Dr. Harold S. Koplewicz

[0] Welcome, welcome, welcome to armchair expert, experts on expert.

[1] I'm Dan Shepard.

[2] I'm joined by Mr. Mouse.

[3] Hi there.

[4] Hi there.

[5] Our guest today, Dr. Harold S. Koppelowitz, is the founding president and medical director of the Child Mind Institute.

[6] One of the nation's leading child and adolescent psychiatrist, he is known as an innovator in the field, a strong advocate for child mental health, and a master clinician.

[7] Please enjoy Dr. Harold Koppelwitz.

[8] Wondry Plus subscribers can listen to Armchair expert early and add free right now.

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[10] Or you can listen for free wherever you get your podcasts.

[11] I want to start with a heartfelt apology.

[12] This is unacceptable.

[13] We're late.

[14] Full 12 minutes late.

[15] I'm so sorry.

[16] We were chatting.

[17] I would you know if I was the shrink, it would totally be unacceptable.

[18] Now, in that situation, Yeah, where a patient is late, I guess there's two ways you could respond.

[19] One is like, hey, it's your money.

[20] I only got to now work 40 minutes.

[21] Not up with a psychiatrist, but say a psychologist.

[22] Right.

[23] That would be one way to go with it.

[24] Another would be like, I'm not going to do this.

[25] You either have to do this correctly or we're not doing it.

[26] I work with kids.

[27] Right.

[28] A lot of times it's not the kid's fault, right?

[29] The parent is disorganized.

[30] They're late.

[31] And sometimes it's resistance.

[32] It's really the kid does it.

[33] want to be there.

[34] Right.

[35] I mean, you talk a lot about your background, even your parents.

[36] My mother was very opposed to me becoming a psychiatrist.

[37] She was.

[38] She definitely wanted me to be a doctor.

[39] Right.

[40] But a psychiatrist, no one really wants to see a psychiatrist.

[41] You're going to spend your life with people who don't really want to be with you.

[42] Like a meter maid.

[43] Kind of like that, except a little better paid.

[44] So there is times where someone just doesn't want, especially a kid, you know, a kid saying, my parents find me difficult, the school finds me difficult.

[45] I don't find myself difficult.

[46] Why do I have to be with you?

[47] Yeah.

[48] And sometimes, in fact, often you have to get past that.

[49] I had recently a consultation for a family that got divorced, and then one of the kids really became very symptomatic.

[50] So the family said they really wanted me to see the child.

[51] And so the child comes in to see me. And during the consultation, it becomes clear she's non -binary.

[52] So it's not she, it's they.

[53] And I'm struggling with plural.

[54] And I'm trying to be very good about it.

[55] And I say to them, why don't you leave the room now?

[56] I'll talk to your parents for a while.

[57] I'll get the history.

[58] And the parents say they're cutting.

[59] The private school's not working out.

[60] They were in a public school.

[61] They're really very concerned, both parents.

[62] And the father's very angry.

[63] The father really feels he's been raked over the coals, and he wants to relitigate the whole divorce.

[64] The child comes back in and is wearing a hat over their eyes.

[65] So it was very difficult to really communicate.

[66] And we're talking and I tell them I understand that you're pissed, that you don't really want to be here.

[67] And after a few minutes, the hack comes off and I am struggling with the pronouns.

[68] I am really trying my best to remember they and them.

[69] And I keep saying she, the parents come back in.

[70] We make a deal that most probably therapeutic school would be a better idea.

[71] There are such things.

[72] Yeah, there are schools where you get regular education, but you also have a therapist.

[73] environment where they're talking to you about your behavior and their consequences, their rewards, and it's a smaller environment.

[74] And you go for a semester.

[75] And also, they had to get away from this conflict.

[76] The conflict was making whatever was going on, which is really depression, 10 times worse.

[77] But you talk about someone who didn't want to be there.

[78] Yeah.

[79] And then while the parents are there, I make the mistake again.

[80] I say, she.

[81] And the father yells at me and says, it's not she.

[82] It's they.

[83] And the child turns to their father.

[84] and says, Dad, Dr. Coploops is really trying.

[85] It's just that he's old.

[86] I thought, you know what?

[87] I am old, I guess.

[88] But I got through.

[89] And I thought, I just have to become more considerate and really try harder in the same way that you try harder for patients to make them feel, I'm listening, I'm really connecting to you, and I couldn't care less that you wore the hat over your eyes.

[90] I know you don't want to be here.

[91] Let's try, because just think about it for other parts of medicine.

[92] If you come to see me and you're telling me that you have a terrible bellyache, I have to have you take your shirt off and I have to lay my hands on your belly and I'm looking for an appendicitis.

[93] You have to examine the patient.

[94] If you're running around the room and I can't get to touch your belly, I'm out of business, right?

[95] So the same way for a child and adolescent psychiatrist.

[96] You have to connect to the patient.

[97] And things have changed dramatically because in the past, We used to do this kind of play therapy, psychodynamic stuff, where it could take forever for you to open up.

[98] And today our attitude is, wait, we need to get a diagnosis.

[99] And once we get a diagnosis, then we can come up with the treatment because diagnosis drives treatment, right?

[100] If you are inattentive, it doesn't mean you have ADHD.

[101] You could be bored.

[102] You could be gifted.

[103] You could have anxiety.

[104] You could have depression.

[105] And the treatment is different for each one of them.

[106] You could have low blood sugar.

[107] Right.

[108] You could be confused.

[109] Right.

[110] So therefore, you need to get a diagnosis.

[111] and to get a diagnosis, you have to get some cooperation from the patient.

[112] So if she's 10 minutes or he's 10 minutes late, that might be symptomatic of something.

[113] But if you get rigid and say, well, we only have 40 minutes left, you're an asshole.

[114] Your diagnosis is you're an asshole.

[115] There's no doubt the kid's going to call you out.

[116] Have you ever started with, because when I imagine being in the situation that you just described, and if I'm them, I'm on high alert for what your agenda is because I live in a household with you parents who are engaged in this divorce and they have agendas and they have things they want to happen.

[117] And then I go away to this school and they have an agenda for me. I feel like as a child, I was on high alert for everyone's agenda.

[118] So I would be looking at you going like, are you a pawn for these other characters in my life or are you genuinely interested in how I feel day to day hour to hour?

[119] Is there a shortcut to let them know?

[120] Like, I don't give a shit about your parents.

[121] No, but I think you have to give them the rules of engagement.

[122] Okay.

[123] So the rules of engagement, are when a kid comes in with their parents.

[124] First of all three of them at the same question.

[125] If you had to pick one area where your child or where you are having difficulty, is it behavior, is it thinking, or is it feelings?

[126] And you give them descriptions of what it's like.

[127] And you say first to the child, then to mom, then to dad.

[128] So at least we know if there's consensus, right?

[129] Yeah.

[130] And then you say, there are rules that I follow.

[131] One of the rules is whatever you tell me, Dax, 16 -year -old Dax, going to tell mom and dad, except if I'm convinced you're going to kill someone or kill yourself.

[132] Right.

[133] But frankly, I've heard everything else.

[134] So if you tell me about sexual behavior or you tell me about drug abuse or something like that, I don't need that to be able to tell your parents with the diagnoses.

[135] Right.

[136] However, what your mom and dad tell me, if it's significant, I'm going to share it with you.

[137] So if they tell me you're not sleeping at night and you're on the computer at eight hours, I'm going to say to you, what's going on, tax?

[138] Why are you doing that?

[139] But you have more rights than the other two people here because today you're the patient.

[140] The other thing that I think is really important is to stop the judgments.

[141] So if you say to someone, Monica, everyone worries about something.

[142] What do you worry about?

[143] Oh, I don't worry about anything.

[144] I said, well, what if I tell you what other people worry about?

[145] And worries are in the anxiety range.

[146] And so you go through basically a checklist without having in front of you.

[147] So you have, again, some idea of what's happening so that you can come up with a doctor.

[148] diagnosis.

[149] And then when you, basically, you get the first information from the parents and the kid will confirm or deny what they're saying so that when you bring them all back in, you give them a treatment plan.

[150] And the controversial part, by the way, of treatment now is medication.

[151] Yeah.

[152] So for instance, at the Chalmine Institute, we put it in our charter 11 years ago that we will not take money from the pharmaceutical industry.

[153] But we went one step farther.

[154] We don't let drug reps on the grounds.

[155] Inevitably, people from farmer, are good looking, they're glib, and they come with pens, post -its, and food.

[156] Frizzies, yeah, yeah, yeah.

[157] And inevitably, you went from Prozac, which is the cheapest SSRI to Lexer Pro, which is one of the most expensive ones, for what reasons?

[158] There's no data that Lexer Prox works better than Prozac, and if anything, Prozac's been given to a million kids, so why would I want to give my kids something that only 100 ,000 people have taken?

[159] Right.

[160] Because they took them to Ruth Chris and got a good steak, and now you're going to be on that one?

[161] Why do that?

[162] You can't be a little pregnant with this.

[163] So either we say to you, we think medicine should be part of it, but we're saying it to you because of these studies or these symptoms, not because some woman who was very articulate, just gave me a pen and a pizza.

[164] Right, right, right.

[165] Okay, I think it would make most sense to maybe proceed through this in acknowledging what the status of the problem is kind of nationally and globally.

[166] And then I want to get into our treatments because I think you'll find that I'm very supportive of all this and also scared of a lot of this.

[167] And we'll get into, I think, some of my fears.

[168] So right out of the gates, let's talk about the breadth of the problem.

[169] And before we talk about kids specifically, I'd love to talk for two seconds about kind of the history of the DSM and where we started turning our eyes onto the gravity or size of the problem.

[170] So, and please correct me if I'm wrong, but I'm going to try to readers digest it.

[171] There were all these problems in diagnostics.

[172] There was no consensus.

[173] There was this great thing that happened in the 70s.

[174] The response to all this became the DSM, as I think, and there's now we're on, I don't know what number, we're on five.

[175] But it's a criteria of questions that if given to a computer, the computer could virtually spit out what the diagnosis is.

[176] It has some attempt at objectivity.

[177] Is that being fair?

[178] I think it's very fair.

[179] But one of the things that they were trying with DSM 2 and then certainly with DSM 3, that's when the criteria started to get tighter, was that if Monica was our patient and she was seen by Dr. Dax in Los Angeles and then seen by Dr. Harold in New York, that there would be some consensus.

[180] That it wasn't that you see everyone as being borderline personality disorder and I see everyone is having ADHD.

[181] Yeah, everyone just sees what their parents had, probably.

[182] Right, or what they have.

[183] Yeah, exactly.

[184] So I think that was very helpful.

[185] Also, you have to remember that homosexuality was a psychic.

[186] psychiatric diagnosis.

[187] And it's because of these kinds of consensus based on research that we got much better.

[188] A very rich philanthropist whose name I'm not going to mention it because I still would like to get some of their money.

[189] But they came for a listening tour and they had the Commissioner of Mental Health for New York City and me in the room.

[190] And she said, I don't like the word disorder.

[191] Yeah.

[192] I said, okay, what do you want to call it?

[193] Problems.

[194] I said, well, the difficulty with calling everything problems, that's 100 % of the population.

[195] Everyone in the population has problems.

[196] If we call it issues, that's 50 % of the population.

[197] But if it's disorders, it's 20 % of the population.

[198] And that's a lot of kids.

[199] That's 17 million kids.

[200] But if you really have a disorder, then you're entitled to insurance.

[201] You're entitled to accommodations in school.

[202] The same way that you get a ramp if you have a wheelchair, the same way you get sign language if you have a hearing loss.

[203] And I think that until we accept it's real, common, and treatable, then we have a problem.

[204] Because what DSM did was also start making you look at treatments.

[205] So what is a reasonable treatment?

[206] So cognitive behavioral therapy, the way we feel affects the way we think, which affects the way we behave.

[207] And if you could break that down, then within 10 sessions, again, you're coming to see me with a child that has depression.

[208] And I say to you, I can get you a really good psychologist who knows how to do CBT.

[209] And after four sessions, if she or he is not any better, we should add some medicine.

[210] Right.

[211] And we add an SSRI, and in 10 sessions, or 12 sessions, really, 71 % of kids get better.

[212] Well, tell me, what other part of medicine?

[213] Do you get a 71 % treatment response?

[214] And the nice part about that is you keep the kid on the medicine for about a year, and then slowly you start taking the medicine off.

[215] So you basically trick the brain.

[216] So you've reset the thermostat, but you don't suddenly get rid of it.

[217] There's a scene in Dear Evan Hansen and the Broadway show where, Evan stops taking the medicine and I was involved with Stephen Levinson and said to him, you can't do that, Stephen.

[218] You get terrible side effects and he said, well, I stopped my medicine when I was in high school.

[219] I said, what were you taking?

[220] And he said, Ativan, I said, well, you're taking the wrong medicine.

[221] He should have been taking an SSRI.

[222] His best line was, I think I should have been seeing you.

[223] I was seeing the wrong psychiatrist.

[224] But again, if you explain to a parent what an SSRI does, you know, these antidepressants, anti -anxiety, but they're not feel -good drugs.

[225] You can't sell them on the street.

[226] Kids respond better to them than you do, Dax, because you're more than 24.

[227] And if you need an SSRI, we're most likely talking about years of taking it because your brain is just not as fluid and as mushy.

[228] It's not as flexible.

[229] Right, as a kids.

[230] Okay, so, again, that would be in the treatment camp.

[231] The only reason I brought up the DSM, I'm not critical of it.

[232] Obviously, as you point out, the fact that homosexuality was problematic and luckily evolved as science does.

[233] But what I wanted to point out more is that in the wake of the DSM in kind of a systematic approach to diagnostics that's agreed upon, what was revealed was that either this test is flagging too many people or mental health disorders are epidemic level.

[234] And that's what I'm most interested in.

[235] So I think in the wake of it, we started going, oh, wow, this isn't something that is affecting 2 % of people or 4%.

[236] This is in the 20s or this is really an epidemic.

[237] And unfortunately, the majority of, certainly kids and teenagers do not get treated.

[238] So, first of all, you just said you're cautious about it.

[239] I think most parents worry about their children, feel guilty about how their kids are doing.

[240] And so the idea that you go see a psychiatrist or a psychologist and they give you a diagnosis is very unnerving versus me telling you your daughter has strep.

[241] Yeah, yeah, yeah.

[242] And it needs to take 10 days of penicillin or amoxicillin or whatever it is.

[243] And that is embroiled in the way we talk about mental health issues as, like, I remember having an anthro linguistics class and talking about how in sub -Saharan Africa, there aren't any mental disorders that are permanent.

[244] You're not schizophrenic.

[245] Like, that's a permanent diagnosis of somebody, whereas theirs is all more like the cold.

[246] They have this now, which implicit in that is they can get over it.

[247] Right.

[248] But the good news is that particularly under the age of 24, and 24 is an interesting age, because if you, when your kids are older, and you're 18, 19 years old, and you go away on vacation and you say, let's rent a car, they're going to say, no, Mr. Shepard, you can rent a car, but we won't rent your child a car until she is 25 years old.

[249] Uh -huh.

[250] That's a business decision, right?

[251] From 18, 25 Hertz is not taking your money.

[252] Yeah.

[253] Some insurance actuary decided, oh, it really drops off a cliff once they turn 25.

[254] Why?

[255] Because until you're 25, you tend not to put a condom on, a seatbelt on, or a helmet on.

[256] You don't do cause and effect.

[257] Your prefrontal cortex, this thing behind your forehead, is just not connected to the rest of your brain.

[258] And so you see opportunity and you don't see risk.

[259] Let's get on the motorcycle.

[260] What about putting the helmet on?

[261] Let's have sex.

[262] What about that condom?

[263] And so the good news is that you can also learn better before you're 24.

[264] You can be treated better.

[265] You can also get bad habits.

[266] So if you start smoking cigarettes at 17 or 18 versus smoking cigarettes at 27, well, so how easy it is for you to stop?

[267] Oh, my God.

[268] Well, you're watching me gnaw on nicotine toothpicks.

[269] I haven't smoked in 16 years, which is great.

[270] But the nicotine addiction is thriving and will continue to thrive.

[271] Yeah, yeah.

[272] I'm not even going to try to get up.

[273] My father actually told me when he stopped smoking in his 40s that he would dream that he was still smoking cigarettes.

[274] I actually started smoking cigarettes for one year when I was in medical school, so I was 25 because you stayed up all night.

[275] Do you mean when you were the pediatric intern, you were up there, you drank coffee and smoked cigarettes, and it was only the next year where I was, I think, 27 or 26, something like that, that I realized I'd wake up in the morning with so much heaviness on my chest.

[276] Oh, it's horrendous, yeah.

[277] I could smoke a whole pack of Marlboro Red, and I love them, but also they got hooked.

[278] I would have a cigarette after sex.

[279] I would have a cigarette after a meal.

[280] I had a cigarette after I had take a dump.

[281] I mean, it was just, and then I thought, I have to stop.

[282] And you know what?

[283] I just stopped.

[284] Yeah.

[285] I don't think you could do that as easily when you start early.

[286] Your brain is just different.

[287] You also had from, let's just arbitrarily say, it's shit starts getting pretty interesting.

[288] You're on 15.

[289] Like, you feel like you're wrestling with some major dynamics and some identity issues and your future and blah, blah, blah.

[290] So if you have had this outside mechanism that helps you regulate that feeling, or at least you perceive it as helping regulate you.

[291] You actually don't have a memory of going through stuff where that wasn't by your side to help you regulate, where at least for you, you had accumulated maybe nine years of dealing with stressful situations without that.

[292] Yeah, so I just think it's more baked in when you're contemplating, who am I without this aid.

[293] But going back to what you were saying about the DSM, the interesting part for psychiatry has been that we started to recognize that there's certain disorders that you get in childhood that if you leave untreated, actually morph during adulthood.

[294] So the fact that we have 2 million kids, teenagers every year who get depression, but I think we have 40 million Americans who have depression, which means these teenagers turn into adults.

[295] So, for instance, if you have separation anxiety, if you're one of those kids who's Sunday night, you get the blues, in the middle of the night you're going to sleep in your parents' bed, you feel nauseous on Monday mornings.

[296] Sleepway camps are really impossible.

[297] Statistically, you are about 50 to 60 percent more at risk, having panic attacks when you become an adult.

[298] And if you're one of those kids and you smoke marijuana, marijuana can actually precipitate a panic attack.

[299] And once you have one panic attack, it's like kindling.

[300] Embers are there.

[301] So isn't it better to know this information so that if you're the parent of a homesick girl or a kid who every Monday morning feels like he's going to throw up, that you talk to them about marijuana?

[302] Marijuana is endemic, you know?

[303] And maybe this is not a good idea for you.

[304] And we also know the kids who have generalized anxiety disorder, these kids who worry before the test, after the test, during the test, they're like the classic pre -med, you know, how you're doing, you know, this kind of nerdy, intense person.

[305] Well, generalizing anxiety disorder, you worry every day.

[306] It's not just school days.

[307] You're more likely when you hit adolescence to get depression.

[308] So it's not only bad life that you're living with being anxious.

[309] It's also mostly bad for your brain.

[310] It's misfiring on a regular basis.

[311] So the prognosis is so much better.

[312] if we nip something in the bud when it's only six months old or two years old, versus you're telling me your cigarette addiction is 20 years old or 30 years old, much harder to manage, right?

[313] Yeah.

[314] You know what's interesting about that is what you're saying is very optimistic, but I also think, let me, you already know them well, but I'll just voice for the audience my fears as a parent, which is if you're a parent, I think we all experience this, where you're watching your kids closely, and they start acting some bizarre way for, could be a week, could be two weeks, could be four weeks.

[315] And in that time, you convince yourself, yep, they have a developmental issue.

[316] I'm on high alert for this, and now I'm seeing it, and we've got to treat this and blah, blah, blah.

[317] And then maybe through laziness, you just don't make that appointment.

[318] And then, lo and behold, eight weeks later, you're like, oh, that was a little phase they went through.

[319] And then you think, God, what if I would have got them on this trajectory where I've labeled them with a pathology?

[320] and now this is part of their identity for themselves.

[321] It's one I've given them, and it was completely unnecessary.

[322] So I think having had that anecdotal experience where you watch your own kids go through these phases, which are very scary, but then you see them come out on the other side of them, I think you're a little right to caution yourself that you're not overreacting to these situations.

[323] So how do we navigate?

[324] So first of all, I think the facts are really terrible.

[325] The average parent in the United States waits anywhere from two to eight years from the onset of symptoms before they go get help, depending on the diagnosis.

[326] Dax is just a little hyperactive.

[327] He's just full of energy, but he's so bright.

[328] He's just a boy.

[329] Yeah, yeah, yeah.

[330] And yet, you're not doing well in school.

[331] You have a high verbal IQ.

[332] Why isn't he getting straight A's?

[333] Well, you just nailed me. No, but maybe there's something else.

[334] Or we don't believe in psychiatry, or we don't believe, the good news is, I love when people say, I don't believe in medication.

[335] I say, well, you know what?

[336] You don't have to.

[337] It really works.

[338] Yeah, yeah.

[339] It believes in you.

[340] Yeah, exactly.

[341] But I think, the reverse of, wouldn't it be wonderful, you take your child, and they say, no, Miss Shepard, you're just a very cautious dad, but...

[342] She's acting like a six -year -old.

[343] Right, and I would be patient.

[344] And your pediatricians, usually, if anything, they underestimate.

[345] They say, oh, it's okay, it's okay.

[346] But even if you went to see someone, and they said, let me give you a primer on what normal behavior is like.

[347] And normal's a big bell -shaped curve, and your daughter is somewhere in the middle there.

[348] And I think it's good that you're cautious, but let's step back and stop being so hyper -vigilant.

[349] Stay tuned for more armchair expert, if you dare.

[350] We've all been there.

[351] Turning to the internet to self -diagnose our inexplicable pains, debilitating body aches, sudden fevers, and strange rashes.

[352] Though our minds tend to spiral to worst -case scenarios, it's usually nothing, but for an unlucky few, these unsuspecting symptoms can start the clock ticking on a terrifying medical mystery.

[353] Like the unexplainable death of a retired firefighter whose body was found at home by his son, except it looked like he had been cremated, or the time when an entire town started jumping from buildings and seeing tigers on their ceilings.

[354] Hey listeners, it's Mr. Ballin here, and I'm here to tell you about my podcast.

[355] It's called Mr. Ballin's Medical Mysteries.

[356] Each terrifying true story will be sure to keep you up at night.

[357] Follow Mr. Ballin's Medical Mysteries wherever you get your podcasts.

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[359] What's up, guys?

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[364] I mean the likes of Amy Polar, Kell Mitchell, Vivica Fox, the list goes on.

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[367] Really quick before I move past the diagnosis part because one critique of the DSM, which I can see some validity to, is what it inadvertently did by isolating different disorders is it accidentally established what normal is.

[368] And that's, I think, potentially dangerous for any society for us to think we understand what normal is and that falling outside of what, quote, normal is, is pathological or wrong.

[369] So I don't think it's a matter of normal or abnormal.

[370] Okay.

[371] So think about this.

[372] It's a group of symptoms that cause distress and dysfunction.

[373] That's when you need to do something.

[374] So, for instance, if I tell you that I'm hearing voices and I believe that God is really talking to me because I'm so special or the TV when Fallon is on and he winks or something, it's a special message to Harold Koppelowitz, not to Dax and not to Monica, just to me, because I'm so grandiose that that could be signs and symptoms of bipolar disorder.

[375] And it makes it difficult for me to sleep, and I've become hypersexual, and I've also become a big spender, that those symptoms are really causing distress and dysfunction.

[376] They're causing distress to me and to my family, and it's dysfunctional that I can't live my usual life.

[377] And so if I got a diagnosis and got put on medicine like lithium, which has been around forever, and I got to speak to a therapist to help me understand what the symptoms are, so that when it's in my toolbox, so I know when I can't sleep more than four hours, that's a telltale sign.

[378] I'm still normal.

[379] It's just that I have a mood disorder.

[380] That doesn't mean I'm abnormal.

[381] And the same even goes for the terrible diseases like schizophrenia, where you really lose touch with reality.

[382] Bipolar disorder is one of the few psychiatric illnesses where the population has a higher IQ than the general population.

[383] Of bipolar.

[384] Have you read Molecule of More?

[385] Yeah.

[386] There is a chapter about bipolar.

[387] And what this author of the book or the two authors suggest is when you have increased levels of dopamine, your desire is to explore, travel, conquer, blah, blah, blah.

[388] So if you look at the population of the United States, which is made up of nearly all people who wanted to leave and find a better future, you're looking at a population that has kind of an inordinately high dopamine level to begin with.

[389] And if you look at Japan, which has nearly zero immigrants, it's a homogeneous population that never left.

[390] it never came, much, much lower rate of dopamine -genic people.

[391] And then if you compare our rates of bipolar, there is as stark as it could get.

[392] It's like under 0 .3 % in Japan.

[393] And here it's up to, what is it?

[394] It's like 2%.

[395] I was going to say 3%.

[396] Yeah, 3%.

[397] I mean, it's like a 10x difference.

[398] So people who are hypomanic, I always think it's confusing because when you say hypomanic, you would think they're lethargic, right?

[399] But hypomanic is just people, they're not manic, but they don't need much sleep.

[400] There's so many of them in New York and Los Angeles.

[401] They're really creative.

[402] You're really excited to be with them.

[403] They talk a lot and you like what they're saying.

[404] And so that stuff's good, right?

[405] You want people who are that energized kind of thing, but they can sleep.

[406] But they don't need eight hours.

[407] They function just fine on four or five.

[408] And they're full of energy.

[409] And they can go work out and they can do everything and they're still okay.

[410] So that's a variant of normal.

[411] Right, right, right.

[412] average.

[413] I think normal's bad.

[414] Yeah, you're right.

[415] I think it should be typical or atypical.

[416] Yeah, yeah, yeah.

[417] It's kind of...

[418] It's like alcoholism, right?

[419] Like, it's different for everyone, but when it's a problem is when there's a consequence or when it's starting to have some negative effects on your life.

[420] Otherwise, if you're someone who can drink and function well, and I mean, then it's, is that a problem?

[421] No. Well, that's the great thing about alcoholism.

[422] Only the alcoholic can decide because I could on the outside being sober, look at it and go, Yeah, the medicine you're taking is working currently.

[423] Yes.

[424] But it's not always going to work.

[425] If you look at the average or the typical alcoholic, it'll stop functioning in the way it's supposed to.

[426] So for me, alcohol work great for 12 years.

[427] And then it stopped working.

[428] So how about kids who are socially anxious?

[429] Uh -huh.

[430] So they're not just shy.

[431] They're pathologically self -conscious.

[432] And the little ones, by the way, the four or five -year -olds, they become selectively mute.

[433] So they talk to mom and dad, or they might talk to the nanny, or they're not.

[434] They talk to their best friend, but the idea of raising their hand in class to go the bathroom, they'd rather pee on themselves.

[435] And so the teacher doesn't see them as shy.

[436] You're just so oppositional, Dax.

[437] I said good morning and you don't say good morning, but I saw you whispered to Monica.

[438] You're just a rude kid.

[439] So people project onto these kids right away.

[440] So it turns out that if you want to get a feeling of what it's like to be socially phobic, the next time you go to a cocktail party with your mate and you walk in and you don't know anyone and you're dressed the wrong way, you think to yourself, this is like the worst, I hate lawyers or I hate teachers or I hate actors.

[441] I can't believe she dragged me here.

[442] And you go over to the bar and you have a drink.

[443] And alcohol works.

[444] It lowers your social anxiety.

[445] The only problem is that dose has to increase the next time.

[446] And so you find that it's not the bad boys who become trouble with, it's the anxious boys and the anxious girls who start to self -medicate.

[447] And marijuana, by the way, for certain kids is self -medication.

[448] They talk about it like a warm blanket.

[449] Oh, it feels so good.

[450] And it decreases, for some people, decreases their anxiety.

[451] Or for kids who have ADHD where they just can't get themselves organized enough and the work keeps piling up that they get relief from that.

[452] Now, the problem is now we have two problems, right?

[453] I'm waking and baking.

[454] I'm waking and baking.

[455] I mean, I keep the joint or the vape right next to me. And all day long, I'm just not as focused.

[456] I mean, I think there's two things I think we should also talk about is the stigma that surrounds this and also the parenting that's really necessary.

[457] I listened to one of your podcasts where you talked about that your parents didn't have very much.

[458] And so you then now have a swimming pool.

[459] So where's your kids going to go from the swimming pool?

[460] Oh, yeah, yeah, yeah.

[461] So my parents are immigrants.

[462] They came here in 1949.

[463] Right.

[464] Your father was a Holocaust survivor?

[465] Yeah, my father was a Holocaust survivor.

[466] He graduated law school in 1936 in Poland.

[467] my mother was in law school and her grandmother had been in law school so they were intellectual Polish Jews but they were still Jews in Poland which was always an anti -Semitic country but they managed you know so the thing that's really interesting is that when they arrive here in 1949 their careers are worthless right it's French law Napoleonic law and the only state they could practice law would have been Louisiana I don't know what that says about the Louisiana bar but go ahead I think, remember, wasn't a Louisiana bar was, or catch me if he can, I think that's where he passed the bar.

[468] But nevertheless, my father becomes a factory worker, my mother becomes a factory worker, eventually she goes back to college, and she becomes a social worker, and my father starts a business.

[469] But the bar was set very low, and Monica and I were talking about it being childs of immigrants that it was about security.

[470] You have to get a good education.

[471] In my case, I had to have something in my head that could travel, because in case there was another Holocaust.

[472] You know, I was going to say, this is the explanation my mother gave me as a child, and I always wondered if it was broiled in any kind of anti -Semitism or anything.

[473] But I don't think it was, which was because of the Holocaust, you needed a trade that had capital everywhere or that had value everywhere.

[474] It's not an accident that so many Jewish people are doctors and lawyers and professionals.

[475] Also, don't forget, in Europe, they weren't allowed to own land.

[476] Right.

[477] And they were the only ones allowed to lend money to.

[478] Right.

[479] So that's why you didn't have a lot of Jewish farmers.

[480] But I think that this attitude was just get security, just be safe.

[481] And when they became grandparents and they had money and I was a doctor and my sister was said as a salesperson and successful, then all of a sudden the kids should be happy.

[482] All of a sudden, all of that happiness was right.

[483] Happiness was never part of the deal.

[484] And that, by the way, is a big change in America because if you look at your grandparents or your great grandparents' parenting style, it was dress your kid, feed your kid, how's your kid?

[485] Happiness was not part of it.

[486] Then Benjamin Spock comes along and he wants to talk about the fact that if your child bites someone, you shouldn't bite them back, you should talk to them, are they hungry?

[487] The inner life of a child and then T. Barry Brasleton.

[488] And today parents tend to be very concerned about how our kids are feeling and about their happiness.

[489] And the shift has made us in very many ways like helicopter parents or I think concierge parents It's like, how can it get you a better table?

[490] Can I get you a better teacher?

[491] Yeah, yeah.

[492] And I wrote a book in February called The Scaffled Effect.

[493] The idea that as parents were scaffolds, we do structure, support, encouragement, but the house is going to be the house.

[494] If your kid decides to have a mid -century or a skyscraper, they live in it, not you.

[495] Well, the cynical part of my brain when talking about this topic, did you read a coddling of the American mind?

[496] Jonathan Haidt.

[497] My most cynical voice says, okay, well, this explosion of anxiety is very very.

[498] likely a result of the helicopter parenting, the managing everything, the kid doesn't acquire any tools of overcoming adversity throughout childhood.

[499] And now here they are.

[500] They're 15.

[501] They're coming into your office.

[502] And so a little bit of me, the cynic, the old fashion person is like, and now we're going to treat it by doing everything.

[503] Because I come from the AA background where it's all behavioral.

[504] There's no pill.

[505] You got to make a fucking fearless moral inventory.

[506] You got to make amends.

[507] You got to live without, you know.

[508] And so they didn't ever deal with any of it then.

[509] And now we're going to kind of try to prevent them from dealing with it.

[510] Now, I know.

[511] I'm telling you this isn't the cynical side of my mind.

[512] So help you out just a little bit.

[513] If you look at cognitive behavioral therapy, which is the most effective evidence -based treatment.

[514] I'm a huge proponent.

[515] It is exposure response prevention.

[516] So you're afraid of germs.

[517] We're going to slowly but surely get you to touch the floor of the subway and then eat some candy without washing your hands because you won't die.

[518] They used to call that immersion therapy?

[519] Yeah, but we do it.

[520] It's much more gradual.

[521] And by the end, the kid is laughing at the fact that these symptoms aren't him.

[522] The symptoms are part of this disorder that's sitting on his shoulder and we're going to get rid of that monster.

[523] But every time we feed the monster, every time we give in, the monster keeps getting bigger and bigger.

[524] And little kids can get or I'm afraid to talk in public.

[525] Well, we're going to slowly but surely get you to answer yes or no. But we do it intensively.

[526] So we have this program called Brave Buddies at the Child Mind Institute where you come for five days, simulated classroom with 10 other kids from around the country and they are being exposed to a clown, to a dentist, to a policeman, to raising their hand, and by the end of the week, they're ordering ice cream from a stranger.

[527] Without a pill.

[528] Okay, great, great.

[529] So I think I said specifically that to you being a psychiatrist, the cynical part of me has no problem with in -person talking therapy whatsoever.

[530] It's the medication that I fear.

[531] And if I could just say really quick, it worked.

[532] It saved my wife's life.

[533] It makes my life much easier to navigate.

[534] I believe chemotherapy works.

[535] That doesn't mean I think a lot of people should be on chemotherapy.

[536] So I guess my fear or my cynicism is a little bit.

[537] I'm worried it's the easiest answer is medication.

[538] I'm worried that there's maybe too many kids on medication that maybe shouldn't be.

[539] That's my fear.

[540] So I think it's a fear that isn't found it in fact.

[541] So the overwhelming majority of kids don't get medicine even when they need it, particularly kids of color.

[542] Yeah, right.

[543] We don't believe there are symptoms at all.

[544] Or people who are of color have a bad history with anything that seems experimental.

[545] Sure.

[546] And psychopharmacology might be experimental.

[547] So they get undertreated.

[548] How about the fact that everyone thinks Beverly Hills in New York City is where you get more riddalin than anywhere else?

[549] Because everyone wants them to get good grades.

[550] It turns out not to be the case.

[551] The case of which states uses more riddle in.

[552] It turns out to be the states where it was Leave No Child Behind, the George Bush thing.

[553] So you got paid less money if more kids dropped out of school.

[554] Right.

[555] Well, you're incentivized.

[556] Nebraska, Arkansas, I figured that out.

[557] And they found pediatricians who would medicate kids to keep them in their seats at school.

[558] That's not the reason why we should be giving medicine.

[559] So the school budget should get better.

[560] So first and foremost, a diagnosis.

[561] And secondly, try some psychosocial intervention.

[562] A psychosocial intervention that even helps a kid get organized.

[563] And maybe their inattention isn't that great, or they get put into a smaller classroom, or they get a shadow, or there's ways that we're waiting this out, or sometimes you can't wait it out.

[564] Sometimes you think to yourself, this is just going to put a kid on a track of thinking they're stupid.

[565] Or thinking that they're dumb or they're inadequate.

[566] And the other thing you said, which is really important, is the trouble with helicopter parenting is that failure isn't an option.

[567] And if you're a scaffold parent, there's nothing wrong with failure.

[568] Failure is an option.

[569] The only way we build resilience, the only way we become self -reliant or secure is we work through bad events, right?

[570] So you brainstorm with your kid and say, you studied really hard.

[571] Is there something we could do together to help you do better on the next test?

[572] Again, not fixing it, not saying, I'm getting your tutor, or I'm taking away television or your screens, you really work with them.

[573] And I think it's a matter of encouragement and being supportive and giving structure.

[574] I think you have to be flexible enough, too, to get off the well -worn pass.

[575] So your kid might not be interested slash excel at any of the things you would prefer them to.

[576] Because one of my other concerns when we talk about all this is like, it's not best that every kid function in an elementary school.

[577] It's not best that every kid thrives in junior, higher high school.

[578] These aren't necessarily, these are places that cater to the average.

[579] So it is tricky navigating when is it outside of something natural variety that we, we would want to encourage, and when is it pathological and destructive to their happiness and well -being?

[580] I love the fact that you said it caters to the average, because I think of lower school, middle school, upper school, in many ways like water going through a hose.

[581] And the water that's in the middle of the hose, that water never touches the sides of the hose.

[582] So it's the kids who are either misbehaving that are touching the sides of the hose that are causing a little disturbance, or it's the kids who are excelling, they're hitting the top of the hose, they get gifted programs or the kids at the very bottom who get special ed but the majority of us including it sounds like you, Dax but certainly me I didn't shine in lower school, middle school or upper school they left me alone you know I got some Bs I got some A's I got some Cs it was all okay my parents were frustrated kept saying you're so bright while you're doing better but my brain didn't connect until I was in medical school or near the end of medical school same college I was like oh I want to do this I think you're absolutely right we definitely catered to the average.

[583] And whether that's good or bad, I'm not sure.

[584] I think when you have a great teacher who all of a sudden picks out the fact that you're really good at poetry or that you're great at math and lets you really get passionate about something, I think that makes a world of difference.

[585] That changed in my life.

[586] Yeah, I'm dyslexic.

[587] I didn't learn to read till fifth grade.

[588] I had a teacher, Mr. Wood, who discovered I was really good at math, which I didn't even know I was.

[589] And he asked me to start teaching the other kids' fractions with these blocks.

[590] And that was the first time I was like, wait, I can do this better than these kids who can all read and write and blah, blah, blah.

[591] Yeah, and everything got built off of that little sliver of confidence.

[592] But you're really lucky that it was in fifth grade because every year for, I think, the past 20 years, I've interviewed someone who had dyslexia or ADHD.

[593] And so Barbara Corcoran, who's now on Shark Tank, but she started Corcoran real estate, Orlando Bloom, who basically said he didn't feel as adequate because he didn't read the classics.

[594] The guy is a talented actor.

[595] Ari Emanuel.

[596] Oh, sure, sure.

[597] He's dyslexic.

[598] And there's no doubt that if you want to go to school every day and it's an unpleasant experience where they're beating you down, it's not good for your self -esteem.

[599] You need to have a mother or a teacher or someone saying, don't listen to the nuns, like Barbara Corkan's mother.

[600] The nuns are stupid, you're not stupid.

[601] Or Trudy Styler's mother, Sting's wife.

[602] They took her to some small little village in England to a doctor, and the mother said, Trudy's mother said, she has a lazy eye.

[603] And the doctor said, she doesn't have a lazy eye.

[604] She's just backward.

[605] Right, right, right, right.

[606] And when she was telling me the story in front of a thousand people at Hunter College, you could see she was going to start to cry, this magnificent, successful producer, mother of several kids, all of a sudden the pain just came right back.

[607] So I think that identifying those kinds of things early really are important because I think it just eats it way at who you are and then it changes the trajectory of your life.

[608] Well, the famous, statistic in a Gladwell book is, yeah, that you are twice as likely to go to prison if you were dyslexic, but then it was later revealed you're twice as likely to be a CEO if you're dyslexic.

[609] So it is one of these things that kind of either makes sure it breaks you.

[610] And obviously, I'm on the side of it that it kind of, I think, made me. So I have a certain position on letting kids work through things that probably isn't broadly advisable.

[611] Is there a fear of self -fulfilling prophecy in all of this?

[612] Like when you label a kid at a young age, dyslexic, okay, you're dyslexic, so you're probably going to have a really, really hard time in school.

[613] And like, look, the truth is, that's right.

[614] He probably is going to have a hard time in school, but what if then, like, does he even have the chance?

[615] Does he have a chance to overcome it if you've labeled it like that?

[616] So I would tell you, first of all, I hate the word label.

[617] I think it's a diagnosis, and I think the most important part is what's the intervention.

[618] Right.

[619] So the fact that today we have these interventions, there's one called Linda Mood Bell, which does in, intensive work.

[620] You go for three weeks in a row, four hours a day.

[621] So 50 minutes, 10 minute break.

[622] And they teach you a multi -sensory approach learning how to read.

[623] So there are brother sounds, you know, P and B. And so, because the rest of us just learn phonetically.

[624] You know, if you don't have dyslexia, your mother and father keep reading to you.

[625] And all of a sudden you say red balloon, rabbit, bunny, you get good night moon.

[626] You just do it.

[627] And if you don't have phonemic awareness, if you don't hear the sounds of the language, your brain is different.

[628] And so if you scan, if you do a functional MRI on the brains of kids with dyslexia, they're underactivating their brain.

[629] And once they learn how to read, they use both sides of the brain.

[630] They read English, the way I read French or Spanish.

[631] They read English as a foreign language.

[632] But isn't it wonderful if we could figure out that by third grade, if you're having trouble with the alphabet, if you're having trouble with the sounds of the language, if there's word retrieval problems, if I say to you, I'm thinking of a little animal that is whiskers and little ears and a long tail and it says, and you say puppy.

[633] Blue whale.

[634] Right.

[635] And you...

[636] I got scared during that.

[637] I was like, oh my God, what is it?

[638] What is it?

[639] If you retrieve the wrong word, so word retrieval, alphabet problems, why do you have to go to Lindenwood Bell?

[640] Why couldn't the school system say, okay, it's worth money because to put him in jail later on or to give him special ed later on is just, it's a waste of money.

[641] Let's just in third grade or second grade, give him what he needs, you know?

[642] Yeah, that's true.

[643] So it's interesting.

[644] My middle son has dyslexia.

[645] Oh, okay.

[646] And Orlando Bloom actually said during the interview, it's a gift.

[647] It's really a gift.

[648] And so by chance, Orlando was in Romeo and Julia in Manhattan on Broadway.

[649] And so I took that son and his then -girlfriend in backstage.

[650] And my son says to him, so Orlando, is it really true?

[651] You told my father dyslexia is a gift?

[652] And he said, yes.

[653] He said, well, if it's a gift, I'd love you to tell me where I could return it.

[654] Because he said, I'm so tired of it taking so long to read a book.

[655] And writing is challenging.

[656] I mean, I could do it, but I really would like to do it faster and easier.

[657] But what you get with it being slow is, I bet your middle son's retention between all your sons is probably the highest.

[658] Yes, yeah.

[659] I can remember virtually everything I read verbatim, only because it takes a while.

[660] Yeah, I'm imprinting it differently.

[661] So let's talk about the scope of the problem, which is 17 million kids have a mental health disorder.

[662] Right.

[663] And so what keeps those kids from getting help?

[664] and I would tell you we don't have enough mental health professionals who understand diagnosis and know how to do evidence -based treatments.

[665] We have this whole thing at the Child Minds where we say every session counts and then parents say well you say he doesn't have to come back next week he should come back in a month.

[666] Don't you like my kid?

[667] I said, I love your kid.

[668] It says I'd rather he'd play baseball or go to the rehearsal for school or go to ballet or whatever you want and we're not going out of business.

[669] So in case the symptoms come back, you can come back more frequently.

[670] We were seeing him three times.

[671] a week for a while, but now once every three months is fine.

[672] So I think the rent -a -friend thing, meaning that you see someone every week and somehow miraculously, June 30th, when school's over, you get two months off, that doesn't logically make sense to me. Right.

[673] I think that's one, but I think also stigma is really a big deal.

[674] And the fact that we have Simone Piles and Kevin Love, I'm in love with Kevin Love, that, you know, he said, I have panic attacks.

[675] And if I don't exercise a lot, I don't take meds, I think, or whatever it is, I can't play basketball.

[676] And this new movie coming out, dear Evan Hansen, which is different, by the way, than the Broadway show.

[677] I've seen it a few times now.

[678] And what I love about it is it makes you feel like every teenager going back to school after the summer, has that icky feeling when the doors are opening and you see some other guys and girls who's physically so much more mature than you and they're cajoling and having...

[679] Cooler clothes.

[680] Right, and just feeling cool and you feel not cool.

[681] Or you go into the lunchroom, you know, the cafeteria, like, oh, who's going to sit with me?

[682] And I think that's great.

[683] because that gives you a baseline of what adolescence is like.

[684] But then there's a whole bunch of other kids who are struggling, whether it's with social anxiety or generalized anxiety or depression, and those kids really need help.

[685] And it's brave to say, I've got a problem here.

[686] Can someone please help me?

[687] I love the idea you're not alone.

[688] And the other part I like about it is what parents go through.

[689] The idea that parents don't have a book on this one.

[690] Like, how do I navigate the fact that my kid's not thriving?

[691] Can we also talk about, this will be a very unpopular thing to bring up, but I think it would be honest to do so.

[692] Kids are also self -indulgent, and so your kid might hurt their foot.

[693] There's no objective evaluation of how your kid has hurt themselves.

[694] Everything is an 11.

[695] Some of them really are, and some of them aren't.

[696] So, for a second, that is true.

[697] So adolescents, when they tell you, tax, you're so lucky, wait until the moodiness happens with two teenage girls at home.

[698] I think they'll be in Germany watching a motorcycle race on this.

[699] And they say, I hate him.

[700] I hate him or I hate you.

[701] You do not say, no, you don't hate them.

[702] They do hate them at the moment.

[703] Sure, sure.

[704] I'm so upset.

[705] I'm so sad.

[706] I'm miserable.

[707] Yes, I understand.

[708] Is there something I can do to make you feel less miserable?

[709] But you don't say, it's not that bad because teenagers feel things more intensely.

[710] Their brains feel things more intensely.

[711] I remember, it was life or death.

[712] My crushes were fucking life or death.

[713] I would have jumped the Grand Canyon to win.

[714] someone's hard.

[715] Well, how about when your mother would say just because everyone else is doing it, you're going to do it?

[716] Yes.

[717] I'm a social primate.

[718] And if they're going to jump off the George Washington Bridge, would you?

[719] Most probably.

[720] I'm not going to tell you, Mom, but I want to be part of the group.

[721] So clearly, a sprained foot could be, oh my God, I need surgery.

[722] Yeah.

[723] So I think that's the really hard judgment call as a parent.

[724] It's like, yeah, my kid's sad.

[725] She's saying she's sad.

[726] She's saying this.

[727] is this the foot that's in 11, or is, when is it time?

[728] Or are they being victimy?

[729] That's the other thing.

[730] It's like, are you raising victims?

[731] That's my huge, huge fear.

[732] Because I wrote the sentence down, I'm just going to read it to you.

[733] I was going to do it later.

[734] I'm going to do it now.

[735] We are both big believers through confirmation bias that you confirm the story you're telling yourself.

[736] Like, I do believe in the magic of that through very worn social science rules that we've kind of stumbled across.

[737] So the story we tell ourselves could be one, we are.

[738] country with epidemic level mental illness and many people were required treatment to function.

[739] That's one story.

[740] Another story might be life is challenging.

[741] Teens are hormonal, angsty, and scared of the future, but these are always temporary and should be expected.

[742] The story is somewhere in between, like most narratives, because the suicide rate is dangerous.

[743] Yeah, so a 1 .2 million kids end up in the emergency room, which is terrifying, and that could include ideations or attempts or any other things.

[744] And then the number of kids who succeed who die of suicide is 5 ,000.

[745] So it just jumped to 6 ,120.

[746] It did.

[747] It's a 20 % increase in the past four years.

[748] Now, no other disease that had an outcome that went up, got worse by 20 % would be ignored the way we ignored this.

[749] I mean, if COVID goes up by 20%, every CNN, MSNBC, even Fox is talking about it.

[750] And here it's kind of a big yawn.

[751] So I would tell you that again, 6 ,120 is serious because you're not supposed to die during adolescence.

[752] So the leading cause of death for girls worldwide between 15 and 19 is suicide.

[753] And the second thing that kills teenagers is either accidents or accidents are number one.

[754] So remember the prefrontal cortex, you're not putting the safety belt on.

[755] And the third thing is usually gunshots, that someone kills them.

[756] So you're either killing yourself, an accident, or someone's killing you.

[757] So adolescence is a dangerous time of life.

[758] But that doesn't mean that the psychiatric disorders, like for instance, ADHD is really a bad disorder.

[759] If it's not treated, there is a higher risk of dropping out of school.

[760] And for good reason, it's not a rewarding place.

[761] And once you drop out of school, a lot of bad things happen to you because who else has dropped out of school?

[762] Well, also, you've got to make a living now and you don't have a...

[763] Yeah, right.

[764] So if you're anxious, for instance, we just got a grant from the state of California for $25 million for us to produce educational materials and film for every student, parent, and teacher in Spanish and English to help them reenter school, but more importantly, stay in school.

[765] Because we are convinced that a high percentage of kids are going to struggle this year because everyone got a learning loss.

[766] I don't care whether you went to Harvard, Westlake, or Dalton, or some poor school in central L .A., you just didn't get as much education and academic growth as you would have in a typical year.

[767] Of course, we're going to be able to start off light with a website, but by January we'll have film and we'll have real techniques to teach social emotional skills.

[768] But the fact that California, by the way, is amazing because the other thing in your budget is $4 billion for children's mental health to build more psychiatric beds.

[769] You have the least amount of beds per population, to do a portal, to educate parents better, to help more clinicians understand, kids, not produce more child psychiatrists, but to get social workers and psychologists about evidence -based treatments.

[770] I mean, you have a secretary of health and human services here, Mark Galley, who's a pediatrician.

[771] This is truly a public servant.

[772] I mean, he recognizes that the one thing we don't teach pediatricians is about mental health.

[773] And think about it.

[774] They know about diabetes.

[775] They know about seizures.

[776] But what's the most likely thing you're going to talk to your pediatrician about?

[777] It's going to be behavior, emotion, or thinking.

[778] Yeah, asthma, diabetes, cancer, and Penant Allergy combined don't equal 17 million kids who have a mental health disorder.

[779] Stay tuned for more armchair expert if you dare.

[780] Okay, so great.

[781] This is a great opportunity to kind of ask this kind of global question because I consider myself one of the spokespeople for mental health.

[782] I talk about being alcoholic.

[783] I talk about being molester.

[784] I talk about dyslexia.

[785] I'm very pro mental health.

[786] But I have these vestigial concerns that Monica just raised, which is like victim.

[787] hood.

[788] Now, I don't have any issue with SSRI inhibitors.

[789] Ritalin and Adderall, those are dicier for me, just as an addict.

[790] Like, those are street drugs.

[791] They're methamphetamine.

[792] And they work in 20 minutes.

[793] They have street value.

[794] Yeah, that one's a little trickier putting a kid on that trajectory.

[795] Now, I remember reading a great article by a psychiatrist who wrote a New York Times thing.

[796] I reference it all the time.

[797] But this psychiatrist was saying that he or she learned to diagnose people by learning what recreational drugs they use and what the outcome of the recreational drugs are.

[798] So they said, if I have a patient who can do cocaine and go to sleep, I know assuredly they have ADHD.

[799] And to me, that makes a ton of sense because I was a cocaine addict, and I did not go to sleep.

[800] Like, I can't imagine that drug having the effect on you that you could go to sleep.

[801] So right there, I can acknowledge, well, that's a lot of brain chemistry that differs between me and an ADHD person.

[802] Likewise, someone who uses marijuana frequently that does not become tired by it or bored.

[803] In fact, it's energetic and blah, blah, blah.

[804] They know they're dealing with depression.

[805] And she just goes through that people find the drugs they need in a weird way.

[806] And so hearing it broken down that way, I really did recognize these drugs have humongous value to the people that have them.

[807] But my bigger question is, is it that historically for the last 60 years when we didn't identify people as ADHD, did they just find their way?

[808] Or is there a huge chunk of the problem?

[809] population that just never thrive because it was undiagnosed.

[810] And this diagnosis and this treatment is the outcome so much superior, but we just don't know what we're talking about.

[811] We don't know how many people fell through the cracks.

[812] We don't know how many dyslexics didn't find careers.

[813] So we don't know what we're comparing what to.

[814] So there's an interesting study that was done in 1970 when Ritalin actually was placed in the general market.

[815] You know, it came out in around 1955, but it's a drug that pediatricians and psychiatrists could prescribe 1970.

[816] And so a a psychologist by the name of Dr. Rachel Giddleman -Kline went to Queens General Hospital, a city hospital that had basically a working -class population, almost exclusively white, in Queens, and she found 100 kids who were around 6 years old who met criteria for ADHD, 100 kids who were 12 years old who met criteria, and she found 100 controls, who were just going to the general clinic.

[817] So 50, 6 -year -olds and 50, 12 -year -olds.

[818] And she gave everyone, except the control group, three months of riddle.

[819] And that was it.

[820] No counseling, checking on side effects.

[821] And after three months, they were free to go, right?

[822] The study was over.

[823] However, she was determined to see what ADHD kids were like grown up.

[824] And she found out that basically the six -year -olds did significantly better than the 12 -year -olds.

[825] And she was baffled by that because she said the six -year -olds who came in were jumping all over the place.

[826] Your grandmother would be able to make the diagnosis, jumping on the desk, bouncing.

[827] And the 12 -year -olds who were back then in junior high school, there was no middle school, seemed very inattentive, but didn't seem to be particularly hyper.

[828] Well, they have probably acquired some tools.

[829] Correct.

[830] Or shame.

[831] Right.

[832] So she does five -year follow -ups, 10 -year follow -ups, and what she's struck by is that when she gets the group, they're all 40 years old, some are 34, 40, she finds out that, first of all, everyone's using marijuana.

[833] So think of it, it's 1970.

[834] but she finds that the 12 -year -olds are using marijuana six -fold more than the six -year -olds or the control group.

[835] By this time, I've hired her at NYU and I've hired a neuroimager from the NIMH and the two of them start to talk and they get a grant from the National Institute on Drug Abuse to scan every brain they can get a hold of of this population.

[836] And it turns out that the six -year -olds, who all she knows is they took at least three months of Ritalin, they might have taken more, they might have maybe never taken any more.

[837] But the six -year -olds, as adults, their brains looked more like the control group's brains than the 12 -year -olds.

[838] So if anything, the answer that they came up is that most probably Ritalin, given at the right time for a pre -teen, six -year -old, was actually possibly a way to prevent substance abuse because kids with ADHD are more at risk for substance abuse.

[839] Now, when I was in training, they told you, wait.

[840] A six -year -old came in, They said, why don't we wait?

[841] Maybe he'll out grow it.

[842] And it turns out that was wrong.

[843] So the fact is that when you get data like this, it's really important.

[844] Now, it's also important to find that something else.

[845] The kids who also had co -occurring anxiety did better than kids who just had ADHD.

[846] So why is that?

[847] Remember, I told you, when you have ADHD, you're very impulsive.

[848] Let's have sex.

[849] Not thinking about sexually transmitted diseases, pregnancy.

[850] Maybe we should wear a condom.

[851] Let's get on that motorcycle.

[852] Well, if you're anxious, the anxiety almost counteracts.

[853] So it turns out that having a second diagnosis, in this case, it was a preventive second diagnosis.

[854] So I think the more we learn about this, the more we're careful about follow -up, the better it is.

[855] So I would say Ritalin's a great example of a medicine that most kids do not want to take because they lose their appetite.

[856] Some of them say they lose their zing.

[857] They'll even tell you, I can't talk.

[858] You mean, I feel like I'm a robot.

[859] And their parents say when they come home at three, they're ravenously hungry.

[860] And so this is something you have to usually say, well, let's lower the dose.

[861] Let's switch to another drug, maybe adderol, metadata.

[862] You find something that might work, but they're not hungry for the medicine.

[863] You can see they're not craving it.

[864] When you see college students who are trading Adderall to stay up all night.

[865] Companion piece for a beer, too.

[866] Right?

[867] Then you think that's abuse.

[868] That's not use.

[869] I've had kids coming to my office and say, Dr. Kofflos, I found a great way for you to make money.

[870] Don't you have three kids?

[871] You should send them out with a whole bunch of Adderall.

[872] I said, what a great piece of career advice.

[873] I can't believe.

[874] So that's abuse.

[875] But I've never had a kid six, seven, eight, ten, eleven.

[876] They don't want it.

[877] The unfortunate recent history, though, these setbacks are so huge and unfortunate that you had for the last 20 years the medical community mobilized to prescribe opiates.

[878] So like the level of of distrust that planet.

[879] And you can understand that.

[880] Yes.

[881] And then you talk about your child and you're like, well, yeah, want to believe doctors, but I also have to acknowledge the power of this lobby, the Purdue lobby, and funding bad science.

[882] But did you actually dig deep?

[883] Oh, I got so into it.

[884] This is criminal.

[885] Oh, yeah.

[886] And the FDA, it's criminal.

[887] They were paid off.

[888] The idea that a letter written to a journal, which suggested that patients in the hospital didn't ask for more pay.

[889] pain medicine, some crazy, tiny little letter was then put into a textbook and appeared like it was a controlled study in the references.

[890] So you taught young medical students in their textbook.

[891] That there's a pandemic of under managing pain.

[892] Right.

[893] And let's be very honest, I just pulled someone's teeth.

[894] And the last thing I want them to do is to call me over the weekend.

[895] Why did you just take this stuff?

[896] And I have no addictions.

[897] But the fact is, for a while, we had so much of the stuff in our medicine chest because every time you went to the doctor, if you hurt yourself or you had a tooth pulled or you had a cavity, they gave it to you.

[898] And then once someone pointed it out to us, we thought we have teenagers in the house.

[899] I think they're pretty good teenagers, but inevitably something could happen.

[900] A lot of addicts are good teenagers.

[901] Right, we started throwing it into the toilet.

[902] And also studies that showed that Tylenol, extraceanth Tylenol, so not codeine, Tylenol can manage pain as well as an opiate.

[903] And I don't blame people for being nervous.

[904] And I think an informed consumer is our best parent.

[905] So they should ask questions.

[906] We want our kids to be symptom -free.

[907] We don't want them to be afraid to leave the house.

[908] We don't want them to feel so tired in the morning that they can't get out of bed.

[909] This isn't the failure that you want to cultivate for them.

[910] The hurdle.

[911] Yeah.

[912] Can I have you speak really quick because I found this to be a really helpful aspect to look at, which is, could you talk about how we've addressed previous?

[913] childhood health threats and our kind of willingness to do so and our success of those.

[914] Yeah, so let's just think right now of the fact that I am a little too young to remember polio.

[915] Mm -hmm.

[916] But polio was around, around five years or six years before I was born, where there were people in iron lungs and people who have braces.

[917] You look at, it's Huck Perlman, the famous musician, he's in a wheelchair.

[918] My grandfather's neck had been permanently paralyzed by polio as a kid, and he ate super slow for the rest of his life, yeah.

[919] Right.

[920] And the fact that America thought that Sock and Sabin, the people who came up with the vaccine, were heroes.

[921] Do you mean?

[922] One of them landed up, I think, marrying Picasso's girlfriend, and deservedly so.

[923] I heard Picasso set the bar low, though.

[924] It probably wasn't hard to be a good boyfriend after him.

[925] So, but the point is we embrace that.

[926] We didn't want our kids to die.

[927] We didn't want our kids to be paralyzed.

[928] And the other thing that we've taken on is something as seatbelts.

[929] So I am old enough to remember that when I was stay in the Sunday school.

[930] As a kid, one of the parents would have a station wagon, and they put six or seven of us in the back of the station wagon.

[931] And they weren't seats.

[932] They were just running around, bouncing next to each other.

[933] And that was okay.

[934] Today, none of my kids would go into a taxi without putting on a seatbelt.

[935] They were like, it's indoctrinated.

[936] So America has been really good, in my opinion, when we get focused and we handle health problems.

[937] I think the amazing part is how we took care of AIDS.

[938] I mean, I was around for that where, as a young doctor, I mean, you, you were petrified of getting stuck.

[939] You were double -gloving and people were afraid that if they sneezed on you and then you realized it was a virus and what that meant.

[940] But people with AIDS, I mean, you see these commercials on television.

[941] They're living full lives, full sexual lives, you know?

[942] So science really is important.

[943] What spooks me about mental health disorders and also now COVID is the fact that science has somehow left the room.

[944] I know.

[945] That it bothers me so much that why would anyone take an answer?

[946] anti -worm medicine for animals when you have a vaccine.

[947] Well, sadly, we just talked about one of the reasons.

[948] I mean, one of the reasons is the opioid epidemic.

[949] These little losses in confidence have such huge outcomes.

[950] Right.

[951] And it's so tragic.

[952] It's not just as tragic as the 400 ,000 people that have OD'd in the last decade.

[953] It's how it erodes the confidence in the whole system.

[954] Well, it's really interesting when you think, remember I was saying, Kevin Love and Simone Biles, and you're, wife and people who say, oh, I had a mental health disorder.

[955] I have symptoms and I got treated and I'm fine.

[956] I'm a famous movie star.

[957] I'm the best athlete in the world.

[958] Somehow, we haven't found a group of people to convince a big chunk of America that COVID is real and that we have kids now in the hospital.

[959] And by the way, it's fascinating.

[960] It's not just Republicans versus Democrats.

[961] It's not the uneducated versus the educated.

[962] I will have discussions with people where, shockingly, a 62 -year old psychologist.

[963] I say, would you like to come and visit us at the trauma and institute?

[964] She says, yes.

[965] And I said, you have been vaccinated.

[966] And she says, oh, no, my husband and I have very strong immune systems.

[967] And I'm thinking, how do you know that?

[968] How do you need the strong immune system?

[969] And how do you know that you won't give one of my eight -year -olds or 10 -year -olds who are not vaccinated here?

[970] COVID.

[971] So somehow something has really made people so anxious.

[972] And I think it's the uncertainty.

[973] This wave of COVID -back, COVID -gone, just unnerves people.

[974] And so logic leaves the room.

[975] I'm sympathetic to those people because I find my natural predisposition is to be like them more than I have acted.

[976] And my explanation is if you grew up in a household with a lot of adults that had ulterior motives and told you truths that were not true, the promise you make to yourself is I will never, ever listen to somebody against my gut as a survival mechanism.

[977] Yes.

[978] And you've got one in four kids have been physically abused.

[979] one in, I don't know what it is, one in four and a half have been sexually abused.

[980] Like, you're talking about a very significant part of our population that have good reason to never listen to anything but their gut again.

[981] And I'm sympathetic to that.

[982] Right.

[983] It's not the right call, but it does well to recognize why people are so apprehensive about, quote, the truth.

[984] So it seems that we have to do more work.

[985] Yeah.

[986] My own personal soapbox is we're not addressing the issue.

[987] We're trying to explain to them through facts, why.

[988] this is the real thing and why this has been vetted and why it's safe.

[989] That's not how one treats a fear.

[990] When my wife says, I'm afraid you're going to do blank, I don't point to the statistics that I've never done that.

[991] I try to figure out what's scaring her and they treat that fear as any relationship requires one to do.

[992] It's not necessarily about the facts.

[993] It's about what are you afraid of and how can I make you feel less scared.

[994] So I think the method we're using to bring these other people into the fold has to be a little more well thought out than just you're wrong.

[995] And I think the problem is that there's an epidemic going on.

[996] People are dying.

[997] There's panic.

[998] I'm sure the White House, they can't believe that all of a sudden vaccination rates are not continuing.

[999] So they get really panicked.

[1000] And so what do you do?

[1001] Versus here in California, you just put $12 billion in your budget to address homelessness.

[1002] And the way they're going to do that is not by building more houses.

[1003] They get a group of people to sit down and contemplate and reflect.

[1004] and they get really smart geniuses in the room to say, wait, is it substances?

[1005] Is it depression?

[1006] Is there something historic in these families?

[1007] How do we do this?

[1008] We can't keep treating the symptom.

[1009] And I think we have to do that with COVID now.

[1010] Because otherwise, we're going to live with this.

[1011] It's possible it could be indefinite.

[1012] Right, but I told it before that I got a booster.

[1013] Well, does that mean every year I'm going to have to get a booster?

[1014] And maybe that's the case.

[1015] But it really would be wonderful if we could get hurt immunity.

[1016] Could we get 75 % of the population or 80 %?

[1017] And this is a wacky virus.

[1018] But we do know that viruses jump into unvaccinated bodies and look for a place to live.

[1019] Yeah, I just read in the L .A. Times, I want to say the number was like 94 % or something.

[1020] 94 % of the people that are dying of COVID are unvaccinated.

[1021] But what I'm concerned about as children, if I stay in my lane for a second, the fact that you have kids having trouble breathing in Louisiana and Arkansas that there's no hospital beds for them, this is chilling to me. It's unacceptable.

[1022] So how do we get to parents to say, you want to protect your?

[1023] kids because I honestly believe that in the same way that I think every kid really wants to please their parent and wants to be praised by the teacher.

[1024] We have this whole thing that we train teachers on called teacher child intervention training.

[1025] And so we tell a teacher, catch the child being good.

[1026] Right.

[1027] We tell parents that also.

[1028] So try it for two weeks.

[1029] Every time your kid does something good, Dax, thank you for being so attentive.

[1030] I really appreciate how well read you are and how interested you are in this topic.

[1031] People don't talk that way, but talk that way to your daughters.

[1032] And then actively ignore insignificant off -task behavior.

[1033] So they didn't put their napkin on their lap or they're chewing with their mouth open.

[1034] Do not say anything.

[1035] And when they do something egregious, intervene appropriately.

[1036] Okay?

[1037] So they can't smack their sister.

[1038] They can't curse you out.

[1039] Do that for two weeks.

[1040] Actively catch your kid being good.

[1041] First thing happens, the child will say, someone took my mother.

[1042] This is not my mother.

[1043] Body stature.

[1044] but number two, the kid will start giving you more and more good behavior because humans like to be praised and they love their parents to love them and they like their teachers to think that they're clever and smart and good.

[1045] But for teachers, sometimes it's very hard because they have confirmation bias.

[1046] And parents are too, this is my dumb kid.

[1047] This is my good kid.

[1048] And so they keep feeding it again again.

[1049] And if you say, wait, let's monitor all behavior.

[1050] Because if we monitor all behavior, we find out, guess what?

[1051] A lot of good behavior here.

[1052] let's focus on that and we'll be able to get more and more of that good behavior.

[1053] It's not that we ignore the egregious behavior, but the nonsense stuff.

[1054] Is it really important that you put the napkin on her lap?

[1055] I agree.

[1056] That is one of my goals with my kids.

[1057] And it weirdly works in a similar paradigm, which is partners and relationships have a story about their partner.

[1058] So my husband never does dishes.

[1059] You most certainly will see all the times he walked by a full sink of dishes.

[1060] but you actually will not see the time that he washed the dishes because that's not part of the story you have about him.

[1061] Right.

[1062] And likewise, your children are receiving virtually that outcome.

[1063] So they're feeling like all you see is them fuck up.

[1064] So they even can reverse engineer what they think your story about them is.

[1065] Correct.

[1066] So it's like you really got to monitor it.

[1067] So if the one thing any parent is listening to is catch your child being good.

[1068] That's such great advice.

[1069] And do it for just two weeks and just see what happens.

[1070] It's not easy.

[1071] It's like redrawing a blueprint, yes, but actively ignore the insignificant behavior.

[1072] I was just talking about it with my wife.

[1073] It's like your instinct is the second you watch them do something.

[1074] So I'm watching my kid use a push broom.

[1075] And all I'm thinking like fucking Terminator, she should pull.

[1076] She's pulling the dirt.

[1077] Like I want so bad to get in there and teach her how to use a fucking push broom.

[1078] And I just have to sit there.

[1079] Dax, I'm so proud of you.

[1080] That's really good parenting.

[1081] Just say that to yourself.

[1082] Well, and I say to my wife, like, I got to fight the urge.

[1083] to be involved in everything they do.

[1084] Okay, would it be bad if he was like, oh my God, buddy, thank you so much for doing that.

[1085] That's awesome.

[1086] You're helping us.

[1087] You're taking, whatever.

[1088] Can I help you make it easier for yourself?

[1089] Like, can you give a tip or no?

[1090] Don't link it.

[1091] Don't link it.

[1092] There's always a time where it's a neutral moment where you can say, by the way.

[1093] Wendy says that, no butts or aunts.

[1094] Oh, my friend Wendy.

[1095] Yeah, we love Wendy.

[1096] We have a show with Wendy on our platform called Nurture versus Nurture, and she does therapy with real parents of children.

[1097] It's the most, for me, fascinating thing you could possibly listen to.

[1098] She gave me a blurb from my newest book, and I have to tell you it means something.

[1099] If Wendy doesn't want to give you a blurb, she's nice enough to just ignore you.

[1100] She's ignoring insignificant who has behavior.

[1101] Well, your new book.

[1102] The Scaffled Effect, Raising Resilient, Self -Reliant, and Secure Kids in an Age of Anxiety.

[1103] And written before COVID.

[1104] So let me tell you.

[1105] you, COVID just made a catastrophe, so everyone needs to be more resilient, self -reliant.

[1106] And there's a message for parents to.

[1107] You have to be a scaffold yourself.

[1108] To be that scaffold, self -care is really childcare.

[1109] And it's so easy to forget about that, to sleep seven hours, to eat something green, to do some exercise, and to do something spiritual.

[1110] Because even during COVID, you could do all those things.

[1111] If you don't take care of yourself, the scaffold isn't strong, and you have to be have a catastrophe like COVID, the building falls down.

[1112] And parents, I think, in my opinion, are very easy to say, wait, wait, the metaphor, put the mask on yourself before you put it on your kid.

[1113] But I really do that?

[1114] We'll do that because if you have more than one kid and you're not breathing, you can't take care of your children.

[1115] I think it's twofold.

[1116] It's that.

[1117] And then it's also everyone underestimates their modeling versus what they're saying.

[1118] And it's just so much more powerful to model.

[1119] My kid wasn't sweeping because I asked her to.

[1120] She was sleeping because she saw me do it.

[1121] She wanted to do what I do.

[1122] So it's like, yeah, if you're not taking time to exercise, if you're eating like shit, if you're doing all these things and then telling them to do that, guess what?

[1123] They're smart.

[1124] They see right through that.

[1125] They're going to do at best what you're doing, which taking you 40 years of practice to get together.

[1126] Okay, so the scaffold effect.

[1127] Also, I want everyone to look into the Child Mind Institute because what incredible work you're doing.

[1128] And also, are you still the editor -in -chief of Journal of Child and Adolescent?

[1129] Psychopharmacology?

[1130] which doesn't take ads from pharma.

[1131] Oh, wow, that's good.

[1132] That seems like that's not a good idea, right?

[1133] It's just handguns and liquor.

[1134] The whole thing is supported by handguns and liquor.

[1135] So just as you know, just for full transparency, no money from pharma, liquor, guns, or tobacco.

[1136] Oh, my gosh.

[1137] So all the people who want to give me money?

[1138] No, I won't take it.

[1139] All the money I need to rate.

[1140] I mean, it's a not -for -profit.

[1141] It's like being a hamster on a little circle.

[1142] You're a politician.

[1143] You're always raising funds for an election, basically.

[1144] And the trouble is the need is great.

[1145] We gave away a million dollars in financial aid last year because you don't want to turn away someone because their parents don't have enough money.

[1146] You want them to pay you something.

[1147] You want everyone to have a little skin in the game.

[1148] But if it's $25 or $500, it really doesn't make a difference.

[1149] You want that kid there.

[1150] And the biggest growth area we've had now is in school and communities programs where you train now schools to have teachers to recognize what mental health 101 is.

[1151] When is that out of range and why are you letting that kid suffer?

[1152] what are some skills you could have as a teacher like catching a kid being good that could just make classroom management so much easier?

[1153] Yeah.

[1154] I mean, I really think the utopian future, I hope, includes within social studies and biology and everything else, like identifying feelings, recognizing feelings, expressing feelings, communicating.

[1155] You know, like, there's just no toolkit being given and there's so much we could that would, I think, have downriver effects on all the other stuff.

[1156] And also let's think about what parents have to do.

[1157] When you have two working parents, in most cases, it's because they have to do it.

[1158] Economically, they need that money.

[1159] And if grandma and grandpa are living somewhere else, who's helping raise the kids?

[1160] And so parents have more to do than ever before.

[1161] And during COVID, it was really, they became the tutor, they became the assistant teacher, they became the playmate.

[1162] I think that, again, self -care is so important.

[1163] 20 minutes, just 20 minutes, go for a walk.

[1164] Try to sweat a little bit.

[1165] You don't want to jog, just go for a walk.

[1166] And if you get into bed, even though you'd love to look at your screen, try to sleep seven hours.

[1167] And spirituality, mindfulness, by the way, which we didn't discuss, is really a great way to calm down your amygdala.

[1168] Do you mean, it's wonderful if you could start training yourself.

[1169] I love TM.

[1170] I'm a big fan.

[1171] Me too.

[1172] But you don't have to go the distance.

[1173] You can learn how to do something with an app like calm and do it for 10 minutes and then do it for 15 minutes.

[1174] And that's a great model again for your kids to recognize that there are times.

[1175] where we just sit with thoughts and we let them come in and we let them leave.

[1176] You both look very fit.

[1177] So I'm sure showing your kids how to exercise is part of your life.

[1178] But at the same time, being calm as part of your life also.

[1179] Yeah.

[1180] Yeah, yeah, yeah, yeah.

[1181] Oh, my gosh.

[1182] Well, what a pleasure to meet you.

[1183] And I'm so happy that you have the Child Mine Institute and I feel like you move my needle a little bit.

[1184] It's not even that you move my needle, but I think you did calm some of my fears.

[1185] Glad to hear that.

[1186] Yeah, yeah, yeah, yeah.

[1187] It is weird.

[1188] I'm trapped in two different generations as you're trapped in six different or whatever, however many generations, but I'm like, I don't know how to break the paradigm I was raised in.

[1189] So, oh, can I get you to give me free therapy for one second?

[1190] Sure, go for it.

[1191] Because I think I need to figure out where I stand on this.

[1192] So my wife has anxiety and we're both very open to our kids about what we have.

[1193] They know I'm an alcoholic and I go to AA and they know I relapse, the whole thing.

[1194] I think one of my daughters does have anxiety.

[1195] But I'm worried about mom has anxiety.

[1196] That's part of her identity.

[1197] I want to be like, mom.

[1198] I'm a little worried about her infusing.

[1199] I have anxiety and her identity at this age.

[1200] So I think it's a matter of symptoms, not the diagnosis.

[1201] Does she have trouble going over and sleeping over to Friends House?

[1202] Does she have trouble going to school on a regular basis?

[1203] Does she worry before the test, during the test after the test?

[1204] Is she petrified of dogs or spiders in an unrealistic way, you know, a simple phobia?

[1205] Does she wash her hands too many times, even though you say once is enough, twice is enough during COVID, but she can't help getting rid of silly thoughts out of her head.

[1206] If those are not the symptoms, and if she's just more of a worrier, that her personality style is more of a worrier, then I think she can live with that and she can work with that.

[1207] Get a job in HR worrying about all the things.

[1208] Or when she gets a boyfriend like her father and she says, wait.

[1209] We're not getting on that motorcycle.

[1210] She does risk reward all the time.

[1211] Can I tell you she rides a motorcycle.

[1212] That's her main hobby because I don't ever want her on the back.

[1213] of one.

[1214] If she's going to be on one, I want her driving it.

[1215] She obviously doesn't have it if she's riding around on a motorcycle at age eight.

[1216] I just want to tell you that I think I'm obligated by law to report this to the administration of children services.

[1217] You should know it's been going on for four years, so you're a little late.

[1218] And I'm actually a licensed physician in California as well as New York.

[1219] You've now put me in this terrible position and it's being recorded.

[1220] It's a tiny motorcycle, her size.

[1221] And by the way, that's the tip of the iceberg.

[1222] Just.

[1223] Yeah, don't look over here.

[1224] Anyway.

[1225] You cannot raise a Formula One champ by not throwing them in the pool at some point.

[1226] That's right.

[1227] The deep end in the pool, on that motorcycle at four.

[1228] That's right.

[1229] But that's really good to note the difference.

[1230] That was great.

[1231] Yeah, like, she doesn't have that.

[1232] She doesn't have any of the things he just said.

[1233] So I feel like that's where you separate the victimhood.

[1234] Or temperament versus pathology, right?

[1235] Yeah, and you can hear her say like, oh, I'm doing this.

[1236] and you can let that go, but no, oh, she's not symptomatic.

[1237] Like, putting it in symptom terms, I do think is great.

[1238] So how about the fact, who did you marry, right?

[1239] It's DNA roulette.

[1240] Every time you make a baby, all three of my sons actually look very much like my wife and my father -in -law.

[1241] It's really interesting.

[1242] Those genes are really strong.

[1243] And I love the fact that someone went over to my 38 -year -old son and said, you know, you look like your mother and not like your father.

[1244] And he said, well, thank God they don't look like Borat.

[1245] I mean, really lovely, nice child.

[1246] I paid for college But you also can see that one kid, my oldest son, was definitely a very socially reserved kid.

[1247] We used to practice, how do you shake hands?

[1248] It's like a puzzle and you should look someone in the eye long enough so you could be able to tell me what color their iris is and about you questions.

[1249] And my third son could run for mayor.

[1250] Right.

[1251] I mean, he just giggling all the way through.

[1252] And so disorganized, but giggling.

[1253] So you know that every time you made the baby, same set of genes, right?

[1254] My wife and I didn't make a lot more money in those five years.

[1255] We didn't move.

[1256] So how did this happen?

[1257] I think you have to recognize that nature has a lot to do.

[1258] Well, when I met my wife, I said, look, if you're in the market for a deaf, dyslexic, alcoholic, you've met the right dude.

[1259] My wife told me that her children, she loved Sleepboy Camp, and her kids were definitely going to sleepway camp.

[1260] And I said, well, I think my kids will go to sleeper camp, but they're going to mostly want to come home because they're going to be very homesick.

[1261] Well, such a pleasure, and I wish you look.

[1262] Everyone should check out the scaffold effect as well as the Childmind Institute.

[1263] It's childmine .org.

[1264] I'm going to give some money today to that.

[1265] I would like you as well.

[1266] Thank you.

[1267] Childmind .org.

[1268] I'm going to give some money and Monica's going to give more.

[1269] I'm going to see how much she gives.

[1270] Oh, you're going to give one.

[1271] I'm going to go after.

[1272] I'm going to divide it.

[1273] I'm going to times it by 0 .9.

[1274] I like it.

[1275] Well, thank you so much, Dr. Arnold.

[1276] I hope we get to talk to you again.

[1277] Yeah, thanks.

[1278] And now my favorite part of the show, the fact check with my soulmate Monica Badman.

[1279] Hello, from 30 ,000 feet.

[1280] Oh, okay, two updates.

[1281] One of our friends, our friend Erica, she texted us that she's listening to the episode and that she's a Capricorn.

[1282] Okay.

[1283] And also does not believe in signs.

[1284] So my theory is correct.

[1285] That Capricorn.

[1286] So Capricorn do not believe in astrology.

[1287] It's so Capricorn do not believe in Capricorn.

[1288] I like that theory.

[1289] Yeah.

[1290] That's a good one.

[1291] Oh my gosh.

[1292] We have to start with this.

[1293] This is the most important thing.

[1294] Okay.

[1295] Oh, Daniel Ricardo.

[1296] Oh, no. But yes.

[1297] We should start with that.

[1298] Daniel Ricardo, the Badger.

[1299] We love him.

[1300] We love him emotionally, spiritually, sexually.

[1301] We both love him sexually.

[1302] TBD.

[1303] Boy, did he?

[1304] He pull a fast one in Italy.

[1305] Oh, pun intended.

[1306] He led that damn race from fucking checker to checker, baby.

[1307] He really did.

[1308] Not checker, checker, green to checker.

[1309] He won.

[1310] He won in Italy, and we all watched and cheered him on.

[1311] McLaren had not had a first place, and I want to say 15 or more years, something crazy like that.

[1312] Daniel hadn't been in first since 2018.

[1313] Landon Norris, his teammate on McLaren, who we love Lando Norris.

[1314] He's one's years old.

[1315] He is.

[1316] He's just a baby.

[1317] I mean, he is, they're all youngest.

[1318] But he also looks really young for his age.

[1319] He's so cute.

[1320] You can't believe he can operate that car in that manner.

[1321] It's really true.

[1322] So, one, two, McLaren, finished.

[1323] Congratulations, guys.

[1324] That's just fantastic.

[1325] It was so fun to watch and so excited for Danny.

[1326] Me too.

[1327] And then my other guy, you know, when I can't root for Ricardo and I'm forced to as a backup, first to happen.

[1328] Yeah.

[1329] Boy, he drove his car right over Lewis Hamilton's.

[1330] Over his head.

[1331] Yep.

[1332] And then he said, that's what happens if you don't leave me space.

[1333] Yeah, I don't.

[1334] That's more reason for me to not be a fan of Verstappen.

[1335] I think if you drive over someone's head and then your response is that's what happens when you don't leave me space, you're not for me. Why isn't Hamilton who crowded him?

[1336] Nope.

[1337] No, you're not, that you didn't see it that way?

[1338] Even if you crowd someone, you don't drive over their head.

[1339] Well, I do think it went a little bigger than either person was expecting to be totally fair.

[1340] But as I believe the FIA rules are, if your front axle is in front of your competitor's rear axle, you have a right to the race line.

[1341] And Verstappen was on the raceline.

[1342] In fact, he was over the curb trying to get a little space.

[1343] Anyways, that's how we're here talking about.

[1344] Dan Ricardo.

[1345] Because we don't like Verstappen.

[1346] Well, hold on.

[1347] Listen, I'm going to just say that.

[1348] I don't like that.

[1349] I don't like that kind of sportsmanship.

[1350] I don't like it in F1.

[1351] I don't like it in spades.

[1352] I don't.

[1353] I don't.

[1354] I like a good sport.

[1355] Yeah.

[1356] You know what?

[1357] It don't make me a bad sport if I'm witnessing bad sportsmanship.

[1358] Sure, sure, sure, sure.

[1359] But you can't call for stopping a bad sport.

[1360] He's like a technician.

[1361] That's way too different of things.

[1362] Oh, probably.

[1363] Yeah.

[1364] Am I introducing a new topic?

[1365] Of course.

[1366] A bad sport is how you conduct yourself with other people.

[1367] In the face of loss?

[1368] Yeah, or winning, all of it.

[1369] Oh, okay.

[1370] How you are with competitors and teammates.

[1371] And he is not one, in my opinion, to be.

[1372] To model?

[1373] Exactly.

[1374] And I was glad because Lincoln was like, I bet he's embarrassed.

[1375] And I was glad that she said that.

[1376] I was like, yeah, you know what?

[1377] I think you're right.

[1378] Oh, he was most certain.

[1379] Comparison, man. Not only, you know, and then he had to walk what was, I don't know, four miles.

[1380] I've never seen a human on TV walk for this long.

[1381] It's got to be a world, it was a really momentous day in two ways.

[1382] Ricardo won, and then a world record was set for the longest walk on television ever aired.

[1383] He was walking for in excess of 28 minutes.

[1384] So, Danny's going to send me some shirts, okay?

[1385] Right.

[1386] Okay.

[1387] But they're never coming.

[1388] But where are?

[1389] But where are the shirts?

[1390] Hey, DR.

[1391] Yesterday would have been a great day for me to have worn the shirt.

[1392] The merch.

[1393] And taking a picture, the merch stand.

[1394] He's a bad businessman with nothing else.

[1395] That's what I'm saying.

[1396] He could be reaching the eyeballs of 400 ,000 adoring fans that will follow Monica Padman into the mouth of a fucking lion.

[1397] Me and you could have taken pictures in Ricardo gear.

[1398] To be fair, you already, you do have the sweatshirt.

[1399] And I'm just waiting on mine.

[1400] But you didn't think to have this idea with the picture.

[1401] I did, but I didn't tell you because I didn't have it.

[1402] You don't want me to steal it.

[1403] Well, no, I just wanted to be a part of it.

[1404] I couldn't because I don't have any merch.

[1405] So, Danny, all this to say, you screwed up on your big day.

[1406] Congrats and you fucked up royal, bud.

[1407] Mate, you really fucked up.

[1408] I was so, I was really smiling from ear to ear, and so were you.

[1409] Oh, we were screaming, we were clapping.

[1410] but then so i was screaming and clapping and getting emotionally aroused at the victory right and then he celebrates in his helmet and then you and i both got emotional yeah but then your emotions then even increased from there because he starts talking on uh in the interview yeah he's because he's overwhelmed mine plateaued at that point which is fine i'm a dude how long can i sustain um but you know what i'm saying it's so it's so special to see someone overwhelmed with happiness.

[1411] Yes.

[1412] It's really rare.

[1413] In gratitude.

[1414] And, you know, on one hand, I kept feeling bad for him that they had to keep bringing up that he was struggling this year.

[1415] Every time they wanted to, so it was starting to annoy me. Yeah.

[1416] And yet, however hard it is to win a Formula One race in that car, however hard that is, I don't know, you got to add in that mentally you've been getting your ass kicked.

[1417] You're at your least confident.

[1418] I know.

[1419] And that's why it's relevant.

[1420] People love a comeback and they love a underdog story, even though he's not an underdog.

[1421] So, yes, I feel that way too because I don't like that they were promoting it as an underdog story.

[1422] I know because he's our hero.

[1423] Yeah.

[1424] He's number one in our hearts.

[1425] Well, and he's incredible.

[1426] Yeah.

[1427] He's among the top five drivers.

[1428] Yeah.

[1429] But it's still a great story.

[1430] People connect with that story.

[1431] Oh, big time.

[1432] You know, he did it with a smile and humility.

[1433] and then his celebration was so sincere and wonderful.

[1434] Oh, what a day.

[1435] Okay, so biggest news besides Danny.

[1436] Okay.

[1437] My artist.

[1438] Oh, my God, arm cherries, you little sluice.

[1439] You came through so quick.

[1440] Embarrassingly so, actually, because everyone immediately was like, it's her, it's this person, it's this person.

[1441] It took me one second.

[1442] So.

[1443] Even if you sucked on a computer, it would have only taken you eight seconds.

[1444] I hope that doesn't make them lose faith.

[1445] than my fact -checking.

[1446] Probably did.

[1447] Well, look, you're trying to diminish my research and probably your fact -checking's going to take a hit, too.

[1448] All right.

[1449] That's fine.

[1450] Yes, you guys found her for me, and you're right, you're dead on.

[1451] It's her.

[1452] It's her.

[1453] And, okay, so also I'm so grateful.

[1454] I'm so grateful to the armcherrys for finding her.

[1455] That was so...

[1456] Oh, I know what's coming.

[1457] No, I'm mad a little bit at the way she was presented to me, like, you'll never find her.

[1458] Like, she's nowhere to be found.

[1459] My painting's on there.

[1460] It is?

[1461] Oh, will you show it to me?

[1462] I think I want you to see it in person, but this is a picture of it.

[1463] I'm seeing characters in here.

[1464] Do you see characters in that?

[1465] I see kind of two people.

[1466] Oh, my God.

[1467] Like a chicken character and a...

[1468] Oh.

[1469] You see, like, a magic eye?

[1470] Not in that way.

[1471] So that's a girl looking that way.

[1472] Oh, okay.

[1473] I can see.

[1474] I can see that.

[1475] Eyeball.

[1476] Oh.

[1477] Arms, long hair.

[1478] Okay.

[1479] I think it's abstract roses.

[1480] Well, actually, that's what it is, because that's what it's called.

[1481] What's called abstract roses?

[1482] Pretty sure.

[1483] And here's a girl, too.

[1484] That's an eyeball and that's her face and her legs.

[1485] Oh, I do.

[1486] I see her.

[1487] Right.

[1488] Okay.

[1489] I like the painting a lot again.

[1490] Because it has, you could stare at it for a long time.

[1491] Yeah.

[1492] We just got, you and I, no one else that would be insufferable, but I just got three, four minutes of entertainment out of that.

[1493] And that's, that's not even real.

[1494] That's not even the real deal.

[1495] Yeah.

[1496] If the Holyfield was hanging here.

[1497] Exactly.

[1498] It's beautiful.

[1499] Oh, gosh.

[1500] But anyway, I just wanted to thank the armchairs.

[1501] Yeah.

[1502] Great job, Ricardo.

[1503] All right.

[1504] Skin disinfects.

[1505] Okay.

[1506] Which one of the people who invented the polio vaccine married Picasso's girlfriend?

[1507] Okay.

[1508] That was a conversation.

[1509] That's abstract.

[1510] So Jonas Salk, who created the polio vaccine, he married.

[1511] buried one of Picasso's mistresses.

[1512] Oh.

[1513] So it was a little convoluted in the way we said it, but there's connections.

[1514] Yeah, pretty, pretty.

[1515] I mean, that thematically it's the same, right?

[1516] Yeah.

[1517] He had one of Picasso's ex -lovers.

[1518] Yeah.

[1519] Actually, yeah.

[1520] Or lovers.

[1521] It's pretty much absolutely right.

[1522] Her name is Francois Guilo.

[1523] Ooh, Francois Guilo.

[1524] I think.

[1525] G -I -L -O -T.

[1526] I'm imagining it's G -G -L -L -L -O.

[1527] Do you think the inventor of the polio vaccine was arrogant?

[1528] So I'm going to say this woman has a type.

[1529] Oh.

[1530] Well, yeah.

[1531] I don't know anything about the other guy.

[1532] I'm just throwing that out there.

[1533] I think he has to have some level of extreme confidence.

[1534] Whether that's moved into arrogance, I don't know.

[1535] Well, and even specifically with his breakthrough, the notion that you should put some of the poison in the body to inoculate it from the poison is groundbreaking you asked me a question the other day this reminded me of it you asked me if you were a white collar worker what would i what would i pick for you yes yes and then vice versa i think you'd be a really good surgeon i didn't want to say that to you because i was afraid of your arrogance that it would me to actually start practicing.

[1536] Yes, because you always already act like you know how to remove stuff from people's legs and things like that.

[1537] What are the ethics of this?

[1538] This is a good Jonathan Haidt thought experiment.

[1539] Okay.

[1540] So I notice there's a squirrel in my yard who's broken its hind legs.

[1541] Okay.

[1542] Did this happen?

[1543] No. No, no, no, no, no. I'm going to be very clear about this.

[1544] This is all imaginary.

[1545] Hypothetical.

[1546] This is hypothetical, which I know it's going to be a cruel hypothetical, but it's better than humans.

[1547] Okay.

[1548] So there's a squirrel in the front yard.

[1549] It's in the front yard.

[1550] And the back, the hind legs are broken.

[1551] And I'm not going to take it to the vet.

[1552] Okay.

[1553] You know, I'm just being honest with you.

[1554] And I'm going to hope my wife doesn't see it because she will take it to the vet.

[1555] And I'm hoping a coyote just can feed it's young based on this.

[1556] Well, everyone's got to eat, circle of life.

[1557] Okay.

[1558] This will be an easy meal.

[1559] So that's what I'm going to do, I hate to say.

[1560] What?

[1561] Give it to a coyote?

[1562] I'm just going to ignore the whole situation.

[1563] Oh, okay.

[1564] You're going to ignore it.

[1565] I'm going to ignore it in hopes that a coyote quickly puts him out of his misery.

[1566] Okay.

[1567] Or I get the little fella up and I give it a shot.

[1568] I try to repair his legs in the kitchen.

[1569] No. Wait.

[1570] Ethically, that's wrong?

[1571] You're going to make him suffer way more.

[1572] There we go.

[1573] What if I learned to anesthetize them?

[1574] I could do that.

[1575] It's just administering drugs.

[1576] I don't know to do that.

[1577] No. I'm practicing for you.

[1578] Oh, my God.

[1579] First of all, I'm not allowing you to have any drug.

[1580] Any anesthesia?

[1581] Yeah.

[1582] And then also, this is why you're a good surgeon and a bad surgeon, okay?

[1583] Because you already think you know everything.

[1584] You already think that there's no way you could possibly mess up in anesthesia in a squirrel.

[1585] Well, no, we have the internet.

[1586] Away the squirrel.

[1587] Do you know how long anestheticians go to school?

[1588] it's definitely more than a summer yeah but again they didn't have youtube anesthesiologists didn't have youtube they go to school for a really long time like one of the longest well they have the highest starting salary too conventionally because they got to carry so much insurance because they do they they're well i don't want to speak i don't want to get sued by anybody the odds that you face for dying in a surgery are significantly Anastasia goes wrong.

[1589] Really?

[1590] Yeah.

[1591] Anesthesia.

[1592] Anastasia.

[1593] My favorite Disney drug.

[1594] You're just going to make the squirrel watch Anastasia.

[1595] Yeah, to lull it to sleep.

[1596] Yeah.

[1597] So what do you think of that?

[1598] Okay, well, I think that...

[1599] If I could successfully anesthetize the little guy.

[1600] Okay.

[1601] I know that for certain.

[1602] Yeah.

[1603] Okay.

[1604] If that's for CERN.

[1605] There's like a 10 % chance I'm going to get him back on the road or he'd be dead in a coyote's belly.

[1606] Listen, if you do it and you do a bad job and you're busting him up and it's bad, then what are you going to do?

[1607] Because the anesthesia is running out in five minutes.

[1608] I'm going to give him too much anesthesia and just drop them, you know, pull the plug.

[1609] All right.

[1610] I actually think that's fine.

[1611] Because I don't want to open my human practice without some anatomical experience.

[1612] Oh my God.

[1613] Oh, my God.

[1614] Some surgical experience.

[1615] I regret this.

[1616] This is exactly why I didn't want to say it.

[1617] But yeah, I do think you have, I think you have a good mix of arrogance.

[1618] Straight up arrogance.

[1619] Straight up the middle arrogance.

[1620] And mechanical skills.

[1621] Okay, thank you.

[1622] Yes.

[1623] You have incredible mechanical skills.

[1624] So I think that makes us pretty good.

[1625] Well, no, I think you do need some level of overconfident.

[1626] I don't know that you need arrogance, but it often is a fine line.

[1627] Yeah.

[1628] I think even surgeons would admit they're arrogant.

[1629] I mean, again, they got to be.

[1630] Them and pilots, you know, let's keep the girls and boys up in the air arrogant.

[1631] Feeling way too confident in the worst situation.

[1632] The problem is with arrogance is it often bites you.

[1633] Like you're so...

[1634] In the fables, it does.

[1635] Yeah, like tortoise in the hair.

[1636] Liberal arts education.

[1637] The classics.

[1638] Messiness of being human.

[1639] Venica.

[1640] Oh, my God.

[1641] Okay.

[1642] All right.

[1643] Anywho.

[1644] So that's the first time you've hit me with liberal arts education.

[1645] That is powerful.

[1646] Oh, man. Okay.

[1647] Oh, I hate to move into this.

[1648] But how many kids in the U .S. have been sexually abused?

[1649] Some of this is a problem with our fact checks.

[1650] Like, you know, you're in one movement.

[1651] and then you very quickly have to transition.

[1652] Oh, sure, sure, sure.

[1653] Yeah.

[1654] Well, that's live news for you.

[1655] That's right.

[1656] And that's what we're in the business of.

[1657] That's right.

[1658] You thought one in four, the staff that I saw, which was in two different resources, was one in nine girls and one in 53 boys under the age of 18 experienced sexual abuse or assault at the hands of an adult.

[1659] That's way lower than But that's not at the hands of another child, which...

[1660] Or anyone under 18.

[1661] Yeah.

[1662] So that's, you know, and also these numbers, it's hard to know.

[1663] Yeah, that would kick me out of the group.

[1664] Exactly.

[1665] And of course, you're not kicked out.

[1666] Chip, maybe I wasn't a lesson.

[1667] Oh, my God.

[1668] Oh, my God.

[1669] Okay.

[1670] What percentage of people dying of COVID are unvaccinated?

[1671] Unvaccinated people are 11 times more likely to die of COVID -19, the CDC report.

[1672] So that's over 90%, yeah.

[1673] I think I read 94 somewhere.

[1674] Yeah.

[1675] I shouldn't introduce new numbers in the fact.

[1676] You do that all the time.

[1677] I know.

[1678] Well, that was a good episode.

[1679] Oh, yeah.

[1680] Really, really, really.

[1681] And I donated.

[1682] You did.

[1683] That's nice of you.

[1684] I need to do that.

[1685] I was going to do one more dollar than you.

[1686] How much did you give?

[1687] 2000.

[1688] $2 ,00.

[1689] A space odyssey.

[1690] Love you.

[1691] Love you.

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