Psychiatry & Psychotherapy Podcast - 200 Episodes Later: A Journey Through Psychiatry with Dr. Puder

Episode Date: December 8, 2023

Join us today on the 200th episode of the podcast, as Dr. Puder sits down with Dr. Mark Mullen to discuss the podcast, answer some questions about his personal journey in psychiatry, and reflect on some of his favorite episodes. Dr. Mark Mullen is a 4th year psychiatry resident at Creighton University in Omaha, Nebraska, and the host of his own podcast, Psychiatry Bootcamp. Link to blog. Link to YouTube video.

Hello and welcome to the 200th episode of the Psychiatry and Psychotherapy Podcast. I'm your host David Pudor, and I am excited to bring you a unique episode today, looking at some of the driving forces that have encouraged me in my journey to become a psychiatrist to build this podcast. One of the things I'm going to be talking about is Dr. Tar and his influence and mentorship. He passed this last summer, and he was such an impactful. person on my life and I don't think I would be here without him. I wouldn't be here without Dr. Cummings and all of his mentorship and guidance. And I wouldn't be here without you, my listeners.

And the encouragement, the support, the enthusiasm, the help. I have a lot of listeners who write up different episodes who do a lot of the digging for different episodes. They volunteer hear their time. Sometimes medical students will spend 200 hours on one particular episode doing this amazing deep dive write-up. I'll work with them, look over it, you know, look over the research with them. And so it's really the support of a community that has led to the success of this. It's, you know, I see myself as a facilitator of a lot of great minds and a lot of energy to produce this content. And I am in deep gratitude for you, the listeners who take the time and the attention to dive into the content and to think through and grow and then execute on what

you've learned in your practice. And every single time I get a little note from y'all, whether it's by email through social media or maybe on an iTunes or a review. view, it really does propel me to continue to build more content and encourage me. And sometimes I get, you know, corrections. You know, you're pronouncing this wrong. Thank you, dyslexia. Or you could phrase this a little bit better. And I appreciate those as well. And so, yeah, thank you for being a part of this journey with me. Thank you for investing. in this process. And I look forward to years of continuing to do this in the future. All right, welcome back to the podcast. I am joined today with Dr. Mark Mullen. He is a fourth-year

resident, the founder of the Psychiatry Boot Camp, which is another great psychiatry podcast aimed at educating really like first-year residents who just need to launch into knowing what you need to know to practice psychiatry. I think you can learn even something as an attending, I might add. And he is at Craydon in Omaha, Nebraska. And so this is the 200th episode. And I asked him to come on and interview me on some aspects of the podcast. And yeah, welcome to the podcast. Thank you. Yeah, so excited to be here. I'm really honored that you asked me. So pretty amazing. I feel like, you know, I've listened to most of your podcast certainly benefited just tremendously from it. So it's kind of surreal for me to be asked to be on. So I really appreciate it.

Yeah, you were telling me that you only used my podcast to study for the, what was it, the prite? And what happened? Yeah, I don't know if I could use the word only, but I say, certainly the most valuable resource for me in kind of didactic and knowledge development in residency has been podcasting, and you're specifically more than any other by a landslide. And so our second year, we're mostly inpatient psychiatry. So our afternoons are a little bit flexible. So I would spend those afternoons trying to be like productive in a life sense, but also, you know, doing some serious learning.

And I spend those afternoons with you. And, you know, I just to be really objective about it, and I would not typically say this, but I'll say this for you because it's true. My pride score just absolutely skyrocketed after that year that I spent the afternoons listening to the podcast. And that's one of the reasons that, you know, one of the things that inspired me to make one is I really think the proof is in the pudding. It works.

It's a great way to communicate knowledge to increase the quality of psychiatric care. And so I really believe in it. And I kind of, I have the receipts, David. I have the receipts. I'm honored that you joined me. I like how you put that join me. And then I saw that article you wrote on podcasting in academic psychiatry, which is cool.

Which, if I can summarize it, it's basically like it sounded like you took podcast episodes and kind of integrated them in the curriculum to think about what lectures of the curriculum might be enhanced by listening to a podcast before the lecture. And then you found that that created richer content of discussion with the attendings? Yeah, so our residency program, you know, medical schools years ago moved from this like lecture-based passive learning model to more of an active learning

model. They said, okay, we know you can listen to this all at home. So if you're going to come, we're going to have you manipulate the information, use the information, discuss, learn, it's better for retention. And so I think now new residents are used to these active learning models. So we have a flipped classroom in Creighton. So I assign pre-work and then when we're in didactics, we are using questions, cases to discuss, et cetera. And the pre-work is largely podcasts. I sent out an email every week about, was a podcast on the topic? About half of them, probably more than half of them are yours. I always think about copying on the email, actually. And the residents love it, you know, that we talk about it when we're outside of didactics,

they send me recommendations. And, you know, one of the reasons that we did this is that the first year, we weren't sure that all of the residents were doing all of the assignments. And so this was sort of our way to meet your residents have way and say, we know you're busy, but what about a podcast? And so far, it's worked out really well. That's, I'm, I'm totally honored. And I'm happy that the podcast has been helpful for you. And so we're kind of thinking about things you could ask me about, and I'll just let you start asking me some questions. Yeah, sounds good. So I think that, you know, for episode 200, it's going to be fun to set aside some time to hear more about you because you're always kind of in the interviewing seat. Not so much a blank slate, but we don't really get to know you, what drives you, why you started the show, your hopes for the show, favorite moments from the show. So that's kind of my goal for today. And then also hearing about, you know, you've got 200 episodes under your belt. So where you're headed next. Cool.

So I do feel like we get kind of pieces of you sprinkled throughout the show, and one of the pieces that is sprinkle, and I notice that every time you talk about it, you light up is Dr. John Tar, one of your mentors. So I want to spend some time talking about Dr. Tar and kind of the influence that Dr. Tar had on you. Yeah. So when did you meet Dr. Tar? I met him my first year in residency, which was actually a second year. So I was a second resident at Lomboleine University. I did a transitional year my first year. So I came in as a second year.

And I joined his introductory class, which was like Therapeutic Alliance 101. And I remember sitting in that class, and I was like, you know, sometimes when you're, when you're with someone who's just truly brilliant, it's like his language and the complexity of his language, like it took all of my brain power to try to stay with him. And it's like I was listening to someone talk about something that was so foreign to me, but like so intuitively true at the

same time. And he was talking about it with such passion. You know, he was in his early 80s at the time. And he was a psychoanalyst and a psychiatrist, and he had been practicing his whole life. And he was very dedicated to practicing. So he was someone who didn't stop practicing ever. Psychoanalysis. So he was seeing people two to three times a week. And he had read prolifically. Like he had read everything. Like his library, which I saw later as we became closer, was just this unbelievable library of the great works of psychiatry, psychoanalysis. psychotherapy, and he had trained with some of the best people. So literally, Franz Alexander, who is like one of the best psychoanalysts, he wrote this, the history of psychiatry, which was

phenomenal. He was the person that coined the corrective emotional experience. This was one of Dr. Tarr's mentors. Dr. Tarr would go to his lectures. He would take copious notes. He said he would be taking notes the whole time. And so, you know, this is a guy who every year would go to conferences, every year would go to Europe, France, Italy. He would know all of the fine arts going on in L.A. He would go to concerts all the time. He was a benefactor of different museums. He was a benefactor of different like orchestras. And by benefactor, I mean, he was not wealthy, but he knew wealthy people through just he was incredibly connected and so he would connect money to these like

different things like the symphony or bring people into the you know so he was incredibly like for the arts for music incredibly high openness part of the big five and just you know listening to him was

it was like I knew nothing about psychotherapy except for like pop culture stuff. And listening to him was like that, like, oh, this is a whole other world that I knew nothing about. But it's like, I want to know about this.

Intuitively, sort of, there was something inside of you that it kind of resonated with you. You could just feel it inside. You didn't have the words previously, but you knew it on some deeper level. Yeah, it's kind of funny because I wrote down one of his favorite words to talk about was like the pre-lexical vocabulary. So it's kind of like what we're talking about right now, right? It's like I didn't have the words to describe like what it was about what he was saying that was so powerful.

And it's only in retrospect after practicing for years and having patients that I see twice a week, three times a week, sometimes, that I have an understanding of the brilliance and the depth of what he was talking about. So it's like when you're just a first year, you're like hearing it. And it's like, I had never been in therapy. I had never been doing therapy. And yet you're, so you're trying to grasp on to something. And so he would talk about pre-lexical, which is like, it means word, it's like communication before vocabulary, before sentences, before, you know, so it's like pre-lexical communication on an infant is like them trying to get their needs met, trying to communicate.

but not having the words to do it. And so a lot of attachment is pre-lexical, right? The first year of attachment, the first four weeks even. There's this, like, dance of nonverbal communication. And things like tone, pauses, sighs, crying, body posture. It's all pre-lexical communication. And so where I think he was an actual. absolute genius was in seeing the pre-lexical content of psychotherapy sessions and

and starting to like communicate that like what was going on so it's like we're not even really we're not trained to think about this it's like attachment language the attachment back and forth that's going on that often is not it's not even the words often that it's like the words are grasping at it but they're not completely contemplating it fully. Good. vocabulary fails us at some points, you know. And I think to that point, too, I think if we reach for our lexicon on our psychiatric

bookshelf and then we try to use those words with patients, to me, like, get out of town, depending on the patient, you know. But for the most part, you know, you need to take these really complicated ideas and bring them onto a level that the patient can understand. and it sounds like you think he had a gift for seeing these deeper issues but then kind of bringing it to the surface in a session and using it as father working with him. Absolutely. And using it as a way to decrease someone's shame and to decrease someone's fear and to connect and to create an attachment, which was a powerful attachment. And so it's, you know, some of the words we use are like transference. So patients have emotions, feelings towards you, sometimes from early attachment relationships.

This is something that occurs in all relationships, right? We all use past representations of previous people to make sense of current people. So transference is like ongoing all the time. but to see it and identify it within like a couple sentences is like it's like it's hard sometimes right to see it like I had a patient today that was like had to cancel and so one of the questions Dr. Tarr might ask is like what might you fear that I was thinking or what might you hope that I was thinking or feeling and so it's like fears and hopes and then the patient said like, oh, I feared that you were going to be upset at me.

And so that's transference right there, right? And it's like, okay, then what do you do with that? You empathize. But here's the thing about Dr. Tar, which, like, it's like, you're not just saying things for the sake of saying them. You're not saying them because you don't believe them. You're saying them because you believe them and you, it's how you make sense of the world. So how you would make sense of this patient in particular is like this person,

has attachment fears. They don't want to push me away. They had something come up in their life. They had to cancel. And so the empathy that I gave her is like, it would be really distressing to fear that I would be upset at you, that I wouldn't understand what you're going through, and that somehow this would lead to me like not wanting to work with you anymore, right?

So you're speaking to that attachment anxiety. So this is kind of like an example of things you might say, but you're saying them not because they're the thing that you should say, but Dr. Tar, his worldview, was so deep that it's like he understood what was going on in the attachment, sort of that space of attachment going on between you and the patient. And it's like he had a deep profound kindness and love for, for people based off of that worldview.

And so that was, like, it's hard to express how that worked, but when I saw that, and so, for example, we would watch videos every week, residents doing psychotherapy, third years and fourth years. Dr. Tahr and me would do this, and we've done that, we did this for the last 10 years until this year. and he um some residents would have like patients would elicit some you know like some of their own emotions some maybe the lack of own understanding on why patient was the way they were like one patient

had like 30 cats or something and just let them poop and pee in her house um that the house smelled awful right and like the residents had some disgust or kind of like why why would they do this like something's really wrong said but dr taw was like of course this patient wants 30 cats think about their childhood think about how attachments were so difficult to have one cat that dies and not have 29 cats to replace them would be so distressing of course they would want 30 cats you know it makes sense and so you're making sense of this person's internal world thinking about their attachments, thinking about their early life experiences

in a way that's very compassionate. And that was beautiful. Yeah, that is absolutely beautiful. And I think all of us can think of patients who are in very similar situations as that you've given me, that's a really good nugget of something for me to kind of hold on to, just a small example of kind of this,

behemoth person in your life, one of the things he taught you, what do you think was, an unfair question admittedly, but what do you think is the single most important thing that he taught you? See, when we talk about, like, something he's taught me, it's like, it's like a lesson that could be taught with words, right? And I would say it's not, it's not the lesson taught by words. It's actually the internalization of Dr. Tar himself in me. So in termination seminar, he would talk about how we internalize our therapist, their kindness, their empathy, their support. And I would say Dr. Tart died this summer, actually. And we were supposed to spend some time.

I was going to travel out in July to spend some time with him. And so ended up spending a day with his wife instead, which was delightful. And I got to take about 80 pounds of books from his library. His wife was very generous with me. And he had a special book for me as well, which was like a Marcus Aurelius, like super old edition, beautifully kept. But the internalization of him is still there.

So I can pull on, I could tell you what Dr. Tar would say in most patient situations. And I could tell you what I would say. And sometimes the thing that I would say is exactly what he would say, because our worldviews, after 10 years of working together, we co-taught psychotherapy classes for the residence two to five hours a week for 10 years. And so I would say something in psychotherapy class, and he would gently correct it or support.

He would be enthusiastically supportive. of it. And, but, but I would say it's, it was also like this like crazy paternal, like, unconditional positive regard that he gave me. I mean, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, it's, like, it's so, like, unconditional positive regard, right? But it was truly there. Like, his letters to me that I still have, I was reading them the other, the other morning. I was just like, weeping. I was like, this is like, it's, it's so beautiful. and it's such a gift and

it's like he saw the best in me you know at all times and he saw that the parts of me maybe that needed to be changed he had just incredible and still need to be changed

he had incredible like compassion for those parts and so somehow that has created a representation of him in me. That is a kinder, more compassionate representation. So not what he taught you, but who he was as a person and what he showed you and kind of what you picked up.

Through osmosis, sometimes just by being with him, it sounds like. And it sounds like this unconditional positive regard, though, I mean, the example you gave with the patient, this isn't just you that he has this with. If he has this, it sounds like for almost probably everybody that he encounters, he doesn't come from a scarcity mindset of, I only have so much in me. I only, I can only treat so many people this way. And then I got to get mine. When I leave work, I'm going to go, this is who it was as a person. He allowed the job to transform him. And he came from a mindset of abundance.

His heart was big enough. He had enough empathy to truly treat everybody, his colleagues, his patients, I'm sure, family members in this personal life, with that sort of unconditional positive regard, assuming positive intention, having enough empathy to try to understand truly where you're coming from before telling you that you're wrong or trying to correct you, et cetera. Abundance, it sounds like you had a lot of it. Yeah. And I think that that kindness over time and witnessing that kindness towards patients,

colleagues, like him trying to not just be reactive, but trying to understand on an attachment, you know, that pre-lexical level, that I think over time that got internalized as like a fatherly figure, a person that, you know, he was not someone who would get reactive when a patient was angry at him. he would get curious. And that is like a Yoda mind shift that I have not completely fully got into. And it's like I was thinking about this episode and it's like, I'm not completely, you know, I still need people. I still need a process with people, difficult cases, difficult situations, right?

and I'm in process, right? It's like this process, you know, I think if I'm humble enough to say, like, hey, I still need supervision. Like maybe some, you know, first-year nurse practitioner who's listening to this can be like, oh, okay, maybe I'll continue to get some supervision, you know? Which I'm like, I need multiple supervisors. I need multiple friends who are therapists to process things. It's like, I don't need just one person, you know? So if I'm that way, I can't help but think that we all need that. Good.

I think Icarus would have a lot to say about this. And also, Dunning Kruger, you know, I think that there's a, this is what tells me that you're an expert, you know, is that you understand that there will always be growing for this job. I'm curious. So A, it sounds like he was a master at working with resistance. I mean, some of these examples that you gave to me, that's what this is. he's able to really leverage this and use it therapeutically. What do you think Dr. Tar would say, though, if he knew that you were comparing him to Yoda, are you asserting that he was at the point in his career where he may not have needed to seek supervision?

Or do you think if he was here now, he'd, yeah, right. Oh, no, absolutely. No. He, I mean, he would say, like, look, look, like, he would say, when I go on vacation, I tell people I'm in sales because I am so depleted sometimes that I just cannot. Like, if I tell someone I'm an analyst, they will just talk to me nonstop. You know? And so he would say, like, Dr. Puder, you know, you're doing so much.

You're working so hard. It's normal to feel depleted. It's normal to feel more lonely. After you've been working so hard, so many hours, it's normal to need a break. It's normal to get some self-care. You can't not do this work and feel emotionally depleted. You need places where you're not. you get renewed yourself.

So he was always talking like this. Yeah. Any final thoughts of Dr. Tauer? Can we turn the spotlight to you just a little bit? I'll just say that in his, I'll just say that in the next couple, in the next couple months or year, I have some audio that I found of like when we like co- lectured.

And I was listening to some this morning. And I was like, oh, it's so good. I found out from his wife that all his life, or his early life, he wanted to be a radio broadcast host. Okay. But he refused to come on the podcast. And when I asked his wife about it, when I told her that he would refuse, she had a microexpression of anger, which she's like the sweetest thing. And so her micro expression of anger looks like, like it still looks happy.

but it turns out I think he was so enthusiastic for me to do what I was doing that he didn't want to take any of the spotlight and he wanted to but I think in his death now I feel comfortable putting him on the spotlight a little bit yeah

I think that's beautiful yeah anyone had to empower you and encourage you know you don't need me to do this you've learned all this. Go now. Go do this on your own. God, that's beautiful. I can't wait for those episodes. That would be awesome. So you brought us back to the beginning there a little bit. And I'm curious, I don't think you've ever talked about this on the air. At least I missed it. When did you decide that you wanted to be a psychiatrist? So I was going through the match and I went through medpeds, medicine pediatrics. And I interviewed like 22.

days of interviews, right? And every door shut. Like, every door shut. And when I say every door shut, I mean, that means like I went through the scramble. I did not match in any of the programs. But the moment that I read the paper that I did not match, I heard audibly in my head psychiatry. And I had been running away from the thought of doing psychiatry.

internally, I think. And so I will leave a little bit of ambiguity for what that might have meant and the meaning that I attribute to that. But at the time, I was like, okay, maybe I'll give psychiatry a chance and I'll do another rotation. So I did two more rotations in psychiatry. And I realized one of my really good friends was a psychiatrist. that I just made spontaneously,

or he was a psychiatrist, and he was a psychiatrist. And shout out to Daniel Bynes, California. And so I realized that through doing the extra rotations, that there was something about it that was actually probably more me than MedPete's. Like I had already read motivational interviewing, William Miller. You know, I was talking on the interview trail

about patients making behavioral changes. and people would look at me with like blank stairs like no we just give insulin and so when i when i chose to go back through the match which i went outside the match so outside the match is different because you can get actually offered a position as a pggy2 on the spot and you can accept it you don't have to go through the match and all the doors opened up like to great programs i decided to go to loma linda because i knew some mentors there that i wanted to be sort of interacting with with. So I decided to go to Loma Linda, but that's that's the story on how it found my way into psychiatry. Yeah, so there was something inside of you that was sort of like pulling you toward

this direction, and that's how it actually happened. Yeah, I think I think about like logotherapy and like meaning, finding something that's meaningful, you know, how you, and I think that kind of can help make sense of it to some degree for me. For sure. Yeah. So what about the podcast? that's how you decided to be a psychiatrist. When did you decide to start the podcast? How did that go? Yeah, so I was in practice for about five years, and I was teaching at the university, and I love teaching.

And I had some teaching awards that I was given. So I was, like, validated that I enjoy teaching. I'm good at it. And specifically the stuff, like, that we talked about with Dr. Tarr, Like for me, that's what I was teaching. That's what I was excited about. And so I had been playing around with this idea of a podcast. I spent about a year procrastinating and then finally pulled the trigger,

just doing something that I'd lecture the medical students on many times, the six boxes of psychiatry or whatnot. And I had this thought in my brain. And I think this is a little bit hypomanic or whatnot. but my thought was like, okay, if I can train 10,000 mental health professionals to do their work better than they were before, like that would create so much meaning that I would do that for free for the rest of my life. And the meaning is like, you know, it's sometimes like in the trenches, seeing one patient at a time, it's hard work, right? Like there's a ripple effect and actually like I'll probably never give up seeing patients. even if this podcast like 100 X's.

You know, I'll probably just find ways to see patients continually. But I think the idea of, okay, maybe a psychiatrist sees 5,000 people over the course of their life. That's 5,000 times 10,000, like 50 million people potentially having that influence and making the world a little bit better.

You know, like just if, so I think, it was like out of my sense of what was meaningful for me, what was meaning making, what was motivating. And that was my sort of thought. And the other thought that I had was like, there's some great teachers that just do not have an audience. Yeah. Dr. Cummings is a perfect example of that. Locally in the inland empire, people drive an hour once a week to get supervision, to just sit in a supervision group with that guy. and it's not just medical students or residents it's like the best of the best psychiatrists so if if someone

like dr melissa pro shout out to her she's at the VA in loma Linda now if when she says when something goes wrong i think about talking to dr cummings like and she is next level she's truly world class okay in terms of what her knowledge is um if she's thinking about like cummings in that way. It's like Dr. Cummings is someone who does not have a platform. And so let's just put out some content of this, you know, and some of the ideas of Dr. Tar, same thing, right? And so I think that's the rubrics which I think about guests. It's like, okay, this person doesn't have a platform. They've been doing this for 20 years or more. They have an expertise in a certain area. And, they have all of this knowledge, but no way to get it out.

Like, that's the person I'm looking for. Like, I just did one on eating disorder with Jennifer Gugliani. And it's like, she has the knowledge. She is in a world that we are not in. She deals with this all day long. And it's like, okay, how do I get over a platform? So, yeah, that's a long answer, but. So you were, I mean, it's pretty straightforward, though, too.

In a way, it's really cerebral, which actually surprised me in the, like, how mathematically you were about it, you know, multiplying all the numbers. But then you did in the classic David Peter way kind of bring it down to that meaning, what really drives you, you know, how to derive meaning in this. And I agree. I think that we're translating knowledge from all of these other mediums, whether it be books, journal articles, living human beings who are saving lives and helping people across the world, and just kind of bringing it to this new audio format.

And I think being early on this technology is helpful for that. too because there's a lot there. And I can tell you as a listener, yes, Dr. Cummings. I mean, Dr. Cummings is doing a board review course on your podcast. He really is. Like if I were to go through and do, because I kind of scrolled through, you know, prepping for this, listening to all of Dr. Cummings podcasts, I would wager that I think you could pass boards with it realistically. If you passed USM at least step three and you knew, like if you had a transcript of Cuter and Cummings and you walked into the board exam with it, I think you could pass. I mean, the man's a genius. And it's like every sentence out of his mouth is just, you have to listen

three times really to get kind of half of what he's saying. And he's one example of many amazing guests you've had. So I agree. And I'll also say that I think if you're not a little bit hypomanic, it would be hard to make 199 podcast episodes because it's a lot, you know, and it's not your full-time job. So I'm interested if when you were first, starting because it was a lot. I'm sure you were sinking outside of your own capital into it, spending a lot of time doing it outside of work on top of a full caseload. What did you really anchor to when it was like, this is kind of a drag? Do I really want to do more of this? Or am I ever going to be successful? What was kind of a thought that kept you going? Okay, so first of all,

the financial piece, because it was not making money for years. And like if you look at amount of time I put into it, I could probably make more money just seeing patience. That's a reality. And so I had to actually quit one moonlighting gig that was underpaying me and start up a private practice to fund this thing so that my wife didn't see any of the money leave our bank account. And so I just put it out there. I'm going to charge top dollar.

I'm going to make some money and I'm going to pump it into the podcast. and I did that for years. What kept me going? I don't know. Like I'm a pretty, like when I'm excited about something and when it's meaningful enough and it hits that like,

like, you know, I've had a lot of residents, a lot of medical students who get excited about projects. So when I can kind of like do something that's meaningful that puts it out there in front of a lot of people,

it feels, motivating. And then, you know, just like people like yourself, kind emails, you know, and it could be like two years after you're listening. I'll get a kind email and I'll just be like, okay, like, if I impacted Mark Mullen to be a better psychiatrist and better educator for like, you're going to go on and be an educator at your residency program, where are you going? I'm going back home to San Luis, San Luis University, so I'll be the director there. Yeah. So you'll be working with medical students. So you know, I mean, think about the multiplier effect of that, too. That's exciting to me. It's like, okay, so I was able to teach Mark Mullen some stuff and then you start your own podcast

and you're teaching medical students and like, that's exciting to me. So it's that kind of stuff, you know, or like even with patients sometimes. Like, I'll have a patient and they'll do a lot better and they'll start describing closer emotional connections they'll have with patients, meaningful exchanges, beyond what they would do just in a pyramid management way. And for me, that's exciting. That's really exciting. So, yeah, I think that's enough to keep me going.

I think not selling out, you know, a couple points I've been offered money from pharmaceutical companies or money from, you know, supplement companies or money from online things that, resemble psychotherapy, but maybe not deeper psychotherapy. I, you know, there's a temptation there, right?

There's a temptation that it's like, do you want to make 50% more than you're currently making, you know, and have like this influence now on the podcast, which is going to change who you have on, what you talk about? And I know personally, and I'm not saying if you do that. this year it's wrong for you but personally i think it would take away some of the um it it it would intellectually take away some of my honesty and excitement you know and you'd be perceived differently yeah i mean it would take the win out of your sales david because your whole thing a big part of your thing is your authenticity you really you care so much about it and you care

about doing it differently. And that's what makes you easy to listen to, is that I think there's a yearning in the heart of every learner who's taking these multiple choice questions in medical school, in nursing school, whatever it is, about people with psychiatric problems. And the psychiatric problem is distill down to a two-sentence stem and then A, B, C, or D. And when you're in that system, I think there's a real yearning because it's like, this cannot be psychiatric training. There's got to be more to this and then you discover your podcast and it's like oh right because you have this format that you can dialogue and you're willing to look beyond the psychofarm beyond the DSM criteria so i think you've definitely achieved that and i would say something from dr tar came up to my mind

that i was listening to this morning he says you know the treatment starts from the first time you meet a patient the treatment the patients come to be heard They come to be understood. They come to be listened to. They don't come for you to take an HMP and write a good note. And so there's a shift that happened in my brain when I really understood that of like, okay, when I'm showing up with someone,

I'm showing up and I'm trying to like connect with this human being from the first encounter. And you know what? You actually get better information if you're connecting. people can share more truthfully. You'll get more of the heart of what's really going on. So you will get a good H&P, but the HMP, the note is not, it doesn't matter.

Like I've had to work with so many residents as a third and fourth year. Like, okay, we're going to set a timer for five minutes. You have five minutes to write this note, and then you're done. You're not sitting here for an hour after you did therapy writing a note. You're going to sit here for five minutes.

They're like five minutes. Give me 10. Give me 10 at first. I'm like, no, five minutes. You got five minutes. And then you sign it and you're done. And it's like some of the notes should be very generic, you know, like discussed interpersonal conflicts.

Exactly. Yeah, there's an hard in that for sure. Yeah. So I think that there's wars and battles moving providers away from the heart of what we're supposed to be doing, you know. And there's a lot of patients who experience just a pure, med management, cold, in and out, five minutes, which I might have a caveat, like, if you're pulling someone out of group therapy and then you're putting them back in, those can be shorter visits.

Like when I run the IOP partial, it's like a 10-minute appointment sometimes. Place for that, right? There's a place for that, but they're going back to group therapy. It's like you're taking them out of group therapy, they're going back to group therapy. So you don't have to necessarily put on that hat all the time. But when that patient in IOPP partial is about to leave the program because of interpersonal conflict with their therapist and I'm about to spend a little extra time with them to work that out get them to process it with the therapist like that's the value that I'm bringing that person in a psychotherapy way anyways okay so where were we getting off yeah no

sure so and I'll I'll say too I think I've to over disclose I have felt this same tension as a patient it's like you come tell your store to someone and they respond to you with a diagnosis and elicit criteria and a med and you're like what did I just do I spent 60 minutes, 90 minutes telling you the story of my life and the responses, here's your diagnosis and here's your treatment. And then I've experienced it the other way where it's, okay, so this is what you're telling me, this is what you're feeling. I think here are some ideas. Here's your prognosis. And it's so healing on day one. It's a real gift, I think, that you're giving us, and not just for learners, but across the globe to people currently practicing. I think it's

a remarkably fresh take. So what do you... With that, before we move on. Yeah. Sometimes when I watch residents and videos, it'll be 10, 15 minutes before I hear any empathy. And so do not wait to the end of the session to give your empathy. Like find little ways to interject it throughout the encounter. I mean, and some patients like, you know, they're talking so fast, it's hard to, like, get in anything that may be like, well, let's slow down here. Let's like what you said here was really important. Let me just make sure I'm understanding this.

This sounds like this was really, really difficult that this happened. know. So don't wait for connection to happen at the end. Like, see it as like the whole session. Like, you're looking for those micro moments of connection and micro moments of where you can attune and where you can express that you're understanding where they're coming from. And that can be therapeutic. That is therapeutic. Yeah, correct. Okay. More specifically, is there anything that you're hoping listeners to your show do differently than, people who have now listened to your show. I think the first thing would be

what I just said, like to attune, to listen to those micro moments of connection. You know, and like if you've gone through the microexpression training, to be able to even pick up like small moments of emotion that are flashing on the face, right?

And to be able to put that to words, to be able to empathize on a deeper level, to have more compassion for people and to have more compassion for yourself, I think, to see yourself as someone who also needs their own healing journey, that also needs supervision, that this is a really, really tough job.

I was talking to someone, I was talking to a small group of people yesterday, and there are not people who know what psychiatrists do or know what I do. And I was just taking them through some, like, a couple days of my life. And this one guy turns to me after, he's like, you've really blown my mind for what you do. And, you know, he thought, like, oh, psychiatrist just dispense pills. And I'm, like, in it with patients, man.

Like, I am in it in the traumas of their life. And I'm trying my best to, like, be there and be present. And so, yeah, so to realize as providers that we need our own sources of support and to not have any shame around doing that, you know, I think we can have stigma against getting our own help as well as providers. And, you know, of course, like having a very holistic approach to psychiatry. So not being sort of pulled into the latest gimmicks of psychotherapy, right?

So psychotherapy is connection, psychotherapy is therapeutic alliance, psychotherapy is more dependent on the provider than the modality. It's like, and then with psychopharmacology, it's like, we spend $300 a day going through medical school. It's about that. And we learn about all the psych meds. And then some drug rep will come to you, take you out to dinner, buy your $50 steak, and change your prescribing habits for the rest of your life. Isn't that crazy? And it's like we need to come back to over and over again what the science says to not be pulled into new gimmicks, to not be pulled into, you know, fancy statistics.

Things like lithium are phenomenal. Things like Closopine are phenomenal. I've done more episodes on like some of these older ones, right? There's never going to be a lithium rep. It's a cheap med. There's never going to be a Closopine rep. It's a cheap med. But these are world-changing medications.

You know, you put someone on, treatment-resistant schizophrenia on a new antipsychotic, like 5% of the time they're going to get better, you put them on clozapine, it could be up to like 60%. And so it's just this, it's incredibly life-changing. So we have to feel comfortable prescribing these meds, which have some side effects, which there's some nuance in how we prescribe it. We have to monitor drug levels, you know. So I think some of my heart is that we would be very comfortable prescribing some of the difficult medications that work really well. Not dodging them. And then avoiding, yeah, the gimmicks, whether it be a new, fat diagnosis,

psychotherapy technique, medication, et cetera. I mean, your point is psychotherapy was not invented in the 1800s, right? It's not like Freud came onto the scene and all of a sudden we had healing. You know, we've had healing since the beginning of human history, religious healers, probably mostly, but people who provide counsel who you can come to when you're not feeling well and they will heal you in some way, form or fashion. And it's a real privilege to now be in that position now as a healer to be someone that someone will trust you to bring their stuff to and to ask for assistance.

And it's sacred. It's sacred. And while there are amazing tools of modern medicine that are really helping us, and we have a lot of evidence to prove it, we can't forget that we're fulfilling a role that's been important throughout all of human history, but it's not actually that new. It's just that now we have all these new sexy

and really effective tools to help people live better, and we can prove it with math, which wasn't always the case. Yeah, Franz Alexander, the history of psychiatry, he doesn't start at Freud. He ends at Freud. He starts with the shamans.

He starts with Judaism. He starts with the religious healers. and he starts with themes like they talk about dreams they talked about listening like Aristotle, Plato, Apocrytys, like all these guys, there was something about listening to people for a very long time which was very powerful.

So, yeah, Freud, if you read like his interpretation of dreams, the way that I read it was like, okay, this guy's pulling from all literature and history, kind of like Shakespeare did almost for like the plays and stuff, he's pulling from all of these great sources because he's read it, right? And so he's pulling from all of these great things. So it's not like he was like just coming up with his ideas on his own. In my, I go through a history of psychiatry class with the residence. And it's like you can see most of his ideas predated him. He's just,

he's just pulling it from everywhere. And he's, and then experimenting with it. Right. and a lot of people think psychoanalysis is dead and like it's not helpful and I think what I've realized is that you know there's this over emphasis on quantitative studies quantitative meaning like numbers like okay show me a randomized control trial right and then from that randomized control trial you know I can distill real information it's true you can you can but qualitative is just very powerful too so like a lot of of psychoanalysis and the great stuff, which is largely attachment based now coming out of psychoanalysis. It's like, you're talking about providers that have seen like Dr. Tar, people over the course of 50, 60 years, they're seeing patterns, they're seeing patterns and they're writing about them.

I see these patterns of how people are behaving, their deeper psychological structures. And it was so interesting, I was talking to Nancy McWilliams the other day, and I was going through this pattern of this one situation, and she knew a couple of the things that were attached to it, which I had no idea that she would be able to know. Because patterns flow together, you know?

And so, yeah, it's just like we shouldn't lose all of the history of psychiatry for a lack of Fahrenheit 451 burning all the books, right, with like the new advent of this statistical method right and psychopharmacology psychopharmacology yeah yeah okay moving on a little bit what surprised you most about the process of developing the podcast over the last 199 episodes what kind of caught you off guard um so i think one of the things is that i would actually be able to interact with people that i looked up to and that sometimes before the episode started, they would be asking me, like, and kind of like, how did you do this?

How do, like, it's kind of like, there was a little bit of a role reversal in my mind there. So, like, people like Jonathan Shedler, like, went through residency, reading his articles, looked up to him, saw him at a conference, and now, you know, I'd consider him like a colleague, right? Someone that, I mean, I still see him as more of a supervisor than a colleague, like on equal footing for sure for his expertise and psychodynamic stuff. Nancy McWilliams is another one. Like I remember reading her books and just being like, this is, this is gorgeous. This is unbelievable. If you have not read Nancy McWilliams books, I'm like, and you want to know about what I want to do in the future, I want to do more stuff with Nancy McWilliams. I mean, if someone

knows her and listen to this, please encourage her to come back on the show. No, but I think like there's this profound level of beauty and how she writes. It's like it sticks to my brain somehow. It's like her writing style and how she's like pulling from so many different things. It just makes sense to my brain. So I was surprised that I would be able to be in a position where I'd be able to interact with people like this and bring them value. Fully agree. And you're an expert in something else. You know, you're an expert in bringing their amazing, but largely academic. I mean, Nancy McWilliams is absolutely brilliant, but having read psychomanalytic diagnosis, it took me a while to chew my way through it, you know?

And so you're taking these amazing ideas and bringing them down to a level, bringing them to a level that anybody across the globe might be able to benefit from and then see their patients. So that's what you're an expert in and that's what you bring, and that's what they really need. And I think there's a common threat here amongst all of these, I don't want to call them deities, but these amazing people in our field who have gone before us. For me, it's Alan Francis, you know, Nancy McWilliams, Shedler is in my top three interviews for you. I mean, he's just amazing, a wealth of knowledge. They're also intuitive. When they speak, they say things. And it's like, oh, duh. You know, I knew that on some level. Like, you know, the whole time, you're just nodding.

you're like, yep, that is completely consistent with my human experience. It's just a deeper level that they bring. They're all very intuitive. Yeah. Yeah, and I would say what I'm trying to do is as I listen to them, I'm trying to imagine my audience and their understanding. And if there's gaps in how my audience might not understand them, I'm trying to elicit more questions for them to fill those gaps.

Because with anyone who's very brilliant, and I did this with Dr. Tar for years as well, it's like he was so brilliant, sometimes he was not even understood. And so I'm like trying to like say things as simply as I can in a way that the most people understand it. And I would say that's like, yeah, that's something that I try to make an active.

That's how I'm thinking about things when I'm talking to people. Totally. And that's where that's my superpower, to be honest with you, is I'm still a trainee. So I'm not trying to help people understand it. I don't get it. I'm actively learning. And I'm like, whoa, whoa, we have to bring this down a little bit because I don't, I don't understand it.

You know, and I think that the more you do internalize it and understand it and get it, the heart of that becomes. But you do do a really, really good job of it. And I think that's one of the reasons that your audience is so large. Reflecting, reflecting on 1099 episodes. any favorites for you i don't know if this is like asking you to pick your favorite child or something like that but i'm going to ask you anyway any moments that really stand out favorite episodes um yes i was thinking about this and i was thinking about nancy big williams this episode was probably one of my favorite um 171 and specifically we talked about listening you know

here's a quote from her listening in a professional capacity is a disciplined, meditative, and emotionally receptive activity, receptive activity in which the therapist needs for self-expression and self-acknowledgement are subordinated to the psychological needs of the client. Beautiful. Beautiful. She talked about dissociation. She talked about the adaptive nature of dissociation in that episode.

And I would say another favorite episode was with Sue Johnson. It was a recent one. she's another person like I never thought I would be able to have a conversation with Sue Johnson you know like I read her book I've seen her at conferences and I think I was able to have like a conversation

where she went deeper about her childhood than I've ever heard her speak about what it was like to grow up in that bar which a European bar is very different than like an American bar there are places where people come together at the end of the day families will come to bars

and she grew up in this setting watching her dad be like a lay therapist, watching him calm people, listen to people. And she was able to bring that attachment research and knowledge and change the face of marriage therapy. So her coming on talking, I felt like it was a historical event.

My heart was screaming as she was saying back. She was talking about how if you're not going to learn everything you're going to use in psychiatry in medical school and then residency. You know, it's who you are as a person. It's your early life experiences. It's your temperament.

Yeah, that was amazing. She was phenomenal. Yeah, Sapolsky talking to Sapolsky, that was the tough one for me because I don't believe in determinism. And so I invite him on my podcast, and then I find out his book that he wants to talk about is on determinism.

And it's like 600 pages. And I've done three episodes on free will, like kind of argue for how actually a sense of free will leads to better psychological outcomes. And so I'm always, you know, my podcast in particular, I don't want to put people on a pedestal who I disagree with profoundly. And so sometimes when I disagree, I'll disagree a little bit more in the blog articles. So if you want to get my two cents, you could read the article I wrote about that episode

in particular. I wrote it myself. but just being able to interact with them I mean I thought it was really I've looked up to him I've seen his neurology series he has on YouTube his book Why Zebras Don't have ulcers

is something that we use in the IOP partial program that I have so it's like I appreciated him and learned enough from him and so it was cool to interact and so that was a fun one yeah you've had some real real ones on the podcast

podcast, especially lately. It's been amazing. I've had his book behave on my shelf. I think I got it when I was a freshman in college and I opened it up and like read 10 pages and I might need to try this. I have a little more background knowledge. It's dense because he's a genius. A couple of big ones for me that I want to mention just if anybody's kind of joining your podcast late and they haven't been through some of the archives. 104 and 106 on Silas Saeus Seidon, you really came to life in that one, I think, because you're appropriate. a skeptic, you know, and you see in the mainstream media how this is being, well, there's a lot, a lot of ink is being spilled about psychedelics right now. And so you're, you're really an evidence critic in that one. I thought that was an amazing overview. It's, it's got a cultish, yeah, charismatic, like I have never, and I probably will not have charismatic psilocybin profiteers on my podcast. I continually get offers, by the way. So it's like, can you have so-and-so, talk about this. He has a new company, blah, blah, blah. It's like, no, I'm not going to have, I'm not going to give your, like, guy, a platform to talk about it without just being able to

open up one article at a time. Yeah. So actually, the resident was a lot more excited about it before than after doing the series with me. He held his own, though. I thought it was a really good academic debate. Yeah. He, like, he was a total fan. Okay. But I think he was less of a fan after. We're doing your job. I'm just trying to look at the actual evidence and think through it critically because we don't want to just be pulled into wasting decades of our life. I mean, not that they're, you know, I'm not saying that if you are really into it and this is what you want to do. Like, yeah, learn everything you can about it. But look at it.

But look at it critically as well because it's like a good example is, you know, like when I did the ACT Act, except it's commitment therapy. And from the interview alone with him, I felt like he was so exuberant about act. And it's like this is, it's almost messianic the way he was talking about it. and I had a total fanboy of his. I said, give me any article that compares it to an act of control. We're going to start the episode with every act of control. And so the first 10 minutes, I review every article I could find comparing acceptance commitment therapy to CBT.

And they're pretty equivalent across most domains. And so it's like, do you want to then dedicate 10 years, of your life to learn this thing that's equivalent to CBT if you've been doing CBT for 10 years. So it's like we can jump from one thing to another thinking it's the cure. I would say it's the therapist. And so how do you develop as a therapist? That's a lot more complex. You have to do your own work. You have to grow intellectually, spiritually. You have to mature as a person. That's a lot harder than just picking a modality that's new and fancy. For sure.

And we always need to be on guard against, I think these charismatic leaders, these messias in psychiatry, partially because while we're measuring is so hard to measure. And one of my firmly held beliefs is that what the thinker thinks, the prover will prove. And so even the most quantitative studies, we need to read with an eye toward,

to me, that reality, that axiom. Another big one, It's funny that you mentioned 171 with Nancy McWilliams, which was incredible, because on my list, actually, and I'm not just saying this, was 164, which was listening psychodynamics, which was sort of a monologue. And I didn't know how I'd feel about that, to be honest with me, because I was like, I don't know, he always interviews, what am I going to think? It was amazing. That was an amazing episode. So I really hope everybody will take some time to listen to that. I appreciate that.

And that is largely based off of my work with Dr. Tar, the information from Nancy McWilliams, and also Shedler. It's very informed by those people. And so, but I'm trying to distill how you listen in a deeper way, because a lot of what we do is listening. And not a lot of people feel listened to, but it's through that, that hopefully. hopefully they can experience something new and different. And hopefully you get internalized to some degree as a more loving, compassionate part of themselves over time like I've had with Dr. Tar and some of my mentors.

So, yeah, it's like, it's, it's like hard to express what all of this means and just words. Despite, you have 400 hours of audio out there, and it's still, you feel like you haven't captured all of it, which is beautiful. Yeah. Yeah. I think, to your point, we have boundaries, et cetera, thinking about falling in love, love,

I think a veil is lifted. I think an artificial barrier disappears when we as clinicians accept, and I'm going to use a word here, kind of a strong word here, but I mean this on a spiritual level, what I don't really feel, when we accept our own brokenness,

you know, and I think you talk a lot about doing your own work in therapy, et cetera, and when we accept that at the end of the day, we're really no different than the person sitting in front of us. This is what really struck me with the ordinary men episode, which I had to, just like psychoanalytosis, I had to go bite-sized through the ordinary man episode. Because when you come to accept the fact that I have no better than anyone else on planet Earth

in any seat anywhere, I think only then, once we kind of admit that about ourselves, can we really connect with our patients? if we feel like we are here with all of the answers, and we're going to reach down from on high and share this with our patient and make them better because I know, to me, we're robbing ourselves as that connection. We're robbing our patient of that connection,

and ultimately we're going to have worse results. Okay, so ordinary men is about, it's literally recording a piece of history because that guy has never been interviewed like that before. he spent 50 years studying the Holocaust. Imagine studying the Holocaust for 50 years. And this guy was deep. And there was a moment when he broke down.

I don't know if you remember that, but it was so powerful. He broke down remembering, discovering this piece of information that the police battalion 101 had the choice on day number one to kill the... to kill Jews point blank or not. They could have chosen to not do the shooting, but most of them chose to do the shooting.

And it's so horrific that we want to think that these guys were psychopaths. They were not. We want to think that they were somehow deeply, ideologically indoctrinated, like the SS maybe, or Hitler youth. They were not. these were people who had a life before Hitler. They were average of 40 years old.

They had drinking the water of anti-Semitism. It was in the water, literally. Not literally, but it was literally everywhere. Okay? And that disgust, combined with conformity, led to this incredibly atrocious, disgusting, almost traumatizing event. Like, as you read the book, it's almost, it's like I literally had to like put it down,

ground myself, talk to friends about it. And so, you know, what do we do with this information? One thing that we do, and we wrote, the article we wrote on this is actually a lot more detailed on what we can actually do with this information. So please go check out that article. But it basically, what I was thinking about was like, okay, How many times do we start to conform to a group and we don't feel right about it? How many times have I done that?

Can I notice small moments of cognitive dissonance? Can I notice small emotions? And can I use those to not allow myself pure conformity to a group? So a good example of this is the Milgram experiment where they shocked people, right? So you had this kind of research laboratory and you could, come in and you're going to shock people progressively. And the shocks are going to go up, up, up, up. And eventually the person is like yelling that you're shocking.

The video of the people doing the shocks shows that they were sweating. They're distressed. They don't want to do this, but they keep doing it. Why? Because there's a research scientist in a white coat behind them that says, please continue, calmly. Please continue. And so what I took away from this was there's small moments where we are distressed conforming,

and we need to pay attention to that. That's number one. Number two is we need to look for any dehumanizing language ever against any group of people. And we should never empathize with one group to dehumanize another group. Well said. And that last one's pretty bright. It's pretty obvious when you see it. This is dehumanizing language.

This is dehumanizing language. And it happens over and over and over again throughout history. You cannot kill innocent children and women like they did in the Holocaust without first dehumanizing them for years. Which I think is. is one of the ways that being a therapist, being a psychiatrist, in a way is like cheating. Because we get to sit in the room with people that we would never otherwise meet and know them on an intimate level that we would never otherwise be privileged enough to know people on. Now, that doesn't mean that psychiatrists and therapists can't be racist, misogynistic, you know,

simple-minded, what have you. But it's a lot harder, I think, to do that when you're having empathic conversations with people who are suffering who belong to all these different groups. You know, on that point, like, during the last election, I had to literally stop watching the news because I had patience on both sides. And I could not... And if you can watch the news and, like,

not have countertransference towards the opposite group, more power to you. Like, don't listen to what I'm about to say. But personally, personally, okay, I found if I got overly invested in one group, it was hard for me to not have countertransference towards the other. And so I had to like, I literally had to stop watching. Like, you know, and I'm the kind of guy that could, like,

I could get into something. I could watch it for like an hour or two hours a day. So I just have to stop watching. And then just because, like, you start adopting the emotions of the people you're watching. If you're a therapist and you're a good therapist, You feel what other people are feeling. You can't not feel it. So you feel all of their anger on the news,

and you internalize it as your own anger. And it's like, then that you have to work through with your patience when you feel that. So it's like I had to just stop. Let's move forward just a little bit here. Kind of round us out. Let's look at the future. Exciting new directions for the podcast.

What comes next? You know, what comes next I'm going to continue to look for people who have 20 plus years of experience specialty in some area maybe they've written in a book and they're experts

and maybe it's a topic that's a little bit fringe that maybe we don't all know I look for the topics that like maybe it wasn't covered in residency completely right so those are the topics that I'm curious about I would like to do a series with a couple key people. I'm courting them to do that.

I'm having Dr. Cummins on continually. I have another one, psychotic depression planned. It's in the books. And so, yeah, I think that's a little bit. I don't plan on slowing down. Yeah. Sounds good.

Well, it's a real gift. It's a real gift, these 200 episodes. It's been really fun to join. you. And it's changed my life. It has. It's changed the way that I approach patients, being able to have this, being able to take my dog for a walk and learn how to help people. Helping me to be a happier person to live a more balanced life. And I certainly wouldn't have a podcast had you not gone before me. I don't know if I would have chosen to be a teacher. That's cool. Because it just, you know, it's all, it just made such an impact on me. But I was like,

huh, there's something there. I think I want to do that. So I'll be forever grateful and I hope we get a chance to do this again. Yeah. Yeah. I think it's meaningful having you on hearing how it's impacted you. That's really cool. That's really cool. It's a beautiful thing. And I think you, I do think you're like your podcast in particular when I heard it, I was like, oh, this is like, this is a conversation because I think the critique I have on some of the other podcasts is it feels like

it feels like someone's reading something it doesn't feel like a conversation it feels like a lecture which people want, people's brains are naturally geared towards hearing a conversation. We've been hearing conversations for tens of thousands of years.

We've been reading things for what, like three or so. And so conversations have been going on for a long time. And that's how people learn. That's how our brains are wired. So, no, I think you do a great job. Okay, final question for you. How can we as listener as best support in you,

you know, in your efforts to kind of make world-class psychiatric education freely available across the globe? Yeah, I think the first thing would be like sharing episodes you love. Like most people find this podcast from other people like yourself recommending the podcast. So if some episode really speaks to you, sent, you know, texted to a friend, say, hey, this is what I liked about it. Two would be to just teach someone based off of what you learned here, right? So if you learn something of value in an episode, like try to teach that the same day or the same week that you learned it.

Like, for example, if you go through the lithium episode, print off the lithium handout and teach the medical students about lithium, give them the handout. You know, all my episodes are for free, all the write-ups are for free. And then, you know, if you're in attending and you need CME or you just want to support the podcast, you can be a CME member. It's like 3.20 a year. It allows me to block off one day a week to do this. Hopefully at some point it allows me to block off two days. And I would say if you're really ambitious, you could try the microexpression training course, which has a lot of training videos. And then you can actually practice doing, reading microexpression. I have hundreds of microexpression clips that are real microexpressions that are coded that can teach you how to actually identify it. And most people are not good at this until they actually do the training. And I think it's monumental in doing psychotherapy, is reading what they actually feel.

It's a part of the tapestry of the work. It's not the full work. it's a pre-lexical expression of emotion. Well said. Drop the mic. All right, man. Have a good one. Thanks for coming on with me.

We'll leave it there. Yeah, it was fun. Thanks for having me.