Psychiatry & Psychotherapy Podcast - Book Club: Marcus Aurelius' "Meditations"

Episode Date: July 8, 2021

In this episode, we will be discussing some themes observed in Meditations, a collection of notebooks written by the 16th Roman emperor, Marcus Aurelius, during the last years of his reign. His writings are still relevant to us and resonate within us, as the emperor himself struggled with some core questions that anyone who is living this thing called life might ponder. By listening to this episode, you can earn 1 Psychiatry CME Credits. Link to blog. Link to YouTube video.

Hello and welcome to the Psychiatry and Psychotherapy Podcast. I'm here to talk about getting rid of burnout, increasing job satisfaction, and feeling like an expert in what you do. One thing that created a lot of burnout and angst for me was trying to get continued medical education right at the last minute. So why not join the CME membership and do CMEE while listening to this podcast. Go to Psychiatrypodcast.com, sign up, sign in, take the test, and the certification is email to you in seconds. Welcome to the psychiatry and psychotherapy podcast. This is the second book review. I am doing it with a group of residents.

We have Serena, Grace, Hassan, and George. You guys want to speak so people can know what your voice sounds like. Serena. Hello. Grace. Hi. Hassan. Hey.

And George. That's me. Okay. Well, let's see. This is our second take. We came here Friday night. We had some good times and it didn't record. So know if you are venturing out in something,

there are no dead ends, only roadblocks. That's what I tell my patience. Often when we think about the future, we think about future dead ends and projects we're doing. But really what we're not imagining correctly is that really all we come to is roadblocks. And then the roadblock becomes something we can problem solve. So I don't see dead ends.

Unless you're trying to be maybe the present of the United States, then there might be some dead ends. So maybe some reality testing is necessary once in a while. All right. Let's see. I think we're going to start with death, right? Hassan, you want to start us off again? Sure, yeah.

I think last time we were talking about how debt really doesn't, does a good job at help us refocusing. You know, I brought up an example with exercising how some people, people who work out hardcore, they use death as a motivation for them. But also, I feel like in day-to-day life, for me personally, when I think, you know, if this was my last day or my last hour, how would I make this count or, you know, how would I want this to look like? And it really helps me refocus too. Yeah. Okay. So we're talking about Marcus Aurelius' book, The Meditations. It was a book that Marcus Aurelius wrote for himself.

He never meant it to be published on the book stands of people that are famous. My mentor, Dr. Tar, it's his favorite book. He's got it like rebound by this like famous French bookbinder who he goes to visit every year. Yeah. He goes to France like every year. Because it's such an old copy. He has all these classic books, like early translations that he then gets rebound in like really, really nice books. Anyways.

That's a field trip to Dr. Tar's office. Oh my gosh. His house is like, it's absolutely unbelievable. But it's in Pasadena. Yeah. Well, so, you know, because we were talking about death, I think that was one of the things that struck me most or was most obvious, like as one of the biggest themes, how focused he was on death. or how much he talked about it. And I thought it was, I thought it was to the points that is like, oh, this guy must really be afraid of death,

with how often he is telling himself not to be afraid of death, you know? And, yeah, just talking so much about death. Yeah. The death is all around in the Roman Empire at that time. He's in battles with the northern Germanic tribes. And it's very chaotic. they do these mercenary like attacks at all times of the day you know and so you have to imagine I don't know if you've got seen the gladiator there's a scene of Marcus Aurelius right before he dies

and just this like northern snow battles you know so you imagine these battles one after another unlike today you don't see people die unless you're a doctor unless you work in health care like death is actually very sort of like we rush people away in ambulances, so most people don't see people die. But you can imagine, you know, back then you would see, especially if you were in ongoing battles, thousands of people die. Yeah, and there was also that plague going on. And I read that Marcus Aurelius himself was a very struggling with his health.

And meditations was written, you know, later in his life. And he passed away pretty, you know, soon after, I heard. that he wrote this book. Yeah, well, he almost passed away one time, and then they thought he was dead, and a general, one of his main generals, married his wife. And this is one of the beautiful stories

where Marcus Reelis lived out of his values of forgiveness, and so he was going to forgive the general and take back his wife. He did take back his wife, but someone brought him his general's head, who was his friend, and he was actually very upset about this. was reported.

So, you know, you can imagine normally someone would be very jealous to take your wife and try to take your kingdom, right? But he kind of like contained those affects, processed them in a meaningful way. You said Marcus Aurelius was in Gladiator? In the movie Gladiator, at the very first scene, it's of him dying. And then his son takes over. His son was actually not a very good emperor. So Joaquin Phoenix is the son of Marcus Aurelius in the movie?

Yeah. That's right. That was, is it comidus? Is that his name? Yeah, something like the son's name. It was like, I think usually heirs were, or heirs to throne were not biological heirs. Like Marcus Aurelius was not the biological heir from before. And I guess that was typical to like find an heir and groom them.

But then he took his own son and then I guess his. because his own son wasn't a good. So Marcus Aurelius' his own son became the heir. Yeah. And this troubled me for a while because I was like, how could such a great man

raise such a licentious son? Right. Where really I think, you know, Marcus Aurelius was not home very much. He was not raising his son. He was off in battles. Yeah, yeah. For a lot of his life.

And he was probably very occupied. And, you know, people choose their own way. So even if you have, and also fame, money corrupts a lot of people, right? So, yeah, his son was not a great king. Although Marcus Aurelius, he tried to, sorry. Yeah, go ahead. Yeah, try to just really not let his status as an emperor, like really rule him per se. So he essentially wrote this meditation as like a jotting, you know, his thoughts, kind of like a journal, very personal, private kind of thing.

And just there's a lot of repetitive things throughout the book. He just talks about the same thing over and over again. And one of the things I think he also mentions in the meditations is how everyone is kind of given like their share of life, essentially. So even if he was born as an emperor versus like someone who's born as a slave or lower, status per se, you know, as long as they're satisfied with what they're born into or what kind of life, destiny that they're living, and they're living that destiny, their life to the fullest, then that's how it should be. And so he really tried to live a life that's given to him as an emperor, but he wanted to be a good man. And so in a sense, he really struggled to just be true to

himself, his values, and that's why he talks a lot about stoicism and philosophy and such. Yeah, so two good points from there is like being content where you are. Not, you know, it's, I think it's good to aspire forward, but still being content where you're at, where you are. So being content in your mind, in your place in life, without jealousy, without ill intent towards people who are maybe more successful, which when I say, that, I realized like, oh, yeah, we'd all kind of agree with that, but at the same time, like, living that is actually very difficult. Right.

Especially if you look at our unconscious and our, like, own sort of desires, you know. So that's one aspect. The other aspect is, you know, oh, you could say, oh, it's easy to say that when you're the Roman Empire, you know? But he got this from Epicticus, who was a slave, who was one of the early Stoke philosophers, who he was well versed in, who was. started out as a slave. And also Seneca, who was very, very wealthy and then became very poor, just kind of went through these cycles. And so these thoughts of, can you be content where you're at

with what you have, living your purpose with what you've been given? I think it's very valuable. And they have a lot of practices to live that. So it's not just like a theoretical thing. It's like, no, actually, let's have a couple days out of the week every year where we eat very simple food, where we sleep on the hard ground, where we remind ourselves that, like, we can live without all these fancy things. Like, do you really need all these fancy things? Like, right now I have an old, beat up car. And I'm like, I'm pretty purposeful in keeping it at this point. Yeah. Because, like, there's a dent in it, you know? And

Was that? And And someone hit my car, yeah, when it was just sitting there. And I could have pushed them for the money, but at the end of the day, I was just like, it's just a dent and it's an older car. And so, you know, it was in the middle of COVID or whatnot, and I just decided to not push them too hard. They didn't have insurance. Oh, forget it. That is not worth it.

Yeah. So anyways, I drive an older car and I think like it's okay to live under your means. I think like the fact that he's Roman Emperor actually makes it more impressive, right? Because this is, it's so unusual almost, I guess. Well, I don't know because I don't, I guess I don't know other Roman emperors. But I would think that somebody is expected to take advantage of all that they can. I think for me, what struck me like the most just reading this was how much I could relate in a way to someone, you know, 2,000 years ago who was also basically the king of the world. He didn't have to, I guess he really didn't have to challenge himself or try to better himself. He was already Roman emperor.

I mean, I guess it's his teaching. Like he said, he was often, he was taught to challenge himself. and work towards a better self and being a better leader. Yeah, one of the verses that surprised me, so he started off with like a series of gratitudes. And I can imagine him, so he wrote this for himself so he could read it and reread it. And so it starts out with like his gratitude towards this person and this person.

And then one of his gratitude sort of lines was like, thank you that I didn't like, or I had this period where I learned how to be sexually, sexually restrained myself. and even though I had power that I didn't take a slave, any slave I wanted to. And I was reading that and I was thinking, imagine like having the ability to get away with anything, but then choosing to not. You know, it's like, Nichi said a lot of morality is just a lack of courage or a lot of like, you know, because people don't have the courage to do the wrong thing. so they restrain themselves. But imagine there are no consequences.

Like you see this like famous people like who like do whatever and they get away with it for years and years and years. You know, but imagine having the ability and having the restraint at the same time. So that was pretty interesting. So he's thankful for that. I don't know. That kind of like flew in the face of like I think modern ethics. But we appreciate that. You know, it's kind of like.

You know, you could as a producer sleep with potential actors, but you decide not to over the years. And because of that, you gain a reputation and respect for, like, being someone that you would trust your daughter to, you know? Or you don't, or you're the opposite, you know, where it's like, yeah, don't put your family in that person's trajectory, right? He talks a lot about, you know, self-control and, and then, you know, refraining from, like, pleasure, he talks a lot about pain and pleasure itself.

Yeah, it's a little bit of a misnomer. Like, Stokes are not against pleasure. Like, they'll say, like, enjoy the riches of food, but then also remember that you don't need those. So it's like enjoy or have emotion, but then also contain the emotion. Or, like, don't let the emotion control you, let your reason control you. So it's kind of a, it's, there's. this word like stoic, like you're stoic if you don't have emotion, that's not necessarily what the stoics believed. They just believe that you should focus your emotion and on the goals

and not be controlled, not be controlled, but be, but listen. Yeah, I was, you know, when you were talking about stoicism, you know, pleasure and pain, I was thinking about, like I was visualizing a tree, right? A tree will stay a tree. whether there's leaves on it or not or whether it's bearing fruits or not or whether it's bearing flowers or not you know the tree is still a tree and it'll stay a tree you know when winter comes it goes through the pain and and you know it's not part of it you know it doesn't take away from the tree when the leaves go away because of the winter or you know the the tree doesn't lose its value the intrinsic value within it when when it gets the flowers or the or the fruits and so in

the same way I see a human as, you know, we stay, if we're internally focused, then we stay true to ourselves, whether we're in good times or bad times, whether we're able to have all the luxury of the world, or we just have the bare necessities, or even not that. And so that was kind of what I was feeling, as if, you know, it can come and go, but its attachment to me does not have a effect. It doesn't affect me. Yeah. There's this theme of nature. going along with what nature has ordained, being content in the midst of your place in nature. I like that. I like that tree analogy.

Thank you. Kind of going along with that, too. I think there was one verse or what you call it the... Meditation. Meditation. Sorry. You know, that Marcus wrote was, you're not surprised by an apple tree bearing an apple fruit. Like, that's what nature's course to do.

And so I think when he says a lot about how kind of going back to like the fame and wealth or power, all those things kind of pass. But whatever that lasts, what's true is kind of like the virtue, kind of like what you're what the, I guess, nature intended it to be or what's going to last is going to be virtue. And I think Stoics above all, they kind of believe the duty to himself make himself as a man of Yeah, there's a huge value of virtue. Yeah. And what is virtue? So Stoics held this value, this understanding of virtue as knowledge, and there were four primary virtues, them being prudential wisdom, which is knowledge of good and bad, courage, knowledge

of what to fear and not to fear, moderation, which is knowledge of what to pursue and what to avoid, and justice, which is knowledge of what to give or what not to give others. George, let's get some George thoughts here. I was thinking, sorry, I'm like still back on the emotion thing. Because I know what the stoics, like, you know, the virtues are really important. And do we talk about this earlier, the apathia? Like pathos being kind of like that unbridled emotion and like a pathos being to, you know, to avoid that. kind of emotion and to use those virtues to kind of govern a person so that they use

logic and rational thought to kind of decide, you know, what, you know, what they need to be doing. And I think it's important that we do incorporate emotions into our lives. Oh, yeah. You know, and, but I could see it being very easy to, to look at this idea and just kind of, say, emotions are bad, like a true stoke is a robot, you know, he or she abides by these virtues. I don't think that they're saying that. If anything, the way he talks is very passionate towards his mentors and he has attachments. So he's not detaching from people. He's actually, it's like a very strong, they believe in strong friendship, strong attachments.

You know, like don't just read knowledge, go to the foot of the person who has the knowledge, you know, build a relationship. A lot on friendship, yeah. I feel like it's more saying don't just listen to your emotions or follow, you know, your basic feelings against what is right. Kind of like steer your emotions or what, you know, so that you're not going over just going after pleasure or just going after your anger. You know, it's kind of like. Well, I think like, okay, so with anger, it would be, courage would be, fighting under the proper circumstances necessary to fight. But using anger to hurt other people, to hurt innocent people to not protect people who are innocent, like this would be like good

examples of kind of like, okay, there's a correct or an incorrect, a natural and an unnatural, right? With other anger, like jealousy, right? So jealousy is kind of like a love and anger combined, you know, he says versus like, just remind yourself that two generations from now, no one will remember your name, you know, and it's kind of like a way of bringing himself back to reality of like, most people don't care about historical figures and most people will forget you. And that's grounding for him actually, right? But then why wouldn't that, why wouldn't that put like anger hatred love and pleasure all in the same plane because love love in the proper circumstances i think i think this is what they would say love in the proper circumstance of

brotherly love of love for your wife of love for your country these would all be good things right but love for things that are fading like wealth or love for things like pleasures that are fading that may be here today but may not be here tomorrow. So it's like, can you with magnanimous fortitude meet the future challenges? Right? So it's like if all of these good things were taken away from you, would you be so distraught that you would just like cave in as a human being?

Or can you prepare your mind even now? Right. And a lot of the preparing your mind, a lot of that stuff sounds a lot of like, cognitive behavioral therapy to tell you the truth. Yeah, for sure. Or act or logotherapy. It's all mixed in there.

For sure. Which is why I think this book is so important for psychology and future psychologists is because it's kind of like, can you prepare your mind to be tougher? Like, had a patient today, first time he's really heard about someone being sexually abused. And one thing I told him was that, look, like, I think I'm not surprised that someone was sexually abused that was close to you that you care about. I'm also not surprised that you haven't heard about the people around you that probably were sexually abused that you just have no idea about. You know, within a couple months of me being in Orlando, I can count on two hands. The people,

friendships that have built of people who have been sexually abused, real people, not patience. One third of females by the time they're 18. One fifth of males by the time they're 18. But they don't talk about it. Why don't they talk about it? Shame, trauma, how it affects the family, how are people going to respond? You know, and so can you, I said, I kind of challenge them. Can you as an individual walk with this person, give them kindness, give them grace, give them, you know, your love, give them your listening ear, your empathy?

And this isn't the first time you're going to hear about something like this. And actually, as you get the mental, ability to suffer with another human being, you're going to have more suffering human beings who open up to you. Because you're going to know what to do with it. You're not going to be overwhelmed. You're not going to be traumatized. But he was a little bit traumatized. And that's okay too, because it was his first time. I mean, that was, it's traumatizing to hear about someone else's trauma the first time, maybe not the 20th time, if you have good supervision. If you're provider listening to this and you felt traumatized by hearing someone else's story, process it with

a supervisor, process it with a mentor, right? We were talking about death of patients the other night together at over ice cream. It's like, you know, as psychiatrists, as mental health professionals, we get directed to the most suicidal clients on earth. One percent of people will eventually commit suicide. It's tragic that that happens. But we directed those. people. So yes, some of our patients over our lifetime will commit suicide. And sometimes it's, or most of the time, it is delayed by the work that we do. And a lot of the times it's stopped completely because of the work we do. But there still will be some people that die. Just like if you're a heart failure, doctor, you're not surprised that some people die of heart failure.

Right? If you're a lung doctor, you're not going to be surprised when someone dies of lung disease. If you're a brain doctor, neurologist, you're not going to be surprised if someone dies of strokes. You might delay the second stroke years. Psychiatry, I don't know, it's something different. It's so hard for us to grapple with someone's death. I think it just feels in the way we talk about it in society as if it's more of a choice or there's something. something that could have been done, like, for some reason, the mind is different than all other parts of the body, you know? It's a disease.

I mean, if you look at autopsies of patients who have committed suicide, there are fundamental changes that have occurred in the brain. Go back to my suicide episode where I really talk about this. Like, look at autopsy studies. I mean, for people who don't think mental illness is a biological disease, it is. And you know what? Psychotherapy changes that. That's the other piece of it. It's like psychotherapy can change. Exercise can change the brain. Right? So it's not just meds that change the brain, how the brain functions. And most people who commit suicide have not seen a mental health professional in the previous months, previous like six months. And most of them have not seen their primary care doctor and told them about it. So it's like most, the majority of people who commit suicide are not even in mental health care. You know? And so. So it's tough. It's a tough aspect of the field.

I hope this is encouraging to you if you've had a death and you're listening to this. I hope it encourages you to think through or to prepare yourself. Maybe you haven't had a patient that committed suicide, but just to hear this, it may prepare you to be sort of psychologically stronger if it does happen. And, you know, if it does happen, reach out to a colleague and process it. reach out to a mentor. And you'll find that a lot of us have already had these situations. And they're really tough.

And you're not alone. You're not alone. Yeah. And I think the book does a really good job about talking about that. Or Marcus Rulis keeps on talking about that, how the universe is all one. You know, everybody is part of, you know, nature. how we're all for the same purpose, you know, we're all going through change,

but nature does not give us more than we endure. So these are all reasons for us, you know, we're all going through the same adversity or different challenges based off of, you know, what we can endure. But, you know, just the fact that we can align ourselves with the fact that this is the reality of our life to go through challenges. you know, that enough is empathy, is worthy for us to empathize with others. And, you know, you were talking about abuse, but, you know, even day-to-day challenges are something that we can empathize over.

Yeah. Right. And I really am intersubjective in this aspect. Like when I'm listening to someone, everyone's situation is unique. And so if they are feeling overwhelmed by it, then I don't think in my mind, like, oh, they shouldn't feel this way. I think, of course, they're entitled to feel this way. It's overwhelming.

And how can I be there with them in the midst of that and suffer with them a little bit? You know, there's a saying of like, what do you, you know, doctor, like, maybe like a general practitioner, they see someone drowning and they jump in and rescue them. What is like a, what is a therapist or a psychiatrist? do. They jump in and drown with them. Wow. Wow.

I was like they give them the right less weights. Ask them, how does that make you feel? For a while, right? They jump in and drown with them for a while. And then maybe potentially that process of like jumping in the water and them seeing you drowning with them. Eye to eye. eye to eye, there's like this eye to eye moment of contact, and then that is enough for them to keep fighting and they get to the edge.

I like that. Although in reality, if you try and rescue someone, you're probably going to drown with them. But no, I like that. I'm putting a twist on the joke. No, because I feel like that is true, right? Because if you empathize with that individual in a way that maybe they've never experienced or hadn't recently experienced, you know, it gives hope that someone, someone understands them and someone, someone who has seen it before understands them and can offer them hope.

Yep. Yeah, I think it helps. Yeah, what are you thinking about? I actually have a therapy supervisor, you know, 30 or, you know, this is the one takeaway, the biggest takeaway that I got from him, you know, I have tremendous respect for him, very experienced, cares so much about his patients. He said, at the end of the day, what matters most with your patient is that you care about them and you're able to connect with them and they know that you care about them. Just the fact that you've built that relationship, you've built that bridge, that suffices as far as what the alliance goes.

And then you can build on that. But if that's not there, you can't go further. I wonder if like, you know, going back to, you know, Marcus Aurelius and talking about, you know, he's the emperor, right? We were saying essentially at that time he was God. So how can he relate to like just everyday citizens who like lived in the Roman Empire? Maybe that was his goal, you know, through these meditations, maybe to think about what life would be like. But I mean, I mean, I guess you can only go so far, but being able to like empathize.

And a lot of his, you know, meditations really focused on like you were saying earlier, Hassan, like we were all, we're all part of the universe. I mean, why be angry at someone who, you know, cuts you off when you're driving down the highway because they are people too and their extensions essentially of ourselves. And Marcus Aurelius would also say, you're going to soon be dead. They're going to be dead. Don't even worry about it. Everyone's going to be dead. Don't get angry.

Yeah. You will always meet people who is going to tick you off. You're always going to meet these people who's going to cut it like. Better than you smarter than you. I mean, like, you're going to get jealous, just get over it kind of in a way because they're always going to be there. Well, let me say how it's helpful for me. He says, when you wake up in the morning, imagine that today people are going to be angry, surly, and snap at you. Okay. And can you maintain your magnanimous status, kindness, knowing that they are all part of the earth? And what this is, guys, is it's a negative. visualization. It's imagining your worst-case scenario, whatever that is, and imagining how you will stay calm in the midst of it. I actually do this with patients. I've done this in groups when I've

never run groups. It's like, can you imagine these situations that normally would irk you, but you are going to be able to be okay? It's like that's a negative visualization. I love it. Because, you know, if you only visualize the best outcomes, you're going to get hit by like curveballs, right? So it's like in sports, you know, when I was a rower, we would sit around as a group and we'd have like this person talking to us. Okay, imagine you're like a boat down and you're all staying calm. The other boat is ahead of you, but you keep pushing. You don't give up. Right? Because you know that you're going to keep pushing. And then that is going to. to allow you to push through. And then you visualize yourself, like maintaining like one stroke at a time, one stroke at a time, one stroke at a time, focusing only on one stroke,

because as soon as you put your head in the other boat, you've lost. And you'll see that sometimes if you feel like when you're going up for like, if you're weightlifting or running, and if you feel like you can't do anymore and you give into that mental thought, you won't be able to do much more.

But if you continue to fight, you can actually do a lot more because we have not really tapped into our reserves often. And he says, right, like nature's not going to give you something you can't endure. Yeah.

And if you can't endure it, well, then you'll die. Yeah, but it's something, you know, with the attitude of, it actually reminded me a lot of Victor Frankl's book, kind of this idea of taking on hardship, you know, like welcoming hardship and using that to grow. I think he calls

like hardships and things that happen to you like nature's prescriptions and take it like, like, you know, a doctor's prescription or, you know, this is to, for you to grow and build from that rather than seeing it as a negative, embrace it as a positive. You know, only what, one fourth of traumas become PTSD. this is rain by the way if you can hear this um good flower of rain yeah yeah i mean if it's a more severe trauma it's probably a higher fraction but a lot of people can overcome pretty traumatic events uh i you know i don't like this idea of nature only gives you that which you can overcome because traumas do happen which are overwhelming to our physiological system what i would say is if if you've been

through traumas. It's like there are people who can help you through that. And you may need to search for them. Like I had one person who came on to an eating disorder Sarah Bradley. She's, she's, um, she went, she got a therapist in India. Talk about incredibly, like, like, virtually. Yeah. She got like a, like a top psychiatrist out there. She could afford them for like $50 an hour or something like that, you know. But it's a steal by the way. You're like conuous. No, but it's like, of course there are actually things that unfortunately make people for at least a good period of time weaker or something that's, it's really hard. You know, so it's not to diminish that, but I think that attitude kind of changes the way you see things, kind of as, I guess, welcoming it as opposed to why did this happen to me.

I think that's the, I guess that's what I mean by that. Like, it's the attitude of approaching it. Yeah, no, I think I have seen incredible strength in people who did the work of therapy, and they come out the other side, and they're incredibly life-changing individuals. Yeah, I think this is all very in line with what Marcus Aurelius also talks about and stoicism. Because, I mean, we were talking about this, how, like, this book is so repetitive. Like, why is he talking about the same thing over and over again? And I remember talking about it before this podcast, you know, but essentially what Stoicism also and Marcus Aurelius believed was writing it down and just kind of keep repeatedly writing things down on its own has power.

He believed that. And that's why he continued to write the same things over and over again. And that and he wanted to like improve himself. Self-improvement was one of the big things for him. And so just you can tell like, oh, some of the stuff we talk about death, like he was fearful of death or he really, wanted to be, you know, man of the virtue or you told, you can tell what, where his mind was at and what kind of like values or virtues that he really wanted to work on. So like in the same line of things, too, when we're talking about patients working through trauma or going through

therapy, you really want to get better. You want to improve yourself. You want to understand yourself better, bring self-awareness, essentially. And that's the point. You're just kind of keep etching that part of whatever you've been going through, what you want to improve. into your mind, your heart, whatever, and that gives you that strength, you know, to live life, move on, you know. Yeah. Like chanting or, you can't take, right?

Like in religion, like you, people chant things and it's like, I don't know, to get it in your head and make it real. Yeah. George, let's, uh, I want to hear some of your thoughts, George. You've been pretty quiet here. Have I thought I've been?

Compared to our first take. Yeah. Compared to our first take. Tell us about the, the force, George. Yeah. Oh, yeah. Oh, we want to talk. Okay.

Well, so we're in Central Florida. You know, Star Wars Land is just over at Disney World, not too far away. I was thinking about, you know, like, while we're reading this, talking about the Stoics, and I'm just like, no emotion, virtues, like, rational thought. Well, clearly we're talking about the Jedi here. And I think it was best put by everyone's favorite Jedi. Jedi who said that fear would leave to the dark side. Was that Yoda? It was Yoda.

Well, he said, what did he? He said, fear leads to anger. Anger leads to hate. Hate leads to suffering. And I think about that. You know, I think in that voice too. But because we know that it doesn't, like that progression, like,

doesn't necessarily make sense. And I guess maybe I'm also referencing what we're talking about earlier in terms of emotions and being able to like bridle your emotions and really control them because that path is not, that domino effect is not necessarily inevitable. Clearly in the case of like Anakin Skywalker, I don't know if people know about Star Wars. Spoiler alert, Anakin Skywalker is Darth Vader. So, right, like, so this idea that like his fear of losing his mother, his fear of losing his wife led down the path to becoming. The biggest villain in the galaxy. Yeah.

Yeah. That's so interesting. Because that's why they didn't want him to become a Jedi because he was too tied to this people. That's really interesting. Yeah, because he was like, I'm afraid for my mom. Like my mom is back on tattooing and she's a slave. And Yoda's like, I don't think we can train him. He's worried about his mom.

And instead of being like, that's a normal human thing. Like, you're a young boy. Like, I'm worried. He's like, I'm worried about my wife Padme. Don't worry about Padme. You can't have any emotional connections. Yeah. But that's kind of what Marcus Aurelius, he, I remember thinking it was kind of interesting about how he, he talks about don't fear your child's death or if your child dies.

Like it's no, like, it's no big deal. But I'm thinking like, wow, like, of course someone's going to be upset. But he kind of, I guess, I mean, he had most of his children died. So maybe that's why he says this. But he's kind of saying that it's not something to feel. fear and it's not something you should be sad about, which is kind of in line. But like, it's normal to be sad. Right?

That's a terrible thing. Right. That actually reminds me of what you described curse to be grace, right? Or through stoicism, what is it, not to fear? Knowing what to fear or not to fear. Exactly, yeah. And I remember what you were talking about. So, you know, with the, I think in the prayers, it was more about, like, instead of praying

that, you know, nothing happens to. my child, like, give me the courage if that happens, then... Like the serenity prayer. Yeah, it was a serenity prayer. It was something like that. But instead of worrying about the extrinsic stuff, you know, worrying more or praying more about the internal strength to increase instead of, you know... Your opinion of it.

Exactly. So kind of going back to what we initially talked about, emotions too, Georgie. You brought it up, you know, they say emotions are kind of like... the symptoms or the outward appearance of what's really going inside. And so it's almost kind of like, I think Dr. Peter mentioned like how some of the emotions, I guess, could be fleeting. They come and go. They're not always static.

So it's good to pay attention and we want to pay attention. Obviously, it's not something we are supposed to ignore and totally like not pay attention to obviously, but acknowledging them, knowing that those are the feelings that we feel, the emotions that's there. but what are the underlying thing that's bringing up those emotions and being able to kind of keep cool if you had to say and then yeah i think that's where deeper work comes in and i would say that's kind of where i might say he didn't really eloquently i mean they didn't really have that back then right is they didn't have psychotherapy and like you could go back and process

things and then be impacted by things differently right not that you i mean i would say it's my goal in life to have attachments. I'm going away for five days, and my son had like this, like, he's five. He, like, really cried tonight. He's like, I don't want you to leave for five days. And it was like, it was real tears, you know? And like another time he, like, grabbed onto me, you know,

and he wouldn't let me go. And, um, I, uh, I, uh, I tear it up too, you know, and I think that's good. I think it's good to have attachments. So I would kind of differ, I think, from maybe the popular conception of stoicism that they say don't have emotions. But I would also say, like, it's through your emotional, spiritual journey, you should be able to have more close attachments with more people in more meaningful ways. You know, as you do your own work, as you process through your own traumas, you should be able to. you should. I don't like the word should, but you will be able to connect with people more deeply.

Do you think, I mean, I guess maybe this is going back to the Star Wars thing, but do you think that like your attachment to your son and the emotions and the love that you feel for him could lead you to make choices that are not rational or logical out of that attachment? I see that happening in some people, but I feel like, for example, like parents who don't have boundaries and limits or like they overlook their kids, you know, moral improprieties because, you know, they will always side with their kids. You know, they're very clan-like behavior, right? Like, I will always just side with the clan no matter what. I, I don't want to say no to my kids. I know about boundaries. You know, I don't allow them to speak unkindly to kids. When I watch them

play on the playground, my kid isn't the one that always is doing everything right, you know, which I see some parents, it's like they have this, I don't know if it's like a healthy attachment they have, they have this attachment where their kid can do no wrong, right? It's always the other kid. I would consider that almost like a narcissistic defense against rather than reality. So I think as you do the work, you see reality more accurately and you can say like, no, that was a selfish act and you need to say you're sorry. It's like actually, apologizing, like how often when you're in a relationship do you apologize? If you say never, then I would say you have some work to do. Too much? If you say always, like in the relationship,

it's always my problem, then I would say you have work to do. But the problem is, is that if you are the one that is always wrong and you start to see that the other person is 50% wrong or 10% wrong or 20% wrong, the equilibrium will be disrupted and the relationship will be on the rocks. So sometimes it's like adaptive to always be the one that's wrong. It may be best for the relationship, but it's not best for you and your growth and your relationship's growth. Okay, that's a little side rant. Good. Yeah, I'm passionate about this. You know, because I think it's like, it's important to know that like we all make mistakes. Yeah. Right. Do you feel like that's a really, Okay, sorry, that's more of the side thing.

No, go ahead. I was just thinking, this idea of my kid can do no wrong, do you feel like that's a more recent thing? Like, I always see kind of like memes or like jokes about back in the day, a kid gets a C or something or an F, and the parents yell at the kid. And now the parents yell at the teacher. You know what I mean? Kind of like, like as if this attitude has changed over the last couple of generations.

That's a problem as well. Yeah. That's honestly a problem. and that's more the parents that's more the parents problem it's like an extension of it's like a little bit of an extension of like a narcissism it's like always the other

always the non-clan member that's wrong we can never look internally we can never take fault in our own actions and our own mistakes the problem is is that when we don't see that we've made mistakes we can't accurately chart a new course we can't act we're taking that anger

which is energy to overcome, and we're directing it at something that will not lead to the change necessary to overcome the obstacle. So this is where, like, I kind of like some of the self-help people who say you should take radical responsibility, you know, and take responsibility for your own life, right?

I know you're referring to. Who am I heard of Jordan Peterson? No. Wait, what? No, I'm not. He talks about radical responsibility. Chaka Willick. I like Jordan Pearson. He's very controversial, but I like the guy.

But he recently talked about how like, what was it, like men of this generation needs to really have like radical responsibility. Come up your room. I feel like Marcus Aurelius. I feel like Marcus Aurelius is all about responsibility. And so it's like, same with Victor Frankel. It's about, you know, take responsibility and do what's right. You know, it's... You're in an environment. You can control how you react to the environment. And once in a while, I come up against a man who, who's like explosive anger, who doesn't believe he has control over his anger. And I'm like, you have control over your anger. You just don't realize it. You know, you didn't go to jail, did you?

Why didn't you go to jail? Well, I didn't want to go to jail. Well, I knew I could stop. Well, there you go. So you could stop. You know, so I feel like people do have control. I mean, obviously there's exceptions to this. You know, we could all make.

I could come up with some creative exceptions about delirium or, you know, blah, blah. Like a frontal. Frontal lobe, damage, delirium, on PCP, on alcohol. Yeah, free will's gone, okay? You've done that podcast already, free will? Yeah. Yeah, three parts. I'll be right back.

The summary is I think that the idea that we don't have free will and the argument that it's neurologically proven that we don't have free will, doesn't stand up actually in the neurological research and that we have probably more of a gradient of free will or choice. Like if you drink alcohol and you have apatic encephalopathy, you have less free will than if you have like no apaticencephalopathy, you know? So there's a gradient of free will. And if you lose your conception that you have the ability to make choices,

then you actually make worse decisions. and you actually fall in more with group think. You're more likely to do what the rest of the group wants to do. You're more likely to lie and cheat. Now, if you're hearing this and you are totally staunch against free will, that doesn't mean I'm saying, I'm not saying you're a bad person. I'm just saying this is what the experiment said, okay? It said that as people lost their ability to believe in free will,

by doing, you know, reading something anti-free will, then they went into an experiment and showed that they lost their ability to make decisions based on individual beliefs rather than they made decisions based on group think. They were more likely to cheat and lie. This is research, okay? So you can listen to those three things. You can look at those studies.

I'm not making a moral imperative about you as an individual. There are a lot of good people out there who believe on both sides of this camp. But that's where the science is overwhelmingly. And that's my argument. And so that kind of aligns with more of the Victor Frankl Marcus Aurelius approach that you can actually do things to change your life, to make improvements, which is a little bit counter to some of the pop psychology that I see out there, that like you are a victim, you're not responsible for any of these things that happen, you had no choice.

You are just kind of like a victim, right? which I think is actually kind of a bad place to leave someone. Well, so that's kind of what you're saying. Like, I personally always believed, you know, we're kind of created by our genetics and our environment and that's kind of it. But the more, you know, doing residency and doing therapy with patients, the more and more I realize how harmful that idea is, whether or not it's true, I think it's, it almost, it goes against CBT, it goes against everything to have people believe.

in that we want to give people a sense of responsibility because as soon as they believe that they're a victim and things just happen to them and they have this external locus of control, the second they stop taking responsibility, their actions are just

going to go downhill. I mean, and you can say that that's environment, right? Like what they're taught about responsibility is the environmental aspect. But I feel like that's, no matter what you believe, that's not a healthy thing to, that's not a healthy way to live your life.

believing that things are out of your control. Because the second you believe things are in your control, you're going to act more appropriately, basically. Yeah. Yeah. If you believe that you, I mean, think about, like, what is learned helplessness, that you have no more ability to change your outcome,

that you're going to be stuck in this rut forever, you know? And I'm concerned that a lot of people are starting to believe this just because that's what they're being told. you know whereas like a lot of people who believe that they can make movements forward that they can learn that they can grow that they can get stronger it's like you can get stronger you can get smarter you can work out your brain you know good i guess i wanted to play like devil's advocate too but because sometimes you work all all you want and the result is the same you can't change anything and there's that sense of help you helplessness. Okay, if that happens, what I would say is change your environment. Uniquely, as humans, we can change our environment. So I used to work in a juvenile hall, and I would tell the guys, like, look, if you get out of here and you go back to the same environment that got you in here, you're likely to come back in here. You have a choice when you come out to change your environment.

So change your environment. Go to CBT. Go to therapy. Go to intensive outpatient program. Go to a partial program, change your environment, pick some mentors, pursue some mentors. That's very interesting, because I think sometimes that's what I see myself, sometimes I see in my patients. Like, I feel like I can't do anything, you know. But if you were to kind of change the perspective slightly, the fact that you can do things, even like suppose it's seemingly external things that you seem to, you don't think you have control over. You don't feel like you have control over them. Write it down. Write down. All the things that you feel like you feel like. You feel like you feel like like you don't have control over, like you can't overcome.

And then slowly look at those with your mentors, with your therapist, with your supervisors, right? Look at those with your spiritual gurus. Look at them. Really, are they completely out of your control? Often they're not. Often we just think that they are, and so we don't do anything about it. It's kind of, I don't know. I don't know if we just went on to a different, this is like a whole other podcast.

This is a whole other tangent. Hey, but you know what? I have enjoyed this conversation. I think we need to wrap it up. Let's go around the room. One thing you took away from this book, Serena. Yeah, so I think more than anything, this book, Marcus Reelius' Meditations reminded me the importance of being intentional about what I do and the importance of, like,

reflecting every day on it. I feel like as we get busier and busier, it's so easy to ignore. Things like you just go through the motions, but it's important to stop and think about, you know, what you value and how you want to live your life. I think that was my biggest takeaway. Yeah, that's good. Grace? Kind of similar with Serena, too. I do journaling, like not every single day, but occasionally, and sometimes it's just, like, gibberish.

Like, it doesn't really make sense what happened throughout my day, what I thought about my patients, maybe myself, you know, with my family, friends, what have you. But I go back sometimes and look over it and realize some of the thoughts that I had. And then, like, months later, I look at it. I'm thinking about the same thing. And you notice how those are some of the things that I struggle with or some of the values, virtues, or whatever, that I want to strive after. And so, yeah, essentially, like, making a point again that it's okay, even if at that moment for that day that I'm just writing gibberish, it may still make sense later down the road. So kind of like self-reflection, self-improvement. Like, I've always liked that redefining of myself.

And essentially that what drew me to psychiatry was part of that too. You know, so, yeah. I would say that's what I would take away from this book. That Marcus Aureli is thought the same thing. I'm on his level. Asan. Yeah, I'm along the same line. You know, reflection is the biggest thing that I took away.

And, you know, understanding the power of my mind and understanding the power of reflecting. And, you know, I can choose the way I see things and I can choose the way I react. And by being grounded and reason and knowing, you know, how my mind thinks helps me to learn more about myself and be more poised. because I think for me, like anxiety has been something that I've struggled a lot with. So like being poised and being grounded in my mind is through reflection is my biggest takeaway. George. For me, I think definitely it was just thinking about things that I didn't like thinking about. And I think, I don't know, most people don't like thinking about whether it's like death, then change.

And he just like repeats them over and over and over again. And for me, it became, like, while reading it, I felt like I was definitely, I don't know, just not just reflective, but I was really affected by it. Like, I was, I was just like, kind of zone out and just think, like, man, it really doesn't matter. Like, no one is going to, barely anyone knows who I am now. Like, who's going to care when I'm dead, you know? And then, like, billions of years from now, you know, all the stars will burn out and, like, they'll, everything will just, you know, go to nothing. Yeah, so I don't know. It just put me in a really reflective place.

I think it's maybe dangerous to live in that place where you're thinking about this constantly, but to kind of be reminded every once in a while that that's kind of ultimately where we're all going to be, that emperors from thousands of years ago thought about that kind of stuff. Oh, yeah, and I think, you know, it's cool that, you know, as psychiatrists, we do get to, you know, take the time to kind of think about this stuff to, you know, read books, read these classics and, you know, reflect on them. If you're a medical student out there, you like this kind of stuff, I think, you know, psychiatry, let's, let's us do that. So that's kind of cool. Yeah. If you don't go to psychiatry, you don't get to read cool books. You can read like Grace Anatomy. Yeah. You get,

textbooks, anatomy books. Yeah. Yeah. That's all you get. Yeah. I think it's the amazing aspect of psychiatry and mental health is that you, you can read books like this and it makes you better clinician. Makes you a better clinician. You know, one of the, one of the things like premeds will ask me or like, what should I do to prepare myself for psychiatry to say? Work as a waiter. And Grace is smiling because she did.

Because you interact with a ton of people and you get, you get sort of, a very sort of quick grasp of human nature and how to sort of. soften those moments of tension, right? Work as a waiter and read the classics, you know, because the classics give you a glimpse. And when I say classics, I mean like the books that have been read and reread throughout the centuries in every culture. That's what I would label as classics.

So this is one of the classics. I hope you guys have enjoyed it. And we will put a summary up on psychiatrypodcast.com for you guys to read. and let's see, I don't have a, I don't, I will post on the summary at the bottom the next book to read. So if you're listening to this and you're like, I want to read the next book so I can get ahead, I'll post it there. Okay. We'll leave it there for today.