The State of Mental Illness in 2025

Hey, hey, hey. Heat. Heat. Oh my. Hello. Hey. Hey.

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Give it up. Give it away. You were barely alive. You made that day. Cut out so much remain. You knew that there was still a way. Cry again and try anyway. Well, you got back and you had to pay. Stand up but still this day. You knew that there was still a way.

This is your only plan. Oh, now this is your only now. This is your only plan. Oh, now this is yours. That's fine. It's all you've ever known. A single state of mind, but you won't ever let it go. When you had the answer, when you were there alone, you left the door unopened. When you knew that you would want more.

Give it up. Give it up. Give it away. While you were barely aware you left that day. Cut out so much remain. While you knew that there was still a way.

This is your only plan. Oh, now this is your only plan. Now this is yours. You're right. You force it to yield. You'll forge it to the lions. You let your be your shield and everyone will say that it all was finished years ago. But you will stay and you won't ever let it go.

When you had the answer and you were there alone, you left the door unoped. When you knew that you were one more then again you found the answer and you were there alone. You lock the door uns when you knew that you was one more.

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When you had the answer, then you were there alone. You left the door unopened. When you knew that you were one more then again you were there alone. The door open.

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A lot of people out there will struggle to pull themselves out of it. Move in the right direction. Take one step forward and let go of what's going to happen.

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For us to a tangled nest of not sac. But the intent was there. I swear we set our eyes on something that we thought was true. So now we sit and stare across a surface the whole state and miles apart. Nowhere to speak. We haven't got a clue. falls apart. There's not a heart to be there. It falls apart. There's not a heart to have.

It falls apart if there's not a heart to be there. It falls apart if there's not a heart to have. Each word on world of its own. Each star rendered only in groans. The syntax skipped and what we're left a growing cleft of language lost kids unknown. And then I guess we slipped right through and lost our meaning on the way. We ended up a tiny piece of every heart of every part of every storm of every grave.

It falls apart. It's not a heart to be there. It falls apart. There's not a heart to have.

It falls apart. There's not a heart to be there. falls apart if there's not a heart to a tangled mess of knots. I confess but the intent was there. I swear we set our sights on something that we thought was true. It falls apart to beat its heart.

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It falls apart if there's not a heart to be there. It falls apart if there's not a heart to have. If there's not a heart to have it up,

it falls apart. There's not a heart to be there. It falls apart. There's not a heart. It falls apart. There's not a heart to be there. falls apart.

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One 2 3 4

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Hey, hey, hey.

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Hey,

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hey, hey.

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Hey, hey, hey.

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Hey, hey, hey.

Hey,

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hey, hey.

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Hello. Hey. Hey.

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Give it up. Give it away. You were barely alive. You made that day. Cut out so much remain. You knew that there was still a way. Cry and try anyway. Well, you got back. But then you had to pay. Stand up. Still this day. You knew that there was still a way.

This is your only

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Allighty chat, let's get started. Welcome to another Healthy Gamer GG stream. My name is Dr. Alo Kenoja. Just a reminder that although I am a psychiatrist, nothing we discuss on stream today is intended to be taken as medical advice. Everything is for educational or entertainment purposes only. If y'all have a medical concern or question, please go see a licensed professional. Welcome chat. Happy Friday, everybody. Hope y'all are doing well. Um, we have a couple of cool things that we're going to be doing today. Hold on a second. Give me a second. Chat. Sorry, I'm running a bit behind. We had some technical difficulties. As you guys know, we are trying to level up our grinding our technical difficulty skill. So, we're inducing lots of them. Let's go, chat. Um, give me a second. Let me pull up chat lords and chat ladies. Let me find Oh, this is integrated chat. Okay, I can see it right here. Wait, hold on. Uh, okay. Let me just see. No, I have not played Mega Bonk. Um, super confused about that game though. I've been playing a bunch of Hades, dude. Hades is like what I'm playing nowadays. Um, let me do I need this. And then let me do this. Uhoh. Twitchcon San Diego. Here we go, chat. Um, give me give me a second, dude. I'm trying to I'm trying to clear chat. No, I don't want to clear chat. Chat highlights. No, shield mode. Slow mode. Subscribers only. Dude, where is pop out? There we go. Okay, got it, chat. Got it. Okay, I'm here now. I'm I'm ready. I'm ready to chat with y'all. Um, okay. Yeah. All right. No, dude. So, that we're we're we got this, fam. All right. I am having a great day. So, um yeah, I'm going to scoot over a little bit because the chat box is I feel crowded by the chat box. So, we're um Yeah. So, we Okay, I got to move more. Okay. Um, yeah. So, I've not played Mega Bonk, dude. I've been playing Hades 2, and that game is amazing. Like, so I I loved Hades. I thought it was an amazing game. I I'm impressed by their ability to innovate so much on a formula. like I was blown away by like so I maybe like 10 hours into it but um yeah it's so good like I I don't want to get too much into it but like just just the way that so I think the problem with Hades one was and not the problem is fun but thing is like basically there are these like busted combos right so it's all about like at least the way that I was playing the game you're just like fishing for the busted combos and once you have a busted combo it's like game over like you just just destroy destroy demolish everything. You're kind of doing high heat runs. Um, and then now it's like they they added like more breadth of options and so there aren't like just straight up or maybe I haven't found them yet, but there don't seem to be just straight up broken combos. So, it seems like you have to like synergize things a lot more like in terms of your move set. It's not like like I remember in the in the first game basically I would like pick one button and I would spam that button, dump everything to that button and you just like one-shot everything. So I had this one build that had like this Poseidon knockback thing where every time you dash you release a bunch of knockback things, but bosses take bonus damage from knockback and they don't get knocked back. So I dashed through Hades like two times and he died in like literally like two seconds. Um, and so this game seems, I think, better in that way where it doesn't seem like you can just get one combo that just obliterates everything. It's really cool. And, um, yeah. So, looking forward to that some Yeah, it's it's crazy. Yeah. So, um, happy happy. Oh, yeah. There also doesn't seem to be like life steal. Like, there were a few lif steal options in the first one, which I've only seen one life steal thing. Um, and look into Bizaarre. Okay, I'll look into Bizaarre. Um, yeah, Alec is studying to be an NP. We're glad it helps, Alec. So, happy World Mental Health Day. Yes. So, happy World Mental Health Day, everybody. Today is World Mental Health Day. We've got a fun stream for y'all today. We're going to be talking about a handful of topics which I think I mean it's not comprehensive by any means but I think we're going to cover a couple of like core reasons why people are struggling. So I think these are somewhat like not new manifestations of of mental health problems but they're um yeah they're they're not new manifestations but I think they're they're they're some of the reasons why mental health is kind of getting worse. And it's kind of weird, right? Because we live in a society where we have the greatest knowledge about mental health that we've ever had, right? We have access to, you know, ancient wisdom. We have access to neuroscience and psychiatry and pharmarmacology. We have uh, you know, over a century of advancements in in psychotherapy and psychoanalysis. And yet people are still struggling. So we're going to talk about a couple of the reasons why that is today. Um, before we do that though, we're going to get through a couple of announcements. One is our we did a collab with Audible, which is 30 days to thrive with ADHD. Nine ratings, chat. Let's go. 4.9 stars. So, this is kind of a 30-day like um when I when I work with my patients, we do two things. One of the things that we do is psychotherapy. We also do psychopharmarmacology. But then a big part of what what I do when I work with people with ADHD is we try to understand our brain and our mind in a certain way where you can like basically adapt to having some kind of ADHD style deficit and succeeding in life. So this is where I think this is important because nowadays everyone feels like they have ADHD. I don't know that everyone has ADHD, but I do think we are starting to see some of the symptoms of that that ADHD induces in people without ADHD because of the influence of technology on our mind. So, we're all becoming a little bit more ADHD. And one of the things that I I try to do is the way that I kind of understand it is if you've got an ADHD brain and you live in a neurotypical world, sometimes that doesn't line up. And so what we try to do in in this 30 days to thrive with ADHD is basically like come up with an adapter, right? So how can you the default solutions that people will give you that are neurotypical may not work for you. So there are other are there other things that you can do once you understand your brain. Can you sort of figure out a way to adapt to the world that we live in? And that's where, you know, I think it's so interesting because when I work with people like streamers, like these are people who very very very high in uh prevalence of of ADHD in the streamer population. And there are certain things about the way that our brain works that could even be advantageous. Some some people really don't like that kind of idea. I think it's like fair enough to think about ADHD as a disorder. Some people sort of think about it as a difference, right? So it's not neurotypical, but it's like neuroatypical. um and they don't really adopt the pathology model. I think both are pretty fair. I've worked with some people who just have really, really crippling disorders. And then some people who really think about themselves and conceptualize themselves as I'm just different. Let me figure out how to play the game in a different way. So, y'all should check that out if you want. Um it was actually a lot of fun to make. So, yeah. Now, let's actually So, I I guess we can get started. Um, give me a second. So, speaking of ADHD, let's talk about it. Okay.

>> Uh, okay. Chat, prepare your ears.

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>> Right. So, when you have power and time, but no drive,

>> there's a task, but there's no deadline. So, let's talk a little bit about why this happens. So, if you're someone who has ADHD, there's a really good chance that there is stuff that you need to do and you actually have a lot of time to do it. So, this should not be a source of stress, right? So, if we think about generally speaking, why are things stressful? They're stressful because there is too much to do and too little time to do it in. But if you're someone who has ADHD, this is a really really really common problem where like you'll have a lot of time to do something, but you can't bring yourself to do it. And people will even say like um you know there's there's people will kind of relate to it like this, like having zero drive is actually the worst feeling in the world. I've had days where I had all the free time, no distractions and such, but there's no drive and it absolutely sucked. And when people talk about this, they'll say, "Okay, this is an executive function deficit." When people, when I say people, I mean myself included, right? We'll say, "This is an executive function deficit." And then if we say, "Okay, it's an executive function deficit. You should go see a therapist. You should get executive function training." I think that's great. That's a great idea. Right? So, we offer a lot of these different tools like Dr. K's Guide to ADHD where we sort of work with all that stuff. What I want to do today is I want to show y'all fundamentally why this happens. Okay. So, why is it that if you have a lot of time and you have something that you want to do and you have ADHD that it feels impossible to do? So, in order to understand this, we have to understand a little bit about neuroscience and a little bit about development. So ADHD is a neurodedevelopmental disorder. I think this is something that we do not appreciate enough. It is not a static illness. It is about the way that your brain develops over time. And the big problem is not just that there's some genetic deficits or whatever. The way that our brain chooses to spend its skill points when it levels up creates this situation. And once you understand how you've leveled up your brain, you can actually respect the brain. And this problem, I know it sounds crazy, will go away. Not 100% of the time. I would say that for 40% of my patients with ADHD, this problem gets 80% better once we understand this aspect of it and we start to retrain the brain. So let's understand how it works. So here's little old me and I have tasks to do and I have difficulty focusing so I don't do them. Okay. Then what ends up happening is I have one of two things happens. Emotions usually negative emotions or oh so this is going to be things like last minute panic or even positive emotions like curiosity. And if I get curious about thing number two then I'm going to do it. If I have last minute panic about thing number one, then I'm going to do it. Or I'll have deadlines. So, I have numbers three and four and once the deadline kicks in, I will do them. Does that make sense? So, I've got homework. It's due at the end of the week. I won't really bother with it. I'm going to just wait and then I'm going to do it. Now, here's the problem. The problem is that every time you do this, you are actually changing the wiring in your brain. I know it sounds crazy, okay? But here's what happens. So here is the part of our brain that governs action. And the part of our brain that governs action, let's kind of say it's a frontal lobe, right? that sort of the the frontal lobe or the anterior singulate cortex is like the part of our brain that integrates a lot of different information. So we have parts of our brain like the nucleus encumbent which give us dopamine. So the nucleus encumbent goes over to the frontal loes and says hey we really want this. This is really exciting. Give me some dopamine bra. And then we also have our lyic system which gives us emotions and the emotions go to our our frontal loes and they say hey bro we're feeling this emotion therefore we should act in this way right so a good example of this is I want to play video games instead of doing my homework and then the lyic system says but if we if we don't do our homework Now we're going to have panic. So we're panicking over here. Okay. And then we want games over here. And then these two things go into the frontal lobe and then they fight. They duke it out. And then one ends up winning. So the video games win and win and win and win and win until the panic rises, rises, rises, rises, rises until we overcome our desire to play video games. And now it's outweighed by the panic. And this is also where deadlines come in. So what happens is there's this part of our brain that is like, okay, when do we need to do this? Okay, it needs to be done on Friday, so we don't need it's only Monday today. We don't need to do it today. Now, here's the big problem. When we look at the way that our brain works, our emotions come from here. And basically what does what does front executive function deficit mean? So if we look at deadline, pleasure and emotion. Every time we do something, we strengthen the connections in our brain. So every time that I let a deadline dictate my actions, what happens is the size of the connection between the deadline circuit and the action circuit in my brain actually increase. So now the influence of deadlines on my ability to act has increased every time I let last minute panic induce my action. If I do not act until last minute panic, what does my brain learn? My brain learns, oh okay, so like we are now becoming a panic dependent brain. Now it requires panic. Every time we play video games, we strengthen the connection. Right? This is how addiction forms. We strengthen the connection. So now these pipelines the ability to influence the brain by emotion and deadline is actually increased. And if we look at things like doing things ahead of time, knocking things out, getting stuff off of your plate, all of these like other non-demanding sort of like healthy way of doing things, all of those connections. Oh, we could do it today. No, we're going to do it tomorrow. This actually shrinks the connection in our brain. So, this is doing things ahead of time, right? And there's a really like interesting example of this. Have y'all ever wondered why you have like 40, 50, 60 year old people who throw like temper tantrums like they're kids? Like, it's kind of weird, right? You'd expect these people to grow up and stop behaving like children. The reason they never stopped behaving like children is because these pathways have been so boosted because they've been behaving in this temper tantrum kind of way for like years and years and years and years and years. Now these pathways are very strong. We are actually training ourselves every time we do this. Every time we have a stuff a pile of stuff to do and we rely on these things to get them done, we strengthen those pathways in the brain and then we weaken other pathways in the brain. This is also important to understand. Whatever pathways your brain does not use, it actually weakens. This is why we do things like forget languages or lose skills because if if we get rusty, our brain is like we don't need this anymore. Let's decrease it. So what I see in my patients is that they've gone through life relying on these things in a very early age, right? Because neurotypical people will say, "Oh, you got to do this. You got to do this." They don't sit kids down and teach them how to do things ahead of time. They don't strengthen those pathways. And then what do you end up with? You end up with this, right? You end up with this where you got to do something and you you literally you can't do it. It's like you're sitting there, you know you need to do it. You know it needs to be done. And you literally like there's this voice in your head that is saying, "Oh my god, we need to do it. We need to do it. We need to do it. I don't want a last minute panic. I don't like last minute panic. Panic doesn't feel good. I don't want to do this. I don't want to do this. I don't want to do this." And we cannot control ourselves. And that's because the part of our brain that wants to do it ahead of time, the influence it has on action is so small. Whereas these influences because of our neuronal wiring are huge. And so what people will do is they'll say things like this. They'll say, "Oh my god, this is coming from someone with ADHD. At a certain point, you got to accept responsibility for your life. Don't rely on fleeting bouts of motivation. Make it a habit to be productive." Now, this is true and it's a problem. It is a habit that has created this situation. Y'all get that? This is a habit. What is a habit? Let's understand this. A habit is this. Once a certain neuronal connection becomes really, really, really strong, that becomes a habit. It becomes automatic. It you don't have to expend effort to do it. The problem is that you have been building these habits. So, do you need to build habits? No, you need to build different habits. And by the way, the endockinabonoid system, which is the the system that creates habits, different neurotransmitters, that is completely intact in ADHD. The real problem in ADHD is not that you need to form habits. It's that your habit or uh building circuitry is really powerful and you have been forming habits to act and be motivated based on emotions and deadlines your whole life. So you have really powerful habits that need to be unmade. So now the question becomes, how do we unmake them? Okay, now this is where things get really, really, really, really weird. Okay, so how do we rewire this? That's basically what we're talking about. Okay, so let's understand this. The first thing that we need to do is start acting when we don't feel like it. Now you will say, "But Dr. K, that's this problem. That's this problem that I I know I need to start acting when I don't feel like it." The problem is I can't. Right? So if I have a big deadline pipeline and if I have a big emotion pipeline, how do we start shrinking these things? You start to take action without using them. Right? Remember this is the do things ahead of time. This is the whole problem. How do we do this? So here's the big problem. If you want to retrain your brain, you need to do it with things that are not important. That's the key thing. See, we try to force ourselves to change when there's a lot of importance, when there are big deadlines and when there's a lot of emotion. I need to do it. I need to. No, you need to start training your brain not with the thing that is really important, but with tiny little things. This is little stuff like, you know, I don't know if you guys So, I've had I've had this on my desk. This is some chocolate that my mom gave me. I've had this sitting on my desk for like two weeks and I should put it away. Either I should eat it or I should put it in the pantry. Like, it doesn't belong here, but I don't put this away. This is a small thing that is not important. And it is the small things that are not important when there is not as much emotion involved in the calculation that is what we need to train. So it's doing little things little tiny things. So take some tiny little task that does not have a deadline is not emotionally charged and do it. So I think cleaning is a really good example of this. And then every time you do that this will strengthen. And now your brain, you're training your brain. Are we acting without a deadline? The answer is absolutely yes. So as we act, even if I there's no deadline on this. You all get that? There's no deadline, but I am acting without a deadline. So what what's that going to do? That's going to shrink our deadline connections, shrink our emotional connections, and strengthen our doing thing ahead of time connection. very important. So this is where the biggest mistake that people make is they try to fix their they try to level up their skills during the time that they need the skills. I'm going to try to say they try to level up during the raid. Basically, y'all understand that? Like if you're playing an MMO and you go into the raid, that's the hard boss. You don't go into the raid at level one. You level up outside of the raid boss and then you go tackle the raid boss. So, we need to level up in little ways. Y'all get me? We talk about stuff like this in the guide. That's what the guide is full of. Okay? Little ways to level up. We want to level up outside of the hard things. Then once our connections are better then if we try to tackle a hard thing we will be able to do it. This paralysis that we feel we'll be way better. Okay. Now there's another thing that we need to do. This is really really hard right is we when we feel so this is like having a no emotion no deadline action right? No emotion, no deadline. Act anyway, but do something small. And the more times you do that, the more you will retrain your brain. The other thing that we need to do is not act. So when you feel really emotional, when you feel like there's a huge deadline, don't do anything. Now, if I say that, so you all understand. So now the there's signals coming into my brain. Oh my god, we got to do it. We got to do it. We got to do it. If you act in that state, you are going to reinforce that part of your brain. You're going to reinforce that circuit. You're going to reinforce that connection. Now, you will say, "But Dr. K, are you telling me I should ignore my deadlines? Oh my, oh my god, you're telling me if I have a paper due, I shouldn't do it?" No, that's not what I'm saying. Oh, technically, that's what I said. But hear me out. Listen, if you have a deadline for work or school or whatever, you have a doctor's appointment, you should show up by all means. And if you need to use last minute panic or whatever to get there, that's fine. But here's what I mean. Just hear me out, okay? There, if you've got ADHD, and even if you don't have ADHD, there is like a really high chance, like 90% chance, that there are times where you feel panicked when you don't need to be panicked. There are deadlines that you are going to feel that are not real deadlines. This is like, oh my god, I have to do this right this second. If I don't do this right this second, everything is going to fall apart. Everything. No, I need I I need to like get this birthday present like right now because if I don't get it right now, then it's going to get sold out and then this is going to happen and this is going to happen. We induce this panic. These are these once these deadline and and emotional circuits, this is the crazy thing. The deadline and the emotional circuit are not necessarily tied to reality. Right? Once we feel the panic, the feeling of the panic creates the idea of a deadline. Does that make sense? Phantom panic. Beautiful. This is what I'm talking about. Right? So, don't sherk your responsibilities. But really, you will notice, and this is what we do in therapy. It's like, okay, you're panicking about this thing. This thing needs to get done. Let's stop for a second and think through it. Let's talk through it. Let's really understand what is the big deal. There are these phantom panic scenarios. When you are phantom panicking, do your best not to give into it. Now, if I say don't give into it, that doesn't really work. So, this is why I'm explaining it in this way. When you feel phantom panic, the mechanism that allows you to activate your frontal loes because in this moment we need our frontal loes to be active and restrain that panic. That is exact exactly part of the executive dysfunction that we see in ADHD. How do we activate the frontal lobe? We activate the frontal lobe by going meta, by rising above it and saying, "Oh, this if I'm just stuck in the phantom pan, if I'm inside the phantom panic scenario, I'm g I'm lost." So, what we need to do is step outside of it. The question is, how how do we activate the frontal lobe? The way we activate the frontal lobe is by saying, "Oh, this is an opportunity for me to overcome phantom panic. This is an opportunity for me to level up my brain in some way." Now, the scope of the problem changes. It's not about this panicking scenario. It's about, okay, like we're we're doing this run for this boss, not we're doing this run to level up to prepare us for a raid boss later on. Do you Does that kind of make sense? Do Do you all understand? Because this is what's hard. We don't know how to turn on our frontal loes. But literally, if you look at someone who's in a panic attack, who is stuck in their emotions, we need to have them step outside of it. So there's certain cognitive techniques that you can use. Okay, hold on a second. Is this phantom panic? Even if you ask yourself the question, is this fan phantom panic? And even if you lose to the phantom panic down the road, that's actually totally fine because which part of your brain reflects upon the phantom panic? That is your frontal loes. So even asking the question, am I phantom panicking right now? That question in and of itself, right? So, if you guys have been in therapy, you'll sort of know this. Asking that question is like half the battle. And that's because that question, if you ask that question, that question comes from the frontal lobe. Now, you're activating your frontal lobe. You're you're weakening the connection between action and emotion, you're strengthening the connection between your anterior singulate cortex, your ability to reflect on your thought process, and your actions. So, this is a problem of habitual training. This is neurode development. Your brain is developed in this way and if you start engaging some of these techniques, things will get better hopefully. Okay, questions before we move on. Right. So, someone's saying, "Yeah, this is so true. I only get things done when I panic." Exactly. So if you only get things done when you panic, the lever that motivates action is panic. Right? So if I'm if I'm someone who throws a temper tantrum and I'm 60 years old, why? That's because when I was 10 years old, I threw a temper tantrum and I got what I wanted. When I was 20 years old and I threw a temper tantrum, I got what I wanted. When I was 30 years old and I threw a temper tantrum, I got what I wanted. When I was 40 years old, I I threw a temper tantrum and I got what I wanted. It is reinforcement of the behavior. Okay. Um Okay. Let's look at a couple of these questions. How do you actually make yourself use the techniques instead of going cool and forgetting about it with practice? So, one thing that you can do is have some kind of like external um like anchor, right? So, you can have something like an external anchor. So, something that my patients will do, especially people who have a history of cutting, what they'll do is they'll use something like a rubber band, right? So this is an example of this is a different scenario but if a patient has borderline personality disorder has a tendency to cut when they feel emotionally overwhelmed. What we'll do is instead of have them cut or burn or things like that we'll give them a rubber band. They put the rubber band around their wrist. You pull the rubber band and you let it go and it it snaps and it creates a little bit of pain. It's not harmful but that anchor can snap you out of it. That's in BPD. So the key thing here is that you know as you listen to this take a moment to anticipate when is the next time this is the frontal lobe deficit that we have right so people with ADHD this is a great question how do you actually make yourself use it so we think about which part of your brain reminds you to use it which part of your brain knows when to use it that's actually your frontal loes so what I would do is anticipate the next scenario where you will need this and prepare yourself that way. Do the thinking ahead of time. Okay, at what point today am I going to need to use this and then you can use some kind of physical anchor if you want some kind of reminder if you want to. But that'll help. The next thing is that every time you do it, acknowledge that you did it. Don't just move on. So slow down and say, "Okay, this was really great. I took a step back. I I took a deep breath and this actually helped. So sometimes I'll have patients who will carry around like little notes or something like that. They'll have notes on their phone. I don't like using the phone. I don't recommend it, but that's what most people end up doing where you have like a, you know, stop, breathe, reflect. Is this phantom panic? Just keep a note with you and then acknowledge whether that was helpful or not helpful. Even if it's not helpful, even if you spend the time to acknowledge it, that will strengthen your frontal lobe. Um, that makes a lot of sense. Is there such a thing as burnout from constantly trying to remain aware only until you get good at it? So is there so maintaining awareness is one of the largest willpower drains that we have. Two of the biggest willpower drains that we have are suppressing emotions and maintaining awareness. But if you think about anything in the body, see this is the key thing to to remember. The body doesn't wear out, it rusts. Lack of activity is what leads to problems, not excessive activity. So if I think about going to the gym, am I going to feel burnt out if I exercise a lot? Yes, in the short term. In the long term, things will get better. Right? And that's why the word is important. So when you say burnout, burnout is a different entity. This is not burnout. This is deconditioned state. So conditioning and burnout feel very similar. Let's talk about this for a second. This is a cool aside. So when I do something, sometimes I feel exhausted afterward. I feel burnt out. But sometimes when I do things that make me feel burnt out, these things are good and sometimes they're bad. What's the difference? If I am conditioning myself, it's good. If I am burning out, it's bad. So, let's understand the difference. If I'm deconditioned, if I'm physically unhealthy, and I start walking up the stairs instead of taking the elevator, I will feel tired. I will feel like I'm burnt out, but I'm not burnt out. I'm deconditioned, and I'm actually getting better. Burnout is actually the exact opposite. It is when you are maintaining the pathological state. So burnout is not I'm not strengthening myself. I'm engaging in the behavior over and over and over and over again and I'm actually depleting myself. Does that kind of make sense? So if you are deconditioned and you are conditioning, it'll feel bad today, but you will feel better tomorrow. Burnout is the exact opposite. The more you do it, the worse you feel. With deconditioning and conditioning, the more you do it, the better you feel. But in the short term, in the 24 hours where you are doing it, it feels exactly the not exactly the same, but it feels bad. So the question is, if I do this for a week, where will I end up? And if you end up in a worse place, then it's burnout. If you end up in a better place, then it's conditioning. Okay. How do you handle panic attacks? So the management of panic attacks is a very clinical thing, right? So as a as a psychiatrist, the way that I treat panic attacks is like two or threefold. The first thing that really does help a lot is pharmarmacology. So you can uh do something like high do not high dose but usually you require higher doses of SSRIs, selective serotonin reuptake inhibitors, some SNRIs, things like that that will help with panic attacks. And this is important to understand. So a lot of people will say, Dr. K, if you start me on a medicine, isn't that just like kicking the can down the road? How is that actually helping? It just makes it go away artificially. This is what's important to understand. The treatment of panic panic attacks has a few different steps. The first step to consider is pharmarmacology. Second step is skills training. Okay, so actually let's draw this out. How treat panic attack. We're going to do this one. How treat panic attack number one pharmarmacology. So we can use an S agent like an SSRI, SNRI. We got to be careful with some of this stuff like venlaxine which can in some patients make anxiety a little bit worse. But people will say but Dr. Okay, if I if I take the medicine and I stop taking the medicine, will the panic attack return? The answer is probably. But this is where we get to number two, skills training. This is where things get really fun. So, what are the skills that we want to train with panic attacks? The first skill that we want to train is breaking vicious mental cycles to snap out of it. So, here's what happens in a panic attack. I have a thought. Oh my god, that is a terrible. And once I have a thought, it activates my sympathetic nervous system. cortisol, adrenaline, nor adrenaline. Okay, now here's the big problem. So thought travels to this these the I have a series of cell clusters along my spine called the sympathetic chain ganglia. So they go all along the spine. My thoughts connect to nerves. nerves travel down my sympathetic chain ganglia activate my sympathetic chain ganglia. My heart rate increases, my blood pressure increases. The sympathetic chain gang ganglia go to these little areas right above my kidneys called my adrenal cortisees where they secrete cortisol and all this kind of stuff. Here's the big problem. All of these are hormones. And hormones are chemical messengers that don't act locally. They travel through the bloodstream and they activate every part of our body including our brain. And adrenaline does something really scary in the brain. It makes possibilities feel real. It makes potential dangers feel like real dangers. So this it also increases the speed of our thoughts. It increases the activation of our emotional centers. So this increases the number of thoughts we have. The more thoughts we have, the more it activates our chain ganglia. The more thoughts we have, more chain ganglia activation. There we have a panic attack. So how do we break this cycle? We break it in the thinking and we break it in the physiology. So if we activate the parasympathetic nervous system through something like a meditation technique, right? Where y'all will see this this kind of thing um like you know that people used to do in movies where they're breathing into a paper bag. Why are they breathing into a paper bag? Really fascinating. So when your sympathetic nervous system is activated, your respiratory rate increases. I start to hyperventilate. When I hyperventilate, two things happen. My O2 increases, but this is more important. My CO2 decreases. This happens way more than O2 increasing. Our O2 really ventilation is more about blowing off CO2. So now my CO2 level is really, really, really low. This can make me feel lightaded. So when I breathe into a paper bag, I start breathing less oxygen and more CO2. The concentration of air inside the bag is CO2. CO2 CO2 CO2 and then just one O2. The more I breathe into it, y'all get that. It's just like I'm exhaling CO2, I'm inhaling O2. Now, this is the really cool thing. As the O2 concentration in the the bag in decreases, as this goes down, I I require deeper breaths. Now, I need to breathe more deeply. I don't want to just breathe at the surface. I don't want to just let this stuff come in and out. What I need to do is take a deep breath. I need to inhale everything in the bag to get this O2 that's at the bottom. Does that kind of make sense? Because if I breathe it in and out, right, that's going to be right at the surface at the top of the paper bag is where there it's going to be full of CO2. So, I need to breathe deeply. Once I breathe deeply, my respiratory rate is now going down. If my respiratory rate goes down, my thinking goes down. The speed of your mind is related to the length of your exhalation. This is what we learned in meditation. Length of exhalation is very very very important. Slow exhalation will slow down your mind. So we activate the parasympathetic nervous system through things like breathing techniques. And then if we break the cycle over here, then we can break the cycle on both ends. But there is more. Okay, before we get to more, let's talk about this. Now, here's why pharmarmacology helps with skills training. If you look at studies basically on any illness, what we find is that if you combine psychotherapy with medicine, the effect is way is symbiotic. So, they help each other out. The question is why? So if I have a level 100 panic attack and I have a level 50 skill, this is insufficient. So what happens is if I try to use my skills, it's not enough, right? And then the panic attack blows over my ability to regulate it. So I get gged out. The cool thing about the medicine is the medicine brings it down to level 50. And now my skills are enough. So now now that the size of the panic has been artificially reduced by the pharmarmacology, my skills are able to handle it. And then something cool happens. I level up my skill. Each time I use it, I get better. And if I'm successful, then my brain automatically starts doing it more and more and more and more and more. Right? So each time I use it, I'm leveling up my skills because this is on board. And then what can we do? Then we can take off. Sorry. Then what we can do is remove the medicine. And now even if I have a level 100 panic attack, my skills have leveled up enough. So what we tend to find, this is a a really great example of this is ADHD medication. What we tend to find is that when you stop taking a medicine, the benefits of the medicine last so ADHD medication has a halflife of about let's say 24 hours. I mean it really doesn't have if you take short acting like methylenad or something the halfife is like 6 hours but in about 5 days all of your ADHD medicine is out of your system and you'll start going through withdrawal. So, the effect of the stimulant medication is gone. But if you look at clinical trials, the benefits of ADHD medication last for up to 6 months after you stop taking it. How does that work? Because the medicine is out of your system. And it's because when you use medicine, it allows you to level up your skills. If we kind of go back to this, you all remember when we were talking about ADHD. So what what ADHD medicine does is it artificially strengthens this and as we artificially strengthen this we can regulate this stuff a little bit better and if we regulate it then the the pipelines start to reduce right the strength of those connections actually starts to weaken. So we med medicine works great in synergistically with skills building. Then we get to the really fun part. This is the stuff that there is what's the right word to use here? I think there is promising evidence for so your capacity your your experience of a panic attack is not just acute right so we talked about this cycle once you start panicking but if we look at SSRIs what do SSRIs do they increase serotonin they increase serotonin transmission in your brain but But in my experience as a clinician, there are all kinds of things that you can do to alter the baseline state of your nervous system. So people with anxiety and panic attacks, I assume this one is actually a little bit of a question mark. I'm not 100% sure. I haven't looked

At data on this, but I I would bet money. This is definitely true for people who have anxiety. They have a baseline nervous system that is wired. Let's say here's the parasympathetic side. Here's the sympathetic side. Most human beings are about here. They live over here. They live in a high alertness state. So small things can tip them over the edge, right? Whereas for a normal person or someone who isn't wired like this, they need a large stressor to tip them over the edge.

So we see this because HRV, if you all remember what HRV is, um heart rate variability is low in people with anxiety disorders. So their heart rate is normally around like 90 whereas most people will run around let's say 70. And people who have very active um parasympathetic nervous systems and have a high amount of heart rate variability, their heart rate will be 40. They'll be bradaartic at baseline. Normally this is dangerous, but these people are like people like athletes. So their their capacity to handle stress is way higher.

So you can alter the baseline state of your parasympathetic and sympathetic nervous system. One of the things that we talk about is diet. Okay. So, highly serotonin diets. So, to support the the gut bacteria that produce serotonin. Okay. So, this is I kid you not. There is a bacteria called ruminobacteria. Rumininoacteria as in this is the bacteria that makes people ruminate. The the level of ruminobacteria in people with anxiety is high. In people without anxiety, ruminacteria is low.

You can also do things like alter your baseline sympathetic uh parasympathetic balance. This can be done through exercise but is better done through mindbody practices things like yoga, taichi and then meditation does this as well. So this goes to this question that somebody else asked. Let me see if I can find it.

Do you have patients who have physiologic anxiety like no thoughts bring on panic? Absolutely. So there's a whole section in Dr. K's Guide to anxiety where we talk about physiologic anxiety. This is I think one of the biggest mistakes that we make. If you all want to know why mental illness is getting worse, it's because 80% of our mental health professionals have very little to no formal training in physiology. It's not their fault. We'd made a big mistake many years ago where we separated out the mind from the body. And so as psychiatrists, one of the things, one of the reasons I love being a psychiatrist is because you get training in the body. And I believed a long time ago, right? This is because I studied like alternative medicine and stuff. I thought that there's like it's it's crazy. There's no way that the mind is not connected to the body because I saw I I went to India and you know learned all this stuff and I was like wow this is changing people's physiology.

There were patients who would come for treatment at some of these ashrams, right? And they would come in with things like panic disorders, generalized anxiety disorder. And from day one to day 30, I would see a profound difference in their like anxiety and panic. And I didn't understand those things clinically. It's just I saw this person, they were like fidgety, they're moving around, they're uncomfortable, they start hyperventilating, they have to step out of the yoga class on day two, they skip the yoga class in the evening and then by day 30 they're like chilling, they're happy, they're whatever. I saw profound changes, right? Using things like diet, using things like mind body practices, meditation, there wasn't so much exercise there. They would mostly do this stuff.

So when I think about treating a P Oh, there's one more other thing. one dimension that I forgot. This is where we get fun. So, when I think about evidence-based treatment for panic disorder, this is high level of evidence. And then we go all the way down, and some people are going to have issue with this, which is totally fine, to low evidence. This is not technically low evidence. This is probably higher than number three, but I personally find that your mileage may vary with number four. And this is the deep psychoanalytic work. So if you look at theories of psychotherapy, they say there's something going on in your unconscious. There's some kind of complex or or psychological thing or defense mechanism activation or like some kind of archetypal like disongruence or unconstellated archetype or something like that depends on what your you know are you from the object relations school or from the are you from the Yungian school are you from the Kleinian school like you know depending on what is there some deep complex that if you if you address that complex you will be cured.

Now I have seen this happen. So I do some scar work which is kind of in the same ballpark arguably like it's in the same ballpark is in the sense that it's not diet right. So diet is like one ballpark and there's doing deep stuff in the mind. The problem is that from my experience as a clinician, this is like a your mileage may vary kind of thing. How long does this take to do? I don't know. Does it work for everybody? Seems like it doesn't. Does it work for some people? Yes. So, it's not that there isn't evidence for it. It's that the duration of treatment is like I don't know. The probability of treatment is I don't know. cuz I've had patients who will have been in psychoanalysis for like 5 years and then they'll like come in and then we'll start doing like this kind of stuff and they get way better. So then it's like I don't know how to understand that. I don't know like does this mean you had a bad psycho analyst? Does this mean that psychoanalysis was not effective for your particular origin of panic disorder? Like I don't know. And this is the problem with the psychoanalytic research is there's so much variability within patients and providers that it's like hard to say. But there's good evidence that this stuff like works, right? So it's not that it doesn't work. It's just I don't know how long it takes and I don't know what the probability is. But this stuff is great, man. I I love doing this work. This stuff is fun. Like it's like the most gratifying moments as a psychiatrist is with bucket number four because you have you know you talk to someone they have some breakthrough. Like I had a patient once who had anxiety and panic problems and then like we had this weird like past life kind of thing that we processed where she had this memory. I've told this story before. The reason I tell it over and over again is because she's given me permission to share it. But she like the origin of her anxiety is like she has these really really vivid memories of being underneath the floor with booted feet on top and she knows if she makes a sound they're going to find her and then it's all over. That's her experience of this anxiety and panic. Did this ever happen to her? No. Is this a past life? Who the hell knows? I think not just as likely. I don't know probability or odds here, but I think there is a very reasonable psychological explanation that has nothing to do with past lives, which is like she saw a movie about the Holocaust when she was four and it was really scary and it sort of formed a psychological injury. I think that is like a very very plausible, reasonable, even more reasonable explanation than past life kind of crap. The key thing though is that sometimes in therapy you get through these break breakthroughs where you find the origin of your panic and you release that emotional knot of energy and then you feel way better. Okay, this is how you treat panic. If you all want more info on this kind of stuff, check out the anxiety guide. Great question. We haven't talked enough about panic disorder on this channel. Okay, I'm going to look at these questions and let's move on.

Is it possible to cure ADHD with meditation? I don't know. I have seen some people get profoundly better with meditation. What I would say is that meditation strengthens several parts of the brain that are different or weaker with ADHD. Now, is the amount that you can level up sufficient to cure you? I think that depends on the person. So, if you have mild to moderate ADHD, maybe. That also depends on the dose size of meditation. So if I have mild or moderate ADHD and I do a little bit versus a lot of meditation, that's going to be like different, right? So it's possible that if I have mild ADHD and I meditate for 6 years that I will be cured, that I won't have any lingering symptoms because I've strengthened my brain. If I have moderate ADHD and I do mild meditation, is it possible to be cured? Maybe, but I wouldn't think so. If it's moderate moderate, honestly, I'm going to say probably not. I believe that the answer is potentially. But if you look at it from a clinical data perspective, the number of people who cure their ADHD with with meditation that we have data on is very small. The reason for that is because many of our studies on meditation don't use very experienced meditators. Right? I've never seen a trial where, okay, we're going to take a hundred people with ADHD and then we're going to put them through a decade of advanced meditation practices. We've never done that study.

So, one can argue that in my case, I had something like ADHD. I mean, I'm pretty sure I would be diagnosed if I had ever been evaluated um because I I met clinical criteria and then do I have it now? It doesn't impair my function, but I'm kind of all over the place. So, did meditation cure my ADHD? Did I just simply grow out of it, which is what 20% of people do? Right? That's what's really hard because if I do meditation for 10 years and my frontal loes are developing from the age of 21 to 31 anyway, how do I know if it's the meditation or my brain growing up, right? We can't we can't say. So, this is where I think a lot of people, you know, who are super into meditation will make claims like this. that yoga and meditation can cure all sorts of stuff. And I think the reason they believe this like kind of makes sense because they have seen people who sometimes they teach who come in really problematic and then at the end of it they're not so problematic and so that that's fine but then like what are the confounding variables? Is it just that because I I really don't know. I mean like I I think there's a possibility that meditation cured my ADHD but there's a possibility I never had ADHD in the first place. maybe I wouldn't have met clinical criteria. That's just a retrospective bias on my part. And there's also the big confounding variable. Maybe I was one of the lucky people who grows out of their ADHD, right? So, it's hard to say. So, I think it's a great question, but there's a nuanced answer.

How does one learn to meditate specifically for ADHD and anxiety? We have a ton of stuff on the channel specifically for that. And if y'all want uh whole scale regimens for that, we have guides that go over lots of meditation for that. We also have this meditation tracks feature. I think it's focus and attention is one of the tracks. So y'all can check that out. I must have all the answers. I can answer many questions, but that doesn't mean that I have a good answer. Okay, let's move on. All right. Done with this. Done with this. Done with this. Okay. Um, I'm going to We have mods in chat. I want to mods. Yeah. Can we do a poll? I want to give people I'm gonna run to the um I'm going to grab something to drink and I'd like to know from y'all while we're while we're doing this chair stream. Uh I'm going to show y'all a couple of posts and I want to know what we want to do next.

Men can stay up till 2:00 a.m., wake up at 6:00, be in debt, broke alone, and still have faith that one day everything will work out. It's called being a man. So, one thing we can talk about is being a man. Um, I did it at 20. Uh, this is going to take 3 years. The time will pass anyway. I did it at 25. It's literally never too late to do what makes you happy. Is 26 too late to start your life over? So, starting life over. And next, my therapist just told me you're in no position to be anyone's girlfriend. Finally. Finally, y'all are talking to real therapists. So, we'll talk about real therapists. Um, restarting life and being a man. And can can y'all go ahead and vote and then let me know what we're doing when I get back? I'm going to I'm going to be right back. V. All of them are interesting. It's not about which one. It's about the next one. Hopefully, we get to all three. I'm I'm ready to talk about all three BRB chat. Okay, dude. This is great, dude. I miss streaming. Let me tell you what. Okay. Um, what what's the verdict? Oh, how to stress less about studies. Mods we have. Well, we're going to do all three hopefully unless we like run out of time. It's depends on questions. What do you think about the study that ADHD can be diagnosed with 95 to 96.9% accuracy by completing a retinal fundus photograph? I I haven't seen the study. I'd have to look at the study. Starting life wins. Okay. Okay. We're going to do retinal fondoscopy later, chat. All right. Just make sure I have my literature pulled up. Okay. cost and benefit. Okay.

The concept of starting your life over at 28. I did it at 25. It's literally never too late to do what makes you happy. This is going to take 3 years. The time will pass anyway. So, a lot of people end up usually sometime early in their 20s, but sometimes later, thinking that we got to restart life, right? And then like when I talk to people like this, they're kind of living these lives where they're not like super thrilled, but the thought of restarting life. And you can tell even in the in the word, right? Restart. It implies that you're starting over from zero. So I want to tunnel down into something weird. We're going to talk about that word restart. Why? When you're thinking about making a change in your life, one human being may say, "Hey, I want to make a change. I want to make an improvement." But another human being will pick the word restart. Why do they pick that word? So your brain chooses words that are appropriate to your brain's conception of the situation. So if I talk to people who are worried about restarting their life, what are the features of restarting, starting over from zero, that there's a lot of effort, right? I'm looking at three years out. I'm only 25 years old. I've been an adult for like seven years, and you're telling me that I have to spend 50% I have to invest 50% of the energy that I've spent being an adult to start over from square one. So, the key thing about restarting your life is that your brain perceives a lot of effort. Does that make sense? It's a lot of work. And not only is a lot of work, at the end of the work, I'm going to start over from zero. And then people will say like, "Look, you're going to be three years older anyway. You might as well like ch make your change now because like, you know, like you don't want to 3 years later like you don't want to be like unhappy, right? If you're unhappy now, you'll be you'll be unhappy when you're 3 years from now, so you might as well make the change. You know, rip it off like a band-aid. But I think that's easy to tell someone, but we have to remember that there's a lot of data that shows that human beings like adapt to their circumstances, right? So, my favorite study about this is you can ask a human being, if you if there was an accident and you lost all four of your limbs, would you rather survive with no limbs or just die? And most human beings would say, I would rather die than survive without any limbs. Something interesting happens once that accident happens. if that hap accident happens to people and then you give them a couple of years and then you take people who are quadripolgic or missing limbs or whatever like disabled in some way and then you ask them are you glad to be alive today the majority of them say yes this is great I'm so glad I didn't die this is awesome life is wonderful I've learned so much like it's crazy so human beings adapt and so this idea the first thing that I want to talk about is this idea of like okay my life is shitty now why do we just keep going that's because like we adapt, right? So, there's a chance, fingers crossed, that things will get better. Maybe the economy will change. Maybe I'll switch jobs. Maybe I can like continue in this general track and things will get better. And if you really talk to these people, the biggest thing they're they're concerned about is even if I make this shift, there's no guarantee that I will be happy, right? So, you're telling me I got to invest years of my life to make this big change, start over from from zero. But what if I'm unhappy there? What if I'm carrying my unhappiness with me? Why would I restart when there's like no guarantee that things will work out? I think that's what I want.

So, this is what's really interesting. If we look at people who are hesitating to restart their life, there are some changes within their brain. Absolutely fascinating. So there's some people who are like okay making changes, right? So like people who are okay to change, people who are not okay to change and like what's the difference? So this can be relationships, it can be careers, like what's the difference? Turns out chances are their brains are different. So the first thing is the amygdala. Okay. So your amygdala is what perceives threat. It makes a calculation about risk. So this perception of threat in people who are not okay to change, don't want to change. I don't want I'm scared to restart my life. They actually perceive a greater amount of threat. So this is amplified. So if I ask you, okay, if you change your career, what are the chances that things will go wrong? This person will say the chances are actually really high. This person will say the chances are low.

Second thing that's different, anterior insula. This is fascinating. This generates gut feelings. So, have you ever thought about this? How do you make decisions? Most of the time, we make decisions based on gut feelings. You may say that's not true. But I I just want you all to think about it, right? So, if you're like, "Oh, do I feel like eating this or do I feel like eating this?" Where does it just like get some signal from me in here just like let me do this. You want to get this game? Do I not want to get this game? It's on Steam sale. Let me just get it. Do I want to switch to a different stream? Do I want to finish this video? Do I want to listen to this guy blabbing? I don't think so. Okay, so here's the crazy thing. People who are not okay to change have a hyperactive anterior insula. So their sensitivity, the amount of gut feelings that they get is actually higher. And if you think about what causes you to not want to change, right? So logically, you're like, you're going to be three years older anyway and you're unhappy now. Just change. It's smart. Like be happy at 28 instead of unhappy at 28. Easy. No problem. Time is going to pass. No way to get around it. Super logical. But that's not the way that their mind, not even mind. Yeah, mind. Their anterior insula perceives all of these like gut feelings that make them hesitate usually in the negative direction. And if you think about danger by the way, right? So what is d what is your subjective experience of danger? It is a gut feeling. So these two things are synergistic. You have more gut feelings and the threat when you have a gut feeling your amydala freaks out every time you have it.

So this this synergizes. This is the devastating one. Strim altered reward prediction. What is the benefit that you will gain from restarting your life? Low. So this person over here will the reward prediction that these people will experience will be lower. So, not only is there a greater threat feels wrong, but the likelihood that things will work out will be lower. Now, here's the really really really really hard thing to understand. Okay? Try to say this to y'all. I can't explain it beyond this. If you are someone who is hesitating to restart your life, you may be hesitating because this is going to sound kind of weird. You're wrong. You're wrong about the possible benefits. You're wrong about the possible threats. And and this this is like I I'm not saying that you're wrong categorically. What I'm saying, what I want you all to understand is that your brain is making calculations. But what if your calculating instrument is not functioning in a typical way, right? Then all of the calculations you're making are going to be potentially incorrect or we're amplifying certain variables, reducing other variables. Okay? And and here's kind of like where we sort of know that if you do this like you know like things are actually going to be okay. The majority of I mean I don't know about data but I haven't looked at a study but I would imagine this is true but if you look at like you know is is 26 too late to start over your life after horrendous four years during the pandemic crush your dreams and even though you were doing everything that was so close. So I want you all to like look at this. What do you think this person's reward prediction circuitry is doing? What do you think what is the amount of gut feelings that they're experiencing? What what do you think is their threat perception? Like we don't know anything about this person, but it's crazy, right? Like you can read this and we can at least develop a hypothesis. This does not sound like someone who is reward prediction is like accurate. Or maybe it is. Who knows?

The other thing is let me see if Yeah. So, how many times have you had to restart your your life? There's this evolve part. We'll we'll talk about that. But this person says, "Fire, flood, and divorce. Getting pretty good at starting over now that I realize that nothing lasts forever." So, if we look at most human beings when they restart their life, they end up okay. 50% of people get divorced. They're not crippled for the rest of their life, right? 50 50 to 60% of I think 50% of people who get divorced ballpark it's probably between 30 and 70 I don't know the statistics get remarried right so we think things are going to like [ __ ] us they don't if you restart your life chances are things are okay and I understand why it's hard right because we have this perception so let's talk about this we have this perception that if I restart my life I have to start over from zero I don't think that's true I think restarting your life may even give you an advantage in the second run because let's remember that you're not really starting over from zero. Your may your brain may think you're starting over from zero but you carry over all of your previous skill set and experience. I spent seven years becoming a monk, studying to become a monk. And then I left and I started I started med school at the age of 28. I finished residency training at the age of 36. That's that's pretty late to like finish school. But did those seven years of being a monk mean that in a sense I'm starting over from zero? But they actually give me a competitive advantage in psychiatry. So here's the really crazy thing. What I've noticed about people who switch careers, people who switch careers have an advantage over people who are not in that career. You have a separate set of skills which if you can bring into your new career are really helpful. I see this a lot with the entrepreneurs that I work with. I I love this. Being a psychiatrist is [ __ ] OP in the field of entrepreneurship. Your ability to understand people, your ability to manage boards and understand narcissism and ego. Like can you imagine like when you're when you're on like I have a buddy who's also in the startup world and you know he has he was telling me things are really bad with their board like their board is really upset they're really upset and like you know everything is like tense but like if you have training in coup's therapy you have training in conflict resolution you have training in understanding narcissism ego and defense mechanisms if you have the ability to hold people's negative emotions instead of react to them it is so OP in the business world. So even if you're starting over, I don't think you're really starting over. And I think a big part of it is that like it's so hard, right? So like if you're a psychiatrist, it's like if you're in if you're in business, it's hard to go to medical school and learn psychiatry. Like that's hard to do, but it's easier. Like so whatever you did in the past can carry forward. Okay.

Now what it comes down to. So if we look at this constellation of of if we look at this constellation this basically boils down to one thing or I'm simplifying it doesn't really boil down to it. So there is something called a transdiagnostic factor called intolerance to uncertainty. What is a transdiagnostic factor? a transdiagnostic factor. So up here we have diagnoses mental illnesses. We have things like depression, we have anxiety, we have OCD. But if I look at like your thought process, I can't or if I look at your genetics and stuff like that, there's some correlations with OCD. But we what we know about these illnesses at the top is they are built on a foundation of mental processes. And those mental processes, a couple of good ones are a couple of good examples are rumination. So rumination is turning a thought over in your head over and over. Cyclical thinking, thinking in a repetitive nature. Now thinking in a repetitive nature is not an illness. But if you think in a repetitive nature, are you more likely to be depressed? Absolutely. Because once you start thinking negative thoughts, they repeat, repeat, repeat, repeat. Are you more likely to be anxious? Absolutely. Now I'm worried about this and I keep worrying about it over and over and over and over and over again. So do you all see how like rumination is a foundational way that your mind works? which predisposes you to a particular set of mental illnesses. It's like that's the real risk factor. In studies, we did a whole video about this, but studies that show that if you target rumination directly, you don't even treat someone's depression. You just treat their rumination, their depression improves just as much as if you treated the depression directly. Really fascinating.

So, there's another transdiagnostic factor called intolerance to uncertainty. And what is that? It's like I I don't know if this makes sense, but if you guys are worried about restarting your life, you'll understand this. You have a friend. Your friend, this [ __ ] guy or this [ __ ] girl. Like, oh my god, dude. They're like, yeah, I'm going to take a gap here and I'm going to travel the world. And they're like, but you're like, but what what are you going to do after that? I don't know. Life will happen. Life is just a journey, bro. Just enjoy it. And it's like, how are you going to pay your [ __ ] rent, man? Like, what do you mean you're just Yeah, I'm going to just I don't know. Like, I'm going to like I'm not feeling like I'm this relationship is working for me anymore, so I'm going to just like leave it. But it's like, dude, there's like a dating and dating crisis. Like, online dating is such a mess. Like, how are you going to like how are you going to meet someone else? I don't know. I'm going to just love life. I'm going to just go I'm going to flop. And these [ __ ] people like they exist. You know them, right? And here's the crazy thing. We like to think that these people suck at life. We we want to say we really want to say, "Yeah, if you don't worry about this stuff, then you get punished for it. If you don't think about how to pay your rent, you end up [ __ ] homeless. If you just like leave this relationship and just go through life like not thinking about it, like you end up alone." But here's the really here's the [ __ ] crazy thing. They don't end up alone. They don't end up broke. They don't end up hopeless. Like some of the time they do, but a lot of the time they don't. And sometimes, this is the most infuriating thing, sometimes they seem to fall ass backwards into amazing opportunities. Do you all know people like this? Have you guys like met people like this where it's like they have no plan? They're just floating through life and they just [ __ ] get lucky over and over and over again. Am I Am I crazy here or you guys Okay, me. I am that person, [ __ ] Get wrecked, shitties. All right, because they live in the moment, right? And they're like, "Oh, yeah. Like, live in the moment, bro. I live in the moment." But it's like, "No, dude. Like, I I I don't know. Like, live in the moment, but like how do you plan for the future?"

So, here's the crazy thing. These people have a high tolerance to uncertainty. Some people have a low tolerance to uncertainty. Now, this is where things get hard because this is going to be the ultimate mind [ __ ] Okay, so I'm going to try to explain this, but it's hard. I don't know how to do it. Well, so when you look at human beings who have intolerance to uncertainty, they have these changes in their brain, right? So, let's understand this. If my life is a big question mark, how does my brain interpret that? There is a potential threat that gets amplified. Gut feelings. I'm really worried that this could happen, this could happen, this could happen, this could happen, right? That that then amplifies the threat and my rewards are predicted as lower. Y'all get this make sense? So, like, we're not going to move because when we're unsure of what's going on, the picture looks bleak. Therefore, there is no movement forward. We're just going to stay right here. No moving. Just sit. Continue to suffer. Right? So, here's the crazy thing. Not only do they have intolerance to uncertainty, the way that we try to fix the uncertainty messes us up. And this is going to [ __ ] blow your mind. Blew mine. I don't know if it's going to blow yours because I don't know if I can explain it well. So bear with me. So when we don't know what's going to happen, right? So our uncertainty level is high. What do we do, chat? What do y'all do when you don't know what's going to happen? For those of y'all that are wondering whether you should restart your life or not, what do y'all do? Okay, some of y'all say nothing. We're going to get to that. That's the real answer. Overthink. Good. Overthink. Excellent. What else? What else? What else? What else? What else? Come on. I'm looking for one answer. Read my mind, chat. Over plan. Good. We're getting there. Find a solution. Oh, there it is. That's the problem. Love it. Find a solution. This is This is what messes us up. Okay. So, this is so hard. I'm going to try. Okay, chat. Give Give me like two shots at this. I got I got to do and I got to redo. Number one, our brain has a fundamental like the the north star the north star of a brain, not even our brain, all living organisms is to reduce prediction errors. When I make a prediction, if that prediction is wrong, I die. If that prediction is right, I live like literally. Like, so if we look at like an amoeba, like let's say I'm a little amieba and I got my little organels, right? And I got my little pill eye or whatever the [ __ ] And I'm like, "Oh, there's food this way." And there is a predator this way. So I make a prediction. Going this way, good. Going this way, bad. If I make that prediction wrong and I end up, oh no, the predator is over here. If that prediction is wrong, I get eaten. Right? So this this reward prediction error, the more we predict incorrectly, the worse off we are. So, okay, now comes the hard part, uncertainty. So, my goal is to reduce the gap between expectation and reality. I want this gap to be zero. Okay, I'm going to stop for a second because this is I know I'm throwing a lot of stuff at y'all. Are y'all following so far? I know like I haven't connected the dots yet, but do you guys understand this? Okay, y'all understand that? Like we're going to get to this in a second. Okay, so remember here are the things that you'll do. We're going to understand why this happens, but this is like so hard to explain. Okay, so what the human organism wants to do is we want this gap to be zero. Okay. So, if I am perceiving a threat and if I'm perceiving low reward. Okay. How do I bring these gaps to zero? God, I hope you guys get this because if you get this, it's going to be great. How do I reduce these gaps to zero? Come on, chat. Y'all can do it. I believe in you. Beautiful. Stop expecting. Good. Do nothing. Excellent. Do nothing. If I expect low reward, how do I reduce the gap? I do nothing. I do nothing. Because being wrong is dangerous. Being right and doing [ __ ] is safer. Avoidance. This is where avoidance comes from. Avoidance. Do nothing. The other thing that we do is we collect information. We collect information to refine our predictions. So I'm going to collect information. Right. So there's there's doing nothing. So we got that one. Good job. Right. But what about these? Overthink, over plan, and find a solution. There's a threat. So, I'm going to think. I'm going to think. I'm going to refine my expectation. I'm going to refine my expectation. I'm going to refine my expectation. Okay? So, the more that I refine my expectation, the more information that I collect, what I'm trying to do is reduce the uncertainty. You all get that? So if if I don't know, let's say I redo my career, am I going to end up happy or am I going to end up sad? I don't know. So I'm going to collect info. Collect info. Collect info. Now, here's the problem. As I collect info, oh [ __ ] this is happy or happy. That's actually what happens, by the way. Right? So people will say, so as I collect info, I try to zero in on what actually happens. This is true. Here's the problem. As I collect info, I know this is going to sound so weird. I reduce my uncertainty. Okay, now let's see if you'll get this. So I I now reduce my uncertainty. Why is reducing your uncertainty a problem? This is now very hard. Okay, this one I think will make sense because y'all have gotten this far. But why is it why is reducing this uncertainty a problem? What is the core problem here? What is this person's core problem? What is the transdiagnostic factor? Chat. Yes. lowering your tolerance for [ __ ] yeah who are you dude hold on Shaggra soul and protoxis and I know other people I'm sure are saying it but I can't read everything from both chats here's the problem you are not building up your intolerance to uncertainty you're making the problem go away so here's the thing if you want to be good at life you need to be able to face the unknown own and go for it. Like that's the skill. The intolerance to uncertainty is the transdiagnostic factor that leads to mental illness, that leads to OCD, that leads to anxiety. Oh my god, I don't know if he likes me or he doesn't like me. Let me ask him. Let me ask his friends. Let me ask his mom. Let me ask him again. Let me ask him again. Let me ask him again. Let me ask. He said yes the first six times, but maybe he's thinking no today. I don't know what's going to happen. Is my professor going to like it or are they not going to like it? Let me let me beg. Let me let me plead. Let me cry. Let me do this. Let me make sure that they like it. Professor, did you like it? Did you like it? Um, let me get my friend to read it. Let me get my mom to read it. Let me get my the TA to read it. Let me let me just do all this stuff. That is the source of suffering. The ability to tolerate. If you want to restart your life, you need to be able to tolerate the unknown. It's okay that it's the unknown. And here's the really crazy thing. The unknown is where the good stuff is. Okay, so let me let me explain this. Okay, bear with me. How did you end up in the position of being 26 years old and wanting to restart your life? What was the strategic meta that you were using? You were like, I'm going to figure out all the answers. I'm going to find I'm going I'm going to become engineer. I'm going to do this. I'm going to do everything right. I'm going to play it safe. I'm going to do this. And then you end up 26 years old. You've got a decent job. Maybe you make 100K, but you're like [ __ ] miserable every day. You made some kind of calculation to get you here. And that calculation was safe. There's also a bunch of evidence about something called premature closure. So oftentimes what we do is like I'm an 18-year-old kid and then I decide on a career, but I haven't really tried anything. So I kind of put all my eggs in one basket. I study engineering. I go to college. After the college, I get a job. I didn't really like my classes. cuz I weren't really super excited about it. Some people were super excited about it. I was super like envious of them, but that's not really what I did. But like, ah, now I'm on this track, so let me just move forward. Let me just move forward. Let me just move forward. Does that make sense? Now, here's the cool thing. When you plunge into the unknown, you are actually collecting data. You're not deciding ahead of time, this is the career that I want, and fingers crossed, I hope I like it. But you don't know what you like because you haven't tried anything because you haven't explored anything. Premature closure happens when there is a lack of exploration. Where does exploration happen, chat? In the unknown. Like you can't explore unless there's unknown. So this is the crazy thing. When you plunge into the unknown, this is not a bad thing. This is a great thing. See, if I decide ahead of time, hamburgers are my favorite food. I'm never going to try anything ever again. Like that's a terrible way to like, you know, live life. Instead, the right way to figure out what kind of food you want is to explore. There's uncertainty. The first time you try sushi, maybe you'll think it's disgusting. The first time you try oysters, maybe you'll think it's disgusting. That very uncertainty of that negative thing is the information that leads you to a fulfilling end. The uncertainty is like it's the way you figure out. If you know ahead of time, then you're making decisions, but you don't actually know. those decisions are going to be bad. You have to plunge into the uncertainty. And as you move into the uncertainty with kind of like blind about it, but like I don't really know what's going on. That's when we discover, okay, this is what I like. This is what I don't like. And then something really cool happens. Once you discover what you like, then you start to build a life in accordance with that. Right? Right. So, I don't know if this makes sense, but this is going to be like so simple, but maybe it doesn't make once I try sushi, hot dogs, hamburgers, pizza, chapati, sambar, dosa, fried rice, chicken feet. Once I try all those things, then I know what I like. Then I can be like, "Yeah, I'm not so into chicken feet. Let's go eat sushi." And then the gratification in your life starts to climb because you know what you like and you know what you don't like. But the only way to get there is through uncertainty. And so as we try to reduce our uncertainty by figuring things out and doing research and I'm not saying that you should like never get information from the outside by the way right what I'm saying though is that there should be an exploration component. And what we see from research on quarterlife crisis and midlife crisis is people who go through the period of uncertainty almost always end up happy afterward. And that's what we see right here which is like at some point right I realize that nothing lasts forever and I get pretty good at it. Like 74 maybe eight times seven maybe eight I'm 74 very content now. Like this is crazy. Money is still a worry, whatever, but I'm happy when I wake up in the morning. That's how you get there. This person, the number of times that you restart your life correlates with how happy you are. Like I restarted my life like six times. Okay. Restart number one, degenerate became a gamer. That was the number one. Number two, monk. Number three, doctor. Number four, streamer. Number five, entrepreneur. Number six, I don't know exactly what right. So, you got to restart if you want to be happy, Dad. Yeah. Right. So, absolutely restart. You'll be better for it. Guru I I think I've had my fill of gurus for the time being, cat. Not me for sure. Um Okay, questions on this before we move podcast bro. Then I will ascend to my final form. Podcast bro. Bro. Okay. Um, okay. What uh how do you figure out what you want to do? By trying trying restart maxing I love it, dude. Oh my god, that's so good. [ __ ] Okay, here's the thing. Okay, guys. I I love it. Just figured it out. Okay, who here cheeses restarts in Civ? Any any restart cheeses in Civ in chat? You guys know what I'm talking about? You have to play Civ to know what I'm talking about. Or something else, right? Oh my god. Oh my god. So, like, why not do that IRL? Like, really? It works right. So like yeah, you have to spend some time and some energy. Um okay, just breathe. I see your message. I'm at a point in my life where I hate life so much I don't even want the small winds. is that will give me hope and I'm tired of having hope and reverting back into hopelessness. I'm 35 and stuck in the mud for 10 years. That is worthy of thinking about. I'm going to spend some time thinking about. I've worked with people like this before who don't want hope, where hope is scary. But I'm going to have to think about that and I'll see if I can put together a lecture on it. Right. So, it's kind of weird. It's like we like I I really do think I really do think that we can learn a lot from video games. Like, we really can. And it it's it kind of makes sense, right? You don't want to you want to keep on r-rolling your start until you find one that you can play for like a hundred years. Now, the problem is video games make it easy because it's like a couple of buttons and then done, right? You get you get a restart. In real life, it takes a lot more. It takes a year. It takes 6 months. It takes two or three years. But the good news is that I I think that finding a good start is like easier to do in real life than it is in civ. But we just need to keep re-rolling. And I think it makes sense. Like this person was saying, I'm happy now I'm 74. I still have problems. And this is the other big thing is that learning to be okay with problems comes from restarting. Okay. Yeah. And then like the last thing is, you know, if y'all are having trouble with this, like I really think help goes a long way, right? So I I'd really consider getting

Some help, some kind of support group or something like that. Like sometimes therapists can help with this, coaching can help with this kind of stuff. Like these are the problems that I see in our community where like people don't know how to get started. They don't know how to face that uncertainty. They don't know how to manage their their feelings, right?

But it's worth it. I think it's like a worthwhile investment to work with a professional so that you can get this [ __ ] going. And y'all have to understand that I I come from a background like I'm a psychiatrist and I know I say that a lot and I know that y'all are familiar with that, but I think the one thing that that is really hard is I've seen what the value of one-on-one work can really be. And it's like there's things just get so much easier when you're working with a professional, right? For anything. It's like if you want to learn how to cook, like sure you can learn on your own, but if you go to a chef and you learn in a dedicated fashion, it matters a lot. It helps a lot.

And somewhere along the way, we think that if there's a problem like, oh, I don't know like if I should restart in my life, we just have this assumption that no one can help us with that. But that's just not true. I think oftentimes this is what's really wild about therapy or coaching is that the the questions that only you can answer that no one else can answer for you. There are some disciplines or techniques that a professional can use to bring your answer out. So working as a therapist I noticed that there are two skill sets. One is bringing an answer out of a person and one is applying knowledge to the person. Applying knowledge to the person when we look at something like the thing that I did on panic disorder that's that's what the clinical training is for. But the skill set of bringing your answers and your motivation out of you, that's what I pulled from therapy based on some of my mentors at MLAN hospital, Harvard Medical School, the Institute of Coaching, right? These are experts in positive psychology. The person who started the IOC at MLAN was a faculty at Harvard Medical School and psychologist focusing on positive psychology. We can take those techniques of bringing answers out of people and applying them to the problems in their life that are not pathological and it works incredibly well. So don't think that just because it's like a you thing that I I think there are professionals for a you thing.

Yeah. So someone's saying I feel like therapy does nothing for me. Sort of two or three options there. One is that I think there are some people for whom therapy is not a very effective method. People are are like that. Like I remember I I had a really brief I met like Alex Hormoszi a few years ago and and he was kind of saying like you know therapy really wasn't helpful for me. I think he said something along those lines. I don't remember exactly. And there was this like there was this assumption that I would be upset by that or I would be offended by that. Not really. I mean I think it doesn't work for everyone. And I I I think that's why you know I I see the shortcomings of therapy as a therapist and that's why I do this. I think that educating people about how their mind works is a huge way forward. That's why we started a coaching program because sometimes you don't need to understand your feelings and you know and if there's pathology then I think therapy is the right move but I think there's a lot of stuff about like if therapy doesn't work for you action and getting to action and working with a behavioral specialist right.

So so I was talking to someone about what the profession of coaching is. Coaching is a field of behavioral change specialists. That's what they do. So if you look at like health coaches in cardiovascular practices, their job is to get you to continue taking your medication every single day. If we look at coaching for weight loss clinics, what do they do? Their job is to get you to stick to the diet that you're supposed to get to. The big advantage of coaching is an intervention that gets you to change your behavior, change the way that you act instead of just thinking all the time. Right? How do you move forward from uncertainty? When you're facing uncertainty, how do you move forward in spite of it? That's exactly what people need to do. So for some of these transdiagnostic factors, I think like some of our coaches do a really good job with those.

Uh, how do how is coaching doing that? So this is interesting. So coaching does that because if you look at behavioral change there's a certain hold on helping people change. Motivational interviewing. This was probably one of the most if not the best book I read in medical school. So when I was doing my family medicine rotation, okay, so this is like GPs, general practitioners, primary care physicians, family docs. There's a a great guy named Dr. Altman who was like our preceptor in med school, just amazing human being, really great doctor. And his whole thing was like, you don't need to know a whole lot of medicine. You just need to get patients to do what they're supposed to do. That's the most important skill in general practice. So if they need to lose weight, you need to teach them how to you need to get them to exercise. The single best thing that a doctor statistically I think can do, I don't know if this is true anymore, but used to be true. The single best thing that a doctor can ever do for their patient is get them to quit smoking. Bang for your buck. Single thing that you can do for your patients is if they're a smoker, you get them to stop smoking. Lung improvements, cardiovascular improvements, dementia improvements, stroke improvements, morbidity improvements, they're not going to be in a wheelchair. Like the that's the best thing you can is it's worth more than any medicine that you can do. Just get them to quit smoking.

The this is what's so challenging about the field of medicine, right? So in in medicine, our field of of medicine has evolved into compensating for the bad decisions that people make. That's like what 90% of medicine is. So if we look at like the disease burden across the world right now, chronic illnesses are super high. We look at things like Ompic and GLP1 agonists. Why are these drugs so successful? Because we as the medical field stopped focusing on getting people to eat healthy, getting people to exercise, right? Like it's crazy. So instead, we come up with GLP. We say if you can't control your diet, if you don't feel like exercising, take inject yourself with a GLP-1 agonist and then you won't feel like it anymore. We've started to use medications as substitutes for behavioral change. Now, that's bad on one level, but it's good on another level. And what's why is it good? It's good because behavioral change is tricky. Because behavioral change is hard. Because behavioral change does take more than 15 minutes once every 3 months. Changing your behavior requires a certain like you know depth and skill and nuance. But that's why like it's so good because if you can change your behavior, if someone can help you change your behavior. The other cool thing is that changing your behavior once through something like motivational interviewing, what this really does is teaches you the skill to change your own behaviors.

So this was the foundation of like the coaching program. Like it was I blew my mind. I was like, you know, in this family medicine rotation and then I went into psychiatry residency and I was like surely I'll get a ton of behavioral change training. That's actually not the majority of the training that we got. Like as a medical doctor, I get a lot of training in pharmacology. Right? Not behavioral change. And there are certainly behavioral change therapists like cognitive behavioral therapy and we got some training in cognitive behavioral therapy. We also got training in MI. So that's why I love addiction by the way. So the most training that we get in in psychiatry or that I got was in addiction treatment. So when I was learning to treat addictions, that's when it's behavioral change. And that's when I was like, "Holy [ __ ] this is wild." Like if I can get someone to change their behavior, that is amazing. Like this is an addiction where they've been struggling with this for 10 years. If I do this series of techniques, and this is what was so cool about it, their their brain and their body are addicted to opiates. They have so many neurotransmitters and and synapses and mu receptors that just love this stuff. And if this can work for that, can this work for someone who spends too much time watching videos on the internet about self-help? Can this actually help them like do stuff instead of [ __ ] sit on their asses?

And the reason that became important to me, I'm not trying to burn y'all here, is because that was my problem. I woke up every single day and was like, I don't want to do this, but I don't know how to change my behavior. Let me just queue up and try to grind the [ __ ] Can you guys imagine how much of a waste of time that is? I used to grind the North America ladder in Warcraft 3 before esports were a thing. I got to top 250 North America Warcraft 3 ladder. How much of a colossal waste of time is that? And like even like I would look at myself and I'd be like, man, I dropped from 272 to 304. And I'd be depressed about it. And then I'd be like, even if I got to 250, like what is that? How does that I'd look at the Fs that I'm getting on my transcript, I I join a fraternity, I'd get hammered at at, you know, parties and like try to hit on chicks and that wasn't going great. You know, sometimes it went okay and then I just woke up with regret because even when you get what you want, sometimes when you're at a frat party, you don't get what you want. You know what I mean? Right? It's like it's like what are we doing here guys? Like what are we doing here?

And so behavioral change if you want to start doing different things on a daily basis that's what coaching is about. Right? So when we took this when I was developing the program this was the foundation. It's like we're just going to take MI, we're going to build it around MI and then we're going to add some of these eastern uh like concepts like VIC psychology and like that's the root of the program and now it's just getting better. So like it's cool because people are adding all kinds of other things and there's other evidence-based things that you know we do at the the Healthy Gamer Institute. We started educating people. We've learned a lot. We've had you know I think 10,000 20,000 clients maybe 26,000 clients at this point at Healthy Gamer. So, we have a ton of data and every every year it gets better. That's another big problem with therapy is that I don't think therapy I I don't think there's a system in place of like customer reviews for therapy and systematic improvement the way that you see in other kinds of products. It's a big problem in in therapy.

So, I'm an engineer and not a messiah. Disappointed. I'm glad you're disappointed because I don't want I don't put me on the pedestal of being a messiah. That's not going to work well for me and it's not going to work well for you. Okay, we got we got stuff to cover, chat. I'm going to go reheat my water. Um, let's take f like not five. I'm I'll be back in like three minutes. Who needs a five minute break? Come on, chat. Okay. Shall we? Actually, I need to go potty now. I will be right back. Care stream has ended. Okay. Um, let me put this back lest I lose it. Sometimes I just look at my bookshelf and I'm like, man, there's some weird stuff in there. It's like some really normal stuff and then there's some weird stuff. Um, so much weird stuff. Okay. Okay. All right. Um, let's take a look at this one is next, right? Uh, which which book was I thinking about? So, I saw these two books next to each other. I have some weird stuff on my bookshelf. So, one is a book by Orabindo called The Life Divine. It's really kind of incomprehensible to me. And equally incomprehensible The Red Book and this one. Yeah, this is like I feel like The Red Book is one of these books that is not actually very and maybe maybe I'll regret saying this later because I'm too dense to understand it or my mind is not open enough. But I feel like The Red Book is one of these books by Jung that it's like it's actually his worst book, but since people are so enamored with Yung, they're like, "Oh my god, it's so deep. It's so deep that it's incomprehensible and I have not the capacity to comprehend it, but it's so deep and wonderful." Whereas I think it could just be bad. Maybe. Maybe. Who knows, right? But it's it's possible. So this this book I think is great memories, dreams, and reflections. And it's possible that you know 10 years from now as I learn more about Yung and as I become a better doctor um I will read the red book and I'll be like oh my god this is brilliant and I was just too stupid to understand it. Possible, right? But it kind of makes me wonder like sometimes when you're dealing with something really difficult, is that because you're not smart enough to understand it or is it because the material is just bad? I don't know.

Okay. So, men can stay up till 2 a.m., wake up at 6:00, be in debt, broke alone, and still have faith that one day everything will work out. It's called being a man. So, this is really scary. But a lot of times as men, we power through, right? We have this sort of like masculine identity. I know everyone's talking about masculine identity and toxic masculinity and healthy masculinity. Like I today, we're not going to talk about masculinity today. I don't even know what masculinity is. We're going to talk about if you're someone who powers through. And here's the interesting thing. So, you know, those of us that power through, we pride ourselves on the toxicity. So, we did this all the time at Massachusetts General Hospital, MGH, one of the flagship teaching hospitals for the Harvard Medical School that is known in the medical community and people at MGH as man's greatest hospital because we are the best. And I remember like being on call as a as an intern and and people would just brag about getting crushed. They're like, "Bro, I got crushed last night." And I would brag about it, too. I still do. I love it. I loved getting crushed, man. We had 64 patients in the ED. I saw 22 patients because they work you, man. Like some some places will call it malignant. I don't think that's a good word. So, when I was interviewing there, you know, the program director was like, we have rigorous training. It's rigorous. And I agree. I think that's good. I think it's a great place. I don't think it was toxic. But there is this sort of like machismo of like the harder you get crushed the stronger you are for surviving it. And this is the crazy thing like that's true, right? So if we're if we're dudes we'll pride ourselves on getting dumpstered and we say this is what makes me a man. Like I'm broke. I'm debt. We persevere. We keep going. You never give up. The thing is, it doesn't have to be that way. You don't have to be that way. There are other ways to do it. You can actually work a lot and be pretty happy.

And I see this kind of attitude in something that we call high functioning depression. So high functioning depression. And it's not necessarily that everyone this way has high functioning depression, but I I think the the research on high functioning depression is really helpful here. So high functioning depression is when you are able to maintain your dayto-day obligations. So you actually don't have a functional impairment. Most of the time when we think about people who are depressed, we think about people who can't get out of bed. People who have low energy levels, people who can't do what they are supposed to do despite feeling terrible. And what is this showing us? This is us. This is showing us feeling terrible but still being powerful, strong, manly. And if you're someone who kind of falls into this sort of like existence of like, oh my god, like it's hard for me every day. Nothing is really going well and I'm going to just keep persevering, keep persevering, keep persevering. It turns out that perseverance is literally the problem.

So I want to show y'all something crazy. So another possible explanation involves sublimation as a high functioning individual may channel the unacceptable urge to quit college, graduate school or med medical school into productive outlets that lead to the attainment of an upper level degree. Okay, what is this saying? See, if you're someone who prides yourself on the punishment, it's hard. This is what happens with men and not just men, but people with HFD, but happens a lot with men. You're in a particular situation where you feel not good about it. You don't want to continue. You don't want to quit. You don't want to give up. And what do you do? You double down. You are not going to be the person who quits. You are not going to be the person who is weak. You are not going to be the person who washes out. In fact, you are going to do the opposite. You are going to take this negative weakness, pussyfooting, weak ass, beta level [ __ ] and you are going to sublimate it into productive outlets that lead to the attainment of an upper level degree. Not only are you not going to quit, you're going to go higher. You're going to succeed. You're going to be the best. And that's how we get here, right? That's how we get to these situations where like we're going to go hard. We're going to do better. We're going to be broke. We're going to be alone. We are going to ignore all of our internal feelings and signals and we're going to succeed anyway cuz that's going to give us pride. That's going to give us a sense that we are good people.

So, what is this? This is uh not this one. Uh, can't find it right now. Hold on. Nope. Maybe it's here. Uh, no, no, no, no, no, no. Okay, I don't know where the paper is. I'll find it later. So, let's take a I'll just do it this way. So, here's what happens. I'm a dude or a woman. and I start to live life and then I have something like a job or family responsibilities and then I start to feel bad. I don't like it. And in a normal situation, I would change, right? I would change my circumstances. I would say, "Okay, I feel bad. So instead, what I'm going to do, like what we could do is maybe I like have a change of job. Maybe I have a change of family. Maybe I set boundaries with people. Maybe I stop." I don't know if you guys y'all have ever seen this, but you know, one thing that I see that's really scary is a lot of families will have like one pillar. They'll have one one adult usually who carries everybody else. Siblings who don't do their [ __ ] The one the one adult who like when mom or dad gets sick or discharged from the hospital or whatever, there's like one adult who bears the default responsibility and this adult is also responsible for wrangling the s siblings to do their part. It's like there's one person carrying everybody else and the whole family gets weighed down and this person can't do it on their own and everyone kind of gets dragged through the mud. It just doesn't work. But if we do this then we are abandoning. If we do this we are weak. So this is a feeling. This is an identity. So if you look at why people stay in situations that are not ideal for them, it is because they are trying to preserve an identity. And we can see it right here, right? It's called being a man. This is an identity statement.

So this is what happens. I don't know if this is going to make sense. We have this kind of like idea of who we want to be. And if I feel weak and if I feel tired and if I feel like I don't want to do this anymore and then I'm like, okay, I'm going to take all those feelings. I'm going to say no, I'm not going to be that person. I'm going to be a stronger person. I'm going to be a better person. I'm going to be the person that people can rely on. I'm going to be better than that. I'm not going to be weak. I'm not going to change my college degree. I'm actually going to go to graduate school. and I turn this negative into a positive. It's because of the preservation of this identity. This is the person that I want to become. I'm a be that person. The problem is as we become that person, there are a couple of scary prices that we pay. The first price that we pay is psychic amputation. We take all of those feelings of being bad and we shut them off because that's not really who I am, right? That is this is an identity that I'm striving for. It is not my general experience of the now. And here's why it's so addictive. Because when we use sublimation and we take I hate my career. Let me show my career who hates who. I'm going to teach my career a lesson. I I going to go to graduate school. I gonna be I'm going to do the career even harder. I'm going to do it harder. I'm going to do it better. I hate it. I'm not going to be someone who quits when I don't like things. Instead, I'm going show myself a lesson, which is if I don't like things, I'm going to do it harder and I'm I'mma like it not like it even more. I'm going to do it more and then I'm not going to like it even more. And then I'm going to keep going. And you guys may think, "Oh my god, Dr. K, you're crazy, bro. That's not really what people do, but it is."

So, the avoidant strategy of denial, denial that one is feeling depressed or denial of the reasons one is depressed, is also congruent with masculine norms which may label feelings of sadness or being effeminite. Let's look at this paper. Okay. However, such individuals may not realize or acknowledge the onset of high functioning depressive symptoms such as increased levels of anhidonia, sadness, distress, poor concentration or lack of emotion. Over time, the ability to employ psychological resilience or sublimation may weaken causing even the high functioning individual with an upper level degree to begin experience to experience the adverse effects of untreated HFD. What does this mean? So, as I do this, I start to lop off parts of myself. I start to feel anhidonic. I don't feel pleasure anymore. There's no pleasure here. Do you all get that? There's no pleasure. There's grinding cuz pleasure is weak. Pleasure is affeminite. Pleasure is for losers. I'm on the grind set. Unless I'm I'm I'mma be so hard I'm going to hit myself in the nuts every day cuz pain is weakness leaving the body. But here's the problem. As you double down, as you start to sublimate, as you go harder into a life of this identity of this person that you want to be, if you don't fundamentally like it, the negative emotions start to pile up. As the negative emotions start to pile up, you suppress them even more. you become even more anhidonic. You don't feel these things. Instead, what you are left with is feeling in debt, broke, alone. You're in this life that you can't quit, but you hate. You all want to know why ma male suicide rates are so high? Here we go. Oh, and by the way, hold on. That's just not me saying it. Um, yeah. Right. So, avoidant coping is associated with an increased risk of suicide in both genders. So, it's not just men, it's just men engage in avoidant coping, I think, more than women do on average. And it's absolutely associated with suicide because now you're in this life where things are building up, things are building up, things are building up. And now you want to and then they get to be too much because at some point the strategy of I don't like this, I'm going to double down catches up with you. It's not fundamentally sustainable. At the beginning it feels like resilience and it is after a fashion for sure, right? Because you're able to keep doing it. But this kind of coping instead of actually addressing the underlying sources of unhappiness. Does this kind of make sense?

So we get stuck in this sort of situation where it's like right. So here's the thing. I don't like it. I feel bad. So, what I'm going to do is sublimate, get promoted, not be a quitter. And now here I am, but I'm in this job and now I feel worse. And then what am I going to do? I'm going to do it again. Sublimate. Go hard. And now I'm in a situation where I feel even worse. and and and we sort of hope, right? Like there's this really scary thing that like have faith that one day it'll work out. If you want it to work out, you need to choose different things, right? So like maybe one day it will work out. This is where the whole light at the end of the tunnel things, oh, if I keep on making sacrifices, eventually I'll be happy. But I I don't know if this makes sense. Each step you're taking is making you more unhappy. Do you think that at some point unhappiness is going to flip into happiness?

So, there's a different way to do it. And this is what's so scary about this is that this cycle works for success, right? Because I'm going to take these negative I'm going to take these feelings of quitting and I'm actually going to like improve using that as fuel. And this is where I see this all the time, right? And and when like, by the way, like when I when I made the guide to depression, the guide to depression was based off of my patients who have this cycle. So half the the very first video in the depression guide is congruent versus inongruent depression. What does that mean? That means when someone walks into my office either they they are depressed and they shouldn't be like everything in their life is going well and they have every reason to be happy. And that's when I think about a neurochemical imbalance. I think okay their brains are not processing information the way that they should. There's some kind of cognitive bias. If they are able to really see what their life is the way it is then they their depression will get better. That's pathologic depression. Half the guide is something completely different. Congruent depression. This is when someone feels bad because they should. They're feeling bad, then they feel worse, then they feel even worse. But this is not illness. This is not a malfunction of the brain. This is an appropriate response to the life that you have created. And then solving that problem is to understand these patterns and change them because you're not depressed because your brain is busted. You're depressed because your brain is accurately assessing this life that you have created.

And these are some of the characteristics that we tend to see in people who have high functioning depression. Right? So male depressive symptoms were recently validated using the MDRS7. It assesses six dimensions of male type depressive symptoms refined from the longer form MDRS22. Emotional suppression boom boom boom drug use, alcohol use, anger and aggression, sematic symptoms and risktaking. The patients that I would see would do these things because remember this is like I I used to do addiction psychiatry, right? That was my specialty. So, they'd come in with substance use problems and what's driving the substance use? What's driving the pornography addiction? What's driving the gambling addiction? What's driving the being a crypto podcast, bro? And the interesting thing is these patients would have all kinds of sematic complaints. That's why they're listening to all these health and wellness podcasts trying to do this supplement kind of stuff because they have all this stuff going wrong in their body. and what is not the real root. That's not the right word. The one thing that they're missing, so I want y'all to understand this. This is like my take, okay? I'm sure there's research to back this up, but I'm sure there's counter there's evidence that's counter to this. Whenever there is a problem that you cannot manage in your mind, it is going to come out through the body. So I've worked with people who are really successful and when they you know we know that there's a connection between stress and heart attacks but what exactly is the connection? What I tend to find is when I have patients who feel mentally bad suppress those feelings power through that stress that you feel in your head is a signal of what's going on in your body. It is a signal to slow down. It is a signal to stop. It is a signal to stop doing what you're doing. But they ignore all those signals and they keep entering and pushing deeper into like the danger zone. So it's kind of like if I jump into a pool of water and I hold my breath and I start swimming downward, if I start to feel like I need to breathe, I need to breathe, I need to breathe, I need to breathe, those are signals for my body to rise to the surface and take a breath. What would happen if I keep swimming down? This is what these people do. They're they're they're getting all these signals of mental stress, but they're so anhidonic. They're so emotionally suppressive. They're so avoidantly coping that they ignore all those signals and they keep driving their body forward until eventually the body gives out. Boom. Myioardial inffection.

So in this way being this kind of being so mentally strong that you ignore your body is one of the most unhealthy things that you can do and everyone thinks this is great like oh my god I'm able to push myself push myself push myself to the limit past the limit even more past the limit and what what happens when I do that I think of myself as someone I'm great there are limits for regular humans but I I am conquering the body. The body is telling me slow down. The body is telling me it hurts. I'm going to be better than that. I'm going to be stronger. I'm going to be better. Right? And if we really think about it, this is what's so scary. Why do you need to be stronger? Why do you need to be better? Because deep, deep, deep down, you are not happy with who you are. The more content you you are with who you are, the less you have to prove to yourself and everyone else around you how strong you are. I got crushed, bro. 62 patients, man. I got through 24 patients in one night, bro. 30 hours of call and I've been there. I do it. I love doing it. It feels great. I still pride myself on going into a hospital on a Friday evening at six o'clock after having worked that day and moonlighting for 48 hours. I go into the hospital at Friday at 6:00. I walk out Sunday morning. I guess that's not 48. I usually leave on Sunday morning. Sometimes I leave Sunday evening. So that would be 48 hours, but that was a bit much, right? I worked so much. I'm a real doctor. I'm not a wuss, right? It feels good. And for and at that point, the reason that I did is cuz I had a family to support. So my wife had stopped working and you know, we needed money. Can you hold on a second? Sorry about that.

So, there's a better way to do things. Right? And this is what's so hard because we pride ourselves on this. We pride ourselves on things like emotional suppression. So what do we do about this? So there there's another thing I I want to show youall something. Someone posted in our chat about this. I mean, sorry, some someone posted on our subreddit. So I want to show you all this. Bro, is anyone else just not really interested in anything? So, something I was thinking about recently is like I don't really have any like genuine passions. Uh, I don't really like feel interested in the vast majority of things. And there are like a couple things that I'm like marginally interested in, but it's not even necessarily really for myself. It's more just because it makes life marginally more interesting and I can recognize that and so I choose to do it. But like I look around and see these people that are like actually interested in doing something, right? and they want to be the best at it or maybe they don't want to be the best at it but you know they they really love doing it and I just get very envious of them because like what do you mean you you really want to do this thing or you really want to be good at this thing like I wish I felt that way like when do I get to feel that way about anything I don't know I just get jealous about it what about you guys >> okay so let's like understand how we end up I mean I have no idea if this person is going through this but right so I think it's an interesting way of conceptualizing like some people just don't feel good, right? They don't feel like doing anything.

So, let's show you this. So, male type depression, high functioning depression. Um, one of the key thing features of it is anhidonia. And anhidonia is the inability to derive pleasure and it's a lack of oh it's also a lack of excitement. So here's what the cycle looks like. I'm in a situation, job, family, I feel bad. And then what I'm going to do is sublimate. So I turn, this is what's cool. This is what's awesome about sublimation. I take this negative feeling and I turn it into positive motivation. And then the reason I'm doing this is to preserve an identity. Now the the problem is when I'm preserving an identity, I'm going to start suppressing this stuff, right? I'm sublimating it. I'm not really feeling it. And this is the real scam in life is that is that once we start suppressing a part of our brain, we can't selectively suppress it. We'll sometimes try with things like psychological defense mechanisms, but most of the time we can't just selectively suppress the bad emotions. It's not like I can go through life just feeling good all the time. I can do that for brief periods of time, but eventually it's going to catch up. So, in order to preserve an identity, my job responsibilities increase, my family responsibilities increase, right? I end up with this picture over here of being a man, supporting the people around me, not being a quitter. So in order to preserve that identity, I have to lop off parts of myself. And this is what gets kind of weird, right? Because the identity is not me. By definition, it's not me. It is something that I am striving for. I am over here and the identity is over here. And I'm trying to move in this direction and the feelings are over here. This is the real feelings, right? I don't feel like doing this. I don't want to be this person. Deep down, I don't want to. But the idea of being a loser, the idea of not being this person, we think we respect this person. We want to be this person. I want to be proud of myself. The only reason that you want to be proud of yourself is if deep down you're not secure in who you are. Does that make sense?

So striving for better requires the psychic amputation of what you feel and this results in anhidonia. And now once I have anhidonia I don't have any compass because now I'm not naturally drawn towards anything right and when I don't know what I'm when I'm not drawn towards anything I double down on my identity. Now I need to get promoted because I feel empty inside. So, let me get this promotion. Let me get this car. Let me buy this watch. Let me do all of these things so that I can when I look in the mirror, the person that I see is successful and maybe that'll fix not feeling successful. If I set up a life that looks beautiful and where everything is perfect, then maybe I will be happy.

So this is where question naturally becomes. What do you do about it? What do y'all think chat? Let's see. How do we fix this? Okay. What if you kind of know you don't like the person in the mirror? Say more. What do you not like about the person in the mirror? Doing nothing ain't going to work, right? I'm sure we've tried that. Stop caring. So, see, this is great. So, y'all say stop caring and do nothing. How does that work? Doesn't work. And this is what happens, right? So, so this is what's so scary is like we have two kinds of men right now. We have the people who are checking in twice as hard, working twice as hard, the podcast bros, self-improvement bros like, I got to be better. I got to be better. I got to be perfect. I want to live forever. I want to be I want to have the best looking girlfriend. I want to have the best looking career. I want it all. I want it all. I want it all. And we have the people who've mentally checked out. Those are both responses to this problem. But I don't know that people who mentally checked out are happy. Oh, so then there's also I have so much potential in me and I am aware that I do nothing with it. Where do you get the idea that there's so much potential within you? See, living up to your potential is becoming the identity that's at the top. And when you look in the mirror, you look at this person and you say, "I don't like the way that this guy is a [ __ ] loser." Okay? And if that's really how you feel about yourself, I don't think that that's like a bad thing necessarily. I know it sounds kind of weird, right? So I I think this is where it's it's it's so hard but simple. So there's a difference between this is the tricky thing. when I feel bad in a situation and I run away from those feelings in order to create a life where fingers crossed I'm I'm not going to be a loser. Okay, I'm running away from my feelings. What I'd focus on is not and this is the tricky thing. We try to use an identity to fix our feelings instead of addressing the feelings directly. So, I'm going to become someone who does not feel this way. That's not the right move. That just leads to sublimation is a short-term solution, but will build up over time. Instead, what you should do is when you look at yourself in the mirror. If you are not happy about something that you see, fix that thing, right? Lean into the feelings. Okay, I I'm ashamed of the way that I look. This is not you trying to be something else. This is what's subtle about it and this is why it's so hard. Right? So if I don't like the way that I look, I can mentally check out or I can become this other version of myself. Instead, what can I do to look at myself and feel proud of that person? That's the operative question, right? So what we want to focus on is this right here. If I feel bad, instead of becoming someone else, who feels good in this situation, right? We want to change ourselves. We're just like, I'm going to I'm going to become someone else. I'm going to become someone who loves getting kicked in the nuts. The other thing that we do is check out The other thing that we do is just feel good. Now what does this mean? This means dopamine. This means drugs. This means games. This means porn. That's avoidance coping. Emotionbased coping. Instead, what is the action? Not the person. You're not going to be anything else that makes you feel good. And not just good, proud. What can you do that will make your internal sense feel good in the way that corrects this bad feeling, not replaces it, not drowns it out. And this is hard, right? This is why there's like this is why this is happening to men across the planet because these three solutions are so accessible. So easy to do these three things. And this is where like it's it's tricky, right? Because we don't know we don't pay attention to ourselves. This path over here is actually not paying attention to yourself. It's ignoring yourself and trying to become something else. You got to pay attention. You got to sit in it. And when you look at and this I I love this this point of I don't like what I see when I look in the mirror. Great. That's a wonderful place to start. You're going to look in the mirror tomorrow and what can you do today that has the best chance of making you feel better when you look in the mirror tomorrow? Once you have the answer to that question, this whole cycle that's a vicious cycle in the negative direction will become a virtuous cycle in the right direction.

So, I I like this. I feel ugly. And then people are saying, "Go to the gym. Fix your diet. Fix your clothes. Fix your this." See, you want to fix it all. Don't fix it all. That's not what we're shoot We're not shoot. This is so It's such a good answer and it also is a subtle problem. That's where you end up, but it's not how you get there. Because if you try to fix it all and you fix one thing, what is going to happen when you look in the mirror tomorrow? Oh, I ate healthy, but I haven't done this. I haven't done this. I haven't done this. I haven't done this. I haven't done this. And then you enter really dangerous territory because now you've taken a step forward and you feel bad. At least I've done this, right? Gratitude is also right but hard. Oh, so now let's talk. This is great. Gratitude. One thing at a time. So, this is going to be kind of annoying because y'all are correct and I'm going to shoot down what y'all say because this is what I've learned working as a psychiatrist. One thing at a time, bro. That's absolutely the right answer. But here's what you got to watch out for. If I do one thing at a time, is it enough? One thing at a time is going to take so many years to fix. I [ __ ] up my life so hard. One thing at a time is never enough. It's too slow. I'm getting older every single day. One thing at a time. If I if I fix my hair today and I do this tomorrow and do this tomorrow, do this, I'm gonna be 35 years old. I'll never be on a date. I'm gonna be a virgin. No one's going to want to date me. It's too slow. Too slow. Slow and steady is too [ __ ] slow. Right.

So now we get to another subtle point. There is the path forward and then there is your reaction to the path forward. Don't confuse one for the other. And this is where if it is too slow, it is too slow. This is where acceptance comes in. And eventually you'll get to gratitude, right? Do you all see? So this is where part of the problem is not just in the actions that we have to take because this is how we, especially as men, we just focus on the actions. Okay, I need to do things one thing at a time. You have to focus on your internal feeling. This feels like it's too slow. Take a deep breath. Be prepared for that, right? It's never going to feel when have you done anything that has felt like enough. So, this is where there's so much mental programming of it's not enough. It's not enough. You're making mountains out of molehills. You're predicting all these kinds of problems in the future, but then I'll be 35 and it'll be too late. And that's where that this is when we get the hardest thing which is you must accept that there is not a solution. You must let go of the identity completely. Right? Let go of it. You're going to continue working. But the identity actually sabotages you because this idea, this identity that you're trying to live

up to, that is where enough comes from. Do y'all follow me there? I know it's like kind of weird and abstract, but in order to have enough, you have to have a target. You're not focused on one step at a time. You're focused on getting there on time, which means there must be something outside of you, which is not the way that you feel in this moment, which is not the data of this life that you are living. This is the data. This is a projection of the life that you want to live. Lovely. I'll be the best POS ever. Is it too late for me? I'm 37 and I have all of these symptoms. This is going to be hard to understand. As long as you are thinking in the dimension of time, not going to work. Is it too late? Do you guys see how that's not where you are now? That is a comparison of like some abstract idea of where you should be. If I say no, it's not too late, that's still damaging because I'm leaning into the conception. The conception is the the the wrong part. You all get that?

This is really important, but it's the perfect question because do you guys see how deeply it's ingrained? You're living inside the box. And then you ask, is it too? And this is why someone was asking earlier about hope. I hate hope. This is another person who will hate hope because if I say it's not too late for you and then you hope but you are hoping within the system and it's the system itself that needs to break down. It is not about too late or too early or anything. It is about where you are and where are you going to go in this moment. What is the step you are going to take? Not where do you want to end up.

The very idea of too late. Like I want y'all to think about this for a second, okay? And for those of y'all that are like philosophers, maybe what I'm saying is absolutely stupid. There is no such thing as too late, right? But you're like, "Bro, I had a flight to catch. I showed up later than the flight the flight has departed. How is that not too late?" I recognize the logical idiocy of what I'm about to say, but I think it's true and I really want y'all to try to hear me. Right? This idea of too late in life in life. Like what is too late in life? Like I I don't I don't know. Everyone lives life. You are a unique set of genetics. You are a unique set of traumas, experiences, learnings. How can you be anything but what you are right now? Like in a literal sense. I don't mean hypothetically. Like sure, hypothetically, I could wave a magic wand and all y'all would be fixed. In a fantasy world, you could be a different person. In a fantasy world, I could be a different person. That's not the world we live in. How can you be anything but what you are? And if you can only be what you are, how can you be too early or too late?

This is where life has brought you. All the decisions that your past self made brought you to this. But that's not you. You weren't that person. You were a different person. Like technically and scientifically, you were not the same person. Your neurons were not wired in the same way. You did not have the same collection of experiences or resources. That was a different person. There's no such thing as too late because there's no such thing as you. You are constantly being reinvented every single moment of every day. You are a a you that has never existed before. That is a statement of technical fact, not philosophy. What I mean is that if I were to take some kind of I don't know quantum alien computer and take a snapshot of your neurons and your thoughts and your experiences, your genetics, the state of your cells right now, the state of your sympathetic and parasympathetic nervous system, this state has never existed before. So this concept of too late is too late is not is measured against like the rest of things around you. It's about society. It's not about you. And so all it comes down to is this moment, right? And this is what yogis in the east have been saying for thousands of years. This is what psychiatrists are now saying, therapists are now saying because we kind of figured it out that there's some validity to this. So abandon the concept of too late. It always comes down to, and this is what sounds kind of weird. Okay, now we're going to get like even weirder.

So, at the end of the day, whether things are too late or on time or whatever, it's creating a certain state of you. Okay, now we're going to y'all seem to be following me, so we're going to get weirder. And your life being good or bad is not is just about your internal state. So whether I'm happy right now or unhappy right now is like a state in this present moment. And you can have 40 years of suffering and still be happy in this moment. Or you can have 40 years of pleasure and suffer in this moment. Does that make sense? There's kind of this concept of like what have you done for me lately in relationships? And that applies to life too. Like you can be happy for 30 years, but then if your next year is [ __ ] like that sort of matters, but like it's still [ __ ] right? So the people who are truly happy figure out one thing which is the maintenance of the state of happiness. It is always temporary. It cannot there's nothing that you can do to be happy forever. This is the most deliluding thing. This is how we get to this cycle, right? this idea that if I do it right, eventually this is going to magically turn into happiness that I never have to work for. Eventually, I'll hit the point where I'll be happy. If I keep going, I'll be happy. If I keep going, I'll be happy. I'm going to run away from the bad. I'm going to run away from the bad. And eventually, eventually I will find the good. Eventually. No, you must learn how to find the good. The people who are happy have learned how to find the good now in spite of your circumstances. And holy [ __ ] the moment that your joy and your happiness in life is independent of your circumstances, then can't [ __ ] touch you. even if it's bad. Right?

And here's the key thing. If y'all are trying to figure out, okay, Dr. K, how do I do that? I will give you one word involvement. If we look at life, one really simple thing to get us unhappy, lack of involvement. Anytime we try to avoid, anytime we try to run away, anytime we try to ignore, anytime we wish that things were different, the more you dive into it, the more that you are involved with your life, the better things will become. If I'm losing a game of Dota 2 and I mentally check out, it's only suffering the rest of the way. If I wish I was in another game, it's only suffering the rest of the way. Even if I abandon and I start up a new game, what do you think that player, the player who abandons the game because they're losing and cues up again, what do you think their life is going to be like? If y'all play Dota 2, you know that you get punted to low priority where all the other shitty abandoners are. That happens in real life, too. You calibrate to your happiness MMR. And I've seen it because I've done a lot of work in investment banking. where you have a lot of really rich people who are [ __ ] miserable. I've seen it with a group of people who are potheads, love getting high, all calibrating to the same MMR. And I've also seen it in ashrams where you have a bunch of people who are like pretty happy despite a variety of circumstances. There's a millionaire over here. There's a student over here. There's a 42-year-old divorced woman over here with two kids. And we all learn to be happy. The learning to be happy is a skill. The core of it is involvement. Questions. They understand the grind is a beautiful and terrible statement. If the grind is designed to get you somewhere, then it's bad. If it is loving the grind, then it's good. There we go again. How do I not forget this tomorrow? You do forget it. So be it. It's gone. You're [ __ ] You're gonna forget it. Great question. How can you maintain? Has there ever been a time in your life where you have understood something, where you've had some motivation and it is persisted for the rest of time? Absolutely not. You're screwed. Make the most of it. How am I not going to forget this tomorrow? Oh [ __ ] Oh my god. It almost sounds like you're not going to do something today and you're going to wait until tomorrow rolls around where you hope your motivation is there and you'll do it then. Oh my god, that's such a great idea. Yeah, let me tell you how to how to maintain your motivation tomorrow so you can [ __ ] slack off today. It is not something that can be kept. It is only something that you can be aware of. It is a state. Do you all know the difference between a state and a trait? Okay, we are looking for traits because traits are easy. Oh my god, I wish I was disciplined. I wish I had high conscientiousness. Yeah, the trait is immutable for the most part. I mean, it's not really, but state is temporary. So, here's the thing. The moment that you start, I want you all to think about this, okay? Imagine for a moment, I know this is insane, that your motivation in this moment cannot be held on to. Accept that as a law, I am motivated now. There is no way to hold on. How would your life change if you truly accepted that this motivation is temporary? I don't know when it's going to run out. I don't know how it's how long it's going to last and there's no way to hold on. How would you live your life? We are so busy chasing the idea that motivation can last forever that we stop living today. Use it now. That's the only [ __ ] shot you've