert or whatever. How do I think about that in a way to

00:44:21.960 not overanalyze this or overinterpret it? How do you decide if my overeating is actually a canary in the

00:44:30.480 coal mine that says, hey, there's something going on inside of you emotionally? And my wife and I will

00:44:36.360 talk about this all the time. She'll be like, you are really emotionally eating right now. And I think

00:44:40.440 we talk about that a lot. I think we understand sort of what that means. She's like, you're so stressed

00:44:45.340 out. Get out of the freaking pantry. You've been walking back in here every 20 minutes and you're elbow

00:44:51.260 deep in the Pringles. What's going on? Is there pathology there? Is that sometimes an okay coping

00:44:56.960 strategy? Like I want to be careful not to kind of demonize everything, but at the same time,

00:45:01.100 I want to be able to use this as signs. Because again, I'm coming back to this idea of, man,

00:45:07.280 when it comes to this domain of health, we don't have biomarkers. We don't have scans that give us

00:45:13.220 answers, blood tests, tests that you can do with objective measurements. I'm searching for other ways

00:45:21.100 to gain an insight into how do I at least start asking questions to get myself help.

00:45:28.380 In the scenario you gave where it's a subject of conversation, like, hey, you're doing that,

00:45:33.040 you're stressed, you're emotionally eating, and we kind of know there's something there.

00:45:36.600 But a lot of times, a place to start is, are we overmanaging ourselves? Every now and then,

00:45:41.380 like a little bit of indulgence is okay. So let's make sure that it's not that that we're criticizing,

00:45:46.100 that we're actually recognizing something that we don't need a biomarker for. Look,

00:45:51.640 when I am very stressed, I am eating in ways I don't want to be, and it soothes me a little bit

00:45:58.980 at the moment, and then I feel worse about it, and I got to go do something to make up for it. Like,

00:46:03.860 that's not good. That is face validity. That's just very clearly not good. So then what we can do

00:46:11.880 and often do is just simply perpetuate that, to recognize that, and it goes no further.

00:46:16.720 And then we continue to do it, as opposed to saying, whoa, this is the place for curiosity.

00:46:22.360 That's interesting. What is different about the feeling inside of you if you eat because you're

00:46:27.720 hungry, or you eat because you're stressed? Can you recognize that difference? Maybe you can if

00:46:33.120 you're paying attention to it. A lot of people can. And if not, what's the context around? You can

00:46:38.800 have an idea of what's going on inside of you, and then it fits into this human thing that we do,

00:46:46.720 which is short-term gratification at the expense of something that in the long term is negative.

00:46:54.720 This is why when we were back in medical school, people were not very interested in studying addiction.

00:47:00.720 And the thought was that addiction was separate from other mental health things,

00:47:04.880 and it was people who were doing something they shouldn't and then weren't able to stop. And it

00:47:10.040 was a very, I thought, denigrating and disinterested approach. It is so different now because what I

00:47:17.960 think the field has come to recognize is that these addiction mechanisms, it's going on in all of us all

00:47:24.060 the time. The short-term soothing of a little bit of food that isn't healthy for you at the expense of

00:47:30.820 you feeling badly about yourself in the longer term is part of that same cycle. It's the same brain

00:47:36.060 machinery that is getting harnessed so that we over-prioritize the short-term at the expense of

00:47:43.040 the long-term while looking away from the fact that we are doing that. And if we become curious,

00:47:49.520 why is it? What crests inside of you that you, a person who's very good at looking at the long-term

00:47:55.360 and foregoing immediate gratification and all of that, would say, I'm going to soothe this right now

00:47:59.400 with food? If we look at that, the thought would be, we've got to be able to do something about

00:48:04.400 that. You've done much harder things than to realize, oh, there's an emotion inside of me,

00:48:09.440 like, wait, let me go look at, what is that? What is that emotion? Where is it coming from?

00:48:13.080 And maybe you can't stop the emotion in the moment, but it might tell you, hey, this thing in my life

00:48:17.340 should be a little bit different. Or it might say, I crest like this with relative frequency. Is this okay?

00:48:23.260 Can I take care of myself? Because sometimes it's harder answers too that the answer might be,

00:48:27.860 well, a person should do less. The answer isn't keep doing everything that you're doing

00:48:31.620 and don't have these emotions that crest in certain ways. The answer might be, why are you doing all

00:48:36.240 the things that you're doing? And again, I'm not saying this is the case for you, but we need to

00:48:39.200 all look at this. What is going on inside of me that something is cresting and all of a sudden I

00:48:43.520 prioritize the short term and I don't look at that. And this can be the beginning of 30 sessions of

00:48:49.080 weekly therapy with a person of talking about this paradigm within us of how are we doing this for

00:48:54.860 all sorts of things in life? What might we be rationalizing about our choices, personal and

00:49:01.060 professional? How are we taking care of ourselves? What's the climate inside of us? Because when a

00:49:06.000 person seems to be taking care of themselves from the outside, and maybe it is, you can see from the

00:49:10.540 outside, but they're so frustrated on the inside or they're so afraid or they're so overly managing

00:49:17.140 themselves to make up for something, then we don't necessarily see that that keeps them healthy.

00:49:22.360 There may be a higher inflammatory state that increases risk of cardiovascular disease,

00:49:27.120 for example, or of autoimmune phenomenon. We know this happens. So we have to be curious about

00:49:33.260 ourselves and it is amazing what we hide from ourselves. We go through life hiding so much of

00:49:39.500 what is going on inside of us from ourselves in the service of maintaining some direction we've decided

00:49:46.280 was important. I've got to go do that. I've got to go achieve that. And then we put these blinders

00:49:51.700 on ourselves and we don't look. Does this make sense for me? Am I being the best person that I can

00:49:56.800 be? What's the whole set of priorities in my life, personal and professional, self-care about other

00:50:03.920 people that you care about, about achievement? Am I balancing all of this right? And it's remarkable

00:50:09.320 how little we inquire of ourselves about our own unhappiness or markers of our own

00:50:17.460 unhappiness, even like excessive emotional eating. It may not be the determinant of absolute misery for

00:50:23.580 a person, but like there's something going on there that's not happy. That's not in alignment with

00:50:28.040 oneself. I think there's this continuum from what we just talked about, which is people that are

00:50:34.480 from the outside. It's obvious that they're not taking care of themselves. And again, the patterns here

00:50:39.960 are many. It could be just a straight up across the board. I don't sleep well. I don't exercise.

00:50:45.520 I don't eat well. I drink to excess. And in those situations, I guess it becomes pretty obvious to

00:50:52.220 someone on the outside. Hey, there's something going on here that you're acting in a manner that

00:50:57.240 is harmful to yourself. We should explore why. Then you have kind of the intermittent example.

00:51:03.100 I talk about using myself as an example of, hey, for the most part, you're taking reasonable care of

00:51:07.940 yourself. But then you really have these breakout moments where you're soothing something,

00:51:12.600 some stress with a maladaptive behavior. And then, of course, you have probably where I think

00:51:19.600 I used to live. And I think there are a lot of people, though not nearly as many, who also live

00:51:23.940 here, which is the overmanagement, which is you're going to be perfect. You're going to be,

00:51:30.420 by any objective measure, you're going to have it perfectly dialed in with respect to your health.

00:51:35.820 You're going to eat like a robot, exercise like a robot, sleep like a robot, etc. That's probably a

00:51:42.040 harder one to get people to look inside and see, isn't it? And if you were talking to somebody like

00:51:48.920 that and somebody watching us who might be that person, how would you help them come to realize

00:51:55.120 that while on the surface that looks really good and it looks like they're doing everything so well

00:52:01.820 that they clearly must be doing this from a place of health, how would you at least challenge the

00:52:07.060 thinking on that?

00:52:08.440 One route of approach is the old sort of Freudian way of seeing this, which is no less valid just

00:52:12.960 because it's old. And the old Freudians didn't get everything right, but boy, they really got some

00:52:18.140 things right. And they thought of this as what they thought of as living in the ego. It wasn't the

00:52:23.840 modern idea of ego. It's like that's a person at their best, at their most self-aware. And it's not

00:52:29.440 easy to live in the ego, right? Like we have to think about ourselves in order to be self-aware,

00:52:33.580 in order to be aware that we're not aware of everything. So it's this idea that as best I can,

00:52:39.520 like I understand myself and what's going on inside of me and what my hopes and fears are and what I

00:52:44.560 want and what I have achieved and what I'm afraid of. It's all within us and the idea is from there,

00:52:50.360 then we can healthily control our lives. But we're keeping two other aspects of ourselves in balance.

00:52:56.680 And what they thought of as the id was the desire for immediate gratification.

00:53:01.440 I feel bad now, where's the food? There's that part of us. I want what I want and I want it now.

00:53:06.200 There's that part of us on one side and the other side is what they call the super ego,

00:53:10.500 the part that manages us, that says, you want what you want when you want now, but like,

00:53:13.880 that's not okay. Keep yourself in check. And there are these parts of us that manage us and that want

00:53:20.040 indulgence and that it's us, the whole us in the middle that has to recognize all that and keep it all

00:53:25.780 in balance. And what we see is that part they called the super ego, the self-management often

00:53:30.860 gets very, in the circumstances you're talking about, gains supremacy over the others and that's

00:53:37.100 not good. That's how we internalize the persecutor. There have been times, it's a parallel to this,

00:53:44.020 but this is a true story where someone who I haven't seen before who is in my office and I'm

00:53:48.120 getting to know them and they're telling me about being really persecuted by someone who says,

00:53:53.500 you can't do anything and you're not worth anything. And they're describing and talking

00:53:57.020 about all of this. And I'm thinking, okay, okay, let's think about where is this person living?

00:54:01.900 How can we get them out of there? And then I learn that other person has been dead for seven years.

00:54:07.840 But the person took into themselves the persecutor, the you're not good enough.

00:54:12.380 Now, that can come from outside of us. And that's very striking when it comes from outside of us.

00:54:18.680 And it does often. It's not striking and rare, it's striking and relatively frequent.

00:54:22.680 It can also come inside of us. Now, there's probably some external modeling, but it can come

00:54:27.420 inside of us where I decide the way I'm going to be good enough is I'm going to berate myself and

00:54:33.380 torment myself until I'm perfect. Perfect isn't just the enemy of good enough. Perfect is really the

00:54:39.480 enemy of everything that's not misery. No one is perfect. Nothing is perfect. When we're over

00:54:46.000 managing ourselves, that's what we're telling ourselves. This super ego part of us, if we want

00:54:50.880 to call it that, is always looking at us. What are you doing wrong? What's not right? What's not good

00:54:55.380 enough? And that becomes a very harsh, critical voice. And often we don't know that that's inside

00:55:01.200 of us. I tell the story at times of a person who was very underachieving given this person's level

00:55:05.940 of intelligence and other things that they had done. And they were so below in role performance,

00:55:12.140 what one might have expected. And I couldn't understand them. I started asking questions

00:55:15.920 and I'm trying to understand. And then I realized this person loved music. So I said, what music

00:55:21.320 are you listening to? I'd learned the person was taking these long drives to go to some awful job

00:55:26.540 that they didn't have to have. And they weren't listening to music in the car. We're not listening

00:55:32.140 to be. So now we have a clue. Why is this person loves music? Is a music aficionado? Because

00:55:38.780 without the music, the person could uninhibited on all that long drive to the job and all the drive

00:55:46.040 back, tell them what garbage they were, what a loser they were. This was going on the whole time. In fact,

00:55:54.120 the person was going to a farther away job than they could have gone to, to have more time

00:55:59.420 to criticize and berate themselves. And it's an extreme circumstance, but it's not that uncommon

00:56:06.300 that we see things like this. And that person needed to stop that in order to increase role

00:56:13.440 performance, which is vastly higher than it was before. It's remarkably different than it was before.

00:56:19.880 But the search for perfectionism through self-criticism, because when you explore that,

00:56:24.420 the person wasn't aware that they were being sadistic to themselves. No one says that when

00:56:29.620 you say, what's really going on there? That actually I'm being sadistic to myself. This is

00:56:34.060 what I need to do. This is how I keep myself moving forward. This is how I might get myself going to

00:56:38.480 any job. No, it's not. No, this is how you're keeping yourself down. But those voices inside of us

00:56:45.500 are very powerful. And yes, I've given a couple really strong examples, but they're not outlying

00:56:51.340 examples where, oh, they're so different from what goes on in us. I think they're examples to

00:56:55.220 elucidate what very often is going on inside of us, where we are trying to manage ourselves,

00:57:00.540 whether we're being perfectionist about it, or we are afraid, or we are ashamed in ways that are

00:57:07.520 very, very harmful to us. Because I think that kind of self-talk destroys motivation, destroys

00:57:12.000 confidence, increases levels of inflammatory markers, increases risk of illness. There's so much

00:57:18.160 bad that comes of that, but that's inside of a lot of us. That is inside. And if a person

00:57:22.900 stops now and think- Is this person aware of it?

00:57:24.620 Yes, they stop and think. Is that inside of you? It's remarkable how many people stop and think and

00:57:28.980 yeah, I'm in the shower in the morning telling myself of all the things you better not mess up

00:57:33.460 today, or what did you do wrong yesterday? There's so much of it inside of us.

00:57:38.960 Did you have to prime this particular individual to get them to recognize consciously what they were

00:57:44.700 doing? Oh, sure. Because we had been talking for a while. So clearly the person wasn't aware of it.

00:57:51.280 We had to, through a process of inquiry, we had to stumble across something that didn't make sense.

00:57:56.220 So when I learned this person loves music, I just got that in my head. It's what this person does.

00:58:00.060 They listen to music when they're home and they have this really long drive. And then I learned

00:58:03.820 they're not listening to music. Then I become curious about that. Now, maybe there was another reason

00:58:08.320 they like looking out the window. I don't know, but it's like, wait, wait, let's inquire there.

00:58:11.800 So that when I point that out, you're taking a longer drive and not doing something you enjoy

00:58:18.300 in order to punish yourself. Well, now we have curiosity about that. How can you not be curious

00:58:24.400 about that if someone you've gone to for help is drawing your attention to that? And that's often

00:58:31.500 how we start changing things, even within myself and in my own therapy of realizing there was such a

00:58:36.220 negative, critical voice all the time. And it wasn't needed to help me move forward with life

00:58:43.880 at some point in time, trying to control things around me and feeling afraid of not being successful

00:58:49.020 or not being good enough leads me to start managing myself pretty closely. But then I stopped managing

00:58:54.580 myself where like when I was in high school, I could do three sports over the course of the year and

00:58:59.300 still maintain academics. That was good to learn how to do that and balance fun and work.

00:59:03.720 But then it gets to be too much of a good thing. And now I'm going to manage myself by being so

00:59:09.000 critical and telling myself all the things that could go wrong and knowing how I'll feel and making

00:59:12.900 damn sure that nothing is any less than perfect, which of course it is. And now I feel worse about

00:59:17.240 myself. And that in me, like in many people was why I could look successful from the outside,

00:59:23.600 but for a long, long time was really not happy and depressed and ashamed of things and feeling in

00:59:30.420 ways I had to then through my own work get out of me. And it's, it's experiences like this that helped

00:59:34.680 me have insights. I think, you know, one doesn't need to go through something to know that others

00:59:39.400 are, but having been through a lot of that, you know, I've learned what you see on the outside

00:59:44.200 doesn't tell you at all what's going on on the inside. Like seeing a beautiful home doesn't tell

00:59:49.140 you what's going on on the inside of it. Who are the people? How are they behaving? Are they healthy?

00:59:53.380 It's not that it's irrelevant. There's a beautiful home on the outside, but it's also not irrelevant

00:59:58.800 if let's say there is a home that doesn't look so good on the outside. There could be so much

01:00:03.940 beauty inside of it and so much happiness inside of it. And we know those things are true. And you

01:00:09.280 and I both been around life enough to know that those things are true. So let's bring that to the

01:00:14.440 forefront. If we know those things are true, let's look inside of us with the same curiosity and not

01:00:20.160 having to hide from ourselves what we might find there. I wrote a little bit about this in the book

01:00:25.240 about the discovery of the inner voice. And in my case, it was so startling. I say startling not

01:00:31.700 because I had an inner monologue, which I suppose many of us do, but in terms of how aggressive and

01:00:37.360 the Bobby Knight voice. But it was remarkable to me. I just had a breakthrough one day at PCS where all of

01:00:45.180 that came out that that's what was actually happening. It's a little sad to me to realize

01:00:51.040 that whatever 47 years of my life went by, probably 45 of them with that voice and yet no

01:00:59.000 recognition of it. And why that is frightening to me is it tells me there have to be a lot of other

01:01:04.720 people out there with potentially as awful a voice in their head. They might be listening to us now

01:01:11.860 thinking, yeah, that would be awful. And yet they have it and they don't recognize it.

01:01:16.660 Right. If your experience of it normalizes it, and also if you have an emotional investment on

01:01:23.020 some level that this voice is causing you to behave and achieve in ways that let you feel good enough

01:01:29.460 about yourself, and even then you don't feel good enough about yourself, so you're really afraid of

01:01:32.960 feeling worse, then it gains almost a buy. We don't go and look at that. It just gets a pass.

01:01:37.840 That happens all the time. It's so automatic within us, just as there are people who say around 20

01:01:44.840 years of age can have schizophrenia that they didn't have before, and they're hearing voices

01:01:49.480 inside of them. And it's only till years later that they realize that's not normal, because they

01:01:56.040 had an experience of now hearing voices inside of them, and they don't know that that's not normal.

01:02:01.140 Like even something we would think about that's so different than what most people are experiencing,

01:02:05.500 but it's not different from what you're experiencing if you're experiencing it,

01:02:09.540 and it's come about in a way that didn't have a marker that told us that it was not healthy.

01:02:14.820 There's a common theme to what we're talking about, which is introspection, curiosity of like,

01:02:19.280 wow, there could be things going on inside of me that are wildly unhelpful to the things I'm trying

01:02:25.740 to achieve, like better health span and lifespan, or better emotional health. They're wildly

01:02:30.440 counterproductive, and they're just going on on the surface. Like they're hiding.

01:02:34.080 There they are waving a flag, and I'm not paying any attention to it. So it is curiosity about

01:02:40.340 ourselves. Like how do I work? What is going on inside of me that makes all the difference? And

01:02:46.340 when we start thinking about that, we become aware of it. That's when we can change. Because

01:02:51.760 you described feeling all this all at once. But that's how change happens in people.

01:02:57.260 There's a great Hemingway quote, which I'm paraphrasing incorrectly, which was,

01:03:00.980 change happens incredibly slowly, and then very quickly.

01:03:05.240 Right. And if you think about quantal leaps, or you and I both mathematics people, like asymptotic

01:03:10.920 functions, what we're getting at is discontinuity. That even, I think this is true on all levels,

01:03:18.500 down from like quantum physics through to astrophysics. You see that we are only here

01:03:24.360 because we are in these eddy pools of counter-entropy, where instead of everything

01:03:28.680 dividing and dispersing, like it does in the vast majority of the universe, there are these places

01:03:34.100 where, oh, certain forces go the other way. Now there's not things coming apart, but coming

01:03:38.300 together. And so whether we're looking at the biggest levels, or we're looking at the smallest

01:03:42.540 levels, the way that things work inside of us is that there are processes of understanding and

01:03:50.780 change that are rare or infrequent, but that we can bring to the surface by looking in the right

01:03:59.640 place. If you look all over the universe, most of what you see is no life. But if you look in the

01:04:04.280 right places, where those forces of coming together are more than coming apart, then you see, oh,

01:04:10.060 there's something that's happening there. The same way inside of us, if we're looking where things are

01:04:15.660 happening, then we can gain understandings that happen very, very quickly, just as in mathematical

01:04:22.020 functions or quantum leaps. These things are discontinuous. So when you develop, I think this

01:04:28.440 will be my thought about that. When you have a curiosity about yourself that leads you to now do

01:04:32.540 something where you're thinking about yourself, and you're thinking about yourself with the help of

01:04:36.860 other people outside of you, and you've engendered this across time, and now you go do something that's

01:04:42.160 intensive, then all of a sudden something becomes clear to you. And you see, oh, I'm now interested

01:04:49.280 in this. And now you start to do all the things that you do when you're interested in things like,

01:04:54.220 hmm, why is this here? How is this developed? How is this serving me? How might this be working

01:04:58.820 against me? And now you can change. Now you can change that when before you couldn't change it.

01:05:05.120 Now, yes, change happens slowly. It's slow, slow, slow, slow, but then it happens fast.

01:05:09.940 So you do a lot of work on yourself to get to that point where the change can happen,

01:05:15.300 which I think is true. Again, these are human, and maybe these are principles of existence.

01:05:20.100 Same with physical health. This person works out and works out, and they don't immediately notice

01:05:23.920 linear change. So you have to have faith that the work you're doing is going to get you there.

01:05:29.420 And lo and behold, it does. And that's how these really big things inside of us.

01:05:34.240 What am I saying to myself? Is there a running narrative inside of myself? Is someone else's voice

01:05:39.500 inside of me? These happen to us, and it's amazing that we often just don't know it.

01:05:45.780 Then isn't it more likely that we're going to choose the short-term soothing in the light of

01:05:50.080 that? Then of course, just get some soothing on board, whether it's Pringles, or it's a drug,

01:05:54.220 or it's whatever it may be. We're more likely to choose short-term soothing because we're afraid,

01:05:59.640 and we're out of control, and we're berating ourselves. It's like, whoa, whoa, let's just bring

01:06:03.420 some peace and understanding to this equation, and then things will change for the better,

01:06:08.700 even if you have to change things for the better. Make change.

01:06:12.640 Yeah, I'll tell you a funny story that happened today. These things occur on a daily basis,

01:06:17.500 so I get a daily reminder of this, and it amazes me. So I was shaving today, and then I went to grab

01:06:23.960 a brand new bottle of aftershave. So this Nivea big glass bottle of aftershave, same thing I've been

01:06:29.780 using for 25 years, and this is the first time this has ever happened, Paul. I went to grab the

01:06:37.180 bottle, and I opened it, and as I was dumping it in my hand, maybe because it's so cold today,

01:06:43.060 it was harder to get out, and somehow the bottle dropped, and it landed on the floor, and it's a glass

01:06:49.040 bottle, and it shattered. So now you've got glass and aftershave on the floor, and in moments

01:06:57.160 like that, I'm always now paying attention to, because there's no one around for me to talk to.

01:07:01.760 I'm not going to like yell out loud or anything, and the only thought I had was, oh, let's make sure

01:07:09.800 you don't step on the glass. Looks like there's no glass over there, so let's just walk over there.

01:07:15.800 Do you have another bottle? Because you're not going to want to reach down on the floor and

01:07:19.260 mop some of that up, because there's probably glass in it. Okay, found another bottle, away we go.

01:07:24.480 And I remember thinking a minute later, wow, what a different conversation that would have been

01:07:29.780 five years ago. I mean, that would have been a three-minute internal lashing of you incompetent,

01:07:40.080 non-attentive piece of shit. What? How could you possibly drop that? But again, the thing that I

01:07:49.100 gravitate towards is the ability to start paying attention, to just listen to that voice. And again,

01:07:56.540 I've talked a lot about the exercise that I used to do that, which was suggested by Katie

01:08:02.040 and by another therapist at PCS, which was the recording. For anyone who has not heard that,

01:08:07.660 I think it is worth, even if one person listening to this has not heard this story, I think it's worth

01:08:11.380 repeating, which is I was instructed as I was leaving PCS to take my phone out every time I made

01:08:18.240 a mistake or fell short by whatever metric and to speak out loud audibly and record the way I would

01:08:27.120 speak to my best friend if he had made the same mistake. So if my best friend had just dropped the

01:08:34.160 aftershave, I wouldn't yell at him and call him a piece of shit. I would say, are you okay? Those are

01:08:40.560 really small pieces of glass there. Let's not step on them. And while that now is a very easy thing

01:08:46.020 to do, it took months of recording those. I still have a number of these recordings, believe it or not,

01:08:53.140 which I would then forward to Katie each time. It's amusing to note how strained they were at the

01:08:59.580 beginning as I had to learn a new language. The, well, you know, hope you're okay. It's okay.

01:09:10.560 Okay. Now, of course it's very natural. So again, I highlight that to say that was a technique that

01:09:16.240 worked for me, incredibly powerful. But most of all, I think the moral of that story is malleable.

01:09:23.900 When this exercise was suggested to me, I did it because I was at rock bottom. And when you're in

01:09:28.640 rock bottom, you don't really have a lot of negotiating power. You can't say that's a dumb

01:09:32.380 idea because it's sort of like, well, how's the current one working out for you? I don't think I

01:09:37.120 actually expected it to work. And I thought if this is ever going to work, it's going to take 40

01:09:41.040 more years because that's how much we're overwriting. Why do you think it took, I mean,

01:09:46.940 I'm not exaggerating, Paul, it took about three months to totally change. How could it have happened

01:09:51.840 so fast? I think three months to totally change, but that's three months of work. It's that same

01:09:58.840 theory that matter is not evenly distributed. Change does not happen in a linear way. Okay. It's only

01:10:05.180 three months, but you had to run countercurrent to patterns of neurotransmission that were inside

01:10:11.820 of you for years and years and years and years. And this is another, I think, big problem with

01:10:16.680 modern mental health is it's packaged to suit insurance paradigms. And that's not serving the

01:10:23.140 people it's supposed to serve. So the idea that whatever has gone on, there's 10 sessions of therapy

01:10:28.800 authorized, progress has to be gained in a short period of time. Let's take an inventory of symptoms

01:10:33.660 and let's throw a medicine at you. So now your symptom is a little bit better without ever

01:10:36.960 knowing what's undergirding it. There are things that take time. And when we establish patterns of

01:10:44.200 neurotransmission, it takes time to unestablish them. The example I often give is if you and I

01:10:49.220 picked a random word and we said it a thousand times, we're going to be saying it later today.

01:10:54.200 If we say it 5,000 times, we're each going to be saying it tomorrow and over the weekend.

01:10:58.180 And why? If we know that it's just a silly experiment, why would it stay with us? Because

01:11:04.200 we said it. And the brain's mechanisms are designed to hold onto it because we said it

01:11:08.840 a lot of times. That's how it goes. The same is true, of course, with what we're thinking,

01:11:14.120 right? We're just thinking what we think we put into words. It's the same. It's thought,

01:11:17.280 it's neuronal connections that don't want to go away because this is how we've developed.

01:11:23.260 We've developed to remember things. We've developed to not forget things that are important.

01:11:26.880 So the brain says, you said that word 2,000 times. I'm not just going to forget it because

01:11:31.700 you said it. It's the evolutionary mechanisms. So that's been in you for a long, long, long,

01:11:36.180 long time. And when you start trying to say something nice, tell me if it's true. There's

01:11:41.200 got to be a fear in you that everything is going to fall apart. Here you're doing this wild,

01:11:45.520 reckless thing, right?

01:11:47.560 Which is going to take your edge away because the Bobby Knight produces great results.

01:11:53.060 Right. Next thing you know, you're going to be lazy and slovenly and not care about anything.

01:11:57.240 You're not going to care when you make mistakes. Yeah.

01:11:59.240 But think about, on one hand, how outrageous that is. The thought that you could possibly be like,

01:12:04.180 a million miles from that. But it's not outrageous to the emotional part of your brain that didn't

01:12:09.000 want to stop it. So it takes bravery to stop it. You have to take a chance. And that part of you that

01:12:14.960 says, you're going to fall apart. And you think you feel like a piece of shit now? Wait till you stop

01:12:18.640 doing this. You have to say, no, I hear the meat and I'm doing something different. It's a leap of

01:12:22.740 faith in myself and in what I've thought about and learned about myself. Then you can go and do it

01:12:29.020 and you start running counter to those neuronal connections and then it changes, but it takes

01:12:33.900 time. It takes effort. It takes bravery. It takes faith in self. So when you say, okay, it only took

01:12:41.400 two months, but you worked really, really, really hard.

01:12:44.400 It was actually probably four. Three to four. Yeah. Three to four. Okay. So then we're talking

01:12:48.680 about like a hundred days or so, like really, really running against those patterns and making

01:12:55.100 new patterns. And then it feels different. And look, as someone who has known you for over a

01:13:00.320 quarter century and loves you and also is trained as a psychiatrist and was here when you came out

01:13:05.080 with the remains of the bottle, it was not lost on me that you're like, oh, I hadn't done that

01:13:10.180 before. And I dropped this bottle and like, there was no edge in you and it was not lost

01:13:16.460 on me that, wow, that's not how that would have been before. And then I think, right, you're

01:13:22.300 happier. You're healthier. If we think about health span and lifespan coming from the place

01:13:28.880 that I come from, right, from the mental health side of things and the really is a psychiatry

01:13:33.480 because it's active brain function, you know, emotional states within us. This is how I come

01:13:38.540 at health span and lifespan. I think this is good for you. And then I know you're healthier

01:13:43.380 inside even without, it's great that biomarkers and all that, but there's not a biomarker for

01:13:47.700 that, right? But I could see and noted not that long ago that change in you. And I knew like you

01:13:53.920 are happier and this is healthy for you. Now, I don't want to make it all rosy, but using

01:13:59.160 myself as an example and to talk about an area where it's still very difficult and I've maybe

01:14:04.460 only had a 50% improvement, which again, in magnitude is huge, but given where I was starting,

01:14:11.680 there's still a long way to go, right? So it's sort of like saying if a person loses 50 pounds,

01:14:16.240 are they necessarily healthy? It depends. If they went from 220 to 170, they almost assuredly

01:14:23.120 are. If they went from 400 to 350, they probably still have work to go. I'm probably the 400 to

01:14:28.880 350 guy in this area, which is just general outburst of anger at a situation that almost

01:14:35.760 assuredly warrants anger. So to be clear, it's something happens that warrants anger,

01:14:39.800 but the response is disproportionate to it and it's counterproductive. So the exercise here was

01:14:45.020 an exercise suggested by Andy White, who of course you very graciously introduced me to.

01:14:50.060 He said, this is an exercise that he does with patients he's working with who are trying to quit

01:14:56.160 smoking. So the exercise is about separating, creating a discontinuity between urge and

01:15:03.100 behavior. So he says, look, and I'm probably bastardizing this a little bit, but let's just

01:15:07.620 say for the next month, you come in here and you're smoking two packs a day for the next month. I'm not

01:15:12.800 necessarily going to reduce the number of cigarettes you smoke, but what I will do is separate the urge

01:15:18.040 from the behavior. Every time you have the urge to smoke, I want you to pull out your phone and set

01:15:23.580 an alarm for 40 minutes. Don't smoke now, but when the alarm goes off, go smoke. Going to separate

01:15:29.680 that. So you're not just feeding an urge every time it comes up, you're going to go smoke. And

01:15:35.040 sometimes you might not actually even feel like going for a smoke. And so what the exercise was

01:15:40.340 for me was the next time something happens, something stimulates a response in you that is

01:15:47.280 going to be an outburst of anger. And that could be, you're going to fire off a really nasty email to

01:15:52.420 somebody, or you're going to call somebody and tear them apart. Pause, set an alarm for an hour,

01:15:59.440 and then come back and respond in an hour. And again, that's much easier to do over email than

01:16:04.300 it is to do sometimes on an interpersonal level. But not surprisingly, when I'm able to do this,

01:16:10.380 and to be clear, I'm probably only batting 500, meaning there's a lot of times I'm failing to do

01:16:16.280 this and I'm just reacting to situations in ways that I almost always regret, as opposed to responding

01:16:22.220 to situations. But when I'm able to do the urge right now is to react, stop, come back, respond,

01:16:30.800 I mean, it's always better. So my question for you here is, why does this appear to be a harder

01:16:37.080 exercise? And would you modify the exercise in any way to produce even greater efficacy? Or am I just

01:16:43.400 being impatient? This one might take years, as opposed to months.

01:16:47.940 Anger is very, very powerful. And anger can propel us forward. You know, I always think of

01:16:54.200 like sprinters coming out of the blocks. And if they come out too fast, then they don't have control.

01:16:59.320 And they're just flying headlong until they fly face first. And that can happen, right? Because

01:17:05.520 they're propelled out, they propel themselves out too strongly. And anger does that inside of us.

01:17:10.440 There's this cascade from what technically is affect to feeling to emotion. And it's worth

01:17:16.020 pointing out the difference that affect is aroused in us, meaning it's created in us without choice.

01:17:21.580 When we have high levels of emotional response, some of it is nature, some of it is nurture,

01:17:26.200 it's cultivated over the years. And then these pathways are very strong. So something is negative,

01:17:31.320 and there's a high level of aroused negative affect, anger in this case. And then that propels forward.

01:17:38.040 So when it comes in us, we don't even know. Affect is aroused in us. We're not even aware of it yet.

01:17:43.740 It's just a split second. But now when we're aware of it, it has a whole head of steam and it runs

01:17:49.320 through feeling when we relate it to self and emotion when we relate it to others. So I am angry,

01:17:54.720 I am an idiot. Man, we went from a lot of aroused anger right through affect to me. And now I'm mad at

01:18:00.740 myself. Or if the target is someone else or something else that has happened to us, then we

01:18:06.680 run right through us. There's a lot of negative affect, of anger raised. And of course, this is

01:18:12.960 what happens to me. We burst right through us. And now we're like, and it's your fault, or it's God's

01:18:17.720 fault, or it's fate, or nothing ever happens right, or I'm cursed. And now we relate it to the world around

01:18:24.040 us. And, you know, I view this as the equivalent of the sprinter being 25 meters from the start of

01:18:30.540 the blocks, sprawled face first on the track. It's like, it's not good. It leads us to unhealthy

01:18:38.100 places. Andy White and Katie Powell, they're fabulous therapists. So what they're doing is

01:18:43.380 saying like, hey, we've got to put a hand between the dominoes. Dominoes are going, this is running

01:18:48.540 ahead. We got to stop, slow that sprinter down coming out of the blocks so that that person has

01:18:53.340 healthy control over the movement of their body. They're not just flying ahead. What they're doing

01:18:57.300 there is they're trying to slow that down and say, affect does not have to run right to feeling when

01:19:03.280 we relate it to self and run right to emotion when we relate it to other. Let's slow that down.

01:19:08.600 And this is a lot of work that we do. You know, we do intensive programs with people where people

01:19:13.620 come to us and they spend a week with us or two weeks with us. We do a lot of this work now.

01:19:18.680 And a lot of the time, the work is around things like this. It's around people like,

01:19:22.320 I want to understand myself better. Like I know that this, whatever this may be is not good. I

01:19:27.200 want things to change. And a lot of what we're doing in that time are these strategies, like

01:19:32.920 you're saying, because they work and we know why they work. But also, there's another aspect of

01:19:38.740 this and we do this also in the intensive work that we do. And this is the part I'm most interested

01:19:43.220 in, which is in the understanding of it. To me, it then becomes interesting that you become very

01:19:49.340 angry. Let's say for me, if I become very angry about something like, oh, the flight is delayed,

01:19:54.380 or I rushed to get to the airport and the flight is delayed and I didn't get the text I was supposed

01:19:58.740 to get, whatever it may be that I become angry. And I'm very curious as why am I angry? Like I say,

01:20:07.760 oh, my flights are always delayed. Like none of this is true, actually, right? I'm like,

01:20:11.220 I'm a very fortunate person. I see myself as a very fortunate person. I don't feel that I'm

01:20:17.660 cursed or that bad things only happen to me or that people have it out for me.

01:20:21.640 But in the moment when something triggers anger, that's not how I feel.

01:20:25.460 So the strategies help you slow down, but what are you slowing down to?

01:20:29.760 So the slowing down step is necessary, but not sufficient for the real insight.

01:20:34.720 Right. It could be sufficient if sometimes just slowing down, it dissipates the energy,

01:20:39.540 but we want more than that. I mean, that's something. How about combining it with understanding,

01:20:44.640 which brings me back to what I believe works for everyone. This is a human thing and it crosses

01:20:52.500 cultures, race, religion, socioeconomic status. Like we are humans and we have these drives

01:20:59.700 within us. There's an assertion drive to be able to have some healthy control in the world.

01:21:06.080 And there's a pleasure drive to feel at least no privation and feel safety, right? And then also to

01:21:11.740 have good things. If we look, we have these drives and there is also a generative drive in us. Are we

01:21:18.860 honoring the generative drive? Are we in balance? Then what comes of that, if we are doing that,

01:21:25.700 is a sense of gratitude and humility. So I think my idea of what's going on inside of you when you're

01:21:32.520 able to stop is that you're able in taking stock of self and being reflective to feel, whether you see

01:21:39.460 and put words to it, you may or you may not. But there's a knowing inside of you that actually

01:21:43.720 your assertion drive is, is like, you're doing well with it. You're putting yourself out there

01:21:47.960 in the world. And like, and I'll take stock of myself. Like I'm not unhappy with how I'm trying

01:21:52.060 to be in the world. And I do take some pleasure and satisfaction in what I do. And I'm able to

01:21:56.900 provide for people and I feel a sense of wholeness and safety. And because of that, I can feel good

01:22:02.060 about myself and I'm learning and curious. And I realize like, wait a second, your life is great.

01:22:06.980 There's nothing wrong with your life. And I feel a sense of gratitude because so much of that is

01:22:11.760 blessing. And also the sense of humility we have when we recognize our own work and effort,

01:22:18.100 and we recognize our own responsibility for where we are. But we also recognize that it's also a

01:22:24.320 blessing to be able to bring ourselves to bear in that way. This is why people say, I got an award

01:22:29.160 and it was so humbling. You say, why would that be? It's because the person recognized, yeah, I got that

01:22:34.060 award and like, I did those things and I worked hard. And also, isn't it wonderful for people around

01:22:39.660 us to acknowledge me? And isn't it wonderful? I've got it in myself to do. And I'm, gosh,

01:22:44.820 I'm fortunate enough that I could bring myself to bear so I can both own it and also feel a sense of

01:22:50.420 the beyond me that, oh my God, I am so fortunate to be in a place where I can own that I worked hard

01:22:55.740 and got something. And I think this pervades people when those other drives are imbalanced. So if we go back

01:23:01.740 to what we started at the very beginning, how do people have healthspan that is a wonderful health

01:23:07.060 span to be have, and it's combined with lifespan and cognitive health and emotional health,

01:23:12.800 the drives inside of people are imbalanced and you've got to look in yourself in order to get

01:23:17.300 them imbalanced. We've been talking about that too. Then when they're imbalanced, you orient yourself

01:23:22.000 to that balance and you live much more in an appropriate and active sense of gratitude and

01:23:28.860 humility. And you feel that when things are difficult. I think that the work that you've

01:23:35.860 done let you feel a sense of humility, like you are not supposed to be perfect despite all that

01:23:39.780 you have achieved. And isn't it wonderful, all the great things in life, then the glass bottle breaks

01:23:43.780 and you're like, huh, that's it. And that's why when I go to the airport later today, if flight's

01:23:49.280 delayed and I'm going to sleep in the airport or whatever it may be like, that's not going to feel

01:23:52.380 great, but I am not going to get down on myself or anything else around me, whether it's God or

01:23:59.460 fate or people, it's not right. And it's not good for me either. And that's another reason we don't

01:24:05.260 do it. That's why once you start doing it, you make progress. And that's why you say you're 50%

01:24:10.360 of the way there. That's a huge achievement. And what does it tell me that the next 50% can't be as

01:24:15.560 difficult as a first, right? So you're going to get there. What percentage of people do you think,

01:24:20.920 or how often do you encounter this? Maybe as an easier question of an individual who feels

01:24:27.520 frustrated or upset at themselves for the following paradox, which is on the one hand,

01:24:36.340 intellectually, they recognize how lucky we are. Any person. We talked about this a little bit over

01:24:43.260 dinner last night. You know, I'm reading this book about the impacts of the dust bowl and the

01:24:46.420 depression. This is 90 years ago. And the people living in the middle part of the United States

01:24:53.820 were subjected to conditions that most of us couldn't survive. I mean, the abject horror of

01:25:01.080 what it meant to live in the depression, in the dust bowl. And the book I'm reading is called The

01:25:05.480 Worst Hard Time, which is amazing. And so you think about that and you think, God, that was only 90 years

01:25:10.000 ago. What's the luck that allowed me to be born now instead of then? Had I been born 100 years earlier,

01:25:17.780 I'd be dead. I would have died an awful death in that situation. So I know that in my head. And then

01:25:24.560 something happens that upsets me. And again, it almost doesn't matter what it is because you think

01:25:30.600 it pales in comparison to what it would have been like to have born just 100 years ago. And then that

01:25:38.560 creates tension internally because you think, why can't you just be grateful? Let's use the airport

01:25:46.260 example, right? Why can't you just be grateful that you can at least get on a plane? It's a miracle

01:25:51.320 that we can do this thing. And yes, so what if it's four hours late, but then you still feel like,

01:25:57.140 but I'm still really upset about it. How often is a person coming to you where that's the source of

01:26:03.040 the tension, the difference between the intellectual understanding of what should be gratitude and the

01:26:10.720 emotional feeling that is incongruent with it? A lot. And if I could comment a little on what you

01:26:16.860 said, see, I think that there's a fallacy there or a problem. I don't know what word to put to it,

01:26:24.440 but something is not real or healthy in the framing. I do not believe that you would have just died if

01:26:34.120 you were in the Great Depression, in the Great Dust Bowl. I also don't know that you wouldn't

01:26:40.100 have been happier. I mean, I don't know that. Yeah. Yeah. I mean, it speaks to what we said earlier.

01:26:44.800 I mean, maybe you would have barely eked out enough food and got some shelter and kept your family

01:26:51.800 going in and dirt poor, but everyone stays alive, or maybe not everyone stays alive,

01:26:57.100 but you keep alive who you can keep alive. And you have a sense of wholeness and goodness in

01:27:02.400 yourself, despite the privation. When we set up, oh, we should feel grateful because then you set up a

01:27:10.360 scenario where like you can't win because anything you feel bad about, you should feel ashamed about

01:27:15.540 feeling bad about because it's not the Great Depression and the Great Dust Bowl. So what are you

01:27:19.000 complaining about? And then I think you've inadvertently set up a situation where the

01:27:24.140 odds are against you. I mean, I'll think this sometimes where up until a couple of generations

01:27:28.360 ago, like probably everyone in my family from all sides extending back generations was a shepherd.

01:27:34.660 So you could look and say, wow, Helmsons, look how fortunate I am. I mean, look at the opportunities

01:27:40.080 I have and the places that I've gone. And I can get into that way of seeing of like, oh,

01:27:44.960 oh my gosh, this is so amazing. But then I'm not giving myself room to say, maybe I would have

01:27:50.900 been happier being a shepherd. I don't know. Maybe if you and I were shepherds next to one

01:27:54.700 another, like we'd have helped each other, others flock out. We have a little bit more sheep. Our

01:27:58.660 families are doing okay. We have a lot of leisure time. We think and talk. Like who knows?

01:28:03.100 You are you. You are not someone else. And you are also you now. So a lot of people come with what

01:28:09.520 you said. And what I try and do with all of them is to say that this is not a framing that we

01:28:15.300 massage. I think it's a framing that we just throw out. I know nothing about you by knowing

01:28:19.480 your reflections on what you think it might be like if you were in the Great Depression. What

01:28:22.720 I know about you, I know from now. This is when you live your life now. And you know what? You're

01:28:27.400 entitled to be angry and frustrated about things sometimes. Now, do you want to modulate that and

01:28:31.440 keep it inside and not let it run out of the starting box? Yes. You're entitled to feel bad about

01:28:36.420 things or annoyed about things at times. This is how this goes. Just because we are not suffering,

01:28:41.440 we can compare ourselves to people all over the world who are suffering. We're living our lives

01:28:45.340 if we live them within ourselves. And we are the marker of comparison. Like how am I taking care of

01:28:51.560 myself now? How am I exercising the drives within me now? How am I serving the generative drive within

01:28:57.640 me? That's between you and you right now. And when we bring people back to that, that's when

01:29:03.040 things can really, really, really start to shift because you then maybe stop doing something that

01:29:07.640 is like kind of going to do something. And immediately you set the odds against yourself

01:29:11.280 by having this comparison. I'm not in the war. I'm not in the Ukraine or I'm not in Israel.

01:29:16.100 And I know that, right? But that doesn't mean that like you can't suffer now. Like it's true,

01:29:21.260 true and unrelated. And the other aspect, as I said, like, don't be an isometric exercise.

01:29:26.780 You might do them. If this is you, don't push against yourself. And that's often what we're

01:29:32.000 doing. If I want to go this way, can I glide my hands this way? Very often what we do is

01:29:35.920 we have 10 units of resistance and 11 of force. And we're doing that within ourselves instead of

01:29:41.800 simplifying. I mean, the rule of all good mental health, which I believe undergirds healthspan,

01:29:47.100 lifespan, is simplicity. It doesn't mean it's simple to get to, but it is simplicity. Like it's

01:29:53.260 really, really complicated to start comparing you to the theoretical you 90 years ago. I start getting

01:29:59.120 very, very confused. But we all do when we do that. And again, I'm not because I do this to myself

01:30:03.900 too, right? When I just stop and think like, look, there's me. I'm here now. I mean, I know my own

01:30:08.560 history pretty well. I am capable of introspecting. Let me stop and think like what's going on inside

01:30:13.540 of me. Am I making a decision? Am I upset with myself or someone else? Like I've got to be able

01:30:18.100 to understand this well enough to simplify it. And if I'm going to beat up on myself and flog myself to get

01:30:23.180 myself somewhere I want to go, that's not how I'm choosing to do it. It's just not good. And is that

01:30:29.060 why things seem to maybe take more energy out of me than they should? These are things that you and

01:30:34.060 I both tried to work with over time. Then now am I more easily frustrated and I'm not getting enough

01:30:39.160 sleep or I'm not sleeping as well. So now I feel a little bit fatigued. It's harder to take care of

01:30:42.720 myself. There's more inflammatory markers. My body doesn't feel as good. So now I'm even more frustrated

01:30:47.820 with myself. Like what is going on here? We can stop and take stock of things and decide a path

01:30:54.660 forward where we are not working against ourselves and we simplify down to what the real truths are.

01:31:01.300 Which I'm not saying that's easy. It takes work and it takes reflection and we've got to run counter

01:31:05.040 to some of these established neuronal pathways. But isn't that a lot easier and a lot more likely

01:31:10.400 to be effective if you're living in the here and now with yourself, knowing what you know about

01:31:15.860 yourself as you make decisions. Whether it's, what am I going to say to myself inside of my head?

01:31:20.760 What am I going to say to someone else? What am I going to do? Now we're intentional. Now in that

01:31:26.600 Freudian way, we're living in the ego. In that sense of the ego being the whole self, am I most

01:31:30.820 self-aware? I'm aware. I don't want the super ego telling me, I actually feel bad about any frustration

01:31:35.400 in me because I'm not a shepherd. I'm like, I'm not having any of that. It doesn't help me. It makes

01:31:39.380 things worse. It's the opposite of simple. And we can reject having ourselves be out of balance.

01:31:44.560 So just like our drives need to be in balance because then the generative drive is what makes

01:31:48.740 you wake up with a glimmer in your eye, right? But we have to be healthy in mind and body and

01:31:53.320 these other drives, the assertion and the pleasure have to serve it the same way we have to be balanced

01:31:57.600 inside of us. We need some gratification. We also need some self-control. How about we have as clear

01:32:02.940 a lens as we can sitting in the middle of it all? And another way, I'm using a lot of analogies,

01:32:09.140 but I don't want funhouse mirrors around me when I'm trying to see what's going on. I want clarity

01:32:15.580 around me. And a lot of times what we don't realize is we create funhouse mirrors around us

01:32:20.160 and then we get angry with ourselves that we don't understand or that we walk in the wrong

01:32:24.800 direction or that we run into something. And in this analogy, is the funhouse mirror,

01:32:29.540 the construct, the mental construct that adds confusion, such as the example I just gave?

01:32:33.940 Yeah, I think that, yeah, a funhouse mirror comes into the room when you start comparing you now to

01:32:38.820 the theoretical you during the Great Depression. Now there's a funhouse mirror. It's a funhouse mirror

01:32:43.280 when I'm mad at myself because something wasn't good enough and I realize that the standard I'm

01:32:49.660 using is actually perfect. Bring another mirror in if I start speaking to myself through the lens of

01:32:55.500 someone who is so critical to myself. These are all the distractions away from clarity and it is so

01:33:01.940 easy. No one else brings the funhouse mirrors and no one catapults ourselves out of the block so that

01:33:07.400 we fall headlong. It is we who do this to ourselves and we don't have to do this. Think about what

01:33:12.980 humans do. We create so much and we destroy so much. Isn't that true? The destruction in the world

01:33:19.040 around us, how long it takes even to create one building that gets destroyed, let alone the vast

01:33:26.620 swaths of the earth that we then destroy and the harm that we do to people. So just as in the

01:33:32.980 universe around us, there's a lot more force towards entropy than there is to things coming

01:33:37.720 together. That's why these small places where like life could be here. This is true in our lives here

01:33:44.540 on earth. It is so much easier to destroy than to create. If we stop working against ourselves as

01:33:51.820 humanity, we're trying to move forward and create 11 units forward, 10 back. Well, maybe we'll get

01:33:57.640 that wrong. It'll be 12 back and 11 forward and we won't survive as a species. We do this as a

01:34:03.400 species and we do this as individuals where we work against ourselves and we don't have to do this.

01:34:09.820 We don't have to have needless destruction happen around us. We don't have to have a society of

01:34:15.020 plenty while there are single mothers with children on the streets. Like there is more that we can do,

01:34:19.820 whether it's trying to lift up the people who are on the verge of not surviving, who are living in

01:34:25.560 misery. We can also do it with ourselves. I don't want to cloud my own picture. I don't want to work

01:34:31.300 against myself. And if I see with clarity and I don't bring in the fun house mirrors, life goes a lot

01:34:36.940 better. And I use a lot less time and energy making it go better. And that's true for all of us.

01:34:43.440 It's true on a universe level. It's true on a global level. And it's true within each one of us.

01:34:48.300 How important do you think it is for our emotional health to have peace with non-existence?

01:34:57.680 I do not really have a great sense of that. And I don't think many people do. In other words,

01:35:04.440 as is the case in the previous example, there's nobody who intellectually, I mean,

01:35:09.180 no reasonable person intellectually doesn't understand that they will cease to exist at some

01:35:13.720 point. We will all die, notwithstanding all the biohackers out there. That knowledge,

01:35:20.520 that cortical knowledge is very difficult to process. It's very difficult to come to peace

01:35:27.380 with the idea. And let's talk about the best case example, which is you live a long, healthy life.

01:35:33.440 And in your nineties, you die in your sleep. You couldn't ask for a better existence. And let's also

01:35:39.440 assume that everything up until that point is moving in the right direction. You don't just die

01:35:44.340 in your sleep. You die in your sleep, having lived a meaningful life and having had wonderful

01:35:49.360 relationships and having raised children and grandchildren who are wonderful people. Like

01:35:55.160 let's make this the best case scenario. And yet many of us, I think, still struggle with

01:36:02.400 the finite nature of our existence. Do you think that coming to some acceptance of that is essential

01:36:12.700 for our emotional health? I do. Whether it's essential in everyone, I'm not sure, but I think

01:36:17.940 it is very important. And there's so many factors that work against us that we can change. So this

01:36:27.060 societal idea that getting old is just so, so, so, so awful and death is something to be feared.

01:36:33.920 It's not clear that that's true. And when you see when people are much older and are closer to death,

01:36:39.280 what they fear is loss of control, not death. So maybe we build up a society that glorifies not being

01:36:47.500 dead as opposed to glorifying living well. That would be a nice switch. Maybe we think about health

01:36:55.180 span and quality of life instead of living in a society where we're so afraid of death that we

01:37:01.960 just don't want to die and we're not even paying attention to whether we're happy or not, right?

01:37:06.860 So I think we could work against that a lot and we could work against these cognitive tricks,

01:37:12.240 these things we do inside of us that torment ourselves. Like I don't want the voice of someone

01:37:15.980 critical of me living in my head. I also don't want to be contemplating my non-existence because

01:37:22.020 what I do then is contemplate that I'm aware that I don't exist and I'm upset about it.

01:37:27.560 That's not not existing, right? If you don't exist, you're not contemplating it.

01:37:31.600 And therein lies the greatest challenge. And I tell you the people I am most envious of are the

01:37:37.260 religious or anybody who believes in an afterlife. If you believe in an afterlife, you have a way to get

01:37:43.440 around that issue. And if you don't believe in an afterlife, then you're stuck with that very

01:37:51.580 bizarre idea that seems impossible to reconcile.

01:37:56.740 I have thoughts about this and they're not fully formed, but I wonder about that. I think a lot of

01:38:02.440 times people ostensibly have faith, but aren't behaving that way because we are in a society where

01:38:08.400 everyone's fearing death and non-existence. But many, many, many of those people are people with

01:38:13.540 professed religious values. And I think oftentimes we're taught religious values when we're young,

01:38:18.560 we identify in a certain way, but we don't really know what do those things mean? What do I actually

01:38:22.400 think and feel? And I think when people do have a deep faith, it could be something different.

01:38:26.940 But I think our religious values don't really work against that very much. I think it was Spinoza whose

01:38:34.040 definition of faith was the belief in something that you don't know for sure. And it's very

01:38:39.880 interesting when people say they know, like, this is my religious values, I know that's true.

01:38:44.680 I don't think that's faith. And I don't think our philosophical and psychological heritage tells us

01:38:50.580 that. I think that's a leap of something because we don't actually know. So if you think you know,

01:38:56.080 and you don't have enough understanding or humility to recognize that there is a leap of faith,

01:39:05.640 then are you doing something that doesn't actually help you? And this isn't me being anti-religious.

01:39:11.140 I mean, I think faith is very, very important, but it's recognized and such. There is something I

01:39:15.260 believe, but I do not know that thing. I believe it. Now, that's very interesting. Why does the person

01:39:22.160 believe it? How do we see the beyond ourselves as opposed to just pasting something on that doesn't

01:39:28.340 actually make change? Because what I think I'm trying to say is when people feel very, very sure

01:39:33.040 of something, I worry about that. And when people feel very, very sure that there's nothing, I also

01:39:38.160 worry about that. If you think about it, I find it quite amazing that there are so many things

01:39:43.820 that we know a little bit about that fills me with wonderment about what else might be there.

01:39:49.340 If you think about things happen outside of time and space, that's interesting. There've been

01:39:54.660 experiments done where you or I could decide what happened in the past, not figure out what happened,

01:40:00.660 but decide. So time, space, movement, the impact of consciousness upon the world around us,

01:40:08.680 this is all so interesting. Even the things we learn about that are going on inside of our

01:40:13.020 brains, the cutting edge of neurobiology and neuroimaging and some of the psychedelic studies and what

01:40:18.580 they've shown going on inside of us tells me, I don't know what happens next. I don't know that.

01:40:25.160 And I may have all sorts of thoughts one way or another. Maybe some of it comes from early education

01:40:29.840 and some of it comes from the faith I was raised in, but I don't know. And that not knowing,

01:40:36.120 I find to be very, very hopeful. I don't know what comes next. It doesn't mean that I'm going to rely

01:40:41.520 on anything in particular, but it certainly means I'm not going to despair about non-existence. I'm

01:40:48.700 not sure of that. And I think that's what it tells us. I think that's what Spinoza was writing about.

01:40:53.100 And I think what great religious thinkers, not that I've read a lot of them, but when they're

01:40:56.460 writing within religions, they're writing in these ways too. And maybe that engenders a

01:41:02.180 respectfulness. I think if we knew that there was nothing afterwards, I would hope we could still find a

01:41:06.200 way to be respectful of our lives. But the fact that we don't know what comes next is interesting.

01:41:11.800 And I think to me, that's full of interest and curiosity and hope. Like the generative drive in

01:41:16.160 me gets activated when I think about dying. Now it doesn't all the time. It can get active. I think,

01:41:22.980 I don't know what comes next. And I think that's interesting. And things happen outside of space

01:41:26.980 and time. They're certainly not absolute. And our consciousness may actually change things,

01:41:31.780 be its own entity in the world around us. And we all have different times. And do we have

01:41:35.960 different dimensions? This is out there in the world around us. This isn't pie in the sky. This

01:41:40.980 is academic studies that are telling us these things. When I think about that and scratch the

01:41:46.160 surface a little bit, I go, huh, I don't know. That's interesting. And I think it helps me to feel

01:41:52.560 a sense of real interest and excitement about then living the best life that I can live. Because if it's

01:41:59.520 all I have, then I want it to be good. I want it to be the best it can be for me and the people

01:42:04.360 around me. But in taking care of myself, I'm better for other people. I feel invigorated by

01:42:10.160 that, not afraid. And I think, again, you see that in people who don't fear death. They're happy

01:42:16.260 with their life. They're leading life in a way that they can feel a sense of pride. And they feel

01:42:21.500 humble. They feel gratitude. They're rooted in that. And there's often a sense of, not always,

01:42:27.800 but there's often a sense of, I don't know. And isn't that okay? Think about how many things we don't

01:42:33.060 know. Can we take care of ourselves and treat every life as precious? This idea that there's

01:42:39.380 nothing special about any of us, but there's something special about each one of us. And I

01:42:45.040 think not knowing what comes next and the idea that if we think there is something or isn't,

01:42:49.580 that there's faith involved, that's a thought process. That's a deciding on the part of the

01:42:53.680 person. That comes through interest. I think that engenders us to be better to ourselves and better to

01:42:59.280 other people. And I think then we stop fearing death and we stop living in this pseudo cult of

01:43:06.240 like, I must not die, which is fed by all these fantasies and these places we can get us. Even

01:43:12.140 in literature, I think about No Exit, a great play by Sartre where people are dead and they're watching

01:43:18.480 themselves. That's interesting as a way of learning something through the fantasy of literature.

01:43:23.800 But there's a theme that runs through that, that we're dead and we see ourselves with despair.

01:43:28.980 And I feel pretty sure that's not happening. It would really make no sense that that happens,

01:43:33.200 right? That there's some punishment of seeing ourselves with despair. Like,

01:43:35.880 why would it be? They just can't be that. I think if we're open to that, we just don't know.

01:43:41.060 And the literature and the philosophy and the world around us, it is interesting things to say,

01:43:46.560 but no one's going to tell us. Like, isn't that awesome? I think it is.

01:43:50.160 Paul, I want to talk a little bit about how a person can find a therapist that's going to help

01:43:58.060 them be a guide through a lot of the stuff we've been talking about today. So there are a few facts

01:44:04.860 that people I think are generally starting to understand, which is of all branches of medicine,

01:44:11.580 this is one in which the interpersonal relationship between the doctor and the patient, and we'll broaden

01:44:19.280 it because it's not just about physician patient, but the therapist and the patient. The interpersonal

01:44:24.240 connection matters more than it matters in any other form of care between a provider and a patient.

01:44:30.700 It's great if you love your dentist. It's great if you have a connection to your surgeon.

01:44:36.600 It turns out to not matter nearly as much. Would you agree with that statement?

01:44:40.440 I don't want to use like as the word. What word would you use for what I'm trying to say?

01:44:44.480 Yeah. Rapport. I mean, there've been so many studies that show how important rapport is. And

01:44:49.480 yes, it is good to have rapport with one surgeon, but it's not the primary factor, presumably.

01:44:55.580 So rapport is very, very, very important, and one might argue indispensable. And that's why you

01:45:00.480 see studies that people can come at things from different perspectives. Like you think about the

01:45:04.680 anger, how Andy or Katie may come at it is, hey, let's talk about getting a space between the

01:45:11.100 anger and the response. Okay. They also want you to understand it too. I might come really from like

01:45:16.040 the understanding. So you go to a place of humility and gratitude, but I want you to pause too.

01:45:20.740 We're not doing different things, but we're doing what we're doing from very different

01:45:25.900 perspectives that will feel very different if you're on the receiving end of it. And that's why

01:45:30.660 when people say, well, rapport matters and does it matter, then maybe it doesn't matter what those

01:45:34.240 people are doing. But that's not true. The presumption is the therapist knows what they're doing.

01:45:38.860 They're coming at the skilled part of it from different perspectives, but it doesn't matter

01:45:44.160 that the therapist knows what they're doing if there isn't rapport.

01:45:48.620 So let's take that as a necessary but not sufficient piece of the equation. What are other things

01:45:55.340 that a person should be asking themselves? And we can handle the following questions separately,

01:46:00.500 but I want to address both.

01:46:01.780 A scenario one, you are going to seek the help of a therapist for the first time.

01:46:09.780 And B you have been working with a therapist for a long period of time and you want to evaluate if

01:46:16.080 this is productive. And the impetus for B is I can't tell you how many people I've met in my life

01:46:23.620 who even to my completely untrained eye, which tends to be more critical of self than others.

01:46:30.720 I look at them and I think, what is your therapist getting paid for?

01:46:35.760 You were having the exact same problems today that you had five years ago. If anything, you seem a bit

01:46:42.160 worse. And yet you tell me you're seeing somebody every week. Again, I don't say that to be judgmental.

01:46:47.620 I say that from a place of, I want you to be better. And maybe somebody listening to this

01:46:53.100 identifies with that. So anyway, again, feel free to tackle those separately. But what I want to

01:46:57.880 understand are what are the questions a person should be asking themselves of the therapist

01:47:04.520 and perhaps of themselves in those two situations to make the best choice. A, how do I find someone

01:47:11.400 de novo to start? And B, how do I decide if I need somebody new? There's a lot of specifics I could

01:47:18.440 say about those things. But I think I would start them in a different place. I would start with an

01:47:23.980 overarching principle because I think the principle always applies and then it can get at a lot of

01:47:31.560 these things underneath the principle. I would ask, does one plus one equal more than two? So the way

01:47:39.040 that mental health was thought about, say, before the end of the Second World War, our minds were

01:47:45.760 conceived of as very transactional. So they would say, like, even now, like, I put something out there

01:47:51.020 in words, you take it in. Then you put it into your brain, you put something out in words, I take it in.

01:47:56.500 Even though they would acknowledge we're doing something, the thought was it's very, very transactional.

01:48:01.040 And what we see is, that's not really the truth. And I think Viktor Frankl's writings after the Second World War

01:48:09.120 were really an impetus to really see this and led to a whole different type of psychotherapy that was called

01:48:14.840 existential psychotherapy. It still is existential psychotherapy. And it doesn't map to the existential

01:48:19.820 philosophers exactly, but there are principles there that are around shared humanness. So do you feel like one plus one

01:48:26.720 is more than two? When you're with the person, you're going to have thoughts and feelings and ideas,

01:48:31.360 and that person's going to have thoughts and feelings and ideas too. And does that create something more

01:48:35.740 between the two of you? And the thought is, this is how we find meaning in life, that when we're with

01:48:41.560 someone we love, for example, it's not just it is us and it is them. There is an us, right? Like you're you,

01:48:48.040 the other person is who he or she is, but together, there's something different that each isn't going to find

01:48:53.460 on their own, and that each isn't going to find with another person. In this case, the dyad is

01:48:58.240 special. The two people together are more than the sum of each of them. And I think that's true for

01:49:05.580 satisfaction, enjoyment, learning in human relationships. And I think because these principles

01:49:12.700 run wide. So the same thing that would apply, applies here too. There should be someone whose presence

01:49:20.100 and whose work with you. Like there's a shared humanness and you're figuring things out and you

01:49:24.880 feel the greater than two of the two people in the room. And I think that's a lot of what rapport is.

01:49:31.500 I mean, some of what rapport is is positive regard of the other. And there are pleasantries and nicer ways

01:49:35.720 we can build rapport, but I think they're more on the surface. They're important, but that's not what

01:49:41.840 makes real rapport when someone is helped. I think what makes real rapport is the fact that here I am with

01:49:47.740 you. And there's something different with us than there is in just the sum of us. Like something new

01:49:53.220 and different is here. And I feel that when I come in the room to see you. And I think you feel it too

01:49:59.980 when I come in. It's a real interest in me and a real like applying of one's brain to the other.

01:50:05.720 And whether we call that rapport, or I just feel great about that person, or man, it's so dynamic,

01:50:11.480 like there is something there that is the therapist really being present. And I think that that's an

01:50:16.440 obligation of the therapist. We're supposed to know technical things. And of course,

01:50:20.340 like there are things that we have to learn, but we're supposed to give of ourselves in a way that

01:50:24.840 has us truly be present with the person. If you figure that out, whoever the person is,

01:50:30.460 should I have this person be my therapist? Or should I leave this therapist and try something new?

01:50:35.260 I mean, if you try that on for size and it doesn't fit, you should probably change something.

01:50:39.720 How long in the context of the first scenario, which is somebody looking for a therapist,

01:50:46.740 how many meetings with a person do you think you need to have before you can evaluate that?

01:50:52.600 I talk about this a lot. You can know if things really aren't right. If a person is approaching

01:50:59.520 the therapy process and they really want to be there and all of that, sometimes you can just tell if

01:51:04.480 you're not going to resonate with someone like someone who's not making eye contact, for example,

01:51:07.700 like, hey, you can tell, or you just feel an awkward sense. Like sometimes this happens with

01:51:12.680 people and sometimes you can know that, okay, that's not going to be right. But again, be fair

01:51:16.740 and reasonable about it. Do you really want to be in therapy, right? If you don't, then maybe you're

01:51:20.800 going to find something wrong with everyone. But if you really bring yourself to the process,

01:51:24.640 then I say you can tell no sooner than you can tell yes. Because in the first couple sessions,

01:51:30.200 what's going on is you're trying to build a relationship and people need to get to know one another a

01:51:34.160 little bit and how they respond and what their mannerisms are and if they have a sense of humor

01:51:38.420 and how much emotional valence is inside of them. And it takes time so there's a little bit of a

01:51:44.200 dance like there is in any new human relationship. So the thought is if something really rubs you the

01:51:49.720 wrong way and you're looking at that honestly, you could probably tell no first, second, third,

01:51:54.280 you know, along the line. If not, give it a little bit of time, you know, five, six, seven,

01:51:58.480 to say, do I feel like I'm resonating with this person? Are we really getting somewhere? Because

01:52:02.040 again, the progress and the perception of progress is not linear. And sometimes the person,

01:52:06.520 oh, four sessions, I'm not so sure. Okay, so I'm not so sure. Let's give it a couple more because

01:52:10.960 sometimes by the six, the person feels like it's kind of falling flat and I don't feel that there's

01:52:15.600 one plus one is not equaling more than two. Or sometimes, you know, the stuff we did early on

01:52:20.180 is kind of clicking a little bit and now it's only session six, it's two more than four,

01:52:24.120 but they start really feeling something. So there's a process to that. But if one just applies those

01:52:29.420 principles, then again, I think there's a process to it, but it's also a process that you can really

01:52:33.140 apply of, I'm looking for things that are real negative. That person isn't making eye contact,

01:52:37.140 that's bad. Or I really feel at odds. Like you can feel it, acknowledge it. If you don't,

01:52:42.560 be observant, be patient. You know, what's going on inside of you? How are you feeling? Are you

01:52:46.500 feeling help? Do you feel what gets called a holding environment, that the space when you go in is a safe

01:52:51.840 space? And you can be open and honest because so many times people fear criticism where they feel that

01:52:57.220 they'll say something, this is often true with trauma, they'll divulge something, and then the

01:53:01.660 other person will recoil in horror, right? And this happens a lot where someone will just talk about

01:53:07.340 The worst thing imaginable.

01:53:09.260 Right, they talk about, and they're saying it, and you'll see, this is kind of known in therapy

01:53:13.500 education, but if you do therapy, and if you see this in people, like they're surprised, oh my god,

01:53:17.540 I said that. And then they're surprised that the other person, that I didn't recoil from them.

01:53:22.900 Because inside of themselves, they've held that this is something shameful, and someone else should

01:53:27.780 recoil. Because they're carrying shame from it, right? But if you develop enough of a

01:53:32.260 holding environment, enough benign regard, enough real humanness with the person, then

01:53:36.560 that can come out of them without them having even decided. It just naturally flows out because

01:53:41.160 they know that they're in a safe place, and somewhere inside of them, they know that other

01:53:44.840 person isn't going to recoil. Just like they wouldn't recoil, just like you're saying, what would you say to

01:53:49.260 your best friend? So somewhere inside of you, you know that you don't really want to be saying the

01:53:52.920 things you're saying to yourself. You kind of know that? Because why would you say it to yourself and

01:53:56.860 not someone else? But that's different than having an experience of it. And having an experience,

01:54:01.900 in your case, when you were making the recordings, you're having an experience of a more accepting

01:54:06.120 self. That's great. We can also have that experience with an other who represents a more accepting

01:54:12.580 self. If the other person doesn't recoil, that's right, you're not really recoiling from that either.

01:54:17.160 No, I mean, I think that's such an interesting example, because I really felt uncomfortable

01:54:21.140 sending those recordings to Katie. And I think initially I said, well, I'm uncomfortable because

01:54:27.700 I hate that I'm wasting her time. I'm lighting up her phone with text messages of these recordings,

01:54:32.440 but that's actually probably less what it was. I think it was more, I'm ashamed of the fact that

01:54:37.600 I'm doing this, and I'm ashamed of how difficult this is, and what is she thinking when she gets this?

01:54:44.380 Again, this is a narrative you're making that's incorrect. If a good therapist isn't,

01:54:49.600 none of those things are true, but that's the thought you're having.

01:54:53.420 Right. So you have to know that she really wants you to send them, that she really wants you to

01:54:58.020 send them, and she really wants to help you, and she really feels good about you. She sees the

01:55:02.820 goodness in you. And then it lets you do something that exposes the shame. I think part of what you

01:55:09.200 feel ashamed of is that you're doing that to yourself. Yeah, no, the shame is that this is

01:55:13.620 so hard to do. This shouldn't be hard to do. It's, I shouldn't be doing this to myself,

01:55:18.980 and therefore this exercise, A, shouldn't be necessary, and B, it should be a piece of cake,

01:55:23.260 and it's not. So now it's witness, because think about this competing shames. So on the one end,

01:55:27.760 the shame of not being perfect leads you to do something shameful to yourself, which is to be

01:55:33.400 berating yourself. Look, if you did that to someone else, we would say, hey, that's a good reason to feel

01:55:37.020 ashamed to talk to somebody like that, just because they broke something. We say, hey, that's not okay.

01:55:41.200 So why is it that you shouldn't feel ashamed when you're saying it to yourself? Shame can help us by

01:55:46.420 changing behaviors. But now you have like competing shame. Should you be ashamed that you're not

01:55:50.540 perfect? And it's good that you're beating up on yourself. Should you be ashamed that you're beating

01:55:53.920 up on yourself? Because it's okay that you're not perfect. This is part of what keeps us in stasis.

01:55:59.060 But then she, as the person, she's not completely separate from you in that way. Like one plus one

01:56:05.340 is equaling more than two now, because she becomes a little bit of an arbiter or a metric of like,

01:56:11.060 what really makes sense here? And her reflecting back to you that, hey, you're worth treating better

01:56:15.260 than this. This is not okay for anyone, including you. It's not okay. You're not the only person who

01:56:21.480 gets to be beaten up this way. Then part of that is her seeing that. It helps make it easier for you

01:56:25.780 to change, because then you put the shame in the right place. Like, right, if I feel ashamed that I'm

01:56:30.080 doing this to myself, I want to stop. And if it's going to take a long time, I'm going to let it take

01:56:35.060 a long time. I'm not going to be so ashamed it's still here in three weeks that I stop. I'm going

01:56:39.100 to keep doing it. But part of what lets you do that, it's the exposure to the outside person

01:56:43.700 who you trust, because then that person becomes a barometer of what's real and true here.

01:56:48.180 And then it helps us get our own minds into place. Like, oh, right, right, okay, I do get this.

01:56:52.900 It is okay that I am not perfect. I do not want to beat up on anyone like this,

01:56:56.260 including myself. Like now you've got the resolve inside of you to do it. Why?

01:56:59.900 Because you've been validated. Whereas before, you might not have been so sure

01:57:03.640 if the shame is with the lack of perfection or with the self-talk.

01:57:07.820 Let's now talk about another question around the person who's been in therapy.

01:57:12.480 They have the therapist. How often do you see a therapist whose rapport is in the way that

01:57:20.260 they think of rapport, which is getting along, but they're not hitting the one plus one is greater

01:57:25.620 than two. That can be difficult to quantify. But the rapport is such that it's almost a

01:57:29.840 enabling the behavior in the client or the patient. And there's no progress being made,

01:57:36.180 yet the client feels like, hey, this is great. I have a therapist. I love my therapist. I see

01:57:40.920 my therapist all the time. I go in there once a week and tell them everything that's wrong.

01:57:45.500 And it feels really great to do that. But if an objective person, if you were sitting there

01:57:50.580 looking at this, you'd say, yeah, but things aren't getting better. Is there value in just having

01:57:54.880 a person that you pay to listen to what's wrong? Or are you paying this person to help you become

01:58:02.000 better at dealing with whatever it is that's going wrong? Question one is the first critical step in

01:58:08.120 that, that the person themselves must recognize that I need to reevaluate this relationship.

01:58:15.220 And if so, then what are the tools to evaluate that?

01:58:18.100 Unfortunately, yes, in the example that you gave, because it shouldn't have to come to that.

01:58:24.460 Therapists are people. And we know that whatever occupation you take, there's a significant subset

01:58:30.000 of people who aren't giving it their best. I mean, that's part of humanity too. So the therapist is

01:58:35.920 really transgressing something there that should not be transgressed.

01:58:40.000 And you see this, right? I'm not just making this scenario up.

01:58:42.520 Sure, it happens a lot. Because again, not everybody brings their best to their work.

01:58:46.160 For some therapists, it's okay. They'll let the person come and go and they kind of rationalize,

01:58:50.640 well, they're kind of still clicking along and they're doing okay in this way or that way. And

01:58:54.540 they'll rationalize that what they're doing is a non-doing. They're not actually doing anything.

01:59:00.480 And the obligation for the therapist is to know, I know this person is benefiting from this.

01:59:05.960 I see where we're going. So even if I don't see it now, I might see there's, I don't think there's

01:59:10.320 going to be any change for the better in six to nine months. Okay. I have to accept that from week to

01:59:14.780 week because I know where we're going to get to if we do the work by the 10th month. I mean,

01:59:19.500 it's just a more complicated situation. But the therapist has to know, we're either achieving

01:59:25.460 something now or we're heading towards achieving something that's changing this person. It's my job

01:59:29.600 to be active about that. And it's my job to not get complacent. Or if I see that person wants to

01:59:34.780 get complacent, to talk about that with them. It's just a harder job. But I think it's the therapist

01:59:40.640 obligation to do the job that way. Now, when that doesn't happen, then we end up in the situation

01:59:45.100 you're describing, right? We're saying, hey, this person is in this situation where things aren't

01:59:49.220 getting better. And I think putting a full stop to that, like, what am I doing here? What am I paying

01:59:55.040 for? Right? And sometimes that's a good question. What are you paying for? You go buy a gallon of milk,

01:59:59.260 you know, you're paying for a gallon of milk. You go for an hour of therapy. Are you going for an hour of,

02:00:04.360 I want to understand myself and make change? Are you going for, it's an hour I talk about all the

02:00:09.500 things that are making me angry the last week? And then that person gives me a little bit of

02:00:12.700 sympathy and I'm no less angry. To really look inside at what the person is serving. And also,

02:00:20.040 how good does it feel? Comfortable does it feel? It shouldn't always feel good and comfortable.

02:00:25.080 There should be times when you're talking about something that's not easy to talk about,

02:00:29.100 or you're crying in therapy, you're upset in therapy. Like, it's supposed to be work.

02:00:33.640 It doesn't mean it has to be work every moment. Although, I mean, there's a lot of fun to it too.

02:00:37.260 And I have great fun doing therapy, whether I'm the one doing it with someone else or I'm

02:00:41.940 doing therapy with Gregory Hamilton. He's been my therapist for, gosh, 13 years or so. It's fun

02:00:47.980 a lot too, but sometimes I'm upset or I'm crying or he says something to me or I say something to

02:00:53.860 someone. It's like, whoa, that's okay. I'm going to take that in. Like, it's supposed to be work.

02:00:58.340 Everything in life is that way too. So if it's too easy, that's not a good sign. If you feel sort of a

02:01:04.520 threadbare, that's a kind of, like you said, it's hard to quantify when one plus one is greater than

02:01:08.360 two, but you do kind of know it often in human relationships. You just feel good with someone.

02:01:13.280 There's something where you're more than the two of you. That's why people want to

02:01:15.980 spend time together. It's why people become romantically interested in one another.

02:01:19.620 There's a lot of that going on in aspects of human relationships.

02:01:23.520 Let's dig into that a little bit more because it really is. I've never contemplated that at all.

02:01:27.240 But as you pointed out, you take two people like you and I who are very close friends.

02:01:32.440 It's such a clear example of that, the accretive nature of the interaction, but we are friends.

02:01:41.820 And yet we don't necessarily feel that a therapist and patient should be friends. So what are the

02:01:50.040 other, what are some other questions a person can ask to try to get at that accretive nature of

02:01:59.020 coexistence? I'd go back to the framing of it. How do we decide people are friends? Can't quantify

02:02:05.580 all of that. Like, well, there's something there. They know something about one another. They're

02:02:10.200 interested in one another's wellbeing. They have points in the past to tether to. That's why,

02:02:15.820 however much I may think about myself or you may think about yourself, there's something different

02:02:20.560 that happens when we're together. I leave feeling different. Why? Because I saw you.

02:02:24.720 Not because I saw someone. It would be different if it were someone who's not you. That's because

02:02:29.280 we have a real human relationship. Now we call that friendship because that's what the language

02:02:33.980 applies to it. That shouldn't be different in therapy. And it doesn't mean that these people are

02:02:38.420 friends and they're going out for dinner together. It's not that. It's that there's a human

02:02:42.500 connectedness and there's something that's greater than the sum of the parts. So if we look at

02:02:47.800 friendship as an aspect of human interconnectedness and a human ability to see and feel and be present

02:02:55.420 beyond the self, then that happens in friendships. That happens in romance. That happens in parent-child

02:03:00.940 relationships. That happens in a therapy room. And if it's not, then I think there's a problem.

02:03:07.320 I think there is supposed to be something greater than the sum of the parts. Whether we say one plus

02:03:12.280 one should be greater than two, or we say there's an element of friendship in therapy relationships,

02:03:17.980 we can say it any way we want, but it has to be more than just the sum of the parts. That person

02:03:24.180 has to have real regard and interest in the person, have some aspect of the friendliness that friends

02:03:30.820 feel when they're together. The existential therapist understood that. The brand of therapy that when it

02:03:36.820 was thought everything is transactional, you could sit behind the person. And it's not as if there's

02:03:40.840 nothing that could ever be gained by that, but that can't be the baseline of it. What has happened

02:03:46.440 since then with people like Harry Stack Sullivan or the existential therapist that came after Victor

02:03:51.660 Frankel's writing, Rallo May and Irvin Yalom, and they were doing something different. They're like,

02:03:56.220 we're humans being with other humans. That's real. I think that that is wonderful. And when I learned

02:04:01.980 that in my therapy training, when that element was added, like, oh, it's okay to be human because I had

02:04:08.140 an existential therapist who was taking care of me at the time. And I also had some mentors who were,

02:04:12.480 I thought, oh, okay, we have to think about the other person. The session is about the other person,

02:04:17.300 but we're both humans and it's going to help them if they see that in me too. Every now and then it

02:04:22.140 makes sense to disclose something, to talk a little bit about yourself in the service of the other,

02:04:26.980 to let the person know something, to let them know that you are not perfect. I mean, I think

02:04:30.620 a reason you and I are able to help people is I don't think either one of us tries to put out there

02:04:38.500 that we are not either now, recently, or potentially suffering through anything someone else out there

02:04:45.680 is suffering through. And I think there's a humanness to that that's just real and honest.

02:04:50.340 And by the way, it doesn't feel better, I think, to hide behind it, to pretend. People can always

02:04:55.320 hide behind something, whether it's socioeconomic or it's a power differential, it's a position in

02:05:00.240 life, but that doesn't make anyone feel any better. The truth of it is, for example, we do share

02:05:06.200 humanness with everyone. Anyone can get trampled by the society around us. Lightning can strike us.

02:05:11.500 We all suffer. We all have struggles within us. So acknowledging that we're all human and we're

02:05:17.260 trying to help one another, but we're coming at it from a place of acknowledging what's going on

02:05:22.380 inside of us and that we are not perfect. That's why therapists learn from their patients. Good

02:05:26.500 therapists learn from their patients. Absolutely. I can think of the life lessons that come. Why?

02:05:31.720 Because I'm human too. And I don't have all the answers. Hopefully I have some education and

02:05:35.440 training that can let me help you, but also helping you will help me too. That's true.

02:05:42.020 I was talking to one of my colleagues before this podcast about trying to organize around a few

02:05:47.800 different phenotypes of people that we interact with in our practice, who, again, each of these

02:05:54.960 examples, which are caricatures, of course, are people who think everything is fine with respect

02:06:00.400 to their mental health, but there's an externality. Phenotype one is the workaholic. We've talked a lot

02:06:05.760 about this person. This is the extreme achiever. This person is so successful on the outside.

02:06:13.640 Everybody just assumes everything is wonderful, but a lot of times, frankly, when you go from the

02:06:20.500 street to the porch, you realize maybe that's not entirely true. And once you step in the house,

02:06:24.560 you realize that's not entirely true. Another one we've also spoken about is the endless optimizer.

02:06:29.800 So incredibly rigid and controlling of everything in order to drive towards perfect health, as an

02:06:38.620 example. Then you have the very anxious person who really struggles with the fear of the future.

02:06:48.340 And the fear of the future can be short-term and it can be long-term. And again, we should have some

02:06:53.080 fear of the future that would allow us to do things that are productive. But obviously, I'm talking about

02:06:57.540 this in a negative way. And then perhaps, at least for me, the most difficult phenotype is the denier.

02:07:04.500 So this is a person who, by any reasonable metric, is suffering. But their barriers to accepting that

02:07:13.300 are so high that you can almost make a cartoon about it, where you see a person who's missing an

02:07:20.720 arm and you ask them if you can help them because they can't do something that would require two arms.

02:07:26.800 And they look at you like, what are you talking about? Of course I can do this thing. I have two arms.

02:07:32.420 Well, but you're missing an arm right there. How do you think about someone, be it a friend,

02:07:40.040 be it a physician, be it anybody, trying to help and get through to any of these phenotypes to put

02:07:47.440 the thin edge of the wedge in there such that they can at least make a tangible step towards self-help?

02:07:56.520 Well, I think the first thing to do is recognize, okay, that there's a problem. And then you go back

02:08:04.080 down this idea that there are these cupboards in the conscious mind and the unconscious mind and

02:08:08.420 there that if we go and look and scrutinize what is going on inside of us, or we have curiosity about

02:08:15.140 what is going on inside of someone else, that we're going to find the answer that this is not a mystery

02:08:20.580 that just like a Sherlock Holmes investigative process or math problem, one can look at it and

02:08:26.420 learn things. Think about the first example, a workaholic. Again, you didn't say someone who

02:08:31.280 works really hard and achieves high, but a workaholic. So even the word by definition is a

02:08:36.240 problem. So what are workaholics doing? Well, oftentimes they're avoiding something. That's why

02:08:42.700 alcoholics are trying to avoid something by drinking to get away from it. Like we understand that,

02:08:46.740 that's no less true with workaholic. There's something going on inside that person that

02:08:51.760 they're afraid of, that they're suffering from, that they're ashamed of. Like something is driving

02:08:55.520 this behavior. So I think, what are you avoiding? What are you trying to get away from? Because

02:08:59.560 workaholic doesn't mean you work very hard and you achieve at a high level. Workaholic means you're

02:09:04.800 working when it makes absolutely no sense to work. So what are you escaping from? So then I think

02:09:09.940 there's a defense here that is usually avoidance as a defense. And there's other defenses that come along

02:09:15.360 with it. The person can put blinders on themselves, go in one direction, feel that that's good enough,

02:09:20.180 but boy, aren't they seeing what's on the other side of it or feeling what they would feel on the

02:09:24.340 other side of it. So then that becomes a point of curiosity. Is there avoidance? What is that

02:09:28.740 avoidance? What's going on inside that person? Then you think, okay, with someone who's optimizing,

02:09:33.580 always trying to perfect, there's something different going on there, which is probably more

02:09:38.280 rationalizing. We all kind of know that things get to a place that's good enough. Everyone kind of

02:09:42.920 knows that. So if the person is still trying to make something that's really solidly good enough,

02:09:47.920 perfect, what's going on there? What are they serving inside of themselves? They're going to

02:09:52.620 soothe something. Some anxiety then gets soothed because they do something that's irrelevant.

02:09:58.280 So let's go look at why the need to focus on optimizing something that's already good enough.

02:10:03.140 There's other things to do in life. There's other ways to spend that time and energy. Why that focus?

02:10:07.840 It's a process of curiosity. When people are very, very anxious, then where that leads us is what's

02:10:13.420 going on inside of them. They may be younger people in my practice call it future tripping,

02:10:18.040 anticipatory anxiety. So is there a way that that person's fear about the future shuts them down

02:10:24.920 so that they're not doing anything in the present and they don't have to be afraid that what they'll do

02:10:30.060 won't work in the future? That doesn't go well, but we get into those places. So what is that

02:10:35.940 anxiety inside? What is it about? Why is it so high? So then again, we become curious about that.

02:10:41.020 Denial is the hardest one. And we think of maladaptive defenses because how do you get

02:10:45.640 someone around maladaptive defenses? You're trying to help them understand. So if you're rationalizing,

02:10:50.300 there's a little bit of a place we can grab onto that. Okay, you're rationalizing. Some of it makes

02:10:54.840 sense, then it doesn't. But denial can be very, very cut and dry and very frustrating to come up

02:11:01.200 against. And I don't know if you met Peter Grover, who's a therapist within our practice who's very,

02:11:06.180 very experienced. Peter has a sign on his wall that says, how's that working for you? Because

02:11:10.440 that's his mantra. He's very, very good at helping people who are in that so difficult denial

02:11:17.340 position by helping them look, well, let's just look at how's it working for you? Because the idea

02:11:22.020 is then the person's at odds with the therapist. So if you're like, how's that working for you? You can

02:11:26.900 then together look out at it. Leston Havens, who I had to meet many years ago, who in an era when

02:11:33.100 most therapists were sitting behind the patient, would sit next to them and look out at the world

02:11:37.640 together. So you're trying to do that. So how's that working for you? It's like, okay, I hear what

02:11:43.900 you're saying. It's not saying it's right or wrong, whether you're working or you're doing this. Let's

02:11:47.740 just look at how it's working for you. That can't really be even answered without some introspective

02:11:52.760 capacity. I've interacted with people where maybe I didn't ask that question point blank,

02:11:58.140 but I can almost imagine that if asked, they would respond, great, everything's great. Can't

02:12:05.360 you see? Everything is great. I totally understand that of the four phenotypes described, that one is

02:12:11.040 hands down the most difficult. I'm just wondering if the people around individuals like that, if they

02:12:17.360 care about them and they want to help, how can they help them probe even further? You hear the term

02:12:22.620 intervention. At this point, you just get everybody in the room who knows them and you just have that

02:12:27.260 riveting intervention. What's the equivalent of that state here? It's hard. Sometimes you can come

02:12:34.200 at it. The idea here is the person is not letting you see with them. You're across from them metaphorically,

02:12:40.860 right? So what you can do is then to tell them, to say to them how you see it. Because I can't

02:12:47.220 impact you. You're not letting me. Barry, there's nothing wrong. That's your story. You're sticking

02:12:52.660 to it. But presumably, if one is having that conversation with a person, one plus one is

02:12:58.080 equaling more than two. That's why you're sitting across from them. Like there's some emotional

02:13:01.660 investment. There's some respect. There's some love or consideration. There's something there

02:13:05.800 that when you say, hey, I just understand that. And I hear where you're coming from. And I hear it loud

02:13:11.160 and clear. I just want to say to you that from where I sit, as someone who knows you, cares about

02:13:16.820 you, loves you, whatever it may be, what I see doesn't seem okay to me. And I just want to say

02:13:22.360 this. I'm trying to force it on you. Because people sometimes will remember that down the road.

02:13:27.140 Sometimes they're like, look, I can't help this person right now. But what I think I can do is

02:13:31.300 maybe put a seed in there that may come about later. Like sometimes I'll see this with someone who's

02:13:36.560 drinking very heavily and not acknowledging. I still feel good. You know, I don't feel any

02:13:40.900 different. So nothing is going to happen. Now we may have a set of underlying labs that we can look

02:13:46.140 back from and we see where those numbers are trending. So it's not hard from the outside to

02:13:50.340 see. But the person is like, I don't feel any different. There's nothing wrong. So even then,

02:13:54.740 sometimes, well, if I can, I'll try and put in an idea of look, at some point, you're going to start

02:14:00.840 feeling something different. At that point, remember this. We're acknowledging like you can't get

02:14:06.280 through to everybody. And like, that's okay. If you can't, don't keep trying. Because like, look,

02:14:10.220 I want to tell you how this is going to be bad for you. That person has long turned you off and

02:14:14.520 tuned you out. You can't get anywhere with them. But if you do them, it's okay. I get it. I'm not

02:14:18.340 the person who like says you stop drinking or something. That's not me. That's not what I'm

02:14:21.360 doing. What I can do is maybe plant a seed that I think you're going to start feeling something.

02:14:27.580 At some point in time, this is going to start feeling different. Remember this then.

02:14:31.340 Sometimes people do, sometimes they don't. But a lot of times when people get help,

02:14:34.920 you do see that they've taken that inside. Sometimes from someone else. Sometimes I'll

02:14:39.500 see it in my own work where someone who I thought things ended very badly and the person wasn't

02:14:44.700 helped and they left and I tried to plant a seed and then they come back in a couple of years.

02:14:48.580 You know, I thought about that and like, wow, that feels great. It's a proof of concept that

02:14:51.960 you're doing the right thing by planting these seeds. But more often than not, we see someone

02:14:55.800 else has planted a seed. Maybe that was another therapist or it was another friend or someone else

02:14:59.520 said that or someone said a long time ago, they read it in a book. If we can plant seeds in people

02:15:04.560 who are in denial, those seeds may grow. But we have to understand when we can't do more than

02:15:10.380 that and stop. Otherwise, you know, we could drive the person away and prevent any help from coming.

02:15:16.080 One final question I just want to ask you, Paul, is about how you manage internally the challenges

02:15:23.300 of what you do in the sense that you work with all sorts of people across all sorts of spectrums.

02:15:28.820 And obviously, we didn't talk about it today because we've spoken about it a lot in the past,

02:15:32.880 but you're going to be very quick to look for the trauma in a person's life that probably shaped

02:15:38.900 many of the adaptations that exist today. And in doing so, sometimes those things are very sad and

02:15:45.560 they're very tragic. And I just wonder how you manage the sadness around that for yourself.

02:15:51.700 I think about what it was like being a resident. Patients would come in and they would die.

02:15:57.400 Trauma victims, someone comes in in a car accident and they're dead. You take care of them and can't

02:16:02.340 save them. We don't really get taught how to manage that at all. I found that to be hands down

02:16:08.460 the biggest failure of our training system. Perhaps that's changed. But certainly when I went

02:16:14.100 through, there was absolutely no discussion even of that. I remember being reprimanded for going to

02:16:20.900 the funeral of a patient. The idea being like, that's a line you never cross and you have to block

02:16:28.020 that stuff out basically. How do you deal with that?

02:16:31.420 I'd start by saying, I agree with you. I think at least in our era of training,

02:16:35.600 medicine did a lamentable job of that. And if you think about medicine, hopefully selecting for

02:16:41.780 empathic people or compassionate people. And when a person is built that way, that one plus one is

02:16:47.600 more than one. So you feel part of a we. If you're taking care of someone and they die,

02:16:51.800 you're not that person. But magically, it's what goes on in our heads. We feel sort of part of them

02:16:58.000 because we're a we. We see that with people we really love who are close to us. They're part of

02:17:02.480 who we are. We see this in settings where we're helping people too. And I don't know if you went

02:17:08.180 through this part of it. I remember when you were talking, I remember very vividly being an intern

02:17:11.920 and having to really tell myself, I am not this person. Because I start feeling like, oh my gosh,

02:17:17.320 I could see this person is suffering. And it's easy to lose those boundaries. So to be able to

02:17:21.780 say, I'm standing here, that person is there. In fact, the only way I'm going to be able to help

02:17:26.180 them is I have to know that I'm not that person. But it wasn't easy. And I remember one of my

02:17:31.520 co-interns, and I remember he and I really talking about that. And we were trying to do it for

02:17:35.940 one another. Like, okay, calm down a little bit. You're not this person. Let's step back from it,

02:17:40.820 catch our breath, and try and help the person. He probably remembers we did it for one another.

02:17:44.200 For me, it starts with that because that's a physical separation.

02:17:47.240 And then the idea that I can mentalize a lot, meaning like think a lot and feel things. We can

02:17:55.640 all do this, but like we do this when you're a therapist, you're feeling what other people are

02:17:58.900 feeling, you're feeling for them. It's easy to keep that in your mind too much. Then just like if we

02:18:03.480 picked a word and said it 5,000 times, it'll be in us tomorrow. If there's something you don't want

02:18:07.780 to do, and you repeat it 20 times, you're more likely to do it again. The same is true when we can't

02:18:13.700 bound ourselves well enough from the suffering in other people. This is why people have post-trauma

02:18:18.540 syndromes from vicarious trauma. I mean, this absolutely happens. The brain is changed. There

02:18:24.360 are biological changes, behavioral changes, and all of that trauma is vicarious. And this

02:18:29.280 is why we see the levels of depression and suicidality and substance use is higher in people

02:18:35.440 who are giving care to others. So it is so important that we have these boundaries inside

02:18:41.840 of us, and they have to come, I think, from this place of balance drives and gratitude and humility.

02:18:47.560 I'm so grateful I get to know other people. They share things with me. I can help them. I can learn

02:18:53.280 from them. That is such a wonderful thing that it helps me to accept the other side of it, which is

02:19:00.660 sometimes things that are very, very hard to hear or very hard to get out of our minds. And I have to

02:19:05.320 have the humility that I am human too. And if I keep this in my head, or if I'm really mad about

02:19:10.140 this and the things that happen to somebody, we see the most awful things people can do to one

02:19:14.360 another that I know these things happen. I can fester on the anger, the frustration, the misery of

02:19:20.460 this, and I will hurt myself. So my obligation to myself and to the people around me that I care about

02:19:28.840 in the world with people I love or people I know and I like them. I want to be healthy. I want to be

02:19:34.300 at my best. And I have to be able to maintain these boundaries inside of me, which means have the

02:19:38.640 discipline to stop thinking about that. Know that, take stock of, I'm doing the best I can for that

02:19:43.720 person. I'm still worried. I'm worried it's not going to have a good outcome. Like, am I doing what I

02:19:47.760 can do? I can. There must be something else that comes into my mind. And I find it is easier to do that

02:19:53.380 as I focus more on the balance of drives. I'm being generative. I'm asserting myself. I'm taking

02:19:57.340 pleasure in what I'm doing. And I feel gratitude for what I'm doing and the humility to know

02:20:02.040 that if I don't take care of myself, it'll kill me too. Paul, I want to thank you again for not

02:20:09.060 just making the trip out, but more importantly, of course, sharing all of these insights in a

02:20:13.140 manner that's incredibly lucid and helpful. I look forward to doing this again, because obviously we

02:20:17.480 will. I do too. Thank you so much for having me. It's wonderful to see you. And, and I so appreciate

02:20:22.460 being on the podcast. Thank you. Thank you for listening to this week's episode of the drive.

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The Peter Attia Drive - April 15, 2024

#298 ‒ The impact of emotional health on longevity, self-audit strategies, improving well-being, and more ｜ Paul Conti, M.D.

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