What Comedians Get Right About Mental Health Trauma
00:03 Hey, chat, welcome to the Healthy Gamer Gigi podcast. I'm Dr. Al-Alo Canoja, 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. Hey, all, I'm Dr. Allo Kanoja, a Harvard-trained psychiatrist, and today we're going to watch some comedians joking about mental illness.
00:34 Hopefully, we'll laugh. But what I really want to do is explain the mechanisms behind the joke. So let's dive in. To self-diagnosed with a disassociate identity disorder. Self-diagnositive identity disorder. It's dissociative. It wasn't me cheating on you. Self-diagnosed, important.
00:53 What does that mean, though? That's what used to be known as multiple personality disorder. This is correct. It's a controversial diagnosis and not getting into it. Yeah. You can just so you know. Like you can totally. You get to, well, I've stayed after this. I've got to meet these people in the parking lot.
01:10 When you say these people, do you just mean one? Okay, so let's get into multiple personality disorders and why it's a controversial diagnosis. So I once asked one of my mentors, professor of psychiatry at Harvard Medical School, hey, are multiple personalities real? And he said, I believe in multiple personalities in the same way that I believe in aliens, which is like statistically, yes, there is probably something out there called multiple personalities or people do really have multiple personalities. But I never believe anyone who says they've seen one. It was, you know, it was, it happened within literally 24 hours. And it was like,
01:47 here's my two other personalities in their names. I was like, can I ask? And I don't mean to be rude, but remember, this is all fake? We'll talk. Okay, so is it fake? We'll get to the fakenness later. We'll talk about, is it fake? Can I ask? We'll explain what it is. Can you like, tell me like when when they introduced the other people was it like actually yes or was it or was it like they're back here yes i'll tell you what they're saying both okay so this is really interesting let's understand what multiple personalities are first of all so normally you have your mind right and your mind is connected and you adopt different roles so like if i'm you know deeply in love with someone in a secure relationship i may start talking to them in like a baby voice
02:38 Oh, baby, I love you so much. Oh, my God. You're so amazing. I love you. And then when I'm like, when I go into work, right, I may adopt a different personality. So I've worked with patients, for example, who are executives at high-powered companies. And one of the really interesting things about media, which is somewhat correct, is sometimes people who are in any very dominant positions will engage in like submissive sexual fetishization. Okay. So we have all these different hats that we put on in our personality. But the thing is, our personalities all connected. So I want you guys to think about like your personality is a crystal that has lots of different facets. What happens in multiple personality disorder is that there's a psychological trauma that basically imagine taking a hammer to the crystal.
03:21 And then all the pieces shatter. So in multiple personality disorder, there's a great text about it where they talk about how trauma causes the personality to shatter along fault lines. So in the way that there's like a weakness in like a certain like, let's say piece of stone or a tectonic place. and then it cracks along those lines, that's what happens in multiple personalities. So whereas all of the different hats that you put on are all still connected, when someone has dissociative identity disorder, their hats are no longer connected. So I don't know if this kind of makes sense, but all the hats that they put on aren't just hats.
03:56 They sort of become different people. And this is where things get kind of interesting because they're all still connected, though, right? Because it's like one brain. So sometimes they do have different mannerisms. sometimes they have amnesia from each other because one altar won't let another altar know what's going on. And then the other thing is also true where since they're all connected by one physical organ, which is the brain, they can actually communicate with each other as well.
04:21 So when you're doing like psychotherapy with some of these patients, what you can do is ask them, hey, can you let so and so come forward? And then I know this, you know, there's that move and stuff like that. But what's really interesting is you'll see changes in tone of voice. you'll see changes in like accent, mannerisms, even body language, posture, stuff like that. I thought I was on an antidepressant. It turns out I'm not. It turns out I'm actually on a mood stabilizer that they use as an antidepressant.
04:47 Fun fact about prescription drugs. Everything they prescribe, they actually use for like four different things. This is correct. Hold on a second. So you don't really know what your deal is until you find a combo that works and then Google all your pills by yourself. So here's what's, we got to understand why we do this. in psychiatry. This comes down to pharmaceutical company and FDA shenanigans. So in order for a drug to be approved by the FDA, and to a certain degree, the European Union as well, you have to show
05:13 efficacy. So if you're a pharmaceutical company, you have to show that it works really well. So oftentimes what pharmaceutical companies will do is they will design a medication that shows a large effect for a very specific condition. And once they get it approved, you are allowed to do something called off-label use. So I'm as a medical doctor can prescribe something for a condition. Once the drug gets approved, that means it's generally speaking safe and stuff like that. So then I can prescribe it for any condition that I want to. And we see this right now with nothing more than the OZempic, right? The pick. You're on a bit of the pick, which is actually like approved for like obesity and like, you know, severe obesity and things like that. But everyone's getting prescriptions for it out of pocket.
05:58 Insurance isn't covering it. If they're like normal weight and just want to like, like lose some weight and be prettier. So this happens all the time where a drug company will get something approved. And then what they'll actually market it to is a completely different way more common condition. So after years of trial and error, I finally found a combination of things that worked for me. And six months ago, I decided to Google it because what the hell? And it turns out that everything I'm taking is primarily used for bipolar disorder. Which is what mood stabilizers are for.
06:27 So I went back to my psychiatrist and I was like, hey, do we think? think. And she was like, oh, yeah. Yeah, this is sad, but unfortunately true. I was like, is this how you fucking tell people? Oftentimes we don't tell people. No, of course not. We didn't know. I'm glad we figured it out. And I was like, we? I said, he really didn't know that I was bipolar. And she goes, no, of course not. We thought we were treating anxiety and depression. And I said, okay, because this kind of feels like a
07:09 putting your dog's medication in cheese situation. Yes. This is sad. We'll explain all this. And I was like, I don't know how I feel about this diagnosis. And she goes, well, if it makes you feel better, you don't have to say I am bipolar. You can say I have bipolar, which feels a lot like someone going, I said you were being a bitch. Not that you are a bitch.
07:35 Okay. So here's why a psychiatrist may give you a mood stabilizer if you're depressed. So basic thing to understand, in depression, we have low mood. But bipolar disorder is different. It is low mood plus elevated mood at times. So if we look at an antidepressant medication, it elevates mood. If we look at a mood stabilizer, it elevates mood and it brings down excessively high mood. So a psychiatrist may prescribe a mood stabilizer to a depressed patient because it actually
08:04 elevates mood. And sometimes what happens in people with depression is we just don't know if they're bipolar yet because they've never had their manic episode. So we start with an SSRI or an antidepressant medication. Maybe doesn't work great. We try another one. Maybe doesn't work great. But us as psychiatrist, what we do is, okay, let's try a mood stabilizer because some patients are more responsive to mood stabilizers than they are to antidepressants. So we give them a mood stabilizer. Their mood gets a little bit better. Now, here's the tricky thing. At that point, are they bipolar? And the answer is really scary, we don't know. Because the way that we diagnose bipolar disorder is you have depressive
08:45 episode, depressive episode, depressive episode. And then at that point, you've got MDD, but the moment that you become manic, that's when you get the diagnosis. So imagine someone has bipolar disorder, depressive episode number one, number two, they haven't become manic yet. So they may truly be bipolar, but we don't have information that tells us definitively that they are bipolar at that point, which is how we end up with this ridiculous situation. One of the upsides of COVID might be, I hope, is empathy for mental health stuff, right? Nice. Everybody was isolated and human beings don't do well with isolation.
09:23 This is true. We still have cave brains, right? So we think if we're isolated, that the tribe is rejecting us. This is true. And then we start picking away at ourselves and finding fault that aren't there. and basically our mental health declines, right? So I hope in the future that people have empathy when someone else, someone says, like, I'm depressed or anxious.
09:44 They'll go like, oh, yeah, I remember that. Let's talk about isolation, because this is a really good point. Human beings evolved in social tribes. And so the key thing to understand is that since human beings are tribal in nature, like we're not great at hunting on our own, we're like pack hunters. We have division of labor. Isolation meant death. So if you were exiled from the tribe, right?
10:05 And this is something that I don't know if you guys have ever wondered about. Like, exile doesn't seem like that bad of a punishment to me. Like, if someone sent me to a different city, like not that big of a deal. But exile used to be basically a slow and painful death. That's what the sentence was. So when a tribe pushes us away, we become isolated. We are risk of dying increases. And our brain tries to protect us from that.
10:30 And the way that our brain protects us from isolation is actually shame. So let's understand this. If a lot of people at school are making fun of me, they're like pushing me away from the group. I feel ashamed. And what does the emotion of shame try to get you to do? Right. So if people make fun of me because I don't have a particular pair of shoes, what would a teenager want to do? I want those pair of shoes.
10:53 Shame induces a behavioral change that leads us to acceptance by the tribe. Okay. Now, it's abused and stuff like that all the time. But here's the key thing to understand. When we feel ashamed, we are isolated. That's how it kind of evolved. So if you artificially isolate someone, they will start to feel a lot of shame. And this is where things get really messed up because generally speaking, isolation and shame and ostracization, all of those things go hand in hand.
11:22 If I use the wrong language, everyone gets upset with me. They stop inviting me to parties, things like that. Okay, let's just keep going. No, I'm all right. I got a therapist recently. Nice. Yeah. Let's go.
11:37 Yeah. Audiences on board. You have to, guys. You do. Like, well, if you're going to complain, as much as I complain, unfortunately, you do have to get one. Like, um, yeah. This is actually a really good point.
11:51 So people will say like, hey, everyone needs to be in therapy. Is that true? I think no. But if you have a lot to complain about in life, therapy is a great place to start. If you have a lot to complain about in life, if you have a lot to complain. complain about and you are not mentally ill, coaching is a great place to start. Hey, all. If y'all want to learn a little bit more, by all means, watch another YouTube video.
12:12 If you guys are actually interested in finding the practical tools to change on your own, that's where memberships comes in. And if y'all are interested in getting some help or achieving a particular milestone four weeks, eight weeks, or 12 weeks from now, check out coaching. So if y'all are interested, check out the link in the description below. Like my friends were starting to be like, you should pay someone to do what you expect of us. I was like, oh, okay. I found this therapist.
12:44 So one quick point about that. So what is the limit of being a friend and when should you see a therapist? Really simple. Reciprocity. So if you are emotionally supporting someone and on balance, they're emotionally supporting you in the same ballpark. You help me through a breakup. I help you through a breakup. That's what friendship is.
13:01 when things become lopsided is when you should consider working with a therapist. He's smart and we zoom and he said something interesting where he said, remember, you are not the feeling. Like, sure, you feel consumed by the feeling, but you are not the feeling. And he said within you and within everyone, there's like a very still, neutral, internal self. And, you know, you experience the feelings, but you're not consumed by them. And he said, rather than identifying so much with the feeling, like, I'm anxious, I'm this. He said, don't be consumed by the feeling.
13:34 Just observe the feelings as they come with curiosity. Yeah, this doesn't work. This is correct, but it doesn't work. Apparently that's the, so I think you're just supposed to be like, huh. This presumes a certain intensity of feeling. I'm experiencing. Rage. See, we as therapists.
13:58 How curious. Okay. This is fascinating. So let's talk about this. This person says, there is a place of stillness within you. I call it Shunya. Just don't identify with the feeling. Oh, I didn't think about that. Oh, my God. Oh, and now that you've told me there's this eternal place a piece of it. Now that I know it's there, I can access it immediately. Not how it works. So let's understand a couple of things. People who say, just be curious about the
14:23 feeling. This is something that blew my mind that I learned after finishing residency. Okay. So I've been a psychiatrist for three years or something and then I finally realized this. People's emotional experience, You can rate it from one to ten, but one person's ten is not another person's ten. If we look at research on people who are highly sensitive persons, if we look at research on conditions like borderline personality disorder, even if we look at, I suspect, conditions like major depressive disorder, what's really confusing for a lot of people is that when I say I'm 10 out of 10 sad today, that may actually be half as sad as somebody else's sad. The volume on all of our emotions is not the same.
15:06 And so this idea of being curious about your emotion is absolutely effective. But generally speaking, works better when you have less emotion. Because when we have very, very strong emotions, just this is how it works in our brain, our amygdala in the limbic system are so powerful, they shut off the part of our brain that is capable of curiosity. So one of the things that really frustrates me is like a lot of people will say like, hey, do this thing. And another good example of this is like, hey, are you feeling lonely? Just put yourself out there. Just put yourself out there, bro.
15:44 But these people are assuming a certain degree of lack of social anxiety. They're assuming a certain, like, their experience of putting themselves out there is not like filled with anxiety and terror, whereas somebody else's experience is filled with anxiety and terror. So I think this is like just being curious about a feeling absolutely does work, but let's be clear that it is way easier for some people to do than it is for other people to do. And this is where we get to, I think, one of the kind of like modern weaknesses of therapy, which gets better with every year, is there some of these concepts, right? Like you have this eternal place of stillness inside you. You can observe a feeling with curiosity. Both of these are true, but they require skill to do.
16:28 We don't do them naturally. In fact, that's not how our brain naturally. works. You have to level up the ability to do it. For me, I had a ton of emotions that took control of me. I had an ego that took control of me. I was crippled with fear of failing out of Spanish and crippled with lust that was unrequited and feeling in love and falling in love with all kinds of people and that wasn't working out. And I literally like had to go sit in an ashram for three, for three months in India to train in these skills. And that's where I discovered things like Shunya meditation, which I teach on the channel absolutely love. It is the skill, build. of finding that emptiness inside you. And once you learn how to do that, you can like put negative feelings into that and they disappear into the void. It's really weird. But when I work with my patients, I teach them very specific meditation practices that they learn over the course of four weeks, eight weeks, 12 weeks, 16 weeks, 20 weeks. And that's really when it starts to work.
17:22 So I think that there are a lot of therapists out there who will utilize this truth, but sometimes are not trained as well in terms of teaching this skill to people who have very intense emotions. I meet so many people, okay? I meet way more people than you. It's not even close. So people usually say nice things to me, you know? They're like, oh, thanks for coming. I had a good time. Conversations naturally will turn and I'll ask somebody, oh, what do you do? Do you know what I hear like 98% of the time? They'll be like, it's fucking sucks. I hate it. And then I go, oh, why don't you do something else and they'll go, it's too late. My life's fucked. It's good to meet you, man, and they walk away. Yeah, that sits in my head. So I think about it, but I have advice, and this is the advice
18:07 that I hope you leave with, all right? This is it. You just need to learn to do one thing really well, and it's this. You need to learn to manage your expectations. It's not an innate thing you're born with. It's a skill. If you work at it, you'll get good at it. And the more you manage your expectations, you'll feel more fulfilled, less depressed, happier overall. I'll share with you my life's greatest disappointment, which in retrospect is my fault. I didn't know it at the time. I do now. We'll talk about this.
18:35 And I'm going to tell you it's going to be upsetting to some people, but hopefully we can use it as a learning tool. So here's what it is, all right? I think that 69ing is overrated and it sucks. Yeah. Yeah, you see that. Some people clap. Some people are like, arrest this man. But listen.
18:58 The story of watch. is more important. Do you remember when you first heard about it? I do. I was in third grade, and that's too young. One of the older kids told me and I was like, what? Pre-puberal exposure to sexual activity in pornography is one of the highest risks, risk factors for pornography addiction. Seeing pornography or being exposed to sexual material before your brain knows how to react to it in an appropriate manner can really end up with this is what your brain does. He does such a good, this is why. This is why. it gets messed up. And that's how you end up as a professional comedian.
19:32 Every birthday, every Christmas, my dad, I go, what do you want? I go, I want to 69. He goes, shut up and stop saying that. And I was like, no, defiant. No. 69, 69, 69. It's going to be the best. Be the best, be the best, be the best, be the best. 69. It's going to be like smoking meth out of God's dick. I want to do it. I want to do what. And I built it up, and I built it up. And I built it up. And when I finally got to do it, I finally got to do it. You know what the first thing I said was, get off me. All right? So I want you guys to understand what's happening here is that some part of his brain has latched onto the idea of something that has really high value, but he doesn't understand what it is. He doesn't have context around it.
20:08 So then what he starts to do is builds up a fantasy or an idea or an expectation around what it is. Right? But that's not based in reality. Let's talk about expectations for a second. One of the key teachings of the contemplative traditions is that expectations are a huge source of our suffering. Let's understand why. I want you all to think about how happy a surprise is, like a good surprise. Right. So if you have like a surprise birthday party or you're not expecting something and you receive something good, it's not even a surprise birthday.
20:38 If someone is just for no reason whatsoever is like, hey, I baked you cookies because you're an awesome person and I care about you. All that is is like straight joy. Whereas you all may have heard of take your favorite video game or movie that has been hyped up. And the more that something is hyped up, the more prone to disappointment that you are. So generally speaking, what the Eastern contemplative meditative traditions teach us is that there is a skill of sitting at neutral. And the less we expect, the less we will be disappointed, right? Because you cannot be disappointed unless you have an expectation. Something can still be bad. So if I was expecting a really good burger and I get a bad burger, this negative loss is this big.
21:19 But if I was never expecting a bag burger and I get a bad burger, then I just experience this loss. So literally like expectations, when it comes to one's happiness are not really good to have. Now, we should make predictions about the future. I'm not saying don't make predictions about the future. The key thing is what is the difference between an expectation and a prediction? An expectation is the idea of a certain result. It is a presumption of a certain result. And a prediction is a possibility of a result or a probability of a result.
21:53 Okay? So by all means, make predictions. Don't ignore the future, but don't presume a result. Don't count your chickens before they hatch. What about persistent genital arousal disorder? Uh-oh. That is a fancy way of saying never not coming. No, it is. These are people that have orgasms every 90 seconds and they can't have jobs. Why can't they have jobs, Tom? Because they're coming. all the time. This is correct. Not appropriate for you to be like, can I try on this shirt? And the guy's like, oh. Let's talk about persistent genital arousal disorder.
22:36 Actually is quite damaging. So first thing about persistent genital arousal disorder is it is not orgasming all the time. It is just being aroused all the time. And the really scary thing about this is that oftentimes people with persistent genital arousal disorder in order to make the arousal go away, they have to orgasm sometimes multiple times to complete the cycle. So persistent general arousal disorder isn't orgasming.
23:02 It's being aroused, sexually aroused, being erect, having vaginal lubrication, it really inappropriate times. And here's why this is actually so damaging. So the first is sometimes it's like really hard to give yourself multiple orgasms or for somebody else to give you multiple orgasms, including men and there's a refractory period and all that kind of stuff. So it's actually quite debilitating to be like aroused all the time, especially when you're trying to concentrate, trying to do work at a funeral. The other thing that I think is even more
23:28 subtle and psychologically so damaging is that it destroys your association between arousal and pleasure. So for most human beings, when we get aroused, that is like something that we covet, we look forward to, or that ends well. And it's like a really basic part of human happiness and fulfillment, like getting aroused, getting laid, cuddling afterward. There's so many good things that come with that. With persistent genital arousal disorder, the problem is that it happens at all of these inappropriate times. We start to loathe it. It causes us problems. It can cause us physical suffering if you have a prolonged direction for a long period of time. If you're trying to focus on your work, if you're trying to take a test and you have sexual thoughts all the time,
24:14 you can't do anything. It creates all these really negative associations. And in my opinion, the most psychological damaging thing is it takes sex and arousal outside of the column of things that you enjoy in life. So it's kind of like the best example of analogy that I can give you all is imagine that you really love eating hamburgers, but you're allergic to them and you vomit every time you eat a hamburger. Now you can no longer enjoy hamburgers, right? But the good news, if you like, of a gluten sensitivity is there's still lots of other foods that you can enjoy. Imagine I have some patients who have things like cyclic vomiting syndrome and stuff like that where it's like, all food makes you vomit.
24:50 And then imagine for a moment what your life is like if you can no longer enjoy food. That's what's scary about persistent genital arousal disorder. I'm somebody who has it, but I got to tell you about it in case you have it. Can I just say I hate hard-coded subtitles, especially in comedy. It ruins the punchline.
25:08 It's like this is so bad. I want you to know, it's okay to have it. I'm having a great week. I'm on day. heaven right now of antidepressants. So if you don't laugh, no, oh, Z. No, I wouldn't do it here.
25:41 But it's too tough to get a hearth through the city. So, it's actually scary how many people consider convenience and not inconveniencing their loved ones when they're considering ending their life. It's like shocking how important that is. The other really interesting thing is it blows my mind how many people, the most powerful protective factor against ending your life for suicide is actually who's going to take care of my pets, really common for so many of my patients. Antidepressants are fickle because everybody says you're supposed to give them about four weeks
26:16 before you feel anything, which is strange. It feels like if you're depressed, the last thing you have is time. This is one of the problems that's why it's a hotline. Not a P.O. Box. I got hooked up with this drug dealer over at the pharmacy, and she was the one who told me.
26:41 She was like, just so you know, when you're on antidepressants, it takes about four weeks for you to feel anything. I was like... Two to four weeks. Well, do you have a same-day option? Yes, we do now. It's called ketamine.
26:57 Because I am depressed right now. That's why I'm so addictive. Actually, I'm more depressed since you told me this. We are headed in the wrong direction right now. She was like, unfortunately, that's not how it works. Your brain needs time to become desensitized to the drug about four weeks. That way, it won't notice the change. This sounds incorrect.
27:21 So to be clear, I am to wait a month before I feel anything, at which point I will be so used to the drug that I will not feel anything. That's actually somewhat correct. Let's talk about this for a second. Antidepressant medication, specifically SSRIs. Problem number one is that benefits take two to four weeks. It's not going to take you two to four weeks to feel anything. It's going to take you two to four weeks to feel good things.
27:49 Side effects happen early. This is one of the hardest things about it. antidepressants is that oftentimes people will feel the negative side effects of antidepressants within a day or days after starting them, but they don't see the benefits for weeks. Now, the reason for this is because of the way that antidepressants work. Probably what they do is they don't have a direct chemical effect. They're not like caffeine where they turn on our cells. What antidepressants probably do is create more machinery for ourselves.
28:18 So this is kind of like, you know, when you see one of these ads about some product on TV, and they're like, allow three to five weeks for delivery. And the reason is because they don't have the product. They get all the orders. And then they send the order to the factory. And the factory produces it and then sends it your way. So that's how antidepressants work. They don't turn on your cells, which is what cocaine does or caffeine does or benzodiazepines, alcohol, marijuana, take your pick.
28:42 What they do is change what machinery your cells have. So your cell starts building more serotonin transporters or whatever. Okay. So the problem with antidepressants is that. When they are working, we feel normal. We don't feel great. They're not happy pills. We just remove the depression.
29:00 And they work so gradually. And sometimes we'll see an effect size of like 30 to 50% for an antidepressant. So it doesn't do take it all away. So it happens so gradually. And what it does is makes you feel normal. And then people are still experiencing the side effects. And they look at their antidepressant and they're like, I feel fine. I don't need this anymore.
29:20 And then they stop the medication. And then the depression will start percolating back, but it doesn't happen within a day. It doesn't happen within two days. Remember, this is cellular machinery that we're talking about. So after a while, the cellular machinery eventually gets broken down. And then weeks later, the depression can emerge. So one of the key things that I do with my patients is if I start them on an antidepressant, I try to have them stay on it for about a year, which is the natural course of a depressive episode.
29:46 And then we can try to take it off. But if you feel normal and you feel like the antidepressant isn't really doing it, anything that could actually be a sign that it's working because it's restoring you to normality was bumming me out she was like just so you know when you're on antidepressants you can't drink i was like you can't drink you don't know shit about me i have unlimited potential you have no idea what i could do on antidepressants she's like i mean it if you drink on this medication you will have internal bleeding. And I was like, well, if there's no mess,
30:29 I'll keep it to myself. You know what I mean? I'll keep it in. She's like, I think keeping things in is what got you here in the first place. I was like, you're actually pretty good at this. I're not going to lie. Then I had her ring me up for a six-pack.
30:49 I got the fuck out of there, you know what I mean? Oh, yeah, you can check. Okay. Let's talk about antidepressants and drinking. So there are some medications that we prescribed that are like really, really bad to drink with because they act synergistically, can put you in a coma. Top of the list is something like a benzodiazepine or an opioid. The most common problem that I see clinically with antidepressants and people who drink
31:09 is not that they can't drink, which is you still shouldn't. But it's that there are many patients I've worked with that feel like antidepressants don't work. And what drinking does, the most common effect that I've seen clinically, is that alcohol cancels or prevents the benefit of an antidepressant. And even very small quantities of alcohol can do this. So you really shouldn't drink on an antidepressant, but it's kind of like the real problem is like, okay, I'm dieting, I'm on keto and I'm doing intermittent fasting. And in between my intermittent fasting, I'm just going to eat a bag of chips when I feel like it. And it's like that defeats the purpose. That's really the most common clinical impact that I've seen. As for the bleeding risk,
31:52 absolutely true. He must be talking about SSRIs because not all antidepressants are the same. SSRIs do increase bleeding risk. So should be used with a lot of care with other kinds of things. Like if you've got anticoagulation or warfarin or whatever, things like that. If you have your history of bleeding, things like that, then you have to be careful with antidepressants. That's correct. Dude, I'm jealous today. Like, they got the internet to shame their parents into paying attention to them. Yeah, something we didn't have. I realized this a couple years ago when I was having a, anxiety attacks. I'm at the doctor's office and she goes, all right, she goes, before I give you any medication, she goes, I want to know what do you take for your ADHD. I was like, uh, this is the first time anyone's ever told me that I have that. She's like, wow, anxiety and ADHD, you have
32:44 be bouncing off the walls when you were a kid. How did your parents handle that? I'm like, they hit me? unfortunately really common. Which I do not condone hitting kids. But ADHD and anxiety, like I could not stand still. Right? Like, what are you going to do? A timeout?
33:01 I can't stand still. I got to go stand in the corner and look at a wall for an hour. Right? Forget that. Timeouts can be absolute torture for kids with ADHD. So this is what's kind of scary about it is like, we'll give them punishments, but we don't understand if you're neurotypical, you don't understand the subjective experience. of the punishment on the kid with ADHD.
33:23 Second thing here is that, you know, physical, corporal punishment, yelling a lot is also really, really common in children with ADHD. And there's a really scary mechanism around this. People don't usually hit their kids as much as they used to, but people will yell at their kids. Here's why parents end up yelling at their kids. So when you have ADHD, you need a large stimulus. If you're hyper-focused on something, you need a large stimulus to break through your
33:48 attentional focus. So if your parents call your name, you don't hear it. They call a bit louder, you don't hear it. Then you have to yell to snap their attention. So in order to get their attention, you have to use a very high volume. The problem with ADHD is that even though you need a high volume to get attention, the effect of the yelling on the other parts of your physiology are not reduced. So you need to yell in order to basically get their attention.
34:13 But when you yell, their cortisol still spikes, their stress hormone spike, their heart rate elevates. are startled by the yell because the yell still startles them. And then you create a really scary scenario because every time I need my kids' attention, I have to scare them. That's the only way that I know how to get it. There are ways around that. So one of the things that I do with my kids is I actually train one of my daughters as neuroa typical. And so one of the things that I do is I train her with an attention word. So we play this really fun game where there's a word that will use moose juice goose juice for example what i'll do is like when i want her attention i'll be like okay when i say i did this one she was like five i'd say moose juice goose juice look at me when you
34:54 hear moose juice goose juice okay so i'd say moose juice goose she looks at me and then we we turn it into a game where i i will start to say it quietly i'll sneak into the room and i'll whisper it and over time she wants to win the game and once you orient her towards trying to pay attention then something really cool happens where she's like now she knows the game she likes to win she gets a prize whatever becomes fun right i'll sneak up behind her i'll hide behind the couch i'll say moose juice goose goose juice and then i'll whisper it something like that and then she learns to she trains her mind to actually pay attention to it and then when i need her intention instead of yelling i will say moose juice goose juice smack me let me go run around in a yard this is true like trying to fix
35:36 ADHD and anxiety with a timeout be like trying to stop someone's asthma attack by having them to jump in Jacks. That can work. Okay, so let's talk about one other other thing, ADHD and anxiety. So one of the features, one of the new features that we've understood about ADHD
35:53 is that emotional dysregulation is a core component. So when someone says, I have ADHD and anxiety, now as a psychiatrist, what I think about is if they have ADHD, I assume that their negative emotions are more intense than baseline.
36:10 So they may have a separate anxiety disorder, but these kids tend to be prone to more anxiety, more depression, more shame. Because the part of their brain that restrains their impulses, the part of their brain that controls the other parts of their brain is a little bit weaker, which means the part of your brain that controls your negative emotion is also weaker, which means, unfortunately, these kids oftentimes have a lot of intense emotion. The real problem with that is that since they've got intense emotion and they have difficulty shifting their focus, Once they start to have an intense emotion, it becomes really easier to get hyper-focused on it for that intense emotion to spiral in their mind and only intensify over time, which is what makes them prone to dopaminergic sources, drugs, devices, video games, etc.
36:57 Because that's the tool that they use to get rid of their negative thinking. It's fine to laugh about some of this stuff, like trying to clean your living room and ending up with more of a mess. But then the question is like, what do you do about it? So we actually have a great video on developing skills with ADHD that you guys can find in our membership. Check out the link in the description below and start your free trial today. 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.
37:27 Until next time, take care of yourselves and each other.
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