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Welcome, welcome, welcome to armchair expert experts on expert Dan Shepherd. I'm joined by Modest Mouse, Miniature Mouse, Maximum Mouse, Mickey Mouse, Monica Mouse man. Welcome to the program.


Today, we have a really, really great psychiatrist, Dr. Nina Verson. Nina is an American psychiatrist. She's a clinical assistant professor in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine.


And I don't want to spoil, but I will. She invited us to come lecture at Stanford.


Yes. So it would appear that we're going to be professors at Stanford. Thanks, Dr. Nina. She's the author of the Amazon number one best selling book, Do Good. Well, your Guide to Leadership, Action and Innovation. So please enjoy Dr. Nina Verson. We are supported by Brooklyn, and nothing makes me happier than being in a hotel and crawling of those crisp, cool sheets bare naked and just writhing around. And I always thought, how do I get these beautiful hotel called the sheets?


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He's in our chance. Hi, I'm Universite, nice to meet you. I'm admiring the art in the background.


Oh, don't don't look too closely. Oh, that was safe, actually. Monica has a beautiful collection of pervy artwork. Yes.


That is displayed behind you. But I have a growing collection.


I mean, look, it is quarantined, so you have to find ways to survive. And if that's what you need that, like, go for it and celebrate it.


This will sound like a bride. Well, it is a. We follow this really pervy artist on Instagram porc, Walker, and he makes I mean, it's the most perverted artwork you've ever seen, but something so comical about it. And then I approached this guy and I asked if he could make a special one off picture for Monica. She's very proud. She should be of her cheerleading accomplishment. She's state champion twice. And the girl.


Thank you, high flyer. So he made a very sexual cheerleading drawing. And if you don't know his work, you just walk into Monica Zafari.


Yeah, it's interactive. It has like a pulley. And what's going on? Yeah.


Yeah, that is I mean, that's going all out. Should we show her I'm a psychiatrist. I have seen everything. Oh I like, I like you.


She comes down, she swallows the spider into her body.


Oh that's amazing. I love that it moves. That's yeah. Yeah.


It's very cool when you go to like Momar Moka or any of these are minor in art institutions.


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


This is going to be in the MoMA one day. Now, just magically.


Now, Nina, you grew up in DC.


Yes, I was born in Washington, D.C. and grew up in a small town in West Virginia. And I've already set Monica a fangirl email because one of my best friends, Mackenzie, has been listening to your podcast. It's fabulous, I think, in particular. So, yeah, my parents are from southern India. They moved here, I think, like forty five years ago or so. I'm thirty five. So they've been here for for a while.


But like exactly what you talk about, Monica, about growing up, it's like the only brown girl in this town where like everyone else is different. And you talk so much about, you know, feeling like another that is one hundred percent how I felt growing up. And it's a really small town. And West Virginia is like the most white state in the entire country. My my graduating class was five hundred. So there were like two or three per class, you know.


Right. And just and the way you talk about both, I think like identity as well as dating, like dating and sexuality and like beauty and all of that stuff, just like literally I've never heard anyone talk about that. And so so resonates not only with what I experience, but with like all my friends who are also like children of immigrants. So what I said to Monica is like, what you are doing is so important. And for you guys, both being entertainment.


Right. Like it's so important to see people like you in entertainment because it really helps you understand yourself and who you are, how you show up in the world. And it really is like a humanitarian Flixster thing. I think. I'm so happy to hear that.


That's so nice. I'm really going to take us on a tangent. Do you follow Mindy Kaling on Instagram one?


I want her to be my best friend. We like that. But like all of her shows, I'm like, I think we should be best friends.


She posted something the other day. It was a video of a little kid in India talking to her mom. She was saying, my sister is going to be such a beautiful bride. And she said, What about you?


And she said, Well, I'm too dark to be beautiful. Do you connect with that? Like it's particularly around so many white people, it felt like you had to be as close to white as possible to meet the standard of beauty.


Yeah, and I think I mean, really all colonialized countries every place. I think where there was European colonialization, there's just this sense of like white equals beauty. And even on that spectrum, the closer you are to white, the more beautiful you are. So I totally felt that growing up. But like I mean, like Monica and I write like we're also darker skin color.


Right, that a lot of other Indian people are so attracted to. I remember when I was in high school, tanning beds were really big, like all the girls like, oh, I'm going to a tanning that somebody said to me, like, you're so lucky. You never need to tan.


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


Everyone wants what they can't have.


The binary options seem to be in childhood that either you did what Monica did, which is like you kind of rejected all things Indian, or you hang out with the one other nice kid and one Korean kid.


And they want like those seem to be one everyone we've interviewed. It's one of those two options. I'm sure there's other options. Did you fall into either of those?


I feel like this is a cop out because I want to say one or the other. But I honestly felt like it wasn't quite bimodal. I think I actually got a little bit of both, and I'll tell you why in our small town. So I. The town I grew up in is to ten thousand people, and there were a few Indian immigrants and folks from the whole I guess like South Asian diaspora. And what I think was interesting about where I grew up is that we had such a few people that if you were dark, that meant that you were like in the community.


And so there actually was like an Mindy Kaling show. You see that there's this like Indian community. And so every week or especially like on like Friday or Saturday nights, you would go to a different Indian person's house and the kids would all play in the basement. And the the dads would sit together in the moms would sit together. And there actually was a community and like Holy in the Valley are the kind of like the two big festivities throughout the year.


There would always be a big party for one of those. And so it's almost like you would turn on being Indian and turn it off. Yeah. In school, like, you know, junior high high school, you know, it was completely trying to blend in and be just like everyone else. I remember I wore dresses all the time and I never had jeans. And in seventh grade, according to my mom, I actually went home and cried because everyone else had jeans and I didn't have a pair of jeans.


And so my mom went to our mall and like went to the Gap or probably the Gap or Aeropostale and bought me a pair of jeans. But even that, I only had one pair of jeans, never more than that. And even now I.


But but I say it because it's like when you're surrounded by everyone else, you know, it is wanting to be just like them. And if you look at stages of development, especially when you're a teenager, all teenagers just want to fit in and be like everyone else. Right. So I think that when I was a teenager, I was just like the Indian style, kind of like, don't talk about that. Just try to be like what everyone else is.


But then because there was this tight knit Indian community, which was, as I said, very small but powerful when you were there, you could kind of like turn the Indian on and learn about things. And it was really interesting for me actually then going to college because in college, you know, if I wanted to only be friends with Indian people in my hometown, I would have had two friends. Right. College was the first time where at Harvard there were so many minorities, but there were also so many minority groups.


In my mind growing up, Indian was Indian. When I got to college, it was like South Indian or Pakistani or Gujarati or, you know, like my parents didn't speak Hindi. Most people in northern India speaking about my parents were from southern India. So people would come up to me speaking Hindi like, I have no clue what you're talking about. Language. And so it was just interesting because then at Harvard, where there was so many that you could actually segregate into different subsections, it was a sense of belonging that I didn't identify with.


And people would tell me, like, oh, you're from the south, you're different from what we are. And I'm like, Oh, but I thought Indian was Indian. Yeah, yeah, yeah, yeah.


Well, isn't that that's just the nature of like in group out group tribalism, because even within an in group and there's another group and then another group and it just keeps getting more and more isolated. It's very interesting. So I try to identify way too much with things. I can, I could. That's my Achilles. We were just talking with the amazing surgeon general, Vivek Murthy, Vivek Murthy.


We we worked together 12 years ago, the Obama campaign. So I I've known for a long time. He's very lovely.


Yeah. And I felt inclined like they had such a shared experience. And it's it's so obviously true. And then I also felt inclined to go like, hey, just so you know, even as a guy who was a bull's eye of what in group was blue eyed, blonde, tall, white dude, I had those figures do not undermine yours and they probably weren't nearly as bad. But I was like, do you realize it is a human condition to constantly fear exclusion?


I think you're exactly right. It makes me just feel like adaptation, right? We all are where we are today because of generations and generations of adapting as humans and whether that means adapting to different environments like the prairie versus the tundra versus, you know, a city or really being able to adapt to the different groups that you're in. And of course, now because of globalization, we feel it, you know, much, much more than any generation in the past.


That is how we survive. And that is a lot of what it means to be human, is to be able to go to different environments and show who you are with different groups. It's one hundred percent a human condition entity.


Now, when reading about you and this is a compliment, I got exhausted. I was like, oh, my goodness, this girl went as high as you could go in the Girl Scouts. You started a youth cancer movement that you got an award for. I mean, you did everything that could be done. And I immediately just thought, oh, wow. So in my own experience, I had a fantasy of what achievement was, what success was.


And you were just racking up those achievements and that success. For me, all of it was pretty extrinsic. And these awards in general are kind of extrinsic. Was there any point in your life where you had like an existential crisis where you're like, oh, wow, I got all the awards, I went to all the schools, I did all the right stuff. What does Nina want to do?


I think that's a fantastic question. And I would say, you know, certainly online on LinkedIn, you know, online BIOS awards are there. It's nice to get the award. That's great. It's nice that someone's honor you or saying that they value what you do. But I think probably by the time I got. To college, I don't want to say empty, but awards did sort of seem empty in the sense of I do think there's a particular time in life, especially growing up and in particular being in junior high and high school.


There is this sense of like awards, equal accomplishment and awards equal success.


And ultimately, probably for your family, like like Monica's just equals safety. At the end of the day, all the roads are leading to safety, which ironically is an internal job, right? Yes.


And I love that you say that because it's really interesting right now. So my parents, they were med school classmates. And so a lot of Indian folks, the US came to the US for a better life for their family. And there are a lot of doctors and there's the stereotype of Indian and Asian and a lot of immigrants in general encouraging their kids, you know, only be a doctor or an engineer or a lawyer. Right. To have those sorts of professions.


And I will give my parents complete credit. You know, they were both doctors and my brother and I are also both doctors, but they never pushed it growing up. They exposed us to everything. They were very, very big on the arts and, you know, just really making sure that we had a diverse exposure and living in a small town. I think we were able to do that. But what's been really interesting is now, because of everything that's been going on with Coronavirus and seeing so many of my friends who have lost their jobs or who have gotten furloughed, while at the same time, I've never been more thankful, I think, and grateful to be a physician than I am right now, just realizing that I can be useful, seeing that with everything going on, that we're seeing a huge increase in folks who are struggling with mental health and knowing that I can continue my profession and continue helping people at a time where we as a country or world are struggling, you know, more than we ever have in our lifetimes.


And I have to say, I've even seen friends actually who are reconsidering their jobs. Right. Who were, you know, here in Silicon Valley, there's so many folks who are working for these sexy, like tech startups. But then it's really realizing at the end of the day, wait, like, what is this widget doing? Is it something that is adding to humanity? Maybe not. Maybe I want to reconsider that. But I want to go back and answer your question.


What does it mean? That right. And so I think that when I was in medical school, I struggled with depression. And this is something that it's funny because you talk about, oh, you know, if you look online, you see all these things. I guess probably about 10 years ago, I changed my LinkedIn to specifically say that I had struggled with depression. And I very purposely in, you know, anything, whatever I'm speaking and someone wants the one paragraph bio sketch of who I am.


I very purposely include in there that I struggle with depression and that I ended up becoming interested in mental health professionally because of my own experience. And I do that because I think people see that right. People see all these awards and they see like, oh, Harvard, Harvard, you know, you must be really successful. And those are some metrics of success. Right. But there are a ton of other metrics of success. And this is going to sound a little corny, but I would have to say it like if I really think of what I'm most proud of and, you know, the last thirty five years, it is having dealt with depression and having overcome depression and being in a place where today I can talk about it openly and share that with other people.


And it was the hardest thing I've ever had to do is the thing that I'm most proud of. And and now I'll tell you now I'm struggling with anxiety right now. And I know that I will be able to say, you know, in a few weeks or a few months that I feel very proud of having dealt with anxiety at this incredibly difficult time and overcome it. Yeah.


In America in particular, we have this paradigm that's still kind of valuing something and measuring ourselves in a way that doesn't seem super appropriate anymore. What we should be envious of is not a person who made a billion dollars with the startup, but somebody who somehow can stay on a regimen of working out four times a week. Like, in truth, what we should envy is states of emotion, right? We should envy contentment. That should be the thing we're all striving for.


And I wonder if we're heading in a direction I sure hope we are where we're starting to envy and compare states of mental health. I completely agree with you.


And I think if you look at Maslow's hierarchy of needs, it's very much like that. The very bottom of that hierarchy, right, is these basic needs of food, water, shelter. And the reality is my parents who are immigrants from India, your grandparents, that is the struggle that they had. Right. They didn't know if they were going to be able to have enough money to put food on the table. And so the world they're living in is one where success is is a representation of having those things, having a lot of money, because then, you know, no matter what you can provide for your family, if there's a Great Depression or a recession or a virus hits the entire country.


Right. We are then very fortunate to be able to actually have happiness as a goal. And it's interesting. I actually think maybe I want to say John Adams or one of the founding fathers talks about this. I think it is John Adams. He talks about how everything that he worked for in his own life, that he hopes then that his children can aspire to be great in the arts. And historically, if you look at civilizations, it's like that, right?


Like Sparta. Sparta is known for just these like warriors. And the skills that they had were this incredible, like, you know, fighting and being able to defend their country. But then when you look at a city like like Rome or Athens because. They had those needs that they were able to grow and flourish and develop their their art and multiple elements of what culture looked like.


Yeah, one safety in quotes was achieved, right?


Exactly. And I think that similarly, we now are fortunate enough that we don't have to worry about those basic needs. And so something like happiness where you can imagine, like I can completely imagine a parent saying, like, why should I care about being happy or why are you focused on your happiness when we're worrying about can you actually, like, pay the mortgage this month? Right. And I think that one hundred percent makes sense.


What would you to just add to that really quickly? What was fascinating and is particularly fascinating in India, which is the evolution of marriage as an economic model into marriage, as a pursuit of love, that that is like an enormous transformation.


You're exactly correct. This is something my parents and I talk about all the time. So my parents were a, quote, love marriage, even though most of their friends growing up were in arranged marriages. And I'm single right now and I'm trying to talk to my parents about dating. And Monica is helping me out here. Everything Monica is doing is helping me talk to my parents about my own dating experience. Thank you, Monica.


Are you staying like I had to do?


I can imagine you have the same warped thing Monica has because she didn't look like the white cheerleader. You guys are both so fucking hot. Brown features galore. Beautiful eyes, nice lips. I just hope you know, you're a hot piece of real estate when you're out there in the field.


I hear you say that I do not believe it. And it truly is like just years and years of feeling different and not not seeing yourself represented on TV. You're not seeing any version of beauty that looks like you. I thank you for saying that. I really appreciate it. No, no, no.


I mean, what you have to do I don't know if you've listened to this episode yet, but we had a hypnotist on and I know I'm armchair expert, not Monica and just the expert.


And I got hypnotized during that episode. And what my goal was, was to look in the mirror and like the image, not like the person, because I feel pretty confident in that physical image to like that. So you don't get hypnotized. I kind of worked, I think. Well, if I had to say like a percentage, I'd say it worked like 40 percent for her. It help.


The point he makes, which is so true, is that nobody looks like you in a good way. You get a good look at this original assortment of symmetry and everything. And look at that. You're the one you're the one that looks like this. And I was watching Beautifuls how that to Monica. And I was like, Yeah, look at her, man. I don't know anyone that looks like her. The way it all comes together, it's so fantastic.


But you have to channel it, right? Because when you hear him say you don't look like anyone, it's like I know that's what I don't like.


That looks like the part that's bad. And then you have to put it through a new picture frame and say like and that's a good thing. Right? You're unique. And it is.


No, you're absolutely right. And even, you know, everyone talks about arranged marriages in India. But if you look back, you know, it was the same thing in Europe five hundred years ago to write marriage was very much this transaction. And what it's like, why are you still single? What's going on? Can't you just find someone and get married? This isn't very hard. I think my parents view it very much as this life thing that you can just do and motion and love is and love is a part of it.


Right, because, again, they were in love when they got married. But when I talk about wanting to find my person or something like that, there is this sense of this should just be like an equation.


And can I say that I've come out on the other side, we're actually kind of agree with them in a way. I want to add one thing. To forget a range. Even when I was in a range, women in the 70s had to make a choice because they didn't have economic independence. Theirs was still an economic arrangement, even though it wasn't set up by their parents. So even when you had choice, it still wasn't economic proposition. The man was going to be gone sixty hours a week so he couldn't raise kids.


He needs someone to raise his kids. The woman's not going to have a job to earn any money, so she needs someone to earn money. So even in America, still in economic endeavor, up until forty years ago, anyhow, we've been fucked by love in movies. And I will say, yeah, I do think we've we've overcorrected from the fifties. And now I do think it's relevant to walk it back a little bit. Yeah.


And I'm with you. I don't I don't have that, you know, romantic comedy vision of that's what I want to see. You know, that's definitely not the case. But I also do think that in terms of I mean, what our relationships look like today are very different. Right. To your point of in the seventies, it's still this gender dynamic of, you know, men providing and women taking care and raising children. And what I want in a partnership, what I want in over the course of the next 50 years of my life, I think is is different.


And so and in particular, my parents marriage, for example. I think for all kids, what you see in your parents, that's your vision of what a relationship is supposed to look like. Right. And the only additional data points you get, maybe you get a little from friends, family, cousins, things like that. And then you see what you see what you see on TV and in movies. But the overwhelming majority like. Eighty percent of your data points are coming from the relationship that you watched as you were growing up, and so I think that does impact then what you end up looking for or what you think is right or wrong for you.


Yeah, I think it's very interesting because it depends also on how you're looking at the paradigm in general. So I wanted separation being Indian and all of that stuff. I wanted so much separation. So the marriage that I saw in front of me was very practical. And I was like, no, I that's not what I want because I don't want anything to do with any of this. So that must be wrong. Whatever they're doing must be wrong.


So I'm going to go in the complete opposite direction. And yeah, it has fucked me big time because now I'm like, I need my soul mate and I need this and that. And now I am circling back, especially having done the podcast. Yep. There are some real merit in practicality and they have this like, wonderful companionship. I was just going to say you need companionship. Yeah, right. Exactly. Those like have something hot and have a great meet someone at a bar, have some crazy emotion filled trauma healing experience.


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


Yeah. So they were right. They're always right.


Is it all right? That is what I have learned. What I've learned is there are a lot of times I think my parents are wrong, but really it's on me. And maybe it's five minutes later or five years later or 20 years later. But they are always right.


OK, so as we collectively aspire to happiness, fulfillment, all these states of being, you know, what are the cornerstones as you see it? Because you have a you have an actual lab at Stanford, the Brainstorm Lab for mental health innovation. What are the goals you guys plan and flags.


And so Brainstorm is the Stanford Lab for Mental Health Innovation. And at the end of the day, there are two really big things that we're looking at. And I'll tell you actually something that I say when I speak about mental health, which is that mental health is the greatest thief of human potential today. And I say that as the very overarching statement, as well as a call to action for everything that I'm doing personally, everything that our lab is doing.


So I'll give you some statistics. I won't do too many statistics, but I'll throw some statistics out there.


We love numbers worldwide. If you look at someone who is struggling with mental severe mental illness, they live 25 years less than the average person. Twenty five years. Now, if you look at all the countries in the world and we line them up in terms of average life expectancy, if you look at the best country in the country, you'll see something like 25 years. It might even be better than that. So to say that someone who has severe mental illness in today's society lives 25 years less, that's astronomical, OK?


Yeah. And the thing is, it doesn't need to be that way. Right? When we think about mental health, we do actually have amazing treatments that work for people. And, you know, a lot of what I do, I think as a psychiatrist and as someone who's, you know, really trying to be public facing is there are enormous misconceptions and misunderstanding about mental health. I think more than any field of medicine I've ever encountered, that people have the wrong understanding.


And if we talk about fake news, there's a lot of fake news about mental health. Right. And so the way people understand and conceptualize it, I think is inaccurate. And so something that's important to me is to really fix those inaccuracies.


What do you think the prevailing myth is that you would debunk what, first of all, that treatments don't work?


And so if you there's this sense of if you have something with mental health, that there's no hope of getting better and that you have to take care of it yourself and suck it up and, you know, like do something internally and things will get better. That is absolutely not true. Medicine has phenomenal treatments that do work. And I think what happens is that everyone knows someone who went to therapy and didn't have a good experience or took a vacation and had, you know, like their libido went down or they gained a little weight.


And so then there's this sense of like, oh, my end of one says that mental health treatment doesn't work. Therefore, I'm never going to try anything. And that's completely false.


Can I add as athlete who's been in AA for 15 years, I get so bored with someone going like, oh, my uncle did AA, it didn't work. And I'm like, well, it didn't work. I'm 15 years sober, OK? You look at me and say, it didn't work. But yeah, that kind of anecdotal one person's bad experience, the exception to the rule becomes. Exactly.


And the thing is, if you look at the medication. So I'm a psychiatrist and there's also a big misunderstanding. I think that there are a lot of different professional fields in mental health. So we have mental health counselors and psychologists and I'm a psychiatrist. And so as a psychiatrist, I'm a medical doctor. And what that means is that in addition to looking at what psychologists look at talk therapy and the psychological and behavioral element of health, we also look at the biological element of health and the way that we think and conceptualize mental health.


The word we use is bio psychosocial. So when we think about why mental illness occurs right from struggling with alcohol to anxiety to depression, PTSD, anything to why it occurs is a combination of biologic. All psychological and environmental factors, biologically, what that means is our genes, our DNA, right, like if your mom struggled with addiction, the likelihood of you struggling with addiction goes way up. Right? So literally what is coded in our DNA as well as neurochemicals and hormones.


And, you know, the brain is one big it's like a lot of electricity and magnetism that kind of goes into the brain. All of that is what makes up the biological component. Right. Then the psychological is really how we talk to ourselves, how we cope with things. And I think of it as like this internal monologue that you have around what's going on and kind of this combination of your thoughts, your behaviors and your actions and how they all fit together.


That's the psychological element. And then social social really means a mix of a few things. It's historical and environmental. So historically, if you and you had Nadine Burke Harris, right. Historically, if you were exposed to childhood trauma, then what your health looks like is different for the rest of your life because of that historical element.


What you're telling us that's new, which is fascinating, is we are both very aware of the biological component, like I might have a genetic predisposition to being an addict and then my environment will probably accentuate that or not if I grew up around other addicts, blah, blah, blah. But the psychological component, I don't think anyone we've had anyone that's talked about that, like how how your thoughts interact with then your actions is.


Yeah, absolutely.


The environmental is a mix of history and your current environment. Right. So, for example, right now everyone is anxious, right. Because the environment that we're living in right now is unlike anything we've ever lived in before. And so when we think about mental health, we think of everyone is being on a spectrum from wellness to illness. Break that down like depression. You're on a spectrum of depression from, you know, major depressive disorder at one end to like it right before the edge being like a little bit, you know, how are you?


A little bit, maybe a little bit irritable. Right. All the way until a little bit of bad sleep. A little bit. Exactly. A little bit of bad sleep. Right. So so at any given point in time, you're somewhere on that spectrum. And where you are on that spectrum is a combination of the biological, psychological and environmental issues. Now, that's what we have in mental health. What makes this differ from other areas of medicine, like, let's say, diabetes or cancer, is that you can actually measure.


Right. You can draw your blood and you can measure, oh, I have this much cholesterol in my body or my insulin levels are this specific number versus for mental health. We don't yet have the technology or tools to tell us what percentage is biological, psychological or social. Right. So if all of us are struggling with sleep tonight, for Modica, it may be 50 percent biological, 40 percent psychological, 10 percent enviromental. For DACs, it might be 80 percent enviromental and 20 percent biological and zero the psychological right.


So once again, we humans are the worst thing to study on planet Earth or most fascinating. But I hear you. I hear you. So that is why we are the way we are. And so then when we think about treatment, we similarly think about treatment in all three of those areas. OK, so what treatment then looks like biologically is medications as well as what we call intervention. So transcranial magnetic stimulation or electroconvulsive therapy. So magnet's or electricity are incredibly, incredibly effective.


That's a hard one to rebrand, though.


Yeah, it is arbitrary that ECT, specially because of like One Flew Over the Cuckoo's Nest and things like that. The the conception people have for ECT is that it's this horribly painful thing. And it was like that, you know, 50 years ago. But and TMS is another thing. Transcranial magnetic stimulation. Basically what we've been able to do is map out particular parts of the brain and you can stimulate those different parts. And that helps enormously with depression, OCD, bipolar disorder, PTSD, all these things.


Is this only in a clinical setting or can people own this kind of thing? Is this is this a consumer level? Yeah. Yeah.


So right now, both in terms of things that have to be done in the hospital, ect, you have a little anaesthesia for TMS. It's about like a 10, 15 minute procedure. I'm a professor at Stanford. We do it at Stanford. But what people are working on is actually trying to figure out how do we make it small enough, portable enough and safe enough that you can do in your home. And so I do think that, you know, maybe like five years from now or so, we will actually have that capability, which I think is really, really fascinating.


Aren't you so glad you're in this field when the fMRI exists? Like, you know, if you were doing this in the 70s, you're like, I think the mid brain's responsible for impulse, but we don't know. Yeah, yeah.


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I was one of the things I say is that mental health is undergoing a renaissance and I feel deeply fortunate that I'm at this stage of my career, which is really just starting my career. I think there are amazing transformations that are happening in mental health right now. Technology is really one of the biggest parts of that. And that's what we do in my lab, which I'll get to it a minute. But I want to go back and finish the the psychological social.


So what is the biological element of disease, its genetics, its electricity, magnetism at neurochemicals, hormones? So that's what we treat with. That's what the medications do. That's what TMS does, is help with the biology. Right. And then we have the psychology. So psychology treatments, psychological treatments are therapy, cognitive behavioral therapy, dialectical behavioral therapy, sometimes even just regular talk therapy alone. And I think what's important about therapy is therapies like exercise in that.


If someone just says, oh, I had a bad experience in therapy, that's like saying I had a bad experience in, like running and therefore I'm never going to do any exercise again for the rest of my life.


Oh, yeah, we went to a bar and it was a terrible bar. Oh, bars are terrible. Exactly.


And so when you think about therapy, there's there's so many elements of figuring out what the right type of therapy is for you. Is that CBT? Is it is that acceptance and commitment therapy and also then finding the right person to deliver it to you. So just like when you're exercising, you want to find that right coach with our right trainer in the same way with therapy, you have to find that that therapist who's the right fit for you. So that's where the psychological comes in.


Then we have the environmental component and that's really where all these elements of behavior like mindfulness and sleep and exercise, that's where those come in. And then even who do you have around you? Right. Are you surrounding yourself with positive, uplifting people or are you surrounding yourself with people who are only talking about the negative? So really thinking about your environment and making environmental changes, you know, numbers one and two for everyone, exercise and mindfulness. Those are the things that we have the absolute best evidence for of making an impact.


It's actually almost ridiculous. Like every day a new study comes out showing how exercise or mindfulness helps everything from mood, stress, anxiety, productivity, even length of life.


Yeah, and we need that paradigm shift even in how we treat medical issues in this country, which is it's all symptom related. Right. So huge billion dollar campaigns against smoking. There's no billion dollar campaign to encourage people to exercise, which in turn would probably alleviate a good portion of the downstream thing. Absolutely.


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


I always bring that up. In fact, I think they'll even pair you with, like, a trainer. I'm so glad you said it, because he does say that all the time. And I'm always, like, trying to fact check it and I can.


So this counts as my fav. I promise. I think that's true. Yeah.


And, you know, and when we think of another disease, like if you think about diabetes, right. It's like, what do you need to do? You need to change how you eat. You need to lose weight. You need to really focus on things like exercise and mental health is no different. And that's why what I love about mental health is when I say biopsychosocial, the reason why you are the way you are is not because of any one thing.


Right? It is a combination of all these factors. And so similarly, in order to get better, you can address it from all these different perspectives. It's a very interdisciplinary thing in terms of how you actually address mental health.


That is an implicit hurdle with mental health, which is people like one thing, they don't like 12 things they want. What should I do was to stop eating sugar. OK, stop eating fat. OK, stop eating. You know, it's a tough sell to say to people like, well, you need to monitor about twelve things.


Well, first is I don't think you need to do twelve things at the same time I say the twelve things because I think it's helpful to know that if one thing isn't working, something else might work right. If X medication isn't going to work, then therapy might work, or if medications don't work, ECT is going to work. So there are a lot of options out there. And what is great about mental health is you can then try another thing.


So I don't think you should try twelve things at the same time. But it's knowing that try one thing, see how that goes and then try something else. And so just recognizing that there are a multitude of options in terms of what you can try to get better at mental health. And I said because what we were talking about before is that a lot of people think I can't get better. And the reality is you can get better. Yeah.


So let's talk about technology to a couple of things I think are really important when it comes to mental health.


One is that we need to democratize mental health and to we need to personalize mental health. Whenever I talk to folks about what are the big challenges in mental health, I always say that stigma is problems one, two and three. Stigma is the biggest issue we have in terms of what's holding us back in mental health. Do you have kids? Right. How old are your kids? Five and seven. Five and seven. OK, so let's say your daughter has a stomach ache and it's not going away.


Right? So she's you know, she's talking about the pain. She's maybe wincing every now and then and she's telling you, you know, Daddy, my tummy hurts and it wasn't getting any better. How long would it take before you went to see a doctor maybe that went to the emergency room or even Googled, you know, stomach pain on online?


To be honest, I think it have to be a two day thing because they have something they claim is existential every hour.


You know, they have a headache that they've never had. Yeah. I think it'd have to be like around for a couple of days before I took it serious. That's fair. You'll make sure that it's going to continue for two days, that you that these cookies don't make it better or, you know, let the stuff edible. Does it make it better? And then two days, but then you'll get help, right? Yeah. Now, let's say instead of a stomach ache, it was depression or some symptom of mental illness.


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


Well, again, I happened to be in a house that talks about it a lot. So for me, they'd have to do a checklist like were you of service to somebody? Did you work out and are you eating? Well, if they did those things and they still felt like they couldn't come out of it, then, yes, I would get help. So I would say that that would probably be a couple of weeks. I'd want them to give a couple of weeks of, you know, what I believe results in in good.


OK, so I'm going to ask Monica the same question. So in this case, we're also talking about your kids. Right. And a lot of times people might be more proactive with their kids than they are for themselves. Monica, if you were, let's say, struggling with your sleep and you weren't able to sleep, you're like waking up at two a.m., you know, how long would it take for you to try to seek medical help if it kept going on?


Wasn't getting any better a long time. Yeah.


What is a long time. So doctors was saying if it's a stomach ache, two days, you know, mental health, maybe a few weeks, what is it like for you?


It's also ironic. If I have a stomach ache, I immediately think it's appendicitis like five minutes in and I'm like ready to go to the hospital within an hour.


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


A long time for you means maybe a couple of months. Yeah, I think I've observed that at the risk of getting into a fight, I think I've observed like four months or she'll go, I'm going to call my therapist, she'll start talking about calling her therapist, she'll talk about calling her therapist for maybe three weeks. He also doesn't know every time I talk to my therapist, every time I've tapped her phone.


But yes, yes. Monica, that app on your phone that you don't know what it is. It's tracking everything.


Um, I think partly it's because it takes me personally maybe three weeks before I even recognize. Oh, I've been irritable for three weeks, so I haven't really been sleeping for three weeks. So I've been sort of down like I can't even recognize it because I'm in the spiral for a while. Then once I recognize then it takes a while before I can act on it because I'm like, well, oh I see. OK, it's that it'll probably go away altogether, so I'll do that.


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


Like how long did you have anxiety when you were working at Solar Cycle before you got a therapist. She was having panic attacks and.


Yeah. Serious, right. Yeah. Hellam Truly probably eight ish months. Eight months.


OK, so now I'm going to ask you guys a question. This is I'm a professor. I teach. So I have to ask you a question. Right. A great. Great. What do you think the averages in the United States, if you have a symptom of mental illness and it's not going away, I think it's five years because I think ultimately for people, they'll start to have to confront the wreckage of that.


So though their marriage will go away, they'll get fired, their kids won't talk to them. Like I feel like people have to experience grave wreckage. And I think that takes years to accumulate.


Yeah, I'd say two years eleven. Oh, great.


Oh, well, you can go too long in a marriage, I guess for eleven years.


Imagine telling a kid with cancer that we're going to you know that like you have to wait eleven years one thirty.


And let me point out that's just to actually go to a doctor. Then the issue with mental health and especially for my field of psychiatry, there's such a supply and demand mismatch where the number of people who need help compared to the number of doctors out there who can provide that help and just that hours, those doctors are working huge supply and demand mismatch. Right. So at Stanford, where I work, we have wait lists of in some clinics literally up to a year.


Mm. That is a travesty. That intellect like today, we have to wait that long to get that sort of treatment. So 11 years to actually get help. Then once you know that you need that help being able to actually get that help, that that's where access comes in. So both there's a shortage of doctors as well as then we have things like money, right. Like the payment side of things and insurance. So what this comes down to is two really, really big elements I think are important or maybe even, let's say three, stigma and democratizing access to care.


Right. So that no matter who you are, no matter how much money you have, that you can get really good care. But I go back that stigma is one, two and three, because I think if you look at something like mental health compared to something like cancer, the way we conceptualize disease is very different. There's this sense of there's something wrong with me as a person and not that there's this external entity of a disease. Me.


Exactly, exactly. So I'm going to throw some of it back at you, the blame, which is another huge issue, is there isn't consensus and that's Unal that's on Accademia. John D. Rockefeller said, look at all these people graduating from these colleges with medical degrees and there's no standard of what a medical degree is. So he said, let's model the whole system after Johns Hopkins University. They seem to have good doctors. Here's a standard we all agree about.


And if you get cancer, sure, there's going to be some standard deviation and care, but it's probably going to involve chemotherapy. It's probably going to involve radiation. It's probably going to involve these things.


I think part of the issue is this enormous body of attempts and no real consensus. So I think that compounds it as well. Like everyone knows, if you have cancer, you're going to get chemotherapy. But if you have mental health things, people don't really know what they're going to get.


I hear you OK? And you see me there. I see you. I hear you. I see you.


There are a few, I think, important elements to bring up. That one is that you're right. At the end of the day, there isn't a clear answer right now of if you have X, then we give you Y point Z, if you will. But cancer is actually not not dissimilar from that. If you look at chemotherapies, there are a wide range of chemotherapies that you might choose to give.


My my dad's a radiation oncologist and everyone will do a little bit of a different range in terms of how big of a circumference they're treating or the dosage that's going in. And there is a lot of math and science behind all this. But there also is an art and a little bit of guessing and hoping behind all this.


And it's going to blow up in a minute when people start mapping their genome at home and taking it in. And we find out actually there's eleven thousand approaches that are approved.


Well, and the genetic component is fascinating. And now we actually have genetic tests to be able to tell us how likely are you to respond well to this antidepressant or what types of side effects are you likely to get because of your genome? Oh, that's good. So where we are today is not where we want to be yet. Where we are today is we do have a lot of therapies and treatments that work. And I think mental health gets a bad rap here compared to other areas of medicine where if you look at the efficacy of like allergy drugs, they're actually the same as antidepressants.


But the way people talk about it, because, again, like maybe, you know, if someone took the medication, it didn't work. Too many people say, oh, antidepressants don't work. If someone took an allergy medication, it doesn't work. You don't have that same story being told.


Mental health, unlike other medical treatments, is so reliant on the person's participation. And this is where a like Dr. Drew and I will fight with people about a it's like you could say that your cancer medicine doesn't work if you only take it on Thursdays when you're supposed to take it seven days a week, you can say insulin doesn't work if you take it three days a week when you're supposed to take it seven days a week. So, you know, because there's so much participation in these mental health issues, they're hard to evaluate sometimes.


Exactly. And if you have cancer, you look to see if the cancer is getting smaller or gone away. Right. So much of mental health is actually objective is, you know, if you're making depression better, we ask, do you feel better? We don't have this metric of, you know, your depression has actually gone away. This is what I'm going to talk to you about, because you're talking about technology. So this is what I think is the most exciting thing about mental health today and why when I say mental health is going through a renaissance, part of that is because of stigma and culture.


Part of that is because of technology. So if we look at what mental health is like today, in a lot of ways it's what cancer was like a hundred years ago. Have you guys read The Emperor of All Maladies? No. Siddhartha Mukherjee, you need to read the book. It's amazing.


Won the Pulitzer Prize. It's basically this whole history of cancer. It's really, really fascinating. I have worked the American Cancer Society for years and years. So when I see these analogies, it makes a lot of sense. One hundred years ago, cancer was really only treated in stage four because you didn't have an X-ray, you didn't have an MRI. It had these late stage manifestations of the disease. And if someone got diagnosed with cancer, they wouldn't tell their employer because there was actually this stigma that you did something wrong.


And so that's why you have cancer.


OK, and then what happened is that the X-ray came around and the CT scan came around and doctors were able to look inside the body and collect data that they never had before that allowed them to see cancer at its earliest stages. And so now when we think about cancer, we've come so amazingly far that we can see it when it's a minuscule thing, we can actually prevent it through screenings. Right. And so what cancer looks like today is completely different.


Now, if we think about mental health, if we look at how we measure mental health, one, it's this mix of objective and subjective and the metrics we have are not that great. Right. It's like asking you, do you feel depressed? And number one, you yourself have to identify that I'm depressed.


You're the worst person to ask. You're the worst person. And what makes it even more complicated is, Monica, you were bringing this up. These diseases like depression, anxiety, substance use, the disease itself makes it that much harder to even know what's going on with you or to seek help if you're depressed. You don't want to go see a doctor. You want to sleep all day, you know, and. Unfortunately, it's this kind of cruel element of the disease that having the disease makes it that much harder to actually get treatment from the disease because of these other issues.


Right. So when we think about mental health, part of it is measurement. What are we measuring in order to diagnose the disease and how do we even see the disease? Right. You don't ask someone do you feel like you have cancer? Do you feel like you have diabetes? But we have to rely on if they feel like they're anxious or depressed. OK, so let me tell you what I think is the most exciting thing going on right now.


It's called digital biomarkers. And move move your hands around a little. What do you have with you?


Like, every moment of the day? My hands. Oh, your phone. Oh. Oh, he found that was a little. We love that. We love it. We did a bad job. That would be a good riddle. That would be a good read. So if we look at the phone, then smartphones, smartphones are now able to measure elements of human behavior that we've never measured before.


So if you look at everything from how fast you're typing or the number of spelling mistakes you're making or the geographic vicinity that you're walking around in throughout the day, these are all measurements of our behavior that can tell us how likely you are to be depressed or be anxious or have bipolar disorder.


And so what's amazing about this is, first of all, like when in the history of human mankind, has there been anything that we've actually had with us every moment of the day that can measure these things that we've never been able to measure before? Sleep is a great example. You know that everyone is sleep trackers on their phone, right? If you ask someone objectively, how well did you sleep or how long did you sleep, then you compare it to those sleep trackers.


There is almost like no correlation, like very, very bad people don't know how well you don't know. And that's just sleep.


Sleep is a lot more objective than mood. So if you think about that, that's what makes Knowledge's really exciting right now, is that now there all these things we're going to be able to measure that can tell us much more objectively like the blood test. You know, how likely is it that you are depressed or that you are anxious and it's in the very, very early stages. So I give that caveat. But what we're starting to learn is things like the radius in terms of where you walk compared to where you are when you're depressed, that goes down well, isolate right in.


This could be a very confusing moment for the A.I. this, right?


Exactly. So that's the issue right now. There's a lot of noise. And when we look at sensitivity and specificity, it's not exact. Right. So maybe you're actually isolating because you're binge watching Mindy Kaling new show. Maybe you're isolating because, you know, you're exhausted. You don't want to go out. So it's not there yet. But what it is, is there's all this new data, much like when the CT scan came around, we could see things we never could see before.


We could measure things we never could before. That's where mental health is right now, is that there all these new metrics related to technology that tell us about the human condition, that tells us about our behaviors and our emotions. And that, I think, is what's going to be really exciting moving forward, because I do hope that now in a few years, we will be able to diagnose with much more accuracy. And you're not going to have to tell me if you're depressed will actually have these measurements that will do that for us.


Did you read homogeneous? I think I'm sapience somewhere here, actually. So Sabin's right about where we came from and then Humeau decide where we're going. And there's this fascinating part in there where you've always talking about that you will maybe one day be walking into a meeting at your work and your phone will say, hey, shut up. In this meeting, your cortisol levels are really high and you have your blood sugars low. In the last time you were like this, you got in a fight with your boss.


Just mum's the word for this meeting. I was like, that is so fascinating. And then opens up this really crazy ethical dilemma of who should that machine service your experience self or your narrative self? Like we have different selves. We have different objectives. AI is so fascinating. And my second question is, do you know Eric Topol? I feel like you guys should be working either because he's doing all this on a biological front with phones about.




Yeah, he's one of the first people who really entered this space at MIT. I'll tell you a funny story. So I haven't met him yet, but my brother is a medical oncologist at Sloan Kettering in New York and he published his first paper in Science and Nature. A few months ago. Eric Topol tweeted Hebb and then I liked the tweet. And then Eric Topol, I think like for me for some reason and said like, oh, are you related to need of acid, which is B?


And then he said something like, I want to study both of you. So so I have not met him. But there is where in the Twitter sphere there's a connection between myself and Eric Topol that I would love to meet.


Oh, we are so in love with who love we can't like there's two people of the two hundred and some we've interviewed Eric Topol and Adam Grant. Like we just want to be joined with them secularly. We just want to fuse with them. We love them. I will join you at that. That would be a dream come true.


OK, so can we future serve for a second and get into assembly vocative like theories of the future?


So this is a very complicated topic for me because again, I am a product of AA, which is a behavioral response to a malady. Right. It's group therapy. It's all these actions to living. And I believe in them. And I'm actually kind of against Suboxone as a treatment. Can you tell me why? Yes, well, listen, I totally. Understand the argument from the other side, which is a we have a bunch of young people dying from opiate addiction and we've got to we've got to curb that.


And so, yes, that is a very good short term cure for the death rate. But Suboxone is an opiate. You still live as a zombie. You're still treating the symptom, and you're not getting even close to what the cause of that disease is. If that's your program, is just to take Suboxone, you will never approach an inventory of honesty, learning why you do the things you do. And so for me. Go a step further, if the sole objective is to prevent deaths, why not just install into people nakama that automatically deploys so that people can just use drugs as much as they want and they'll always be revived with the Narcan?


Is that a solution? We think we would like because it's in the realm on a spectrum of a Suboxone and just give everyone an automatic deploying Narcan can. It's closer to that. So I just I don't think it approaches the problem. So that's my issue with it. I would almost make the same argument with insulin, right, it's like if someone is diabetic and you don't want them to keep eating cake every day because if they could eat the cake and then they could give themselves some insulin and then you can just end up in that cycle where your blood sugar might stay, OK, because as you're doing the kind of triggering behavior, you're putting the stress on your organ and then you're artificially giving it what it needs.


You know, you would you end up dying from low blood sugar? No. Would you have those same rights of high blood sugar? No. But is that a life that you want to live? It's not actually curing the disease. It's basically letting you live with the disease. Really quick.


If I can just say the my issue with that analogy is that if you have Type one diabetes, you're born with the pancreas that doesn't create insulin. So there is no solution to that. You're not going to work through how that came about and solve it. I am of the opinion that you can work through alcoholism and you can solve it.


So I mean, type two diabetes, actually. So you're absolutely right. Type one diabetes, you're not producing insulin, but type two diabetes, you just you don't produce as much when there's a lot of sugar in your body. Your body doesn't produce as much insulin as it needs to. So you have to artificially take insulin.


I am of the opinion for Type two diabetics that the solution is that you take insulin so you can eat a bunch of cake. I don't think that's the case.


I agree with you. What is the solution? I agree with you hundred percent. But look, the solution is finding out what it is you're treating by eating the cake. What happens just before you self regulate your emotions and your cortisol levels with cake?


I love that you said that. I'm going to add to that. So you're absolutely right. And that's critically important. Is the what's going on emotionally that's leading to you engage in that behavior? Similarly, what's going on emotionally that's leading to you want to drink or want to take drugs, right? Yeah. And I would say there are two components there. The medication is one thing, but there's also education. Right. In the case of diabetes, it's educating yourself on what is healthy, what's not healthy, what are the ranges of foods I can eat that will be in particular range of keeping me healthy.


And so, you know, we were talking about biopsychosocial. Same thing holds true for diabetes, which is like you can exercise, you can change your behavior and exercise, and that helps with diabetes. You can decrease the amount of carbohydrates and sugar and that improves your diabetes. And you can understand what that emotional trigger that's leading to me wanting to eat the cake.


Uh huh. All of that is what leads to you struggling with your blood sugar. All of that is what leads to you struggling with addiction or struggling with any element of mood or emotion. Yeah, and so I say that because there are three big things that you need. You need education therapy, which really changes the way that you talk to yourself and understand why am I feeling this way and, you know, picking up the bottle of wine and then medication.


And so all three of those end up helping you get better. And to your point, before, it's like I'm not saying everyone should, like only take medication and never do anything else. We don't know what's going to work for everyone.


There's also a unique paradox, though, with Suboxone, which is the work one would need to do. Suboxone prevents, in my opinion, from you doing so. Someone could be taking insulin and then still go on the jog and they could still go buy the good groceries and put their fridge in order. The insulin wouldn't stand in their way from doing that. Suboxone does stand in your way from dealing with the stuff because it is numbing the part of your brain that is agitated and needs addressing.


So it's weird because the other things that you'd want to couple with Suboxone, the Suboxone itself makes it harder to do that. Well, what I would say to that is I don't think there's any one treatment you should try multiple treatment. I've had a number of patients where they come in and tell me I don't want to do therapy. I only want to take medication or I never want to take medication. I only want to do therapy. Yeah.


In reality, what we see is that if you start one, the likelihood of the other one being a lot more effective goes up tremendously. And then you add on to that, OK, like I'm so depressed I can't get out of that. So I'm not going to go do mindfulness if I can't even get out of bed. Right. So maybe first I need that medication that's going to get me out of that. So it's stepwise, right?


And just so you know my position, I am very pro medication for depression. I believe in SSRI inhibitors. I believe in that. I just Suboxone itself is an opiate. So that's where it gets tricky for me.


I'll bring up some other medications, Naltrexone or or Antabuse. Disulfiram I Antabuse is awesome.


It's awesome. It doesn't get you high. It just is this great backstop for getting drunk. I love it.


And Naltrexone is a medication that decreases your alcohol cravings. Or when you do drink alcohol, you know, the joy you get is a little bit lower. So what we see when people take Naltrexone is that they actually end up drinking less because they're not getting that same. The serotonin, all of those the neurotransmitters aren't working the way they want.


Exactly. Exactly. So Suboxone is its own thing. The reason I mention this is it is important for whether it's alcohol or opiates or anything. And I grew up in a small town in West Virginia, and the number of my high school classmates who have struggled with or even overdose from opiates is is really, really heartbreaking. So I absolutely hear you on that. And this is not a problem we need to solve.


I get the parents of a 19 year old that are like, yeah, man, whatever, they're not going to go away and figure out what their child or whatever, they'll be alive. So I get it. Like I understand the other point of view.


I think AA is awesome and medications are great, too, is what I mean.


Yeah, me too. OK, anyways, when I was going with that is is so, so I'm conflicted because I have this kind of I think you need to get to the root of your ailments and I think sometimes buffering them with, with medication isn't always the case. But with all that said, I have to acknowledge that the world is heading in a direction and it's not going to stop. There's nothing I'm going to say that's going to stop the direction it's heading in.


The direction is getting further and further and further away from how we were designed to live. We are inhabiting a world that we were not designed to live in. We're not supposed to be traveling at 90 miles an hour on a highway. We're not supposed to be interacting with light at 10 p.m. the way we do. There's all these things we know that the hardware wasn't set up for it. And so it seems like we're going to have to make a leap at some point.


And for me, it probably involves hooking your brain up to some electro gizmo that's going to offset all the stress that this life we've inhabited. You know, I see a utopian future where maybe we do have an instrument that keeps all of our levels at the right spot. And then within that lies some kind of ethical question. What do you think about that?


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


Right. So that's where it gets so complicated, because, again, the story of my life, the narrative self is proud of hard work. It's proud of sacrifice. It's proud of service. It's proud of things that require great willpower. And I didn't want to do.


But then the result was positive. Right. So that's tricky because that's what I what I'm proud of DAX Shepard for is those things now my resting state of well-being might not reflect that at all in my resting state of well-being. Might be is scrolling through Instagram, which is a bummer.


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


I don't think that's aspirational yet.


I don't know. Is that going to be the only option?


You know, stay tuned for more armchair expert, if you dare.


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I agree with you 100 percent, I think that when we think about, like what brings you the greatest joy in life when you're engaging with your family or with your community, when you're making an impact in the world like that's what we need. And, you know, today is even a really good point to think about what's going on right now. We're all in the middle of this quarantine. And, yes, a lot of people are looking at their screens.


And yet what we're seeing is like the best of humanity come out and we're seeing that people are good and benevolent and want to be able to help other people and give back. And and especially given how many people have lost their jobs or are working from home. And very well could be, you know, on screens all day and scrolling through Instagram or whatever. That's not what they're doing. And if anything, right now, when we're in this environment where we are actually have so much more screens than we're used to, I think the majority of people are just craving being able to go out and give someone a hug or, you know, take a run outside.


And so I say that because maybe there will be some machine like that. But that's not what it means to be human. That's not why we got to where we are today. And that's not what has brought us joy and, you know, helped us move forward as humanity. A machine like that, I think would hold us back from creativity and discovery and just, you know, being able to really be ourselves. I think growth and exploration would die.


Yeah, I think. Yeah, yeah. Because if you could I mean, for me, that machine would have me feeling two beers. I'll steal from Gordon Keys.


We're all born two beers shy of happiness like that machine would have me at the peak of that second beer before the craving got insane and all the records started. But I don't think I do anything but hang and talk. If that was my resting state, I completely agree. So I went to Stanford for business school and the admissions essay for Stanford. There's one question that they ask you. What matters most to you and why me? So the answer I gave was community.


And, you know, a lot of this, I think, for me comes from growing up in a small town in West Virginia where the commitment that my parents and our neighbors all had to community there is this amazing sense of people working together and supporting each other. And even now, you know, I haven't been home in a while. And I I graduated, what, 18 years ago. The connection I have to my home community is enormous, but it's even more than that.


It's not recognizing the power of what it means to be a part of a community. We evolve over time and eventually we're in tribes. And now, you know, we're living in a very different society now. But being a part of a community, whether that's a racial community or religious community or professional community, that sense of connection being connected to each other. So much of that is what is is very, very intrinsic and inherent to being human and experiencing joy and love and what what it means to have a purposeful life.


I think that's something that we're really seeing now in this time of quarantine, where people crave that connection to a community. They find so much meaning in that. And so I say that because there are these other things, like you can get, you know, dopamine hits by continuing to scroll online or maybe there will be some pill that can help you feel a particular way. But these basic things like belonging are so critically important. And what I think about also what we need to get better as a psychiatrist, the state we are in today, I am very concerned because of what we're going through right now with coronavirus and with social isolation, with the financial crisis that has started to come but is only going to get worse.


We know historically and epidemiologically when we look to see what happens at a time like this, that we are going to see an increase in depression, suicidality, anxiety, substance use and trauma. Like we're all collectively going through this trauma. And it's not just something that we're going to see for a few months. We're going to see it for a few years. And so for us as psychiatrists, as this mental health community, what we're trying to think about now is how do we be proactive because we know what we're in for and what people are going to be struggling with.


How do we proactively address that to help people get better so that either, you know, they're going to not face these things that they're facing or because we know what's happening, we can protect them and give them the resources that they need to get better. And so I say community. I think community is a huge part of that. And we're talking about AA. The AA community is one of the most powerful communities I think we have in the world.


And the the number of people who would say, like they got their lives back because of being a part of that community is enormous. Yeah. And, you know, everyone will have a different answer to this because they're all, you know, that's that's beautiful, that there are different things that are important to all of us. But when we think about mental health and what people need to get better, being a part of a community is tremendously important.


Again, I think AA is a great as a great testament to that.


By the way, we talk about mental health so much we do. And just that whole psychology component. I feel so I feel so silly that I didn't think of it in three terms.


Oh. The other thing we're going to talk about was emotion. Yes. Actions and behavior. So that's the triad. That's like the sacred triad, if you will, of cognitive behavioral therapy. So basically what it's saying is if you think about how you feel. What you think and what you do, that they're all very much connected, right, if you feel sad, then you might think no one likes me. And then the way you might act is you don't go outside and you stay isolated because you think no one likes me.


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


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


Exactly. So the idea behind one type of therapy, cognitive behavioral therapy, is recognizing that there is this loop and these things are all connected. How do you then actually break the cycle? And so basically what that comes down to is what can you change? And if you think about those three areas, feelings or emotions, thoughts and behaviors, what we learned is that it's actually very hard to change your feelings, right? If you're feeling sad, if you're feeling depressed, if you're feeling anxious and someone just says to you, stop feeling anxious, you can't do that.


Even if you tell yourself, stop feeling anxious, you can't do that. And it turns out also changing behaviors by itself is also very hard, right, like if you're isolating, telling yourself to get out is actually pretty hard. What it turns out the easiest of those three things to change is your thoughts. And so specifically, there's a term called cognitive distortions, and what these are are patterns of thoughts that we all have that are unhealthy sorts of thoughts.


And so I'll give you some examples. One is what we call black and white thinking. You know, you don't see the shades of gray. Either something is great or it's horrible. Hmm. Another would be fortunetelling, which is this thought that, you know, if something happens, you assume that something bad is going to happen, even though there might not be any concrete evidence of that. That's just what you think, like your bosworth's by your desk and doesn't talk to you.


You think, oh, he must be mad at me or I'm not going to get the promotion tomorrow or things like that. There are 10, 15 or so different patterns like this of what we call cognitive distortions that we all do. What happens is that we then believe that. Right? We think it's true. And we don't realize that that's actually false. When you do cognitive behavioral therapy with a therapist or with an app, there are a lot of apps that do that now is that you learn these distortions and then you learn to identify your own distorted thinking.


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


Then I start to realize, wait a second, that's not actually true. Actually, I did something pretty good for myself. I'm not a failure. And you start to understand your patterns of thinking. Once you recognize that you have this pattern, then you catch yourself acting in that pattern. Then you can actually change that pattern. You can recognize for yourself. Oh, I am thinking in that distorted way. Let me actually correct that. And I can say, you know what?


I wanted to run two miles. I didn't get to my goal. But that doesn't mean I'm a complete failure because I did run those point five miles and good for me. And so then what happens is then when you change your thought around that actually start to feel better. But I don't feel like I'm a loser or failure. I start to feel better. And then similarly, I might act of, OK, I'm going to go try again tomorrow because I feel better about what I've done.


So that's actually the foundation of cognitive behavioral therapy, which is something that I think needs to be taught in schools. It's like, you know, when we say like this, should you put the drinking water cognitive behavioral therapy, should you put the drinking water? I think some schools are teaching it that. But it really should be a mandatory part of curriculum because this is something that whether you've had trauma or depression or substance use, even psychosis, there are forms of cognitive behavioral therapy that help people get better.


This is all the psychological element of how are we talking to ourselves? How are we thinking and then how are we acting as a result of that? That can be changed and kind of behavior therapy does not really.


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


But this this kind of challenge is that well, yes and no. I'll give you another loop there. So when when you want to doctor, you're really good at exercising, it sounds like, right?


Yes. That and other physical actions. Pick up my phone and call somebody I don't want to call who wants my help. Yeah. Or my counsellor or whatever it is. Right. A gratitude list. I can't think of things I'm grateful for, but if you give me the task to write a gratitude list, I know I have to write five things. I will think of them. And then by doing that, I actually reset my thinking. But again, it was the physical action that required me.


But also there was a thought before you made the action that if I do this, I will feel better. So there was a thought involved.


It wasn't just that you are blindly calling well, but most often the reason I'm doing those things, I don't want to. I feel like shit. I don't want to do anything. I want to feel like a victim and I want to feel like life sucks for me. And then this muscle memory through practice, which has become habitual, is fuck it. I feel like I should just start doing it. Walk down stairs, get on the treadmill, then walk upstairs, write on the piece of paper, then pick up the phone and call somebody like, yes, I am thinking of it, but it's actually contrary action to what I want to do.


Yeah, and the reason I bring up exercise is that everyone knows they should exercise, but most people or a lot of people don't do it. And what a lot of people have the sense of is I want to feel motivated. When I feel motivated, I'll go to the gym or they want to feel like going to the gym. Right. Because we've all had times where we felt motivated and then went and did something right. So you then keep waiting for that feeling or that thought of, you know, I'm going to go do it or that feeling.


So what holds us back a lot of times from acting is that we're waiting for that motivation. We're waiting to feel a particular way before we act. We assume that there's this arrow, right, like motivation, arrow action. What we actually know is that about 90 percent of the time and Monica, I know you're fact checking, so this is a good one 90 percent of the time.


It's actually the other way around. We're taking the action leads to motivation. Right. So think about it. When you go to the gym, then once you get started, you can keep going.


My big cheat and I advise it to people don't make a promise that you're going to the gym, make a promise to yourself that you're going to put your workout clothes on and drive to the gym. That's all. You don't have to do anything beyond that. No one's not going to walk in the hardest part. Just get in the fucking car and put on the outfit so everyone can put an outfit on and get in their car. Exactly.


That behavior, when you actually engage in the behavior, then the feeling actually comes. And then, you know, by the end of the workout, everyone feels great, right? You're like, oh, this was awesome. I want to do it yet. But then the next day happens and you want to hit the snooze button, tell yourself, oh, I have too much work to do. I'll go tomorrow. So cognitive behavioral therapy is getting at that link between the thoughts, the actions and the emotions.


And at the same time, exactly what you're talking about is true, which is that it's much more likely that the action changes the feeling than the feeling leading to the action. This is specifically about motivation and action.


And so what to me seems very inherent in the cognitive behavioral therapy approach. Is your conviction and your conclusion about your feeling needs to be challenged. You need to absolutely say I might not know shit, I might be completely fucking wrong. All of us are completely fucking wrong all the time. And you have to start with the admission that we're all completely fucking wrong all the time and you have to be diligent and try on other conclusions. Right.


And feelings are such a good example of that. We had hundreds or thousands of feelings a day. We also have hundreds and thousands of thoughts a day. I don't know the exact number, Monica, but look this up to tell us both thoughts and feelings right throughout the day if you're going to add it up, hundreds, maybe thousands, what's the likelihood of all of those being correct?


Right, right. Right. Even if you're IBM blue. Yeah. You're in the 90s, you're talking about several thousand conclusions being wrong.


We were talking before about what's so hard about something like depression or anxiety versus something like cancer. Is that with cancer, you can see there's this external manifestation when one is struggling with their mood or their emotions or their thoughts or any of these things, there's this first sense of this is who I am. This is what I'm thinking. But then when you think something it never crossed your mind. Could my thoughts be wrong? Right. Right. A disease could a disease be impacting my thoughts?


Yes, I will. And this is why I think it's so crucial for people to have an objective outsider hearing me and having trust in that person where they can point out this habitual pattern that you find yourself in, you will find.


Data to support your crazy fucked up theory about why you feel the way you are. You got to get someone else involved, right? Absolutely.


I'll talk about depression. So when I was depressed, you know, I'm I'm an extroverted person when even at the worst times of my depression, I still felt happy when someone would be around me. I would feel really happy. I was thrilled to be there versus my conception of depression was like yours and Winnie the Pooh. It was this sense of someone who's sad.


And I was I was successful for these objective metrics of success or, you know, what success means.


You are maybe different. Let's call it I was productive, but I was at Harvard Medical School.


I was working on the Obama campaign. I was happy when people were around. But then what was happening is I was tremendously procrastinating when in terms of getting things done, it would take me hours and hours literally just to like read a page in a textbook. But I didn't realize that I was depressed because that image of what depressed looked like was not how I was actually thinking or feeling. And when I think of what it looks like to be depressed, that wasn't me.


I didn't have the sense of how can you be successful and how can you be happy and be depressed at the same time, I knew there was something going on with me, right? There was something wrong. But it didn't seem like depression because there were these other things that I that I could convince myself, oh, it must be this or it must be that. And to your point, someone else has actually been able to see and what was happening for me, I was canceling plans with friends.


I love going out with people. But last minute I would cancel left and right. And so I would say something else is going on. And only then when someone saw me for like a month at a time and realized, oh, wait a second, this is not a one time thing. This is a pattern. I think something's wrong with you. Then I was able to actually recognize. Oh, wait a second. You know, maybe this is something else.


Like the classic measurement for depression is a scale called the Q nine. And this is something where if you think you're depressed, you can get online Google depression scale. Ask yourself. These questions are nine different questions. And what it comes down to is things like how is your sleep and do you feel like you're a failure? And all these things I was saying yes, yes, yes to. And, you know, only then was I able to actually realize, oh, wait a second, that's depression.


Was the test called Again Cuneen? It stands for Patient Health Questionnaire nine and their nine questions. What I asked you to do is think about the last two weeks of your life. How often did you feel a particular thing? One of these nine things, but it's hard to get at is different symptoms. Another element is what we call psychomotor. So do you feel heavy and slow, like actually physically feel that, or are you jittery and you're like moving around and all these different directions and you can't sit still a symptom of depression, you know, for your audience to know both.


There's a Q nine for depression as well as another scale for anxiety called the Gads seven, which stands for Generalized Anxiety Disorder seven. So that one has seven questions. Both of these are on a scale of zero to three. Looking over the last two weeks. How often did you feel this? And what happens when you take that test is it tells you, number one, are you depressed? Yes or no? Are you anxious, yes or no?


But then where are you on that spectrum? Is it that you're severely depressed or severely anxious? Maybe you're somewhere in the middle. Maybe you're actually OK. And the reason why the test like this and measurements like this are so helpful is because it's really hard for us to tell for ourselves how we're doing. Someone else is much better able to actually see that. But a lot of people don't have someone there who can tell you right now you're living by yourself, or especially now when you're isolated in quarantine.


It's really hard for someone else to know that something's going on with you. So these questionnaires can be really helpful to you. And, you know, this is not a diagnosis, right? In order to get diagnosed, you need to see a doctor. If you take this scale, this test, the Q nine are God seven and see that you're moderately or severely anxious or depressed. That's a really, really good sign to go do something about it and get some help.


I'm a little trigger that it's out of three. I just got to say everything should be ten. Any scale that doesn't go out of ten is do we learn nothing from the standard measurement system?


I do like times. I do actually a real test. I'll tell you about the real tests. So I'm a professor at Stanford and I teach two courses on mental health innovation. And actually you guys should covid lecture at Stanford. Oh, we would love.


Yes. Of Stanford. Yeah. Would you. That's the only way we'll get there. Yeah.


Fortunately, come and be a guest lecturer in my class next year. One shelter in place ends and you can come in person, come and lecture in the class, talk about what you're doing. It would be awesome. Love it. Done. So my labs focus on innovation. What you're doing here is really, really awesome. So you're going to come lecture at Stanford. That's number one over two. The first time I taught this course was two years ago and Ariela was a student, my classmate.


She was a senior at Stanford studying computer science and math. So really, really smart kid is who was in my class. And what my class is doing is trying to teach you how to actually create a solution in mental health. And so the classes all around mental health innovation for a lot of people that starting a company that might be creating a technology, it might be starting a nonprofit or proposing a new policy, this class is very interdisciplinary. You have folks from medical school, law school, business school, engineering, school, education, school, just all different perspectives who are all interested in solving mental health in some way.


And so when. I love about being a professor is that, you know, these students are just brilliant and have great ideas about, you know, change that we need to make in the world. And Ariela was one of those students. She was one of the best students in the class by far, probably teacher's pet. And I know I probably shouldn't say that as a professor, but told a teacher's pet.


So you she was you in junior high school?


I did get teacher's pet actually, when we had those ended the year. The problem teacher's every everywhere. But what we'll do don't say it was just seventh grade.


Not when I was little in elementary school when we had parent teacher conferences, I would always get in trouble because the teachers would say, you know, oh, you know, she's nice and she's good in class, but she talks too much or she talks too loudly.


So I always got in trouble because I had some elementary school is used to I still somewhat in Sandahl.


I got in trouble. I got in trouble as a little kid for sure, because I love the stealing cookies.


So Ariela had a friend who attempted suicide and that really motivated her to try to understand more about the mental health care system and why is it so broken. And so that's what led to her. Creating real and so real is basically this really innovative company that's trying to address mental health in a very different way. And so, you know, I'm a psychiatrist. I'm in the health care system, and we know that the health care system is broken in terms of being able to deliver quality health care to everyone who needs it.


And that's what Aryal is trying to do with Real. It's basically the idea is meet people where they are. That's the kind of value and philosophy behind it. And so what she's done is it's almost like Balaton for mental health. Or if you think about, you know, with exercise, right. You're trying to go to the gym. You have every option from having a one on one trainer all the way through doing, you know, group classes.


Or even now you can watch videos online. Right. And do these workouts when you're in your living room. That's basically what real is doing for mental health. So they're offering this huge range of services so that regardless of what type of treatment you need, what type of therapy, with whom you want to do it, and whether you want groups or you want one on one, the whole offering is there for you. Real was and will be in person.


But because of what happened then with Coronavirus and recognizing that we're all at home, they created this whole digital platform to be able to offer treatments and therapies to people online. How cool. Everything from a therapy. Right. Like having those one on one sessions with these amazing therapists, but this whole range, including events and salons and what we call pathways. So the thing about mental health that I think that people find frustrating a little bit with therapy is that when you go into therapy, it almost feels like like you enter this ether and you don't know what therapy is going to look like.


You don't know what you're going to get. You don't know when you're going to get it. You just sort of go in and it's like you have to wait for your therapist to guide you with real. We've actually created what we call these pathways around particular issues you might have. So maybe it's, you know, stress around being single during coronavirus or maybe it's pleasure and sexuality or, you know, how to cope with depression or how to talk to your partner like they're all these different issues that we end up having.


And so real actually offers you these customized pathways that are personalized for the actual issue that you're going through. So everything from, you know, videos, therapists teach you different things to activities, you know, things like gratitude, journaling. Right. Or even like your own personalized meditation. And the reason why we're doing this is what we see with mental health, is that there's a different solution for every single person. Right. We don't all fit into this box.


And just like with exercise, where we all want different things and we all need different things in order to get healthy. That's what Real's offering. It's not just like that's standard one on one, you know. Forty five, 50 minute session with a therapist, which we do have, but we also have all these other things so that what we wanted to be able to do is democratize mental health so that no matter who you are, you know, you would be able to afford treatment and get the actual right treatment for you.


It's so crucial. Yeah, because I think a lot of times when we're talking about mental health on this show, people are in their cars delivering pizza, going like, that's awesome, rich people. That's cool that you can do that. I can't. So that's awesome. Real. How do people go there?


Join hyphen Instagram is at joined real. I think all the all the social media handles are actually real and real. Motto is what I love.


Celebrate therapy. Uh huh. I think that's really, really important because it's not just that we want to make it OK. Right. It's not just that we want to, like, take stigma away and say that, oh, it's OK to get treatment for mental health. It's OK to go to therapy. We're taking it one step beyond that.


No, it's a party. It's a party. I look forward to my Tuesday night AA meeting, like I'm going out dancing truly.


Right. And you feel so good about it, right? Like when you go to the gym, when you go to your AA meeting, you know, you're taking care of yourself. You know, you're doing something great for your health, literally. It's like you get that gold star right. Like you did a good thing for yourself. And that's exactly the experience that we want everyone to be able to have of celebrating therapy and realizing I'm doing something good for myself because we need to change the culture and dialogue around therapy and around mental health.


That needs to not just be something that, oh, there's something wrong with you when someone's going to go see a personal trainer. Right. You think that is someone who values their physical health and they're doing something good for themselves? Yeah, that's the same way that we need to think about therapy and mental health is I value myself. I value my mental wellbeing. And I celebrate that I. Investing in myself and doing something about it. Well, Nina, we love you, we're going to see you again.


We're going to connect you with Dr. Eric Topol. We are now professors at Stanford.


Yes. Professor Dock's professor. My God.


Oh, my God. And we can't wait to talk to you again. So thanks so much for your great bye.


And now my favorite part of the show, the fact check with my soul mate Monica Padman. Welcome to No Power Fact Check in the attic.


I wish she was in the dark, so would be spooky. It's like you don't like being spooked. Are you sure you'd like to.


I don't, but I do. You know, it's a mixed message now. I just was away for two days. I'm back to work on Top Gear. Yeah. And so I had an evening in a hotel room by myself. You did. And I plowed through so much TV and I've come back to report all these good things I discovered. Tell us about your discovery. OK, Westworld is phenomenal.


Now, I know what I've heard is that the quality of the seasons varies a bit. So I guess some people get mad about certain seasons. Right? I've kind of heard that rumblings of that.


But I'm telling you, the first couple episodes I watch were dynamite. And also I watch the Roy Cohn documentary on HBO, which was phenomenal. I know you're in the part that's not very fun yet. You just did the beginning.


Yeah, but, boy, if you go the whole distance in what a personal story. I'm going to go crazy. I got really distracted by watching a video of a girl giving her boyfriend a haircut. And you found that really soothing?


I did. I found it very satisfying to watch. And I really want to give someone a haircut now.


Oh, you do? Yeah. OK, I like you. Well, but here's the thing. I was going to suggest maybe someone who's not on TV. Well, on TV currently, I need the stakes to be.


No, no, no, no, no, no. You need to practice on Jess and work your way through the friendship circle. And so you get to the on air person. Fine, fine.


I mean, you agree it's kind of high risk, right? Yeah, that's what I like about it.


I might have to drug you and then hold your head up with something.


It'd be worth it because I'd be a freebie for me if you just drug me, you know, but I mean drug, you know, and like, oh, dragged no drug with drugs. But I give you so much that you're almost dead and still sounds good. Oh no.


Yeah, sounds good. Yeah. Like a bloviation obligation was to the goal.


Oh wow. Yeah. To obliterate it. But you're so out of it that I have to tie your head up to be upright with like some rope.


My drinking took some turn with about a year left where. It got to a very specific spot and I've talked to other people about this, Bree, we go to bed, we get drunk together and be like a social drunk, and then she'd go to bed and then I would turn it up and I would sit in my La-Z-Boy and I would drink to a point where and I don't know why I wouldn't throw up, but I would be obliterated. Like, I can't I could almost not think.


And that's what I ended up loving. You loved that. I loved it. And I would do it every night.


And it was so bad. It was so fucking bad. Well, what did you like about it? I guess I just kind of think, like, I was incapable of evaluating my life.


Sounds like you needed an antidepressant. I think I probably did. Didn't really. What you needed.


I don't have that at all. I don't have ever a desire like I don't disappear. I don't like numbing. Yeah, I like drinking, but not for a numbing effect.


Right. For an effervescent effect. Yeah. Probably. Yeah. Yeah. Luser. Exactly.


Yeah. Yeah, yeah. I think that's what makes it very addictive is when you want total and I guess I must've been semi desiring death, I mean like I must have been semi suicidal that I was trying to just be gone entirely gone in when the Michael Jackson stuff came out like that, him doing propofol every night. I was like, yeah, I understand that desire, like kill me every night so I don't have to evaluate my life so sad.


I think that's I think a lot of people feel underwater in that way.


Yeah. And I also hadn't really, I think, fully dealt with some past traumas or. Yeah. Yeah. Worked through some stuff. I don't, I don't know. Yeah.


I'm certain if I drank I'm sure I would quickly find my way back there, although someone got this was we figured out this mystery, this is the craziest mystery. So when I went to the track, DeCastro got me some Heineken zero zero some alcohol free beers. Yeah.


And I had one. And then he said, bring this thing home.


I'm never going to drink it when the day was over. So I brought it back to the house. Right. Yeah.


And I opened one of them and I took half a sip. And my first thought was, oh my God, this went bad. Must got hot the sun. And then I was like, No, didn't go bad. That's alcohol. Oh, not really. Yes. And so this fucking so I'm telling Cali about it. I don't understand why there was an alcohol one within the 12 pack. This feels like yes. Or something. Whatever. Yeah.


So Cali like really investigated it. And once she discovered she found the 12 pack, the 12 pack came with three free beers in the three free beers were zero zero I guess. So people will try them who are getting normal beer like here. So that was normal beer.


The 12 pack was 12 normal beers and three zero zeroes.


And on the fucking box it says zero.


So dice, that's not safe at all. So you just happened to have one of the three non-alcoholic ones when you were at the track?


Yes. Well, I assume DeCastro opened up the top and grabbed what I guess was maybe the three bonus beers and put them in the cooler. And I had had one at the track. Oh, wow.


And then I brought the thing home. It was very I mean, it's said zero zero on the the 12 pack. Oh. But there was real beer inside.


I mean, it makes total sense for them to try to get people interested in their zero zero beers like you're about a twelve. Like let me show you how good these days everyone is on the package. Don't put it on the package. Yeah. Because you got to think of it went the other way. Like, I bet they were just locked into like we got to introduce these beer drinkers who love beer and they don't want to get drunk during the day.


Try these. That makes sense. Sure. They also need to like but the really labeled them incredibly different. Yeah. They don't label it zero zero on the package.


Oh boy. That's not well anyhow.


That's why was so so was it hard for you to dump it out.


No it wasn't. No, no. It would be hard for me if I felt a buzz then I'd be very scared. I don't know how how I would dump it out. If I felt a buzz, I would probably need to maintain that buzz. Well, I don't know.


It's all hypothetical. Yeah. I mean, it's all it was was a taste. Yeah. Oh, that's bad.


I turn bad. Oh no, no, that's I remember this. This is alcohol. Oh, boy. Yeah, just thinking about it, it scares me. It does. I know. I know. I wish it didn't. I'm sorry. It does. I know it bothers you.


Well, I just wish it didn't scare you.


It only scares me because I care about you so much. Yeah. It's very flattering also because I know that you work so hard. So if that is at risk, I feel very sad and scared for you.


All right. I, I'd say over the last 16 years, I've had probably five sips of alcohol. Very memorable. Was my favorite one was with my friend and we were at Jackson Hole and we he ordered a ginger ale and I ordered a Diet Coke and then my Diet Coke head, Jack Daniels in it. Oh yeah. Yeah.


It's not their problem. I love Heineken and I love zero zero and people should try them.


They're very delicious. I'm very pro Heineken zero zero. Maybe they were worried if they didn't put zero zero on the box and someone popped up one of those three bonus beers open and it didn't have alcohol in it, they'd be furious.


All of it's kind of bad. Yeah, like I said. Yeah, yeah, yeah. And no one's going to be happy, right. Consumed all these calories for no reason.


I like my feeling it was going on.


I'd be pissed. I've had three beers and I feel nothing on an empty stomach.


OK, so Nina, this is all so apropos.


That's right. Because Nina is all about mental health. And after we talk to her, I texted her and said, I think I need to be on some medication. Can you help me find a psychiatrist in my area or what do you think? Or whatever? And so we chatted a good bit. And then I had an appointment with my psychiatrist two days ago, and he prescribed me with an antidepressant and I'm picking it up today.


Are you nervous, too? Yes, it's really funny. I mean, I understand it like everyone's nervous about anything. But the one thing I don't understand about people being nervous to try it is like you don't like it. You just stop.


I know. Yeah, for sure. Does it feel like a weakness? You feel like, oh, I should be able to overcome this with exercise and no, weirdly, no.


I'm more just nervous. It's going to change something about me that I like. Right. Right, right. But it most likely will just change something I don't like.


I think so I'm not going to rob you of anything other than your misery. Exactly.


But what if misery it causes that? I don't know. I don't think it does. I don't think it does either. But it took a long time to get to that point.


Why occasionally. So did you end up talking to that psychiatrist yet? It was annoying, right? Oh, no, it wasn't annoying.


OK, good. I'm not annoyed like you're annoyed when I get nervous about the alcohol.


So I'm going to start it, I guess, tomorrow. And my hunch is you will not feel anything. Yeah, that's what my psychiatrist said.


Yeah. You won't feel anything.


You just won't get in the gutter. That's what he said. The goal is to it's like almost treat it like a vitamin. In retrospect, you'll be able to look back and be like, oh, I had less or irritability or less those tantrums.


When there's not another episode of my last name, I'm always going to have to oh, I don't know if I want those to stay. OK, you love your tantrum medication.


That's going to let me keep my hand there, really pivotal in my life. But I do have to credit Nina because I had been on the fence about this for a really long time and thinking like I probably should. I think I might need to. Yeah. And after that episode I was like, I'm going to.


Yeah, shocker. I'm arrogant. And I thought I knew most stuff about psychiatry. Yeah. And the third whole window of it biopsychosocial, yeah, yeah, I had I didn't even know, so I found the whole thing really, really informative and I just adored her.


She was fine. Yeah, she's spunky.


OK, so her facts. Yeah, she's from West Virginia. And she said it's the whitest state in the country. Maine is the whitest state in the country. Ninety five point five percent. Oh, my God. Then New Hampshire. Then West Virginia. Okay, top three. Yeah, top three. And maybe it when she was living there, it was number one. And it's, you know. What do we think is the blackest state in the country?


Probably Michigan, Illinois, Michigan, Texas might be up there.


Houston's very good.


I wonder if Georgia because of Atlanta, but there's so many. Only Atlanta.


You. Yeah, let's look it up. OK, Virgin Islands, we're not counting them, OK? I don't count them contiguous. OK, number two is District of Columbia. Oh sure. Yeah. Cause of course. Fifty percent. This is 2010 though I bet some of this has changed. This is the 2010 census. We'll get new census.


So, so there's a big clue in there. That's number two or number one.


DC was number two. The Virgin Islands was number oh. So there's a good clue in there. So also, DC has to have the highest urban versus rural population. There's no rural population in DC, is there not?


No, virtually not really tiny. And there's a little bit of suburbs where the embassies are. But in general, the whole place is a city. That's why I think Illinois will be high up there.


What's after DC? Mississippi, sure. Thirty seven point three four is Louisiana and five is Georgia. Oh, so the bayou is really.


Yeah, the south. I mean that makes sense. Maryland, South Carolina. What did you say you thought was. Yeah, I thought Illinois would been high up in Illinois. Number sixteen. That's not very high.


I mean it's in the upper one third but give me the top ten.


OK, so DC forget that Virgin Islands, DC, Mississippi, Louisiana. Georgia, Alabama.


Nope. Maryland. Oh yeah. South Carolina. Oh, Alabama. OK, North Carolina. Delaware. And then we'll add in since we're taking out no one will add one Virginia.


OK, Michigan didn't even make it in Michigan's number eighteen. I'm surprised. I really thought that would be much higher. Yeah. I guess Detroit's only just a small.


It's a small. That's 2010. Yeah. This might if you had done like ninety three when I lived there, then there was still close to a million people in the city. Yeah. No I think now there's, I don't know, I got this all wrong one time and I can try it again.


I thought Grand Rapids had as many people as Detroit now is wrong. Someone told me it past Detroit for population in passing like maybe at a grocery store. And I said, yeah, all right.


I believe that like twenty census should be. We'll get those results soon ish next year, I hope. Yeah, I did it.


Everyone should do the census. You should. Yeah. Because for my facts mainly. Yeah. If you want the facts to be clean and accurate and right. So yeah.


Why the states are Maine, New Hampshire, West Virginia, Iowa, Idaho, Wyoming, Minnesota, North Dakota.




Have you seen that picture of Ruby Bridges going around? She was the first black girl to go to a white school. Oh, and she's six years old. And like the I don't know, FBI, some people had to, like, escort her in. And there is all these, like, protests every day of this little cute little six year old walking into this school is so horrifying. And a lot of the kids, the white kids in her class, parents pulled them out of school.


Oh, jeez. And so she had her and and her teacher. So her teacher was just like teaching her.


And there's this picture of the smartest person ever to live. Yes. One on one instruction. And there's this picture of her with her teacher now. And Ruby Bridges is so young. She's I mean, she's in her 60s.


She's younger than your mom, I think. Really? Yes.


And you see this like this person. This is five minutes. Five minutes ago. Yeah.


It's, um. Anyway, OK, so she said ninety percent of the time taking action leads to motivation. I think I was was to fact check the number. Ninety percent I, I looked and I couldn't really find that but. But it's true. Yeah.


So she said we have hundreds and thousands of feelings a day and hundreds of thousands of thoughts. Today it was found that the average person has about twelve thousand to sixty thousand thoughts per day. Of those thousands of thoughts, eighty percent were negative and ninety five percent were exactly the same repetitive. As the day before. Oh, Jesus. Oh, man. And then there's another, like, similar study that says seventy thousand as the main number. But yeah, a lot of people say 12 to 50.


But in that in that range, does this sound like a pat on the back to say that? I think I'm in the hundred thousand range. So, no, I mean, is that sound like I'm bragging? No, I don't think it's Bragge. Well. Oh I see what you mean.


Like, I'm never not having a thought, like I often look at and I'll go, like, what are you thinking about?


And you go, oh, I don't know. Oh, I've only she must be thinking about something though.


I mean no one is just not thinking just white. Yeah I don't think so. I'm always thinking about something too. But sometimes that thought is long. Yeah. I can really think about one thing for a long time.


Yeah me too. But also something happens on TV, right. Like a one frame and then I'm off to the races. Right. And then I miss a scene and I say what.


And I'll say I got to go back and Chris will be like, why are you going? And I'll go while I say everything about this.


Then this, then this. I mean in the end it's generally like I thought of 30 things in that a minute and a half, like I went on this little ride and it took me to, you know, I guess that's everyone knows that I.


I don't know if everyone does. I think I do. Part of it is probably again, I don't want to say depression, but kind of like it's a spiral, like our brains are maybe more apt to spiral out, because even when I was talking to my psychiatrist, one of the questions he asked me was, if you're reading a book, can you concentrate on it? And I was like, no, I definitely can.


Now that I think about did you go?


Well, I've bought one hundred twenty books in the last year and I've read none of them.


So yeah, I guess that is why I know that's a good indicator.


Yeah. If you can't focus on the thing. Yeah. And I definitely can't, I'll use that as a benchmark once I start my medication. I am reading a pretty good book right now. OK, and then it seems as if there are twenty seven human emotions. Oh I had a list but they're on my computer and there's no power.


There's no power. OK, so sorry. They're actually twenty seven human emotions. New study finds in previous thought it was understood that there were six distinct human emotions happiness, sadness, fear, anger, surprise and disgust. But scientists have now found that the number is as many as twenty seven, though it is not telling me the frequency of which you come in and out of an emotion.


I couldn't find that.


I don't feel like I have. What did she say? How many hundreds and thousands of like. So the same as thoughts. Yeah, yeah. I don't feel like I have thousands of emotions a day.


Maybe mine. I'm dead.


No, I think it's supposed to be less. I think that would be really not good if you had thousands of thousand jackhammer of emotion all day.


Exactly. Well, and I guess some people do and that's when to seek some help. Yeah.


So that's all for Nina. That's all for Nina. Yeah. Well, I really, really like her and for the people that weren't watching her on Zoome, if you're single and you live in the Bay Area, you should be dedicating your life to finding her and wooing her.


I mean, don't stalker.


I'm not advocating stalking her, but she's a real catch. Yeah. So if you're in the Bay Area, you could probably find her. Sure. Yeah. Hot and smart. Those are good things to say they assets. Yeah. OK, that's all right. Love you.