Chris Palmer (Harvard psychiatrist on brain energy)

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

[1] I'm Dan Shepard, I'm joined by tiny torso.

[2] Self -proclaimed tiny torso.

[3] I did not.

[4] No, the eye side.

[5] You have a very long torso.

[6] I don't, I don't.

[7] It's objectively teeny tiny.

[8] It's one inch.

[9] It's long as a summer night in Anchorage, Alaska.

[10] Today we host Dr. Chris Palmer, who's an assistant professor of Psychiatia.

[11] at Harvard Medical School and the director of the Department of Postgraduate and continuing education at McLean Hospital.

[12] Dr. Palmer has an incredible book that we talk about at length.

[13] We even diagnose Monica in this, where we don't diagnose, but we thought maybe I should start a new career path.

[14] Treatment, yeah.

[15] Treatment.

[16] He's got an incredible new book.

[17] It's called Brain Energy, a revolutionary breakthrough in understanding mental health and improving treatment for anxiety, depression, OCD, P .T. ESD and more.

[18] This is a very fun paradigm challenging look at psychiatry.

[19] Yes.

[20] I really enjoyed it.

[21] And Chris was a sweetheart.

[22] Very, and told a very personal story.

[23] Yeah, beautiful, vulnerable, nice story.

[24] I really liked them.

[25] Yeah.

[26] That was a fun episode.

[27] All right.

[28] Well, buckle your tiny torso off.

[29] It's time for Dr. Chris Palmer.

[30] Wondry Plus subscribers can listen to armchair.

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

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

[34] How are you?

[35] I'm well.

[36] Nice to meet you.

[37] You're visiting from Massachusetts.

[38] From Boston.

[39] And where are you staying?

[40] Downtown.

[41] The Marriott.

[42] Oh, wonderful.

[43] It's good.

[44] Not too far.

[45] You get to pick.

[46] before you stay?

[47] I mean, presumably.

[48] Why downtown?

[49] Tell me about that.

[50] Well, I've been rotating.

[51] So I stayed in Beverly Hills first time.

[52] Okay.

[53] And that was not fun.

[54] Because too boring or?

[55] Well, at least where I stayed, it was strip malls everywhere.

[56] Yeah.

[57] And there were no really good restaurants.

[58] And then I stayed at the W. That's a little grimy over there, yeah.

[59] Yeah, no, it was.

[60] But I was like, where's the nice sections of LA?

[61] Okay, well, we're going to be your guys.

[62] guide right now.

[63] This, where we're at, Los Felis, all the amazing restaurants are just like three blocks that way.

[64] They just built this little boutique hotel.

[65] They didn't even build it.

[66] They retrofitted this cruising hotel to now a beautiful boutique hotel with an incredible restaurant in, Kara, think about that.

[67] Nice.

[68] Where are you eating downtown?

[69] Because we got to make sure you're stopping at the right spots.

[70] I don't know.

[71] Okay, well, tonight.

[72] There's a lot of good places downtown.

[73] Incredible.

[74] We'll have to get you a list.

[75] Well, first, what's the one at 7th and Grand?

[76] I love So much.

[77] Bodega Louie.

[78] Oh, yeah.

[79] Yes, very, very wonderful.

[80] Good.

[81] Good to know.

[82] It's good.

[83] It's really good.

[84] No, it's great.

[85] It's really great.

[86] But there are other new ones.

[87] But she's like, no, no, no. There are some newer ones that are really good.

[88] Well, Oriam, where did we eat?

[89] Yeah, what's that one called?

[90] O -Tium.

[91] O -Tium.

[92] Okay, have you seen the Disney Music Hall?

[93] It's close to where you're staying.

[94] Worth the trip.

[95] Disney Music Call.

[96] Frank Gary building, incredible swirls of stainless steel, beautiful.

[97] It looks like that famous building in Ba -Bow -Bow -Bow -Bel -Bow in Spain.

[98] I went there, flower puppy.

[99] I know, I'm an eating tour of Spain.

[100] Right next to Disney Music Hall are like four kind of Michelin Star -style, incredible restaurants.

[101] Cool.

[102] Okay.

[103] You don't seem as scared for yourself as I am for you.

[104] I want you to optimize this trip.

[105] How many more days do you have?

[106] I'm actually here till Sunday because I'm going to go to a wedding on Saturday on Upland.

[107] Where the fuck is Upland?

[108] I don't know.

[109] I'm going to have the Uber driver take me there.

[110] Okay.

[111] Wow, you're going to Uber.

[112] This could be like $7 ,800.

[113] If we don't know where Upland is.

[114] No, I checked it.

[115] It's kind of far out.

[116] It's an eastern suburb, it looks like, but it was like $60 for an Uber.

[117] Oh, that's not funny.

[118] I know.

[119] Easy, Peezy.

[120] Chris, I took an Uber last night and I don't ever take Uber.

[121] A professor at UCLA went to school with.

[122] We were both fall down, at UCLA.

[123] It's incredible.

[124] He's now a professor there, archaeologists.

[125] Haven't seen each other in decades.

[126] He's like, let's go to the Lakers game.

[127] Great, come over.

[128] Great.

[129] Let's take my old truck.

[130] That'll be fun.

[131] Yes, halfway there.

[132] No, no. Yeah, truck dies.

[133] Oh, you know, and you got a hard start.

[134] They're not going to delay the Lakers game for us.

[135] Oh, God.

[136] So then we hoofed it like a half mile to an auto zone.

[137] I got a new battery.

[138] Then we ubered back because we were on the clock.

[139] Oh, this is stressful.

[140] I had to buy a rump there too, put the new battery in.

[141] We made it in time for tip off.

[142] Wow.

[143] I ubered back to the truck.

[144] The car, yeah, okay.

[145] Fix the truck and then got onward.

[146] That's resourceful.

[147] Well, thank you.

[148] Thank you.

[149] That says bread and butter.

[150] I know, I know.

[151] But at some point you would think like you would graduate beyond broken down cars.

[152] I know, right?

[153] Because you're heading to a Lakers game.

[154] Yeah, you would think.

[155] And what's your knee -jerk reaction to that?

[156] I guess maybe other people in my financial position when I just abandoned the car took an Uber to the Lakers game and had some flatbed come deal with that?

[157] Yeah.

[158] I wouldn't like myself if I did that.

[159] I wouldn't like myself either.

[160] You want to hear something really fucked up?

[161] Yes, of course.

[162] So I'm from the Midwest as well.

[163] Where?

[164] Fort Wayne, Indiana, not too far from Detroit.

[165] So I grow up in the Midwest.

[166] It's all about exactly what you're saying.

[167] Resourcefulness.

[168] Yeah.

[169] Don't pay somebody to do something that you can do yourself.

[170] It's almost sinful.

[171] Like, it is sinful.

[172] Weakness and vulnerability and like, are you incompetent?

[173] What's wrong with you?

[174] Cowardness.

[175] And so I'm pretty handy around the house.

[176] Okay.

[177] I've done numerous projects over the years, but a few years ago I had a little bit of a run -in, and now I have two short fingers.

[178] Holy smokes, Chris, let me get on that.

[179] Two short fingers.

[180] You didn't say how it happened.

[181] I'd like us to guess.

[182] Oh, okay.

[183] Go ahead and guess.

[184] Oh, fuck.

[185] I think some sort of saw.

[186] Well, it's clear.

[187] What?

[188] No. That's a good guess.

[189] Oh, gosh.

[190] It's not a drill or a hammer.

[191] No. You know what else is?

[192] it could have been, your hand got stuck in the garage door.

[193] Wow.

[194] So, they're options.

[195] I'd love to see how that, I need an illustration.

[196] That happened to my dad.

[197] He didn't.

[198] He has all.

[199] He didn't.

[200] No, he didn't.

[201] But if he had let it stay in there for a bit, they would have been.

[202] Yeah, that could happen.

[203] Okay, so really the question for me is, is what kind of saw.

[204] That's what we're really getting at.

[205] And what he was sawing.

[206] Can it go table saw?

[207] Yeah, yeah, yeah, yeah.

[208] You're feeding the board through.

[209] Yeah.

[210] And it caught you.

[211] No. caught me. Chris, Chris.

[212] This is so awful.

[213] Did you have shop in Fort Wayne in high school?

[214] Did you have to take a shop?

[215] You didn't.

[216] No, I'm just a do -it -yourselfer.

[217] Clearly that paid off well for me. Yeah, you did it.

[218] You did it yourself.

[219] What was it?

[220] I did it myself.

[221] I had that table saw for 20 years in fairness.

[222] Okay.

[223] So it's not like it was a first -time rookie mistake.

[224] It was just kind of a fucked up accident.

[225] Did it kick back on you?

[226] It was with absent -mindedness?

[227] We need to know.

[228] Kick back.

[229] And my hand flew.

[230] and it was immediate.

[231] Oh, my gosh.

[232] What was your reaction?

[233] Was it calm or hysteria or some mix?

[234] You know, at first I didn't know what happened.

[235] Because you can't feel it, right?

[236] It was immediate.

[237] I didn't feel too much.

[238] I knew something happened, and then I looked down at the floor, and it was like the gory scene from a horror movie, and I see the bloody finger, like, lying on the floor.

[239] And I was just like, fuck.

[240] And I'm home alone.

[241] Oh, Jesus.

[242] Home alone.

[243] I look down.

[244] blood everywhere.

[245] I'm like, shit, I'm going to lose a lot of blood maybe and pass out down here.

[246] And like, who knows what's going to happen?

[247] You're in a basement?

[248] So I'm in a basement.

[249] So I'm like, okay, okay, just like, hold it.

[250] Call 911.

[251] That's what I need to do.

[252] Call 911.

[253] I've got her on the phone.

[254] Ambulance is on the way.

[255] She's like, go ahead and, you know, see if you can retrieve the finger and put it on nice.

[256] She said, look at your hand.

[257] How many fingers are missing?

[258] Oh.

[259] I thought it was just one.

[260] I finally get the courage to open up my hand and look.

[261] And I'm like, it's two.

[262] Now I got another finger to find.

[263] Oh, my goodness.

[264] This is horrifying.

[265] It's also a scene from Chips.

[266] A finger?

[267] I don't remember.

[268] I urge you to watch this movie Chips I made.

[269] Because I've seen it 400 times.

[270] Pena gets his three fingers blown off.

[271] And he wants them.

[272] It's in the middle of a battle scene.

[273] Oh, yeah.

[274] I need my fingers.

[275] And I'm like, okay.

[276] And I'm running out into gunfire.

[277] And I get two of them.

[278] And I come back, he's like, there's only two.

[279] I'm like, fuck him.

[280] You're going to have to make do.

[281] Yes, that's right.

[282] Oh, this makes me feel like such a baby.

[283] because a couple months ago, I got a cut, and I was freaking out.

[284] I thought I was going to pull it out.

[285] I know, I was chopping an onion.

[286] Same situation, done it a million times, but got out from under me. Mistakes happen.

[287] Oh, I'm so sorry that happened.

[288] I guess I would immediately think, oh, I got to put these things on ice.

[289] We all heard that.

[290] The other thing I'd be thinking is maybe first I tried to do a tourniquet on my finger.

[291] I didn't have to do that.

[292] I ended up getting a towel and just wrapping it.

[293] Okay.

[294] Kind of putting as much pressure as I could.

[295] Yeah.

[296] Did it send you into retirement for using that table saw?

[297] Are you back on the horse?

[298] Yeah, no. I got back on the horse and finishing the project.

[299] Wow, good for you.

[300] I was like, there's no fucking way I am going to let this defeat me. Were you putting molding in or something?

[301] What were you doing?

[302] I was putting in molding in the bathroom.

[303] You knew that?

[304] How'd you know?

[305] I was trying to impress you.

[306] That's what I was doing.

[307] I guess table saw and I guess molding.

[308] Yeah.

[309] You're good.

[310] You are good.

[311] This is why I come to the expert.

[312] I miss. I've spent all this energy.

[313] I really should have been a guy at a circus trying to guess things.

[314] I think that's what I really wanted to be.

[315] Can you get some lottery numbers for me, please?

[316] I'm not great with that.

[317] I'm more can guess like what kind of car someone drives pretty good.

[318] Oh, that don't you guess.

[319] Well, first of all, do you own a car?

[320] Because you do own a car.

[321] Okay.

[322] And then I got to ask, are you driving a car you want to drive?

[323] Because that's important.

[324] Are you driving a car that you feel like?

[325] you got the car you loved?

[326] Or is it just utilitarian you wanted to get from point A to point B?

[327] Can you see how that matters?

[328] I can see how it matters.

[329] And I'm hesitating because it's a little bit of a combination of both.

[330] If I tell you it's my dream car, you're going to think I'm a loser.

[331] No, no judgment in this sense.

[332] It's not just me. So I have a son.

[333] So when I purchased the car, I had to think of that.

[334] Him borrowing it or just him wanting to think that's cool?

[335] An infant in the back seat.

[336] And probably safety.

[337] So I've got to think safety.

[338] I've got to think all of those types of things.

[339] Wow.

[340] Okay.

[341] That really complicates it.

[342] I guess I'm going to go Tesla.

[343] No. Yeah.

[344] What is it?

[345] It's a 2007 Lexus ES 350.

[346] Great car.

[347] The SUV or the four -door sedan.

[348] Just the four -door sedan.

[349] Okay.

[350] Yeah, that would have been hard for me to guess.

[351] Yeah, good for you.

[352] That makes you a unicorn.

[353] Okay.

[354] So you're two for out of three.

[355] today.

[356] It was between that or the BMW 5 series, but the BMW 5 series was like sold out and it was going to be months before I could get it.

[357] And so I ended up just breaking down and saying, I'm just going to go with it.

[358] And did you say it was a 13, 2013?

[359] No, 2007.

[360] I'm from the Midwest.

[361] We drive cars into the ground.

[362] So you're going on year 16 with this vehicle, which is nothing for Alexis.

[363] It's in great shape.

[364] People ask me like, why aren't you getting a new car?

[365] You can afford a new car.

[366] What's wrong with you?

[367] And I'm like, but this is a perfectly good, healthy car.

[368] It doesn't give me any problems.

[369] Why would I do that?

[370] So there's a utilitarian part of me of just like, it's just here to get me from point A to point B. Right.

[371] Wait, I have one more question about the finger.

[372] Now, did you think you were going to maybe die?

[373] So when I was in the basement and I saw the bloody finger on the ground.

[374] Yeah.

[375] I did think I could bleed out and potentially pass out.

[376] And then if it just bleeds unfettered, I guess I could.

[377] I don't know how bad this is, and I'm alone, so nobody's going to find me. So I rushed to call 911, and then before I even did that, I went and opened the front door wide.

[378] Because I was like, if I pass out, if I pass out, I just want them to come in.

[379] Like, I don't need them banging on the door thinking they're at the wrong address and then leaving.

[380] Yeah.

[381] That's very wise.

[382] Oh, no one's here.

[383] He's not here anymore.

[384] What if they came in and you already had yourself on a stretcher, like, ready to?

[385] Are you insecure about the hand now?

[386] Oh, my God, I've got so many other insecurity.

[387] Okay.

[388] That one's low on the totem pole.

[389] I mean, I was having so much phantom finger pain.

[390] It was actually quite excruciating and was not going away.

[391] And there was a period of time where I actually thought, I don't know if I'm going to be able to go back to work like this.

[392] And somebody made the flippant remark, oh, well, it's good.

[393] You're not a surgeon.

[394] Like, you can work.

[395] You're just a psychiatrist.

[396] And I'm thinking, but I can't listen to people for even 10 minutes when I feel like my fingers are burning off.

[397] And in excruciating pain, I was taking some medications that were numbing the pain.

[398] I know them well.

[399] Of course, they're numbing my cognition at the same time.

[400] So there was a short period of time where I was like really worried.

[401] What does this mean for my future?

[402] How long did that last?

[403] Several months.

[404] It's close to all the way better now.

[405] Okay.

[406] How long ago was it?

[407] I think 2018.

[408] Okay.

[409] So pretty recent.

[410] Yeah.

[411] Okay.

[412] What was a cautionary tale about table sauce?

[413] You can never be too safe.

[414] And even when you think you're a pro at it, there's always the opportunity to have those fingers got up.

[415] Okay, so Fort Wayne, Indiana, a lot of Amish experiences growing up?

[416] Actually, yeah.

[417] Yeah.

[418] So my father was a pharmacist.

[419] He owned a pharmacy up in Gravel, Indiana, which is one of the suburbs.

[420] And it is a huge Amish community.

[421] Horses and buggies everywhere.

[422] Amish would come into our pharmacy, tracking horse shit all over.

[423] So we got to know them well.

[424] But they are absolutely wonderful, honest, hardworking people, was my experience.

[425] This is kind of an interesting segue for you.

[426] Your work weirdly, we could argue that we may find out in 150 years.

[427] We may end up trying to steer ourselves back in that direction a little bit.

[428] In some of the principles, we are suffering from our technology, that we are the victims of it, that it's made us lonelier, raised mental health issues.

[429] What I think might happen is we may find ourselves willingly in choosing to live a little more Amish, maybe without the deities and the notion of sin.

[430] Yeah.

[431] I mean, that's a far stretch, but I'm trying to make this work.

[432] I don't think it is a far stretch.

[433] I don't know that we go back to the Amish value that it's forbidden, but I think we reach a new level of enlightenment that some of our technologies, even some of our medications and therapeutics, although they can reduce symptoms in people, although on the surface they seem like they might be a good thing, maybe they're not.

[434] Although a lot of people may think, how dare you say that, you're a Harvard physician, whatever, just look around the world at the health and wellness of the human population.

[435] It is declining rapidly.

[436] Mental disorders are the leading cause of disability, both in the United States and worldwide with this single medical diagnosis of depression, topping the list.

[437] So depression causes more people to not be able to work or go to school than any other medical illness on the planet.

[438] I think to most people, that's shocking because we have so many treatments for depression.

[439] We've got dozens of antidepressants, we've got psychotherapy, we've got ketamine injections, We've got electroconvulsive therapy and TMS and everything.

[440] And a lot of these people are getting those treatments and they're not working.

[441] That's the probably concerning thing.

[442] I guess we'll do our disclaimer now.

[443] You and I have the same opinion.

[444] I've heard you make your disclaimer.

[445] First of all, I know many, many people whose lives have literally been saved by pharmacological intervention with their mental disorders.

[446] I do too.

[447] And I have provided those pharmacological interventions.

[448] And I've provided electroconvulsive therapy to people or at least recommended it to.

[449] to people, and I've seen it save lives.

[450] Can you tell me what electroconvulsive therapy is?

[451] That's electroshock.

[452] Well, you used to call it shock therapy, yeah.

[453] And what happens?

[454] The horrible example is one flew over the cuckoo's nest.

[455] The modern example is that you go down to a surgical suite.

[456] You get anesthesia.

[457] You're on a gurney.

[458] Once you're out, they actually paralyze your body at the same time.

[459] And once you're out, essentially the two paddles that they use to shock a heart, they take those paddles and put them on your brain.

[460] Wow.

[461] So in the heart, it makes sense.

[462] The heart is this electrical apparatus, and often the signals are firing erratically, and this great shock can get them to all of a sudden coordinate again in the heart, right?

[463] Yeah.

[464] That's exactly the theory behind the brain.

[465] So there's all this electricity in there, and somehow it's firing abnormally?

[466] I offer some new explanations for how to understand it, but right now the current paradigm is nobody knows how it works.

[467] It's been around for a century.

[468] Nobody knows how or why it works.

[469] When it was first used, it really was used to suppress wild, crazy, dangerous people.

[470] And there's a huge anti -ECT movement and groups of people who feel that it has not evolved at all.

[471] But since then, we've got tons of randomized controlled trials showing the ECT can, in fact, make people less depressed, make people less suicidal, have anti -manic properties, have antipsychotic properties.

[472] Do you know offhand or ballpark what percentage of people who undergo this treatment have, let's say, long -term success?

[473] It is not a long -term success treatment.

[474] It is a short -term intervention that takes a couple of months.

[475] usually.

[476] You usually get three treatments a week if you're being really aggressive.

[477] And a lot of people end up needing anywhere from 12 to 25 treatments.

[478] There's a lot of memory impairment for people, a lot of side effects.

[479] Also seems very, very fertile for placebo effect.

[480] I mean, you've made the ultimate commitment to your belief in this system.

[481] I mean, you're going to get knocked out and shocked.

[482] You would think, but the placebo effect on psychotic symptoms, for instance, is very, very low.

[483] Psychosis, you know, you can get a very transient placebo effect for a day or two where somebody might say, I'm hearing fewer voices or something.

[484] What's under the psychosis umbrella?

[485] Most people think schizophrenia.

[486] So psychosis is hallucinations and delusions.

[487] Okay, great.

[488] So you're hearing things, you're seeing things that aren't there.

[489] You're believing things.

[490] You cut your finger and you think you're dying.

[491] Exactly.

[492] Exactly.

[493] How dare you.

[494] that, but you think you know how to work a table saw.

[495] You think you can guess people's cars.

[496] You've got grandiose delusions about being a carpenter.

[497] I'm like, come on, come on, who the fuck do you think you are?

[498] Calm down, Chris Palmer.

[499] So that's what psychosis is.

[500] It can actually occur under a wide variety of diagnostic categories.

[501] Schizophrenia, bipolar disorder, major depression.

[502] About 10 % of people with major depression have psychotic features.

[503] 40 to 50 % of people with Alzheimer's disease will have psychosis.

[504] A lot of people with Parkinson's disease will have psychosis.

[505] Is it predominantly auditory?

[506] It is predominantly auditory.

[507] And usually when we see people with visual hallucinations, everybody starts saying, oh, this must be delirium or more likely to be delirium as opposed to schizophrenia, as though schizophrenia is like a legitimate thing.

[508] Yeah, yeah.

[509] So it gets really messed up and convoluted.

[510] And we will have to dedicate a few minutes to the DSM and diagnosing these illnesses and how arbitrary they may or may not be those diagnoses.

[511] But to the electric shock thing.

[512] So in the randomized clinical trials, obviously, they're not shocking.

[513] Some people they put out.

[514] They have done those where they do give people anesthesia, no shocks.

[515] And those people do not have the same response.

[516] Okay.

[517] Is it like 30 % of people that respond to it?

[518] No, over 70%.

[519] No, shit.

[520] Believe it or not, ECT is probably, the most effective treatment we have for severe depression.

[521] Isn't that wild?

[522] It comes with huge side effect burdens and some risks and costs and everything else, so we would never use it as a first -line treatment.

[523] That's shocking, pun intended, true.

[524] It is shocking.

[525] Yeah, but it is shocking.

[526] Literally and figuratively.

[527] Yeah, because our colloquial relationship with it or our feelings about it or is it's medieval, it's like leeches.

[528] Because I think we think also people did it to change culture kind of.

[529] Sure, societal.

[530] And some of that sort of stuff still happens.

[531] Like, Russia is kind of unfortunately notorious for using psychiatry to torture anybody who's a dissident on any issue.

[532] Okay.

[533] And so they say, well, you've got some crazy political ideas or you've got some crazy sexual ideas.

[534] We're going to put you in a psych institution.

[535] You're clearly crazy.

[536] We're going to dope you up with antipsychotics and or ECT and or whatever.

[537] You're going to be so horny for women when this treatment's over.

[538] You just wait.

[539] You just wait.

[540] How severe does it need to be for you to diagnose that?

[541] Because I have someone in my life who...

[542] You can say my name.

[543] No. Who has been diagnosed.

[544] This was maybe 15 years ago at this point.

[545] She was in a psychotic depressive state.

[546] She was hearing voices and suicide attempt and all of that.

[547] It was so crazy to see someone who you know then endure a psychosis.

[548] But I feel like if someone had said, let's try this, we would have been like, absolutely not.

[549] And that's pretty much the worst that can happen is trying to kill yourself.

[550] Yeah, what side effects would be worse.

[551] Yeah.

[552] But also now she's fine.

[553] That's great.

[554] Chris, if you're comfortable, Chris, more than anyone firsthand, had a mother who was high functioning.

[555] And then at 42 made a turn.

[556] That was pretty severe.

[557] Yeah.

[558] You want to hear that story?

[559] It's up to you.

[560] This is a very vulnerable place.

[561] You know.

[562] I don't know if you ever heard the show, but...

[563] I have heard the show.

[564] Okay, okay.

[565] And I am so excited because I get my free therapy session.

[566] Great.

[567] And I see that you two have A -list clients.

[568] I've seen some of the people you've interviewed.

[569] And I am like, how the fuck did I get on this show?

[570] Oh, my God.

[571] There's like somebody named Chris Palmer, who's an NBA player.

[572] And I'm like, did they think I was him?

[573] They're like, who are you?

[574] How did you get in here?

[575] Chris, we knew who you were, but I have to tell you one time I thought I was interviewing the actor Brian Cox.

[576] Do you watch Succession?

[577] No. Okay, Brian Cox's famous older English actor.

[578] He's on that show.

[579] His catchphrase on the show Succession on HBO is he's always saying to people, fuck off!

[580] If he wants them out of there.

[581] So I see on the calendar, we got Brian Cox is coming, you know, and I make a few jokes to these guys over the week.

[582] I'm like, oh, God, I got to get this guy to say, fuck off.

[583] off.

[584] We got to give him a couple of fuck off.

[585] Then I started saying like, God, I hope those stairs aren't going to be an issue, whatever.

[586] I've done all the research on the actor, Brian Cox.

[587] And we're having lunch like 40 minutes before Brian Cox arrives.

[588] And I do the fuck off thing.

[589] What are you talking about?

[590] Why are you doing that?

[591] And he goes on succession.

[592] No, the physicist Brian Cox.

[593] It's also very famous.

[594] So it has happened.

[595] I was like, I go.

[596] I got to learn everything about physics in 45 minutes.

[597] That's great.

[598] So by my mom.

[599] I mean, the book is dedicated to her.

[600] There's no. no way someone's reading your book and not knowing this history, if not in detail, they're knowing, it's an apology to her that she didn't live long enough for you to help her.

[601] Yeah.

[602] I made the decision a long time ago when I started writing the book that I did not want to share my personal story and I did not want to share any of my family story because I wanted this to be a professional book based on science.

[603] And I felt like if I start getting too personal, it's going to taint it somehow.

[604] And or they're all going to think I'm crazy.

[605] If I share my own psych history, if I share my mother's psychotic history, and I'm presenting this ridiculously bold, disruptive new theory of mental illness, I'm like, they're going to just think I'm having a psychotic break just like she did.

[606] I can't put that in.

[607] And then when it came time to do the dedication, people have asked me a million times.

[608] times like, why are you a psychiatrist?

[609] And I've had my own shit years of it, but the real reason I'm a psychiatrist is because of my mom.

[610] And that's not a blame thing.

[611] It's a, I desperately wanted to save her.

[612] So the kind of sort of quick version is that she was ridiculously smart, hardworking.

[613] She actually grew up in a family with tons of abuse, but they were extraordinarily wealthy.

[614] They actually lived in the old governor's mansion in Indiana and had servants but she actually grew up feeling like they were white trash there was all sorts of domestic abuse and alcoholism and everything else going on in the house and so from that she actually made the decision I hate money I hate status I hate all of it I just want a normal middle class life and she was devoutly Catholic she wanted big family four kids She and my dad ended up with eight kids.

[615] Wow.

[616] And I asked really quickly where you're at in that show.

[617] I'm the third oldest.

[618] I'm the oldest boy.

[619] And that's what she wanted.

[620] And then my father decided to start a pharmacy on his own up in Grable, Indiana with the Amish.

[621] And he needed help.

[622] So she helped him.

[623] And so they both worked like 12 hour days, six days a week.

[624] She was usually taking the youngest kid with her to work.

[625] But that's the life she wanted.

[626] And then around the time that she was 41, 42, all.

[627] All sorts of wild shit happened.

[628] Was there an inciting incident?

[629] Yes.

[630] There was.

[631] Not with her, but with other people from her family.

[632] She did nothing wrong.

[633] She wasn't involved in any of the shit that went down.

[634] I would tell you more details, but these people are still alive.

[635] And it would actually kind of ruin their lives if I were to make that public.

[636] She ended up front and center in the whole shit show.

[637] She ended up being the key witness.

[638] Oh, boy.

[639] in what was potentially a life and death trial.

[640] Did she have to betray her family in this process?

[641] Or did she have to betray herself and support them?

[642] That was the dilemma.

[643] Do I put someone I know in love possibly sentenced to death?

[644] Or do I lie, but I can't lie?

[645] I have to swear on the Bible.

[646] I am Catholic and Christian and there's no way in hell.

[647] I will ever swear on the Bible.

[648] It ended up putting tremendous stress on our entire family for lots of reasons, for other people involved.

[649] It started what she called a nervous breakdown, which was depression, essentially, and just overwhelm.

[650] She started becoming suicidal because she didn't know how to manage this moral dilemma of hers.

[651] And she actually felt like the truth needs to be told, and I have to say it.

[652] And yet it's going to have dire consequences and how can I live with myself?

[653] Well, look, talk about a biblical dilemma.

[654] thou shone that kill, your involvement could result in a death.

[655] Yes.

[656] That's a pretty big one on the Ten Commandments.

[657] It is.

[658] And I think that's the way she felt.

[659] Yeah, it's like, wow, when is it appropriate?

[660] And yet she also felt like justice needs to be served.

[661] Truth needs to be served.

[662] She's an honest person.

[663] And again, she had nothing to do with it.

[664] She just happened to be the key person that got confided in and was told.

[665] Dragged in, really against her will.

[666] And then our whole family was dragged in.

[667] Very quickly, she developed psychosis.

[668] Major depression with psychotic features is what we would call it.

[669] She became convinced that she was Mary Magdalene reincarnated.

[670] She was going to this priest for counseling.

[671] She began to believe that this priest was Jesus Christ reincarnated.

[672] I have reason to believe this priest actually probably raped her or molested her or something.

[673] Right.

[674] And that may actually at least serve as.

[675] Some of the theme of that delusion.

[676] Yeah.

[677] This is Jesus.

[678] I'm the whore.

[679] I'm Mary Magdalene.

[680] So she becomes psychotic.

[681] She becomes convinced that my father is the devil.

[682] Oh, no. Literally the devil.

[683] That starts a divorce proceeding.

[684] They go back and forth with custody.

[685] How old are you?

[686] I mean, at this point, I'm 1213 because this is taking place over the course of like a year.

[687] It's a really good time for some destabilizing because junior high is already such a. Oh, my.

[688] Oh, if we get into my personal shit, it's just like, you have no idea how bad that was for me. So they end up getting divorced.

[689] Divorce courts basically completely fuck her over.

[690] She loses everything.

[691] Because it's quite easy for your father to say she's psychologically unfit.

[692] In his defense, if my current wife thought you were Mary Magdalene, I don't really want my kids with her.

[693] No, and my mom did some erratic stuff.

[694] She actually took the three youngest kids to Hawaii, an impulsive triumphant.

[695] trip to Hawaii.

[696] Nobody else knew.

[697] I didn't know.

[698] I was pissed it.

[699] I didn't get go.

[700] I'm dealing with all the downside.

[701] Give me the ramp -up part of this.

[702] But woke up one morning.

[703] She's gone.

[704] We find out she's in Hawaii with the three kids.

[705] So I fully understand why they would not give her custody.

[706] But she didn't get any ownership of the pharmacy.

[707] She didn't get any alimony.

[708] She got poverty level support.

[709] Okay.

[710] I hate to do this.

[711] Is it possible in their minds at that time they were thinking she actually can't be trusted with any of this?

[712] She'll immediately give it to this preacher or she'll go blow it on some crazy trip.

[713] She'll buy some car.

[714] Kind of the Britney Spears thing like with the conservatorship.

[715] Like it's a very complicated issue to give someone wrestling with that, the means by which to hurt themselves, end up somewhere strange.

[716] Do you think that was the prevailing notion or do you think it was just greed?

[717] I don't think it was greed.

[718] My sense is that they were trying to force her to stay with my father.

[719] Okay.

[720] They were trying to make her like so horrible and impoverished that she would not leave him, that somehow that would make her snap out of it and that she would not get divorced.

[721] Right.

[722] Obviously that didn't work.

[723] She got the van and essentially nothing else.

[724] For temporary support still, because divorce isn't finalized, she's getting like $50.

[725] a week.

[726] She's staying in a rooming house that costs $55 a week.

[727] Oh, geez.

[728] So I'm terrified for her and terrified for like what's going to happen to her because she's psychotic, depressed, suicidal.

[729] Yeah.

[730] I didn't know those terms, but I knew that mom is not okay and this is unfair and this is unjust.

[731] And this is not going to help the situation.

[732] I'd also argue it's the most unfortunate time for this to happen to you because you're kind of on the verge of adulthood.

[733] So it's like you might feel like you should be competent enough to help, but you're just not there either.

[734] And then on top of that, my father and I never got along.

[735] I hated my father.

[736] I hated him.

[737] I hated his guts.

[738] So at some point, I make the decision to go live with her.

[739] So we're both staying in this rooming house.

[740] The court gives her like an extra $20 a week for support for me, and my room was like $45.

[741] We stay in this rooming house until there's no more money.

[742] So we ended up homeless for a while.

[743] We were living out of the van.

[744] And we ended up in a homeless shelter.

[745] It was this Catholic homeless shelter.

[746] You left a homeless shelter and went off to your first day of high school.

[747] Yeah.

[748] Oh, man. Wow, wow, wow.

[749] And your brothers and sisters, seven of them are at a house nearby with dad.

[750] I think her family helped her, her father helped her a little bit or something, gave her some money.

[751] And then we got some tiny apartment.

[752] by the railroad tracks.

[753] I don't think it was the worst time in my life because I wasn't suicidal at that point and I subsequently developed my own shit and suicidality and everything else.

[754] It was pretty close to one of the worst times in my life.

[755] In high school, I'm guessing, it's not like a refuge from the situation.

[756] It's not like you're going off somewhere for seven hours a day and like forgetting your problems.

[757] This isn't different problems there.

[758] High school was awful.

[759] I flunked classes.

[760] The fact that I got into Harvard I know.

[761] I'm a Harvard professor.

[762] Yeah.

[763] They didn't look at my high school transcript.

[764] If they did, I probably would not have gotten in.

[765] So I ended up with my mom absolute misery.

[766] I remember crying myself to sleep every night.

[767] After about like two or three months of that, I actually lost the ability to cry.

[768] And that persisted for probably like 20 years.

[769] Stay tuned for more armcherry.

[770] expert if you dare we've all been there turning to the internet to self -diagnose our inexplicable pains debilitating body aches sudden fevers and strange rashes 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 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.

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

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

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

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

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

[776] guys, it's your girl Kiki, and my podcast is back with a new season, and let me tell you, it's too good, and I'm diving into the brains of entertainment's best and brightest, okay?

[777] Every episode, I bring on a friend and have a real conversation, and I don't mean just friends, I mean the likes of Amy Polar, Kell Mitchell, Vivica Fox, the list goes on.

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

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

[780] Were you, like, disassociated a lot during this and living in a fantasy world?

[781] Did you create a world in your head of your future that was going to exist?

[782] What was the coping mechanism?

[783] I guess my fantasy world, so I'll go ahead and say it.

[784] So I'm gay.

[785] And my fantasy world was that there's like some man who's going to hold me and protect me and take care of me. Of course.

[786] You don't have that with your dad.

[787] Your dad's, I'm filling in the blanks.

[788] He's totally disappointed.

[789] Yeah.

[790] Oldest son, he has some hunch is not straight.

[791] Yeah.

[792] And this is completely unacceptable.

[793] he's a product of his Fort Wayne life.

[794] Yeah, I know.

[795] He thinks your dad is fucked up and twisted as it is.

[796] He might think this is going to kill him.

[797] Like, this is the worst thing that could have happened.

[798] He's going to be a pariah.

[799] He's going to be assaulted.

[800] He's all these things.

[801] No, it wasn't that.

[802] It wasn't that.

[803] It was just the shame of having a gay side.

[804] You are disgusting, reprehensible.

[805] You're a faggot.

[806] Yeah.

[807] The worst option.

[808] Yeah.

[809] All right.

[810] Well, I end my defense of him.

[811] No, it's interesting.

[812] There's a long story with my dad.

[813] And the last three years of his life, I took care of him.

[814] There was a part of me that was hoping to reconcile with him.

[815] Yeah.

[816] Before he died, because I knew he was dying.

[817] And I was also trying to rehabilitate him and help him and all sorts of other shit.

[818] And I'm really glad I had that experience because the conclusion that I came to is he's just a fucking asshole.

[819] That is who he is.

[820] You must love David Cedaris's work.

[821] Yeah.

[822] He has a very similar story.

[823] Yeah.

[824] His dad at least said to him on a deathbed, David, you won.

[825] But you didn't get that, right?

[826] I really didn't.

[827] But yet a similar dynamic, because David's one of the world's most successful authors.

[828] Everything his dad thought he should hide.

[829] He embraced, and it's why he's the most successful writer.

[830] And you end up at Harvard.

[831] He lived long enough to see your success.

[832] Yeah, I mean, my dad was racist, misogynistic, all of it.

[833] Like many men of his generation, I get it.

[834] And I don't necessarily blame him for that.

[835] I'm not angry at him for that.

[836] I know he's the product of his environment.

[837] Yeah.

[838] But I was old enough at the time that he was dying to recognize I don't like this product.

[839] At his core, these are his values.

[840] This is what he firmly believes.

[841] And I don't really respect that.

[842] I don't admire it.

[843] My mother, on the other hand, even with a psychotic illness, was able to evolve and adapt.

[844] She started out very homophobic and eventually got to a place of, actually writing a letter to the editor of the Fort Wayne paper defending homosexuality.

[845] Oh, really?

[846] Like, why would God make people this way if he didn't intend for them to act on it?

[847] Like, he's not that cruel.

[848] He's not a sadistic God.

[849] So my dad was absolutely lovely by comparison.

[850] But he left when I was three.

[851] He was an addict.

[852] It was just a very complicated relationship.

[853] And I, too, ended up being the one that cared for him when he died.

[854] And I at least did have this moment where he was so vulnerable.

[855] he was so incapacitated he was dying of cancer but he also had had heart disease and he had gout so bad he couldn't get out of bed so i was changing his diapers and i'm looking at this big baby and i'm like oh my god we're all just little scared babies i put so much on this little scared baby's shoulders like i got to at least acknowledge i was not looking at him as a human with his own struggles for most of the time.

[856] I was looking at what I wanted out of that role that I didn't get.

[857] And that for me was some bit of peace and closure.

[858] I was like, oh, thank God I saw him as a human once before it was over.

[859] I had the exact same experience.

[860] You did.

[861] I was changing diapers, wiping up shit off the floor and all of it.

[862] And I saw him for what he was.

[863] Just another human being with all his flaws.

[864] And with all his strengths.

[865] And the biggest strength I'm going to give him is he has eight kids.

[866] He's running his own business.

[867] His wife becomes psychotic and he took custody of the eight kids.

[868] Doing his best, it was a shitty job, obviously, because it's an overwhelming job for anyone.

[869] Nobody can take care of eight kids and work full time at a pharmacy and everything else.

[870] But he did his best.

[871] And for that, I honor him and respect him as an individual human being in terms of his values and how he treats other people and how he thinks about other people, it was repugnant.

[872] And even in the end, when I was taking care of him, he would still brag about two of my other brothers and never about me. And I'm like, fuck you.

[873] Like, how much do I have to do to please you?

[874] I'm a fucking Harvard psychiatrist.

[875] I'm wiping up your shit, changing your diapers, giving you a home, rehabilitating you, but I'm still not good enough to like, at least.

[876] say a kind word about?

[877] Come on.

[878] If you're not reading Sedaris, you must read Sadares.

[879] This is the same story.

[880] You have to just laugh about it.

[881] It's preposterous.

[882] It's preposterous, yeah.

[883] So she was hospitalized, tried medications, saw psychiatrists.

[884] Lithiums and stuff.

[885] What kind of...

[886] Oh, antiscotics.

[887] Hal dolls and shit like that.

[888] Trazodone.

[889] And she was drugged.

[890] She could not walk a straight line.

[891] She was slurring her speech.

[892] She had this ridiculously dry.

[893] mouth.

[894] You could hear it when she just opened her mouth.

[895] It's like so dry.

[896] Mommy, you want a sip water?

[897] Like her eyelids are drooping and she's still psychotic.

[898] And I'm just like, what the fuck are these people doing?

[899] You know, at that point, I was furious with the mental health field.

[900] Just a bunch of incompetent, arrogant assholes is what they were.

[901] Did it stay that same Mary Magdalene thing or did it morph?

[902] It stayed.

[903] Wow.

[904] I mean, she developed other delusions along the way.

[905] She would get paranoid intermittently.

[906] And it would wax and wane like it does with everyone.

[907] She'd have good days or good months and bad months.

[908] She became estranged from most of her family.

[909] And she would become estranged from even my siblings.

[910] And I think some of it was just their inability to tolerate her symptoms.

[911] It would just get so furious with her.

[912] Yeah.

[913] They wanted a certain mother and they didn't get it.

[914] You wanted a certain father.

[915] You didn't get it.

[916] No one was really hitting a jackpot in this scenario.

[917] No. So again, mine's on a two compared to your 10, but similarly, I've always been incredibly close with my mother, three suicide attempts over the course of, I don't know, 20 years, and me very much feeling like if anyone's going to help in this scenario, it's going to be me. She'll listen to me the most.

[918] I've got to solve this for her.

[919] I can relate to the anxiety of that and the powerlessness, yet you're the appointed person, so it's like throwing your hands in the air is not really an option.

[920] Yeah.

[921] I was actually really religious when I grew up, too.

[922] You really had it all.

[923] And by late high school, I gave up.

[924] I was furious with God because I prayed every day for her.

[925] If you exist, you've got to help.

[926] Well, you've got to start exploring some different options, minimally.

[927] Like, well, this is not yielding any results.

[928] So let's go into psychiatry.

[929] Eventually, you go to Harvard.

[930] You go to UW first?

[931] No, so a year after I was living with, my mom, she made me go back and live with my dad.

[932] I actually moved out before I finished high school.

[933] I moved in with some friends from McDonald's.

[934] I was working at McDonald's.

[935] Okay.

[936] Hold on a second.

[937] You're just painting every target on your back possible.

[938] I was actually ready to drop out of high school.

[939] I went to the guy and his counselor said, I'm here to drop out.

[940] Can you give me some information on a GED?

[941] Maybe I'll do that someday.

[942] She went and got the vice principal and made him come down and he was like, you are not dropping out.

[943] You're going to come see me for counseling.

[944] He was kind of a take charge.

[945] person and I was like, well, that's what I'm looking for.

[946] I take charge.

[947] Oh, you seem to actually care about me. Okay, fine.

[948] I'll listen to you.

[949] I won't drop out.

[950] But I was on my own and I remember graduating from high school and my two older sisters who were at Purdue came and they asked me, so Chris, what are you going to do?

[951] I said, the people I'm living with told me I have still graduation day to move out.

[952] So I'm going to get a full -time job at McDonald's and I'm going to get an apartment.

[953] I had no college plans.

[954] Right.

[955] My sisters are like, well, no, don't do that.

[956] Why don't you come live with us it'll be cheaper we'll get a three bedroom apartment so i went and lived with them oh that's nice i worked like three jobs i was donating plasma twice a week oh my god and then ended up going to peru the first year or two horrible shit show depressed suicidal a couple of suicide attempts more i attempted in high school but then things turned around when i finally came out i found people like me. And I started to accept myself.

[957] Because I had to work my ass off to save up money for tuition, I decided if I was going to go to college, I'm going to get straight A's.

[958] Why am I wasting all of this effort and time?

[959] So I ended up doing really well at Purdue and then ended up at Wash U medical school and did really well at Wash U. I got like an award for being one of the top students one year.

[960] And then ended up at Harvard.

[961] Wow.

[962] And I've been there for 27 years.

[963] Okay.

[964] This is actually not the thrust of your theory, but it is worth just pointing out that if you were to have seen a psychiatrist at that period just prior to coming out, I'm your psychiatrist.

[965] I'm going to attempt to treat the symptoms of your depression.

[966] And really, you got to come out.

[967] There's no treatment.

[968] that's going to be such an enormous piece of this equation that really a doctor can't do for you, can't prescribe for you.

[969] It's imperative and probably going to be the most important aspect in you coming out of this depression.

[970] 100%.

[971] You know, you come to me, you're on the verge of killing yourself or you're attempted or you have ideation, and I'm going to try to prevent that from happening.

[972] Ethically, I think I'm on good ground to do so.

[973] And maybe I could treat those symptoms for long enough that you don't come out for some period of time after, and we're not actually treating at all one of the core roots of all these problems.

[974] That happened to me. I got the whole spectrum.

[975] So in high school, I was attempting suicide, severely depressed, could not function, ended up hospitalized at one point, and they did exactly the wrong thing that you just said.

[976] They were prescribing me pills.

[977] I used the pills that they were prescribing.

[978] to overdose.

[979] So I hated being gay.

[980] I was disgusted and repulsed with myself as a human being.

[981] And I also was convinced I will never, ever find love because I don't want to be a faggot.

[982] I don't want a gay man as a lover.

[983] I want a straight man as a lover.

[984] Yeah, if you hate yourself from it, you're probably homophobic at that point too.

[985] You hate other gay men.

[986] I do.

[987] Right?

[988] I do.

[989] It's so wild, right?

[990] They're disgusting.

[991] Yeah.

[992] Mental health did nothing.

[993] for me all through high school.

[994] And I saw a few different therapists.

[995] I tried several different medications.

[996] And then by the time college came around, I was still miserable, still very suicidal.

[997] At one point, I decided to go to a psychologist at Purdue.

[998] And they give you like three visits.

[999] So I go to the psychologist.

[1000] And I actually went in saying, okay, I'm ready to be changed.

[1001] I cannot tolerate living this way anymore.

[1002] I don't think I can be changed.

[1003] It just feels like such a core part of who I am.

[1004] I can't imagine somebody taking this out of me. But if you think you can take it out of me, then I'm at least willing to hear you out and try.

[1005] It's crazy how similar that is to addiction as well.

[1006] For me, to at some point go, I'm going to go to this program that I despise that has God in every third sentence.

[1007] I'm going to take direction from men who I don't trust.

[1008] I'm going to do all these fucking things that I don't want to do.

[1009] I reject fundamentally because the alternative appears to be death.

[1010] That was it for me. Yeah.

[1011] And thank God I got a decent mental health professional who said that's impossible.

[1012] No one can change you.

[1013] You have to accept being gay.

[1014] And I initially was like, no, no way.

[1015] All be the feminine men.

[1016] She then goes on to that.

[1017] I'll be a parade of Every other day?

[1018] Who's got the time?

[1019] There are NFL players who are gay.

[1020] You just wouldn't know it.

[1021] They're closeted, but you could get somebody like that if you want a big strong man. And I'm like, really?

[1022] Is that true?

[1023] I have to start looking it up.

[1024] There's no way that can be true.

[1025] So she encouraged me to go to this gay support group or Catholics.

[1026] It took me probably four or five months to actually make it to a meeting.

[1027] I drove by the church where they met numerous times and just, could not go in and I finally went in.

[1028] And do you immediately start hearing your story and you immediately know you're not alone or no?

[1029] It was weird because so I walk in, there were only like probably eight people there.

[1030] Most of them are all older than me. Two women are holding hands and being like affectionate with each other, which I had never seen in my life.

[1031] And I'm so uncomfortable seeing this.

[1032] I'm like, why are they doing that?

[1033] That's not appropriate.

[1034] People can see that.

[1035] They're going to get beaten up.

[1036] They can't do that.

[1037] They're going to be on to all of us.

[1038] Stop.

[1039] You're going to get in trouble.

[1040] It's so ridiculous and trivial.

[1041] But the thing that switched at all is really hot graduate student walked in.

[1042] And I'm thinking, you're gay?

[1043] Oh, my God.

[1044] Wow.

[1045] Wow.

[1046] Maybe there's something to this gay community for me after all.

[1047] Yeah, yeah.

[1048] I pined over him for like a few months.

[1049] And then he asked me out.

[1050] He was like the first.

[1051] Oh, that's so exciting.

[1052] It was so exciting.

[1053] It was on my 21st.

[1054] birthday too.

[1055] Wow.

[1056] I had never gone out on a day.

[1057] That's a happy ending.

[1058] I was like literally jumping up into myself in joy.

[1059] Things didn't work out with him because he was closeted and homophobic and everything else as well.

[1060] So many of my male gay friends have told me about the level of homophobia they have.

[1061] It's like the insult to the injury.

[1062] It's so sad and so prevalent.

[1063] Yeah.

[1064] I mean, even to this day, it plays out.

[1065] in gay hookups and gay dating.

[1066] Gay men treat each other like shit.

[1067] One of our friends in particular who's very, very active on Grindr, he walks us through some of these hookups, and I'll just give you the best nutshell one.

[1068] He said they'll come in, I'll offer them a water, so it'll be kiss, kiss, kiss.

[1069] I will immediately look at their dick, and if it's not what was advertised, I'll come up and I'll say, oh, we're not a match, and the guy will go, okay, and turn around and leave.

[1070] And I said, let me welcome me to the straight world.

[1071] If I ever took a glance at a gal's vagina, came up and said, we're not a match.

[1072] The notion that that's cool and the person just turns and walks away as if nothing to happen, I'm like, that's so foreign to me. One could never be that insensitive in the straight world.

[1073] And the reality is gay men come into that world sensitive.

[1074] Yeah.

[1075] And they are devastated and it happens over and over and over again.

[1076] And then they just decide, I guess this is who I have to be.

[1077] Again, then just supports the internalized homophobia.

[1078] You know, we're supposed to have progressed.

[1079] Gay rights, gay marriage, everything.

[1080] And yet there's still all of that kind of awful behavior.

[1081] When you look at the suicide attempt rates in LGBTQ youth today, 30 % will at least attempt.

[1082] Oh, really?

[1083] In the trans community, it's at least 50 % attempt rates.

[1084] Wow.

[1085] But that's with our children's kind of environment.

[1086] See, we have acceptance of that.

[1087] Everything's supposed to be good now.

[1088] Gay -Straight alliances, teachers, teaching the politically correct stuff.

[1089] And the kids are still attempting suicide.

[1090] There's still a disconnect.

[1091] Okay.

[1092] I appreciate that so much.

[1093] I know we're here to talk about your book and we're going to, but I got to say that to me was I'm going to guess as helpful as anything could possibly be to hear your story through that and unexpected.

[1094] so i appreciate it sure let's talk really quick about what the current paradigm is i'll give you a different example that's not psychiatry but siddharthar mucogee he's written this book the cell it's a great book he talks about the old paradigm of how we do medicine which is find pathogen kill pathogen with pill that's the model period that's what we've been doing for a hundred years and he is suggesting we flip this whole thing and we look at the health of the cell and whatnot.

[1095] So similarly, there's a paradigm for psychiatry that I don't know how many years we would delineate it's been going on.

[1096] But let's just say 40 years, we've got a pretty sophisticated bag of pharmacological options, right?

[1097] So generally, someone's experiencing some kind of mental health issue.

[1098] And then they go to a psychiatrist and then what happens next?

[1099] So the generic first step is the psychiatrist or clinician is going to do a diagnostic interview.

[1100] At the end of that interview, maybe a second one if needed, but in the insurance -based model, you get one diagnostic interview.

[1101] At the end of that interview, you need to have a diagnosis, a DSM -5 -TR diagnosis.

[1102] So the criteria for PTSD is a symptom checklist.

[1103] Whether you are currently being abused or not is not part of that diagnosis.

[1104] category.

[1105] So right now, a lot of people in Ukraine would be classified as having a mental disorder, post -traumatic stress disorder, even though their country is still being bombed.

[1106] Right.

[1107] They're actively.

[1108] Right.

[1109] This isn't like residual.

[1110] This is real time.

[1111] Yes, this is real time.

[1112] Yeah, they have trauma real time.

[1113] But if your symptoms go on for two months or longer, you get PTSD, even if the war rages on, even if the husband who's beating the wife is still beating her.

[1114] Right.

[1115] She gets diagnosed with a brain disorder.

[1116] called Post -traumatic Stress Disorder, and that's all we need.

[1117] So that's the diagnostic interview, is you're going to ask for symptoms, what are the primary symptoms, you're going to go through the checklist of different diagnoses that you're entertaining.

[1118] You're going to ask about medical conditions to rule out any medical causes of this disorder.

[1119] You're going to ask about prescription meds, family, history, brief social history, substance use history, those types of things.

[1120] There's something called a mental safety.

[1121] status exam, where you're going to maybe even test people's memory very briefly.

[1122] And based on all of that, you're going to come to a diagnosis or more than one diagnosis.

[1123] And yeah, you're going to start treatments, psychotherapy, medications.

[1124] If it's a substance use issue, maybe refer for a 12 -set program.

[1125] So you can augment with other strategies, but the overwhelming majority of people will be prescribed a pill.

[1126] What is that overwhelming majority?

[1127] Like in the 60s, the 70s?

[1128] So the majority of people who are treated for mental health are actually seeing their primary care docs.

[1129] Usually they're internist or family practice or OBGYN and pretty close to 100 % of those interventions are going to be pills.

[1130] Right.

[1131] We're going to start trying.

[1132] You've got depression.

[1133] I'll give you an antidepressant.

[1134] You've got a mood instability problem.

[1135] I'll give you a mood stabilizer.

[1136] If you have psychosis, most of those people are going to say refer to a psychiatrist and or refer to the hospital.

[1137] So that's how it works.

[1138] Yeah.

[1139] And then I guess what is the outcome of this approach broadly.

[1140] This is where I start getting into trouble with my colleagues sometimes.

[1141] Okay.

[1142] So I want to say treatments do work.

[1143] You are a perfect example of that.

[1144] 12 -step programs can work for people.

[1145] Treatments can save people's lives.

[1146] A psychologist can tell you, I can't change you, go accept your sexual orientation.

[1147] That one brief intervention can be life -saving or life -changing.

[1148] Can we also really quickly add, and I might be wrong about this, but I also think implicit in this model, just the simple fact that the most common prescription is an SSRI inhibitors.

[1149] So they have concluded that serotonin, and a lack of serotonin, is what is underpinning the depression, and that if we inhibit the uptake of it, more will pool in your brain and you will have more on demand.

[1150] So what's really saying is that we've isolated the cause, it's the chemical or the neurotransmitter or the hormone, you know, neuroepidepidepidivine, dopamine.

[1151] These neurotransmitters are what we're going to measure, even though we can't really measure it.

[1152] Actually, we can, and they've been measured, and I think you really know the real answer.

[1153] They're not really imbalanced in the brain.

[1154] They're normal.

[1155] Yeah.

[1156] They're normal in the brain.

[1157] Yet the paradigm, because the treatment is changing serotonin or the treatment is targeting dopamine, the paradigm that persists in the minds of the overwhelming majority of clinicians is that, you have a serotonin imbalance, I'm going to prescribe you.

[1158] Prozac, because I've seen it work.

[1159] Yeah, sure.

[1160] So you must have a serotonin imbalance because Prozac is supposed to increase your serotonin levels between the synapse and how or why exactly it all works.

[1161] We don't know, but you've got a serotonin problem, so I'm going to give you a serotonin drug.

[1162] Somebody with ADHD, you've got a norapine or dopamine problem.

[1163] I'm going to give you a stimulant that's going to increase norapine and dopamine.

[1164] Right.

[1165] You've got a psychotic disorder.

[1166] You've too much dopamine.

[1167] I'm going to give you a dopamine blocking drug.

[1168] Let's block that toxic dopamine in your brain.

[1169] It's interesting.

[1170] So really it's saying yes, the bottom line of all these things is their neurotransmitter issues.

[1171] This model is speculation based on serendipitous findings.

[1172] So the first antidepressant was a tuberculosis medication.

[1173] Nobody knew why the fuck it worked.

[1174] They were prescribing it for tuberculosis and they noticed that some tuberculosis patients who had been clinically depressed, we're now all of a sudden no longer depressed.

[1175] Some astute infectious disease doctor noticed maybe we should use this and all the depressed patients on that psych ward and see what happens.

[1176] Lo and behold, it made some of them less depressed.

[1177] They didn't know how it worked.

[1178] They didn't know about any neurotransmitters at that point.

[1179] They just knew this pill reduces symptoms of depression.

[1180] It's incredible how many medications are that kind of unintended off -label.

[1181] Even like I started taking propitia, you know, whatever, 18 years ago to keep my hair and to realize, oh, well, that was a prostate medicine.

[1182] This thing was a that and we notice, oh, my God, here's a weird side effect we would all want.

[1183] How many medicines are like that?

[1184] You think they went in with a theory?

[1185] I bet if we make this molecule chain, it'll affect this area of the brain.

[1186] No. Oh, by God, we're right.

[1187] No, it's like, oh, just accidentally we found out it was doing this.

[1188] The prototype for every psych drug is that.

[1189] So the first antipsychotic was actually being studied as an anesthetic compound serendipitously.

[1190] Lithium seems to stabilize wild, crazy mood swings.

[1191] We don't know why.

[1192] We don't know how, but it works.

[1193] So just give them the pill.

[1194] And then the pharmaceutical revolution looked at these prototype drugs, studied them meticulously.

[1195] What the hell is that doing to the brain?

[1196] Right.

[1197] And then they figure out, oh, it seems to like block dopamine D2 receptors.

[1198] Let's create more molecules that block.

[1199] dopamine D2 receptors, and maybe we'll develop better drugs, better medications with less side effects or something.

[1200] And so there's a whole class of antipsychotics based on that model.

[1201] We notice that it blocks these receptors, and then more receptors were discovered along the way.

[1202] Well, this molecule seems to also play a role in serotonin receptors or serotonin levels.

[1203] Can we say then from this that if antidepressants do work well for you, that you probably do have imbalance of serotonin?

[1204] Because that is fixing that?

[1205] No. Okay.

[1206] Because serotonin plays a lot of roles in the human body.

[1207] So just because you give a medication that reduces symptoms doesn't mean you've identified anything about cause and effect.

[1208] So the easiest example, I'll give you, I use this in the book.

[1209] If somebody has a headache and they take Tylenol, the headache can go away.

[1210] The cause of the headache was not a Tylenol imbalance.

[1211] Right.

[1212] Or a Tylenol deficiency.

[1213] Totally.

[1214] That's in the brain.

[1215] Interesting.

[1216] Yeah.

[1217] And yet Tylenol reduced symptoms.

[1218] So if we go to these serotonin reuptake inhibitors and they work, we should not assume that the cause of the disorder was a serotonin imbalance.

[1219] But that improved serotonin levels will alleviate the symptoms or increased serotonin levels.

[1220] It says that we don't know how or why.

[1221] this works.

[1222] Now, again, the neuroscientists have been studying this for decades.

[1223] So the logical assumption is there must be a serotonin imbalance in the brain.

[1224] Let's measure it.

[1225] We've got all these fancy brain scans.

[1226] We could do lumbar punctures.

[1227] I mean, we could measure blood levels.

[1228] We could do something.

[1229] Let's measure it.

[1230] Because the field of psychiatry has desperately wanted biomarkers for the illnesses that we treat.

[1231] Yeah.

[1232] Decades and decades of this research have been done.

[1233] Billions of dollars have been spent on it, and the answer is, no, there doesn't seem to be a serotonin imbalance there.

[1234] But they can measure it?

[1235] They can measure all sorts of stuff.

[1236] So it's not a serotonin imbalance per se, but that doesn't necessarily mean that elevating serotonin levels doesn't give you an effect.

[1237] Right.

[1238] Like cocaine.

[1239] Yeah.

[1240] Cocaine has a powerful effect on human beings.

[1241] It cares depression immediately.

[1242] Caffeine has a powerful effect on human beings.

[1243] Yeah.

[1244] It doesn't mean you had a caffeine.

[1245] infallengen imbalance.

[1246] Right.

[1247] So just because a molecule improves your symptoms doesn't necessarily tell us anything about the etiology.

[1248] So coffee will wake you up.

[1249] It's not that you had a coffee deficiency.

[1250] It's that you maybe had too little sleep, but coffee can ameliorate too little sleep.

[1251] And then you can get specific down to adenosine and adenosine receptors to understand the mechanisms of action.

[1252] And so coffee, sleep, all of that.

[1253] And so coffee, sleep, all of that.

[1254] we actually have some of those mechanisms worked out, and it does come down to adenosine and blocking adenosine receptors.

[1255] Unfortunately, with all of the psych drugs, we don't have a figure out.

[1256] But what we know is that these medications can reduce symptoms and or sometimes put disorders into remission.

[1257] So what's not to love about that?

[1258] But back to your question, how are we doing?

[1259] The sad reality is that although we have treatments at work, and I don't want to step away from that, The majority of people who seek treatment for mental health conditions end up with a chronic disorder, meaning that their depression will come and go, their anxiety will come and go, their bipolar symptoms will come and go, their psychotic symptoms will come and go.

[1260] They will be lucky if the symptoms are put into remission.

[1261] It's not even that the person no longer has symptoms.

[1262] It's just that the person no longer meets criteria for the disorder.

[1263] So in order to be diagnosed with major depression, you have to have five out of nine symptoms.

[1264] If somebody comes in with five out of nine symptoms and we can clip one off, that's called remission.

[1265] Even though I still have four of the nine symptoms because they no longer meet criteria.

[1266] Now, obviously, somebody could come in with nine symptoms of depression and we could get rid of five of them.

[1267] That's significant benefit.

[1268] I mean, you could really help.

[1269] And or you could still have mild lingering.

[1270] symptoms, but the symptoms are better.

[1271] Again, I don't want to take away from the efficacy, but the outcome data for schizophrenia and bipolar disorder are abysmal, and everybody knows that.

[1272] Those are chronic lifelong disorders.

[1273] You've got a brain disorder.

[1274] You've got a chemical imbalance in your head, and you just need to take your pills for the rest of your life.

[1275] Right.

[1276] That is the paradigm.

[1277] Depression should be a treatable disorder on paper.

[1278] We've got these great efficacy studies.

[1279] Everybody talks about evidence -based medicine.

[1280] One study followed over 400 people for 12 years, all getting treatment for depression.

[1281] And they were allowed to get any treatment they wanted.

[1282] Pills, the psychiatrist could change their pills.

[1283] They could add psychotherapy.

[1284] They could do groups.

[1285] They could do AA.

[1286] They could do anything.

[1287] What the study found is that only 10 % of the people achieved remission and sustained their remission.

[1288] Other studies have looked at if a primary care doctor starts an SSRI, five years later, how many of those patients are still on antidepressants?

[1289] Don't they just get better and stop the medication after a year or something?

[1290] you would think they should.

[1291] 95 % are still on antidepressants.

[1292] Many of them are still having lingering symptoms of depression, waxing and waning.

[1293] They come and go.

[1294] And when they come back, they up the dose or they change your medicine.

[1295] Why?

[1296] Well, we don't know.

[1297] We don't really understand it.

[1298] The medication pooped out or you had a stressor in your life.

[1299] Okay, two things I'll just pressure test.

[1300] One is, yeah, 10 %'s rough.

[1301] I will just throw this out there.

[1302] So, AA's, it's not good.

[1303] It depends what you read.

[1304] It's very hard to determine what a success of that program is.

[1305] Did they work it correctly?

[1306] But let's just say, in general, it's like in the 30 % success rate.

[1307] If you kind of take all these different numbers and average them, it's not a very effective solution.

[1308] Unless you make it relative to no AA, and the no AA is like 0 .5 % of people who are going to achieve long -term sobriety by themselves.

[1309] So when you make it relative to the other option, it's 60x.

[1310] You know, it's quite relevant.

[1311] Yes.

[1312] Could you argue in that group of 400 people that 10 % sucks, but also 10 % relative to 0 % is pretty good, or at least worthy?

[1313] In fairness, it's not even just the 10%.

[1314] So 10 % got a durable, lasting remission of illness, meaning they no longer met criteria for depression and that was sustained over 10 years.

[1315] And they weren't on their therapies anymore.

[1316] They were still getting their treatment, but at least the treatment was working fully and durably.

[1317] Got it.

[1318] I'm not saying that the 90 % weren't getting any benefit from treatment.

[1319] A lot of them probably were occasionally getting remission.

[1320] It's not enough to leave the...

[1321] They might get six months of remission, but then it comes back.

[1322] So their life could have gotten 2x better by some measure.

[1323] Yes.

[1324] But it just not enough to take them off of what the DSM says.

[1325] was yes okay it just means that depression is a chronic relapsing remitting illness right that's what it really means the reason that's important is that it says that our treatments are not targeting the root cause our treatments for 90 % of those people in that study were not getting at the heart of the root cause they were symptomatic treatments i got you reducing symptoms but the illness was still festering it would be like using Tylenol to treat an infection.

[1326] Tylenol can reduce your symptoms, but it's not going to make the infection go away.

[1327] Right.

[1328] So I'm not anti -treatment at all.

[1329] I mean, those treatments are reducing suffering, putting some people into remission.

[1330] It's great.

[1331] You're asking the question, could we turn this from a chronic illness to an acute?

[1332] Can we do better than what we're doing?

[1333] More importantly, why aren't we able to do better?

[1334] And to bring it home with that statistic for anybody who's listening who thinks you're being way too pessimistic, Chris Palmer.

[1335] How dare you?

[1336] I just want to remind people depression as a leading cause of disability on the planet.

[1337] And all of those people or most of those people are in fact getting treatment.

[1338] You can't qualify for disability in the United States without getting treatment.

[1339] You have to have a physician sign that you are disabled.

[1340] If you're not getting any treatment at all, you're not going to get disability.

[1341] You're not in that statistic.

[1342] And everyone listening is going to have had a person in their life that they've seen great improvement through the current pharmacological answer.

[1343] Yeah.

[1344] I think.

[1345] Yeah.

[1346] You love it.

[1347] Yeah, I love it.

[1348] Yeah, my wife loves it.

[1349] It is funny, though, because yesterday something happened with somebody in my life.

[1350] And immediately, I was like, why aren't they medicated?

[1351] It was like the first thing I thought.

[1352] I was like, I don't understand why they aren't medicated.

[1353] So this is interesting timing.

[1354] But I still feel that today.

[1355] I'm like, I would feel better if that person was medicated.

[1356] Stay tuned for more armchair expert.

[1357] if you dare.

[1358] So you are now looking at this through a different lens, right?

[1359] Which wouldn't be just, oh, you don't have enough of this chemical.

[1360] You're considering that mental illness is the same as all other illness in the body.

[1361] I am arguing that mental disorders are metabolic disorders.

[1362] So right now there are three clearly accepted metabolic disorders, and those are obesity, diabetes, and cardiovascular disease.

[1363] Hormonal imbalances get thrown in, and it could really be any hormone.

[1364] But a lot of times people just talk about those as endocrine disorders or hormonal disorders.

[1365] Right.

[1366] But they're clearly impacting metabolism, but a lot of people would not necessarily refer to them as metabolic disorders.

[1367] Okay.

[1368] And metabolism is what?

[1369] So metabolism is a fundamental part of all living organisms.

[1370] And it actually is a key aspect of the definition of a living organism.

[1371] So some biologists will say viruses, for instance, are not officially living organisms because they cannot do metabolism on their own.

[1372] They can replicate, but they have to use another living organism to replicate themselves.

[1373] And so it's that other living organism that's perpetuating them.

[1374] So metabolism in a nutshell is taking in food and oxygen, turning it into energy or building blocks that are used to sustain life.

[1375] And it also includes like the management of waste products of that process.

[1376] Right.

[1377] So those things come into a cell.

[1378] The cell turns it into proteins or it builds something and then it excretes a waste that is deposited somewhere.

[1379] Yes.

[1380] And these cells can start malfunctioning.

[1381] Any one of those elements can start going awry.

[1382] They can't get rid of their waste.

[1383] They're not processing oxygen.

[1384] They're not building a protein.

[1385] whatever the thing is, a cell can get into a state of disrepair.

[1386] Yes.

[1387] If a cell is metabolically compromised, it will get into a state of disrepair or it will die.

[1388] Explain to me what's happening within the three you mentioned metabolically.

[1389] Like what's happening in a diabetic?

[1390] So this is one of the fundamental things.

[1391] You know, if you ask even a lot of physicians, what are the connections between diabetes, obesity, and cardiovascular disease?

[1392] if you ask people in the general population, most people will say it's diet.

[1393] If you eat a shitty diet, you're going to have one of those things or all of those things.

[1394] Some people will start to throw an exercise.

[1395] It's exercise.

[1396] If you eat a clean diet and exercise a lot, you will not have any of those three things.

[1397] Clear cause, clear effect.

[1398] In reality, if you look at the science and if you look at all of the exceptions to the rule, it's actually not at all that simple.

[1399] Diet and exercise do play profound roles in metabolic disorders and human health, but they are not the only factors that play a role.

[1400] I want to make sure I understand it very clearly before we march forward.

[1401] A metabolic disorder, for it to be called a metabolic disorder, it's not performing one of those things.

[1402] I'm still unclear.

[1403] You and numerous scientists are unclear about how to define a metabolic disorder.

[1404] Okay.

[1405] I am proposing that the fundamental easiest definition of a metabolic disorder is dysfunction in these tiny things in our cells called mitochondria.

[1406] So that if a cell has either insufficient mitochondria or if those mitochondria are not functioning properly, that cell will, by definition, be metabolically compromised.

[1407] Great, because of course my question now is, what is mitochondria?

[1408] Most people know mitochondria as the powerhouse of the cell.

[1409] So they take in food and oxygen.

[1410] They are the only thing in the human body that uses oxygen for the most part.

[1411] So we breathe in oxygen.

[1412] It is exclusively for our mitochondria.

[1413] So mitochondria take food and oxygen and they turn it into ATP, which is the energy currency of the cell.

[1414] And that's what most people know, powerhouses of the cell.

[1415] Research over the last 20 years has completely shattered that definition.

[1416] Oh, no. That's what you write on the test.

[1417] It is.

[1418] Well, you can still write it on the test because the teacher will probably think that is still the correct answer.

[1419] They are still the powerhouses of the cell.

[1420] They are still doing the Krebsitric acid cycle, all of that.

[1421] But in fact, they are doing so, so much more.

[1422] They play a direct role in the production of neurotransmitters like serotonin and dopamine and Gabba and others.

[1423] They play a direct role in the regulation of gene expression in the cell nucleus.

[1424] They are the primary regulator of epigenetics.

[1425] They create signals called reactive oxygen species and other signals.

[1426] They actually create proteins that communicate with the cell nucleus.

[1427] They play a profound role in calcium regulation.

[1428] And those signals are the key factors that turn genes on and off in a cell.

[1429] And determine what the cell actually is.

[1430] During development, yes.

[1431] And mitochondria are critical to that process as well.

[1432] And when you disrupt mitochondrial function during cell development, the cell will not develop normally.

[1433] So mitochondria are sending signals to the nucleus.

[1434] It very orchestrated timed sequences so that the cell development.

[1435] in a very clear and precise way.

[1436] Mitochondria play a direct role in turning inflammation both on and off.

[1437] So they play a key role in immune system function.

[1438] They play a key role in the production and regulation of some really important hormones, such as cortisol, testosterone, estrogen, and progesterone.

[1439] So they control the synthesis of that very first step in the synthesis of those hormones.

[1440] hormones.

[1441] And so if they are, quote, unquote, malfunctioning or if they are in short supply, one might begin to develop hormonal imbalances.

[1442] I'll stop there, but actually new functions of mitochondria are being discovered.

[1443] There are some very prominent aging researchers who are saying that mitochondria are exclusively in control for aging.

[1444] Well, this is what's in Claire, his lab, right, turning mice.

[1445] Yes.

[1446] Yes.

[1447] It's administrative.

[1448] could we say?

[1449] The easiest way to think about mitochondria is if you think of a cell as a computer, this is a great analogy that one mitochondrial researcher used.

[1450] A lot of people think of mitochondria as the power cord to the computer because they're the powerhouse.

[1451] And in fact, they are the power cord.

[1452] If you turn them off, there's no power, and that cell dies.

[1453] The computer won't work.

[1454] But they are also the motherboard of that computer.

[1455] They are allocating resources.

[1456] They are orchestrating all of the different cell parts to do different things at different times.

[1457] And they're doing it in response to the environment.

[1458] So they are key sensors of our environment.

[1459] They actually respond to human stress, psychological stress.

[1460] Well, they tell you our immune system to ramp up.

[1461] Yes, because they're controlling cortisol.

[1462] They're controlling inflammation.

[1463] They're controlling adrenaline.

[1464] And they actually play a role in releasing neurotransmitters and hormones.

[1465] Releasing a neurotransmitter or hormone is actually an active process.

[1466] And mitochondria are kind of shepherding vesicles filled with neurotransmitters or hormones to the cell membrane and releasing them.

[1467] And then they actually move just nanometers and release another batch and then release another batch.

[1468] And if you interfere with their function, these things don't get released.

[1469] Okay.

[1470] So the core of metabolic disorder would be malfunction.

[1471] cheney mitochondria.

[1472] That's what I would argue.

[1473] I don't know that that's a universally agreed upon definition.

[1474] Well, people write in the comments that they're angry.

[1475] This happens.

[1476] This is the nature of all this stuff.

[1477] Yeah, we're not there yet.

[1478] We both will admit, right?

[1479] We're just not there.

[1480] We're not there.

[1481] And everyone's doing their best.

[1482] I would argue, if you look at all of the evidence, all lines are pointing to mitochondria.

[1483] In a nutshell, what I'm arguing is, so we know that for obesity, diabetes, cardiovascular disease, endocrine disorders.

[1484] We know it for some cancers.

[1485] We know it for Parkinson's disease unequivocally.

[1486] More and more research is suggesting it's true for Alzheimer's disease and seizures.

[1487] And what I'm arguing is that it is almost certainly true for people with what we call mental brain disorders.

[1488] But I distinguish a mental disorder from human suffering or human adversity.

[1489] Right.

[1490] That's its own three hour episode.

[1491] Yeah.

[1492] Sorry.

[1493] I think, no, no. No, but just I would say in a nutshell, we have come to a little bit dangerous part where we think any suffering is abnormal or pathological as opposed to part of the human experience and condition.

[1494] It's really just us trying to figure out like what point is pathological and what point is, quote, normal.

[1495] The DSM is exactly that, an attempt to establish what normal is, which is mired with all of its own shortcomings.

[1496] But yes, there is an appropriate amount of suffering.

[1497] There's a useful amount of suffering.

[1498] We can't even agree upon what that amount is, can we?

[1499] We can't.

[1500] As I said, Ukraine right now is a perfect example.

[1501] Do those people really have brain disorders?

[1502] Right, right.

[1503] Their country's being bombed.

[1504] You can check off the boxes for PTSD.

[1505] And do we really think that all of a sudden, a significant portion of a population of human beings all developed A brain disorder.

[1506] Right.

[1507] And is that the right way to think about it?

[1508] Or are they having normal reactions to adversity?

[1509] To help people understand what I'm trying to get at, the easiest example is pain.

[1510] All human beings have pain.

[1511] If you don't have pain, you're really in trouble.

[1512] You're going to injure yourself and you're going to get an infection at the bottom of your foot.

[1513] You're not even going to feel it.

[1514] You're not going to know it.

[1515] And you're going to die.

[1516] It's not pleasant.

[1517] It sucks.

[1518] Pain is normal.

[1519] If you get surgery, you're going to have a shitload of pain.

[1520] Does that mean it shouldn't be treated?

[1521] Of course not.

[1522] Should all pain be treated?

[1523] Of course it should.

[1524] If you get surgery or are you going to maybe take pills?

[1525] I'm sorry to bring this up.

[1526] Actually, no, no. I listened to that episode and I'm sorry.

[1527] No, no, no. People who get surgery are going to have pain.

[1528] That pain needs to be managed one way or another.

[1529] But there is also a class of disorders called pain disorders in which people's pain system is malfunctioning and they are having pain for no clear reason.

[1530] Vibromyalgia is a pain disorder.

[1531] Migraine headaches are a pain disorder.

[1532] Chronic low back pain is a pain disorder from a herniated disc.

[1533] All of those disorders represent normal neurons or pain systems in the brain malfunctioning.

[1534] They are sending a pain signal.

[1535] An alert signal that's not warranted.

[1536] When they should not be.

[1537] As a rule of thumb, those disorders are thought to be disorders of hyper -excitability.

[1538] The neuron is firing when it should.

[1539] not be firing.

[1540] It is creating the sensation and suffering of pain when there is no clear reason for that pain.

[1541] I think of mental disorders in the same way.

[1542] We all have depression and anxiety.

[1543] That's normal.

[1544] If somebody is under extreme stress, like surgery, soldier on a battlefield, Ukrainians, your country is being bombed, you're seeing loved ones die, your life is threatened, extreme stress, you're going to have extreme symptoms, maybe extreme depression, extreme anxiety, PTSD symptoms or trauma symptoms.

[1545] But those really quick, we could deduct the triggering element and it would go away.

[1546] Yes.

[1547] In my mind, that is the ideal treatment.

[1548] And the third group are people who have mental symptoms, depression, anxiety, panic, with no clear reason.

[1549] They're sitting in the comfort of their home on the sofa.

[1550] They're not even having scary thoughts or stressful thoughts.

[1551] And out of the blue, they are experiencing anxiety.

[1552] depression and they're like what is wrong with me why am I having this experience yeah the reason I think it is so critically important to distinguish those is because the treatments should in fact be different the last category represents the brain malfunctioning and that requires an approach to correct the brain malfunctioning but the second example as you said the treatment is remove the adversity or the gay boy who can't accept himself get him to accept himself let's get him to accept himself let's get a hot co -ed.

[1553] Exactly.

[1554] Or get him into a different environment where people are accepting.

[1555] If he's unsafe, get him to safety.

[1556] But there's a huge difference between those two.

[1557] You know, soldiers on a battlefield.

[1558] I really kind of don't want to medicate them with anything sedating because their life depends on it.

[1559] So they're not getting eight hours of sleep every night.

[1560] Right.

[1561] Well, you know what?

[1562] They shouldn't be.

[1563] Yeah.

[1564] And they're hyper -startling at night.

[1565] They hear the slightest sound and they wake up.

[1566] And they might say, Doc, I've got insomnia.

[1567] Well, you better not use a pill to make that soldier sleep soundly for eight hours because that may cost him or her their lives.

[1568] They need to wake up.

[1569] Their body is trying to save itself.

[1570] Yeah.

[1571] But what about 10 years down the road when that's over?

[1572] That is a brain disorder.

[1573] Okay.

[1574] If they have been safe and sound for the last 10 years, the majority of human beings, bodies do adjust.

[1575] Their brains adjust.

[1576] They go through an adaptator.

[1577] period where all of the soldiers first stay home, they're all still hyper -startling, they're all still numb, triggering, I mean, everything.

[1578] Yeah.

[1579] Because the symptoms don't go away right away.

[1580] But where do we draw that line?

[1581] Yeah, lots of controversy.

[1582] Right now, DSM draws it at two months.

[1583] But again, DSM unfortunately doesn't say that the offending trauma or danger has to be removed.

[1584] Yeah.

[1585] Again, the battered woman can still be diagnosed with a brain, disorder while she's actively being battered.

[1586] Yeah.

[1587] Okay, so what makes total sense to me is that in the pain example, you have some hyperactivity of the nerve endings, let's say it's in your arm.

[1588] It seems to me that the issue, the metabolic disorder, whatever, the issue is localized to where the pain's coming from, that's where the cells are that are in a state of overactivity.

[1589] They go up to your brain, they tell you it hurts there, but would I be right into think that that's where the issue is, wherever you're feeling the pain is where the cells are that are overactive?

[1590] Not necessarily.

[1591] It certainly could be.

[1592] The area of the brain that perceives pain in that location could actually be hyper -excitable.

[1593] It could be either or.

[1594] Or anywhere along the path of that neuron from your arm, say, to your spinal cord up to your brain.

[1595] If you get a tumor, for instance, pinching on that nerve anywhere along the line, you might actually get pain when the tumor's in your upper arm.

[1596] Yes, you might feel it as hand pain.

[1597] Okay.

[1598] So then my question is because mental illness is in your brain, is it logical to assume that it starts and ends there, that that's where the sources, or do we think that it too can be coming from somewhere else in your body?

[1599] I think that's one of the unfortunate flaws in the mental health field is thinking of mental illnesses as localized to the brain and thinking that the brain is disconnected from the rest of the human body when we know it's not.

[1600] The latest, greatest thing that everybody's already heard, the gut brain connection.

[1601] Your gut actually has 90 to 95 % of the serotonin in the human body.

[1602] Oh, wow.

[1603] Wow, wow, wow, wow.

[1604] Did not know that.

[1605] So you have a serotonin problem?

[1606] Well, maybe you should be thinking of your gut before you think of your brain.

[1607] Oh, interesting.

[1608] And researchers have not found serotonin imbalances in the brain.

[1609] Maybe there's something going on in the gut, but psychiatric researchers aren't, for the most part, studying the serotonin system in the gut, because, well, what the hell would that have to do with depression?

[1610] Depression has to be come from your brain because that's what controls everything.

[1611] But for better or worse, the human body is interconnected and interdependent.

[1612] The brain relies on your heart, obviously, to pump blood up to it.

[1613] The brain relies on the liver to send fuel sources when called for.

[1614] The brain is actually telling the liver and pancreas to secrete things or not secrete things.

[1615] You can see why they've made this division, though, right?

[1616] It is a bizarre thing.

[1617] It's not somatic cells.

[1618] It doesn't go through mitosis, right?

[1619] It doesn't repair the brain cells.

[1620] There's a blood -brain barrier.

[1621] There's all these things that do, make it unique to the rest of the body, you can see the temptation to think of it as almost completely separate.

[1622] I don't fault anyone for thinking that.

[1623] What I'm arguing is that we've been pursuing that path for at least a century, for a century.

[1624] Yeah, all resources.

[1625] And we have spent billions, if not trillions of dollars.

[1626] And the answer right now still is nobody can figure it out.

[1627] It's too complicated.

[1628] We can't even figure out why or how Prozac works.

[1629] And for whom will it work and for whom won't it work?

[1630] Right.

[1631] Okay, so your theory is that mental illness or disorder is a metabolic condition.

[1632] Now, how do we treat the other accepted metabolic conditions?

[1633] Let's just start with the ones that are accepted.

[1634] So if obesity and diabetes are metabolic disorders, how are they activated and how are they treated?

[1635] We know risk factors for obesity, diabetes, and cardiovascular disease, and they largely overlap, although there can be some distinct differences for specific disorders, but they're minor.

[1636] Overarchingly, diet, exercise, toxin exposure, cigarette smoking is the easiest example.

[1637] Excess alcohol drugs are also examples, all sorts of things.

[1638] But infections play a role in this.

[1639] Inflammation plays a role in all of those disorders.

[1640] So some people with obesity have a specific virus in their fat cells.

[1641] And people who have that virus in their fat cells are much more likely to become obese.

[1642] Is the virus named and understood and studied?

[1643] It is.

[1644] I'm not going to say the name because I'm not an expert in this area.

[1645] I know the concept, and I'm certain of the concept, so I'm not going to make a fool of myself.

[1646] And say the wrong virus name.

[1647] But there is the virus that's been identified for actually a few decades now, much, much more prevalent in obese people.

[1648] I've heard some of those explanations.

[1649] The thing that's really, really hard to ignore is obesity rates over the last century.

[1650] Yeah.

[1651] So what you'd really have to be suggesting is that the prevalence of this virus has quintupled and quintupled and quintupled.

[1652] And I find that very hard to believe.

[1653] I'm not at all asserting.

[1654] it's all this virus.

[1655] Again, first one I listed is diet.

[1656] What we do know is like starting in the 50s, it just starts climbing and it's in this is fucking insane.

[1657] It's like the only thing that mirrors the tech explosion.

[1658] I want to add psychological and social factors as well.

[1659] So stress, loneliness, a sense of meaning and purpose in life.

[1660] Sexual trauma.

[1661] All adverse childhood experiences play a role in all of those, quote unquote, metabolic disorders.

[1662] So now we're talking about.

[1663] about biological, psychological, and social factors all play a role in metabolic disorders.

[1664] I want to just highlight one specific example because a lot of people will still say, well, trauma just makes people overeat.

[1665] And so many people feel that they are certain that if you have obesity, the problem is clear.

[1666] You're eating too much.

[1667] If you just ate less, you wouldn't be obese.

[1668] And so it's a problem of willpower.

[1669] But one clear example are cigarette smokers.

[1670] So cigarette smokers on average tend to weigh less than non -smokers.

[1671] And yet, they are much more likely to develop heart attacks, a metabolic disorder.

[1672] And they are also twice as likely to develop type 2 diabetes.

[1673] That starts to challenge this notion that it's overeating delicious food, makes people fat, which then makes them diabetic, which then makes them have a heart attack.

[1674] That's the sequence that most people know and assume is fact.

[1675] That sequence can happen, but it's not the only sequence.

[1676] Can I also flag?

[1677] This is where everything unravels for people, I think, and what gets very frustrating for people.

[1678] That very well may be the exact mechanism, and it might even be for 80%.

[1679] We're so varied.

[1680] There's so many outcomes to a human life.

[1681] People are very attracted to this is the singular mechanism, but there's multiple.

[1682] There has to be some kind of appetite for the many different ways.

[1683] So yes, the cigarettes.

[1684] smoking thing is an interesting anomaly in that equation.

[1685] But what I would argue is there's a lot of different ways to heart disease.

[1686] Yes.

[1687] And unfortunately, someone comes along and everything's got to be binary.

[1688] And then people seem to lose credibility when it's not one size.

[1689] A hundred percent agreed.

[1690] There's going to be like 90 different versions of how someone gets to each one of these places.

[1691] And despite that, the good news is it, we can do something about these illnesses.

[1692] We can help people lose weight.

[1693] We can help prevent heart attacks.

[1694] We can help reverse even type 2 diabetes.

[1695] We can help people improve through changes in diet, exercise, stress reduction, sleep, psychosocial intervention.

[1696] Connections with one another.

[1697] We can do that.

[1698] We don't necessarily need to know the exact biological pathway.

[1699] ways for each and every one of those steps.

[1700] What I'm arguing is if you look at any one of those risk factors are also all risk factors for all mental disorders.

[1701] So this is about looking at all of the basic cell biology to the risk factors, to the exacerbating factors.

[1702] Mental disorders and metabolic disorders are indistinguishable.

[1703] Mental can feed metabolic and metabolic can feed mental.

[1704] Metabolic can result in mental symptoms or mental disorders.

[1705] Because they're not functioning correctly.

[1706] They're not playing their role in the overall ecosystem and then it may materialize as that mental health disorder.

[1707] Yes.

[1708] In the same way that all of those factors can make your heart malfunction or in the same way that all of those factors can disrupt your endocrine system or your fat cells or whatever to cause obesity or to contribute to obesity, what I'm arguing is that the brain is an organ too.

[1709] And in the same way that all of those factors can come together to cause what we call metabolic disorders, those exact same factors also come together to cause dysfunction in the brain, which we end up calling mental disorders.

[1710] Right.

[1711] And then splintering into a million different diagnoses.

[1712] Because the brain is such a fucking complicated organ.

[1713] Yeah, yeah.

[1714] And you, or at least minimally in some of the other interviews I've heard in a big component of brain energy, your book, is the diet.

[1715] You seem to focus heavily on the diet.

[1716] Most specifically, ketogenic diet you're a proponent of?

[1717] You know, in the book, I actually don't focus on the ketogenic diet much at all.

[1718] Okay.

[1719] Believe it or not.

[1720] Just you and Tim Ferriss really got off on the ketogenic diet.

[1721] No. So, and Andrew Huberman focused on the ketogenic diet as well.

[1722] So a lot of people are really interested in that because that is kind of.

[1723] of the novel treatment?

[1724] Well, can I tell you something?

[1725] I'm not.

[1726] In fact, one hesitation of interviewing you was, I happen to love this guy.

[1727] He's in the same world as Ferris and Huberman.

[1728] And his name's Lane Norton.

[1729] He's a nutrition scientist.

[1730] Do you know Layne Norton?

[1731] I do know.

[1732] Wonderful.

[1733] But I know who he is.

[1734] I don't know him personally.

[1735] Of all these guys, he's kind of my favorite.

[1736] He seems to be the most dogmatic to the actual study in the meta -analysis of all the states.

[1737] And I think the world of diets is so fucking fundamentalist, religious, wacky.

[1738] And I don't ever like giving fuel to any one of those specific ones.

[1739] So that was like my own reservation.

[1740] I was like, I don't want anyone walking away from here with either more shit to defend their keto choice, which go crazy, be ketogenic.

[1741] I also agree with Lane that if you control for protein, all these diets work, it's really which one fits your lifestyle and your temperament.

[1742] I think that's really important for people to remember.

[1743] Those are my caveats.

[1744] But tell me why ketogenic is very helpful in this metabolic disorder.

[1745] So the reason I have been doing work on the ketogenic diet, it was all serendipity.

[1746] Doris?

[1747] Doris was actually subsequent.

[1748] She was just like the brilliant case example of what's possible.

[1749] This story really began with my own story.

[1750] So I did a low carb, what was subsequently a ketogenic diet, before it was really.

[1751] really referred to it.

[1752] It was Atkins then, right?

[1753] By the way, you and I have a parallel life.

[1754] So I did when I was 20, I did low fat for a year.

[1755] Almost no fat.

[1756] I did no fat.

[1757] Terrible.

[1758] Lost weight.

[1759] Felt like shit.

[1760] No muscle mass. And then at some point, me and my girlfriend did Atkins for a year.

[1761] It too.

[1762] I lost weight.

[1763] So again, like, yeah, all of them ultimately end up being caloric restrictive in some capacity.

[1764] And they all kind of work.

[1765] And then for me, it's like, what is my body compensation after I've lost the weight and I end up caring about.

[1766] But I just thought it's funny that I've been down both the roads that you have.

[1767] Yeah.

[1768] And I think speaking about diet and the work that I do, we have to get really granular about what are the goals and what are you trying to achieve.

[1769] Some people might want to put on muscle mass and maintain that muscle mass. Other people might want to lose fat.

[1770] Everyone wants a larger penis.

[1771] I'm not aware of any good dietary interventions for that.

[1772] My work has really focused on the use of the ketogenic diet.

[1773] epilepsy.

[1774] So the ketogenic diet is a 100 -year -old evidence -based treatment for epilepsy.

[1775] It can stop seizures even when medications and surgery fail to stop seizures.

[1776] You know I have epilepsy.

[1777] I did not know that.

[1778] Well, I do.

[1779] This bitch is epileptic.

[1780] Yeah.

[1781] And did you not know that?

[1782] This is tragic that you do not know it.

[1783] She has a neurologist.

[1784] That's fine.

[1785] If your epilepsy is controlled, then you would not be considered a quote -unquote candidate for it.

[1786] They will do brain surgery before they will prescribe a diet for someone's epilepsy.

[1787] Yeah.

[1788] Because a diet is crazy.

[1789] Come on.

[1790] Like, you don't want to do a diet.

[1791] Well, this is the same paradoxes physical therapy versus surgery.

[1792] It is perfect with that.

[1793] Also, did I read you have found some connection between depression and epilepsy or no?

[1794] Oh, absolutely.

[1795] Oh, my God.

[1796] Buckle up.

[1797] At least a third of patients with epilepsy will attempt suicide.

[1798] Oh.

[1799] Most of those suicide attempts occur before the person is diagnosed with epilepsy.

[1800] Oh, my God.

[1801] People with epilepsy, about 50 -ish percent will be suffering from depression and anxiety.

[1802] That compares to like 8 % of the general population.

[1803] They've got a huge risk.

[1804] Ninefold increased risk for schizophrenia.

[1805] That's 900%.

[1806] Markedly increased risk for bipolar disorder.

[1807] one study, the sample probably skewed it, but they actually found 25 times the rate bipolar disorder and people with epilepsy.

[1808] People with epilepsy are more likely to have autism spectrum disorder.

[1809] People with epilepsy are much, much more likely to have ADHD.

[1810] They're much more likely to have enormous podcasts and beautiful homes.

[1811] I don't feel like I have a lot of those things to be bad.

[1812] Also, I would imagine it's commensurate with the level of epilepsy you have, which is she's only had a few and they were at night.

[1813] And we can get to that.

[1814] Like, why would people have different sims?

[1815] If you've got a metabolic problem, why wouldn't you have all of the symptoms of metabolic stress?

[1816] So I actually, when reading the connection you were making between epilepsy and the keto diet, I was actually then going back in my mind, imagining what state your diet was in the times you had them.

[1817] It made me real curious.

[1818] So the bottom line is we've got two Cochrane reviews.

[1819] Cochrane reviews are the gold standard in the medical field.

[1820] They are the gold standard meta -analysis of all of the randomized controlled studies that have been done.

[1821] And those two Cochrane reviews have concluded that the ketogenic diet for children with treatment -resistant epilepsy, children and adolescents, it is a superior intervention than trying yet another medication.

[1822] Six -fold increased risk of being seizure -free with a ketogenic diet.

[1823] If a kid comes in with treatment -resistant epilepsy, meaning they've tried three or more medications and or brain surgery or neurostimulmonary.

[1824] or electrodes or whatever.

[1825] Acupuncture.

[1826] Throw in acupuncture.

[1827] Throw in some happy thinking.

[1828] If those things aren't working to control the epilepsy, if that child gets another pill, the chances of them becoming seizure -free is almost zero.

[1829] The chances, if that child tries the ketogenic diet, the chances of them becoming seizure -free are about 33%.

[1830] And another 33 % will have a significant reduction in CETA.

[1831] Seizures.

[1832] Sixty -six percent essentially will have at least some improvement, if not seizure freedom with ketogenic diet.

[1833] The research trials in adults are not as good.

[1834] And that's because adults don't seem to be able to do the diet and or there's something.

[1835] No one's making their food every day.

[1836] Any mom to move on a keto diet.

[1837] So I want to come back to the statement that you said Dachs, which is, you know, different diets, calorie restriction.

[1838] Different diets do not stop seizures.

[1839] Gotcha.

[1840] Mediterranean diet, calorie restricted, does not stop seizures.

[1841] High protein diet does not stop seizures.

[1842] The ketogenic diet stops seizures.

[1843] That is a medical fact.

[1844] Okay, but one thing I thought of, not unlike the way we made some spurious conclusions based on the SSRI inhibitors, no arguing the outcome, no arguing the correlation for me. you go on a ketosis diet, you get your ketones up, you have all these outcomes that are really favorable.

[1845] But the only thing I just wanted to pause, and of course is based on my own anecdotal, self -centered thing of having psoriotic arthritis and how I've ultimately figured out how to control it over 20 years.

[1846] Just because we're seeing elevated ketones, instead of the presence of the ketones being responsible, what if it's not just the absence of the fucking allergen?

[1847] When you go keto, you're getting rid of all these grains.

[1848] You're getting rid of gluten.

[1849] You're getting rid of a ton of potential allergens that people are probably suffering from.

[1850] You definitely are.

[1851] So first and foremost, there are numerous variations of the ketogenic diet.

[1852] You can do a vegan ketogenic diet.

[1853] No, thanks.

[1854] You can do a vegetarian ketogenic diet.

[1855] Most people do an omnivore version, and some people will do a carnivore diet, which is 100 % animal -sour -sour -sour -foods.

[1856] The most fundamentalist of the fundamentals.

[1857] Yes.

[1858] So that whole spectrum are the diet wars.

[1859] Yeah.

[1860] And what I'm saying is keto is an umbrella over all of them.

[1861] You can be in any of those camps and still be keto.

[1862] Intermittent fasting can play a role in ketosis and a ketogenic diet.

[1863] But the ketogenic diet, it's more than just the presence of ketones because we have ketones that you can drink now.

[1864] So people can drink ketones.

[1865] They're called exogenous ketones.

[1866] You can buy a bottle of them and drink them.

[1867] and that will increase ketones in your bloodstream.

[1868] That does not stop seizures.

[1869] The mechanism of action is not the presence of ketones alone.

[1870] The presence of ketones is a biomarker for a lot of other things happening.

[1871] And exogenous ketones play a role in physiology and brain function and all sorts of other things.

[1872] Is that a supplement worth taking?

[1873] I mean, neither of us are in the prescription business of supplements, but is exogenous ketones worth exploring?

[1874] Here in LA, it's all the rave.

[1875] Oh, my God.

[1876] How did I miss out?

[1877] Hemsworth, what if Paltrow.

[1878] Oh my God.

[1879] I haven't even heard of that.

[1880] Andrew Huberman, Tim Ferriss, all sorts of people are drinking ketone.

[1881] Okay.

[1882] So, um, you guys are missing out on the ketone party.

[1883] I can't imagine how good I would look.

[1884] Well, and for Dax, you in particular, I'll come back to it if you want, but there's a study of alcoholics on ketones and possibly exogenous ketins and all that.

[1885] Wait, I can drink and look like Chris Hemsworth.

[1886] No, you're not to drink.

[1887] Wouldn't that be awesome?

[1888] You can drink ketones and look like yourself, I wish.

[1889] Ketogenic diet has been studied for decades by neurologists and biotech companies trying to figure out how the hell does this diet stop seizures.

[1890] It was first developed from this millennia -old observation that fasting can stop seizures.

[1891] Hippocrates knew that fasting could stop seizures.

[1892] One version of the New Testament talks about Jesus treating an epileptic child.

[1893] child seizing, his disciples were praying, praying wasn't working, and Jesus came and said, you must fast the child plus prayer to stop the demon possession.

[1894] It was demon possession of that point.

[1895] You must fast.

[1896] Still is maybe.

[1897] And the fasting stopped the seizures.

[1898] So this has been known for over 2 ,000 years.

[1899] About 100 years ago, 1920s, two physicians put it to the test because it was largely thought, to be religious folklore.

[1900] The problem with fasting, though, is that once people start eating again, the seizures come back.

[1901] If you fast too long, you starve.

[1902] And that's a really bad medical intervention.

[1903] They say dead men have no seizures.

[1904] That's true.

[1905] This is true.

[1906] So the ketogenic diet has been studied for 100 years trying to figure out how it works.

[1907] We know that it changes neurotransmitter systems in the brain.

[1908] It decreases brain inflammation.

[1909] It changes the gut microbiome in profound ways.

[1910] A paper just published in Cell, which is the leading biological journal.

[1911] Those researchers are arguing that the primary mechanism of action might be through the gut microbiome.

[1912] And so again, now we're getting to the gut brain connection.

[1913] Like, why would something stop seizures?

[1914] Those researchers in an animal model tried to prove, they think they did.

[1915] I'm not 100 % persuaded yet, but it's pretty compelling that the ketogenic diet changes the gut microbiome.

[1916] That somehow stops seizures in the brain.

[1917] And that they could actually transplant the microbiome from a ketogenic diet -fed mouse into a sterilized mouse not on a ketogenic diet who's also having seizures and that sterilized mouse will get the anti -seizure effect from the gut microbiome from the mouse fed the ketogenic diet.

[1918] So it gets complicated quickly.

[1919] It changes hormone systems, it changes all sorts of things.

[1920] Central to my thesis, it does two things to mitochondria.

[1921] It stimulates a process called mitophagy, which is getting rid of old and defective mitochondria and replacing them with new ones.

[1922] And it also stimulates another process called mitochondrial biogenesis, which is the production of new mitochondria.

[1923] So when people do the ketogenic diet, their cells over time will have more mitochondria and those mitochondria will be healthier.

[1924] And just really quick, I hate to ask a dumb question, but that's measurable.

[1925] This has all been measured.

[1926] Decades of neuroscience research.

[1927] They've removed some cells and they can see.

[1928] the mitochondria.

[1929] Because anytime we're talking nutrition, people are bouncing back and forth from what's observed and what they think is happening as the downriver result of it.

[1930] I'm going to say something shocking.

[1931] We know more about the effects of the ketogenic diet on the brain than we do any other dietary intervention.

[1932] And the reason is because it stops seizures when medications don't.

[1933] That's so fascinating.

[1934] Pharmaceutical companies have been studying it to look for new targets.

[1935] They want to develop new pills.

[1936] They're trying to figure out what the fuck is this diet doing.

[1937] How can you get into ketosis without the troubling diet associated with it?

[1938] Well, that's the thing.

[1939] You can drink ketones, but that doesn't work.

[1940] But I'm saying that would be the holy grail.

[1941] So it's not so much ketosis.

[1942] I'm arguing.

[1943] And again, this is going to be controversial, but I'm arguing it's mitochondria.

[1944] If you can improve mitochondrial function and number, those cells will function properly again.

[1945] There are many other ways.

[1946] Exercise increases mitophagy and mitochondrial biogenesis.

[1947] I'm doing one of these things.

[1948] Stress reduction, good sleep, staying off of alcohol, marijuana, cigarettes, vaping even.

[1949] Staying off those things is good for your mitochondria.

[1950] Especially processed foods with lots of fat and sugar, like donuts and cookies.

[1951] If you are eating those on a regular basis, we know that they are highly associated with higher rates of obesity, but also depression, anxiety, Alzheimer's disease, and other mental disorders.

[1952] Interesting.

[1953] And the metabolic disorders, too.

[1954] So not just obesity, but type 2 diabetes and also cardiovascular disease.

[1955] And this is exactly when I get back to my 0 .6 hours ago that we're going to find our way back to the Amish.

[1956] I mean, truly.

[1957] Yeah.

[1958] It gets so complicated to get back to the, the notion of eating good, unprocessed food.

[1959] Real food.

[1960] Yeah, real food.

[1961] We've got to get so complicated to come back.

[1962] The sad truth is it's increasingly difficult to find real food.

[1963] Almost impossible.

[1964] When you look at all the pesticides that are used on the food that we eat, when you look at all the hormones and antibiotics and other things that are pumped into any animal -sourced foods, whether it's salmon or cows or they're in the milk, we see.

[1965] Girls going through puberty much earlier in life.

[1966] We see hormone disruption from these chemicals.

[1967] Everybody's scratching their head.

[1968] What's causing it?

[1969] Well, like, open your eyes to these chemicals.

[1970] We know these chemicals disrupt hormone systems, and then that plays a role in all of this.

[1971] Unfortunately, I'm not a doctor.

[1972] I've done no research, and I haven't read any.

[1973] You play a doctor on armchair expert.

[1974] Might be the only thing I've never played in a movie as a doctor.

[1975] But I have this super gut anecdotal feeling.

[1976] Again, it's from my 20 -year experiment with psoriotic arthritis, which is, I think at the end of the day, we're all allergic to a lot of things we eat.

[1977] And I think the inflammation and the elevated everything, I think we're all like having allergic reactions to a lot of the stuff we're eating.

[1978] And I don't think you can detect it the way.

[1979] I mean, I've been to an allergist and had the prick test on the back.

[1980] It didn't really tell me anything, but then lo and behold, I cut out this thing for a long time.

[1981] My knee doesn't swell up.

[1982] You know, my overarching hunch is we have a lot of allergies going on in our body.

[1983] So what I'm going to argue is a little different.

[1984] Okay, great.

[1985] It's very related.

[1986] But I'm sticking with my central hypothesis.

[1987] So all arrows are pointing to mitochondria.

[1988] So instead of looking for a classic allergy that causes histamine release, that causes inflammation and rash.

[1989] But just really quick, those are a part of the system.

[1990] The rash creates another thing.

[1991] Absolutely.

[1992] A lot of the things in our food supply today that did not exist 200 years ago cause mitochondrial dysfunction.

[1993] And this has been fairly well established.

[1994] High fructose corn syrup causes mitochondrial dysfunction.

[1995] Eating a lot of processed foods causes mitochondrial dysfunction.

[1996] A prominent researcher in the diabetes field has been studying this in the end phase of her career.

[1997] And she has identified at least like three or 400 chemicals in the current food supply that all change mitochondrial function, mitochondrial reactive oxygen species, which then causes inflammation.

[1998] So when you look at what causes inflammation, like if you say eating toxic foods causes inflammation, that's true.

[1999] But if you say why?

[2000] Yeah, what's the mechanism?

[2001] The mechanism is mitochondria.

[2002] There is no other way around it.

[2003] because mitochondria are stimulating all of the processes that trigger inflammation.

[2004] Mitochondri are actually directly controlling our immune cells.

[2005] They are playing an instrumental role in whether immune cells are turning on or off, whether they go through different phases.

[2006] So all signs are pointing to mitochondria.

[2007] And some people will hear this as Chris Palmer you're making it sound really simple.

[2008] And the good news is on some fronts, it is really that simple.

[2009] The overarching theory is that mitochondria are controlling the human body.

[2010] And we need to understand that.

[2011] And once you understand that, we can start to understand all of these different risk factors and how they result in illness.

[2012] This is in concert, by the way, with Mukherjee's cell book.

[2013] Yeah.

[2014] If you actually open the door and step into this new world, it's a different paradigm, but it's an overwhelmingly complex new universe.

[2015] There is so much about mitochondria that we don't understand.

[2016] How are they controlling gene expression during development of a cell, a lot of them will move around the cell.

[2017] They fuse with each other.

[2018] They form these tubular networks and then they split off from each other.

[2019] During development, they actually go around the cell nucleus, line up, and take on different conformations.

[2020] And those changes in their structure and function affect the regulation of genes.

[2021] How the fuck is all that happening?

[2022] Nobody knows.

[2023] It's all a big mystery.

[2024] So we spent so many years decoding the human genome and we've gotten some information from it.

[2025] But we have not gotten the magical answers that we had hoped to get to prevent illness.

[2026] And we certainly haven't gotten anything of a breakthrough in the mental health field because of mapping the human genome over 20 years ago.

[2027] And what I'm arguing is we need to shift now.

[2028] We need to step away from the human genome and start.

[2029] looking broadly at these concepts of metabolism and mitochondria to understand the bigger picture.

[2030] The good news is it does present possible treatments today like the ketogenic diet.

[2031] And we haven't said this outright.

[2032] I just want to say it to put in the plug for what even set me on this path.

[2033] I have now seen in well over 100 patients, a ketogenic diet put into full remission, what are supposed to be chronic lifelong disorders, bipolar disorder, schizophrenia, full and lasting remission.

[2034] Over like what timeline?

[2035] Like, how long are we talking?

[2036] So Doris, the woman you mentioned, is the longest example that I'm aware of, that I actually know her whole story.

[2037] That's like 15 years or something?

[2038] 15 years.

[2039] She had suffered from schizophrenia for 53 years.

[2040] She was 70 years old.

[2041] She had tried to kill herself at least six times between the ages of 68 and 70.

[2042] She was overweight.

[2043] She was obese.

[2044] She had a guardian.

[2045] She was in and out of hospitals.

[2046] Had tried lots of antipsychotics and mood stabilizers.

[2047] Nothing worked.

[2048] She was the classic example of a schizophrenic.

[2049] She heard voices all the time, had paranoid delusions.

[2050] She tries the ketogenic diet to lose weight under the guidance of Dr. Eric Westman at Duke, who's just running a weight loss clinic.

[2051] He's not trying to treat mental disorders right now.

[2052] He's just helping people lose weight.

[2053] Using the ketogenic diet.

[2054] And within two weeks, she starts losing weight but notices dramatic reduction in her hallucinations and delusions.

[2055] Within months, she's off all of her psychotropic medications and in full remission from her schizophrenia.

[2056] Doris was 70 years old when that happened.

[2057] She went on to live another 15 years, remained symptom -free, medication -free, and no more mental health professionals no more psychiatric hospitalizations no more suicide attempts sadly she passed away this past January or last January I guess now of COVID pneumonia but she was 85 so I don't want anybody to think ketogenic diet killed her from COVID because she lost like 150 pounds wow wow yeah that's incredible all of this is in brain energy a revolutionary breakthrough in understanding mental health and improving treatment for anxiety, depression, OCD, PTSD, and more.

[2058] There's a ton of great case examples like Doris in the book.

[2059] And I do love the handful of books now I've read that are ushering in this.

[2060] To your point, like DNA, great.

[2061] All we really did is figured out what every ingredient in the pantry is, but we have no idea how the fucking cake is baked.

[2062] And we're trying to cook a specific cake and the fucking ingredients are a little bit irrelevant.

[2063] Yeah.

[2064] Yeah.

[2065] Yeah.

[2066] So I love the direction that this is all heading in.

[2067] You're fantastic.

[2068] I really appreciate your personal stories.

[2069] That was my favorite part.

[2070] And I'm so excited you came and stopped by.

[2071] This has been a pleasure.

[2072] Yes.

[2073] And I'm hoping you wander over to Disney Music Hall and take some of the sites in and get the good food.

[2074] I will.

[2075] Yeah.

[2076] It's been a total pleasure having you.

[2077] Thank you so much for inviting me. And I'm not the fake Chris Palmer.

[2078] Brain energy, everyone.

[2079] Get it now.

[2080] Thanks so much, Dr. Chris Palmer.

[2081] Thank you.

[2082] And now my favorite part of the show, the fact check with my soulmate, Monica Padman.

[2083] Okie -doke.

[2084] We're home.

[2085] How was your trip home?

[2086] Trip home was fine.

[2087] We reversed.

[2088] We reversed.

[2089] I had no TV.

[2090] Yeah.

[2091] And no bed.

[2092] Uh -huh.

[2093] Yeah.

[2094] But it was okay.

[2095] No recline.

[2096] Yeah, no recline.

[2097] But it was all right.

[2098] I had work to do and I got it done.

[2099] Oh, good.

[2100] Mm -hmm.

[2101] I started panicking because we took a red eye.

[2102] Yep.

[2103] First of all, what time did you land last night?

[2104] I landed at 10 .15.

[2105] PM?

[2106] Yes.

[2107] Okay, and then what did you do?

[2108] You went straight home.

[2109] Went home?

[2110] Made a pasta?

[2111] I showered.

[2112] Yeah, I made a stew.

[2113] No, I showered.

[2114] Okay.

[2115] And then I went to bed.

[2116] 99.

[2117] Mm -hmm.

[2118] Okay.

[2119] Even though it was 8 o 'clock your time now.

[2120] Well, by the time I went to bed, it was 12 .30.

[2121] Okay.

[2122] So it was 10 .30, Hawaii.

[2123] Sure.

[2124] Which is about.

[2125] about when you were hitting the hay.

[2126] That's right.

[2127] That's right.

[2128] New York trip?

[2129] So we had a 10 -10 departure time.

[2130] Yep.

[2131] And when I selected the seats, you know, when I ordered the tickets.

[2132] Yeah.

[2133] It seemed to me like they were going to be groovy, like they would lay down because it's a red eye.

[2134] Oh, my God.

[2135] Hold on a second.

[2136] I don't want to set too much of a bait and switch.

[2137] But let's just say I was like 90 % confident.

[2138] That's what the sitch was.

[2139] Yeah.

[2140] And then when we got to the gate, I don't know why.

[2141] Just we both started feeling like there's no way this.

[2142] It just seemed, it just seemed bad.

[2143] It seemed bad.

[2144] There was a million and a half people.

[2145] Also the flight, I won't say what it is, but the airline you took, it could have gone either way.

[2146] More of a crapshoot.

[2147] I was like, you were very confident.

[2148] You kept telling Lincoln over and over again that you guys would have beds.

[2149] And I kept thinking, oh, no. Yeah, and that confidence was waning.

[2150] Like, so, you know, long trip, Delta played hard.

[2151] By the time we arrived to the airport at night, she's cut her foot.

[2152] She can't walk, okay?

[2153] And you just walked through that airport.

[2154] And especially where we dropped off the rental cars.

[2155] So you start at one end.

[2156] Conservatively speaking, it was three quarters of a mile from where we, maybe a mile, because there's a very end gate.

[2157] You don't want to take a shuttle?

[2158] Well, we walked to ticketing, which was across the, you park in the airport.

[2159] Right.

[2160] And then you walk across a bridge and then we walk a while, we get to ticketing.

[2161] But then the gate was in the opposite universe of the ticketing.

[2162] Maybe were you at the same gate?

[2163] G6.

[2164] I was in E, but there is a shuttle in that airport.

[2165] Okay.

[2166] I don't know how that works.

[2167] Yeah.

[2168] Point is I had Delta on my shoulders.

[2169] Oh, God.

[2170] Okay.

[2171] And I had my backpack on it.

[2172] I brought my computer because we were working on a computer, iPad, fucking headphone, whatever.

[2173] The backpack conservatively was 35 pounds.

[2174] Then you throw 60 pounds for Delta.

[2175] So I was walking with like 100 pounds on and it's fucking hot.

[2176] The whole airport, which is cool when you're in the mood for it, is kind of outdoors.

[2177] Yep.

[2178] So it was hot and muggy and I was in my Daniel Ricardo sweat outfit.

[2179] Oh, your fart pants.

[2180] My fart suit.

[2181] Needless to say, by the time we got to the gate, I would.

[2182] was very drenched and just the negative thoughts started seeping in like Kristen's like, you sure these are going to lie?

[2183] I'm like, oh, yeah.

[2184] But as I say it, I'm like, oh, fuck, I mean, judging from the photo I clicked on.

[2185] Oh, yeah.

[2186] And then, and again, everyone deserves it.

[2187] But let me just say, I've never seen this before.

[2188] So, you know, they'll do disabled passengers board first.

[2189] Yes.

[2190] That's great.

[2191] That's a ding, ding, ding.

[2192] Oh, okay, great.

[2193] Then it was servicemen and women, which is great, but there's a big base there.

[2194] So now there's...

[2195] We did have a lot on ours, too, now that you're saying.

[2196] There's 25 people, right?

[2197] And it's one of these things where it's like, oh, boarding's at 9 -10.

[2198] You know, we're planning this whole thing out.

[2199] You give the kids like a night time, hello -bello.

[2200] Yes, melatonin for the flight because we've got to be out cold when the wheels are up.

[2201] Anyways, everything's kind of back, you know, reverse engineered from that boarding time.

[2202] Whatever.

[2203] I sound like such a brat right now.

[2204] But I'm just, the reason I'm painting it this way is I'm just trying to explain how much time there was for more and more doubt to slip in.

[2205] Of course.

[2206] So then they go parents with small children.

[2207] Now, Monica, no, it was like three and on there.

[2208] Oh.

[2209] The number here is 30 or 40.

[2210] It's like So like a hundred people have gotten on this plane already And so I'm just starting to now feel jinxed I'm like yeah this isn't going to go our way It's gonna okay long story short We get in there they did recline Everything's groovy But I had I know I know I know I know But I had two hours of like What next?

[2211] What happens when no one sleeps on this whole thing We land I've got to work You know But it was fine It was fine.

[2212] It was maybe, it's a four hour and 50 minute flight.

[2213] Yeah.

[2214] And I bet you I slept a good three and a half hours.

[2215] Oh, nice.

[2216] So we landed 5 a .m. L .A. time.

[2217] Yep.

[2218] Get in the car.

[2219] Yep.

[2220] 5 a .m. today?

[2221] A couple hours ago.

[2222] Yes.

[2223] Yes.

[2224] And then again, now you got two kids who've just slept four hours and we got to go to baggage claim.

[2225] And then we flew out on one airline.

[2226] So I parked in P5.

[2227] Flew back a different airline.

[2228] Yes.

[2229] That landed us way the fuck at the end.

[2230] Oh, shit.

[2231] So, you know, we got to walk another mile to get to the car that we've parked there.

[2232] Anywho, total lemonade, though, because we got on the highway and I was like, look this, girls, we're never on the highway at 5 .40 in the morning.

[2233] A, no traffic or relatively no traffic.

[2234] Yeah.

[2235] And we're going to watch the sun come up, which we never do because we're lazy.

[2236] We're not up to watch the sun come up.

[2237] And there's that beautiful moment where you're on the 105 and you're going to take that big left hand bridge.

[2238] In fact, we shot some of chips up there.

[2239] Big left hander up into the sky to turn onto the 110.

[2240] And you're 100 feet off the ground and baby, boom!

[2241] The East Horizon was just glowing orange.

[2242] And then you'd look to your left and then downtown was pitch black.

[2243] And then you'd pop your head to the right again to the east.

[2244] Orange, left black.

[2245] Orange is the new black.

[2246] Orange is the new black.

[2247] It certainly was at 6 a .m. this morning.

[2248] Yeah.

[2249] So then the right home.

[2250] was lovely.

[2251] Did you sleep when you got back?

[2252] What I chose to do was as soon as I got off the plane, I grabbed a coffee.

[2253] Oh.

[2254] So I got to drive everyone home and I've just slept three hours.

[2255] So I want a little pick me up.

[2256] Sure.

[2257] So I banged back a large coffee on the ride home.

[2258] Yeah.

[2259] And then I got at home and then went up into my bedroom and shut everything down and laid there.

[2260] And hoping I grabbed like a nice three hour nap.

[2261] But I just had that big tall coffee.

[2262] Oh my gosh.

[2263] So I really laid there for about 90 minutes, but then I did fall asleep for about an hour and 20.

[2264] Okay.

[2265] And I feel great now.

[2266] Oh, good.

[2267] I just got out of the shower.

[2268] I washed my hair.

[2269] Yeah.

[2270] I felt great.

[2271] I shaved everywhere.

[2272] Oh, nice.

[2273] Yeah.

[2274] You cleansed it.

[2275] I got rid of the Hawaii trip.

[2276] I did that last night, too.

[2277] You did?

[2278] I felt like not, I mean, the trip was wonderful.

[2279] It was awesome.

[2280] Yeah.

[2281] It was so perfect.

[2282] There's no reason to clean it off.

[2283] Right.

[2284] But I feel.

[2285] I've been feeling grosser and grosser As you age Yeah Exactly Like on planes I think it must be a post -COVID thing Where I'm just aware of the dirtiness Okay A little bit of a germophobe now Again I think I always was But so I needed to And I hadn't washed my hair all week As a To see how crazy it could get Yeah Yeah And so I needed to watch it wash up.

[2286] Well, similarly, I love how my hair behaves once I get it in the salt water.

[2287] And so I swam in the ocean all day yesterday.

[2288] Yeah, I just love it.

[2289] But then one red eye later.

[2290] The nasty.

[2291] It's nasty.

[2292] It's nasty.

[2293] You look gray and swamp ready.

[2294] I'm like seeing grays everywhere between the grease.

[2295] You got to watch that off.

[2296] And I had, you know, I like to, this is something of me. I don't know what it is.

[2297] I'm out of adjectives for it.

[2298] They've all been rendered obsolete.

[2299] But I trim my forearm here.

[2300] Right.

[2301] So that, and I started doing that once I got my excessive tattoos.

[2302] Because otherwise you can't see them.

[2303] Okay, that's to see the tattoos.

[2304] Well, what really happened is she shaved my whole arm to do the tattoo.

[2305] And then come to find out, I'm talking with Charlie and Matt and Charlie about it.

[2306] They're both heavily tattooed.

[2307] And I'm like, oh, yeah, you got to shave her.

[2308] And I come to find out they do that.

[2309] as well.

[2310] So anyways, I've been doing it, but I was really lacking on it.

[2311] Yeah.

[2312] And I couldn't even see this, this artwork.

[2313] You know, I've been doing that for years.

[2314] Shaving your arms.

[2315] Well, I use a, it's not to see.

[2316] It's because someone made fun of me when I was young.

[2317] Called me a werewolf.

[2318] Arms.

[2319] And so, I called me a werewolf.

[2320] Arms.

[2321] So I started using clippers on them.

[2322] So I didn't.

[2323] Yeah, that's what I do.

[2324] Yeah.

[2325] I don't shave, shave.

[2326] Right.

[2327] You just get it to a tiny amount of hair.

[2328] One guard.

[2329] Right.

[2330] On the peanut.

[2331] Is it coming thicker, though?

[2332] That's what they say, but I don't think so.

[2333] I mean, I think the shorter it is, the thicker it is.

[2334] I mean, that's with even hair, hair.

[2335] Like, if it grows out, it just spins out.

[2336] But you have a genetic coating for how much hair you're going to have.

[2337] I don't think you can augment it.

[2338] But isn't it good to get, like, your...

[2339] Trimmed.

[2340] Hair trimmed?

[2341] Doesn't that stimulate growth?

[2342] Look, I'm not I don't know enough about I'm not a dermatologist Although I do play one on TV You share skin and hair That's all I'm sure Hair Carotin atoll Yeah I don't know about hair For dermatology Well look there's no such thing As a hair doctor So I'm sure it would fall Under the purview of a dermatologist Before any other one I guess Or Dennis Yes if you trim your hair It does stimulate growth But that doesn't have to do With thickness That's length Also that might be to that some resources are going to the hair.

[2343] Well, that's different hair, too.

[2344] A auxiliary hair, a secondary hair.

[2345] Anyway, I've been doing it, but I've been wanting to get laser and I just haven't done it.

[2346] But I need, I want to.

[2347] Oh, okay.

[2348] You could.

[2349] You shouldn't actually.

[2350] It might mess up your tattoo.

[2351] We don't know.

[2352] It would probably, right?

[2353] Yeah.

[2354] Yeah.

[2355] Also, I want the option to grow it back in case I'm ever like become a woodsman or something.

[2356] Oh, sure.

[2357] I have a whole second stage of my life.

[2358] I don't know if I'm going to be outdoors a lot in the, Tundra.

[2359] I have a feeling you're always going to have those tattoos, though.

[2360] Yes, I think so.

[2361] Even if I didn't like them, I would not go through the pain in the ass of laser removal.

[2362] That was interesting, remember Brolin on that episode, Josh Brolin had his removed.

[2363] He said, I used to need him, and now I don't.

[2364] I love that sentiment.

[2365] Yeah, me too.

[2366] I have a friend who got a tattoo removed.

[2367] But was it probably a shitty one, though?

[2368] Well, no. Oh.

[2369] It was her first tattoo.

[2370] Okay.

[2371] And it was on her foot.

[2372] Was it a dolphin jumping over?

[2373] No. But you always see it in pictures And she doesn't like that Okay She regretted it After many many years And so she got removed, yeah Was it, it's painful, right?

[2374] Yeah I've seen it, look, look I don't want to talk disparagingly About tattoo removal Because I don't know enough about it But I have seen versions of it Where I can't believe that's preferable To the person It just like melted skin Ew Yeah, have you seen that?

[2375] Yeah, Josh is, you could I didn't inspect his body But you could not Sadly, and either of us got to.

[2376] Who's Josh?

[2377] Brolin.

[2378] I was surprised that, because he, I mean, his arms were out.

[2379] Yeah.

[2380] Yeah, they looked normal.

[2381] Yeah, I've just seen the melted version.

[2382] Yeah.

[2383] That's not better than, unless it was turned out to be racist or something.

[2384] Maybe she wanted, I mean, maybe that person asked for the melty.

[2385] There's options.

[2386] And the setting.

[2387] What setting do you want?

[2388] Removal or scarification.

[2389] Let's go scarification.

[2390] Yeah.

[2391] Because you still want to be tough.

[2392] but you just don't want the visual.

[2393] Yeah, got to be tough at all times.

[2394] Yeah.

[2395] There was a guy at the beach yesterday that was just really looked like he just left the CrossFit gym.

[2396] Right.

[2397] He was younger than me. You know, I'm aging as we talked about on the last time.

[2398] Oh, I'm just talking about this.

[2399] Mm -hmm.

[2400] Yeah, we're just talking about this.

[2401] Yeah, if I myself, give myself a little pep talk, this guy had a better physique than me. That guy's superior to me in his build, right?

[2402] And then some protective part of my ego goes, well, let's see how he's doing when he's 48.

[2403] Like, that crosses my mind as well.

[2404] I think, like, you know, be realistic for your age.

[2405] Yeah.

[2406] You're trying to compete here with this 29 -year -old guy.

[2407] No, why?

[2408] Why what?

[2409] Why are you trying to compete?

[2410] I'm not.

[2411] I'm just evaluate.

[2412] I shouldn't say compete.

[2413] I'm evaluating myself against a 29 -year -old guy.

[2414] Yeah, not fair.

[2415] And then I remember I'm 48.

[2416] Mm -hmm.

[2417] Yeah, that's interesting.

[2418] If I see someone on the beach.

[2419] A chick.

[2420] Yes, a woman.

[2421] A chick.

[2422] Well, in this case, we could say a chick now.

[2423] Bikini.

[2424] I'm going to say a woman.

[2425] Okay, a woman.

[2426] Whose body I admire, or I think is nice.

[2427] Yeah.

[2428] I don't, I don't ever think, hmm.

[2429] Of it relative to your body?

[2430] No. Wow.

[2431] I mean, no, no, no, I will, but I think, oh, I wish I looked like that.

[2432] Yes.

[2433] But I never think, oh, that's better than mine or worse than my.

[2434] Do you know what I mean?

[2435] But if you want that, isn't that a sub.

[2436] I guess.

[2437] Isn't that actually saying that you think it's.

[2438] better because you would prefer it.

[2439] I guess so.

[2440] I mean, I guess that's the subtext of what's happening.

[2441] What body part will you see that you'll go, hmm, I wish I had?

[2442] I don't want to actually harass you, but you're never seen anyone's boobs and going like, oh, shit.

[2443] And it's rare, yeah.

[2444] Right, right.

[2445] Good, good.

[2446] That's great.

[2447] And I have some height and some shoulders.

[2448] So right at the gates, I'm like, I'm doing fine, you know.

[2449] Well, really the thing is I do like my body.

[2450] But I, there are things about it that I can't control, like, my height.

[2451] Uh -huh.

[2452] So sometimes.

[2453] I see bodies and I'm like, ugh, they have like a nice long torso.

[2454] Oh.

[2455] I don't have that.

[2456] I wish I had that.

[2457] But it can only go so far because like I have a short, I have a teeny tiny torso.

[2458] Mini torso?

[2459] It's half an inch.

[2460] I'm going to start calling you mini torso.

[2461] Tiny torso.

[2462] Well, I will say this.

[2463] You'll like this.

[2464] This feels like growth in something.

[2465] Okay.

[2466] Okay.

[2467] Okay.

[2468] He looked like Charlie.

[2469] Like he just, he was probably.

[2470] 225 and 6 % body fat.

[2471] Aren't you used to it?

[2472] You see Charlie all the time.

[2473] I know, but we're best buddies, so I'm rooting for him.

[2474] Oh, I'm happy to take second place to him because I love him.

[2475] Oh, this is interesting.

[2476] But this fucking random guy going for the crown.

[2477] But I did have the wherewithal to go.

[2478] Actually, most women actually wouldn't prefer that.

[2479] Well, we shouldn't say that.

[2480] That's not true.

[2481] It's so, you made me take my headphones off.

[2482] Oh, my God.

[2483] Because you're getting hot or what?

[2484] It just my hair felt floofy.

[2485] Okay.

[2486] It's so dependent on the woman.

[2487] Yep.

[2488] Charlie's wife, Erica, loves that body.

[2489] Like, that is the bigger, the fucking better.

[2490] Yeah, she loves the rock.

[2491] Yeah, yeah, yeah.

[2492] But I'm going on the data I talked about the other day.

[2493] Which data?

[2494] The data about how men overestimate how much they think women like muscles.

[2495] Sure.

[2496] And women overestimate how much.

[2497] much they think men like thinness.

[2498] Exactly.

[2499] So I thought to myself, you know, I'm vibing this guy's chassis.

[2500] What a rack this guy's got.

[2501] Yeah.

[2502] But he's, I think he's probably too big for the majority of women.

[2503] I guess that's what's also interesting.

[2504] I don't really see the women's bodies and think, I don't think of it in relation to men.

[2505] Right, right.

[2506] Yeah, yeah.

[2507] Oh, that body, I like that body, but men don't.

[2508] Like, I just like it and want it.

[2509] Yeah, and I don't either.

[2510] This was new.

[2511] That's what I'm saying.

[2512] This feels like a step in the right direction.

[2513] I'm not sure.

[2514] It seems like two steps forward, one step back.

[2515] Oh, okay.

[2516] But.

[2517] Yeah, I was like, he's probably bigger than most women want.

[2518] I just like it because he's...

[2519] How many pounds did he weigh?

[2520] I bet he was 2 .30 of...

[2521] Oh.

[2522] Yeah.

[2523] Like a Brad Pitt?

[2524] How tall is...

[2525] No, like Hemsworth.

[2526] More than Hemsworth.

[2527] Hemsworth is 208.

[2528] Oh, my God.

[2529] Yes.

[2530] How tall was he?

[2531] He was tall?

[2532] He was?

[2533] Yeah, he was probably 6 -2.

[2534] Oh, my God.

[2535] Speaking of nothing, not speaking of, but before I came, Jonah Hill has a new movie.

[2536] Oh, right, on Netflix.

[2537] Yeah, and I started it.

[2538] You started it?

[2539] Yeah, and I like it so far.

[2540] Yeah.

[2541] Is it great?

[2542] I like the trailer was really funny.

[2543] Yeah, I'm not far.

[2544] Okay, just the credits.

[2545] I watched only a little bit last night, too.

[2546] Oh, my God, you guys, that's not great.

[2547] No, no, I had to come here.

[2548] I watched it this morning and then I had to come here.

[2549] You're watching movies in the morning now.

[2550] Today.

[2551] So, yeah, and I like it.

[2552] I love him.

[2553] You do, yeah.

[2554] You're in love with him.

[2555] A little.

[2556] Yeah, yeah.

[2557] I do find him very attractive.

[2558] He's a podcaster in it, too.

[2559] Yeah.

[2560] Oh, my God.

[2561] You guys are in the same line of work.

[2562] You bump into each other at one of the many conventions.

[2563] He should probably reach out and get some...

[2564] He should have reached out to get some advice on how to make podcasts real.

[2565] Yes, he should have shadowed you.

[2566] Yes.

[2567] And asked you a million questions.

[2568] Followed me around.

[2569] Yeah, laid in bed with you, asked you questions, stood up with you, leaned against you.

[2570] He should have.

[2571] Should have sat you on a countertop.

[2572] Oh, boy.

[2573] Looked you in the eyes and asked you the questions.

[2574] Anywho.

[2575] Now, we talked about a lot of vain stuff.

[2576] Yeah, let's talk about some...

[2577] No, let's have something really serious.

[2578] Oh, okay.

[2579] Okay.

[2580] When I was gone, I had a furniture delivery.

[2581] Oh, in your absence.

[2582] Uh -huh.

[2583] Wow.

[2584] It was this armoire because, as we've already discussed, I'm not moving into my house.

[2585] 2030.

[2586] Forever.

[2587] I'm never moving in there.

[2588] It's cool to all, no, right?

[2589] Yeah, it's great to be just spending money for no reason.

[2590] So my closet is just so small in my apartment and I'm fashion and there's no space.

[2591] Mm -hmm.

[2592] So I had to buy an armoire So that I could put more stuff in it Ordered it.

[2593] It tried to get delivered A couple weeks ago Couldn't so then it came While I was gone Very exciting I had someone Receive it And then You know I'm the plane home I thought oh yeah Yeah you get my armwar is there And I'm so excited To see it And then I walk in You don't like it I love it Love the look of it, but it looks preposterous crazy in its current location because it's huge.

[2594] Okay, yeah.

[2595] And where is it at?

[2596] In the dead center of the living room?

[2597] No, no, no. It's in my bedroom, but it's on the wall.

[2598] Okay.

[2599] Like, it's for the bedroom, but it's on...

[2600] But not your bedroom.

[2601] Yeah.

[2602] I have one bedroom.

[2603] No, but I mean, it's for a bedroom, but not your current bedroom.

[2604] No, no, no. It's too big for your car.

[2605] Your bed barely fits in your bedroom.

[2606] It's fine for the bedroom.

[2607] The problem is the wall it's on is the wall where like the door open.

[2608] Basically it just looks really bad where it is.

[2609] But it will look good if I move it to the other wall.

[2610] Oh, okay.

[2611] The problem is the other wall has another big shelving situation.

[2612] Yeah.

[2613] You have all these other fears of death and it should be the fact that you're living in a room of too much furniture in an earthquake zone.

[2614] You're going to get like, you're going to get fucking buried in armoires.

[2615] Yeah.

[2616] I also have this fear, because I think the fan is loose.

[2617] Like, it makes a really unsettling noise when it's on, and I keep imagining it, crashing down while on.

[2618] Uh -huh, sure.

[2619] And then just...

[2620] Decapitating you?

[2621] Yeah, just tearing me up.

[2622] Like going through the prop of a boat.

[2623] Exactly.

[2624] Okay.

[2625] So that might happen.

[2626] Anyway, so I think...

[2627] Although...

[2628] Yeah.

[2629] Just the glass half full.

[2630] Yeah.

[2631] There's an earthquake.

[2632] Yeah.

[2633] You're buried in armoires.

[2634] Yeah.

[2635] You're dying.

[2636] Yeah.

[2637] The earthquake also loosened the fan enough that it comes down at blinding speed and chop, chop, chop, chop, chop, chop, chops up all the armwars.

[2638] Okay.

[2639] And saves your life.

[2640] And then you hug the fan.

[2641] Oh.

[2642] The first thing you do is put your arms around the, and hug it.

[2643] That's, and then you go, Jonah, save me. Jonah, my fan, save me. Oh, I'm going to name the fan.

[2644] Jonah Hill.

[2645] Thank you, Fan Hill.

[2646] Jonah Fan Hill.

[2647] Oh, my God.

[2648] Okay.

[2649] This is all.

[2650] to say, tonight, today, this afternoon, I'm going to attempt to rearrange this furniture.

[2651] Now, these are two enormous pieces of furniture.

[2652] I don't know how it's going to go.

[2653] I would prefer if a strong man would help, but I also want to try my hand.

[2654] Well, mainly because I want to get it done today, and I don't think a strong man will come over today.

[2655] Right.

[2656] You seem busy.

[2657] And Rob is looking the other way like he doesn't want to help.

[2658] I can help me move it if you need to.

[2659] Okay, well, I'll try it, but I'm really excited to get some clothes in there.

[2660] I bet you are.

[2661] Yeah.

[2662] I was going to offer up another thing that was not vain.

[2663] I said in the wake of our vanity, I'm going to add something substantive.

[2664] Mm -hmm.

[2665] Mm -hmm.

[2666] She's having a story about a vanity, though.

[2667] We should do a story about a vanity?

[2668] An armoire?

[2669] No, if that's similar, Rob, that was close.

[2670] A vanity is not quite an armor.

[2671] Oh, okay.

[2672] But similar.

[2673] Same thing.

[2674] It was like a pun.

[2675] It was trying to be a pun, yeah.

[2676] Okay.

[2677] It was close.

[2678] Big development and we kind of, you know, we hung her out to dry on the previous fact check.

[2679] We exposed her for her night walking and her bozoori.

[2680] Oh my God.

[2681] Delta.

[2682] Yeah.

[2683] So now we got to put a feather in her cap.

[2684] Yeah.

[2685] Huge development on this trip.

[2686] Delta learned how to play spades.

[2687] Yes.

[2688] She did so good that I think we, did we play three games or two games?

[2689] Definitely two.

[2690] I think maybe three.

[2691] Yeah.

[2692] I went nil twice.

[2693] She was my partner.

[2694] And I went nil and pulled them both off.

[2695] Yeah.

[2696] That's nuts.

[2697] It was crazy.

[2698] And what's even better was after the first day she learned it, she said to you, I want to play, next day.

[2699] I want to play spades.

[2700] She had the bug already.

[2701] And now the other thing is she never stayed vertical in her seat for more than three minutes.

[2702] So as much as mentally she had the game, she was, it was like playing with a chimpanzee.

[2703] Anytime she wasn't actively playing, she was.

[2704] flip in and putting her feet on the table.

[2705] It was wild.

[2706] It was wild.

[2707] It was fun, though.

[2708] But it was very impressive.

[2709] Mm -hmm.

[2710] She's very advanced.

[2711] Okay.

[2712] Circling back to the ding, ding, ding.

[2713] Okay.

[2714] He said...

[2715] Mental health is the...

[2716] Well, yeah, he said mental health is the leading cause of disability with depression at the top of the list.

[2717] That is correct.

[2718] I confirmed.

[2719] You got that one right.

[2720] Mm -hmm.

[2721] Wonderful.

[2722] Okay.

[2723] I want to call you out on something.

[2724] Oh, right.

[2725] Can you prep yourself?

[2726] Mm -hmm.

[2727] I'm seated.

[2728] Okay.

[2729] That's a good start.

[2730] So I want you to travel back in time.

[2731] Okay.

[2732] What year?

[2733] Last year.

[2734] Neil Patrick Harris interview, armchair expert.

[2735] P .H. Uh -huh.

[2736] Do you remember that he was talking about using a saw?

[2737] Mm -hmm.

[2738] And wanting to follow the directions on YouTube.

[2739] Correct.

[2740] And I was urging him to just build something.

[2741] That's right.

[2742] Mm -hmm.

[2743] Now let's fast forward to this episode where Chris lost two fingers using a saw.

[2744] Right.

[2745] And he knew what he was doing.

[2746] Right.

[2747] He built many things.

[2748] Even more reason that following instructions, not such a bad idea.

[2749] Okay.

[2750] I'm going to counter.

[2751] Go ahead.

[2752] His losing the fingers was not from his lack of education.

[2753] Accidents happen.

[2754] Even if you're a master carpenter, people lose fingers.

[2755] Well, they're, you know.

[2756] Yeah.

[2757] So I don't think his wasn't the result of not being an adequate carpenter.

[2758] But if accidents happen to even the master's, someone who does not know what they're doing, that's a dangerous instrument, is my point.

[2759] So you should, I think he was right to think, I should maybe learn a thing or two before I handled this.

[2760] And listen, I'm all for, and I was supportive of Neil Patrick Harris watching a safety video on how to operate a table saw and use a guide, for sure.

[2761] What I don't want him to do is to mimic an ape someone building a birdhouse.

[2762] Right.

[2763] I want him to just stare at a birdhouse and start cutting wood, see if he can do it on his own and not be perfect.

[2764] Phil Stutz.

[2765] That's what I wanted him to do, is not be perfect.

[2766] Right.

[2767] Yeah.

[2768] But I understand it was a good opportunity to hoist me by my own fatard.

[2769] I think it was just, it's totally okay to follow some rules.

[2770] Sure.

[2771] Especially when you're dealing with dangerous instruments.

[2772] Okay.

[2773] He was talking about the LGBTQ youth suicide rate.

[2774] The Trevor Project estimates that more than one point.

[2775] 8 million LGBTQ youth, that's 13 to 24, seriously considers suicide each year in the U .S. And at least one attempt suicide every 45 seconds, four times more likely to attempt suicide than their peers.

[2776] Suicides the second leading cause of death among young people in general 10 to 24.

[2777] And then LGBTQ more than four times as likely than those peers.

[2778] So is that probably the number one cause of death for them?

[2779] Yeah, so you brought up Siddhartha Mukerjee's book a couple times.

[2780] It's called The Song of the South.

[2781] Okay.

[2782] If anyone wants to check it out or listen to our episode with him.

[2783] You too will have to go back in time to 2022.

[2784] That's right.

[2785] As I just did.

[2786] It wasn't that painful.

[2787] Check out Neil Patrick Harris while you're out back there.

[2788] Great episode.

[2789] Yeah.

[2790] And see if you think what I'm suggesting is to be dangerous or to be creative.

[2791] We'll let you decide when you go back in time.

[2792] Go ahead and decide for yourself.

[2793] Okay.

[2794] found something interesting because you mentioned a couple times that the success rate of AAA is about 30.

[2795] Can I just tell you what I'm basing that on?

[2796] I'm actually basing that on treatment center success rates that use AAs 12 -step program.

[2797] That's the only thing I know data of is like Hazleton and some other treatment centers.

[2798] Yeah.

[2799] Well, yeah.

[2800] According to the National Institute on Alcohol Abuse and Alcoholism, about 33 % or one -third of people who are treated for alcohol problems have no further symptoms one year later.

[2801] But then a New York Times article said that AA claims, although who's who's who, yeah.

[2802] A doesn't claim anything.

[2803] In fact, it's in the bylaws that they can't.

[2804] But go ahead and tell us what they said they claim.

[2805] Yeah, they claim up to 75 % of its members stay abstinent.

[2806] Alcoholics synonymous Big Book touts about 50 % success rate stating that other 25 % remain sober after some relapses.

[2807] It's also, you can't evaluate the efficacy of chemotherapy.

[2808] if you skip 60 % of your treatments.

[2809] Yeah.

[2810] So that's one big hurdle in establishing it.

[2811] Did they do all 12 steps?

[2812] I don't know.

[2813] Do they have a sponsor?

[2814] Did they go to meetings?

[2815] There's so many things to do.

[2816] Who knows?

[2817] A, B, I think another relevant thing is I don't think the measure of success should be you never drank again in the rest of your life or you never use.

[2818] I don't know.

[2819] I think it has to be a little bit more of a murky, what we would call success.

[2820] If someone drinks eight times in the next 40 years by using AA, I'm pretty fucking successful.

[2821] Mm -hmm.

[2822] Yeah.

[2823] But if we're saying...

[2824] Well, unless something that leads to, like, death, I wouldn't say, you know.

[2825] Right.

[2826] I'm saying they, let's say they died sober and they...

[2827] Yeah.

[2828] Okay.

[2829] The gut does provide approximately 95 % of total body serotonin.

[2830] Mm. Pretty cool.

[2831] Really cool.

[2832] So, IBS.

[2833] Bad That's your conclusion Yeah Also I don't think your your ball's not your stomach No no it's gonna It says some stuff about IBS I just don't want to read it I don't really want to get into it but Bad Bad I mean it's just not good Because Yeah I thought I had it remember I have it I do I do What Well Monica I would I'm trying to be respectful of people who have ibs and like their life's ruled by it and they have to have a perfect diet to say i just think it's a little unfair to you know that's not really but it's not it's it's a lot of ibs is caused by stress it's not food okay there is an ibs diet um there's a diet for absolutely everything to help but i mean there's a medical doctors put people with ibs on a diet specific can you look a percentage of women with ibs i have been told by a doctor that i have it this is a lot of time i don't know how natalie hasn't too see 14 to 24 percent of women and only 5 to 19 percent of men um it affects 8 to 20 percent of the u .s population yeah you know about my honest but monica i i what i'm saying is i think you would have shit your pants in public a lot of times if you had bona fide.

[2834] Like, I think people with real bad IBS, they have, you know, they're like sprinting to bathrooms and shitting their pants in public is what I think of it.

[2835] But maybe not.

[2836] I mean, I think that's like.

[2837] Extreme IBs.

[2838] I think if you say you don't have it because you haven't shit your pants in public is like not a good measure.

[2839] If you're shit in the toilet every time then what's the prop, you know?

[2840] Women are just more responsible with knowing their.

[2841] themselves to the toilet.

[2842] That really is counter to what seems to be the narrative which is men are shitting their pants all the time and women aren't, yet women have IBS more.

[2843] Exactly, because they just run or hold it.

[2844] I mean, I've had to hold especially while driving.

[2845] It's very close calls.

[2846] Some very close calls.

[2847] Okay.

[2848] Oh, the virus he was referring to that's often seen tied to obesity is called A .D. 36.

[2849] Adinovirus 36.

[2850] People can look into that if they want, but that's what it's called.

[2851] Okay.

[2852] So, let's see, is there anything else I want to talk about?

[2853] Let's talk about six, me, let's talk about, oh, let's talk about prompts for the month.

[2854] Yes, for next month.

[2855] Armchair anonymous prompts.

[2856] This one's for March.

[2857] That's right.

[2858] Okay.

[2859] We want to hear about a crazy divorce story.

[2860] Ooh.

[2861] I could go anyway, you know?

[2862] It could be like a really, like, Bob's your uncle, Sionara suckass.

[2863] Yeah.

[2864] By the way, that's kind of what Gabrielle Union's divorce sounded like, right?

[2865] Yeah.

[2866] It sounded like, they were like, you know what, man, we like to fuck so much other people.

[2867] I love that her therapist was like, okay.

[2868] It's time.

[2869] Yeah, that's a good therapist.

[2870] Yeah.

[2871] Okay, so please tell us about a crazy divorce.

[2872] That's prompt number one.

[2873] Prompt number two, tell us about a time you got caught.

[2874] Okay.

[2875] Could be so many things.

[2876] Oh, fill in the blank, embezzling, cheating, stealing, murder.

[2877] This is what I'm most excited about.

[2878] Your most embarrassing fart.

[2879] Okay, a very embarrassing fart.

[2880] But it used to be a story, guys.

[2881] Don't just like, I far.

[2882] and my girlfriend's, I don't know.

[2883] I want it to be a story.

[2884] I think it'd have to be to be embarrassing.

[2885] Like, we just fart in your house and you're like, oh, my God, that's rank.

[2886] Are you embarrassed or proud?

[2887] I mean, you might be embarrassed if it's like a lover's in there.

[2888] Oh, see, that's what I really want to hear.

[2889] There's like some farting during lovemaking, some farting during job interviews.

[2890] You know, shaking Obama's hand and farting.

[2891] Oh, me, I'm farting in front of Liz.

[2892] Oh, sure.

[2893] Yeah, during the pitchers, that type of thing, you know.

[2894] And hopefully with some fallout of some variety.

[2895] Okay.

[2896] Let's see.

[2897] Most embarrassing fart.

[2898] And then this is going to be new for us.

[2899] This is called Wildcard.

[2900] So this is a story.

[2901] You've got some great story and you're like, when on earth are they going to have the prompt attacked by a dolphin?

[2902] Yes.

[2903] This is Wildcard.

[2904] Yep.

[2905] Your craziest story, feel free to write in.

[2906] What could be fun is, so they'll click Wildcard and then maybe they write what the prompt would have been oh most embarrassing yeah yeah they write you write what the prompt is to your story and then you write your story great divorce got caught most embarrassing fart wild card those are your march madness prompts oh shit we should have done march we do the craziest basketball disaster all right well that is that was one i was well betting i wanted to do if you have a story about like winning the lottery or winning a bunch of money.

[2907] We can do that not on Mars, though.

[2908] That's not specific to NCAA.

[2909] I know, I know.

[2910] I just felt like a tie -in, but I guess it's not.

[2911] Rob's really by the numbers today.

[2912] I was trying to give you some support as to why.

[2913] All right.

[2914] Love you.

[2915] Love you.

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