#15 – Paul Conti, M.D.: trauma, suicide, community, and self-compassion

1. 0:00 – 0:04

   Intro

   1. PAPeter Attia0:00

      [upbeat music]

2. 0:04 – 6:36

   Introduction and Meeting in Medical School

   1. PAPeter Attia0:04

      Hey, everyone. Welcome to The Peter Attia Drive. I'm your host, Peter Attia. The Drive is a result of my hunger for optimizing performance, health, longevity, critical thinking, along with a few other obsessions along the way. I've spent the last several years working with some of the most successful top performing individuals in the world, and this podcast is my attempt to synthesize what I've learned along the way to help you live a higher quality, more fulfilling life. If you enjoy this podcast, you can find more information on today's episode and other topics at peterattiamd.com. [upbeat music] Welcome to this week's episode of The Drive. My guest this week is one of my dearest friends, Dr. Paul Conti. Paul is a brilliant psychiatrist. In fact, I often refer to him as the single best psychiatrist I've ever come in contact with, and I've met some many very sharp people over the years. I've long wanted to have Paul on the podcast. I've always wanted to interview Paul just in general, because there's not that many people who I find myself having discussions with and I think to myself, "How can this discussion be shared with others?" And throughout this interview, you'll hear us even comment to that effect, which is, God, it's almost like we're not even talking in front of microphones. This is exactly the kind of conversation we find ourselves having so often. Paul's a very special person. He doesn't get into great detail, but his life has been shaped by a number of really, really tragic events, a couple of which he alludes to here, many of which he does not. In fact, some of the most tragic events in Paul's life he does not allude to. But I think the point that comes across here is that Paul is one of the most empathetic, kind, giving individuals, and his understanding of the human condition is, is really unparalleled. So in keeping with one of the general themes here, which is longevity, of which healthspan and happiness are important components, we go really deep on this topic. We talk about what is meant by trauma. Many people just think of trauma as, you know, you got hit by a car or something like that. But we get really into emotional trauma. We talk a lot about shame, which is the result of trauma and what it ends up doing. We talk a lot about depression, suicide, and a number of other topics that are closely related to this. I, I do think at times this is a little bit heavy, but, you know, we really don't get into any of the technical stuff that I thought we might get into, in, in large part just because I think there was so much to talk about without getting into the neurobiology. I, I do think that Paul and I will need to sit down again in the future and get a lot deeper on some of those other topics that I also thought, you know, would be interesting and I suspect a number of you will find very interesting. So again, this is not a deep podcast from a technical standpoint, though we do get into some of the heavier stuff. Unfortunately, Paul is not someone you're really gonna find much about on social media. Paul is someone whom can be contacted through his office, of course, and we'll provide that contact information for folks who do want to reach out to his office. But the good news is Paul is really considering writing a book, and after we finished recording this podcast, we spent another twenty minutes talking about the book he wants to write. And the, the gist of it is the book is exactly about the stuff we talked about today. So I couldn't be more encouraging of Paul doing this, and I, I think that, uh, the world will be a better place for that. So I hope you enjoy this episode half as much as I enjoyed listening to Paul talk about all of these things, and I think almost anybody will find something of, of great value in this episode. [upbeat music] Hey, Paul. How are you, man?

   2. PCPaul Conti3:50

      I'm doing well, Peter. Thank you for having me.

   3. PAPeter Attia3:52

      You're a super trooper here. You have laryngitis.

   4. PCPaul Conti3:55

      I do indeed have laryngitis. I am persevering, and I appreciate your patience in persevering with me.

   5. PAPeter Attia4:01

      Well, luckily... I guess luckily is the wrong word, but most people here don't know what you sound like normally, so they probably won't even know that you're that. I'm only bringing it up because I, I know you're straining a lot to speak. But this is such an important topic, we didn't really wanna put it off. Between the two of us, we're so busy, even though we're in New York often, that we could both have a night when we don't have something else to do, uh, I think makes this worth it, so thank you.

   6. PCPaul Conti4:23

      It's, it's my pleasure. And even though I sound like the Godfather, I'm still gonna do my best to-

   7. PAPeter Attia4:27

      [chuckles]

   8. PCPaul Conti4:27

      ... come across as, uh, open and honest in a way that's not quite consistent with the Godfather.

   9. PAPeter Attia4:32

      Although you did pull one old school Italian trick a moment ago, which was-

   10. PCPaul Conti4:37

       I did?

   11. PAPeter Attia4:37

       [chuckles] as I-- as you came in my apartment. You beelined for the kitchen. What did you do with the aspirin?

   12. PCPaul Conti4:42

       I gargled with hot water and aspirin, just like my grandmother taught me to do.

   13. PAPeter Attia4:46

       [chuckles]

   14. PCPaul Conti4:47

       She gets credit. If people can understand me, credit goes to my grandmother.

   15. PAPeter Attia4:51

       All right, so there you have it, your first old Italian old school trick on what to do with laryngitis, to take some boiling water, smash some baby aspirin into it, and gargle it.

   16. PCPaul Conti5:00

       They didn't teach us that in medical school, but I'm still doing it.

   17. PAPeter Attia5:03

       [chuckles] All right, so speaking of medical school, you and I have now known each other for twenty-one years.

   18. PCPaul Conti5:09

       Amazing.

   19. PAPeter Attia5:09

       Yeah, almost exactly twenty-one years. And I think, uh, the relationship that you, me, and the other five coconuts had in our med school class, the seven of us, probably in some ways really annoyed most of our med school classmates because we were-- we became close, like, within the first week of school and never separated. We were just-- we were an inseparable group of knuckleheads that-

   20. PCPaul Conti5:31

       I s- I strongly agree that that annoyed people.

   21. PAPeter Attia5:33

       Yes. Yeah, yeah, yeah, it did.

   22. PCPaul Conti5:34

       Yes.

   23. PAPeter Attia5:36

       But we're fortunate, and I feel blessed to, to have met all of you guys. And in, in particular, probably all-- of, of the seven of us now, I think you and I by far spend the most time together because so much of our work clinically overlaps. I don't wanna go deep so soon, but I think-- I feel like I have to. So I'll never forget the first day we met. All med students on day one are sort of nervously talking about why they're here and blah, blah, blah, and Truthfully, most med students don't really know what they wanna be when they grow up. They have sort of figured out they wanna be doctors, and that's about it. But there were some of us that knew. I wasn't really one of them. I kinda knew I wanted to do something in oncology. I thought at the time pediatric oncology. One of our buddies decided on day one he was a plastic surgeon, and that is exactly [chuckles] what he is today. You said the most interesting thing I'd ever heard, which was that you wanted to be a psychiatrist. And I just remember thinking, "I didn't know people went to med school to become psychiatrists." I thought that was sort of a lifestyle choice that they made later on or something like that. But, but you were adamant about it.

3. 6:36 – 14:02

   Why Paul Chose Psychiatry: Searching for Truth

   1. PAPeter Attia6:36

      Why was that the case?

   2. PCPaul Conti6:37

      I think it represented a search for truth. I think it represented a search for truth and probably a, a response to some of the difficult things in my life and to a lot of the dissatisfaction that I was feeling with achievement, with my personal life, my professional life. From top to bottom, there was a sense of wanting to understand things more. And I think it's interesting, you know, you talk about how quickly, you know, this group of us became really fast friends. And I think there was a commonality there that we'd all had some life experience. And in different ways, as we came to learn, we'd all really been through a lot. And I think we were coming into medical school searching for something and trying to find that something for ourselves through doing things that are good for other people. And, and I understand that the idea is that's why people go to medical school, and I'm not saying other people weren't doing [chuckles] that, right? But we'd all been through a fair amount, and I think it's the, the suffering component that drove the ability to maybe be open and honest earlier with one another and to form bonds that were based upon the searching that we were all doing that drove all of us, right, to change career, to do something different than what we might have thought we were doing as a response to an internal need and I think ultimately as a response to trauma.

   3. PAPeter Attia8:01

      It's interesting you bring that up. I, I, I mean, I always knew this, but I guess I sort of forgot until you re-primed it. None of us were pre-meds, and all of us were a little older. We were all a couple years older because we'd all, in some cases, like, you know, in Bobby's case, I mean, Christ, he'd been a mountaineering instructor [chuckles] for a decade or something like that. Uh, you know, Zoli had been in the Army for four years, same with Jason, all these guys. Uh, sorry to be calling all our boys out [chuckles] here on the show. But yeah, none of us had just come through.

   4. PCPaul Conti8:31

      Right. Right. And, you know, certainly people can go through a lot by the time they're, you know, out of infancy, right? So it's not as if people need to be out of school, do different things in order to really gain life experience. But I think the choices that, that each of us made were choices that came from a place of drive and ambition, but ultimately that were colored by very personal things and I think led each of us to really want something more. And, uh, I think we came to medical school in part to find that. And, and I don't think that there's a distinction between what are the things that we do for other people and the things that we do for ourselves. I think that that's a false dichotomy that follows through sort of Western logic that things have to be one thing or another. And I think often the best things that we do for others, we do in a, in a search for some healing or soothing in ourselves. And I, I think that that was part and parcel of all of us. It was part and parcel of, I mean, many people that you and I went to medical school with, trained with, but I think it's what made the seven of us fast friends, and I think it's why there's, there's remained a strong bond, in part because that searching and that desire to do for self through doing for others I think really hasn't changed.

   5. PAPeter Attia9:49

      So what were you doing before medical school? In other words, you, you studied, you were an undergrad and you, you went to Penn, you studied math, and then you c- you moved to New York. You were working in finance, right?

   6. PCPaul Conti9:59

      Yeah. I, I minored in math. I, I majored in political science.

   7. PAPeter Attia10:02

      Mm-hmm.

   8. PCPaul Conti10:03

      And I studied a lot of history and a lot of literature. And what I didn't realize was that the attraction to me of everything that I was studying was, was, was really the, the allure of people. You know, like I, I studied World War II a lot, and for a while I thought I wanted to go to grad school and be a World War II historian. And at some point I realized what fascinated me was the, the people, right? The, the people who were driving the action, good, bad, or otherwise. You know, the people who were caught in the crossfires, you know, the millions of people who were part of that event. And, and what I realized over time was it, it, that there was a commonality of drive about understanding what was leading people to do things or how people were responding to things. And oddly enough, it may seem odd, but I think math is kind of part of that too, right? That, that there are things that happen inside of people, and there are aspects of our choice, our choices that we, we design with a certain linearity. But ultimately, y- you know, the, the complex functions in all of us that make things that we might think are predictable very unpredictable. And, and I only kind of realized that in retrospect. I mean, when I graduated from school, I just really wanted a good job. And I came out in 1991, and there was a little bit of an economic downturn, and I was fortunate to get a job with a good consulting firm. And, you know, I just thought, "Okay, that's where I'm gonna go," you know, that I'm gonna have this business career. And it fits with my father having, uh, been entrepreneurial and had a business career. And I just thought like, "Okay, that's for me, and I'm gonna make my way doing that."

   9. PAPeter Attia11:32

      So then what changed?

   10. PCPaul Conti11:34

       What changed is it, it really, really did not make me happy. And I say that with no criticism or aspersion whatsoever to people for whom, to whom it does make happy. But there was something very much missing from it for me, and, and I think that was the intensity of human interaction and so the intensity of human struggle. And what I found is... You know, I, I did that for four years, and I took some time in the middle, and I, I traveled for, for several months, uh, because I was kinda trying to figure something out, like, why am I not happy, right? And I came back, and I took a better job with the same company, right? So as time went on, you know, I had more authority. I was making more money. I was doing more interesting things, and I was less happy. And it really became quite stark to me that, um, unless I was delving into, like, the intensity of what's going on inside of people, I wasn't gonna be happy. And I think, you know, what I didn't t- Really fully realize was that that was gonna be a way of kinda delving into the things going on inside of me. And I mean, as you know, and you and I have talked about many, many times, there were some traumatic things that happened during that time that really just brought to the fore to me, I wanna understand better, and I wanna be able to help soothe things in other people. And what I didn't realize at the time was that wasn't a way of saying, "Oh, I'll be selfless, and, you know, and altruistic," right? And, like, that's gonna save the day for me. But, but really, you know, that also... What I didn't realize at the time was the mirror that it would put up that would allow me to, like, just get access to help that I didn't have before, be open and communicative and understand myself in ways, uh, that I wasn't necessarily programmed to do, right? I mean, I was programmed to, like, work hard, achieve, um, not be weak, right? And that inability to express, right, even to myself, let alone to other people, you know, was ultimately draining the life from me and actually did, you know, drain the life i-in terms of, like, actual death from some people around me that I, I very much cared about. And in some ways, I was rebelling away-- uh, rebelling against that way of being in the world and that way of teaching people to be in the world. And I had some, I think, inkling of understanding of that, but it more came through anger and, and rejection of things than it came through an understanding, uh, through the lens of compassion that, you know, we've kinda structured our society in a way that makes it very, very difficult to live in it, I think.

4. 14:02 – 17:29

   Losing a Brother and a Friend: Silent Struggle and Functional Death

   1. PAPeter Attia14:02

      You're alluding to, um, obviously something I know is very difficult, and we've talked about it a lot. Uh, I don't know that we need to necessarily go into great detail here, but in the span of a year, if I recall, you lost your brother and your best friend.

   2. PCPaul Conti14:15

      Yeah, my, my brother, my brother died by suicide, and, uh, about a year later, one of my closest friends, so the same, uh, a close group of friends growing up-

   3. PAPeter Attia14:25

      Mm-hmm

   4. PCPaul Conti14:25

      ... sort of like we had in medical school, but there were a group of us, and one of those very, very close friends from childhood also died. And he didn't die by suicide, but there was sort of that same kinda desperate recklessness that I, I saw this common root in those two deaths. And, you know, they confused me and, and infuriated me and, you know, made me feel very helpless and, and vulnerable and wanting to be able to understand better and to kind of fight against this thing that made it so hard for people to really to get help, right, and to be vulnerable. And that was really the commonality is, like, both of the people who died had real and significant needs inside of them that came about naturally, right? And like something you-- one would never criticize a person for having those needs, right?

   5. PAPeter Attia15:19

      Mm-hmm.

   6. PCPaul Conti15:20

      Or those struggles, but there just wasn't a venue of, of getting real acknowledgement and, and help for any of that. So that kinda silent bravado and silent struggle, you know, became very real to me that like, "Oh, that leads to death," right? I mean, it doesn't all the time lead to death, but it leads to death, you know, way more often than is even remotely acceptable.

   7. PAPeter Attia15:41

      I mean, I think as we've discussed it, sometimes it can lead to death immediately, like in these cases, and sometimes it can lead to a functional death, which is you're still technically alive, you know, you still respire, but you're effectively dead.

   8. PCPaul Conti15:55

      Right.

   9. PAPeter Attia15:55

      In, in many ways, that's probably the more endemic, more sinister, more destructive over the long term, given its sheer volume problem, right?

   10. PCPaul Conti16:06

       Oh, a-absolutely. I think, uh, the deaths that we see in front of us as like actually, okay, that person is not breathing anymore are-- they're a viscerally moving hallmark of what is so pervasive in our society. And, and I do think I, I-- that I didn't understand that then. That in many ways, the way our society is structured and the way our matrices of achievement are structured really beckons us to death in life, to losing touch with the basics of our own value system and essentially to incessant striving. And not incessant striving to achieve, although we may see it that way, but incessant striving to not pause and to not feel the vulnerability that I think is so pervasive now. I mean, even in the twenty years, you know, since we went to medical school, I mean, you think about how pervasive media is, right? I mean, how there's just marker after marker after marker after marker that says that you're not good enough, you don't have enough, you're too vulnerable. You know, there could be a terrorist attack any time. Your kids could be killed. Uh, we could die. I mean, i-it's one stimulus after another that tells us not to stop and to, to really value ourselves by the things that we really value.

5. 17:29 – 26:04

   Training at Stanford and Harvard; Is Freud Still Relevant?

   1. PAPeter Attia17:29

      We get through med school, and true to your word, you get a psychiatry residency spot. You decide to stay at Stanford in part because your wife was still-- your soon-to-be wife. You guys weren't married yet, but your girlfriend was a couple years behind us in med school. And you end up spending half your time at Stanford, and then your wife matches at Harvard, so you go and finish your residency at Harvard. So whenever I'm telling patients about you, and I'm probably bastardizing all of my knowledge, which is so limited in this field, but I say, "You know, one of the things about Paul that's so unique is he did half of his training at Stanford," which is probably one of the foremost institutions when it comes to understanding the neurobiology and the pharmaco-neurobiology and the pharmacology of psychiatry, and then does the other half at Harvard, which is sort of a more old school but, you know, a place that specializes so much in the, in the psychotherapy. I-is that an ac-- Am I, am I making that up when I say that? [chuckles] 'Cause I've just decided to take the liberty and say that about you.

   2. PCPaul Conti18:28

      Uh, it sounds good, so please keep saying it.

   3. PAPeter Attia18:29

      [chuckles]

   4. PCPaul Conti18:30

      Um, no, no. A-actually, I think th-there is truth to that, and there's even more-- there's more truth to that the longer I get from it and the more I reflect on it. I, I think that, you know, I'm not A very positive or hopeful person about the state of the field that I'm in, which I think does not broadly enough train people in brain biology, not just in the use of medicines, but in what those medicines actually do and on a very real level, what are those medicines doing as interventions in the brain, in the many, many systems of the brain, in the cascade of effects that occur in the brain. And we don't think about structural neurobiology. We don't think about neurochemistry in general. So there's that part of the field that often gets ignored, and then the other side is the psychology. There has been a debate of, of should psychiatrists still be trained in psychotherapy? I mean, I see this come up and, and I, I just think that it's, fuck, we're putting it crazy to consider having people that are, that are schlepping medicines to other people that aren't thinking about what it's like to really try and understand someone and what are the paradigms of understanding other humans, right? The kind of things that are valid and have a scientific basis for them, but that are not hardcore brain biology. And I was very, very fortunate to learn so much neurobiology at Stanford and to have that integrated into my training. But when I got to Harvard, I was struck by that several very, like, prominent influential people there who, like, were influential over, like, for example, whether I graduated, right? Were, like, really shocked at how much brain biology I knew and really shocked at how much psychology I didn't know. And even though I had sought out some of this on my own, uh, being in a place that was kinda steeped in an older analytic tradition really helped me kinda embrace this belief that understanding psychology a-and certainly from the perspective of what's psychodynamic, right? The things that influence and motivate us that are in our unconscious, you know, the gigantic part of the iceberg that's underneath the water, but that is most deterministic of our behaviors and our choices and our feelings, and being able to integrate that with the brain biology upon which it rests, I think, is-- I think it's the way to at least try and have the most broad set of abilities to try and help people. And in some ways, it was very fortuitous for me to split my time between those two places and to find a couple very, very good people who took it upon themselves to try and teach me in a short period of time, um, what maybe I should have learned over a longer period of time.

   5. PAPeter Attia21:14

      When, when those of us who are not trained in this discipline think back to, you know, our Psych 101 class or something as undergrads in college, you, you get introduced to all of the, the luminaries in the field. And one of the things I still remember was sort of the, the id, ego, superego stuff. How much of that stuff is still relevant today? I mean, even sometimes when you and I talk, we still-- I think when we talk about personal things, this idea of ego still comes up. I mean, you and I both completely separate to all of this discussion 'cause we won't go down this path. It just takes too long, but we share an enormous interest in psychedelics and the promise that they hold for people. And of course, one of the hallmarks of this is dissolution of ego. So when you think about what, what someone like me or someone who's listening to this who doesn't have the training thinks at a very crude level of, you know, the id, ego, superego, h-how much does that still apply to how you think about these problems?

   6. PCPaul Conti22:06

      I think it applies tremendously, like, on a foundational level. And the problems we often run into are often about semantics. And even among, like, experienced psychiatrists, the definition of words and terms can obscure any understanding. So for example, in the, the, the Freudian concept of the ego, it's, it's much more the whole self. It's the part of self that one can bring i-in a conscious way to bear on the questions and issues at hand. It's the, it's the part of self that can mediate between the different poles, right? So the id may be about gratification. The superego may be about what you should or shouldn't do. But ideally, it's the ego, the whole self that pulls that together. And that's a very different use of the term ego than how it often is used these days, where ego is a sense of self that essentially indicates a defense mechanism. And the idea of dissolution of the ego through the use of psychedelics is not dissolution of the classic psychodynamic or Freudian ego, which is like the whole self at its most poised and comprehensively aware and empowered. It's more the dissolution of ego as defense that we, we build up over time, I, I think a shocking number of defense mechanisms that serve us well at the time, but that ultimately are an unhealthy part of the foundation that then gets built upon. So, uh, for example, a sense of insecurity in childhood, and I'm not good enough, and I need to achieve more, and I need to please people. You know, we build so much around that, that defines us in a certain way, for example, right? That tells us that we must be perfect, and we f-may beat up on ourselves if we're less than perfect 'cause that's how we're gonna make ourselves perfect, right? And then you can think of all the things that build on top of that, which could be maladaptive friendships, maladaptive romantic relationships, maladaptive career choices, right? There's so much that we can build on top of that. And then i-in, in a very strong sense, it's almost as if, like, the true us, right, the Freudian ego is surrounded by, you know, ninety-story high walls that are built to protect us, but actually protect us from real connection with self and others and real understanding. And, and some of what the psychedelics, it seems through the, uh, the phenomenology, the people's experiences, the research, right? When you put all of that together and you look at it with the brain imaging and, and the knowledge we have about brain biology is, is in an amazing way they can take down those defenses, which if not done in, you know, a, a therapeutic and a controlled setting, obviously can be dangerous. But in the right setting opens one up to an experience of self and an experience of the truth of self that is no longer walled off by all of these unhealthy defenses. So, I mean, it's a long answer to the question, but yes, what's going on in our unconscious, what's going on deep in our brain, the things that we're not consciously aware of are so deeply impactful. So Freud certainly didn't get everything right, but th- but this concept of the unconscious pulls on us and the ability to integrate those things in a healthy ego that can actually decide and choose, I think is as relevant or more so than ever when there are so many pulls away from authenticity of the self. And then the, the hope of psychotherapy, just shared human experience and psychedelics, is to be able to take those defenses down so we can have an experience of self that reflects who we truly are, which the vast majority of the time involves acknowledgement of the things that we're ashamed of, the vulnerabilities, the things that we've insured ourselves against, which are often the very things that, that keep us away from happiness.

   7. PAPeter Attia26:03

      You know,

6. 26:04 – 34:35

   The Wounded Child, Striving, and Whether It's Getting Worse

   1. PAPeter Attia26:04

      I'm, uh, as you know, I'm writing a book now, and it's not a particularly easy thing to do. I, I think it's probably hard even for someone who's a natural writer. But for, certainly for someone like me, it's very difficult. And I'm toying with a chapter that I've been really, really flailing with for the past three weeks. It may not end up in the book because I just don't know of how to, how to write it. But it's a chapter that centers around the experience I had in Kentucky, which might seem like an obscure thing to write about in a book about longevity, but of course, as I've become very, um, you know, clear on lately, I don't think all of this obsession with longevity and living longer and living better means a lick if you're miserable. And so much of our misery is self-imposed. And I think obviously I, I-- you are the reason I went there. I would never have done what was required to go through that experience were it not for you insisting on it. And frankly, even had you insisted on it, you know, at a different time without the confluence of events that led to it, I probably could never have done that because the, the vulnerability that's required to do and to go there, and you even put me in touch with another patient who you had sent, who had gone. Again, the thing that amazed me about that was how long I had lived my life never even considering the idea that there can be a child that gets wounded, that wounded child develops an, an adoptive child, and sometimes that adoptive child is the one that shows up in the adult body.

   2. PCPaul Conti27:34

      Yes.

   3. PAPeter Attia27:35

      And not, as opposed to a functional adult.

   4. PCPaul Conti27:37

      Yes. Yes.

   5. PAPeter Attia27:38

      And I guess I just sort of feel like I'm Neo in the Matrix, and after I've gone through this whole experience, I see my life in a totally different way, and I realize, "Oh my God," like all of that achievement, all of that perfectionism, all of those things I was chasing, it's basically a kid trying to protect you. And I've certainly not held out any hope that it's gonna be ever fully resolved. I mean, I'm not, I don't know, maybe I'm just too pessimistic. It's going to get better. I'm absolutely confident because it has gotten better. But [chuckles] it just strikes me as so hardwired that it, it kind of makes me wonder like, is this something that's getting worse, or is this something that has always existed in our civilizations, in our societies, and only now because so many of our other needs are being met. You know, no, none of us that are, are lis- if you're listening to this podcast, you're probably not worried about where your next meal is gonna come from. You're probably not worried about a plague. You're probably not worried about, hopefully you're not worried about a civil war or something like that. So is it just that our basic needs, you know, of, of, of Maslow's hierarchy of needs, they've been met, and so now we, we have the quote unquote "luxury" of worrying about self-actualization and, and, and what does happiness mean and what does it mean to be fulfilled and content, that we're now realizing this? Or do you think there are things that are actually making it worse today, and there are more wounded kids out there and more adults that are effectively nothing more than adoptive kids?

   6. PCPaul Conti29:10

      It's such a fascinating question. And I mean, of course, I don't know the answer, but I, I do suspect that we are making it worse for ourselves in ways that we haven't intended. So o- of course, look, I'm all for opportunity.

   7. PAPeter Attia29:25

      Meaning like we are numbing ours-- we have more nu- agents to numb and soothe ourselves?

   8. PCPaul Conti29:30

      No. We, we've made more opportunity for ourselves in certain ways, right? And that opportunity is a wonderful thing in many ways. But every good thing has its potential for a downside and something that can work against or even negate the good thing. So for example, a- as far as I know, for generations, you know, the people in my family lived, you know, up in the hills of central Italy and, and, and, and as far as I can tell, most of them were shepherds, right? And we could look at that and say, "Look, there's a, there's, there's a limitation to what they could achieve, and how fortunate am I that people sailed across the Atlantic, and now I go to college, and I have a business career, and then I go back to school, and I take undergraduate classes, and I apply to medical school after all of that, and I get in." And you could like, you could, you could list forever the additional opportunities that I have that people didn't have before, and that's wonderful, and I, and I certainly would not argue against opportunity, right? But it also brings greater opportunity to run away from the things that plague us. So for example, you and I, and probably many, many, if not most of the people listening to this podcast, are driven to be powerful. So okay, some of the motivation for what I do or what you do is intellectual curiosity, the desire to help others, a desire to learn about self, right? But a significant aspect of the strength of the fuel in the tank, right, is running from something, right? It's running from vulnerability. Because there's more opportunity, there are higher expectations, and I think there are high expectations for both of us, not that I am arguing against, you know, the fact that our families instilled in us conscientiousness and ambition. But I, I think we internalize that as must be perfect, must achieve more. Like when is, you know, when is enough enough? And it becomes very, very unclear, and it becomes very easy to run from things. And- You know, it's that that I think that the modern world doesn't actually help us define what we are striving for. So more striving, more power, whatever that means, right? Um, could mean money, it could mean prestige and titles, influence, whatever it means, like more of that by definition becomes better, and we live in a world that constantly reminds us of our vulnerability. So there's never a time. I mean, my guess is having spent time, you know, in places where like people are shepherds, right? And people do have these simpler lives, and sure, they don't have the opportunities we have, but there are ways that I often can see them at the end of the day feel a sense that the day is over, and that what's-- the, the day's exigencies are over, the day's ambitions are over, right? They're like, "Things are okay and it's time to rest and there'll be tomorrow." And I think most of us don't have that feeling. You know, most of my life when I fall asleep, I'm exhausted and I have a sense that, well, now I need to sleep for a little bit so that I can get up and strive more. And I don't think there's any way, if we're honest with ourselves, that we can frame that as, "Oh, that's a drive to something." No, that's a drive away from something, right? And it's running away from ourselves and it's running away from our problems, and we don't even know what those problems are. And the fact that, as you know, I have a pretty diverse practice, right? That, that like really I think spans the spectrum of psychiatric and neuropsychiatric things, and I absolutely believe, and I've come to believe more and more and more and more as time goes on, that 80% of what I treat is trauma. 80% of what ails me, 80% of what ails you, 80% of what ails the world around us is all trauma. There's another 20% that might be a head injury, schizophrenia, you know, the complications of physical injuries, biological determinants of addiction. I mean, but, but none of those things, even those things that, that seem and are very biologically determined are free of the impact of trauma, and the rest of it I think is purely trauma. Its manifestation is anxiety, depression, panic attacks, choices to abuse substances, choices to do things that are unhealthy, whether it's overeating or it's cutting or it's gambling or whatever it is that we're doing. So much of that is driven by trauma and, and I think that, you know, yes, it's an opinion, right? It's not something I can prove, that you can prove like a, you know, like a math problem, right? But I think if you really look at it and you look at what's going on at the root of, of what ails people, I think it becomes self-evident that I think there actually is a way of proving that, which is just look at what's really going on in people instead of categorizing them. You know, there's a DSM-V that's a half a city block long [laughs] that, that just looks to like... Look, if we flip through it, I don't know how many diagnoses you and I would have between us, right? 'Cause it's designed to capture everybody multiple times over. But categorizing what ails somebody and putting a number on it is not understanding them. That is not synonymous with understanding them.

7. 34:35 – 45:47

   Diagnosis vs. Understanding, and Suicide Statistics

   1. PAPeter Attia34:35

      This is the tragedy of your profession, right?

   2. PCPaul Conti34:37

      Yes. I believe it is.

   3. PAPeter Attia34:37

      Is that's the direction it's going in.

   4. PCPaul Conti34:39

      Um, it's, it's, it's designed to categorize, 'cause if you categorize something, you can put a number on it.

   5. PAPeter Attia34:43

      You can bill. Yeah.

   6. PCPaul Conti34:44

      Right? And then you can get 20 bucks f-f-for insurance and you haven't actually understood people. I, I, I think that both the practitioners in my field and the, the p-people who come to care deserve better than what the field gives them, and we've stepped away from really trying to understand people. And, and I'll give you an, an anecdote. I was very, very fortunate when I was interviewed for Stanford. I was interviewed by Peter Rosenbaum, who, uh, was an emeritus professor of psychiatry.

   7. PAPeter Attia35:10

      This was in medical school or for residency?

   8. PCPaul Conti35:12

      Stan-- No, for medical school.

   9. PAPeter Attia35:12

      For medical school.

   10. PCPaul Conti35:13

       Yeah. And, um, we got along really, really well, and he's a wonderful person. And later on when I decided to become a psychiatrist, I told him. You know, I, I got his email out of the archives and I told him, and he sent me, uh, some redacted histories, right, of patients and he wanted me to understand that yes, there have been so many biological advances. There's space age neuroimaging. There's an understanding of brain biology that was unimaginable 30, 40 years ago. But if you look at what they were writing about people, it really evokes a human being. Whereas very often now when I look at reports of people, I, I can't tell anything, right? It's just, it's an inventory of signs and symptoms that you could conclude anything from.

   11. PAPeter Attia35:57

       Mm.

   12. PCPaul Conti35:58

       And then a number gets put on top of it and, and yes, I'm, I mean, I'm being critical of the field as I'm saying this, but in many ways it's a societal criticism, right? It's a criticism of a society that dumbs things down and that doesn't respond to the individual, whether it's the, the incessant phone trees that prevent us from ever solving any problems, [laughs] right? No matter what it is, whether it's my bank or it's the phone company. I mean, when do you actually connect, right? And, and I think it's that isolation that is a societal malady and it affects psychiatry, which is a very bad thing because psychiatry is trying to help us have better mental health and we're kind of disarming its ability to do that, I think. And then it pervades our society in a way that leads to isolation and desperation and, you know, if I think-- if you look at suicide rates and, and just levels of general misery, I mean, I don't want to glorify the past, including the recent past, but it's pretty hard to look at that and to think that, no, there's not, that, that there's not something here that's getting worse.

   13. PAPeter Attia36:58

       Yeah. Well, I mean, touching on that, there was an article in The Wall Street Journal recently after the, um, sort of very close to back-to-back suicides of Kate Spade and Anthony Bourdain, and it showed some stats from the CDC. So these are obviously US-based statistics, but when you looked at men and women be-between the ages of 40 and 60 across the board, there was about a 30% increase in the rate of suicide over... I, I, I don't wanna be, be misquoted on this, so I... It was either a decade or two decades, but it was a relatively recent period of time. And, and my, my approach to longevity is very It's very kludgy, right? I mean, I'm kind of a hack if you really stop to think about it. I don't have like some single magic pill that I think can make you live longer. Instead, it's like a whole bunch of reverse-engineered problems, and one of them is, you know, it's, it's you figure out what it, what it is that's gonna kill you and start to back out of that. And so I spend a lot of time poring over actuarial tables and looking over mortality trends and trying to understand how they're shifting, where are we, quote-unquote, "winning," and where are we losing. And it seems to me that, you know, even though most of my energy focuses on three things, atherosclerotic disease, cancer, and neurodegenerative disease, the only disease that shows up in every single decade as a top ten cause of death outside of the first decade, so birth to nine, is suicide. Accidents do as well, and but, but, but I think the suicide thing... But, but the nature of accidents, by the way, changes so much from beginning to end that it's a very different, you know-- In other words, the accidents that kill, you know, thirty-year-olds and forty-year-olds are quite different from the accidents that kill eighty-year-olds and ninety-year-olds.

   14. PCPaul Conti38:32

       And sorry to interrupt, but how many of those accidents, especially ones that are killing younger people, are what we might call parasuicidal, right? It's people being reckless and getting killed because their mental state is such that they're not invested in staying alive.

   15. PAPeter Attia38:46

       Uh, not only that, so that's a great point. The other point is when you look at the top three causes of accidental death, it is automotive accident, falling, and accidental ingestion, which of course begs the question, how many accidental ingestions are not accidental? When I was in college, a friend that I grew up with, his dad shot himself in the head. I remember the Sunday afternoon that it happened. He literally, they all went out to church like a normal day, went out for lunch after, and then when they got back home, his dad went out to the shed and shot himself in the head.

   16. PCPaul Conti39:19

       Mm-hmm.

   17. PAPeter Attia39:19

       Probably one of the saddest lessons I ever learned was maybe two months later during finals, my mom said, "So-and-so," my friend, "is not doing well. He's really down in the dumps. You, you, you ought to come home and see him this weekend." And I, I still to this day just cannot, um, I can't believe what I'm admitting and acknowledging now. It's so embarrassing and painful to say this, but I said, "Mom, look, I'm in the middle of finals here, you know. I gotta graduate first in my class, right? I have to be the best engineer that ever lived. I'll be done in two weeks. I'll see him then." A week later, he was dead.

   18. PCPaul Conti39:54

       Oh my gosh. I'm so sorry.

   19. PAPeter Attia39:56

       Now, we don't know, you know. I don't know that he'll get counted as a, quote-unquote, "suicide," because it was alcohol, barbitua-- you know, it was like a cocktail of drugs in his system, and he just never woke up. And again, I only tell that story not because it's, you know, it's just such a sad-- It's a sad reminder to me to how to prioritize. It's, it's b- It, that overnight changed the way I prioritize things in life. But it also begs the question, you know, his death might not be one that actually gets counted as a suicide, but I would call it a suicide.

   20. PCPaul Conti40:27

       Absolutely. I mean, the, the deaths by suicide are, in general, the ones that are just very clearly suicide, right?

   21. PAPeter Attia40:33

       Yeah.

   22. PCPaul Conti40:33

       But if you, if you-

   23. PAPeter Attia40:35

       There's a note written. The, the gunpowder's on the hand as the gun points at the head, yeah.

   24. PCPaul Conti40:40

       Right. But so many deaths that are not labeled as suicides actually are suicide, and so many that aren't someone saying, "I'm going to kill myself now," are the result of an approach to one's life that doesn't value it and wants it to end, what gets called parasuicide. When, when you, when you add those things together, those numbers just are undoubtedly are strikingly higher than the shockingly high numbers that we're reading now. And I've, I've always kept a mental note of if someone I know, you know, which includes, again, I don't make much of a distinction between people in my personal life, my patients, uh, people I consult to, I mean, just humans, right, of what they died of on the death certificate versus what they really died of, right? And it might be, oh, auto accident, accidental overdose, fall, right? And I'm looking, and I'm saying, "Oh, that person died of Madoff, that they're so ashamed of what happened to them when they were swindled and humiliated," right? That person died of rape that was never adequately addressed, and the, the sense of shame and the sense of misery that was imparted on them was never addressed. That person died of childhood bullying, right? That was so intense. They, they, they decided that they were this awful, reprehensible person in sixth grade, and that never changed. I mean, every now and then, the actual cause of death matches what, what is, is, you know, my brain registers as the real cause of death, but very, very often there's a difference there. And, and the difference I, I account for by the role of trauma, right? The role of trauma that pushes people to either end their life or to move towards the end of their life, even if they're not overtly acknowledging that they're doing that, which can be a clever way of not having to feel accountable, right? If the religion says, "Don't commit suicide," well, let's say ultimately it was an accident, or, well, I don't want to leave my kids, ultimately it's an accident. I mean, you know, I'm not saying that in any negative way, but we, we don't help people to understand what's going on inside of them, right? And, you know, you're talking about, like, how you run your practice and how you try and understand the, the routes to not just to longevity, but to healthy longevity. And, you know, and I would argue, I mean, my take on that is that you actually have become the best engineer because what you're doing is, as you said, you're reverse engineering to ways of living longer and being healthier. And with so many complex variables, I'm not so sure if it's possible to figure that out without reverse engineering. And I view it as a marker of your, I truly mean this, your intense and incredible thoroughness, that you look beyond the factors and the reasons for the factors and the reasons that underlie the factors and the reasons. And it's, you know, I think what leads you to have me here instead of someone who could talk more about oncology or cardiovascular pathology, right? The realization that what undergirds a tremendous amount of The things that actually take someone's quality of life or take their life ultimately has a root in, in mental health, right? That people who are depressed are more likely to die of cardiovascular disease, are more likely to die of accidents, are more likely to become addicted, right? People who've been through terrible trauma are more likely for all of those things to happen. The role of stress and its impact on the immune system and the growth of cancer cells, right? There's a level underneath the things to which we attribute morbidity and mortality that strongly influence morbidity and mortality, and I believe that's true. I mean, I think that 80% of what I treat is trauma, but I actually think, I don't know what the numbers are, but I think more than 50% of what everyone treats, any doctor, more than 50% of what walks through that door is ultimately resting in misery inside of that person that I would attribute to trauma. And, and again, it's not my way of saying, "Oh, we're all suffering," and in some way that it just kind of denigrates, you know, you know, like when really awful things happen to people. I mean, the, the problem is we don't take stock of really awful things that happen to people, like, most of the time. And even when those things are something so overt as, you know, an assault, a, a terrible loss, right? We, we can ignore even those things, let alone the impact of, you know, loss of a, a parent as a child, loss of a friend who moves away, loss of a pet. I mean, like, these are things sometimes that, that you ask somebody what their inner life is like 20, 25 years later and, and that thing may go through their head a thousand times.

   25. PAPeter Attia45:14

       Mm.

   26. PCPaul Conti45:14

       And it may be that the, the loss of the pet is symbolic of they will have no stability, no peace, no freedom. So then it becomes, you know, it becomes the internal symbol of their, their sense of hopelessness in life or their sense of infinite striving with no hope of getting where they wanna go. So, so I don't mean to say that in some, I don't know, trite way, but I, I mean to say it in a way that I do think, the way if you sit with individual people, you see the depth of that and you see the pervasiveness of it.

8. 45:47 – 50:47

   Trauma Beneath Disease and the Road to The Bridge

   1. PAPeter Attia45:47

      When you recommended that I needed to go to Kentucky, needed to go to this place, The Bridge to Recovery, which we'll be sure to link to in the, um, show notes here, because I really think if anybody takes anything away from this and they even have a suspicion that their, some of their actions, some of their pain could be sort of driven by trauma that had occurred earlier in life, I wanna make sure that people at least pick up the phone, give them a call, and at, at least commit the time to doing an intake interview with them. But, I mean, I was so incredibly resistant to this idea, right? It was this idea that how could there really be anything wrong with me? Look at how hard I work. Look at how, quote-unquote, "successful" I am. And by that, I just meant, like, I'm not an alcoholic. I don't have a drug problem. I'm not a gambler. Like, I don't have any of these overt signs of pathology. Yeah, I've got these other things that are kind of pathologic, but I can mostly keep them in check. But I kind of remember when I did my intake call with them, how pissed off I got.

   2. PCPaul Conti46:51

      Ugh.

   3. PAPeter Attia46:52

      And that, to me, there was, there was two things, right? So the first is I'm talking to this poor woman whose job it is is to just do a basic screening call, but she's asking me a lot of questions nobody's ever asked me and questions I don't wanna answer.

   4. PCPaul Conti47:05

      Yeah.

   5. PAPeter Attia47:05

      And at [laughs] one point, she asked me a question. I won't tell you what the question was, but my answer was, "Fuck you."

   6. PCPaul Conti47:11

      [laughs]

   7. PAPeter Attia47:12

      Like, that was just my answer.

   8. PCPaul Conti47:14

      Right.

   9. PAPeter Attia47:14

      Right? Like [laughs] and when I later told that story once I finally got there, everybody thought that was so funny 'cause they're like, "Wow, she asked you a question about X and she found out you have X and a bad temper."

   10. PCPaul Conti47:25

       [laughs] Yeah.

   11. PAPeter Attia47:26

       It's like, it's really great. Anger management and this other thing.

   12. PCPaul Conti47:29

       Yeah.

   13. PAPeter Attia47:29

       Check. But that was also kind of the reason wh- Uh, that, that was certainly one of the things that made me think, 'cause as you recall, you know, you wanted me to go, and I agreed to go, and then I backed out, and, you know, it was just like this had been something that had been on the table for years and I just refused to acknowledge this needed to be done. And I think part of it was the semantics, right? It's like, what does trauma mean? We get so far in our lives, our skin gets so thick that I think people get into different patterns. And for me, I know the pattern was minimization.

   14. PCPaul Conti48:01

       Uh-huh.

   15. PAPeter Attia48:01

       You know, I didn't forget any of the stuff that got me there. I just didn't think it mattered. You know, when they talk about trauma at The Bridge, they really refer to it in five roots. So the first root is abuse, which can be physical, emotional, sexual, spiritual. They talk about neglect, abandonment, enmeshment, and the witnessing of tragic events. And so I, I think it'd be impossible to think that somebody listening to this hasn't experienced at least some of one of those branches and, and many of us more than one. For me, the single most powerful way to let my guard down was... 'cause we're now, what, three or four days into the most intense experience of my life, which is 13 hours a day of group, you know, therapy, and I had still sort of ref- I mean, I was there, so I'd shown up, but I wasn't happy. But I'd refused to sort of even have a discussion about any of this stuff. I was happy to listen to other people, but I, I wasn't gonna get into it. And one of the counselors, and I had these two amazing counselors, Jeff and Julie, I can't remember if it was Jeff or Julie, but one of them said something to the effect of, "You know, if such and such," 'cause we were talking about an event in my life, "if such and such occurred to your son, Reese," 'cause Reese is four, about the age that, you know, I was, "would you think that was okay?" It's a very different question, right? It's one thing when it's like, "Look, that happened. What the, you know, I'm over it. Come on. Look at, you know, blah, blah, blah." You could, I could even rationalize, "Look, these things have made me more resilient. This has given me a chip on my shoulder. This has given me an edge." But when they turn it into you have a kid and that-- And it's so interesting because just last week I was having dinner with a friend in, um, in Malibu, and he opened up to me about something incredibly personal and private that I'd never known, which was that his wife had had a really difficult year. She'd relapsed into her smoking. A whole bunch of other stuff had completely fallen off the rails in her, in their lives, but in particular in her life. We get through the whole dinner, and he tells me everything about the story, and it's just a heartbreaking story. And then he alludes to a fact that was clearly the trigger, which was his, his wife had been abused very badly by her stepfather, had been sexually abused nonstop. It started when she was seven years old. Earlier this year, their daughter turned seven.

   16. PCPaul Conti50:31

       Mm-hmm. Yeah.

   17. PAPeter Attia50:32

       And it completely triggered this because... And again, if I'd heard that before, I would have been like, "Come on, that sounds like sort of psychobabble nonsense."

   18. PCPaul Conti50:40

       Right.

   19. PAPeter Attia50:41

       How is it that seeing your daughter at the same age that you were at when something happened could do that? I mean, do you see this often?

9. 50:47 – 56:42

   How Shame Works and Why Children's Ages Trigger Trauma

   1. PCPaul Conti50:47

      Oh, sure. Yeah, a-absolutely. And, and to kind of lead up to addressing that, I want to comment on a couple of things, right? One, you said that the, the woman who was asking you the questions, okay, she learned, okay, this, th-there's this issue, and then she learns about anger, right? I would frame that a little differently. I would say that, that there's a very skilled clinician that is doing the same thing over the telephone that we might do physically examining a patient, right? You know, you touch, "Does it hurt here? Does it hurt there?" Right? I mean, if you get where it hurts and we know we're not-- even if we're very gentle about it, right, at times the person has a reaction, right? And then you learn like, "Oh, you hurt there, right? And that's why you reacted that way."

   2. PAPeter Attia51:27

      Mm-hmm.

   3. PCPaul Conti51:27

      And I think that's what she learned. "Geez, does it hurt here? Does it hurt here?" And then she went, "Oh, shit, it really hurts there." And you know, it, it, it tells us something, right? And, and what it tells a good mental health clinician is where there's shame and fear, right? And you know, shame is extremely powerful. And it's, it's, it's, technically it, it's an aroused affect. I mean, the word arouse, you know, doesn't-- it, it's not purely a sexual word. I mean, it, it often gets used in that way because the idea is say something can turn a person on that you didn't choose to have turn you on, right?

   4. PAPeter Attia52:01

      Mm-hmm.

   5. PCPaul Conti52:02

      But the idea of aroused affect is something that's created in you without your volition. Someone shoves you, you get angry, right? Someone shoves you really hard, you might get afraid, right? There are things that make a certain what gets called affect, but colloquially a feeling inside of us that we don't have a choice over. And there's an incredible automaticity to that. And, and that's, like what, what's, what you're talking about with, okay, like wh-wh-what is this trauma thing and what is it doing, right? It's not necessarily what happens. It's what does it make you feel? And my guess is, and again, I don't know. I don't know the person you're talking about, but probably that person is carrying some sense of shame over what happened to her. Because, you know, at the age of seven, you know, th-there's not the cognitive capacity of deciding, "Look, what's going on to me, happening to me is wrong." You know, the child needs to make sense of it, right? And often how the child makes sense of it is to decide somehow that it makes sense or what's happening to them is deserved or it's their fault, right? Or it's the way it should be, right? And that evolves into a sense of shame that the problem here is me. Someone's hurting me in some way. Whatever's happening to me doesn't feel good, and it's my fault. And then it creates a sense of shame that does not give a damn about the clock or the calendar or levels of achievement. You have a trillion dollars and fifteen PhDs, right? It does not make a difference unless that shame is directly addressed. So that's really the answer, right? Is what has happened to a person and what is it triggering inside of them? The same way there's lit-- there's pretty good literature that's, that talks about, um, you know, if someone is shot, right, how much does it hurt? And like clearly it hurts more if there's no damn reason to have been shot, right?

   6. PAPeter Attia53:44

      Mm-hmm.

   7. PCPaul Conti53:44

      Like if you try to save somebody and, you know, and you get shot, then, then people tend to feel less pain because there's, there's a sense that, that it makes sense in some way. That, that this bad thing has happened, but something good has come of it, or I was trying to do something good, right? It doesn't seem senseless and sadistic. And you know, that sense of absurdity, the sense of, of evoked shame or aroused affect of shame, the sense of an aroused affect of fear, the sense of a- of absurdity and meaninglessness is what then creates the trauma that stays with someone. And kinda like, it's not even like a ghost shadowing, you know? It's like, you know, just imagine someone who like can't stand you, that just shadows you all the time and says awful things. And that's essentially what this kind of thing evolves into. And it's, it's that, that, you know, that raises that triggering, that if there's still a sense of shame and now the daughter is seven years old, you know, what does that make the person feel like, right? The person identifies with the daughter. Um, they still identify as the hurt child, but now they're supposed to take care of a child who's vulnerable because that child has reached the age at which they were hurt. I mean, it's very, very triggering for reasons that make damn good sense.

   8. PAPeter Attia54:58

      So you've seen this where people's trigger is a, a child that reaches an age at which some traumatic event occurred?

   9. PCPaul Conti55:05

      Yes, it's very co-- it's, it's very common because that is a trigger. That they say, "Okay, it's my job to make sure that does not happen to them, but I am still in the throes of it."

   10. PAPeter Attia55:15

       Mm.

   11. PCPaul Conti55:16

       Right? So then while I am the traumatized seven-year-old child who is supposed to protect the seven-year-old child, that's terrifying. Right? It's terrifying. And then the part of the brain that is terrified says, "Look, this, uh, this absolutely could happen to your child." And you can't protect them. And then, you know, the brain, again, the brain doesn't care about the clock and the calendar. So that trauma is very, very, very real to the person, and it's very immediate. It doesn't matter if it was two days ago or if it was thirty years ago. It's just as immediate. And, and we also lose sight of that. And many times I hear people say, "Well, that couldn't still be bothering me. It was, what, two months ago, two years ago, fifty years ago." And, and the answer to that is it does not matter one bit how long ago it was. If it instilled terror, shame, a sense of responsibility for something that wasn't the person's responsibility, then, you know, my guess is we could probably live to be a thousand years old and, and that would still be with us. And again, very germane to what-- to your practice is, uh, that's one of the things that often prevents us from living longer, right? It's that kind of internal stress that leads not only to suicide and parasuicide, but also to the kind of strength... Sorry, the kind of stress that contributes to cardiovascular disease, to cancer, to autoimmune problems, right? To all the things that ultimately, you know, i-if you look at the population as a whole, that chips away at our health, at our healthy lifespan, and at our lifespan.

10. 56:42 – 1:06:17

    The Brain's Power Over the Body: A Patient Case and the Inner Voice

    1. PAPeter Attia56:42

       I still remember to this day the very, very first patient we ever collaborated on, which of course was such an interesting experience for me that it's what basically led to you and I being so close at the hip in terms of, like, how many patients we overlap with. But I obviously won't use her name, but the woman in San Diego that I was taking care of-

    2. PCPaul Conti57:01

       Yes

    3. PAPeter Attia57:01

       ... very interesting case.

    4. PCPaul Conti57:02

       I remember.

    5. PAPeter Attia57:03

       I think most of my patients are incredibly nice people, but she would certainly be on the shortlist of, like, the nicest.

    6. PCPaul Conti57:08

       Mm-hmm. Mm-hmm.

    7. PAPeter Attia57:09

       Just a very, very special woman.

    8. PCPaul Conti57:11

       Good person. Yeah.

    9. PAPeter Attia57:11

       And there were a lot of things that didn't look metabolically right. Frankly, her chief complaint when she came to me was, you know, she just wanted to have more energy. She wanted to, to feel better. Her father had died prematurely of heart disease. She wanted to make sure that was not gonna be her. And we got to it. We changed her nutrition, and we fixed her hypothyroidism, and we tweaked a bunch of things, and everything on paper looked right, but we couldn't eradicate certain things. There was still a degree of inflammation in her body. There was still a degree of insulin resistance. I probably hadn't seen a patient who could be so compliant with her nutritional plan as she was. And the only one of her meds I couldn't really offer any input on was she was on an SSRI, I think. I don't remember which one. It was Wellbutrin, if I can remember, actually. And, you know, I think this had been prescribed by her family doctor, like, ten years earlier or something like that. But I remember one day thinking about what she talked about when her dad died, when she was in medical school. She was a physician. And it cleared me on this particular day, which was, like, a year after the first time I'd heard this story, that, like, that had s-- that-- I, I didn't know to use the word trauma, but that was clearly a traumatizing event in her life. And, uh, my first thought w-was actually, I thought of these Zucker rats, right? [chuckles] Which I thought of these experiments that occurred... 'Cause, 'cause what I couldn't understand was why in the world does this woman who's doing everything right seemingly have a metabolic rate of a slug, right? It was like she's doing everything by the book, and the only way that we could infer what's going on with her is that her metabolic rate has shut down because she's no longer hypothyroid. All these other things have been fixed. And I thought about these Zucker rats where they, you know, they sustain certain lesions into parts of the hypothalamus, and they can alter the metabolic rate.

    10. PCPaul Conti59:02

        Yes.

    11. PAPeter Attia59:03

        And so I floated the idea by you, and you said, "Look, anything is plausible." And to make a long story short, I introduced the patient to you. She came up. She saw you. And over the course of the next six months, without making any change in the thyroid meds, in the nutrition, in the exercise, she probably lost thirty pounds, and she looked like a different person. In fact, I remember when I got her Christmas card with her and her family. At first, I thought, "I don't know who this is. Why am I getting a Christmas card from a random person?" And I mean, what, what do you remember about that case? Uh, again, maybe not even the specifics, but just, like, were you as surprised by that as I was?

    12. PCPaul Conti59:46

        You know, I, I, I think the fact that I wasn't is, is just indicative of... It's not indicative of, like, some genius that I figured things out that other people haven't. It, it's just indicative of things that I have witnessed that utterly shocked me at the time that lead to what I would describe as more than a healthy respect, but an utter reverence for the impact of what the brain can do to the body. And, you know, a couple of examples are, like, paralysis of a limb. I mean, I've seen people, seen cases in my training and subsequently taken care of people who do something that they find reprehensible or almost do something that could have been disastrous, and then the limb that they did it with is paralyzed, right? And now it's like it's ten years later, and the limb hasn't moved in ten years. I mean, the nerves haven't been severed, but they may as well have been. There's contractures and everything else. I mean, when you see that the brain can, like, shut off vision, right? The brain can shut off movement to a limb. You know, these are really shocking things, and, and I think that we as a society, like, we, we, we just don't appreciate how much impact over all aspects of our functioning some of the things that torment us inside can have. So, so there was something tormenting this lovely woman that was, like, shutting her metabolism off, and in many ways, I get it. It's a, it's a shocking thing, and, and it would've, like, you know, knocked me off my feet if I hadn't been, like, seen paralyzed limbs before and, you know, things that, that, that really kinda told me things that, to be honest, really made me angry. And I thought, like, how is it that... I, I consider myself to be a curious person. I, I mean, even l- like before psychiatric training, right? You know, I'm a well-read person. I'm a well-traveled person. I'm interested in other people. I, I took a broad curriculum in college. Like, how is it that I didn't understand these things of what Our brain, and, and what does that mean? It means what our brain in the context of trauma, which, which think about evoke shame, fear. Think about things we're talking about in the patients where we've had these kind of, you know, these kind of experiences, right? And even in ourselves. Think about the impact of shame and fear and what it does to us and, and people don't tell us that. So then a person feels ashamed, right? That they're eating less and they can't lose weight. They feel ashamed that they're sleeping but they're not well-rested. They feel ashamed that they wanna be patient with their kids and they can't be as patient as they want. I mean, I could go on and list thousands and thousands of things and what we often don't, again, don't appreciate is where's all that coming from? And has anyone ever asked about it? I'll, I'll give you a very-- a, a quick aside that I saw a person in my practice, uh, several years ago, maybe five years ago or so. Very, very intelligent person. Very capable, academically accomplished who was working many, many, many levels underneath where, uh, he could would've been operating. You know, $10 an hour job and somebody, you know, who should be running a company. That dramatic. And you know, I was-- I don't know how many people had seen and talked to this person before, right? And I asked him a question and you know, we had been talking so it's not like it came out of the blue. But, but I asked him, "You know, how many times a day do you say something to yourself inside that's some version of like, 'I suck?'" And his response was, "Oh, it's, it's, 'I'm a piece of shit.'" And his answer was like, he stopped and he says, "Hundreds. Hundreds of times." All the way to the job, all the way back in the shower before he goes, when he's back at home with his kids. Nonstop. You know, that was all trauma-based and it was based upon belittling, bullying, all things that had happened. I mean, you could take a trauma history from this person and no, like no one's ever shot him, no one's ever sexually assaulted him. Like it was, "Oh, there's no trauma." Oh, no. There was gigantic trauma. And if you're saying something to yourself over and over and over again that is, that is profoundly negative and that makes you feel vulnerable, ashamed, inadequate, how are you supposed to be at your best? How does it affect your brain? How does it affect your endocrine system? How does it affect your immune system? How does it affect your vasculature? The answer is dramatically. And then you look at this person who now was aware of substandard role performance and now he feels worse about himself. And by going after that, we were actually able to like change everything. I mean, the, the person's life is dramatically different if you look at what he's doing for a living now. You're like, "Okay, that's, you know, that's something that seems more commensurate." And in this person it doesn't represent the endless striving of you who never, you know, achieve enough, right? In this person it represents something that makes him feel whole. That this wasn't, you know, his ability to be something he could feel proud of to support his family in a way he could feel pr- feel proud of it wasn't taken away from him. But if you looked at what was the etiology of that problem, it absolutely was in single digit ages and it doesn't matter that this was like three or more decades along, right? It was with him hundreds of times a day and that's why these things don't surprise me. And, and you know, I've had an increased awareness over time of my own inner voice that, you know, I may as well have somebody [chuckles] you know, behind me all the time. I mean, I've been trying to alter this and some, when, some is with your help and a couple of other people around us. You know, it's kinda gotten better and the realization that I carry around with me a voice that tells me how shitty I am for everything that's not utterly perfect from the moment [chuckles] I wake up to the moment I go to sleep has created a lot of misery in my life and has created unhealthy situations and you know, at times real risk to my l- to life and limb for me. So you know, I'm a, I'm a huge believer that the, the reality and the truth that, that we're living... I say the, the reality and what we view as truth that, that we're living in is often n-not apparent to anyone around us and nor is it apparent to ourselves. And if we make that apparent, then we can make some decisions about it which is why that woman was able to lose weight is 'cause we, we started talking about like what was actually going on inside of her and you know, in a certain person if you are intensely ashamed and feel inadequate from the moment you wake up to the moment you fall asleep, you probably eat 20 calories a day and you're gonna gain weight.

11. 1:06:17 – 1:14:52

    Generational Transmission of Shame and the Myth That Pain Makes Us Stronger

    1. PAPeter Attia1:06:17

       Yeah. That, that's the part that just blows my mind in her case. The other thing with this stuff that I think it's worth people who are listening understanding and, and it, it's, it, it's so important I, I certainly didn't understand it until the past year. I think I wasn't so naive to know that or to... I wasn't so, so, so maybe naive's the wrong word. I, I wasn't so ignorant to think that, look, bad things happen. I got it. But, uh, uh, my sort of blinder-based mentality was I can prevent that exact set of things from happening to the next generation, to my kids. And of course the irony of it is you learn that trauma almost always comes out in some orthogonal way and so it's not necessarily that the child of the alcoholic becomes the alcoholic. In the case of the woman that I'm, was just talking about earlier who when she saw her daughter turn seven triggered all these flashbacks of the sexual abuse, I don't think that... I think the probability that that mother is gonna go ahead and like sexually abuse her daughter because she was sexually abused by her stepfather, I think the probability of that is like close to zero.

    2. PCPaul Conti1:07:24

       Oh, absolutely.

    3. PAPeter Attia1:07:24

       That is not how the shame will be transferred to the next generation.

    4. PCPaul Conti1:07:28

       Absolutely.

    5. PAPeter Attia1:07:28

       It will not be through the same root cause. It will come out in something different and, and to me that's the part of this thing that is so, is such an epidemic. You know, Terrence Real who we've talked about a lot in, in his book which I've talked about on other podcasts, one of the most important books I've ever read, "I Don't Want to Talk About It," he talks about this, the, the number of generations it takes for shame to sort of work itself out and it's like, you know- This happened to the grandfather, this happened to the, to the mother, this happened to the child. And, um, this idea of shame transference through trauma is, I don't know. I guess like I said, even though I don't do this for a living, it occupies more and more of my time because I spend more and more of my time thinking about it with, with the patients that I'm lucky enough to get this close to. And truthfully, there are some of my patients I just don't get close enough to to understand this part of their lives. But I want to because I realize so much of what we do without knowing this becomes quite futile.

    6. PCPaul Conti1:08:33

       Well, absolutely. If, I mean, if the manif- if the only thing we were guarding against was the manifestation of something that we recognize, things would be different. I mean, I think the number of generations to get rid of shame without intervention, you know, is either infinite or there's just some, you know-

    7. PAPeter Attia1:08:50

       Yeah. Minus... It's practically infinite.

    8. PCPaul Conti1:08:52

       Right. Because why would something like that change unless it's understood? Now, people at times can intuitively understand. I mean, there, there are things that can intervene, but otherwise, you're absolutely right. I mean, it finds a way out, right? So the person who was sheltered and over-controlled as a child, and that led to, say, you know, big problems of rebellion and then something traumatic happens, maybe if they don't understand it, they may overcompensate with the sort of freedom and what seems like opportunity for their own kids. But what actually, you know, puts them inadvertently in danger. Just as the person who was neglected and was then left in situation of danger may overcontrol their kids, and then the kids rebel and the same thing happens. I mean, if we don't understand it, there's a very good chance that it will find a way to get us. And, you know, sometimes that's something dramatic and, you know, I see these cases like, "Oh my gosh, like this person did the opposite thing their parent did, and look, the same thing happens," right? But a lot of times, you know, I think most human suffering and most bad outcomes, you know, happen with a fizzle, not a bang. And, and I think that's part of the really the biggest sadness of it. It's the things that we don't know or the person who just languishes, who doesn't have a strong sense of self and is burdened with regret, and that's the story. I mean, there, there's so much about this that because we don't talk about it, we don't educate ourselves about it, we just let be perpetuated. And in many ways, like I'm not trying to say, oh, this is all easy to address, right? But some of this I think is low-hanging [chuckles] fruit of, look, why are we not talking about these things, right? Why is it that we enter medical school and you have all these like overly powerful guys and, you know, we don't think of like, what are we all defending against? Like, why do we have to be so powerful all the time? What are we guarding against? Why is it that we feel ashamed if we're not powerful, right? If we're not, you know what I mean? If we're not perfect. If we're not the best, right? Why is it? And, and, and you know, a- and I'm not saying, gee, let's, let's have some like soft way of going about life and then people aren't driven to achieve things. But it's, it's, a lot of it is based on this lie that like what doesn't kill us makes us stronger. Okay. That is a lie, right? Sometimes something doesn't kill us and makes us stronger. You know, we can get an infection. It doesn't kill us, we develop antibodies, right?

    9. PAPeter Attia1:11:16

       Mm-hmm.

    10. PCPaul Conti1:11:16

        It can happen on a biological level. Um, it can happen with a life tribulation. But my experience in my own life and in the people around me that I take care of or my friends, family, patients, like the humans in my life, is that bad things that don't kill us often make us weaker, right? They hurt us. And if we don't acknowledge that, what has this thing done to me, right? Then we put it under the surface and we soldier forward, right? And for a lot of people, you know, what does that mean? I mean, it does mean languishing. And oftentimes for people who maybe are blessed with more drive and perseverance, sure, it means we drive ourselves to achievement. But amidst all that achievement, we remain miserable because the, the hurt part of us is, is like still what we're living in every mo- like every mo- most of the time we're living in that hurt person. But that hurt person is festooned in a way that doesn't look like that. And, and if you think about very powerful things in culture, you know, the, The Wizard of Oz, you know, like such a, a cultural touchstone across generations. Even the s- The Emperor's New Clothes. I mean, we're, we're infatuated with things looking some way, but being another way. You know, things looking strong and powerful, but being weak and vulnerable. And part of our infatuation with that is it, it can take the fear out of some of the things that scare us. But I think an even bigger part of that is that we often identify with that, right? We identify with, you know, festooning ourselves. Look how great I am, and like, you know, really, I'm not festooned in anything, right? I mean, there's like a, there's a pathetic nakedness to some of it, right? But, but we sort of posture that way, right? And we posture that way in order to shore ourselves up. And if I see a commonality between like how you and I practice medicine and how the vast majority of, I think, good doctors practice medicine is, is it's with not hiding vulnerability. I do not feel in any way, shape, or form healthier than the vast majority of my patients. I mean, some people, yes, have had a bad head injury, have schizophrenia. Okay. I, I, I don't feel any better or necessarily healthier to them a lot of the time. But there's an identified problem that we wanna address and treat that can let the person feel a greater sense of wholeness. Okay. That's valid. But it-- most of the people that I encounter are just struggling the same way that I am. And, you know, there really is no difference except that person may do something. Maybe someday I need an architect, a financial manager, you know, a lawyer, whatever it is that they're doing. But we're no different. It, it just happens to be like, okay, this thing I do brings them to come to me for help about this certain thing. But we're all people, like trying to make our way and survive in the world. And often some of the people who I feel are most put together are not the people that you might think, right? They're the people who if you look at their achievements, you know, you, you, you know, you're not gonna like be wowed-

    11. PAPeter Attia1:14:15

        Yeah

    12. PCPaul Conti1:14:16

        ... by it necessarily. But they're people who have a greater sense of wholeness. They're people who have Maybe spent more time and effort on themselves. And a- again, this is not an anti-ambition, uh, agenda that I have here. But what I, what I absolutely am saying is that very, very high levels of achievement are a marker in my brain for suspicion that this person is defending against something. And, you know, that's the reason why I felt that you should go to The Bridge. It's the reason why trauma therapy is part of my psychotherapy. It's the reason why at some point w- I, I should go to The Bridge too, right? I mean, this, this-

    13. PAPeter Attia1:14:52

        You know

12. 1:14:52 – 1:21:49

    The Bridge Experience: Camp Misery, Roommates and 12-Step Meetings

    1. PAPeter Attia1:14:52

       what the nickname for that place is?

    2. PCPaul Conti1:14:54

       You-

    3. PAPeter Attia1:14:55

       All right, tell me

    4. PCPaul Conti1:14:55

       ... you're the first person who told me. I send a bunch of people there, and no one tells me this, and then you do, right? Do you wanna-

    5. PAPeter Attia1:14:59

       It, it has two nicknames.

    6. PCPaul Conti1:15:00

       Huh?

    7. PAPeter Attia1:15:01

       Camp Misery-

    8. PCPaul Conti1:15:02

       [laughs]

    9. PAPeter Attia1:15:02

       ... and The Crying Factory.

    10. PCPaul Conti1:15:04

        Yeah, can you tell me The Crying Factory?

    11. PAPeter Attia1:15:05

        Oh my God. Damn.

    12. PCPaul Conti1:15:06

        Right? Right? And, you know, it, it points out that making ourselves healthier often is difficult. It does involve misery.

    13. PAPeter Attia1:15:16

        Right.

    14. PCPaul Conti1:15:16

        It involves tears and exposure of things we're ashamed of. And, you know, of all the places that I have sent people in, you know, at this point in almost two-decade career, you know, I think that they are the most effective or among the most effective of, uh, places, and I think part of it is because they don't shy away from that.

    15. PAPeter Attia1:15:35

        I remember something you said to me because you suggested, "Look, there are two or three places where I think you could go. Here's why I think The Bridge is the best for you." And one of the reasons was, oh, uh, I rem- I'm almost embarrassed to admit, uh, live, you know, to, to people, to so many people what I asked you, but I said, "You know, Paul, when I looked at these other places, The Bridge seems unique in that the socioeconomics of it look very different from where I've come from, meaning I'm not going to be there with other people who have gone to medical school or gone to law school or whatever. Will I have enough in common with-

    16. PCPaul Conti1:16:10

        Right

    17. PAPeter Attia1:16:10

        ... the other people there?" And you said, "That's exactly why I think you should go there."

    18. PCPaul Conti1:16:14

        Yes.

    19. PAPeter Attia1:16:15

        And I didn't understand that. So I go there, and of course, the first rule is everybody has a roommate. Well, I don't want a goddamn roommate. I'm 45 years old. [laughs] I, I'm, I'm, I've passed that course, right? I did that. I did summer camp already. I don't want a roommate. So I, you know, have my assistant call over and say, "Hey, we'll pay extra, but he needs a solo room."

    20. PCPaul Conti1:16:33

        Yeah. Yeah.

    21. PAPeter Attia1:16:33

        To which they sort of said, "Thanks for telling us how to do our job. That ain't the way it works. He gets a roommate."

    22. PCPaul Conti1:16:39

        Right.

    23. PAPeter Attia1:16:39

        Again, everything that they did that I thought was pure torture turned out to be perfect. There was exa- and it's exactly what you said. I had to be around people who I could relate to intellectually, who I couldn't relate to intellectually, who I had a similar education to, to whom I did not. But in the end, what I realized was we are all the same.

    24. PCPaul Conti1:17:01

        Right.

    25. PAPeter Attia1:17:01

        And again, that is such a banal, glib, idiotic statement, but it's fucking true.

    26. PCPaul Conti1:17:07

        Right.

    27. PAPeter Attia1:17:07

        We are all the same.

    28. PCPaul Conti1:17:09

        Yeah.

    29. PAPeter Attia1:17:09

        My roommate, I swear for the first three days, I thought, "I don't have one thing in common with this guy." I loved him out of the gate. I mean, he was the, just an amazing guy. But I was like, "We don't have anything in common." And that, that's fine. I mean, I, didn't make me like him any less. But two weeks later, I realized, oh, actually, we have more in common than I would have ever dreamed we have. The di- the reason we look like we have nothing in common is perhaps some innate wiring, perhaps some stochastic events, but in the end, we took very different divergent paths. You know, mine led me to college. His did not. My weaknesses led me in a different area than his did. One of the things that I found most powerful, and, and I'm bringing this back to a point you made earlier, was in addition to 13 hours of Camp Misery every day, seven days a week, you get to go to a 12-step meeting every single night, and you get to pick what it is. So they're not gonna tell you which one you're going to, but you're either going to AA or Al-Anon or CoDA or NA or SA or SLA. You're going. I think you got one night off a week. I think Sunday night you got spared the meeting. And I remember thinking the first few times, like, "I'm so tired." I'm just so emotionally exhausted that, you know, it's 7:00 PM or 8:00 PM, all I wanna do is go lay on my shitty bunk bed and sleep. But they're like, "Nope, you gotta go."

    30. PCPaul Conti1:18:29

        And you're a guy, by the way, who could work, what, how many hours-
13. 1:21:49 – 1:30:24

    Separating Ourselves, Shared Humanity and Everyone Having Been a Client

    1. PCPaul Conti1:21:49

       I think that it's, it's so important to, to try and take stock of how are we trying to separate ourselves from other people. I mean, think about the things you're saying. It's, it's, it's very interesting. And people listening to this who know you will know that this is true. And for the people who don't know you, please, I would ask, take my word for this. I mean, you are, you know, the, the least entitled, condescending human being, right? I mean, you do not feel superior to other people. I don't think I've seen one wit of that in the two decades I've known you. So why is it that you want a private room and that you wanna be different? It's a reflex, and the reflex is like, "I've gotta stand out in some way because that's what allows me not to feel superior, but to not feel ashamed." And that's often what is driving us. And it drives good things, right? I mean, your expertise and, and often being the focus in the room because you have, you know, things to say, to o- to offer. It's like these are good things, but they're also driven by the need to separate ourselves. And, you know, we-- it's not that both of those sides of the coin have to come together. But if we're not aware, they do come together. And then you're doing something by reflex that is the exact opposite of what you need. What you need is to be part of the humanity around you, right? What you need is to relate to people. What you need is to feel that, my God, I'm, I'm a human w- who suffers from human things like these people around me, some of whom are nothing like me, some of whom may be like me, but, like, none of that matters. We're all people, and our suffering is shared. That takes away the unique stigma of the things that you are suffering from. But your reflex, as mine has been, and as is the case in many people who are sort of driven to differentiate themselves, is to differentiate yourself so that you guarantee loneliness. And, you know, that's what people, I think, really should try and be aware of is when are we differentiating ourselves from the world around us because we are trying to escape from something, but in doing so, we isolate ourselves, and we don't, we don't get a chance to just be human. We don't get a chance to just be people. Like, you know, the people who were there at the bridge with you had trauma and suffering, and they needed to express emotions, and they needed to cry, and they needed to get angry. And, and you did, too, right? And, and I have, too. And so many people need that to heal, but we work so hard to separate ourselves from that. And that's what I think, you know, if, if there's one thing, like, some-- a person's gonna be attuned to is how much are you separating yourself from, from the, the humanity around you. You know, groups of people, when people have agendas or are angry, can feel threatening and intimidating, but there are many places that people gather in order to feel some sense of openness and shared humanity. And that's really what we're all seeking. You know, I know you, you know this, but seven, eight years ago, when I had a, a clinic that myself and, uh, my practice partner built, you know, to be relatively sizable, and we were doing a lot of individualized treatment, and we were running groups. And a lot-- The groups we were running were around addiction. And we were absolutely adamant that we did not stratify people by what they were addicted to. So gambling, cutting, sex, cocaine, it doesn't matter. Nor did we stratify people by age, socioeconomic status. And there was a pressure to do that because certain of the people who had more resources, right, like, wanted that, not realizing that what they were asking for was, was the very thing that was gonna stand in the way of their ability to get help.

    2. PAPeter Attia1:25:42

       That's exa-- See, you told me this exact story when I called you up to say, "Wait a minute. I don't think the bridge is the place for me."

    3. PCPaul Conti1:25:49

       Yeah.

    4. PAPeter Attia1:25:50

       "And, and, and I should be going to this place or that place." And you, you said, "No. What you're missing is you absolutely need to be around people who, on the surface, you think you're different from to realize that you're not."

    5. PCPaul Conti1:26:03

       Right. And it's an advantage that people have if they're at a stage of life or for whatever reason, they're, they're not in a socioeconomic class that allows them to differentiate, because then they don't strive for something that stands in their way. And, you know, and I think back on that venture, which over about five years, you know, my partner and I and, you know, we had, I don't know, thirty people or so in some way, shape, or form were, were working for us by the end. We all, like, really slaved away to make that place as good as it could be. And when I think back on it, you know, I, I think the proudest moment-- People have asked me this, like, "Oh, that was so difficult," and especially people who know me and kinda know what we struggled through. And, like, some of the people ask, "What do you feel good about?" Right? And, and the same image comes to mind is I, I remember, you know, a young woman who at pres- I think she was nineteen, who really had struggled and was trying to find her way and had been on the streets and, you know, to the outward look of things, you know, as piercings and tattoos and all the kind of things that kind of mark her attempts to differentiate herself, to say, "Okay, stay away from me," in a way that she was using to separate herself. And God, she had made so much progress, so much progress in embracing who she was and not feeling ashamed of who she was and not feeling responsible for things that happened to her that she had no control over. And I remember her, I walked by kinda late one day after groups had let out, and she was having this, like, really intense conversation with a neurosurgeon, and it was so clear that she was teaching him [laughs] like a lot of things. And, you know, and he was in sort of rapt attention, and i-it's a marker for me of, like, our shared humanness is like, you know, i-if you look at him and you look at her, you, you say, "Okay, look at the things they've achieved." You think, "Oh my gosh."

    6. PAPeter Attia1:27:49

       Clearly, he's the authority. She's not.

    7. PCPaul Conti1:27:50

       He's got a CV a half a s- you know, half a mile long, right? And, you know, this woman has been struggling to stay off the streets. She had done more work on herself, so she had a lot to teach him. And I have found that. Again, it sounds trite, but the things that I have learned, uh, through the course of my work, uh, so much of them have just come from people who have been through such difficulties and have learned things about themselves that I hadn't yet learned, uh, not at all tied to any metric other than that. And I think that's part of the secret of it. And we don't do these things anymore. We d- we don't have places where people can come and even get some mental health education, some idea of, like, what ails them in terms of trauma. Like, we, we don't as a society acknowledge this, so then it becomes some, like, shocking rarity when somebody finds their way to it. And I just-- I, I, I'm astounded by that, that we should be, like, setting a roadmap with, like, really gigantic arrows for all of us. But, you know, a person has to stumble upon it or come across it inadvertently.

    8. PAPeter Attia1:28:59

       And in many ways, I think I'll forever be grateful, I mean forever be grateful to you for making this happen because I guess some people just c- they need a greater degree of immersion to finally break down. I think I could have spent two hours a week in therapy for the rest of my life and never, never come close to what finally takes place when you're doing thirteen hours a day plus 12-step [chuckles] meetings. And, and, and not only that, it's like every meal you're sitting there with the same group of people. We only got coffee once a day. Seven AM was coffee time, and it was like I would get up at four and work out, and then I'd be, you know, waiting to have my coffee at seven, and there were, like, six of us that showed up for coffee every morning. And the other thing about this place that was so amazing, which I-- it, it really ties into what you're saying, is everyone who works there, obviously not just the counselors and the therapists, but the kitchen staff-

    9. PCPaul Conti1:29:55

       Yeah

    10. PAPeter Attia1:29:55

        ... the custodial staff-

    11. PCPaul Conti1:29:56

        Yeah

    12. PAPeter Attia1:29:56

        ... the people that worked at the barn where we did equine therapy, every one of them had themselves been a client there.

    13. PCPaul Conti1:30:02

        Wow. I didn't, I didn't know that. That's amazing.

    14. PAPeter Attia1:30:04

        An unbelievable shared experience.

    15. PCPaul Conti1:30:06

        Wow.

    16. PAPeter Attia1:30:06

        Like, we are all the same at this place.

    17. PCPaul Conti1:30:09

        Wow. And isn't there comfort in that, right?

    18. PAPeter Attia1:30:12

        Absolutely.

    19. PCPaul Conti1:30:13

        How can you be some exception who deserves shame for being something less than perfect when you fully apprehend that reality? You can't be, right?

    20. PAPeter Attia1:30:24

        You know,

14. 1:30:24 – 1:46:46

    David Foster Wallace and the Role of Meaning

    1. PAPeter Attia1:30:24

       you said something a moment ago that made me think of one of my favorite talks. So, you know, you and I, you know that I'm the biggest fan of David Foster Wallace, this person who I've just, uh, I've just always been kind of so amazed by his insight. I, I just, you know, here's a guy who was not a trained psychiatrist, he's a writer, and yet his insights into humanity go behind [chuckles] almost anything. I think y-y-you couldn't learn this stuff in a textbook.

    2. PCPaul Conti1:30:50

       Uh-huh.

    3. PAPeter Attia1:30:50

       And, um, you know, I've been asked before, like, "If you could bring anybody back from the dead," you know, of recent era, right? "Who would it be?" And I think it would be him. You know, if I could, if I could go back in time and spend a day with anybody, it would probably be with David Foster Wallace. He has a very famous commencement speech from 2005 that he delivered at Kenyon College, uh, titled "This Is Water." And in it, he talks about the fact that we're-- I think he-- the way he describes it is, there's no such thing as atheism. We are all worshiping some god. Do you worship money, power, your body, you know, your physical allure? And he almost makes the case that at least if you pick a god to worship, [chuckles] the harm to you might be less.

    4. PCPaul Conti1:31:37

       Wow.

    5. PAPeter Attia1:31:37

       Because if it is money you worship, you'll never have enough. If it's power you worship, you'll never feel strong enough. If it's intellect that you worship, you'll always feel like a fraud. And I remember listening to this for the very first time, which was many years ago, and thinking, "Yeah, I get that." Like, I really get that. Like, I, I've, I, and I know I'm not alone, but I think a lot of people who place their self-worth in their intellect You think, "What if people find out I'm not that smart? Like, I'm just a fraud." And, you know, it's, again, it's just, it just speaks to this entire nature of humanity. And of course, the tragedy in the case of David Foster Wallace is that he ends up taking his own life by suicide three years after he gave that talk. Now, totally unrelated, I wanna play something for you. So I was actually just listening to this today. I'd ne- I hadn't come across this before, but this is an interview with David Foster Wallace and Terry Gross from NPR, I believe it was '97, so it was like a year or two after Infinite Jest came out. So I wanna, I wanna play this for you, if I can queue it up on my phone here.

    6. SPSpeaker1:32:41

       Great.

    7. PAPeter Attia1:32:42

       'Cause I thought of you as soon as I heard this, right? Okay, here we go.

    8. SPSpeaker1:32:45

       You know, I really like the way you talk, you write about a, a pleasure and how, um, difficult it can be [laughs] to, to really achieve. Um, you write about pleasure in The Infinite Jest, your, your, your latest novel, and I'm thinking, you know, one of the things relating to that, in Infinite Jest, uh, one of the characters finds that, that marijuana is, marijuana is no longer a pleasurable experience. It just makes him terribly self-conscious and therefore anxious. And I'm wondering what happens to you when you do something that's supposed to give you pleasure, and it just makes you uncomfortable or anxious.

    9. SPSpeaker1:33:22

       Boy, I'm not really even sure how to respond to that. Th- th- look, a lot of the impetus for writing Infinite Jest was just the fact that, that I was about 30, and I had a lot of friends who were about 30, and we'd all, you know, been grotesquely over-educated and privileged our whole lives and had better healthcare and more money than our parents did, and we were all extraordinarily sad. I think it has something to do with, with being raised in an era when really, um, the ultimate value seems to be, I mean, a successful life is, let's see, you make a lot of money, um, and you have a really attractive spouse, uh, or you get, um, you get infamous or famous in some way so that it's a life where you basically experience as much pleasure as possible. Uh, which ends up, which ends up being sort of empty and low calorie. The, the reason I don't like talking about it discursively is it sounds very banal and cliché, you know, when you say it out loud that way. Believe it or not, this was, this came as something of an epiphany to us at around age 30, sitting around talking about why on earth we were so miserable when we'd been so lucky.

    10. SPSpeaker1:34:27

        Well, when did you realize that, uh, all the, all the benefits you had in an educated middle class life weren't bringing you happiness?

    11. SPSpeaker1:34:36

        Well, I c- look, I guess it, I guess it sort of depends on what, what you mean by happiness. I mean, it's not like we were walking around fingering razor blades or anything like that, but it just sort of seems as if, uh, we, we sort of knew how happy our parents were, and we would compare our lives with our parents and see that, at least on the surface, or according to the criteria that the culture lays down for a successful, happy life, we were actually doing better than a lot of them were. And so why on earth were we so miserable? I d- I don't think, I, you know, I, I, I don't mean to suggest that, that it was, you know, a state of constant clinical depression or that we all felt that we were supposed to be blissfully happy all the time. There was just, um, I have a very weird and amateur sense that, that an enormous part of, like, my generation and the generation right after mine is just an extremely sad, sort of lost generation, which when you think about the material comforts and the political freedoms that we enjoy, is just strange.

    12. PAPeter Attia1:35:28

        I could listen to interviews with David, well, indefinitely. But it's interesting that I came across that today for the first time. Again, I don't know how I missed it.

    13. SPSpeaker1:35:36

        Oh, wow. Today?

    14. PAPeter Attia1:35:37

        Today.

    15. SPSpeaker1:35:37

        Wow.

    16. PAPeter Attia1:35:37

        Just, just literally today. And, um, you know, I knew that we were gonna be speaking this evening, and I thought, "You know, I'm gonna put Paul on the spot and play that for him and ask him not just to explain that, but even more broadly, what the heck is going on," right? Why? I mean, let's take a step back. It would seem to me that suicide is the least likely cause of demise for our species, just given our evolution. I mean, it seems to me that we are wired to survive. So in other words, and again, I'm certainly not being critical of suicide. I'm, I have nothing but empathy for-

    17. SPSpeaker1:36:15

        Yes

    18. PAPeter Attia1:36:15

        ... obviously anyone who commits suicide. It strikes me as the saddest thing ever. But I don't understand it. Like, I don't, I don't understand how it can be so prevalent when we must be so wired to not want it, when we must be so wired to want to survive. And it, I remember very recently, I remember having this thought, probably in the wake of, of the, you know, these high-profile suicides, which, you know, w- I remember when Robin Williams killed himself. The same sort of thoughts go through my mind, which is, did our ancestors do this? Is suicide a symptom of our civilization? Is what David Foster Wallace is talking about here, even comparing ourselves to one generation ago, are we less happy, or do we just have greater expectations? And those expectations being unmet is what makes us feel unhappier.

    19. SPSpeaker1:37:05

        Again, it's, I mean, it's so complicated, and I wanna start off by saying, like, by, by no means do I, um, uh, attest to any expertise, right, or, or a right to offer an opinion that's more valuable than anyone else's. But the, the thoughts that occur to me is, yeah, we're wired to survive as long as we see meaning in survival. And I am not here trying to glorify struggle, but there is something around struggle that gives meaning. You know, people who struggle to survive in war zones, you know, are, are people who see meaning in survival. They see meaning in what they're fighting for. You know, Viktor Frankl writing Man's-

    20. PAPeter Attia1:37:49

        Of course

    21. SPSpeaker1:37:49

        ... Search for Meaning, right, is like if, if you don't have meaning, then why would you struggle to survive? And it's not a lengthy extrapolation of that to say if you don't have meaning, w- why are you interested in surviving?

    22. PAPeter Attia1:38:03

        Have you read Tribe by, uh, Sebastian Junger?

    23. SPSpeaker1:38:06

        I have not. I, I probably should, and I've been told several times [laughs] I should. I just haven't gotten to it yet, but I, but I, I mean, I understand I think something of the concept.

    24. PAPeter Attia1:38:13

        But I think this is sort of part of what he's getting at, yeah.

    25. SPSpeaker1:38:16

        Yeah, that, that, that we... Like, uh, okay, for example, like I really, I mean, it's interesting, right, given what I do for a living.

    26. PCPaul Conti1:38:23

        That like, I don't know how I value myself, right? I don't know how to value myself and whether I'm succeeding or not. I mean, is that what my family of origin thinks of me? How much time I spend with them? I've certainly ranged far afield and, and left the place I grew up in order to achieve things and do things. Like should I be proud of that? Have I, have I, you know, not been a good friend or family member to the people I grew up with? Do I value myself by what, what other people think of me, how many patients I feel I can help, the health of my relationship with the people I love as adults, the kinda parent I am, the kinda husband I am, how much money I have, how many, you know, people want me to offer some expert opinion on something? It's like I have no idea. I have no idea whatsoever. And it occurs to me sometimes that I'll bet all those ancestors of mine really knew how to value themselves. Like, are the sheep safe? Is there a roof over our heads? And again, I mean, I am not glorifying the lack of opportunity, you know, the lack of like a basic medical care, right, in generations past. But there is something very, very concrete about that. And when people go through struggle, wh- when we often most worry about them is when the struggle is over, when people feel like, "Oh, I, I made it through that." You know, whatever that was. Maybe that was chemotherapy. Maybe that was the death of someone close to them. Maybe it was a particularly trying time at home or in their career. You know, people will persevere when they see meaning in their struggle. But when there's not a struggle, the struggle is over, or we're not particularly struggling for something, what does... How do you value yourself? And I think often we don't even know enough to answer the question. I mean, like you and I have never sat down and talked about this. We spend a lot of time together. We've been close for two decades. Like, why do we not talk about this? In part because we don't understand how meaningful it is, right? So, so we value ourselves by persevering. But that's endless, right? I mean, as you said, you, you-- there's always more of things to have. So at, at a certain point, that can seem very, very hollow. And I think that in many ways, that's the disease of the modern civilization. I mean, even when we grew up, the time of the Cold War, I mean, I grew up with this very, like, clear idea, and, and I get that, you know, it was a simplistic idea, right? Like the West is good, and, you know, we fight for democracy and, uh, you know, the Soviets are bad. And, and look, I get that this is not the case. I mean, I've spent time in Russia and in Eastern Europe, and like, I get like people are people. But it was an easy, it was an easier algorithm to grow up in, and it instilled faith in, uh, in America and faith in what we stood for. And, and as we get older and wiser, we, we all learn about the hypocrisy of life and the, the truths of life and, you know, learning of, you know... So I remember learning about like things that America had done in Central America, right? And, you know, and feeling a sense of like, "Oh my God," like, "We are not this force of good." [chuckles] And it doesn't mean that we were a force of evil. It, it means that the situation was far more complicated, but it provided a heuristic. And even that was something that kinda made sense. I mean, I can remember the Olympics coming around and like feeling this sense of, "Okay, like it's-- are we gonna beat the East Germans and the Russians?" And, you know, there was just a sense of dichotomization, which is why people who want to control other people know to make struggle, right? You, you make an enemy. So this is all a double-edged sword, and you can make meaning in ways that is not valid, right? You say, "Okay, those people are bad. Let's go kill them." I mean, that's a way of making meaning for people. It's not an honest or a moral way. But what I'm trying to point out is that we see value to our struggle if we see meaning. And I think that for a long time, even as people got wisdom and, and greater knowledge of things like hypocrisy and the, really the truths of the world, I think we still saw greater meaning. And I'm not so sure that we do as much now. You know, I, I, I think that, um, things are much more nebulous, and then it's hard to get around the idea of, "Well, do I really matter?" You know, "What am I doing? What am I standing for? What's, what's really the difference?" And I just think, look, that can happen at any time, and probably did happen, you know, back, you know, when everybody lived in caves. But I think we're much, much more susceptible to it because we don't have some sense of community, right? We don't have a sense of community. I mean, it's interesting, right? People have written about why do human beings, when we're so focused on survival, right, there's a lot of people that will spontaneously risk their life for somebody else. Jump into the river, right? Try and rescue somebody. Why do we do that? I think the answer is because in that moment, we see, we see very clearly defined, a very lucid meaning to our actions. And I think that that's, um, like very, very profound, and I think it's the opposite. I see that as the opposite of suicide, which is, which is, uh, I mean, ag- this, it can happen for a lot of reasons, right? People can be very depressed and, and, you know, the delusions of lack of worth. I mean, again, it's very complicated, and I'm not trying to trivialize it. But I think a lot of what promotes suicide is the absence of meaning, which I see as the opposite of someone who's taking good care of themselves and maybe wants to stay alive, very much so, but will risk their life to help someone else. That, that's a, a focus of meaning, that there's a compelling meaning right now.

    27. PAPeter Attia1:43:44

        Right. What parent wouldn't jump in front of a car to push their child out of the way?

    28. PCPaul Conti1:43:49

        Right. And a lot of those parents who wanna be there for their child will, would jump in a river for someone else's, like, 'cause they see a child. So, you know, it's that just capturing of the attention, like, "This is meaningful. Look at this. I, I, the, this is a chance-- I will make a difference now," right? "And I'm willing to take a chance to do that." And I think it's very, very different than how a lot of people feel, I think by all socioeconomic demographics. I mean, if you think that, I don't know what the exact numbers are, but, you know, what percentage of people in this country... You know, I, I, I was sort of reading the, the, the reports around like a $500 unexpected bill, right? And like, just people can't Survive that, right? Like, they're not gonna get medical care. They're not gonna, you know, service the car, and then they can't get to work, or they're not gonna-- You know, they can't live a life that we would consider acceptable, you know, with an unexpected, in the grand scheme of things, otherwise surmountable amount of money that's needed. And, you know, I think that's a very, very hard way to live, that, that, you know, a lot of what we're talking about is Foster Wallace was talking about of like, "Well, we have so much opportunity and we don't have to struggle," right? But if you are struggling to put food on the table and, you know, you know that if, uh, somebody needs to go to the emergency room, how the hell are you gonna get enough food? That's a struggle it's very hard to see meaning in. That's a struggle that seems like denigration. I mean, it's, it's, you're gonna struggle.

    29. PAPeter Attia1:45:10

        Whereas it's different, our ancestors, if they had to struggle through a famine or drought, I mean, it was just, that was just, th-th-that was the gods, right? That was nature. That was the season. Th-- And they were in it together.

    30. PCPaul Conti1:45:21

        Right. And I think that's very important.
15. 1:46:46 – 1:59:46

    Rebuilding Community, Tribe and Friendships

    1. PAPeter Attia1:46:46

       unfortunately, Paul, everything you just said doesn't really seem to offer a foreseeable remedy to this. And if today we're seeing thirty percent more suicide or thereabouts than we were a couple of decades ago, is there anything on the horizon that's going to curb that trend? Or is suicide going to become an increasingly greater part of our humanity? And, and perhaps worse yet, for every person who actually kills themselves, what if there's nine people who are in that category we described earlier as basically functionally dead?

    2. PCPaul Conti1:47:25

       And then you think of the effect of the suicide or the functional, right.

    3. PAPeter Attia1:47:27

       Exactly. What's the trickle-down effect of that on the next generation?

    4. PCPaul Conti1:47:30

       I do think that there are ways to make this better, and I feel strongly and passionately about them. You and I have talked about some of them, and I'm fortunate to have dialogues with people who can really kinda help make a difference in this way. Again, do I know that it's the right way? No, I don't, but it's the best I can think of, which is, you know, it's a simplification, right? Like, w-we don't have places where people can come together and have shared experience and have a sense of community. Like, what about places where there are people to facilitate human connection and education even about the basics of what's going on inside of people, and there's a couple comfortable couches and a pot of coffee. These are not expensive things. I mean, you think about in this country what things cost. Go get an X-ray is seven hundred dollars, right? I mean, we've built up so much cost around things, so much liability, so much that prevents really basic, simple things from happening, and we've lost the basics of community support. I mean, there was an era before you and I were practicing medicine, certainly before I was, before I was a psychiatrist, right, where, where there were community support centers, and they were publicly funded, and it didn't cost very much money in the grand scheme of things. And there were places where people who were pretty mentally ill could go for support. Not only do we not have places like that for you and me and the other people who are like, who are func- managing to function, we don't even have those places for people [chuckles] who are really mentally ill. So we, we don't provide a nidus in the community for the basics of what w- I would call psychoeducation and for the ability to do that in a way that really links human beings and looks at what their needs are. You know, how many times have I seen where a person who, i-if they overdose or they slit their wrists, right, the, the world will pay a million dollars for their intensive care unit stay. But what we will not do is buy them the three hundred dollar alternator that could fix the car that allows them to not have to go back to the abusive household situation that leads to the suicide attempt that, that society pays a million dollars for. Like, a lot of what we do is utterly absurd as a society. It's not even cost efficient. If you took out care and concern for human beings and, and said, "Look, let's factor that out," it's absurd. You know, it's like you, it's like, you know, you, you'll throw away ten thousand dollars to get a dollar, and that's how we operate as a society. And I think that if we're gonna survive our own progress, you know, as a species or certainly in this country, we're gonna do things that are around mutuality and community support, and we're gonna do things where people who have something can help people who don't, and maybe that's three hundred dollars to buy an alternator. You know, maybe it's not that. Maybe it's somebody who doesn't have the education or resources that you or I might have who shares some wisdom that they've learned. I mean, it's not just all the people who have do things for the people who haven't. I mean, we all have, and we all don't have. And I'm not trying to trivialize the struggles of people who can't put food on the table. Like, that's, we, we need to work so that that's not the case, and it's actually not that hard to do. But at the same time, we need to recognize that, that people, that, that some of the things that we've done through drive to separate us make us lonely and isolate us. And I think you and I have as many emotional needs and as many struggles that can be soothed by other people as somebody does who might identify as underprivileged or ill, right? Like I said, we're all in it together, uh, but we work so damn hard to separate ourselves, and you end up with maybe not everybody, but most people feeling some sense of loneliness and isolation.

    5. PAPeter Attia1:51:25

       Mm. It's, uh, there's no easy antidote. You and I have spoken a lot about the idea of creating a tribe. We, we, we think about the, the seven of us from medical school, and it was like we had this fantasy, like what if we all could get jobs not only in the same city, but like we could all live on the same block. And it, we could all just sort of be one family. The kids could go between the homes interchangeably, meals were consumed interchangeably. Like, it was just, [chuckles] you know, creating a tribe in the way that it would have existed 10,000 years ago. But, you know, we still put our shirts and ties on in the morning and go to work. But you, but there's this closeness that seems so distant right now. I mean, you and I are so fortunate because of the geography in which we work that at least a few times a month, we get to have a meal together.

    6. PCPaul Conti1:52:22

       Right.

    7. PAPeter Attia1:52:22

       But that is harder and harder to do with friends. And I, I suspect that there are many people who go months, if not years, without really getting to do that be- because it's just too busy. There's just too much to do that's mission critical.

    8. PCPaul Conti1:52:37

       Right. And there again is the automaticity of a value system that, you know, I, I struggle very much with how many people do I care about who've been really important in my life, and I think, and I in theirs, that we exchange two emails a year. I mean, why? Right? Why is, why do I not take two weeks every three months and go around and see people I care about? Like, why don't we do that? And I think, again, I think, I do think that all paths, maybe not all paths, but I think the majority of these paths lead back to trauma, that there's a way in which I feel too insecure to do that. I'll step away from my work, and maybe I won't be as good at my work, um, or opportunities will pass me by, and I'll earn less, and all these things that actually make no sense whatsoever. But it's not as if I can stop them from driving me. And, and, and I don't wanna sound futile about that. I mean, I think, like, there are things that we can do, right? And I think, like, you and I do some things, um, that we might not have done e- even a couple of years ago, right? But do I think that we do enough of it? No, I don't. And you think about th- those other people that, you know, we were in school with and care very much about, and then think about people who weren't, like, sort of in that group that we know well and, knew well and care very much about. How much do we really see of them, right? Almost nothing, right? And, you know, it's a strange thing to, to have so much automaticity to our value system. And we might think, "Well, I never decided I don't value that, or I value, you know, another day of work over seeing those people." Okay, I never actually put words to it, but I've decided it, right? Because I, I act in accordance with that decision. And yes, I'd like to be healthier about those things. Um, but I think the answer is as a, is as a community, that we start teaching ourselves and teaching people how to be healthier about those things. Because you can still be very good at what you do, very successful, move society ahead, all these things that we wanna do if we achieve and have a better sense of balance and mutuality, which is why a lot of these fantasies, and it's what kids say in kindergarten to their best friend, like, "We're gonna live next door to one another," right? Okay, we're still saying that in medical school after-

    9. PAPeter Attia1:54:49

       Yeah, we're, we're fricking 45-year-old dudes, and we still say the same thing.

    10. PCPaul Conti1:54:53

        Right, because I think we still have the same needs within us, and we still have the same fears of loneliness and isolation and struggle and isolation. So the fantasy is still there, I think because there's meaning to the fantasy. It's a recurrent fantasy in a lot of people that tells us something about our desperate sense of isolation.

    11. PAPeter Attia1:55:13

        And I, I have no basis to back this up, and it probably is politically incorrect to say this, but I actually don't give a shit. You can be married, you can have the perfect spouse, you can have all that stuff going on, but, and I say this only being able to speak from my vantage point, which is as a male, I think that there are certain needs that can't be met by your spouse. There are certain needs that, like... And again, I think my wife doesn't even like hearing that. Like, she'd like to believe, understandably, that every problem I have emotionally can be rectified by discussing it with her. But I do think there's something different that, that I think there's a de- maybe even a degree of vulnerability that exists outside of that relationship and/or maybe even there's just something gender specific, like a guy needs to be with a guy sometimes, a, a girl needs to be with a girl sometimes as far as, like, truly talking about some of these things. And I, and I think that for many people, as they get older, as they have families, as they have kids, as they have careers, they lose sight with those other people, meaning the, the woman loses touch with her female friends who I think can offer her something that her husband cannot, even if they're the most well-adjusted couple. And similarly, I mean, I can't tell you the premium I place on the time I get to spend with my male friends. And it's hard because as you said, it often comes at the expense of time with your family. I mean, every minute I'm here in New York right now, you and I are here, we're not with our families.

    12. PCPaul Conti1:56:42

        Right. I mean, I, I, I think that that is a human problem. I mean, I think that we, you know, we can s- we see it through our own lens, right? But I, I don't think it's based upon gender, gender, socioeconomic class, sexual orientation. I mean, I think it's a human problem that, that there's a fallacy that says that we're supposed to enter, you know, a committed relationship, which already think about like there are people who, you know, might not be able to do that, right? Might not want to do this. So we're already saying de facto that that's not okay. So think how many people we're invalidating already. Then we say, "Okay, even if you do that, we're gonna put so much pressure to be everything to one another that, that we guarantee almost a sense of a failure or of inadequacy." Why should your lovely, wonderful wife think that she can be everything to you, right? Like that's just not how humans work, but somehow society has told her that, and then it engenders some negative feeling because both you and she, being healthy people, need a broader set of connections. But we're taught to kind of hunker down, and that's what we're supposed to do. And then when we're getting away and we're doing these things with our friends, that there's, there's something about that that seems kind of trivialized because we don't, again, we don't live in communities where... And, and look, think about it. I haven't thought about this before. We think about in medical school when we were kind of living in a community, and we did spend time, like if we were friends, then I spent time with Jill, and you spent time with Brooke. We were in a community, so there was more of a sense of communality. And now we don't have that as much. Like that's not the way it's supposed to be in a sense. And then it, it engenders these unrealistic expectations of self and others. And the question I would most ask about that that I don't know the answer to is like why don't we continue to live in a, in a communal way? And, and I think that that's some of what, you know, communities offer people, right? Communities that are based around religion or based around shared interests. Those can be very, very good things for people. Of course, like anything else, the other side of that sword is they can, you know, that's-- they can be used to create cults and how about like affiliate, right?

    13. PAPeter Attia1:59:01

        Mm-hmm.

    14. PCPaul Conti1:59:01

        And people are desperate to affiliate. So, you know, I think if there isn't health and balance, then, you know, we see more the negative side of things. We don't have enough community affiliation, so there are a lot of people who get caught up in cults or cult-like things, you know, more than we would-- more than we necessarily know on the surface because there are a lot of things like that that don't get defined as such or don't get, you know, acknowledged as such. They just don't come to attention. But there's a desperation for connection and for a multiplicity of connection and a variety of connection. And we live in a way often that really makes no sense. There's no reason that why should one person be everything to one other person? You know, life is more complicated and more interesting and richer than that.

16. 1:59:46 – 2:09:20

    Takeaways, Book Recommendations and Closing

    1. PAPeter Attia1:59:46

       Are there any books that you would recommend people read? I mean, I have my sort of list of go-to books that I've suggested to people over time. I certainly hope that anybody who's listening to this that thinks that some trauma in their life has continued to sort of yield its grip around their neck will look into some of these trauma-based treatment facilities and ultimately seek out therapists who themselves are, are well-versed in trauma-based therapy. Again, you don't have to go to an inpatient place to start, but I've since learned the importance of trying to vet therapists to find out who truly understands this. But what other resources, whether it be books or facilities or anything, like, I mean, what, what kind of things can we, can we leave people with to, to think about as they begin to navigate their own path? I mean, like I said, I suspect there's gonna be some people for whom this episode scratches a scab a little bit, creates a little bit of bleeding. What do they do now?

    2. PCPaul Conti2:00:42

       I think it's so important to take stock of one's inner dialogue. We can say things to ourselves hundreds and hundreds and thousands of times over and never stop and reflect that we're saying it to ourselves. So I think thinking about what's going on inside of us and talking to people that are close to us. I mean, most people have people that they can talk to more openly than they're talking to, and that can be complemented with professionals. I mean, I think anyone who has no problems or issues whatsoever should never have psychotherapy, right? Which is, you know, my way of trying to be clever and saying every damn human on the planet should have psychotherapy, right? Because it's a way of understanding ourselves better. It's a way of being able to commune with someone without feeling the pressure that we're burdening them. Like, you know, personal and professional relationships help us understand each other better. Going to a 12-step meeting helps a person understand oneself better, even for no other reason by the, the feeling of shared humanity. Some of those things which may sound kind of basic, I think are just of inordinate importance, inordinate importance of take stock of what's inside of you, connect with people around you. That may sound trite, but most of us are not doing it. We're not doing nearly enough of it. And in terms of literature or books, I mean, I, um, I tend to have very, very few book recommendations. I'll say a couple of the standards that I say when people ask me. I would consider reading Camus' "The Plague." You know, "The Plague" is about a city that is afflicted by the plague, but it, it is also about the afflictions of all of us, and are we all living amidst the plague, and are we all living amidst threat to our life and health and safety? Yes, we are. And, and I think it is, um, it's a way of potentially thinking about and framing things inside of us, this feeling often of being beset upon and needing a sense of community and a sense of mutuality that we often don't acknowledge. And I think for that reason, the book is of tremendous value. Somewhat of a very different recommendation is read some short stories by Katherine Mansfield. I think that, yes, Chekhov was a wonderful, brilliant short story writer, but my favorite in terms of evoking the realness of being human, the subtle nuances of human interaction, I think is actually best evoked by Mansfield. And I think if we're searching for a way of identifying with our own humanity, I think those two authors can help us get there. So it's not the most typical literature to recommend, but I think exploring things that great writers have written that help elucidate our humanity is a good thing if one is trying to gain a greater grasp on what's going on inside of us and what may be really driving us to misery. And I think those things engender compassion and compassion for self is what can ultimately lead somebody to take that step of getting help, right? Is we have to feel like, hey, there's something going on inside of me that I've been hiding and that I feel really ashamed of that I don't want to feel ashamed of anymore and I don't want to hide anymore. And in general, people won't take that step unless they've engendered some compassion for themselves.

    3. PAPeter Attia2:04:00

       Paul, there are so many other things I want to talk about. I'm looking at my little notepad here where I had just scribbled down other things to talk about that amazingly, we literally did not get through half of what I wanted to talk about. We didn't get into, you know, the real understanding of distress tolerance, the completely nuanced geeky discussions that we have over dinner about all of the different pharmacokinetics of every class of drug and every neurotransmitter. I think the only real remedy for this is we have to do this again. So I think there needs to be a part two of this discussion where we can get into all of these other things.

    4. PCPaul Conti2:04:40

       And perhaps between now and then I could try and become less annoyingly long-winded.

    5. PAPeter Attia2:04:45

       No, no, no, no, no, no.

    6. PCPaul Conti2:04:46

       So I will work on that for our next one.

    7. PAPeter Attia2:04:47

       You don't understand. Despite the short tenure of this podcast, I've already been given feedback by a few friends who have said, "Peter, we are really loving your podcast, but can you shorten it? I would really like to just have a 30-minute podcast." And I've said, "Honestly, I appreciate your feedback, but that's not what I'm trying to do here." One is I want these conversations to be the conversations that we have. And what we just discussed tonight, the only thing that separates it from a normal discussion is we have these microphones in front of us and we're not eating a meal.

    8. PCPaul Conti2:05:18

       Right. I mean, it was very similar to a conversation you and I had three weeks ago while we were sitting around the same table eating really good Indian food.

    9. PAPeter Attia2:05:26

       Right. Now, the fact that I'm in the middle of a one-week fast makes that image particularly distressing to me right now.

    10. PCPaul Conti2:05:31

        Ooh, sorry.

    11. PAPeter Attia2:05:31

        I don't appreciate that, but thank you.

    12. PCPaul Conti2:05:33

        See, part of how I keep myself in business is by causing trauma.

    13. PAPeter Attia2:05:36

        Yeah, you just caused a shit ton of trauma in me by reminding me of that incredible lamb vindaloo that I was eating sitting right where you're sitting now.

    14. PCPaul Conti2:05:46

        Right. And I'm not going to have any of it tonight because I'm going to live in sympathy.

    15. PAPeter Attia2:05:49

        I want you to go home and have nothing. Yeah, yeah.

    16. PCPaul Conti2:05:51

        I'm going to.

    17. PAPeter Attia2:05:52

        Well, Paul, I can't thank you enough for all of the insights you've brought to all of these topics from depression, suicide, trauma, shame, all of these things that are, I think, near and dear to our hearts, but more importantly, kind of near and dear to the hearts of pretty much everyone who's listening. I know I said there's a lot more I'd like to get into. I think we should certainly plan to sit down again and talk more about this stuff. I believe that there's a lot here that people can take with them and hopefully at least take some steps that kind of improve the quality of their lives. I've said it before. I will continue to say it. I don't think it makes much sense to fixate on living longer if you can't on some level rectify being happier. And that seems to be, you know, if we talk about diabetes and all these other things being diseases of civilization, there may be no greater disease of civilization than our unhappiness.

    18. PCPaul Conti2:06:49

        Yeah. It's probably a good time for me to say, you know, what I truly believe, which is I'm honored that you have had me on here. And I really do mean that. I do think that the things that I have to say from the mental health perspective, not because I'm saying them, but because mental health undergirds, you know, our ability to live good lives are so important. And I think it's a testament to, you know, your sort of relentless drive to understand things better that make a difference to the lives of the people that you take care of that has you looking at elements of the substructure that people often ignore. So I consider it an honor and a privilege to be on your podcast and to be able to talk about things that I think really are so important and that are just so often overlooked. So I thank you for the opportunity to get the word out in a way that I hope ultimately helps some people. Thank you.

    19. PAPeter Attia2:07:44

        Paul, I have no doubt that it will. Thank you for your generosity of time and insight.

    20. PCPaul Conti2:07:49

        You're welcome.

    21. PAPeter Attia2:07:52

        You can find all of this information and more at peterattiamd.com/podcast. There you'll find the show notes, readings, and links related to this episode. You can also find my blog and the Nerd Safari at peterattiamd.com. What's a Nerd Safari, you ask? Just click on the link at the top of the site to learn more. Maybe the simplest thing to do is to sign up for my subjectively non-lame once-a-week email where I'll update you on what I've been up to, the most interesting papers I've read, and all things related to longevity, science, performance, sleep, et cetera. On social, you can find me on Twitter, Instagram, and Facebook, all with the ID PeterAttiaMD. But usually Twitter is the best way to reach me to share your questions and comments. Now for the obligatory disclaimer. 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. And note, no doctor-patient relationship is formed. The use of this information and the materials linked to the podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnoses, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have and should seek the assistance of their healthcare professionals for any such conditions. Lastly, and perhaps most importantly, I take conflicts of interest very seriously. For all of my disclosures, the companies I invest in and or advise, please visit peterattiamd.com/about.

Episode duration: 2:09:24