#105-Paul Conti, MD: The psychological toll of a pandemic & the societal problems it has highlighted

1. 0:00 – 0:11

   Intro

   1. PAPeter Attia0:01

      [upbeat music]

2. 0:11 – 4:34

   Paul Conti's Presumptive COVID-19 Illness

   1. PAPeter Attia0:11

      Hey, everyone. Welcome to "The Drive" podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, full stop, and we've assembled a great team of analysts to make this happen. If you enjoy this podcast, we've created a membership program that brings you far more in-depth content if you want to take your knowledge of this space to the next level. At the end of this episode, I'll explain what those benefits are, or if you want to learn more now, head over to peterattiamd.com/subscribe. Now, without further delay, here's today's episode. [upbeat music] Welcome back to another COVID-19 episode of "The Drive" podcast. My guest this week is Dr. Paul Conti. Some of you may recognize that name, as Paul was a previous guest on the show about a year and a half ago when we spoke about mental health, depression, trauma, and a number of other things. On this episode, we kind of pick up a little bit of that thread, but obviously talk much more specifically through the lens of the anxiety, trauma, uncertainty that many people are experiencing in the midst of the pandemic, the quarantine itself, the isolation, the uncertainty that comes from it, both economically, socially, politically, et cetera. Paul and I go off on a number of tangents here that I think, you know, on some level speak to societal problems, on other levels speak to challenges that we all have at the individual level. So I hope you'll enjoy this as a bit of a deviation from the normal flow of information as it pertains to some of the more technical aspects of this, which we'll obviously continue to return to. But I found this to be a very helpful discussion, and frankly the type of discussion that Paul and I will often find ourselves having in the midst of, uh, situations like this. But hopefully by being able to have this discussion and share it with you, some of you may find value in this. So without further delay, please enjoy my discussion today with Dr. Paul Conti. [upbeat music] Hey, Paul. Thank you so much for making time to talk this afternoon. I know you're even busier than you normally are, but I know you appreciate that some good can probably come of us setting some time aside to talk.

   2. PCDr. Paul Conti2:28

      Thank you very much, and I, I so appreciate you having me back on at such an important time, and there's so much to think about and talk about. And thank you for taking the time to have me on.

   3. PAPeter Attia2:39

      So Paul, before we jump into some of the stuff I really wanted to talk about, it, it's probably worth you sharing with people your own experience with what has to be believed as a presumptive diagnosis of COVID-19. You got sicker than hell about a month ago, as did one of your children. And then as you've described those symptoms to me, they are very classic for the diagnosis here. H- And, and you're no stranger to getting the flu and things like that, but tell folks a little bit about what you experienced.

   4. PCDr. Paul Conti3:08

      My wife and my two-year-old both just had malaise, mild symptoms. But my six-year-old, who is-- We're kind of like carbon copies of one another. She had pretty significant symptoms by pediatric standards. So I kind of knew it was coming. And I had the, the malaise and just generally not feeling good, and that was there for a couple of days, and then I very rapidly got very, very sick in a way that felt different than flus or food poisonings or other illnesses. Felt extremely hot, alternating with really terrible chills that kind of took over, along with like an awful headache and this just deep nausea, not like I've experienced before. And interestingly, I wasn't congested. It was strange to start to have a feeling of shortness of breath, really having to catch my breath and to start taking deep breaths and to be that sick, but to not have any congestion. And it was scary. I mean, I remember at one point I was in the shower, and I had the water turned up high enough to scald me, like it should have been really painful. And you know, and I was just shivering, and I had goosebumps and just things that haven't happened before, and I could really see the lethality in someone who has some of the medical comorbidities I'm fortunate not to have or is, is older. And you know, it was scary. It was scary.

3. 4:34 – 8:24

   Helplessness and Viewing the Pandemic Through Trauma

   1. PAPeter Attia4:34

      Well, and I think it also kind of gives you an interesting perspective to be able to talk about the stuff I want to talk about with you today. As you know, I've been spending the past month trying to figure out how to be useful, and that's required more starts and stops and fits and starts than normal because there is this feeling of helplessness. You and I were talking about this earlier, which is like the-- you have this desire to do something, but at the same time you feel like you can't really do anything. And there are days when I just wake up, and all I want to do is watch Netflix and play in my simulator and, and literally have nothing to just forget that this is all happening. But then there's days when I wake up, and I feel really motivated, and I think, "How can I help?" And I, and I haven't figured the answer to that. I suspect doing these podcasts is helpful. Uh, the feedback has been great. And I also think that people are probably at least as interested, if not more interested, in the kind of stuff we're gonna talk about today as they are on the nuances of this type of RNA virus versus that type of virus versus this drug and that drug. And, and while those things matter, I get a very vague sense there's a coming fatigue around the uncertainty of when are the cases gonna peak and what-- all these things. And, and there's a little bit more of a sense of, "Okay, well, what does this mean for me as a person?" And how have you been sort of struggling with the role that you play as an individual to your family and then the role that you're trying to play with your patients and then maybe even thinking more broadly?

   2. PCDr. Paul Conti5:59

      As I know that you know and you and I have talked about on your podcast, I see the world through the lens of trauma. And I think part of what just frustrates me at times to just utter exasperation is I think the predictability of so much that has gone on around us. And I think we've had an explosion of so much technology, so much increase in capability, and I think we've made errors as a society in how we're utilizing that technology, and we've really paved the way, I think, for deeply traumatizing ourselves as a society, as a country, and also just as species. And, and I think, obviously I'm a psychiatrist, and one of the principles that's, that's at times used in psychotherapy is this idea that everything is as it should be, which does not mean morally right. It means that the vast majority of things that ail us, I mean, some of them befall us. But so often there's a predictability that we've gone 19 steps down a 20-step path and then are surprised when we get to the 20th step. And I think that we have been paving the way for terrible trauma to happen both medically and also socioeconomically. And what so disturbs me is that as the virus itself recedes, in whatever way that ends up happening, we're gonna have to make decisions, and I think that those decisions have tremendous gravity to them. I mean, I try not to be inclined to hyperbole, but I think that they are as serious as you and I have discussed in other venues. I mean, is, is it America passing the torch as really no longer being the world leader that we have been since the Second World War? Are we setting the planet on a reckless course that we can't recover from? And, and I think we have to learn from this. And I think where I wring my hands and gnash my teeth is the idea that maybe we won't learn from this, and I'm worried that we may then, we could then sort of traumatize ourselves out of existence.

4. 8:24 – 11:33

   Why Pandemics Isolate Rather Than Unite

   1. PAPeter Attia8:24

      What do we know about how humans internalize this type of stress versus other types of stress that are more potentially uniting? So I know that the sort of-- There's a body of literature that would say, "Look, pandemics do different things to the human psyche than most other things like war, terrorist attack, even natural disaster, because by their very nature, they are isolating." Sebastian Junger has written very eloquently in his book Tribe about how post 9/11 suicide rates actually went down. People united. There was a common enemy, and then there was something we could all do to stand together. But the literature on pandemics actually doesn't suggest that to be the case. What is your take on these sort of differences in the, the psychology and, and psyche of us when confronted with these different external stresses?

   2. PCDr. Paul Conti9:17

      I think on the one hand, it creates tremendous feelings of loss of control and tremendous vulnerability, and it also creates suspicion. We know that viruses are real, but there's still that part of human beings that we can't see it. We can't just stop it no matter what we're doing. It can be lurking around invisibly. And those are things really that terrify us, the idea of an invisible enemy, and we internalize this in a way that is more and more isolating, and I think historically just makes people very suspicious of one another. I don't know... Like the idea that, hey, if I meet you on the street, I don't know if you're gonna accidentally kill me. And I can't read-- I can't use what I would do to read safety, to read control in order to keep myself safe. And I think in addition to that, we have a very big added problem, which is that that feeling of vulnerability, that feeling of loss of control is looking for an enemy. I mean, after 9/11, whether we ultimately were targeting the right enemy or not is there was, there was an attack, there was an enemy. And here I am very, very worried that the social structure we have allowed to arise is a social structure that searches for an enemy. And I see the xenophobia, the racism that then makes us f-feel that there's an enemy that actually isn't our enemy. Instead of seeing, look, this is a human ailment, and people who are suffering are suffering in the same way. I mean, as you and I know as physicians, when you see someone who's really suffering, nothing else matters. And we're not thinking about like, what's the color of that person's skin, and how much education or money do they have? Like, it makes us all the same. But we lose that perception of people who are suffering in China, suffering in Iran, suffering in America, suffering in Europe, suffering in Africa and South America. We lose that, and we start to, I fear, further the processes that are separating us already to such a dangerous degree.

5. 11:33 – 16:23

   Global Cooperation, the Middle School Playground and Blame

   1. PAPeter Attia11:33

      Paul, if you could wind back the clock to January 12th, so the virus has been now identified, the scientists in China have sequenced it. If you could-- If you had mind control over world leaders at that moment in time, and you could have programmed everyone in such a way that there would have been complete cooperation and borders would have effectively dissolved, not from the standpoint of interstate travel and things like that, but in terms of nationalism. Everyone said, "Hey, you know what? We're all in this together. This thing's gonna be a potential disaster Let's completely share every piece of information we have, and we're all part of the same country. So whether you're our enemy in Iran from a political standpoint or not, no, no, no, we're all going to share resources of testing, of data, of medication, et cetera. Is there any precedent for the world being cooperative and productive in a manner like that? Because I gotta be honest with you, the only thing that comes to my mind is these goofy sci-fi movies where the aliens come to invade, and all of a sudden the Russians and the Americans are friends 'cause they have to sort of fight the alien. Like, so outside of goofy sci-fi, is there any reason to believe we even possess the ability for that degree of cooperation?

   2. PCDr. Paul Conti12:48

      I don't think we do right now. I think we can, but I don't think we do. And this is because it is much, much easier to ally around a common enemy. How long has the expression, you know, "My enemy's enemy is my friend"? I mean, that's probably been around since people developed language in some form or another. It's very easy to identify, "That is my enemy, so now you are my friend," hence the alien invasion. Even you look during the Second World War, nations that had a lot of adversity, there were examples of unification around fighting the common enemy. The, the problem is what is-- becomes much, much, much harder and requires different elements of a human being's ability to call upon the deeper parts of our brain, the parts that don't just react with what I think of as traumatic aggression, in order to ally around something that really isn't an enemy. The virus isn't plotting against us. It doesn't have intelligence. It's invisible. In order to unite, we have to recognize our shared humanity and our ability to-- for people to cross borders. Our ability to destroy one another with weapons has so far exceeded our ability to do that. I mean, if you look at the reactions in various countries, it's been the same reaction. I mean, I think to me, core principles here are the everything is as it should be. If we make decisions one through 19, we're gonna end up at decision point 20. And the other point is how much the middle school playground plays into all of this. Even it was three, four weeks ago... Around maybe three weeks ago, my, my father, who's in his eighties, his girlfriend, who's in her eighties, were gonna go out to an event with, like, 500 people. My response is, "Oh my God, stay home." And then he responds, "Why would I stay home? There are no cases of the virus in New Jersey," where my father lives, right? Sure, if you don't test people, then you don't know that there are cases. And I think this is so part of the problem, that we've reacted in this, "Hey, not-- I don't have the cooties. It's not mine." It's a middle school playground reaction. And when you combine that with how easy it is to just blame somebody, it's someone else's fault, and that we've, I think, socialized ourselves through how media in general, let alone the subcomponent of media that's social media, has grown up around us to self-indulge to that appeal. It's not me. It's somebody else's fault. Somebody's my enemy. Can't land here. And then it's a combination of misguided aggression and sticking our heads in the sand. And then look where this leads us. I mean, the scenario that you cited shouldn't have to be science fiction. We should be able to collaborate in ways that recognize common threats to us, but we don't do that. We so quickly devolve into the first part of what we were talking about, which is, "I feel insecure. I feel vulnerable. Are you my enemy? And I certainly don't want you to think that there's something wrong with me. Maybe you'll think I'm your enemy." And then we all put our heads in the sand and look what happens down the road. It's so clear how preventable this was and also how inevitable it was given that we did not set the groundwork in place to prevent something like this.

6. 16:23 – 21:35

   Socioeconomic Precarity and Those Left Behind

   1. PAPeter Attia16:23

      So you've been very busy, obviously, in the last month. You're as busy as I am, if not more busy generally. But my guess is that the people you help have found themselves relying on you perhaps even more than normal. Is that a fair assumption?

   2. PCDr. Paul Conti16:40

      In some ways. I mean, it's been interesting. That has been the case for some people. For other people, there is some sense of safety in sort of hunkering down at home and that idea of circling the wagons. So it's interesting how much it has really dichotomized in that way. And also what I'm not seeing nearly as much of are the people who were so at risk socioeconomically before this. You know, a lot of what I do bifurcates. You know, I'm, I'm the medical director at a place that, that provides drug and alcohol treatment for mostly an indigent population. That's part of the work I do, and the other part tends to be with people who have more resources. What I'm not seeing is the gigantic, and I mean gigantic swath of most of the country that were on a socioeconomic precipice before this. So then not only do they have the medical risk, the fears that I do think are pervasive and are perhaps temporarily soothed by holing up at home, but they're not soothed by holing up at home if you don't know what you're coming out to. We've known for a long time that the specific numbers vary by study, but, but the idea that, like, half the population in this country couldn't survive and move forward from $500 unexpected cost or a $500 shortfall. So on the one hand, we've talked about, "Oh, look how great the economy is doing because employment rates are high," but so many people are living either in desperation or one step away from desperation. And I think what we are doing is, yes, a lot of people are traumatized, absolutely, but that gigantic swath of the population that is most of us are traumatized disproportionately because they don't know what they're emerging to because we've set up a system that has essentially made that inevitable. I mean, how long was it going to be if half or more of the population can't survive through a $500 need or a $500 shortfall? Something is going to trigger that, and it's not a surprise that something triggers it en masse. And I think that's where this is a gigantic medical problem. It is a social problem. It is an economic problem. When you add those things together, those things synergize, and it becomes a societally threatening medical socioeconomic problem, and we haven't had that before.

   3. PAPeter Attia19:24

      So let's take both extremes of the types of patients that you're most working with, most commonly working with. In the first group you said is the indigent population who you're helping with substance abuse, presumably many other medical and psychiatric problems that accompany those. How is that population doing in the presence of what's happened in the past four to six weeks?

   4. PCDr. Paul Conti19:48

      I think it's added desperation on top of desperation, which is obviously not a good thing. It's an element of the population that, I mean, I think in large part we've left behind. Because I see the world through the lens of trauma, I see part of my reason for existing in fighting the shame that's created by trauma. But there are ways in which shame is called for, and I think as a society, there are things that we really should feel ashamed of. The ways we don't give people chances to get back on their feet, and then we have a populace that's-- There's just so much desperation in that part of the population that, yes, this makes things worse, but it's not a change in how a lot of people in that situation are living day-to-day life. And I think that's lamentable.

   5. PAPeter Attia20:37

      Which is a sad statement.

   6. PCDr. Paul Conti20:38

      Yeah. It's a terrible thing to say, but that's even in the 20 years or so that I've been doing this, right? Which is it's not a gigantic amount of time. It's not a small amount of time. But the change has been dramatic, where there is a part of the population that we just leave behind. They need more resources than we're willing to put towards them. So we check a few boxes, and we say we're doing things that we're not really doing as a society, and we've written people off en masse. Now, that is not true of everyone, and there are people who of course work so hard and so selflessly to help other people. But as a society, we've sort of decided that it's okay if you can't navigate complex systems or if a couple of bad things happen, either things happen to you or you make bad choices, that as a society, I don't think it's subtle that we've written people off that way.

7. 21:35 – 25:34

   Pervasive Insecurity and Hypervigilance

   1. PAPeter Attia21:35

      And then what about the patient population you take care of for whom the economic stress of this is not nearly as it is for perhaps the majority of people, but who still have their own demons, their own neuroses, their own stresses? What are you seeing that is unique to this environment that is maybe either similar to or even distinct from other things that you have been in the capacity of being a therapist, for example, during the economic catastrophe of 2008, 2009, again post 9/11, uh, you know, any other sort of external stressor? How does this stack up, and what is it that you see that's maybe unique about it?

   2. PCDr. Paul Conti22:19

      I think I've never seen something that just supercharges this idea that if I fear enough, then I'll be safe, which I believe is an, an impact of the insecurity that many, many people, if not-- well, certainly most people I encounter, I believe feel-- so feel about the world. This idea that our biological drive to recognize threats so that we can stay alive and pass on our genes has in so many people mutated to where we're essentially living in a state of constant hypervigilant discomfort. There's always something else to do. It's never enough for us to be safe and secure, and I think the society's always telling us that. The news has mutated from providing news to grasping people's attention, grabbing people's attention in a way that says, "Look at that news again because you're gonna see something else bad." All the anecdotes of, "He got up at 9:00 and felt healthy and by noon was in the intensive care unit," right? It's like we know this. We don't need to be assailed every moment by every threat to us, and we have become prisoners of the insecurity that we have generated. And I think that comes through these biological drives that have led us to a place that is no longer keeping us safe. And, and if you think of the, the biological drives and psychological drives to, to increase our safety by participating in social systems and economic systems, and a lot of that has mutated into strivings that make no individual sense within systems that make no group sense. So people that are working and working and putting money away for retirement, but the vehicles that they're in aren't safe vehicles anymore We've created so much insecurity that it affects people even who say have enough economic means, but still have this pervasive feeling that there's always, always, always something to fear. And then this idea that if I fear enough, I'll be safe then starts to spiral out of control, and people get obsessive and people get ruminative. The same, the negative thoughts go over and over and over. What if something happened to my kids? And, and like, okay, what if we all get sick? Or, well, what if we don't get sick, but there's a terrorist attack? Or what if, what if, what if, what if? And becomes so pervasive that what's fascinating to me is that I don't see peace in any demographic. Doesn't matter if people have tremendous amounts of money or have no money. I just don't see peace anywhere. And I think I am trying to scientifically ascertain for it, right? [chuckles] I mean, I'm trying to listen to people, talk to people, learn what's going on inside of them, and sort of what is uniting us is this pervasive insecurity. And then these parts of our brain that want to keep us safe go into overdrive and inadvertently make us feel so much more vulnerable.

8. 25:34 – 35:07

   Demoralization and the Failure of Expertise and Protection

   1. PAPeter Attia25:34

      What do you think is actually happening from a neurobiology standpoint? I mean, we're now over a month into our quarantine here and spoken about this on the podcast before. Pretty fortunate. There are people who are quarantining inside tiny apartments, and they don't have the luxury of being able to go outside in their yard and things like that. So I wanna be clear that I'm not for a second lamenting the quarantine I'm in 'cause I feel really, really lucky. But I can't for the life of me understand the degree of irritability that I've experienced over the past month, and I've done a little bit of a better job in the past few weeks at least not lashing out. But there's no denying internally a feeling that I have that is... Well, frankly, I don't know how to explain it. I'll tell you because, I mean, it's so frequent. I can tell you how I felt this morning. So this morning I was, I was exercising, so I'm lucky to have a gym at home so I can exercise. So, and again, intellectually, it's not lost on me what a privilege. Like, I think of all the people who can't go to the gym now, and their best thing they can do is push-ups and sit-ups in their apartment. So intellectually, I get that, right? But I'm sitting there thinking, "I don't really feel like doing this." And frankly, if this quarantine ended tomorrow, I don't feel like going anywhere. There's this weird feeling of I don't know what I want, but I don't want this. I have a lack of interest in anything, but of course, I'm as busy as I've ever been. So there's this very difficult feeling of every minute I'm moving, I'm hustling. I mean, even my exercise is scheduled in between calls and this thing and the other thing. But if you told me, hey, I could wave a magic wand and make the coronavirus go away tomorrow and everything would be back to normal, I didn't even have a sense of joy over that. I was just like, "Ugh, well, what would I do?" I don't know how to describe this, Paul. It's like I'm sure there's a word for this sort of overall just lack of interest in life. Maybe that's too broad a way to explain it, but it's this really weird oscillating feeling of sort of sadness and irritability and almost wishing I could just escape something, but not sure what I want to escape. Does any of that make sense?

   2. PCDr. Paul Conti27:47

      Absolutely, and then I am finding there are more people who are escaping, through say, drugs and alcohol and other really unhealthy things through that sense of desperation. And I think what you are describing is demoralization. And you can tell me if this resonates with you. You and I haven't talked about this before, so you tell me if this resonates, that, that I think somewhere in there is a sense of futility that says, hey, if you look on two different levels, one on a personal level, you've worked very, very hard to better yourself, better your situation in the world, take care of your family. And there's something that speaks to, okay, there's a roof over our heads and we're sheltered here, but have I succeeded in doing that? Or have those efforts been futile because I can't protect the people around me? I can't make things okay, that my personal efforts to make life okay have come to naught. I mean, obviously not saying these things are true, but this is what goes on inside of us because you feel that, okay, you can shelter everybody for now, but what does this say about the world around us? And what does it say about the next threat that maybe you won't be able to shelter from? That's one aspect of how we become demoralized, the idea that, hey, no matter what you do and how hard you work, you can't make a difference because you're gonna be vulnerable anyway. And I think it brings that home to a lot of us because I think... I'm not saying that we should be demoralized, but I'm saying I believe there's truth to that 'cause I think the world around us, the world around us leads to that. The everything as it should be says the world is such that we're not safe. On the other hand, there are things that you've done on a broader level that are about trying to contribute to the world in a bigger way around you.

   3. PAPeter Attia29:36

      I think what you said is incredibly spot on, and of course, that's part of what makes you who you are, is your ability to sort of see things I would never see. I've never thought of this as being demoralized, but I think you're absolutely right. And I think you're right that I'm not alone. I suspect people in 2008, 2009 were demoralized for a different reason, which is if you're that person who did everything right and found themselves on the wrong side of a mortgage because the value of their home came crashing down and they were not sophisticated enough to know that, hey, these types of loans have these hard, nasty resets on interest rates, et cetera, et cetera, you could very easily say, "Hey, I did everything right and look what happened," right? And now I think you're seeing that same thing all over again But with far less economic stratification. The economic stratification plays probably a broader role in your resilience to this, but it probably doesn't play as much of a role in what you just described, which is whether you're the wealthiest person in the world or the least wealthy person in the world, there's still sort of a view that you should live in a world where you have some ability to control your health if you do the right thing, if you take care of yourself, if you eat, sleep correctly, exercise correctly. Like, you shouldn't be afraid for your life. And I'm not saying that that fear is rational, by the way, because as we've discussed, the majority of healthy people who get this virus are going to be totally fine. But there is a degree of fear that says that that might not be true.

   4. PCDr. Paul Conti31:23

      I think that's right, and that's where I'm sort of fond of saying it's the soup that we're all swimming in, and I think that's the commonality. Wealth status or social standing, like those things don't matter when we're swimming around in the same soup. And neither you nor I, we're not political animals and, and we don't have political discussions in that way, and this isn't about politics. I mean, I'm a believer that many things in the world are driven by strong individual people, good, bad, or otherwise. But I do believe that that's not always the case. There are cases when social forces evolve, and then they produce something that's going to be a certain way regardless of the specifics about it. So this isn't Republican, Democrat, like it's so far from that. But the idea that the importance of expertise actually has become less and less and less and less important because everybody can have an opinion and can just yell that opinion louder, and then what we get is an erosion of expertise where it doesn't so much matter anymore what does somebody know or not know because, well, everybody's got an opinion. And I think we've seen that evolve, and my thesis is that the inevitable outcome where the basics that we think of about the state around us, the government, right, keeping us safe, like just isn't true. And we do expect that. We live in this society. We participate in it. We vote. We pay taxes. Like I expect that if I'm driving down the highway, there's not gonna be like 20-foot long hole that's 20 foot deep that my car falls in. Like I expect that's not gonna happen. But that's not the only expectations we have. We expect that there's something going on that's providing us with some sense of protection, that there's some foresight to the world around us, that everything isn't just based upon opinions, and opinions that then justify whatever the person expressing them wants to justify. And I think what we're seeing here is like truly that the emperor has no clothes. And, and again, I am not speaking-- This is not me trying to be political about the president. I mean like the emperor of the society we live in. It's not adorned with the splendor that we think will protect us. There's a truth here that there can be hurricanes that devastate individual places, and people don't come to help. I mean, look, some people go to help, but not in a way that says, "Look, let's make sure that this doesn't devolve into complete lawlessness." Like we haven't been able to pull that off in focal settings. How are we gonna pull that off on a national setting where there has to be acumen and resolve to decide what tests should we deploy, to have the willpower to deploy? I mean, it's not that long ago where people were still saying, "Oh, some person somewhere in this place, uh, had the coronavirus. Oh my gosh. Oh my gosh." Then we look at that person had it. We now know there's maybe half a million people who have it. There's a seduction of like, "Let's look at that person and look at that bad thing, and then we can posit that we're other than that." And the truth is that that never made any sense. That never made any sense. That example you gave where everybody's cooperating, we would identify who's been exposed, know who those people are, test those people, protect their contacts. We could have done so much better containment, but instead, th-there really hasn't been that much going on to protect us. And I think this lays that bare in the way that the hurricane showed us in a focal way. But it's not just about health. I think it's about socioeconomic risk.

9. 35:07 – 38:33

   Trauma Facing Healthcare Workers

   1. PAPeter Attia35:07

      Paul, I want to shift gears for a minute and talk a little bit about healthcare workers. I don't know how much time you've spent thinking about that in this setting, but do you have any thoughts about sort of the lingering effects of this on that population, which has a couple of things working against it. One, they're on the front lines, so while people like you and I have the luxury of working remotely with people we care about during a time like this, they don't. The doctors and nurses that take care of these patients don't get to do so remotely, so now they're at this increased physical risk. And there's, you know, still some evidence to suggest that the risk that they face is even greater just based on potentially the viral loads they're encountering and things like that. So this is real risk. Secondly, you have the sort of the morale insult that comes with seeing their own colleagues also become patients, so when they start to have to care for each other. Do you have any thoughts about sort of the PTSD that comes to this population in the months that follow this or in potentially even longer?

   2. PCDr. Paul Conti36:21

      I think it's gonna be so pervasive. I think the trauma is going to be pervasive and even generational I think that family members, children of people in that situation will be affected by it and potentially deeply affected by it going forward. I think we are facing the, what I think of as the appalling consequences of compounded ignorance. I mean, look at what we have done in our health system. Like you and I have both been in it in a whole bunch of different ways, and I think people in it can see how little it makes sense that we're trying to run our healthcare system in a way that is sort of pushing people to the limits and extracting profit and reducing costs wherever possible, and then ultimately everything is running in a way that stretches people to the limit. Stretches people to the limit. And how much have we seen of that in anyone, doctors, nurses, social workers, respiratory therapists? I mean, everybody is pushed to the limit in systems that have, in a sense, abdicated their intelligence. They're not being run with intelligence. They're being run by rules that no one is looking at whether they make sense or whether they keep people safe or whether they make the people who are doing the work in that system feel so disempowered and so devalued. How many times have we heard, I mean, you must, I would guess you hear this the way I do, of healthcare workers just talk about the feeling of their own expendability. They're working in a system that doesn't know them, care about them, value them. And again, I'm not trying to criticize individual people. There's so many people trying to do their best, but we've allowed the systems evolve into this compounded ignorance where we can't take care of the people who are supposed to take care of us. And they know that, and they've known that for a long time, and they're seeing it come to the forefront.

10. 38:33 – 46:33

    Acknowledging Trauma and Building an Alliance of Common Sense

    1. PAPeter Attia38:33

       So what's a path forward either in the scenario where this just lingers on longer than any of us would like to imagine or where it becomes sort of a vacillating, ebbing, flowing pandemic, or even under the scenario where, look, six months from now everything is back to normal, this virus is squarely in the rearview mirror, we have effective treatments, and the healthcare system is back on its feet. In either situation, how would you think about managing the long-term toxicity of this? 'Cause especially if it's sort of smoldering but not resolved. And I mean that from a psychological trauma perspective.

    2. PCDr. Paul Conti39:19

       I think the first thing we have to do, which is by no means a given, is acknowledge the trauma. When a person has been through trauma, there is a strong and reflexive impulse to keep that inside. We don't understand it. We feel ashamed of it. It's so threatening, and we push it down, and we need it to be validated. I think we need to validate as a society that we set ourselves up for this, that we set the healthcare systems up to be overwhelmed, to not have the protection mechanisms and the testing that they needed. And now we need to essentially acknowledge and atone. And I don't mean in some way that's atonement in some abstract way, but we actually need to make things different. I mean, I think you would agree, and again, you're the master of what data tells us, right? I think we can look at data and see how we can and should be doing things better. There's not a tremendous mystery to that. I mean, there are places that are doing it better. There are paradigms that we could utilize more that don't reduce people to cogs in a system. And I think we need to, number one, acknowledge that to the people who have felt like just things in the system. And, you know, you can throw away a mask, uh, just like you can throw away a gown, just like you can throw away a person. We have to get out of the interchangeability of employment in the modern world, in healthcare as well, and we have to look at what are we doing with our resources. And we have to make it different so people feel like you understand me and what has happened to me, and you are trying to make it better, the you being all of us as a society. If we don't do that, just like with any other trauma, if no one acknowledges it and there's nothing being done to try and make it better, then it will stay with that person and fester, and it will lead to all sorts of bad outcomes that we'll see years down the road. We'll look in retrospect, and we'll see rises in rates of alcoholism. We'll see rises in rates of domestic violence. We'll see rises in rates of suicide. We'll see rises in rates of people just giving up and walking away from important things to them. Like, we'll see all of this. We will see all of this because if we demoralize the population and we don't rectify that, it's not going to be okay. And if somehow it seems to be in six months, that will be a deceit, that it will be tempting to just believe that and go on. But we have to have the courage of our convictions to know that, like, that's not okay. Let's look at is it true that everything is as it should be, meaning we led ourselves here. If it's not, let's argue about that and prove that it's not. If it is, let's look at it and change it. And I think it involves people standing up and saying, "Look, this needs to change." There needs to be not how do we make the systems better, how do we fine-tune this or that or give this to this population that really suffered. No. No. It's how do we acknowledge the need for change? And that's the hardest thing to do, is not that we're gonna make systems better. We're gonna look at systems, and we're gonna bring change to them.

    3. PAPeter Attia42:32

       What does that look like? I mean, I, I understand what you're saying in the abstract. I don't think I understand what it means. I don't think I know what that looks like five years from now when this is long forgotten. How does a society, from a mental health perspective, look if they are going to be resilient to the next pandemic? So if there's a SARS-CoV-3 that's coming in 2030, what does a national psyche, what does the mental health of a population need to look like the year before that hits to do a better job than we might be doing today and to do maybe the best job that can be done given the circumstances? What has to be true of that population?

    4. PCDr. Paul Conti43:16

       I think what we need is what I would call an alliance of common sense. And I was talking about this earlier this morning with our friend and colleague, Jim Kochalka, about the ideas of how would one-- how would we work towards an alliance of common sense where people would say, "I can't pretend that something is okay just because it suits my interests, even if I know it is false. I have to first prioritize looking at truth." And can we, the people who would do this, which ideally could be a growing movement led by people with influence and with the ability to say, "We have to put aside whatever our wishes might be, whatever our animosities might be," that we actually do have to treat this like post 9/11 or like the Second World War and say, "What we need to look at now is truth. What are the failings in our public health system as a planet and also as a nation?" They stretch people to the limit. They stretch resources to the limit. When do we pretend that lies are truth, and how can we say that that's okay? Republican, Democrat, or other, who cares? And again, this gets contentious because as soon as you get political, and you can't talk about change without treading into the political, then there's such bitter and brutal animosity that it tells all of us. I mean, part of me, I want to have this conversation because I care about the world. Even if I didn't have children, I would care about the world, I hope. But the fact that I have children is I, I want to have this conversation. But there's a part of me that says, "Hey, put your head down and go back home," because ultimately, whatever you say is gonna make some people really, really angry, and people get angry and bitter and vindictive. What we need is something that fights against that, that says we are going to ally around truth in our medical system, in our social systems, in our economic systems. We have to look at this. And if people start allying in that way, then we have all the expertise that we need medically, social systems, public health, economically, whether it's economic on a local or on an international commerce system. We absolutely have every single bit of expertise we need. What we do not have is an alliance of common sense of people who say, "I will stand by that come hell or high water. I will not give in to lies. I will stand by that." Then we can start making the world better. If half the population can't survive a $500 shortfall, I am not going to pretend that the economy is okay or that our social systems are okay. Or if the healthcare choices that people are facing are too complicated for them to understand, and then people ultimately don't get the care that they need, they show up at emergency rooms for their primary care, demoralizing the emergency room staff that wants to take care of people who have emergencies. Like there's so many thousands and thousands of examples, and we just need people to say, "It's enough."

11. 46:33 – 53:10

    Personal Truth, Absolute Truth and Logic Versus Emotion

    1. PAPeter Attia46:33

       Do you think that this event is potentially a catalyst for changing the way people think about science and truth? And again, I use those two in the same sentence because when you take a step back and think about what the truth means, I think we have to differentiate between personal truths and absolute truths. I think it's true that Formula 1 is amazing, but I also recognize that that's a personal truth. It's shared by you, but it's not necessarily shared by everybody else, and that's okay.

    2. PCDr. Paul Conti47:08

       You and I believe it, that doesn't make it true?

    3. PAPeter Attia47:09

       [laughs]

    4. PCDr. Paul Conti47:10

       Oh. New thought. Yeah.

    5. PAPeter Attia47:13

       I believe Ayrton Senna is the greatest Formula 1 driver of all time. Again, I think that verges on being an absolute truth, but-

    6. PCDr. Paul Conti47:20

       [laughs] Yes

    7. PAPeter Attia47:20

       ... I'll leave it in the category of a personal truth.

    8. PCDr. Paul Conti47:23

       Yes.

    9. PAPeter Attia47:24

       But when you start to get into things that are absolute truths, that's really where science comes in. Science is a toolkit that allows us to test hypotheses. It's a methodology that allows us to examine absolute truths. And do you think there's a chance that what we're seeing here could ever be a catalyst for allowing that distinction to be made in broader society? Because I-- it's not clear to me that it does. I think that for, for the majority of society, there's a blurred line between absolute truth and personal truth or relative truth.

    10. PCDr. Paul Conti48:03

        Peter, I think you're striking to the heart of the matter because absolute truth operates through logic systems in our brain. I mean, ultimately, this does relate to brain biology. Absolute truth resonates with logical systems in our brain. Relative truth, personal truth resonates with emotional and what's called affective or limbic systems in our brain. When we engage effectively in the world around us, and again, I have a thesis that says we as a society are not engaging effectively because we have lost the distinction between those two that lets us make the personal truth secondary to the absolute truth. So the idea is there's a strong resonance if I feel something to be true. I mean, there are social issues I feel very strongly about. That resonates with me emotionally. Why? Because I'm a human being and says because I believe that, that makes it true. That's my belief. So it-- that's how I want it to be, so that's true. But then the, the other systems in my brain say there are absolutes that I want to hold up and against that, and I want to have those absolutes govern my own personal feelings. So I may feel just as rabidly that Formula One is the greatest sport ever. I want everybody to believe that, and if I let my emotion run away with me, where do I end up? I end up thinking everybody who doesn't believe that is an idiot, as opposed to saying, "Look, I feel that way, but hey, look at all these other sports," and there are people who really love those other sports, and they see the excitement and the personal strivings that I see in Formula One. So the reflex in us is to elevate the personal truth, the emotional, to supremacy, and we need to overcome that so that logic wins the day because logic is not charged the way that emotion is. And I think media, social media, I mean, like this is the heart of the matter, have made it very easy to elevate personal truths. You believe A, I believe B. Instead of having a conversation about it, isn't it just easier and in some ways doesn't it feel better for us each to say the other one's an idiot and that's that? We're indulging that in a way that then starts making logic subservient. It makes the absolute truth subservient to the emotions, to the personal truths. And if you look at how change happens, the concept of a dialectic where you have something and you have something different from it, right? You have two different things, and they become something that's different from both of them, I think is where we're at. This is going to be a catalyst to something, and the something on the other side of it, I strongly believe, is going to look differently than what it looks like now. If it's not after this and things seem to be back to normal, this will just be one of steps that lead us to things being different. And one way things could be different is that absolute truths really do go out the window. We very much come back to superstitions, and we're, we're really kind of not that far away from it now, and we could very, very easily get there. Or this will be a catalyst for us righting ourselves and saying, "Look, we must prioritize logic whether I like what it says or not." And there, I think how do we make the catalyst, the resolution of that dialectic go one way and not the other, is we need people to make this, I'm just calling this, no magic to the words, but an alliance of common sense that says, "Hey, if you think A or you feel A and I feel B," that's the words. "If you feel A and I feel B, that instead of immediately being at each other's throats, let's stop and look at the facts. Let's stop and look at logic." Otherwise, h- I mean, how far-- Again, I'm not trying to be overly dramatic, but look, when the Khmer Rouge took control in Cambodia, right, one thing they did away with was doctors, right? This is very easy to-- Well, you put one person's blood into another. We can teach people to do that. Okay, what about blood types? You didn't have any doctors or science or hospitals, and then they just started randomly transfusing people and either making hemorrhages or putting one type of blood into another. I mean, that was an utter human catastrophe there, but there are whiffs of that going on now. Who cares what the science says about hydroxychloroquine? Try it. I mean, this is emblematic of us leading ourselves away from logic. I don't see how we're not heading towards destruction. Like the everything is as it should be tells me that we can't let that happen because that ends at destruction. There's nowhere else it ends. So we need this alliance of common sense, of people who will stand up and say, "If I disagree with you because I feel differently, I'm gonna look at the logic, and if logic tells me that what you're saying is right and what I'm saying is wrong, then damn it, I'm gonna, I'm gonna go forward with your way of seeing it no matter how I feel." We need more of that.

    11. PAPeter Attia53:10

        I mean,

12. 53:10 – 58:02

    An Unfair Fight: Limbic Drives and Runaway Emotion

    1. PAPeter Attia53:10

       do you worry, Paul, that we have spent such a scant period of our evolutionary history with any formal language around logic and science? I mean, for all intents and purposes, it's about one-tenth of 1% of our evolutionary history has operated with even the nomenclature of science, the skill set and the tools for logical thought. The reason that I think religions exist and the reason that mythology exists and superstitions exist is they became ways to explain things prior to a nomenclature that could describe things. The sun went up on this side and the sun went down on that side, and before you understand that the Earth is spinning around the sun, you have to concoct another explanation. And so we're not hardwired to think critically. Our limbic system has literally billions of years of repetition and maybe not our limbic system exclusively, but say from amygdala up, right? In other words, the most primitive part of our brains have billions of reps in them. And as you point out, the brain stem, the amygdala, the limbic system are generally driving us now, when in reality this would be the time to have higher cortical functioning take over. But that is such a recent, recent development, not just evolutionarily, where maybe for the past fifty thousand years we've had those structures of our brain, and I could be off by some magnitude there, but directionally, but really only about five hundred years in terms of formal structure of, of scientific methodology. Is this just not even a fair fight? I mean, we're sitting here having this philosophical discussion about logic, but I mean, in times like this When we recede to our lowest common denominator, how in the world can we expect those systems of logic and science to prevail?

    2. PCDr. Paul Conti55:09

       So on the one hand, you're speaking to a very powerful truth, which is we are driven to be driven by the limbic system, by emotion. It has always held the upper hand. So it's not a fair fight, but it's a fight we can win. You know what I mean? The odds may be stacked against us, but we can win that fight, as evidenced by the fact that we have evolved in a way that the scientific method was-- became understood, and then we learned, "Oh, wait a second, the Earth does revolve around the sun." We can fight that just because the odds are against us. Just because we're swimming against a strong current doesn't mean that we can't, with the right preparation and cooperation, successfully swim against that current. What has happened, and I think my amateur read of the sociological data is that what has happened is our ability to unleash emotion has way outpaced our ability to, to sort of-- for our logical processes to keep up with that. The explosion of social media, of people being able to communicate with one another so rapidly about what they feel, our control mechanisms haven't kept up with that. I mean, the fact that the lead physician in charge of fighting this virus has to have bodyguards, [chuckles] right? Right? I mean, whether he does or whether it's been talked about, again, I don't know. It's part of this anger that that person said something I don't like, so stone him, right? I mean, these emotional responses are in us, and what we need to do is, like, be adults and not be children. We're being children, and we need to be adults, and we need to say, "Look, we need to hone our control mechanisms." But what we're not doing is saying we can't have systems around us that propagate just how someone feels about something and then stokes the emotion of everyone else who feels the same way. "I don't like this. That person is bad. I don't like this political opinion. I don't like whatever it is I don't like." That spreads like wildfire. I think in a way, I don't know if it's happenstance or not, but I think the wildfires that are plaguing us in California and Australia, right? It's, it's-- These are far-flung events that I think mirror the wildfires of emotion that go on, and it doesn't matter what's true. People's emotion runs wild, and what we need to do is to step up to the plate and develop greater control mechanisms and look at how do we stop misinformation? How do we establish sources that are arbiters of truth outside of politics, that are arbiters of what's actually true? And we don't have that. We need more of the things that aren't sexy and aren't glamorous. Otherwise, this emotion you're talking about is running wildly ahead of us, and it's gonna metaphorically make wildfire that consumes us. And I don't think that's catastrophizing.

13. 58:02 – 1:06:55

    Uncertainty, Humility and Politicization

    1. PAPeter Attia58:02

       Do you think part of it is we're also not very well equipped genetically to understand uncertainty? So in what we're talking about of sort of absolute truth versus personal truth, there's another layer of complexity. So if the personal truth is that Formula One is the most exciting thing on the face of the Earth, I think most people, if they're being intellectually honest, can come to an understanding that that's a personal truth, no matter how strongly one feels about it. But let's use the example you've brought up, the example of hydroxychloroquine as a potential treatment for this. To say that hydroxychloroquine is an effective treatment for COVID-19 doesn't really fit in either of those categories. It depends on how it's expressed. It could be expressed as, "Hey, it's my opinion that looking at the scant data to date, the risk of this is lower than a certain threshold which deems it an effective treatment in someone whose risk is high enough." That level of nuance to something kind of straddles both personal and absolute truth. Another example is climate change. Part of the struggle with climate change is nobody can really talk about it in terms of probabilities and with error bars, and so you basically get polarized arguments that both sort of have their own flaws. So on the one hand, you have people that just completely deny it, or if they don't deny climate change, they're sort of adamant that man can play no role in it. And on the other end of the spectrum, you have these extreme hyperbolic estimates that might represent a scenario, but not necessarily the most likely scenario or not necessarily a complete picture of the plausible scenarios. In other words, again, it comes down to uncertainty and probabilities. And I think that something like this, this experience that we're dealing with, makes it very complicated for our little plebeian brains, our little reptile brains, to deal with. And I'm struggling with it, and I'm someone who understands probability, and I understand logic, and I understand science. But I have to be honest with you, I am tired of saying I don't know, and yet it is the only answer I have to give. A hundred times a day, I get asked a question, and it can be my daughter saying, "Dad, when do we get to go out and have dinner?" And it can be one of my patients, and he was asking me, "Let me ask you your opinion, Peter. What do you think is gonna be happening in six months?" And again, all I can say is I don't know. I can give you five different scenarios of maybe this, maybe this, maybe this, maybe this, but there is no absolute truth that I can offer that person. So I could give a personal truth, which is this is my opinion, but science rarely proves anything. It's not like mathematics, right? In mathematics, we have proofs, but in science, we just have high degrees of certainty. And again, I just, I worry that this introduces a new layer of complexity to a discussion that already makes it impossible to sort of cope with a lot of signal, a, a reasonable amount of signal, an extraordinary amount of noise, and then a supercharged emotional swamp that dilutes and amplifies the wrong things, if that makes sense. I'm rambling a little bit. I think my point is I'm generally pessimistic, Paul, I guess is my point.

    2. PCDr. Paul Conti1:01:51

       Yes. Peter, of course, I don't know, [chuckles] right, for sure, but I see it maybe in a more simplistic way. I don't think there's another level on top of it, because I think that "I don't know" is actually a beautiful answer if you don't know. What do we really know, right? So we know so little that admitting that we don't know engenders humility. It engenders the humility that makes us careful. I don't know if a pandemic is coming. Let's, look, let's have some preparedness to it. I don't know if this is helpful or not. Let's learn more about it. There's a caution that then leads to alliance. I mean, we started early on talking about how can people, countries, nations ally. It's through a sense of humility that, you know what? I don't know, and I'm not ashamed of not knowing. I mean, think about in medical school, I think part of the myths of medical education, right, is that you never say you don't know. I think that's the worst thing ever. I think why would you ever say you know when you don't know, and we're talking about somebody's health? There's a humility in "I don't know" that leads to collaboration, that pushes against aggression. It pushes against that middle school playground of, "Oh, I don't know, and now I'm ashamed." And it leads towards progress. The other side of that coin is what I see as the hubris that leads people to just declare that they know, and there's a recklessness to that, right? I mean, I think we're a society of angry, frustrated people, and we're getting angrier. You think we're not gonna come out of this with more of that? I mean, people already were feeling insecure, traumatized by the systems that we live in, the insecurity about where my healthcare is coming from, or people's fear of that $500 that's gonna sink them. We're not gonna come out of this angrier? And the anger is what fuels the emotion. And then it's the emotion that then falls into the political spectrum. So if that's the case, then whether you agree with something or not, it becomes a mechanism of your allegiance. We, we start to look more like systems that say, "It doesn't matter what's right or wrong. Do you agree with me? Because if not, you're bad." And we're doing that all the time. Why is the efficacy of hydroxychloroquine a politically charged question? That's insurmountable then. We need to make it not a politically charged question. There are political issues, taxation rates, social equality, value systems we're deploying. There are lots and lots of political questions. But because we are so angry and I think so traumatized and desperate as a population, we make everything a political question. And then that adds to that emotion side of things. I think it is just the real truth versus personal truth, logic versus emotion. It is that, but it's become so convoluted because the emotion is so high, and it gets attached to things as vehicles for that emotion. And that's what we have to work against. That's where the, this alliance of common sense would say, "Look, we have to not be children. We have to be adults, and we have to look at what is it that I don't know. And if there are 20 questions and I don't know the answer to any of them, well, at a minimum, I hope that that engenders humility in me and ability to work together with other people and listen to their opinions. Even if I have a say, if I have a strong personal opinion about 15 of those questions, but actually there's no logic to know any of the 20 of them, can I find it in myself to have the cu- humility to admit that and to say that, and to say that to you and know that you're okay with that? You're not gonna humiliate me for it and embarrass me for it," right? And that's what people are afraid of, is you have to know because you have to fight with what you're gonna say you know. We need to stop that. And we don't have to be-- I, look, I'm pessimistic too, but that doesn't mean that I feel hopeless. I am pessimistic, but not nihilistic, because I think the wake-up call, what this can catalyze is people who, who are trying to do good things but may be hesitant to step into what seems like a political arena. I don't mean run for office, right? I'm just saying that truth, personal truth versus real truth just has to stand aside from politics. And our economic system, our social system, these are systems tied in politics, and we have to look at the truth of those systems because they are not serving us well. We have to separate ourselves, our trauma and our anger and our shame and our frustration from what is logical truth or not. And I think, again, I think you and I, between us, it's what I was talking to Jim about this morning. There are enough people who could step up to this plate, but boy, it's the thing people are least inclined to do because it's the thing that draws the most flak and the most personal animosity.

14. 1:06:55 – 1:14:51

    Self-Care, Meaning and Connection as an Antidote

    1. PAPeter Attia1:06:55

       Paul, I want to shift back from the macro to the micro now. You and I have spent a lot of time over the years talking about something that I think you're better at than I am, but I think we both struggle with. What has been your recipe in the past month for self-care? I don't know how you do what you do. I mean, I think... And, and I don't just mean you, I mean people like you, right? People whose job it is to take on sort of the burden of other people's pain and suffering, and then to be able to do it in a manner that's not detached, but rather to be fully involved and invested in whatever crisis, whatever struggle, whatever turmoil that person exists in. How you then manage to buffer yourself from that without being detached, take care of yourself so that you can continue to take care of people, take care of your family. Again, you and I have had endless discussions on the types of things that one can do here. I just wonder if there's something that you can teach listeners about how you've done that, and what can somebody take away from this when they're feeling, going back to where we were a while ago, back to that feeling of sort of low in morale. Just, I forget how you described it. The way you d- you very aptly described how I was sort of feeling-

    2. PCDr. Paul Conti1:08:10

       Demoralized, right?

    3. PAPeter Attia1:08:11

       Yeah, demoralized I think is the word you used. Yeah. So let's assume that this quarantine is going to continue in the weeks and even months that follow, and people are going to be in their routines that are full of stresses and stressors that they might normally be able to escape from. And they don't have the luxury of picking up the phone and speaking with you or Jim or some of the other amazing people out there who are really just sort of a godsend to folks who have access to you. Is there something that they can do to ease the suffering? And I mean the suffering in their mind, which is of course the worst kind, I think.

    4. PCDr. Paul Conti1:08:57

       I think the answer to that is finding one's way to the lowest common denominator of what matters. And I think if people are experiencing a truth now that they're, say, with their family, the realization that that is what matters the most now, and it's also what's gonna matter the most tomorrow. I mean, I'd rather be with my family in a lean-to out in the middle of nowhere than any luxurious living situation alone. And part of that realization that I think I can sustain that. If everything else went away, I could probably, I don't know, put some sticks together, give us some shelter, right? Like, it, it gives me a feeling that what matters is care and concern between people, being with the people we care about. And look, I'm hearing that from people too. I'm hearing a lot about the silver lining of this, which is more time with family. I talked to n- almost nobody who, say, purchased anything in the last month other than necessities. I don't care. So much that I think matter, matters doesn't matter. And look, I'm not advocating, like, I'm not a Luddite or saying l-let's go back to just living like we did 1,000 years ago or 100 years ago or whatever. But it is meaningful to realize that the things I care about most are actually more immediately accessible to me in the moment, and I think that's still gonna be the case tomorrow. Hopefully, everyone's staying safe, and we're trying to ensure that. That's what most matters, and it's a good place to start from. I think it engenders practicality. It engenders humility. It engenders a sense that everything is okay. I've sat at home with my family for periods of time I wouldn't have before, and I have a very strong sense that everything is okay. Sit around with my family, 'cause I have a six-year-old and a two-year-old, and we blew up six balloons, and we're just throwing these balloons between the two of us. I mean... And we're happy, right? And I think we need more of that because it works against the trauma. There's a realness and a connectedness to that that works against the trauma. Now, look, I think we need to change the social systems or we are not gonna change the trauma and things are not gonna be okay. If I understood your question, you're not saying, "How do we fix this on an individual level of people in their homes?" I think the answer is we don't. But how do we feel better? How do we let ourselves find some peace? I think that is the answer. My daughter, who's turning six this coming weekend, said to me, she said, "Daddy, with you at home more, it's like spring has come, but inside of me." And my thought was, "Oh, I'm not sure what else really matters." And that doesn't mean I don't wanna go to work and do my job, but when I'm talking with people on the phone, I'm looking more through that lens of what else really matters to that person that I'm talking to than the people that they love. And I think we need more of that. We need to fix our social systems, but we need more of that, and that's something that each of us can do at home, right? Because it's really our interpretation of things. Are things not okay because I don't know what it's gonna be like when it boots back up? That's true too. But I don't have to live in that every moment, and I can live in more time with my kids. That's real and that's tangible, and that's gonna mean something to me this evening and tomorrow. And that can be real for everybody. And people who don't get to be with people that they love and that love them, start thinking of how do we make more of that in our life? The idea that we all need love and we need things that are generative, that make where there wasn't before, does not just have to apply to human relationships. It can apply to nurturing a pet or nurturing a garden, to making a poem where there wasn't before. Like, like, it's kind of strange, but our needs are not that complicated. But I'll be damned if they aren't hard to meet in the system that we've set up around us. We need to change it. We need to change the systems, but part of how we change the systems is to change how we're looking at them as individual people. What am I valuing?

    5. PAPeter Attia1:13:01

       So if I'm hearing what you're saying, it sounds like you think that this sort of attachment to others or connection to others is sort of an antidote to this trauma?

    6. PCDr. Paul Conti1:13:12

       Put more broadly, I think the attachment to things that are meaningful

    7. PAPeter Attia1:13:16

       Yeah, yeah, sorry. Not to-- Yeah. I'm meaning to other people in relationships that matter, to our kids, to our friends, to our spouses.

    8. PCDr. Paul Conti1:13:25

       Right. Right. Right, 'cause think about it, not for all the money, success, prestige, world mastery, I mean, if you could have all of it, I mean, you wouldn't sacrifice the ability to be with one of your children. Like, that stuff matters the most to us, and it's also where we generate our own meaning. That's where I don't feel demoralized. That's where I don't feel demoralized 'cause I know that I have meaning to people, and people have meaning to me. And then I can find within myself the strength to put one foot in front of the other, keep doing what needs to be done, even though I sure do feel demoralized often. I mean, the reason why I think I can project and guess how you were feeling is because, one, you and I know each other very, very well, and, and, and I'm feeling the same way that you are. Has whatever I contributed to the world made a difference, or whatever I've done for myself and my family made a difference? I mean, the answers to those questions are yes, but we feel that they're no when we're confronted with the state of the world around us. And again, it just brings me back to that something more is called from us. I mean, there's a little bit of, again, I'm not trying to be political, but when John F. Kennedy said, like, "Ask not what your country can do for you, but what you can do for your country," and yes, he was speaking about difficult things. He wasn't just saying, "Do more of what you're good at doing," or, "What's easier for you to do," or even things that are hard for you to do. But you may need to do some things that are very, very difficult.

15. 1:14:51 – 1:26:23

    Reintegration, Unpalatable Action and Closing

    1. PAPeter Attia1:14:51

       Do you see people having a difficulty reintegrating back into the world when the quarantines lift? Do you see lingering fears, I mean fears literally of infection, recurrence of pandemic, other forms of phobias that might not even seem logical or, or rational? I mean, do we have any insight into what people do after quarantines and what their psyches are left with?

    2. PCDr. Paul Conti1:15:18

       This idea that if I am more afraid, I will be safer is, is going to precedence. We're gonna see more anxiety, more obsessiveness, more panic, more agoraphobia, right? Fear of being outside of the home. We're gonna see more and more of that, and we're gonna see more of the unhealthy coping mechanisms to that. More drugs and alcohol. We're gonna see more of the unintended results of that, like depression and accidents. We're gonna see more of all of those things because there's nothing to prove to you that you're not safe, like a period of time in which you were very clearly not safe. And I think if we reintegrate into the previous lies, then underneath that is the knowledge that this is not okay. It wasn't okay before, so if we're now back to it, it's not okay now either, which is why we need to make change. That ultimately, yes, th-this is about trauma and how this pandemic is traumatizing us and how we paved the way for the trauma of it to be so bad, and we need to change that, just like we need to change what traumatizes people individually. If someone has been traumatized individually, someone has been attacked and hurt, and that person knows that there are people around them that care about that, that care about them, that care about what happened to them, and that are working for change in the systems that allowed the trauma to happen in the first place, then we help move that person towards healing. And yes, we need to do that for individual people in their trauma treatment, and we need to do that as a society. Otherwise, we will be no more successful as a society than will be the individual sufferer from trauma who is trying to deal with that trauma by pretending everything is okay, which is a natural response 'cause we're afraid of it and we're ashamed of it and we don't know how to deal with it, and there aren't the systems around us to say, "You can come and talk about that, and you don't have to be ashamed of it. And you know what? I have that too. Maybe I have a different flavor from you, but I have what you have." And like you and I know this. I mean, part of the reasons I think we've survived our own traumas is because we have not gone through them alone, and we've had them validated, and we ourselves have been validated, and then we look to ways to make the world better. And that's part of our demoralization, that like it kinda hasn't had as much of an effect as we might have wanted. So let's start doing something new about it because it does not have to be this way. Say, rape cultures on college campuses. You know what? Doesn't have to be that way. And we start making changes. My-- 'cause not that we've made the changes we need to, but we start looking at that, looking at what it really is, and looking at the lies that said, "Oh, it's all okay," and, "People are consenting," and, "Everybody who's drinking is de facto giving consent." We look at those lies, and we start making change, and we start making less trauma, and we start better being able to help the people who have suffered trauma. That is a very real and tangible example that we are going to need to do on an individual basis, whether it's healthcare workers who are afraid to go back in the hospital, or it's people who are afraid to try and go find the next job, or it's our society as a whole. We have to change those things. There's nothing else that makes it better.

    3. PAPeter Attia1:18:44

       I think it's worth pointing out for listeners, you and I have known each other for twenty-five years. We're pretty much inseparable. In fact, this is probably the longest we haven't seen each other in person, 'cause the last time we were together in person was January. So that's, for us, that's an eternity. I think it's worth the listener knowing you and I have never once talked about politics except in the context of history. In other words, you and I together, we are not the type of people that sit here and wax on about current political affairs. We, over a meal, will sit here and discuss the Cuban Missile Crisis ad nauseam and talk about Nixon and all these things. We love to talk about the history of politics. We're not political people, and I think it's important that people who are listening to this don't take this to be a political rant. Everything we've talked about today seems to come down to a common theme, which is Those of us who sit here in the peanut gallery who are not in a position of leadership are going to have to sort of become the movement of change. In other words, it's not enough to just sit around and pontificate about this stuff. We are going to at some point have to do something about it. We're going to have to take some sort of action. It's not going to be enough to just think about this, lament this, talk about this with our friends. That won't change the system. Everything you've talked about from this most recent example, which I think is a great one of sort of date rape culture on college campuses to social support network. I mean, all of these things in the end come down to not just being open about what we think is right and not right, but it's also taking some sort of action. It is going to come down to that. And I don't know. You know, it's funny. I didn't come into this discussion with any sense of what we were really going to talk about. I just knew it was going to be something sort of interesting and not sort of the how does this drug work versus that drug work. But I don't know that I really thought about it as broadly as you've been thinking about it. It sounds to me like this experience, you've made good use of your time, your forced exile from the busy travel schedule. And you've thought even more broadly and deeply about some of these problems that we've thought about and talked about in the past together. But I don't think I think you've coalesced a broader mission urgency around this.

    4. PCDr. Paul Conti1:20:57

       I think so, Peter, because I've just felt it. These are not foreign concepts to me, and these are things I have been afraid of. But really seeing it play out, it becomes so compelling. And you talked about we're all going to have to do things. Those of us in the peanut gallery, we're going to have to do things. And it's not just that. It's we're going to have to do things that are unpalatable. And that's what I've really come to realize. It's like a couple weeks ago, garbage disposal gets kind of clogged. And there's a whole bunch of strategies I have to try and fix that. I mean, I pour a bunch of water down, and I've got a butter knife, and I'm trying to do things with it, right? And I'm doing things, but ultimately, what I had to do to make it better was the thing that was unpalatable. I had to stick my hand down there into a bunch of gross stuff and unclog something, and now everything is okay. I have a willingness to do things, and you do too, and lots and lots of people do. But what we shy away from is doing the thing that's unpalatable. And the way society has developed, I don't think we can get around the political flavor of this, right? Because if you want to set up, like if I had my way, there would be committees of people with expertise that would look into these different areas. But what they have to do is really unpalatable things. Stand against the status quo. Enter into areas, arenas that are politically charged. Enter into minefields, knowing that something unpleasant is going to happen, right? I'm going to try not to get myself killed doing it, but something unpleasant is going to come of it. And I think those are the things we shy away from. And I have the privilege of knowing and interacting with lots and lots of people who are helping, and God bless that people are helping. But there's a difficult message for all of us here that says, yes, help in the ways that you're built to help and comfortable helping. But you got to help in the I'm sick of my hand in the garbage disposal way too, which is why when Chau calls and talks about this and he starts talking about leadership in ways that come through humility, that come through marshaling people to do unpleasant or unpalatable things to really look at this. It resonates with me in part because like you and I, I mean, he and I have an ongoing dialogue about life, but because I just I can't not believe that's what's necessary. I try and do thought experiments where I come at a position that's diametrically opposed to mine. It's different from mine. I feel differently. I have a different personal truth. And I can't but come to this conclusion, which obviously doesn't mean that it's right. But I'm using all the due diligence I can inside of myself and I can't but come to any other conclusion.

    5. PAPeter Attia1:23:39

       Well, Paul, on that note, I want to thank you for this discussion today. I look forward to continuing our discussions over the coming weeks. I rely on them heavily.

    6. PCDr. Paul Conti1:23:50

       Thank you so much. As always, Peter, I appreciate your trust in me and my opinions to have me on. And as always, I deeply appreciate your friendship. Thank you, Peter.

    7. PAPeter Attia1:24:01

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Episode duration: 1:26:51