#298 ‒ The impact of emotional health on longevity, self-audit strategies, improving well-being, and more | Paul Conti, M.D.

27:11It's not the locomotive of history. It pushes history backwards. And what is actually the locomotive of history is the generative drive within us as human beings and our ability to realize it. This is why people learn and create and imagine like Mendeleev in front of the periodic table and the joy of like putting, wait a second, I see a pattern here and figuring it all out. Like there is a joy in creation, whether it's watching a child or they can be watching something grow or discovering something. This is the locomotive of history, but we pay so little attention to it inside of us, even the idea of valuing ourselves by by what we see from the outside, by things that we feel bring us prestige.

27:50And we know that that doesn't make happiness. So we've kind of gotten lost a little bit and a little bit away from what our core humanity is telling us is we want to feel worthwhile and we want to be interested in things around us. And we want to be sort of delighted by new knowledge and new experience. And when people carry this through the lifespan, going back to where we started, these are people who are happy and who are taking care of themselves and who age well and who don't fear death. That's also another part of it is when people are living through the generative drive, they're taking care of themselves in mind and body and emotion, they don't find they're afraid of death.

28:29They said that people want to die, they want to stay alive because they're healthy and happy, but there's a difference between that kind of enthusiasm and fear. Then I think that is remarkable. We should look very closely at who are people who are not fearing death. and we see that they are often in very good balance. The generative drive is being honored and the assertion within them, and the ability to feel pleasure and satisfaction. These are all well -balanced, and then they're in places where they can find some peacefulness and some reflective capacity and some ability to feel contentment and delight in the world around them.

29:04I mean, we see this, and these are happy people. And we know that is not tied to the things we might think it's tied to wealth, for example. So how can a person begin that examination? I think what you said is very insightful, which is from the outside, these can be indistinguishable. You can have an individual who looks like they are doing remarkably well. Again, by any metric, I don't just mean financially, but I mean in terms of actual achievement, But it could be fueled by fear, by anger, by insecurity, by any of these other things. And you can have an individual who's achieving the same things, or frankly less, but it's coming from this generative place.

29:52So if an individual listening says, hey, how can I take this first diagnostic step and evaluate my own drive? What would you say to them? The first thing to do is to look inside oneself. How do I feel? I talk a lot about a life narrative and a person could just start writing, you can start talking with someone, you can start introspecting with their ways of taking stock of what is going on inside of me. Am I being kind to myself? What's the voice inside of me saying to me? Do I feel good about any of this? Is any of this what I want? Let's stop there for Zan Paul because that's not an easy question to necessarily answer.

30:35I want to dig into this because it can be very difficult to answer that at a deep level. Because sometimes the superficial answer is so obvious. If you have everything, if you have material success, your knee jerk answer would be, of course this is what I want. How do you go deeper into that question to what you're talking about, which is the look inside? Use more specific tools. So what do you say to yourself when you're alone? Is there something that you say to yourself over and over? If you make a mistake, what do you say to yourself then? Is there an urge in you to be helpful to other people when you see them around you?

31:15If someone stumbles in front of you, do you feel like you want to move forward to help that person? These are the ways in. These are the ways to give us answers about how we feel about ourselves. There was a period of time, seven, eight years ago, where I would, for some period a week or so, would see people who had very, very high levels of success that, from the outside, looked as if they must be happy. And when I would stop doing that, I came back and I would do clinical work on a unit that takes care of people who don't have insurance, many of whom were indigent, not all, who have drug and alcohol problems.

31:56So the opposite end of the socioeconomic spectrum, I swear to you that this is true. I could find no difference in overall happiness between the two groups. So someone who looked to have it all would feel, if I don't have that next achievement, it all goes away. So the person isn't owning what they have earned for themselves. And this is a theme inside of me. So the person may have made a lot of money. Now they don't have to worry about being in need or they may have achieved that they're chosen art form, but they're so afraid that if the next thing doesn't go right, it'll all be taken away or they'll feel ashamed of themselves.

32:32This goes on a lot in people who are high achieving. It's like, what have I done for myself lately? And if I haven't done something good enough, I can't feel good enough about myself. There is so much of that. Whereas I could see people who from the outside literally had nothing who would be saying, you know, when I get out of here, I'm going to do it differently. I'm going to do it better. I'm going 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 myself away from what got me in here in the first place and they might have an enjoyable story or memory to say.

33:05I remember one point meeting someone who is living behind a bush under bad conditions who is far, far happier than the vast majority of people I had seen over the previous several days. The truth is, we are often running from something or trying to achieve something that makes us safe in the world and all of a sudden we're going to feel better about ourselves and what we really need to do is honor that we are human. And what is going on inside of us is so important. If we are willing to look at that, we're willing to ask the questions, what do I say to myself? How do I feel about myself versus other people?

33:38Do I feel like a fraud? Am I afraid everything will be taken away? From me, every time I drop something, do I say, what an idiot. inside of myself, like what is going on inside of me? Do I feel like I have an openness of spirit to new things or people who are different from me? Like we can ask ourselves these questions, but we have to stop feeling that what we adorn ourselves with is what brings us happiness. Then we can get to this owning what is ours. So that person who is going to try and put a roof over their head when they leave can own what's theirs, which is the tenacity to have what survived behind the bush, survived and lived in that way and maintained a good spirit.

34:18And often these are people who are helpful to other people and are looking out for people around them like that is something to feel so good about as you strive for what comes next just as someone who has worked and learned and studied could feel good about the achievements they have or someone who goes to a difficult job that doesn't provide them with satisfaction that they feel is back breaking labor and underpaid. But they go and do that and they take home a salary that supports a family and puts a roof over people's heads. Feel proud of that when we don't feel good about ourselves. Often we are out of kilter with the generative drive within us.

34:57That is absolutely a part of what makes people unhappy. But also coming along with that is not owning what is ours. and how many people who've raised families, right, done things that are so impressive from the outside, have told me over the years that, oh, they're not worth anything, they didn't make enough money, they didn't do this, they didn't do that, and it's not what matters. It is not what matters within us. It is being the best that we can be in honoring the drive inside of us to live and to create. How would you make the case to somebody who's listening to this and says, Paul, I get what you're saying, but there's no way that if I had to choose between those two extremes, meaning I live behind a bush, but I have some sort of happiness, but I have nothing.

35:44No material possessions, no status in society, versus I could be incredibly successful in the eyes of society and with it have all of the comforts that come from that success, all of the wealth, but you'll tell me that I'm unhappy. be. Someone listen to us might not be able to even wrap their head around what you're saying, because they might be right somewhere in the middle. They're not living on the street, but they're struggling. And they believe that their struggle is because they don't have something greater. Or even they acknowledge it and say, yeah, but if I had to choose between those two, I'd rather have all the comfort of the world materially and be miserable.

36:23So silly question, but how would you make the case to them that, hey, it's not a zero some game and that's a false choice. So we'll come back to that. But more importantly, even in that extreme choice, why is that not the wise choice? I would say get to know people in both categories better if you're in the middle because I know what I would choose. I mean, I would absolutely choose that person who doesn't have any material possessions. If I were making the choice for myself, like the selfish choice is to choose that person. I don't want to be the other person because I know that's not happy. I see where that goes.

36:54I see where the dissatisfaction leads and I don't want that. I would much rather have within me the spirit that makes me feel like I can do something, I can make some change because we all need the basic minimum in order to have some safety and satisfaction, like a roof over our head, enough to eat. But oftentimes, if you give a person a little bit of help, they can go off and do that. If I were that person getting some help so that maybe now I can move my life forward, I would feel an enthusiasm about that. I can make things better. I can have the minimum that I need. And from there, what is it that I choose to build?

37:36When we look at measures of satisfaction, societies that even today who are by and large, hunter -gatherer societies or the societies that we, from the outside, think have nothing, are often happier than we are. So like there's your proof. There is your proof. So I think as a society, we have so much plenty that we can look after people better. And I always say we live in a society that runs ahead so quickly that we're always trampling people along the way. And one, it's just not right to do. And two, any of us can be in that group of people who has something really difficult happen to them, was up against something really, really big, and then something else really, really big, and gets to a place where like we need a helping hand, oh, and any of us could be that person, or someone we love could be that person.

38:25And even if that weren't the case, it's just not right, and even if that weren't the case, it's not even economically efficient. Help people to be productive members of society, that's important economically, and of course beyond economics is the human part that matters, but even just the dollars and cents of it tells us help people up when they need help. We can do more for people to give them an opportunity to make a life for themselves that can feel productive and contain happiness within it. And if we do this for all of us, we give all of us an opportunity to have the generative drive within us realized as that may be for someone who's very interested in academic learning and success.

39:14You may think, look, I like that. I like when I get in accolade. I like when I learn something and then maybe they go off and they start building businesses and they feel great about that. Like, that's wonderful. That is wonderful if that's what that person feels good about. There are also people who live good productive lives and they're good neighbors to the people around them and they take care of children if they've chosen to be responsible for children. These aren't people who should feel any less good about themselves. And the irony in the world is that often what I see are both groups of people are not feeling good about themselves They're not earning what is there is the person who went off and studied and created and kept feel good about the Well they generated that now may be good for people around them and they don't feel good about that or the people who Struggled and worked and made good lives for themselves.

39:58Don't feel that they have enough I see this is coming along with this idea about aging that always should feel so bad about getting old and And oh, we should feel so bad about whatever we can identify in ourselves that isn't what we think it should be if we look from the outside. There is a real simplicity in just sitting with ourselves and introspecting or sitting with someone that we're talking to or writing with a pen or being in a therapy room of, let me think about me. Because the truth is, all of us are so different as to be really and truly unique. So if we take ourselves out of how we try and tether ourselves to all the shoots around us and say, let's talk about your life and let's talk about what your experience of life has been, your experience of being in the world and trying to Have some healthy control over a world that's difficult to control.

40:50Let's talk about that And it's to those discussions that lead people to interesting decisions. Sometimes their decisions to leave a very high -paying job for lower -paying job But then the depression goes away or the substance use goes away. Sometimes it's a decision to strive for more that leads a person ultimately to achieve external measures of success. But we don't know what that is. We don't know what that is. But if we start thinking about it and talking about it, we also go back to the basics of how are you taking care of your body? It's going to be very difficult to feel good. If one is not taking care of the basics of their physical function, we get down to the first principles, physical health, the things that contribute to lifespan, health span, cognitive health, and emotional health.

41:33But we have to go back to the first principles of like, who are you? And let's talk about your story because that understanding is what leads to the next decisions. And the next decisions are not obvious from where we stand now. How positive in terms of its predictive value would the following be? And again, I'm still thinking through this as almost a self audit tool. If a person ostensibly recognizes that they are not taking care of their physical health, okay, they're drinking too much, smoking, using substances in an unhealthy way, eating too much, not exercising, all of these things. If a person can recognize objectively that those things are true, and that's a generally pretty easy thing to recognize, what is the PPV, the positive predictive value of that sign that says there is something unhealthy going on in me emotionally.

42:23Recognizing the sign? If those signs are present, the sort of physical not doing the things to make yourself the best version of yourself physically, let's assume that that's easy to recognize. How likely is it to then be predictive of the fact that you're emotionally unhealthy? Oh, very, very high, very, very high predictive value because, see, but what's the link between the two? It doesn't feel good to get up every day and not feel good. It doesn't feel good to know that one is unhealthy and energy levels are low or it doesn't feel good to look at oneself in the mirror and say, I could, would, should be healthy, right?

43:00Or to not be able to keep up with one's kids or whatever it is that goes on inside of us that makes us know that if that's going on, something isn't aligned well within us. What is the reason for that? Or I have to work to do this, this, and this. 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. We've all seen reasons, but there's not good reasons. This is what we have. Our bodies and our minds are what we have. So the idea that we can just push that aside and not pay attention to it, like, can't be right. They cannot be right to not pay enough care and attention to everything that we have as we move forward.

43:41So the key is the curiosity to link the two. So there's a high -prositive predictive value that there is something emotionally than out of balance if you wanna look at it that way, or something in the mental health realm, whatever it may be, but whether or not good comes of that is the link of curiosity. It's amazing Paul, because that's such a common phenotype. For all of us, I include myself in this category. There are absolutely things that I do for me, it's clearly overindulging in food often. Even when I'm saying to myself, Peter, you don't need to be eating this extra helping of dessert or whatever.

44:20How do I think about that in a way to not overanalyze this or overinterpret it? How do you decide if my overeating is actually a canary in the coal mine that says, hey, there's something going on inside of you emotionally. And my wife and I will talk about this all the time. She'll be like, you are really emotionally eating right now. And I think we talk about that a lot. I think we understand sort of what that means. She's like, you're so stressed out, get out of the for -compantry. You've been walking back in here every 20 minutes and you're elbow deep in the pringles. What's going on? Is there pathology there?

44:55Is that sometimes an okay coping strategy? Like I want to be careful not to kind of demonize everything, but at the same time, I want to be able to use this as signs. Because again, I'm coming back to this idea of, man, when it comes to this domain of health, we don't have biomarkers, we don't have scans that give us answers, blood tests, tests that you can do with objective measurements. I'm searching for other ways to gain an insight into how do I at least start asking questions to get myself help. In the scenario you gave where it's a subjective conversation like, hey, you're doing that, you're stressed, you're emotionally eating, and we kind of know there's something there.

45:36But a lot of times a place to start is are we over managing ourselves? Every now and then like a little bit of indulgence is okay So let's make sure that it's not that that we're criticizing That we're actually recognizing something that we don't need a biomarker for look when I am very stressed I am eating in ways I don't want to be and It suits me a little bit at the moment and then I feel worse about it And I got to go do something to make up for like that's not good That is face validity. That's just very clearly not good. So then what we can do and often do is just simply perpetuate that.

46:14To recognize that and it goes no further. And then we continue to do it. As opposed to saying, whoa, this is the place for curiosity. That's interesting. What is different about the feeling inside of you if you eat because you are hungry or you eat because you are stressed? Can you recognize that difference? and maybe you can if you're paying attention to it, a lot of people can. And if not, what's the context around? You can have an idea of what's going on inside of you. And then it fits into this human thing that we do, which is short term gratification at the expense of something that in the long term is negative.

46:54This is why when we were back in medical school, people were not very interested in studying addiction. And the thought was that addiction was separate from other mental health things and it was people who were doing something they shouldn't and then weren't able to stop. And it was a very, I thought, denigrating and disinterested approach. It is so different now. Because what I think the field has come to recognize is that these addiction mechanisms is going on in all of us all the time. The short term soothing of a little bit of food that isn't healthy for you at the expense of you feeling badly about yourself in the longer term is part of that same cycle.

47:35It's the same brain machinery that is getting harnessed so that we over -prioritize the short term at the expense of the long term while looking away from the fact that we are doing that. And if we become curious, why isn't what crests inside of you that you, a person who's very good at looking at the long term and foregoing and mediate gratification and all of that. I say, I'm going to sue this right now with food. If we look at that, the thought would be, we've got to be able to do something about that. You've done much harder things than to realize, oh, there's an emotion inside of me. Like, wait, let me go look at what is that?

48:11What is that emotion? Where is it coming from? And maybe you can't stop the emotion in the moment, but it might tell you, hey, this thing in my life should be a little bit different. Or it might say, hey, I crest like this with relative frequency. is this okay? Can I take care of myself? Because sometimes it's harder answers to that, the answer might be, well, a person should do less. The answer is, keep doing everything that you're doing, and don't have these emotions that crest in certain ways. The answer might be, why are you doing all the things that you're doing? And again, I'm not saying this is the case for you, but we need to all look at this.

48:40What is going on inside of me that something is cresting and all of a sudden I prioritize the short term, and I don't look at that. And this can be the beginning of 30 sessions of weekly therapy with a person of talking about this paradigm within us of how are we doing this for all sorts of things in life? What might be be rationalizing about our choices, personal and professional? How are we taking care of ourselves? What's the climate inside of us? Because when a person seems to be taking care of themselves from the outside and maybe it is, you can see from the outside, but they're so frustrated on the inside.

49:13They're so afraid, they're so overly managing themselves to make up for something, Then we don't necessarily see that that keeps them healthy. There may be a higher inflammatory state that increases risk of cardiovascular disease, for example, or a viral immune phenomenon. We know this happens. So we have to be curious about ourselves, and it is amazing what we hide from ourselves. We go through life hiding so much of what is going on inside of us from ourselves in the service of maintaining some direction we've decided was important. I've got to go do that. I've got to go achieve that and then we put these blinders on ourselves and we don't look does this make sense for me?

49:54Am I being the best person that I can be? What's the whole set of priorities in my life? Personal and professional self -care about other people that you care about about achievement? Am I balancing all of this right and it's remarkable how little we inquire of ourselves about our own unhappiness or markers of our own unhappiness, even like excessive emotional eating, it may not be the determinant of absolute misery for a person, but like there's something going on there that's not happy, that's not an alignment with oneself. I think there's this continuum from what we just talked about, which is people that are from the outside, it's obvious that they're not taking care of themselves.

50:38And again, the patterns here are many. It could be just a straight up across the board. I don't sleep well, I don't exercise, I don't eat well, I drink to excess. And in those situations, I guess it becomes pretty obvious to someone on the outside, hey, there's something going on here that you're acting in a manner that is harmful to yourself. We should explore why. Then you have kind of the intermittent example I talk about using myself as an example of, hey, for the most part you're taking reasonable care of yourself, but then you really have these breakout moments where you're soothing something, some stress with a maladaptive behavior.

51:16And then of course you have probably where I think I used to live and I think there are a lot of people, though not nearly as many who also live here, which is the overmanagement, which is you're going to be perfect. You're going to be by any objective measure. You're going to have it perfectly dialed in with respect to your health. You're gonna eat like a robot exercise like a robot sleep like a robot, etc. That's probably a harder one to get people to look inside and see, isn't it? And if you were talking to somebody like that and somebody watching us who might be that person, how would you help them come to realize that while on the surface that looks really good and it looks like they're doing everything so well that they clearly must be doing this from a place of health, How would you at least challenge the thinking on that?

52:08One round of approaches, the old sort of Freudian way of seeing this, which is no less valid just because it's old, and the old Freudians didn't get everything right, but boy, they really got some things right? And they thought of this as what they thought of as living in the ego. There wasn't a modern idea of ego. It's like, that's a person at their best, at their most self -aware. And it's not easy to live in the ego, right? Like, we have to think about ourselves in order to be self -aware. in order to be aware that we're not aware of everything. So it's this idea that as best I can, like I understand myself and what's going on inside of me and what my hopes and fears are and what I want and what I have achieved and what I'm afraid of.

52:47It's all within us and the ideas from there then we can healthily control our lives, but we're keeping two other aspects of ourselves in balance than what they thought of as the the id was the desire for immediate gratification. I feel bad now, where's the food? There's that part of us, and I want what I want and I want it now. There's that part of us on one side, and the other side is what they call the super ego, the part that manages us. That says, you want what you want when you want now, but that's not okay, keep yourself in check, and there are these parts of us that manage us, and that want indulgence, and that it's us, the whole us in the middle, that has to recognize all that and keep it all in balance.

53:26And what we see is that part they call the super ego, the self -management often gets very, in the circumstances you're talking about, gains supremacy over the others, and that's not good. That's how we internalize the persecutor. There have been times. It's a parallel to this, but this is a true story where someone who I haven't seen before who is in my office and I'm getting to know them, and they're telling me about being really persecuted by someone who says, you can't do anything, and you're not worth anything, and they're describing and talking about all of this and I'm thinking, okay, let's think about where is this person living?

54:01How can we get them out of there? And then I learn that other person has been dead for seven years. But the person took into themselves the persecutor, the you're not good enough. Now that can come from outside of us and that's very striking when it comes from outside of us and it does often. It's not striking and rare. It's striking and relatively frequent. It can also come inside of us. There's probably some external modeling, but it can come inside of us where I decide the way I'm going to be good enough is I'm going to be rate myself and torment myself until I'm perfect. Perfect isn't just the enemy of good enough.

54:38Perfect is really the enemy of everything that's not misery. No one is perfect. Nothing is perfect. When we're over managing ourselves, that's what we're telling ourselves. This super ego part of us if we want to call it that is always looking at us. What are you doing wrong? What's not right? What's not good enough? And that becomes a very harsh, critical voice. And often we don't know that that's inside of us. I tell the story at times of a person who was very underachieving given this person's level of intelligence and other things that they had done. And they were so below in role performance, what one might have expected.

55:13And I couldn't understand. I'm going to start asking questions and I'm trying to understand. And then I realized this person loved music. So I said, what music are you listening to? I learned the person was taking these long drives to go to some awful job that they didn't have to have, and they weren't listening to music in the car. We're not listening to you. So now we have a clue why this person loves music as a music official notto because without the music, the person could uninhibited on all that long drive to the job and all the drive back. Tell them what garbage they were. What a loser they were.

55:51This was going on the whole time. In fact, the person was going to a farther away job than they could have gone to to have more time to criticize and berate themselves. And it's an extreme circumstance, but it's not that uncommon that we see things like this. And that person needed to stop that in order to increase role performance, which is vastly higher than it was before. It's remarkably different than it was before. But the search for perfectionism through self -criticism, because when you explore that, the person wasn't aware that they were being sadistic to themselves. No one says that when they say, what's really going on there that actually I'm being sadistic to myself?

56:33The thought is, what I need to do? This is how I keep myself moving forward. This is how I get myself going to any job. No, it's not. No, this is how you're keeping yourself down. But those voices inside of us are very powerful. And yes, I've given a couple really strong examples, but they're not outlying examples where oh, they're so different from what goes on in us. I think there are examples to elucidate what very often is going on inside of us where we are trying to manage ourselves, whether we're being perfectionist about it, or we are afraid or we are ashamed in ways that are very, very harmful to us.

57:08Because I think that that kind of self talk destroys motivation, destroys confidence, increases levels of inflammatory markers, increases risk of illness. Like there's so much bad that comes of that, but that's inside of a lot of us. That is inside of a person's sense. Is this person aware of it? Yes, it's stopping thinking. Is that inside of you? It's remarkable how many people stop and think. And yeah, I'm in the shower in the morning telling myself of all the things you better not mess up today or what did you do wrong yesterday or you know, there's so much that Did you have to prime this particular individual to get them to recognize consciously what they were doing?

57:45Oh, sure, because we had been talking for a while. So clearly the person wasn't aware of it. We had to through a process of inquiry, we had to stumble across something that did it make sense. So when I learned, this person loves music, and I was got that in my head. That's what this person does. They listen to music when they're home, and they have this really long drive, and then I learned they're not listening to music, then I become curious about that. Now, maybe there was another reason they liked looking at the window. I don't know, but it's like, wait, wait, let's inquire there. So then when I point that out, you're taking a longer drive and not doing something you enjoy in order to punish yourself.

58:21Well now we have curiosity about that. How can you not be curious about that if someone you've gone to for help is drawing your attention to that? And that's often how we start changing things, even within myself and in my own therapy be a realising there was such a negative critical voice all the time. And it wasn't needed to help me move forward with life at a some point in time trying to control things around me and feeling afraid of not being successful or not being good enough. Leads me to start managing myself pretty closely, but then I stopped managing myself where like when I was in high school I could do three sports over the course of the year and still maintain academics.

59:00That was good to learn how to do that and balance fun and work. But then it gets to be too much of a good thing. And now I'm going to manage myself by being so critical and telling myself all the things could go wrong and knowing how I feel and making damn sure that nothing is any less than perfect, which of course it is. And now I feel worse about myself. And that in me, like in many people was why I could look successful from the outside, but for a long, long time was really not happy and depressed and ashamed of things. and you're feeling in ways I had to then through my own work get out of me.

59:32And it's, it's experiences like this that help me have insights. I think you don't, one does it need to go through something to know that others are, but having been through a lot of that, you know, I've learned what you see on the outside. Doesn't tell you at all what's going on on the inside, like seeing a beautiful home. Doesn't tell you what's going on on the inside of it. Who are the people? How are they behaving? Are they healthy? It's not that it's irrelevant. There's a beautiful home on the outside, but it's also not irrelevant. If, let's say there is a home that doesn't look so good on the outside, there could be so much beauty inside of it and so much happiness Inside of it and we know those things are true.

1:00:09You and I both been around life enough to know that those things are true So let's bring that to the forefront if we know those things are true Let's look inside of us with the same curiosity and not having to hide from ourselves what we might find there I wrote a little bit about this in the book about the discovery of the inner voice and And in my case, it was so startling, I say startling not because I had an intermonologue, which I suppose many of us do, but in terms of how aggressive and the Bobby Knight voice. But it was remarkable to me that I just had a break through one day at PCS where all of that came out that that's what was actually happening.

1:00:48It's a little sad to me to realize that whatever 47 years of my life went by, probably 45 of them with that voice and yet no recognition of it. And why that is frightening to me is it tells me there have to be a lot of other people out there with potentially as awful a voice in their head. They might be listening to us now thinking, yeah, that would be awful. And yet they have it and they don't recognize it. Right. If your experience of it normalizes it and also if you have an emotional investment and on some level that this voice is causing you to behave in achievement ways that let you feel good enough about yourself.

1:01:30And even then you don't feel good enough about yourself. So you're really afraid of feeling worse. Then it gains almost a buy. We don't go and look at that. It just gets a pass. That happens all the time. It's so automatic within us. Just as there are people who say around 20 years of age can have, it's because of any other they didn't have before. And they're hearing voices inside of them. And it's only till years later that they realize that's not normal. Because they had an experience of now hearing voices inside of them and they don't know that that's not normal. Even something we would think about that's so different than what most people are experiencing.

1:02:05But it's not different from what you're experiencing if you're experiencing it. And it's come about in a way that didn't have a marker that told us that it was not healthy. There's a common theme to what we're talking about which is introspection, curiosity, of like, wow, there could be things going on inside of me that are wildly unhelpful. To the things I'm trying to achieve, like better health span and lifespan or better emotional health, they're wildly kind of productive and they're just going on on the surface. Like they're hiding. They're they are waving a flag and I'm not paying any attention to it.

1:02:38So it is curiosity about ourselves like how do I work? What is going on inside of me that makes all the difference. and when we start thinking about that, we become aware of it. That's when we can change, because you described feeling all this all at once. But that's how change happens in people. There's a great Hemingway quote, which I'm paraphrasing incorrectly, which was change happens incredibly slowly and then very quickly. Right. And you think about quantum leaps, or you and I both mathematics people, like asymptotic functions. What we're getting at is discontinuity. That even, And I think this is true on all levels down from quantum physics who threw to astrophysics.

1:03:22You see that we are only here because we are in these eddy pools of counter entropy, where instead of everything dividing and dispersing, like it does in the vast majority of the universe, there are these places where certain forces go the other way. Now there's not things coming apart but coming together. So whether we're looking at the biggest levels or we're looking at the smallest levels, The way that things work inside of us is that there are processes of understanding and change that are rare or in frequent, but that we can bring to the surface by looking in the right place. If you look all over the universe, most of what you see is no life.

1:04:03But if you look in the right places where those forces of coming together are more than coming apart, then you see, oh, there's something that's happening there. The same way inside of us, if we're looking where things are happening, then we can gain understandings that happen very, very quickly, just as in mathematical functions or quantum leaps, these things are discontinuous. So when you develop, I think this will be my thought about that, when you have a curiosity about yourself that leads you to now do something where you're thinking about yourself and you're thinking about yourself with the help of other people outside of you and you've engendered this across time and now you go do something that's intensive then all of a sudden something becomes clear to you and you see Oh I'm now interested in this and now you start to do all the things that you do when you're interested in things like Why is this here?

1:04:55How is this developed? How is this serving me? How might this be working against me and? Now you can change now you can change that when before you couldn't change it now Now, yes, change happens slowly. It's slow, slow, slow, slow, but then it happens fast. So you do a lot of work on yourself to get to that point where the change can happen, which I think is true. Again, these are human, and maybe these are principles of existence. Same with physical health, this person works out and works out and they don't immediately notice linear change. So you have to have faith that the work you're doing is going to get you there and low and behold, it does.

1:05:31And that's how these really big things inside of us. What am I saying to myself? Is there a running narrative inside of myself? Is someone else's voice inside of me? These Happened to us and it's amazing that we often just don't know it then isn't it more likely that we're going to choose the short -term Suthing in the light of that then of course like just get some soothing on board whether it's Pringles or it's a drug or it's whatever it may be we're more likely to choose short -term I'm soothing because we're afraid and we're out of control and we'll be rating ourselves. It's like, whoa, whoa.

1:06:02Let's just bring some peace and understanding to this equation and then things will change for the better even if you have to change things for the better. Make change. Yeah, I'll tell you a funny story that happened today. These things occur on a daily basis. So I get a daily reminder of this and it amazes me. So I was shaving today and then I went to grab a brand new bottle of aftershave. So this Nivia big glass bottle of aftershave. Same thing I've been using for 25 years. And this is the first time this has ever happened, Paul. I went to grab the bottle and I opened it. And as I was dumping it in my hand, maybe because it's so cold today, it was harder to get out and somehow the bottle dropped.

1:06:46And it landed on the floor and it's a glass bottle and it shattered. So now you've got glass and aftershave on the floor. And in moments like that, I'm always now paying attention to, because there's no one around for me to talk to. I'm not gonna like yell out loud or anything. And the only thought I had was, oh, let's make sure you don't step on the glass. Looks like there's no glass over there. So let's just walk over there. Do you have another bottle? Cause you're not gonna wanna reach down on the floor and mop some of that up, cause there's probably glass in it. Okay, found another bottle away we go.

1:07:25And I remember thinking a minute later, wow, what a different conversation that would have been five years ago. I mean, that would have been a three minute internal lashing of you incompetent, non -attentive piece of shit. What? How could you possibly drop that? But again, the thing that I gravitate towards is the ability to start paying attention to just listen to that voice. And again, I've talked a lot about the exercise that I used to do that, which was suggested by Katie and by another therapist at PCS, which was the recording for anyone who has not heard that. I think it is worth, even if one person listening to this has not heard this story, I think it's worth repeating, which is I was instructed as I was leaving PCS to take my voice.

1:08:16my phone out every time I made a mistake or fell short by whatever metric and to speak out loud, audibly and record the way I would speak to my best friend if he had made the same mistake. So if my best friend had just dropped the aftershave, I wouldn't yell at him and call him a piece of shit. I would say, are you okay? Those are really small pieces a glass there, let's not step on them. And while that now is a very easy thing to do, it took months of recording those. I still have a number of these recordings, believe it or not, which I would then forward to Katie each time. It's amusing to note how strained they were at the beginning as I had to learn a new language.

1:09:04The, well, you know, I hope you're okay. It's okay. Now of course it's very natural. So again, I highlight that to say, that was a technique that worked for me, incredibly powerful. But most of all, I think the moral of that story is malleable. When this exercise was suggested to me, I did it because I was at rock bottom. And when you're at rock bottom, I mean, you don't really have a lot of negotiating power. You can't say that's a dumb idea because it's sort of like, well, how's the current one working out for you? I don't think I actually expected it to work. And I thought, if this is ever going to work, it's going to take 40 more years.

1:09:42Because that's how much we're overriding. Why do you think it took, I mean, I'm not exaggerating, Paul. It took about three months to totally change. How could it have happened so fast? I think three months to totally change, but that's three months of work. It's that same theory that matter is not evenly distributed, change is not happening in a linear way. It's only three months, but you had to run counter -current to patterns of neuro transmission that were inside of you for years and years and years and years. And this is another, I think, big problem with modern mental health is it's packaged to suit insurance paradigms.

1:10:21And that's not serving the people it's supposed to serve. So the idea that whatever has gone on, there's 10 sessions of therapy authorized, progress has to be Gained in a short period of time. Let's take an inventory of symptoms and let's throw a medicine at you So now your symptom is a little bit better without ever knowing what's undergirding it. There are things that take time and when we establish patterns of neuro transmission it takes time to unestablish them Example I often give is if you and I picked a random word and we set it a thousand times we're going to be saying it later today. If we say it 5 ,000 times, we're each going to be saying it tomorrow and over the weekend.

1:10:58Why? If we know that it's just a silly experiment, why would it stay with us? Because we said it. And the brain's mechanisms are designed to hold on to it because we said it a lot of times. That's how it goes. The same is true, of course, with what we're thinking, right? We're just thinking what we think we put into words. is the same. It's thought it's neuronal connections that don't want to go away because this is how we've developed. We've developed to remember things. We've developed to not forget things that are important. So the brain says, you said that word two thousand times. I'm not just going to forget it because you said it.

1:11:32It's the evolutionary mechanisms. So that's been in you for a long, long, long, long time. And when you start trying to say something nice, tell me if it's you, there's got to be a fearing you, everything is going to fall apart. Here you're doing this wild, reckless thing, right? That you're just going to take your edge away. Because the Bobby Knight produces great results. Right. Dexing, you know, you're going to be lazy and slavently and not get anything. You're not going to get anything. You're not going to get anything. You're not going to get anything when you make mistakes. But think about in one hand, how outrageous that is.

1:12:02The thought that you could possibly be like, you had a million miles from that. But it's not outrageous to the emotional part of your brain that didn't want to stop it. So it takes bravery to stop it. You have to take a chance in that party that says, you're going to fall apart and you think you feel like a piece of shit. Now wait till you stop doing this. You have to say, no, I hear the meat and I'm doing something different. It's a leap of faith in myself and in what I've thought about and learned about myself. Then you can go and do it and you start running counter to those neuronal connections and then it changes.

1:12:33But it takes time. It takes effort. It takes bravery. It takes faith in self. So when you say, okay, it only took two months, but you worked really, really, really hard. That's actually probably four. Oh, so three to four, yeah. Three to four, okay. So then we're talking about like 100 days or so like really, really running against those patterns and making new patterns. And then it feels different. And like as someone who has known you for over a quarter century and loves you and also has trained as a psychiatrist and was here when you came out with the remains of the bottle, It was not lost on me that you're like, oh, I hadn't done it before and I dropped this bottle and like there was no edge in you and It was not lost on me that wow that's not how that would have been before and then I think right You're happier You're healthier if we think about health span and lifespan Coming from the place that I come from right from the mental health side of things and the really is a psychiatrist because it's active brain function, emotional states.

1:13:37Within us, this is how I come at health span and lifespan. I think this is good for you. And then I know you're healthier inside, even without, it's great that biomarkers and all that, but there's not a biomarker for that, right? But I could see and noted, not that long ago, that change in you and I knew like, you are happier and this is healthy for you. Now, I don't want to make it all rosy, but using myself as an example and to talk about an area where it's still very difficult and I've maybe only had a 50 % improvement, which again, in magnitude is huge, but given where I was starting, there's still a long way to go, right?

1:14:13So it's sort of like saying, if a person loses 50 pounds, are they necessarily healthy? It depends. If they went from 220 to 170, they almost assuredly are. If they went from 400 to 350, they probably still have work to go. I'm probably the 400 to 350 guy in this area. which is just general outburst of anger at a situation that almost assuredly warrants anger. So to be clear, it's something happens that warrants anger, but the response is disproportionate to it. And it's counterproductive. So the exercise here was an exercise suggested by Andy White, who of course you very graciously introduced me to.

1:14:50He said this is an exercise that he does with patients he's working with who are trying to quit smoking. So the exercise is about separating, creating a discontinuity between urge and behavior. So he says, look, and I'm probably bastardizing this a little bit, but let's just say, for the next month, you come in here and you're smoking two packs a day. For the next month, I'm not necessarily going to reduce the number of cigarettes you smoke, but what I will do is separate the urge from the behavior. Every time you have the urge to smoke, I want you to pull out your phone and set an alarm for 40 minutes.

1:15:25Don't smoke now, but when the alarm goes off, go smoke. Gonna separate that. So you're not just feeding an urge every time it comes up. You're gonna go smoke and sometimes you might not actually even feel like going for a smoke. And so what the exercise was for me was the next time something happens, something stimulates a response in you that is going to be an outburst of anger. And that could be you're gonna fire off a really nasty email to somebody or you're gonna call somebody and tear them apart, pause, set an alarm for an hour, and then come back and respond in an hour. And again, that's much easier to do over email than it is to do sometimes on an interpersonal level.

1:16:07But not surprisingly, when I'm able to do this, and to be clear, I'm probably only batting 500, meaning there's a lot of times I'm failing to do this, and I'm just reacting to situations in ways that I almost always regret, as opposed to responding to situations. But when I'm able to do the urge right now is to react, stop, come back, respond. I mean, it's always better. So my question for you here is, why does this appear to be a harder exercise? And would you modify the exercise in any way to produce even greater efficacy? Or am I just being impatient? This one might take years as opposed to months.

1:16:47Anger is very, very powerful and anger can propel us forward. You know, I always think of like sprinters coming out of the blocks and if they come out too fast, then they don't have control and they're just flying headlong until they fly face first. And that can happen right because they propelled out, they propelled themselves out too strongly. And anger does that inside of us. There's this cascade from what technically is affect to feeling to emotion. And it's worth pointing out the difference that affect is aroused in us, meaning it's created in us without choice. When we have high levels of emotional response, some of his nature, some of it is nurture, it's cultivated over the years, and then these pathways are very strong.

1:17:30So something is negative and there's a high level of aroused negative affect. Anger in this case. And then that propels forward. So when it comes in us, we don't even know. Affect is aroused and we're not even aware of it yet. This is a split second, but now when we're aware of it, it has a whole head esteem and it runs through feeling when we relate it to self and emotion when we relate it to others. So I am angry, I am an idiot. Man, we went from a lot of aroused anger right through affect to me and now mad at myself. Or if the target is someone else or something else that has happened to us, then we run right through us as some as there's a lot of negative affect of anger raised and of course like this is what happens to me we like burst right through us and now are like and it's your fault or it's God's fault or it's fate or nothing ever happens right or I'm cursed and now we relate it to the world around us and you know I view this as the equivalent of the sprinter being 25 meters from the start of the blocks sprawled face first on the track.

1:18:33It's like It's not good. It leads us to unhealthy places. Andy White and Katie Powell, they're there's fabulous therapists. So what they're doing is they're saying like, hey, we've got to put a hand between the dominoes. Dominoes are going, this is running ahead. We got to stop, slow that sprinter down, coming out of the blocks so that that person has healthy control over the movement of their body. They're not just flying ahead. What they're doing there is they're trying to slow that down and say, affect does not have to run right to feeling when we relate it to self and run right to emotion when we relate it to other.

1:19:06Let's slow that down. And this is a lot of work that we do. We do intensive programs with people where people come to us and they spend a week with us or two weeks with us. We do a lot of this work now and a lot of the time the work is around things like this. It's around people like, I want to understand myself better. Like I know that this, whatever this may be, is not good. I want things to change. and a lot of what we're doing in that time are these strategies, like you're saying, because they work and we know why they work. But also, there's another aspect of this, and we do this also in the intensive work that we do, and this is a part I'm most interested in, which is in the understanding of it.

1:19:46To me, it's then becomes interesting that you become very angry. Let's say for me, if I become very angry about something, like, oh, the flight is delayed or I rush to get to the airport and the flight is delayed and I didn't get the text I was supposed to get whatever it may be that I become angry. And I'm very curious. Why am I angry? Like I as oh, my flights are always delayed. Like none of this is true. Actually, right. I'm like I'm a very fortunate person. I see myself as a very fortunate person. I don't feel that I'm cursed or that bad things only happen to me or that people have it out for me.

1:20:21But in the moment when something triggers anger, that's not how I feel. So So the strategies help you slow down. What are you slowing down to? So the slowing down step is necessary but not sufficient for the real insight. Right. It could be sufficient if sometimes just slowing down it dissipates the energy, but we want more than that. I mean, that's something. How about combining it with understanding, which brings me back to what I believe works for everyone. This is a human thing and it crosses cultures, race, religion, socioeconomic status. Like we are humans and we have these drives within us.

1:21:01There's an assertion drive to be able to have some healthy control in the world. And there's a pleasure drive to feel at least no privation and feel safety, right? And then also to have good things, if we look, we have these drives and there is also a generative drive in us? Are we honoring the generative drive? Are we in balance? Then what comes of that, if we are doing that, is a sense of gratitude and humility. So I think my idea of what's going on inside of you when you're able to stop is that you're able in taking stock of self and being reflective to feel, whether you see it, put words to it, you may you may not, but there's a knowing inside of you that actually your assertion drive is, is like you're doing well with it.

1:21:47You're putting yourself out there in the world and like, I don't take stock of myself, like I'm not unhappy with how I'm trying to be in the world. And I do take some pleasure and satisfaction, what I do, and I'm able to provide for people, and I feel a sense of wholeness and safety. And because of that, I can feel good about myself, and I'm learning and curious. And I realize, wait a second, your life is great.

1:22:10There's because so much of that is blessing. And also the sense of humility we have when we recognize our own work and effort and we recognize our own responsibility for where we are. But we also recognize that it's also a blessing to be able to bring ourselves to bear in that way. This is why people say, I got an award and it was so humbling. You see, why would that be? It's because the person recognized, yeah, I got that award and I did those things and I worked hard and also, So isn't it wonderful for people around us to acknowledge me? And isn't it wonderful I've got it in myself to do? And I'm, gosh, I'm fortunate enough that I could bring myself to bear so I can both own it and also feel a sense of the beyond me that, oh my God, I am so fortunate to be in a place where I can own that I worked hard and got something.

1:22:56And I think this pervades people when those other drives are imbalanced. So if we go back to what we started at the very beginning, how do people have health span that is a wonderful, how span to be have and it's combined with lifespan and cognitive health and emotional health. The drives inside of people are in balance and you've got to look in yourself in order to get them in balance. We've been talking about that too. Then when they're in balance, you orient yourself to that balance and you live much more in an appropriate and active sense of gratitude and humility and you feel that when things are difficult.

1:23:33I think that the work that you've done let you feel a sense of humility, like you are not supposed to be perfect, despite all that you have achieved. Isn't it wonderful all great things in life? Then the glass bottle breaks and you're like, huh, that's it. And that's why when I go to the airport later today, if flight's delayed and I'm going to sleep in the airport or whatever it may be, that's not going to feel great, but I am not going to get down on myself or anything else around me, whether it's God or fate or people, it's not right and it's not good for me either. And that's another reason we don't do it.

1:24:05That's why once you start doing it, you make progress. And that's why you say you're 50 % of the way there? That's a huge achievement. And what does it tell me that the next 50 % can't be as difficult as the first, right? So you're going to get there. What percentage of people do you think or how often do you encounter this? Maybe as an easier question of an individual who feels frustrated or upset at themselves for the following paradox, which is on the one hand intellectually, they recognize how lucky we are, any person. We talked about this a little bit over dinner last night. I'm reading this book about the impacts of the dust bowl on the depression.

1:24:47This is 90 years ago, and the people living in the middle part of the United States were subjected to conditions that most of us couldn't survive. I mean, the abject horror of what it meant to live in the depression, in the dust bowl, and the book I'm reading is called The Worst Hard Time, which is amazing. And so you think about that and you think, God, that was only 90 years ago. What's the luck that allowed me to be born now instead of then? Had I been born a hundred years earlier, I'd be dead. I would have died an awful death in that situation. So I know that in my head. And then something happens that upsets me.

1:25:26And again, it almost doesn't matter what it is, because you think it pales in comparison to what it would have been like to have borne just 100 years ago. And then that creates tension internally, because you think, why can't you just be grateful? Let's use the airport example, right? I can just be grateful that you can at least get on a plane. It's a miracle that we can do this thing and yes, so what if it's four hours late? But then you still feel like but I'm still really upset about it. How often is a person coming to you where that's the source of the tension? The difference between the intellectual understanding of what should be gratitude and the emotional feeling that is incongruent with it.

1:26:13A lot. And if I could comment a little on what you said, I think that But there's a fallacy there or a problem, I don't know how to what to put to it, but something is not real or healthy in the framing. I do not believe that you would have just died if you were in the Great Depression in the Great Dust Bowl. I also don't know that you wouldn't have been happier. I mean, I don't know that. Yeah, yeah. I mean, it speaks to what we said earlier. I mean, maybe you would have barely eat out enough food and got some shelter and kept your family going and dirt poor, but everyone stays alive, or maybe not everyone stays alive, but you keep alive who you can keep alive, and you have a sense of wholeness and goodness in yourself despite the privation.

1:27:05When we set up, oh, we should feel grateful because, then you set up a scenario where like you can't win, because anything you feel bad about, You should feel ashamed about feeling bad about because it's not the great depression and the great dust Bolesal, what are you complaining about? And then I think you've inadvertently Set up a situation where the odds are against you. I mean, I'll think this sometimes where up until a couple generations ago Like probably everyone in my family from all sides extending back generations was a shepherd So you could look and say wow Hemsons look how fortunate I am.

1:27:38I am looking at the opportunities I have in the places that I've gone and and I can get it into that way I'm seeing of like, oh my gosh, this is so amazing. But then I'm not giving myself room to say, maybe I would have been happier being a shepherd. I don't know. Maybe if you and I were a shepherd next to one another, like we had to help each other, others flock out, we have a little bit more sheep, our families are doing okay, we have a lot of leisure time, we think and talk like, who knows? You are you. You are not someone else. And you are also you now. So a lot of people come with what you said.

1:28:09And what I try and do with all of them is to say that this is not a framing that we massage. I think it's a framing that we just throw out. I know nothing about you by knowing your reflections on what you think it might be like if you're in the Great Depression. What I know about you, I know from now. This is when you live your life now. And you know what you're entitled to be angry and frustrated about things sometimes. Now do you want to modulate that and keep it inside and not let it run out of the starting bucks? Yes. You're entitled to feel bad about things or annoyed about things at times.

1:28:38This is how this goes just because we are not suffering. We can compare ourselves to people all over the world who are suffering We're living our lives if we live them within ourselves and we're that we are the marker of comparison Like how am I taking care of myself now? How am I exercising the Drives within me now. How am I serving the generative drive? I mean that's between you and you right now And when we bring people back to that That's when I think can really really really start to shift because you then maybe stop doing something that it's like kind of going to do something and immediately you set the odds against yourself by side having this comparison.

1:29:13I'm not in the war. I'm not in the Ukraine or I'm not in Israel. I know that, right? But that doesn't mean that like you can't suffer now. Like it's true, true and unrelated. And the other aspect, as I said, like don't be an isometric exercise. You might do them. If this is you, don't push against yourself. And that's often what we're doing. If I want to go this way, can I glide my hands this way? Very often what we do is we have 10 units of resistance in 11 of force. And we're doing that within ourselves instead of simplifying. I mean, the rule of all good mental health, which I believe undergirds, health span, life span, is simplicity.

1:29:49It doesn't mean it's simple to get to. But it is implicit. Like it's really, really complicated to start comparing you to the theoretical you 90 years ago. I start getting very, very confused. But we all do when we do that. And again, I'm not becured. I do this to myself too. And when I just stop and think like, look, there's me. I'm here now. I mean, I know my own history pretty well. I am capable of introspecting. Let me stop and think like, what's going on inside of me? Am I making a decision? Am I upset with myself or someone else? I've got to be able to understand this well enough to simplify it.

1:30:20And if I'm going to beat up on myself and vlog myself to get myself somewhere I want to go, that's not how I'm choosing to do it. It's just not good. And is that why things seem to maybe take more energy out of me than they should? These things, you and I both tried to work with over time. Then now my more easily frustrated and I'm not getting enough sleep, I'm not sleeping as well. So now I feel a little bit fatigued, it's harder to take care of myself. There's more inflammatory markers, my bite isn't feel as good. So now I'm even more frustrated with myself like what is going on here? We can stop and take stock of things and decide a path forward where we are not working against ourselves and we simplify down to what the real truths are.

1:31:00which I'm not saying that's easy. It takes work and it takes reflection. We've got to run counter to some of these established neuronal pathways but isn't that a lot easier and a lot more likely to be effective if you're living in the here and now with yourself knowing what you know about yourself as you make decisions whether it's what am I going to say to myself inside of my head? What am I going to say to someone else? What am I going to do? Now we are intentional. Now in that Freudian way were living in the ego in that sense of the ego being the whole self and my most self -aware. I'm aware I don't want the super ego telling me as you feel bad about any frustration in me because I'm not a shepherd.

1:31:36I'm like I'm not having any of that. It doesn't help me. It makes things worse. It's the opposite of simple and we can reject having ourselves be out of balance. So just like our drives need to be in balance because then the generative drive is what makes you wake up with a glimmer in your eye, right? But we have to be healthy in mind and body and these other drives the assertion and the pleasure have to serve it the same way we have to be balanced inside of us. We need some gratification. We also need some self control. How about we have as clear a lens as we can sitting in the middle of it on another way I'm using a lot of analogies but I don't want fun house mirrors around me when I'm trying to see what's going on.

1:32:14I want clarity around me and a lot of times what we don't realize is we create fun house mirrors around us. And then we get angry with ourselves that we don't understand or that we walk in the wrong direction or that we run into something. And in this analogy is the fun house mirror, the construct, the mental construct that adds confusion such as the example I just gave. Yeah, I think that yeah, I find house mirror comes into the room when you start comparing you now to the theoretical you during the Great Depression. Now there's a fun house mirror. The fun house mirror when I'm mad at myself because something wasn't good enough and I realize that the standard I'm using is actually perfect.

1:32:51Bring another mirror in if I start speaking to myself through the lens of someone who is so critical to myself. These are all the distractions away from clarity and it is so easy. No one else brings the fun house mirrors and no one catapults ourselves out of the block so that we fall head long. It is we who do this to ourselves and we don't have to do this. Think about what humans do. We create so much and we destroy so much. Isn't that true? the destruction in the world around us, how long it takes even to create one building that gets destroyed, led along the vast swaths of the earth that we then destroy, and the harm that we do to people.

1:33:32So just as in the universe around us, there's a lot more force towards entropy than there is to things coming together. That's why these small places where life could be here. This is true in our lives here on earth. It is so much easier to destroy than to create. If we stop working against ourselves as humanity, we're trying to move forward and create, it was 11 units forward, 10 back. Well, maybe we'll get that wrong. It'll be 12 back and 11 forward and we won't survive as a species. We do this as a species and we do this as individuals, where we work against ourselves and we don't have to do this.

1:34:09We don't have to have needless destruction happen around us. We don't have to have a society of plenty while there are single mothers with children on the streets. Like there is more that we can do, whether it's trying to lift up the people who are on the verge of not surviving, who are living in misery. We can also do it with ourselves. I don't want to cloud my own picture. I don't want to work against myself. And if I see with clarity and I don't bring in the fun house mirrors, Life goes a lot better and I use a lot less time and energy making it go better and that's true for all of us It's true on a universe level.

1:34:44It's true on a global level and it's true within each one of us How important do you think it is for our emotional health to have peace with non -existence? I do not really have a great sense of that and I don't think many people do in other words as is the case in the previous example, there's nobody who intellectually, I mean, no reasonable person intellectually doesn't understand that they will cease to exist at some point. We will all die. Notwithstanding all the biohackers out there, that knowledge, that cortical knowledge is very difficult to process. It's very difficult to come to peace with the idea.

1:35:28And let's talk about the best case example, which is you live a long, healthy life. And in your 90s, you die in your sleep. You couldn't ask for a better existence. And let's also assume that everything up until that point is moving in the right direction. You don't just die in your sleep. You die in your sleep. Having lived a meaningful life and having had wonderful relationships and having raised children and grandchildren who are wonderful people. Let's make this the best case scenario. And yet many of us, I think, still struggle with the finite nature of our existence. Do you think that coming to some acceptance of that is essential for our emotional health?

1:36:14I do. Whether it's essential in everyone, I'm not sure, but I think it is very important. And there's so many factors that work against us that we can change. So this societal idea that getting old is just so so so so awful and death is something to be feared It's not clear that that's true and when you see when people are much older and are closer to death what they fear is loss of control Not death. So maybe we build up a society that Glorifies not being dead as opposed to glorifying living well that would be a nice switch. Maybe we think about health span and quality of life, instead of living in a society where we're so afraid of death that we just don't want to die and we're not even paying attention to whether we're happier or not, right?

1:37:06So I think we could work against that a lot and we could work against these cognitive tricks, these things we do inside of us that torment ourselves. Like I don't want the voice of someone critical of me living in my head. I also don't want to be contemplating my non -existence because what I do then is contemplate that I'm aware that I don't exist and I'm upset about it. That's not not existing, right? If you don't exist, you're not contemplating it. I know. Is it then therein lies the greatest challenge? And I tell you, the people I am most envious of are the religious or anybody who believes in an afterlife.

1:37:40If you believe in an afterlife, you have a way to get around that issue. And if you don't believe in an afterlife, then you're stuck with that very bizarre idea that seems impossible to reconcile. I have thoughts about this and they're not fully formed, but I wonder about that. I think a lot of times people ostensibly have faith, but aren't behaving that way, because we are in a society where everyone's fearing death and non -existence, but many, many, many of those people People are people with professed religious values. And I think often times, we're taught religious values when we're young.

1:38:18We identify in a certain way, but we don't really know. Like, what do those things mean? What do I actually think and feel? And I think when people do have, say, a deep faith could be something different. But I think our religious values don't really work against that very much. I think it was Spinoza, whose definition of faith was like the belief in something that you don't know for sure. And it's very interesting when people say they know, like, this is my religion. I know that's true. I don't think that's faith. And I don't think our philosophical and psychological heritage tells us that. I think that's a leap of something because we don't actually know.

1:38:54So if you think you know and you don't have enough understanding or humility to recognize that there is a leap of faith, then are you doing something that doesn't actually help you? And this isn't me being anti -religious. I mean, I think faith is very, very important, but it's recognized in such a... There is something I believe, but I do not know that thing. I believe it. Now, that's very interesting. Why does the person believe it? How do we see the beyond ourselves as opposed to just pasting something on that doesn't actually make change? Because what I think I'm trying to say is when people feel very, very sure of something, I worry about that.

1:39:35And when people feel very, very sure that there's nothing, I also worry about that. But if you think about it, I find it quite amazing that there are so many things that we know a little bit about that fills me with wonderment about what else might be there. If you think about things happen outside of time and space, that's interesting. There have been experiments done where you or I could decide what happened in the past. Not figure out what happened, but decide. So time, space, movement, the impact of consciousness upon the world around us, this is all so interesting. Even the things we learn about that are going on inside of our brains, the cutting edge of neurobiology, and neuroimaging, and some of the psychedelic studies and what they've shown are going on inside of us, tells me, I don't know what happens next.

1:40:23I don't know that. And I may have all sorts of thoughts one way or another, Maybe some of it comes from early education and some of it comes from the faith I was raised in but I don't know And that not knowing I find to be very very hopeful. I don't know what comes next It doesn't mean that I'm gonna rely on anything in particular But it certainly means I'm not going to despair About non -existence. I'm not sure of that and I think that's what it tells us I think that's what Spinoza was writing about and I think what great religious thinkers I've read a lot of them, but when they're writing within religions, they're writing in these ways too.

1:41:00And maybe that engenders a respectfulness. I think if we knew that there was nothing afterwards, I would hope we could still find a way to be respectful of our lives. But the fact that we don't know what comes next is interesting. And I think to me, that's full of interest and curiosity and hope. Like the generative drive in me gets activated when I think about dying. Now, it doesn't all the time, It can get active. I don't know what comes next and I think that's interesting and things happen outside of space and time There's certainly not absolute and our consciousness may actually change things be its own entity in the world around us And we all have different times and do we have different dimensions like this is out there in the world around us This isn't pie in the sky like this is academic studies that are telling us these things when I think about that and scratch the surface a little bit I go, huh, I don't know that's interesting and I think it helps me to feel a sense of real interest and excitement about then living the best life that I can live because if it's 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 around me But in taking care of myself.

1:42:06I'm better for other people and I say I feel Invigorated by that not afraid and I think and you see that in people who don't fear death They're happy with their life If they're leading life in a way that they can feel a sense of pride and they feel humble, they feel gratitude, they're rooted in that. And there's often a sense of not always, but there's often a sense of, I don't know. And isn't that okay? Like, think about how many things we don't know. Can we take care of ourselves and treat every life as precious? This idea that there's nothing special about any of us, but there's something special about each one of us.

1:42:44And I think not knowing what comes next and the idea that if we think there is something or isn't that there's faith involved, that's a thought process, that's a deciding on the part of the person that comes to interest. I think that engenders us to be better to ourselves and better to other people. And I think then we stop fearing death and we stop living in this pseudo cult of like, I must not die, which is fed by all these fantasies in these places we can get us. Even in literature, I think about no exit, a great play by Sartre, where people are dead and they're watching themselves. That's interesting as a way of learning something through the fantasy of literature, but there's a theme that runs through that that we're dead and we see ourselves with despair.

1:43:29And I feel pretty sure that's not how it would really make no sense that that happens, right? There's some punishment of seeing ourselves with despair. Like, why would it be? They just can't be that. I think if we're open to that we just don't know and the literature and the philosophy in the world that around us It is interesting things to say but no one's gonna tell us like isn't that awesome? I think it is Call I want to talk a little bit about how a person can find a therapist that's gonna help them be a guide through a Lot of the stuff we've been talking about today So there are a few facts that people I think are generally starting to understand, which is of all branches of medicine.

1:44:12This is one in which the interpersonal relationship between the doctor and the patient, and we'll broaden it because it's not just about physician -patient, but the therapist and the patient. The interpersonal connection matters more than it matters in any other form of care between a provider and a patient. It's great if you love your dentist. It's great if you have a connection to your surgeon. It turns out to not matter nearly as much. Would you agree with that statement? I don't want to use like as the word. What word would you use for what I'm trying to say? Report. There have been so many studies that show how important report is, and yes, it is good to have a report with one surgeon, but it's not the primary factor, presumably.

1:44:55So, rapport is very, very, very important and one might argue, indispensable. And that's why you see studies that people can commit things from different perspectives. Like you think about the anger, wow, and your Katie may come at it is, hey, let's talk about getting a space between the anger and the response. They also want you to understand it too. I might come really from like the understanding, so you go to a place of humility and gratitude, but I want you to pause too. We're not doing different things, but we're doing what we're doing from very different perspectives that will feel very different if you're on the receiving end of it.

1:45:30And that's why when people say, well, for poor matters, and does it matter, then maybe it doesn't matter what those people are doing. But that's not true. The presumption is the therapist knows what they're doing. They're coming at the skilled part of it from different perspectives, but it doesn't matter that the therapist knows what they're doing if there isn't rapport. So let's take that as a necessary but not sufficient piece of the equation. What are other things that a person should be asking themselves? And we can handle the following questions separately, but I want to address both. A, scenario one, you are going to seek the help of a therapist for the first time.

1:46:09And B, you have been working with a therapist for a long period of time and you want to evaluate if this is productive. And the impetus for B is, I can't tell you how many people I've met in my life, who even to my completely untrained eye, which tends to be more critical of self than others, I look at them and I think, what is your therapist getting paid for? You were having the exact same problems today that you had five years ago. If anything you're seeing somebody every week. Again, I don't say that to be judgmental. I say that from a place of, I want you to be better. And maybe somebody listening to this identifies with that.

1:46:54So anyway, again, feel free to tackle those separately. But what I want to understand are what are the questions a person should be asking themselves of the therapist and perhaps of themselves in those two situations to make the best choice. A, how do I find someone denovo to start and B, how do I decide if I need somebody new? There's a lot of specifics I could say about those things, but I think I would start them in a different place. I would start with an overarching principle because I think the principle always applies and then it can get at a lot of these things underneath the principle.

1:47:33I would ask, does one plus one equal more than two? So the way that mental health was thought about, say before the end of the Second World War, our minds were conceived of as very transactional. So they would say, like even now, like, I put something out there in words, you take it in, then you put it into your brain, you put something out in words, I take it in. Even though they would acknowledge we're doing something, the thought was it's very, very transactional. And what we see is that's not really the truth. And I think Victor Frankl's writings after the Second World War were really an impetus to really see this and led to a whole different type of psychotherapy.

1:48:14It was called existential psychotherapy. It is existential psychotherapy and it does it map to the existential philosophers exactly, but there are principles there that are around shared humanness. So do you feel like one plus one is more than two? When We can have thoughts and feelings and ideas, and that person is going to have thoughts and feelings and ideas too. And does that create something more between the two of you? And the thought is this is how we find meaning in life. That when we're with someone we love, for example, it's not just us and it is them. There is an us. Like you're you, the other person is who he or she is, but together there's something different that each isn't going to find on their own, and that each isn't going to find with another person.

1:48:56In this case, the diet is special. The two people together are more than the sum of each of them. And I think that's true for satisfaction, enjoyment, learning in human relationships. And I think because these principles run wide. So the same thing that would apply, applies here too. There should be someone whose presence and whose work with you. Like there's a shared humanist and you're figuring things out and you feel the greater than two of the two people in the room. And I think that's a lot of what report is. I mean, some of what report is positive regard of the other. And there are pleasantries and nicer ways we can build rapport.

1:49:37But I think they're more on the surface. They're important. But that's not what makes real rapport when someone is helped. I think what makes real rapport is the fact that here I am with you, and there's something different with us than there is in just the sum of us. like something new and different is here. And I feel that when I come in, the room to see you. And I think you feel it too when I come in. It says, it's a real interest in me and a real like applying of one's brain to the other. And whether we call that rapport or I just feel great about that person or man it's so dynamic, like there is something there that is the therapist really being present.

1:50:15And I think that that's an obligation of the therapist we're supposed to know technical things. And of course, like there are things that we have to learn. but we're supposed to give of ourselves in a way that has us truly be present with the person. If you figure that out, whoever the person is, should I have this person be my therapist, or should I leave this therapist and try something new? I mean, if you try that on for size and it doesn't fit, you should probably change something. How long in the context of the first scenario, which is somebody looking for a therapist, How many meetings with a person do you think you need to have before you can evaluate that?

1:50:52I talked about this a lot. You can know if things really aren't right. If a person is approaching the therapy process and they really want to be there and all that, sometimes you can just tell if you're not going to resonate with someone. Like, it looks like someone is not making eye contact, for example. Like, hey, you can tell or you just feel an awkward sense. Like, you sometimes just happens with people and sometimes you could know that, okay, this is not going to be right. But again, be fair and reasonable about it. Do you really want to be in therapy, right? If you don't, then maybe you're going to find something wrong with everyone.

1:51:22But if you really bring yourself to the process, then I say you can tell no sooner than you can tell yes. Because in the first couple of sessions, what's going on is you're trying to build a relationship and people need to get to know one another a little bit and how they respond and what their mannerisms are. And if they have a sense of humor and how much emotional valence is inside of them and it takes time So there's a little bit of a dance like there isn't any new human relationship So the thought is if something really rubs you the wrong way and you're looking at that honestly You could probably tell no first second third, you know along the line If not give it a little bit of time you have five six seven to see do I feel like I'm resonating with this person Are we really getting somewhere because again the progress and the perception of progress is not linear And sometimes it presents up for sessions.

1:52:07I'm not so sure. Okay, so not so sure. It's given a couple more because sometimes by the six, the person feels like it's kind of falling flat and I don't feel that there's one plus one is not equaling more than two. Or sometimes, you know, the stuff we did early on is kind of clicking a little bit and now it's only session six. It's two more than four, but they start really feeling something. So there's a process to that, but if one just applies those principles, then again, I think there's a process to it, but it's also a process that you can really apply of. And looking for things that are real negative, that person isn't making eye contact, that's bad.

1:52:38Or I really feel it odd, like you can feel it, acknowledge it. If you don't, be observant, be patient, you know what's going on inside of you. How are you feeling? Are you feeling help? Do you feel what gets called a holding environment that the space when you go in is a safe space? And you can be open and honest. Because so many times people fear criticism, when they feel that they'll say something, this is often true with trauma, they'll divulge something, and then the other person will recoil in horror. And this happens a lot where someone will just talk about the worst thing imaginable. They're saying it and you'll see this is kind of known in therapy education.

1:53:13But if you do therapy, if you see this in people like they're surprised. Oh my God. I said that. And then they're surprised that the other person that I didn't recoil from them because inside of themselves, they've held that this is something shameful and someone else should recoil because they're You're carrying shame from a right, but if you develop enough of a holding environment and enough benign regard, enough real humanists with the person, then that can come out of them without them having even decided. It just naturally flows out because they know that they're in a safe place and somewhere inside of them, they know that other person isn't going to recoil.

1:53:46Just like they wouldn't recoil, just like you're saying, what would you say to your best friend? So somewhere inside of you, you know that you don't really want to be saying the things you're saying to yourself. You didn't know that? Because why would you say to yourself and not someone else? But that's different than having an experience of it. In having an experience, in your case, when you were making the recordings, you're having an experience of a more accepting self. That's great. We can also have that experience with another who represents a more accepting self. If the other person doesn't recoil, that's right.

1:54:15You're not really recoiling from that either. No, I mean, I think that's such an interesting example because I really felt uncomfortable sending those recordings to Katie. And I think initially I said, well, I'm uncomfortable because I hate that I'm wasting her time. I'm lighting up her phone with text messages of these recordings, but that's actually probably less what it was. I think it was more, I'm ashamed of the fact that I'm doing this and I'm ashamed of how difficult this is and what is she thinking when she gets this. Again, this is a narrative you're making that's incorrect if a good therapist isn't.

1:54:49None of those things are true, but that's the thought you're having. Right, so you have to know that she She really wants you to send them. That she really wants you to send them. And she really wants to help you. And she really feels good about you. She sees the goodness in you. And then it lets you do something that exposes the shame. I think, part of what you feel ashamed of, is that you're doing that to yourself. Yeah, no, the shame is that this is so hard to do. This shouldn't be hard to do. It's, I shouldn't be doing this to myself. And therefore, this exercise, A, shouldn't be necessary and B, it should be a piece of cake and it's not.

1:55:24So now it's witness because think about this competing shames. So the one in the shame of not being perfect leads you to do something shameful to yourself, which is to be berating yourself. Look, if you did that to someone else, we would say, hey, that's a good reason to feel ashamed to talk to somebody like that just because they broke something. We say, hey, that's not okay. So why is it that you shouldn't feel ashamed when you're saying it to yourself? Shame can help us by changing behaviors. But now you have like competing shame. Should you be ashamed that you're not perfect? and it's good that you're beating up on yourself.

1:55:52Should you be ashamed that you're beating up on yourself? Because it's okay that you're not perfect. This is part of what keeps us in stasis, but then she, as the person, she's not completely separate from you in that way. Like one plus one is equaling more than two now, because she becomes a little bit of an arbiter or a metric of like what really makes sense here and her reflecting back to you that, hey, you're worth treating better than this. This is not okay for anyone, including you. it. It's not okay. You're not the only person who gets to be beaten up this way. Then part of that is her seeing that it helps makes it easier for you to change because then you put the shame in the right place like right.

1:56:29If I feel ashamed that I'm 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 a long time. I'm not going to be so ashamed it's still here in three weeks that I stop. I'm going to keep doing it. But part of it lets you do that. It's the exposure to the outside person who you trust because in that person becomes a barometer of what's real and true here. And then And it helps us get our own minds into place like, oh right, okay, I do get this. It is okay that I am not perfect. I do not want to beat up on anyone like this, including myself. Like now, you've got the resolve inside of you to do it.

1:56:59Why? Because you've been validated. Whereas before, you might not have been so sure if the shame is with the lack of perfection or with the self -talk. Let's now talk about another question around the person who's been in therapy. They have the therapist. How often do you see a therapist whose rapport is in the way that they think of rapport, which is getting along, but they're not hitting the one plus one is greater than two. That can be difficult to quantify, but the rapport is such that it's almost enabling the behavior in the client or the patient. And there's no progress being made. Yet, the client feels like, hey, this is great.

1:57:38I have a therapist. I love my therapist. I see my therapist all the time. I go in there once a week and tell them everything that's wrong and it feels really great to do that. But if an objective person, if you were sitting there looking at this, you'd say, yeah, but things aren't getting better. Is there value in just having a person that you pay to listen to what's wrong or are you paying this person to help you become better at dealing with whatever it is that's going wrong? Question one is the first critical step in that that the person themself must recognize that I need to re -evaluate this relationship.

1:58:15And if so, then what are the tools to evaluate that? Unfortunately, yes. In the example that you gave, because it shouldn't have to come to that therapist or people. And we know that whatever occupation you take, there's a significant subset of people who aren't giving it their best. I mean, that's part of humanity too. So the therapist is really transgressing something there that should not be transgressed. And you see this, right? I'm not just making this scenario up. Sure, it happens a lot because again, it's not everybody brings their best to their work. For some therapists, it's okay, they'll let the person come and go and they kind of rationalize, well, they're kind of still clicking along and they do no K in this way or that way.

1:58:54And they'll rationalize that what they're doing is a non -doing. They're not actually doing anything. And the obligation for the The therapist is to know, I know this person is benefiting from this. 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 going to be any change for the better in six to nine months. Okay. I have to accept that from week to week because I know where we're going to get to if we do the work by the 10th month. I mean, it's just a more complicated situation, but the therapist has to know we're either achieving something now or we're heading towards achieving something that's changing this person.

1:59:28It's my job to be active about that. And it's my job to not get complacent or if I see that person wants to get complacent to talk about that with them It's just a harder job But I think it's the therapist obligation to do the job that way now when that doesn't happen Then we end up in this situation you're describing right we're saying hey this person is in this situation where Things aren't getting better and I think putting a full stop to that like what am I doing here? What am I paying for right and sometimes that's a good question? What are you paying for you go buy a gallon of milk? You know you're paying for a gallon of milk You go for an hour of therapy.

2:00:02Are you going for an hour of, I want to understand myself and make change? Are you going for it's an hour I talk about all the things that are making me angry the last week and then that person gives me a little bit of sympathy and I'm no less angry? To really look inside at what the person is serving and also how good does it feel? Comfortable does it feel? It shouldn't always feel good and comfortable. There should be times when you're talking about something that's not easy to talk about or you're crying in therapy, you're upset in therapy. Like it's supposed to be work. Doesn't mean it has to be work every moment.

2:00:35Oh, I mean, there's a lot of fun to it too. And I think I have great fun doing therapy, whether I'm doing it with someone else, or I'm doing therapy with Gregory Hamilton, is in my therapist for, gosh, 13 years or so. It's fun a lot too, but sometimes I'm upset, or I'm crying, or he says something to me, or I say something to someone's like, whoa, that's okay, I'm gonna take that in. and like it's supposed to be work. 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 threadbare, that's a kind of, he said, it's hard to quantify when one plus one is greater than two, but you do kind of know it often in human relationships.

2:01:11You just feel good with someone. There's something where you're more than the two of you. That's why people want to spend time together. That's why people become romantically interested in one another. There's a lot of that going on in aspects of human relationships. Let's dig into that a little bit more because it really is. I've never contemplated that at all. But as you pointed out, you take two people like you and I who are very close friends. It's such a clear example of that. The accretive nature of the interaction. But we are friends. And yet we don't necessarily feel that a therapist and patient should be friends.

2:01:48So what are the other, what are some Some other questions a person can ask to try to get at that accretive nature of coexistence. I'd go back to the framing of it. How do we decide people or friends? Can't quantify all of that. Like, well, there's something there. They know something about one another. They're interested in one another's well -being. They have points in the past that tether to. That's why, however much I may think about myself or you may think about yourself, there's something different that happens when we're together. I leave feeling different. Why? Because I saw you. Not because I saw someone.

2:02:25It would be different if it were someone who's not you. That's because we have a real human relationship. Now we call that friendship because it's what the language applies to it. That shouldn't be different in therapy. It doesn't mean that these people are friends and they're going out for dinner together. It's not that. It's that there's a human connectedness and there's something that's greater than the sum of the parts. So if we look at friendship as an aspect of human interconnectedness and a human ability to see and feel and be present beyond the self, then that happens in friendships, that happens in romance, that happens in parent -child relationships, that happens in a therapy room.

2:03:04And if it's not, then I think there's a problem. I think there is supposed to be something greater than the sum of the parts. Whether we say one plus one should be greater than two, or we say there's an element of friendship in therapy relationships. We can say it any way we want, but it has to be more than just the sum of the parts. That person has to have real regard and interest in the person, have some aspect of the friendiness that friends feel when they're together. The existential therapist understood that the brand of therapy that when it was thought everything is transaction, we could sit behind the person.

2:03:40And it's not as if there's nothing that could ever be by that, but like that can't be the baseline of it. What has happened since then, whether people like Harry Stack Sullivan or the existential therapist that came after Victor Frankl's writing, the Raleau May and Irvin Yollem, and they were doing something different. They're like, we're humans being with other humans. That's real. I think that that is wonderful. And when I learned that in my therapy training, when that element was added, like, oh, it's okay to be human because I had an existential therapist who was taking care of me at the time, and I also had some mentors who are like, oh, okay, we have to think about the other person, the session is about the other person, but we're both humans and it's going to help them if they see that in me too.

2:04:21Every now and then it makes sense to disclose something, to talk a little bit about yourself in the service of the other, to let the person know something, let them know that you are not perfect. I mean, I think a reason you and I are able to help people is, I don't think either one of us tries to put out there that we are not either now recently or potentially suffering through anything someone else out there is suffering through. And I think there's a humanist to that. That's just real and honest. And by the way, it doesn't feel better, I think, to hide behind it, to pretend people can always hide behind something, whether it's socioeconomic or it's a power differential, it's a position in life, but that doesn't make anyone feel any better.

2:05:02The truth of it is, for example, we do share humanists with everyone. Anyone can get trampled by the society around us. Lightning can strike us. We all suffer. We all have struggles within us. So acknowledging that we're all human and we're trying to help one another, but we're coming at it from a place of acknowledging what's going on inside of us and that we are not perfect. That's why therapists learn from their patients. Good therapists learn from their patients absolutely. I can think of the life lessons that come because I'm human too and I don't have all the answers. Hopefully I have some education and training that can let me help you, but also helping you will help me too.

2:05:40That's true. I was talking to one of my colleagues before this podcast about trying to organize around a few different phenotypes of people that we interact with in our practice, who again, each of these examples, which are caricatures, of course, are people who think everything is fine with respect to their mental health, but there's an externality. Fina type one is the workaholic. We've talked a lot about this person. This is the extreme achiever. This person is so successful on the outside. Everybody just assumes everything is wonderful, but a lot of times, frankly, when you go from the street to the porch, you realize maybe that's not entirely true.

2:06:23Once you step in the house, you realize that's not entirely true. Another one we've also spoken about is the endless optimizer. So incredibly rigid and controlling of everything in order to drive towards perfect health as an example. Then you have the very anxious person who really struggles with the fear of the future. And the fear of the future can be short -term and it can be long -term. And again, we should have some fear of the future that would allow us to do things that are productive, but obviously I'm talking about this in a negative way. And then perhaps at least for me, the most difficult phenotype is the denier.

2:07:05So this is a person who by any reasonable metric is suffering, but their barriers to accepting that are so high that you can almost make a cartoon about it where you see a person who's missing an arm and you ask them if you can help them because they can't do something that would require two arms and they look at you like, what are you talking about? Of course I can do this thing. I have two arms. Well, but you're missing an arm right there. How do you think about someone be it a friend, be it a physician, be it anybody trying to help and get through to any of these phenotypes to put the thin edge of the wedge in there, such that they can at least make a tangible step towards self -help.

2:07:57Well, I think the first thing to do is recognize that there's a problem, and then you go back down this idea that there are these cupboards in the conscious mind, in the unconscious mind, And if we go and look and scrutinize what is going on inside of us, or we have curiosity about what is going on inside of someone else, that we're going to find the answer that this is not a mystery that just like a Sherlock Holmes investigative process or math problem, one can look at it and learn things. Think about the first example of workaholic. And you didn't say someone who works really hard and achieves high, but a workaholic.

2:08:34So even the word by definition is a problem. So, what are workaholics doing? Well, oftentimes they're avoiding something. That's why alcoholics are trying to avoid something by drinking to get away from it. Like, we understand that. But it's no less true with workaholic. There's something going on inside that person that they're afraid of, that they're suffering from, that they're ashamed of. Like, something is driving this behavior. So I think, what are you avoiding? What are you trying to get away from? Because workaholic doesn't mean you work very hard and you achieve at a high level. Well, workaholic means you're working when it makes absolutely no sense to work.

2:09:07So what are you escaping from? So then I think there's a defense here that is usually avoidance as a defense. And there's other defenses that come along with it. The person can put blinders on themselves, go in one direction, feel that that's good enough, but boy aren't they seeing what's on the other side of it or feeling what they would feel on the other side of it. So then that becomes a point of curiosity. Is there avoidance? What is that avoidance? What's going on inside that person? Then you think, okay, with someone who's optimizing, always trying to perfect, there's something different going on there, which is probably more rationalizing.

2:09:39We all kind of know that things get to a place that's good enough, everyone kind of knows that. So, if the person is still trying to make something that's really solidly good enough perfect, what's going on there? What are they serving inside of themselves? They're going to soothe something. Some anxiety then gets soothed because they do something that's irrelevant. So let's go look at like why they need to focus on optimizing something that's already good enough. There's other things to do in life. There's other ways to spend that time and energy, why that focus. It's a process of curiosity. When people are very, very anxious, then where that leads us is what's going on inside of them, that they may be younger people in my practice called future tripping, anticipatory anxiety.

2:10:19So is there a way that that person's fear about the future shuts them down so that they're not doing anything in the present and they don't have to be afraid that what they'll do won't work in the future. That doesn't go well, but we get into those places. So what is that anxiety inside? What is it about? Why is it so high? So then again, we become curious about that. Denial is the hardest one. And we think of maladaptive defenses because how do you get someone around maladaptive defenses? You're trying to help them understand. So if you're rationalizing, there's a little bit of a place we can grab onto that.

2:10:55You'll But denial can be very, very cut and dry and very frustrating to come up against. And I don't know if you met Peter Grover who's a therapist within our practices, very, very experienced. Peter has a sign on his wall. It's, how's that working for you? Because that's his mantra. Like that's he's very, very good at helping people who are in that so difficult denial position by helping them look, well, let's just look at like, how's it working for you? Because the idea is that the person's at odds with the therapist. So if you're like, how's that working for you, you can then together look out at it.

2:11:29Less than Havens who I had to meet many years ago who in an era when most therapists were sitting behind the patient would sit next to them and look out at the world together. So you're trying to do that. So how's that working for you? I was like, okay, I hear what you're saying. It's not saying it's right or wrong. Like, you're working or you're doing this. You're like, let's just look at how it's working for you. That can't really be even answered without some introspective capacity. I've interacted with people where maybe I didn't ask that question point blank, but I can almost imagine that if asked, they would respond, great, everything's great.

2:12:05Can't you see? Everything is great. I totally understand that of the four phenotypes described that one is hands down the most difficult. I'm just wondering if the people around individuals like that, if they care about them and they want to help, how can they help them probe even further? You hear the term intervention. At this point, you just get everybody in the room who knows them, and you just have that riveting intervention. What's the equivalent of that state here? It's hard. Sometimes you can come at it. The idea here is that person is not letting you see with them. You're a cross from them metaphorically, right?

2:12:41So what you can do is then to tell them, to say to them, how you see it. Because I can't impact you. You're not letting me. Barry, there's nothing wrong. that's your story, you're sticking to it. But presumably if one is having that conversation with a person, one plus one is equaling more than two, that's why you're sitting across from them. Like there's some emotional investment, there's some respect, there's some love or consideration, there's something there that when you say, hey, I just understand that and I hear where you're coming from and I hear it loud and clear, I just wanna say to you that from where I sit as someone who knows you, cares about you, loves you, whatever it may be, what I see doesn't seem okay to me.

2:13:21I just wanna say this, I'm gonna try to force it on you. People sometimes will remember that down the road. Sometimes I'm like, look, I can't help this person right now. But what I think I can do is maybe put a seed in there that may come about later. Sometimes I'll see this with someone who's drinking very heavily and not acknowledging I still feel good. You know, I don't feel any different. So nothing is gonna happen now. We may have a set of underlying labs that we can look back from and we see where those numbers are trending. So it's not hard from the outside to see, but the person is like, I don't feel any different.

2:13:52There's nothing wrong. So even then sometimes, well, if I can, I'll try and put in an idea of, look, at some point, you're gonna start feeling something different. At that point, remember this. We're acknowledging, like, you can't get through to everybody and like, that's okay. If you can't, don't keep trying, because like, look, I want to tell you how this is gonna be bad for you. That person has long turned you off and you tuned you out, you can't get anywhere with him. But if you do that, it's okay. I get it. I'm not the person who like says you stop drinking or so. That's not me That's not what I'm doing.

2:14:22What I can do is Maybe plan a seed that I think you're gonna start feeling something at some point in time This is gonna start feeling different remember this then sometimes people do sometimes they don't but a lot of times when people get help You do see that they've taken that inside Sometimes from someone else sometimes I'll see it in my own work where someone who I thought things ended very badly and the person wasn't helped and they left and I tried to plan a seed and then they come back in a couple years You know I thought about that and like wow that feels great It's a proof of concept that you're doing the right thing by planning these seeds But more often than not we see someone else's planet a seed Maybe that was another therapist or is another friend or someone else said that or someone said a long time ago They read it in a book if we can plant seeds in people who are in denial Those seeds may grow but we have to understand and when we can't do more than that and stop, otherwise, you know, we could drive the person away and prevent any help from coming.

2:15:15One final question I just wanna ask you, Paul, is about how you manage internally the challenges of what you do in the sense that you work with all sorts of people across all sorts of spectrums, and obviously we didn't talk about it today because we've spoken about it a lot in the past, but you're gonna be very quick to look for the trauma in a person's life that probably shaped many of the adaptations that exist today. And in doing so, sometimes those things are very sad and they're very tragic. And I just wonder how you manage the sadness around that for yourself. I think about what it was like being a resident, patients would come in and they would die, trauma victims.

2:15:58Someone comes in and a car accident and they're dead. You take care of them and can't save them. We don't really get taught how to manage that at all. I found that to be hands down the biggest failure of our training system. Perhaps that's changed. But certainly when I went through, there was absolutely no discussion even of that. I remember being reprimanded for going to the funeral of a patient. The idea being like, that's a line you never cross and you have to block that stuff out basically. How do you deal with that? But at start by saying, I agree with you, I think at least in our era of training, medicine did a lamentable job of that.

2:16:39And if you think about medicine, hopefully selecting for empathic people, or compassionate people, and when a person is built that way, that one plus one is more than one. So you feel part of a we, if you're taking care of someone and they die, you're not that person. But magically it's what goes on in our heads. We feel sort of part of them because we're a we. we see that with people we really love, we're close to us. Like they're part of who we are. We see this in settings where we're helping people too. And I don't know if you went through this part of it. I remember when you were talking, I remember very vividly being an intern and having to really tell myself, like, I am not this person because it started feeling like, oh my gosh, you could see this person is suffering and it's easy to lose those boundaries.

2:17:21So to be able to say, like, I'm standing here, that person is there, then in fact, the only way I'm gonna be able to help them is I have to know that I'm not that person, but it wasn't easy. And I remember one of my co -interns, and I remember he and I really talking about that, and we were trying to do it for one another. Like, okay, like, you come down a little bit, like, you're not this person. Let's step back from it. Catch our breath and try and help the person. You probably remember as we did it for one another. For me, it starts with that because that's a physical separation. And then the idea that I can mentalize a lot, meaning like think a lot and feel things.

2:17:55We can all do this, but like we do this with your therapist. You're feeling what other people are feeling you're feeling for them It's easy to keep that in your mind too much Then just like if we picked a word and said it five thousand times it'll be in us tomorrow If there's something you don't want to do and you repeat it 20 times and we're likely to do it again And the same is true when we can't bound ourselves well enough from the suffering and other people This is why people have post trauma syndromes from bicarious trauma. I mean this absolutely happens the brain is change. There are biological changes, behavioral changes, and all of that trauma is vicarious, and this is why we see the levels of depression and suicidality and substance use is higher in people who are giving care to others.

2:18:37So it is so important that we have these boundaries inside of us, and they have to come, I think, from this place of balance drives and gratitude, and humility. I'm so grateful I get to know other people. They share things with me. I can help them. I can learn from them. That is such a wonderful thing that it helps me to accept the other side of it, which is sometimes things that are very, very hard to hear or very hard to get out of our minds. And I have to have the humility that I am human too. And if I keep this in my head, or if I'm really mad about this thing, the things that happen is somebody's, we see the most awful things people can do to one another.

2:19:14That I know these things happen. I can fester on the anger, the frustration, the misery of this, and I will hurt myself. So my obligation to myself and to the people around me that I care about in the world, people I love, or people I know, and I like them. I want to be healthy. I want to be at my best, and I have to be able to maintain these boundaries inside of me, which means have the discipline to stop thinking about that. Know that take stock of I'm doing the best I can for that person. I'm still worried. is, more is not going to have a good outcome. Like, am I doing what I can do? I can.

2:19:48There must be something else that comes into my mind. And I find it is easier to do that as I focus more on the balance of drives. I'm being generative. I'm asserting myself. I'm taking pleasure in what I'm doing. And I feel gratitude for what I'm doing and the humility to know that if I don't take care of myself, it'll kill me too. Paul, I want to thank you again for not just making the trip up, but more importantly, of course sharing all of these insights in a manner that's incredibly lucid and helpful. I look forward to doing this again because obviously we will. I do too. Thank you so much for having me.

2:20:20It's wonderful to see you and I so appreciate being on the podcast. Thank you. Thank you for listening to this week's episode of The Drive. It's extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members. And in return, We offer exclusive member -only content and benefits above and beyond what is available for free. So if you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of the subscription. Premium membership includes several benefits.

2:20:53First, comprehensive podcast show notes that detail every topic, paper, person, and thing that we discuss in each episode. And the word on the street is, nobody's show notes rival ours. 2. Monthly Ask Me Anything or AMA episodes These episodes are comprised of detailed responses to subscribe questions, typically focused on a single topic and are designed to offer a great deal of clarity and detail on topics of special interest to our members. You'll also get access to the show notes for these episodes, of course. 3. Delivery of our Premium newsletter, which is put together by our dedicated team of research analysts.

2:21:30This newsletter covers a wide range of topics related to longevity and provides much more detail than our free weekly newsletter. 4. Access to our private podcast feed that provides you with access to every episode including AMAs, Sons, the Speel you're listening to now, and in your regular podcast feed. 5. The Qualies, an additional member -only podcast we put together that serves as a highlight reel featuring the best excerpts from previous episodes. of the drive. This is a great way to catch up on previous episodes without having to go back and listen to each one of them. And finally, other benefits that are added along the way.

2:22:09If you want to learn more and access these member -only benefits, you can head over to peteratia -md .com forward slash subscribe. You can also find me on YouTube, Instagram, and Twitter, all with the handle peteratia -md. You can also leave us, review on Apple podcasts, or whatever podcast player you use. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional healthcare services including the giving of medical advice. No doctor -patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk.

2:22:47The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek assistance of their healthcare professionals for any such conditions. Finally, I take all conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit peteratiamd .com forward slash about where I keep an up to date and active list of all disclosures.