The Chris Voss Show - The Chris Voss Show Podcast – The Anatomy of Anxiety: Understanding and Overcoming the Body’s Fear Response by Ellen Vora

Episode Date: March 24, 2022

The Anatomy of Anxiety: Understanding and Overcoming the Body's Fear Response by Ellen Vora From acclaimed psychiatrist Dr. Ellen Vora comes a groundbreaking understanding of how anxiety manifests in the body and mind—and what we can do to overcome it. Anxiety affects more than forty million Americans—a number that continues to climb in the wake of the COVID-19 pandemic. While conventional medicine tends to view anxiety as a “neck-up” problem—that is, one of brain chemistry and psychology—the truth is that the origins of anxiety are rooted in the body. In The Anatomy of Anxiety, holistic psychiatrist Dr. Ellen Vora offers nothing less than a paradigm shift in our understanding of anxiety and mental health, suggesting that anxiety is not simply a brain disorder but a whole-body condition. In her clinical work, Dr. Vora has found time and again that the symptoms of anxiety can often be traced to imbalances in the body. The emotional and physical discomfort we experience—sleeplessness, brain fog, stomach pain, jitters—is a result of the body’s stress response. This physiological state can be triggered by challenging experiences as well as seemingly innocuous factors, such as diet and use of technology. The good news is that this body-based anxiety, or, as Dr. Vora terms it, “false anxiety,” is easily treated. Once the body’s needs are addressed, Dr. Vora reframes any remaining symptoms not as a disorder but rather as an urgent plea from within. This “true anxiety” is a signal that something else is out of balance—in our lives, in our relationships, in the world. True anxiety serves as our inner compass, helping us recalibrate when we’re feeling lost. Practical, informative, and deeply hopeful, The Anatomy of Anxiety is the first book to fully explain the origins of anxiety and offer a detailed road map for healing and growth.

You wanted the best. You've got the best podcast, the hottest podcast in the world. The Chris Voss Show, the preeminent podcast with guests so smart you may experience serious brain bleed. Get ready, get ready, strap yourself in. Keep your hands, arms and legs inside the vehicle at all times. Because you're about to go on a monster education roller coaster with your brain now here's your host chris voss hi folks is voss here from the chris voss show.com the chris voss show.com hey welcome to another podcast episode of the chris v Show. Who knew we'd do it again? We certainly wonder. We

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I think I'm just going to run with it. So we're excited to announce my new book is coming out. It's called Beacons of Leadership, Inspiring Lessons of Success in Business and Innovation. It's going to be coming out on October 5th, 2021. And I'm really excited for you to get a chance to read this book. It's filled with a multitude of my insightful stories, lessons, my life, and experiences in leadership and character. I give you some of the secrets from my CEO Entrepreneur Toolbox that I use to scale my business success, innovate, and build a multitude of companies. I've been a CEO for, what is it, like 33, 35 years now. We talk about leadership,

the importance of leadership, how to become a great leader, and how anyone can become a great leader as well. Or order the book where refined books are sold. Today, we have another amazing author. We put him in the Google machine and say, amazing authors, and then these names just come up pouring, these wonderful new books they're coming out with. And today we have A. Nutter, who has graced us with her presence on the show. This book is going to be coming out March 15, 2022. So the beautiful part about that is you can be your book clubs, your neighbors, or whoever you compete with to read the book first. You can preorder that baby right off the interwebs wherever fine books are sold. The name of the book is called The Anatomy of Anxiety.

I just got excited just reading that. Understanding and Overcoming the Body's Fear Response. Let me cut that again so people don't assume that's the title. The Anatomy of Anxiety, Understanding and Overcoming the Body's Fear Response. People are going to be like Googling that other thing I said. And we have Dr. Ellen Vora on the show with us. She's going to be telling us about this amazing book, her studies, her research, and everything that went into it. She is a holistic psychiatrist, acupuncturist, and yoga teacher. She takes a functional medicine approach to mental health, considering the whole person and addressing imbalance at the root. Dr. Vora received her BA from Yale University and her MD

from Columbia University, and she is a board certified in psychiatry and integrative holistic medicine. She lives in New York City with her husband and daughter. Welcome to the show, Ellen. How are you? Chris, thanks so much for having me here. I'm doing and daughter. Welcome to the show, Ellen. How are you? Chris, thanks so much for having me here. I'm doing well. Good, good, good, good. And I'm glad we have a doctor on the show. Does this look infected to you?

No, I'm just kidding. It's a joke I always do with doctors. I know I always hear that doctors are the one thing that you guys go to parties and like people try and get you to work. Like, boy, does this rash look like it should go away? So it's always fun. But give us your plug so people can find you on the interwebs, please. Sure. Good places to find me are on Instagram.

I'm at EllenVoraMD. And then my website is EllenVora.com. And if you want to get my book, you can really find it anywhere you like to buy books. But on my website, I have a whole list of different bookshops I recommend. There you go. Wherever fine books are sold. But don't go to the fine places they're sold. Don't go to those dark alleyways they sell books. I got stabbed in one.

So anyway, what motivates you on to write this book, Ellen? Yeah, I mean, the book is about anxiety. And what I was noticing was that nearly all of my patients struggle to some degree with anxiety. And I also, the way I feel when I meet somebody with anxiety is I'm actually on some level excited because I really think there's a lot of low hanging fruit when it comes to treating anxiety and things that nobody's talking about, things that people aren't really already knowing to try. So I like getting this information out there so people have some strategies and some tips to reach for to feel less anxious

pretty much right away. So give us an overall arcing view of the book, if you would, please. Sure. So it starts the kind of actionable strategies. I break anxiety into two different categories rather than what I was trained to. I was trained according to the DSM or Bible in mental health, where you call anxiety, generalized anxiety disorder, or OCD or PTSD or social anxiety. And I don't find that that all that meaningfully guides management in my practice. What's more useful is to divide anxiety into two categories, false anxiety and true anxiety. And false anxiety, that's not meant to sort of invalidate the very real suffering of anxiety, but it speaks to the very straightforward path out of it. False anxiety are those times when the body gets tripped into a stress response,

and that manifests as what we call anxiety. But it's completely avoidable. It's unnecessary. We don't need to be suffering in this way. And it has to do often with really mundane things that we don't even realize are contributing to our anxiety. Everything from strong coffee and hangovers and sleep deprivation and technology to certain dietary intolerances and inflammation, things like that. You just described Fridays around here. Yeah. And then it's common. We're all in this together. And then the second half of the book is really an exploration of what I call true anxiety, which is not something we can medicate away or decaf or gluten-free our way out of. This is purposeful anxiety. It speaks to what we're really here to carry out in our lifetimes.

And so this is something we want to actually slow down and listen to. And so it's a lot of different ways of how can we access that truth? How can we slow down and listen to it and then take steps accordingly so that we don't feel so burdened by that kind of anxiety? We don't need to pathologize it. We really can let that fuel us and nudge us back onto our path. This is kind of interesting. False anxiety and purposeful anxiety. Do I have those two correct? Yeah, false and true, or you can think of it as avoidable anxiety and purposeful anxiety. I like to avoid all anxiety completely, pretty much. But that's probably not possible, is it?

Not exactly. And it wouldn't even be desirable. I went through in the nineties when I started my, I started two companies on top of each other within a year and a half of each other. And I was losing my mind going through physical panic attacks every day. I didn't understand what was going on with me. All I knew that I'd get angry and destroy office equipment. And I would go through this whole stress body lockup that would eventually shut me down where I had to take a nap. It's a wonder I didn't have a heart attack at the time. And finally, I walked into an emergency room going, I think I have a brain tumor. I don't know what's wrong with my brain. My head hurts, everything. My whole life is just living hell from every day. And the gal said to me,

she says, she says, uh, you have anxiety. And I about verbally, I didn't verbally rip her head off, but it went through my head. But I was, I did say to her vocalized. I said to her, I said, yeah, I also have fear and anger and a whole lot of other things. So I don't know what you're, I don't know what this anxiety crap is you're telling me because you're just listing emotions to me. And she says, wait, wait, hold on. Don't kill me yet. And she explained that anxiety, the condition of anxiety and everything else. And is it still this misunderstood? I think more people know about anxiety now than what I knew or what, I don't know, for some reason I never come across it in the 90s.

Yeah. I mean, we've come a long way, but I think that it's still plenty misunderstood. And in a way, the emergency room is such an interesting setting where you do see anxiety sort of being said almost as this dismissive idea of like, you're not having a heart attack. It's all in your head. And it's fine. Somebody in that moment is not having a heart attack, it's all in your head. And it's fine. Somebody in that moment is not having a heart attack, but there's something so gaslighting and invalidating about the way the term anxiety is being used in the conventional medical setting. And what I think is so much more useful is to understand you're having a very normal, understandable response

to a certain set of circumstances. And in a way, it's actually not all in our heads. That's really the whole first half of my book is to help people understand that it really starts in the body, that mental health is physical health. And in the ER, you might be told what you think is physical is actually mental. And I'm here to say what you think is mental and what we've been told is mental is really very often physical. And so that's a nice entry point. I find it's a much more hopeful way of understanding mental health because rather than it taking seven years of therapy or ridding ourselves of all of the stressors in our lives, it really means we can just make a couple diet lifestyle shifts and really get ourselves out of a constant stress

response in the physical body that is feeling like anxiety. That's pretty interesting. I just opted for the lobotomy and I feel great. Most of my audience probably right now is, this makes a lot of sense. I've been following it for 12 years and yeah, the lobotomy, that explains everything. No, and I will, I'm no scientist, but I will suggest that you're right. They put me on like horse tranquilizers that by the time I weeded myself off them. Weedled myself off them? Weed, yeah.

Weed myself off them? I did not go to medical school, clearly, and I would become like a normal human being again. And I'd be like, wow, this is weird to me. And then by the time I weeded myself off them, I got down to like, I don't know, a quarter. And if I took a quarter of that, it would knock me out, sleep for eight hours. And I'm like, how jacked up was I? And what I did was I started learning to listen to my body and there would be a muscle somewhere in my stomach that I would clench. And it would be the first, if I experienced stress, the first thing I would do is feel that physical clench in my stomach. And I'd be like, oh God, here it goes.

And I had a whole ramp up that would, that would happen with my muscular system where eventually my chest would be collapsing in my heart and I would be a Hulk. And, and so, yeah. And so once I learned how to kind of cut that off or intercept that, Oh, Hey, the stomach clenched, we're going to go on a rampage here. Either shut it down or understanding what my body was doing. That really helped me start understanding my anxiety and getting control of what I was going through. There you go. It's exactly that. You said it so much better. It took me probably 50 pages to explain what you just did in a minute. We want to slow down and listen to our body. So much of

our anxiety starts there, whether it's a clenching, like a muscle tension in the stomach, or we're drinking slightly stronger coffee that day. We're coming down from alcohol, our blood sugar is crashing. That's an incredibly common one where so many of us are operating on a day-to-day basis on a blood sugar rollercoaster because the modern American diet is really just refined carbohydrates and coffee drinks that are secretly milkshakes and rosé all day. And so our blood sugar is swinging up and down. And when our blood sugar is swinging up and down. And when our blood sugar crashes, this induces a stress response in the body that can feel synonymous with anxiety. So it's really helpful to observe and listen and start to

identify that's what trips my body into a state of stress, which feels to me like what I'm calling anxiety. And my body would just use it as an escalator. It was like, as soon as that, that stomach part, whatever that muscle was in my stomach that got tripped, it would just turn into like 10, 15 minutes. I'd be a raging, angry muscle destruction machine. And in learning where that started, it was like really important for me to try and get control of my life again and, and wean myself off of, I think Zoloft is what they had me on. And I think within about nine months, I was off it. I've gone back once or twice when I've gone through some really hard times in my life. But now how, let me ask you this, how different

is anxiety than like OCD or obsessive compulsive, well, that is obsessive compulsive disorder, or what's the other thing I'm looking for? ADHD and stuff. Do these all play together or are they very different? It does all play together. I mean, they're definitely different disorders. I remember when someone was once describing the difference between depression and anxiety. I think it's Johan Hari who wrote the book, Lost Connections. I think he has a new book out now too. He's great. He put it as these are different covers of the same song, like in many ways, same lyrics, really different quality to them though. We of course know that there's certain overlaps on a really, in terms of our

neurochemistry, serotonin plays a role in both. But what I find is interesting is that basically I think it has a lot more to do, they can have a common root cause and then how they show up in you has more to do with our individual variation. And so, but I do think that there's some difference between say OCD I find very often has an inflammatory basis. ADHD I find very often has something related to the quality of sleep, which in turn has often something to do with the quality of breathing, whether we're able to breathe effectively through our nose. It can be so many, many other things. And I get a lot of grief on the internet where people say, no, it doesn't have to do with sleep or breathing. It's just a genetic disorder. This

is neurodivergence. And that's all true. That's all valid. But I'm always interested in figuring out what are potential root causes. And all of these different conditions can have slightly different root causes. So it's worth investigating because if you can identify and address a root cause of a mental health issue, you can improve symptoms dramatically. And I think I've been through this in my life. I think maybe everyone has where you, if you have OCD or anxiety or ADHD, which I've had in my life, when I was younger, I would go check the doorknob 12 times, 15 times going, did I really lock it? Did I really lock it? And you're like, dude, you've been down there like 10 times and it still drives you mad. You've got to go down and check it again. And, and then that doesn't't help you get good sleep. And then you don't

breathe well if your body's feeling stressed, I'm sure. And then it's just probably a cycle that just kills you. That's right. Yeah. Okay. Okay. What about sleep apnea? Is that part of the breathing while you're sleeping thing? Yeah. So sleep quality is going to impact every single mental health issue known to man. And so sleep apnea, which is so common right now, it's really somewhat epidemic. And often people aren't aware that they have it going on. That's going to impact our ability to focus and pay attention during the day and have good attention. It's going to impact our mood and our anxiety levels and our cognitive function, ultimately even our longevity. So something like sleep apnea, whenever I have the tiniest inkling and suspected in

somebody, I always want them to go and get a sleep study so that they can at least know that they have it going on. Typically, the next step is to use something like a CPAP machine. And as a physician, I'm actually really low on intervention. I tend to avoid interventions at all costs, but a CPAP machine is one area where I say, if you have sleep apnea, get thee to a CPAP machine because it's a life-changing intervention. It really has a lot of upside. I know sleep is really important. The older I've gotten, I'm now 54 and I go to the gym almost every day.

And sleep is, man, if I don't get my eight hours of sleep, people are in danger of their lives and I'm probably in danger of going to prison. And I just can't function. I have trouble. If I can get a good eight hours of sleep, and I had a really hard time during the COVID lockdown. I was sleeping. I mean, I was doing four and four. I would nap four hours and nap four hours. And it was just an insane way. And yeah, I guess a lot of people don't realize this. And if you're not sleeping, if you're up all night thinking about your thoughts and having anxiety, what are you going to do? So let's talk a little bit more about how to identify true anxiety and false anxiety. How do we identify these and maybe know what they are? Yeah. I think it makes sense to start with false anxiety. In the book, I actually just include an inventory.

Basically, go through this checklist and in the moment of anxiety, ask yourself, which of these apply? Did you not get a good night of sleep last night? Do you feel like something's off in your digestion? Did you eat something you don't ordinarily eat that your body doesn't tolerate? Do you have food poisoning right now?

Are you sick or inflamed in some other way? Like a lot of my patients will email me kind of in crisis on the day that they seem to be coming down with a cold or a flu. And they're like, yeah, I sort of feeling fevers and chills, but also I'm feeling a sense of despair. And inflammation really does make the brain feel like it's under threat and it can make it very hard to have a positive outlook, but it's part and parcel with the inflammatory response. Sometimes just knowing that can be really grounding. And then blood sugar is always one to look for. Are you a little bit more caffeinated than usual, a little bit less caffeinated? Are you coming off of a big night of drinking? One common one that comes up in my

practice is actually, are you at that point when you're due for your medication, what's called the pharmacologic knee dare, or when your body has metabolized the medication and you're due for your medication, what's called the pharmacologic nadir, or when your body has metabolized the medication and you're kind of down to nothing in your bloodstream and your body is sort of jonesing for its next dose. And that can feel like anxiety. So just having this list, like you could even have it on your refrigerator. So when you're in that moment of peak anxiety and everything feels kind of tunnel vision and overwhelming, just to be able to glance at that and be like, okay, well, actually, yeah, some of these really do apply right now. That can just help the steps you can take to feel a little bit better, but it also takes some of the charge out of the feeling when you realize this is a physical state first and foremost.

That's really interesting. We've had a lot of doctors on the show over the last two years and they've all talked about inflammation and the ways that when the stomach is not happy with whatever we're up to, it can inflame the brain and expand it, I guess, and cause all sorts of just systematic problems. And it's kind of interesting how much of our, I guess, our body is regulated by our gut. Yeah, the gut is central to our functioning. And I don't make the rules. This is the design of the body. There's the trillions of microorganisms that have an enormous impact on how we feel.

And they really have a direct impact on our mental health. For example, in anxiety, we certainly talk about the neurotransmitter serotonin, which we know now the gut is the second brain, something like 90, 95% of our serotonin is really made and exists in our gut, not our brain. But there's another neurotransmitter we're not talking enough about called GABA. And it's also related to anxiety. It's our primary inhibitory neurotransmitter of our central nervous system. So in English, it's basically the neurotransmitter that lets us feel calm, like things are okay. And it's largely manufactured by our gut bacteria. Certain strains of bacteroides bacteria help us make GABA. So of course, in modern life where we take antibiotics and we drink chlorinated tap water and we're chronically stressed and we don't eat fermented foods, a lot of us are missing these strains of bacteroides and then we're not making enough GABA. And then the gut,

when it's inflamed, it can create the conditions for systemic inflammation throughout the whole body. And when our whole body is inflamed, this causes all kinds of problems, including heart disease, risk for cancer, but it also directly impacts the threat detection centers in our brain. They're scanning for the state of the body. And when cytokines or inflammatory markers cross the blood-brain barrier and tell our threat detection centers, hey, we are under threat, that can make us feel anxious and uneasy. So inflammation impacts our mental health. It impacts our quality of life, life our longevity it's really at the heart of so much of the ways we struggle and it starts in the gut yeah it's it's really amazing to me we've been we've been learning a lot about it and and like i've learned

about how just a better diet can just make everything work better and yeah if you make the stomach happy but if you're you're constantlyving Taco Bell in there, you might not get the best results. I drank for, I don't know, hard for about 20 years. And it was really hard on my body. And as I aged, it just got so hard. I just had to quit because I'm just like, this isn't fun anymore. A couple hours. And I started tuning in more into my body and listening.

And I'm like, two or three hours of fun drinking. And I didn't have to drink a lot, but I could still feel my body dragging for two to three days of dehydration and just trying to cleanse itself. And just, it just wasn't fun anymore. And I'm just like, this is not worth two hours of fun. I'll just, I'll drink some water or some coffee and be happy. And then I don't have to lose a whole week of pain. But, yeah, it's really interesting how all this stuff comes in. You talk about how the body sends a signal up to the brain that something isn't right, and that makes sense to me, and it lets your brain create an anxious narrative. And then I guess we are what we're doing.

Like, say I ate some Taco Bell. I'm going to pick up Taco Bell here. I'm going to lose the Taco Bell crown. I think we lost it a while ago. So I ate some bad tacos or something, and it's just not sitting well in my stomach. I put that, urgh. But maybe am I taking and going through anxiety where I'm thinking about, I don't know, how Marge gave me a dirty look at the office and clearly hates me and wants to kill me,

and I start creating some sort of weird sort of paranoia about that anxiety. Is that what's going on with some of us? Precisely. Yeah. So great. That's such an astute point. So here's the thing. I would say the vagus nerve is really what to think about when it comes to the Taco Bell anxiety moment. Our vagus nerve is our largest cranial nerve. It's winding through our whole thorax and abdomen. It's going to all our visceral organs. And we all kind of know that if we're stressed upstairs in our brain, that it has a way of transmitting information to our organs. Our heart rate's going to increase. Our breathing becomes more rapid and shallow. We sort of know that feeling of an uneasy stomach

when we're nervous. Maybe you get diarrhea before a big exam. But what we don't really appreciate for most of us is that it's a two-way street of information. So just as our brain is sending information down to the body, the body is also sending information back up to the brain. And actually most of the nerve fibers in the vagus nerve are afferent, meaning they are transmitting information from places like the digestive tract up to the brain. So if we eat the Taco Bell and it's not sitting right, that's sending an information signal up to brain that's saying something's not okay here. Feel uneasy so that you'll rest, so that you'll make different choices next time. Whereas if things are good in the gut, then it kind of sends the all clear. Everything's copacetic down here. Go have a great day. And our brain, when it gets that signal that things are not okay, feel uneasy, that's just a

primal state of feel uneasy. But we always swoop in with a narrative to justify the feeling, to explain it. And if you think about it, our brains are meaning makers. If you give us a piece of paper with two dots and a line, our brain is like, I know what that is. That's a face. And if you give us the vagus nerve saying something's really not right here, we tell ourselves, ah, it's because of that look that Marge gave us. We'll swoop in with a narrative to make sense of the sensation. But it's actually first and foremost a physical state. And that's really the level in which we should address it.

Yeah. Hey, can you guys call Marge? Tell her she gets her job back. Sorry, it was a Taco state. And that's really the level in which we should address it. Yeah. Hang on one sec. Hey, can you guys call Marge? Tell her she gets her job back. Sorry, it was a Taco Bell. I'm sure she'll understand. Yeah, it's okay. And can she withdraw those assault charges? Anyway. That was her Taco Bell. That was always Marge, man. Anyway, let's flip the script to true anxiety. Tell us about that and what that is. Yeah, it's purposeful. This is where I think we over-pathologize anxiety. And sometimes this anxiety is really kind of our true north. It has to do with our calling, what we're here uniquely to do.

We have a unique set of skills and perspective. And there's a contribution we can make here. And it's not like super. It doesn't have to be heavy. We don't have to think of this as like, I have to save the world or make the world a better place. It's just, what are you uniquely here to do? It could be making sure that your grandmother has somebody to take her to her doctor's appointment. It's something where you're uniquely positioned to make a contribution. And I think that a lot of us can feel a sense

of anxiety when we secretly know we're not on track in that sense. And I think it also pertains to the way in our population, we're all along this spectrum. Some people are, in the words of Sarah Wilson, life naturals. Things just come easily to them. It's all just kind of low key and chill. And that's fine. We need our life naturals. Be our pilots and our surgeons.

And it's great that they're here. But we also have our sensitive folks, our anxious folks. And we have a tendency culturally to pathologize that, to say, you're too sensitive. You're too much. And even those people are saying, I don't like being this way. This is a nuisance. It's a burden. And I think we really need to rebrand and understand these are our canaries in the coal mine. And this anxiety is in many ways, kind of a prophetic superpower. They're here to feel and sense the things that the rest of us can't pick up on. And they really help course correct us as a society and keep us on track. So it's basically like you're Liam Neeson. I have a specific set of skills. So this is a good anxiety and it helps us tell that something's out of balance in our world. So it's kind of like a

signal like, hey man, something's screwed up. Now, do we also just like false anxiety off place that to the wrong sort of places where like marge again or something? If I'm understanding you correctly, I always think you want to start with the false anxiety, kind of wipe that out, eradicate it from your life. And then you see what's remaining behind it. And these two anxieties have a slightly different quality. It can be subtle, but we start to recognize like, this is just my body in a stress response versus this is my inner truth nudging me and saying, you have to get out there and do this change in your life. And so they have a different quality, but at first they can all feel like what we would call anxiety. Is there a good way to get

into true anxiety to get back in balance? So like meditation, some people may do that or yoga or murder. I usually stick with murder. Murder's not something I recommend, but there's meditation is great. Breath work is great. I talk about a shaking exercise that I like to do where I just put on shamanic drum music and shake for a couple of minutes. And that actually really helps excavate whatever's kind of stuck and blocked in there. And I cover the work that people can do with psychedelics. And that's a controversial topic. It requires all the caveats. It's not safe for everyone or in all settings. It's really something that you want to do when indicated and appropriate and with the proper set and setting. But when it's the right treatment, it really can be like this golden road to accessing our true anxiety.

Note to self, Dr. Voris has stopped the murders. Okay. Just make that note there. This is really interesting. You wrote this in the book. Instead of asking how can I stop feeling so anxious, we should be asking what is my anxiety telling me? That's kind of interesting question. Yeah. That's really the question at the heart of true anxiety. The true anxiety is not something here to be like, oh, I hate this feeling. This is a nuisance. How can I medicate this away? That that feeling is there for, with a purpose. It's there with a reason and it's a communication from within. And it usually pertains to something like in our personal lives, we need to change our job. We need to get out of a relationship. We need to make some change there. We need to rehabilitate a friendship that's fallen out of habit. And then

there's also sometimes true anxiety that speaks to more the community around us or the world at large. And it might be that we know that we need to take action in a certain, you name it, the cause that lights your heart up. And so I think that it's there with purpose and it's not something that we should want to suppress. And it really can change the quality of how it feels. When we see it, when we resist it and we just think, I don't like this feeling, that just makes it proliferate and double. And I think that when we start to say, is there a communication here that I can listen to and I can take steps accordingly,

that feeling of anxiety transmutes into more of a feeling of purpose and it fuels our actions and it doesn't feel so negative anymore. Would you say that, well, what's that old line that understanding the problem is 95% of solving or something? There's something of variation that maybe knowing is 95% of doing or something. But basically, like I didn't understand what's going on with me. All I knew was I was being very destructive and had a lot of anger and rage. And then once I started really understanding what was going on with me and being able to see how I go through different progressions in my stomach and stuff, do you think that that's something that really helps us if we really start asking the questions, like you say in your book, why am I angry? What's happening to me? Why am I feeling this way? And maybe it's not

other people in my external environment. It's really inside of me. Yeah. I mean, I think you're an interesting example, right? So you first want to go through all the false anxieties. In what way is stomach issues or dietary intolerances or what have you, the alcohol, is that contributing to the false anxieties? You get that out of the way. But that's a project that takes a few weeks, sometimes a month or two. And then what remains is, in a sense, I think many of us are a product of growing up in this emotion phobic culture, where we don't really have that license to feel our feelings, to identify our emotions, to move through them. And so sometimes it's a matter of then saying, okay, let me give myself permission to feel what I'm feeling. Maybe the world expects me to be stoic or the world expects me to be always in a good mood or smiling or a people pleaser and always in service of others. And maybe instead what it is is, no, I'm angry. I'm'm frustrated here i have rage and we need to be able

to move through that it never works to push emotions under the rug like that that message alone if we could learn that in elementary school it just never ends well so what we need to recognize instead is human emotions there's a unit of energy there it can't go away it's conserved and if we push it under the rug it it just doubles down. It transmutes into chronic headaches, chronic back pain, digestive issues. What we want to do instead is feel it. And I think we need to give ourselves permission to dive into our feelings and to recognize that when we are rolling with our emotions, that can look from the outside like, oh, they're in a bad place, or this is an overwhelming amount of emotion. It feels like a

bottomless pit sometimes. But actually moving with it when it's flowing, I'm never worried about somebody in that state. I'm worried about people who are blocked, who are stuck. But if you're crying, if you're expressing your emotions, processing, talking about it, things are going to be okay. You are going to move through it and metabolize it. There you go. And don't do the murdering. Do women process feelings and they deal in a feeling state? I think someone on the show said they have about a 30% larger in their brain. They process emotion. Do women seem to be able to handle that sort of thing better than men? Because I know as men, we repress a lot of emotion. We hide a lot of emotion. We're kind of expected to suck it up and not be emotional beings. Men don't cry and that sort of thing.

Is there a difference there or is that accurate? I believe there's a difference. And I think that we both have a lot of challenges. I really love the work of Liz Plank, who wrote the book For the Love of Men. And she talks about kind of asking this question, like, are the men okay? Because we as a society have said, you need to be stoic, you need to be strong, you need to be the red winner. Please don't cry. Please don't show weakness. That's not attractive. And so, yeah, no, men are really struggling under those expectations. That's a straight jacket of

expectations. And men need to be able to be vulnerable, to be weak sometimes, to have their feelings and their emotions. And then women, it's an entirely different set of problems. I think part of what is maybe most challenging for us is this expectation to always be in service of others. I think that a lot of the conditioning that women get is that we're not allowed to inconvenience other people. We're not allowed to, like there's a whole really damning idea around a woman being selfish and i think that gets women really into a lot of trouble because what we do is we compromise our own needs our own energy like forever and then we're deeply burned out and then that actually doesn't help

anybody and we lay that at everybody's feet and so i think for women to little by little be able to say no this is actually my energetic boundary right here. And I need to protect that so that I can keep showing up and finding that balance of being in service of others and keeping myself intact. Yeah. It's like, it's the mom who feeds everybody else in the family and takes care of everybody else and then feeds herself last and all the giving things that women do. Although I think there's a whole nother bit of selfish on TikTok. If you want to check in there, you probably have some clients. And the dark underbelly to that mom who's living selflessly and feeding everyone else

is that underneath that she's developing resentment and burnout. And pretty soon, like she's just going to be laid up in bed and not be able to help anybody. So I think that there's something to selfishness that keeps us intact. Yeah, yeah, it definitely grinds out. So you have a lot of resources on your website. I noticed one thing. I think you have a free gift that you offer people that sign up on your website. Yeah.

So there's like a handout that just gives people really the highest yield, most actionable tips to keep yourself well and with a real eye towards the fact that behavioral change is hard. So this is what's easy and realistic and doable. So the best thing to do is for people, of course, read your book. If they want to go beyond that, or if they feel they need more help with their systems, what do you usually recommend that they do or reach out to something? The best thing for now is just to be on my newsletter because that's where I'm going to announce when I do start holding groups, live Zoom events and courses. And so there's different ways I'm figuring out how can I support this pretty big demand for a different way of approaching mental health. Because right now, a lot of people are feeling like the mental health field as it exists is not sufficiently supporting their needs, but there's not a whole lot of us yet offering up a different approach. I love the format of it. And to me, like what I say, I went through it. It was really

confusing. Like I said, the poor nurse, if I go back and apologize to her, but I was so ready to rip off her head verbally. And I just politely held back. But I said, I said, yeah, I have fear and I have anxiety and I have anger and misery. And why don't you just name all the emotions, like all the seven dwarfs or whatever. And she was very nice. And she explained to me, but she could tell that I was about to go Hulk on her. But, and that's when she explained to me what anxiety was. And I thought she was smoking the crack. I didn't have a choice. I was at the, I was at my line where I'm just like, I have to do something. And if she says I have anxiety and I should go see this guy and take these drugs, I'll do it. And within a half an hour with the drugs she'd given me, I, I became a human being.

I'm like, wow, this is weird. I've never been like this for a few years. And so I think it's good. And people need to realize that because some people are just rolling. I remember when I met with these, I don't know if it's psychiatrists or psychologists, the one who gives you the drugs. Yeah. And he says, he says, I'll bet you think about the same subjects every day at the same time. And I said, no, you're full of crap. You're full of crap. And he goes, he goes, keep a journal. He goes, he goes, you watch because a lot of people that we get so much in our heads with anxiety and OCD and stuff, we don't realize how much we're just rotating the same crap. And he made a bet with me. He goes, he goes, keep a journal. He goes, I want you to monitor,

you know, what you're, what the shifting thoughts are in your mind and the times that you do them. And son of a gun, he was so at 10 o'clock, I was thinking about, I don't know, whatever the hell it was, right? Same thing every day, 11 o'clock, 12 o'clock, same thing. It was the same rotation of anxieties and OCD that I was having. And it was just madness because it was, who knows how long I'd been operating for that long. It's crazy. And there's your Marge effect. So like while the cortisol comes on in the morning with the coffee, we have those stressful responses. And then as we have our lunch and we have gluten and dairy and sugar, then we get leaky gut and all these opiate-like qualities of these foods hitting our

brain. We get kind of fuzzy and bleary-eyed and we feel like I'm totally unmotivated and hopeless. And then we often, many of us have kind of a crash and a come down from a variety of different hormones and chemicals later in the day. We kind of sundown and then we feel despair and rinse and repeat the next day. And so much of it, and then March comes in and acts as our explanation for why we're feeling that way. But it's really first quite chemical. I'm sorry, Marge. Poor Marge. I mean, we can hire back, I'm sure. So what have we touched on that you want to touch on before we go out and tease out about it? I'll touch on medications because you brought it up here and there. I think we're in a moment right now where, and I'll say, first of all, just as a caveat, I am not dogmatically against psychiatric medication. I'm a psychiatrist. I'm the one who writes the drugs. I prescribe medication. I am not dogmatically against psychiatric medication. I'm a psychiatrist. I'm

the one who writes the drugs. I prescribe medication. I have patients who I start on medication. Seldom, but it happens. But my book has a very, it's an alternative to pharmacologic interventions. Mainly 99% of psychiatrists, no problem. This is how we are trained to meet the mental health needs is to write a prescription. And I find that that doesn't help everyone sufficiently. So I'm here to offer a message of hope that even if you're not sufficiently helped by meds, if maybe they worked at the beginning and they faded over time, or you want to be off of them, or you don't want to start them, there are other things that we can do to support your mental health. But I also want to acknowledge

that there are people out there who are on their meds who think about getting off of their meds. And I think we have a little silent epidemic of the struggle with getting off of psychiatric medications. And I think it's really important for people to recognize these are powerful psychoactive substances. They have a very real withdrawal. Like any illicit drug, they have a real withdrawal. So if you're getting off of a med and you feel lousy, we get messaging that tells us that's relapse. And that's a reason to think that the med was helping you and that you should go right back on it. And I think that that is withdrawal. And we want to recognize it as such. And take any medication taper so much more slowly and support it in all kinds of ways. You want to work with a practitioner who really knows their way around medication and tapering and to just recognize what you're working with.

People get off of meds successfully. You want to go slowly and you want to realize that those symptoms that come up are largely withdrawal. What's interesting about your book and what you just said is that that's what I recognize. Over nine months, I slowly weaned myself off of the meds. But I was also figuring out, like what you've written about in your book, what my body was doing and how to cut it off at the pass when I'd feel the stomach clench. And I'd be like, okay, let's just go. I wouldn't go meditate, but I just kind of, okay, time to disengage from whatever's pissing me off. And we need to go to a quiet space and just kind of not let the next steps go. And I think some of it

was a little bit of breathing, which is kind of meditative actually, but yeah, it was able to figure it out, but yeah, you shouldn't do it. I've had some friends that recently they, they, they were having some issues. They got on Zoloft. And then of course the hardest thing people have is waiting to get that right dosage that finally kicks in and you have that normal moment. Like, I think a month went by and my doctor, I'm like, nothing's happening. My doctor's like, you'll know when it happens, Chris. And I'm like, dude, I don't know, this freaking guy. And then, yeah, I'll never forget the moment.

It was like the most clear moment of my life where I was just like, I could pick up thoughts and put them down again. I'm like, whoa, this is really wild. And people don't, number one, have that patience and then they can throw it away. And one of my friends, he got really sick going off of antidepressants. He decided that he was going to stop one day. Yeah, no, cold turkey, I would even kind of warn people to say, I even think of it as potentially a little neurologically damaging. I think it's really not something you want to play around with and you want to go so slowly and really support it in all kinds of ways with nutrition, with meditation practice, even with some supplements and detoxification support. Yeah. Yeah. And stay away from Marge because Marge is always at fault.

She gets a bad rap. Poor Marge. Well, it's been wonderful having the show, Ellen. Thank you for coming on and sharing this brilliant stuff with us. Chris, thank you so much. Thank you. Thanks, my audience, for tuning in. Give us your plugs, Ellen. Marge.

I called you Marge. Give us your plugs, Ellen. You can find me at marge.com. You should go buy it now. Again, I'm on Instagram, but all the things, Twitter, TikTok even. I'm at EllenVoraMD. And then my website is EllenVora.com. There you go.

All of the things. Order the book up wherever fine books are sold. It's going to be coming out March 15, 2022. The Anatomy of Anxiety, Understanding and Overcoming the Body's Fear Response. Thanks, my friends, for tuning in. Go to YouTube.com, 4ChestChrisVoss. Hit the bell notification button. Go to Goodread YouTube.com, 4ChestChrisVoss. Hit the bell notification button. Go to Goodreads.com, 4ChestChrisVoss. All our groups on

LinkedIn, Facebook, Twitter, all those places. Those crazy kids are playing these days, and Marge is over there, too. Anyway, guys, thanks for tuning in. My apologies to Marge, and I'll see you guys next time.