#119 – Terry Real: Breaking the cycle of shame, anger, and depression

1. 0:00 – 3:15

   Intro

   1. PAPeter Attia0:01

      [upbeat music] 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 wanna 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 wanna learn more now, head over to peterattiamd.com/subscribe. Now, without further delay, here's today's episode. [upbeat music] My guest this week is author, speaker, and family therapist Terry Real. As a family therapist and teacher for more than twenty-five years, Terry's the best-selling author of a number of books, including I Don't Want to Talk About It: Overcoming the Secret Legacy of Male Depression, How Can I Get Through to You?: Reconnecting Men and Women, and I believe his most recent book is The New Rules of Marriage: What You Need to Know to Make Love Work. Terry also founded the Relational Love Institute, offering workshops for couples, individuals, and patients around the country, along with a professional training program for clinicians. Now, if you've listened to this podcast for a while, I think on at least three or four episodes, I have brought up Terry's name and his book, I Don't Want to Talk About It, and I think I've even alluded to it as probably one of the books I have gifted more than any other. I've wanted to interview Terry for quite some time now because I just think that the way he thinks about the relationship between anger, depression, and interrelational strife is so illuminating. And, you know, I sort of sheepishly worked up the nerve to ask him at some point, "Hey, Terry, you know, would it be okay if I interviewed you?" And, and I was just delighted that he agreed to it, and he agreed to it on very short notice, like in a matter of days. In this episode, we talk about Terry's background. He grew up with an abusive father, and that has turned out to be, while an awful and unfortunate thing that happened to Terry, probably the greatest gift that came to many of us who have been helped by Terry because it was that relationship with his father that really forged his path to become a therapist and to better understand male depression and anger. We talk about how trauma during a child's upbringing can shape them later in life and how it can be passed on for generations over and over again. We talk about why people sometimes need to be in painful situations to have breakthroughs, what it means to hit rock bottom, how to live a relational life, and the importance of living with healthy, satisfying, rich emotional connections. We talk a lot about narcissism and touch on David Foster Wallace and the idea of how we don't truly know what someone is going through in life, this idea of being able to put yourself in someone else's shoes. We talk about a lot of other things, but I think in the end, I hope you'll just take my word for it that this is worth investing the time in listening to. I enjoyed this discussion immensely, and I,

2. 3:15 – 15:15

   Terry’s upbringing with a depressed and abusive father

   1. PAPeter Attia3:15

      I look forward to sharing it. So without further delay, please enjoy my discussion with Terry Real. [upbeat music] Terry, thank you so much for making time to speak with me. It's been a long time that I've wanted to, I don't know, turn the tables a little bit and ask you the questions.

   2. TRTerry Real3:33

      Yeah, well, it's a great pleasure to be here, and I'm looking forward to an interesting conversation.

   3. PAPeter Attia3:38

      I think I just wanna kinda jump into some stuff. Maybe for the listener, I'll tell a little bit of a story about how we were connected and then jump into you telling your story. So about eighteen months ago, a woman who I have yet to interview on the podcast but certainly will, Esther Perel, who I was working with at the time and still continue to work with, said, "Peter, you've got me and Lori as these two amazing therapists in your life, but you don't have a male therapist and you need one." And I'd already worked with two or three guys, but I just didn't have that connection. And she said, "I want you to read a book. And next week when we meet, I want you to tell me what you thought about the book and if the book resonated with you. And if it did, I will introduce you to the author. And if it didn't, that's okay. We'll keep looking." And the book was I Don't Want to Talk About It. And so I went home, bought the book, read the book, and came back in a week and said, "Even if not one other person has read that book, he wrote it for me and it was worth the effort he put into it." And the rest is sorta history. So can you start with a little bit about your background, how you grew up?

   4. TRTerry Real4:52

      Well, I mean, this is a little glib, but people always ask me how I became a family therapist, and my stock answer is I started at about four. I grew up at poor in Camden, New Jersey, a little hanging on by your fingernails middle class enclave in a town that was rapidly becoming a ghost town. My parents were under a lot of stress. My father was a loving, smart, violent, emotionally brutal man. And I went to therapy school. I'd already spent four years in a doctoral program in literature, and then I went to therapy school after that. And I had to go to therapy school to get the skills I needed to talk to this man, to get him to open up to me. And I needed to understand what the hell had happened to him. I needed to make sense out of my father and his violence so that I would not repeat it, and I have.

   5. PAPeter Attia5:54

      Terry, you described him using three phrases. I might be paraphrasing a little bit, but I could've sworn you said loving, smart, and brutally violent, or at least violent. Those... People don't think of those as going together. That seems like a contradiction in some way?

   6. TRTerry Real6:11

      Yeah, it does for me, too. [laughs] Imagine what it felt like to a four-year-old. It's confusing, but real life is confusing. There are many, many parents who are warm and nurturant when they're warm and nurturant, and then they turn on you and they're brutal. That's not an uncommon pattern, and what that does to a child is it's confusing. It's very confusing, and it breeds a great deal of mistrust because the rug is always being pulled out from under you.

   7. PAPeter Attia6:40

      When did that first occur to you that something wasn't right? I mean, I... It sounds odd that a four-year-old could be even perceptive that anything that they're experiencing is not the norm. We've glossed over this, but I do wanna go back into it. I mean, you weren't exactly the perfect child. You were kind of a bad kid growing up, if I recall, right?

   8. TRTerry Real6:58

      Well, I became a bad kid. I didn't start off as a bad kid. I was-

   9. PAPeter Attia7:02

      I guess nobody does, right?

   10. TRTerry Real7:04

       Yeah. I was invited to be a bad kid, and I took the invitation, and then I was punished for it. You know, I was a scapegoat child, Peter. There are three... It, it is an old 12-step. The hero child, the good one, the achiever; the scapegoat child, the bad one, the rebel; and the lost child, the one that nobody pays any attention to at all. And I was a scapegoat child, and scapegoat child, I'm really happy, I feel it's a gift to have been the scapegoat child. The scapegoat child is the one that wants to bring up to the surface all of the pathology and the truth that's being denied and suppressed, and they usually do it through action rather than verbs, but they express the family dysfunction or pathology or ill ease, and then they get punished for it. Or they tell the tru- they literally tell the truths about the family and they... "Dad's an alcoholic." "Only you would say that." So I was a scapegoat and I was a truth-teller, and now I'm a professional truth-teller and it's what I do for a living [laughs] . And, uh, instead of getting punished for it, I'm getting paid for it, so there we are.

   11. PAPeter Attia8:11

       So it's not a given that when you were sitting there in high school, you were gonna, quote-unquote, "make it." Tell me a little bit about that transition from high school into college. There's a story in your book about, I think your dad even accompanied you off to college, didn't he, that first trip?

   12. TRTerry Real8:26

       Yeah, they did. Uh, first of all, oh my gosh, let me go back of my schooling. It-- The whole thing really started in about second grade. I came home with bad report card, and you never knew what my dad was gonna do. I, I was scared to death, but he looked at it and he threw it on the floor and he laughed. And he said, "It's just because those assholes are so stupid and you're so bright, they don't know what to do with you." Okay, now the technical term for what my father was doing just then is called false empowerment. He was pumping me up. It was no favor to a little boy. I didn't get good grades in school until I got to college. I went through elementary, junior, and high school. I figured out that if I showed up every other week, that would be enough to get a D average, and that's what I did. And then I went to the boardwalk in Atlantic City and I sat down at Woolworth and I'd spend the whole day writing, and I would show up at school once every 10 days to two weeks. I was gonna go to Europe and be a writer, but I got a 1-A in the draft, which is a whole other story. I was scared to death, and I went to college to get out of the draft. And I had no grades, so the only college that would accept me was Atlantic Community College, and that's where I spent my first year, and I needed to get out, and I got all A's 'cause I wanted to get out, and then I transferred from there to Rutgers. My mother and my father came to visit me. They stood out like sore thumbs. I was completely embarrassed by their blatantly blue collar out-of-placeness. The last word my father said before he left me was, "Keep your nose to the grindstone and your pecker dry," which to this day I don't really quite know what the hell that was supposed to mean. And my mother, who was six foot and obese, banged on the car that I was driving off in with friends. Banged on the car so that the guy jammed on his brakes, and then she gave me a little wave and a kiss goodbye. [laughs]

   13. PAPeter Attia10:37

       Were you the oldest of your siblings?

   14. TRTerry Real10:39

       No, no. And in true birth order, the older one is more the hero child usually, and the second one is the scapegoat. Older one goes to father, second one goes to mother, if you have two boys, so the story goes anyway. That's what happened to me. I have a fraternal twin brother. He's six minutes older than I am, and he's every inch the older brother and I'm every inch the younger brother.

   15. PAPeter Attia11:03

       How much did you know at the time of your father's pathology in his upbringing, what brought pain into his life?

   16. TRTerry Real11:12

       Oh, nothing. He wouldn't talk to me. He wouldn't talk to me about anything of consequence, let alone his own life. And it wasn't until I was in my late 20s and I'd already become a therapist that I finally had enough skill to persist and get through, be gentle enough to get through his defenses. And finally, at about 28, 29 years old, he told me his story, which is a pretty horrific story in its own right.

   17. PAPeter Attia11:40

       Can you tell us some of that story?

   18. TRTerry Real11:43

       Sure. My father's mother died when he was nine. It was during the Depression in America. He had a younger brother. He was 11, his younger brother was nine. His mother was dead. His father, who he describes as a passive loser of a man, owned a little candy store and lost it. The family broke up and lived in various people's houses and one day, in a fit of depression, my father's father Tried to kill him and his brother and himself. He, uh, tried to gas them in the garage with his car. My father remembers his father cradling him in his arms and saying, "Shh. It's okay." And at 11, my father knew there was something horribly wrong, and he began to fight, so the story goes, and he kicked the window out of the car, and that woke his father up, and he grabbed his little brother and, and got out of the car. And according to my father, that was the last real authentic contact he had with his father for the rest of his life.

   19. PAPeter Attia12:56

       So it's safe to probably assume that his father also inherited a legacy of pain that may have gone beyond just the e- experiences he had in the loss of his wife.

   20. TRTerry Real13:08

       Yes. I think that's right. I think depression runs up and down my family. I've struggled with depression in my day. I am gratefully on antidepressants as we speak, and happily so. I'm sure that my grandfather was subject to depression, and the circumstances were dire.

   21. PAPeter Attia13:27

       So when you talk about your dad, you said brutal, loving, smart, but you didn't say depressed. So how does depression fit into what your father was experiencing and, and also lashing out?

   22. TRTerry Real13:41

       Well, there's a saying in AA. They say, "Hurt people hurt people." And as you know, central to my work on masculinity is the translation of shame into grandiosity, of feeling less than, inadequate, unlovable somehow to the one-down of shame, and then you flip into the one-up of grandiosity, superiority, better than, attack, avenging angel, righteous indignation. And this, I believe, is the dynamic of abuse and most violence on this planet, and it's central to masculinity and traditional manhood, the flip from the one-down victim to the one-up avenger. Anyway, what's devilish about shifting from shame into grandiosity, from injury to attack, is it works. It makes you feel better in the short run. It just creates havoc in your life, and that's what happened with my father. My father despised vulnerability because he despised his own father. He saw his father as weak, and he despised weakness ever since. And so when I was, in his eyes, weak, precisely when I was vulnerable, is when he would attack. He was punishing his own father and punishing his own vulnerability. It was a hyper-masculine response to trauma. Does that make sense to you, what I'm saying?

   23. PAPeter Attia15:14

       It does.

3. 15:15 – 19:00

   The importance of the repair process, after relational disharmony, to break the trauma cycle

   1. PAPeter Attia15:15

      How prevalent do you think this is? I mean, it's possible, I think, if I just consider the sampling of my own population of male patients, which m- maybe males make up two-thirds of my patients, 60% say. I wonder just how prevalent this is in the lives of people who haven't been maybe so literally abused the way your father was.

   2. TRTerry Real15:39

      Yeah. Well, I wasn't... I mean, I was, actually. My father wa- did get physical, but there, there are many... Look, one of my great mentors, a woman named Pia Mellody, defined trauma or injury as any significantly less than nurturant transaction between parent and child. Any significantly less than nurturant transaction between parent and child injures the child. Now, that's a whole range, of course, and we're all imperfect, and it's exactly our parents' imperfections and how we adapt to them that shapes what most people would call our character. I call it our adaptive child self. But at any rate, we're all shaped by injuries. The question is, are they part of the imperfect dealings of being a human being with other human beings? Is there repair? Is there accountability? Is there something beyond the rupture, or is it just injury and rupture? My model for relationships comes from Ed Tronick, who was the pioneer of infant observational research. He actually stuck a camera in front of mothers and babies and saw what they did. And Ed believes that the basic rhythm of all relationships is harmony, disharmony, and repair, closeness, disruption, and return to closeness. And in my dysfunctional family and in all the dysfunctional families I've treated over the years, there's little to no repair. The repair process has gotten jammed up somehow, and so there's just injury, and then you live with it until the next injury.

   3. PAPeter Attia17:27

      So it's not the disharmony, you're saying. It's not the harmony to disharmony that's the problem. It's the inability to go from disharmony to repair?

   4. TRTerry Real17:35

      Right. At the upper levels, we all hurt our kids. We're all imperfect. I told a story about putting Justin's hockey shoes on the wrong feet.

   5. PAPeter Attia17:43

      Why don't you tell that story, actually? I think it is a great illustration that any parent can relate to.

   6. TRTerry Real17:50

      Yeah. Well, we were really rushed. Justin was a hockey player, which is... Sports in general is completely not my domain. My kid is a total jock. He's been really disappointed in some ways that he doesn't have a Boston sports dad, and I appreciate that. He says, "I'm gonna go to South Boston Irish, South Boston, and, uh, I'm gonna find a beer-drinking, Trump-supporting real father." [laughs] Who does nothing but sports all day. That ain't me. Anyway, we were playing hockey. I was already feeling a little overwhelmed 'cause it's not my domain. We were late. He was whiny. I was putting his shoes on. The parents were trying to talk to me. I was trying to get him out on the ice. He goes out on the ice, comes back. He must've been, like, I don't know, eight or nine. Comes back 10 minutes later, says, "My feet hurt. My boots are killing me." And I go, "Come on, Justin. Just go out there and play."

   7. PAPeter Attia18:46

      Oh, he's got his skates on right now, you're saying?

   8. TRTerry Real18:48

      Yeah, his skates, yeah. And then... And he does, obedient little boy, and he plays his little heart out, and when I'm taking his skates off at the end of the game, to my horror,

4. 19:00 – 27:15

   The impact of a patriarchal society, and relational growth as the next step for feminism

   1. TRTerry Real19:00

      there are two red pre-blisters on his feet. I had put the damn shoes on the wrong feet.

   2. PAPeter Attia19:06

      [laughs] Oh, God.

   3. TRTerry Real19:09

      But here's what I say when I tell this story. If it had been Justina instead of Justin, would I have been so firm, or would I have listened to my daughter? And I think the honest answer is I would've listened more. This is masculinity. In that moment, I was the voice of patriarchy inflicting itself on my son.

   4. PAPeter Attia19:34

      You've spoken about this patriarchal model that is... I mean, it's really everything you rail against, isn't it? You're not a fan of this. Can you vent a little bit more about this? Because for many men, it's all we've known. I mean, it is... You describe-- We're gonna get to what relational living means, which is... I mean, I think prior to meeting you, I didn't-- I just couldn't have fathomed what you were talking about. So-

   5. TRTerry Real19:59

      If you pause for a moment, that's a hell of a sentence that just came out of your mouth.

   6. PAPeter Attia20:03

      Sure.

   7. TRTerry Real20:04

      That's a big sentence, and you speak for an awful lot of men. Most, many, many, many of the men that I see simply don't know what living in healthy, satisfying, rich emotional connection feels like. They just don't know what... What are you talking-- It's Greek.

   8. PAPeter Attia20:25

      Yeah, it is a little bit abstract, and it's... If it hasn't been modeled for you, which it's not generally, that's not a common model. I, I would-- It's the less common model, I guess I would say. I don't-- can't speak to prevalence again. But say a little bit more about this. What is it that you're talking about as the norm? Let's start with what the sort of traditional model is.

   9. TRTerry Real20:47

      Sure. Well, there, there are a number of ways of saying it. The simplest way of saying it is when I mean patriarch, I'm talking about traditional gender roles for men and women, and well, I mean traditional, pre-feminism, but still very much with us. So the traditional role for women, as everybody's written about for the last 50 years, is to be accommodating and resentful, to lose their voice. Carol Gilligan wrote this back in the '80s in A Different Voice, and she wrote about the women's loss of voice, loss of authentic connection about the edge of adolescence, 13, 14. They fall prey to what Carol calls the tyranny of the nice and the kind, and they lose their voice. They stop telling the truth. They start being, to be honest, manipulative. That's part of the traditional female role. So traditionally, what you've got is an accommodating, resentful woman, and on the other side, you have a shutdown, driven, inwardly haunted, outwardly successful... One of the things I say, Peter, maybe you'll be able to relate to this, [laughs] one of the things I say is an inwardly shame-based, outwardly driven man coupled with a inwardly resentful, outwardly accommodating woman, that's America's power couple, man. [laughs] They're a successful couple in the world.

   10. PAPeter Attia22:13

       Well, it's a dangerous combination because there's not enough, there's not enough inertia to question it or challenge it internally. That probably doesn't make sense what I'm saying, but I think you know what I mean. It's... It doesn't have enough of a forcing mechanism to call into question, whereas at least if one of those two phenotypes is different, there could be more tension that drives a change potentially.

   11. TRTerry Real22:35

       And then feminism hit, and there was tension that drove the change, and I'm gonna say something, and maybe some of your listeners will push back on this, but I believe that in the '60s, '70s, and '80s... Here's a question, Peter. What value is shared by mainstream patriarchal culture and almost virtually all of the so-called counterculture personal growth movements? What value is shared by mainstream and counterculture?

   12. PAPeter Attia23:09

       Hmm. Probably some semblance of independence or freedom.

   13. TRTerry Real23:15

       Yeah, you're close. The individual, the sanctity of individualism. Personal growth is personal growth, not relational growth, and so I summarize personal growth or personal empowerment as I was weak, now I'm strong, go screw yourself, and it was big. I lived through that revolution in the '70s and the '80s, and women were mad at us guys, and I was weak, now I'm strong. I'm gonna stand back and say it any old way I want to, and you best listen and like it. Okay, that's a step in the right direction, but I think there's another step, and if I can be so bold as to be a male therapist, but I have been doing feminist family therapy for 40 years. Look, the next step is loving voice. When women move from voicelessness and resentment to finally le-- I call it stash and blow. I see it all the time in my office. Finally, when women do speak, they often speak in ways that are so aggressive That nobody in their right mind can listen to them. So relational empowerment is the next step. Relational empowerment is, "I'm gonna be strong and loving at the same time, in the same breath." You see, I believe that under the patriarchal system... This is a little bit abstract, but let me say it. Under the patriarchal system, one can either be connected or powerful, but you can't be both at the same time. Let me say that again. Under patriarchy, which is the system we're all in, we're fish and patriarchy is the water. Under the system we're all in, you can either be connected, that's affiliative feminine, or you can be powerful, that's independent masculine, but you can't be both at the same time. When women do become powerful, and when they did as a movement back in the '70s and '80s, it was... A lot of the women in my office, I say to them, "You, after 50 years of feminism, you have earned the right to be as obnoxious as men have always been. Congratulations." The next step is loving voice, and that's true for both men and women. That's standing up for yourself and cherishing the other person in the relationship in the same breath. "Honey, I love you to pieces. Could you please tone down the way you're speaking to me right now so I can hear you?" Versus, "I don't like how you're talking to me." Three ways of saying the same thing.

   14. PAPeter Attia25:44

       Yeah, you've talked a lot about this idea of enlightened self-interest. This might be one example of it.

   15. TRTerry Real25:52

       Yeah, because under the patriarch... Patriarchy is linear, and there are two aspects of patriarchy for men. The essence of traditional masculinity is twofold. One is the denial of vulnerability. The more invulnerable you are as a man, the more manly you are. The more vulnerable, the more girly you are. It's like physics. It's just straightforward. It's misogyny. It's my dad. It's despising the vulnerable. And then the second issue is the delusion of dominance. God gives Adam dominion over the Earth, which is really a bad idea. The Greeks knew better. The Greeks spoke about hubris. Placing yourself above nature was the tragic flaw in every Greek tragic figure. They knew better. They knew about humility. The delusion of dominance, feeling that you are over nature, that you have the right, the entitlement, and even the responsibility to be above nature, is a core delusion that will kill us. If the nature that you're above is your wife or your kids or your body or your own thinking, or it's the planet at large, Mother Nature, don't worry about it. We'll cook up something in a lab and take care of it. We'll kill ourselves

5. 27:15 – 35:30

   Origins of deep-rooted shame, and the difference between feeling ashamed and feeling guilty

   1. TRTerry Real27:15

      if we don't come out of this delusion. That's the masculine part of the traditional gender role, cut off and false empowerment.

   2. PAPeter Attia27:25

      You alluded to shame earlier. I wanna go back to that because I think it sets the stage for some of the other concepts that I want to explore. Can you explain the difference between shame and guilt?

   3. TRTerry Real27:37

      Yeah. Well, this is Brené Brown. I used to say healthy shame and unhealthy shame, but she kinda ruined that, made shame bad altogether. So for simplicity's sake, healthy self-esteem, let's start off with that. That's one of those things that everybody talks about, and who really defines it? What does it really mean, healthy self-esteem? It means the capacity to cherish yourself, to esteem yourself, healthy self-esteem, to esteem yourself in the face of your imperfections and screw-ups. What you do, and I have to teach this to people in general, men in particular, what you do is just what we wanna do with our children when they screw up. You hold the person in warm regard. You cast a very sober eye on the bad behavior. Feel bad about the bad behavior you've done, but don't take yourself apart as a person. You're a good, flawed person who screwed up. You're fine. Learn from it, make amends, and get on with it. Shame is, "I'm a bad person." Shame is, "I feel bad about the behavior. I feel bad about who I am as a person." And it eats you up alive. It is, for many of us, a constant companion. For those of us who were unloved or shamed as children, we contend with that a lot. And shame is the feeling of unworthiness, impotence, helplessness, unlovability, defectiveness.

   4. PAPeter Attia29:10

      Why does it happen, though, Terry? Is it something we are born... Is it the default setting that we're born with?

   5. TRTerry Real29:17

      I don't believe so. I believe that we're shamed. We're shamed as children by either being neglected and abandoned somehow and/or by being mistreated and misaligned somehow, and we take on that shame, and we feel bad about ourselves usually. Now, guilt is feeling bad about the bad behavior, and one of the things that I teach particularly men is, when you go from some sort of acting out, some offensive behavior, when you're in-- doing that offensive behavior, you're in a state of grandiosity. You're entitled. You're better than. You deserve it. So you're in a state of grandiosity, and you're in a state of self-entitlement and self-preoccupation. When you go from that, when you go from inflation to deflation, from "I deserve" to "I'm big shit," what I tell my guys is, you go from one form of self-preoccupation to guess what? Another form of self-preoccupation. Just went from positive to negative. You know what? Here's what I want you to do, Bill. I'm sitting with Bill and his wife, and Bill just screwed up. Here's what I want you to do. What I want you to do is what my kids tell me. I want you to get over yourself. I want you to stop thinking about what a shit you are and start thinking about how you hurt your wife. Pay attention to her. Feel bad for her. Make amends to her. Let the energy go out to her. Now, shame's really hard to get over. I understand that. I'm gonna give you 60 seconds. Ready? Go." And they do. They come out of shame.

   6. PAPeter Attia30:52

      But do they need your permission? I mean, do you think that... And again, we could even use examples of patients. Is there a sense of, "I feel guilty about what I've done. The right thing to do is to dwell on it for a very long period of time and despise myself for it"?

   7. TRTerry Real31:12

      Yeah, right. [laughs] For all the good it does.

   8. PAPeter Attia31:15

      Well, notwithstanding the lack of productivity, but is that the underlying sort of emotional logic behind shame, or at least in the example you gave of Bill?

   9. TRTerry Real31:26

      Oh, no, it goes way beyond that. Look, most shame starts in childhood, and there are big, uh, forces at play. First of all, I was an exception. Most children, if you mistreat them, if you're harsh to them, if you don't meet their needs, they will blame themselves, and they will try to contort themselves into whatever the parent needs in order to win that connection and love. We're love-seeking animals. And you blame yourself. You try and get that parent back into connection with you. You start reading them. This is the gift of the, the drama of "The Gifted Child." This is the gift. You read them. You blame yourself. And you see, Peter, it's compassionate to blame yourself because you're feeling bad for your... When my father would beat me, I would feel bad for him. That's enmeshment. I would feel sorry for him. He was pathetic to me.

   10. PAPeter Attia32:27

       At what age, Terry, does that... A four-year-old would experience that, or is that a 10-year-old's experience?

   11. TRTerry Real32:34

       Five, six. The point being, for most children, it's safer to blame yourself than to come to grips with a random hostile universe. It makes a lot more sense that I brought this on myself. That means that if I do something different, I might be able to control it, versus the people who are supposed to protect me from the world are inflicting me with the brutality of the world, and I'm completely in their care and helpless. That is a scary thought. So people do shame to protect themselves, and people also do shame because, this is complicated, it's a multi-generational legacy. My father beat his depression into me with a strap. His father beat the depression into my father with gas. We pass this on from generation to generation until somebody does something about it.

   12. PAPeter Attia33:35

       One of the most profound things I remember you've ever said to me, and again, I think it... I don't... Maybe you were paraphrasing, but it's... I wrote it down, and I see it often in my journal, is, "Every man is a bridge spanning two legacies, the one he inherits and the one he passes on." Did I get that about right?

   13. TRTerry Real33:54

       You got that absolutely right. And let me give you another one. They say it's the height of pretension to quote yourself, but I do it [laughs] in this one. I'll butcher it, but here it goes. "Family pathology rolls from generation to generation like a fire in the woods, taking down everything in its path until one person in one generation has the courage to turn and face the flames. That person brings peace to his ancestors and spares the children that follow." That's what I'm about. I'm about facilitating that.

   14. PAPeter Attia34:31

       What's the natural history of not doing anything about this? I mean, is this literally something where you could say, "Look, shame will..." The laws of entropy basically dictate shame will always propagate unless there is deliberate and active attention brought to halt it?

   15. TRTerry Real34:50

       Yes, because even the best of parents will injure or will neglect. "Oh, uh, honey, I'm sorry you skinned your knee. La, la, la. Let me just... Oh, uh, Doris, let me call you back. Okay." And you know what? You should've hung up the phone and dealt with the knee on the spot. That's a little misalignment. That's a little injury. That's normal. It's part of human development. It's okay. The child cries. Maybe in a very safe house, the child says, "Mommy, why don't you just, uh, hang up the phone and..." "I'm sorry. I'm sorry, honey," and there's repair. And this is the kind of traffic that is part of being human. That

6. 35:30 – 37:30

   Preventing the propagation of trauma without over-coddling kids

   1. TRTerry Real35:30

      part's fine. But when you start going lower down on the spectrum, then things get a lot less fine.

   2. PAPeter Attia35:36

      How does one differentiate between preventing the propagation of shame or trauma and the over-coddling of kids? Because right now, the pendulum has really swung the other way in society, where there are books about this entire topic of how we've coddled an entire generation, and as a result of that, there's an entitlement and a whole bunch of other things that are the result of it. Internally, I have my own litmus test, but I don't know that it's worth much. I'm very curious as to how an expert thinks about this.

   3. TRTerry Real36:08

      I don't know that I have a particular formula. I would say trust your gut and civilize the little creatures. The thing is that you have to understand self-esteem. Like the California, no offense, the California drive for self-esteem was so misguided, it just made me pull my hair out. What most people think of as self-esteem is confidence and mastery. Okay, that's fine, that's what it is, but that ain't self-esteem. Self-esteem is spiritual. It's ontological. You have worth and dignity as a human being because you're here on this planet, and your worth cannot be better or worse than the guy to the left or the guy to the right of you, no matter what you say or do. It can't be added to, it can't be subtracted from. It's a spiritual fact. You know this as a doctor, Peter. This is part of the Hippocratic Oath. If one guy is pulled into the ER and he's a skid row bum, and the other one's a state senator, by the book, at any rate, it's triage based on need, because you don't triage based on status. That's grotesque. Every person is equal. We know this in the abstract, but we don't live it, unless you do some of the work that I invite you to do. You don't live like that. You judge other people as better than or less than, and you judge yourself as better than or less than all day long. I have to tell you,

7. 37:30 – 40:00

   The one-up/one-down cycle from grandiosity to shame

   1. TRTerry Real37:30

      I've been doing recovery work for 30, 40 years, ever since I was a teenager. At 69, I don't do that anymore inside my head. I don't go up, and I don't go down. Not much. It's not my baseline. And if I do, nine out of 10 times, I'll catch it. It's a lot better living like this than it was living like that. I help, uh, men and women move from that to this all day long. That's what I do for a living.

   2. PAPeter Attia38:01

      Say more about the up and the down. You've alluded to it already with the one-up/one-down cycle, but say a little bit more about that. I suspect that resonates for people when it's described in some detail.

   3. TRTerry Real38:15

      Yeah. The field of psychotherapy and self-help and all that, for 50 years has done a great job of figuring out how to h- people come up from the one down of shame. Oprah Winfrey, all that stuff has been great, and the trauma techniques in therapy. We've done a terrible job of the other self-esteem disorder, helping people come down from the one up of grandiosity, and they're flip sides of the same coin, one down, one up, inferiority, superiority. And it's our grandiosity that gets us into so much trouble in our relationships. Shame is an implosion. Grandiosity is acting out or some kind of explosion. The great secret that I run around the country telling therapists is this: shame feels bad. Grandiosity feels good. That's the open secret. It feels good to get drunk. It feels good to get high. It feels good to make out with your secretary. It feels good to tell your boss to shove his job. In the moment that you're being grandiose, it's like an intoxicant. It feels good. So you have to think your way down from grandiosity. It takes a smarter person, and you think your way down. You come down from grandiosity even though it feels good because it's in your interest to come down from it.

   4. PAPeter Attia39:39

      Are men more susceptible to grandiosity than women?

   5. TRTerry Real39:43

      Well, men's grandiosity in this culture tends to be more overt. Men tend to lead from the one-up grandiose position and have covert shame. Tend to, there are tons of exceptions. Whereas women tend to lead more from the victim one-down position

8. 40:00 – 50:00

   Covert depression—Steps to fixing the secret legacy of male depression

   1. TRTerry Real40:00

      and have covert issues of grandiosity. So we're complements for each other.

   2. PAPeter Attia40:06

      Yeah, let's go over that a little bit more because in the book, I Don't Want to Talk About It, you talk a lot about overt and covert depression, and it's the opposite of that, as you said. The, on average, for what it's worth, men tend to be more covert in their depression, w- women more overt. Explain that distinction.

   3. TRTerry Real40:28

      Well, when I first wrote I Don't Want to Talk About It, depression was seen as a woman's disease. This was the first book that had ever been written about male depression. Nobody said that phrase, male depression.

   4. PAPeter Attia40:37

      What year was the first edition of that, early '90s?

   5. TRTerry Real40:40

      Late '90s, '97, '98. And the idea was that women were two to four times more prone to depression than men. The subtitle of my book, I Don't Want to Talk About It, is The Hidden Epidemic of Depression in Men, and it's hidden for two reasons. The first is that men are ashamed of it. It's not unwomanly to be depressed. It is unmanly to be overwhelmed by feelings and vulnerable. So women face the stigma of a mental disorder, but men feel that very personally. It feels like they're unmanned by this disorder, and they're ashamed of it, and they hide it, and the people around them will often collude with their hiding it. Family physicians are the first line of defense in depression, and 70% of them do not diagnose a patient with depression, the studies indicate. And I believe it's because we're afraid to unmask that poor man and further shame him. Wives are like that. Kids are like that. Everybody gets very protective. Some men do such a good job of hiding the depression that they hide it from themselves, and this is what I call covert depression. And what you see is not the depression so much, but the defenses the man has erected to, to defend against the depression. And you see acting out. You see sexual acting out. You see porn addiction. You see self-medication. You see anger. You see, uh, sudden isolation and withdrawal. I talk about the unholy triad of covert depression, radical isolation, anger, and acting out, sexual acting out. And of course, the self-medication includes drinking and, and drugging. If you look at women and men, look at o- what I now call overt depression, it's like two to four times more women than men. If you add into the grid domestic violence and alcoholism and drugs, it comes right back up to equal. And we know things like, for example, in areas where men lose their job, there's a dramatic rise in domestic violence. And the missing billiard ball in the middle between those two points is depression, low self-esteem. And what happens to men with covert depression is what I've been talking about all evening, which is the transliteration of shame into grandiosity, of helplessness into righteousness, of victimhood into attack. And that translation of shame into grandiosity, helplessness into attack, is a central motif of traditional American masculinity. Look at all the adventure movies. I wrote about this, and I don't wanna talk about it. Rambo. These guys are innocent guys who are pressed to the wall by bad guys, and then finally, about halfway through the movie, they pick up an Uzi and start blowing people away, and we cheer. We cheer. The move from shame to grandiosity feels like the swell of empowerment, and we get drunk on it, but it's violent. It's emotionally violent. It's violent to the person you're grandiose to, and it does violence to your own soul.

   6. PAPeter Attia44:05

      And this comes back to the sort of patriarchal society which places a value on that strength. I mean, what do you think biologically or socially accounts for that distinction?

   7. TRTerry Real44:16

      We could wrestle around this one [laughs] for a long, long... Most of the people in my field are not saying, "Is it biological or is it cultural and social?" That's not the question for almost anybody anywhere. The question now is how do they interact, because it's both. It's both. Of course it's both. But just because something's biological doesn't mean, necessarily mean that we should cede to it. Aggression is biological. Freud said the first man to hurl an epithet instead of a rock was the creator of civilization. We have all sorts of impulses that are biological, but that doesn't necessarily mean we're supposed to go with them. The thing between our raw biological impulses and our behavior is called civilization.

   8. PAPeter Attia45:04

      Yeah. You've talked a little bit about this idea in the past, and you've written about it, that the steps to sort of fixing this... So if everything we've talked about is recognizing this, how hard is that? How long does it take for you with a patient? I know you work a lot with couples. Do you work individually with men and women equally or disproportionately with one or the other?

   9. TRTerry Real45:31

      No, I work disproportionately with men. I'll see a woman now and again and, but I do mostly couple... You see, and I, I don't know, somebody may correct me on this, but what I do is I teach people how to live relational lives, how to open their hearts, how to open their voices, how to listen, how to respond without getting defensive and egotistical, how to do this, how to live relationally. It's what we're born for. It's the only thing that really makes us happy. And I do believe that the best way of teaching somebody how to live a relational life is to get their partner and maybe their kids in and work on the relationship rather than do it abstractly on the side.

   10. PAPeter Attia46:12

       Do you find that most men need to be in crisis to hear what you're saying right now?

   11. TRTerry Real46:18

       Yeah. I had a guy, an older gentleman, very successful businessman, and we started talking about men and grandiosity and, and he, he got very resonant with it. And he came to me and he said, "I have a young colleague that I just, I brought on to our team, and he's the most brilliant young man I've ever met, but he's so narcissistic it's impossible to work. What do I do?" And I sadly said to him, "I think he's too young. I think that life hasn't roughed him up enough yet." You have to start to get it that your old tricks are not working. And for some men, particularly if they're successful and wealthy, they're shielded from those consequences, but it's not... It doesn't do them good. Yes, you want a crisis. Look, the so-called midlife crisis in men is... This is my read on it. The midlife crisis comes at whatever age when you've peaked, when you're at the top of your game, and you either feel that the masculine agenda is something that you have failed, you have not caught the brass ring, you're not rich enough, you're not smart enough, or you feel that the agenda's failed you. You have the brass ring. I deal a lot with high rollers. You have the brass ring, and guess what? You're as miserable as you were before.

   12. PAPeter Attia47:43

       So that's kind of a damned if you do, damned if you don't realization that seems to suggest, as you've said, once you reach a point at which either you've reached or achieved whatever success is supposed to be, if you deem it to be hollow, you're hosed, and if you haven't achieved it, you're hosed because you're Willy Loman or pick your favorite example, right?

   13. TRTerry Real48:05

       Right. That's right. You fail or the agenda fails you, and that's a great opportunity. I like crisis as a family therapist. The other crisis, of course, for men is their women or if they're gay, their male partners. I like to say that most of the men I treat are what I call wife-mandated referrals. [laughs] Or they've been sent, or their marriage is in crisis, or they've already separated from their wife of 30 years and they're a wreck, but there's some sort of crisis in their relationships that's driving them deeper.

   14. PAPeter Attia48:39

       In your book, you certainly... Most of the case studies fit that description, right? I'm trying to remember, is there an example of a man in the book who just showed up on his own doing sort of self-exploration and introspection?

   15. TRTerry Real48:53

       Yeah, there are a few. There are a few, and I love them dearly. There was a young fella, Kurt, who came from the Midwest. He was a farmer's son. And he came to me because he couldn't get girls. He couldn't get past the first date. This is deconstructing patriarchy, so I said, "Well, what do you do?" 'Cause he was a good-looking guy, and he was intelligent. And he said, "Well, I just, I tell them that I do this and I do that, and I'm capable of this, and I've won that award." And I said, "Wait a minute, what are you doing? That's not a date. That's a resume." And he [laughs] said to me, "I just figure I've only got one shot, so I better make it good."

   16. PAPeter Attia49:36

       [laughs] It's funny, but it's sad.

   17. TRTerry Real49:40

       Well, it's patriarchy. Men are taught that just being who you are is not enough, that you have to earn connection through achievement and turn your back on relationship. I call this the Icarus syndrome. You have to leave hearth and home, go fly into the sun to be worthy of, guess what? Hearth

9. 50:00 – 51:45

   Three forms of false self-esteem

   1. TRTerry Real50:00

      and home. You're the one that left to begin with. They're waiting for you. This happens all the time. Guys go off and work 100 hours a week to be worthy of the wife and kids who just want him to come home already.

   2. PAPeter Attia50:12

      Where does that come from? Where is that drive coming from? Where is this inferiority coming from? Does it all stem from this shame that you've talked about, the seeds of which are sown in, in little boys?

   3. TRTerry Real50:24

      Yes. We're taught to supplement the lack of inside-out healthy self-esteem with outside-in false self-esteem, and there's three. This is PIA. There are three. There's performance-based esteem, I have worth because of what I can do, and that's a big one for men. There's other-based esteem, I have worth because you think I do, and of course, pushed to extreme, that's love addiction, and that's big for women. And then you have, I have worth because of what I have. I have big muscles. I have a beautiful wife. I have... In Boston, I have a kid at Harvard. That's the be-all and end-all. Attribute-based esteem is what our culture runs on. If everybody woke up tomorrow with healthy self-esteem and full recovery, our economy would collapse. [laughs] The whole advertising industry is built on, "Use this deodorant and be a special person."

   4. PAPeter Attia51:20

      What was the first one? The second one was other based. The third one was attribute based. What was the first one?

   5. TRTerry Real51:25

      Interesting you [laughs] forgot it. Performance based. I have worth because of what I can do.

   6. PAPeter Attia51:30

      [laughs] Okay, I ge- funny guy. It's ironic that I forget that one.

   7. TRTerry Real51:36

      Yeah, it kind of is.

   8. PAPeter Attia51:37

      [laughs]

   9. TRTerry Real51:38

      Not to be Freudian or anything, but...

   10. PAPeter Attia51:41

       Well, while we're on the topic of deconstructing, uh, people

10. 51:45 – 54:15

    Narcissism—a misunderstood concept

    1. PAPeter Attia51:45

       like me, let's talk about narcissism a little bit. You've already alluded to the Greek gods. You write very eloquently about this.

    2. TRTerry Real51:53

       Yeah. Thank you. Narcissism is largely misunderstood. Narcissism is not a disorder of too much self-love, but too little. Narcissus is an addict. If you remember the myth, he pisses off, I forget who, Juno, I think, uh, doesn't fall for any of her nymphs, and she curses him and says, "You're gonna fall in love with the first, next thing you see." Wily curse. The next thing he sees as he bends over a well to get some water is the image of himself. He is rooted from that moment to the well, bent over, endlessly sighing as he tries to grasp the beautiful creature in the well, and every time he tries to touch it, it dissolves. The great thing about Narcissus is, if Narcissus had self-love, he could leave the well. He's rooted to the well because he's addicted to his image, not the internal self, but the image, the constructed self that comes when you have no internal self. That's what he's addicted to, and he dies. He dies on that well. He starves to death. And Echo, beautiful Echo, is placed next to him. This is, to me, the essence of heterosexual relationships traditionally. Narcissus is bent over his well, and Echo is bent over Narcissus, and Narcissus has no motility, and Echo has no voice, and Narcissus endlessly sighs at his own beautiful reflection, and, uh, Echo endlessly repeats those sighs as she sighs for him. There we are.

    3. PAPeter Attia53:42

       Is there any benefit in narcissism? Is it always pathologic?

    4. TRTerry Real53:47

       No, there's healthy... We talk about healthy narcissism, healthy entitlement. That's good. Does your healthy entitlement get strained through patriarchy? It goes back to what the great anthropologist, Riane Eisler, speaks of as the difference between power over and power with. Is your narcissism about agency and assertiveness and power with? Fine. Is your narcissism about

11. 54:15 – 1:06:30

    The interplay of shame, anger, and grandiosity, and how to break the cycle

    1. TRTerry Real54:15

       superiority and contempt? Not so fine.

    2. PAPeter Attia54:19

       These concepts, they resonate. I think you and I, we've spoken about David Foster Wallace. I'm such a fan of the commencement speech he delivered 2005 at Kenyon College, "This Is Water." And so much of what he's talking about is this sort of grandiosity one-upmanship that he describes as being the root of so much misery, and that's the interesting side of it, isn't it, right? Which is in the short run That grandiosity is an amazing anesthetic, but it, it has a very bitter aftertaste.

    3. TRTerry Real54:52

       Well, it's like drinking three martinis. It really would've been better with just one, and that third one makes you feel better in the moment, but oh boy, do you pay for it. This is how I describe it to my, usually my guys, and to audiences. Bear with me. I'll meander a little bit. So, uh, Boston, I'm convinced, and I think statistically, has the worst drivers in the United States. I come from New Jersey. I, I lived for 10 years in New York. In New York or Jersey, somebody'll cut you off because they're kind of a pig, and they'll speed up and keep going. In Boston, somebody will cut you off, and then they'll drop down to 20 miles an hour because they're passive aggressive, and they'll just stick their fanny in your face and make you sit there. All right, so I got one of these guys, pulls that move on me, pulls out ahead of me, and then slows down. I'm looking through the windscreen at that fat little head in front of me, and I'm doing that Star Wars laser beam thing, you know? I'm like, I'm like exploding that fat little head. And I'm way into grandiosity. I mean, this guy is the shit. This guy is a moron. This guy is whatever. Bare- barely deserves to breathe. In a former day, I would've pulled up, rolled down my window, and let him have it. Now, as I'm looking at that fat little head through the windscreen, I start breathing myself down from my anger, from my indignation, from my superiority, from my contempt, and I say to myself as I look at that head, "This isn't for you. This is for me. You may deserve to have somebody pull next to you and blow you away, but I deserve to not be that person." And here's what I say, Peter. I grew up in a contempt-drenched family. I internalized that contempt, and it became depression I've wrestled with for 40 years. I played out that contempt, and I did damage to a lot of nice relationships that way. You know what, fat little head? Not today. Not today. I've had enough contempt in my life. I can do without it.

    4. PAPeter Attia57:04

       So that's an interesting take. That's the take that is coming at in a very self-interested way, which is just from a pure self-preservation standpoint, there is no upside to you being upset about this. And to just preserve your own sanity, you're saying, "Look, assume the worst about this person," which is to say they've done this deliberately or they've somehow done this to spite me and it's all about me. Even if that were true, I'm not gonna give into it. Now, the flip side to that, the thing that, as you know, I work on, and I'm, I think I'm batting 50% at this now, or I'm batting 500, to use baseball terms, which is a hell of a lot better than what I used to bat, which was zero, just straight up zero, is I go through that sort of Foster Wallace narrative of I don't know the story of what's going on. I don't know that maybe that person, that's as fast as they're able to drive. Maybe there's something else going on in that person's life. Maybe that person's wife just left them today, or maybe that person lost their kid and they're so distracted they can't... Driving around or something as mundane as that is so trivial. And I just wanna share with you an interesting story, 'cause I had a pretty interesting example of this, uh, a couple of months ago. I don't think I told you this story, but we have this thing, it's a grocery delivery service. I'm blanking on the name of it, but it's like Instacart, something like that. It's awesome. You literally on your phone pick up what the groceries are gonna be, and the groceries show up. This is a bit of an embarrassing story, so bear with me. It's embarrassing in the sense that as I tell it, it highlights what a sort of grandiose prick I can be. So it's 4:00, and I pull out the Instacart, and it says, you know, it'll be here in 90 minutes, and I think, "That's perfect, 'cause it'll be here at 5:30." Uh, it's a Saturday. I g- I gotta make dinner, and it's gotta be ready by 6:00, so it's perfectly timed. And to make a very long story short, at every step of the way, Terry, this thing just keeps dragging it out. "Sorry, it's gonna be 15 minutes late. The store is crowded." "Sorry, it's gonna be another 20 minutes late. The store is really crowded." "Sorry," do do, to do, to do, to do, to do. And I'm too stupid to put the phone down and go and do something else, and I'm not making this up. I wish I was making this up. I actually pace around the kitchen for about an hour just waiting for the updates, because now I realize I've lost my window to go and work out, which was, I was, what I was planning to do, or something else. And so [laughs] it's now 7:00. It's a full three hours late. So I've blown my window to make dinner. I sort of feel like I screwed up and, you know, whatever, whatever. And if I get one more text message from this thing giving me one more dumb excuse, like, I'm gonna lose my mind. And my wife, who is now sort of hovering around me, has a real practical concern, which is this person is going to come to the door and get blasted by me, being the idiot that I am. And sure enough, the doorbell rings, and I beeline to the door with every intention of obliterating this person. I have no idea what I'm actually going to say, by the way. It's not like I've rehearsed what I'm gonna say, but it's, "How does it take you..." Yeah. I know what I'm capable of. Let's put it that way. And Jill is on my heels basically thinking to herself, "How am I going to mitigate this damage?" 'Cause this person, even though they're an hour and a half late, does not deserve what's about to come. And I open the door, and it's this overweight woman who's sweating profusely And she's got the three five-whatever bags of groceries on the ground, and she says, "I'm sorry I'm late. It was really crowded, and I broke the eggs." And I'm not kidding, Terry, I almost started crying. And I thought, "My God, you asshole. How could you have almost torn into this person?" I don't know how to describe it. I just, in that moment, I couldn't get out of my own way. I invited her in. I said, "Oh, don't worry about the eggs. I think I ordered them by accident. I don't even want eggs. We don't eat eggs. I hate eggs. Come on in. Do-- would you like a drink?" I mean, I practically invited her to stay for dinner in that moment because I felt so bad about how I had been thinking about her. Now, to this day, I don't know what changed in me and how I got lucky in that moment. But I thought to myself, "If I could reproduce this at every moment of my life, I would be a happy man. I wouldn't be the piece of shit that I'm probably hardwired to be, or at least softwired to be."

    5. TRTerry Real1:02:00

       You're not a piece of shit. You're just like the rest of us. Listen, that's a beautiful story, Peter, and what you had was a moment of empathy, of compassion, of humanity. That's like what I teach sex addicts who stare at women to remind themselves, "This is somebody's daughter. This is somebody's mother. This is somebody's sister. This is not a porn queen or a blow-up doll. This is a person." And that's what you did. You got past your entitled indignation. The thing about it is it's case in point of what I've been talking about. You felt helpless. You wanted the goddamn food, and it was not gonna get there until it was ready to get there, and you had nothing to say about it. The more helpless you felt, the more angry you got. That's how it works. The helplessness is one down in shame. The anger is grandiosity and righteousness. And like a lot of men, the longer that food took, the more helpless you got, the more angry you got. That's the formula.

    6. PAPeter Attia1:03:07

       When you describe it that way, it seems so obvious and so predictable. Does the knowledge of that in any way help us?

    7. TRTerry Real1:03:14

       I think it does. I think it does. It's funny. Just before I started this, I would spend all day with a couple, and she was about to leave him after twenty-five years of marriage, both in their 70s. And they have a wonderful time except once or twice a day, he'll scream at her, or he'll yell with utter annoyance and contempt. What I got-- He was raised by two alcoholics. His father would talk to his mother this way all day long. It was a terrible, terrible childhood growing up. And I told him that he had adult child of alcoholic stamped on his forehead, and that the issue when you grow up with alcoholics is trust. Why would you trust? What has intimacy ever done for you? And I know this from my own dysfunctional family. And what happens to him is he described that he was waiting for her and they were late to get to somewhere, and he got annoyed with her. And if she were responsible and if she were competent, then, and if she loved him, then she wouldn't be dragging her feet like that. Well, we get to the details of his alcoholic parents, and guess what? They're not responsible or competent.

    8. PAPeter Attia1:04:25

       But can I pause for a second and ask you a question, Terry?

    9. TRTerry Real1:04:27

       Yeah.

    10. PAPeter Attia1:04:28

        When you're doing that type of work with a couple in that situation, does he actually believe that, or is that a subconscious thing that you have to extract that is part of the template of his belief system?

    11. TRTerry Real1:04:41

        Wait, does he actually believe that his wife is incompetent and irresponsible?

    12. PAPeter Attia1:04:45

        Yes.

    13. TRTerry Real1:04:46

        Yes, he actually believes that. But he hired her because she is a little ditzy. We always marry our unfinished business. So he gets triggered. That's not the issue. We all trigger each other. We all pick people who will trigger us. That's a whole other conversation. I call that the mysticism of marriage. That's not the point. The point is what happens then. And what happened then to him is he would move into control. Now, listen. What I said is, "I'll bet every time you get angry is a moment when you feel you're dependent on her, and she's not coming through for you because you're anti-dependent. And the more dependent on her and the more she doesn't come through for you, the more helpless you feel and the angrier you feel, and then it all comes out." And he got it. He got it, and he started to cry. And I said, "Listen, I have a mo-- I have a way out. I have a move you can make. Next time you feel that rush of annoyance, you memorize," and he is, he's gonna repeat this ten times a day to himself, "when I'm annoyed, it means that I'm dependent and I don't like it or trust it. That's what this means. I'm feeling helpless. And I want you to go to your wife and say one word to her, vulnerable. And honey, you hear vulnerable, you stop on a dime and you go give your husband a hug, 'cause he just did a good piece of work." And she said, "Fine." And he said, "Fine." I honestly believe that after this day with me, he's not gonna yell at her anymore. And if he does, if he slips, she can touch him on the shoulder and remind him, "Vulnerable?"

12. 1:06:30 – 1:15:30

    The Relational Life Therapy framework

    1. TRTerry Real1:06:30

       "Oh, yeah, vulnerable." That's leading a couple out of patriarchy.

    2. PAPeter Attia1:06:36

       We talked about relational living. You once explained to me something... You used Dickens as a way to describe it, which is the sort of the ghost of Christmas future, the ghost of Christmas past, and the ghost of Christmas present, and you did it in that order. Do you remember this discussion?

    3. TRTerry Real1:06:54

       Oh, yeah. This is what I tell my therapists, my students. This is the best rendition of the work that I've created. I call it Relational Life Therapy, for obvious reasons, I guess. The essence of that rhythm... Well, let me just say it this way Let me do it straight first. Relational therapy as I've created it has three phases. The first is loving confrontation. "This is what you're doing, Peter, to blow your foot off. Take a look at it and feel bad about it. You've been on cruise control. Wake up." The second phase is family of origin work. "Where did you learn this? Where'd you learn this growing up? Who did you see do it? Or who did it to you? Or who did you do it to and nobody stopped you and corrected you? Where did this come from?" And I'll do trauma work, deep family of origin inner child work in the presence of the other partner sitting there. That's the second phase. And then the third phase is teaching. "This is how you do it right. This is how you stand up for yourself in a loving voice, not a harsh one. This is how you listen to your partner's complaints and don't get defensive, but enter into their experience and be compassionate, like you did with that woman." These are skills. So the third phase is skills. So to go back to Dickens, I said the best rendition of RLT, Relational Life Therapy, is A Christmas Story. You've got Scrooge, who's anti-relational and self-medicating with attribute-based esteem. The more money he has, the more self-esteem he feels he has. And he's visited by three ghosts. I don't know Dickens' order, but I'll do it mine. The first is the Ghost of Christmas Future, and he takes Scrooge to his own funeral, and everybody's delighted that he's dead. That's the negative consequence. That's the confrontation. Then he goes back into his past, and he had a miserable childhood, a miserable, sad childhood. That goes back to the family of origin and where all this comes from. And then he goes to Bob Cratchit's house, Tiny Tim, where he sees what a functional family looks like, and he learns what connection looks like. Then he goes and buys a whole bunch of turkeys, and he's a transformed human being. What is the transformation? He's relational. He's in connection.

    4. PAPeter Attia1:09:13

       It seems that that order is necessary. It doesn't always occur in that order, but it goes back to sort of a question I asked you earlier, which was, how do you get somebody to do this if they're not in crisis? And my own personal experience and that of the people that I've known is everything you're talking about, Terry, is really hard. It's harder than anything I've ever described or tried to do. If you said to me, "Peter, just go run a marathon," I'd be like, "Okay, I know how to do that." You put one foot in front of the other, and you just keep doing it until you're done, and you'll get blisters, and it won't matter. But at least for me, the type of work that you describe is so challenging that the activation energy to get there, the barrier to overcome that, you have to be in incredible pain. You have to be incredibly miserable, incredibly depressed, incredibly angry, or see incredible pain in others that you've caused. I mean, it's some combination of these things, and, and that's why I do like the way that that story, the way you tell that story. But, I mean-

    5. TRTerry Real1:10:18

       Let me tell you another story which I think illustrates the work. It's sort of Dickens in the flesh. May I, can I tell you a story of Harry?

    6. PAPeter Attia1:10:29

       Absolutely.

    7. TRTerry Real1:10:31

       So Harry comes to me. His marriage is in crisis. You're absolutely right about that. His wife is about to leave him. I see them as a couple. And it's a typical he said, she said. A couple never presents with a presenting problem. There are always two, his and hers, or his and his, and hers and hers. Anyway, his problem with her was that she was a "ditz," quote, unquote. Okay. And her problem with him was that he was "brutal," quote, unquote. Okay. "Harry, give me some examples of Shirley being a ditz." "Well, she's often 10, 15, sometimes even 20 minutes late. She never apologizes. Send her to the store for five things, she'll come back with four, and she's just a ditz." "Okay. Shirley, tell me about Harry's being a brute." "Well, in just the last two weeks, he called me the C word, he stood in the doorway and physically barred me from leaving, and he spit on my windshield." This is an absolutely true story. I go to Harry. I say to him, I pick the most egregious one. I say, "You spit on her windshield?" "Well, yeah." First of all, let me pause and say, in the work that I do, I take sides. We're taught as fa- couples therapists to never take sides and always be even. Bullshit. This is Harry's problem. This is not Shirley's problem. It's Harry. We name names, and we tell it like it is in this work. Anyway, "Harry, you spit on her windshield?" "Well, yeah. Well, yeah, but you should've heard what she was saying. You don't expect me to take that kind of bullshit and just..." So I look at him for a little bit. Beat, beat, beat, beat. And I say to him, "Harry, I don't know. I barely know you, but it occurs to me you don't know the difference between standing up for yourself and attacking somebody." That stopped him a little bit. "Now, listen, where did you get this from? Who was the angry person in your family growing up?" He says, "My father." I said, "Tell me about it." He said, "He was, he was horrible. He would come home, and man, you scattered. You get in his way, you wish you hadn't. In fact, my mother was never around. She worked three jobs, so she was nobody to count on. I took care of my little sister." "Well, and what did you do?" "I protected her. I kept her out of my father's way. I locked her in the basement." He said, "Now, don't get me wrong. This is a finished basement with TVs and videos and coloring books and all that, but I would lock the door so Dad couldn't get her." I said, "How old was she?" "Three." "How old were you?" "Five." True story. I said to him, "I, I don't know, Harry. I wasn't there, but, pardon my French, but I imagine there was some five-year-old version of looking at your father and saying to yourself something like, 'You lay a fucking hand on my sister and I'll kill you.'" He said, "Yeah, yeah, that's exactly right. That's exactly what it was." I said, "Harry, how did I know that?" He said, "Okay, I'll bite. How did you know that?" I said, "Because you defend yourself like an angry five-year-old. Will you let me teach you how to do this in a more civilized way?" And he looked at me, this is not a sensitive New Age guy, he looked at me and he said, "I think you better." And we did. That's how this works.

    8. PAPeter Attia1:14:00

       So in that situation, I'm amazed by at least one element of that, which is maybe you just glossed over it, but what was the pain point that got him to so easily be willing to put... I mean, I'm gonna come back to the language of wounded children and adaptive children and maladaptive adults in a moment, but in that parlance, you very quickly got him to at least agree to put the adaptive child in another chair. And I, and we'll come back to that inner child stuff 'cause I really wanna dig on it, but, I mean, is that normal that in such a short period of time you can, you can get, in particular, an angry man to accept the error of his ways?

    9. TRTerry Real1:14:41

       Yes. I call it waking up the client. You know, wake 'em up.

    10. PAPeter Attia1:14:46

        And is that in part just because you took sides, named names, and didn't mess around?

    11. TRTerry Real1:14:53

        Yes, in large part. I run around the country, Peter, telling therapists that there are some serious design flaws in therapy, and the biggest design flaw is that we're all taught to be terminally nice to our clients, and people don't tell the truth. I tell, uh, therapists, "What you tell each other at the water cooler after the session, 'Oh, I can't believe what a bitch she was. I can't believe what a milk toast this guy is,' that's what you should be saying in the session. Find a responsible way to say it there, 'cause that's the damn issue." But we therapists are taught to hold back, and I think it's a great,

13. 1:15:30 – 1:21:45

    How the adaptive child becomes the maladaptive adult

    1. TRTerry Real1:15:30

       great disservice to everyone.

    2. PAPeter Attia1:15:33

       So let's go back to Harry. So you got a pretty quick pass on the ghost of Christmas future. You talk straight to him. Some people, certainly me, need a lot more than that. I needed to literally go to some funerals before I could get my head out of my ass. And then you go back and you do the family of origin and the trauma work. You posed a series of questions. Can you repeat them?

    3. TRTerry Real1:16:00

       Yeah. Who did this to you? Or who did you see do it? Or who did you do it to and no one stopped you?

    4. PAPeter Attia1:16:08

       And basically... I mean, I've thought about this so much, Terry. It's hard for me to come up with too many examples of behaviors that don't have at least one of those three types of mirroring.

    5. TRTerry Real1:16:20

       This is how this stuff gets transmitted from one generation to the next. This is exactly how it's done.

    6. PAPeter Attia1:16:29

       So Harry was... I mean, that's just an awful example of how wounded he was as a kid. Fortunately, most kids don't need to go through something that extreme. How did Harry respond to that? How would you take... Use this language now of what was his adaptation to that, and then what's that little adaptation serving him today?

    7. TRTerry Real1:16:50

       Well, I have a saying, "Adaptive then, maladaptive now." I mean, I always teach my students to have great respect for that adaptive child part of the person. The, the adaptive child part of you, when people do trauma work, we always think of the young wounded child, the one that was on the receiving end of the abuse or neglect. But between that child and the functional adult, there stands a, an older child part of us, older children, but I conglomerate them, and that's how you adapted. So for example, I have an intrusive mother, say, okay? My adaptation is I defend myself from her intrusion by coming behind thick walls. I erect thick walls. Interestingly, not all that unlike my father's in when he deals with my mother. I marry a woman who, of course, is highly emotional, just like my mother, and when she gets highly emotional with me, guess what you think I do? I put up a wall. So she's my intrusive mother. I'm that little boy, and I'm using the same adaptation that I used when I was four, now at forty-five. Uh, it was exactly what I needed to do at four. It's getting me into a world of trouble at forty-five.

    8. PAPeter Attia1:18:11

       When we do that inner child work, I think that what you just said is an important part of it that sometimes maybe if you're on the outside, you miss this distinction, which is sort of one of the first things you do is you thank the adaptive child, right?

    9. TRTerry Real1:18:25

       Yes. "You saved my ass." I have an exercise, and, and your listeners can do this exercise if they want. When I do a workshop, I do a two-day workshop for the general public on basic skills, and I give people a homework assignment on the first day. Now, I'm giving away my, my secrets here, but this is what I tell you to do, and everybody does it. I want you to take at least an hour on this. I want you to write a letter to your adaptive child. "Dear little Peter," "Dear Petey," or whatever you call them. "First, I wanna thank you. You really saved my ass. You protected my autonomy. You preserved me from... You taught me this. You g-" Okay. "This is what you did for me. Thank you. This is what you gave to me." You gave me drive. You gave me intelligence. You gave me discernment. You gave me, uh, ambition. You gave me goals. This is what you cost me. You cost me me. You cost me connection. You cost me love. You cost me being honest with myself. You cost me getting comfort from anybody else." And then the last one, "I'm here now, the adult, the inner adult, and I can take care of both of us. And from now on, what that's gonna look like is..." And then you sign it, "Love, Peter." That's the assignment.

    10. PAPeter Attia1:19:58

        This type of work is very emotional.

    11. TRTerry Real1:20:01

        Yeah.

    12. PAPeter Attia1:20:03

        Does one heal enough from sort of inflicted wounds to ever... Does the adaptive child ever vanish?

    13. TRTerry Real1:20:13

        No, it never vanishes, and we're always-- we often mistake our adaptive child for a functional adult. But let me just say, the functional adult has nuance. The, the functional adult is forgiving. The functional adult is warm and supple. The adaptive child is rigid and harsh and black and white, and it's a kid's version of a grown-up. Anyway, no, they're always with us. I don't believe... Uh, some trauma people say they're gone forever, but I think we contend with these little parts of us. The difference is, as you move into deeper and deeper recovery, the baseline is not this little boy. The baseline is my adult. And the little boy takes over episodically and, as your recovery work deepens, less frequently, and you catch it earlier, and you bring yourself down from that one up or up from that one down, so that the net-net is you're spending... It was that health was the island, and peaks of grandiosity and shame, for example, were the norm. And over time, as you tame those peaks and spend more time in health, that becomes your life, and up and down become episodes. So too with fighting in the couple. So too with any of it. You start off all over the place, and then... You know what it's like? It's like physical training. It's like core work. This is core work. And the stronger

14. 1:21:45 – 1:26:30

    Speaking the language of social relationships

    1. TRTerry Real1:21:45

       your core, the more you spend your time in health, and the more ill health becomes the exception.

    2. PAPeter Attia1:21:54

       Okay.

    3. TRTerry Real1:21:54

       That's how it works.

    4. PAPeter Attia1:21:56

       I mean, this might be kind of a dumb question, but how long do you think it really takes to go from a state of pathology? So you're, you're a person who is really quite dysfunctional. You've really reached a nadir in terms of your misery and the misery you inflict on others. But you've gone through the first two stages, meaning you've confronted what the world in your continued state is going to look like, and you've gone back and looked at the family of origin. You've gone through the inner child work as appropriate or as necessary, and you're now at the teaching skill development stage, which strikes me as the most difficult stage and the one that takes the longest. Is this, is this a journey of years?

    5. TRTerry Real1:22:44

       Yes, but it doesn't mean you have to be in therapy for years. Look, it's like once we get to the skill phase, it's mastering what I call a relational technology. It's a technology, and it's like any adult mastering a new skill set. It's like learning to ski in your 40s or learning to play the piano or learning how to speak French, and it takes about the same amount of time. If you're assiduous at it, it takes about three to five years. You don't need to be in therapy all that time, but it takes about three to five years of practice until you're really pretty fluent. I remember we had an interview once, and I said that relationality was my second language. My first language is selfishness, which is true. They thought I was brave. But I feel pretty fluent in relationality. I've lived in the world of relationality for decades, and I speak it pretty well. Is it my native language? Deeply, deeply, deeply, but in terms of what hits the surface, it's my second language. But it's the country I'm in.

    6. PAPeter Attia1:23:41

       That's actually a really great analogy because I think most people who have tried to learn another language can appreciate that it's doable. It's not just something you can decide you wanna do without practicing it. It's one thing to say, "Oh, God, I'm going to Italy this summer. I can't wait to learn Italian." "Oh, great. Did you hire an Italian teacher?" "No." "Oh, did you download one of those Italian teaching apps?" "No." "Did you buy a book about it?" "No." [chuckles] "Well, exactly how do you hope to learn Italian?" I mean, there's truth by fire. You could just simply go to Italy, immerse yourself in it, and not allow yourself to speak English, and eventually, I suppose you'll learn Italian. But for most people, a little bit of structure can help that, but you'll probably never speak it without an accent. And that doesn't mean you're not functional, but yeah, I think that analogy's a great one.

    7. TRTerry Real1:24:29

       So let me say, it takes about three to five years before you're really pretty comfortable speaking this new language of relationality. Having said that, this way of thinking ecologically instead of linearly, you're in the system, you're not above the system, you want power with, not power over, these ways of handling yourself are so different from the defaults that you were raised with and the culture at large, and they work so much better that doing them poorly will transform your life and your relationship. And you can start doing them poorly right away.

    8. PAPeter Attia1:25:08

       That is probably, again, there's probably an analogy there within language, which is if you even spent a couple of months practicing a language, you could certainly get to the point where the people in the restaurants and the taxis would appreciate your efforts and make every effort to help you.

    9. TRTerry Real1:25:23

       Yeah, I think that's right. And you know what? In terms of how long it takes, it's really simple. It depends on the sincerity of the person. I'm not blown away by diagnoses. I'm not blown away by character disorders or cha... Look, I had a couple, they would be called in psychiatry borderline personality disorders, bad people, tough, tough people. I mean, yelling, screaming, throwing things. He goes to the hotel. She goes after him. She's banging on the door. She's dragged off by the police. This is true. This actually happened. But here's the thing. She got pregnant, and she was determined that she was not gonna do to her kid what was done to her, and he, he came on board. And with my help, these people cleaned up in about six months. I've dealt with neurotics who have attitude, and I can't get to them for two years. These people were different people within a matter of months. She went on and became a therapist, and she studied. She's now a relational life therapist and a good one. So I don't care how far

15. 1:26:30 – 1:28:15

    When does it make sense for a couple to separate?

    1. TRTerry Real1:26:30

       back you are. I just wanna know if you have heart.

    2. PAPeter Attia1:26:33

       Do you ever find in couples therapy that you have to recommend to the couple a separation or just a divorce where you realize one person is really in this to change and the other is not? Is that usually what a breaking point comes down to?

    3. TRTerry Real1:26:47

       Well, it depends on what change we're talking about. I mean, if one person just wants to be neater and the other one doesn't, that's survivable. If one person wants to be monogamous and the other one doesn't, that's more of a serious problem. It depends on what's going on, but there are some deal breakers. I wrote a piece, you can get it off my website, which I would love people to come and check out.

    4. PAPeter Attia1:27:12

       Yeah, your website is your name. Is it Terry or Terence is the website?

    5. TRTerry Real1:27:16

       T-E-R-R-Y R-E-A-L. Just Google me, and it'll take you there. Yeah, what do you wanna know about?

    6. PAPeter Attia1:27:22

       You said you wrote an article.

    7. TRTerry Real1:27:24

       Oh, yeah, called Rowing to Nowhere. You can get it off my website. And it's about... It's for couples therapists, but it's about when to break somebody up and what we put ourselves through when we do that. But there are deal breakers. If somebody has a drinking or a drug problem, they don't wanna do anything about it, or somebody doesn't wanna be monogamous, and the other one does. Here's an interesting one, which I think is what you were talking about. If there's a serious discrepancy in the level of maturity between the two people, level of health, if one of them gets healthy and the other one doesn't, then eventually the pathology of the unhealthy one is too hard for the other one to stomach, and they leave. So they're deal breakers. Obviously, violence is a deal breaker. Not every couple is saved. And in terms of... I

16. 1:28:15 – 1:30:45

    Witness abuse—Consequences of screaming at your partner in the presence of children

    1. TRTerry Real1:28:15

       often always recommend a physical separation if there's yelling and screaming in the house and there are children about. I universally just tell the people about what's called witness abuse. Children are boundary-less. They're wide open. If your child is listening to you scream at your wife, it goes into them as if you were screaming at them. There's no difference. And so since you're screaming and yelling at each other and your children are there, I give you 30 days to clean up. I do this almost every time. If you're still yelling and screaming at each other 30 days from now, one of you leaves. Which one should it be?

    2. PAPeter Attia1:28:53

       That's an interesting point you alluded to earlier, which is up until a certain age, a child is incapable of differentiating between being screamed at directly versus just being a bystander. How long does that effect persist?

    3. TRTerry Real1:29:11

       Forever. It persists as long as if it's exactly the same as if you were standing there and your parent was screaming at you. It persists until, frankly, until you do some trauma work and, and metabolize it.

    4. PAPeter Attia1:29:24

       How long are kids susceptible to that? What's the window in which... Obviously, that, I can see that being the case for a five-year-old. Is that the case for a 12-year-old as well?

    5. TRTerry Real1:29:34

       Absolutely the case for a 12-year-old.

    6. PAPeter Attia1:29:36

       That's really sobering, uh, especially for someone like me, for whom anger is such an easy default.

    7. TRTerry Real1:29:43

       Yeah. That's right. That's right. You can go to my website. I did a piece for "20/20" with a raging woman and her, her, uh, passive-aggressive husband, and I said to her, "Do you have pictures of your kids?" And she did. She had beautiful golden-hued Latino kids. They were gorgeous. And I said, "This is what I want you to do. Before you rage at your husband, I want you to take the pictures out of your children, and I want you to look them in the eyes, and I want you to say, 'I know that what I'm about to do is gonna cause you harm, but right now my anger is more important to me than you are, so screw you.'" And I said, "Shall we try that?" This is on TV. You can see it. And I put my arm around her. I hold up the pictures. "Right now I'm thinking about..." And she sobs, and she puts down the pictures, and she says, "I will never yell at my husband again." And that was about 17 years ago, and she has been true to her word.

17. 1:30:45 – 1:33:45

    Cases of instantaneous change, and others which take more time

    1. TRTerry Real1:30:45

       They're divorced. She got rid of him and whatever on that, but no more rage after that session. People routinely... There's a thing about three to five years of learning. Uh, let me do the other side. People routinely sit on my couch, swear off behavior they've engaged in their entire lives, get up, and it's gone, permanently gone. That's what happened today with this man. He realized every time he was, quote-unquote, "annoyed" with his wife that the contempt coming out of him was 10 times greater than what he experienced it being because he grew up with so much contempt. He thinks it's just a love tap, and she's flat on the floor. And when he got it, when he really got it- He turned to her, this has just happened before we started our call, he turned to her with tears in his eyes and he said, "You are the most delicate, precious thing in the world to me. Why in the world have I been punching you?" And he says, "Never again. Never again. Never again."

    2. PAPeter Attia1:31:53

       Terry, do you find that that type of transformation can also exist when there's an actual chemical addiction involved as well? I mean, you sort of very loosely, we sort of glossed over it quickly about the substance addiction, sex addiction, process addiction, other sort of real numbing medications out there. Is it just as easy to get somebody to stop gambling or stop a sex addiction or an alcohol addiction?

    3. TRTerry Real1:32:19

       Absolutely not. They need treatment, and they need probably intensive treatment.

    4. PAPeter Attia1:32:25

       But why is anger different? I mean, anger strikes me as very similar. I mean, dopamine producing, it has all of the same, you know, grandiosity, anger, shame. Doesn't that have all of the same attributes as alcohol addiction?

    5. TRTerry Real1:32:41

       Yes, and you know, Peter, I don't know the answer to this one because you're right, there are many behaviors that will kick out endogenous chemicals that mimic the substances that you ingest. And why didn't you have to go to a 12-step program for your anger? I do send people to 12-step programs for their anger sometimes. I don't know the answer to that. What I look for with substance abuse is you wake up and you say, "Okay, I'll go to rehab." You wake up and you go, "Okay, I'll go to 12-step. I'll go to 90 days, 90 meetings." So you get committed to recovery, and that's the transformation, but the recovery takes a long time and a lot of help. So does the rest of it. Look, I'm recounting these marvelous one-session turnarounds, but let's be clear, when I'm done with people, I send them back for ongoing therapy 99 out of 100 times. Yes, you've made the turnaround. Now, in order to keep it, you're gonna have to have ongoing support for a while. The transformation

18. 1:33:45 – 1:39:45

    Reconciling with his father—Terry’s final conversation with his dad

    1. TRTerry Real1:33:45

       needs to be digested and made real.

    2. PAPeter Attia1:33:47

       Terry, you talked about at the outset that the whole reason you turned your life around, got into therapy, was to fix yourself and somehow reconcile your relationship with your dad. How did that end?

    3. TRTerry Real1:34:01

       Sadly, and as well as can be expected, I'll tell you two little stories. My dad died of ALS, which is a great metaphor. He lost his arms and then his legs and finally his lungs, and he died. When he had ALS, before he died, he was paralyzed, and my mom, who was a nurse, was taking care of him. I asked for his blessing, and it was very funny because my mom was holding up the phone and he was gonna give me my blessing, and my mom dropped the phone, [chuckles] and my dad started screaming at her, "Ollie, I can't believe it." And then she starts yelling back, and I... "Guys, guys, guys, can you stop? Guys." "Oh, yeah, sorry. Can I have my blessing now?" "Okay, okay." That's my family. Anyway-

    4. PAPeter Attia1:34:51

       [laughs] It's so sad and so funny, Terry.

    5. TRTerry Real1:34:55

       Yeah. But my father gave me a beautiful blessing. He said... I remember this. He said, "May nothing I've said or done in your life prevent you in any way from achieving your greatest potential, and may your work with men be blessed." And he was a stone atheist. "May your work with men be blessed." That's a nice blessing. And on his deathbed, as I wrote about in I Don't Want to Talk About It, he looked at my brother and me, and he said, "Listen, I'm really sorry," and he apologized for the way he'd been with us. And he said, "I gotta tell you, when you're looking at this the way I'm looking at this right now in this hospital bed, it's only about love," he said. "It's only about love. Everything else is just fucking bullshit." That's probably the last conversation I had with him.

    6. PAPeter Attia1:35:54

       I mean, I don't think you could say it any better, could you?

    7. TRTerry Real1:35:58

       No. No, that's the bottom line.

    8. PAPeter Attia1:36:02

       Well, Terry, I promised you we'd wrap this up at a certain time, and we are to the minute at that time. So I wanna thank you very much for making the time, especially on a short notice. I've been wanting to have a discussion like this with you publicly almost from the day I read your book, which was even before we started working together. I wanna just thank you for everything, personally and otherwise.

    9. TRTerry Real1:36:26

       Thank you, Peter. I wanna thank you for the service of this podcast that you do. I want to acknowledge, if I may, that it's been very moving for me to watch you change in our work together, and the changes, as I'm sure you speak about at times, have been truly transformational. You are one of those people we've been talking about tonight, and I'm very, very proud of you, if I can say that.

    10. PAPeter Attia1:36:52

        [upbeat music] Thank you very much. Thank you for listening to this week's episode of The Drive. If you're interested in diving deeper into any topics we discuss, we've created a membership program that allows us to bring you more in-depth exclusive content without relying on paid ads. It's our goal to ensure members get back much more than the price of the subscription. Now, to that end, membership benefits include a bunch of things. One, totally kickass comprehensive podcast show notes that detail every topic, paper, person, thing we discuss on each episode. The word on the street is nobody's show notes rival these. Monthly AMA episodes or Ask Me Anything episodes, hearing these episodes completely. Access to our private podcast feed that allows you to hear everything without having to listen to spiels like this. The Qualies, which are a super short podcast, typically less than five minutes that we release every Tuesday through Friday, highlighting the best questions, topics, and tactics discussed on previous episodes of The Drive. This is a great way to catch up on previous episodes without having to go back and necessarily listen to every one. Steep discounts on products that I believe in, but for which I'm not getting paid to endorse, and a whole bunch of other benefits that we continue to trickle in as time goes on. If you want to learn more and access these member-only benefits, you can head over to peterattiamd.com/subscribe. You can find me on Twitter, Instagram, and Facebook, all with the ID peterattiamd. You can also leave us a review on Apple Podcasts or whatever podcast player you listen on. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit peterattiamd.com/about, where I keep an up-to-date and active list of such companies. [outro jingle]

Episode duration: 1:39:45