The One You Feed - Beyond the Buzzwords: How to Talk About Mental Health Without Losing Its Meaning with Joe Nucci

Starting point is 00:00:00 What we give up, I think, when we shirk the idea of diagnosis altogether, or like these are just socially constructed or whatever people might say, is we're basically saying, okay, well, then all of the evidence, all the scientific evidence, all the clinical wisdom that has gone into studying and treating these things quite successfully a lot of the time, we're just going to kind of throw it out the window. And I think that's completely unfair. Throughout time, great thinkers have recognized the importance of the thoughts we have. Quotes like, garbage in, garbage out, or, you are what you think, ring true. And yet, for many of us, our thoughts don't strengthen or empower us. We tend toward negativity, self-pity, jealousy, or fear. We see what we don't have instead of what we do. We think things that hold us back and dampen our spirit. But it's not just about thinking.

Starting point is 00:00:56 Our actions matter. It takes conscious, consistent, and creative effort to make a life worth living. This podcast is about how other people keep themselves moving in the right direction, how they feed their good wolf. I used to think that having precise clinical language for my internal experience would help me navigate it better. Turns out, that's only half true. Joe Nucci is a therapist who wrote Psychobabble because he noticed something. As mental health language became more popular,

Starting point is 00:01:28 it became less useful. Clinical terms used for specific purposes turned into everyday descriptions that ended up describing everything, which means that they describe nothing. Like, if everyone has trauma, what does that word even mean? If we're all depressed when we're sad,

Starting point is 00:01:46 what happens to people who are actually clinically depressed? The words we use create the world we see. Once you start viewing yourself through a diagnostic lens, it can be hard to see any other way. One of the most powerful takeaways for me was the idea that the value of a psychological term lies not just in its accuracy, but in its usefulness. And sometimes the language we use builds a cage instead of offering clarity. I'm Eric Zimmer, and this is the one you feed.

Starting point is 00:02:18 We are conducting a survey to find out what you want. Look, you know this, I know this. There's ads on this podcast. It's how the podcast stays alive. and feeds those of us who devote ourselves to it. But I'd love to improve that ad experience for you. And in order to do that, though, I need to know a little bit more about you. The survey is quick, it's easy, and it is really important to us right now.

Starting point is 00:02:42 It takes two minutes to do, and really would be a huge help. Go to one you feed.net slash survey. Again, that's one you feed.net slash survey. Thank you so much. Hi, Joe. Welcome to the show. Hey, thanks so much for having me. I'm excited to talk to you. I really love your book, which is called Psychobabble, viral mental health myths and the truths to set you free.

Starting point is 00:03:06 But before we get into that, we'll start like we always do with the parable. And in the parable, there's a grandparent who's talking with their grandchild. And they say, in life, there are two wolves inside of us that are always at battle. One is a good wolf, which represents things like kindness and bravery and love. And the other is a bad wolf, which represents things like, greed and hatred and fear. And the grandchild stops. They think about it for a second. They look up at their grandparent and they say, well, which one wins? And the grandparent says the one you feed. So I'd like to start off by asking you what that parable means to you in your life and in the work that

Starting point is 00:03:42 you do. To me, the parable is highlighting something that I think is fundamentally true about human beings that I do think we have good and bad in all of us. And I don't think that that's a belief that necessarily everybody buys into. I think it's much more comfortable to think that, you know, everyone is good and that it is, you know, our past or our childhoods or the culture that that brings that out of us. But I think that's a little oversimplified. I think it's a little bit more nuanced than that. From a psychological perspective, we're pretty actually bad in a lot of ways at perceiving our reality in the sense that there's just too much data. Like even in this moment like talking to you like i see you but then i can't actually see the high resolution version of

Starting point is 00:04:29 like your total biology your total history like the context that we're in it's just it's too much data and so what what different psychological scientists have essentially figured out is that you filter it through your assumptions and projections and beliefs it's from about what's in here and if you're feeding that bad wolf right that is how you're going to fill in the gaps as you're trying to make sense of all the data around you and if you're feeding the good wolf that is also going to be the same. And there's lots of studies to just validate that idea around like self-fulfilling prophecies. And if you approach someone with aggression, they're going to be aggressive to you versus if you approach someone with reciprocity. And so that's what I think it means to me. I think it's

Starting point is 00:05:05 not just ancient wisdom, but I think that there's some pretty cool evidence for it. Right. Right. I mean, I think that is such a fundamental reality of life, which is that we are always seeing it from some point of view that is concocted out of all of our experiences up till now. And I almost think you can't turn it off, but you can be aware that it's happening. And you can begin to question it and say, hey, well, what about this or what might it look like? And I think one of the things that you do a really nice job of in this book and in your work is you don't tend to let people get too fixed into one spot. I'll give you an example. So in your book, you've got a myth about how evil isn't really there and that, you know, people, everything people do is a mental health issue.

Starting point is 00:05:58 Like all the bad that happens is a mental health issue. And you're like, I think that's an oversimplification. I think that's missing some things. And sometimes people should be judged based on what they do. And then you have a talk recently I heard about masculinity where you encourage people to look at sort of bro culture and wonder. what happened to those people to make them that way. And on one hand, I could point to that and go, well, that's contradictory, Joe. But I actually don't think it is because what you're saying is you've got to look at things

Starting point is 00:06:31 from different points of view in order to triangulate into the most useful strategy. Absolutely. In dialectical behavioral therapy, there's this idea that one of the most essential psychological skills you can learn is being able to sit in paradox. And so being able to sit, like with on one hand, like make one claim, on the other hand, make the other claim and have it be like okay, you know, within yourself, but also in just like in how you're relating to reality, I think is very important. And it doesn't necessarily have to be with something, you know, super deep or kind of like cultural. Like you mentioned, a very basic example might be, well, when you let yourself

Starting point is 00:07:13 feel your feelings, right, they will go. away they won't have as much power over you like there's something very paradoxical about that because in the moment it feels very very hard yeah but clinical psychology and mental health is just littered with paradoxes like that yeah absolutely so let's start kind of at the top with the book and you say the speed at which talking about mental health has gone from taboo to commonplace is unprecedented and as someone who's been in this space more or less for 11 years now, I couldn't agree more. I mean, the way that we as a culture talk about mental health and the amount of content and material on it and even a decade is staggeringly different, right? It is staggeringly different. And while in some

Starting point is 00:08:03 ways, I think that's a really good thing, I think there are other ways in which it's not such a good thing. So tell me from your perspective, sort of the downside to what has happened with mental health becoming almost a cultural phenomenon in a way. Well, like you said, there's lots of good things about it. I believe in mental health. I believe in the project of it and the vision of it. But I think that in the popularization of it, because it's not just that we've destigmatized it. It's almost become popular. People talk about their therapy journey and their dating apps. People are building whole careers out of it, you know, even like myself included, like I also talk about like mental health in the public space. And so when that happens, there's a few things that are coming up that I do

Starting point is 00:08:47 find to be very significantly concerning. One is this danger of just pathologizing everyday life using these terms and concepts, not just from psychology, but specifically the mental health part of psychology, specifically like clinical psychology science to then explain everyday life and experiences, I think it can lead to a whole bunch of things. I think it can lead to people unnecessarily labeling themselves and others. I think it can lead to certain kinds of social contagion. But I also think that oftentimes it's just not that helpful. One thing I read about in the book, just as a big example, like mindfulness, mindfulness is a wonderful tool. Many people can benefit from it. But there was this really big study done where they brought in basically

Starting point is 00:09:31 like mindfulness through like social emotional learning classes to high schoolers I want to say that it was like adolescents and what they found was there's depression and anxiety scores were worse after why well it's because if you're a teenager and you need to let's say speak in front of your class for the first time and you're really nervous now might not actually be the time to be mindful like you're in puberty your hormones are raging you've never done this before like like you're feeling things so deeply like maybe now is not the time time to do like breathing and just feel your anxiety all the way through. The reason why therapists love mindfulness is because anxiety, depression, a bunch of different mental health concerns are

Starting point is 00:10:11 correlated with emotional suppression. And I see it all the time. Someone's depressed. They learn to feel their feelings. The depression goes away. But for that teenager, what they need to learn to do, it's called adaptive avoidance. They need to actually suppress in a healthy way, get up on stage, realize they can do it, and build some confidence. And we're not in the desire to make everyone mentally healthy, it kind of seems like we're, we're tripping up on things like that. I have so many examples of that. And it doesn't really seem like despite all that we're investing in it and how much we're branding and talking about it, it doesn't feel like we're just all so mentally well. Yeah. Yeah, I agree. I mean, I think that the problem is really that

Starting point is 00:10:50 different people need different things at different times. If we start from that as a truth or an assumption, then you realize that any one intervention aimed at a big group of people is going to help some of them as going to probably do nothing for some of them. And some of them, it may not even be helpful for. And that's the problem with one size fits all advice of any sort. We're not all the same size. And we change size even month to month, year to year. The things that helped me when I was 26 getting over addiction, don't help me now. I need different things. You know, And I think there's just a subtlety to all that that gets lost in TikTok, Instagram, you know, clips about mental health. And I also think it is really interesting.

Starting point is 00:11:39 I've watched it also, like you said, kind of the way in which I see people arguing for their diagnoses and making, like it's an identity in a positive way. And I sort of understand that, right? I was a homeless heroin addict at 25. And for a few years, an identity as a recovering person was really helpful. I needed that because I had to put so much focus in one direction in order to get well at that time. And I had a serious, serious problem. But over time, loosening that identity has been really important. And I kind of am curious to see that journey for some of these people who are very early in the process

Starting point is 00:12:20 because nobody's more evangelical than somebody who's like a year. from being significantly helped, in my opinion. Right. That's about when you're like, holy crap, this actually worked. I feel better. Now everybody needs to do it. Totally. Something that I like to remind people of is the spirit of this book and my content and what

Starting point is 00:12:41 I'm up to in the world is not this, like, finger wagging. Like, this is the incorrect definition, like, of this term or that term. It's kind of like, you think I wasn't the number one offender of Psychobabble when I was, like, in grad school, like, semester one? Like, of course, like, every psych student is. Like, of course they are. But the difference is we keep learning and we're able to get into that nuance and context. And it kind of feels like culture.

Starting point is 00:13:04 It's like we've taken Psych 101. And I'm here with my content in my book. And I'm like, okay, but here's psych 102. Like, here's, like, actually, like, what you, like, need to know, you know. That's a really great analogy. So let's get into it. I don't want to spend all our time sort of criticizing what's out there generally. I want to get into some of the specific.

Starting point is 00:13:23 specifics that you do a lot. But I think it's important that we start with an idea of the way that we use certain words. Depression, anxiety, trauma, ADHD, pick your sort of phrase. You introduce an idea in the book of concept creep. And you talk about it in context of trauma, but I think it applies to all of these terms. So walk me through what concept creep is and how it applies to sort of these vague mental health term. Yeah. So concept creep is a term studied and coined by Dr. Nicholas Haslam. He's based out of Australia. I'm really wonderful researcher. He applies it to so many terms, not just mental health, but stuff like bullying, harm, violence. This is happening in culture right now, like is speech violence, right? Is exclusion, like not getting invited to the birthday party

Starting point is 00:14:16 in middle school? Is that bullying? You know, like 10, 20, 30 years ago? It was. But now there's kind of this question. So these terms are creeping over time. He's noticed that it almost exclusively happens to harm-based terms, it seems. And when it comes to mental health, I think it may happen to other ones, too, but that's the focus of his research. And that seems to be where it happens more by my anecdotal observation as well. When it comes to mental health terms, what him and his team found was that if you look at the words of depression and anxiety, it's not just that over time, are used interchangeably with sadness, apathy, nervousness, you know, anticipation. It's that

Starting point is 00:14:57 these terms have actually started to become what these words mean, like the semantic definition has expanded. And they looked at like millions of data points. The way people can do research now with like language processing models allowed them to really see it over long term. And so what does that mean? It means that, well, I don't feel sad anymore. I'm depressed. It means that I'm not nervous or self-conscious, like, I'm anxious or I have anxiety. And the issue with that, I think, is that everyone gets sad. Everyone can get apathetic and bored. Everyone can feel nervous and self-conscious. I know for myself, I get nervous, like, before I, like, come on a podcast or before I post a video, you know, almost every single time. I do it anyways. And that's what's

Starting point is 00:15:42 given me, like, a lot of my resilience and resolve. But I think that the issue is that people can, You were talking about identity earlier and this stuff. And diagnosis, it's kind of like the doorway. It's not the destination is how I like to think about it. And so it's really important at the beginning. And it's okay to identify with it. An accurate diagnosis, you will be very easily able to identify with it. But the goal of therapy is to help you move through those things.

Starting point is 00:16:06 And the truth is, therapy can't fix sadness. It can't fix you from never being nervous about things that actually matter to you or things that are nerve-wracking. it can fix anxiety and depression like for sure like you know like that is right we know how to do that but but they're but they're different Mr. Monopoly here, Monopoly is back at McDonald's. Register in the McDonald's app, so you're ready to... Get your bag!

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Starting point is 00:17:20 November 2nd. Monopoly is a registered trademark of Hasbro. Copyright McDonald's. I think about this a lot and I talk about it on the show a lot. Listeners will have heard me talk about this about depression as a word. You know, a couple years after I got sober in my 20s, I had clinical depression. It was seriously impacting my ability to function and I had it and I've treated it for a long time and it and it recurs. quite to that severity, but it recurs. But I've been spending a lot of time over the last, I mean, probably four or five years thinking about that term.

Starting point is 00:17:54 And is it accurate to describe what I have? Or I don't even want to say what I have, what I experience. That's a better way to say it. And how much of that might just be temperament, right? I may just have a slightly more melancholy temperament than the average bear. Maybe. I've also started to realize the number of times that tiredness I label as depression. And so it's just this question of really, to your point, concept creep, you know, of where this term begins to encompass a whole lot of things that if I'm not paying really close attention to, I miss. Definitely. Tell me, because you're not a clinician, I am, so I wonder how much of that colors my experience. But in my day-to-day life, if I'm with a friend and they let me know that they're nervous about something like they're nervous to go approach someone at a party that they think is attractive or nervous to to leave their job and to you know go chase their dream like whatever it is

Starting point is 00:18:54 when someone lets me know how they're feeling like that like i'm nervous like i don't know if like if i can do it i feel pulled in to want to like comfort them and encourage them as a friend but when if they describe it as like it's like well i have anxiety about that there's something like that kind of like almost like deters me even as a licensed clinician because then it's kind of it's like oh well this is like it's it elevates it to this level that is like beyond that is just beyond the basic and encouragement and so I think it's I don't know I just it's just coming up for me right now but I think that that's something that's kind of a bummer about all the psychobabble as well you know because when you let people how you're feeling you're telling them that you trust them and you

Starting point is 00:19:32 invite them in but when you're like using like an authoritative like psychological jargon you know there's something that feels just more definitive about it. And maybe that's why people use it. But my sense is that people use it because they want people to take their feelings seriously. But maybe it paradoxically has the opposite effect. Interesting. Yeah. That is really interesting. Let's talk about diagnosis for a second because you've got several myths around diagnosis. You know, one is receiving a diagnosis is terrible. But I'd really like to talk more about this one, which is mental health diagnoses are just made up. I think about this one a lot, and I've talked to a lot of different people with a lot of different opinions on this. Walk us through your thinking on this.

Starting point is 00:20:15 So what you will sometimes hear on social media and in culture is, you know, a bunch of psychiatrists at the American Psychiatric Association that comes out with the DSM, the diagnostic and statistical manual of mental disorders, basically kind of sat at a room and they just kind of were like, okay, well, if you're experiencing like nine of these 14 criteria, then that means you have depression or that means you have borderline personality disorder if it's within these different parameters, like how long you've been experiencing at the severity of the symptoms and so on and so forth. And that leads people to then say, it's like, well, diagnoses are just like made up. Like they're not, they're not like reflecting anything like real. Now one argument for this

Starting point is 00:20:57 myth is that you learn about these different diagnoses and then when these different diagnoses and the treatment of them are studied, they are studied on people that fit this fixed criteria. But then as a therapist, people walk into your office and they don't necessarily fit these neat little boxes. They might have something resembling more than one

Starting point is 00:21:16 or like whatever it is. And so I think about that and I think it's a pretty good argument. But then I realize that the point of this field is not that when we talk about categories, we're not talking about them like we're chemists or like a category of a triangle

Starting point is 00:21:35 has three sides and three angles and the equal 180 degrees and it's not that it's not a triangle but someone that has major depression they can look like you know five different combinations or more of depression and so I like to think of it

Starting point is 00:21:48 as well diagnoses are helpful and they're not just made up in the sense that if I say the color blue this is a different kind of category there's also different kinds of blue it's still helpful as a category it's helpful for me to talk about if I need to go research it, if I need to go read books about it, if I have to talk to a colleague

Starting point is 00:22:05 about it. What we give up, I think, when we shirk the idea of diagnosis altogether, or like these are just socially constructed or whatever people might say, is we're basically saying, okay, well, then all of the evidence, all the scientific evidence, all the clinical wisdom that has gone into studying and treating these things quite successfully a lot of the time, we're just going to kind of throw it out the window. And I think that's completely unfair. Therapy is like medicine in the sense that it's a craft. It takes evidence and science and knowledge, but then it takes practice applying it. And it seems like in that move when you like leave the ivory tower and then go into helping that person in front of you, people like to say like, well, this is just made up

Starting point is 00:22:43 anyways. And my argument is, no, it's not. This is something like this is seen across cultures, across gender, across time. The last thing I'll say, and I'd love to know like what you're thinking about all of this is that one way to understand what mental illness is, is under-sucing. efficient, stressful circumstances, your nervous system will cope by kind of manifesting what we call a mental disorder. And some people, they get depressed. Some people get anxious. Some people, their OCD comes out. Some people, they start eating. Kind of funny, it becomes disordered eating, maybe eating disorder. And so learning how your nervous system works like that is a great way to keep your mental health in check. Does that make any of this made up? I would argue, no. I actually

Starting point is 00:23:25 think that this has been studied. These concepts have been narrowed. down for a reason because there are patterns that we see just in people. Yeah, I think an important thing that you say in the book that jumped out at me was that diagnoses are there to inform treatment. That's the point. Nothing else, right? And I think that is a useful way to think of it. I tend to be, I think like you, just from what I've read and I'm making an assumption about you, I tend to be a middle of the road kind of guy, right? Like, I avoid extremists on both sides, right? Somebody who says that the DSM is completely pointless, I think, is missing the boat. Somebody who says that it's got everything right is also probably

Starting point is 00:24:02 missing the boat. I think that what is hard and the criticism that I actually take seriously and I think is worth thinking about is given the nature of the fact that you described like five depressed people could show up with looking kind of differently, with different symptom clusters, and that that same person is more likely to get multiple diagnoses. The question that I think that it's right or important is have we missed something in our categorization do we have the wrong categories here you know because we sort of slotted things into these boxes which is helpful but it's sort of like the four humors in medicine i don't remember what they were like bile oh right yeah right and so you had a category of things but but now we know like okay those categorizations were wrong and

Starting point is 00:24:50 i think that's the meaningful critique of the dsm that i think is worth looking at for people Or this is what people smarter than me, like you that are in the field, are, you know, thinking about is, is there something underlying here that we're missing? So I had a guy on the show. I don't know if you come across him. His name's Christopher Palmer. And he's got a theory of like the brain energy theory of mental disorders. And he basically, you know, talks a lot about this sort of heterogeneity and morbidity of these things that, you know, one person has lots of different symptoms or different from each other. and you get multiple diagnosis, pointing to something that is lower level, underlying it.

Starting point is 00:25:31 Now, he eventually takes it to metabolism, which to me is sort of a way of saying, like, well, it's everything, right? Metabolism drives everything. Of course, it's all metabolism related on some level in the same way that it's all atom-related at some level. I don't know that that's particularly helpful, right? And so I think as we abstract up into the diagnoses we have, I do think they can be enormously helpful. I do think it was really helpful for me to recognize depression as a condition that I had. You make the point that, you know, it's useful to have a category for blue, even though there's hundreds of shades of blue.

Starting point is 00:26:09 But if I walk into a paint store, it's helpful for me to be able to say, I could use some blue. And somebody goes, oh, blue's over there. And I think the same thing is true for, say, depression. We may not know exactly what I need, but we go. you're in that section. Go over there. There's where the depression stuff is. There may be different opinions on how to treat it and what to do, but you're in the right section. And I think your analogy is actually one that I found really useful. So here's the slight pushback I would have on what you're saying. I'm not sure that it's, is that the categories are wrong. Because like I said,

Starting point is 00:26:46 if you compare it to something like paint colors, they're useful enough. And for those listening you were interested, this is called family resemblance categories versus something like a shape. It's a classical category. There's not as much like wiggle room. I think that the issue is not so much that the categories are wrong, but what's complex is that there's what's called multiple possible etiologies or origins of the quote-unquote illness. So for an example, someone might come in presenting with something on the bipolar spectrum. Chris Palmer, and I am moderately familiar with his work, and I think it's exciting work.

Starting point is 00:27:23 I think it's very innovative and I'm excited to see, you know, what comes out is very true and useful and what is maybe a little bit more anecdotal for him. But I think that, you know, if changing someone's diet can help the energy swings of someone with bipolar, like, I think that's awesome. And I know that sometimes people have come in with a preexisting bipolar diagnosis. I do further assessment. I refer them out to a testing psychologist I trust. And it comes back. And it's like, you know what? I think this person has had PTSD for years.

Starting point is 00:27:56 They are super, super dysregulated. And we actually think this is a misdiagnosis. We actually think that they need like, you know, this medication, not this medication. This is the kind of treatment. We need to really calm their nervous system down. It's been on fire and burning out and catching fire and burning out. And it's looked like bipolar, but it's not. I have been diagnosed with ADHD.

Starting point is 00:28:17 I sometimes struggle with, you know, a busy mind and impulsivity. And, you know, who also struggles with that are people who are on the borderline spectrum and people who are bipolar. But the way I treat my ADHD super different. And that's why, even though they share symptoms, but they're still different categories and for good reason. I like that idea of different etiologies because I think of addiction often. You know, I was an addict.

Starting point is 00:28:45 I got into recovery at 25. I've been in that world 30 years now, amazingly. So I've thought a lot about this. And, you know, there's this idea of alcoholism as a disease, which I think is interesting. I don't think it's quite correct. But I do think to think of addiction as a, I like the word syndrome for lack of a better word. And I know now we say, you know, people are on a scale of addiction, a spectrum of addiction, not, you know, you've got like there's a hard line between somebody and the other. But I do think that what makes addiction interesting.

Starting point is 00:29:19 is the way people get to it because there's a lot of different things that drive somebody towards being an addict, right? And so it's why something like a 12-step program is a miracle for a lot of people like it was for me and it doesn't work at all for other people. And it's because, like you said, the underlying causes can be very different. I think the thing that's worrisome and your book sort of even reinforced it for me, a little. little bit is the fear of the wrong diagnosis because you could take a certain person that's got sort of a confusing thing and trot them out to three different clinicians and you might get three different diagnoses that's concerning because those diagnoses then very often are driving

Starting point is 00:30:08 a medical treatment right of some sort which is then starting to change the brain in different ways. So I love the fact that you talk about you, for difficult cases, you send it out to someone who's even more specialized in this. Tell us about that. Yeah. So if diagnosis informs a treatment plan, then the proof in my thinking is that the proof that the diagnosis is accurate is that the treatment plan works. Now, the caveat is that there are often more than one ways to treat a given diagnosis. And so you could reconceptualize like your treatment modality. And, Kind of to your point, like if you're treating addiction or substance misuse, it's like, well, I was treating the underneath that I thought was this, but maybe it's this. Yeah.

Starting point is 00:30:53 You know, and so the diagnosis is still accurate, but it's like how we're getting at it might take, like, you know, a couple of tries. I'm thinking of, and I write about this in the book, I've had more than one case in which someone comes in and they're picking at their skin or they're pulling their hair. It's traditionally seen in OCD, trichotelomania or excoriation disorder. And the way you traditionally treat someone with OCD, and it's pretty evidence-based, is it's through a lot of, like, exposure therapy and helping them kind of rewire those patterns in the brain. But I've had cases where people come in, either looking for exposure therapy or that's what we try, and then it just doesn't work. And then it's like, okay, like, why? I found that, well, sometimes the picking behavior is from, like, an OCD-related diagnosis where there's these, like, obsessive thoughts and then the compulsive. so behaviors are keeping those thoughts at bay. But sometimes people are picking because they are

Starting point is 00:31:48 trying to emotionally self-soothe. There's these emotions that are just like very big and maybe that's because it's an anxiety disorder or maybe they're just, they're just really sensitive. Like it's not even a diagnosis, but they just feel very, very deeply and you have to help them with that. It's completely different treatment. Check in for a moment. Is your jaw tight, breath shallow? Are your shoulders creeping up? Those little signals are invitations to slow down and listen. Every Wednesday I send weekly bites of wisdom, a short email that turns the big ideas we explore here in each show, things like mental health, anxiety, relationships, purpose, into bite-sized

Starting point is 00:32:57 practices you can use the same day. It's free. It takes about a minute to read, and thousands already swear by it. If you'd like extra fuel for the weekend, you also get a weekend podcast playlist. join us at one you feed dot net slash newsletter that's one you feed dot net slash newsletter and start receiving your next bite of wisdom all right back to the show it's funny to be you know talking to you and so many wonderful people like about diagnosis and why it's important and what its limitations are because in my practice i just don't actually diagnose that often because well one i don't accept insurance

Starting point is 00:33:34 and so that's important for people to know right you you are if you're going through insurance you're getting diagnosed with something, it's probably not anything bad. They're actually diagnoses that are for, you know, very like mild cases of like, quote unquote, nothing, but they just have to put something on your billing. You know, like an adjustment disorder. Like, if you read the criteria, it's like, oh, experiencing heightened stress or anxiety due to a life transition. It's like, well, that's like everybody at any given point in life, you know, but... We need an ICD code for a mild case of nothing. That's beautiful. Totally. Oh my God. Yeah, clip it. I bring that up to say that it's like, I will if it's, you know, clinically appropriate and ethical. But a lot of times for me, like my focus in my practice is like, but how do I help you? And so like, yes, maybe the OCD treatment doesn't work. So I'm going to shift to this. And that's where you start to see the different diagnoses. And that's, I think, one of the limitations of the diagnosis, right? I think the treatment plan that follows is way more important than the label. And one of the things I tell patients in my practice,

Starting point is 00:34:37 is I say, listen, I want you to think of your diagnoses a little bit kind of like an astrology constellation. And I know it's funny because I'm like, I'm like speaking out, you know, for like, you know, like the evidence matters like in psychology. We have to like keep these terms. And then astrology is like, you know, like so different. But, you know, different astrological signs will share the same star, right? So it's like someone with ADHD is impulsive. But so is someone with borderline personality disorder. So is someone with psychopathy. So is someone with bipolar. So is someone with who is like a conduct disorder like but they all share this one star and so what i tell them is like look i'm more concerned about the details i'm more concerned about which stars fit you than i am

Starting point is 00:35:17 the constellation that it looks most like i'll tell you like you know what the constellation it looks most like is but just like you would never say that you know an aquarius describes everything about who you are we think we have to approach diagnoses with a similar lens one of my favorite chapters in the book is that personality frameworks are reductive and unhelpful. My argument is actually like, but don't criticize these frameworks like diagnosis or like the anneagram or Myers-Briggs or astrology even for being inaccurate. It's not what they're for. It's a little bit like criticizing a restaurant's menu for not being the cookbook that the chef uses. It's to communicate something effectively and quickly and not for necessarily scientific accuracy in the same way.

Starting point is 00:36:02 Yeah, I loved that chapter, too, because I used to be a personality test enthusiast. And now I am a personality test avoider. I'm not saying that everybody should do that. I'm saying, for me, I don't want it, right? Because I don't want to think of myself through a certain category, right? You talk in that chapter about something really interesting called a terministic screen. Tell us what that is. So Dave Logan at the University of Southern California, I believe coined this term.

Starting point is 00:36:36 It was his papers that I first encountered it. And the idea is that words create your world. Like I was saying at the beginning of our conversation, it's really difficult for us to take in all the data at high resolution from our surroundings from like what we see and what we know and what we're hearing and smelly. It would overwhelm our nervous system. So we have to filter it. And one of the ways we filter it or there's something called terministic screens.

Starting point is 00:37:00 So a terministic screen is when you learn enough of a jargon about something, there becomes this aha moment where something clicks and now you see the world in a completely different way through a lens, through a terministic screen that unless someone else has learned all those words and distinctions and jargon, they can't see it. And so what Dave Logan writes about is he, he's at the business school, I believe. So he writes a lot about leadership and how part of building a really effective company culture is making sure you all have the same vocabulary. and language. But I think when it comes to different subjects, like me as a psychotherapist, I have words for human emotion and human behavior and distinctions

Starting point is 00:37:39 that people who haven't been trained as a clinician, they just don't have. And so if I'm out with a friend of mine who's a therapist and something like happens, like we might give each other a little look. It's like, did you notice that? And it's not anything good or bad, right or wrong. It's just we're seeing something

Starting point is 00:37:55 that other people aren't going to. Just like, you know, I have friends. I live in New York. So I have friends who work like in fashion and beauty and we're at brunch and they're like, oh my gosh. And then they're like pointing to someone and they're all immediately seeing something special about the person's outfit or hair or makeup. And I'm just like, I don't know.

Starting point is 00:38:13 I mean, they look good. Like that's as deep as I'm getting with it. Exactly. You know, so that that's how it works. It can be for any subject. Right. And I think that idea of terministic screens is why I don't like personality tests for me anymore. I don't want to see any aspect of me through a terministic screen.

Starting point is 00:38:33 I sometimes get frustrated by personality tests. Like I have people in my life who are very intigram focused, right? And I've taken the enneagram. I think I kind of know what I am, all that. But they're always describing what I do through the lens of being a nine enneagram, which is a useful lens, but it's not the only lens, right? And I think maybe maybe people like me who like, I guess here to here to validate a nine, right? A nine has a little bit of everything in it.

Starting point is 00:39:05 True. I always feel like when I take any personality test, I fall right down the middle. I get driven crazy by questions like, do you feel energized and stimulated by being around people and social activities? And I'm like, well, who are the people? What's the activity? After work, first thing in the morning. Like, you know, same thing. Do you like to work in groups or collaborate with others?

Starting point is 00:39:25 What are we working on? Who are the other people? I feel like for me, context is so important in the way I react to anything that when I feel like, you know, these questions sort of today I feel boxed in by them. And again, I'm not saying that's right or anybody else should feel that way. It's the same reason I won't go get like a psychic reading, even though I don't really believe in it. I don't want it in my head. Right. I have enough stories in my head about the way, why things are the way they are.

Starting point is 00:39:54 Totally. I'm working on getting rid of them. I don't need to introduce more, you know. So again, that's just me where I'm at today. I've had phases like that where I'm like not really like thinking in terms of the personality frameworks or whatever it is. But my, the thing I would offer you is that maybe the solution isn't to turn away from them. It's just to add more screens and stack on top of each other.

Starting point is 00:40:17 And then you get to decide like what are those like, what are those like glasses that like I guess like doctors or like mad scientists used to wear where it's like you, there's like multiple. pull lenses that you could like flip down you know optometrists yeah they yeah oh yeah like an optometrous they do that yeah exactly right yeah exactly so it's like is it is it one or is it two is it three is it four um i kind of like to think of it like that because there are moments where like intuitively i'm like well the anagram could actually help me right now understand maybe what's happening here having some empathy for this person that's different from me but then there's other times i'm like actually i don't want to like you think about psychology at all like i want to think about like

Starting point is 00:40:53 I want to look at it through this subject or through this lens. Yeah, exactly. I think this kind of goes back to where we started the conversation to a certain degree, which is, or maybe we even talked about this in the pre-show, before we even hit record, but this ability to know that you're always looking through some lens and to be willing to say, well, let me try a different lens. And, okay, what if I look at it, this lens, right? I just think all that's good.

Starting point is 00:41:18 So let's take people pleasing as an example. You've got a chapter in there about people pleasing. So I'll let you set it up and then maybe we can we can kind of go into it. Right. So this term of people pleasing is one that's certainly popular on social media and has trickled its way into culture where it has seemed to become like an identity that people will will claim. And it's like, well, you know, I'm a people pleaser because of this or because of this.

Starting point is 00:41:44 And for me, my pushback is not so much that people pleasing isn't real, but it's it's so broad. It's such an umbrella term that I find it to be. inherently unuseful. I'm much more interested in the because. Yeah. So if you say I'm a people pleaser because I'm afraid of conflict, my thinking is skip the people pleasing part. Just say it, say it with me, like, I'm afraid of conflict. How does that hit you? What does that mean for you? You know, exactly. Well, if you come in to see me, and I think I would argue if you go to see any therapist that's worth their salt, that's going to be their first curiosity.

Starting point is 00:42:19 Does it mean you're a martyr? Does it mean that you're a sort of? Does it mean that you're a so agreeable just in your personality, speaking to personality frameworks, that you're so agreeable that sometimes you don't even know what you want because you're so cooperative and you're so go with the flow and you're in you so like to quote unquote please people. Is there anything even necessarily wrong with that? I think that's far more useful data than just the I'm the people pleaser. There's the identity piece which we've already covered. It's like don't box yourself in to the identity. But there's also, you know, if you, the promise of therapy, I believe is not identity. It's not just understanding yourself. It's learning the tools to transform

Starting point is 00:42:56 yourself or at the very least correct for your downsides. So if it's just that you have a very agreeable personality, well, do you know how to negotiate? Do you know how to navigate conflict with someone who is very disagreeable? Because if you don't, I got news for you. The disagreeable people are going to walk and run right all over you because they are not depleted by conflict. They are energized by it and they like it. And, you know, that's, That's how they're wired. I have a whole previous marriage that sort of follows exactly what you described, a extraordinarily agreeable person like me and conflict avoidant with somebody who has very strong

Starting point is 00:43:33 opinions about everything and is energized by contract. And I'm not saying one's better than the other. I'm just saying you put the two together. It can be problematic. It was in our case. But I like that people pleasing peace because, again, we've talked about this, you know, one of the risks of mental health culture is that we pathologize normal behavior. I also feel like we, you know, people swing too, we swing too far.

Starting point is 00:44:00 I am a people pleaser by the general definition of it. But I don't always think that's bad. And you make that case in your book. Like compromising in order to make other people happy is not a bad thing. Sacrificing in the spirit of the relationship is not necessarily bad. For me, what I have to spend a lot of time looking at, and it's murky, is when is that my general agreeableness? I think I probably am very high on agreeableness as a personality trait. Where is that my belief in kindness and compassion and that I do best when I'm caring about other

Starting point is 00:44:36 people? Where does that cross into what we might say more earlier mental health issues that came from fear of conflict, you know, avoidance, all that? And it's a murky sort of soup down there to sort out even today i was going through that with something in my life i was like okay well what's behind this you know what's what's driving this is it just kindness there's a there's a concept in buddhism that i love about near and far enemies and i think it's interesting i don't if you're familiar with it i don't think i am so it says that take a trait like compassion it has a near and a far enemy the far enemy of compassion would be like meanness or hatred or whatever you know whatever term we want to throw up the near enemy of compassion might be something like indifference

Starting point is 00:45:22 right it looks similar you know or indifference would be a better near enemy for a trait like equanimity is it equanimity or is it indifference they look similar and i feel like in my life i've had to spend a lot more time as i've gone from grosser forms of suffering like addiction or or clinical depression to just more day-to-day stuff there's a lot of that getting in there and to discern that how do you help clients think through like the kind of thing I'm describing so is it is a potential near enemy of compassion maybe something like enabling or coddling yeah yeah or pathological kindness okay right yeah yeah well listen without even knowing the specifics of what you're going through today when it comes through when it comes to stuff like this I think this is actually very cool

Starting point is 00:46:12 it's been on my mind a lot so in every chapter of the DSM every single single mental health concern there's always a specification and the specification is and it's causing emotional psychological or social and relational dysfunction right and i've been thinking a lot about that social dysfunction piece and i've been thinking a lot about what it means because you hear therapists talk about well that's adaptive or that's maladaptive and what we mean by adaptor or maladaptive is is it in harmony with your social relationships that's sustainable you know in the long term or is it maladaptive? Is it causing unnecessary conflict?

Starting point is 00:46:50 And so I think about something like people pleasing or having a very compassionate person. I'm a very compassionate person by temperament. And everything has like the light side and the dark side. So I believe it's funder's first law of personality is there is no weakness without a strength and vice versa. When I'm talking to patience about it, I sometimes bring up Pokemon.

Starting point is 00:47:12 You know, the water Pokemon is great, but it has weaknesses. You know? Whose law is that? F-U-N-D-E-R. He's a personality researcher. Okay. I'm not familiar, but boy, do I love that statement, I can agree more.

Starting point is 00:47:28 It's similar to Aristotle's idea of virtue. Like, any quality has, you know, you take it too far, it's problematic, right? Courage, you know, if you have too much of it, you become rash and foolish. If you don't have enough of it, you become a coward. Or another way of saying it is like, you need to use the right tool for the right. job. Yeah, totally. So when it comes to something like someone who's people pleasing, maybe because they're very compassionate, you have to ask yourself, well, is this in this moment, in this contextual moment, and the answer can change as a relationship progresses or even as a

Starting point is 00:48:00 conversation progresses, maybe the thing to do is to be compassionate, be allowing to give space to have some sort of allowance for where someone is. But there comes a point, right, where that spills over into the enabling, into the coddling, into the being permissive. for things that you don't actually agree with or aren't good for them. So this one trait all of a sudden becomes something very, very dark. That's the shift, right? Someone has PTSD. They're hypervigilant.

Starting point is 00:48:26 They're scanning for danger everywhere. Well, they didn't actually fit the criteria for PTSD when they were in the war because there was danger everywhere. They didn't want to get shot and die. It was adaptive behavior then. It was adaptive, exactly, exactly. And so now they're back. They're a civilian again.

Starting point is 00:48:43 And they think that every loud noise is a gun or a bomb. It's not adaptive anymore. Very interesting. There was a study done. I read this book. If you haven't read it, I think you'd love it. It's called Tribe by Sebastian Younger or Junger. I'm familiar with it, but I've not read it.

Starting point is 00:48:59 So he talks about how it's actually in Israel, there's some really, really low rates of PTSD. Despite that country having military conflicts with people, you know, pretty constantly throughout the ages. Why? Well, it's because if you have a touch of hypervigilance, but you live in Israel and there's always rockets going off and stuff, it's adaptive, you know, versus you come and live in a different country or you move from like the, you know, you move to like a small town in like middle America, right? That's not going to be adaptive anymore. So a lot of what we talk about is mental health concerns. I think there's there's a relational piece that I think cannot be overstated. I don't think people think about it enough. Yep. All right. Let's move to trauma. Besides mindfulness, if there's been one word that has exploded in the culture over the last decade and particularly in mental health, whether it be true mental health like what you do or, you know, talking about it like me sort of with experience and trying to ask people who know more than I, trauma is everywhere. I mean, I have a good view on this because I get submissions for all the books that are written in the world, right? All the publishers know us. this point. So we're on that list. And I could tell you the number of books that have trauma in them over the last three or four years is 10x what it was eight years ago. So talk to me

Starting point is 00:50:21 about the overuse of trauma and maybe how we define that word. So I have a very bold and sincere belief that in the coming decades, we will look back on this moment as the mental health community and we're going to cringe a little bit at how often we use this word because it's to be clear it's not just the mental health influencers on social media it's it's it's clinicians and other researchers that i a lot of people agree with me a lot of people don't with what i'm about to say this idea that everything that bad that happens to us is a trauma right or we all have trauma symptoms or develop trauma responses from things in our past i think it's a very dangerous story to tell and i think it's inaccurate

Starting point is 00:51:07 it's inaccurate because we know two people can get in the same car accident and one will walk away a little shaken up but fine and the other one will develop full blown PTSD. You know, why? There's all sorts of reasons why there's temperamental, different temperamental differences like in personality that can predict getting PTSD or developing trauma symptoms. There's also like if you had a lot of tragic events that resulted in trauma responses happened before, do they stack on to each other? All sorts of. of things can predict why or why not someone might develop PTSD, but I'm much, much more interested in the person that doesn't develop PTSD. George Bonano, I believe is how you pronounce his last name, is a scientist and researcher at Columbia. He studied first responders after 9-11, and he found that trauma was actually the exception. It wasn't the norm. Resilience was the norm. If you give people a window to have their emotional normal responses, some of which can mimic what we might classify as trauma responses, but for most people, they fade very quickly without intervention, without treatment, because it's normal, right?

Starting point is 00:52:16 Like, if you witness a disaster or something scary, like, you'll think about it more. Is that having flashbacks and being unable to focus, right? Or is that actually the normal response? It's very confusing because as trauma research progressed, there was this idea introduced of like little T traumas. And I want to be very clear for anyone listening or watching, I believe. in little T traumas, I believe that something more minor can happen to you and it can affect your nervous system in a way that you develop a full-blown trauma response. But that doesn't mean

Starting point is 00:52:46 that everybody has them. And it certainly doesn't mean that every response you have to hardship or a tragic event is going to result in something like trauma. I'm very fond of what Dr. Alan Francis says he wrote this book, Saving Normal, a bit's about the pathologizing of everyday life. he says most things that you go through in life will get resolved with the healing powers of time, you know, and support from your loved ones. I'm paraphrasing, but it's something like that. He goes, a mental disorder will not get better with time. It will get worse. And the longer you delay treatment, the harder the treatment is going to be. I'm thinking of some of people in my practice who have come in with PTSD. And by the time they come to see me, they have a gorophobia. They're not leaving their house. Now, in their nervous defense never leaving the house is a great way to make sure the thing that happened to them never happened again but that's not adaptive right and so yeah i'm curious to know how how you see all of this for your perspective the last thing i'll say is you know i in the book i write about losing my dad when i was 11 and i certainly developed trauma responses from that and i think it's completely

Starting point is 00:53:54 distinct from grief i think that grief is something that will be with me all my life and i think grief i think grief touches all of us but i think that's so different from this i idea that I'm traumatized. I have this wound and I have this wound that cannot be healed without some sort of clinical attention. Yeah. I in general think that the word, and you say this in your book, a couple different places, which I agree with, when a word is used to describe everything that ultimately ends up describing nothing. If everybody has trauma, what are you saying? Everybody's a human being? Well, I knew that, right? Like, that isn't exactly helpful. And so I do think it's become an overused term. I have some questions for you, though, that I'd like to go a little deeper

Starting point is 00:54:36 on, because my thinking is always sort of in flux on this. Let's just take, let's just take me for an example. Sure. I was a homeless heroin addict at 25. I had clinical depression coming out of that. I was a kleptomaniac at age 10. Like, I was never really doing well. So I developed some very maladaptive strategies, we might say, to coping with things going on inside of me. And I don't think I fully understand the difference between like a trauma response and just a normal maladaptive response. Because I don't think I could point to in my childhood. Now I've had therapists tell me there's something you don't remember, which that's a whole other subject I don't want to even go into. But I can look at my slightly older life. I can look at my parents. I can see the way they kind of are. I can see the way I am. I can see

Starting point is 00:55:21 why as a young child, like, okay, that was not a good environment for me. But I don't know if I'd call it traumatic. I don't know what to say about it. Well, I think the reason why you're confused is because I think the field is confused. And I think they're confused because this is a super difficult thing to measure scientifically. And the reason it's difficult if not impossible to decide scientifically is because I think we've left, you know, clinical research and we now have a foot in philosophy or theology or spirituality. 100. Yes. You know, and so I think for me, this idea that everyone has trauma, it's a pretty tragic view. of human nature and not in like the small c conservative sense it's it seems to be like it's like

Starting point is 00:56:02 it's it's almost worse than that because they're saying not only do the bad things that happen to you cause trauma but you need like the attention of a professional that is trained that is trauma informed and and to me that that's that's giving like capitalism like that's giving like mental health industrial complex but that's a whole other conversation i think for me the way i differentiate it is a trauma response is one in which your nervous system overcorrects, over being the key part of that, over corrects so that you do not have to experience what happened to you again. So I can give you a personal example that I've been open about. I lose my dad unexpectedly at age 11. Throughout high school and even into college, I became aware

Starting point is 00:56:50 of a pattern where I was just like distant with with men in my life. I always thought it was because I was gay and like gay dude stereotypically will like have lots of friends with be lots of, have lots of girlfriends and and stuff. But over time, what I realized is my nervous system was saying, well, oh, well, don't get too close to these guys because you might actually end up really like liking the friendship and like valuing it.

Starting point is 00:57:13 And like what happens? What happens if they go away unexpectedly? Like you don't want to go through that again like you did. And in my nervous system's defense, fair enough. You know what I mean? Right. But it wasn't adaptive. You know, I wasn't letting people get close to me.

Starting point is 00:57:26 Like, I wasn't fully putting myself out there. And for people listening, take sexuality out for a second. I'm just talking about like platonic friendship. Yeah. You know, because this is really where it was showing up. And so I think that that is, I think that is properly classified as a trauma response. I was overcorrecting, right? And I had all these sorts of rationalizations or beliefs in my day-to-day life about why I was conducting myself, like the way that I did.

Starting point is 00:57:47 But like, ultimately, not adaptive. not what I needed for me. I think that that is the trauma, right? You can point to the behavior, you could even point to the underlying beliefs. I think if you want to look at like the grief perspective, well, how might his death, like, affect me over the long term because this was a meaningful event that happened in my past?

Starting point is 00:58:07 Well, it's probably going to mean that relationships of all kind, male relationships especially, are very important to me, right? Maybe even to a degree. Totally. maybe even to a degree that other people aren't necessarily putting the same kind of like psychological or emotional like capital or energy into them. Is that maladaptive? I mean, it is if I'm not aware of it, right? But I don't think the solution is for me to be like, well, no, I can't feel this way or I can't conduct this way because this is part of my anatomy. It's not necessarily causing problems, you know?

Starting point is 00:58:43 Yeah. I agree with so much of what you're saying. I think I've been informed by Buddhism to a large degree. And Buddhism, I mean, a core concept is that you are the result of a whole bunch of causes and conditions. Everyone is. We all are. That's what's happening. Right. You are conditioned by what happens to you, I believe, to a large degree. But to label all of that, I think, as trauma can be challenging. It's a term for me that I've just, I don't know what to do with. And I, And I appreciate your sensitivity on it because you're actually willing to call it into question, which you probably get all sorts of grief for. A little bit.

Starting point is 00:59:25 But I do think it's a question that's worth asking, right? Because it's a real thing. But if we use it in ways that aren't helpful, then it lessens its ability. I want to finish with what you just said there because I want to get back to this underlying idea that you bring up again and again, which is usefulness. Talk to me about usefulness as a way of approaching all of this. Yeah, absolutely.

Starting point is 00:59:53 I'm a super practical guy, you know? So if it comes to the DSM in diagnosis, I'm kind of like, well, how can I use this for the benefit of my patient or whoever is in my care or for myself? When it comes to this term, it's like, well, where is it useful? Where is it not?

Starting point is 01:00:09 Sometimes people are surprised to hear, you know, I'm very pro-coach, I'm pro-spirituality. Not that there aren't problems with coaching or certain spiritual circles can obviously generate a good amount of pathology. But sometimes the spiritual phrasing of something is just super practical and useful and people just like get it. You know what I mean? And so for me, as a practitioner and as a person, I think I'm always really curious on how can we use this tool? If you have a toolbox, you know, the hammer and the saw are very different.

Starting point is 01:00:40 But they both have pretty valuable applications. And, you know, if you can do something about it, then I say do it. If you could use the tool. My belief is that the more tools you have, the better. There is this wonderful study done on emotional granularity, basically, the more words you have for your feelings, the more resilient you're going to be. There's a related study that found that people with PTSD will often use limited words to describe their negative emotional experiences.

Starting point is 01:01:13 And so part of treatment and part of instilling resilience is like let's give ourselves more words and more tools. And I think that's the issue with psychobabble. The issue is, well, everything is trauma and everyone bad is a narcissist, you know, and everyone else is a people pleaser, right? We're really boiling down our world where we only have like three or four constructs or three or four tools. And that's not going to be helpful.

Starting point is 01:01:33 It's not going to be useful in the long run. Before you check out, pick one insight from today and ask how, will I practice this before bedtime? Need help turning ideas into action? My free weekly bites of wisdom email lands every Wednesday with simple practices, reflection, and links to former guests who can guide you, even on the tough stuff like anxiety, purpose, and habit change. Feed your good wolf at one you feed.net slash newsletter. Again, one you feed.net slash newsletter. You and I are going to continue in the post-show conversation because I could talk to you for about another six hours. But I want to talk about this idea of expressing your feelings is valid and analyzing

Starting point is 01:02:19 your thoughts is always good for you. So in the post-show conversation, we're going to dive into that. Listeners, if you'd like access to that, as well as ad-free episodes, a special episode I record each week especially for you. And most importantly, if you would like to support what we're doing here. If you believe in what we're doing, we could use your support, and you can go to one you feed.net slash join. Joe, thanks so much for coming on the show. I've really enjoyed it. Thank you for having me. Thank you so much for listening to the show. If you found this conversation helpful, inspiring, or thought-provoking, I'd love for you to share it with a friend. Sharing from one person to another is the lifeblood of what we do. We don't have a big budget,

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The One You Feed - Beyond the Buzzwords: How to Talk About Mental Health Without Losing Its Meaning with Joe Nucci

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