Psychiatry & Psychotherapy Podcast - Book Club: Viktor Frankl's "Man's Search For Meaning"

Episode Date: April 22, 2021

In this episode, we will be going over a book every therapist and psychiatrist should read, Viktor Frankl's "Man's Search for Meaning." Being in the trenches with our patients, we see so much pain and suffering and potentially undergo vicarious trauma ourselves through their suffering. The question, "What is the meaning of life?" often comes up in such a context. By listening to this episode, you can earn 1.5 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 emailed to you in seconds. Welcome back to the podcast.

I am joined today with three residents. All third years, Serena Mammon Weber, Hassan Kanani, Grace Kim, and this is alive in Florida. This is the first Florida book club session. And this book club, we will be going through Victor Frankl's Man Search for Meaning. I've spoken about this in my Therapeutic Alliance series on Logo Therapy. if you want to look at the research on how this has played out in like evidence-based trials, that's a good episode to go through. But in this one, we're going to be going through, in particular, his life and the book that he wrote in a nine-day period after he was released from a concentration camp,

actually the fourth concentration camp he had been through. He wrote this book in nine days, and it was released in 1947. in German without his name. He did not want to put his name on it because he wanted it to be, but he didn't want it to, he didn't want it to be about him. And so that's valuable to me. It's kind of like Marcus Aurelius' meditations. It's like he wrote that for himself, right?

And in the same way, I think Victor Franco wrote this in such a way that he wanted to benefit people but not make it about him. and in this book we will be talking about how he practically lived out does meaning get you through hard times how do you develop meaning in the midst of trials how stress can actually be a good thing how death can awaken our meaning how we at times don't want to live in this sort of comfort equilibrium, how sometimes we want to be pulled out of it, or we need to be pulled out of it, or life pulls us out of it, or respective of if we need it or want it. And through that, we can develop a deeper sense of meaning and purpose. Nici said, he who has a why to live for

can live through any how, is that it? He who has a why to live for can bear almost any how. Can bear almost anyhow. Okay. So we will be going a deep dive into this. It's sometimes we digress into what life is like for residents and because they are residents. And so I hope as a listener you can sort of reflect on your own life. I also talk about some of the people that I've known in my own sort of work that have found a meaning and purpose and how that's played out and how they make decisions differently

and how that opens up new doors and how awesome. in my own life, I think I'd talk about how I became a psychiatrist through sort of a journey of discovery and it was unexpected, but it has been very meaningful. And then we end talking about how this has played out. Just reading this book has really ignited in us some changes. So I hope that you enjoy this and I hope it inspires. you to read the book as well. And if it does, I'll put a post on this on my Instagram and you can jump on and comment your thoughts and how it's touched you. And then I'll be sure to read that and

comment and we can enjoy as a community together. And if this has been helpful, let me know. And we'll do more books that you should read as a mental health professional. So we were having some coffee the other day together, some ice cream. And we were talking about, you know, it would be a lot of fun to come on here and talk about Victor Frankel and my favorite book, Man Search for Meaning. I'd put it up in there like the top 10 books you should read if you are into mental health. And so I was thinking, you know, we should start a little book club here and get through the top 10 books. And this will be the first one.

So if you haven't read the book, please go ahead and purchase that book, that audio book or both and read along with us and think through. Our thoughts on it. So, Hassan, break down, what were some of the key, like, things coming out of this book? Absolutely. So I guess the purpose of life was something that stood out simply, you know, the book introduced Logotherapy through Victor Frankl's experiences through the concentration camp.

And through his experiences, he was able to help me understand and what it means to have meaning in life and what that would look like. I think there were a couple of things that stood out for me. Let's start at the top. So, Serena, why don't you start by just taking us through the outline, and then we'll just kind of riff off of that. Okay. So in the book, Victor Vinkle first talks about his experiences in a concentration camp,

and then he goes more into the aspects of the... of Logo Therapy. So in his experiences, you know, he talks about how horrible it is to be brought to one of these camps. And in total, he was in four of them, including Auschwitz. It's about, he mentions, you know, the different stages, the psychological stages of a prisoner there. And then how he survived. And a big part of that was like the wise. You know, he said, that Nietzsche quote of a man could, I'm going to butcher the quote, man could go through anything if he has a why to live for yeah exactly yeah it's kind of like this idea of if you have a purpose and meaning then you can suffer and that suffering can be put into

perspective of that meaning yeah and i think it's um it's a powerful book because you know he actually was a psychiatrist before he went into the concentration camps he was someone who had you know, written letters with Freud. He had a falling out with Adler. He was married. He had a private practice. He worked at a what sounds like a pretty busy inpatient psychiatric hospital for a while. And then, you know, he got drawn into this drama of World War II, put into a concentration camp. And it's a tragic story. It's like it was actually like I had to like stop listening to it. I'm a big audio book. So I had to like stop listening to it after like 10 minutes at times because it was just too much.

Yeah. Yeah. Yeah. At any of you like did it wear on you psychologically just listening to the kind of the torturesome realities of concentration camp life, Grace? Yeah. He definitely didn't try to go into all the gruesome details of Holocaust because everyone knows about it. But regardless, you know, he talked about how people suffer through, you know, undernourishment, you know, being, you know, beaten and things like that. And it is still very emotionally taxing.

And so I also had to pause multiple times throughout the very first part of the book, just to relieve myself and also kind of think about what they went through. And he has very nice little quotes in that first part as he's explaining what he observes in prisoners. And you just get to reflect what that would look like. Yeah. How about you, Hassan? Was it weighty at all for you to read that part? Yeah, thinking back about it.

it did take me much longer to go through the first half of the book. I noticed that I was taking a lot more pauses. It was harder for me to get through it. I was more hesitant to, you know, read through it, you know, in big chunks at a time. But absolutely, looking back, it was tough to get through it. It was a lot. Yeah. And he said, as far as, you know, how horrible everything is with the lack of food.

and the abuse, he said something, it is not the physical pain that hurts the most, and this applies to adults as much to punish children, but the mental agony caused by the injustice of it all, and that a blow that even if it didn't hit him, even if it doesn't hit the market, can be a lot more painful than one that does. So it's like the mental agony.

So it's not just, you know, in addition to all the hunger and suffering, the fact that they're there in the first place, that they literally have nothing that they had before except for their own bodies. It can only be a shock. Yeah. It seemed like some of the hardest part was the experience of other people's malevolence,

especially people who are like Jewish people who are living, surviving, trying their best to just, you know, make it through this horrible experience. But because of it, they were, it sounded like horrible to the other Jewish people, you know, so that some of the Jewish people were employed by the concentration camps. and that seemed like really difficult, you know. Or just like the cold and the harshness and the, it seems like at times they had them busy doing things that were completely repetitive. You're like none of a purpose. Like move this dirt from this side to the other side and then move it back again. And you're like, wait a minute, what is the purpose of my suffering, right?

Yeah. He talks about, you know, the different kinds of things that he could focus on and that having this manuscript, right, Logo Therapy, he already had that idea and wanted to write about it and had written much of a manuscript that he then lost, or was taken away from him actually when he came to the camp, right? And just having that and knowing like, oh, he needs to share this with other people was a reason. he feels like he survives when he got ill and was weak. Yep. And I think also that he talked about how he had this manuscript about how meaning is important, but then he realized his journey through this and would be like a testimony to this reality, which would be a far stronger argument than actually some like philosophical treaties, you know,

of like, you know, how important meaning is, which I think. is so true. You know, this story and it's, I think it's timely because we, we've just gone through a very difficult period of history relatively, you know? Like, going through COVID, a lot of people are isolated where they've never been isolated like that before. They were deprived of human connection. One of my patients is, basically, multiple of my patients have been isolated largely.

to their home alone, you know, without real human connection. But maybe like every two weeks they'll see someone, you know? And, you know, if you have no meaning in a difficult life, I've found with one one patient in particular, he's like, I have no meaning, I have no purpose. And it's really hard for him to find that. It's even harder to deal with the losses that he's had. So to some degree, meaning can justify suffering. You know, it can help us through suffering.

And that's a big thrust of the book. And I think it really does speak to that. I think it's complicated. How does he get to that point where he says, okay, there still can be meaning in the midst of being in a concentration camp? So I think one of the things that I took very, I guess, Some of the things that just marked in my mind was he talked about how, you know, because the undernourishment was so, you know, prevalent, obviously, you know, prisoners would get together and they would have like this natural desire for the food and, you know, it was their major primitive, you know, instinct. And so they would talk about food and their share of recipes and ask about their favorite dishes.

And they would plan the menu for the day when they will finally have like a reunion in a distant future when they would be like liberated. returned home. Just like having that kind of hope, something to look forward to and just having that comfort, despite all the immediate surroundings, I think, is powerful. And another thing they discussed was like just looking out the sunset, the beauty of sunset, just appreciating that moment, or that would, you know, have some songs. Somebody would play a violin. They would do, like, read jokes, do jokes or poems. And that alone would just, like, forget that, you know, terrible time that they were going through. So they did really try to have hope and meaning despite the situation that they were in,

which I think was really beautiful. Yeah. Serena, read this quote that you found, and tell me why this spoke to you. So, Frankel says that a person may remain brave, dignified, and unselfish, or in the bitter fight for self-preservation, he may forget his human dignity and become no more than an animal. Hassan, did you find that one? I did, yeah. Tell me about that.

It did stand out to me. It talks about how it is a choice at one point. You can go either way and it can determine, you know, what the fate will be or what the result will be. You can go either way. You can become, you can kind of follow that more animalistic self-preservation, side of our side of our mind, right? Or, you know, there's a hurt instinct.

There's other sides. There's like a sacrificial side, right, that's there, like, protect the tribe, be for the people around you. So there's two voices, and they're both, and probably the self-preservation voices is yelling at you, you know?

And that's why this quote is so powerful. You may remain brave, dignified, and unselfish, in the bitter fight for self-preservation, he may forget his human dignity and become no more than an animal. You see some brittle, brittle narcissists who have lived a very comfortable life here, you know, who haven't struggled like this, and they are living this way. And it's, I think it's like a very off-putting and difficult client to sometimes work with. and here you have this trend that he saw in the concentration camps where the average person could be pushed further and further to this, right?

I thought it was interesting, you know, related to this. He mentioned at one point that Freud would argue, you know, people seem different, but if you put them through the same, like, very difficult, like, level of hunger, those differences would disappear. You know, they would blur and become the same person. But he argued, well, in reality, the concentration camps, that's exactly what they were put through. And that's where you saw people really diverge in taking one of those paths, either becoming, I think he said, like, saints versus swine. So that's like, you know, very strong words. Swine is in like sort of embodying more of the self-preservation, the more like sort of animalistic drives that we all have, right?

saints being kind of like embodying the higher principles that the archetypes throughout history have pointed to and that sort of we look up to the people who, you know, were self-sacrificial archetypally in throughout history. And he had some very self-sacrificial moments that actually led to his survival, which I found interesting. And we'll talk about that as we go on. Yeah. He also talked about how. how Freud kind of had his focus on pleasure and Adler had his focus on power and how people are driven by power. And for him, it was about meaning. Interestingly, I've met people who have different drives that are probably their predominant drive who may not follow that predominant drive.

Like, I can remember one, he's not a patient of mine, but this person, whenever I was around them, I could feel their desire to gain wealth, their desire to have multiple sexual relationships going on, yet they were monogamous and yet, you know, well, they were pursuing wealth and they were doing things that would get them wealthy. But it's like you could feel it, you know, and everyone around them knew, like all the nurses would be like, yeah, he takes a lot longer with any attractive female client or any super wealthy client, you know? It was just known, you know? And so people can feel or people can have like a main predominant drive that's there

and they can feed that and that may grow because they feed it. And I think that he was noticing that there were some people who clung to the meaning and that greater purpose. And those are the people that had the strength. strength to endure, right? Because at some point, you know, if power is your drive and you're like in a concentration camp and you're getting beat up, it's like that is like not going to sustain you. You bring up a good point, Dr. Peter. Endurance. And that's really the difference between the people. And, you know, the biggest thing that kind of stood out here was to be able

to see and see this in a very not-judgmental way. And looking back at, people that were just fighting for self-preservation, you can really empathize with them just because, you know, survival is our first instinct. And to be able to endure a lot more in order to hold on to the inner holds, it takes a lot of endurance, a lot of energy to be able to do that. And he had mentioned how there were very few people who were able to, you know, with meaning and hope and perspective, hold on to their values and inner holds, but very much was possible. And that was the part where they had to make a choice, a difficult choice, but a choice nonetheless. Right. And what he said was that those examples of people who could remain in this place of meaning

and purpose and living for other people kind, you know, in the trenches with these people yet miserable, yet hungry, yet starving. He said that was sufficient proof that man's inner strength may raise above his outward fate. That was like a big theme, right? Like him talking about even despite everything they were struggling with and everything they'd endure, that they still had that choice. Like he focuses very much on, you know, that person is still there. There's still something that hasn't been taken.

away from you, that we're not simply a product of our environment. And, you know, he says that's, he disagrees with the, the idea that we are, right? Because then someone can just, rather than taking responsibility and finding meaning, they can say, you know, this just happened to me. Right. It takes you from internal locus of control to, you know, extra locus of control is that the world is happening to me. I'm a victim of my own.

environment. You know, I've, I've known people who have been through horrible, horrible traumas, and yet they are living a life where, like, it's, it's almost as if the trauma has given them a sense of like, this is my purpose, this is my meaning, I'm going to help people. And it's, it's so amazing to meet those people. And then you meet people who have been through horrible trauma. And then it's like they're still, you know, in process, right? And I think with enough treatment and with enough therapy, usually they come out the other side and they also turn outward. That's what I've seen.

So it's like, I don't know if you know about the case, Anna O, but this was an early psychoanalytic case. She became a social worker. She became someone who was very chariomatically empowered to like do this huge, you know, human rights thing, you know. And so I've seen a lot of patients after a couple years of really deep therapy, they turned from thinking about themselves all the time, very egocentric, just because they're trying to survive to helping out. Like, I had one patient who became a teacher in an impoverished area. And, you know, it was really tough work, but for her, it was deeply meaningful.

And this is someone who thought she probably would be on chronic disability the rest of her life before about three years of treatment. And, you know, think about all the lives that that person is touching. So, yeah, I like the idea that we can make a choice that we're not just a product of our environment. Sometimes the environmental change we need to make is getting the treatment. We need to keep moving forward. but I do believe in choice. That's why I've done like those three long episodes on free will. Yeah.

Kind of breaking down why I think there is a logical and scientific argument that the verdict is not out, that there is just determinism and, you know, people are going to do exactly what the events that precede them predict they will do, you know, that there's the choice in there. And, you know, we're talking about with this, even if there is a, even if it is, like, you know, even if there was some, you know, ultimate answer, we don't know what that is. You know, it's not like you can plug in. There's no computer system we have, right, that can plug in exactly what you're going to do. And we don't know how much of it is actually there. You know, he mentions even a Nazi.

if I remember correctly, he was like one of the worst people, and he found out later in life, he had kind of redeemed himself and become like a very caring man. And how like even even in that situation, even with that same person, you just don't know how people are going to be, you can always make a choice and change. Yeah. Yeah, there's good examples throughout history, biographies of people who are going to one way and a series of events happened or, you know, some, some moment of epiphany. And they went directly the opposite way, you know? And they made a huge difference in countless

people's lives. Yeah, so Serena, take us through part one of the book and what were some of the things that jumped out at you? Yeah, so in part one, he has experiences in a concentration camp. Basically, he talks about coming to the concentration camp, you know, how terrible it is, being stripped of everything you have, you know, you lose your clothes, your hair shaved, the shock of being there, and, you know, kind of the stages that are involved in the psychological stages of the prisoner. So first, there's a lot of shock. Then there's apathy, which is kind of a defense. You're getting used to it. And also that leads to, that's when you start seeing people, you know, divert in the way they treat one another. And then he talks about, you know, what was it, basically?

That's what this section is about. What was it that through all the brutality and the suffering, what kept him going? And those are, you know, the wise. Yeah. So shock, apathy, then, do you? depersonalization. Interestingly, he talks about how depersonalization was when they were liberated. So it was almost like they came out in this dissociated, you know, I don't feel quite like

my self-state. Bitterness was also a potential stage that people would have. Just the brutal conditions, the hunger, the lack of sleep. You know, I'm thinking like low frontal, low function, right? So it's like usually meaning, purpose. those things are more like my brain is fully operating, right? But actually, I can relate. There were some points when I was in the most suffering.

And like when I used to row, we'd be in a state of just, you know, we were beat up for a couple weeks at a time. And you'd be really, really, really tired. Like I remember one time walking my bike up this very, not a very steep hill, just walking it up very slowly on my way back home from like school because I was just so run down, you know? And so I think there's in that in that state for me, meaning and purpose, like reminding myself what I was doing, why I was doing this? Which is, it was like a constant question. Like, why are you doing this?

Why are you doing this? This is, why are you putting yourself up with so much suffering? If any of you have done the ergometer, you know what I'm talking about. Or maybe you've done a little bit or you can relate as far as on. Yeah, I guess not as much erowing, but just exercising. You know, a lot of times, you know, you get into the routine and sometimes you get off track. And typically for me, when I have been on track, it's really the meaning that has kept me together, you know, what that means.

It's not the exercise itself, but it's, you know, being able to be more functional. Or I would say even more than that is like residency. Yeah. the first couple years of residency, you're like working 80, more than 80 hours, you know, under the table. It's very difficult. And there's, I remember being on night float for like six weeks straight. Oh, man.

The last like two weeks, I was like in this like, do, am I, am I alive? Just going from one suicidal patient to the next psychotic, angry patient to the next psychotic, angry patient, to the next angry intern who wants you to do something. You know, it's like you just wander around. For us, you know, you just wander around like three different hospitals, you know, going from one to the other. And I imagine a lot of you who are listening to, some of you who are listening to this, are either going to go into that and you're like, okay, why am I choosing to do that?

Or you're in the middle of it right now, or you've gone through it and you may be a little bit like burned out. And we definitely. Yeah. Yeah. Hassan, tell me about that. Yeah. I think there are points in time when we get comfortable and we sometimes lose focus of why we're doing certain things.

And those are times when we do get more burned out. And burnout I see as an alarm sometimes on kind of refocusing on where the where my, what the reason is for what I'm doing. And I think. for me personally, every time I've been burnt out, I have came out stronger on the other side. And the book does kind of, the book does talk about what doesn't break you, makes you stronger. It doesn't quote Nietzsche, but it basically says that he has a why to live for Kimber, almost anyhow. Yeah, that quote comes from Nietzsche. And I didn't know it came from Nietzsche, actually. That was pretty powerful.

But, you know, it's that point of like, he talks a lot about meaning. coming from struggle. Not that you have to suffer to have meaning, but I do think I think most people can probably relate, even if they haven't done residency, you know, just the times that we're struggling the most, you often think more about what life is about and what you're doing, you know? I found a couple people reach out to me for coaching who have come to a place where they're comfortable in life.

Like they're in attending, they're comfortable. They could just be cruising through at this point in their life. But there's this aching, underlying thought like there's something else. You know, there's, am I just going through the motions in my day to day? Or am I missing this like peace, right, that we're talking about today? That's like, am I missing this like peace, this like purpose and how do I live out that purpose? I love it when I get those people.

It's like awesome. We're going to explore that. And sometimes it comes out in dreams actually. Like the dreams reveal the truth. It's like the dreams are speaking to them directly. I wish I could tell the particular dreams. I could speak about my dream. Yeah.

Like I had a dream one time where I think it was during Metzsche. actually. I was choking myself, like, almost like killing myself in my dream. I woke up and it's like, what am I doing to myself? I, I mean, obviously medical school is difficult. I think it was like probably step one, step two. I don't know. Something else was going on. I was very like beating myself very hard, obviously. And so when that dream like came up, I realized, I really am killing myself. Like I need to let my like be compassionate with myself that it's okay. I don't need to do this to myself. And that was like a really big realization.

Like that dream still sticks to my mind. And I don't want to do that again, like driving myself to that point where I think I'm killing myself, you know? That's powerful. It's you are in the dream and you're choking yourself. Yeah. And when you wake up, what you realize is that the way that you're driving yourself is with, without self-compassion, without self-love. So it kind of reset your core a little bit.

Absolutely. And your, like, motivation. By what's really important, like... What's important? Yeah. And it's not important to kill myself. Exactly. That I'm worth more, that I can do more things.

I can not by killing myself, that I got to live to do things that I want, right? Yeah, yeah. And how did you change after? Yeah, definitely. What was the mindset change that helps? helped you? So not beating myself over like test scores or not doing enough for residency. You can never do enough. Exactly. And then quickly learning to accept that it's okay. And I think acceptance was really a key part for me actually. And that's been like an ongoing thing I think in my

life to accept the situations that I guess I cannot control or just kind of saying like it's okay that, you know, things are like this or that if I don't do harder, that it's okay. Like, life is good, and I will just do what I can at this time. And I guess in similar ways of, you know, what Viktor Frankl is saying, you have choice to make in certain situations. And I guess for me was to accept and make choices that will allow me to change certain things that I can do, like, at that time. And just live happily. That's great. That's great because I think your mindset change allowed you to run this race with endurance without getting totally burned out, right?

Because if you beat yourself up like that and nothing is ever good enough, no test score is ever good enough, you're never well enough prepared in medicine and psychiatry, there's always more things to learn, you know? and so accepting the things that we cannot change and not focusing your attention on those things, but focus on your attention on the things you can change. Right. There's a serenity in that for sure. Serenity. It sounds like the serenity prayer. Yeah.

Yeah. But he talks about that, right? Like, kind of accepting and not, because if you hyper-focused, or he called it, right, he called it, like, hyper-intention. If you do that, then it's, it's. It's more likely to happen, right? Like the negative stuff is more likely to happen because that's what you're hyper-focusing on and as opposed to like accepting. And if it's something you can't change, he said, like, change ourselves instead,

change our attitude towards it. Yeah. Yeah. So. That was a, that's a crazy challenge that he put out there. That we can change our attitude. Like that's the last, that's the last human freedom that they can't take that away from us. the way that we look at things.

Everything can be taken away from a man but one thing, the last human freedom, to choose one's attitude in any given set of circumstances, to choose one's own way. It is this spiritual freedom, which cannot be taken away that makes life meaningful and purposeful. I love that.

It's a good challenge. I mean, don't think by, me saying these things that like this isn't a struggle like I need to recalibrate myself as well from time to time it's like why am I doing this what am I motivated about like there's there's um different at different stages in your career as a psychiatrist there'll be different things that kind of get you off track you know and to remember like okay but at the end of the day I'm doing this because of these reasons and so how do I choose my Like, how do I take my choices and align them with that purpose?

Like, I get offered to do different things. And some of them are very, like, financially, like, wow, that would be very nice. But then I'm like, ah, but I don't really believe in that. Like, I don't even want to say what it was recently. But, you know, it's like, I'm not going to promote a drug or a genetic test or something like, that unless I actually really believe it. And then it's going to come out naturally. It's not going to come out like getting paid like $100,000 to promote this thing, you know. But there's a temptation there. But I got to keep my goals aligned. Because otherwise, like, what am I doing, right? I don't know.

There's things more valuable than money at the end of the day. It kind of reminds me in the book how I talked about how to follow your conscience and to act accordingly and how happiness and success will follow. Because if we go towards happiness and success, we probably won't achieve it. Let it be a side effect. Yeah. Like byproduct. Happiness as a side effect of pursuing our meaning, pursuing our purpose. Yeah. And happy, I would say joy. Joy is like that too, right? Satisfaction, deep satisfaction. I often think to myself like, okay, if I were to die and like if all of the people that I impacted were to be before me and they were to be able to tell me how I impacted them, like, that to me is like how I think about, like, okay, that gives me a piece of understanding on what is meaningful or purposeful. and by the way guys if you're in mental health you probably don't realize how big of a crowd that would be like if you are in the trenches day by day doing therapy doing medication management you have no idea

you just don't but because there's a ripple effect so it's not like you just affect that one person you know like let's say you're a teacher of like residents or you know you're a therapist and you teach like there's a ripple effect not just to the resident you're teaching, but to the patients they're treating. And to your patients, like, you know, mental health effects and family, for sure. To the families. And to the community and to their friends. And, you know, like this one person who became a teacher and this, like, very impoverished

area, it's like those kids, right? Those kids are benefiting. And often, they're totally ungrateful in the moment, right? That's the other thing I've realized is like, it's like the best, sometimes it's like years later, right? Then you get gratitude. You're like, oh, yeah. Thanks, Doc for doing that the other day. As in, like, patients would say, you know, like for sticking through whenever at the moment, when we're going through like therapies or medication management, they would like hate you for doing that or, you know, but then later things change, turn around and they're like, thanks for

being there and sticking through with me. Yeah, I had one patient literally charged me on the hall because I had detoxed her from clonopin and then I had told the pharmacy to burn the clonopin so she wouldn't be taking the clonopin with her okay from the psychiatric hospital so it was like day five she was being discharged and she straight charges me in the hall I jump through the door shut the door and lock it right I'm like in the resident room now I'm like oh my gosh she's like banging on the door to computer I'm going to kill you. You did not have any right.

That was my personal papity. She ended up being there two more days. No, that was a joke. No, I think she left. But then she saw me again. Like, I saw her again, like, in a supermarket. Oh, man. Okay?

Like, literally, like, literally, like, three months later, okay? And I'm, like, ready for this woman to charge me again? I'm like a little bit like bracing, you know, and I'm a big guy. So it's like kind of funny to tell this story. I'm like six five, you know, and just like this little thing. But, you know, anyone angry enough can do some damage. So she sees me and she starts the head towards me and I'm like, okay, I'm looking at her eyes. Like, can I trust this woman?

And she's like, Dr. Puder, thank you so much. I am so sorry. And she was like a totally different person. And I was like, oh, okay. Yeah, nice to see you. Yeah. I'm like, okay. Can I let my guard down with this person yet?

Probably not. But it's so important to think about like the, you know, the effects of every interaction. I try to remind myself, you know, even if I'm having a bad day, like that doesn't mean to, you know, show the, you know, show that I'm tired or that I'm like not with it, you know, because seeing your mental health physician or being at a hospital, like that's such a huge experience, right? That's such a, that's going to be, that's going to carry with them like forever. I had a patient who came, I saw them last week. I'd seen them a month before. It was kind of, it ended up, it ended badly. And I remember thinking, oh, that, that's unfortunate because I couldn't give them some

thing that they wanted and, you know, this communication. But they came back last week saying, you know, I've, in all my experiences with mental health, it's, it's always been a very poor one. And, you know, I just realized that like this place is different. And I want to, you know. Well, and that's, and that's probably why it was a really rough start. Because every experience they had before was very difficult. And, you know, people can have horrible experiences.

For real, I mean, they're put in a place against their will. They're given medication. It may cause side effects, acesthesia. So now they're like, they gave me this medicine and I'm worse. It's like, yeah, now it's like trying to convince that person that actually, you know, engage in treatment if we find the right combination of things, if we find the right therapy, you know, things will get better. It's like, good luck.

That's like an up. That's a difficult uphill battle. And, you know, I don't know if you've read The Center Cannot Hold. Yes. You have, that might be a future one, by the way. That's a very good book. That would be a really good book to do. Evelyn Sachs, who is a lawyer at USC now, had very severe schizophrenia.

And she goes through all of the graphic details of her journey. I do believe she has schizophrenia. She's on Closopine now. And I've met her, actually. in person, a small group. And she really is a survivor of this disease. And one of the things about reading the book was she had been through a lot of trauma in her journey in mental health. Because the time she was put in restraints felt like a trauma to her.

Because the psychotic beliefs combined with the restraints, it made it into something that was a life or death trauma. And so she had to, you know, work through that in psychotherapy. So just realize, like, we can, like, patients can have vicarious trauma. And so we can empathize with their distress when they bring it up because it's like, yeah, that's a real thing. I'm really sorry that that happened to you. That must have been a lot of suffering. Okay, getting back to this book, which is, could be vicarious trauma to read it as well. If you're a sensitive soul.

I'm trying to relate it to our lives. I know obviously there's nothing worse than what he went through, which is why these words are meaningful. But because it is so much worse than stuff we have gone through, probably, I know there's probably some patients and people out there who have lived through hellish ordeal is probably worse than this in their childhood. But I'm hoping that this can give you a sense of meaning

a sense of, okay, there's things that I can do. There's ways of looking at things that can help, even if you're not in a concentration camp ever. Hopefully, we're never again in concentration camps, although there seems to be some in the world going on. I won't speak to that right in this topic, but... The same kind, too. There's real concentration camps.

And there's people who are stuck in horrible, horrible, situations that are probably akin to a concentration camp. Humor was another of the soul's weapons in the fight for self-preservation. I like that. It's funny how I describe them at times laughing together, telling jokes and in the midst of the laughter, kind of like losing the sense of the reality of the situation that they're in. Jokes in therapy can be difficult.

you know, when my mentor, Dr. Tar, tries to dissuade me of making jokes ever in therapy. But once in a while, you feel like it's just the right moment, you know. But always, you know, it's for the patient, right? And it's satire, sometimes humor can be a weapon in the fight for self-preservation and the fight that we're in. Okay, what other parts in this do we want? want to hit on that really were meaningful. I like the part where he talks about, you know, mental, good mental hygiene or mental

health hygiene involves a degree of tension and, like, avoiding that kind of homeostasis where there's no stress at all. You need something, like something to strive for. And he talks about how you can see that, you know, in people who aren't able to work or, you know, people who are aging and no longer doing the things they used to do, even if they are tended to as far as housing and food, that might not be enough a lot of times. Because if they don't have a purpose, then not working and doing nothing all day. It kind of, it's bad for your health, right? Like, your soul kind of atrophies. And so I felt like that was a big part of what

he talks about and what we do often, I feel like a big component of CBT and like therapy and like getting people doing things, right? Like finding a purpose. They might say their goal is to be happier or less depressed. And we say, okay, well, what does that look like? Like, what would you want to be doing? And then focusing on that purpose. It's like that with overcoming like a phobia or an anxiety.

It's like you're not going to overcome it unless you actually do it. So what we help people do is to do it, but do it slowly, progressively. you know, the smallest increments of movement towards that. And there's something about that sort of repetitive, you know, we're going to go back to this thing that creates stress in your mind, and we're going to do it over and over again, until it's not so overwhelming that you dissociate, but you can actually, like, be in this moment doing this stressful thing.

Is there value in actually... doing things that are uncomfortable, that are stressful. You know, yes, I think there is. I mean, this is why my big argument on strength training, right? It's like doing progressively more physical exercise, what it does to you is it slowly changes the way your body will experience stress. It's in preparation for when you actually need to get through something. stressful. And I would say actually, I've thought about this a lot, like the first two years of residency

and even medical school is kind of like this. It's like a ton of stress. And you learn how to catabolize and to sort of tolerate very, very suicidal people who otherwise are very distressing to be around, you know? So there's that. So strength training, exercise, rowing, you know, or whatever it is, there's always like this thing that you can think of that's stressful and you know you need to do it. And there's part of you that wants to do it, part of you that doesn't want to do it. It's like, okay, how do you break that down into a progressive process to make you stronger so that when a trial that you can't control comes, you're ready for it, right? Different aspects of life kind of spills into it.

I guess so you're saying like physical exercise is one of the ways that you also deal, I guess, when the professional setting with patients, like the, or the stresses that come. You know, it's not just one setting. Because our stress system and our body is only one system, when we create a stress and we learn how to recover and adapt, and then we create another stress and we learn how to recover and adapt, and we do that progressively over long periods of time, our body actually is handling stress in different ways. And the stress, it doesn't matter what the stress is

because the body doesn't know the difference between a physical stress and a psychological stress. So that's where I think the physical can train the mind. And this is why, you know, exercise has an impact on depression, probably to some degree. You know, there's this overlap. I mean, it's doing a lot of good stuff. stuff in the brain as well. How do you reset your stress point? So I'll have some people who come to me whose stress point is so low that they're having symptoms from very little stresses. You know,

they'll faint, for example, they'll go phase of vagal. Fainting is, it's almost like when they're dissociative instead of just having a little bit of numbness or feeling disconnected from their mind, they'll literally faint or they'll have a psychogenic seizure. Okay, how do we get them to progressively go through some stresses to reset that point at which the stress will lead to the fainting or the psychogenic seizure? And the natural thing is to further avoidance, right? And then you just are lowering that point further. Yeah, you see some parents who do this. They take their anxious kid out of school in the home school. Right.

And there is a natural inclination to want to remove every stress from our kids. You don't want to make them deal with pain. Yeah, we don't want to see them pain. I took my daughter to swimming practice today. She didn't want to go. She cried about it for about 30 minutes. In it, she was fine. You know, she's being challenged.

She doesn't know how to do everything. she likes to know how to do everything she does. She likes to have that. Grace is like, yeah. I got this, but like I can't do that, so I'm not going to do that. Right. So it's good to be stressed. And to some degree, it's like, how do you make sure that you recover sufficiently?

Is another question is asleep. If you're trying to recover from being stressed out, from like a weekend call that was really difficult, sleep, spend time with friends, get some extra light exercise, you know, do some walking, some cardio maybe, you know, eat some good food. What are you smiling? Hasad? No, I just resonate with all of that. You know what I mean though, right?

Absolutely. Yeah. There is one part we had talked about when we are no longer able to change a situation. We were a challenge to change ourselves. And, you know, when he talked about that, he also mentioned an elderly man. I believe he was a doctor who had lost his wife and was just suffering without her. And Dr. Frankel was able to help him find meaning in that, you know, saying, well, if you had died before your wife, how would she be right now? And he was saying, you know, she'd be suffering horribly.

and he said, well, such a suffering has been spared for her. It's you who spared her this suffering. And it actually reminded me you had Dr. Burns on a podcast, right? Okay, yeah. And I believe this was from Yel's interview. He talked about having a therapist as a patient who wanted to get rid of her, you know, it was anxiety or depression. And he pointed out that it allowed her to connect with her patients and how much that, how it itself, you know, had a positive side and how she totally changed the way she saw herself and her suffering because it's, you just made the suffering have meaning and give it.

You know, it's still suffering. You can't change. Like he can't bring his wife back. That happened. Yeah. But you can see it in a different way. that there is purpose in what you're going through. Yeah.

So I've used this before successfully. I felt it was successful. It's like this idea that so one partner outlives the other partner. And so to make the partner that outlive the other partner reflect on how much suffering it would have been for the other partner to outlive them and get them to sort of meditate on how they're, spared them that suffering, it changes the meaning of the outliving, the other partner, to think that you had spared them the suffering because that's your love for them is part of the grief. He says that there's like a quote, in some way, suffering ceases to be suffering at the moment it finds a meaning, such as the meaning of sacrifice.

When I heard about this meaning type of work, I thought about, some of the stoic philosophers on how they sort of meditate on death quite a bit. Victor Frankel talks about how imagine you lived your first life wrong, and then this is the second time that you've had to live, and you get to make the choices to live it the way that you wish you would have lived it, knowing how you lived your first life the wrong way, and the inevitable progress. of things that occurred and the suffering that occurred to other people because of that.

I see some similarities with some stoic philosophy there and kind of their focus on death and what the, like if this was your last day, how would you live it? It sounds cliche, but to actually think through this kind of idea of like, okay, you're probably going to do the wrong thing, but you have the choice in this second life to do something different. What is that? Somebody pose that to you, Hassan. What would you do differently?

I guess I would spend time, you know, focusing more on my values, things that bring meaning to my life, staying more on track. What would that, like, put some meat to that. Like, what would that actually be? Like, what would you be doing differently?

I think it would be two-fold thing, one thing that would bring me pleasure would be connecting with family more friends more being more present around them the other aspect would probably be living more selfless being more aware of people that need help i mean one thing that i've learned um reading a book called uh loving kindness also you know through other psychotherapy learning is that you know we all suffer and that's just the reality of it is and so being more in tune with other people and their sufferings and being able to be present for them and because being a better person in their life someone that they can rely on or somebody that they can open up to I think it

would really be about the connections for me yeah that's meaningful how are you Yeah, I think those kind of questions, I guess, we also ask to our patients. And, you know, I also think about it sometimes here and there. Like, what if I were to have a freak accident and just die tomorrow? And it's sombering, right? It's, and you kind of reflect back like, yeah, like the things that really matter is my family, my friends. And I don't care if I make money. I don't care if I reach a certain point. You just really come to realize what's really. really, like, meaningful in your life. I don't want to be known as someone who was, yeah, like Hassan was saying, selfish, just, like, driven by my power, my money or financial whatever. I want to make a meaningful life, and that would mean my relationship with people that matter the most. Yeah.

Yeah. Have you certain? I mean, it's kind of similar. I feel like relationships more than anything. So, because I used to be sometimes so focused and, I don't know, like studying or doing whatever that other things go aside. But I now have like the attitude of, you know, it's okay if, but if family's in town, you know, making family a priority, making friends, a priority making, those things that would matter if you found out you were going to, you know, die next week. It wouldn't be some grade, which I don't, you know, we don't have grades anymore exactly. Yeah. Yeah, you would, I'm essentially hearing all of you that connection, family, friends, you know, kind of like the focus on your work in your career is more is secondary, but also I would, I don't know, I think it's meaningful, but it's like how do you approach it? How do you make decisions for what that would look like, you know?

But making like patience, the priority in that, so in that sense it's more relationships. Yeah. And stuff. I guess less than the focus on prestige or money. Yeah. I feel overall my interactions would be so much more, I don't know, the word that comes to mind is pure. They would be just so much more genuine.

It would be much more present with people. If I was spending time with my daughter, each and every second would be much more powerful. If I was spending time with my patience, you know, that 20 minutes would probably be not as distracted, thinking about things that may be running in the back of my mind. I would be much more present. Yeah. I think that's what I would. Yeah.

Yep. I would try to make people feel special. I think my goal would be to be able to, when they would walk away, they would feel like the most special person because of me being able to be fully present for them. Yeah. That's good. So there was one other thing he talked about in this like logo therapy that was kind of unique is the paradoxical intent. I think that's what it's called right. Paradoxical intent. So he gives the example of, or let me tell you my own example. Okay. So you have someone with like premature ejaculation. And so the thought. And the anxiety around the premature ejaculation actually is going to make this worse. Right. And so what you do is you give them a goal which they can't lose. Like, so you are going to, instead of, you know, ejaculating in 10 seconds, you're going to go for five.

And you're going to try as hard as you can to do it in five seconds. and they look across the room at me and they're like, what? Or sometimes I've had the partner in the room with me and I'll say, okay, what you do now is you tell him to go as quickly as you can. And you do that over and over again. And you make it like, that's what you want, right? And it changes the pressure and takes away the pressure. It's liberating.

It's liberating, right? Yeah. So that's paradoxical intent. And another patient I had was so fearful of passing gas in his class that he was in. This is like a professional student. And it just the anxiety of the fear of passing gas would give him incredible gas. Like I don't know if you like if you're an anxious gas person, but like you just get all like bloated and everything. And so I said what you're going to do is you. you are going to pass gas in class, and you're going to do it every five minutes. Okay? And he looked at me like, this is my worst fear. Like, what are you talking about? I'm like, no, you're going to do it.

It's a contest. It's a contest. Okay. He came back and he said, I couldn't do it. Yeah. He said, I couldn't get any gas out. It was like... Because he wasn't anxious in the first place.

It moved him from that like, that the fear, the preemptive fear, you know? Any thoughts on his discussion of this? You know, I liked it because I feel like it's so true for so many things. He also mentioned, you know, somebody sweating. And of course, thinking about sweating, when you notice you're then sweating, you're going to sweat more. A kid who was studded.

And then to get sympathy from like a police officer wanted to show that they stutter. So intentionally stuttering and then realized, oh, suddenly, suddenly they have no stutter. Yeah. So trying to stutter. Yeah, he was trying to stutter. So trying, you know, instead of, you know, fearing sweating, you are going to sweat 10 times more than you normally do. Okay. Instead of...

Or laughing at it. He talked about making it, like pointing it out in an ironic way. or a humorous way so that it just takes the fear out of it rather than it having power over you, you're having power over it. Yep. Yep.

It's creating a scenario that it's like they think they can do and they can't lose that one. But then when they can't do it, it's like they really win. Yeah, I think Ficto Frenkel kind of talks about how like, you know, Hassan mentioned it earlier about happiness, you know, how happiness shouldn't be the goal of it,

but it should be a byproduct, a side effect of it. And I think Victor Frankel, in the beginning, I think he had mentioned how American culture, when he was in the States, how American culture has kind of put happiness as the goal in life. And because we're all striving for it too much that people lose sight of what life should actually look like and therefore people become more depressed. You know, because it's not what it should be. Like, it's not, it should be a byproduct. And that is also, I think, as we let go of the paradoxical intention, essentially, of pursuing happiness,

but doing something that is meaningful in your life, then it kind of comes along. Yeah. It's like, it can be weighty almost to think that you should be happy at all times. He talks about, I'm totally going to mess up her name. Dr. Weiss Cop Jolson or something like that, that people who are unhappy don't, they no longer have to just deal with that unhappiness, but also being unhappy that they're unhappy and then being ashamed in front of other people that they're unhappy. You know, like that unhappiness, you know, just those ideas have made it so much worse.

And then just because you're not, you're not hitting this goal of so much fun all the time. you know, just taking that as something to accept. Yeah. I think that when someone's like grieving, the loss of someone, the thought that they should be happy is like, no, no, it's okay to not be happy. It's actually like your sadness that shows how much you cared, and that's meaningful.

And I'm really glad that you shared that. Some patients have been conditioned throughout their life to think that they should be happy at all times or like should be presenting this happy face to society or to their friends. And so they don't reveal aspects about themselves, which are darker or sadder or, you know, because they put value judgments on this thing

that we should pretend. I remember a patient who came into partial who had this very sort of, she was smiling the whole interview, even while she's talking about horrible things. and it was a very pressured smile. I think she would get away with it with most people. Most people would think, oh, she's a very happy person,

but underneath it was so much sadness. And I was like, you know, it's okay if you want to smile and, you know. But I want you to know that here it's also okay to just be wherever you're at. And it's probably, this wasn't the exact. conversation, but it's adaptive to smile and to sort of put on this facade or put on this image, you know, where we're happy. But at the same time, it's, it's okay to not be that way here. It's like you're trying too hard. You don't have to try too hard to be happy. Well, you know, I mean, you're trying, the trying, the trying hard is one thing, but the pretending

to be happy is the other thing that I'm speaking to that we've been incultuated to. How are you doing? Oh, good. Yeah. Everything is awesome. It's also, I feel like in line with, when people talk about writing reflex,

like you need to fix something. Like, it's not okay to not be happy, or it's not okay to at least seem like you're not happy. Yeah. It's okay to not be happy. Yeah, any other parts from this, second half of the book that you guys wanted to go through any big categories. I really liked how I talked about how a logotherapist is more like an eye doctor rather than a

painter. That was very interesting. This goes back to putting the ball into patient's court or the person's court and taking desimentality out of the question or out of the therapy and Basically, what I understood by that was the eye doctor sees it for how it is, and the painter, you know, shares his perspective of it. And so it's really important for the patient to be able to figure out his own meaning and for us to be able to observe on the outside and help him get to his meaning rather than our interpretations of it. So I think the biggest thing that stood out there was not being judgmental and helping the patient, you know, getting to the most genuine version of self and kind of finding himself through meaning and life. Yeah. And to that point, I think one of the other important points is that everyone will have different meaning and that moment to moment, that meaning could also change. And I think that was, that's important.

That, you know, it doesn't always have to be like a fixed meaning that you have. Because like life changes all the time. You know, people change, events happen. So I thought that was important, especially for us, you know, as psychiatrist, you know, mental health providers, to be aware of that and interacting with our patients. Yeah. Yeah. What is meaningful?

I think, you know, like even within the same religion, maybe the same, like, sect of the religion, you could meet people and they're not going to have the same meaning. Like, even if they believe this same concept, you know, the same, it's like the meaning and the purpose that is embodied is very personal. And so we don't want to necessarily put our meaning or purpose or what's worked for us on another person. we want to kind of approach them and be curious what it what is inside of them you know i remember um i was doing this i was creating the videos for the micro expression app and so i was showing people youtube videos and i had this one guy who i showed a series of really bad things that were happening all around the world and the only one that he got sad about was people

people with disabilities, like people with like, you know, physical disabilities. And what occurred to me when I was watching this over and over again, I was like, well, this is what's meaningful for this guy. It's like, this is what stirs up that emotion, right? And so as I'm helping people find their meaning, I'm looking for the emotion. And I'm looking for what is real, you know? Because the other thing is like we all have things that we've been taught by society to say is meaningful.

And so, like, there is those sort of things of, like, kind of like the superficial meaningfulness that we project that we should be... I should, as a psychiatrist, prize this over this, you know? Like, if you're a psychiatrist, you can also have a phase in your life where you're like, well, I really just got to take care of my family,

you know? And so I have to choose a job that does that first, you know, and foremost. And that's okay. or I really need to, you know, prioritize my own mental health. Okay. That's okay, because that's like, if that's like what's on your sort of mind and heart that is going to, that you're, that's kind of pulling you towards that, right?

Frankl talks about this as like fate. He kind of like said, well, I sometimes just allow fate to occur, you know, and how like, You know, was he supposed to go with this group of people here or stay and take care of this person with typhoid? He ended up staying because he felt guilt about going. He felt like his inner pull was to stay and help. And, you know, the people were like not understanding why he made this decision. You know, why aren't you going to this rest place, you know, or this better place, right? It ended up being a good decision for him.

I think everyone else got gas that left or something at that time. which is a lot more weighty probably than some of the decisions we have to make. He talks about the superficial, like what someone's meaning might not be actually their meaning. You just have to work on unmasking the actual meaning. But then he talks about not going too far. Occasionally you might have to do that. But then once you find their purpose and meaning, that's when the analysis, I guess you could say, stops. because it's not about what that meaning is from related to their past or what that means.

It's about, you know, getting to that meaning and then pursuing it. Right. There's this, sometimes people can do this to themselves as well, I found. I had a person just this week who had this deep desire to help people in a particular way. And then she said, well, maybe I'm just sublimating from. blah, blah, blah. And I'm like, no, no. Supplementing is like when you have a sexual drive

and you go dance or something like that. This is like a deeply profound sense of purpose that you're talking about. Like, let's leave that there, right? That's, well, let's not analyze that and look at like, oh, there's some, like, daddy issues underneath or something like that. I mean, if you're doing that as a therapist,

I'm wondering, you know, maybe it's your own. stuff, right? That's kind of leaking through. So it's like, no, when you find that like profound truth, that meaning, that purpose, that drive, it's like, yeah, you just got to like stop there, right? And he says that, right? Like, for those who say this is just a defense mechanism or like reaction formations, I would not be willing to live merely for the sake of my defense mechanisms, nor would I be ready to die merely for the sake of my reaction formations. Like this is not, this is a purpose. It's not just something to.

Yeah, and I'm glad he said that honestly, because like I think if he wouldn't have said that, it's almost like how do you have that argument with someone on a logical basis? He's like, look, I've lived this. Like, I've suffered. I get it. Like, I didn't suffer because of a reaction formation. like there's something of substance here

and I think that's what suffering does to some degree is it takes you past the fluff to like what is really there and sometimes what is really there is like yelling at you like pay attention to me don't let me die this is meaningful I'm recalling I think in the book it talked about how There's a person who was meeting with a psychotherapist for five years and wasn't happy at his job.

And, you know, there was a reason that kept on coming up, but, you know, that really didn't help much. And so I think he met Victor Frankel, got therapy through him. And they realized that, you know, the reason he was unhappy his job was because there wasn't meaning. And he was looking for something else. So you had to. Right. So he presents to a psychoanalyst. And the psychoanalyst is saying, like,

look, this is your issue with authority. This is issue with your daddy. And he has him in psychoanalysis for years. And in one session, Victor Frankel is like, no, this is, your job is miserable. You know? I've said that to some people. Like some people, there was one person who came to me was like really burned out. I was like, well, that's kind of the environment of the job.

Right? He was at a job, I won't say the name of it. But it's like, if you're a therapist in this job, you get to see a patient once a month. if you want to see patients intensely and do the work, it's like once a month is not enough, you know? You will be driven crazy by that schedule, you know? Or like a psychiatrist who's like has no control over the amount of patients coming in. And so they're seeing patients like once every like six months.

It's like, and they go to their boss and their boss won't change it. It's like, okay, there's a problem with like, you know, the environment that's, you know, forcing you to see these clients in such a way, right? That is, it's not just you. You're burned out for a reason, right? You're burned out because, actually a lot of studies on burnout that I've looked at. It's the environment that makes a huge impact on physician burnout. And a lot of it's surrounding like busyness and, you know, not supporting them in their work, basically. You say not every conflict has to be a neurotic or pathological thing, right? Like in that scenario, it was natural for him to not be happy in his environment.

It didn't have to be analyzed necessarily about his childhood. Yeah, or there was one guy I saw, and he was in therapy twice a week for two years. And once I actually got him to do a sleep study and wear his CPAP, he felt completely normal. And I think it was like directly related because his episode, his episode, sleepworth sleepiness scale was like a 12 it was like super high um it was a super high number and so he was tired all the time well some people are tired because of chronic trauma and stuff that's going on like that and some people are chronically tired because they're not breathing throughout the night right you know so you have to like you have to see the big picture any other big points we're not we haven't hit yet

that you guys definitely want to hit before we wrap up. I think we might make it a little bit more practical. I think Viktor Frankl mentioned about how do you discover like meaning of life, I guess. And then he talked about three different ways. And one is through work. Creating some kind of meaningful work or doing a good deed is one way to find meaning in life. Second would be through love, which is experiencing something that is good, true, beautiful, or something by loving someone.

And third point was suffering with dignity and having the attitude as we're going through suffering and how that transforms a tragedy into a triumph. So I thought that would be some points that you can practically reflect on as we are searching for our meaning in life. Yeah, and I would say about the work thing, sometimes it's not,

sometimes the job that you take makes you realize what you don't want to do. Like I started off in medical school thinking that I was going to be an orthopedic surgeon. I wanted to do surgery too. You wanted to do surgery too? Initially, yeah. Yeah. So I spent some time doing orthopedic surgery over my first second summer in medical school,

went over to Dominican Republic, Haiti, spent some time with this amazing surgeon, Scott Nelson. And despite him probably being the archetypal surgeon, I would want, like, to be. to be, right? I realized it wasn't me. And that I had this kind of like idealization of it, which didn't really come to be like, this is me.

Can you see me to be an orthopedic surgeon? No. I'd be like, yeah, and then I thought I was going to do med peds. I thought that for a long time. I interviewed all the way through med peds. So many programs. And there's like two days The interviews, it's horrible

It's like you do one Peds Day One Internal Medicine Day I hope that's changed And I didn't match And when I didn't match And I read that letter I heard in my mind Psychiatry

And before that moment I had not thought serious About psychiatry Really So it was like It was something deep from it Within me And I was like

Psychiatry I was like I want to run away from that. Look at you now. But I wanted to run because I probably needed some therapy on some of my previous life stuff. So, I mean, it's definitely me though, right?

But it's like it's so sometimes you do things and you pursue them and then like something happens and you're like, you know, there we go. And you didn't know. And I think that this is another. other point, but it talks about how life is a movie and, you know, the movie doesn't end until death happens. And so sometimes, you know, we're at a point and life may seem terrible, but that's because we haven't reached the end or we haven't reached like an appropriate, you know, time, maybe not a climax or something. And so it's hard to judge if it is fair, if it's helpful,

if it's going to help you towards the meaning or it won't. But I know Victor Frankel talks, quite about how with super meaning, you know, being certain that life does have meaning. So in those times when it feels like everything gets falling apart, but if you're going towards your values and, you know, following your conscious and working towards that. Yeah. And with that, I would say, like when I'm helping clients work on this, we've started to crystallize like, okay, these are the things that have value. you for me. These are the ways that I like to practice my life. So there's this one person in business I'm working with who's definitely a high achiever. And this person likes to make decisions

on what is 100% best for the person that she's working with. And she has lost lots of money doing this, right? And no one else around her, like the people, her comrades, you know, are acting in this type of way, or a lot of them are not. And some of them are doing a lot, you know, they're getting a lot more money coming through. And yet there's this super long game that's starting to happen where these referrals are coming to her based on these people that she's helped and they can tell like someone can tell if you're really for them and so she's getting these like referrals you know and and this type of thing and so this is a value okay a deep value now a new opportunity comes does this new opportunity and does this person

you are going to work under align with this value that is so true to you and it doesn't okay and can we put that into perspective of these these values that you have so then you can once you have a set of values then you can start to say no to two opportunities which like if you haven't learned how to say no you eventually will um there will be too many opportunities right and uh learning to say no is a good thing sometimes you have to say no if you're given a a title without given, without the power to make decisions that align with your values. So that's another thing I've helped clients with lately. It's like, okay, so you have this title and this responsibility, but you don't actually have

the power to make the decisions that align with your values. And so maybe it makes sense letting go of that title. And it actually is like a weight off of them. So, you know, can you be in a situation that aligns with your values and aligns with this meaning that you have? Can you live that out? And can you look for environments where you can live that out and make decisions and say no and you can't? So those are some practical ways that I've seen that play out lately. What energizes them?

What gives them a sense of meaning and purpose? And then how do we make decisions based off of that? and slowly things get better because it's like you want to be you want to feel pigeonholed and burned out it's like yeah do the do the things that are live live and operate in a system that are is very contrary to your values really difficult yeah i couldn't imagine even doing like I couldn't imagine doing residency without feeling like it was for something. You know, that like if I was in psychiatry and I didn't actually have any passion for it, I think I'd have a lot of like, you know, you have hard days.

And I just couldn't imagine, like, it would just be so much worse, you know. Like, I just couldn't imagine doing something like that unless you're very passionate because it is exhausting and there's a lot of sacrifice. There's vicarious trauma listening to some stories, you know? It's like there's some suicidal mere neuron juice that can really bring you down quickly if you're an empath. It can be hard to learn how to tolerate that level of negative thought. But we can. We can get better at.

We can grow in it. And the meaning of it, right? It's like, okay, this person's life. It's literally, it's like they're not. not dying. That could be one of the meaningful things. All right, let's do a wrap-up. So why don't we go through like one big takeaway that maybe you're coming out of this discussion with. It's like an aha moment or just something you're excited about or something about Victor Frankel that you really, that's like, I'm glad I read this book because. So Hassan, why don't you start off?

Yeah. I think I'm just going to take the bury. That's just like kind of like, the large one that's just standing out there and it's really meaning and specifically that there is meaning in life and it's just a matter of people finding it and something that I've already been doing even, you know, with my patients is goal-oriented care and so now I can walk away and kind of reframe or add this to to make that much more stronger. thinking about what values they have, what meaning they have in life in order to begin working towards recovery. Cool.

Yeah, so I really liked how, and I know Hassan touched upon this, the not knowing necessarily, just because while you're going through suffering, not knowing necessarily, like the movie's not over where it's going. because so sometimes it will feel like suffering is just without purpose and maybe you're trapped in your life and you see no way out. But he gives a lot of examples of, you know, people, patients of his coming back and they found that meaning or the solution to something or that suffering actually ended up taking them to great places and finding meaning.

And I just really, I like that idea, you know, that. that you just have no idea what's in store for you or how this seemingly horrible thing could maybe be one of the best things that happened to you because there's a lot of ways to turn suffering and traumatic experiences into experiences of growth. I think keeping that in mind and for our patients. Yeah.

Yeah, I think for me, I think after reading this book, I was thinking more about my meaning in life. And for me, it was Viktor Frankl at the end, he says, you know, aim of psychiatry was the healing of the soul for him. And I definitely thought a lot about being a healer, but healing of a soul that just like rang really true to me. But like I said, you know, family and friends are important, but as my job, as a psychiatrist, I chose this because I wanted to be there at the moment when people are suffering. and to see them through, like, you know, as a healer. I hope that me being a healer or me living my life to the fullest can extend it to my patient so that they can live their life to the fullest.

Ooh, I love that. Can I share this one part? At the end, actually in the afterward by William Winsled, he talks about how once Victor Frankel was asked to write, you know, say in one sentence, what is the meaning of his life, or what does he feel like is the meaning? And he wrote it down and asked the students, you know, in the audience, what they think he would have written down.

And someone said, the meaning of your life is to help others find the meaning of theirs. And he responded, that's it exactly. Those are the very words I had written down. And I just, I thought that was so, you know, I mean, it's clear. Like that that was logotherapy and writing this manuscript and teaching as many people about it. That was his purpose. And I feel similarly, I guess, not in obviously in the exact same way, but just in helping guide our patients and, you know, that there is meaning.

And no matter how hard residency is or anything else. Yeah. Yeah, it is hard. I think that's a great point. I see us as beacons of hope, as providers, as clinicians, as psychiatrists, and, to be able to, you know, believe or to be able to, you know, sit down in front of my patient and, you know, in the back of my mind, know that there is meaning in his life and be convinced that there is meaning in their life and to be able to convey, you know, what I'm thinking

and to be able to guide them to, first of all, become aware that there may be meaning in their life if they're not already there. And then once they do come to that point and to walk them through. Yeah. And give them hope in life. Just saying, like, I have hope for you to a patient. They say thank you because nobody in their life may potentially have the capacity to say that or, you know, situation. So, yeah, I love that.

Those are all good things. Yeah, thank you so much, guys, for coming. I'm thinking I should probably wrap up my final thoughts. I'm like thinking, what am I? Honestly, rereading this at this point in my life, it's a good, it's a good, it's a good, it's a good way to kind of rethink like, okay, I'm not doing this to pay off my student loan debt. You know, so there's these things that kind of like barrage and insert themselves into your mind, you know, which I probably think about more than I should, right?

So it's kind of like a good reset to be like, you know, at the end of the day, like, what is meaningful for me? we moved out to Florida for the kids largely. We were like really excited about this school. And that was one of the, like, that was the moment that I decided was when I went on the tour of the school. I was like, I won't make it to be at the school. And so I think for me in this phase, it's like family, kids, you know, like they're only young for a couple more years, you know.

And to really capitalize on those years. and that's that's meaningful for me so it's like okay put the phone down put the put the laptop away put the stress of of all the things that I'm trying to balance away and be present with them so Hassan your idea of presence that was meaningful for me and learning from you guys you know as you read through this and as we talk about it and I would say the other aspect is at the end of the day I really the thing that gets me really excited is producing content where people are growing themselves and able to better help, you know, their own journey and also the journey of their patients.

And initially I started out thinking I would be able to walk maybe with, you know, a couple hundred people. And this has become so much bigger. And I'm thankful for that. And that excites me. And it gives me a sense of meaning and purpose. So whenever I hear stories about like, you know, Oh, I was, from something you said, I went into therapy and I feel very different now.

Or, you know, from something I learned from you, it's helped me better, connect with patients. That's very meaningful for me. So that energizes me. That keeps me going. So that's probably work-wise, what excites me the most. But, yeah, thanks guys for coming. This is fun. Thanks for having.

Thank you. Yeah, we'll leave it there.