Nina Vasan

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

[1] I'm Dan Shepard.

[2] I'm joined by modest mouse, miniature mouse, Maximum Mouse, Monica Mouse, Monica Mouse Man. Welcome to the program.

[3] Today we have a really, really great psychiatrist.

[4] Dr. Nina Vassin.

[5] Nina is an American psychiatrist.

[6] She's a clinical assistant professor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine.

[7] And I don't want to spoil, but I will.

[8] She invited us to come lecture at Stanford.

[9] Yeah, so it would appear that we're going to be professors at Stanford.

[10] So get ready for that.

[11] She's the author of the Amazon number one bestselling book, Do Good Well, Your Guide to Leadership, Action, and Innovation.

[12] So please enjoy Dr. Nina Vassen.

[13] Wondry Plus subscribers can listen to armchair expert early and ad free right now.

[14] Join Wondry Plus in the Wondry app or on Apple Podcasts.

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

[16] He's an armchair.

[17] Hello.

[18] Hi.

[19] Hi.

[20] I'm Nina Bawson.

[21] Nice to meet you.

[22] I'm admiring the art in the background.

[23] Oh, thank you.

[24] Oh, don't look too close.

[25] Oh, that wall is safe, actually.

[26] Monica has a beautiful collection of purvey artwork.

[27] Yes.

[28] Awesome.

[29] None of that is displayed behind you, but I have a growing collection.

[30] I mean, look, it is quarantine, so you have to find ways to survive.

[31] And if that's what you need, then, like, go for it and celebrate it.

[32] This will sound like a brag.

[33] Well, it is a brag.

[34] We follow this really pervy artist on Instagram, Poris Walker.

[35] And he makes, I mean, it's the most perverted artwork you've ever seen, but something's so comical about it.

[36] And then I approached this guy, and I asked if he could make a special one -off picture for Monica.

[37] She's very proud as she should be of her cheerleading accomplishment.

[38] She's state champion twice in Georgia.

[39] Yeah, girl.

[40] Thank you.

[41] High Flyer.

[42] So he made a very sexual cheerleading drawing.

[43] And if you don't know his work, you just walk into Monica's apartment.

[44] Yeah, it's interactive.

[45] It has like a pulley.

[46] And there's a lot going on.

[47] Yep, yep.

[48] That is, I mean, that's going all out.

[49] Should we show her?

[50] I'm a psychiatrist.

[51] I have seen everything.

[52] Oh, oh, I like, I like it.

[53] She comes down, she swallows the spotter into her body.

[54] That's amazing.

[55] I love that it moves.

[56] That's super cool.

[57] It's very cool.

[58] It's not, when you go to like MoMA or Moka or any of these, what's name of a couple?

[59] Fine art. Fine art institution.

[60] You never get to pull something and then watch someone disappear in the painting.

[61] This is going to be in the MoMA one day now.

[62] Just wait.

[63] Now, Nina, you grew up in D .C. Yes, I was born in Washington, D .C. and grew up in a small town in West Virginia.

[64] And I've already sent Monica a fan girl email because one of my best friends, McKenzie, has been listening to your podcast.

[65] It's fabulous.

[66] And I think in particular, so, yeah, my parents are from Southern India.

[67] They moved here, I think, like, 45 years ago or so.

[68] I'm 35.

[69] So they've been here for a while.

[70] But, like, exactly what you talk about, Monica, about growing up as like the only brown girl in this town where like everyone else is different.

[71] And you talk so much about, you know, feeling like an other.

[72] That is 100 % how I felt growing up.

[73] And it's a really small town.

[74] And West Virginia is like the most white state in the entire country.

[75] My graduating class was 500.

[76] So there were like two or three per class, you know?

[77] Right.

[78] And just and the way you talk about both, I think, like identity as well as dating, like dating and sexuality and like beauty and all of that stuff.

[79] Just like literally, I've never heard anyone talk about that.

[80] And it's so, resonates, not only with what I experienced, but with, like, all my friends who are also, like, children of immigrants.

[81] So what I said to Monica Dax is, like, what you are doing is so important and for you guys both being entertainment, right?

[82] Like, it's so important to see people like you in entertainment because it really helps you understand yourself and who you are, how you show up in the world.

[83] And it really is, like, a humanitarian public service.

[84] Wow, thank you.

[85] I am so, I say it.

[86] I'm so happy to hear that.

[87] That's so nice.

[88] I'm really going to take us on a tangent.

[89] Do you follow Mindy Kaling on Instagram?

[90] Instagram?

[91] One, I want her to be my best friend.

[92] We've never met.

[93] But like all of her shows, I'm like, I think we should be best friends.

[94] She posted something the other day.

[95] It was a video of a little kid in India talking to her mom.

[96] She was saying, my sister is going to be such a beautiful bride.

[97] And she said, what about you?

[98] And she said, well, I'm too dark to be beautiful.

[99] Do you connect with that, like especially around so many white people.

[100] It felt like you had to.

[101] You had to.

[102] be as close to white as possible to meet the standard of beauty.

[103] Yeah.

[104] And I think, I mean, really all colonialized countries, every place I think where there was European colonialism, there's just the sense of like white equals beauty.

[105] And even on that spectrum, the closer you are to white, the more beautiful you are.

[106] And so I totally felt that growing up.

[107] But like, I mean, like Monica and I, right, like we're also darker skin color, right, than a lot of other Indian people.

[108] Thank God.

[109] I'm so attracted to it.

[110] I remember when I was in high school, tanning beds were really big.

[111] like all the girls, like, oh, I'm going to a tanning bed.

[112] And someone even said to me, like, you're so lucky, you never need to tan.

[113] The deep irony of all this is like all the white kids want to be darker and the brown kids want to be lighter.

[114] Everyone wants what they can't have.

[115] The binary options seem to be in childhood that either you did what Monica did, which is like you kind of rejected all things Indian.

[116] Or you hang out with the one other Vietnamese kid and the one Korean kid and the one, like, Those seem to be, when everyone we've interviewed, it's one of those two options.

[117] I'm sure there's other options.

[118] Did you fall into either of those?

[119] I feel like this is a cop -out because I want to say one or the other.

[120] But I honestly felt like it wasn't quite bimodal.

[121] I think I actually got a little bit of both.

[122] And I'll tell you why.

[123] In our small town, so the town I grew up in is to 10 ,000 people.

[124] And there were a few Indian immigrants and folks from the whole, I was like South Asian diaspora.

[125] And what I think was interesting about where I grew up is that we had such few people that if you were dark, that meant that you were, like, in the community.

[126] And so there actually was, like, in Mindy Kaling's show, you see that there's this, like, Indian community.

[127] And so every week, especially, like, on, like, Friday or Saturday nights, you would go to a different Indian person's house and the kids would all play in the basement and the dads would sit together and the moms would sit together.

[128] And there actually was a community.

[129] And, like, Holy and the volley are the kind of, like, the two big festivities throughout the year.

[130] There would always be a big party for one of those.

[131] And so it's almost like you would turn on being Indian and turn it off.

[132] Yeah, in school, like, you know, junior high high school, you know, it was completely trying to blend in and be just like everyone else.

[133] I remember I wore dresses all the time and I never had jeans.

[134] And in seventh grade, according to my mom, I actually went home and cried because everyone else had jeans and I didn't have a pair of jeans.

[135] And so my mom went to our mall and like went to the Gapper or probably the Gap or Aero Postel and bought me a pair of jeans.

[136] But even that, I only had one pair of jeans, never more than that.

[137] And even now I only have a pair of jeans.

[138] But I say it because it's like when you're surrounded by everyone else.

[139] You know, it is wanting to be just like them.

[140] And if you look at stages of development, especially when you're a teenager, all teenagers just want to fit in and be like everyone else, right?

[141] Yeah.

[142] So I think that when I was a teenager, I was just like the Indian stuff kind of like, don't talk about that, just try to be like what everyone else is.

[143] But then, because there was this tight -knit Indian community, which was, as I said, very small but powerful, when you were there, you could kind of like turn the Indian on and learn about things.

[144] And it was really interesting for me actually then going to college because in college, you you know, if I wanted to only be friends with Indian people in my hometown, I would have had two friends, right?

[145] College was the first time where at Harvard there were so many minorities, but there were also so many minority groups.

[146] In my mind, growing up, Indian was Indian.

[147] When I got to college, it was like South Indian or Pakistani or Gujarati or, you know, like my parents didn't speak Hindi.

[148] Most people in Northern India speak Hindi, but my parents were from Southern India.

[149] So people would come up to me speaking Hindi.

[150] I'm like, I have no clue what you're talking about.

[151] I don't know this language.

[152] And so it was just interesting because then at Harvard, where there was so many that you could actually, like, segregate into different subsections.

[153] It was a sense of belonging that I didn't identify with.

[154] And people would tell me, like, oh, you're from the South.

[155] You're different from what we are.

[156] And I'm like, oh, but I thought Indian was Indian.

[157] Yeah, yeah, yeah, yeah.

[158] Well, isn't that, that's just the nature of, like, in -group, out -group tribalism.

[159] Even within an in -group, and then there's another in -group, and then another in -group, and just keeps getting more and more isolated.

[160] It's very interesting.

[161] So I try to identify way too much with things I can't identify with.

[162] That's my Achilles.

[163] We were just talking with the amazing Surgeon General.

[164] Vivek Murphy.

[165] We worked together 12 years ago on the Obama campaign.

[166] So I've known to make for a long time.

[167] He's very lovely.

[168] Yeah.

[169] And I felt inclined like they had such a shared experience and it's so obviously true.

[170] And then I also felt inclined to go like, hey, just so you know, even as a guy who was a bullseye of what in group was, blue -eyed.

[171] blonde, tall, white dude, I had those fears, too.

[172] Not to undermine yours, and they probably weren't nearly as bad, but I was like, do you realize it is a human condition to constantly fear exclusion?

[173] I think you're exactly right.

[174] It makes me just feel like adaptation, right?

[175] We all are where we are today because of generations and generations of adapting as humans, and whether that means adapting to different environments, like the prairie versus the tundra versus, you know, a city, or really being able to adapt to the different groups that you're in.

[176] And of course, now because of globalization, we feel it, you know, much, much more than any generation in the past.

[177] That is how we survive.

[178] And that is a lot of what it means to be human is to be able to go to different environments and show who you are with different groups.

[179] It's 100 % a human condition entity.

[180] Now, when reading about you, and this is a compliment, I got exhausted.

[181] I was like, oh, my goodness, this girl went as high as you could go in the Girl Scouts.

[182] You started a youth cancer movement that you got an award for.

[183] I mean, you did everything that could be done.

[184] And I immediately just thought, oh, wow.

[185] So in my own experience, I had a fantasy of what achievement was, what success was.

[186] And you were just racking up those achievements and that success.

[187] For me, all of it was pretty extrinsic.

[188] And these awards in general are kind of extrinsic.

[189] Was there any point in your life where you had like an existential crisis where you're like, oh, wow, I got all the awards.

[190] I went to all the schools.

[191] I did all the right stuff.

[192] What does Nina want to do?

[193] I think that's a fantastic question.

[194] And I would say, you know, certainly online, on LinkedIn, you know, online bios, awards are there.

[195] It's nice to get the award.

[196] That's great.

[197] It's nice that someone's honoring you or saying that they value what you do.

[198] But I think probably by the time I got to college, I don't want to say empty, but awards did sort of seem empty in the sense of, I do think there's a sort of particular time and life, especially growing up, and in particular, being in junior high and high school, there is this sense of, like, awards equal accomplishment and awards equal success.

[199] And ultimately, probably for your family, like Monaco's, it just equals safety.

[200] At the end of the day, all the roads are leading to safety, which ironically is an internal job, right?

[201] Yes.

[202] And I love that you say that because it's really interesting right now.

[203] So my parents, they were med school classmates.

[204] And so a lot of Indian folks, the U .S., came to the U .S. for, you know, a better life for the family, and there are a lot of doctors.

[205] And there's this stereotype of Indian and Asian and a lot of immigrants in general encouraging their kids, you know, only be a doctor or an engineer or a lawyer, right, to have those sorts of professions.

[206] And I will give my parents complete credit.

[207] You know, they were both doctors.

[208] And my brother and I are also both doctors, but they never pushed it growing up.

[209] They exposed us to everything.

[210] They were very, very big on the arts and, you know, just really making sure that we had a diverse exposure.

[211] And living in a small town, I think we were able to do that.

[212] But what's been really interesting is now, because of everything that's been going on with coronavirus and seeing so many of my friends who have lost their jobs or who have gotten furloughed while at the same time, I've never been more thankful, I think, and grateful to be a physician than I am right now.

[213] It's just realizing that I can be useful, seeing that with everything going on, that we're seeing a huge increase in folks who are struggling with mental health and knowing that I can continue my profession and continue helping people at a time where we as a country or world or struggling, you know, more than we ever have in our lifetimes.

[214] And I have to say I've even seen friends actually who are reconsidering their jobs, right, who were, you know, here in Silicon Valley, there's so many folks who are working for these sexy, like tech startups, but then it's really realizing at the end of the day, wait, like, what is this widget doing?

[215] Is it something that is adding to humanity?

[216] Maybe not.

[217] Maybe I want to reconsider that.

[218] But I want to go back and answer your question.

[219] What does it mean then, right?

[220] And so I think that when I was in medical school, I struggled with depression.

[221] And this is something that it's funny because you talk about, oh, you know, if you look online, and you see all these things, I guess probably about 10 years ago, I changed my LinkedIn to specifically say that I had struggled with depression.

[222] And I very purposely, in anything, whenever I'm speaking and someone wants the one paragraph biosketch of who I am, I very purposely include in there that I struggled with the depression and that I ended up becoming interested in mental health professionally because of my own experience.

[223] And I do that because I think people see that, right?

[224] People see all these awards and they see like, oh, Harvard, Harvard, you know, you must be really are successful.

[225] And those are some metrics of success, right?

[226] But there are a ton of other metrics of success.

[227] And this is going to sound a little corny, but I'm going to have to say it.

[228] Like, if I really think of what I'm most proud of in, you know, the last 35 years, it is having dealt with depression and having overcome depression and being in a place where today I can talk about it openly and share that with other people.

[229] And it was the hardest thing I've ever had to do is the thing that I'm most proud of.

[230] And now, I'll tell you now, I'm struggling with anxiety right now.

[231] And I know that I will be able to say, you know, in a few weeks or a few months that I feel very proud of having dealt with anxiety at this incredibly difficult time and overcome it.

[232] Yeah.

[233] In America in particular, we have this paradigm that's still kind of valuing something and measuring ourselves in a way that doesn't seem super appropriate anymore.

[234] What we should be envious of is not a person who made a billion dollars with a startup, but somebody who somehow can stay on a regimen of working out four times a week?

[235] Like, in truth, what we should envy is states of emotion, right?

[236] We should envy contentment.

[237] That should be the thing we're all striving for.

[238] And I wonder if we're heading in a direction, I sure hope we are, where we're starting to envy and compare states of mental health.

[239] I completely agree with you.

[240] And I think if you look at Maslow's hierarchy of needs, it's very much like that.

[241] The very bottom of that hierarchy, right, is these basic needs of food, water shelter.

[242] And the reality is my parents, who are immigrants from India, your grandparents, that is the struggle that they had, right?

[243] They didn't know if they were going to be able to have enough money to put food on the table.

[244] And so the world they're living in is one where success is a representation of having those things, having a lot of money because then you know, no matter what you can provide for your family, if there's a great depression or a recession or a virus hits the entire country, right?

[245] We are then very fortunate to be able to actually have happiness as a goal.

[246] And it's interesting.

[247] I actually think maybe I want to say John Adams, or one of the founding fathers talks about this.

[248] I think it is John Adams.

[249] He talks about how everything that he worked for in his own life, that he hopes then that his children can aspire to be great in the arts.

[250] And historically, if you look at civilizations, it's like that, right?

[251] Like Sparta, Sparta is known for just these like warriors and the skills that they had were this incredible, like, you know, fighting and being able to defend their country.

[252] But then when you look at city like Rome or Athens, because they had those needs met, they were able to grow and flourish and develop their art and multiple elements of what culture looked like.

[253] Yeah, once safety, in quotes, was achieved, right.

[254] Exactly.

[255] And I think that similarly, we now are fortunate enough that we don't have to worry about those basic needs.

[256] And so something like happiness, where you can imagine, like, I can completely imagine an immigrant parent saying, like, why should I care about being happy or why are you focused on your happiness when we're worrying about can you actually, like, you know, pay the mortgage this month, right?

[257] And I think that 100 % makes sense.

[258] Well, which is going to just add to that really quickly, what's fascinating and it's particularly fascinating in India, which is the evolution of marriage as an economic model into marriage as a pursuit of love.

[259] That is like an enormous transformation.

[260] You're exactly correct.

[261] This is something my parents and I talk about all the time.

[262] So my parents were a, quote, love marriage, even though most of their, you know, friends growing up were interranged marriages.

[263] And I'm single right now.

[264] And I'm trying to talk to my parents about.

[265] dating.

[266] And Monica is helping me out here because everything Monica is doing is helping me talk to my parents about my own dating experience.

[267] So thank you, Monica.

[268] Are you so sexting like I had to do?

[269] I can imagine you have the same warped thing Monica has because she didn't look like the white cheerleader.

[270] You guys are both so fucking hot.

[271] Round features galore, beautiful eyes, nice lips.

[272] I just hope you know you're a hot piece of real estate when you're out there in the field.

[273] I hear you say that.

[274] I do not believe it.

[275] And it truly is like just years and years.

[276] of feeling different and not seeing yourself represented on TV or not seeing any version of beauty that looks like you.

[277] Thank you for saying that.

[278] I really appreciate it.

[279] No, no, no. Nina, what you have to do, I don't know if you've listened to this episode yet, but we had a hypnotist on.

[280] And I got hypnotized.

[281] On a wheelchair expert, not Monica and Jess Love Boys.

[282] Just be clear.

[283] And I got hypnotized during that episode.

[284] And what my goal was was to look in the mirror and like the image.

[285] Not like the person, because I feel pretty confident in that, but physical image to like that.

[286] So you need to get hypnotized.

[287] I kind of worked, I think.

[288] Well, if I had to say like a percentage, I'd say it worked like 40 % for her.

[289] It helped.

[290] The point he makes, which is so true, is that nobody looks like you.

[291] In a good way.

[292] You are this, look at this original assortment of symmetry and everything.

[293] And look at that.

[294] You're the one.

[295] You're the one that looks like this.

[296] And I was watching him tell that to Monica and I was like, yeah, look at her, man. I don't know anyone that looks like her.

[297] The way it all comes together, it's just so fantastic.

[298] But you have to channel it, right?

[299] Because when you hear him say, you don't look like anyone, it's like, I know, that's what I don't like.

[300] That's the thing I'm trying to fix.

[301] Like, that's the part that's bad.

[302] And then you have to, you know, put it through a new picture frame and say like, and that's a good thing that you're unique.

[303] Which it is.

[304] No, you're absolutely right.

[305] And even, you know, everyone talks about arranged marriages in India.

[306] But if you look back, you know, it was the same thing in Europe 500 years ago, too, right?

[307] Marriage was very much this transaction.

[308] And what it's like, you know, are you still single?

[309] What's going on?

[310] Like, can't you just find someone and get married?

[311] This isn't very hard.

[312] I think my parents view it very much as this like thing that you can just do.

[313] And emotion and love is, and love is a part of it, right?

[314] Because, again, they were in love when they got married.

[315] But when I talk about wanting to find, you know, my person or something like, that, there's this sense of this should just be like an equation.

[316] And can I say that I've come out on the other side where I actually kind of agree with them in a way?

[317] I want to add one thing too.

[318] Forget a range.

[319] Even when it wasn't a range, women in the 70s had to make a choice because they didn't have economic independence.

[320] Theirs was still an economic arrangement even though it wasn't set up by their parents.

[321] So even when you had choice, it still wasn't economic proposition.

[322] The man was going to be gone 60 hours a week so he couldn't raise kids.

[323] He needs someone to raise his kids.

[324] The woman's not going to have a job to earn any money.

[325] So, even in America, still an economic endeavor up until 40 years ago.

[326] Anywho, we've been fucked by love in movies.

[327] And I will say, I do think we've overcorrected from the 50s.

[328] And now I do think it's relevant to walk it back a little bit.

[329] Right.

[330] And I'm with you.

[331] I don't have that, you know, romantic comedy vision.

[332] of that's what I want to see.

[333] You know, that's definitely not the case.

[334] But I also do think that in terms of, I mean, what our relationships look like today are very different, right?

[335] To your point of in the 70s, it's still this gender dynamic of, you know, men providing and women taking care and raising children and what I want in a partnership, what I want in over the course of the next 50 years of my life, I think is different.

[336] And so, and in particular, my parents' marriage, for example, and I think for all kids, what you see in your parents, that's your vision of what a relationship is supposed to look like, right?

[337] And the only additional data points you get, maybe you get a little from friends, family, cousins, things like that.

[338] And then you see what you see what you see on TV and in movies.

[339] But the overwhelming majority, like 80 % of your data points are coming from the relationship that you watched as you were growing up.

[340] And so I think that does impact then what you end up looking for or what you think is right or wrong for you.

[341] Yeah, I think it's very interesting because it depends also on how you're looking at the paradigm in general.

[342] So I wanted separation.

[343] of being Indian and all of that stuff.

[344] I wanted so much separation.

[345] So the marriage that I saw in front of me was very practical.

[346] And I was like, no, that's not what I want because I don't want anything to do with any of this.

[347] So that must be wrong.

[348] Whatever they're doing must be wrong.

[349] So I'm going to go in the complete opposite direction.

[350] And yeah, it has fucked me big time because now I'm like, I need my soulmate and I need this and that.

[351] And now I am circling back, especially having done.

[352] on the podcast.

[353] Yep, there's some real merit in practicality.

[354] And they had this, like, wonderful companionship.

[355] I was just going to say, you need companionship.

[356] Yeah, right.

[357] If your goal is to, like, have something hot and heavy, great.

[358] Meet someone at a bar.

[359] Have some crazy emotion -filled trauma healing experience.

[360] But if a goal is to have a companion and raise a family, then, you know, it's just a different criteria, I think.

[361] Yeah.

[362] So they were right.

[363] They're always right.

[364] They're always right.

[365] They are always right.

[366] That is what I have learned.

[367] What I've learned is there are a lot of times I think my parents are wrong, but really it's on me. And maybe it's five minutes later or five years later or 20 years later, but they are always right.

[368] Okay, so as we collectively aspire to happiness, fulfillment, all these states of being, you know, what are the cornerstones as you see it?

[369] Because you have an actual lab at Stanford, the Brainstorm Lab for Mental Health Innovation.

[370] What are the goals you guys planted flags in?

[371] So Brainstorm is the Stanford Lab for Mental Health Innovation.

[372] And at the end of the day, there are two really big things that we're looking at.

[373] And I'll tell you actually something that I say when I speak about mental health, which is that mental health is the greatest thief of human potential today.

[374] And I say that as a very overarching statement, as well as a call to action for everything that I'm doing personally, everything that our lab is doing.

[375] So I'll give you some statistics.

[376] I won't do too many statistics, but I am an academic.

[377] So I'll throw some statistics out there.

[378] We love numbers.

[379] Worldwide, if you look at someone who is struggling with mental, severe mental illness, they live 25 years less than the average person.

[380] 25 years.

[381] Now, if you look at all the countries in the world and we line them up in terms of average life expectancy, if you look at the best country and the least country, you'll see something like 25 years.

[382] It might even be better than that.

[383] So to say that someone who has severe mental illness in today's society lives 25 years less, that's astronomical, okay?

[384] Yeah.

[385] And the thing is, it doesn't need to be that way, right?

[386] When we think about mental health, we do actually have amazing treatments that work for people.

[387] And, you know, a lot of what I do, I think, as a psychiatrist and as someone who's, you know, really trying to be public facing is there are enormous misconceptions and misunderstanding about mental health.

[388] I think more than any field of medicine I've ever encountered that people have the wrong understanding.

[389] And these, like, if we talk about fake news, there's a lot of fake news about mental health, right?

[390] And so the way people understand and conceptualize it, I think, is inaccurate.

[391] And so something that's important to me is to really fix those inaccuracies.

[392] What do you think the prevailing myth is that you would debunk?

[393] First of all, that treatments don't work.

[394] And so there's this sense of if you have something with mental health, that there's no hope of getting better and that you have to take care of it yourself and suck it up and, you know, like do something internally and things will get better.

[395] That is absolutely not true.

[396] Medicine has phenomenal treatments that do work.

[397] And I think what happens is that everyone knows someone.

[398] who went to therapy and didn't have a good experience or took medication and had, you know, like their libido went down or they gained a little weight.

[399] And so then there's the sense of like, oh, my N of one says that mental health treatment doesn't work, therefore I'm never going to try anything.

[400] And that's completely false.

[401] Can I add as someone who's been in AA for 15 years, I get so bored with someone going like, oh, my uncle did AA.

[402] It didn't work.

[403] And I'm like, well, it didn't work.

[404] I'm 15 years sober.

[405] How can you look at me and say it didn't work?

[406] But yeah, that kind of anecdotal one person's bad experience, the exception to the rule becomes...

[407] Exactly.

[408] And the thing is, if you look at the medication, so I'm in psychiatrists, and there's also a big misunderstanding, I think, that there are a lot of different professional fields in mental health.

[409] So we have mental health counselors and psychologists, and I'm a psychiatrist, and I'm a psychiatrist.

[410] And so as a psychiatrist, I'm a medical doctor.

[411] And what that means is that in addition to looking at what psychologists look at, talk therapy, and the psychological and behavioral element of health, we also look at the biological.

[412] element of health.

[413] And the way that we think and conceptualize mental health, the word we use is biopsychosocial.

[414] So when we think about why mental illness occurs, right, from struggling with alcohol to anxiety, to depression, PTSD, anything.

[415] So why it occurs is a combination of biological, psychological, and environmental factors.

[416] Biologically, what that means is our genes, our DNA, right?

[417] Like if your mom struggled with addiction, the likelihood of you struggling with addiction goes way up, right?

[418] So literally what is coded in our DNA, right?

[419] So literally what is coded in our DNA, as well as neurochemicals and hormones.

[420] And, you know, the brain is one big.

[421] It's like a lot of electricity and magnetism that kind of goes into the brain.

[422] All of that is what makes up the biological component.

[423] Then the psychological is really how we talk to ourselves, how we cope with things.

[424] And I think of it as like this internal monologue that you have around what's going on.

[425] And kind of this combination of your thoughts, your behaviors, and your actions and how they all fit together.

[426] That's the psychological element.

[427] And then social, social really means a mix of a few things.

[428] It's historical and environmental.

[429] So historically, and you had Nadine Burke Harris, right?

[430] Historically, if you were exposed to childhood trauma, then what your health looks like is different for the rest of your life because of that historical element.

[431] What you're telling us that's new, which is fascinating, is we are both very aware of the biologic component, like I might have a genetic predisposition to be an addict.

[432] And then my environment will probably accentuate that or not if I grew up around other addicts, blah, blah, blah, but the psychological component, I don't think we've had anyone that's talked about that, like how your thoughts interact with then your actions is, yeah, fun.

[433] Absolutely.

[434] The environmental is a mix of history and your current environment, right?

[435] So, for example, right now, everyone is anxious, right?

[436] Because the environment that we're living in right now is unlike anything we've ever lived in before.

[437] And so when we think about mental health, we think of everyone as being on a spectrum from wellness to illness.

[438] break that down, like depression, you're on a spectrum of depression from, you know, major depressive disorder at one end to like, right before the edge being like a little bit, you know, having a little bit, maybe a little bit irritable, right, all the way until good.

[439] A little bit of bad sleep.

[440] Exactly.

[441] A little bit of bad sleep, right?

[442] So, so at any given point in time, you're somewhere on that spectrum.

[443] And where you are on that spectrum is a combination of the biological, psychological, and environmental issues.

[444] Now, that's what we have in mental health.

[445] What makes this differ from other areas of medicine, like let's say diabetes or cancer, is that you can actually measure, right?

[446] You can draw your blood and you can measure, oh, I have this much cholesterol in my body, or my insulin levels are this specific number.

[447] Versus for mental health, we don't yet have the technology or tools to tell us what percentage is biological, psychological, or social, right?

[448] So if all of us are struggling with sleep tonight, for Monica, it may be 50 % biological, 40 % psychological, 10 % environmental.

[449] For DACs, it might be.

[450] 80 % environmental and 20 % biological and zero psychological, right?

[451] So once again, why humans are the worst thing to study on planet Earth.

[452] Or most fascinating, but I hear you.

[453] I hear you.

[454] So that is why we are the way we are.

[455] And so then when we think about treatment, we similarly think about treatment in all three of those areas.

[456] Okay.

[457] So what treatment then looks like biologically is medications as well as what we call intervention.

[458] So transcranial magnetic stimulation or electroconvulsive therapy, so magnets or electricity are incredibly, incredibly effective.

[459] That's a hard one to rebrand, though.

[460] Yeah.

[461] It is a hard one to rebrand.

[462] ECT, especially because of like one flew over the cuckus nest and things like that, the conception people have for ECT is that it's this horribly painful thing.

[463] And it was like that, you know, 50 years ago.

[464] And TMS is another thing, transcranial magnetic stimulation.

[465] basically what we've been able to do is map out particular parts of the brain and you can stimulate those different parts and that helps enormously with depression, OCD, bipolar disorder, PTSD, all these things.

[466] Is this only in a clinical setting or can people own this kind of thing?

[467] Is this a consumer level yet?

[468] Yeah, so right now, both ECT and TMS are things that have to be done in the hospital.

[469] ECT, you have a little anesthesia for TMS.

[470] It's about like a 10, 15 minute procedure.

[471] I'm a professor at Stanford.

[472] We do it at Stanford.

[473] But what people are working on is actually trying to figure out how do we make it small enough, portable enough, and safe enough that you can do in your home.

[474] And so I do think that maybe like five years from now or so, we will actually have that capability, which I think is really, really fascinating.

[475] Aren't you so glad you're in this field when the fMRI exists?

[476] Like, you know, if you were doing this in the 70s, you're like, I think the midbrain's responsible for impulse.

[477] But we don't know.

[478] Yeah, yeah.

[479] I mean, you're like at the perfect time to really learn a lot about the brain.

[480] Stay tuned.

[481] for more armchair expert, if you dare.

[482] What's up, guys?

[483] This your girl Kiki, and my podcast is back with a new season, and let me tell you, it's too good.

[484] And I'm diving into the brains of entertainment's best and brightest, okay?

[485] Every episode, I bring on a friend and have a real conversation.

[486] And I don't mean just friends.

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

[488] So follow, watch, and listen to Baby.

[489] This is Kiki Palmer on the Wondery app, or wherever you get your podcast.

[490] We've all been there.

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

[492] 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.

[493] 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.

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

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

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

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

[498] Prime members can listen early and ad free on Amazon Music.

[499] One of the things I say is that mental health is undergoing a renaissance.

[500] And I feel deeply fortunate that I'm at this stage of my career, which is really just starting my career.

[501] I think there are amazing transformations that are happening in mental health right now.

[502] Technology is really one of the biggest parts of that.

[503] And that's what we do in my lab, which I'll get to it in a minute, but I want to go back and finish the psychological and social.

[504] So what is the biological element of disease?

[505] It's genetics, it's electricity, magnetism, neurochemicals hormones.

[506] So that's what we treat with.

[507] That's what the medications do.

[508] That's what ECT and TMS does is help with the biology, right?

[509] And then we have the psychology.

[510] So psychology treatment, psychological treatments are therapy, cognitive behavioral therapy, dialectical behavioral therapy, sometimes even just regular talk therapy alone.

[511] And I think what's important about therapy is therapy is like exercise in that if someone just says, oh, I had a bad experience in therapy, that's like saying I had a bad experience in like running and therefore I'm never going to do any exercise again for the rest of my life.

[512] Oh, yeah.

[513] You went to a bar and it was a terrible bar and you're like, oh, bars are terrible.

[514] Exactly.

[515] And so when you think about therapy, there's so many elements of figuring out what the right type of therapy is for you, is that CBT, is it DBT, is it acceptance and commitment therapy?

[516] And also then finding the right person to deliver it to you.

[517] So just like when you're exercising, you want to find that right coach or the right trainer in the same way with therapy, you have to find that therapist who's the right fit for you.

[518] So that's where the psychological comes in.

[519] Then we have the environmental component.

[520] And that's really where all these elements of behavior, like mindfulness and sleep and exercise, that's where those come in.

[521] And then even who do you have around you, right?

[522] Are you surrounding yourself with positive, uplifting people, or are you surrounding yourself with people who are only talking about the negative?

[523] So really thinking about your environment and making environmental changes, you know, numbers one and two for everyone, exercise and mindfulness.

[524] Those are the things that we have the absolute best evidence for of making an impact.

[525] It's actually almost ridiculous.

[526] Like every day a new study comes out showing how exercise or mindfulness helps everything from mood, stress, anxiety, productivity, even length of life.

[527] Yeah, and we need that paradigm shift even in how we treat medical issues in this country, which is it's all symptom -related, right?

[528] So huge billion -dollar campaigns against smoking.

[529] There's no billion -dollar campaign to encourage people to exercise, which in turn would probably alleviate a good portion of the downstream thing.

[530] Absolutely.

[531] And, you know, in the UK, because they have a nationalized health system, before prescribing an antidepressant, if someone comes in with anxiety or depression, they'll say, go exercise for a few months and then come back, right?

[532] I always bring that up.

[533] In fact, I think they'll even pair you with like a trainer or something.

[534] I'm so glad you said it because he does say that all the time and I'm always like trying to fact check it and I can't.

[535] So this counts as my fact check.

[536] I promise.

[537] I promise.

[538] That's true.

[539] And, you know, and when we think of another disease, like if you think about diabetes, right, it's like what do you need to do?

[540] You need to change how you eat.

[541] You need to lose weight.

[542] You need to, you know, really focus on things like exercise.

[543] And mental health is no different.

[544] And that's why what I love about mental health is when I say biopsychosocial, the reason why you are the way you are is not because of any one thing, right?

[545] It is a combination of all these factors.

[546] And so similarly, in order to get better, you can address it from all these different perspectives.

[547] It's a very interdisciplinary thing in terms of how you actually address mental health.

[548] That is an implicit hurdle with mental health, which is people like one thing.

[549] They don't like 12 things.

[550] They want, what should I do?

[551] Was it stop eating sugar?

[552] Okay.

[553] Stop eating fat.

[554] Okay.

[555] Stop eating.

[556] You know, it's a tough sell to say to people like, well, you need to monitor about 12 things.

[557] Well, first is I don't think you need to do 12 things at the same time.

[558] I say the 12 things because I think it's hopeful to know that if one thing isn't working, something else might work, right?

[559] If X medication isn't going to work, then therapy might work.

[560] Or if medications don't work, ECT is going to work.

[561] So there are a lot of options out there.

[562] And what is great about mental health is you can then try another thing.

[563] So I don't think you should try all 12 things at the same time, but it's knowing that try one thing, see how that goes, and then try something else.

[564] And so just recognizing that there are a multitude of options in terms of of what you can try to get better in mental health.

[565] And I said because what we were talking about before is that a lot of people think, I can't get better.

[566] And the reality is you can get better.

[567] Yeah.

[568] So let's talk about technology.

[569] A couple of things I think are really important when it comes to mental health.

[570] One is that we need to democratize mental health and two, we need to personalize mental health.

[571] Whenever I talk to folks about what are the big challenges in mental health, I always say that stigma is problems one, two, and three.

[572] Stigma is the biggest issue we have in terms of what's holding us back in mental health.

[573] Dax, you have kids, right?

[574] How old are your kids?

[575] Five and seven.

[576] Five and seven.

[577] Okay.

[578] So let's say your daughter has a stomach ache and it's not going away, right?

[579] So she's, you know, she's talking about the pain.

[580] She's maybe wincing every now and then and she's telling you, you know, daddy, my tummy hurts.

[581] And it wasn't getting any better.

[582] How long would it take before you went to see a doctor?

[583] Maybe that went to the emergency room or even Googled, you know, stomach pain online.

[584] To be honest, I think it'd have to be a two -day thing because they have something they claim is existential every hour.

[585] You know, they have a headache that they've never had.

[586] Yeah, I think it'd have to be like around for a couple days before I took it serious.

[587] That's fair.

[588] You'll make sure that it's going to continue for two days.

[589] Make sure that like cookies don't make it better or, you know, like the stuff the animal doesn't make it better.

[590] And then two days, but then you'll get help, right?

[591] Yeah.

[592] Now, let's say instead of a stomach ache, it was depression or some symptom of mental illness.

[593] How long do you think it would take to get medical help for your daughter?

[594] Well, again, I happen to be in a house that talked.

[595] talks about it a lot.

[596] So for me, they'd have to do a checklist.

[597] Like, were you have service to somebody?

[598] Did you work out?

[599] And are you eating well?

[600] If they did those things and they still felt like they couldn't come out of it, then yes, I would get help.

[601] So I would say that that would probably be a couple weeks.

[602] I'd want them to give a couple weeks of, you know, what I believe results in good feeling.

[603] Okay.

[604] So I'm going to ask Monica the same question.

[605] So in this case, we're also talking about your kids, right?

[606] And a lot of times people might be more proactive with their kids than they are for themselves.

[607] Monica, if you were, let's say, struggling with your sleep.

[608] And you weren't able to sleep.

[609] You're like waking up at 2 a .m. You know, how long would it take for you to try to seek medical help if it kept going on and wasn't getting any better?

[610] A long time.

[611] Yeah.

[612] What is a long time?

[613] So Dax was saying if it's a stomach egg two days, you know, mental health maybe a few weeks.

[614] What is a long time for you?

[615] It's also ironic.

[616] If I have a stomach egg, I immediately think it's appendicitis.

[617] I'm Googling five minutes in and I'm like ready to go to the hospital within an hour.

[618] And yes, if it's lack of sleep, truly it probably takes like two weeks before I even start to do like meditation, then if that doesn't work, probably another like month before I would really be like, I think I got to do something else now, like slow, slow.

[619] So a long time for you means maybe a couple of months.

[620] Yeah.

[621] I think I've observed, at the risk of getting into a fight, I think I've observed like four months where she'll go, I'm going to call my therapist.

[622] Like she'll start talking about calling her therapist.

[623] She'll talk about calling her therapist for maybe three weeks.

[624] He also doesn't know every time I talk to my therapist.

[625] Well, I know every time because I've tapped her phone and I know everything.

[626] But yes, yes.

[627] Monica, that app on your phone that you don't know what it is, it's Dax.

[628] He's tracking everything.

[629] I think partly it's because it takes me personally maybe three weeks before I even recognize.

[630] Oh, I've been irritated.

[631] for three weeks.

[632] So I haven't really been sleeping for three weeks.

[633] So I've been sort of down.

[634] Like, I can't even recognize that because I'm in the spiral for a while.

[635] Then once I recognize, then it takes a while before I can act on it.

[636] Because I'm like, well, oh, I see.

[637] Okay, it's that.

[638] It'll probably go away.

[639] I'll do this or I'll do that.

[640] So let's say worst case scenario, give me a number here.

[641] Like, how long did you have anxiety when you were working at SoulCycle before you got a therapist?

[642] She was having panic attacks and full, like.

[643] Like serious.

[644] Real red flags.

[645] How long?

[646] Truly probably eight -ish months.

[647] Eighths' months.

[648] Okay.

[649] So now I'm going to ask you guys a question.

[650] This is, I'm a professor.

[651] I teach, so I have to ask you a question, right?

[652] And grade your exam.

[653] What do you think the average is in the United States if you have a symptom of mental illness and it's not going away?

[654] I think it's five years.

[655] Because I think ultimately for people, they'll start to have to confront the wreckage of that.

[656] So their marriage will go away.

[657] They'll get fired.

[658] their kids won't talk to them.

[659] Like, I feel like people have to experience grave wreckage.

[660] And I think that takes years to accumulate.

[661] Yeah, I'd say two years.

[662] 11 years.

[663] Oh, great.

[664] Oh, my God.

[665] Oh, well, you can't coast along in a marriage, I guess, for a decade.

[666] 11 years.

[667] Imagine telling a kid with cancer that we're going to, you know, that like, you have to wait 11 years to get treatment.

[668] And let me point out, that's just to actually go to a doctor.

[669] then the issue with mental health, and especially for my field of psychiatry, there's such a supply and demand mismatch where the number of people who need help compared to the number of doctors out there who can provide that help and just the hours those doctors are working, huge supply and demand mismatch, right?

[670] So at Stanford where I work, we have weightless of, in some clinics, literally up to a year.

[671] That is a travesty that in today, like today we have to wait that long to get that sort of treatment.

[672] So 11 years to actually get help.

[673] then once you know that you need that help, being able to actually get that help, that's where access comes in.

[674] So both there's a shortage of doctors, as well as then we have things like money, right, like the payment side of things and insurance.

[675] So what this comes down to is two really, really big elements that I think are important, or maybe even, let's say, three.

[676] Stigma and democratizing access to care, right?

[677] So that no matter who you are, no matter how much money you have, that you can get really good care.

[678] But I go back that stigma is one, two, and three, because I think if you look at something like mental health compared to something like cancer, the way we conceptualize disease is very different.

[679] There's the sense of there's something wrong with me as a person and not that there's this external entity of a disease that is making me, exactly, exactly.

[680] So I'm going to throw some of it back at you, the blame, which is another huge issue is there isn't consensus.

[681] And that's on y 'all.

[682] That's on academia.

[683] John D. Rockefeller said, look at all these people graduating from these colleges with medical degrees.

[684] And there's no standard of what a medical degree is.

[685] So he said, let's model the whole system after Johns Hopkins University.

[686] They seem to have good doctors.

[687] Here's a standard.

[688] We all agree upon it.

[689] If you get cancer, sure, there's going to be some standard deviation in care, but it's probably going to involve chemotherapy.

[690] It's probably going to involve radiation.

[691] It's probably going to involve these things.

[692] I think part of the issue is this enormous body of attempts and no real consensus.

[693] So I think that compounds it as well.

[694] Like everyone knows if you have cancer, you're going to get chemotherapy.

[695] But if you have mental health things, people don't really know what they're going to get.

[696] I hear you.

[697] Okay.

[698] You see me. I see you.

[699] I hear you.

[700] I see you.

[701] There are a few, I think, important elements to bring up there.

[702] One is that you're right.

[703] At the end of the day, there isn't a clear answer right now of if you have X, then we give you Y. Point Z, if you will.

[704] But cancer is actually not dissimilar from that.

[705] if you look at chemotherapies, there are a wide range of chemotherapies that you might choose to give.

[706] My dad's a radiation oncologist, and everyone will do a little bit of a different range in terms of how big of a circumference they're treating or the dosage that's going in.

[707] And there is a lot of math and science behind all this, but there also is an art and a little bit of guessing and hoping behind all this.

[708] And it's going to blow up in a minute when people start mapping their genome at home and taking it in and we find out actually there's 11 ,000 approaches that are appropriate.

[709] Well, and the genetic component is fascinating, and now we actually have genetic tests to be able to tell us how likely are you to respond well to this antidepressant or what types of side effects are you likely to get because of your genome.

[710] Oh, that's great.

[711] And so where we are today is not where we want to be.

[712] Yet, where we are today is we do have a lot of therapies and treatments that work.

[713] And I think mental health gets a bad rap here compared to other areas of medicine, where if you look at the efficacy of like allergy drugs, they're actually the same as antidepressants.

[714] But the way people talk about it, because again, like maybe, you know, if someone took the medication and it didn't work, 20 people say, oh, antidepressants don't work.

[715] If someone took an allergy medication, it doesn't work, you don't have that same story being told.

[716] Mental health, unlike other medical treatments, is so reliant on the person's participation.

[717] And this is where A .A., like Dr. Drew and I will fight with people about A .A., it's like you could say that your cancer medicine doesn't work.

[718] if you only take it on Thursdays when you're supposed to take it seven days a week.

[719] You can say insulin doesn't work if you take it three days a week when you're supposed to take it seven days a week.

[720] So, you know, because there's so much participation in these mental health issues, they're hard to evaluate sometimes.

[721] Exactly.

[722] And if you have cancer, you look to see if the cancer is getting smaller or gone away, right?

[723] So much of mental health is actually objective is, you know, if you're making depression better, we ask, do you feel better?

[724] We don't have this metric of, you know, your depression has actually gone away.

[725] This is what I'm going to talk to you about, because we're talking about technology.

[726] So this is what I think is the most exciting thing about mental health today and why, when I say mental health is going through a renaissance, part of that is because of stigma and culture.

[727] Part of that is because of technology.

[728] So if we look at what mental health is like today, in a lot of ways, it's what cancer was like 100 years ago.

[729] Have you guys read the emperor of all maladies?

[730] No. You need to read this book.

[731] It's amazing.

[732] Wamba Pulitzer Prize.

[733] It's basically this whole history of cancer.

[734] It's really, really fascinating.

[735] I've worked the American Care Society for years and years.

[736] So when I see these analogies, it makes a lot of sense.

[737] So 100 years ago, cancer was really only treated in stage four because you didn't have an x -ray, you didn't have an MRI, you had these late -stage manifestations of the disease.

[738] And if someone got diagnosed with cancer, they wouldn't tell their employer because there was actually this stigma that you did something wrong, and so that's why you had cancer.

[739] Okay?

[740] And then what happened is that the x -ray came around and the CT scan came around.

[741] And doctors were able to look inside the body.

[742] and collect data that they never had before that allowed them to see cancer at its earliest stages.

[743] And so now when we think about cancer, we've come so amazingly far that we can see it when it's a minuscule thing.

[744] We can actually prevent it through screenings, right?

[745] And so what cancer looks like today is completely different.

[746] Now, if we think about mental health, if we look at how we measure mental health, one, it's this mix of objective and subjective.

[747] And the metrics we have are not that great, right?

[748] It's like asking you, do you feel depressed?

[749] And number one, you yourself have to identify that I'm depressed.

[750] You're the worst person to ask probably.

[751] You're the worst person.

[752] And what makes me even more complicated is, Monica, you were bringing this up.

[753] These diseases like depression, anxiety, substance use, the disease itself makes it that much harder to even know what's going on with you or to seek help.

[754] If you're depressed, you don't want to go see a doctor.

[755] You want to sleep all day, you know?

[756] And so unfortunately, it's this kind of cruel element of the disease that having the disease makes it that much harder to actually get treatment from the disease because of these other issues, right?

[757] So when we think about mental health, part of it is measurement.

[758] What are we measuring in order to diagnose the disease?

[759] And how do we even see the disease, right?

[760] You don't ask someone, do you feel like you have cancer?

[761] Do you feel like you have diabetes?

[762] But we have to rely on if they feel like they're anxious or depressed.

[763] Okay.

[764] So let me tell you what I think is the most exciting thing going on right now.

[765] It's called digital biomarkers.

[766] And move your hands around a little.

[767] What do you have with you like every moment of the day?

[768] My hands.

[769] Oh, you're found.

[770] You're found.

[771] Oh, we failed.

[772] That was like a riddle.

[773] We love riddles.

[774] We love riddles.

[775] We did a bad job.

[776] That would be a good riddle.

[777] That would be a good riddle.

[778] So if we look at the phone, then smartphones, smartphones are now able to measure elements of human behavior that we've never measured before.

[779] So if you look at everything from how fast you're typing or the number of spelling mistakes you're making or the geographic vicinity that you're walking around in throughout the day, these are all measurements of our behavior that can tell us how.

[780] likely you are to be depressed or be anxious or have bipolar disorder.

[781] And so what's amazing about this is, first of all, like, when in the history of like human mankind, has there been anything that we've actually had with us every moment of the day that can measure these things that we've never been able to measure before?

[782] Sleep is a great example.

[783] You know that everyone has sleep trackers on their phone, right?

[784] If you ask someone objectively, how well did you sleep or how long did you sleep, then you compare it to those sleep trackers, there is almost like no correlation.

[785] Like we are very, very bad.

[786] And estimating how well we slept.

[787] We don't know anything.

[788] And that's just sleep.

[789] Sleep is a lot more objective than mood.

[790] So if you think about that, that's what makes knowledge is really exciting right now, is that now there are all these things we're going to be able to measure that can tell us much more objectively, like the blood test, you know, how likely is it that you are depressed or that you are anxious.

[791] And it's in the very, very early stages.

[792] So I give that caveat.

[793] But what we're starting to learn is things like the radius in terms of where you walk compared to where you are.

[794] When you're depressed, that goes down.

[795] Well, isolate, right?

[796] And this would be a very confusing moment for the AI, this quarantine.

[797] Right, exactly.

[798] So that's the issue.

[799] Right now, there's a lot of noise.

[800] And when we look at sensitivity and specificity, it's not exact, right?

[801] So maybe you're actually isolating because you're binge watching Mindy Kaling's new show.

[802] Maybe you're isolating because, you know, you're exhausted and you don't want to go out.

[803] So it's not there yet.

[804] But what it is is there's all this new data, much like when CT scan came around, we could see things we never could see before.

[805] We could measure things we never could before.

[806] That's where mental health is right now is that there are all these new metrics related to technology that tell us about the human condition that tells us about our behaviors and our emotions.

[807] And that I think is what's going to be really exciting moving forward because I do hope that now in a few years we will be able to diagnose with much more accuracy.

[808] And you're not going to have to tell me if you're depressed.

[809] We'll actually have these measurements that will do that for us.

[810] Did you read Homo Deus?

[811] I think I have Sapiens somewhere here, actually.

[812] So Sapiens right is about where we came from.

[813] and then homo -day is about where we're going.

[814] And there's this fascinating part in there where Yuval's talking about that you will maybe one day be walking into a meeting at your work and your phone will say, hey, shut up in this meeting.

[815] Your cortisol levels are really high and your blood sugar's low.

[816] And the last time you were like this, you got in a fight with your boss.

[817] Just mums the word for this meeting.

[818] I was like, that is so fascinating.

[819] And then it opens up this really crazy ethical dilemma of who should that machine service your experiential self or your narrative self?

[820] like we have different cells, we have different objectives.

[821] It's so fascinating.

[822] Then my second question is, do you know Eric Topol?

[823] I feel like you guys should be working either because he's doing all this on a biological front with phones about health.

[824] Yeah.

[825] He's one of the first people who really entered this space.

[826] And I'll tell you a funny story.

[827] So I haven't met him yet, but my brother is a medical oncologist at Sloan Kettering in New York.

[828] And he published his first paper in science and nature a few months ago.

[829] Eric Topel tweeted him.

[830] And then I liked the tweet.

[831] and then Eric Topel, I think, saw me for some reason and said like, oh, are you related to Nina Vosin, which is me?

[832] And then he said something like, I want to study both of you.

[833] So I have not met him, but there is somewhere in the Twittersphere.

[834] There's a connection between myself and Eric Topal, and I would love to meet him.

[835] Oh, we are so in love with him.

[836] We love it.

[837] We can't, like, there's two people of the 200 and some we've interviewed.

[838] Eric Topal and Adam Grant, like we just want to be joined with them cellularly.

[839] We just want to fuse with them.

[840] We love them.

[841] I will join you in that.

[842] It would be a dream come true.

[843] Okay, so can we use future surf for a second and get into some provocative, like, theories of the future?

[844] So this is a very complicated topic for me because, again, I am a product of AA, which is a behavioral response to a malady, right?

[845] It's group therapy.

[846] It's all these actions to living.

[847] And I believe in them.

[848] And I'm actually kind of against Suboxone as a treatment.

[849] Can you tell me why?

[850] Yes.

[851] Well, listen, I totally understand the argument.

[852] from the other side, which is, A, we have a bunch of young people dying from opiate addiction, and we've got to curb that.

[853] And so, yes, that is a very good short -term cure for the death rate.

[854] But Suboxone isn't opiate.

[855] You still live as a zombie.

[856] You're still treating the symptom, and you're not getting even close to what the cause of that disease is.

[857] If that's your program is just to take Suboxone, you will never approach an inventory of honesty, learning why you do the things you do.

[858] And so for me, go a step further.

[859] If the sole objective is to prevent deaths, why not just install into people Narcom that automatically deploys so that people can just use drugs as much as they want and they'll always be revived with the Narcom?

[860] Is that a solution we think we would like?

[861] Because it's in the realm on a spectrum of A .A. Suboxone and just give everyone an automatic deploying Narcon can.

[862] It's closer to that.

[863] I just, I don't think it approaches the problem.

[864] So that's my issue with it.

[865] I would almost make the same argument with insulin, right?

[866] It's like if someone is diabetic and you don't want them to keep eating cake every day because if they could eat the cake and then they could give themselves some insulin, and then you can just end up in that cycle where your blood sugar might stay okay because as you're doing the kind of triggering behavior, you're, you know, putting this stress on your organ and then you're artificially giving it what it needs, you know, would you end up dying from, low blood sugar, no, would you have those same rates of high blood sugar?

[867] No. But is that a life that you want to live?

[868] It's not actually curing the disease.

[869] It's basically letting you live with the disease.

[870] Really quick if I can just say, my issue with that analogy is that if you have type 1 diabetes, you're born with a pancreas that doesn't create insulin.

[871] So there is no solution to that.

[872] You're not going to work through how that came about and solve it.

[873] I am of the opinion that you can work through alcoholism and you can solve it.

[874] So I mean type 2 diabetes, actually.

[875] So you're absolutely right.

[876] Type 1 diabetes, you're not producing insulin.

[877] But type 2 diabetes, you don't produce as much.

[878] When there's a lot of sugar in your body, your body doesn't produce as much insulin as it needs to.

[879] So you have to artificially take insulin.

[880] I am of the opinion for type 2 diabetics that the solution isn't you take insulin so you can eat a bunch of cake.

[881] I don't think that's the solution.

[882] I agree with you.

[883] What is the solution?

[884] I agree with you 100%, but we'll get to this.

[885] The solution is finding out what it is you're treating by eating the cake.

[886] What happens just before you self -regulate your emotions and your emotions and your, your cortisol levels with cake.

[887] I love that you said that.

[888] I'm going to add to that.

[889] So you're absolutely right.

[890] And that's critically important is the what's going on emotionally that's leading to you engage in that behavior.

[891] Similarly, what's going on emotionally that's leading to you want to drink or want to take drugs, right?

[892] Yeah.

[893] And I would see there are two components there.

[894] The medication is one thing, but there's also education, right?

[895] In the case of diabetes, it's educating yourself on what is healthy, what's not healthy, what are the ranges of foods I can eat that will be in X particular range of keeping me healthy.

[896] And so, you know, we were talking about biopsychosocial.

[897] Same thing holds true for diabetes, which is, like, you can exercise.

[898] You can change your behavior and exercise, and that helps with diabetes.

[899] You can decrease the amount of carbohydrates and sugar, and that improves your diabetes.

[900] And you can understand what's that emotional trigger that's leading to me wanting to eat the cake.

[901] Uh -huh.

[902] All of that is what leads to you struggling with your blood sugar.

[903] All of that is what leads to you struggling with addiction or struggling with any element of mood or emotion.

[904] Yeah.

[905] And so I say that because there are three big things here that you need.

[906] need.

[907] You need education, therapy, which really changes the way that you talk to yourself and understand why am I feeling this way and, you know, picking up the bottle of wine and then medication.

[908] And so all three of those end up helping you get better.

[909] And to your point before, it's like, I'm not saying everyone should like only take medication and never do anything else.

[910] We don't know what's going to work for everyone.

[911] There's also a unique paradox, though, with Suboxone, which is the work one would need to do, Suboxone prevents, in my opinion, from you doing.

[912] So someone could be taking insulin and then still go on the jog and they could still go buy the good groceries and put their fridge in order.

[913] The insulin wouldn't stand in their way from doing that.

[914] Suboxone does stand in your way from dealing with the stuff because it is numbing the part of your brain that is agitated and needs addressing.

[915] So it's weird because the other things that you'd want to couple with Suboxone, the Suboxone itself makes it harder to do that.

[916] Well, so what I would say to that is I don't think there's any one treatment.

[917] You should try multiple treatments.

[918] And I've had a number of patients where they come in and tell me, I don't want to do therapy, I only want to take medication.

[919] Or I never want to take medication.

[920] I only want to do therapy.

[921] In reality, what we see is that if you start one, the likelihood of the other one being a lot more effective goes up tremendously.

[922] And then you add on to that, okay, like, I'm so depressed, I can't get out of bed.

[923] So I'm not going to go do mindfulness if I can't even get out of bed, right?

[924] So maybe first I need that medication that's going to get me out of bed.

[925] And so it's It's stepwise, right?

[926] And just so you know my position, I am very pro -medication for depression.

[927] I believe in SSRI inhibitors.

[928] I believe in that.

[929] I just Suboxone itself is an opiate.

[930] So that's where it gets tricky for me. I'll bring up some other medications.

[931] Naltrexone or antibuse, disulfuram.

[932] Antibuse is awesome.

[933] It's awesome.

[934] It doesn't get you high.

[935] It just is this great backstop for getting drunk.

[936] I love it.

[937] And now trachshone is a medication that decreases your alcohol cravings, or when you do drink, alcohol, the joy you get is a little bit lower.

[938] So what we see when people take naltrexone is that they actually end up drinking less because they're not getting that same, the serotonous dopamine, all of those, the neurotransmitters aren't working in the same way.

[939] The escape they want.

[940] Exactly, exactly.

[941] So Suboxone is its own thing.

[942] The reason I mentioned this is it is important for whether it's alcohol or opiates or anything.

[943] And I grew up in a small town in West Virginia, and the number of my high school classmates who have struggled with or even overdose from opiates is really, really heartbreaking.

[944] So I absolutely hear you on that.

[945] And this is not a problem we need to solve.

[946] I get the parents of a 19 -year -old that are like, yeah, man, whatever.

[947] They're not going to go to AA and figure out what in their child, whatever, they'll be alive.

[948] So I get it.

[949] Like, I understand the other point of view.

[950] I think AA is awesome.

[951] And medications are great, too, is what I would say.

[952] Yeah, me too.

[953] Okay.

[954] Anyways, where I was going with that is, so I'm conflicted because I have this kind of, I think you need to get to the root of your ailments.

[955] and I think sometimes buffering them with medication isn't always the grace.

[956] But with all that said, I have to acknowledge that the world is heading in a direction and it's not going to stop.

[957] There's nothing I'm going to say that's going to stop the direction.

[958] It's heading.

[959] And the direction is getting further and further and further away from how we were designed to live.

[960] We are inhabiting a world that we were not designed to live in.

[961] We're not supposed to be traveling at 90 miles an hour on a highway.

[962] We're not supposed to be interacting with light at 10 p .m. the way we do.

[963] There's all these things we know that the heart.

[964] hardware wasn't set up for it.

[965] And so it seems like we're going to have to make a leap at some point.

[966] And for me, it probably involves hooking your brain up to some electrode gizmo that's going to offset all the stress that this life we've inhabited.

[967] You know, I see a utopian future where maybe we do have an instrument that keeps all of our levels at the right spot.

[968] And then within that lies some kind of ethical question.

[969] What do you think about that?

[970] I'm curious if you think about that machine and if you think about what you want out of life or what life looks like, how do you kind of put that machine together with like the meaning of life, if you will?

[971] Right.

[972] So that's where it gets so complicated because, again, the story of my life, the narrative self is proud of hard work.

[973] It's didn't want to do, but then the result was positive, right?

[974] So that's tricky because that's what I, what I'm proud of Dak Shepard for is those things.

[975] Now, my resting state of well -being might not reflect that at all.

[976] And my resting state of well -being might be happiest scrolling through Instagram, which is a bummer.

[977] And I don't think people should live a life on planet Earth where they stare at a screen all day.

[978] I don't think that's aspirational.

[979] Yet, I don't know.

[980] I don't Oh, is that going to be the only option, you know?

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

[982] I agree with you 100%.

[983] I think that when we think about, like, what brings you the greatest joy in life?

[984] When you're engaging with your family or with your community, when you're making an impact in the world, like that's what we need.

[985] And, you know, today is even a really good point to think about what's going on right now.

[986] We're all in the middle of this quarantine.

[987] And yes, a lot of people are looking at their screens.

[988] And yet what we're seeing is like the best of.

[989] humanity come out.

[990] And we're seeing that people are good and benevolent and want to be able to help other people and give back.

[991] And especially given how many people have lost their jobs or are working from home and very well could be, you know, on screens all day and scrolling through Instagram or whatever, that's not what they're doing.

[992] And if anything right now, when we're in this environment where we actually have so much more screens than we're used to, I think the majority of people are just craving being able to go out and give someone a hug or, you know, take a run outside.

[993] And so I say that because maybe there will be some machine like that, but that's not what it means to be human.

[994] That's not why we got to where we are today.

[995] And that's not what has brought us joy and, you know, helped us move forward as humanity.

[996] A machine like that, I think, would hold us back from creativity and discovery and just, you know, being able to really be ourselves.

[997] I think growth and exploration would die.

[998] Yeah, I think innovation.

[999] Yeah.

[1000] Because if you could, I mean, for me, that machine would have me feeling two beers.

[1001] I'll steal from Gordon Keith.

[1002] We're all born two beers shy of happiness.

[1003] Like that machine would have me at the peak of that second beer before the craving got insane and all the wreckage started.

[1004] But I don't think I'd do anything but hang and talk if that was my resting state.

[1005] I completely agree.

[1006] So I went to Stanford for business school.

[1007] And the admissions essay for Stanford, there's one question that they ask you.

[1008] What matters most to you and why?

[1009] So the answer I gave was community.

[1010] And You know, a lot of this, I think, for me, comes from growing up in a small town in West Virginia where the commitment that my parents and our neighbors all had to community, there was this amazing sense of people working together and supporting each other.

[1011] And even now, you know, I haven't been home in a while and I graduated, what, 18 years ago, the connection I have to my home community is enormous.

[1012] But it's even more than that.

[1013] It's that recognizing the power of what it means to be a part of a community.

[1014] We evolved over time and eventually we're in tribes.

[1015] And now, you know, we're living in a very different society now, but being a part of a community, whether that's a racial community or religious community or professional community, that sense of connection, being connected to each other.

[1016] So much of that is what is just very, very intrinsic and inherent to being human and experiencing joy and love and what it means to like have a purposeful life.

[1017] I think that's something that we're really seeing now in this time of quarantine where people crave that connection to a community.

[1018] They find so much meaning in that.

[1019] And so I say that because there are these other things like you can get dopamine hits by continuing to scroll online or maybe there will be some pill that can help you feel a particular way.

[1020] But these basic things like belonging are so critically important.

[1021] And when I think about also what we need to get better, as a psychiatrist, the state we are in today, I am very concerned because of what we're going through right now with coronavirus and with social isolation, with the financial crisis that has started to come but is only going to get worse.

[1022] We know historically and epidemiologically, when we look to see what happens at a time like this, that we are going to see an increase in depression, suicidality, anxiety, substance use, and trauma.

[1023] Like, we're all collectively going through this trauma.

[1024] And it's not just something that we're going to see for a few months.

[1025] We're going to see it for a few years.

[1026] And so for us, as psychiatrists, as this mental health community, what we're trying to think about now is how do we be proactive?

[1027] Because we know what we're in for and what people are going to be struggling with.

[1028] how do we proactively address that to help people get better so that either, you know, they're going to not face these things that they're facing or because we know it's happening, we can protect them and give them the resources that they need to get better.

[1029] And so I say community, I think community is a huge part of that.

[1030] And Dax, we're talking about AA.

[1031] The AA community is one of the most powerful communities I think we have in the world.

[1032] And the number of people who would say, like, they got their lives back because of being a part of that community is enormous.

[1033] Yeah.

[1034] And, you know, everyone will have a different answer to this because, they're all, you know, that's what's, that's beautiful, that there are different things that are important to all of us.

[1035] But when we think about mental health and what people need to get better, being a part of a community is tremendously important.

[1036] Again, I think AA is a great, is a great testament to that.

[1037] By the way, we talk about mental health so much.

[1038] We do.

[1039] And just that whole psychology component, I feel so, I feel so silly that I didn't think of it in three terms.

[1040] Oh, the other thing we were going to talk about was emotion, actions and behavior.

[1041] So that's the triad.

[1042] That's like the sacred triad, if you will, of cognitive behavioral therapy.

[1043] So But basically what it's saying is if you think about how you feel what you think and what you do, that they're all very much connected, right?

[1044] If you feel sad, then you might think no one likes me. And then the way you might act is you don't go outside and you stay isolated because you think no one likes me, right?

[1045] And then what happens is when you stay inside and isolate yourself, you end up feeling more sad.

[1046] They all have their own momentum, which is so scary.

[1047] Exactly.

[1048] Exactly.

[1049] So the idea behind one type of therapy, cognitive behavioral therapy, is recognizing that there is this loop and these things are all connected.

[1050] How do you then actually break the cycle?

[1051] And so basically what that comes down to is what can you change?

[1052] And if you think about those three areas, feelings or emotions, thoughts and behaviors, what we learned is that it's actually very hard to change your feelings, right?

[1053] If you're feeling sad, if you're feeling depressed, if you're feeling anxious and someone just says to you, stop feeling anxious, you can't do that.

[1054] Even if you tell yourself, stop feeling anxious, you can't do that.

[1055] And it turns out also changing behaviors by itself is also very hard, right?

[1056] Like if you're isolating, telling yourself to get out is actually pretty hard.

[1057] What it turns out, the easiest of those three things to change is your thoughts.

[1058] And so specifically, there's a term called cognitive distortions.

[1059] And what these are are patterns of thoughts that we all have that are unhealthy sorts of thoughts.

[1060] And so I'll give you some examples.

[1061] One is what we call black and white thinking.

[1062] You know, you don't see the shades of gray.

[1063] Either something is great or it's horrible.

[1064] Another would be fortune -telling, which is this thought that, you know, if something happens, you assume that something bad is going to happen, even though there might not be any concrete evidence of that.

[1065] That's just what you think.

[1066] Like your boss wants by your desk and doesn't talk to you.

[1067] You think, oh, he must be mad at me or I'm not going to get the promotion tomorrow or things like that.

[1068] There are 10, 15 or so different patterns like this of what we call cognitive distortions.

[1069] that we all do.

[1070] What happens is that we then believe them, right?

[1071] We think it's true and we don't realize that that's actually false.

[1072] When you do cognitive behavioral therapy with a therapist or with an app, there are a lot of apps that do that now, is that you learn these distortions and then you learn to identify your own distorted thinking.

[1073] So for example, if I say, oh, I ran half a mile, I wanted to run two miles, I ran half a mile, therefore I'm a failure.

[1074] Then I start to realize, wait a second, that's not actually true.

[1075] Actually, I did something pretty good for myself.

[1076] I'm not a failure.

[1077] and you start to understand your patterns of thinking.

[1078] Once you recognize that you have this pattern, then you catch yourself acting in that pattern.

[1079] Then you can actually change that pattern.

[1080] You can recognize for yourself, oh, I am thinking in that distorted way.

[1081] Let me actually correct that.

[1082] And I can say, you know what?

[1083] I wanted to run two miles.

[1084] I didn't get to my goal.

[1085] But that doesn't mean I'm a complete failure because I did run those 0 .5 miles and good for me. And so then when happens is then when you change your thought around that, I actually start to feel better, right?

[1086] I don't feel like I'm a loser or a failure.

[1087] I start to feel better.

[1088] And then similarly, I might act of, okay, I'm going to go try again tomorrow because I feel better about what I've done.

[1089] So that's actually the foundation of cognitive behavioral therapy, which is something that I think needs to be taught in schools.

[1090] It's like, you know, when we say like this should be put in the drinking water, cognitive behavioral therapy should be put in the drinking water.

[1091] I think some schools are teaching it now, but it really should be a mandatory part of curriculum because this is something that whether you've had trauma or depression or substance use, even psychosis, there are forms of cognitive behavioral therapy that help people get better.

[1092] This is all the psychological element of how are we talking to ourselves, how are we thinking?

[1093] And then how are we acting as a result of that?

[1094] That can be changed.

[1095] And cognitive behavioral therapy does that really well.

[1096] That's so interesting because it flies in the face of something I believe to be true, which is you can't think your way into behaving differently, but you can behave your way into thinking differently, which I really do believe that.

[1097] But this kind of challenges that.

[1098] Well, yes and no, I'll give you another loop there.

[1099] So when you want to, Dax, you're really good at exercising, it sounds like, right?

[1100] Yes, that and other physical actions.

[1101] Pick up my phone, call somebody I don't want to call, who wants my help or my counsel or whatever it is, write a gratitude list.

[1102] I can't think of things I'm grateful for.

[1103] But if you give me the task to write a gratitude list, I know I have to write five things.

[1104] I will think of them.

[1105] And then by doing that, I actually reset my thinking.

[1106] But again, it was the physical action that required me. But also, there was a thought before you made the action that if I do this, I will feel better.

[1107] So there was a thought involved.

[1108] It wasn't just that you were blindly calling.

[1109] Well, but most often, the reason I'm doing those things, I don't want to.

[1110] I feel like shit.

[1111] I don't want to do anything.

[1112] I want to feel like a victim.

[1113] and I want to feel like life sucks for me. And then this muscle memory through practice, which has become habitual, is, fuck it.

[1114] I feel like shit, just start doing it.

[1115] Walk downstairs, get on the treadmill.

[1116] Then walk upstairs right on the piece of paper.

[1117] Then pick up the phone and call somebody.

[1118] Like, yes, I am thinking of it, but it's actually contrary action to what I want to do.

[1119] Yeah.

[1120] And the reason I bring up exercise is that everyone, like, knows they should exercise.

[1121] but most people or a lot of people don't do it.

[1122] And what a lot of people have this sense of is I want to feel motivated.

[1123] When I feel motivated, I'll go to the gym.

[1124] Or they want to feel like going to the gym, right?

[1125] Because we've all had times where we felt motivated and then went and did something, right?

[1126] Yeah.

[1127] So you then keep waiting for that feeling or that thought of, you know, I'm going to go do it or that feeling.

[1128] So what holds us back a lot of times from acting is that we're waiting for that motivation.

[1129] We're waiting to feel a particular way before we act.

[1130] We assume that there's this arrow, right?

[1131] Like motivation, arrow, action.

[1132] What we actually know is that about 90 % of the time, and Monica, I know you're fact checking, so this is a good one.

[1133] 90 % of the time, it's actually the other way around where taking the action leads to motivation.

[1134] Right.

[1135] So think about it.

[1136] When you go to the gym, then once you get started, you can keep going.

[1137] My big cheat and I advise it to people, don't make a promise that you're going to the gym.

[1138] Make a promise to yourself that you're going to put your workout clothes on.

[1139] drive to the gym.

[1140] That's all.

[1141] You don't have to do anything beyond that.

[1142] No one's not going to walk in.

[1143] The hardest part is just getting in the fucking car and putting on the outfit.

[1144] So everyone can put an outfit on and get in their car.

[1145] Exactly.

[1146] That behavior, when you actually engage in the behavior, then the feeling actually comes.

[1147] And then by the end of the workout, everyone feels great, right?

[1148] You're like, oh, this was awesome.

[1149] I want to do it again.

[1150] But then the next day happens and you want to hit the snooze button.

[1151] Tell yourself, oh, I have too much work to do.

[1152] I'll go that link between the thoughts, the actions, and the emotions, and at the same time, exactly what you're talking about is true, which is that it's much more likely that the action changes the feeling than the feeling leading to the action.

[1153] This is specifically around motivation and action.

[1154] And so what to me seems very inherent in the cognitive behavioral therapy approaches, your conviction and your conclusion about your feeling needs to be challenged.

[1155] You need to absolutely say, I might not know shit.

[1156] I I might be completely fucking wrong.

[1157] All of us are completely fucking wrong all the time.

[1158] And you have to start with the admission that we're all completely fucking wrong all the time.

[1159] And you have to be diligent and try on other conclusions.

[1160] Right.

[1161] And feelings are such a good example of that.

[1162] We have hundreds or thousands of feelings a day.

[1163] We also have hundreds and thousands of thoughts a day.

[1164] I don't know the exact number.

[1165] Monica will look this up and tell us.

[1166] Both thoughts and feelings, right?

[1167] Throughout the day, if you were going to add it up, hundreds, maybe thousands.

[1168] What's the likelihood of all of those being correct?

[1169] Right, right, right.

[1170] Even if you're IBM blue, yeah, you're in the 90s.

[1171] You're talking about several thousand conclusions being wrong.

[1172] We were talking before about what's so hard about something like depression or anxiety versus something like cancer is that with cancer, you can see there's this external manifestation.

[1173] When one is struggling with their mood or their emotions or their thoughts or any of these things, there's this first this sense of this is who I am, this is what I'm thinking.

[1174] But then when you think something, it never crosses your mind.

[1175] could my thoughts be wrong, right?

[1176] Or could a disease be impacting my thoughts?

[1177] Yes.

[1178] And this is why I think it's so crucial for people to have an objective outsider hearing knees and having trust in that person where they can point out this habitual pattern that you find yourself in.

[1179] You will find data to support your crazy fucked up theory about why you feel the way you are.

[1180] Like you got to get someone else involved.

[1181] Right.

[1182] Absolutely.

[1183] I'll talk about depression.

[1184] So when I was depressed, you know, I'm an extroverted person.

[1185] When even at the worst times of my depression, I still felt happy.

[1186] When someone would be around me, I would feel really happy.

[1187] I was thrilled to be there versus my conception of depression was like Eeyore and Winnie the Pooh.

[1188] It was this sense of someone who's sad.

[1189] And I was successful for these objective metrics of success or, you know, what success means is maybe different.

[1190] You were productive.

[1191] Let's call it that.

[1192] I was productive.

[1193] I was at Harvard Medical School.

[1194] I was working on the Obama campaign, I was happy when people were around.

[1195] But then what was happening is I was tremendously procrastinating.

[1196] In terms of getting things done, it would take me hours and hours, literally just to like read a page in a textbook.

[1197] But I didn't realize that I was depressed because that image of what depressed looked like was not how I was actually thinking or feeling.

[1198] And when I think of what it looks like to be depressed, that wasn't me. I didn't have the sense of how can you be successful and how can you be happy and be depressed the same times.

[1199] I knew there was something going on with me, right?

[1200] There was something wrong.

[1201] But it didn't seem like depression because there were these other things that I could convince myself, oh, it must be this or it must be that.

[1202] And to your point, someone else is actually then able to see.

[1203] And what was happening for me, I was cancel plans with friends.

[1204] I love going out with people.

[1205] But last minute, I would cancel left and right and say something else is going on.

[1206] And only then when someone saw me for like a month at a time and realized, oh, wait a second, this is not a one -time thing.

[1207] This is a pattern.

[1208] I think something's wrong with you, then I was able to actually recognize, oh, wait a second, you know, maybe this is something else.

[1209] Like the classic measurement for depression is a scale called the pHQ9.

[1210] And this is something where if you think you're depressed, you can get online, Google, depression scale, ask yourself these questions.

[1211] There are nine different questions.

[1212] And what it comes down to is things like, you know, how is your sleep and do you feel like you're a failure?

[1213] And all these things, I was saying yes, yes, yes, too.

[1214] And, you know, only then was I able to actually realize, oh, wait a second, that's depression.

[1215] What's that test called again?

[1216] PHQ 9, it stands for patient health questionnaire 9, and there are nine questions.

[1217] What it asks you to do is think about the last two weeks of your life.

[1218] How often did you feel a particular thing, one of these nine things?

[1219] What it starts to get at is different symptoms.

[1220] Another element is what we call psychomotor.

[1221] So do you feel heavy and slow, like actually physically feel that?

[1222] Or are you jittery and you're like moving around in all these different directions and you can't sit still?

[1223] A symptom of depression.

[1224] You know, for your audience to know, both there's, it's a piece of, PHQ 9 for depression, as well as another scale for anxiety called the GAD 7, which stands for generalized anxiety disorder 7.

[1225] So that one has seven questions.

[1226] Both of these are on a scale of zero to three, looking over the last two weeks, how often did you feel this?

[1227] And what happens when you take that test is it tells you, number one, you know, are you depressed, yes or no?

[1228] Are you anxious, yes or no?

[1229] But then where are you on that spectrum?

[1230] Is it that you're severely depressed or severely anxious?

[1231] Maybe you're somewhere in the middle.

[1232] Maybe you're actually okay.

[1233] And the reason why tests like this and measurements like this are so helpful is because it's really hard for us to tell for ourselves how we're doing.

[1234] Someone else is much better able to actually see that.

[1235] But a lot of people don't have someone there who can tell you, right?

[1236] If you're living by yourself or especially now when you're isolated in quarantine, it's really hard for someone else to know that something's going on with you.

[1237] So these questionnaires can be really helpful to you.

[1238] And this is not a diagnosis, right?

[1239] In order to get diagnosed, you need to see a doctor.

[1240] If you take this scale, this test, the PHQ 9 or GAD 7 and see that you're moderately or severely anxious or depressed, that's a really, really good sign to go do something about it and get some help.

[1241] I'm a little triggered that it's out of three.

[1242] I just got to say, everything should be 10.

[1243] Any scale that doesn't go out of 10 is, do we learn nothing from the standard measurement system?

[1244] I do like 10s.

[1245] Actually, real 10.

[1246] I'll tell you about the real 10s.

[1247] So I'm a professor at Stanford, and I teach two courses on mental health innovation.

[1248] And actually, you guys should come and lecture at Stanford.

[1249] Oh, we would love to be guests of Stanford.

[1250] Would you?

[1251] That's the only way we'll get there.

[1252] Yeah, unfortunately.

[1253] Come and be a guest lecturer in my class next year.

[1254] Once shelter in place ends and you can come in person, come and lecture in the class, talk about what you're doing.

[1255] It would be awesome.

[1256] Love it.

[1257] Done.

[1258] So my lab is focused on innovation.

[1259] What you're doing here is, you know, really, really awesome.

[1260] So you're going to come lecture at Stanford.

[1261] That's number one.

[1262] Number two, the first time I taught this course was two years ago.

[1263] And Ariela was a student in my class.

[1264] She was a senior at Stanford studying computer science and math.

[1265] So really, really smart kid, right?

[1266] She was in my class.

[1267] And what my class is doing is trying to teach you how to actually create a solution in mental health.

[1268] And so the class is all around mental health innovation.

[1269] And for a lot of people that's starting a company, that might be creating a technology, it might be starting a nonprofit or proposing a new policy.

[1270] This class is very interdisciplinary.

[1271] We have folks from medical school, law school, business school, engineering school, education school, just all different perspectives who are all interoperatives who are all interested in solving mental health in some way.

[1272] And so what I love about being a professor is that these students are just brilliant and have great ideas about, you know, change that we need to make in the world.

[1273] And Ariello was one of those students.

[1274] She was one of the best students in the class by far, probably teacher's pet.

[1275] And I know I probably shouldn't say that as a professor, but totally teacher's pet.

[1276] So you.

[1277] She was you.

[1278] In junior high school, I did get teachers pet actually when we had those end of the year's superlatives.

[1279] I have a teacher's pet every year.

[1280] But we'll don't say it was just seventh grade.

[1281] Not when I was little.

[1282] In elementary school, when we had parent -teacher conferences, I would always get in trouble because the teachers would say, you know, oh, you know, she's nice and she's good in class, but she talks too much or she talks too loudly.

[1283] So I always got in trouble because of that.

[1284] I had some elementary school issues, too.

[1285] I stole someone's cookies and sand art. I got in trouble.

[1286] I got in trouble as a little kid for sure.

[1287] I love the stealing cookies.

[1288] That's great.

[1289] So Ariela had a friend who attempted suicide, and that really voted.

[1290] her to try to understand more about the mental health care system and why is it so broken.

[1291] And so that's what led to her creating Real.

[1292] And so Real is basically this really innovative company that's trying to address mental health in a very different way.

[1293] And so, you know, I'm a psychiatrist.

[1294] I'm in the health care system.

[1295] And we know that the health care system is broken in terms of being able to deliver quality health care to everyone who needs it.

[1296] And that's what Ariel is trying to do with Real.

[1297] It's basically the idea is meet people where they are.

[1298] That's the kind of value and philosophy behind it.

[1299] And so what she's done is, is it's almost like Peloton for mental health.

[1300] Or if you think about, you know, with exercise, right, you're trying to go to the gym.

[1301] You have every option from having a one -on -one trainer all the way through doing, you know, group classes.

[1302] Or even now, you can watch videos online, right, and do these workouts when you're in your living room.

[1303] That's basically what Real is doing for mental health.

[1304] So they're offering this huge range of services so that regardless of what type of treatment you need, what type of therapy with whom you want to do it in, whether you want groups or you want one -on -one, the whole offering is there for you.

[1305] Real was and will be in person.

[1306] But because of what happened then with coronavirus and recognizing that we're all at home, they created this whole digital platform to be able to offer treatments and therapies to people online.

[1307] How cool.

[1308] Everything from teletherapy, right?

[1309] Like having those one -on -one sessions with these amazing therapists.

[1310] But this whole range, including events and salons and what we call pathways.

[1311] So the thing about mental health that I think that people find frustrating a little bit with therapy is that when you go into therapy, It almost feels like you enter this ether and you don't know what therapy is going to look like.

[1312] You don't know what you're going to get.

[1313] You don't know when you're going to get it.

[1314] You just sort of go in and it's like you have to wait for your therapist to guide you.

[1315] With Real, we've actually created what we call these pathways around particular issues you might have.

[1316] So maybe it's, you know, stressed around being single during coronavirus or maybe it's pleasure and sexuality or, you know, how to cope with depression or how to talk to your partner.

[1317] Like there are all these different issues that we end up having.

[1318] And so Real actually offers you these customized pathways.

[1319] pathways that are personalized for the actual issue that you're going through.

[1320] So everything from, you know, videos, therapists teach you different things to activities, you know, things like gratitude journaling, right?

[1321] Or even like your own personalized meditation.

[1322] And the reason why we're doing this is what we see with mental health is that there's a different solution for every single person, right?

[1323] We don't all fit into this box.

[1324] And just like with exercise where we all want different things and we all need different things in order to get healthy, that's what Reel is offering.

[1325] It's not just like that standard one -on -one, you know, 45, 50 -minute session with the therapist, which we do have.

[1326] But we also have all these other things so that what we wanted to be able to do is democratize mental health so that no matter who you are, you know, you would be able to afford treatment and get the actual right treatment for you.

[1327] It's so crucial.

[1328] Yeah, because I think a lot of times when we're talking about mental health on this show, people are in their cars delivering pizza going like, that's awesome, rich people.

[1329] That's cool that you can do that.

[1330] I can't.

[1331] So that's awesome.

[1332] How do people go there?

[1333] Join -hyferreal .com.

[1334] Instagram is at JoinReel.

[1335] I think all the social media handles are at Join Reel.

[1336] And Reel's motto is what I love, celebrate therapy.

[1337] Uh -huh.

[1338] I think that's really, really important because it's not just that we want to make it okay, right?

[1339] It's not just that we want to like take stigma away and say that, oh, it's okay to get treatment for mental health.

[1340] It's okay to go to therapy.

[1341] We're taking out one step beyond that.

[1342] No, it's a party.

[1343] It's a party.

[1344] I look forward to my Tuesday night a meeting like I'm going out dancing.

[1345] truly right and you feel so good about it right like when you go to the gym when you go to your a meeting you know you're taking care of yourself you know you're doing something great for your health literally it's like you get that gold star right like you did a good thing for yourself and that's exactly the experience that we want everyone to be able to have of celebrating therapy and realizing i'm doing something good for myself because we need to change the culture and dialogue around therapy and around mental health it needs to not just be something that oh there's something wrong with you when someone's going to go see a personal trainer right you think that is someone who values their physical health and they're doing something good for themselves.

[1346] That's the same way that we need to think about therapy and mental health is I value myself.

[1347] I value my mental well -being.

[1348] And I celebrate that I am investing in myself and doing something about it.

[1349] Well, Nina, we love you.

[1350] We're going to see you again.

[1351] We're going to connect you with Dr. Eric Topol.

[1352] Yes.

[1353] We are now professors at Stanford.

[1354] Yes.

[1355] Professor Dax, Professor Monica.

[1356] Oh, my God.

[1357] And we can't wait to talk to you again.

[1358] So thanks so much for your time.

[1359] Great talking to you.

[1360] And now my favorite part of the show, the fact check with my soulmate Monica Padman.

[1361] Welcome to a no power fact check in the attic.

[1362] I wish it was in the dark so it would be spooky, but it's light.

[1363] You don't like being spooked.

[1364] Are you sure you'd like to?

[1365] I don't, but I do.

[1366] You know, it's a mixed message.

[1367] Now, I just was away for two days.

[1368] I'm back to work on Top Gear.

[1369] Yeah.

[1370] And so I had an evening in a hotel room by myself.

[1371] You did.

[1372] And I plowed through so much TV.

[1373] Oh, my gosh.

[1374] And I've come back to report all these good things, I discovered.

[1375] Tell us about your discovery.

[1376] Okay, Westworld's phenomenal.

[1377] Now, I know, well, what I've heard is that the quality of the seasons varies a bit.

[1378] So I guess some people have been mad about certain seasons.

[1379] I've just kind of heard that, rumblings of that.

[1380] But I'm telling you, the first couple episodes I watched were dynamite.

[1381] And also I watched the Roy Cohen documentary in HBO, which was phenomenal.

[1382] I know you're in the park.

[1383] That's not very fun yet.

[1384] Just at the beginning.

[1385] Yeah, but boy, if you go the whole distance, what a personal story.

[1386] It's crazy.

[1387] I got really distracted by watching a video of a girl giving her boyfriend a haircut.

[1388] And you found that really soothing me. I did.

[1389] I found it very satisfying to watch and I really want to give someone a haircut now.

[1390] Oh, you do.

[1391] Yeah, okay.

[1392] Like you.

[1393] Well, but here's the thing.

[1394] I was going to suggest maybe someone who's not on TV, filming on TV currently.

[1395] I need the stakes to be high.

[1396] No, no, no, no, no, no. You need to practice on Jess and work your way through the friendship circle and so you get to the on -air person.

[1397] Fine, fine, fine.

[1398] I mean, you agree it's kind of high risk, right?

[1399] Yeah, that's what I like about it.

[1400] I might have to drug you and then hold your head up with some.

[1401] It'd be worth it because that'd be a freebie for me. If you just drug me and I had.

[1402] No, but I mean drug in like a. Oh, dragged?

[1403] No, drug with drugs.

[1404] Uh -huh.

[1405] But I give you so much that you're almost dead.

[1406] Still sounds good.

[1407] Oh, no. That sounds good.

[1408] Yeah, like obliviation.

[1409] Obliviation was the goal.

[1410] Oh, wow.

[1411] Yeah, to obliterate myself.

[1412] But you're so out of it that I have to tie your head up to be upright with like some rope.

[1413] My drinking took some turn with about a year left.

[1414] Okay.

[1415] Where it got to a very specific spot.

[1416] And I've talked to other people about this.

[1417] Brie would go to bed.

[1418] get drunk together.

[1419] Yeah.

[1420] It would be like a social drunk.

[1421] And then she'd go to bed.

[1422] And then I would turn it up.

[1423] And I would sit in my lazy boy and I would drink to a point where, and I don't know why I wouldn't throw up, but I would be obliterated.

[1424] Like I could almost not think.

[1425] And that's what I ended up loving.

[1426] You loved that?

[1427] I loved it.

[1428] And I would do it every night.

[1429] And it was so bad.

[1430] It was so fucking bad.

[1431] What did you like about it?

[1432] I guess I just couldn't think like I was in cable.

[1433] of evaluating my life.

[1434] Sounds like you needed an antidepressant.

[1435] I think I probably did.

[1436] It's really what you needed.

[1437] I don't have that at all.

[1438] I don't have ever desire.

[1439] Like I don't...

[1440] To disappear.

[1441] I don't like numbing.

[1442] Yeah.

[1443] I like drinking, but not for a numbing effect.

[1444] Right.

[1445] For an effervescent effect.

[1446] A bubbly.

[1447] Yeah.

[1448] Looser.

[1449] Exactly.

[1450] Yeah.

[1451] Yeah, I think that's what makes it very addicty is when you want total an eye.

[1452] I guess I must have been semi -desiring death.

[1453] I mean, like, I must have been semi -suicidal that I was trying to just be gone, entirely gone.

[1454] And when the Michael Jackson stuff came out, like him doing Propheaval every night, I was like, yeah, I understand that desire.

[1455] like kill me every night so I don't have to evaluate my life.

[1456] Oh, so sad.

[1457] I think that's, I think a lot of people feel underwater in that way.

[1458] Yeah, and I also hadn't really, I think, fully dealt with some past traumas or, yeah, work through some stuff.

[1459] I don't, I don't know.

[1460] Yeah.

[1461] I'm certain if I drank, I'm sure I would quickly find my way back there.

[1462] Although, someone got, this was, we figured out this mystery.

[1463] This is the craziest mystery.

[1464] So when I went to the track, De Castro got me some Heineken Zero Zero's, some alcohol -free beers.

[1465] Yeah.

[1466] And I had one.

[1467] And then he said, bring this thing home.

[1468] I'm never going to drink it when the track day was over.

[1469] So I brought it back to the house, right?

[1470] Yeah.

[1471] And I opened one of them.

[1472] And I took half a sip.

[1473] And my first thought was, oh, my God, this went bad.

[1474] It must have got hot in the sun.

[1475] And then I was like, no, it didn't go bad.

[1476] That's alcohol.

[1477] What, really?

[1478] Yes.

[1479] And so this fucking, so I'm telling Carly about it.

[1480] I mean, I don't understand why there was an alcohol one within the 12 pack.

[1481] That feels like you could sue or something, whatever.

[1482] Yeah.

[1483] So Carly, like, really investigated it.

[1484] And once she discovered, she found the 12 pack.

[1485] The 12 pack came with three free beers.

[1486] And the three free beers were zero zeros.

[1487] I guess so people will try them who are getting normal beer.

[1488] Like here's.

[1489] So it was normal beer.

[1490] The 12 -pack was 12 normal beers in 3 -0 -0s.

[1491] And on the fucking box, it says 0 -0.

[1492] Oh, my God.

[1493] It's so dicey.

[1494] That's not safe at all.

[1495] So you just happened to have one of the three non -alcoholic ones when you were at the track?

[1496] Yes.

[1497] Well, I assumed a castor opened up the top and grabbed what I guess was maybe the three bonus beers and put them in the cooler and I had had one at the track.

[1498] Oh, wow.

[1499] And then I brought the thing home.

[1500] It was very, I mean, it said zero -zero.

[1501] on the 12 -pack.

[1502] Ooh.

[1503] But there was real beer inside.

[1504] I mean, it makes total sense for them to try to get people interested in their zero -zero beer.

[1505] It's like, yeah, you're buying a 12 -pack.

[1506] Let me show you how good these alcohol free ones taste.

[1507] But don't put it on the package.

[1508] Don't put it on the package.

[1509] Yeah.

[1510] Because you've got to think of it went the other way.

[1511] Like, I bet they were just locked into like, we got to introduce these beer drinkers who love beer and they don't want to get drunk during the day.

[1512] Try these.

[1513] That makes sense.

[1514] Sure.

[1515] They also need to like really label them incredibly.

[1516] different and then don't label it zero zero on the package.

[1517] Oh boy.

[1518] That's not great.

[1519] Well, anywho, that's what, that's what happened.

[1520] Wait, so was it hard for you to dump it out?

[1521] No. It wasn't?

[1522] No, no. It would be hard for me if I felt a buzz, then I'd be very scared.

[1523] I don't know how I would dump it out.

[1524] If I felt a buzz, I would probably need to maintain that buzz.

[1525] Well, I don't know.

[1526] It's all hypothetical.

[1527] I'm just, all it was was a take.

[1528] Yeah.

[1529] And I'm like, oh, that's bad.

[1530] That turned bad.

[1531] I'm like, no, no, that's, I remember this.

[1532] This is alcohol.

[1533] Oh, boy.

[1534] Yeah.

[1535] I'm just thinking about it.

[1536] It scares me. It does.

[1537] I know.

[1538] I know.

[1539] I wish it didn't.

[1540] I'm sorry it does.

[1541] I know it bothers you.

[1542] Well, I just wish it didn't scare you.

[1543] It only scares me because I care about you so much.

[1544] Yeah.

[1545] Yeah, it's very flattering.

[1546] Also, because I know that you work so hard.

[1547] So if that is at risk, I feel very sad and scared for you.

[1548] Right.

[1549] I'd say over the last 16 years, I've had probably five sips of alcohol.

[1550] Very memorable ones.

[1551] My favorite one was with my friend, and we were at Jackson Hole.

[1552] And he ordered a ginger ale and I ordered a Diet Coke.

[1553] And then my Diet Coke had Jack Daniels in it.

[1554] Yeah, yeah.

[1555] It's not their problem.

[1556] I love Heineken and I love zero -zero -zero's and people should try them.

[1557] They're very delicious.

[1558] I'm very pro -Hineken Zero.

[1559] Maybe they were worried if they didn't put zero -zero on the box and someone popped up, one of those three bonus beers open and it didn't have alcohol in it they'd be up furious all of it's kind of bad yeah like i be pissed yeah yeah yeah no one's gonna be happy probably i consumed all these calories for no reason and i'm like i'm not feeling it what's going on i'd be pissed i've had three beers and i feel nothing and on an empty stomach okay so nina this is all so apropos that's right because Nina is all about mental health.

[1560] And after we talked to her, I texted her and said, I think I need to be on some medication.

[1561] Can you help me find a psychiatrist in my area?

[1562] Or what do you think or whatever?

[1563] And so we chatted a good bit.

[1564] And then I had an appointment with my psychiatrist two days ago.

[1565] And he prescribed me with an antidepressant.

[1566] And I'm picking it up today.

[1567] Are you nervous to?

[1568] Yes.

[1569] It's really funny.

[1570] I mean, I understand it.

[1571] Yeah.

[1572] Everyone's nervous about anything.

[1573] But the one thing I don't understand about people being nervous to try it is like, you don't like it.

[1574] You just stop taking it.

[1575] Yeah, for sure.

[1576] Does it feel like a weakness?

[1577] Do you feel like, oh, I should be able to overcome this with exercise and?

[1578] No, weirdly no. I'm more just nervous.

[1579] It's going to change something about me that I like.

[1580] Right, right, right.

[1581] But it most likely will just change something I don't like.

[1582] I think so.

[1583] It's not going to rob you of anything other than your misery.

[1584] Exactly.

[1585] But what if misery causes that?

[1586] I don't know.

[1587] I don't think it does.

[1588] I don't think it does either.

[1589] But it took a long time to get to that point.

[1590] Well, I occasionally said, did you end up talking to that psychiatrist yet?

[1591] And it was annoying, right?

[1592] No, it wasn't annoying.

[1593] Okay, good.

[1594] I'm not annoyed like you're annoyed when I get nervous about the alcohol.

[1595] So I'm going to start it, I guess, tomorrow.

[1596] And my hunch is you will not.

[1597] feel anything.

[1598] Yeah.

[1599] That's what my psychiatrist said.

[1600] Yeah, you won't feel anything.

[1601] You just won't get in the gutter.

[1602] That's what he said.

[1603] The goal is to, it's like almost treated like a vitamin.

[1604] In retrospect, you'll be able to look back and be like, oh, I had less or irritability or less lows.

[1605] Less tantrums when there's not another episode of last dance.

[1606] I'm always going to have tantrums.

[1607] No, I don't know about that.

[1608] I want those to stay.

[1609] Oh, okay.

[1610] You love your tantrums.

[1611] You mean the medication that's going to let me keep my tantrums.

[1612] They're really pivotal in my life.

[1613] But I do have to credit Nina, because I had been on the fence about this for a really long time and thinking like, I probably should.

[1614] I think I might need to.

[1615] And after that episode, I was like, I'm going to.

[1616] Yeah.

[1617] Shocker, I'm arrogant.

[1618] And I thought I knew most stuff about psychiatry.

[1619] Yeah.

[1620] And the third whole window of it.

[1621] Biosynosocial, yeah.

[1622] Yeah, I didn't even know.

[1623] So I found the whole thing really, really informative.

[1624] And I just adored her.

[1625] She was fun.

[1626] Yeah, she's spunky.

[1627] Okay, so her facts.

[1628] Yeah.

[1629] She's from West Virginia and she said it's the widest state in the country.

[1630] Maine is the white estate in the country.

[1631] 95 .5%.

[1632] Oh, my God.

[1633] Then New Hampshire, then West Virginia.

[1634] Okay.

[1635] So top three.

[1636] Yeah.

[1637] Top three.

[1638] And maybe when she was living there, it was number one and it's, you know, drop.

[1639] What do we think is the blackest state in the country?

[1640] Probably Michigan.

[1641] Illinois, Michigan, Texas might be up there, Houston's very blind.

[1642] I wonder if Georgia because of Atlanta, but there's so many.

[1643] Only Atlanta.

[1644] Let me look it up.

[1645] Let's look it up.

[1646] Okay.

[1647] Version Islands.

[1648] We're not counting that.

[1649] Okay.

[1650] I don't count that.

[1651] Contiguous.

[1652] Okay.

[1653] Number two is District of Columbia.

[1654] Oh, sure.

[1655] Yeah.

[1656] Of course.

[1657] 50%.

[1658] This is 2010, though.

[1659] I bet some of this has changed.

[1660] This is the 2010 census.

[1661] We'll get new census.

[1662] So there's a big clue in there.

[1663] That's number two or number one?

[1664] D .C. was number two.

[1665] Virgin Islands was number one.

[1666] Oh, so there's a good clue in there.

[1667] So also D .C. has to have the highest urban versus rural population.

[1668] There's no rural population in D .C. Is there not?

[1669] No, virtually not.

[1670] It's really tiny.

[1671] And there's a little bit of suburbs where the embassies are.

[1672] But in general, the whole place is a city.

[1673] That's why I think Illinois will be high up there.

[1674] What's after D .C.?

[1675] Sure.

[1676] 37 .3.

[1677] Four is Louisiana.

[1678] Uh -huh.

[1679] And five is Georgia.

[1680] Oh.

[1681] So the bayou is really.

[1682] Yeah, the south.

[1683] I mean, that makes sense.

[1684] Maryland, South Carolina.

[1685] What did you say you thought was?

[1686] Yeah, I thought Illinois would have been high up there.

[1687] Illinois is number 16.

[1688] That's not very high.

[1689] I mean, it's in the upper one -third, but give me the top 10.

[1690] Okay.

[1691] So, D .C., forget that Virgin Islands.

[1692] D .C., Mississippi, Louisiana, Georgia.

[1693] Alabama?

[1694] Nope.

[1695] Maryland.

[1696] Oh, yeah.

[1697] South Carolina.

[1698] Oh.

[1699] Alabama.

[1700] Okay.

[1701] North Carolina.

[1702] Oh.

[1703] And then we'll add a next, since we're taking out number one, we'll add one, Virginia.

[1704] Okay.

[1705] Michigan didn't even make it in there.

[1706] Michigan's number 18.

[1707] I'm surprised.

[1708] I really thought that would be much higher.

[1709] Yeah.

[1710] I guess Detroit's only just a small.

[1711] It's a small.

[1712] That's a small.

[1713] Yeah.

[1714] This might have changed.

[1715] If you had done like 93 when I live there, and there was still close to a million people in the city.

[1716] Yeah.

[1717] I think now there's, I don't know, I got this all wrong one other time.

[1718] I'm not going to try it again.

[1719] I thought Grand Rapids had as many people as Detroit.

[1720] And that was wrong.

[1721] Someone told me it passed Detroit for population in passing, like maybe at a grocery store.

[1722] And I just like, yeah, all right, I believe that.

[1723] Oh, my God.

[1724] 2020 census should be we'll get those results soonish next year I would hope yeah I did it everyone should do the census you should yeah because for my facts mainly yeah if you want the facts to be clean and accurate that's right so yeah white estates are Maine New Hampshire West Virginia Iowa Idaho Wyoming Minnesota North Dakota okay have you seen that picture of Ruby bridges going around she was the first black girl to go to a white school.

[1725] Oh.

[1726] And she's six years old and like the, I don't know, FBI.

[1727] Some people had to like escort her in and there was all these like protests every day of this little cute little six year old walking into the school is so horrifying.

[1728] And a lot of the kids, the white kids in her class parents pulled them out of school.

[1729] Oh, geez.

[1730] And so she had her and her teacher.

[1731] So her teacher was just like teaching her and there's this picture of her.

[1732] She's the smartest person ever to live.

[1733] Yes, one -on -one instruction.

[1734] And there's this picture of her with her teacher now.

[1735] And Ruby Bridges is so young.

[1736] I mean, she's in her 60s.

[1737] She's younger than your mom, I think.

[1738] Really?

[1739] Yes.

[1740] And you see this like this person.

[1741] This is five minutes ago.

[1742] This is five minutes ago.

[1743] Yeah.

[1744] Yeah.

[1745] It's anyway.

[1746] Okay.

[1747] So she said 90 % of the time taking action leads to motivation.

[1748] I think I was supposed to fact check the number 90%.

[1749] I looked and I couldn't really find that.

[1750] But it's true.

[1751] Yeah.

[1752] So she said we have hundreds and thousands of feelings a day and hundreds of thousands of thoughts a day.

[1753] It was found that the average person has about 12 ,000 to 60 ,000 thoughts per day.

[1754] Of those thousands of thoughts, 80 % were negative.

[1755] and 95 % were exactly the same repetitive thoughts as the day before.

[1756] Oh, Jesus.

[1757] Oh, man. And then there's another, like, similar study that has 70 ,000 as the main number.

[1758] Uh -huh.

[1759] But, yeah, a lot of people say 12 to 50, but in that, in that range.

[1760] Now, does this sound like a pat on the back to say that I think I'm in the 100 ,000 range?

[1761] No. I mean, does that sound like I'm bragging?

[1762] No. I don't think it's brag.

[1763] Well, oh, I see what you mean.

[1764] Like, I'm never not having a thought.

[1765] Like, I'll often look at Kristen, I'll go like, what are you thinking about?

[1766] And she'll go, oh, oh, I don't know.

[1767] Yeah.

[1768] Oh, I'm always.

[1769] She must be thinking about something, though.

[1770] I mean, no one is just not thinking.

[1771] Just white.

[1772] Yeah.

[1773] I don't think so.

[1774] I'm always thinking about something, too.

[1775] But sometimes that thought is long.

[1776] Yeah.

[1777] Like, I can really think about one thing for a long.

[1778] time.

[1779] Yeah, me too.

[1780] But also, something happens on TV, right?

[1781] Like one frame.

[1782] And then I'm off to the races, right?

[1783] And then I miss a scene and I say, what, what?

[1784] And I'll say, I got to go back.

[1785] And Crystal, I'll be like, why you got to, and I'll go, well, I started thinking about this, then this, then this, then I mean, and it's generally like, I thought of 30 things in that, a minute and half.

[1786] Like, I went on this little ride and it took me to, you know, I guess that's everyone does that.

[1787] I, I don't know if everyone does.

[1788] I think I do.

[1789] Part of it, is probably, again, I don't want to say a depression, but kind of.

[1790] Like, it's a spiral.

[1791] Like, our brains are maybe more apt to spiral out.

[1792] Because even when I was talking to my psychiatrist, one of the questions he asked me was, if you're reading a book, can you concentrate on it?

[1793] And I was like, no. I definitely can't.

[1794] Now that I think about it.

[1795] Did you go, well, I've bought 120 books in the last year and I've read none of them.

[1796] So, yeah, I guess that is why.

[1797] No. That's a good indicator.

[1798] Yeah.

[1799] If you can't focus on the thing.

[1800] Yeah.

[1801] And I definitely can't.

[1802] I'll use that as a benchmark once I start my medication.

[1803] I am reading a pretty good book right now.

[1804] Okay.

[1805] And then seems as if there are 27 human emotions.

[1806] Oh.

[1807] I had a list, but they're on my computer.

[1808] And there's no power.

[1809] And now there's no power.

[1810] So sorry.

[1811] They're actually.

[1812] 27 human emotions new study finds in previous thought it was understood that there were six distinct human emotions happiness sadness fear anger surprise and disgust but scientists have now found that the number is as many as 27 though it is not telling me the frequency of which you come in and out of an emotion I couldn't find that yeah I don't feel like I have what did she say how many hundreds and thousands of thoughts yeah I don't feel like I have thousands of emotions a day maybe my mine I'm dead.

[1813] No, I think it's supposed to be less.

[1814] I think that would be really not good if you had a thousand, a thousand, a jackhammer of emotion all day.

[1815] Exactly.

[1816] Well, and I guess some people do, and that's when to seek.

[1817] Some help.

[1818] Yeah.

[1819] So, um, that's all for Nina.

[1820] That's all for Nina?

[1821] Yeah.

[1822] Well, I really, really like her.

[1823] And for the people that weren't watching her on Zoom, if you're single and you live in the Bay Area, you should be dedicating your life to finding her and wooing her.

[1824] I mean, don't stalk her.

[1825] I'm not advocating stalking her, but she's a real catch.

[1826] Yeah.

[1827] So if you're in the Bay Area, you can probably find her.

[1828] Sure.

[1829] Yeah.

[1830] Hot and smart.

[1831] Those are good things to be.

[1832] Big assets.

[1833] Yeah.

[1834] Okay.

[1835] That's all.

[1836] All right.

[1837] Love you.

[1838] Love you.

[1839] Follow armchair expert on the Wondry app, Amazon music, or wherever you get your podcast.

[1840] You can listen to every episode of armchair expert early and ad free right now by joining Wondry plus in the Wondry app or on Apple podcasts.

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