HealthyGamerGG - The State of Mental Illness in 2025

Episode Date: October 27, 2025

In this special World Mental Health Day stream, Dr. K explores why mental illness continues to rise even as awareness, therapy, and neuroscience have advanced. He connects the dots between modern lifestyles, constant stimulation, and a growing disconnection from the body. Using insights from both Western psychiatry and Vedic psychology, Dr. K explains how anxiety, burnout, and attention issues are symptoms of a deeper imbalance. The conversation blends brain science with practical tools for rewiring habits and developing real resilience. Topics include: Why mental health is declining despite more treatment options How technology and constant stimulation mimic ADHD symptoms The role of panic, urgency, and emotional reactivity in shaping attention Practical steps for retraining motivation through small, low-pressure actions Understanding “phantom panic” and how to regulate the nervous system The link between breath, CO₂ balance, and anxiety How diet and the gut–brain connection influence mood Combining therapy, medication, and mind–body practices Meditation as a long-term way to build focus and emotional stability HG Coaching : ⁠⁠https://bit.ly/46bIkdo⁠⁠ Dr. K's Guide to Mental Health: ⁠⁠https://bit.ly/44z3Szt⁠⁠ HG Memberships : ⁠⁠https://bit.ly/3TNoMVf⁠⁠ Products & Services : ⁠⁠https://bit.ly/44kz7x0⁠⁠ HealthyGamer.GG: ⁠⁠https://bit.ly/3ZOopgQ⁠⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Good, so good, so good. New spring arrivals are at Nordstrom Rack stores now. Get ready to save big with up to 60% off ragging bone, Mark Jacobs, free people, and more. How did I not know Rack has Adidas? Because there's always something new. Join the Norty Club to unlock exclusive discounts, shop new arrivals first, and more. Plus, buy online and pick up at your favorite rack store for free. Great brands, great prices.

That's why you rack. There's a world. where legends race across city skylines, romance blossoms in glittering ballrooms, and there's magic around every corner. It's a world known to many as Great Britain. You've seen the action on screen. Now visit the real star of the show. Visit Great Britain. To discover more, go to tripadvisor.com slash great Britain. Hey, chat, welcome to the Healthy Gamer Gigi podcast. I'm Dr. Al-Alo Kanoja, but you can call me Dr. K. I'm a psychiatrist, gamer, and co-founder of Healthy Gamer. On this podcast, we explore mental health and life in the digital age,

breaking down big ideas to help you better understand yourself and the world around you. So let's dive right in. All righty, chat, let's get started. Welcome to another Healthy Gamer Gigi stream. My name is Dr. Alok Kanoja. Just a reminder that although I am a psychiatrist, nothing we discussed on stream today is intended to be taken as medical advice. Everything is for educational or entertainment purposes only. If you all have a medical concern or question, please go see a licensed professional.

Welcome, chat. Happy Friday, everybody. Hope y'all are doing well. 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 mental health problems, but yeah, they're not new manifestations, but I think there are 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 pharmacology. We have, you know, over a century of advancements 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. 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, when I work with my patients, we do two things. One of the things that we do is psychotherapy. We also do psychopharmacology.

But then a big part of 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 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 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 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 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 prevalence of ADHD in the streamer population.

And there are certain things about the way that our brain works that could even be advantageous. 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 neuroa typical. 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 you all should check that out if you want. It was actually a lot of fun to make. So, yeah. Now, let's actually, so I guess we can get started. So speaking of ADHD, let's talk about it.

Okay, chat, prepare your ears. 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, you know, 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 I say 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. But 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 neurodevelopmental 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, we'll 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 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, I'll do 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 frontal lobe or the anterior cingulate 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 accumbens, which give us dopamine. So the nucleus accumbens goes over to the frontal lobes and says, hey, we really want this. This is really exciting. Give me some dopamine, bra. And then we also have our limbic system, which gives us emotions.

And the emotions go to our frontal lobes. 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 limbic system says, but 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.

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 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 is, what is 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, 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 you all ever wondered why you have like 40, 50, 60 year old people who throw like temper tantrums like their 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 stop 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're actually training ourselves every time we do this. Every time we have 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 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 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 to last minute panic, I don't like last minute panic, 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, 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, a certain point you've 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. 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 endocannabinoid system, which is 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 a 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. Hey, y'all, if you're interested in applying some of the principles that we share to actually create change in your life, check out Dr. Kay's Guide to Mental Health. And so we start by understanding what literally is meditation. How does experience shape us as human beings? How do we strengthen the mind itself as an organ. And so by understanding our mind, we understand a very, very simple tool, a crucial tool that we have to learn how to use if we want to build the life that we want to. So check out the link in the bio and start your journey today. 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 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 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. 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'll get that? There's no deadline. But I am acting without a deadline. So 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 level up during the raid, basically. You'll 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. You'll 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 will be way better.

Okay? Now, there's another thing that we need to do. This is really, 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 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 God, you're telling me if I have a paper due? I shouldn't do it? No, that's not what I'm saying. 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? 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. No, I need to 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 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 shirk 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 act your frontal lobes because in this moment, we need our frontal lobes to be active and restrain that panic.

That is 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, if I'm just stuck in the phantom panic, if I'm inside the phantom panic scenario, I'm lost. So what we need to do a 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 doing this run for this boss, not, we're doing this run to level up to prepare us for a raid boss later on. Does that kind of make sense? Do you all understand? because this is what's hard.

We don't know how to turn on our frontal lobes. 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 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 lobes. 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 weakening the connection between action and emotion. you're strengthening the connection between your anterior singular cortex, your ability to reflect on your thought process and your actions. So this is a problem of habitual training. This is neurodevelopment. 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 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 threw a temper tantrum and I got what I wanted. It is reinforcement of the behavior. Okay. 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, 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 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 lobes. 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 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 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. 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 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 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 psychiatrist, the way that I treat panic attacks is like two or threefold. The first thing that really does help a lot is pharmacology. So you can do something like high dose, not high dose, but usually you require higher doses of SSRIs, selective serotonin, re-uptake 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 attacks has a few different steps. The first step to consider is pharmacology. 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, pharmacology. So we can use an agent like an SSRI, SNRI. We got to be careful with some of this stuff like van lafaxine, which can, in some patients,

make anxiety a little bit worse. But people will say, but Dr. Kay, 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, noradrenaline. Okay?

Now, here's the big problem. So thought travels to this, 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 ganglia go to these little areas right above my kidneys called my adrenal cortices 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 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 gangles. 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 kind of thing 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.

Or O2, really ventilation is more about blowing off CO2. So now my CO2 level is really, really, really low. this can make me feel lightheaded. 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 bag decreases, as this goes down, 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 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 pharmacology 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 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 Gigied out. The cool thing about the medicine is the medicine brings it down to level 50. And now my skills are enough. So now that the size of the panic has been artificially reduced by the pharmacology, 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 really great example of this is ADHD medication what we tend to find is that when you use you stop taking a medicine, the benefits of the medicine last. So ADHD medication has a half-life of about, let's say, 24 hours. I mean, it really doesn't have a half. If you take short acting like methyl thanate or something, a half-life is like six hours. But in about five 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 six 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 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 pipeline start to reduce. The strength of those connections actually starts to weaken. So medicine works great 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 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 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 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, 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 parasympathetic nervous systems and have a high amount of heart rate

variability, their heart rate will be 40, they'll be bradycardic at baseline. Normally this is dangerous, but these people are like people like athletes. So their capacity to handle stress is way higher. So you can alter the baseline state of your parasympathetic. sympathetic nervous system. One of the things that we talk about is diet. Okay? So highly serotonergic diets.

So to support the gut bacteria that produce serotonin. Okay? So this is, I kid you guys not. There is a bacteria called ruminobacteria. Ruminobacteria. And this is the bacteria that makes people ruminate. The level of ruminobacteria in people with anxiety is high.

In people without anxiety, ruminobacteria is low. You can also do things like alter your baseline, parasympathetic balance. This can be done through exercise, but is better done through mind-body practices. Things like yoga, Tai Chi, 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 made a big mistake many years ago where we separated out the mind from the body. And so as psychiatrists, 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 crazy. There's no way that the mind is not connected to the body because I saw, 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 ashrums, 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 pain, 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 people,

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. It's 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 psychological thing or defense mechanism activation or like some kind of archetypal, like discongrance or unconstlated archetype or something. Like it depends on what you're, you know, are you from the object relations school or from the, are you from the Jungian school? are you from the Kleinian school? Like, you know, depending on what is, there's some deep complex that 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 moment. mind. The problem is that from my experience as a clinician, this is like a year 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. because I've had patients who will have been in psychoanalysis for like five 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 psychoanalyst?

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 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 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. This episode is brought to you by CarMax.

Want to buy a car the easy way? Start at CarMax. Want to browse with confidence? Get pre-qualified with no impact on your credit score and shop within your budget. From luxury to family rides, CarMax has options for almost every price range, including over 25,000 cars under $25,000. Want to get started?

Head to CarMax.com for details and get pre-qualified today. Want to drive? CarMax. 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 six 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 possibly 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 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. I've never seen a trial where, okay, we're going to take 100 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. Because 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? That's what's really hard. Because if I do meditation for 10 years and my frontal lobes 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 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's fine. But then like, what are the confounding variables? Is it just that? Because I really don't know.

I mean, like, 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 you all want 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 you 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. I want to give people, I'm going to run to the, I'm going to grab something to drink, and I'd like to know from y'all while we're doing this chair stream, I'm going to show you all a couple of posts, and I want to know what we want to do next, okay? Men can stay up till 2 a.m., wake up at 6, 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. I did it at 20. This is going to take three 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, restarting life, and being a man. And can y'all go ahead and vote and then let me know what we're doing when I get back, I'm going to be right back. 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 ready to talk about all three. Okay. Dude, this is great, dude. I miss streaming. Let me tell you what. What's the verdict? Oh, how to stress less about studies. Mods?

We have, we're going to do all three, hopefully, unless we like run out of time. It 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 haven't seen the study. I'd have to look at the study. Starting life wins.

Okay. Okay. We're going to do retinal fundoscopy later, chat. All right. Just make sure I have my literature pulled up. 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 three 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 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. 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've only 25 years old. I've been an adult for like seven years. And you're telling me that I have to spend 50 percent. I have to invest 50 percent 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, make your change now because, like, you know, like, well, you don't want to, three years later, like, you don't want to be, like, unhappy, right? If you're unhappy now, you'll be unhappy when you're three 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 accident happens to people, and then you give them a couple of years, and then you take people who are quadriplegic 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 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 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 lives, life. There are some changes within their brain. Absolutely fascinating. So there are 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. 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'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. Interior insula. This is fascinating.

This generates gut feelings. So have you ever thought about this? How you make decisions? Most of the time, we make decisions based on gut feelings. You may say that's not true But 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, nah, 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? Yeah, 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 they're mine, that's not even mine, 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 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 amygdala freaks out every time you have it. So this synergizes. This is the devastating one. Striatim, 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 this is like, 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 you're 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 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 26 too late to start over your life after horrendous four years during the pandemic, crushed 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 is the amount of gut feelings that they're experiencing? What do you think is their threat perception? 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 if you had to restart your life? There's this evolved part.

We'll talk about that. But this person says, 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% 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 cripple 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 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 love this. Being a psychiatrist is fucking O.P. 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 on, like, I have a body who's also in the startup world, and, you know, 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 couples therapy, you have training in conflict resolution, you have training and 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 O-P 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 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, if we look at this constellation, this basically boils down to one thing. Or I'm simplifying it. 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 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 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. You're a friend, this fucking guy or this fucking 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 are you going to do? going to do after that? I don't know. Life will happen. Life is just a journey, bro. Just to enjoy it. And it's like, how are you going to pay your fucking rent, man? Like, what do you mean? You're just going to, yeah, I'm going to just, I don't know. Like, I'm going to, like, I'm not feeling like, 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 mating 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

and these fucking 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 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 fucking 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 fucking 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 met people like this where it's like they have no plan? They're just floating through life and they just fucking get lucky over and over and over again. Am I crazy here or you guys? okay me i am that person bitch get wrecked shitties right because they live in the moment right and they're like oh yeah like live in the moment bra i live in the moment but it's like no dude like 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 to be the ultimate mind fuck. 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 feeling, I'm really worried that this could happen, this could happen, this could happen, this could happen, right? That amplifies the threat. And my rewards are predicted as lower. You'll 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 fucking blow your mind, a blue mind. 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 you all say nothing. We're going to get to that. That's a real answer. Overthink, good. Overthink.

Excellent. 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 what messes up. us up. Okay. So, this is so hard. I'm going to try, okay, chat? Give me like two shots at this. I get, I got a do and I get a redo. Number one, our brain has a fundamental, like 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 amoeba and I got my little organelles right and I got my little pill eye or whatever the fuck 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 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 expectations. 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 all 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 am perceiving low reward, okay, how do I bring these gaps to zero? God, I hope you guys get this. 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 a low reward, how do I reduce the gap? I do nothing. I do nothing. Because being wrong is dangerous. Being right and doing shit 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 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 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 expectations, the more information that I collect, what I'm trying to do is reduce the uncertainty. You'll get that? So 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 shit, this is happy or happy. That's actually what happens, by the way. Right? So people will say, ha-ha. 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 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 of problem what is the core problem here what is this person's core problem what is the transdiagnostic factor chat

yes lowering your tolerance fuck you who are you dude hold on chagrosol and protoxus 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 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. know if he likes me or he doesn't like me. Let me ask him. Let me ask his mom. Let me ask him again. Let me ask him again. Let me ask him again. 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 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? Let me get my friend to read it.

Let me get my mom to read it. Let me get the TA to read it. Let me get everyone to read. 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 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 fucking 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. I wasn't really super excited about it. Some people were super excited about it. I was super envious of them, but that's not really what I did. But 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, my 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 so those decisions aren't going to be bad.

You have to plunge into this. 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?

So I don't know if this makes sense, but this is going to be like so simple, but maybe it does. doesn't make. Once I try sushi, hot dogs, hamburgers, pizza, chapati, sambaar, dosa, fried rice, chicken feed. Once I try all those things, then I know what I like. Then I can be like, yeah, I'm not so into chicken feed. 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 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 quarter-life 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. Ambition comes in all shapes and sizes. At First Citizens Bank, we're fit for your ambitions, whatever shape they may take.

Whether you're planning for today or tomorrow, we've got the flexibility and know-how to help you reach your goals. Because we're built for what you're building. First Citizens Bank, fit for your ambition. Learn more at firstcitizens.com slash ambition. Guru. I think I've had my fill of gurus for the time being chat. Questions on this before we move. Podcast, bro.

Then I would have sent to my final form. Podcast, bro. Bro. How do you figure out what you want to do by trying? Trying. Trying. Restart maxing. I love it, dude.

Oh my God, that's so good. Fucking. Okay. Here's the thing. Okay. Guys, I love it. Just figured it out. Okay.

Who here? cheeses restarts in Siv. Any restart cheesers in Siv in chat? You guys know what I'm talking about? You have to play Siv to know what I'm talking about. Or something else. Right? Oh my God.

Oh my God. So like, why not do that R.R. Like, really? It works. Right? So, like, yeah, you have to spend some time and some energy. 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 win. 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 really do think, I really do think that we can learn a lot from video games. Like, we really can. And it kind of makes sense, right?

You don't want to, you want to keep on rerolling your start until you find one that you can play for like 100 years. Now, the problem is video games make it easy because it's like a couple of buttons and then done, right? You get a restart. In real life, it takes a lot more. It takes a year. It takes six months.

It takes two or three years. But the good news is that I think that finding a good start is like easier to do in real life than it is in SIV. 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.

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'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 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 the shit going. And you all have to understand that 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 is really hard is I've seen what the value of one-on-one work can really be. And it's like, 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. 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 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 notice 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 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 McLean Hospital, Harvard Medical School, the Institute of Coaching. These are experts in positive psychology. The person who started the IOC at McLean was a faculty at Harvard Medical School and psychologists 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, I think there are professionals for a you thing. Yeah, so someone saying, I feel like therapy does nothing for me. So there are 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 like that. Like I remember, I had a really brief, I met like Alex Hormosey a few years ago 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 think that's why, you know, 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 for. That's why we started a coaching program because sometimes you don't need to understand your feelings. 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 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.

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. 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 and reading. 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. This is 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, that's the best thing you can, 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 medicine, our field 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 Ozempic and GLP1 agonists. Why are these drugs so successful? because we is 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, 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 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 three 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 psychiatry 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 shit, 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 brain

and their body are addicted to opiates. They have so many neurotransmitters 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 fucking 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. how to change my behavior. Let me just queue up and try to grind the fucking... 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 join a fraternity. I'd get hammered 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, 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 concepts like Vedic 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 we do at 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 year it gets better. That's another big problem with therapy is that I don't think therapy, 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 therapy. So I'm an engineer and not a Messiah disappointed. I'm glad you're disappointed because I don't want, 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. We got stuff to cover, chat. I'm going to go reheat my water.

Let's take five, like, not five. I'll be back in like three minutes. Who needs a five-minute break? Come on, chat. Chair stream has ended. Okay. Let me put this back. 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. So much weird stuff. 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 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 Jung, 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 possible. So this book, I think, is great. Memory, dreams, and reflections. And it's possible that, you know, 10 years from now, as I learn more about Jung and as I become a better doctor, 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, 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. We have this sort of like masculine identity.

Everyone's talking about masculine identity and toxic masculinity and healthy masculinity. We're not going to talk about masculinity. 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 things. So 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

is an intern and people would just brag about getting crushed. They're like, bro, I got crushed last night. And I would brag about it 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 places we'll 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 strong. stronger you are for surviving it. And this is the crazy thing. Like, that's true, right? So 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 think the research on high functioning depression is really helpful here. So high functioning depression is when you are able to maintain your day-to-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 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, keep persevering. It turns out that perseverance is literally the problem. So I want to show you 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 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 shit. And you are going to. 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're going to ignore all of our internal feelings and signals, and we're going to succeed anyway, because 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, not this one. Can't find it right now. Nope, maybe it's here. No, no, 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 of, 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 shit, 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 siblings to do their part. It's like there's one person carrying everybody else. And the whole family gets weighed down. 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 going to 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? 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'm going to go to graduate school. I'm going to 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 to show myself a lesson, which is if I don't like things, I'm going to do it harder. And I'm going to 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. Kay, you're crazy, bra. that's not really what people do, but it is. So, the avoidance 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 effeminate.

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 anhydonia, 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 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 an hedonic. I don't feel pleasure anymore. There's no pleasure here. Do you all get that? There's no pleasure. There's grinding.

Because pleasure is weak. Pleasure is effeminate. Pleasure is for losers. I'm on the grind set. Unless I'm going to be so hard. I'm going to hit myself in the nuts every day. Because 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 an hedonic. 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 male suicide rates are so high? Here we go.

Oh, and by the way, hold on. That's just not me saying it. 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 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 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 by the way, like when I made the guide to depression, the guide to depression was based off of my patients who have this cycle. So half the very first video on the depression guide is congruent versus incongruent depression. What does that mean? That means when someone walks into my office, either they're 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 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 MDRS 7. It assesses six dimensions of male type depressive symptoms refined from the longer form MDRS-22.

Emotional suppression, boom, boom, drug use, alcohol use, anger and aggression, somatic symptoms, and risk-taking. The patients that I would see would do these things. Because remember, this is like, 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 somatic 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 you 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 evidence that's

countered, there's evidence that's countered 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 getting all these signals of mental stress, but they're so anhodonic. 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.

Myocardial infarction. 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. But even more past the limit. And what happens when I do that? I think of myself as someone. I'm great.

There are limits for regular humans, but 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 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 6 o'clock after having worked that day and moonlighting for 48 hours. I go into the hospital at Friday at 6 o'clock. 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? Feels good. And at that point, the reason that I did is because I had a family to support. So my wife had stopped working and, you know, we needed money. Can you all hold on a second?

So there is 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's another thing, I want to show you all something. someone posted in our chat about this. I mean, sorry, 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. 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. 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 really love doing it. And I just get very envious of them because, like, what do you mean 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. One of the key features of it is Anhedonia. And Anhedonia 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 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 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 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 it. 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 Anhedonia. And now once I have Anhedonia,

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 you all think, chat? 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 you 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 a 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, ho. 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 fucking 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 think this is where 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 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'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 feels good in this situation, right? We want to change ourselves. We're just like, 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. Emotion-based 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 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 love 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 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. 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. Now let's talk of 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 you all say because this is what I've learned working as a psychiatrist. One thing at a time, bra, that's absolutely the right answer. But here's what you've 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 figure. One thing at a time is not.

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, do this tomorrow, do this, I'm going to be 35 years old. I'll never be on a date. I'm going to be a virgin. No one's going to want to date me. It's too slow. Too slow. Slow and steady is too fucking 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? 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, 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 you 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 wrong part. You'll 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 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. 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, brie, I had a flight to catch. I showed up later than the flight. The flight is 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 you all to try to hear me.

This idea of too late in life, in life, like what is too late in life? Like, 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 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, it 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 shit, like that sort of matters, but like it's still shit. 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. There's nothing that you can do to be happy forever. This is the most deluding 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 shit, the moment that you're a joy and your happiness in life is independent of your circumstances, then can't shit touch you, even if it's bad. Right? And here's the key thing. If y'all are trying to figure out, okay, Dr. Kay, how do I do that? I will give you one word, involvement. If we look at life, one really says.

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 you'll 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 fucking miserable. I've seen it with a group of people who are potheads. Love getting high. We're all calibrating to the same MMR. And I've also seen it in ashrams. We 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 fucked.

you're going to 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 has 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, shit. 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 maintain your motivation tomorrow so you can fucking 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're looking for traits because traits are easy. Oh my God. I wish I was disciplined. I wish I had high

conscientiousness. Yeah, the trade 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.

Except 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 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 fucking shot you've got. Thanks for joining us today. We're here to help you understand your mind and live a better life. If you enjoy the conversation, be sure to subscribe. Until next time, take care of yourselves and each other.