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Dr. K: Why dopamine kills love and modern life feels empty

A Harvard psychiatrist on how dopamine, devices, and trauma erode love and motivation. Real change starts with awareness, not goals or willpower.

Dr. K (Alok Kanojia)guestSteven Bartletthost
Sep 30, 20242h 37mWatch on YouTube ↗

EVERY SPOKEN WORD

  1. 0:00 – 3:30

    What Does Dr K Do?

    1. KK

      This is the whole problem that everyone makes. Any time we have a problem, the first thing that we do is we try to jump to a solution. If I'm unhappy in life, I need to make more money. If I'm struggling with dating, I need to be sexier. It's a concept that I call toxic fuel, and that will never work because if I give you a glass of water, and then I piss in it, and then I add sugar, it doesn't remove the piss, because no amount of building something good will remove something bad. In order to change behavior, what you need to do is-

    2. SB

      Say (censored) to you. Dr. K is the Harvard-trained psychiatrist and former monk specializing in modern mental health-

    3. KK

      Blending neuroscience with real-life wisdom to help millions of people unlock their true potential. There's a loneliness epidemic. Social anxiety is increasing, and falling in love seems harder, but we have all the answers. The problem is that everyone is doing the wrong things now. First of all, talking about our problems can absolutely make things worse because there's a particular way we have to talk, but we're not taught how to do that. The second thing is that we are struggling to fall in love, and that's actually because we're exhausting our dopamine through things like devices. Yeah. People don't realize. And then the rise in social anxiety is because everyone is texting. So the parts of our brain that reassure us in social situations are starting to rust. So there are core things that we have to start doing. So the first is that-

    4. SB

      Dr. K, why don't people achieve their goals?

    5. KK

      Now, this is really interesting. There are two kinds of people in life. There are people who are like, "I'm gonna advance towards my goals," and then there are the rest of us, who are like, "You know, I'm trying to be like these people who are productive, but I'm gonna do nothing." And trauma is the big difference here.

    6. SB

      Really?

    7. KK

      Yeah. And this is what tends to happen. So-

    8. SB

      Question. If you could sit at a table with any four guests from The Diary of a CEO, who would you choose? Here's a challenge for the entire Diary of a CEO community. If we hit 10 million subscribers by the end of 2024, you will get to pick four guests for your dream conversation, and you can make it weird or you can make it wonderful. And here is the best part. 3,000 of you that subscribe will be invited to join this conversation live, in person, and for free. Subscribe now, and let's make this happen together. (instrumental music) Dr. K, if you had to summarize what you do for people, professionally, how would you summarize it?

    9. KK

      I help them understand themselves.

    10. SB

      And now expand for me-

    11. KK

      (laughs)

    12. SB

      ... what that means. (laughs)

    13. KK

      Yeah. So, so here's the thing, right? So there are two great traditions that have taught us about how humans work. One tradition is spirituality, which we've had for a couple thousand years. The other tradition is science, which we've seen an explosion of, especially in the fields of like neuroscience and psychiatry over the last 20 years. And so these are the two places that human beings learn about themselves. So when I work with someone, what I try to do is draw on both of those traditions, and I especially focus on the area of spirituality that has scientific verification and teach people like how they work. So in the same way that if we think about like, you know, when you buy a car, you have like a manual that is in the glove b- compartment that tells you what everything is and how it works. The problem is that in life, like we don't have that manual for ourselves, but we do have these two great traditions that can teach us so much about this stuff. And so what I try to do is basically translate those two traditions to an individual, the situation they face, the challenges they face, and the goals that they want to achieve.

  2. 3:30 – 6:08

    Dr K's Background

    1. KK

    2. SB

      And what experiences and what are you drawing on to arrive at the conclusions and the support that you give people? What have you done in your life? What experiences have you had? How many patients have you seen?

    3. KK

      The first experience that I draw on is my own, so I struggled a lot in high school, college, failed out of college, was addicted to video games, had no idea what I wanted to do with my life. Then I went to India at the age of 21 to find myself, and I found myself. I spent about seven years studying to become a monk. Um, so that was very, very formative in helping me see how human beings work. But then I was really like kinda skeptical a lot, of a lot of that stuff, so I started doing neuroscience research for a couple years. I had a couple of spiritual experiences, and I was super curious. Like, what is happening in the brain? I'm starting to change as a human being, but like that has to be at a neuroscientific level as well. Then I ended up going to medical school. So I, I was thinking about how can I learn the most about human beings? So considered doing like a PhD in neuroscience, but ul- ultimately went the medical route because, you know, the brain exists within the body. Um, became a, a doctor. Um, became a psychiatrist 'cause the mind was my favorite organ. Trained at Harvard Medical School where I was faculty for a few years, and then, you know, over the last couple of years have focused a lot on addiction psychiatry and also like performance-based stuff. So once we understand, okay, uh, I once had a patient, for example, who came in after about two and a half years and was like, "Dr. K, I'm still depressed." And then I assessed them, right? So when, when someone has like a mood disorder, they have like depression which causes them problems in their professional life, causes them problems in their personal life, and I ask them, "Are you having problems in your professional life?" And they're like, "No." "Are you having problems in your personal life?" They're like, "No, but I still feel the same." And that's when I told them, I said, "Mike, you're not depressed. You're unhappy, and there's a difference."

    4. SB

      (laughs)

    5. KK

      And then he turned to me and he's like, "Well, what do we do about that?" And I was like, "I don't know, but let's see if we can figure it out." So really the work that I do is on that whole continuum of pathology where something within you is broken, but then going from -100 to 0 is what medicine does. Right? A doctor is not going to help you become healthy. They are going to remove sickness. And then from 0 to positive 100 is when we really draw on things like spiritual traditions, because meditation, if you look at like the teachings of the Buddha, the Buddha was not using mindfulness to treat social anxiety disorder. He was using mindfulness to attain enlightenment, to attain the heights of human perfection. And so that whole continuum is where I work.

  3. 6:08 – 8:46

    The TikTok-ification Of Mental Health

    1. SB

      It's so interesting, you mention there the case of Mike. He came to you and he had self-diagnosed his situation, and I'm not surprised frankly, because of the world we live in now, there's a lot of people calling a lot of things depression, anxiety-

    2. KK

      Mm-hmm.

    3. SB

      ... we kind of use that word quite flippantly when we go through different moods and situations. How do you think the whole mental health and psychology sort of revolution we've seen over the last 10 years, and the TikTok efication of mental health has led us astray?

    4. KK

      So, I think, um, there are some things that are good about it and some things that are problematic. So I think the really good thing about it is that there is a lot more awareness of mental health. So we now realize, so what I used to see about 10 years ago, right, w- when I was seeing patients is like people would come in and they would not realize that this is a problem that can be fixed. So people would come into my office and they'd say, "I'm a loser. Other people are able to get out of bed, they're able to have discipline, they're- they're productive, they're happy, but I'm a loser, I have no willpower, I'm pathetic, I can't get out of bed." People didn't realize that that was depression. I've worked with so many people who have adult diagnosis of ADHD, which, uh, many years ago, you couldn't even be diagnosed as an adult. ADHD had to be something that was kind of like a pediatric diagnosis. So now I think the- the best thing is that people recognize that, okay, there- maybe this- maybe what is wrong with me is not like me, I'm not fundamentally broken in some way, but there is some kind of process going on in my brain, in my mind, that is responsible for my problems, and if I fix that, then I can be well. Now on the flip side, what started to happen is no one on the internet understands the concept of differential diagnosis. So everyone is like, "Oh, I have a TikTok that if this-" If you sometimes forget your keys, you have ADHD. If you are happy in the morning and sad- if you have a kid who throws temper tantrums, they're bipolar. So everyone is taking a symptom and jumping- jumping to a diagnosis. Whereas like literally half of what we learn in med school and what we do as doctors i- uh, everyone thinks it's about treatment. It's about differential diagnosis. It's about understanding that if you lose your keys, there are all kinds of reasons for that. If you have difficulty getting out of bed, maybe it's depression, maybe it's trauma, maybe it's ADHD, maybe it's anemia, maybe it's obstructive sleep apnea. And so the biggest problem is that everyone is jumping to a conclusion on the internet, which then causes problems because that may not be the right conclusion.

  4. 8:46 – 11:30

    Dr K On Men's Mental Health

    1. SB

      We spoke last time about men.

    2. KK

      Yeah.

    3. SB

      Um, and there was a lot of discussion around just this- this wild difference between how men are feeling in the world and how they're being understood in the world versus women. We were- before we started recording, you said your thoughts have developed even further since we last spoke on that.

    4. KK

      Yeah, so I think, um, there are a couple things to understand. So the first is that if you're a man who's struggling in the world today, we as men assume that if we're struggling, we need to fix something on the outside, right? So if I am not making enough money, the answer to that is to get some additional certification or become more produ- produ- productive, maybe use some kind of supplement. So that men are fundamentally different because we are conditioned, and this could be somewhat biological, but it's certainly societal, to solve our problems externally. But the one overwhelming thing that I've learned about men is that, you know, if you're a man who wants to get better, 90% of what you need to do is not outside of you, it's actually inside of you. But this is not where men look, right? We- we think like, okay, I need to get this kind of car, or I need to get sexier, or I need to be able to bench twice as much. So we always look to things outside of ourselves, but in the majority of the work that I've done with men, really the work that they n- they need to do is internal, but we're not taught how to do that. There's a really great example of this. So if you look at the top 1% of earners versus the top 10%, so the top 10% of earners on the planet have a higher IQ than the top 1%. The people who actually make the most money have a lower IQ than the- the quartile right underneath them, and the big difference there is that people in the top 1% have a h- very high EQ. So we grossly underestimate the capacity to control one's self, and if you really want to achieve the most in life, that's what you really need to focus on. And the more that I work with men, I- this is basically what I teach them, and the outcomes that I see are amazing, right? We're talking like on- on the worst end, you know, I worked with a 32-year-old guy who started using drugs when he was 13 years old, poly substance use, mostly opiates and heroin. Uh, so at the age of 32, no job, um, not living on the street, crashing with his girlfriend, and then within the span of four years, this guy became a therapist himself, had a stable income, got married, and published his first dystopian fiction novel. So we're talking about a four-year s- span of like being literally a heroin addict to, you know, being a published author and like having a stable, fulfilling relationship and job, and all of that work is like internal. It's about understanding the way that you work, understanding the way that your brain works, and learning how to control yourself.

  5. 11:30 – 14:11

    Women's Mental Health Issues

    1. KK

    2. SB

      Is that the same for women though? Because I've got women friends who are same age that are really, really struggling, have- they're not doing heroin or drugs or anything like that, but their- the objective sort of situation of their life is they're so far from all of their goals, no partner, feeling lonely, unhealthy, and seemingly out of control.

    3. KK

      Yeah, so I've worked with plenty of women for whom that is a problem as well, but I think if we look at on average, right? So remember that like within any population of men and women, there's going to be more variance between women than there is between men and women.

    4. SB

      Sure.

    5. KK

      So I- uh, absolutely the case for a lot of women. I think the big difference is that a lot of the...... tools that we have were sort of designed with women in mind. A great example of this is like psychotherapy or talk therapy. So if you look at the gold standard of how we process our emotions, it's verbally. Now, studies actually show that if you look at, like, estrogen, estrogen has a very, very interesting effect on awareness of your m- internal emotional state and the ability to articulate your internal emotional state. So as estrogen rises, you literally feel emotions more. So this is why men- uh, women will have, uh, problems like premenstrual dysphoric disorder, PMS, you know, d- when there are these hormonal fluctuations, it's not that we should treat them poorly or anything like that, but they actually literally feel emotions in a more intense way because of the fluctuations in their estrogen level. So... (laughs) I know it's-

    6. SB

      (laughs)

    7. KK

      It's like- like that- that's, like, scientific fact, it's not like-

    8. SB

      Yeah.

    9. KK

      ... it- it's not good or bad, right? It- it- it could, it- it's just something that's a fact. So the higher your estrogen is, the more emotional awareness you'll have. So there are some biological factors and then there's also, like, if you look at the way that women are conditioned, they're conditioned to be good listeners, to provide emotional support for the- the men around them. And so they- they use, they're a lot better with, at verbal fluency, like, that's not even related to emotions. You can look at, you know, boys and girls who are eight years old, girls will have a higher level of verbal fluency than boys do at the age of eight. So there are a lot of things in our mental health system that rely on being, um, aware of your emotions, being able to articulate your emotions, using words to process your emotions. And so absolutely they can learn more about themselves, I think 99% of human beings on the planet, myself included, can benefit from learning more about themselves. But I think that women have somewhat of a leg up, which is why women are 70% of patients who seek psychotherapy, right? Even 70% of therapists are women. So there- there's, like, a- a very clear gender gap in the field of mental health.

    10. SB

      So going back up the

  6. 14:11 – 17:30

    How To Understand Yourself

    1. SB

      river then, so the crux of the issue is not being able to control oneself, essentially.

    2. KK

      Uh, I would, control is even, uh, a step too far. Uh, the crux of the issue is not understanding yourself, right? Good diagnosis precedes good treatment, control comes later.

    3. SB

      Okay. So first you need to understand oneself.

    4. KK

      Absolutely.

    5. SB

      And how do I go about understanding oneself? And in the case of the gentleman you mentioned as the case study there, how did he go about understanding himself as a heroin addict who had polysubstance abuse to this successful person?

    6. KK

      So I think the best place to start, I know it's gonna sound kinda simple, but is to look at yourself. So what a lot of us do is any time we have a problem, the first thing that we do is we try to jump to a solution. So if I'm unhappy in life, I need to make more money, if I'm struggling with dating, I need to get a better job or be sexier or whatever, so we tend to jump to solutions. So I think the first thing that you've gotta do is slow a little bit down and look at yourself. And when you look at yourself, there are a couple of things that I think a lot of people really miss. The first is what drives a lot of their behaviors. So we focus so much on fixing a behavior, like using heroin, for example, right? But we don't really ask ourselves, "Why am I using heroin in the first place? Where does the drive for using heroin come from?" And that is the key question, right? So it's not about how you need to change, it's about, "Why am I the way that I am?" And this is where people make such a simple, simple mistake. I'd say the majority of people that I talk to when they look at themselves, they don't actually, they're not critically thinking. What they actually do is they'll make some kind of conclusion, "I'm lazy." So, like, think about what that means. Like, laziness, first of all, is, like, not a thing. There is not, like, a laziness circuit in the brain, you can't measure laziness. Laziness is a lazy way of looking at laziness. If we look at human behavior, motivation, discipline, things like follow-through, willpower, these are all discrete functions within our brain and then we just say, "Oh, we're lazy," but which one of those things is lacking? So as we understand, okay, why are we lazy, what does that really mean, where is my motivation coming from, what is the status of my willpower, um, y- you know, as we explore these kinds of things, that's when we see really what the answer is. And the really cool thing is if you look at a lot of research on things like, we use this technique called motivational interviewing where in order to change behavior, you don't need to convince anyone of anything, you need to help people understand things. And once a human being understands something themselves, they will automatically change behavior, right? If I touch, if I tell you, "Hey, Steven, don't touch that- that pan, it's hot," and you touch the pan and you burn yourself, you won't listen to me.

    7. SB

      Mm-hmm.

    8. KK

      But the moment that you touch it and you get burned, suddenly your behavior will change on its own. We learn through experience, but if you look at the way that most people try to solve their problems, it's not through experience, it's through information. "Oh, I have a problem, let me buy a book. I have a problem, let me listen to a podcast, let me watch a v- YouTube video." And this is what we see, right? There are literally millions, if not tens of millions or hundreds of peoples- uh, millions of people out there who are gaining a lot of information about change, but aren't actually changing. It's wild.

  7. 17:30 – 18:54

    Are We Addicted To Self-Development?

    1. KK

    2. SB

      Why is that? There's a, there's a qu- quite a complex psychological thing, because there's a certain type of person who is, like, a self-development junkie, but they never self-develop.

    3. KK

      Yeah.

    4. SB

      (laughs) They go to all the conferences, they watch all the videos, they've got, you know, they can, they- they know all the words, but they- they don't actually put anything into action.

    5. KK

      Yeah, so there's- there's a lot of subtlety, but the craziest thing is that, see, any time we engage in some kind of self-help kind of thing, it actually is a coping mechanism to deal with some negativity within us. So let's say that I feel like I'm lazy, so then my mind looks- looks at me and says, "Okay, I'm lazy, I need to do something about it." And then it's really tricky, right? Because y- you have, your brain sees two options; one is that I can do something hard or the other is I can do something easy. And we have to understand this, the brain has evolved to be lazy.... the brain has evolved, laziness is efficiency. We want to get the most yield out of the smallest investment. So then what happens is our brain is like, "Okay, I could like go to the gym or I could watch a video about working out. And if I watch a video about working out, I will be more efficient when I go to the gym." There are all kinds of scams that we run in our mind to actually activate parts of our brain that make us feel like we're making progress without actually making progress. That's how you become a self-develop- junkie or self-help

  8. 18:54 – 23:32

    Does Talking About Problems Make Them Worse?

    1. KK

      junkie.

    2. SB

      On this point of psychotherapy not being perfectly designed for men, I was watching a clip before you arrived, um, where a lady who's an author of a, a book that's just come out said that talking about our problems makes them worse. And I was wondering if that's true.

    3. KK

      It can be. So I think this is a big problem, is that talking about our problems can absolutely make things worse. So let's understand a couple of things. So the first is that there's this assumption that talking about your problems makes them better, but there are actually very specific things that need to happen in order for talking about your problems to make things better. The most important thing is something called an emotional catharsis. So this is where you have like a breakthrough in therapy, so there's like this moment where there's a lot of dormant stuff, and Freud even described this, where you have this moment of very, very intense emotion that is relatively new, or I mean, it's kind of dormant, but it's not like venting. We'll get to venting in a second. And so there, there's a particular way we have to talk about problems that triggers emotional catharsis. Emotional catharsis creates something ca- like a breakthrough, so this is also like an experience. So this is not just talking about my problems, this is experiencing my problems in a different way, so it's kind of like touching the hot pan.

    4. SB

      Mm-hmm.

    5. KK

      Usually it's kind of painful, so when we're doing like work with a trauma survivor, we don't wanna just talk about the trauma, we wanna sort of dig into it a little bit more and have an emotionally healing experience. Um, the, the real problem is that sometimes what'll happen is people will just talk about their problems, so they'll use therapy as essentially like a venting session, and venting, if we look at kind of the neuroscience of venting, venting is useful for reducing our negative emotion in the moment, but this is the really tricky thing. If we kinda think about it, you know, like I'll, I'll ask you, maybe you know this, maybe you don't, but why do we have negative emotions, Steven?

    6. SB

      It's a signal.

    7. KK

      For what?

    8. SB

      It d- I, I would, I would guess that it's a, depends on the negative emotion, but I guess it's a signal that is there to help us connect with people? S-

    9. KK

      Oh, okay, so let's, uh, I think it can be, sure.

    10. SB

      Like, like lon- loneliness.

    11. KK

      Loneliness is a great example-

    12. SB

      Yeah.

    13. KK

      ... of a signal that's designed to connect with people. What about something like anger or fear? Why do we have fear?

    14. SB

      To warn us against i- impending danger?

    15. KK

      Absolutely, right? So if I'm like running through the jungle, and I see a tiger, and I have fear, w- fear gives us information and what else does it do?

    16. SB

      Gives us e- physiological energy and release-

    17. KK

      Very good.

    18. SB

      ... adrenaline.

    19. KK

      Absolutely, for what purpose?

    20. SB

      T- to flee.

    21. KK

      Absolutely. So this is a big thing that people don't understand, the primary motivator for change is actually negative energy and negative emotion, so this is the problem with venting. If you vent and get rid of all of your negative emotional energy, the drive to change will disappear. So if we kind of think about it, what motivates you the most? It's actually negative emotion, and you can literally look at the, like the neuroanatomy of things like the amygdala, so the amygdala is very close to the hippocampus, which is where learning and memory happen, so we actually learn the most through negative emotions. So if I, if I'm, if I've been happily married for 15 years and there's infidelity, right? One case of infidelity, the negative emotion from that one case of infidelity can drastically motivate me. So one of the biggest problems that I see is that we try to get rid of our negative emotions, and in doing so, we actually hamstring our motivational capability.

    22. SB

      Mm.

    23. KK

      So the, I've seen this a lot where people will come in and they'll go through like what they think therapy is, which is like... Actually same, same guy, Mike, came in and he'd like kinda talk about his problems, and I was like, "Bro," I was like, "Mike, is this helping?" So I was still a trainee at the time, so I, he'd been seeing me for about six, eight months, and I was like, "You come in here and you kind of talk about your problems and, but like you're, you don't seem to be getting better." (laughs) I didn't know how to do therapy at the time. And then he's like, "Isn't that what I'm supposed to do is come in and talk about my problems?" I was like, "Yeah, I think so."

    24. SB

      (laughs)

    25. KK

      I was a second year psychiatry resident, but I was like, "Is this helping?" He's like, "No." And I was like, "Okay, we gotta do something else then." Coming in and just venting is not actually psychotherapy. That's not like, so talking about your problems, reducing your negative emotional energy can actually keep you stuck, and if you pay attention to people in your life, you'll notice that there are some people who just like bitch all the time, right? They're just like constantly complaining, they're constantly venting, and they don't actually do anything to change their life.

    26. SB

      It's interesting

  9. 23:32 – 25:19

    How Society Promotes Deficiencies

    1. SB

      because with the advent of social media, you now get reinforced by deficiency promotion, I call it. There's kinda these two types of ways that you can build an audience or a personal brand. One of them is idea promotion, "These are my, my ideas, this is how I think about something," and the other that's emerged which is really interesting and a little bit toxic is like deficiency promotion, "These are all the ways that I'm broken. These are all the ways that I'm inadequate." And you can build an entire audience around that which resonate with your inadequacies, and then that inadequacy that you, uh, you get held there, because that's the speaking appointments you get booked to do, that's what your book's about. Your book is about all the ways you're broken and flawed, all the stuff you've been through, and then you, it becomes your, your profession, and I just, I watched that play out so many times, I'm like, I talk to my friends about it, I'm like, "Be careful of deficiency promotion 'cause you might acc- you might accidentally build a revenue stream there and then you're fucked." (laughs)

    2. KK

      Yeah, absolutely. I, I, I think we, what we see is that there's a lot of empathic resonance, right? So, and I think in some ways that's a good thing, so I, I think when, when I'm a broken human being-There are a lot of broken other, uh, human beings. The problem is when you're a broken human being, you don't feel like you're a part of society. You're, like, broken and everyone else is out there living their lives and being positive. And so, it can feel so relieving-

    3. SB

      Mm-hmm.

    4. KK

      ... to connect with someone else, to realize, "Oh my God, I'm not alone."

    5. SB

      Mm-hmm.

    6. KK

      Right? So I think with some of these deficiency promotion, and we see that a lot in, like, psychotherapy groups on trauma and stuff like that, where there's a lot of, like, trauma bonding and there's also some weird ego there with, like, "I'm more broken than you and my trauma's worse than you," a lot of toxic comparison. So there's a lot of stuff that can kind of go awry. But I, I think it, there's absolutely a reason why that's a way that you can build your brand, because there are a lot of people out there who feel broken-

    7. SB

      Mm-hmm.

    8. KK

      ... and feel alone.

    9. SB

      Mm-hmm.

    10. KK

      And I'd rather be broken and with someone-

    11. SB

      Yeah.

    12. KK

      ... than broken and alone.

  10. 25:19 – 27:55

    The Role Of Dopamine In Happiness

    1. KK

    2. SB

      It's all about belonging, at the end of the day.

    3. KK

      Yeah.

    4. SB

      All of these things are about, you know, feeling like you belong.

    5. KK

      Absolutely.

    6. SB

      What role does dopamine play in all of this? Because we, we talked at the start about taking back control, but much of the reason, as I learned from Andrew Huberman that it's hard to gain control is because many of us are in this sort of dopamine roller coaster in our lives.

    7. KK

      Yeah, so I, I think, uh, dopamine plays an important role, but the one thing that I've really come to appreciate is that how little of a role it plays. So everyone is, like, hung up on dopamine. But dopamine, first of all, is a neurotransmitter, right? So dopamine is also, like, deals with things like smooth movement, so my ability to go like this is governed by dopamine.

    8. SB

      You, well, waving your arm, um, yeah.

    9. KK

      Yeah. J- just, like, so, so, like, a- anytime you have a smooth motion, so if we look at something like Parkinson's disease, Parkinson's disease is a deficiency of dopamine. So there, there are all kinds of things that dopamine does. I'd say dopamine is like a letter in the alphabet for the brain. We use it in all kinds of circuits to create all kinds of behaviors. So dopamine's absolutely important, we'll talk about it, but I think that there's, uh, almost, like, too much of an emphasis on dopamine, and we oversimplify the problem when we focus too much on dopamine. I'll give you a really simple example of that. So one is, i- in my clinical experience, it's almost like dopamine and serotonin have an inverse relationship. So dopamine is what gives us a sense of pleasure. Dopamine also gives us behavioral reinforcement. But dopamine gives us pleasure, but will not give us contentment. So I have, I've had plenty of patients who chase dopamine, right? And we know that, you know, partying a lot, using a lot of drugs, having high adrenaline activities that all activate your dopamine system don't usually leave people feeling fulfilled and contented at the end of it. I've had plenty of millionaire playboys in my practice who, like, tried that to find happiness and maximize the pleasure in their life, and it doesn't work. It's never going to work. And the, the problem with that is that our brain has this principle of tolerance, so the more that you activate your dopaminergic system, the more tolerance you'll develop to it. This is why people need higher doses of drugs to achieve the same goal. This is why people, when you first play a video game, it's a lot of fun, but hour five, six, seven, eight, it becomes less and less fun. And then you have old gamers like myself who are still chasing the beauty and the high of the games that we used to play when we were kids.

    10. SB

      (laughs)

    11. KK

      So dopamine is almost like a scam neurotransmitter, because it offers you pleasure temporarily, but in an unsustainable way. On

  11. 27:55 – 29:32

    What Serotonin Really Does

    1. KK

      the flip side, we have serotonin. So serotonin is, is associated more with, like, contentment and peace. When we look at things like mood disorders, oftentimes what we're doing is improving the serotonin level, boosting the serotonin transmission in the brain. So peace and contentment is very different from pleasure, and these two things are almost inversely proportional, where... And it's really interesting, you can look at something like orgasm, which is a great example of this. So when you have an orgasm, you get a spurt of dopamine and you feel a ton of pleasure, and then after your orgasm, you actually get a rise in serotonin and you feel incredibly contented. The really interesting thing is that if your serotonin levels are high, you won't feel horny. So, like, what'll happen is, is we know this because when we give someone serotonergic medication, if we boost your serotonin transmission, one of the side effects is anorgasmia and, like, you can't have an orgasm, and then you also, like, aren't as sexually, you're not as thirsty, okay? So, like, this is one of the side effects. This is one of the, number one reason why my patients stop seroton- serotonergic medication has to do with the sexual side effects. But if we kind of think about the neurotransmitters involved, right? When we boost serotonin, and we also see this in monks who are, like, super content and peace and they're not very thirsty.

    2. SB

      (laughs)

    3. KK

      Right? So if we kind of think about it, peace and happiness and contentment in life comes from serotonin. Dopamine is, like, actually kind of the opposite, and monks aren't, like, thrill chasers, right? They're, they're able to develop this internal sense of contentment. So dopamine is absolutely a part of the problem. It's a very important part of the problem, but I think that it's, like, one piece in a, in a larger whole.

  12. 29:32 – 31:29

    Why Couples Get Comfortable And Have Less Sex

    1. KK

    2. SB

      Does this explain why people's sex lives t- typically get worse when they're comfortable and they're married?

    3. KK

      Absolutely. It's amazing how much science can tell us about the formation of relationships and falling in love that we just don't apply. So being attracted, falling in love, developing a relationship, these can discretely be described neuroscientifically. So being attracted actually starts in the thalamus. So the thalamus is our sensory organ of the brain. It's kind of the sensory gateway, so it interprets a lot of sensory stimuli. So when I first meet someone, I'm like, "Oh, they look really good," right? Looks really fantastic and I, I feel physically attracted to them, they smell great, their laugh is beautiful. So the initial stages of attraction are all about sensory input. Then what happens, now this is what's really interesting, falling in love is actually very dopaminergic. So this is one of the pr- reasons why I think we're seeing declining birth rates, this is why it's like if you talk to people nowadays, like, it's hard to fall in love. Everyone's dating, everyone's going out on dates and stuff, but, like, falling in love seems harder, and that's actually because of dopamine.So what happens is, if you look at the phase of falling in love, what that involves is a dopaminergic connection. And a great example of this is like if we're going to dinner, right? And I put my hand out, "Steven, hold my hand." And then we're, all we're doing, we're gazing into each other's eyes and we're just holding hands, and then we feel in love. And if you kinda think about people in love, like, it's like a dopaminergic high because that's literally what's going on. Now what you see, if you see, if you go out on, if you go to a restaurant and you people watch, which I love to do, what you'll see is two people on a date, both on their phones. So what's starting to happen is we're, like, developing this dopaminergic tolerance to things like devices. We're actually exhausting our dopamine, which is something that a lot of people don't understand. We run out of dopamine because we're using these devices, and then we have none left to fall in love. And then there are later things in the relationship that are more serotonergic in nature where it's not as much about pleasure, but it's about connection and all kinds of other

  13. 31:29 – 34:43

    How To Find Love

    1. KK

      stuff.

    2. SB

      So what does that mean if I'm single (laughs) and I'm looking to find love?

    3. KK

      So if you're looking to find love, there's, this is where we have to start with diagnosis before solutions, right? So the first question is, do you have trouble falling in love? Do you... 'Cause a lot of people who are single are like, "Oh, like, I don't feel anything," right? "I don't feel a connection." This is something that I've heard so much from our community, so much from patients anymore. "I just don't feel a connection. They seem great on paper, but I just don't feel a connection." There's actually neuroscience behind how to form a connection too. Um, but w- what, the first question that I ask people is, "Okay, do you feel like you just can't feel an emotional connection to people?" Then what you actually need to do is reduce your dopamine activation through things like cellphones, uh, we see this also with pornography where we know that pornography correlates with, like, unhappiness in relationships, and that's probably also, like, a dopaminergic effect as opposed to all the other things. There's a lot of stuff going on there. So play fewer video games, be on your phone less, and especially before you go on a date, you wanna, like, give your dopamine a chance to recharge. So go on a walk for about one hour before you go on a date, and then you're, literally your brain's capacity to engage in a date and fall in love and activate those feelings is gonna be higher. Also, I'd avoid as much dopaminergic activity as you can before the date, before you see that person, and the more that you do that, the easier it will be for you to actually fall in love.

    4. SB

      Am I right in thinking from what you said there that dopamine is required for us to initiate sex and w- want to have sex? Is that what you're saying?

    5. KK

      Yes and no. So dopamine is not actually required to initiate sex. And s- it's so fascinating. You can, like, and so I tried to figure this out, like where, where, how does love work in the brain? It's like every circuit is involved, every neurotransmitter is involved. Um, so dopamine is what gives us the pleasure of orgasm, but initiating sex also for men and women is somewhat different. So, like, you know, women will say like, "Oh, foreplay is really important," right? And dudes are like, "We don't need a whole lot of that." And so the question is why? So this is what's really interesting. So to develop an erection, you actually need activation of the parasympathetic nervous system, which is the part of our nervous system that involves rest and digest, which is why we have morning wood, right? So when dudes wake up in the morning, we have an erection. Why? We're not, like, horny in the morning. Well, I don't think so, anyway. Maybe, who knows? But, like, it, it, there's a physiology to it, right? Where when we're relaxed, we'll develop an erection because the, the development of an erection actually involves relaxation, and then the sexual act involves transition to the sympathetic nervous system. Now this is the fight and flight kind of response. So what we wanna do is, like, we wanna be relaxed first, and then we start getting sweaty, our heart rate increases, blood pressure increases, and this is the other thing that a lot of dudes don't understand because our, our s- nervous system is a little bit different, so when it comes to women, they have the same thing going on where they need activation of the parasympathetic nervous system before they get activation of the sympathetic nervous system. And then as you activate the parasympathetic nervous system with something like a massage or making out or some- something like that, some playfulness, relaxation, people really need to feel safe, then you can sort of graduate to the more explicit sympathetic nervous system sexual act.

  14. 34:43 – 36:29

    How Stress Affects Your Libido

    1. KK

    2. SB

      This has answered so many questions that I had that I've never sort of vocalized because I didn't realize the issue, but I have come to learn that I am most aroused when I'm not stressed in any way, but I don't just mean stressed as in, like, "Ugh" stressed. I mean if it's Friday night and I've just come back from work and I've got home at 9:00 PM after a really, really long day and week, I am not aroused typically. So what tends to happen, and, um, like, we know this in my relationship, and it's the same for, same for my partner, is on, like, Saturday once I've had time to relax and I've, like, chilled down and I've-

    3. KK

      Yeah.

    4. SB

      ... all those kind of things, then I'm, then I get aroused. Um, and there is this, I think, misunderstanding between men and women because we get aroused in different ways.

    5. KK

      Absolutely. Once again, like, we- we're seeing so many problems in relationships, so many problems in dating, and, and y- you know, what happens is, like, uh, women will get branded as all kinds of the she's an ice queen or whatever, she won't put out, and, like, there's a lot of, like, toxic misogyny there. And then men will also get branded as like, oh, men only want one thing and they're, they're, you know, so horny, which can somewhat be true, but I- I think this is the, the kind of thing where once you understand, you know, how does the male body work, how does the female body work, what are the ways, because the majority of it is actually very similar, so, like, the, what separates men and women is less than what we share.

    6. SB

      Mm-hmm.

    7. KK

      Um, so if you look at, for example, like, how to create romantic attraction on a first date, like, that's, there's a lot of good, like, neuroscience data about things to do, and it's not surprising at all because if you look at what's the trend in dates, everyone is doing the wrong things now. Dates are turning into, like, interviews, right? Where it's like I don't know, I don't want, n- n- I need to know if I'm gonna waste my time or not, so we're gonna sit down to the table, "Oh, do you want kids? What do you want this? How much do you like to travel? How many trips per year?" It almost becomes a negotiation, and if you look at the science of how human f- beings fall in love, it's completely different.

  15. 36:29 – 41:04

    The Science Behind Attraction

    1. KK

    2. SB

      What is that relationship between- 'cause as you're describing that dating process, I just, in my head I thought, "God, that sounds stressful." And then I thought of how expectation generally creates stress, so whether it's in the bedroom having an expectation that we're gonna fuck tonight 'cause it's Thursday and it's date night or having an expectation when you go on a date, the impact that that stress has on your dopamine and your ability to be, like, open and receptive.

    3. KK

      Yeah, so it's, it's, it's so interesting, right? So like, I know this sounds kinda weird, but let's use your example of it's Thursday and we're gonna fuck tonight-

    4. SB

      (laughs)

    5. KK

      ... so that can be stressful, or, like, I don't know if you've been in a relationship like this, it can be awesome, right? So like, if I haven't seen you all week and you haven't seen me all week and it's like Thursday and this is the time we've set aside and like we're finally meeting and we both are like, "We're gonna fuck tonight," then it's great. Like, you know what I mean? Or not so much? Or I don't know.

    6. SB

      No, no, yeah, yeah.

    7. KK

      Yeah, right? So like, this is the key thing that a lotta people don't understand. So attraction is not about whether we're gonna have sex tonight or not, it's that we- you and I need to be on the same page. So there's a really fascinating study that looked at first dates on bridges, okay? So one bridge is a stone bridge. One bridge is a rickety wooden bridge that's wobbly. And what the study found is that when you have a date on a stone bridge, it's le- y- people feel less attracted to each other than when you're on a rickety bridge. Now, what's the difference? On the rickety bridge, I'm a little bit scared and you're a little bit scared. So what, what really the, the foundation of romantic attraction is actually empathic resonance. When I feel the same things that you feel, when we both feel... It doesn't even have to be good. It can be negative things, it can be good things. We just need to both be feeling the same thing. That's what creates attraction. This is also why people fall in love in rehab. Like, literally at the rehabs that I worked at, like, we have to, like, almost have a rule, right? We can't technically control them, but we're like, "Hey, no fucking in rehab." So this is gonna, we're gonna have... And, because people will trauma bond, right? We're sharing all of this deep emotional stuff. You can be honest, you can be authentic, and there's someone else in the group who's also honest and authentic and you feel connected. What is the nature of that connection? It's shared empathic resonance. So one of the biggest things that I tell people who are, you know, struggling to succeed in dating is like, what are the emotions that you're bringing to the table? What are the emotions they're bringing to the table? And if those emotions are not aligned, how can you do some kind of experience that creates an emotion? So this is also where, like, movies aren't necessarily good or bad. The question is, do you guys like the same kind of movies? If y'all like the same kind of movies and you both laugh a lot, that's a great date. You don't need to talk. You just need empathic resonance. So whatever you can do to get empathic resonance will create a connection.

    8. SB

      My brain went in two directions then. The first question, like, that popped into my head was about the role oxytocin's playing in all of that, because I've heard about this chemical called oxytocin-

    9. KK

      Yeah.

    10. SB

      ... which is there to help us bond, et cetera. Um, and I remember Simon Sinek saying to me that when, like, cities have earthquakes, it's crazy how much the city comes together, b- and that's, he pointed at oxytocin as much of the reason for that sort of shared struggle. I was thinking about your rickety bridge scenario. Life sometimes becomes a rickety bridge and people bond because of that. So should I be taking my dates to theme parks, for example, to terrify the shit out of them, or what do you think (laughs) ?

    11. KK

      Only if you're equally terrified.

    12. SB

      Okay.

    13. KK

      So that's why it's so important, right, for you to figure out, like, what is something that is gonna give us a shared emotional experience?

    14. SB

      Ah, okay, so you've got... Okay, we've got to both have the same emotion.

    15. KK

      Absolutely.

    16. SB

      So if I'm not scared by it and she's terrified...

    17. KK

      Then that's, generally speaking, not good. Now, there are other versions of that. So like, you can demonstrate caring, right? So if I'm terrified and you take care of me, then that can feel good in a different way. But generally speaking, like, what gets us like, "I'm into this person" is that we feel an emotional connection, right? That's what, "I'm, like, into this person." They're like, we're like... What is the nature... If the emotional connection is shared emotion. So oxytocin is another phase of the relationship. So oxytocin forms emotional bonds. So when we feel like, not this... And this is what's so interesting, there's different parts of the brain, different neurotransmitters. So oxytocin is what we get from cuddling, what we get from different kinds of touch, something like a massage can form oxytocin, hugging, holding hands, all this kind of stuff triggers oxytocin. And oxytocin will form an emotional bond, will alleviate feelings of loneliness. I think one of the reasons that men are so lonely now is because we don't feel bonded to each other.

    18. SB

      Mm-hmm.

    19. KK

      So oxytocin is more about forming emotional bonds.

    20. SB

      And the other way my brain went when we were talking about that is, a question I've asked a lot of sex therapists I've spoken to, which is, should we be scheduling sex? This is such a tangent from when we started, but, um, based

  16. 41:04 – 42:31

    Should You Plan Sex?

    1. SB

      on what you said, Thursday night, date night, et cetera, should we be scheduling sex? When I ask sex experts this, they, they go in two different directions. One group says yes, one group is so passionately saying no, because it kills that spontaneity, they say, um, and that, you know...

    2. KK

      R- right. So, so I think this is a good example of like... Uh, this is exactly what I'm talking about, where we know so much more about physiology and neuroscience now that the right answer to that question depends on the science.

    3. SB

      Mm-hmm.

    4. KK

      So you can schedule sex, it's just make sure that you do the things... Y- are you killing some degree of spontaneity? Potentially. Um, a- and, but at the same time, like, so what is it about the spontaneity? Like, let's, let's tunnel down. I think this is exactly what we need to do. What is it that makes spontaneous sex fun, Steven?

    5. SB

      Oh, gosh. Uh, fuck. Um, what makes spontaneous sex fun? It is exciting, novel. It is-

    6. KK

      Hold on. Who's excited by spontaneous sex?

    7. SB

      Me (laughs) .

    8. KK

      So, and is it gonna happen if your partner is not equally excited?

    9. SB

      Well, I think most couples would say that they, much of the reason why their sex life is not great is because it's became, become boring and predictable and samey. So this sort of spontaneity element adds a bit of surprise, and intrigue, and y-

    10. KK

      Now ho- hold on a second. Okay, great. So this is, we're gonna, we're gonna figure out an answer. When things become samey...

    11. SB

      Yeah.

    12. KK

      So if I watch... Like, what's your favorite movie, Steven?

  17. 42:31 – 44:40

    How Overexposure Affects Our Emotions

    1. KK

    2. SB

      Hmm. The Pursuit of Happiness.

    3. KK

      Okay, so if I watch Pursuit of Happiness w- the first time, how am I gonna feel emotionally?

    4. SB

      Oh, f- I've r- it was profound the first time, I swear.

    5. KK

      Second time you watch it?

    6. SB

      Mm, you know-

    7. KK

      Third time?

    8. SB

      ... interesting.

    9. KK

      Fourth time? Fifth time? So the more that we get exposed to something, what changes within us? Our emotional...... the emotions change, right? So, the first time I do something-

    10. SB

      Yeah.

    11. KK

      ... emotions are activated. When it becomes habitual, emotions no longer become activated.

    12. SB

      Right.

    13. KK

      So, this is the problem of non-spontaneous or spontaneous sex, is it, it has to do with that emotional empathy, that emotional connection that leads to attraction. So, this is exactly what I'm talking about. When we look at problems in life, should couples do this or should couples not do this, let's understand the mechanisms at play, and then if we can activate those mechanisms in the right way, then it'll work. So, the, the issue about spontaneity is, is like, you know, if you feel like having spontaneous sex but your partner doesn't, that's not gonna work, because y'all aren't emotionally ... I mean, they can accommodate you, and that can be fine. But generally speaking, what spontaneity adds is more of that emotional connection.

    14. SB

      Mm-hmm.

    15. KK

      So, when I work with, um, you know, patients who are exhibitionistic, right? So, like, w- why do they like exhibitionism?

    16. SB

      What's exhibitionism?

    17. KK

      Having sex in public places.

    18. SB

      Okay.

    19. KK

      So, um, it's a, it's a kind of fetish, right? Can get you into trouble. That's how, sometimes how they end up in my office. (laughs) Um, but, so- so what- what- if you really look at it, like, what- what it's about is emotional resonance. So, if I'm having sex in a public place, that's gonna activate me emotionally in some way. It's gonna activate my partner emotionally in the same way. That's why we do it. So, it all comes down to emotional resonance. So, the second thing is that if you're gonna have scheduled sex ... so like, spontaneous is great, but if you're gonna have scheduled sex, that's still fine too. It doesn't kill the spark. You just need to figure out how to activate it, right? So, this is where activation of the parasympathetic nervous system, do something like, you know, give a massage, or even like, the sex should come after some kind of emotional resonance. Let's go out and watch a movie together, or let's do something that we both find emotionally engaging.

    20. SB

      Mm-hmm.

    21. KK

      Then once you're emotionally connected, the sex will be, it'll be a lot

  18. 44:40 – 48:11

    How To Keep Sex Exciting When It Feels Like A Chore

    1. KK

      easier.

    2. SB

      I have a friend who has been trying for a baby.

    3. KK

      Uh-huh.

    4. SB

      I'm trying for a baby as well, by the way, but this is not about me. (laughs)

    5. KK

      Okay.

    6. SB

      This is not me like, asking for a friend. He lives in America, and he has just had the news that he's having a baby. Very, very happy. And I saw him recently, and I was asking him- him about the process of, you know, timing the sex around your partner's cycle, and-

    7. KK

      Yeah, yeah.

    8. SB

      ... they had gone for I think three years trying to have a baby, so it got increasingly more difficult, all of the complicated emotions. And he was saying to me, he was like, "Honestly, bro, like, sometimes we were having to have sex like three or four times a day." And I was like, "Bro, how- how do you keep an ere- like, h- when it becomes a job in that, in that context, y- you're doing it because you need to try and hit this egg, how did you arouse yourself?" And he was like, "No, I couldn't." He was like, "I- y- I really struggled. I'd lose my erection all the time." Um, um, and he literally said to me, yeah, he was, he was having sex 40, 50 times a month to try ... (laughs) and he was basically being ordered to have sex with her. Like, "These are the five days you better, like-"

    9. KK

      Yeah.

    10. SB

      "... have sex with me." And that, you know, that- that is maybe the extreme case of total dissipation of emotional resonance as it relates to sex.

    11. KK

      Yeah.

    12. SB

      And the other case, the other end of that pole would be pursuing someone for the first time, I guess, a stranger for the first time. And I guess the job for people in their relationships is how do you keep that emotional resonance?

    13. KK

      So, I- I think that that's- that's exactly the kind of question, and I think the first thing is, that's half the answer, is that a lot of people don't realize, so like, when people get bored sexually in a relationship, right? So, we have two populations of people. Some people will get married-

    14. SB

      Mm.

    15. KK

      ... and they'll continue to have healthy sex lives, like well into their 70s. Like, one of the craziest things that I remember (laughs) encountering in med school was like, you know, when I meet a 70-year-old, I don't think about sexual health counseling, and it's one of the biggest mistakes we make as doctors. Like, you know, when you have these retirement communities and stuff, no one's worried about getting pregnant. You can get outbreaks of like, syphilis and gonorrhea that'll tear through the community like- like COVID. Like, it's crazy. Like, we just don't ... but sexual desire doesn't necessarily decrease with age. I know it's crazy, but we, you know. So, then- then the question becomes, okay, how do you maintain a healthy sexy- sexual relationship over time? So, at the very beginning, there are things like thalamic inputs, right? So, what you see ex- arouses you. There is some amount of novelty, which is also like, new emotions, right? So then, then the tenth time we watch the same movie, our emotional connection is less to the movie. But then, this is also how couples have sex over- successfully over time, is that they do have emotional connections. So they- a- as you continue to bond with your partner over the new experiences that your relationship has, so I think having kids is a great example, where like, having kids will destroy your sex drive for some amount of time.

    16. SB

      They say what, two years or something?

    17. KK

      Uh, y- on- on average.

    18. SB

      A year and a half.

    19. KK

      But even within that, it's amazing, because you'll find these moments where like, n- you sort of forget, right, like how good sex with your partner is. And then the stars align and you have sex and it's actually like, incredibly fantastic. It's like, "Oh, we should do that more." (laughs)

    20. SB

      (laughs)

    21. KK

      Right? Like, that's-

    22. SB

      Yeah.

    23. KK

      ... that's like, what kind of starts to happen. So, over time what we want to do is really lean into still that shared emotional connection, "Oh my God, I had such a, like I can't believe that our kid," like, finally like they're, the fever's gone. They're relaxing. We're gonna sleep, and then at like 2:00 A.M. you're gonna wake up and you're, you know, it's gonna be great, (laughs) right? But like, uh, and so as long as you maintain that bond, it's totally fine.

  19. 48:11 – 53:46

    The Dangers Of Devices In Relationships

    1. KK

    2. SB

      And w- when we think about the mechanisms in neuroscience that drive our behavior, once we're in a relationship, and even if it's a platonic relationship, um, how do we keep the relationship thriving? Like, how do we ... what are the mechanisms I need to be aware of in the brain and in neuroscience that are gonna enable my relationship to be strong and thriving, whether it's platonic or romantic? You know, 'cause we talk about loneliness a lot, and there are so many people that are struggling with loneliness, and it's ... and, you know, the reasons that we often attribute to that are the way we're living our lives, or we're behind screens on social media.

    3. KK

      Mm-hmm.

    4. SB

      But-You know, you're, it was really illuminating to me that you're able to point to a mechanism in, um, smartphones and social media that is actually inhibiting us forming relationships. And I wondered if the same mechanisms might inhibit us keeping the relationships that we have?

    5. KK

      Yeah, so I think there are so many things that are going on there. So, one is, like, how is technology negatively impacting our relationships? And the second is, how do you maintain a healthy relationship over time? So, it's like two different things, if that makes sense, like, what gets in the way-

    6. SB

      Mm-hmm.

    7. KK

      ... and how do you, how do you keep your tire nice and full of air, versus how do you, uh, fix it if a nail punctures it?

    8. SB

      Mm-hmm.

    9. KK

      So, let's start with, like, what technology is doing. So, this is what technology is basically doing to our social connections. There is a whole scale social skills atrophy and a deconditioning of certain parts of the brain when we use technology. So, the first thing to understand about the brain, this beautiful thing about the human body, inanimate objects, the more you use them, the worse they get. But the moment that you have biology, the human brain doesn't wear out, it rusts. So, inactivity of the human brain is actually what causes problems. Okay? That's number one. So, we can look at studies of, like, dementia prevention and what we know is that encouraging neuroplasticity through things like learning how to play the piano at the age of 60 will protect us from dementia. So, we need to utilize our brain to make it the strongest. There's also where you can look at the physical body, right? So, when I, when I think about what causes muscle atrophy and what causes muscle growth, the more I use my muscles, the more they grow. The more you use your brain, the more it grows. So, when we look at connections, if you actually look at human communication, words are maybe, I would say, 25 to 50% of communication, at most. So, you can walk into a room and without even hearing a single thing that's said, you can know there's tension in the air. Something is wrong. You can even, like, I remember when I was a kid, I used to get bullied a lot, right? And I would walk into a room and I immediately knew that they were making fun of me.

    10. SB

      Mm-hmm.

    11. KK

      Like, eh, all the conversation would stop and everyone would look, like, one person would look at me, I'd see alarm in their face. They would all see, uh, everyone else would see the alarm in their face and they'd look over and they'd see me and, oh, everyone would stop talking. I know I'm being made fun of. So, body language, tone, volume. This is really interesting. So, there are even video game companies that are starting to ban people over voice comms. So, how do you know if someone is toxically communicating or not? What we used to do is use, like, words, right? So, if you say some kind of racial slur in chat, like, if you type it out, the game knows to scan for that and then people will start to get around that and they'll use an at sign instead of an A. So, now what they're doing over voice comms is measuring tone.

    12. SB

      Ah.

    13. KK

      So, depending on the volume of what you're saying, right? Like, that's how they're actually detecting toxicity because that's where toxicity exists. It's not, "Oh, hey, Steven, you're a real loser. I really dislike you." It's like, "Steven, bro, you're such a loser, man. Oh my God." And even if I say that, right, it's not negative at all, even though I'm using negative words. As another quick aside, so men are really specific for using the negative expression of a positive affection. This is something that's different about men. So, what we'll do is we'll actually say negative things to a friend of ours to express approval. Like, when someone gets engaged or gets married, it's like, "Oh, man," like, it's the whole ball and chain, "We're gonna lose you. You're whipped." But everyone's smiling, everyone's congratulating you.

    14. SB

      (laughs)

    15. KK

      But w- we just express it in a negative way.

    16. SB

      Yeah.

    17. KK

      So, so much of our communication is tone, is body language, is volume. Now what's happening is everyone is texting, so then the brain does something very, that it's designed to do, it's like, "Hey, we're not using this thing. Let's lose it." So, if you don't speak a language, our brain forgets it. So, as you, and this is what a lot of people don't realize, is that there's a rise in social anxiety. Why is there a rise in social anxiety? It's because the parts of our brain that reassure us in social situations are starting to atrophy. So, when we don't pay attention to body language, when we don't pay attention to tone, those parts of the brain shut off. And then when I go into a social situation, those parts of the brain are inactive so they can't reassure me. Now, what happens is I go to a party that I was invited to, or I go to dinner with my friends that I was invited to, I'm kinda sitting at the end of the table, no one's really talking to me and I'm like, "Oh, like, I really shouldn't be here. These people just invited me out of politeness. They don't really care about me." But if your brain is functioning well, you're able to read all of this non-verbal communication that's reassuring. So, when it comes to platonic friends and why this is hard, we are atrophying a lot of the social skills, a lot of these brain regions that allow us to form connections, allow us to feel reassured, allow us to feel safe. Right now, I kinda feel like, "Oh, my friends are inviting me, but I'm bothering them by going."

    18. SB

      Mm-hmm.

    19. KK

      Like, all these kinds of things we're seeing more and more

  20. 53:46 – 55:48

    Are Gen Z More Connected Than Ever?

    1. KK

      of.

    2. SB

      Are you hopeful about Generation Z that have, that have been connected from birth?

    3. KK

      Yeah. So, so, I, I, I think that even though things are problematic, right? We're talking about how things are negative and social anxiety's increasing, the suicidal- su- suicidality is increasing, I'm very optimistic because I think we have all the answers. Like, that's what's so cool. Like, we have a problem, but we haven't been addressing it directly. Even between the last time I was here and now, we've learned so much more. People are taking social stuff more seriously. The Surgeon General of the United States released, like, this, this, um, uh, bulletin on lone- like, the loneliness epidemic, right? So, even, like, the medical establishment is starting to see loneliness as a problem that we need to target. Half of the problems that we see in the world today is because we haven't tried to fix them. They kinda crept up on us. Things like video game addiction, things like loneliness. Now we see, "Okay, this is a big problem, so let's start devoting resources to it. Let's understand what's going on." And we see this a lot, like, even in our community, like, where we start targeting a problem and people do better. The only reason we're losing the war is because we haven't been fighting back.

    4. SB

      Why haven't we been fighting back? Technologies must play a pretty significant role in, in this.

    5. KK

      I think we were slow. We, we're really good at creating things without (laughs) understanding what they will do to us.

    6. SB

      Because the impact doesn't show its face for a couple of decades sometimes.

    7. KK

      Absolutely.

    8. SB

      Yeah.

    9. KK

      And there's, there's a, there's an even more insidious thing, which is right now, the, since it's isolation, like since we're seeing more isolation, we don't see the impact because literally these people are staying home. So the majority of, of, you know, young men, for example, like won't ever go to a therapist, which is why we can't help them with their problems. They won't share their problems with other people, because first of all, they don't know how to and secondly, they don't even know what they're feeling so then they just like, feel like they're a loser. So what we've started to see is that, oh these problems have been going on for about 10, 20 years, but they're now reaching a critical point where like, we're now noticing what's going on, but this has been going on for a while.

  21. 55:48 – 1:02:03

    Are People Becoming More Narcissistic?

    1. KK

    2. SB

      Are people becoming more narcissistic?

    3. KK

      Yes.

    4. SB

      They are?

    5. KK

      Yeah, absolutely.

    6. SB

      And what impact is that having?

    7. KK

      I don't even know where to start, like so I, I think it's affecting our relationships, it's ac- affecting our happiness, it's affecting our professional ability.

    8. SB

      I was thinking, is social media making us more narcissistic?

    9. KK

      Absolutely.

    10. SB

      And is that then driving us to be more lonely? And if so, how do we first define the word narcissism in this context?

    11. KK

      Yeah, so I'm gonna lean into, um, kind of a more yogic definition. So we have this, this word in Sanskrit called ahamkara and ahamkara means ego. So ahamkara is your sense of self. I am... okay? So I am tall, I am short, I am doctor, I am father, I am winner, I am loser. The first thing to understand about ego is that it is not a real thing, it is an abstraction. So if you were to look at me and you say, if I, if I say, "I am a doctor," I know this sounds kind of like, kind of a weird question, but is that true? Like, what makes me a doctor? I can't biopsy myself and find doctor. You can't find doctor anywhere within me. Doctor is, I have a piece of paper on a wall. That's what makes me a doctor. I have a license to practice medicine, that's what makes me a doctor. It's an abstraction. So it's not like a truth, it's like a societal shared delusion that we all agree that I'm a doctor, that's why I'm a doctor. Okay? And does that make sense?

    12. SB

      Yeah, of course.

    13. KK

      Okay. So this is the ego. Now, what we also know is that from studies on narcissism, that narcissism has its roots in insecurity. So if you think about someone who's like, egotistical and confident, like Steven, I'm sure you know both. What's the difference between the two?

    14. SB

      Confidence feels more secure and-

    15. KK

      Yeah.

    16. SB

      ... egotisticalness feels more insecure.

    17. KK

      Absolutely. Where does a confident person's esteem come from?

    18. SB

      Inside.

    19. KK

      Where does a egotistical's esteem come from?

    20. SB

      Outside.

    21. KK

      Beautiful. So this is what s- what social media is doing. Social media and technology is externalizing our perception. So if I think about it like, think about a couple thousand years ago, what was my mind focused on? So I would go out to hunt. I'm looking for an animal. I shoot a deer and then I walk three hours back. So for some amount of time, my mind is paying attention to the external environment. Maybe I'm talking with the people that I'm hunting with, but what is there to say? Like, I can't talk to them for ten hours a day. There's no substance, there's no news, right?

    22. SB

      Mm-hmm.

    23. KK

      We're like this tribal community. So if you really look at the history of humanity, our perception has been internally focused at least 50% of the time. Literally what we are paying attention to is our own thoughts, our own feelings, the voices, the desires, the drives that come within us.

    24. SB

      Mm-hmm.

    25. KK

      What technology has done is wholescale externalize our perception. And this is even where like, you know, I used to be like an efficiency junkie, and so when I was in med school I was gonna be like you, Steven, and I was gonna be super efficient, I was gonna be super successful. So I was like listening to a podcast in the morning about self-help.

    26. SB

      Mm-hmm.

    27. KK

      I was gonna listen to lectures on my way to the subway. I was gonna read on the way, uh, on the subway. I was gonna listen to a lecture on my way to the classroom, pay attention in the classroom and then do some questions, like some test questions, whatever. So my mind was constantly outside of me. Social media makes this even worse because now we're doomscrolling, we're looking at what other people are doing. So we are starting to exist outside of ourselves. Once we exist outside of ourselves, all of our esteem comes from the outside world 'cause that's where we're spending our time. So what's happening is as we become more externalized, we are becoming insecure because where does confidence really come from? It doesn't come from inside. This is a big mistake a lot of people d- uh, don't realize which is, if you do really well and you don't believe in yourself, you don't become secure. A lot of people think that becoming secure is about being successful. That's not the case. If you're really successful, you don't end up with security, you end up with imposter syndrome. So I went to Tufts for medical school and I did my residency training at Harvard, and what I saw is that the more successful you become, that increases the rate of imposter syndrome. There's way more imposter syndrome at Harvard than there is at the University of Texas. There's way more, um, imposter syndrome at a place like Goldman Sachs than there is at Bank of America. So lots of success actually creates this idea that, "I don't really know if I can do this. Oh, everyone else is so much better than me." So we see actually lots of success leads to imposter syndrome. Confidence doesn't come from success, it comes from surviving failure. It's also far more internal. So it's not something that anyone else gives you. It's like when you believe in yourself, then you're confident. And then the beautiful thing is that once you believe in yourself, then other people can think whatever they want to about you. The way that you receive criticism if you, if you criticize an egotistical person, they will argue with you and convince you that you're wrong and call you stupid.Whereas if you're confident and someone says, "Hey, you're an idiot," I can say, "Okay, help me understand why. Like, I could be an idiot. Help me understand."

    28. SB

      Mm-hmm.

    29. KK

      Right? So this is where what s- social media's doing is externalizing our perceptions, building our ego. We're so focused on the judgment of other people. I see the amount of body, like subtle, low-level body dysmorphia that I see in young women is skyrocketing. And I have a buddy who's a plastic surgeon at Yale, and you know, he's just stunned by, y- you, you have now young women and they're 25, 26, 27, who are getting plastic surgery like on a yearly basis, like small amounts of Botox injections or lip fillers or like whatever.

    30. SB

      Men too.

  22. 1:02:03 – 1:04:26

    The Epidemic Of Loneliness

    1. SB

      how does this then result in loneliness on a societal level?

    2. KK

      Oh, (laughs) it's so many different things. So the first reason it makes us lonely, so this is, I've also seen the highest level of being around people and being lonely. So I see so many people who have jobs, even have girlfriends, boyfriends, have friends, and they feel so incredibly lonely. So what happens when we are externally focused, right? So if I, um, if I'm lonely, like I need to put myself out there. So what I'm gonna do is transform myself, and this is where a lot of, it's so interesting 'cause a lot of the guidance we give people helps in some way, but actually worsens the problem. So if I'm lonely, I'm gonna focus on my social skills. I'm gonna get a good haircut. I'm gonna learn how to dress. I'm gonna start working out. I'm gonna become professionally successful, and now I've, I've become something that I can be proud of. And now that I've become something that I can be proud of, I'm gonna go interact with other people and look at, they're going to love me because now I'm sexy and I'm successful and I'm, I know how to talk to people and I'm going to, you know, talk to them in this way, and I'm going to do eye contact and I'm gonna do all of the things to-"

    3. SB

      Why are you doing that accent? (laughs)

    4. KK

      To connect with you, to make you like me, right?

    5. SB

      (laughs)

    6. KK

      See now you're s- now you're laughing, so now I feel okay because now I know, oh, Steven's laughing.

    7. SB

      (laughs)

    8. KK

      He likes me. I'm likable.

    9. SB

      Mm-hmm.

    10. KK

      So what we actually do is we create a false version of ourselves for people to love, and that's what really screws us, because they don't fall in love with us. They don't like us. They don't like the broken, pathetic kid that I used to be. They like this glossy, polished version, and that creates a fundamental loneliness, even though you can be dating... It's so interesting 'cause I, I'll work with influencers, like we have a creator coaching program and like, it's so hard for influencers to date because who is falling lo- are you falling in love with the influencer? Are you falling in love with Diary of a CEO host, or are you falling in love with Steven? Right? Is it Dr. K or is it Alok? So this is what's really paradoxical is that we think that forming all of these connections will help our loneliness, where oftentimes it creates the opposite effect, where now what they love is a version of me, not the real me. And now the problem is they love this polished version. What happens if I show them the ugly version? They won't accept me. I can never show it to them.

  23. 1:04:26 – 1:09:40

    The Power Of Self-Realisation

    1. KK

    2. SB

      This is what I noticed in my own life. I noticed that before 25, I was a total failure with women, and before 25, the real defining characteristic of that chapter of my life was all the external stuff, like the Louis Vuitton bag, the champagne bottles in the nightclub, the really trying really, really hard to convince them. And then after 25, I had much more success with women, and that chapter of my life can c- be characterized by knowing who I was and being cool with it. All the stuff seemed to fall away, like all the external stuff seemed to fall away. And for some reason I, 'cause I, I talk to my friends, um, who are struggling with dating at the moment about this, just to see if it can help them in any way. The chapter of my life where I was reading those, those, um, books, the like pickup artistry books, and I was trying really hard, was my most unsuccessful, but the phase after where I stopped chasing so much, um, it... The only way I can describe it is there's like a thousand little micro things in me that changed, whether it's my posture, the way that I... I don't know what it was, but for me it's that season of insecurity and then the season of confidence. And I'm just throwing that out there because, um, it kinda overlaps with what you were saying about the influencers and when you're trying too hard, you're actually struggling the most to date, and, um, and if, if you see this in your practice.

    3. KK

      Now, hold on a second. So let's define success. So when you were doing Louis Vuitton bags and pre 25-

    4. SB

      Yeah.

    5. KK

      ... were you going on dates?

    6. SB

      I was going to the club every like two times a week to, with like, and ordering as much champagne as I could to get people to come to my table and like to impress the girls that were at my table and stuff.

    7. KK

      Did it work?

    8. SB

      Well, all the girls that I wanted never wanted me back. So the like four girls that I really pursued, I could name them, but I probably shouldn't, um, I could never get them to be in a relationship with me. Like they wouldn't... It would, I would have like short term success and then they would never-

    9. KK

      There we go. So this is really important, right? So this goes back to what we were saying. Short term success is thalamic, right? So that's sensory perception. So you could never get into a relationship. So this is like perfect, right? So let's understand. So champagne will get you to come to, get them to come to the table. Oh, who's this, Steven?

    10. SB

      Yeah, yeah, yeah. Yeah.

    11. KK

      Right?

    12. SB

      Bring them back to the apartment. (laughs)

    13. KK

      Right? A- a- and like you can get somewhere, but think about where you were emotionally and where they were emotionally. You were like, "Oh, please, please, please."

    14. SB

      (laughs)

    15. KK

      Right? And they're, that's not where they are emotionally, so it's doomed to failure.

    16. SB

      Yeah.

    17. KK

      So like I was just using that 'cause it's like a prime, prime example of it, and then what happens is you're confident, so you're like meeting them where they're at.You're a little bit confident, hopefully they're a little bit confident, you form a connection, and just doing a little bit of math, it sounds like you've been dating your current girlfriend for a couple of years now. It sounds like it didn't take long from you being confident to, like, find someone that you've been with.

    18. SB

      Exactly.

    19. KK

      Right?

    20. SB

      I've been with her for almost six years, yeah.

    21. KK

      Yeah, like- like sna- it's like so easy.

    22. SB

      Yeah.

    23. KK

      Once you do it right, it- you kind of get locked down real quick, right? And the same thing happened with me. So wha- a couple of things, so first is, like, this just goes back to once again we can take your test case with the neuroscience of how to fall in love and it maps on. And like that's the beauty of science, is that it's true. Now, I even forget wha- uh, so you were saying- talking about security and insecurity. So now y- y- you said something beautiful, which is like a thousand different microcosm- microcosmic things in here, right?

    24. SB

      Yeah.

    25. KK

      Like microscopic little, tiny little things that you do within you.

    26. SB

      I say that because when I read the book on how to pick up women, it would give you these little games, these little tricks you could do, and even if I did those, even if I acted, there was still something going on which meant these women didn't want to be with me, like in a relationship. I could- I could pull, quote unquote pull them, I could get them on, you know, short term, but I couldn't get them to s- to be with me.

    27. KK

      Yeah. Right. So- so and I- I think that's because human beings are incredibly empathic, so what you feel on the inside is what other people resonate with. So even if we look at this podcast, why is this podcast so successful, Steven? It's because you are authentic, it's because you're genuinely interested, and the moment that you become genuinely interested, everyone in the audience is gonna become genuinely interested. So this is what's really crazy that a lot of people don't understand, everyone is trying to manipulate other human beings into doing what you want. "I want this person to fall in love with me." If you want to be a leader, if you want other people to be with you, the most important thing is authenticity. There are studies about this, that if you look at, like, how people in- in the workplace rank leadership, authenticity is at the top of the list. So authenticity and the ability to navigate negative challenges, these are the two most important things to, like, be a leader if you look at studies of psychology. So when you're talking about these thousand microscopic things that you do, that's exactly what I do in my work, right? It's helping people... It's not solving the problem outside of you, it's solving the problem in here, and once you know how the instrument works, people will flock to you. This is what charisma actually is. Charisma is like authenticity and the confidence to face hard times. If you have these two things, when you walk into a room people will, like, stop what they're doing and just, like, look at you. It- it changes the way that you conduct yourself, right? So we even know that there's this- this discipline called psychoneuroimmunology.

  24. 1:09:40 – 1:13:57

    How Your Beliefs Shape Your Reality

    1. KK

      When you believe something in your mind, it affects your brain. When it affects your brain, it affects your whole immune system, it affects your physiology, and other people pick up on that.

    2. SB

      Hmm.

    3. KK

      So you have to solve internally first, like the more internally solved you are, like- like...

    4. SB

      Yeah. So fucking true. And I say this as well from a position of, um, both leadership but also being a founder of companies who appoints leaders, and if I think back over the last 10 years every single leader that I've appointed as CEO or something in the C-suite who has then struggled was not being themselves.

    5. KK

      Absolutely.

    6. SB

      And I just... and it's so, and I three cases in my brain right now of leaders who I appointed over the last 10 years in these companies and three, all three of them failed. And if I can, if I could articulate exactly why they failed, it was because they were trying to be what they thought a leader was and they weren't being themselves, and people can see it. Like the thing I said about the thousand little micro-expressions that you can't control that just show up invisibly when you are, when you feel a certain way inside, that's exactly what those three leaders that come to mind didn't understand, was I watching them do the presentation to the team was g- thinking, "God, that person is not being themself and they're trying to be a leader. And if I know it, I bet everyone else in this bloody room can feel it too." And then I've seen the opposite as well, um, where leaders have been tremendously successful and you just know that this person that I'm experiencing right now is who they are.

    7. KK

      So that's the crux of it, right? So I think that the challenge right now is everyone is looking to become something that they're not as opposed to really understanding who you are, the good and the bad.

    8. SB

      Well, that's easier said than done though, isn't it? Like in the world we live in. Do-

    9. KK

      Well, that's tr- well, uh, that's because we don't know how to do it, I mean, until now, we don't know how to do it properly.

    10. SB

      How do we- how do we do it?

    11. KK

      So I think there are a couple of core things that we have to start doing. So the first is that you have to become less alexithymic. So alexithymia, I don't know if- I don't remember if we've talked about this before, but alexithymia is color blindness to your internal emotional state, so you have to know what you are feeling basically at all times. Our emotions are our primary source of motivation so... And our emotions will also, like just because we are numb to our emotions doesn't mean that our emotions don't act. So we see this a lot with technology where technology suppresses your internal emotional state, you don't know what you're feeling, but like this is crazy, like just because you don't- you're not aware of your anxiety doesn't mean that, like it's not like the- your anxiety portion of your brain shuts off. And you'll... I- if you're- if you're worried about this, there are a couple of really interesting signs. So one thing that's a really interesting sign of suppressed emotion is what happens when nothing else is going on. So a lot of- a lot of us are addicted to this external world, "I need to be doomscrolling, I need to be doing social media. I need to be productive. I need to be listening to a podcast." We can't sit with ourselves. So if you- when you go to bed at night, can you just fall asleep naturally? Or what happens a lot is suppressed emotions start to come out when we sleep, and this is the big problem is the more technology we use that we get into this weird situation where another good place that emotions come out is during dreams, so we do a lot of our emotional processing when we sleep.Now, the big problem that we're seeing nowadays, this is kind of a random aside, is that normally, the human being processes emotions throughout the day for about 16 hours, and then whatever's left over at night gets processed while we sleep. We have dreams and things like that. Now, what's happening is we do zero emotional processing through the day, and so our brain can't really make any emotional progress because it has all this work that's been built up. We've been suppressing emotions, suppressing emotions, suppressing emotions. And in my case, when I was like addicted to video games, I had to play until the state of absolute exhaustion, because if I went to bed, all of these thoughts will come up. I saw this hilarious meme about, you know, we have o- w- during the day, we're sitting upright, so all of our anxiety is at the bottom of our feet, and when we lay down, like a liquid, it enters our brain.

Episode duration: 2:37:42

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