Qualy #33 - How silent bravado and incessant striving can lead to a functional (and actual) death, and why Paul is critical of the current state of psychiatry
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Summary
In this episode, Dr. Peter Tmd joins Dr. Kelly to discuss his experience as a pediatric psychiatrist at Harvard Medical School and how he became interested in the field of psychiatry. Dr. Tmd is a member of the Advisory Board of the American Association of Psychiatry and a professor of psychiatry at Harvard University. He is also a frequent contributor to The Daily Mail and The New York Times.
Transcript
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welcome to the qualies a subscriber exclusive podcast qualies is just a shorthand slang for
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a qualification round which is something you do prior to the race just a little bit quicker
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qualies podcast features episodes that are short and we're hoping for less than 10 minutes each
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which highlight the best questions topics tactics etc discussed on previous episodes of the drive
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we recognize many of you as new listeners to the podcast may not have the time to go back and
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listen to every episode and those of you who have already listened may have forgotten so the new
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published exclusively on our private subscriber only podcast feed now occasionally we're going
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to release quali episodes in the main feed which is what you're about to hear now if you enjoy these
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subscribe so without further delay i hope you enjoy today's quali you're alluding to um obviously
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something i know is very difficult and we've talked about it a lot i don't know that we need to
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necessarily go into great detail here but in the span of a year if i recall you lost your brother and
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your best friend yeah my my brother my brother died by suicide and uh about a year later one of
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my closest friends so the same a close group of friends growing up like sort of like we had in
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medical school but there were a group of us and one of those very very close friends from childhood
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also died and he didn't die by suicide but there was sort of that same kind of desperate recklessness
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that i i saw this common root in those two deaths and you know they confused me and and infuriated me
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and you know made me feel very helpless and and vulnerable and wanting to be able to understand
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better and to kind of fight against this thing that made it so hard for people to really to get help
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right and to be vulnerable and that was really the commonality is like both of the people who died
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had real and significant needs inside of them that came about naturally right like something you one
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would never criticize a person for having those needs right or those struggles but there just wasn't a
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venue of of getting real acknowledgement and help for any of that so that kind of silent bravado and
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silent struggle you know became very real to me that like oh that leads to death right i mean it
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doesn't all the time lead to death but it leads to death you know way more often than is even remotely
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acceptable i mean i think as we've discussed it sometimes it can lead to death immediately like in
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these cases and sometimes it can lead to a functional death which is you're still technically alive you
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know you still respire but you're effectively dead in many ways that's probably the more endemic
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more sinister more destructive over the long term given its sheer volume problem right oh absolutely i
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think and the deaths that we see in front of us is like actually okay that person is not breathing
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anymore are they're a viscerally moving hallmark of what is so pervasive in our society and and i do
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think that i think that i didn't understand that then that in many ways the way our society is structured
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and the way our matrices of achievement are structured really beckons us to death in life to losing touch with
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the basics of our own value system and essentially to incessant striving and not incessant striving to achieve
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although we may see it that way but incessant striving to not pause and to not feel the
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vulnerability that i think is so pervasive now i mean even in the 20 years you know since we went to
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medical school i mean you think about how pervasive media is right i mean how there's just marker after
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marker after marker after marker that says that you're not good enough you don't have enough you're
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too vulnerable you know there could be terrorist attack anytime your kids could be killed uh we
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could die i mean it's one stimulus after another that tells us not to stop and to to really value
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ourselves by the things that we really value we get through med school and true to your word you get
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a psychiatry residency spot you decide to stay at stanford in part because your wife was still your
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soon to be wife you guys weren't married yet but your girlfriend was a couple years behind us in
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med school and you end up spending half your time at stanford and then your wife matches at harvard so
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you go and finish your residency at harvard so whenever i'm telling patients about you and i'm
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probably bastardizing all of my knowledge which is so limited in this field but i say you know one of
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the things about paul that's so unique is he did half of his training at stanford which is probably one
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of the foremost institutions when it comes to understanding the neurobiology and the pharmaconeurobiology
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and the pharmacology of psychiatry and then does the other half at harvard which is sort of a more old
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school but you know a place that specializes so much in the in the psychotherapy is that an act am i am
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i making that up when i say that because i've just decided to take the liberty and say that about you
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it sounds good so please keep saying it um no no actually i think that there is truth to that
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and there's even more there's more truth to that the longer i get from it and the more i reflect on it
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i i think that you know i am not a very positive or hopeful person about the state of the field that
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i'm in which i think does not broadly enough train people in brain biology not just in the use of
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medicines but in what those medicines actually do and on a very real level what are those
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medicines doing as interventions in the brain in the many many systems of the brain in the cascade of
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effects that occur in the brain and we don't think about structural neurobiology we don't think about
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neurochemistry in general so there's that part of the field that often gets ignored and then the other
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side is the psychology there has been a debate of should psychiatrists still be trained in psychotherapy
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and i see this come up and and i i just think that it's putting it crazy to consider having people
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that are that are schlepping medicines to other people that aren't thinking about what it's like
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to really try and understand someone and what are the paradigms of understanding other humans right
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the kind of things that are valid and have a scientific basis for them but that are not hardcore brain
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biology and i was very very fortunate to learn so much neurobiology at stanford and to have that
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integrated into my training but when i got to harvard i was struck by that several very like
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prominent influential people there who like were influential over like for example whether i graduated
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right were like really shocked at how much brain biology i knew and really shocked at how much
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psychology i didn't know and even though i had sought out some of this on my own uh being in a place that
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was kind of steeped in an older analytic tradition really helped me kind of embrace this belief that
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understanding psychology and certainly from the perspective of what's psychodynamic right the
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things that influence and motivate us that are in our unconscious you know the gigantic part of the
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iceberg that's underneath the water but that is most deterministic of our behaviors and our choices
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and our feelings and being able to integrate that with the brain biology upon which it rests i think
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is i think it's the way to at least try and have the most broad set of abilities to try and help
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people and in some ways it was very fortuitous for me to split my time between those two places and to
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find a couple very very good people who took it upon themselves to try and teach me in a short period
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of time um what maybe i should have learned over a longer period of time i hope you enjoyed today's
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quality now sit tight for that legal disclaimer this podcast is for general informational purposes
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