The psychiatrist and tv writer (Chicago Med) shares about his childhood, why some of his peers overprescribe medications, the importance of talk therapy, some info on hypnosis and Paul opens up about his health fears especially around meds and long-term health.

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http://paulrpurimd.com

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Episode Transcript:



Welcome to Episode 420, with my guest, Dr. Paul Puri. He's a, uh, psychiatrist. Get into some great stuff in this interview today. I'm really, uh, happy to share it with you guys. And I didn’t realize that I had so much anxiety about my health and especially my long-term health, uh, in regards to my meds and bloo0d pressure and stuff like that until I (laughs) started talking to him. So, there's a couple of places in it where it becomes like a free therapy, uh, session for me, with a, uh, with a psychiatrist. But, um, yeah, we've had some interesting, uh, in the surveys, post-interview, we've got some interesting, uh, babysitter surveys. And, um, yeah. I'm excited to share this, uh, this episode with you guys. God I—Yesterday, I had a … depression that I hadn’t felt in a long time. And I think it was sugar related. But I was so exhausted, and I got into that thing where then I was starting to … I don’t know if shame myself would be, uh, too strong of a word. But just feel hopeless about my productivity. And, um, I decided to not have any sugar last night, and I'm feeling markedly better, uh, today. Something I've been really, uh, getting … I heard somebody say one time, uh, about depression: one of the ways that they know it's depression is if they lose interest in things that normally bring them pleasure, like their hobbies, etcetera. And that was kind of the case for me yesterday. But, uh, today, I'm kind of back. Lately, I've been obsessed with music theory, in particular the circle of fifths. I've been playing a lot of guitar and recording stuff. And, I'm always fascinated by why … one chord sounds good with another chord. And, maybe I'll listen to a song that I really like. And there will be a particular moment in a song where the emotion is just so great. It just could be like one note that the bass is, is, playing. And, I wanna try to unlock what those things are. And I know a little bit about it, but the, the circle of fifths is, it's, it's (laughs) almost … it, it feels like what pi is to mathematics. And, um, it's just kinda hard to wrap my head around, um, how it all interrelates with major keys and minor keys, and how they relate to each other. And, oh I'm just super excited. So I guess that means that I'm, I'm coming out of that, that brief, brief depression.

[00:03:09] I just want to read a couple of—Oh, and we're also back doing some struggle in a sentence surveys. I took a little break from those for a while, and we've got some, some good ones, uh, including this one. This one is filled out by, uh, a guy who's calling himself "John Smith." And, uh, he is gay, and his biggest struggle is anxiety. And he writes, "It feels like the world is at war, and leaving your house is like entering a war zone." Which is not surprising because, as you … I read this, he writes, "I'm a police officer. I work the midnight shift, and it's made my anxiety so much worse. I feel like I can't get help and that my fellow officers wouldn’t understand. I'm also gay, and in the law enforcement profession, it's a very conservative, masculine environment. Sometimes, it just feel like I'm just going through the motions of life, but not actually in the driver's seat. I still struggle to make it out of the house sometimes. I have to come up with a plan, but even then, I procrastinate for simple things like going to the supermarket. I wish I wouldn’t carry the fear of everything constantly, and I feel so guilty that I'm so afraid when I'm supposed to be courageous and brave …" Oh! "… when I'm supposed to be courageous and brave always. I saved a man's life once, so I do feel good about my job and myself most of the time. It's just a pretty big struggle that hardly anyone I know sees. It's like I have this mask on. One of my friends from work killed themselves. Apparently, it wasn’t directly job-related, but I know it was, at least partly. I wish more people understood how hard the job can be, working long, hard hours, not knowing what time you'll be home, not knowing if you'll even make it home at all. Everyone thinks the police should have all the answers and solve all the problems. Little do they know we have problems just the same." Thank you so much for that. I just love when I get a peek into … a part of society or the world that I don’t know much about. And you accomplished that in this brief survey that you filled out. And, um … one of the things that struck me is, is … you talking about feeling good about your job; most of the time it's struggling to feel good about yourself. And, one of the things that I know I personally have struggled with is to not derive … the bulk of any positive self-regard I have for myself from what I do for a living, because it will never be enough. I have to find … that self-love just as I am. You know, if I wait until I do something great to give myself that love, that's, that's not a kind thing for anyone to do them, to do to themselves. And, you know, or wait until I grow into the person I wanna be, because I don’t know if we ever necessarily hit that finish line, where we're like, "Okay, now I'm good! Just gonna send a big, mass email out and let everybody know I'm ready to be social again." But thank for that, for that survey. I really appreciate it.

[00:06:41] This is also a struggle in a sentence survey filled out by a woman who calls herself "Lost," and describing her depression, she writes, "Heaviness and just emptiness inside you. A great void." That's so descriptive. Snapshot from her life: "Lying in bed, unable to even lift my hand. And just obsessing about how I should just get up, but I can't. Then the thoughts start spinning about all the consequences and I get lost in all of it. I just want to disappear among the covers. I have to lure myself up, taking tiny steps one at a time." Man, those are (phew) so relatable.

[00:07:23] And … and this one from "Brandon," talking about depression: "A fuzzy, heavy ball in my head." That's like s gray blanket, just, uh … weighing down everything. Snapshot from his life: "A serving of depression, a side of compulsive eating with anxiety on top. After doing nothing all day one Saturday—not leaving the house, watching TVs and movies all night—I slept in on Sunday. Depression is exhausting. You need your rest to rest more. I wake up to discover I've nothing to eat except crackers. I eat them, all of them. The whole box. I avoid calls and texts from perfectly fine people. Can't explain what I'm doing, so avoid those calls. After seven hours of wondering what I should do, I go to the grocery store, unshowered of course. Baseball hats are the best. I buy some essentials and also two frozen pizza. There's a sale, for god sake! You have to buy 'em both, right? One for tonight and another one for … another day! But I tell myself I'll eat both. 'You shouldn’t buy both; don't do it,' I say to myself. I know what's gonna happen and that I shouldn’t, but I do. I get home—congrats, I did something! I left the house and went to a store. Victory! I'm so productive! I cook both pizzas. I eat both pizzas. I immediate feel disgusted with myself. I think how much of a fucking gross human I am. Worthless. If somebody saw me do that, oh my. Then I realize it's 9:30 at night and I haven’t prepared for work on Monday. I didn’t do the reading I was supposed to do. I'm gonna be unprepared at work, get in trouble. I'll lose my job. I'll be unemployed, can't pay bills, become homeless. Who can I live? Where will I go? My life is over. Because of emotional eating. Depression, pizza, food. No, I made; that didn't happen. I still have my job. Good. That means that it's okay to sit home all weekend, do nothing, feel sad, and eat compulsively. Go ahead and do it again next weekend. That’s' what I did and how I thought. Or, I could get help. Go to counseling. Enter a 12-step program. Admit. Start to recover. Have an amazing therapist who understand you and also recommends Mental Illness Happy Hour. Then you can share your story on some webpage. I also did that. And I had a normal serving for dinner. The end." Oh, man. I love that. I love that. Thank you. It's my favorite thing in the world, is seeing the light come on in people.

[00:10:22] This is a struggle in a sentence survey filled out by a woman who calls herself "Breezer." And, about her depression, she writes, "When I feel a depressive episode come on, it feels like a dream where I'm running, but in slow motion. There's nothing physical pulling me down or holding me back. And nothing I can do to go faster." About her anxiety: "If I don't turn my car around and make sure I locked my front door—I always do—someone will break into my home, my pet will escape, and all my things will be ruined, and I will live with guilt forever." God, that is so … good! That is … Honestly, one of the things that is keeping me from getting another dog is the fear of them escaping and getting hit by a car. About her compulsive eating: "I have to go to different stores to buy my candy and treats because I'm convinced the workers at each store judge me for buying eight different types of candy at 10 p.m." Honestly, they're probably busy feeling shame about how much they're jerking off. It’s amazing how little life has to do with us personally. So much of it—If you eliminated people being obsessed with shaming themselves and feeling like they don’t match up, the amount of time we would have free to have fun and not take ourselves too seriously and connect to each other, would be mind-blowing. About her PTSD: "How unfair is it that I have PTSD, get triggered, can't perform daily activities, and pay for therapy, but my rapist is a free man with no criminal record?" About being a sex crime victim: "The detective on my rape case told me 'Sounded like a case of buyer's remorse,' and the guy that assaulted me and his friend, who was in the room, seemed like 'nice guys.'" Wow! Wow. Sometimes I just don’t even have words. (Pauses) (Sighs) I'm so sorry that that … I mean, you talk about an injury to an injury. Fuck! And … you know, the person that … It's ea-, it's almost easier for me to understand somebody being pathologically violent than it is for me to understand somebody making a simple, compassionate adjust-, adjustment to their attitude and choice of words in doing their job.

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[00:14:56] As I've mentioned … before, BetterHelp is also our sponsor for today. And, I just wanna read a, uh, little … shout-out they got from a, uh … listener, who wants to be referred as "Tuts." And, uh … she was writing about something else, but she added this in her email: "I've also begun another round of therapy through BetterHelp. My therapist, Celeste, is like my own little guardian angel in my pocket. She's fantastic! She's able to read through my words and give me her thoughts, exercises to help challenge my brain, and most of all, she listens, agrees, and is always there. Thank you, thank you, thank you so much for promoting BetterHelp!" So, if you're interested in trying betterhelp.com, guys, go to betterhelp.com/mental. Make sure you include the "/mental" so they know you came from the podcast. Just fill out a questionnaire and then they’ll match you with a betterhelp.com counselor and you can experience a free week, free week of counseling to see if online counseling is right for you. And you need to be over 18.

[00:16:02] And then, uh, this is the last survey before the interview. This is, uh, struggle in a sentence filled out by a woman who calls her "MC." And, her description of depression, she writes, "I'm running through a forest, trying to find my way to the sunlight at midnight."

Intro

[00:17:19] Paul: I'm here with Dr. Paul Puri, who is a, uh, psychiatrist. You still practice once—

Dr. Puri: I do.

Paul: —once a week. But your main gig is, uh, writing for TV, which sounds like so fun to be able to bring your experiences. The name is the show is Chicago Med?

Dr. Puri: Chicago Med. It's one of the Dick Wolf shows on NBC.

Paul: Oh, okay. Is it a procedural, or, I guess because it's not police necessarily. It, it's … But is it about the, kind of the day-to-day?

Dr. Puri: Yeah. I mean, it's about, I would say it's got kind of a procedural core. So it's, you know, there are cases of the week every week that they kind of work through, and they're usually resolved. But then there's still character arcs. So there's some serialized elements to it.

Paul: And, and is it, uh, a focus on the mental aspect or the medical aspect of it?

Dr. Puri: It's medical, but there is a psychiatrist character, uh, played by Oliver Platt. And then, for two seasons there, one of the, the character that was a medical student became a psychiatry resident, a trainee. So you sort of followed her journey a little bit as well.

Paul: Oh, I got you. And, and, what … have been some moments where you’ve been able bring your insight or experience and get to see it on screen through another character, where you felt like, "You know, if I hadn’t been in that room, that might not have been able to show this part of the process or humanity or what I, what psychiatrists do?"

Dr. Puri: Yeah. I mean it's, it's fairly, I don’t wanna say constant. But I mean, you know, everyone generalizes from their experience. So some people on the staff have their own direct experience with a psychiatrist or in therapy and, you know. Or they’ve just read something. And so, trying to, uh, you know, ground it in, here's what people actually say in these circumstances. Here's what they actually experience. So it's, you know, one ex-, one example might be, um, like a, a specific, uh, case in an episode that I, that I co-wrote about anorexia. And so, being able to understand what the mentality is, and the sort of, um, the, the, not just the persistence, but the, um … missing the word at the moment, but how in-, uh, insidious it is, in terms of, into every little bit of your thinking. And people would think like, "Well, why doesn’t this person just get better?" It seems so obvious to someone who doesn't actually struggle with it. And so, being able to bring the, the reality of sort of clinical experiences to it, um, I think enhances it.

Paul: Yeah, I would imagine. Because … I didn’t realize until I started doing this show and, and talking to people who've, uh, battled it, that it's, from what I've told, it's about control.

Dr. Puri: Oh, absolutely. And perfectionism so often. Yeah.

Paul: And, I assume, that's because they feel a lack of control in their … life.

Dr. Puri: Absolutely. Very often, they come up as, you know, they're the straight-A students and the, the perfect child. And this just becomes another manifestation of that control: "I'm gonna control everything the goes, comes into my body." And then when they get to the, the science, the neuroscience of it, they actually, the reward system is sort of flipped. They actually feel the hunger pangs that we all get that are kind of painful, they actually feel rewarded by it in their brain, if you … wanna follow the neuroscience, which I think it sort of a mixed bag in its, its own way of using, uh, letting the tail wag the dog.

Paul: Yeah. I've heard people describe it as feeling clean. That, that word gets used a lot, you know. That, um … I mean, there's the healthy thing with food, where people say, "I'm eating clean." But … you know, when people who, uh, have anorexia, um, speak sometimes, they talk about it when they deny themselves, they feel clean.

Dr. Puri: Absolutely. And it goes cross-culturally, outside of like Western society, it can sort of manifest in a form of purity, rather than on the fact of, uh, on the idea on like sexuality or body image, per se. It still becomes a restricting process, but it manifests more almost religiously, in some cases.

Paul: With fasting and things like that.

Dr. Puri: Exactly. Yeah—

Paul: Like, Ramadan and Lent and things like that.

Dr. Puri: And in Hinduism, yoga practices, things like that, it becomes like, "How devout can I be and use this as a process of restricting from myself?" Yeah. I don’t see a lot of anorexics, but that was just an example.

Paul: And it's interesting, too, uh, how often one thing will share the traits of another thing, which, I think, why the topic of mental and emotional health is so endlessly fascinating, because, um … (laughs) I was sharing with my girlfriend, the other night, why I'm loving watching this Ted Bundy documentary—

Dr. Puri: (Laughs) On Netflix?

Paul: On Netflix. And I said, "Because on some level, I understand him, as an addict." I understand compulsive behaviors and knowing that it doesn’t make sense to do this thing, um, I'm glad that my thing isn't killing people. I'm glad it's Pop Tarts and, you know, beer and … weed and stuff like—

Dr. Puri: Your vices are a little more benign than his.

Paul: Yes. Although pornography, which certainly has, you know—I had battled with in, uh, in the past. And I certainly don’t think, "Oh, you know, that's past me now. I don’t ever have to worry about that again." But, um, that gap between the intellectual and the, and the emotional. Is that neurologically, kind of, the prefrontal cortex versus the amygdala kind of thing, or what is it?

Dr. Puri: In terms of—sorry, I missed it.

Paul: In, the disconnect. How you can intellectually understand I shouldn’t have this sixth ice cream sandwich. But there's a part that feels like I'm gonna jump out of my skin, if I don’t.

Dr. Puri: Yeah. I mean, I think if there's, um, there are, sort of, you know, neurologic, neur- … I would say there's sort of behavioral loops that are sort of firing in your brain. And you have your, your, frontal or prefrontal is sort of your awareness and sense of control. And very often, those are, um, in conflict. But, it becomes something, um, it becomes else. But if I, can I jump over to something else that you were just saying?

Paul: Yeah!

Dr. Puri: I was thinking about, um, what you were just saying, that the, the nature of how there are similarities between so many different, different things. And I think that that's the, the, the nature of how we understand other people, Whether it's through story or through, you know, mental health. The work that I do, it's, there's a level of, um, someone describes empathy as vicarious introspection. And it's like, I'm gonna think about what's going on with them and put that, put myself in their shoes and imagine what I would go through. And sometimes I can get a little bit better insight through that. I don’t have particular OCD or anorexia or something. But I might have an inkling of something like that. And it were like, sometimes I'll a little angry, and so maybe I could understand what a psychopath or sociopath might, might intend in terms of joy of cutting someone off in traffic. So I can understand that aspect and then learn from them.

Paul: So true. I think the world would be such a better place if we took the time, uh, to put ourselves in other people's shoes and not take things necessarily personally, uh, which isn't to say that, you know, be a doormat. But to say, I might, I recognize some traits I have in that person, even if, you know, they were traits I haven’t displayed in a long time.

Dr. Puri: Totally.

Paul: Cuz so often, our worst behaviors, it seems like are driven by a feeling of neediness, emptiness, or fear.

Dr. Puri: Uh-hmm. And there's sort of an aspect of demonizing other people in that, when you view them as other. And when you can sort of understand them, it humanizes them. It makes them, you know, part of the tribe versus, you know, this foreign other thing that can be an enemy.

Paul: Have, have there been any moments in your, uh, schooling or your practice where … you had that, that moment, where you suddenly understood … something that had just been kind of intellectual for you until then? Maybe, maybe it was a psychopath or, or … something like that where you began to get the sense of seeing it from their perspective, that they weren’t just, "I'm gonna be evil because I don’t give a shit about anybody." Rather, it, there's … as Ted Bundy described, "There's an entity inside me," that, that he can't control. And I know what that's like, fortunately: just beer and, you know, weed and, and … other things. But, still.

Dr. Puri: Yeah. I think the, you know, I think one, uh, thing that first comes to mind is, uh, experience with someone with OCD, and they were having … they were really kind of beating themselves up every minute of every day because they have these images in their head of doing something that was terrible. It was like, you know, it, at that moment, it was driving into traffic, but it was also the idea of, you know, hurting someone that they cared about. And thus, "How could I ever do that? I must be a terrible person." And so they would go through the, that OCD loop, where they do something to themselves to lessen the anxiety temporarily. And then they go back on the loop and it repeats. But the, um, understanding that, that when an image comes into your head, the, the process of blame and shame almost toward yourself of having that. I don't know that it had quite clicked before. You know, when you read textbooks, it becomes like, "Well, they have an obsessive thought, and then they have a compulsion on top of that. They have the thoughts about germs, and then they wash their hands to make it less." But when you get into the, the real personal nature of it and the suffering that's going on in there, it becomes something else. It really … again, it's humanizing someone.

Paul: And, and so many people, myself included, needed a mental health professional, or a support group … to initially give me the permission to not shame myself, to believe that my thoughts weren’t my morality. That was news to me when I first started going to therapy. But, uh, I will still struggle with shame. And, and I see so many people in my support groups, especially the ones that, that revolve around intimacy and sex and romance and stuff like that, things that can get a little, a little taboo. And … getting some distance from the shame is … like stepping out of a suffocating experience that you didn’t realize was suffocating until you were breathing fresh air. And then you're like, "Oh my god, I was in a prison of my own making."

Dr. Puri: Yeah. And it's so … That's one of the most insidious things, because that usually starts in childhood. It like you never, ma-, many people in that have never had any perspective in that, until, if they're lucky enough, they have that experience in adulthood. And then they get that fresh air and they can say, "Oh my god, I can't believe I was in the dark all that time. Change my sensory modalities from air to vision." But, yeah, it becomes something that, um, that they need some help to be able to get that. It's, what's especially sad is how many people have no idea that they're stuck in that dark.

Paul: None. And, I would imagine a lot of them then project that self-hatred sometimes onto other people as well. Just go on Facebook and you can tell there's a lot of people just projecting their shame and feeling of powerlessness unto "the other side."

Dr. Puri: Absolutely. It's just like, um, it's like a child's playground. It's like, "I have to beat up other people to make myself feel well, because I don’t know how to make myself feel well in any other healthier way."

Paul: Yeah. I think, I think if … if, if you hear the, the term self-love, and it makes you wanna puke, you could use some self-love (both laugh) … cuz it used to make me wanna puke. That, and self-parenting. And then, after years of doing it, seeing the positive results of it, the peace and the freedom, uh, from it, I, I just thought, "Man … we're uniquely positioned to be our own best friend, and yet, we talk to ourselves like our worst enemy and we think it's discipline."

Dr. Puri: Yeah. It becomes, um, you know, there's a lot of schools of therapy—it's like 400 schools of therapy, if you wanna really blow it up—but some of them talk about parts work and the idea that we have parts of us that are kind of in battle all the time. And what very often happens is we don't understand, we try to shut out one of these parts. We try to lock it up in a box or beat it down with a club or whatever it is. And, the more we do that, the angrier it gets. And then it comes out in other ways. It comes out in me getting inappropriately angry with my dog or, you know, doing, you know, having terrible nightmares or something else. And if we can learn to embrace that, in terms of giving it love or appreciation, then, um, then something shifts.

Paul: So, how do we do that while not neglecting the desire to grow and responsibility to be a good person to those around us?

Dr. Puri: Yeah, I mean, I think it become, it comes down to … embracing that without necessarily saying that that part is right. So it's kind of like, sometimes I'll, I'll do this with patients and I'll talk about, you gotta kinda talk to that part like it's an angry kid. And, you know, it's like … it's related, similar to inner-child work. It's like that kid's throwing a tantrum. Now you can go shut that kid in the closet whose having a tantrum; it's not really gonna make them better. You kind of have to find a way to hug it out with them until the screams and the wails calm down, and they can sort of be more vulnerable with you and feel supported. Because they didn’t have that anywhere else. And it's weird to even think about that, because you got two parts of you that you're talking. And yet, that's how we function.

Paul: Is that, uh, what … who is it, Jung, referred to as the shadow self?

Dr. Puri: Absolutely. So like, Jung had that as the shadow self. Fritz Perls in Gestalt therapy talked about it as a topdog/underdog. You have the top and, you know, those are similar to Freud's, you know, um, superego and like id or sometimes ego. It's like one part's in charge and had this parent conscience and is beating up the other part. And that part is then firing back whenever it can, but it's really the, the underdog in its way.

Paul: I heard, heard someone in a support group one time, I, I don't know if they made it up or not, but they said, "I …," they were speaking of themselves; they said, "I have a tyrant and a rebel I my head, and that tyrant barks and the rebel says 'Fuck you. We're not cleaning the room. We're gonna go eat five pizzas.'"

Dr. Puri: Yes. And so like, people will then flog themselves for saying, "Well, there's this part of me that wants to eat five pizzas. It's like I've seen patients who have bulimia, and they're like, they’ll beat themselves up because they have this craving for food. And it's like, well, that part is craving something. We shouldn’t blame it for craving something. And you're then undoing it because it's overdoing it. What we need is to understand what each of those sides wants. Like, bulimia's a good representation of two parts that are in battle and the pendulum is swinging back and forth.

Paul: I struggle—maybe you could help, give me some insight on this—I struggle with sweets, but only like the last two or three hours that I'm awake.

Dr. Puri: Oh, me, too.

Paul: Yeah?

Dr. Puri: Yeah, totally. I mean, for me, what I've discovered is, I use it as a way to stay awake. I'm actually naturally tired at that hour. And so I crave sweets because I wanna sort of be up with my wife and like spend some time. It's like, oh, I can, I get a little bit of a sugar kick, it something other than caffeine. And then, you know, I have regret afterward, of course cuz I'll eat too much of it. But, it's absolutely a, a pattern for a lot of people, at the end of the day.

Paul: So how … if I wanted to break it, I just make peace with that, that desire to eat, uh, four Pop Tarts and an ice cream sandwich?

Dr. Puri: Is that what it is?

Paul: That's what it’s been lately. And I am—and by the way, unfrosted; I'm not an animal.

Dr. Puri: Okay, thank you.

Paul: Yes.

Dr. Puri: I mean, at least we can, we can honor that side. I think the, in this model, you know, I, I work in a couple different therapy models. The, it would, it be, just start by not demonizing that. Just say, "Okay. There's a part of me that's gonna wanna eat ice cream and Pop Tarts late at night. "And let's just give that part a little time and attention and say like, "All right, kiddo. You need, you need something. What is it you need? What is this doing for you?" It might comforting you. It might be, you know, whether it's comfort food or feeling like you're treating yourself or rewarding yourself for a long day and hard work. And then you can say, "Okay, what else would do that?" Or, "Can we make an agreement on something else that'll get you partway there?" But it doesn’t become a battle or a denying of that part.

Paul: It's, it's not like to the level of self-disgust or anything like that. It's more of just kind of disappointed in my, my lack of, of impulse control. And, and if I look … at the rest of my like and, you know, being 15 years sober and … you know, doing a lot of internal work, I, I'm proud of who I am. But it's like the last thing that I'm holding onto. And I think it's affecting my health a little bit, And, I, I want to … it’s something I would really like to get a handle on. But I also, when I am making that fourth Pop Tart and going, "Well … we're a little wound up here," it, there's a part of me that wants to understand it better without just going, "Shut the fuck up. Let's have our fourth Pop Tart, because we love sitting on the couch and it feels, it feels warm eating it." It feels like I'm giving myself a treat.

Dr. Puri: There we go. So the question is (clears throat), this is the thing that you're doing that gives yourself a tr-. You, you’ve used this many times in the podcast, which is that your coping mechanisms as a child become your—

Paul: Character defects as an adult

Dr. Puri: —character defects as an adult. Yeah. And so, it's something that was adaptive for you at one point, you know. Doing this was something that was helpful, and maybe it was the only thing you had at that moment. And then it gets locked into us or programmed as being the thing that we default to. So, an approach to this is recognizing what need is that filling and then diversifying. "We else can I try to fill that need? Let me try three other things. Oh, I like warmth. What happens if I—" I'm just gonna make stuff up— "What if it do a warm blanket on me at night? Or what if I do, I sip some tea that's warm and comforting? Or soup? Or something else? Is it about, something about my stomach? You know. And trying these other things out until you might discover something that at least gets you partway there.

Paul: Okay. I'm …

Dr. Puri: The key with, the key with this whole thing is not denying the need hat's behind it, um, because that's shutting out that part again.

Paul: Or assigning quality to it.

Dr. Puri: Yeah. Yeah. Judging it.

Paul: Judging it.

Dr. Puri: Yeah.

Paul: Let's talk about your childhood a little bit and what led you to want to get into psychiatry. Who fucked you up, Paul?

Dr. Puri: (Laughs) I don’t think anybody fu—I think I—Well, I had a neighbor who told me about, um, you remember "America's Most Wanted?"

Paul: Um-hmm.

Dr. Puri: So, I had a lot of phobias as a kid. And I remember my neighbor, who was like a few years older than me, told me about John Walsh's son, Adam, and getting, and he was murdered and found in like a cornfield or something. And, when he told me about that, I then had nightmares for years of someone coming into my house and kidnapping me. But it was, you know, it was—

Paul: How old were you?

Dr. Puri: I was probably like six.

Paul: What the fuck is this neighbor?!

Dr. Puri: (Laughs)

Paul: Was it somebody your age or an adult?

Dr. Puri: Yeah. No, he was about, he was probably like nine.

Paul: Oh, okay.

Dr. Puri: So he was like, you know, he was still a kid—

Paul: I thought it was like, you know, an adult next door.

Dr. Puri: No. He's not like purposely traumatizing me as a—

Paul: "Yeah, kid, you seemed to be having a good time. You know, you're unaware that Adam Walsh's son wound up in a cornfield as a skeleton."

Dr. Puri: (Laughs) "Let me show you some photos (laughs). Really visualize it for you." Yeah, I became, so I have, you know, I had all kinds of phobias. I had, uh, planes, heights, water, serial killers, thunderstorms … pretty much all of that stuff. And, um … yeah, took a while to, to get past. And I don’t know that there was any … I don’t necessarily blame anybody as sort of fucking me up. I think it was, it was definitely baked in for me. And then, um, when I got older, it was like there was, you know, there was some depression and anger and sort of teen angst-related stuff. All of that. So, the work I did to sort of get through some of that … led to me having an interest in this kind of work.

Paul: You know, that's interesting, because the, the, the things that you listed are things that it's healthy to have a reasonable fear of.

Dr. Puri: Oh, absolutely.

Paul: But, with you, how did it become excessive, and how do you know when something is excessive?

Dr. Puri: I mean, for water, for example, I was afraid to take swimming lessons from, you know, as … at any age. And so, they really had to sort of hand-hold me and get me through the, the phobia. Better get on a plane or, um, you know, became a, I was terrified every night of, would have to like double-lock my door, because of the serial killer thing. So it became, um … That was excessive, in that it was causing me a lot of anxiety as a kid.

Paul: I got you.

Dr. Puri: So there was some suffering that was going on. But, you know, if I was, if there was a serial killer epidemic in my home town, then I would say, oh, yeah. That was a good, it was a protective thing for me to be anxious about it. That hypervigilance.

Paul: I would imagine … that … makes it a little easier for you to have empathy for your patients.

Dr. Puri: Oh, totally. One hundred percent.

Paul: Talk about that.

Dr. Puri: I mean, it's kind of the thing I was talking about before, this vicarious introspection. I find I've got like, you know, that, that half a percent of everything. And so, I can understand what little impulse myself is, might be parallel to this. And then, use that to gain some introspection into them. And thus, it's like just putting myself in their shoes. And then, you know, you don’t … I don’t, uh, assume I'm right. That's sort of the, the narcissism of it, of like, of presuming just because I understand myself a little bit, I understand this other person. So, one therapist, uh, um, mentor of mine, used to say, "You hold those ideas lightly." So you take this idea and say like, "Well, is it like this? Cuz I imagined it's like this." And you present that and you see what they say. And if they go for it, then you're like, "Oh, okay. I guess I'm right." And sometimes you're not. That's the, that’s sort of part of the process of underst-, of getting to know someone.

Paul: And that’s when you cut 'em loose as a client.

Dr. Puri: Yes!

Paul: And they say, "Why?" And you say, "Because you told me I was wrong."

Dr. Puri: Yeah. "We're done here." It's pretty much over by that point.

Paul: (Laughs) One of the things that you did in your residency was you took, uh, training on how to do talk therapy. Which … is—Paul and I were talking before we started recording—um, and, it's obviously no news to him, but how many psychiatrists don’t have good people skills.

Dr. Puri: Yeah. I mean, it's really, it's very, um … it's a generational thing, and it's also kind of institution dependent. There's a lot of training programs all over the country. And, you know, there's a lot of need. And so, some of them will just take whoever is interested. Bu the generational thing, there, you know, there was this thing in the 90s called, um, the National Institutes of Mental Health, which is a branch of the national Institutes of health. They do all the research on mental health that's government funded. They had this, this endeavor called the Decade of the Brain in the 90s. And everything was neuroscience-oriented and biology-oriented and psychopharmacology-, medications-oriented. And so, there was this culture shift that happened during that, where psychiatrists stopped getting trained in therapy. Because before that, if you go back before the 80s, most psychiatrists were the ones doing therapy. There was a lot fewer psychologists, a lot fewer other types of psychotherapists. And then, when this happened, suddenly all the psychiatrists-in-training didn't get any therapy training. And then those are a lot of the ones that are out in the field now. So they're just like lost generation of psychiatrists who influenced the public image and influenced the, um, you know, the real well-being of people, because they're relying solely on medications. And, it becomes the hammer-nail scenario. It's like if all I have is a hammer, everything looks like a nail.

Paul: So, are … some of them going back and getting training, now that they know that, uh, there's a lack of there, or they're well on their way, and if, uh …

Dr. Puri: A lot of times, they don’t. Most of the time, they don’t, I would say. And it becomes … it's a job, for some people, and they can make a living. The insurance companies don’t necessarily reward for … excuse me, for doing, um, for doing therapy, though that changed a little bit, with some of the billing codes a few years ago. They now, now it becomes a little bit more, you're able to more make a living comparable to doing medications if you do some therapy. So some people are going back, or they go back later in their careers, cuz they've always had an interest. But, what we really see is, there's a shift going on. You know, I teach at, um, at UCLA, there's a shift going on in trainees, where people are coming interested in therapy. They're choosing psychiatry cuz they're interested in therapy. Not all of them, but many, a much larger percentage.

Paul: That's so great.

Dr. Puri: So, hopefully, that will swing the pendulum back for the field over time.

Paul: So often, I have had issues that, whether it's medical issue or it's a mental or emotional issue, where I'm seeing two or three separate people for it. And I want them all to be able to confer because it just feels like it’s too spread out there. And it seems, to me, that if you could find a psychiatrist that was really, really great at talk therapy, it would, it would be so nice because …

Dr. Puri: Yeah, the fragmentation of care is terrible.

Paul: It’s terrible! And, and the over-prescription and under-prescription of meds, I, is that a fair assessment?

Dr. Puri: No; absolutely.

Paul: Talk about that, if you would.

Dr. Puri: Sure. I mean, the, the over-prescription is the, is this sort of fallacy, I think, that within a lot of psychiatrists, that if we find the right cocktail, things will be sort of solved. There was, um, there was a great, uh, Broadway show that won the Pulitzer, uh, Next To Normal; have you heard of that?

Paul: I think, I (unintelligible), is that the one … No, no, no. I did not see that one.

Dr. Puri: It was, um, it's a, it's an amazing show about, um, a family, and it covers a lot of areas. But it's the, um, it's about a family with a mother who has bipolar and the son died in ch-, in, uh, at like two years old. And then the daughter is now a teenager, and sort of their struggles with things. But there's entire songs about, um, My Psychopharmacologist and Me. And one of the line is, you know, "Well, we'll keep trying, and one of these days we'll get it right." As if like, just by trial and error, we'll get a little closer to that. And I think that's why you end up with this, um … this cocktail, uh, uh, approach. It comes from the, um, the way that psychiatrists are taught, is we target symptoms; we don’t target illnesses or diseases. So, "Oh, you're having low energy. Well, let me give you a medication that targets low energy. You're having, um, anxiety; let me give you medication that targets that anxiety. Oh, you still having 'x' amount of the anxiety. And we'll rate on an eight out of ten. Let's bring that down to a six out of ten by bringing up this dose." And the idea that you can somehow tweak those doses right to give somebody a better quality of life. And I think that that's … there's something there that's … that's, um … you know, coming from the right heart place of trying to give, relieve suffering. But it, it, I think it misunderstands the nature of how we live as humans, and the way that life sort of contributes to our symptoms. If you don’t really identify and appreciate that, then you're just sort of chasing things with, "Oh, you had a bad break-up? Let me raise this dose."

Paul: Right. So … it's not considering the necessity of processing trauma, developing coping school, skills, learning how to communicate, identifying needs, set boundaries …

Dr. Puri: Absolutely—

Paul: Self-care—

Dr. Puri: How to have healthier relationship. How to be able to do any, yeah, any level of self-care. Like all of that is sort of missed in the process. What can I do, what can I do for myself? It's also sort of outsourcing all of your care to somebody else. It's like, "Okay, well my psychiatrist will change my medication. That will be the thing that makes me whole." And I think that that … again, I think medications are very, um are very effective. They have tremendous benefits. But they aren’t the whole picture. And so, that the over-prescribing side. The under-prescribing side, I think, comes when a lit-, somewhat of the stigma behind it. This is my perspective, and you might be referring to something else, but the …

Paul: I think people that … think, "No, I don’t, I don’t need meds." And, you know, they're in a state of crisis, they're not getting out of bed—

Dr. Puri: Right!

Paul: —you know, they're … on disability and they don’t wanna do anything.

Dr. Puri: It's like a philosophical choice to not take this. It's like, "I don’t wanna put something in my body that going to pollute it or corrupt it," as if it's a purity thing. And—

Paul: "I'm cheating." Or, "I'm weak, if I take it."

Dr. Puri: Right. "There's something—" Then they have to somewhat admit that there's something wrong that’s going on with them. It's al-, for some people, I've heard it say, it's like they're admitting they're damaged in some way—and I put that in quotes. That to be able to require a medication: "It's not that serious. Come on, I don’t need a medication. It's not that bad."

Paul: I, I have a female, uh, friend, who actually I had to cut contact with, um, because she … I don’t know if it would be called bipolar with psychosis or, uh, what’s the other word, schizo-affective; is that, is that what that is?

Dr. Puri: Uh-huh. Yeah, those are, uh, very related (clears throat) and may all be the same thing; that's a longer discussion which we can get into, about the nomenclature in psychiatry and … its imperfections. But yeah, I get your, what you're saying. So there's a, an emotional side of ups of the manic and the depression, as well as psychosis.

Paul: Yes. She was, uh, imagining that the FBI was out to get her, people were spying on her, every license plate that she looked at, uh, has sixes on it, and …

Dr. Puri: Ideas of references, we call that.

Paul: Yes. Some religiosity in there. And an absolute refusal to take meds. And, to me … I can understand that if somebody's marginally depressed, they feel like something's missing from their life, and they want to pursue talk therapy, yoga, eating better, you know, all of those other things, I think that’s the right thing to do first. But, to me, if you're experiencing hallucinations and paranoia, no amount of meditating, in my … in my guess, is going to—

Dr. Puri: You're absolutely right. There's not a—There's certain criteria where medication should be the first run. And, and psychotic symptoms of just hallucinations, paranoia, um, magical thinking, like thinking you have special powers, things like that, um, are, are definitely ones that, uh, necessitate a medication first. The depression side is a little bit of a grayer area. I usually, um, I don't, I'm a psychiatrist that errs on less medication. But what I tell people is, "I'm not gonna push it, but I am gonna tell you if I think it's a good idea for you." And so, people who are in an especially a deep rut, and sometimes they need a medication to give them a little bit, enough momentum for the talk therapy to actually work, I'll say that. So, someone who can't get out of bed is a great example.

Paul: That's the mother fucker about depression, is when you're really depressed you don’t feel like helping yourself.

Dr. Puri: Yeah. I mean, I think of it, um … I like, I like getting away from, I mean, I, I appreciate the, the biological models of it. And there's, you know, the, the chemistry of, you know, serotonin and the monoamine. And then there's the thing with BDNF, if you’ve heard of that before. It's this—

Paul: Is that's when one person has the whip, and the other person …

Dr. Puri: That's BD, what is that—

Paul: (Laughs)

Dr. Puri: BDSM—

Paul: BDSM.

Dr. Puri: Thank you (laughs). BDNF is, um, brain-derived neurotrophic factor? So, the old school teaching is that you're—

Paul: That was the name of my first band.

Dr. Puri: Oh yeah?

Paul: (Laughs)

Dr. Puri: No, but it should be (laughs). That’s a lot terrible; don’t do that one (laughs). This (laughs), this chemical, uh, you see your brain actually—The old school teaching was your brain, uh, whatever brain cells you're born with, that's all you have. And then, turns out that your brain actually regenerates over time, makes new brain cells. And the way that it, one of the ways that it does this is via this chemical called BDNF, which is a signal it uses to tell itself to make new brain cells. And so, when people are depressed, um, and when they have really severe anxiety also, PTSD, high levels of cortisol, the BDNF is actually lower. And what runs out is all the different antidepressants, regardless of how they work, cuz a lot of them have different mechanisms, they all raise BDNF back towards normal.

Paul: Oh!

Dr. Puri: So that's an interesting chemical side. For me, the getting beyond that and into the psycho-social aspect, there's this evolutionary hypothesis that, um, we're, you know, humans have been around for hundreds of thousands of years, if not much longer, in our current form. And that, if mental illness as an idea was not, um, beneficial for our survival for some way, it would have gotten selected out. People like the giraffes with the longer necks, longer necks, you know, were able to eat higher branches and they'll survive in a drought. And so, you know, the ones with shorter necks die off, and they don’t pass off their genetics. So if mental illness was a bad thing for us and, and didn’t allow us to survive, it would have gotten selected out. That's the idea.

Paul: So, you're saying I'm a giraffe?

Dr. Puri: Yeah!

Paul: Okay.

Dr. Puri: You, I mean, you’ve got the, your neck is amazing. Paul, it's, it's very—

Paul: You should see my closet full of turtlenecks.

Dr. Puri: Really?

Paul: They go on forever (both laugh).

Dr. Puri: The idea, um, is that, for that kind of depression, for example anergic depression, meaning no energy, um, is this, there's a question you can ask clinically, is do you have a, do you have a goal that you feel is impossible to achieve and impossible to let go of? And many people, and that might, uh, a version or an identity, a version of yourself. And (sigh), for people who are depressed in that state, it's very often a yes, for whatever reasons. And so, for, we’re all animals—cuz we're all animals as humans—(clears throat) and let's say a badger and you're building a dam, and then the river, you know, swells and then washes it away. And the river swells and it washes it away and you keep building it, eventually you're gonna realize it's impossible to keep building a dam; it's not gonna succeed. So the solution for survival is to shut down, is to go into hibernation. Don’t keep putting energy into this impossible task, and you don’t know how to let go of it. So you just go into hibernation, and that's kind of what an anergic depression is.

Paul: Oh!

Dr. Puri: It's the shutdown mode to help you survive until something else changes.

Paul: So, instead of … meds, then might somebody, by changing the logistics of their life … work their way out of it?

Dr. Puri: So, in that model, and again these are all models that we can jump through—and they don’t all work, and that’s why you shift to a different model—you, you can change your outside circumstances or you can change your perspective. Maybe it's not really impossible, or maybe it's something that you can figure out how to let go of. If you could change any of those three, then yeah, you could come out of it. But it's, people can get very dug in. And so that can be the difficult therapy work.

Paul: It, it, it is hard, sometimes, to know if the depression is situational, spiritually, medical, um, emotional, attitudinal, um, although I can tell you … this is—I'm talking to listeners, don’t EVER suggest to somebody who's depressed that they have a better attitude (laughs). That is like the fucking worst thing you can say to, to somebody. And on the receiving end, I can tell you, it just feels like a kick in the nuts.

Dr. Puri: Trying to fix it is a big problem, when people are trying to connect to other. There's a, have you ever seen the video, um, "It's Not About The Nail?"

Paul: I don’t think so.

Dr. Puri: It's like a two-minute video. You can check it out … but the short—should I explain it?

Paul: Sure.

Dr. Puri: It's basically this woman who's talking about this aching feeling in her head, with her partner on the other side of the couch, her boyfriend or her husband or something. And then, as the camera pans back, you see that she's got a big nail in her head. And he keeps trying to say, "Well, you know, you do have a nail in your head." And she like, "It's not about the nail."

Paul: (Laughs)

Dr. Puri: And it goes back, and she's like, "I just want you to hear—" and she's like, "I really want you to just listen." He's like, "Fine, I'm gonna listen, I'm gonna listen." And she's like, "It's just achy and, all my sweaters keep getting snagged. And I don’t know what it is." (Laughs) So he says, "Well, yeah, that really sucks." And she goes, "Yes. Thank you!" And they lean in to kiss, and she bumps the nail on his head. And he's like, "Will you just—" And she's like, "Don’t say it!" And it's this idea that when we get caught in trying to fix it, the person never gets heard, and thus they never, they never feel validated, and they can't actually hear the input.

Paul: Oh!

Dr. Puri: So it's just flipping it first. If you can validate someone and say, "God, I hear you're suffering. I appreciate how much you're suffering," then often they'll soften enough to hear the suggestion.

Paul: So, not forcing your prioritization—

Dr. Puri: Right!

Paul: —on, on somebody else.

Dr. Puri: Yes, and that you have to know best on how to help them.

Paul: Even if you're right.

Dr. Puri: Right. Again, sometimes you are, but they can't hear that when they're in that state.

Paul: That's such an important, such an important point. And I know I am guilty sometimes of trying to fix people because I feel that I am right.

Dr. Puri: We—Absolutely, we all are. I had a patient who came in, and she specifically (laughs) came in, saying, "Here's what I want. I want direct homework and you telling me how to work on this." And every time I would give her homework, I was like, "Okay." And she was depressed and has a terrible family situation, every time I would give her homework to work on something, she would do none of it. Absolutely none of it. And we did this for, probably like two months. And I kept like trying to give her what she said she wanted. And then, I said, "You know what, I'm trying to fix it." So I switched my mode, and I just started like, I said "You know what, I'm not going to tell you how to change this right now. I'm just gonna tell you how much it sucks, how much you're suffering, and how hard the situation is, and tell you why I think it's so bad." And then, she got better in … two weeks, and her, her depression lifted 50 percent, just from that. Because I stopped trying to fix it right there. Even though she asked for that, it's not what she really wanted.

Paul: How many … people would do marginally, if not … more than marginally better, if their pain were validated and on a daily basis they felt some degree of being seen, felt and, heard?

Dr. Puri: Yeah. I mean, I don’t know how to quantify that. Seventy-five percent? I mean, we all want that. I mean, that's all we, that's the … the appreciation for us is being, as a human, that's what we're all really looking for. I mean, isn't that some aspect of love, in its way? Not having to, like an unconditional appreciation, in some way.

Paul: Yeah. I, I, I'm picturing somebody going to a psychiatrist, and that person maybe not having love in their life. Not having connection. And no amount of meds are going to be a substitute for love and connection and meaning and purpose and intimacy and those, all of those other things. And yet, it seems like, if there was some biochemical thing keeping them stuck, that might be the thing that loosens it up to get them out there to make the connections. So how do you know when …

Dr. Puri: To do what?

Paul: … when to do what? I suppose that's why you go for eight fucking years to—

Dr. Puri: (Laughs) For training?

Paul: For training.

Dr. Puri: Yeah. Even then, you don't always know. It's really, there's a trial and error process, in terms of the therapy, and it's happens minute to minute. For me, this is my approach, where you're really testing what will work here. It's like, okay I'm gonna try out an idea and see whether this person can, can run with it. And if they can't, I'm gonna pivot to a different approach. And if that doesn't work, I'm gonna pivot to a different approach. And, let's say it's someone who has, um, relationship anxiety, intimacy issues, and they get very anxious when they're in there. Well, maybe they can't really, they're so anxious, that they can't really slow down enough to process what's going on with them. So maybe they do need a little medication. Not a lot, but a little bit to soften it, so they can look at it or spend more time with the person so that they can realize that they can learn to trust them. And so, there's, it's, I dunno, it's a dance, sometimes.

Paul: Yeah. Which, uh, I imagine … anything (laughs) in-, involving the brain probably is. It's so wonderfully complex. I know that sounds so obvious, but … you know, we, we so often engage in black and white thinking. And boy, if there's something you shouldn’t apply to the brain …

Dr. Puri: Yeah. I mean, I think there's more—I forget what the statistic is. We use this in a line on, on med, and I'm gonna terribly misquote it—that there's more connections between brain cells than there are starts in the universe. Something like that. It's like, it's the most complex there is … is our brain. So, it' does-, I don't really get, you know, I get a lot of, uh, psychiatry hate from people, compared, it's like, "It's not cardiology. It's such a soft …" I'm like, "Well, you know—"

Paul: Really?!

Dr. Puri: Oh, tons. People are like—

Paul: That, to me, it's the most noble of the ones, because it's, it's them, it’s the, the final frontier.

Dr. Puri: Right. I use that when I try and tell med-, medical students why to go into psychiatry. Is that, this is the thing where you're gonna benefit the field the most. It's like, we already know everything about the heart. Like, maybe we'll make little improvement, and you can be like a mechanic on how to tweak your, you know, diuretics or whatever else. But, you know, this is the thing where we need smart people, and we need people to take this into the next century. And it's … it's a much nobler thing to go into that, to work in these gray areas, than it is to work something that we already know everything about.

Paul: Right.

Dr. Puri: But that's the, that's the pitch; not everybody buys that.

Paul: In, in, in my opinion, it's also the, the portal to, perhaps, the spiritual, the metaphysical, um …

Dr. Puri: And there's an entire, there's an entire branch of, um, called trans-personal psychology and psychiatry and getting into all of these other things. There spiritual aspects, you know, there's people who take religious aspects to it. I think that those can be wonderful. It's the—The key is to … make sure that, if something's not—this is my general—There's a, um, there's a great quote from the 60s, this spiritual leader, uh, this guy Jack Schwarz used. It's, um, it's my philosophy in life. There are at least 21 paths to the top of the mountain. If anyone says he's on THE path, he isn't even on the mountain.

Paul: (Laughs)

Dr. Puri: And so, anytime someone over-, like, "The only thing that's works, is gonna work for you is this." I say, "Well, I think you should question that." So I don’t know that any, like—Spiritual approaches can be amazing, but make sure you're not neglecting other things at the same time.

Paul: Very often, I will get, uh, pitched guests by publicists, and the guest has a book out. And the surest way to not come on this show is to have a book that claims a solution for something. A catch-all solution for something that's complicated. That just, it just makes my skin crawl.

Dr. Puri: Yeah. I think that's, you have a healthy response there, Paul. I mean, it's, um … Sometimes, I mean, things can be beneficial. But it's just missing, I don't wanna … mix my metaphors, but, um, it's like when you, when you miss the forest for the trees. It's like you think this one thing is the solution for everything. It's like, it may be helpful and recognize you fit into a larger ecosystems that also has other things that are good, too.

Paul: Yeah, Are you're now covering it with your own eco-shit.

Dr. Puri: Yes!

Paul: That's that problem I have—

Dr. Puri: I like that. I like that (laughs).

Paul: —is it's like, you may have some great tips in there, but calling it a solution, um, for everything, is, is just, uh … Before I forget—speaking of, we were talking about community, talk about the, the app, uh, that, that you had mentioned.

Dr. Puri: So, I, um, I'm the chief—You know, I have a lot of stuff that I'm doing. I wear a lot of hats. And one of the things I do is I'm working with this mental health tech start-up called Ootify. Ootify is like, um, it's a, it's a mental health platform. It's trying to be a hub to deal—It's like, has a forum, um, that's intending to be sort of a centralized place where people can go and get quality answers and connect to other people suffering. Like your own forum, except it's in a much earlier phase. And the goal is that we're gonna be using data along the way to help map out what's actually helpful for people. So there's a lot of stuff. It's, it's, uh, it's a new company. We're only, we only launched like three months ago. But, um, our goal is to have people, um, come on and, and trying it out and give feedback and, and even just checking out the free online forum is, is great.

Paul: Cool!

Dr. Puri: Yeah.

Paul: Cool.

Dr. Puri: Ootify, by the way, um, comes from the Hindi word oot, uh, o-o-t, which means, um, to raise up. So, the term means, um, a process of lifting each other up.

Paul: Oh, cool.

Dr. Puri: That's the intention.

Paul: And so, spell the name of the app then.

Dr. Puri: It's O-o-t-i-f-y. And you can go to ootify.com, um, that's one thing, or look for it on the, any of the app stores.

Paul: I am just gonna browse quickly, uh, our email, and make sure that we're covering all the things that, uh, we wanted. Oh, this is a great one. What's hypnosis? Is it real? What can it help with?

Dr. Puri: (Laughs). Yeah, I've, you know, hypnosis was an interesting … thing. A lot of people are like skeptical about because they done have a lot of training in it. And they're—So, hypnosis is, uh, um … is a state. A trance is a state that people go into all the time. You ever had, people call it highway hypnosis. You even been driving and sort of forgotten about the rest of the world and just get absorbed in the, in the road.

Paul: Past your exit.

Dr. Puri: Right, exactly. That's, uh, that's a trance state. And so, um, hypnosis—

Paul: Would that be the same as dissociating? Or does it share some—

Dr. Puri: That's a great question. So, um, a trance state actually has a dissociative side to it. So there's, um, it's, it's sort of triangle of dissociation, concentration, and relaxation. And so, those three things sort of manifest when someone goes into a trance, and you can actually go into a trance through any of those things. So, the classic relaxation approach to hypnosis, relax different parts of your body and then you're in a little bit of a trance. But you can do things via enhancing concentration or doing things where people sort of dissociate a little bit, can lead you into a trance. So, all of that being said, it's a, um, it's real. It can be very effective, and I think it's one of the, the most underused therapy approaches, if you work with someone who knows what they're doing. But … it can't make you, to get through the myths of it, it can't make you do anything you don't wanna do. You're not gonna cluck like a chicken, all that stuff. But that, it doesn’t work for everybody. There's, um, you know, there's a responsivity scale: some people are more responsive than others. But it's, um, it's something that I think a lot of people can benefit from, especially from the anxiety camp. That's like one of the most responsive, chronic pain issues, things like that. And behavioral change, bad habits, um, those are some of the most evidence-based, um, things for it.

Paul: And is, is it … partly working because it's bypassing the judgment part of the brain?

Dr. Puri: Yeah. So like, if you, um, some, my, my old mentor in San Diego, he used to draw this, this little thing, he'd draw "C," and then a line underneath it, and then a "U" underneath it. It's like you're conscious and you're unconscious. And many people come into their therapist and they say, "I'm doing something that I don’t like." And all these parts are, we call "I." We call the conscious self "I;

we call the unconscious "I." And he says, "Well, if you're doing it, just knock it off." And they're like, "I can't. I can't stop." And really, it's, "I'm doing something," the unconscious is doing something that your conscious mind doesn’t like. And so, hypnosis allows you more direct access to the unconscious and bypassing the conscious mind, which is different than most therapies. And so, allows the opportunity to makes changes, sometimes a little quicker, a little more directly. Yeah.

Paul: And is it more just for behavioral modification or can it be used to process trauma?

Dr. Puri: It can be used for, it can absolutely be used to process trauma. What I would say is that you don't wanna go to someone who doesn’t have training in other therapies with it. It can be used to enhance any therapy. So, for example, if someone's doing EMDR work, if you go, if you're in a trance, you can have enhanced, um, memories or access to memories. And so, you're working with a trauma can be more vivid and thus yield more. But you don’t wanna do that with someone who doesn’t have any idea how to manage it otherwise. The, the rule of thumb is, um, someone should never treat something with hypnosis that they don’t know how to treat without hypnosis. So thus the, don't go to, um—You know, I train, well, I actually went to a schooling for it when I was 20 years old. I had hypnotized someone in college, and it was fun. And I go, "Oh, I wanna go figure out what the hell I'm doing." And so I went to a lay training. And I re-, only years later after med school, I realized I really didn’t know what the hell I was doing. So just be careful with going to lay hypnotherapists because, it's like, um, a little knowledge can be a dangerous thing.

Paul: Yeah. So, I shouldn’t do trauma work at a carnival?

Dr. Puri: No, or on stage. That's probably not the best place. Or while drunk; don’t do that.

Paul: (Laughs) What are some ways that you can tell if that person is perhaps as quality therapist, and perhaps that they're not?

Dr. Puri: You mean any therapist or for hypnosis?

Paul: For hypnosis.

Dr. Puri: For hypnosis, I would look, there's some accrediting agencies. There's something called ASCH, which is the American Society of Clinical Hypnosis. You can go to ASCH, a-s-c-h.net. And you can look up, um, people who've been certified or, or otherwise on there. So they, that they only certify people who are like masters-level therapists and above. So you have to be like the clinical professional for that.

Paul: Okay. In what things … you, you talked about anxiety, um, some other things. What are, what are some other things that hypnosis is great with? And typically, how many sessions … does it take somebody to get, um, some ground covered on their issue?

Dr. Puri: Well, I think trauma can be, it can be very powerful. You can use it with sort of, um, you know, habit changes, behavioral changes. So the classis things are things like smoking or, you know, um, eating related changes, diet related changes. Alcohol is a little bit of a mixed bag. Chronic pain, headaches, um, things like that are, are, um, much of the, the higher yield. And then, I would usually say about four to six sessions, with most traditional approaches. You know, I've done—There, there are some more advanced approaches that can be even more efficient. But, um, but not everybody knows how to do those. So I would ballpark at like six, six sessions.

Paul: I'm a huge fan of, uh, EMDR and somatic experiencing. I've had, uh, breakthroughs in, in both of those. Something I wanted to ask you, you know, we were—I've been seeing the same psychiatrist for probably 16 years now. And currently, I am on—it's almost embarrassing to say—but I'm on 300 of Wellbutrin; 30 of, uh, uh, Buspar; 20 of Celexa—

Dr. Puri: Buspar's twice a day?

Paul: Once a day.

Dr. Puri: Huh!

Paul: Thirty once a day.

Dr. Puri: Okay.

Paul: I, I had somebody recommend I split it up and do it twice a day. And he said that's not necessary because it's a long-release one—

Dr. Puri: Hmm. Okay.

Paul: Two-hundred of Lamictal. Ten milligrams of Adderall, twice a day.

Dr. Puri: Uh-huh.

Paul: I, I think … And then, I had to start taking NAC, because, um, I was just having trouble finding words. And I feel like … I feel embarrassed that I'm on so many … things. But when I, we try to cut doses, I feel the effects of it. I feel, um … like I wanna crawl back into bed.

Dr. Puri: Hmm.

Paul: What do I do?

Dr. Puri: Yeah (laughs).

Paul: Do I, should I find another psychiatrist?

Dr. Puri: Well, it's a hard thing—

Paul: Paul save me.

Dr. Puri: (Laughs) Paul, you're in a, you're in a stable, you know, we call it a polypharmacy. You know, you're using multiple medications, and so you're … the question is how much are you willing to sort of shake things up for the pure purpose of getting on less medications. And so, you’ve tried several times to change things, and it hasn't quite helped. So, you know, there might be ways of doing that, via, for example, um, Wellbutrin and Adderall might have some sim-, they do have some similarities, but they're, you know, one's a, a slower sort of acting thing versus Adderall's more instant. You might be able to go up on one and down on the other, and thus like cut down a medication.

Paul: By the way, actually, I just did, uh, reduced Adderall from 20 twice a day to 10.

Dr. Puri: Okay. So there—

Paul: Twice a day.

Dr. Puri:—there's something.

Paul: Yes.

Dr. Puri: And then I would look at, um, you know, what are the things that you might be able to do to help self-regulate, that the medications are doing for you? So this is sort of, if sometimes people come to me for the purpose of trying to get on less medication. And so, we look at, you know, okay what are you doing for, how's your sleep? What are other thing, you know, is this something that's helping with anxiety? Okay. How would you feel about us stepping down this medication for anxiety, and then we do a little anxiety therapy, um, to help you cope with that and help dial it down? That way, so you don’t need as much medication.

Paul: Well then, let me give you, uh, the, the list of the things that I do, uh, on a daily or weekly basis.

Dr. Puri: Okay.

Paul: I pray. I meditate. Play hockey—

Dr. Puri: What kind of meditation?

Paul: TM. Like 20 minutes.

Dr. Puri: Okay.

Paul: Play hockey … anywhere from two to three times a week for, vigorously, for about an hour. Sometimes an hour and a half. I eat pretty healthy, except for the—

Dr. Puri: Pop Tarts and ice cream.

Paul: —right before I go, uh, to bed. I try to stretch. I get a, a two-hour massage once a week, and she kicks my ass. And, um, what other things and I not—I've, I go, I'm in two 12-step, uh, programs. So I go to probably two to three meetings a week. I have service commitments. I am seeing therapists and a psychiatrist—

Dr. Puri: I mean, you're doing a lot of stuff. That's a long list, Paul, of self-care-related things. What's the biggest thing you struggle with that the medications help with?

Paul: I think, probably, uh, the anxiety and the depression. And I still sometimes feels, I'll find mysafe, I'll find myself holding. My fist clinching or my feet—

Dr. Puri: Are you breathing?

Paul: Yeah. I've been diagnosed with mild sleep, uh, apnea and high blood pressure.

Dr. Puri: Uh, huh. I'm actually referring to the moments when you're clenching your fists.

Paul: Am I breathing? I'm not breathing relaxed.

Dr. Puri: Uh-huh. So, um—

Paul: Relaxedly.

Dr. Puri: Right (chuckles). So what I would examine, um, and this is coming from, uh, like a Gestalt therapy approach is, we have things that we can do to help our bodies self-regulate and to regulate around anxiety or tension or anything else. Breathing is one of the easiest ones. And so, um, and you know, like, um, sensory motor work, there's other therapy approaches that, that, uh, draw from this as well. So when we hold, we tend to hold our breath when we feel intense emotions or pain. And that sort of gets an emotion stuck. And so, one of the biggest things—it's so small, and yet it can be tremendous when, um, when utilized properly—is just noticing when you're holding your breath and just making sure that you take a couple of deep breaths. Anytime you're holding it, anytime you're feeling an emotion, check your breath.

Paul: I, I’m pretty good at doing that, um, wh-, when I notice it. I will always take a deep breath. I'll, you know, maybe shake my hands out, loosen my feet, just check for any tension in my body and try to let it go.

Dr. Puri: Great.

Paul: I just feel like, in some way … this is not to say that I don’t love my life. I, I feel like I'm, I'm firing on nine out of ten cylinders. But, I worry about the long-term effects of these meds, especially because I have high blood pressure.

Dr. Puri: Uh-huh. I mean, the, the longer, the long-term, there's been no—and they’ve looked at this—there's been no research that shows that long-term use of anti-depressants, anti-anxiety medications, aside from benzodiazepines—those are like tranquilizers like Xanax, Valium, Klonopin, Ativan—those, those ones long-term are not a good idea. But the antidepressants that you're taking, Wellbutrin, Buspirone, um … and also Adderall have not shown any long-term problems. There is, I would examine, um … have you always had lo-, high blood pressure predating the Adderall or Wellbutrin?

Paul: No. I mean … let's see, the Adderall, uh, got added about three years ago, and I didn’t have high blood pressure until like six, eight months ago.

Dr. Puri: Oh. Okay, so it's pretty new. (Sighs) You know, you could look at ... I mean, so basically Adderall and Wellbutrin both have the risk of raising your heartrate and potentially your blood pressure. So that might be, those could be contributors.

Paul: Oh, and I smoke meth I should have mentioned that—

Dr. Puri: Oh, geez!

Paul: Yes!

Dr. Puri: Way to bury the lede! (Both laugh) I mean, yeah … stop that.

Paul: I, I went and saw a cardiologist, and I have a thickening of the heart walls. It's not … an alarming thickness yet, but it's right on the bord-, it's a millimeter, I guess. I dunno, does that …

Dr. Puri: Hype-, as far as the hypertrophy. I'm assuming it's like, um, left ventricular, is what they said? That's like the, the chamber—Basically, when your heart, your blood pressure is high, then your heart rate, your heart has to work harder to push against the blood pressure. And so, the muscle gets thicker. And eventually, that can cause a problem because it can lead to, um, it can lead to heart failure basically. The muscle just gets so exhausted. It's gets sort of soft and floppy. And then, you get all kinds of other problems. So, it depends on how bad your high blood pressure is.

Paul: It's, uh, averages like 145/90.

Dr. Puri: That’s not terrible. I mean, uh, you can talk to the cardiologist about it. And, of course, they have much lower target numbers. But that's like in the Stage 1, Stage 2—they keep changing the, the standards on what they're calling Stage 1. But, I mean, I would, I would consider, you know, if you, if you have a window where you could come off of the Adderall and you wanted to try it or coming down on it, you might try that for a week and see how your blood pressure is. But you might be, it might be like a vacation, where you don’t have to pay attention in the same way. Something like that. And then the alternatives is you could try something else. So like, um, like Strat-, uh, not, well, Strattera is one thing. Or Ritalin or Concerta, things like that, and seeing if you, if those change it as well.

Paul: And what about uh, uh, doing like a, a daily Cialis. Doesn't that help with blood pressure, if I'm taking ED meds anyway?

Dr. Puri: That's, well, I don’t actually know the data on that. That’s a good question. I mean, those are vasodilators. Those dilate your blood vessels, and thus can cause a, a drop in your blood pressure. I don’t know, uh—this is a little bit outside my scope—I don’t know if there's research that shows that taking an ED med leads to continuous drop, uh, lower blood pressure.

Paul: I gotcha.

Dr. Puri: But I would, if you get dizzy or lightheaded while you're taking it, then that's too much. Are you, did they put you on blood pressure meds?

Paul: No, but that's what they will, if it doesn’t change. And, um, one of 'em is gonna be a, a diuretic. And I don't wanna be thirsty all the, all the time—

Dr. Puri: Yeah. And peeing all night.

Paul: —and peeing all the, all the time.

Dr. Puri: Yeah. Yeah. So, you know, one thing you could consider, you could talk to your psychiatrist, if they feel comfortable with it, with replacing something like, um—this is, I'm just speaking off the cuff; there may be reasons to not do this—but you could look at, such as replacing the Buspar with something like, um, Pranolol, things like that. These are, uh, beta blockers that are actually used for blood pressure, but also benefit anxiety. So you can, might be able to get two birds with one stone there.

Paul: Oh, okay.

Dr. Puri: And become, that sort of changes how hard the heart contra-, uh, uh, constricts. And so, could help both blood pressure, anxiety, and, um, and everything the same time.

Paul: Oh, okay.

Dr. Puri: Something to change and talk to him about—

Paul: Wow! It, it … apologies to the listener for you (laughs) having to sit through a, a half-hour of my free, um, medical advice.

Dr. Puri: (Laughs)

Paul: But, um—

Dr. Puri: The one other—

Paul: It does, it does cause me anxiety. I do think about this—

Dr. Puri: Sure.

Paul: It's, it's really the only area of my life that I don’t feel peace.

Dr. Puri: Yeah. I mean, you can, you can talk to the cardiologist more about this, in terms of the, the lowest stages of high blood pressure, raise your risk only 'x' amount, and I th-, it's a pretty low percentage. So it's bad, but it’s not like so bad. And I would think of it as, like if you were in the 160s, 180s with your blood pressure, that could be a bigger problem and there can be a progression. But I would, um, have a discussion with them about how alarmed you should actually be.

Paul: Okay.

Dr. Puri: They're just thinking long-term, like they're trying to think decades down the road and preventing that.

Paul: Yeah. I think what they say was that I'm, I'm not there yet, in terms of, I'm just kind of on the cusp of where they would begin to have concerns.

Dr. Puri: Yes, exactly. One other thing you could consider is, um, there's sort of emerging science—we're moving into this field of personalized medicine. And, um, there are genetics tests that are out there. And a lot of the companies are branding it and talking as if they can give you an absolute, um, equation to tell you what's gonna work for you. It's, the science is not there yet. But what they can tell you with this, you know, they do like a cheek swab or, or something. They can test your genetics to tell you if you might metabolize certain drugs too fast or too slow. And if you metabolize certain drugs too fast, it might be that your body breaks it down so much you can't get a lot of benefit. And if it's too slow, you might be really sensitive to those medications.

Paul: Oh, okay.

Dr. Puri: So that might make your, inform some of your psychiatrist's, um, choices a little bit.

Paul: Why would he have not suggested that yet? Because I've been hearing about this from so many people, and I always wondered does he, is he just not that hands on?

Dr. Puri: I don't know. I don’t know your psychiatrist. I mean, the, the, the sales and advertising of it is a little ahead of the science, so it's advertised as being more helpful than it is. And, you get a lot of salesmen showing up at your of-, at your office door, trying to tell you about, whatever the next technology is. So he might just be waiting. But it, it's, I think there are, there are some benefits as long as you're, again, not taking it as the Holy Grail that's gonna solve everything. Yeah.

Paul: Thank you for that.

Dr. Puri: Sure.

Paul: I love this question. Is madness and genius linked?

Dr. Puri: (Laughs)

Paul: Does mental illness make people better artists? What's your take?

Dr. Puri: I think indirectly, yes. But I think it does, like the … I think the idea that madness and like, you have to be mad in order to be a genius or in order to be good creatively, is misguided. There was this, um, this psychiatrist that I had trained under. His name's Hagop Akiskal, and he's, um he's retired or in his—what do they call it—emeritus years now. And he is an expert in bipolar and some of his claims are ridiculous. Like anyone who wears red shoes on a regular basis probably has some bipolar genes in them. And anyone's who's been married more than three times and all this other stuff. But, he did go and research, um, artists all over the world and interviewed jazz musicians and painters and dancers, and he asked them this question. And, uh, um, people with all kinds of different mental illness on top of that, including, uh, substance abuse issues, addictions. And, um, he asked them, "Do you think that this actually helps?" And the, and the solu-, the answer that he got over and over again is that people were good artists in spite of their mental illness, not because of it. It's something that they struggled against.

Paul: I, I would agree. And I believe it's a total myth that, you know, drugs or alcohol make you more, uh, creative. It may make you more comfortable, uh, you know, in the afternoon with your, you know, dis-, get a couple of drinks, you might be more comfortable with the idea of what you're doing and where you are in your life.

Dr. Puri: Totally.

Paul: But, uh, I think it limits the pallet you can draw from because, in my mind, untreated alcoholism and addictions and trauma, it kind of … it, like, you were talking about the analogy of, if you have a hammer, everything looks like a nail. And, for me, before I got help … the only emotion I was really … conversant in was anger. And that can work for comedy, but it can also make it really limited. I didn’t know how to be vulnerable—

Dr. Puri: Totally.

Paul: —on stage. And so, it really limits, uh … it limited me. And so, it always makes me a little … ANGRY, ironically, when, when somebody, you know, says … you know, "I don’t wanna get sober cuz it's gonna take my edge off."

Dr. Puri: Yeah. I mean, I think the only benefit, if I had to spin a benefit from, from mental illness, it's, um, for, for art, is that it, it go-, it puts you in touch with sort of the suffering of humanity. And that's a good reference point to draw from creatively, to do something that's, that's relevant to other people, and helping them understand their own suffering.

Paul: Yes. And, and, you will still have that perspective after you get help. You can feel better. You will not lose it. You will not lose the ability to be angry, uh, you know, when, when you get better. It's still there to draw upon. There's just more, uh, more colors, uh, that you can, uh, paint with, if you will. So, do we answer that, that … Do you feel like we answered that question?

Dr. Puri: I think we did. But if there's more, uh … Madness and gen-, yeah, I think that's the, the ex—I mean, there's some other things of like, you know, for example, drinking might make you a little more impulsive. So you might get something out that you're otherwise too shy to sort of let out. That might be an opportunity. And I'm sure there's plenty of stand-up comics who have done that. I've treated, you know, people who are strippers who have trouble, you know, they, they get, they become alcoholics because they are, get loaded with drinks before they go out on stage. Or people in the sex industry, also, it's … it's, you know, the occupational hazard.

Paul: Understandable, yeah.

Dr. Puri: But the, but the other of, um, you know, being manic or otherwise, gives you … gives people that energy that they can harness in their work sometimes. But I don’t think that that's what makes them a good artist. It just gets the ball rolling sometimes.

Paul: There's a lot of boring people with mania (both laugh).

Dr. Puri: God, that's depression—

Paul: A lot of people with mediocre ideas (both laugh). Being up for four days in a row. Anything else?

Dr. Puri: No, I don’t think so.

Paul: Dude, I'm SO glad, uh, we, we got in touch with each other. I … the door's open, if you ever wanna come back—

Dr. Puri: Oh, absolutely—

Paul: I'm sure I will, uh …

Dr. Puri: I live down, just down the 405; it's not far.

Paul: That would, uh, that would be awesome. And, go get some sleep. Paul has a three-week old—

Dr. Puri: Indeed.

Paul: And, um, thank you so much, man; I appreciate it. And we'll put the links to your stuff, uh, up under the, uh, the show notes.

Dr. Puri: Thanks, Paul. It's been my pleasure.

End of Interview

[01:28:07] Man, did I enjoy talking to him. I felt so good after our conversation. I was in a little bit of a funk. And then afterwards, I feel like I got so much off my, off my chest. Very easy guy to talk to. I bet he's an amazing, uh, amazing psychiatrist.

[01:28:23] Before we take it out with some interviews, uh, wanna give some, uh, some shout-outs. One of our sponsors for today is Madison Reed. Madison Reed is hair color reinvented, giving you gorgeous, salon-quality color, delivered to your door for less than 25 bucks (slaps table). I've gotten great feedback from listeners that have tried Madison Reed. They like the packaging, they love that there are no … you know, toxic chemicals in it, the smell is pleasant. It's multi-tonal, ammonia-free, and made with ingredients that you can feel good about. Go right now! Find your perfect shade from Madison Reed. Get an expert consultation, or take the color que-, queeze?! (Laughs) Take a color queeze; everybody's doing it (laughs)! Take the color quiz at madison-reed.com. You guys, the listeners, get 10 percent off, plus free shipping on your first color kit with code "mental". That's code "mental" at madison-reed.com. And, uh, as always, we will put the, the links to anything that we mention, uh, under the show notes for the episode.

[01:29:36] Today's episode is also sponsored by Third Love. Using millions of real women's measurements, Third Love designs its bras with breast size and shape in mind for an impeccable fit and incredible feel. Just answer a few simple questions from their Fit Finder® Quiz to find your perfect fit. And offers double the number of sizes that most brands offer: cups A through H, and bands up to 48. And with lightweight memory-foam cups, straps that won't slip, and tagless labels, you'll wanna wear these soft and breathable bras and underwear every day, especially new cotton T-shirt bras and underwear. My girlfriend, Christina, wears the, uh, the cotton bras, and she's loves them. She says that they're super comfortable, and I like how they look on her. And, thanks to the 100 percent fit guarantee, returns and exchanges are free and easy. So, Third Love knows there's a perfect bra for everyone. And right now, they're offering you guys 15 percent off your first order. So go to thirdlove.com/mental, and find your perfect fitting bra, and get 15 percent off your first purchase. That's thirdlove.com/mental for 15 percent off today.

[01:30:55] Let's get to some surveys. Got some struggle in a sentence surveys. This one is filled out by a woman who calls herself, "Dr. Google's Best Patient." And, uh, her biggest struggle in anxiety. And she writes, "I'm so sick of fearing a cancer diagnosis, that I'm starting to wish I just had cancer instead of anxiety so that I could get on with the healing." One of the reasons I wanna read this, in, in addition to relating, uh, is that anxiety can be dealt with, you know? It's not something that we're stuck for the rest of life. There are a TON of great tools to deal with anxiety. And … why, why spend the rest of your life … in a prison that you might have the key to? That almost made me sick, that little (laughs), that little analogy. Not only the words that I chose, the inflection that I used in it. Ugh!

[01:31:58] This is filled out by "Jules." And she writes, about her depression, "Emotional exhaustion, relieved only by isolation." Holy fuck, is that spot on! About her anxiety: "Nothing is ever good enough or right, and somebody is always seeing every mistake you make. Inherently, you never deserve anything good, and everything that's coming to you will only be 10 percent good, with the other 90 percent being awful or wrong." OH my god! Ah, these are so spot on, at least in my experience. (Sighs) Thank you for that. Thank you for that. I dunno—I can't imagine what this show would be without you guys filling out the surveys. So if you haven’t don’t so yet, go to the web site. There's about a dozen different surveys that. That we have. And they're all anonymous. We don’t even have, take the URL, or the IP address of the people filling them out. So you can share anything and be assured that it is completely, completely anonymous.

[01:33:05] This is a babysitter survey filled out by a woman who calls herself "Kitty." And she writes, "I was 17, babysitting a 12-year-old from down the street. Cute kid, single mom. I was on his bed playing a video game with him. It was my turn. I laid belly down with the remote in my hand. He climbed on top of me, with his crotch directly on my butt. He was playfully grabbing the remote. Next thing, I feel his erection. He starts dry humping me. It felt really good, so I let him continue on, while I played the video game pretending not to notice what he was doing. I pushed him off of me, knowing it was wrong, but didn’t acknowledge it or say anything to him. When I went to the bathroom, my panties were dripping wet. I was really turned on, yet also felt shame after. I remember getting nervous his mom might find out." Did you ever tell anyone? "No." Remembering these things, what feelings come up? "Sexual excitement, taboo, and fear." Do you feel any damage was done? "It was innocent and natural, or somewhere in between. Innocent, I suppose." And she was also raised in a, uh, chaotic environment and, uh, has been the victim of sexual abuse and never reported it. Thank you for sharing that. One of the things, uh, I've learned doing this podcast is, every, everything is like on a continuum, and nothing is black and white, cut and dried, you know, this is wrong, that's right. And, um, I, I appreciate your, your honesty in, in sharing that.

[01:34:49] This is a struggle in a sentence filled out by a woman who calls herself "Bonkers." And, about her depression, she writes, "Not sure what type of depression; it has morphed over the years. It’s like looking at the world through gray-colored glasses." About her compulsive eating: "I stuff myself like there's a food shortage and need to get as many calories as I can in a short time." Oh my god, did I relate to that one. It's … I will sometimes go for that second or third ice cream sandwich or whatever it is, like somebody's gonna burst through the door and take it away from me. It, it, there's almost like a panic in it. And, even though I'm aware of it when I'm doing it, there, it's like somebody's pushing me, and, and I don’t want to say, "Hey! What am I feeling? Is there, is there another way that I can deal with this?" There's a part of me that feels like if I had a dog that I could cuddle with at night, that I wouldn’t have this feeling. Because the, this … compulsively eating sweets right before I go to bed really started, uh, after my marriage broke up and I started living on my own. We're so complicated. About her codependency: "I constantly fear and envision that my loved ones could die at any moment." About living with an abuser: "My father would spank us until our butts were black and blue and then forced us to say we loved him afterward. As a kid, it was a sad feeling." How could you not, how could you not feel sad? That's just so … you know, at the very least, DAD should say, "I love you." Snapshot from her life: "I was anorexic as a teenager. My mom, who lived with a judgmental mother as well, exhibited these same things to her kids. She came up behind me, put her hands on my hips and sang, 'It looks like it's time to stop eating!'" I love, too, how some people think that if you sing it in a (laughs) happy, melodic … way, that it's (laughs) … (In melodic tone) "You look disgusting in the nude!" (Laughs) "Well, I was gonna be offended, but YOU sang that in such a lullaby tone! Let's just … let's just do a two-person shame-filled conga line." Thank you for that.

[01:37:45] This is a struggle in a sentence filled out by a, a … girl who is in her … early teens. She's either be-, she's between 10 and 15 years old, and she calls herself "Emma." And a snapshot from her life, she writes, "My mom doesn’t understand. Anytime I try to tell her I need help, she brushes it off and says I'm saying it because it's 'cool to be depressed.' If she would listen to my cries, she would understand how much I hurt every single day." That is so heartbreaking to read. You know, it's hard enough that somebody wants to get help, and says they want to get help. I mean, that is a victory in itself. But then, to have the person who is supposed to be guiding them and protecting them and helping them, say, "No" … and insult what they're saying on top of it. Ugh! You know, if you're listening, Emma, maybe open up to a school counselor. I dunno. I don’t, I'm not, I'm not a therapist. BUT, I am the speaker of the house. Did I not mention that? That I recently got into politics about a week ago, and somehow I have elevated myself to being the speaker of the house. I think I might be. I'm not sure. I was playing a video game and I was very sleepy.

[01:39:21] This is a babysitter survey filled out by a guy who calls himself "Moses The Vampire Slayer." And he writes, "When I was a young teenager, I used to babysit my cousins. When they were sleeping, I would go into my aunt's room and try on her underwear, smell them, masturbate with them on, snoop around to find her toys and imagine her using them." Well, actu-, I, I believe … yes, yes. He is, uh, he is male. And he is, uh, straight and in his, uh, 20s. I couldn’t remember; there's another survey, I, babysitter, I have where the person identifies as a gender-fluid. "I've never told anyone about this. To be honest, I've never thought much of it. I felt extremely guilty and disgusting at the time, but that wasn’t a far departure to my daily life. I know I felt absolutely intoxicated while doing that and it was much more powerful than the guilt." Remembering these things, what feelings come up? "I suppose all of the above: sadness, anger, regret, sexual excitement, fondness, longing, shame, etcetera. I don’t feel much shame now because I never got caught and feel more like it was out of my control. To this day, I do the same things at my friend's house with her mom's underwear when no one is home. The almost getting caught part is unbelievably thrilling to this former shoplifter." Do you feel any damage was done? "It's an existing issue, but no one else knows, so I haven’t hurt anyone, I don't think." You know, as, as I was reading this, I was thinking, there is nothing wrong with the feelings and urges that you're having. But the way that you're expressing them might wind up hurting someone. You know, people come home unexpectedly sometimes. And that might be traumatizing for somebody to walk in. In fact, I KNOW it would be traumatizing for somebody to walk in and see that; they would feel, they would feel violated. And, you know, you, you owe it to yourself, you know, even if you put the other side, aside, the other person's needs for a moment. It's not kind to yourself to … engage in something that is, is shaming you. And it's totally understandable that you would want to find a way to get those feelings out of you. But there, there can be better ways, and maybe attending a support group or, um, talking to a sex therapist might be a way. Because it's always, you know, there's always more under the surface than we know. And sometimes it might be something that, um … can take the intensity of something to a level where … it doesn’t have to be acted out in a way that is detrimental to ourselves or other people, you know. And I'm not saying that the, the, the fantasy of it is something that should be erased from you. But, you know, it might be something that, that you could, um, share with a, a trusting partner and feel seen in that way. That could be exciting. But, I'm sure there is a lot of complicated stuff, uh, under, underneath that. And, uh, that can often be the pathway to healing, is taking the very things that causes shame and anxiety; opening up to trusted people about them; letting out the anger, the tears, or the other stuff that we sexualize. You know, sex isn't bad, but when, when we use it to avoid life or to turn negative feelings into sexual acts, that's … problematic and we deserve better. Sending you some love, man.

[01:43:30] This is a struggle in a sentence filled out by a woman who calls (laughs) herself "All My Issues Are Fake Or My Fault." You are my new best friend. And this is a painful one to read. She's, she's young; she is, uh, between 16 and 19, and she writes, "Drunkenly asking my friend why her boyfriend doesn’t think I'm pretty. Him raping me later that night. Now I'm left simultaneously wondering if he enjoyed it and slut-shaming myself." And we've covered this topic many times. And, and it's—was not necessarily, you know, the exact detail of this—but the taking on the guilt of somebody else abusing us and having complicated feelings about it. And that’s totally normal for our brain to do that. It's a way of trying to protect us. But, you have nothing to be ashamed of. Saying that you … you know, are intrigued by somebody or you wonder if they think that you're pretty is a totally innocent human thing to think or even say. You know, let, let's take this to 