HealthyGamerGG - What Euphoria Says about Mental Health Care | Psychiatrist Reacts

Episode Date: May 9, 2022

Today Dr. K analyzes Euphoria delving into addiction, rehab, clinicians, diagnosis, and more! Support this podcast at — https://redcircle.com/healthygamergg/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy Learn more about your ad choices. Visit megaphone.fm/adchoices

How do you manage your emotions? You must become adaptive managing your emotions. What happened is there were people who were addicted to substances, and they leaned into oftentimes nowadays Christian ideology, and they found that that Christian ideology was very, very helpful. So it's kind of weird, because if you look at Alcoholics Anonymous, what they'll start with is that I'm powerless in the face of my addiction, and that there's a higher power,

and only through the grace of that higher power, can I overcome this addiction? And that sounds kind of like weird, right? So like if you're admitting powerlessness, how is that a winning move when it comes to addiction? An addiction hijacks your power, right? Like that's how the addiction thrives. The addiction tells you, don't worry about it, we got this, we can handle it. You'll be okay. They won't find out.

What we're going to do is talk about euphoria. So for those of you that don't know, Euphoria is a TV show on HBO. and it centers around a lot of like substance use and things that make people euphoric. And what I really like about it is that it really captures, I think, a lot of what mental health and mental illness looks and feels like. So I think the challenge with like clinical approaches to mental health is that we don't really capture what the experience of some of these things is. So we'll have like, you know, we'll have these diagnostic criteria.

Like if you check five out of nine, you know, boxes for a particular, for depression, then you have major depressive disorder. Like if you have trouble sleeping, if you've had a weight change, if you're an hedonic, which means you have difficulty getting pleasure from things, if you're suicidal, if you feel restless. There are all these like categories, right? And so we kind of like check them and it's very scientific and it's very clinical. But I think the challenge is that if we look especially at psychiatry, like psychiatry is not. as scientific as other disciplines of medicine. So it's very scientific. I don't mean to me to say that it's not scientific, but it's not as like materialistic, I should say, probably is a better term. So like psychiatry is a lot more like lived, right? So it's not like

I can biopsy you and diagnose you with depression. I can do surgery and remove a piece of something that will take away your depression. That's not how it works. So depression or addictions, which we're going to be focusing on today, is such a huge part of, like, who we are as people, and not just who we are as people, but the people we surround ourselves with, as well as, like, the society that we grow up in. And so what I really liked about euphoria is that it really captures how entangled addiction is with every dimension of someone's life. So addiction is, sure, there's a genetic vulnerability, but there's also, like, if I have ediction, you know, if I have existential dread about my future, how do I manage those feelings? And as we'll see, they even

sort of touch on psychoanalytic theory based on psychoanalysts that were writing books about this like 100 or over 100 years ago. So a lot of interesting concepts about psychoanalytic theory, genetics, circumstances, peer pressure, and just what drugs do for us and why we use them, how they manage our, how they impact our social relationships. So the thing, my experience as an addiction clinician has been that addictions can permeate every element of your life. Who you hang out with, how you manage your emotions, your family relationships, your success, your, like your difficulty with dealing with the uncertainty of the world.

And I think it really captures all of those things. So let's kind of like dig into euphoria. And specifically, like, what I'm going to talk about today, we're just going to focus on the first 20 minutes of the show. And the cool thing about the first 20 minutes of the show is you're going to learn so much about mental health and how people navigate mental health in a very like, what's the right word, in a non-clinical way. Because mental health and mental illness is so much more than just like the clinical diagnosis and treatment. And that's what I really think is great. So we're going to learn kind of everything you need to know about mental health in 20 minutes. Okay. So let's start with this. Okay? So it's kind of interesting. So the show starts off. So there's going to be spoilers, by the way, but not too many spoilers. It'll be like the first 20 minutes. So it's kind of interesting. So the show actually starts off with this image. And it starts off with like this fetus, presumably Roo, who's kind of the protagonist, being in the womb, right? And what happens when we're in the womb, right? And what happens when we're in the womb,

is we're content. So if we think a little bit about like the womb, right? So the womb is like a place where we have an umbilical cord that's connected to our parent, our parent, our mother, usually. And that umbilical cord kind of supplies us with everything that we need. So all of our waste products, like all of our, the results of cellular metabolism are sent out through the umbilical cord. All of our glucose, our fats, are everything that we need, even hormones. and things like that are sort of transmitted through the umbilical cord. We're very protected in this environment. So we're filled, the uterus is filled with something called amniotic fluid.

And the amniotic fluid like protects us from things like bumps, right? So if I'm, if my mother is walking down the street and the pavement is kind of rocky, the amniotic fluid is going to protect me against vibration. It's going to protect me against sound. It's going to protect me against everything. And so what sort of people. realizes is that like the womb is sort of the perfect environment, right? It's dark. It's just kind of filled with relative contentment. And the interesting thing is that even like psychoanalysts

100 years ago, we're talking about that. And there was a guy named Auto Rank who basically posited that the first major traumatic experience that all human beings go through is birth. So prior to birth, we're perfectly content, right? And like we don't have any needs. There's nothing wrong in the world because we're not even aware of what we are, but all of our needs are getting met. And the second that we were born, suddenly like something drastic changes, right? So we're not, this is where things kind of like evolve into discomfort. So all of our needs are met. And then when we're born, suddenly like we're capable of feeling cold.

We're capable of feeling hungry. We're capable of feeling alone. We're capable of feeling frightened. suddenly like all of these things change. Like we're not perfectly protected in a temperature-stable environment. Sites can be scary. Lights can be bright. Sounds can disturb our rest.

Whereas in the womb, none of these things happen. So AutoRank sort of showed up and he kind of hypothesized that the most basic trauma that human beings experience is the process of being born. And there's some interesting physiologic kind of connotations to this. So, for example, when children are born, they have spikes. of cortisol. So cortisol is a stress hormone. And literally, that cortisol helps with things like lung maturity. So even the process of being born, the stressful experience and all the crying that you experience has a physiological effect of boosting your cortisol level. And that

boosting of your cortisol level actually helps our lungs understand, hey, we need to start breathing and prepares our lungs for breathing, which is why if we have premature babies, sometimes what we'll do is we'll have to use cortisol injections to prepare them for. For or birth and like being able to optimally survive in the external world. So there were a lot of other interesting psychoanalytic theories about birth trauma. So people sort of posited that the most basic form of anxiety or discomfort happens during birth trauma. So there was another analyst named Beyond Bayan, I'm not quite sure how to pronounce it, B-I-O-N, who basically talked about how the basic imprint of anxiety and trauma is like through birth trauma.

So what he sort of noted was that as we look at as we're born, if you think about the infant brain within hours of birth or even days or weeks of birth, we don't really like have the capacity to understand what's going on. We don't even understand like what emotions are. All we have are these raw unfiltered experiences. So in this infant brain, like, you just feel hungry, right? And you don't even know what hungry is. All you know is that there are all these signals that are working their way through your body that make you feel discontent. And you have no control. Like you can't, you don't understand what's going on. You feel bad. You don't even know in what way things are bad. And you're completely at the mercy of the world, right? Do you get fed or do you not get fed? Do you get cold? Do you get changed? Do you get warmed up? Do you get, do they put a beanie on your head? Do they not put a beanie on your head?

So it's kind of this unfiltered roller coaster of negative experience followed by contentment, hopefully, in which you kind of like get milk drunk and you pass out and then you wake up again and you're hungry. And then you're back to this like unfiltered state of discomfort. And so this was very, very fundamentally analysts sort of believe that this is incredibly traumatic and lays the foundation on a very core level of anxiety. And so if we think about what anxiety is, anxiety is like worry about the future, right? What if things don't work out? What if? And if we think a little bit about how does the human brain learn to fear the future? How does it learn to be anxious?

It's through this birthing process. Or at least that's the theory that these people would posit, right? That suddenly now you're in this world where like you don't know how long the contentment is going to last. And you're just getting bodied by all of these weird sensations, you know, frustration. being hungry, needing to get changed, feeling uncomfortable, feeling afraid, but you don't even know what those are. So those experiences when sort of put into the fetal mind or the infant mind are just so incredibly traumatic because there's no way to process them.

There are also like, you know, criticisms or other perspectives on this, but I think it's really interesting that the show essentially talks about this contentment as the beginning of things. Now, the interesting thing is that if you look at a lot of this traumatic birth kind of stuff, what they sort of talk a little bit about is the way that children learn to navigate this in a healthy way or unhealthy way. The way that we learn that anxiety is to be feared above all else, or the way that our anxiety gets reassured, is actually through our original like maternal parent or paternal bonding. So when children are born, they bond. And this show also is kind of really interesting because they talk a little bit about this,

the state into which the main character was born. So the main character, I think, was born right around 9-11. And so they talk a little bit about how their parents, for the first 48 hours of their life, were just watching stuff related to the Twin Towers and the terrorist attacks. And this kind of makes me wonder because, like, you know, this sort of bonding that happens between children and parents is so important. And so what happens to a child who is bonding with a mother or father, who are like concerned about 9-11, right?

So the world was shocked. People are grieving. People are, like, worried. There's a lot of uncertainty in the world. People, like, sort of think the world is going to end. You know, it's very, very shocking. And if the parents are sort of for 48 hours sitting in a hospital room where they're obsessing over 9-11, what impact does that have on maternal child bonding, right?

Because the interesting thing to remember is that children, when we're born, we don't really have logic. We don't have really emotional awareness. We have no way of communicating or understanding other people. All children have is empathy, right? So like the most important circuit, the most important way to communicate and interact with a child is empathy. So parents sort of develop a feeling for, okay, is this kid doing okay? Is this not doing okay? And similarly, kids will be exquisitely sensitive to the moods of their parents. And for those of you that sort of grew up in households where, unfortunately, you experienced some amount of abuse or maybe like drinking in the house, you'll remember that you were exquisitely sensitive to your parents' moods.

So we've had people that we've interviewed, and, you know, this is not just people we've interviewed here, but this is my experience as a clinician. You know, if you talk to kids who grew up in abuse of households, they know within seconds of seeing the parent whether they're in trouble that day or not. They're exquisitely sensitive to the mood of others. And so it starts to beg the question, like, if we grow up in a particular situation where our parents are grieving, our parents are paranoid, our parents are concerned, what does that do to the anxiety that was laid down by our birth trauma?

And this is where it's kind of interesting, because from the get-go, we can explore things like attachment theory. So attachment theory is this idea that how we relate to other human beings, depends on something called attachment. And so whether we have secure attachment or anxious attachment or avoidant attachment or fearful attachment, the way that we fundamentally relate to other human beings gets kind of determined very early on. So let's explain this a little bit, because this is important for drug addiction as well. So when I'm a kid, I don't really understand the world, right? Like the world sort of doesn't make sense to me. So the most

important thing that reassures me, the way I fundamentally get my internal anxiety about the world being reassured or not, is the consistency of the world around me. So, for example, if you think about a child who becomes confident with gravity, right? So, like, if I have a three-year-old, a three-year-old is, like, happy to jump off of sofas, you know, jump onto things, roll around, jump around, jump on a trampoline. They're happy to throw balls, pick up balls, even one year olds will like pick up food and like drop it on the ground right so like kids are confident when it comes to gravity and why are kids so damn confident when it comes to gravity even to the point where parents are like you know have to you have to really watch your kid because they'll do things that are

unsafe when it comes to gravity they'll jump off of things they'll jump into things like you have to be really careful about kids right where does that confidence with gravity comes come from it comes from consistency so the cool thing about gravity is gravity doesn't have moods right like gravity isn't happy one moment and pissed one moment. Gravity isn't sober one moment and like drunk the next moment. So consistency of parenting is what leads to confidence in the child. The second aspect of attachment theory that's really, really important is emotional mirroring, which is related to that consistency. So the other thing to remember is that a one-year-old doesn't know what they're feeling. So how does a one-year-old understand what they're feeling? What they actually do is look

at the facial expressions of the people around them. So when a one-year-old gets hurt, what do other adults do? They pick up the child and they're like, oh, poor baby, is what to baby okay? Are you all right with a baby? Right? So as we do that kind of thing, we sort of like, we show the child what they should be feeling. And so they understand what anger is, because if they're upset, you know, maybe we're going to have to discipline them. If they're acting out and angry, a child may have to be disciplinary. If the child is hurt and falls down, a parent will pick them up and cuddle them and be like, oh, it's okay, baby, it's okay. And then the other thing that happens is positive reinforcement is also emotionally mirrored in like a greater way.

So let's think a little bit about, you know, when the kid draws something that is illegible, and they bring it to you with pride. They're like, look, daddy, like, look at this weird thing that I drew. And as you show the weird thing that you drew, the parents are like, oh, my God. God, that's amazing. Look at that. What is that, by the way? I can't really tell. So what we tend to see with kids in early on is that if parents respond to them consistently

in an emotionally mirroring and supportive way, those children become securely attached. They become confident about the world. And the reason that they're confident about the world is because the world makes sense, right? And you compare that to, you know, children who grow up with. inconsistent caregiving. So this is like a good example of, we'll kind of talk about a couple of these examples. So what we tend to find is that, you know, people who are secure have low avoidance and low anxiety, right? So they're like willing to engage, they're willing to try new things. They're not like, they have confidence in themselves. And then we also have like an anxious attachment,

which is like when people are very, very high anxiety. But they're also, they may be, be willing to engage with other people. So this comes from sort of inconsistent parenting. And then you'll also have like avoid an attachment. So I think avoidant attachments are very, very classically common in terms of men who have difficulty forming strong emotional bonds. So in avoidant attachments, what sometimes will happen is you'll have a child that shares their emotional needs, which are not met by the parent. And so then what happens is the the child starts to resent the parent for not meeting our emotional needs, and then they avoid the parent altogether. So this is the kind of thing where if I share emotional vulnerability and you don't meet me

where I'm at, then I'm going to start resenting you, and then what I'm going to learn is to be fiercely independent, right? Because like the lesson that I learn is if I share my emotional needs with people and they don't meet them, then like I can't rely on people. So it doesn't necessarily make me anxious, but it keeps me, like, separated from other people. So these are people who have struggle to form connections. And if we kind of think about it, it's almost like a protective model, where people with avoid and attachment styles will be, like, very, very careful about, you know, what kind of relationships they form, because they're afraid that, like, if I am vulnerable with you, like, what's going to happen, I don't know. So the best thing to do is not be emotionally

vulnerable to begin with. So there are some interesting experiments that kind of go into this. My point here is that generally speaking, you know, this is protective against drugs, and these three are not protective against drugs. And the cool thing about the show is that the show has different attachment styles that you'll see with different characters that all relate to substance use in some different way. Okay. But the key thing here is that if we're talking about the show, like, I don't know what impact, you know, growing up with 9-11 has on attachment. Now, this doesn't, you also have to be careful. I'm kind of overgeneralizing here because, you know, there are all kinds of kids that grew up after 9-11 that have good and secure attachment who are alive today. So you can't really draw that one-to-one correlation.

But it just sort of makes me wonder a little bit because if we kind of look at the show, the show really emphasizes some of these concepts, right? And like even in this is the first two minutes of the show or 160 seconds and 90 seconds of the show where they kind of talk about the hand that Rue was dealt when Rue came into the world. And that's something that I think is really, really important to think about in terms of addictions. So we tend to think about addictions as diagnoses, right? And we talk about brain stuff and neurotransmitters and genetic vulnerabilities. But the truth is, there's a lot of really core stuff involving addictions that I think the show really sets up very well. Next up. Now, this is fantastic.

So what happens next in the show? Right? So this is actually before we kind of get to this, I want to talk about one other thing. So the other challenge right now that we tend to see, I think, with substance use is that if you really look at it objectively, this is this show sort of shows, okay, 9-11 happened. Rue grew up in this kind of situation. She grew up sort of in a world of fear, right? So in the first 10 years of her life, for those of you in the U.S., like you remember what the post-190. 9-11 world was like, right? So we went to war as the United States. There was an emphasis on terror.

The Department of Homeland Security was created. There was a lot of like racism. There was a lot of discrimination that happened. And so like we kind of grew up with this like once in a lifetime event. I think if you look at substance use, right? So we're seeing that substance use is generally speaking getting worse, or not just substance use. Let's just talk about addiction as a whole. So it's not just like chemical addictions, which are getting worse for all. kinds of reasons. So some of the reasons that chemical addictions are getting worse, substances are getting worse, it's all kind of fascinating stuff. So the first is that we've been breeding stuff to be more addictive. So if you look at the potency of marijuana, the potency of marijuana has

increased drastically over the last like 40 years, right? So people have been like breeding stronger and stronger strains. And that doesn't even include the synthetics. So the other thing that we started doing is getting very, very creative with what kind of synthetic substances will make. So there's like Native American, you know, spirit journeys that involve ayahuasca, and now we've isolated DMT, and people will take DMT, and they'll take different metabol, I mean, different kind of chemical modifications of DMT. And so what we're seeing from addictions is that, like, drugs are getting stronger. They're getting more potent. They're also becoming more nuanced. So this is where we'll get into this in a little bit, but when you get

into addiction, you know, people have a drug of choice, right? So some people will really get addicted to one substance over a different substance. And why is that? It's because their neurochemistry, the way their brain is wired is just a little bit different. There are studies that show that, you know, the dopaminergic or reward response that a particular addict gets from alcohol will be different from what they get from marijuana, whereas another person may get. a huge response from marijuana and very little from alcohol. Now, what you do is you take a world where we have all these different kinds of drugs, right? So it's not just one type of drug.

It's not just marijuana. Now you have sativa blends and you have indica blends. You have CBD heavy stuff and you have THC heavy stuff. Not to mention all of the different kinds of synthetic marijuana, like K2, for example, which is highly psychotic and like doesn't really calm people down. It's like the opposite of CBD. where people, it gives people very, very powerful experiences, but also makes them like kind of crazy. When I was in residency, so huge disclaimer, by the way, like don't do drugs, kids.

And this is a really, really good example of this. So when I was in residency in Massachusetts, you know, people would use K2 and like they would get really, really messed up, like mess themselves up permanently. And it just messes you up so bad. And what we're seeing right now in substance use is that as we make five or ten different variants of drugs, what we're essentially doing is selecting for all of the different variants, right? So if you start using drugs and you try out five different variants of marijuana, you may be able to find the perfect marijuana blend for you, which we'll get to in a second in terms of why people use it, but then what that actually does is opens you up to more addictive potential and more possibility to like really screw up your life. So you've got to be careful

about that stuff. But the other thing that the show kind of highlights, if we kind of think about it, is some of this stuff about, you know, tragedy in the world. So if we think a little bit about what environment Rue grew up in, she grew up in the post-9-11 world. And this is the interesting thing about growing up in this generation, not talking about Gen Z, so mostly y'all who were listening to this, is that we've had like four once-and-a-one-11. lifetime crises within 20 years, right? It's kind of wild. Like, if you think about, you know,

what we, what this generation has had to deal with, it's been like thing after thing, after thing, after thing. And if we talk, we'll get into this a little bit more, but if we talk a little bit about what predisposes us to drug use, okay? What we're going to find is that like, you know, this is the happy and content world. And then you get born into a world, but what kind of world do you get born into? Do you get born into a world that's like post-9-11? And then like, you know, after 9-11, we had the 2007, 2008, you know, economic crash, at least in the United States. And so that was like a once in a lifetime, black swan, unpredictable economic crisis. And then we've got like climate change, right? So the world is like, it's a little bit unclear whether the world will just

straight up end at some point, right? Whether there's some kind of catastrophic collapse to our ocean system. If there's a catastrophic collapse to our ocean system and like all the algae dies, that's what actually produces like traps the most greenhouse gases, right? Algae like or carbon fixers. So they take CO2 out of the environment and they produce oxygen. And then like if they die, like, you know, the fish die and all that kind of stuff, we could see a catastrophic collapse to the world. Like we could be like literally like apocalyptic kind of times, right? And no one really knows whether this is going to happen or not happen. Some people think we're overblowing the risks. People think that this is, we're definitely on the path to destroy ourselves within 100 years.

I don't really know. I've looked at a lot of science. It concerns me, but it's not my area of expertise. The point here, what we are focused on is not whether the world is going to end or not, but growing up in a society where there's like a lot of very strong scientific evidence that we're on the path to screwing ourselves, right? There's economic crises. There's climate change. There's stuff like 9-11. and by the way, there's also this global pandemic,

which basically shut down the world for two years, right? And like the human rights related stuff that's happening with COVID as well. Like, there's all kinds of stuff going on. And this is the problem is that, like, what is that doing to our psychology? What is it like to be a 20-year-old kid existing in the world today? And there's a counter argument here as well, where you can say that, well, like humanity on the whole has gotten a lot better. and like, there's definitely an argument for that, right?

So if you look at medical advancement, like, it's pretty cool that, you know, we've basically eliminated polio through vaccines. We've basically, we can catch, we've essentially eliminated cervical cancer or reduced cervical cancer drastically through the HPV vaccine. So that's huge, right? People are dying of cervical cancer. Like, I remember in culturally and, like, religiously kind of the same thing. You don't name a kid until they're, like, 30 days old in several cultures.

right? Why is that? Like, why don't we even we even give kids names? It's because infant mortality used to be through the roof. Now people think about their kids' names before even they're pregnant. Like, we take it for granted that our children will survive, right? Which is that is an assumption that human beings didn't have 100 years ago. So there's absolutely been progress. Like, there's no question about that, right? So we've got like solo panels, like, that's pretty cool. We've got electric cars. Like, that's pretty cool. We've got technology and video games and virtual reality and medicine is improving. That's pretty cool. We're in the days of like Uber and Uber eats and we have so much cultural exchange. Like I can watch a Korean soap opera if I want to.

Like that's pretty cool. So life has definitely gotten better by a lot of objective measures as well. But when we think about the psychology of what it's like to grow up in the world today, we get bombarded by like some really, really scary stuff. And what do we do about that? Right. How do we manage that? Like it's like, okay, So you're telling me I have to go to college, right? And the reason I need to go to college is so that I can get a good job. The reason I can get a good job is so that I can be financially independent and then presumably get married and have kids and all this kind of stuff. But like, what if the world ends in 20 years?

I've had several patients talk to me about they're afraid to have children. And it's like, why is that? Well, it's like, I don't want to bring a child into a world that's like apocalyptic because the climate is collapsing and then like human beings die. like, that's terrible. Like, I don't want to do that. I've had patients who talk about the anxiety and concern about bringing children into this world, which I'm sure to some degree has always been there, right? So every generation is concerned about the world ending, like, in the next 100 years.

I'm sure that there are people who sort of do that, but are concerned about that. But I really think that our exposure to this kind of information, the volume at which we get it, because it's always one disaster after another, right? we just has something to do with the internet and the way that we consume information, the way that information floats to the top. So what information floats to the top? The information that is emotionally charged, that's what we react to. And so what ends up happening is we see the most emotionally charged stuff from all over the world,

day after day after day after day. And what impact does that have on our psychology? Well, it's like, okay, I've got a choice between this or this. and this is what I want, right? I want to go back to the womb where, like, there was no sense of, you know, things are going to hell in the womb. In fact, everything was perfectly content.

Okay? So now you get kids who are growing up with some amount of existential dread. And this is where things are going to get a little bit tricky. So then what happens is, like, you'll get some kids, right? And here's the thing.

Kids are unique. Not all kids are the same. I don't know if you guys can kind of see this. one, but she's just, she's counting up here. So she's just like counting things on the ceiling. And then the parents like look at the kid and they're like, wait a minute, I don't understand what my kid is doing. So I want you to think a little bit about, you know, if Rue was born 200 years ago and she was counting objects, right, maybe a little bit of like obsessive compulsive tendencies, what would a parent do? A parent would be like, I don't really know what's up, right?

we didn't have answers for everything back then. But now living in the information age, it's very subtle. But we look at something and we see a kid and we don't understand what they're doing. They're maybe a little bit unique. It's a little bit of a strange behavior. And then like the parent is like, okay, what is going on? Because there's sort of this assumption that there is an answer out there. And I don't know if that makes sense to all, but like 100 years ago, you know, there wasn't Wikipedia.

Like, we didn't have answers at our fingertips. In fact, like most human beings like didn't really have answers to stuff. which is why religion used to be so big. So religion would give us some vague sense. Oh, this is just like God makes each and every one of us in a particular unique way. Okay, period, right? Is Rue really doing anything that's problematic in this scene? Like, no, she's just like counting stuff, maybe a little bit distracted from her dinner.

Like maybe that's, you know, there's just something like a little bit weird. Like our kid is doing something that's a little bit suss. Completely normal. But nowadays, we need answers for everything, right? Because we've grown up with the assumption that there are answers for everything. There's a reason I'm doing this. There's a reason my kid is that way. And what's even more terrifying is if you're a parent, what if you're like messing up, right?

So you want to be a good parent. And your kid is doing something that you don't understand. So what do you do if your kid starts doing things that you don't understand? You can't let uncertainty be a part of it because what if you screw up? What if you're missing something? What if something is going on? Because everyone's talking about mental illness. What do we do?

We take him to see a psychiatrist. Right? we're like, oh, I don't understand what's going on here. So let me go take my child to get help. And so now we get into the bucket of pediatric diagnosis. And this show, I think, does a good job of sort of sharing some of the frustrations with it. The reality of it is that this would never happen in real life. Like this would never, ever, ever, ever, ever happen.

But I think it captures or is hyperbole for one of the points. So this is where she gets diagnosed. with OCD, generalizing anxiety disorder, ADHD, bipolar disorder, but maybe she's a little bit too young. We can't really tell. There's also this sort of idea that we think that psychiatric diagnoses have to happen because of drastic negative things. So she talks a little bit about, like, she wasn't physically abused or, like, didn't grow up

in, like, a situation where she didn't have clean water, like, there was nothing really traumatic, right? And so we sort of assume that, okay, the kids who get psychiatrically diagnosed are kids that, like, grew up with traumatic situations, like parents who are using IV heroin. And that's how you get kind of mentally ill as a kid. So there's kind of like a lot of really good things in this imagery where essentially what happens is we, you know, take people to psychiatrists, they see something unusual and they like, you know, they go looking for a diagnosis. And this is where there's kind of this funny sort of thing about medicine. and which is that if you take people, if you take someone to a doctor, that doctor will diagnose them with something, right? So this is kind of like a funny sort of scenario, but a family member of mine about 10, 15 years ago was having a medical problem. And what they did is they went and saw three

specialists. And each of the specialists gave them a different diagnosis. They gave them a diagnosis from their specialty. So I'll give you all like kind of a good example of this, a simple example. So there's now a condition called IBS, which is irritable bowel syndrome. So irritable bowel syndrome is sort of like this nonspecific condition, where your bowels are kind of irritable. Like that's just what they are. So sometimes you get diarrhea, sometimes you get cramps, sometimes you get constipation. There's no like real blood in the stool.

Biopsies don't really show anything. Lab tests are pretty nonspecific. It's not like you have an infection. You know, if you do a stool culture, you're not going to grow out like parasites or anything like that. But something's just like our bowels are just kind of messed up, right? So it's like, you go to a GI doctor, they'll diagnose you with IBS. You go to a psychiatrist, they'll diagnose you with generalized anxiety disorder, because anxiety has stomach components with it. So sometimes people with anxiety can get their bowels messed up, right? So you can get diary and stuff

like that. You can go to an endocrinologist and they may diagnose you with something else. So this is the kind of thing where if you, like, show up to a, see a psychiatrist, they're going to do their job, which is diagnose you with something. And there's another, like, subtle problem here, which is that people tend to get tacked on, like, diagnoses. So you'll see this a lot, unfortunately. Maybe you'll have been through this as well. Whereas, like, you'll get diagnosed with the first thing.

Like, you'll get diagnosed with anxiety. Generalized anxiety disorder. You get started on a medication. And then if something happens, like, let's say you have a traumatic breakup. And then you end up feeling suicidal and you go to the hospital. What the people at the hospital are going to do, they're going to see, okay, you've got generalized anxiety disorder. You're on medication for anxiety. And you're in the hospital.

So, like, there must be something else, right? Because the medication you're on is treating the anxiety. So there's like another disorder that has been missed. And since there's another disorder that has been missed, because the anxiety was being treated by this, let's tack on another diagnosis. Oh, so now you have bipolar disorder and generalized anxiety disorder. but it's really hard to go back and wipe away the generalized anxiety disorder because that's also where, like, as a clinician, if you're diagnosing someone with bipolar disorder, you don't know what the person who diagnosed them with generalized anxiety disorder saw, right? So you don't know if they were seeing bipolar and just misdiagnosed it, or out of like your own humility, you're like, maybe they just saw anxiety and I can't see the anxiety because the bipolar is active, right? So it's like a really, like, I don't know if I'm missing y'all here, if that's a little bit complicated. But if there's, like, active bipolar disorder, like, that may drown out the generalized anxiety disorder.

So then as a clinician, you're left kind of confused because you're like, is this anxiety plus bipolar? Or was it bipolar all along? Well, I don't know, because I wasn't there. I didn't see what that person saw. So maybe that wasn't bipolar. And then what happens is, like, the safest thing to do, because you don't want to, like, underdiagnosed, right? So, like, think about it. You don't want to, like, take away generalized anxiety disorder from their.

chart if that's what they've got because then you're signing them up for suffering because now we're treating generalized, we're treating bipolar disorder and then their anxiety is now untreated and you're sending them out the door like setting them up to fail because you've taken away treatment that could be really helpful for them. So what do you do? You tack on bipolar. And then something else happens another traumatic breakup, right? And then like they get sent back to the hospital because sometimes people get suicidal. And then it's like, well, okay, well, hold on a second. They've got anxiety. They've got bipolar. They're on medications for both of these things. That's not enough. We're missing something else. Aha. As we tunnel down further, tunnel down further,

ah, there's trauma. So now you get tacked on a PTSD. Right? And so what happens is we build up these diagnoses for people over time. And you get diagnosed with this and this and this and this. And the show, I mean, there's no way that this would actually happen where like, you know, they're diagnosing a kid with like four things at the same time. Not going to happen. Even people are not that negligent. But I think the show does a good job of highlighting that this is what happens, especially to like kids, right? We're like, we don't know what it is.

The parents are concerned, so like it kind of fits some checkboxes. And this is a problem with psychiatric diagnosis because there's no biopsy. There's no x-ray. All we have are checkboxes. And I'm sure that y'all can understand that like, I mean, maybe I'm taking this for granted. But, you know, the checkboxes for anxiety, the checkboxes, the checkboxes, for bipolar and the checkboxes of OCD can overlap quite a bit.

Right? Like, if I'm OCD and I'm not able to control things properly, I'm going to get really, really anxious. The experience of people with OCD is oftentimes anxiety. Because if you think about it, like if I have OCD and I have to turn on the light,

on and off the light switch 15 times, right? Before, like, and if I don't do that, everyone in my household is going to die from a meteor strike. That's literally the kinds of thoughts that people with OCD have. What do you imagine my internal experience is going to be? It's going to be anxiety. So I go to a psychiatrist and say, I'm anxious all the time. Or my friends see me and they say, oh, you're like, you're super anxious and you need to relax. You need to go see a therapist. And then you go to the therapist and you say, hey, the therapist asks you like, why are you here today?

And you're like, well, my friends think I'm super anxious, then I need to chill out. And the therapist is like, okay, so tell me about your anxiety. Well, I'm, like, worried that people, like, bad things are going to happen to people that I love. Okay, tell me more about that. Now, hopefully you have a competent clinician, and the competent clinician actually assesses you for OCD, which is what they're supposed to do. But this is where, like, unfortunately, we live in the real world where, you know, people get a certain amount of time for a diagnostic assessment. Sometimes clinicians are burnt out. Like, and you just answer questions in a particular way, and, like, you think you have anxiety.

and one of the things you learn in medicine is that learn to trust the patient, right? Honestly, I'm not kidding. So I've had, like, patients come in and, you know, they're like, I'm afraid something's wrong with me. And we do tests and stuff, and we're like, we don't think anything's wrong with you. They're like, something's wrong with me. It's like, okay, like, let's take that seriously. Let's do, like, more tests. Let's try to figure this out.

Because patients know their body is better than doctors do, right? So we listen to the patient. So sometimes they get diagnosed with anxiety when really what they have is OCD. And so they get treated for the anxiety, but they don't get treated for the OCD. and then later on a clinician comes along and then like assesses them for OCD and this is, oh, they've got OCD. And then that clinician has the same problem. Now, okay, so I diagnose OCD, but does that mean that the anxiety was the OCD or did this person see something else that is now being medicated and treated by this treatment?

So it's actually like generalized anxiety under control. You all get that? Like, it's really hard as a clinician. So I'm not sort of blaming that. I'm not blaming clinicians here, but unfortunately, like, this is way too common, where kids will, like, get diagnosed with one thing and another thing and another thing. And we don't have biopsies to diagnose you with major depressive disorder or OCD. And we sure as hell don't have x-rays to rule out psychiatric diagnoses.

So it is so hard to get a psychiatric diagnosis taken off of your chart. Right? Like, how do people know? Like, we don't know. FMRI doesn't do it, my friends. Sorry. I'd love it if it did, but it just doesn't do it. Okay?

So, I think the show does a great job. This is also like the first two minutes. Oh, man. So the next part is even worse. Okay. So the most terrifying thing as a child is when your parent starts manically reassuring you

for something that isn't wrong, right? so they're like, like, you're just a kid. You're just you. And then suddenly your parent shows up and says, honey, it's just the way that you were hardwired. Plenty of great, intelligent, funny, and interesting people have what you have. Struggle with the same things you struggle with. But like, here's the thing.

I want you all to understand this. This is not a struggle. The kid is fine. They're just counting. Right? You'll get that? Like, I'm not saying that the kid doesn't have OCD and doesn't need treatment and stuff like that. But this is the other thing that tends to happen is that kids who get diagnosed with something,

they're not broken in some way. Like that maybe is a statement that I'll get in trouble for. But I really, as a psychiatrist, I don't view that child as broken. And these statements are true, right? Like, sometimes people are just wired differently. But then it's like you're the kid and you're like, what's going on? Like, I'm confused. I went and I saw the doctor and now I have to take these pills. And there's mom with a huge smile on her face. Right? Look at how, oh, honey, here, take this medicine. Your brain is wired differently. And there's nothing wrong with you.

You can be so successful. Lots of brilliant people who are just like you are, hon. And then like, it confuses the hell out of the child. They're like, what is going on here? I didn't think that I'm just counting, yo. I like to count. It makes me feel good about myself. And this is what parents do because parents, it's not their fault.

Because parents are terrified, right? When they see, like, look at this. Look at this facial expression, right? The parents are terrified. They're terrified of all of these diagnoses. What does this mean for my child? Oh my God, I'm so scared. I'm so scared.

I'm so scared. And look at the kid. The kid has no idea what's being said, but what's the kid's facial expression? Kid is matching dad. Kid doesn't know what the hell is going on, but they know it ain't good. and then mom shows up with smiles. Hey, everything's going to be okay. Because the parent, too, the parent wants everything.

They're devastated. Parents devastated on the inside. But we can't let the child be devastated. We can't let them know that, oh, my God, they're taking all these pills because they're crazy. So we see this like false positivity that the parents are like, oh, like people have struggled with what you've struggled with, right? Like, you can be okay. Like, everything's going to be great.

Like, you're going to be awesome. There's nothing to worry about. And the kid was like, I'm just counting. I wasn't worried to begin with. I was okay. Right? And so there's this discrepancy between the way the parent feels and the way they act. And that can really mess kids up.

So now it's like confused. But there are a couple of other things that the kid learns, right? Okay, so if I feel bad, maybe these are the antidote. And then we get into this, which is devastating. So like, it's so beautifully written. So just that the world moved fast and my brain moved slow, right? And so, like, what starts to happen when you get medicated is that, like, some of these medications, so I don't know what this, I don't know what these are, but let's assume that

there started on a mood stabilizer. We wouldn't do this all at once. This is terrible. No clinician would do this. You get started on a mood stabilizer, an SSRI, maybe like some kind of anxiolytic medication. and what are those going to do? They're going to slow you down a little bit. So the hardest thing that I've struggled with as a clinician is, like, my patients with bipolar disorder

really, really dislike the medicine, some of the medicine anyway, because they feel like it slows them down, especially if they have a creative interest. And this is really interesting, but, you know, this isn't wrong. So a lot of, like, very funny, interesting and creative people do have mood disorders. And I call it something called the artistic temperament. I've worked with a lot of people, and I work really hard to really minimize their medication. Because the truth is that those experiences of depression or mania are what is what inspires these people to create their art. It's like understanding the depths of despair and suicidality, which then you put into a piece of art that is powerful and resonates with the community and makes your art magnificent.

right? And it's the price that we pay for being geniuses and like our mental kind of gets busted as a result. Or there's something there where I've just seen too many successful artists struggle with mental illness. And it's it's really hard. But like I think that there's absolutely a way to kind of navigate that in a forward in a healthy way. The first is it helps the artist that I work with when I'll sort of share with them. Like I think you have the artistic temperament. And they'll be like, what is that? It's like, yeah, we can diagnose you with something, sure. But I think that you need to understand that, like, this is what makes you great.

Right? These experiences that you have, I understand that they make you suffer. We're not going to try to, like, let them go unchecked, right? And the real pathway forward is trying to figure out how we can access that authentic suffering part of you. And yet not let that part take over your life. and my goal is a clinician when I work with people who have the artistic temperament is to somehow let them create art without sacrificing everything else. Because that's oftentimes what they have to do.

Because they're like, you know, when they're, you know, hypomanic and they're painting for 20 hours a day and they create this like life-affirming artwork. It's like they're not paying their bills. They're ruining their relationships. They're losing custody of their kids. And like, that's not worth it. Or maybe it is. It's not for me to say.

But as a clinician, my job is to help you create that art while at the same time, like, helping you put together a life that is, like, stable and worth living. And so this is the experience of people, right? That the world move fast and my brain move slow. And then you find yourself, like, trying to outrun your anxiety. And the truth is, it's exhausting. It's just exhausting. That's the best word for it.

So now what happens is I want you able to think about this for a second. So, like, you're a, what, 12-year-old, third? 13-year-old kid, you're in middle school. And like, middle school is hard enough. But if you have anxiety, if you have medication, everything becomes harder. Both of them make things harder, right? Ideally, I mean, in a good clinical scenario, you know, and I've seen this for kids as well, where medication can be drastic and it just makes your life feel fantastic. Like, you just, it really fixes the problem and allows you to live life. That's the purpose of medication. Right? We want to use it to the point where it doesn't make your brain move slow. It just makes

so that you don't have to outrun your anxiety. Like, that's the goal of medication, is to let your brain be calm so that you can enjoy life. But oftentimes what we tend to see is that it makes life just exhausting. You're outrunning your anxiety one moment. You're struggling to understand math the next moment

because you're on a mood stabilizer that slows your cognition a little bit. Right? And that's just how you feel. And so, like, this is your life. Like, you forget about existential dread and all that crap, which has been baked into this person from birth. But life is just hard.

You're tired of it. And so this is where we start to get into identity. And so at some point, you know, this is the scene in the movie where mom distrusts Rue and Rue basically smuggles fake urine in to dodge a drug test. And this is, this captures so much about what it's like to be an addict. So the first thing that I want you to understand is that, you know, at some point, your symptoms start to become you. So at this point, we have a diagnosis. The diagnosis is separate from you.

And then it's the way our brain is wired. And now you find yourself trying to outrun your anxiety. Right? So there's still your anxiety and there's the you. And at some point, it becomes who you are. so you become an addict. It becomes the person that you are. If I could be a different person, I promise you, I would.

They don't ask for this, right? Rue didn't ask for this. She didn't ask for this. She didn't ask for this. She didn't ask for this. She didn't ask for this. And she sure as hell didn't ask for that. Right?

And so we hate being addicts. We wish we were different. We wish we were so different. right? But this is where I think things get really challenging. So the challenge is that like we're in this world that is full of existential dread. Our brain is hardwired a particular way. We didn't ask for it. We just kind of show up one day. And I just showed up one day without a map or a compass or to be honest, anyone capable of giving me an iota of good advice, right? And we have our mom who's like, did you eat breakfast this morning? And this, I think, is a consequence of this is, it's a beautifully

written set of dialogue because I think it captures so much about what's wrong with our world right now. And what's going on is like Rue is a person, right? This is a whole person. The problem is that what we've managed to do is separate out all of the aspects of the person. So if you've got a disease, go see a psychiatrist and take these pills and it'll fix that. Right? Like, if you have body image issues, like or peer pressure or things like that, that's something that the school should handle. So the therapist should handle this. The school should handle this. The psychiatrist who's prescribing your medication is supposed to handle that. Remember, those aren't even the same anymore. and then the parent is supposed to make sure that you eat.

Right? But like, who is supposed to help you with all of it? Because the psychiatrist isn't going to be asking about your diet. Your coach in gym class is not going to be asking about your medication. And your mom is not going to ask you, like, it isn't like going to help you with the existential dread. Right? Because mom is just worried about making sure you get your meds. There's a, you know, like,

They're just going to make sure that you're getting fed, which is all they can handle. There's another scene here where mom is frustrated on the phone trying to figure out how to get, how to pay for Ruse treatment. Right? So mom's got a lot on her plate. Like, I'm not really faulting her. And this is the problem is that if we look at a human being, like it's all of this stuff. Right? It starts with here. It starts with this. It moves on to this. Moves on to this. Moves on to this. Moves on to this. and like how do you, who is going to help you with the fact that you're just exhausted as a 13 year old and the world is moving fast and you're moving slow and your brain is moving slow. Who's going to help you with the fact that you're trying to outrun your anxiety,

but you take it with you wherever you go so you never succeeds? Who's going to help you with all? It's like, what am I supposed to do with my life? How do I handle these feelings? What does this mean for my future? Forget about the feelings. Like, they're the therapist as talking to you about your feelings, but like what is the therapist?

actually going to do about climate change? Because that's a valid fear, right? It's like, sure, I can go see a therapist because I'm depressed because I have crushing student loan debt, US once again. But like, what is the therapist going to do about that? Oh my God, that must be so hard for you. Yeah, you're damn right. It's so hard for me. Like, what are we going to do about it? And so, like, this is where we end up. We don't know how to navigate life, right? And I'm not trying to crap on therapy. I'm just saying that therapists are great. Don't get me wrong. It's just that therapists can't fix climate change.

And this is a real subtle problem, which is that therapists can help you with cognitive distortions. The problem is that the anxieties that you have may not be distortions. You all get that? Like, a lot of what we struggle with, like half the problem, the reason that mental health is getting so much worse is because these are not malfunctions of the brain. People aren't, like, misinterpreting stuff.

This is actually what's going on. If you look at things like grooming, how old were you, if you're a girl, I guess applies to guys too, but generally speaking, I think about girls. How old were you when you got your first dick pick? Right? Like, that's a reality. Like, you have to deal with that. This is not a cognitive distortion. It's not a malfunction of your mind.

Right? You guys get that? Like, these are real problems that we don't, we're not given advice or a compass. or Matt, right? And we see, like, people like 9 to 13, shocking, but that is like really consistent with most of the people that I've worked with. Right?

It's staggering how bad of a place the world can be. And so this is beautifully said. And at some point, you make a choice about who you are and what you want. Right. And this, I assume, is Rue's mom, right? So we see that there's a genetic predisposition to anxiety. that her mom uses Xanax, and you make a choice about who you are and what you want.

And you take a substance. And everything you feel and wish and want to forget, it all just sinks. And then over time, it's all I wanted, those two seconds of nothingness. And you're just so happy. And thus is an addict born. Because for two seconds, after you take this pill, it's back to the womb. And this is the interesting thing. I was talking to, you know, there's one person, one patient that I really learned a lot from. And, you know, it's kind of weird. So I'm a psychiatrist. Sure, I'm qualified and stuff. Like, you know, I've got good training behind me and I'm a medical doctor and all that good stuff. But the truth of the matter is that if you really want to understand any addiction or any disease, the psychiatrist is not the expert. The patient is the expert. And it's a patient that I was talking to a patient once. And we've gotten close. Right? So I'd been working with them for a while, and I was just stunned. And I said, you have such an amazing life. You have such an amazing life. You know, you've got a career that I know you enjoy. You've got a family that loves you and, you know, all this kind of stuff. And you're throwing it away. Right? So you're going through divorce proceedings. You're now in debt. You've like had one of your cars repossessed and things like that. You had to sell off some stuff. Your children are being alienated from. You're now in debt. You've like had one of your cars repossessed and things like that. You had to sell off some stuff. Your children are being alienated from. You're. You're. You're

you, why don't you stop using? And then they blew my mind, but they said, it's because of that that I can't stop using. Because you're right, that, like, my life is turning into a mess. And every hour of every day, my life is a mess, except when I get high. And so I have, all I have to do is put a needle into my veins, and, like, for a few hours, like, none of those, all those things cease to exist. Right? I'm just, so happy in those two seconds of nothingness. I'm just so happy. And this is where I want to sort of take a, let me just see where this is going. Let's see. Okay, hold on. So we're going to talk for a second about what addiction does for people, okay? So these seconds of nothingness in which you're

just so happy has a Sanskrit word for it. And that Sanskrit word is Saman. And that Sanskrit word is someone. Samadhi. Samadhi is a temporary state of enlightenment. Where the ego dissolves, you dissolve, and all you are is unadulterated experience. You're just sort of this weird, like cosmic awareness, which is also nothingness. So keep in mind that drugs are not addictive. So people talk about nothingness, but they think it's like oblivion, but it's not oblivion. So remember that drugs don't put people to sleep. That's not why they use them. They keep people awake, right? Like, you want to stay awake when you use drugs. Because what it puts you into is a state of consciousness where you're beyond mind, where you're beyond time, and you're just existing in nothingness. Which sounds like kind of an oxymoron, right? Like, how can you exist in nothingness?

Or the other way to call it is like, it's like pure existence without, like, attachments. So there's no, like, consequences to things, right? you can just appreciate the colors and everything that you wanted, all of your wishes, all of your desires, all of your sufferings, all of them disappear. And this is what's so confusing for a lot of people who meditate is they're like, I don't want to get rid of my desires, right? It's my desires that motivate me. It's my desires that make me what I am.

It's my desires that make me happy. But as people meditate and as they attain states of samadhi, their desires begin to melt away. And you don't know how to continue living. until you've experienced it, you don't know what that means for you. And so you can appreciate things when you're high, like colors and the taste of food and the feeling of wind on your skin. And the other people that talk about experiencing this stuff are the yogis. Because they say, oh, look, you know, like just be with, just be.

You know, enjoy. Transcend ego. And so I think for a lot of people, drugs are basically like a budget. Samadhi. They're like a temporary shortcut to bring you to a place where like the yogis, like, Buddha has been trying to teach people how to do this for thousands of years. And then like, here's the problem is that your brain is like, okay, so I can do hardcore meditation for 15 years and maybe I'll get to this state because remember when you start to meditate, you don't know what this feels like. Right? So like this is all a myth to you. It's a hope. It's like telling someone that,

you know, sail to the end of the. the ocean and you'll, you know, the world is round and like you won't fall off. It's faith, but you have to embark on that very, very long voyage on faith and you have no idea what you're going to be getting at the end of it. And then what you have is you've got a pill that can bring you there. It's so much easier. Like, why bother meditating when you can get high? Like, because it's so immediate. It's so enjoyable. It allows you to forget all of your body images. issues. Here you are, exhausted, worried that you're overweight, worried that your brain is moving slow, and disappears. It's a pill to make it go away, right? Why bother? It's bliss, samadhi.

And so then we get into trouble, right? We use for a while. In Rue's case, she has an overdose. That's a medical emergency that she possibly could have died from. And then parents get free out, and understandably so, right? Because they're parents and they love you. So what do we do? You've got a diagnosis. You're an addict. There's treatment for it. Let's not judge. Let's give you treatment. And so they send you to rehab. And oh, chat, could I talk about rehab? So here's the thing about rehab. Man, where do I even begin? Okay, let's talk about rehab. So rehab is fantastic in some ways, and awful in others. So the first thing is that if we look at some of the rehab traditions,

what happened is there were people who were addicted to substances, and they leaned into oftentimes nowadays Christian ideology, and they found that that Christian ideology was very, very helpful. And it was for a lot of good reasons. So I'll give you guys just some example of some of the ideology behind Alcoholics Anonymous that I think is very kind of like scientifically validated. So it's kind of weird because if you look at Alcoholics Anonymous, what they'll start with is that I'm powerless in the face of my addiction and that there's a higher power and only through the grace

of that higher power can I overcome this addiction. And that sounds kind of like weird, right? So like if you're admitting powerlessness, how is that a winning move when it comes to addiction? And it's interesting because it absolutely is. And this is where the yogis have been talking about this for a long time as well, surrender, the power of surrender. And so the tricky thing about an addiction is that an addiction hijacks your power. Right?

Like that's how the addiction thrives. The addiction tells you, don't worry about it. We got this. We can handle it. You'll be okay. They won't find out. You'll be able to handle it. You'll be able to handle it.

It'll tell you whatever you need to do to get to that next hit. Right? It says, don't worry about it. I have things under control. I'm in control. Sure, I got a DUI, but I just won't let it. that happen again. It's fine if I continue drinking as long as I don't get another DUI. Got another DUI? Oh yeah, I slipped. There were like some, you know, mitigate, there were some

circumstances there. It wasn't really my fault. Uber's from now on. And you'll even adjust a little bit, right? That's how you become a functional alcoholic. As you adjust and you adjust and you adjust. The one thing that you're not going to give up, you'll adjust all these different dimensions of your life except for the alcohol. That's got to stay because you're in control. And if we look at where a lot of addiction gets out of control, it's from this fundamental idea that I am in control. Because as long as you're in control, you can keep doing it, right? Because you're in control.

Like, it's okay. And so A.A. stumbled upon this or discovered this, you know, whatever. And they sort of start with these things like the alcohol is going to win any combat we engage in. And that's actually incredibly powerful. So they discovered like some of these things and they sort of leaned into religiosity. and like they developed, you know, A.A. And so that's what the rehabs are like. They tend to, and then they develop these systems, right?

And so there's a lot of religiosity to it. There are the steps and the coins, and this can be really powerful stuff. Don't get me wrong. But the tricky thing here is that you can, like, and then rehab becomes a treatment, right? So people do studies and stuff. And as we do studies on rehab, we realize, okay, this is how you fix an addiction. This is the best evidence-based people. will go there, you're going to be sober for 30 days, you're going to get clean, it'll turn your

life around. Because some people that leave sing the praises, right? They say, oh my God, it works so well for me. It'll turn your life around. It fixed my kid. And so you're a parent and you're terrified that your child almost died. So you'll pay whatever. You drop 50 grand for one month of treatment. And you send your kid there. But this is the same problem as before. It's the same problem as before. It's same problem is, you know, like this, where now it's like there's another problem that shows up. Let's ship our kid off to rehab. Outsource the addiction treatment. They'll fix my child at rehab.

My child will come back and everything will be fine. But here's the problem with rehab. It's going the wrong way. What you want when you go there is really important. So I've seen this unfortunately time and time and time again where people come to rehab. but do they want to get clean? Half the reason that people come to rehab is not because they want to get clean.

It's because someone is making them get clean. And so here's the trickiest thing about rehab is you can participate 100% and you can be completely sober at the end of it or you can be a complete addict at the end of it. You can go through all of the motions of rehab and not be rehabbed one iota. Do you all get that?

This is the problem with rehabs. an addiction treatment in general, is you can show up to every meeting, you can talk about your feelings, you can hold hands with other people, and say, and God grant me the serenity to accept the things that I cannot change,

and in your fucking mind, not buying one bit of it. And no one will ever know. The only person that will know is you. This is the problem with rehab. Can it be helpful? Absolutely. Is it an evidence-based intervention

that helps people with addictions? Absolutely. Have I worked at rehabs where I've helped people make substantial and transformative changes to their life? Absolutely. And I've worked at rehabs where I've seen people who talk to talk but aren't going to walk the walk. Because on the inside is where it matters. And if you actually, when you say this prayer, there are two ways to say this prayer, right? God grant me the serenity to accept the things I cannot change.

You can say it as words. and in your mind be thinking about whatever you want to, or you can actually like think about it and recognize that when I use a substance, it is because it is intolerable for me to not use it. And that if I can accept that intolerability, then I have a pathway to sobriety. It's simple.

I cannot tolerate this. And the problem with the drug, the problem with the fucking drug, is that the drug makes you need to never, learn how to tolerate. You don't need to tolerate it. Because if you take the medicine, if you take the drug, you don't need tolerance anymore because it puts you in this state. It puts you into a state of samanthi. And so you say this prayer because they're like, they just like toss this stuff out at you, right? Because even in these rehabs, they're like,

they're like factories. You get, oh, we've got 14 newbies today. Go get checked in over here. There, you know, room checks every two days. Thursday is lasagna night. You'll get your one-day chip, your one-week chip, and your 30-month chip. And then they have graduations and all these other kinds of like ceremonies and things like that, which matter to some people and don't matter to other people. And so it's like this script. But like a script is not a substitute for a map or a compass. A script is not a substitute for anyone capable of giving one iota of good advice. But this is what's happened is we become scripted.

And so you go and you go through the motions, right? And then like, are you better off after? Who knows? Who knows? This is a problem with rehabs. The other subtle problem. I mean, rehabs are great in general. Just to be clear. We're just sort of talking about the downsides, which, remember, that has a lot to do with her, right? It's not so much that the rehab doesn't work. The downside, though, is that there are some rehabs whose business model is to not work. So I've seen this, unfortunately in some very upscale, very expensive rehabs that cater to executives. But their business model is like you're going to come to this beautiful place, like on an island off the coast of Florida or something, like some beautiful area of California like in Napa Valley. And we're going to like, you're going to get sober.

We're going to do this like spiritual kind of like talking about stuff. You're going to talk about your feelings to see a therapist. You're going to do an infrared sauna and you're going to do this and you're going to get massages and you're going to do yoga. You're going to learn how to meditate. And by the way, we're going to like artificially. restrict your substances, you don't actually have to real work, but it's going to be like basically a

30-day vacation that you feel fantastic afterward. And then we're going to have very poor aftercare and we're going to send you back into the environment where you have access to alcohol. And you're just going to screw up again. And when you screw up, you had such a positive experience here that you'll come back and we get repeat business. And by the way, here's your loyalty rewards

program. Ten visits, your 11th is free. these kinds of places exist. It's unfortunate. But their business model survives off of repeat customers, right? I don't know how intentional it is because they'll collect data, sort of, right? So very few rehabs, very, very few rehabs will advertise what their success rate is, like two years out or three years out. They won't even collect it. Like, no one knows.

It's sad. But unfortunately, it's true. true. And here it is, right? What? You think because I went to rehab? I stayed clean? I mean, ain't that the point? Well, the whole world's coming to an end and I haven't even graduated high school yet, right? So here it all comes together. This is the thing about addictions, is that it's an integration of everything. It's an integration of all the above. It's an integration of like the world going to hell, outsourcing various things, pieces of your life that are being handled by this person versus that person. that person versus that person.

And you can choose to participate or not participate. You just go there, you sit with the therapist, you talk about your feelings for an hour, you leave and you go and you get high. You go to rehab, you get your chip. You say the words, you go and you get high. And so now what we're going to do is dive into a little bit about drug addiction and what to do about handling addictions. okay.

So let's start with like the different dimensions of addiction. So the first thing is we now know that addiction is like genetic in nature. So we know that there's inheritance with vulnerability to drug addictions. So we know that, for example, depending on how your brain is wired, if you use alcohol, your brain will look like this. And if you use marijuana, it won't look anything like this. It'll just be like normal. So we know that there are genetic predispositions to particular substance of addiction. This is why people have a drug of choice, quote unquote, right?

And they'll use a substance once in their life, and they'll be like, oh, my God, it transformed my life. It revolutionized everything for me. And so, you know, this is just the way that our brain is wired, and some of this is inherited. But it's actually more than just genetics. It's more than just neuroscience. It's also parents, right? So what is the scenario, if you guys have seen the show? So here's a mom who's having, you know, a little bit too much wine at dinner.

So how are we taught to handle things by our parents, right? So how does this mom handle her emotions? She just drinks. What are the lessons that we're taught by our upbringing? So, you know, is drinking normal? Is it okay? Is it not okay? Like when you have conflict, when mom and dad get into a fight and mom sighs,

and walks out of the room and opens a bottle of wine. And dad yells at her and calls her a drunk and she flips him the bird and goes out to the patio. And that dad goes to his like garage and mom goes outside and she's just drinking and like, what are you being taught by your parents about substance use? What are you being taught about if things are intolerable, right? If you don't have the ability to accept things that you don't change, what do you do instead? So a lot of that stuff comes from parents. And it's not just genetics.

It's about programming. So it's not just nature. It's also nurture. And then so we're sort of given this kind of setup, right? This is the hand of cards we're dealt. And then what happens is personal anxieties come in. So like I have a predisposition to alcohol. I've been taught that alcohol is a good way to manage my emotions.

And then I'm a 13-year-old kid who just has like anxiety about my body because you know, that's a thing, by the way. I don't know if you guys have heard of platforms like Instagram and other forms of social media in which they propagate pictures of very, very attractive people and you have 13-year-old boys and girls who are looking at these things, and they start to become uncomfortable with their body image.

And so when you look in the mirror, right, this is the frigging mirror. Normally, what kind of emotions is that supposed to bring up? Like, you're just supposed to see yourself, right? I'm supposed to look in the mirror to see if there's stuff, that there's spinach stuck in my teeth. But now when I look in the mirror like, I got to make sure I'm slim.

I got to make sure I'm trim. That's what we have to do. And now these emotions start coming up. They're exacerbated by technology. They're exacerbated by peer pressure. And then we turn to our coping mechanisms. How do we handle these kinds of things? Right?

And then we go to our genetic vulnerability. And then there's drugs. And so now we kind of go back to this point about designer drugs. Because what's happening now is like things are getting worse because now you have so many different things. Are you going to use DMT? Are you going to use MDMA?

Are you going to use, you know, a variant of DMT? So that's like, I don't know if you guys remember that scene, but the kid is like here, I've got like three different things that are three different variants of the same drug. All different kinds of dimethyl tryptene. DMT. Trptamine. And so which one works for you? Is it Indica blend?

Is it Sativa blend? Is it THC heavy? is it CVD heavy? Is it K2? Is it PCP? Is it meth? Is it nicotine? Is it vaping? Right? There's so many different answers that we've got. And now what's happened is we have all these vulnerabilities and we have the perfect substance. The thing that buries your anxiety the most. The thing that makes your brain light up the most. Right? So 5M-E-O-D-I-P-T. And that's just the way that we're wired. And the problem is that like we're given like answers, right? We're given drugs. We're given rehab. The problem is that the answers just don't answer things well enough.

Like, I can start you on medication. I can even send you to rehab. But does it fix this? Does it fix this? Does it fix this? No. Never mind like all the other stuff that it doesn't fix like climate change and existential dread and like, you know, we also learned later that Rue's dad apparently died. of cancer or something like that? Because the truth is that the world is going to hell, and I do have anxiety, and I don't feel confident in myself. And I don't know what to do about it,

because I have no one to guide me. And so as we deal with all these things, like, what do we turn to, right? We go back to this. And all we want to do is go back to this. Happiness and contentment. So how do you deal with this stuff, right? How do you get back here, in a sense?

And I think that this is where as an addiction psychiatrist, like you can absolutely get here. But I think it's integrated. I think it's not, it's not, you can't outsource it. That's the biggest thing. Should you get sober? Like, absolutely. Don't get me wrong. Don't use drugs kids. Seriously. But the thing is like not using drugs and getting sober is not, you can't outsource it, right? You can't just like go to rehab once and that's going to be the end of it. This is where you really have to integrate everything. You You have to understand, first of all, appreciate the genetics. Appreciate that, like, your brain is particularly vulnerable to a certain substance.

Second thing is, like, develop healthy coping mechanisms. That goes back to the mom who's drinking. Because here's the thing. We were taught when things are intolerable, you were taught how to deal with them, which is through substances. And so it's about developing things like a meditative practice, grounding practices, learning how to urge surf, all these other kinds of topics. How do you manage your emotions? You must become adaptive managing your emotions. Tolerating your emotions. Because that's what the drugs do, right? They give you a pass at dealing with your life. Next up is actually, how can I say this, reducing the power of the emotions to begin with.

And this is where a lot of people who struggle with addiction kind of fall short is they're like, okay, I need to learn alternate coping mechanisms. Like, I need to learn how to meditate. But meditation can only get you so far when it comes to dealing with some of the like how hard life is. This is also where like therapy can come in in really powerful. Because here's the thing. If I have a pile of emotion that I have to cope with, so I need like this amount of meditation skill. That may be too much. The drug can get me here. This is the crap I have to deal with. You can actually reduce the crap that you have to deal with through things like therapy. But the whole point is that therapy is not going to be enough, right?

When you kind of dig down and like recognize that it was incredibly traumatic when your parents like how terrified you were that when they first took you to the psychiatrist and they said, oh, sweetie, nothing's wrong. Don't worry, you're going to be okay. And they had tears in their eyes and you're like, what the hell is going on? Like I don't understand anything. But I know that whatever it is, it's bad. And then your parents are like, no, honey, don't worry.

Everything is going to be okay. And that's the moment in which really. reassurance no longer worked for you. And then you stopped trusting people reassuring you. And if you think about if I can no longer be reassured by other human beings, what does that do for my anxiety? Because now I can't be reassured. So I'm just screwed constantly. And then the only thing that works is drugs, because I'm not able to be reassured. Why am I not able to be reassured? Because I had a traumatic experience where my parents were reassuring me and nothing is wrong. And then I started a distrust reassurance. You guys get that? I'm just kind of tossing that out there.

it. Right? So like once you start to distrust reassurance, like the world becomes a terrifying place. Because if you ever get anxious, there's nothing that can make that anxiety go away. And so as you work with a therapist, hopefully a good therapist who can help you realize that, then it's like, oh my God, I need to practice, I need to learn how to be reassured again. You work on that and then suddenly you're able to be reassured, which means when you're feeling like this and a friend comes and says, hey, let me. me help you, that they can actually bring it down. And now you can meditate enough. Right. So it all has to come together. You have to work through the crap that you've built up psychologically, through all

of your micro traumas and whatnot. But that's not going to be enough. You're also going to have to learn how to meditate. You're going to have to learn alternate coping mechanisms. You're going to also have insight and understanding into how your parents taught you to deal with emotions. So in Sanskrit, we call those kinds of things some scars. Right. These are like the lessons that your mind learn through suboptimal emotional processing. They're the psychological scars that are left with you through negative experiences.

And then you carry those scars with you. We understand this stuff really well because we call it like relationship baggage, right? Like, oh yeah, like, why didn't that relationship work out? Oh, like, that dude just had way too much baggage. We carry stuff with us that's unprocessed and affects the present. So you've got to go through and clean that crap out.

And by all means, engage in treatment, right? There may be a role for medication. Like here I am sort of talking about the downsides of medication and stuff like that because it does like zone people out. But this is where like if you have a good clinician and this is where I sort of hate the direction that psychiatric treatment is going because we've started to separate out like psychopharmacology from psychotherapy. So as medicine is becoming more and more specialized, I've got my prescriber and I've got my therapist and then I've got my group therapist. And then I have my yoga teacher and then I have my meditation app. like as human beings, we're having to assemble all of that. But the truth is that if all of that is housed in one mind, it helps the patient so much,

which is precisely why I like doing everything. Like as a clinician, it's like we're doing the patient to disservice. I'm just prescribing medication. And then I'm supposed to have a conversation with their therapist once every two months to try to get the lowdown. Like, that works. Coordination of care is important. But like, ideally, like, one person is going to be able to do it.

at all. One person is going to teach you meditation. One person is going to pick their meditation based on what traumas you've had. And they're also going to figure out, okay, I'm going to start this medication. We're going to teach you this meditation. And then in eight weeks, hopefully the meditation is going to work. And I'm going to know ahead of time that we're going to try to cut down on the medication. And for the next eight weeks, I recognize that you feel like a zombie, but I really think you need the medication. And this is why we're doing the meditation so that we can cut down on the medication in eight weeks. But I need you to take it every single day. And I'm I recognize it sucks and you can't create art.

And it all needs to be put together. And the most important thing is to build a life that is worth living. So here's the thing that I think is like missing most fundamentally from addiction treatment is that when the value of forgetting is more than the value of remembering, someone will reach for a drug. The true antidote to addiction is to want to be in the world. Right? It's when like forgetting the world in oblivion is not as good as being awake and alive. Doug.

That's the honest to God's truth. And this is the reason why we like focused on like creating a something like a coaching program here at H.E. Is because like the problem is that like, like, like Roo said, no one gives you a map for like what to do in life. And so like therapists are really good at like dealing with trauma and stuff. but I don't know that therapists are great at, like, helping you work on your resume, right? Because that's not what we're trained in. But at the end of the day, like, the sacrifice of the drug, the reason that people get addicted to drugs is because the benefit that they get from the drug outweighs the cost.

At the end of the day, very simple. And so what you have to do if you really want to stay sober is build a life that is worth living, build a life that you don't want to forget. And that's hard. And the problem is that, like, we don't even have a formal way of doing this. that. Right? It's all this autopilot crap that's gotten hijacked. It's like, go to college. They stopped teaching a lot of stuff at college a long time ago. It stopped being about education, and they still teach a lot. But college has stopped being about education. University has stopped being

about education. Think about the incentives of the people at your university. Who are your professors? How much formal training in teaching do your professors have? Think about that. Right? Like, I teach at Harvard Medical School, but I'm not a trained educator. Thankfully, my program was really emphasized that, so I feel lucky. But it's not like I have a master's in education. And so you have people teaching biochemistry who are not great teachers. Some of them are. Some of them like it, and some are forced to do it.

So all of our incentives are messed up. And the problem is like, you're the one who pays the price. You're the one who pays the price of 9-11. You're the one who pays the price of the 2008 economic crisis. You're the one who pays the price of the genetics that you were born with. You're the one who pays the price of the parenting emotional style that you were raised with. You're the one who pays the price of living in 2022 when there are like 15 kinds of designer drugs. So you're literally your tendency to be addicted is at an all-time high,

because you have so many freaking options out there, and they've been purified and refined. If you think about vaping, people have recently seen studies that show that vapes are more addictive than cigarettes. Oh, who is surprised? Not I. The amount of nicotine and stimulant in the vape is actually at a higher dose than cigarettes.

Why do you think they did that? It's to get people to smoke vapes. The deck is stacked against you in so many different ways. And the challenge here is that you have so many answers, right? Go to therapy. Go to rehab. Start medication. see a psychiatrist, go to Alcoholics Anonymous, do all these different things.

Watch Dr. Kay. Change your life. But none of that is going to be enough. I'm not saying it isn't helpful. It's great. We're great too, by the way. Like, I believe in all of those things. But the problem is that that's not enough, right?

The basic problem with addiction is that you can't just go through the motions. That's what's so devastating about being a parent with a child with an addiction. is you can send them to rehab and you can see them go through the motions, but in the back of your mind as a parent, you never know what is going on in that child's head, right? You never know. And that's ultimately what it comes down to. If you're a parent with a child with addiction, you understand this, that ultimately it's what's going on in their head. It's not what they show. It's not what they tell. It's not how they act. It's not what they say. It's none of that. It's what's going on in their head. Are they actually committed to sobriety or not? And in terms of getting sober, that's the only thing that

matter, or it's not the only thing that matters. It's incorrect. The thing that matters the most. You can't be a passive recipient of the rest of it. And so I love euphoria because I think it does such a good job in 20 minutes to explain all of this stuff, from how the world that we're brought into, to how we get diagnosed, how we get piled with diagnoses, how we get piled with medications, how that makes it hard for us to function, how we have all these anxieties about like body image and all this kind of crap. And why we start using. And what happens when we go to rehab?

And what doesn't happen when we go to rehab? And why addiction is so devastating? Because it's like, can you really blame someone if like, what the addiction does is take away all their problems? That's just the first 20 minutes. We've got a lot more. I mean, not today, but in general. So check out the show.

It's worth watching. If you have, if you know someone, who struggles with addiction, I think it's pretty insightful. If you yourself struggle with addiction, I think it's pretty insightful. I think it's like a really good compliment to like all the other stuff, right? So by all means, go see a therapist, go to rehab, and then watch the show. Sure. Okay.

Did you like the rest as well? I haven't finished it. So I was taking notes during watching Euphoria. In my notes for the first 20 minutes are 10 pages long. So we're going to, we have so much, dude. Do you guys want to hear about, like, maybe we can vote or something? I don't know. It's a mistake, but.

So there's a lot of good stuff. Okay. So there's a correction. So ayahuasca DMT is technically South American, not Native American, mostly in Amazonian cultures, but not limited to. Paiote-Mescalin is the Native American equivalent and is limited historically to tribes in what we call now Mexico and Texas. Thank you for correcting us.

Apologies for that misattribution. Questions. Yes, someone saying a friend who's an addict once told me felt people that did uppers still had to want to live while those who did downers like she does don't want to live anymore. Yeah, so here's the thing. There's a lot of wisdom to come out of addiction.

A lot of wisdom. I don't know if that's true for all people, but is becoming a psychiatrist still worth it if I want to actually help people personally? 100%. I love being a psychiatrist. Dr. Kay, do you think parenting style you mentioned in the start could have caused me to have obsessive thoughts and health anxiety, not diagnosed? Sort of. So that's where like, so the point I'm trying to make is that when it comes to you as a person,

you can't fix any particular thing with just one-dimensional. treatment, and not one of these things causes who you are. Right? So it's like there's a genetic component. There's an upbringing component. There's a world is going to hell component. So your health anxiety or obsessive thoughts, could they have been influenced by your parents? Certainly. But that's where like if you haven't been diagnosed, I would go talk to someone about that, right? So get an expert opinion and help figure out where does this, where does this part of me come from? Because that's important to understand. So I'm seeing an unusual amount of personal questions. How do you get out a reasoning addiction? Oh, wait, hold on. I don't know quite what that means. Are you addicted to

reasoning or I don't know what that means. But here's what I'd say. Like, so some people get stuck in reasoning for sure, right? And like, if you're someone who just gets stuck in logic and doesn't act, there's a simple reason for that. It's because logic is a safe space. Right? Like, The realm of logic is a hypothetical. It's, it's, you know, you can fantasize about relationships as much as you want to and you're never going to get hurt. It's when you actually engage in a relationship that stuff is out of your control. And so a lot of people will, like, tunnel down into logic and just rely on logic. How are you so mentally stable after seeing so many dark things?

It's a good question. So, first of all, there's an assumption that I'm mentally stable, which, you know, Time will tell. The second thing is that I think this is where we have an assumption that darkness, that things are dark and that darkness is bad. Whereas like my experience of seeing darkness is like that's actually when you see real strength and real wisdom. And like, so people think that it's, you know, it's bad.

Like how can I sit with people like day after day and like listen to their trauma and stuff? It's because it's out of that strength that they become the people that they are. right, which can be like amazing, beautiful, powerful things. And so it's not like you just take the darkness on. That's what happens. And the cool thing is like, I mean, I don't know how to say this, but it's inspiring to see someone come out of that. And like the devastation of hearing about someone's trauma

is outweighed by watching them overcome it. Right? And so like I get to see those wins too. And that's why I do this work. It's because, like, there wins to be had. Like, this is a fight that can be won. Can you be addicted to Dr. K? I don't, I wouldn't use the word addiction,

but I think that there are a lot of people out there who spend a lot of time thinking about making change instead of actually making change. So it's interesting because, I mean, I think that we can become, you can procrastinate on Dr. K just like you can on anything else. And you've got to be a little bit careful because just because you may be learning something here, I'm not saying that it's, hopefully this is less damaging procrastination in terms of you're getting some benefit from watching us.

But at the end of the day, like, don't stop living your life because you spent too much time listening to Dr. K, right? Like that, we can be, we can be a part of the problem too, 100%. So if you're using listening to Dr. K is a substitute for doing something in your life, then that's a problem. How do you learn to accept being unable to tolerate? So that's the first thing is you recognize that you're not able to tolerate, right? And that's got to be okay.

And then the other thing that's really wild is that people who don't believe they can tolerate, a big part of that is the assumption that the suffering will go on forever. So it's not that you can't survive this second. It's that you can't survive the next five minutes and the next 10 minutes and the next 10 minutes in the next hour. So when a human being is suffering, we think the duration of that suffering is forever.

And especially when we start to use drugs, something weird happens in the mind where when we get instant relief, I wish I could explain this well. This may sound, this may not make any sense, but the more instant my relief is, the longer my suffering feels. Does that make sense?

Like, for normal people, it's like, here's the duration of suffering. Here's how long it takes to get better. And those things kind of match. And then as I shrink the amount of time it takes to get better, the window of suffering, like, increases by a proportionate amount. I don't know if that makes sense or not. But it's kind of weird. But like, and we sort of know this because if you look at different kinds of benzodiazepine drugs, the drugs that have the prescribed drugs that have the fastest onset of action are the ones that are the most addictive.

So this is why, like, Xanax is so damn addictive, because its onset of action is very fast. Whereas you can take a medication like Clinacepam, which has a slower onset of action, can still be abused, but is generally speaking less addictive. And so something weird happens that as long as you think that you're suffering is forever, that's what makes it intolerable. And so the key thing about learning to talk about. tolerate your suffering is that it's intolerable, it's intolerable, it's intolerable, but I'm not going to act in this moment. I'm not going to act in this moment. It's intolerable. I'm not going to act

in this moment. And then something magical will happen, which is that at some point you'll realize that, like, the suffering will go away on its own, because that's how the human mind works. Right? So imagine, you know, some kind of resentment that you had from a birthday party in high school. That resentment it can sort of stay with you in some level, but it's not like the suffering of that moment lingers for the rest of your life at that intensity. The flip side is also true. The joy of the birthday party doesn't linger

for the rest of your life. So I'll talk to people who are really obsessed about their weddings. Sometimes I'll get like marital conflict about weddings. I mean, it's not marital. It's pre-marital. Like, oh my God, I want this wedding and it needs to be this way, this way, this way. And the other person's like, no, like we don't need that.

We talk about it a little bit. It's like, how long does the happiness of the wedding last. Right? You want this perfect day, this day of perfect happiness. How long do you get to hold on to that day of perfect happiness? How long can you hold on to the resentment of not having a perfect day of happiness? That can last a lifetime. 100%. The resentment can last forever, but the happiness never does.