298 ‒ The impact of emotional health on longevity, self-audit strategies, & improving well-being

1. 0:00 – 0:54

   Intro

   1. PAPeter Attia0:00

      So if an individual listening says, "Hey, how can I take this first diagnostic step-

   2. PCPaul Conti0:08

      Mm-hmm

   3. PAPeter Attia0:08

      ... and evaluate my own drive?" What, what would you say to them?

   4. PCPaul Conti0:13

      The first thing to do is to look inside oneself. Like, how do I feel, right? [chuckles] This is where sometimes I, I talk a lot about a life narrative, and, and a person could just start... You can start writing. You can start talking with someone. You can start introspecting. There are ways of taking stock of what is going on inside of me. Am I being kind to myself? What's the voice inside of me saying to, to me? Do I feel good about any of this, right? [chuckles] Is any of this what I want?

   5. PAPeter Attia0:42

      [upbeat music] Hey, everyone. Welcome to "The Drive" podcast. I'm your host, Peter Attia. Paul,

2. 0:54 – 5:53

   The importance of prioritizing emotional health as we age

   1. PAPeter Attia0:54

      so great to see you again.

   2. PCPaul Conti0:55

      Thank you.

   3. PAPeter Attia0:56

      Uh, it's never frequent enough.

   4. PCPaul Conti0:57

      Thank you.

   5. PAPeter Attia0:58

      But, uh-

   6. PCPaul Conti0:58

      I agree. Thank you.

   7. PAPeter Attia1:01

      So, um, you know, uh, uh, I don't know. Somehow in the evolution of my thinking on longevity, um, I feel more and more drawn to healthspan over lifespan.

   8. PCPaul Conti1:13

      Mm-hmm.

   9. PAPeter Attia1:13

      Uh, and again, not that these are ever mutually exclusive. They're not.

   10. PCPaul Conti1:16

       Mm-hmm.

   11. PAPeter Attia1:16

       And virtually without exception, anything that's enhancing healthspan is enhancing lifespan.

   12. PCPaul Conti1:22

       Right.

   13. PAPeter Attia1:22

       I think it's just a question of focus, and I think when you focus more of your energy on healthspan, you're getting a lot of those lifespan benefits for free.

   14. PCPaul Conti1:31

       Mm-hmm.

   15. PAPeter Attia1:32

       And you can clearly do a lot of the one-off stuff that is purely lifespan related, like managing your ApoB and cancer screening-

   16. PCPaul Conti1:40

       Mm-hmm

   17. PAPeter Attia1:40

       ... and things like that.

   18. PCPaul Conti1:41

       Mm-hmm.

   19. PAPeter Attia1:41

       But it's this focus on cognitive health and, uh, physical health that get you so much of that lifespan benefit, and of course-

   20. PCPaul Conti1:50

       Mm-hmm

   21. PAPeter Attia1:50

       ... you're enjoying the quality of your life. Um, those two def-- you know, decline quite predictably, and so really what we're trying to do as we age is delay the rate of decline. But then there's this third component of-

   22. PCPaul Conti2:05

       Mm-hmm

   23. PAPeter Attia2:05

       ... healthspan, which is emotional health, which is what obviously we're gonna speak about in, in great detail. [lips smack] Um, and what I tell people and what I tell myself when I'm feeling a little depressed about aging is that the thing we have going for us is that's the one that doesn't have to get worse with age.

   24. PCPaul Conti2:23

       Mm-hmm.

   25. PAPeter Attia2:23

       Right?

   26. PCPaul Conti2:24

       Right.

   27. PAPeter Attia2:24

       Everything else gets worse with age. And, you know, again, you can, you can do quite a bit to mitigate that-

   28. PCPaul Conti2:31

       Mm-hmm

   29. PAPeter Attia2:31

       ... and reduce the, uh, magnitude of the negative-

   30. PCPaul Conti2:35

       Mm-hmm
3. 5:53 – 12:21

   The impact of emotional health on healthspan & how to foster a proactive approach to emotional well-being

   1. PAPeter Attia5:53

      let's talk about kind of emotional health in the sense of, um, how it fits into healthspan. So when someone asks me to explain what, what the cognitive component of healthspan is- We can talk about executive function. We can talk about processing speed. We can talk about recall memory. And, and of course, you can drill down further and further and further into these things, and you can start to paint a pretty comprehensive picture of what cognitive health involves. And you can also do that cognizant of the changes that occur. So Arthur Brooks has written quite eloquently about the transition from fluid intelligence to crystallized intelligence. And so while, you know, our fluid intelligence peaked when we met each other-

   2. PCPaul Conti6:38

      Right. Long time ago

   3. PAPeter Attia6:39

      ... uh, and we've in that regard only become stupider, we've gained other intelligence, this crystallized intelligence that's more experiential and more about pattern recognition. And while we might not have the processing speed we once did, we're intelligent in a different way.

   4. PCPaul Conti6:53

      Mm-hmm.

   5. PAPeter Attia6:53

      Sim- similarly on the physical side, we have really tangible... And, and I should say one other thing, Paul. We test these things. These are all testable, right? These are quantifiable things. And while most people don't necessarily do it, it can be done. We do it with our patients. You go to the physical, it's the same way. I can, I can spend the next five hours talking about the nuances of strength, power, explosiveness, cardiorespiratory efficiency, maximum cardiorespiratory, you know, flexibility, balance, all of those things. And yes, we can measure all of those things effectively.

   6. PCPaul Conti7:27

      Yeah.

   7. PAPeter Attia7:27

      And we can track progress and things like that. I kind of have a definition for how I think of emotional health, but I would much rather hear yours. How would you explain the umbrella of a person's emotional health? And then I'll plant the seed, which is where I wanna go with that is, given that we don't have biomarkers for these things-

   8. PCPaul Conti7:51

      Mm-hmm

   9. PAPeter Attia7:51

      ... and necessarily tests that we can do, I wanna talk about how we can evaluate it.

   10. PCPaul Conti7:56

       Sure, sure. Well, I think the way we evaluate it is by looking inside. So, so then what are we looking for inside? We're, we're trying to understand what's going on in us. You know, when we wake up in the morning, how do we feel about ourselves? How do we feel about life? Are, are we low grade afraid, right? Do we feel on the back foot? You know, there's so much of this going on in us, and then that impacts our self-talk, which is why we may not have biomarkers, but we can look inside, so to speak, by asking the right questions. Like, what do you say to yourself when you're alone, right? What, what kind of phrases or mantras seem to repeat over and over? Um, do you criticize yourself? Do you have a shadow voice within you that is, that is oppressive or that is regretful or that is ashamed, right? What is going on inside of us is often very opaque to us, even though we're living through that when we then interface with the world. So this idea that if we inquire, if we become curious about ourselves, we learn so much more about what is going on inside of us, and it can guide us towards change. So if a person wakes up and doesn't feel good about waking up or feels afraid or feels ashamed, why is that, right? What can be done to change that? Because very often the environments inside of us we're not taking good care of. So we, we, for example, harbor traumas within us that we haven't talked about or processed. It's, it's one example. Or we know that we don't feel great, we don't know quite why, and then we're sort of afraid and confused, and we move forward. This idea that we should be as interested at what is going on inside of our minds, what is going on inside of us emotionally as we are about our bodies, even though we have many more markers, you know, biomarkers internal and external to look at physically. And sometimes what I'll see is, is a person is paying a lot of attention to that, but, but it's all kind of couched in an emotional climate that is not good and that at times becomes angry and aggressive. Like, "I'm gonna fight aging," and, you know, "I'm not gonna let this get the, the best of me." And, and, like, that's not a recipe for happiness and health. There's so much acceptance called for. So acceptance of the fact that we're aging. So you're right. When you and I met, we had much greater processing power. And, like, that's great. We, we could sprint better, say. But life isn't a sprint, right? It was, it was fun to be able to sprint when we could sprint really, really well. But I, I hope and believe that we're both smarter now, even though if we stop and look at our processing power, that we can see the change for the negative. But that's one factor that's negative. I mean, overall, I, I think and hope that we're wiser and happier, but we have such a bias in us, a salience bias towards the negative. So we look and say, "Oh, look, I could do so much more before. I could hold so much more in working memory. I was so much faster. Look, I'm getting old." Okay. The trade-off for that of, of increased intrinsic knowledge, things we know without having to think about it, that reside in our unconscious mind, you know, we, we don't value that as much. And I think if we can get over some of the biases that come from outside of us and then come inside of us, both that our emotional health maybe isn't so important or, or that there's something that's not so high yield, uh, paying attention to that or even that it's weak to pay attention to that instead of seeing that's undergirding everything else that we're doing on t- on top of it. Let's pay close attention to that, and let's be interested and curious about ourselves. 'Cause that's where it really, it leads us, is to be curious at what is going on inside of me? How is it affecting me? How are all these things I do, uh, you know, from morning till night affecting what's inside? And how's what's inside affecting that? Or things I wanna change or do differently. Now we become curious and engaged, and we wanna learn, which is, which is a characteristic of being younger, when people wanna learn and think expansively and, you know, are interested in new music and new sights and sounds. And if we can maintain that, that curiosity about ourselves and about the world around us, then we change this really, really big factor that often is working against us, and we're not aware of it. By looking at it, we can control it and make it work for us.

4. 12:21 – 23:42

   The discrepancy between outward success & inner fulfillment, & the importance of a healthy “generative drive” for genuine well-being

   1. PAPeter Attia12:21

      So where do some of these other things that, uh, you know, that I think of at least, um, and, and certainly others fit into the overall equation? So I'll give you three things that are probably subsets of that.

   2. PCPaul Conti12:36

      Mm-hmm.

   3. PAPeter Attia12:36

      And I kind of want to think about how you integrate them. So, so one would be something that's talked about a lot, which is sense of purpose.

   4. PCPaul Conti12:42

      Mm-hmm.

   5. PAPeter Attia12:42

      Right? And I think there's so much literature on this, inasmuch as there's literature in this field, which is obviously harder to, you know, do this type of work. But, you know, you say to a person who's, you know, working hard but down and out, "Hey, look, would your life be better if you won the Powerball today and you never had to work again?" And the data are pretty clear that the answer is no, right?

   6. PCPaul Conti13:04

      Mm-hmm. Right.

   7. PAPeter Attia13:04

      Like, if you didn't have something to do, and it doesn't have to be the job, but if you don't have something to do, if you don't have a purpose, it's very difficult to have an emotional keel-

   8. PCPaul Conti13:18

      Mm-hmm

   9. PAPeter Attia13:18

      ... that's, that's, that's, that's adequate. Um, so sense of purpose would be something.

   10. PCPaul Conti13:23

       Mm-hmm.

   11. PAPeter Attia13:23

       Another thing, um, would be kind of this idea of satisfaction, so kind of achievement following struggle.

   12. PCPaul Conti13:31

       Mm-hmm. Mm-hmm.

   13. PAPeter Attia13:32

       Um, and again, I think anybody listening to us right now can relate to that. A, a- achievement with no struggle-

   14. PCPaul Conti13:38

       Mm-hmm

   15. PAPeter Attia13:38

       ... is not particularly satisfying.

   16. PCPaul Conti13:40

       Mm-hmm.

   17. PAPeter Attia13:41

       Um, Arthur Brooks, again, has talked a lot about this idea that satisfaction is sadly fleeting.

   18. PCPaul Conti13:46

       Mm-hmm.

   19. PAPeter Attia13:46

       But nevertheless, um, uh, it, it provides, you know, temporarily-

   20. PCPaul Conti13:52

       Mm-hmm

   21. PAPeter Attia13:52

       ... it temporarily provides, um, a sense of, uh, a, a positive feeling-

   22. PCPaul Conti13:57

       Mm-hmm

   23. PAPeter Attia13:57

       ... that is, you know, worth reinforcing. And then obviously, what you're, I think, talking a lot about is relationships too.

   24. PCPaul Conti14:03

       Mm-hmm.

   25. PAPeter Attia14:03

       So what, what is the nature of our relationship to self and then the, the-

   26. PCPaul Conti14:07

       Mm

   27. PAPeter Attia14:07

       ... the quality of our relationships with others?

   28. PCPaul Conti14:10

       Mm-hmm.

   29. PAPeter Attia14:10

       What else would you add to this, or would you subtract anything from it?

   30. PCPaul Conti14:14

       I think the first thing I would do is, is take the extremely important things that you just said and, and put them under the heading of a generative drive. You know, the, the field of mental health has long understood that we have drives within us, and it has been focused on an assertion or an aggression drive, which makes sense. Like, we, we have to do things, right, in order to survive, in order to achieve, in order to move ahead. So there's a- an assertion drive within us, and there's also a pleasure-
5. 23:42 – 29:57

   A deeper dive into generative drive: impact on human behavior, resilience, purpose

   1. PAPeter Attia23:42

      I wanna ask a question, but what you said I wanna come back to, 'cause, uh, actually, I'll start with my, my question on that. So maybe I'm not understanding it correctly, but sometimes when I think of a strong generative drive, I think of, you know, a person who is striving so much, who is so productive in the eyes of the world, right? They're, you know, running three companies. They're-

   2. PCPaul Conti24:05

      Mm-hmm

   3. PAPeter Attia24:05

      ... you know, successful by every metric you would have, but they're actually not taking care of themselves, right?

   4. PCPaul Conti24:11

      Right.

   5. PAPeter Attia24:11

      They're working so hard that they're not taking care of themselves. That, that seems a little bit at odds with what you just said.

   6. PCPaul Conti24:16

      Mm-hmm.

   7. PAPeter Attia24:16

      Or have I misunderstood generative drive, and I'm now talking about a pathologic state-

   8. PCPaul Conti24:23

      Right

   9. PAPeter Attia24:23

      ... or a state that is harmful?

   10. PCPaul Conti24:25

       Yeah, achievement is not the measure of the generative drive. So there are people who are phenomenally successful in the eyes of the outside world and running three companies, and they feel great about what they're doing. They have great relationships with people around them. They're thinking as they're doing. They're taking pride in moving forward, uh, businesses or ideas in ways that wouldn't be happening without them, and there's an engagement in life, and they feel productive, right? They feel worthwhile. They wake up with a good feeling, right? But there are people who look the same from the outside and are driven by shame or fear or previous deprivation, that there can never be enough to, to... so that what you have can't be taken away from you, right? There are people who are laboring under those fears, often from early childhood experiences.

   11. PAPeter Attia25:16

       Mm-hmm.

   12. PCPaul Conti25:17

       And from the outside, they look very, very, uh, productive and, and successful. But on the inside, th-things are very threadbare, or they're filled with fear, right? Whereas you can see a person who, from the outside world, is, you know, not doing very much or coming and going from a routine job, but they're growing a beautiful garden in their backyard, and they are filled with the generative drive, and they are happy. So what we see from the outside tells us something, but it's just data. It's like any other data. Data outside of context-

   13. PAPeter Attia25:49

       Mm

   14. PCPaul Conti25:49

       ... i-is, is not of value and, in fact, becomes misleading. And I, and I see this at times in people who are very successful who don't understand why they are not happy because they are very successful. So it should back map that they must be successful. But what really is going on, they may have a very strong assertion or aggression drive because they're running away from something, their own fears about themselves or shame or prior poverty or whatever it may be. That drive is very, very strong. Their enjoyment, their ability to take pleasure in all of it is very, very low, and then the generative drive inside of them is at a much lower level than it seems to be from the outside.

   15. PAPeter Attia26:30

       That's very helpful, and it actually, I think, alm- probably answers part of my next question, which is, would it be your belief, again, knowing that this is not knowable, that everyone is, at least from a nature perspective, born with the capacity for enough generative drive to be happy later in life?

   16. PCPaul Conti26:52

       I think the answer to that is yes. I, I think, as you commented a little while ago, we're selected for that because that is adaptive, high levels of generative drive. You know, this is the person who in hunter-gatherer days would say, "Hey, the, the food is a little bit sparse. You know, there's a mountain over there. Like, we don't know what's on the other side of it. Maybe we should check."

   17. PAPeter Attia27:12

       Mm.

   18. PCPaul Conti27:13

       Right? "Or maybe we should do things differently so that we're, we're better prepared for what may come next." The generative drive and the enthusiasm and the joy inside people, when, when that is being realized, it does pull humanity forward. I, I think it was, uh, I think Leon Trotsky said that the, uh, the locomotive of history is war. And I, I would beg to differ with Trotsky. I, I think war and, um, the aggression driven by human envy and destructive capacity is, is the opposite. It's not the locomotive of history. It pushes history backwards. And what is actually the locomotive of history is the generative drive within us as human beings and our ability to realize it. This is why people learn and create. And imagine like Mendeleev in front of the periodic table and the joy of, like, putting, "Wait a second, I see a pattern here," and, like, figuring it all out. Like, th-there is a joy in creation, whether it's watching a child or they can be watching something grow or discovering something. This is the locomotive of history. But we pay so little attention to it inside of us, ev-even the idea of valuing ourselves by what we see from the outside, by things that we feel bring us prestige, and we know that that doesn't make happiness. So we've, we've kind of gotten lost a little bit and a little bit away from what our, our core humanity is telling us, is we wanna feel worthwhile, and we, we, we wanna be interested in things around us, and we wanna be sort of delighted by new knowledge and new experience. And when people carry this through the lifespan, going back to where we s-started, these are people who are happy and who are taking care of themselves and who age well and who don't fear death, right? That's also another part of it, is when, when people are v- are, are living through the generative drive, they're taking care of themselves in mind and body and emotion. Th-the-- I, I don't find they're afraid of death. I mean, it's not that people wanna die, right? They wanna stay alive because they're healthy and happy. But there's a difference between that kind of enthusiasm and fear. And I think that is remarkable. We should look very closely at who are people who are not fearing death. And, and we see that they are often in very good balance. The generative drive is being honored and the assertion within them and the ability to feel pleasure and satisfaction. These are all well-balanced, and then they're in places where they can find some peacefulness and some reflective capacity and some ability to feel contentment and delight in the world around them. I mean, we see this, and these are happy people, and we know that is not tied to the things we might think it's, it's tied to, like wealth, for example.

6. 29:57 – 43:34

   Evaluating one’s inner self: introspection, self-awareness, challenging societal norms, & returning to the basics of physical & emotional well-being

   1. PAPeter Attia29:58

      So how can a person begin that examination? Because I, I think what you said is, is very insightful, which is from the outside, these can be indistinguishable.

   2. PCPaul Conti30:09

      Mm-hmm.

   3. PAPeter Attia30:09

      Right? You, you can, you can have a, a, you know, an individual who looks like they are doing remarkably well.

   4. PCPaul Conti30:18

      Mm-hmm.

   5. PAPeter Attia30:18

      Um, again, by any metric. I don't just mean financially, but I mean in terms of actual achievement.

   6. PCPaul Conti30:24

      Mm-hmm.

   7. PAPeter Attia30:25

      But it could be fueled by fear, by anger-

   8. PCPaul Conti30:29

      Mm-hmm

   9. PAPeter Attia30:30

      ... by insecurity, by any of these other things. And You can have an individual who's achieving the same things or frankly less, um, but it's coming from this generative place. So if an individual listening says, "Hey, how can I take this first diagnostic step-

   10. PCPaul Conti30:48

       Mm-hmm

   11. PAPeter Attia30:48

       ... and evaluate my own drive?" What, what would you say to them?

   12. PCPaul Conti30:54

       The first thing to do is to look inside oneself. Like, how do I feel, right? This is where sometimes I, I talk a lot about a life narrative. And, and a person could just start-- you can start writing, you can start talking with someone, you can start introspecting. There are ways of taking stock of what is going on inside of me. Am I being kind to myself? What's the voice inside of me saying to, to me? Do I feel good about any of this, right? Is any of this what I want?

   13. PAPeter Attia31:23

       But, but let's stop there for a second, Paul, because that's not an easy question to necessarily answer. I mean, I think I wanna dig into this because it, it can be very difficult to answer that at a deep level.

   14. PCPaul Conti31:36

       Mm-hmm.

   15. PAPeter Attia31:36

       'Cause sometimes the superficial answer is so obvious.

   16. PCPaul Conti31:38

       Mm-hmm.

   17. PAPeter Attia31:39

       Right? If you have everything, if you have material success-

   18. PCPaul Conti31:44

       Mm-hmm

   19. PAPeter Attia31:44

       ... your knee-jerk answer would be, "Of course, this is what I want."

   20. PCPaul Conti31:47

       Mm-hmm. Mm-hmm.

   21. PAPeter Attia31:48

       So how do you, how do you go deeper into that question to, to what you're talking about, which is the look inside?

   22. PCPaul Conti31:53

       Mm-hmm. Mm-hmm. Then you use more specific tools. So what do you say to yourself when you're alone? Is there something that you say to yourself over and over? If you make a mistake, what do you say to yourself then? Is there an urge in you to be helpful to other people when you see them around you, right? If someone stumbles in front of you, do you, do you, do you feel like you wanna move forward to, to help that person, right? The- these are the ways in, these are the, the ways to give us answers about how we feel about ourselves. And, you know, there, there was a period of time, uh, seven, eight years ago, where I would, for some period of, a week or so, would see people who had very, very high levels of success, that from the outside looked as if they, they must be happy, right? Look at all of this, right? And when I would stop doing that, I came back, and I would do clinical work on a unit that takes care of people who don't have insurance, uh, many of whom are indigent, not all, uh, who have drug and alcohol problems. So the opposite end of the socioeconomic spectrum. And I, I swear to you that this is true.

   23. PAPeter Attia33:04

       [chuckles]

   24. PCPaul Conti33:05

       I could find no difference in overall happiness between the two groups. So someone who looked to have it all would feel, "If I don't have that next achievement, it all goes away," right? So the person isn't ear- isn't owning what they have earned for themselves, and this is a theme inside of me. So the person may have made a lot of money, and now they don't have to worry about being in need, or they may have achieved at their chosen art form. But they're so afraid that if the next thing doesn't go right, it'll all be taken away, or they'll feel ashamed of themselves. This goes on a lot in people who are high achieving. It's like, "What have I done for myself lately?" Right? "And if I haven't done something good enough, I can't feel good enough about myself." There is so much of that. Whereas I could see people who from the outside literally had nothing, who would be saying, "You know, when I get out of here, I'm gonna do it differently," right? "I'm gonna do it better. I'm, I'm gonna go see this person I really miss who is helpful to me. I'm gonna get a job. I'm gonna keep myself away from what, what got me in here in the first place." And they might have a, an enjoyable story or memory to, to say. I remember one point meeting someone who was living behind a bush under bad conditions who was far, far happier than the vast majority of people I had seen over the previous several days. And the, the truth is we are often running from something or trying to achieve something that makes us safe in the world, and all of a sudden we're gonna feel better about ourselves. And what we really need to do is honor that we are human, and what is going on inside of us is so important. And if we are willing to look at that, we're willing to ask the questions, "What do I say to myself? How do I feel about myself versus other people?" Right? "Do I feel like a fraud? Am I afraid everything will be taken away from me? Every time I drop something, do I say, 'What an idiot,' you know, inside of myself? Like, what is going on inside of me? Do I feel like I have an openness of spirit to new things or people who are different from me?" Like, we can ask ourselves these questions, but we have to stop feeling that what we adorn ourselves with is what brings us happiness. Then we can get to this, this owning what is ours. So that person who is gonna try and put a roof over their head when they leave, right, can own what's theirs, which is the tenacity to have what survived behind the bush, right, survived and lived in that way and maintained a good spirit. And often these are people who are helpful to other people and have-- and are looking out for people around them. Like, that is something to feel so good about as you strive for what comes next, right? Just as someone who has worked and learned and studied, you know, could feel good about the achievements they have, or someone who goes to a difficult job that doesn't provide them with satisfaction, that they feel is backbreaking labor and underpaid. But they go and do that, and they take home a salary that supports a family and puts a roof over people's heads. Feel proud of that, right? When we don't feel good about ourselves, often we are out of kilter with the generative drive within us. That is absolutely a, a part of what makes people unhappy. But also coming along with that is not owning what is ours. And how many people who've raised families, right, done things that are so impressive from the outside, have told me over the years that, oh, they're not worth anything. They didn't make enough money. They didn't do this. They didn't do that. And it's not what matters, right? It is not what matters within us. It is being the best that we can be and honoring the drive inside of us to live and to create.

   25. PAPeter Attia36:40

       How would you make the case to somebody who's listening to this and says, "Paul, I, I get what you're saying, but there's no way that if I had to choose between those two extremes," meaning I live behind a bush, but, you know, I have some sort of happiness, but I have nothing, no material possessions-

   26. PCPaul Conti37:00

       Right

   27. PAPeter Attia37:00

       ... no status in society, versus I could be incredibly successful in the eyes of society, and with it, have all of the comforts that come from that success-

   28. PCPaul Conti37:12

       Mm-hmm

   29. PAPeter Attia37:12

       ... all of the wealth. But you're-- you'll, you'll tell me that I'm unhappy. Um, someone listening to us might not be able to even wrap their head around what you're saying.

   30. PCPaul Conti37:22

       Mm-hmm. Mm-hmm.
7. 43:34 – 53:15

   Self-auditing tools: introspection, curiosity, & exploring underlying reasons for unwanted behaviors

   1. PAPeter Attia43:34

      do you believe it's, um, or, or h-h-how, how positive in, in terms of its predictive value would the following be? And again, I'm still thinking through this, uh, uh, as, as almost a self-audit tool.

   2. PCPaul Conti43:46

      Mm-hmm.

   3. PAPeter Attia43:46

      But if, if a person ostensibly recognizes that they are not taking care of their physical health-

   4. PCPaul Conti43:53

      Mm-hmm

   5. PAPeter Attia43:53

      ... okay, they're drinking too much, smoking, using substances in an unhealthy way, uh, eating too much, you know, w- pick-- not exercising, all of these things. If a person can, can recognize objectively that those things are true, and that's a, that's a generally pretty easy thing to recognize, what is the, what is the PPV, the positive predictive value of that sign that says there is something unhealthy going on in me emotionally?

   6. PCPaul Conti44:21

      So the, the s- of recognizing the sign?

   7. PAPeter Attia44:24

      If, if those signs are present, the-

   8. PCPaul Conti44:26

      Mm-hmm

   9. PAPeter Attia44:26

      ... the sort of physical-

   10. PCPaul Conti44:28

       Mm-hmm

   11. PAPeter Attia44:28

       ... you know, not doing the things to im-- you know, make yourself-

   12. PCPaul Conti44:31

       Mm-hmm

   13. PAPeter Attia44:31

       ... the best version of yourself physically. If gi- let's assume that that's easy to recognize. How likely is it to then be predictive of the fact that you're emotionally unhealthy?

   14. PCPaul Conti44:43

       Oh, very, very high. Very, very high predictive value because, because think about what's the link between the two? Like it doesn't, doesn't feel good to get up every day and not feel good, right? It doesn't feel good to know that one is unhealthy and energy levels are low, or it doesn't feel good to look at oneself in the mirror and say, "I could, would, should be healthy," right? Or to not be able to keep up with one's kids or whatever it is that goes on inside of us that makes us know that. I-if that's going on, something isn't aligned well within us, right? Like, what is the reason for that? Oh, I have to work to do this, this, and this, so I don't have time to take care of myself, or I've gotta be in this job I hate, or I've-- I'm so stressed that I can't... Like, we have all these reasons, but, but they aren't good reasons, right? I mean, like this is what we have. Our bodies and our minds are what we have. So the idea that we can just push that aside and not pay attention to it, like can't be right, right? It cannot be right to not pay enough care and attention to everything that we have as we move forward. So the, the key is the curiosity to link the two, right? So there's a high positive predictive value that there is something emotionally then out of balance, if we wanna look at it that way, or something in the mental health realm, whatever it may be. But whether or not good comes of that i-is the link of curiosity.

   15. PAPeter Attia46:09

       I mean, uh, it's amazing, Paul, because it's-- that's such a common phenotype among-

   16. PCPaul Conti46:15

       Mm-hmm

   17. PAPeter Attia46:15

       ... for all of us. Like I don't-- I include myself in this category. There are absolutely things that I do. Uh, you know, for me, it's clearly overindulging in food [chuckles] often, right?

   18. PCPaul Conti46:26

       Mm-hmm.

   19. PAPeter Attia46:26

       Even when I'm saying to myself, "Peter, you don't need to be eating this extra helping of dessert or whatever." Um, h-how do I think about that in a way to not overanalyze this or overinterpret it, right? I mean, how do you, how do you decide if, you know, my, my overeating is actually a canary in the coal mine that says, "Hey, there's something going on inside of you emotionally"? And, and, and my wife and I will talk about this all the time. She'll be like, "You are really emotionally eating right now."

   20. PCPaul Conti46:55

       Mm-hmm.

   21. PAPeter Attia46:55

       And I think we talk about that a lot. I think we-

   22. PCPaul Conti46:57

       Mm-hmm

   23. PAPeter Attia46:57

       ... understand sort of what that means. She's like, "You're so stressed out. Get out of the fricking pantry."

   24. PCPaul Conti47:03

       Mm-hmm.

   25. PAPeter Attia47:04

       Like you wa-

   26. PCPaul Conti47:04

       Right

   27. PAPeter Attia47:04

       ... you've been walking back in here every twenty minutes, and you're elbow deep in the Pringles.

   28. PCPaul Conti47:09

       Right.

   29. PAPeter Attia47:09

       What's going on?

   30. PCPaul Conti47:10

       Right.
8. 53:15 – 1:03:57

   Breaking free from destructive cycles by understanding the continuum of self-care & addictive behaviors

   1. PAPeter Attia53:15

      think there, you know, there's, there's this continuum from what we just talked about, which is people that are even out-- from the outside, it's obvious that they're not taking care of themselves. And again, the patterns here are many. It could be just a straight up across the board. "I don't sleep well. I don't exercise. I don't eat well. I drink to excess."

   2. PCPaul Conti53:36

      Right.

   3. PAPeter Attia53:37

      And, you know, in those situations, I guess it, it becomes pretty obvious to someone on the outside-

   4. PCPaul Conti53:42

      Right

   5. PAPeter Attia53:42

      ... "Hey, there's, there's something going on here that y- you're, you're, you're, you're acting in a manner that is harmful to yourself."

   6. PCPaul Conti53:49

      Right.

   7. PAPeter Attia53:50

      Um, we should explore why. Um, then you have kind of the intermittent example. I talk about, you know, using myself as an example of, hey, you're, you know, uh, for the most part, you're taking reasonable care of yourself, but then you really have these, these breakout moments where you're soothing something, some stress with, with a, a maladaptive behavior.

   8. PCPaul Conti54:11

      Right.

   9. PAPeter Attia54:12

      And then, of course, you have probably where I think I used to live, and I think there are a lot of people, though not nearly as many, who also live here, which is the over-management.

   10. PCPaul Conti54:21

       Mm-hmm.

   11. PAPeter Attia54:21

       Which is you're, you're going to be perfect. You're going to be-

   12. PCPaul Conti54:26

       Mm-hmm

   13. PAPeter Attia54:26

       ... by any objective measure, you're going to have it perfectly dialed in with respect to your health, right?

   14. PCPaul Conti54:33

       Mm-hmm.

   15. PAPeter Attia54:33

       You're, you're gonna e-eat like a robot, exercise like a robot, sleep like a robot-

   16. PCPaul Conti54:38

       Right

   17. PAPeter Attia54:38

       ... et cetera. That's probably a harder one to get people to look inside and see, isn't it? And-

   18. PCPaul Conti54:44

       Mm-hmm

   19. PAPeter Attia54:44

       ... and if you were, if you were talking to somebody like that and, you know, again, somebody watching us who might be that person, w- how would you help them come to realize that while on the surface that looks really good-

   20. PCPaul Conti54:58

       Mm-hmm

   21. PAPeter Attia54:58

       ... and it looks like they're doing everything so well that they, they clearly must be doing this from a place of health, um, h-how would you at least challenge the thinking on that?

   22. PCPaul Conti55:08

       Yeah. One route of approach is, so the, the old sort of Freudian way of seeing this, which is no less valid just because it's, it's old.

   23. PAPeter Attia55:15

       [laughs]

   24. PCPaul Conti55:15

       And, and the old Freudians didn't get everything right, but boy, they, they really got some things right. And they thought of this as what they thought of as living in the ego. It wasn't the modern idea of ego. It's like that's a person at their best, right? At their most self-aware. And it's not easy to live in the ego, right? Like, we have to think about ourselves in order to be self-aware, right? In order to be aware that we're not aware of everything, right? So it's this idea that as best I can, like I understand myself and what's going on inside of me and what my hopes and fears are and what I want and what I have achieved and what I'm afraid of. It's, it's all, it's all within us, and the idea is, i- from there, then we can healthily control our lives. But we're keeping two other aspects of ourselves in balance. And what they thought of as the id was the desire for immediate gratification. "I feel bad now. Where's the food?" Right? Like, there's that part of us, right? I want what I want, and I want it now, right? There's that part of us on one side, and the other side is what they call the superego, the part that manages us, that says, "Hey, you want what you want when you want now, but like, that's not okay. Keep yourself in check," right? And, and there are these parts of us that manage us and that want indulgence, and that it's us, the whole us in the middle, that has to recognize all that and keep it all in balance. And what we see is that part they call the superego, the self-management often gets very-- in the circumstances you're talking about, b- b- gains, uh, supremacy over the others, and that's not good.

   25. PAPeter Attia56:44

       Mm.

   26. PCPaul Conti56:44

       That's how we internalize the persecutor, right? Where there have been times-

   27. PAPeter Attia56:48

       Mm

   28. PCPaul Conti56:48

       ... it's, it's a parallel to this, but this is a true story where someone who I haven't seen before who is in my office and I'm getting to know them, and they're telling me about being really persecuted by someone who says, "You can't do anything, and you're not worth anything." And they're, they're describing and talking about all of this, and I'm thinking, "Okay. Okay, let's think about where is this person living? How can we get them out of there?" And then I learn, oh, that, that, that other person has been dead for seven years.

   29. PAPeter Attia57:14

       [laughs]

   30. PCPaul Conti57:16

       Right? But the person took into themselves the persecutor, the you're not good enough. Now, that can come from outside of us, and that's very striking w- when it comes from outside of us. And it, and it does often. It's not striking and rare. It's striking and relatively frequent. It can also come inside of us. Now, there's probably some external modeling, but it can come inside of us where I decide the way I'm gonna be good enough is I'm going to berate myself and torment myself until I'm perfect. And, you know, perfect isn't just the enemy of good enough. Perfect is really the enemy of everything that's not misery, right? Because no one is perfect.
9. 1:03:57 – 1:13:45

   Critical self talk: the malleability of one’s inner dialogue & the potential for transformative change with perseverance & self-compassion

   1. PAPeter Attia1:03:57

      Y- you know, I wrote a, a little bit about this in the book about the discovery of the inner voice.

   2. PCPaul Conti1:04:02

      Mm-hmm.

   3. PAPeter Attia1:04:02

      And, uh, you know, in my case, it was so startling. Um, I say startling not because I had an inner monologue, which I suppose many of us do, but in terms of how aggressive and, you know, the Bobby Knight voice.

   4. PCPaul Conti1:04:15

      Mm-hmm.

   5. PAPeter Attia1:04:15

      Um, but it was remarkable to me that it, it, it w- like, like I just had a breakthrough one day at PCS where all of that came out, that that's what was actually happening. And it's, it's a little sad to me to realize that, you know, whatever, 47 years of my life went by, probably 45 of them with that voice-

   6. PCPaul Conti1:04:37

      Mm-hmm

   7. PAPeter Attia1:04:37

      ... and yet no recognition of it.

   8. PCPaul Conti1:04:40

      Mm-hmm.

   9. PAPeter Attia1:04:40

      And why that is frightening to me is it tells me there have to be a lot of other people out there with-

   10. PCPaul Conti1:04:46

       Absolutely

   11. PAPeter Attia1:04:46

       ... potentially as awful a voice in their head. They might be listening to us now thinking, "Yeah, that would be awful." And yet they have it, and they don't recognize it.

   12. PCPaul Conti1:04:56

       Right. If your experience of it normalizes it and also if you have an emotional investment on some level that this voice is causing you to behave and achieve in ways that let you feel good enough about yourself and-

   13. PAPeter Attia1:05:11

       Right

   14. PCPaul Conti1:05:11

       ... even then you don't feel good enough about yourself, so you're really afraid of fearing, feeling worse, right? Then it gains almost a by, right? Like a by... W- we don't go and look at that. It just gets a pass, right? And that happens, that happens all the time. It's so automatic within us, just as there are people who, say, around 20 years of age can, can have schizophrenia that they didn't have before, and they're hearing voices inside of them, and it's only till years later that they realize that's not normal, right? Because they had an experience of, of now hearing voices inside of them, and, and they don't know that that's not normal. Like, even something that's so out-- what we would think about that's so different than what most people are experiencing. But it's not different from what you're experiencing if you're experiencing it and it's come about in a way that didn't have a marker that, that told us that it was not healthy. So, so again, we, you know, there's a common theme to what we're talking about, which is introspection, curiosity of like, wow, there could be things going on inside of me that are wildly unhelpful to the things I'm trying to achieve, like being, like, better healthspan and lifespan or better emotional health. They're wildly counterproductive, and they're just going on on the surface, like they're hiding, right? There they are waving a flag, and I'm not paying any attention to it. So it is curiosity about ourselves, like, "How do I work? What is going on inside of me?" that makes all the difference. And when we, when we start thinking about that, we become aware of it, that's when we can change. Because you described, like, kind of feeling all this all at once, right? But that's how change happens in people. Now, I, I think the same principles-

   15. PAPeter Attia1:06:52

       Yeah, there's a great Hemingway quote, right, uh, which I'm paraphrasing incorrectly, which was, "Change happens incredibly slowly and then very quickly."

   16. PCPaul Conti1:07:01

       Right. Right, and, and if you think about quantal leaps or, you know, you and I are both, like, mathematics people, like, you know, asymptotic functions, right? Like, they're-- w- what we're getting at is, is discontinuity.

   17. PAPeter Attia1:07:12

       Yeah.

   18. PCPaul Conti1:07:12

       Right? That, that even I, I think this is true on all levels, you know, down from, from like quantum physics through to astrophysics, where, you know, you see that we, we are only here because we are in these eddy pools of counter entropy, where instead of everything dividing and dispersing like it does in the vast majority of the universe, there are these places where, oh, certain forces, you know, go the other way. Now there's, there's not things coming apart, but coming together. And so whether we're looking at the biggest levels or we're looking at the smallest levels, the way that things work inside of us is that there are processes of, of understanding and change that are rare or in-infrequent, but that we can, um, we can bring to the surface by looking in the right place. If you look all over the universe, most of what you see is no life. But if you look in the right places where those forces of coming together are more than, than coming apart, then you see, oh, th-there's something that's happening there. The same way inside of us, if we're looking where things are happening, then we can gain understandings that happen very, very quickly. Just as in mathematical functions or quantum leaps, these things are dis-discontinuous. So when you develop, I, I think this will be my, my thought about that. When you have a curiosity about yourself that leads you to now do something where you're thinking about yourself, right? And you're thinking about yourself with the help of other people outside of you, right? And you've engendered this across time, and now you go do something that's intensive, then all of a sudden something becomes clear to you. And you see, oh, I'm now, I'm now interested in this. And now you start to be-- You start to do all the things that you do when you're interested in things, like, "Hmm, why is this here? How has this developed? How is this serving me? How might this be working against me?" Right? And, and now you can change, right? Now you can change that when before you couldn't change it. Now, yes, change happens slowly, right? It's slow, slow, slow, slow, but then it happens fast. So you do a lot of work on yourself to get to that point where the change can happen, which I think is, is true. Again, these, these are human, and maybe the-these are principles of existence, right? Same with physical health. This person works out and works out, and they don't immediately notice linear change.

   19. PAPeter Attia1:09:36

       Yeah.

   20. PCPaul Conti1:09:36

       So you have to have, you have to have faith that, that, that the work you're doing is gonna get you there. And lo and behold, it does. And that's how these really big things inside of us. What am I saying to myself? Is there a running narrative inside of myself? Is someone else's voice inside of me? These happen to us, and it's amazing that we often just don't know it. Then isn't it l- more likely that we're going to choose the short-term soothing? You know, in the light of that, then of course, like just get some soothing on board, whether it's Pringles or it's a drug or it's, or it's whatever it may be, right? W- it-- we're more likely to choose short-term soothing because we're afraid and we're out of control and we're berating ourselves. It's like, whoa, whoa, let's just bring some peace and understanding to this equation, and then things will change for the better, even if you have to change things for the better. Make change.

   21. PAPeter Attia1:10:28

       Y- yeah. Tell you-- I'll tell you a funny story that happened today, and it's, it's, um, these things occur on a daily basis. So I get a daily reminder of this, um, and it amazes me. So I was, uh, shaving today, and then I went to grab a brand-new bottle of aftershave.

   22. PCPaul Conti1:10:45

       Mm-hmm.

   23. PAPeter Attia1:10:45

       So this Nivea big glass bottle of aftershave. Same thing I've been using for twenty-five years. And this is the first time this has ever happened, Paul.

   24. PCPaul Conti1:10:54

       Mm-hmm.

   25. PAPeter Attia1:10:54

       I went to grab the bottle, and I opened it, and as I was, uh, dumping it in my hand, maybe because it's so cold today, uh, it was harder to get out.

   26. PCPaul Conti1:11:03

       Mm-hmm.

   27. PAPeter Attia1:11:04

       And sort of-

   28. PCPaul Conti1:11:05

       Uh

   29. PAPeter Attia1:11:05

       ... somehow the bottle dropped, and it landed on the floor, and it's a glass bottle.

   30. PCPaul Conti1:11:09

       Mm-hmm.
10. 1:13:45 – 1:26:44

    Slowing the anger response & gaining insights into the underlying triggers to achieve lasting change & self-understanding

    1. PAPeter Attia1:13:45

       it's amusing to note how strained they were at the beginning as I had to learn a new-

    2. PCPaul Conti1:13:51

       Right

    3. PAPeter Attia1:13:51

       ... language.

    4. PCPaul Conti1:13:53

       Right.

    5. PAPeter Attia1:13:53

       D- you know, like the, the, [grunts] "Well, [lip smacks] you know, hope you're okay. It's okay." You know, it w- it just-

    6. PCPaul Conti1:14:03

       Mm-hmm

    7. PAPeter Attia1:14:03

       ... and now of course it's very natural.

    8. PCPaul Conti1:14:04

       Mm-hmm.

    9. PAPeter Attia1:14:04

       So again, I, I highlight that to say that was a technique that worked for me.

    10. PCPaul Conti1:14:10

        Mm-hmm.

    11. PAPeter Attia1:14:10

        Incredibly powerful.

    12. PCPaul Conti1:14:11

        Yeah.

    13. PAPeter Attia1:14:12

        But most of all, I think the moral of that story is malleable.

    14. PCPaul Conti1:14:16

        Mm-hmm.

    15. PAPeter Attia1:14:16

        Like-

    16. PCPaul Conti1:14:17

        Right

    17. PAPeter Attia1:14:17

        ... you, you know, if when this exercise was suggested to me, I did it because I was at rock bottom.

    18. PCPaul Conti1:14:22

        Mm-hmm.

    19. PAPeter Attia1:14:22

        And when you're at rock bottom-

    20. PCPaul Conti1:14:23

        Mm-hmm

    21. PAPeter Attia1:14:23

        ... you don't really have a lot of negotiating power.

    22. PCPaul Conti1:14:25

        Mm-hmm.

    23. PAPeter Attia1:14:25

        You can't say, "That's a dumb idea," 'cause it's sort of like, well, how's the current one working out for you?

    24. PCPaul Conti1:14:31

        Mm-hmm.

    25. PAPeter Attia1:14:31

        But I, I don't think I actually expected it to work.

    26. PCPaul Conti1:14:34

        Mm-hmm.

    27. PAPeter Attia1:14:34

        And if I, if, and I thought, if this is ever gonna work, it's gonna take 40 more years 'cause that's how much we're overwriting.

    28. PCPaul Conti1:14:40

        Mm-hmm.

    29. PAPeter Attia1:14:41

        Why do you think it took, I mean, I'm not exaggerating, Paul, it took about three months-

    30. PCPaul Conti1:14:46

        Mm-hmm
11. 1:26:44 – 1:30:39

    Foster gratitude & humility by achieving balance between the three drives—assertion, pleasure, & generative

    1. PAPeter Attia1:26:44

       Yeah.

    2. PCPaul Conti1:26:44

       Which, which brings me back to what I believe works for everyone. Like, this is a human thing, right? And it crosses cultures, race, religion, socioeconomic status. Like, we are humans, and we have these drives within us. And if we look at, there's a, an assertion drive to be able to have some healthy control in the world, and there's a pleasure drive to feel at least no privation and feel safety, right? And then also to have good things. If we look, we have these drives, and there is also a generative drive in us. Are we honoring the generative drive? Are we in balance? Then what comes of that, if we are doing that, is a sense of gratitude and humility. So I think my idea of what's going on inside of you when you're able to stop is that, that y- that you're able, in taking stock of self and being reflective, to feel, whether you see and put words to it, you may or you may not, but, but there's an un- there's a knowing inside of you that actually, you know, your assertion drive is, is like you're doing well with it, right? Like, you're, you're, you're putting yourself out there in the world and like, and I'll take stock of myself. Like, I'm, I'm not unhappy with how I'm trying to be in the world, right? And, and I do take some pleasure and satisfaction in what I do, and I'm able to provide for people, and I feel a sense of wholeness and safety. And, and, and because of that, I can feel good about myself, and I'm learning and curious and like, and, and I realize like, wait a second. The-- like, your life is great, right? There's nothing wrong with your life. And I feel a sense of, of gratitude because so much of that is blessing, right? And also the sense of humility we have when we recognize our own work and effort and we recognize our own responsibility for where we are. But we also recognize that, that it's also a blessing to be able to, to bring ourselves to bear in that way, right? This is why people say, "I got an award and it was so humbling." You say, "Why would that, why would that be?" Right? It, it's because the person recognized, yeah, I got that award and like, I did those things and I worked hard. And also, isn't it wonderful for people around us to acknowledge me? And isn't it wonderful I've got it in myself to do? And I'm, I'm, gosh, I'm fortunate enough that I could bring myself to bear so I can both own it and also feel a sense of, of the beyond me that, oh my God, I am so fortunate to be in a place where I can own that I worked hard and got something, you know? And I think this pervades people when those other drives are in balance. So if we go back to what we started at the very beginning, how do people have healthspan that, that is a wonderful healthspan to be have, right? And it combined with lifespan and cognitive health and emotional health. The drives inside of people are in balance, and you've got to look in yourself in order to get them in balance. We've been talking about that too, right? Then when they're in balance, you orient yourself to that balance, and you live much more in an appropriate and active sense of gratitude and humility, and you feel that when things are difficult. Like, I think that the work that you've done let you feel a sense of humility, like you are not supposed to be perfect despite all that you have achieved, and isn't it wonderful, all the great things in life? Then the glass bottle breaks and you're like, "Huh." [laughs] You know, the glass bo- that, that's it, right? And that's why when I go to the airport later today, if flight's delayed and I'm gonna sleep in the airport or whatever it may be, like, that's not gonna feel great, but I am not going to get down on myself or anything else around me, whether it's God or fate or people. You know, it just, it's not right, and it's not good for me either. And that's another reason we don't do it. That's why once you start doing it, you make progress, right? And that's why you say you're 50% of the way there. I mean, that's a huge achievement. And what does it tell me? That the next 50% can't be as difficult as the first, right? So you're gonna get there.

12. 1:30:39 – 1:42:14

    The conflict between intellectual understanding & emotional feelings, problematic comparison frameworks, & the importance of living in the present with intentionality

    1. PAPeter Attia1:30:39

       What percentage of people do you think, or how often do you encounter this, maybe is an, an easier question, of an individual who feels frustrated or upset at themselves for the, the following paradox, right? Which is on the one hand, intellectually, they recognize how lucky we are. Any, any person. I mean, I, y- you know, we talked about this a little bit over dinner last night. You know, I'm reading this book about the, the, the, the depression-

    2. PCPaul Conti1:31:10

       Mm-hmm

    3. PAPeter Attia1:31:10

       ... the, the, the impacts of the Dust Bowl-

    4. PCPaul Conti1:31:11

       The Dust Bowl, yeah

    5. PAPeter Attia1:31:11

       ... and the Depression. Okay, so, you know, this is 90 years ago, and the people living in the middle part of the United States were subjected to conditions that, uh, v- most of us couldn't survive. I mean, the abject horror of what it meant to live in the Depression, in the Dust Bowl, um, and the book I'm reading is called "The Worst Hard Time," which is amazing. And so you think about that and you think, "God, that was only 90 years ago," right? So just what's the luck that per, you know, allowed me to be born now instead of then? Had I been born 100 years earlier, I'd be dead. I would have died an awful death in that situation So I know that in my head, right? And then something happens that upsets me. And again, it almost doesn't matter what it is because you think it pales in comparison to what it would have been like to have born just 100 years ago. And then that creates tension internally because you think, "Why can't you just be grateful for the fact that you, you know, you're at the..." Let's use the airport example, right? Why can't you just be grateful that you can at least get on a plane? Like, it's a miracle that we can do this thing. And yeah, so what if it's four hours late? But then you still feel like, "But I'm still really upset about it." Um, how often is a person coming to you where that's the source of the tension? The difference between the intellectual understanding of what should be gratitude and the emotional feeling that is incongruent with it.

    6. PCPaul Conti1:32:51

       A lot. And, um, and if I could comment a little on what you said. See, I think that there's a fallacy there or a problem, I don't know how to, what word to put to it, but something is not real or healthy in the framing, right? I do not believe that you would have just died if you were in the Great Depression, in the Great Dust Bowl. I also don't know that you wouldn't have been happier.

    7. PAPeter Attia1:33:23

       Hmm.

    8. PCPaul Conti1:33:24

       I, I mean, I don't know that.

    9. PAPeter Attia1:33:25

       Yeah. Yeah.

    10. PCPaul Conti1:33:25

        Right?

    11. PAPeter Attia1:33:25

        I mean, it speaks to what we said earlier.

    12. PCPaul Conti1:33:27

        I mean, maybe, you know, you would have barely eked out enough food and got some shelter and, and kept your family going and, and, and you're dirt poor, but everyone stays alive, right? Or maybe not everyone stays alive, but you keep alive who you can keep alive, and you have a sense of wholeness and goodness in yourself despite the privation, right? We, we-- so when we set up, "Oh, we should feel grateful because..." then you set up a scenario where, like, you can't win, right? Because anything you feel bad about, you should feel ashamed about feeling bad about because it's not the Great Depression and the Great Dust Bowl, so what are you complaining about? And then I think you've inadvertently set up a situation where the odds are against you, right? I mean, I'll think this sometimes where up until a couple generations ago, like, probably everyone in my, you know, family from all sides extending back generations was a shepherd, right? So you could look and say, "Wow, just look how fortunate I am," right? "Look at the opportunities I have and the places that I've gone." And, and like, and I can get into that way of seeing of like, oh, like, oh my gosh, this is, this is so amazing, right? But then I'm not giving myself room to say it is not clear that maybe I would have been happier being a shepherd.

    13. PAPeter Attia1:34:41

        Hmm.

    14. PCPaul Conti1:34:42

        Like, I don't know. Maybe if you and I were shepherds next to one another, like, we'd, uh, help each oth- others flock out. We have a l- little bit more sheep. Our families are doing okay. We have a lot of leisure time. We think and talk. Like, who knows, right? So look, you are you.

    15. PAPeter Attia1:34:55

        Yeah.

    16. PCPaul Conti1:34:55

        You are not someone else, and you are also you now. And so a lot of people come with the, with what you said, right?

    17. PAPeter Attia1:35:03

        Okay.

    18. PCPaul Conti1:35:03

        And, and what I try and do with all of them is to say, like, th-this is not a framing that we massage. I think it's a framing that we just throw out and we say-

    19. PAPeter Attia1:35:11

        Wow

    20. PCPaul Conti1:35:11

        ... I, I know nothing about you by, by, like, knowing your reflections on what you think it might be like if you were in the Great Depression. What I know about you, I know from now. This is when you live your life now. And you know what? You're entitled to be angry and frustrated about things sometimes, right? Now, do you wanna modulate that and keep it inside and not let it run out of the starting blocks? Yes. Right? You're entitled to feel, you know, you're entitled to feel bad about things or annoyed about things at times. I mean, like, this is how this goes, right? Just because we are not suffering, we can compare ourselves to people all over the world who are suffering. We're living our lives. If we live them within ourselves and we're the-- we are the marker of comparison. Like, how am I taking care of myself now? How am I exercising the, the drives within me now? How am I serving the generative drive within me? That's between you and you right now. And when we bring people back to that, you know, that's when, like, things can really, really, really sh- start to shift because you, you then maybe stop doing something that, like... It's like kinda going to do something, and immediately you set the odds against yourself, right? By sort of having this comparison. People will say, "Well, I'm not... Oh gosh, you know, but I'm, I'm not in the war. I'm not in the Ukraine," or, "I'm not in Israel." And I know that, right? But that doesn't mean that, like, you can't suffer now or, like, you know? Like it's, it's true, true, and unrelated, right?

    21. PAPeter Attia1:36:24

        Mm-hmm.

    22. PCPaul Conti1:36:25

        And the other aspect is that, as I said, like, don't be an isometric exercise, right? Like, you might do them, but, like, if this is you, don't push against yourself, right? And, and that's often what we're doing. If I wanna go this way, can I glide my hands this way? Very often what we do is we have 10 units of resistance and 11 of force, right? And we're doing that within ourselves instead of simplifying. I mean, the rule of all good mental health, which we, which I believe undergirds, uh, healthspan, lifespan, is simplicity. It doesn't mean it's simple to get to, but it is simplicity. Like, it's really, really complicated to start comparing you to the theoretical you 90 years ago. Like, I start getting very, very confused, right? But we all do when we do that. And, and again, I'm not being critical. I do this to myself too, right? When I just stop and think like, "Look, there's me. I'm here now." I, I mean, I know my own history pretty well. I, you know, I, I am capable of introspecting. L-let me stop and think, like, what's going on inside of me? W- am I making a decision? Am I, am I upset with myself or someone else? Like, I've gotta be able to understand this well enough to simplify it. And if I'm gonna beat up on myself and flog myself to get myself somewhere I wanna go, that's not how I'm choosing to do it. It's just not good. And is that why things seem to maybe take more energy out of me than they should? Like, you know, these are things if you and I both tried to work with over time, then do I-- now am I more easily frustrated, right? And, and I'm not getting enough sleep, or I'm not sleeping as well, so now I feel a little bit fatigued. It's harder to take care of myself. There's more inflammatory markers. My body doesn't feel as good. So now I'm even more frustrated with myself. Like, what is going on here, right? We, we just need to-- we can stop and take stock of things and- decide a path forward where we are not working against ourselves and we simplify down to what the real truths are, which I'm not saying that's easy. It takes work and it takes reflection, and we've gotta run counter to some of these established neuronal pathways. But isn't that a lot more, a lot easier and a lot more likely to be effective if you're living in the here and now with yourself, knowing what you know about yourself as you make decisions, whether it's what am I gonna say to myself inside of my head? What am I gonna say to someone else? What am I going to do, right? Now we're intentional. Right now, in that Freudian way, we're living in the ego, in that sense of the ego being the whole self. Am I most self-aware? I'm aware. I don't want the superego telling me I should feel bad about any frustration in me because I'm not a shepherd. I'm like, "I'm not having any of that." [chuckles] That's, it, it doesn't help me. It, it makes things worse. It's the opposite of simple, right? A-and, and we can reject having ourselves be out of balance. So just like our drives need to be in balance 'cause then the generative drive is what, you know, makes you wake up with a glimmer in your eye, right? But, but we have to be healthy, you know, in mind and body, and these other drives, the, the assertion and the pleasure have to serve it the same way we have to be balanced inside of us. We need some gratification, right? We also need some self-control. How about we have as clear a lens as we can sitting in the middle of it all? And a-another way, I'm using a lot of analogies, but I don't want fun house mirrors around me when I'm trying to see what's going on, right? I want clarity around me. And a lot of times what we don't realize is we create fun house mirrors around us, and then we get angry with ourselves that we don't understand or that we walk in the wrong direction or that we run into something.

    23. PAPeter Attia1:39:42

        And in this analogy, is the, is the fun house mirror the construct, the mental construct that adds confusion, such as the example I just gave?

    24. PCPaul Conti1:39:50

        Yeah, I think that, yeah, absolutely. A fun house mirror comes into the room when you start comparing you now to the theoretical you during the Great Depression.

    25. PAPeter Attia1:39:57

        Mm-hmm.

    26. PCPaul Conti1:39:57

        Now there's a fun house mirror. It's a fun house mirror when I'm mad at myself because something wasn't good enough, and I realize that the standard I'm using is actually perfect, right?

    27. PAPeter Attia1:40:08

        Mm-hmm.

    28. PCPaul Conti1:40:08

        Bring another mirror in, right? I'm, I'm mad at myself if something go-- Or, or I'm... Bring another mirror in if I start speaking to myself through the lens of someone who is so critical to myself, right? Like the-these are all the distractions away from clarity, and it is so easy. Like no one else brings the fun house mirrors in. No one catapults ourselves out of the block so that we fall headlong. It is we who do this to ourselves, and we don't have to do this. Just as, think about what humans do. Like we create so much, and we destroy so much. Isn't that true? Look at the destruction in the world around us, how long it takes even to create one building that gets destroyed, let alone the vast swaths of the earth that we then destroy and the harm that we do to people, right? So just as in the universe around us, there's a, there's a lot more force towards entropy, right-

    29. PAPeter Attia1:40:58

        Yeah

    30. PCPaul Conti1:40:58

        ... than there is to things coming together. That's why these, these small places where like life could be here. You know, this is true in our lives here on earth. It is so much easier to destroy than to create. And if we stop working against ourselves as humanity, right? We're trying to move forward and create. Is it 11 units forward, 10 back? Well, maybe we'll get that wrong, and it'll be 12 back and 11 forward, and we won't survive as a species. We do this as a species, and we do this as individuals, where we work against ourselves, and we don't have to do this, right? We don't have to have needless destruction happen around us. We don't have to have a society of plenty while there are single mothers with children on the streets. Like there is more that we can do, whether it's trying to lift up the people who are, uh, who are on the verge of not surviving, right, who are living in misery. We can also do it with ourselves. I don't wanna cloud my own picture. I don't wanna work against myself. And if I see with clarity and I don't bring in the fun house mirrors, f-life goes a lot better, and I use a lot less time and energy making it go better. And that's true for all of us. It's true on a universe level, it's true on a global level, and it's true within each one of us.

13. 1:42:14 – 1:52:22

    How making peace with our mortality can foster a sense of hope, purpose & well-being

    1. PAPeter Attia1:42:14

       How important do you think it is for our emotional health to have, um, sort of peace with non-existence?

    2. PCPaul Conti1:42:27

       Mm-hmm.

    3. PAPeter Attia1:42:28

       Right? I, I, I, I do not really have a great sense of that, and I don't think many people do. In other words, uh, a-a-as is the case in the previous example, uh, there's nobody who intellectually, I mean, no reasonable person intellectually doesn't understand that they will cease to exist at some point. We will all die, um, notwithstanding all the biohackers out there. But that knowledge, that cortical knowledge is very difficult to process.

    4. PCPaul Conti1:43:01

       Mm-hmm.

    5. PAPeter Attia1:43:01

       Right? It's very difficult to come to peace with the idea. And let's talk about the best case example, which is you live a long, healthy life and, you know, in your 90s, you, you, you die in your sleep. I mean, it couldn't, you couldn't ask for a better existence. And let's also assume that everything up until that point is moving in the right direction. You don't just die in your sleep. You die in your sleep having lived a meaningful life and having had wonderful relationships and having raised children and grandchildren who are wonderful people. Like y- let's, let's make this the best case scenario. And yet many of us, I think, still struggle with the finite nature of our existence. Do you think that coming to some acceptance of that is essential for our emotional health?

    6. PCPaul Conti1:43:56

       I do. Yeah, I, I think it's, whether it's essential in everyone, I'm not sure, but I think it's, I think it is very important, and there's so many factors that work against us that, that we can Change. So this societal idea that getting old is, is just so, so, so, so awful and death is something to be feared, you know, it's, it's not clear that that's true. And when you see when people are much older and are, and are closer to death, what they fear is loss of control, not death, right? So maybe we build up a society that glorifies not being dead as opposed to glorifying living well, right? I mean, that would be a nice switch, right? Maybe we think about healthspan and quality of life instead of living in a society where we're so afraid of death that we just don't wanna die, and we're not even paying attention to whether we're happy or not right now. So I think we could work against that a lot, and we could work against these cognitive tricks, these things we do inside of us that torment ourselves. Like, I don't want the voice of someone critical of me living in my head, okay? I also don't wanna be contemplating my own existen- my non-existence, 'cause what I do then is contemplate that I'm aware that I don't exist, and I'm upset about it. That's not not existing, [chuckles] right? If you don't exist, you're not contemplating it.

    7. PAPeter Attia1:45:19

       I know. Is it-- And therein lies the-- To me, that's the, that's the greatest challenge. And, and I, I tell you that I, the people I am most envious of are the religious, right? Or, or anybody who believes in an afterlife, right? If, if you believe in an afterlife, you have a way to get around that issue.

    8. PCPaul Conti1:45:37

       Uh-huh.

    9. PAPeter Attia1:45:37

       And if you don't believe in an afterlife, then you're stuck with that [chuckles] very-

    10. PCPaul Conti1:45:43

        Right

    11. PAPeter Attia1:45:43

        ... bizarre, uh, idea that seems impossible to reconcile.

    12. PCPaul Conti1:45:49

        Right. You know, I have thoughts about this, and they're, they're not sort of fully formed, but I wonder about that. I, I think a lot of times people ostensibly have faith but, but aren't behaving that way, right? I mean, just because we're in a society where everyone's fearing death and non-existence, but many, many, many of those people are people with professed religious values. And I think oftentimes we're taught religious values when we're young, or we identify in a certain way, but we don't really, you know, we don't really know, like, what do those things mean? What do I actually think and feel? And, and I think when people do have a, say, a deep faith, could be something different, right? But I think our religious values don't really work against that very much. And, and you know, it makes me think I, I think it was Spinoza whose definition of faith was, like, the belief in something that you don't know for sure, right? And, and it's very interesting when people say they know. Like, "This is my religious values. I know that's true." I don't think that's faith, right? And I don't think our, our-

    13. PAPeter Attia1:46:49

        Hmm

    14. PCPaul Conti1:46:49

        ... philosophical and psychological heritage tells us that. I think that's a leap of something because, like, we don't actually know, right? So if you think you know and you don't have enough understanding or humility to recognize that there is a leap of faith, then are you doing something that doesn't actually help you? And this isn't me being anti-religious. I mean, I think faith is very, very important, but it's recognizing such. There is something I believe, but I do not know that thing. I believe it. Now, that's very interesting. Why does the person believe it? How do we see the beyond ourselves as opposed to just pasting something on that doesn't actually make change? Because I, I think-- What I think I'm trying to say is when, when people feel very, very sure of something, then it makes me... I, I worry about that. And when people feel very, very sure that there's nothing, I also worry about that. If you think about it, I find it quite amazing that there are so many things that we know a little bit about that, that fills me with wonderment about what else might be there. If you, you think about-

    15. PAPeter Attia1:48:00

        Yeah

    16. PCPaul Conti1:48:00

        ... things happen outside of time and space. That's interesting, right? There have been experiments done where you or I could decide what happened in the past. Not figure out what happened, but decide, right? So time, space, movement, the impact of consciousness upon the world around us, this is all so interesting. Even the things we learn about that are going on inside of our brains, you know, the, the, the cutting edge of neurobiology and neuroimaging and some of the psychedelic studies and what they've shown going on inside of us tells me I don't know what happens next. I don't know that. And I may have all sorts of thoughts one way or another. Maybe some of it comes from early education, and some of it comes from the faith I was raised in. But, but, like, I don't know, right? And, and that not knowing I find to be very, very hopeful, right? I don't know what comes next. It doesn't mean that I'm gonna rely on anything in particular, but it certainly means I'm not going to despair about non-existence. I'm not sure of that, right? And I think that's what it tells us. I think that's what Spinoza was writing about, and I think what great religious thinkers, not that I've read a lot of them, but when they're, they're, they're writing within religions, they're writing in these ways too. And maybe that engenders a respectfulness. I think if we knew that there was nothing afterwards, I would hope we could still find a way to be respectful of our lives. But the fact that we don't know what comes next is interesting, and I think to me, that's full of interest and curiosity and hope. Like, the generative drive in me gets activated-

    17. PAPeter Attia1:49:33

        Hmm

    18. PCPaul Conti1:49:34

        ... when I think about dying.

    19. PAPeter Attia1:49:36

        Why?

    20. PCPaul Conti1:49:36

        Now, it doesn't all the time.

    21. PAPeter Attia1:49:37

        Mm-hmm.

    22. PCPaul Conti1:49:37

        Right? I can feel afraid. I can feel... But, but it can get active. I think I don't know what comes next, and, and I think that's interesting. And, you know, things happen outside of space and time. They're certainly not absolute, and our consciousness may, you know, actually change things, be its own entity in the world around us, and we all have different times, and do we have different dimensions? Like, this is out there in the world around us. This is out there. This isn't pie in the sky. Like, this is academic studies, right, that are telling us these things. When I think about that and scratch the surface a little bit, I go, "Huh, I don't know." Okay? That's interesting. And I think it helps me to feel a sense of real interest and excitement about then living the best life that I can live. 'Cause if it's all I have, then I really, I want it to be good. I want it to be the best it can be for me and the people around me. But in taking care of myself, I'm better for other people, right? I say I feel invigorated by that, not afraid. And, and I think, you know, you see that in people, uh, uh, who don't fear death. They're happy with their life. They're leading life in a way that they can feel a sense of pride in. They feel humble. They feel gratitude. They're rooted in that, and there's often a sense of, not always, but there's often a sense of I don't know, and isn't that okay? Like, think about how many things we don't know, right? Can we take care of ourselves and treat every life as precious? This idea that there's nothing special about any of us, but there's something special about each one of us. And I think not knowing what comes next and the idea that if the, we think there is something or isn't, that there's faith involved, that, that, that, that's a thought process. That's a deciding on the part of the person. That comes through interest. I think that engenders us to, to be better to ourselves and better to other people, and I think then we stop fearing death, and we stop living in this kind of pseudo cult of like, I must not die, which is fed by all these fantasies and these places we can get us. Even in literature, I think about like No Exit, a, a great play by Sartre where, where like people are dead, and they're watching themselves, right? You know, that's interesting as a way of, like, learning something through the fantasy of literature, right? But there's a theme that runs through that, that we're dead and we see ourselves with despair.

    23. PAPeter Attia1:51:56

        Mm-hmm.

    24. PCPaul Conti1:51:57

        Right? And I feel pretty sure that's not happening. It would really make no sense that that happens, right? [chuckles] That there's some punishment of seeing ourselves with despair. Like, why would it be? It just can't be that. And I think if we're open to that we just don't know, and the literature and the philosophy and the world around us, it has interesting things to say, but no one's gonna tell us. Like, isn't that awesome? I think it is.

    25. PAPeter Attia1:52:21

        Paul, I wanna

14. 1:52:22 – 2:07:01

    Advice for finding a compatible therapist

    1. PAPeter Attia1:52:22

       talk a little bit about, um, how a person can find a therapist that's gonna help them be a guide through a lot of the stuff we've been talking about today. So, you know, there are a few facts that people I think are generally starting to understand, which is of all branches of medicine, um, this is one in which the interpersonal relationship between the doctor and the patient, and we'll broaden it 'cause it's not just about physician-patient, but the therapist and the patient, the interpersonal connection matters more than it matters in any other form of care between a provider and a patient.

    2. PCPaul Conti1:53:05

       Yes.

    3. PAPeter Attia1:53:06

       So it's great if you love your dentist. It's great if you, you know, have a connection to your surgeon. It turns out to not matter nearly as much. Would you agree with that statement?

    4. PCPaul Conti1:53:17

       Yeah, and I think-

    5. PAPeter Attia1:53:17

       And may-- like, I don't wanna use like as the word, but what I, I... What, what word would you use for what I'm trying to say?

    6. PCPaul Conti1:53:23

       Rapport. I mean, there've been-

    7. PAPeter Attia1:53:24

       Okay

    8. PCPaul Conti1:53:24

       ... so many studies that show how important rapport is, and yes, it is good to have rapport with one's surgeon, but it's not the primary factor presumably, right?

    9. PAPeter Attia1:53:33

       Right.

    10. PCPaul Conti1:53:34

        So rapport is very, very, very important and, and one might argue indis- indispensable, and that's why you see studies that people can come at things from different perspectives. Like, you think about the anger part. Like, y- okay, so how Andy or Katie may come at it is, "Hey, let's talk about getting a, a, a space between the anger and the response." Okay, now they also want you to understand it too, right?

    11. PAPeter Attia1:53:55

        Yeah.

    12. PCPaul Conti1:53:55

        I might come really from like the understanding, so you go to a place of humility and gratitude, but I want you to pause too, right? I mean, we're not doing different things, but we're doing what we're doing from very different perspectives that will feel very different if you're on the receiving end of it, right? And that's why when people say, "Well, if rapport matters, then does it matter, then maybe it doesn't matter what those people are doing," right? But that's not true. Like, the, the, the presumption is the therapist knows what they're doing.

    13. PAPeter Attia1:54:22

        Yep.

    14. PCPaul Conti1:54:22

        They're coming at the, the skilled part of it from different perspectives, but it doesn't matter that the therapist knows what they're doing if there isn't rapport, right?

    15. PAPeter Attia1:54:32

        So let's take that as a necessary but not sufficient piece of the equation.

    16. PCPaul Conti1:54:37

        Mm-hmm.

    17. PAPeter Attia1:54:40

        What are other things that a person should be asking themselves? And we can handle the following questions separately, but I want to address both. A, scenario one, you are going to seek the help of a therapist for the first time.

    18. PCPaul Conti1:54:56

        Mm-hmm.

    19. PAPeter Attia1:54:56

        And B, you have been working with a therapist for a long period of time, and you want to evaluate if this is productive.

    20. PCPaul Conti1:55:03

        Mm-hmm.

    21. PAPeter Attia1:55:03

        And the impetus for B is I can't tell you how many people I've met in my life who even to my completely untrained eye, which tends to be more critical of self than others, I look at them and I think, "What is your therapist getting paid for?"

    22. PCPaul Conti1:55:21

        Mm-hmm.

    23. PAPeter Attia1:55:22

        Like-

    24. PCPaul Conti1:55:22

        Mm-hmm

    25. PAPeter Attia1:55:23

        ... you, you are, you are having the exact same problems today that you had five years ago. If anything, you seem a bit worse, and yet you tell me you're seeing somebody every week.

    26. PCPaul Conti1:55:35

        Mm-hmm.

    27. PAPeter Attia1:55:36

        And again, I don't say that to be judgmental. I say that from a place of I want you to be better. Um, and maybe somebody listening to this identifies with that.

    28. PCPaul Conti1:55:45

        Mm-hmm.

    29. PAPeter Attia1:55:45

        But so, so anyway, again, y- feel free to tackle those separately, but what I wanna understand are what are the questions a person should be asking themselves of the therapist, um, and per- perhaps of themselves in those two situations to make the best choice? A, how do I find someone de novo to start? And B, how do I decide if I need somebody new?

    30. PCPaul Conti1:56:10

        There's a lot of specifics I could say about those things, and, and maybe we'll talk about the specifics.
15. 2:07:01 – 2:16:43

    The key components of therapeutic progress

    1. PAPeter Attia2:07:01

       Let's now talk about kind of, um, a, a, sort of a- another question around the person who's been in therapy. They have the therapist. Um, how often do you see a therapist whose rapport is in the way that they think of rapport, which is getting along, but they're not hitting the one plus one is greater than two?

    2. PCPaul Conti2:07:23

       Right.

    3. PAPeter Attia2:07:24

       Um, 'cause again, that's, can, that can be difficult to quantify. But, but the rapport is such that it's almost enabling the behavior in the client or the patient.

    4. PCPaul Conti2:07:31

       Right.

    5. PAPeter Attia2:07:31

       And th- there's, there's no progress being made, and in part it's be... And, and yet the, the, the client feels like, "Hey, this is great. I have a therapist. I love my therapist. I see my therapist all the time."

    6. PCPaul Conti2:07:45

       Right.

    7. PAPeter Attia2:07:45

       "I go in there once a week and tell them everything that's wrong, and it feels really great to do that." But if you're, if, if an objective person, if you were sitting there looking at this, you'd say, "Yeah, but things aren't getting better."

    8. PCPaul Conti2:07:58

       Right.

    9. PAPeter Attia2:07:58

       Right? Like, so, you know, is there value in just having a person that you pay to listen to what's wrong?

    10. PCPaul Conti2:08:04

        Right.

    11. PAPeter Attia2:08:04

        Or are you paying this person to help you become better at dealing with whatever it is that's going wrong, which might indirectly result in less frequency of these things happening?

    12. PCPaul Conti2:08:16

        Right.

    13. PAPeter Attia2:08:16

        So, yeah, and my question, I'm fumbling through it a little bit, but I think I know what you a- what, what, what I'm asking.

    14. PCPaul Conti2:08:21

        Mm-hmm.

    15. PAPeter Attia2:08:21

        Um, so, so question one, is the first critical step in that that the person themself must recognize that I need to reevaluate this relationship? And, and if so, then what are the tools to evaluate that?

    16. PCPaul Conti2:08:36

        Well, I think unfortunately, yes, in the example that you gave, because it shouldn't have to come to that. You know, therapists are people, and we know that whatever occupation you, you take, there's a significant subset of people who aren't giving it their best. I mean, that's part of humanity, too. Um, so the therapist is, is really transgressing something there that should not be transgressed. Um-

    17. PAPeter Attia2:08:59

        And you see this, right? I'm not just making this scenario up.

    18. PCPaul Conti2:09:01

        Oh, sure, this happens. Sure, it happens a lot because, again, it's, you know, it's, it's not everybody brings their best to their work, right? And for some therapists, it's okay. They, they'll let the person come and go, and they f- they kind of rationalize, "Well, they're kind of still clicking along, and, you know, they're doing okay in this way or that way." And, and they'll rationalize that what they're doing is a non-doing. They're not actually doing anything. And the obligation for the therapist is to know, "I know this person is benefiting from this. I see where we're going. So even if I don't see it now, I might see there's, I don't think there's gonna be any change for the better in six to nine months, okay? I have to accept that from week to week because I know where we're gonna get to if we do the work by the tenth month." I mean, it's just a more complicated situation. But the therapist has to know we're either achieving something now or we're heading towards achieving something that's changing this person. It's my job to be active about that, and it's my job to not get complacent, or if I see that person wants to get complacent, to, to, to talk about that with them. It's just a harder job, right? But I think it's a therapist obligation to do the job that way. Now, when that doesn't happen, then we end up in the situation you're in, you're describing. So you're, you're describing, right? Where you're saying, "Hey, this person is in this situation where things aren't getting better," and I think putting a full stop to that. Like, what am I doing here? What am I paying for, right? And sometimes that's a good question. You know, what are you paying for? You go buy a gallon of milk. You know you're paying for a gallon of milk. You go for an hour of therapy. It-- What are you g- are you going for an hour of I want to understand myself and make change? Are you going for it's an hour I talk about all the things that are making me angry the last week, and then that person gives me a little bit of sympathy, and I'm no less angry?

    19. PAPeter Attia2:10:39

        Right.

    20. PCPaul Conti2:10:39

        You know, to, to really look inside at, at what the person is serving and also how good does it feel, comfortable does it feel? It shouldn't always feel good and comfortable, right? There should be times when you're talking about something that's not easy to talk about or, you know, you're crying in therapy, you're upset in therapy. Like it's supposed to be work, right?

    21. PAPeter Attia2:11:00

        Yeah.

    22. PCPaul Conti2:11:00

        It doesn't mean it has to be work every moment all the time. I mean, there's, there's a lot of fun to it, too, and I mean, I have great fun doing therapy, whether I'm the one doing it with someone else or I'm having, doing therapy with Gregory Hamilton, who's been my therapist for, gosh, 13 years or so now. Like it, it's fun a lot too, but sometimes I'm upset or I'm crying, or he says something to me or I say something to someone that's like, "Whoa, that's... Okay, like I take that in." Like it's, you know, it's supposed to be work. That everything in life is that way too. So if it's too easy, that's not a good sign. If you feel sort of a threadbare, that's a kind of... You say it's hard to quantify when one plus one is greater than two, but you do kind of know it often in human relationships. You just feel good with someone. There's, there's something where you're more than the two of you. That's why people wanna spend time together. It's why people become romantically interested in one another. It's, there's a lot of that going on in, in aspects of human relationships.

    23. PAPeter Attia2:11:52

        Uh, let's dig into that a little bit more because it really is. I've never contemplated that at all. But, um, as you pointed out, you take two people like you and I who are very close friends. Um, the, the, it's such a clear example of that, right? Um, the, the, the-

    24. PCPaul Conti2:12:08

        Yes, absolutely

    25. PAPeter Attia2:12:09

        ... the sort of the accretive nature-

    26. PCPaul Conti2:12:10

        Yes

    27. PAPeter Attia2:12:11

        ... of the interaction. But we are friends.

    28. PCPaul Conti2:12:17

        Right.

    29. PAPeter Attia2:12:18

        And yet we don't necessarily feel that a therapist and patient should be friends.

    30. PCPaul Conti2:12:24

        Right.
16. 2:16:43 – 2:27:51

    The caricatures of four common patient phenotypes, & how to get through to them

    1. PAPeter Attia2:16:43

       I think about, you know, I was talking to one of my colleagues before this podcast about trying to organize around a few different phenotypes of people that we interact with, um, in our practice, who a- again, um, each of these examples, which are caricatures, of course, um, are people who think everything is fine with respect to their mental health, but there's an externality. Um, so, so kind of like phenotype one is the workaholic. We've talked a lot about this person.

    2. PCPaul Conti2:17:14

       Mm-hmm.

    3. PAPeter Attia2:17:14

       This is the extreme achiever. This person is so successful on the outside that you, everybody just assumes, you know, everything is wonderful. But, you know, a lot of times, frankly, when you go from the street to the porch, you realize maybe that's not entirely true, and once you step in the house, you realize that's not entirely true. Um, an- another phenotype would be kind of the, another one we've also spoken about is the, the, the op- you know, the endless optimizer, right? So-

    4. PCPaul Conti2:17:44

       Mm-hmm

    5. PAPeter Attia2:17:44

       ... incredibly rigid and controlling of everything in order to drive towards, you know, perfect health as an example.

    6. PCPaul Conti2:17:53

       Mm-hmm.

    7. PAPeter Attia2:17:54

       Um, then you have kind of the, the very anxious person who really struggles with the, the fear of the future.

    8. PCPaul Conti2:18:05

       Mm-hmm.

    9. PAPeter Attia2:18:05

       Um, and the fear of the future can be short term and it can be long term, but it can be, uh... And again, we, we should have some fear of the future that would, you know, allow us to, you know, do things that are productive. But, but obviously I'm talking about this in a, in a negative way. Um, and, and then kind of like perhaps, at least for me, the most difficult phenotype is the denier, right?

    10. PCPaul Conti2:18:27

        Mm-hmm.

    11. PAPeter Attia2:18:27

        So this is a person who by, by, by any reasonable metric is suffering, but their, their barriers to accepting that are so high that y- y- you know-

    12. PCPaul Conti2:18:44

        Yeah

    13. PAPeter Attia2:18:44

        ... you, you could almost see, you could almost make a cartoon about it, where you see a person who's missing an arm and you ask-

    14. PCPaul Conti2:18:51

        Yeah

    15. PAPeter Attia2:18:51

        ... them if you can help them because they can't do something that would require two arms.

    16. PCPaul Conti2:18:55

        Right.

    17. PAPeter Attia2:18:55

        And they look at you like, "What are you talking about?"

    18. PCPaul Conti2:18:58

        Right.

    19. PAPeter Attia2:18:58

        "Of course I can do this thing. I have two arms." "Well, but you're missing an arm right there." You know, so, um, so how do you, how do you think about someone, be it a friend, be it a physician, be it anybody trying to, to help and get through to any of these phenotypes to, to kind of put the thin end of the wedge, the thin edge of the, thin edge of the wedge in there such that they can at least make a tangible step towards self-help?

    20. PCPaul Conti2:19:34

        Mm-hmm. Mm-hmm. Well, I think the, the first thing to do is recognize, okay, that there's a problem, right? And then you go back down this idea that there are these cupboards in the conscious mind and the unconscious mind, and they're, they're, that if we go and look and scrutinize what is going on inside of us or what, or we have curiosity about what is going on inside of someone else, that we're going to find the answer, that, that this is not a mystery, that just like a Sherlock Holmes investigative process or a math problem, right, one can look at it and, and learn things. So think about the first example, a workaholic. Again, you didn't say someone who works really hard and achieves high, but a workaholic. So even the, the word by definition is a problem, right? So what are workaholics doing? Well, oftentimes they're avoiding something. Like they're, that's why alcoholics are trying to avoid something by drinking to get away from it. Like we understand that, but it's no less true with workaholic, right? There's something going on inside that person-

    21. PAPeter Attia2:20:33

        Mm

    22. PCPaul Conti2:20:33

        ... that they're afraid of, that they're suffering from, that they're ashamed of. Like something is driving this behavior. So, so I think what are you avoiding? What are you trying to get away from? Because workaholic doesn't mean you work very hard and you achieve at a high level. Workaholic means you're working when it makes absolutely no sense to work. So what are you escaping from? So, so then I think there's a defense here that is usually avoidance As a defense. And there's other defenses that come along with it. You know, the person can put kind of blinders on themselves, go in one direction, feel that that's good enough, but boy, aren't they seeing what's on the other side of it or feeling what they would feel on the other side of it. So then that becomes a point of curiosity. Like, is there avoidance? What is that avoidance? What's going on inside that person? Then you think, okay, with someone who's optimizing, always trying to perfect, no, there's, there's something different going on there which is probably more rationalizing, right? Like things-- You know, we all kind of know that things get to a place that's good enough. Everyone kind of knows that. So if the person is still trying to make something that's really solidly good enough perfect, what's going on there? Like, what, what are they, what are they serving inside of themselves? They're gonna soothe something. Some anxiety then gets soothed because they do something that's irrelevant. Like, that's not... So let's go look at, like, why, why the, why the need to focus on optimizing something that's already good enough? There's other things to do in life, right? There's other ways to spend that time and energy. Why that focus? So, you know, it's a process of curiosity. When, when people are very, very anxious, then that-- where that leads us is what's going on inside of them. The, the, the-- They may be, you know, with the younger people in my practice call it future tripping, right? Or-

    23. PAPeter Attia2:22:08

        Yeah

    24. PCPaul Conti2:22:08

        ... anticipatory anxiety. So is there a way that that person's fear about the future shuts them down, right? So that they're not doing anything in the present and they don't have to be afraid that what they'll do won't work in the future. Like, that doesn't go well, right? But, but we-

    25. PAPeter Attia2:22:25

        Mm

    26. PCPaul Conti2:22:25

        ... get into those places. So what, what is that anxiety inside? What is it about? Why is it so high? So then again, we become curious about that. I think you, you, I think you, you called denial is the hardest one when we think of maladaptive defenses. Because how do you get someone around maladaptive defenses? You're trying to help them understand, right? So if you're rationalizing, there's a little bit of a, you know, place we can grab onto that, right? Like, okay, you're rationalizing. Some of it makes sense, then it doesn't. But denial can be very, very cut and dry and very frustrating to come up against. And, um, I don't know if you've met Peter Grover, who's a, a therapist within our practice who's very, very experienced. Peter has a sign on his wall. It says, "How's that working for you?" Right? Because that's his mantra. Like, that's-- he's very, very good at helping people who are in that so difficult denial position by helping them look. Well, let's just look at, like, how's it working for you? Right. Let's just-- So because the idea is then the person's at odds with the therapist, right? So if you're like, "How's that working for you?" You can then together look out at it, right? Where Leston Havens, who I, I got to meet many years ago, who, who in, in an era when most therapists were sitting behind the patient, would sit next to them and look out at the world together.

    27. PAPeter Attia2:23:37

        Mm.

    28. PCPaul Conti2:23:37

        Right? So, so you're trying to do that. So the how's that working for you is like, okay, so I hear what you're saying. It's not saying it's right or wrong, like whether you're working or you're doing this or that. Let's just look at how it's working for you, right? And then you can sometimes get people-

    29. PAPeter Attia2:23:52

        But that, that can't really be even answered without some introspective capacity, right? Because I've, I've, I've interacted with people where maybe I didn't ask that question point blank, but I can almost imagine that if, if asked, they would respond, "Great. Everything's great."

    30. PCPaul Conti2:24:10

        Yeah.
17. 2:27:51 – 2:33:21

    How Paul manages his own well-being & the emotional challenges with his line of work

    1. PAPeter Attia2:27:51

       One final question I just wanna, wanna ask you, Paul, is about, um, how you manage internally the, the challenges of what you do in the sense that, you know, you, you, you work with all sorts of people across all sorts of spectrums and obviously we didn't talk about it today because we've spoken about it a lot in the past, but, [clears throat] but you, you know, you're gonna be very quick to look for the trauma in a person's life-

    2. PCPaul Conti2:28:17

       Mm-hmm

    3. PAPeter Attia2:28:17

       ... that probably shaped many of the adaptations that exist today. And in doing so, sometimes those things are very sad and they're very tragic.

    4. PCPaul Conti2:28:27

       Mm-hmm.

    5. PAPeter Attia2:28:28

       And, um, I, I just wonder how you, you, you manage the sadness around that for yourself. Um-

    6. PCPaul Conti2:28:36

       Mm-hmm

    7. PAPeter Attia2:28:36

       ... uh, uh, I, I think about what it was like being a resident.

    8. PCPaul Conti2:28:40

       Right.

    9. PAPeter Attia2:28:41

       You know, you-- patients would come in and they would die. You know, trauma victims.

    10. PCPaul Conti2:28:45

        Right.

    11. PAPeter Attia2:28:45

        Someone gets in a-- someone comes in in a car accident and they're dead. Uh, or you take care of them and, but you can't save them.

    12. PCPaul Conti2:28:50

        Right.

    13. PAPeter Attia2:28:50

        And those things are-- we don't, we don't really get taught how to manage that-

    14. PCPaul Conti2:28:53

        Right

    15. PAPeter Attia2:28:53

        ... at all.

    16. PCPaul Conti2:28:54

        Right.

    17. PAPeter Attia2:28:54

        I found that to be hands down the biggest failure of our, of our training system. Perhaps that's changed.

    18. PCPaul Conti2:29:02

        Mm-hmm.

    19. PAPeter Attia2:29:02

        But, but certainly when I went through, um, there was absolutely no discussion even of that. I remember being reprimanded for going to the funeral of, of a-

    20. PCPaul Conti2:29:13

        Mm-hmm

    21. PAPeter Attia2:29:13

        ... of a patient. Um, b- b- the idea being like you, that's a line you never cross.

    22. PCPaul Conti2:29:18

        Mm-hmm.

    23. PAPeter Attia2:29:19

        And, um, you, you know, you have to block that stuff out basically.

    24. PCPaul Conti2:29:24

        Yeah.

    25. PAPeter Attia2:29:25

        Um, so how, how do you deal with that?

    26. PCPaul Conti2:29:28

        Well, I'd start by saying I agree with you. I think at least in our era of training, uh, medicine did a lamentable job of that. And, and if you think about medicine, hopefully selecting for empathic people or compassionate people, and when a person is built that way, that one plus one is more than one, so you feel part of a we. If you're taking care of someone and they die, you're not that person, but, but magically is what goes on in our heads. We feel sort of part of them because we're a we. We see that with people we really love who are close to us, like they're part of who we are.

    27. PAPeter Attia2:30:04

        Sure.

    28. PCPaul Conti2:30:04

        But we, we see this in settings where we're, we're helping people too. And, and I don't know if you went through this part of it. I remember when you were talking, I remember very vividly being an intern and having to really tell myself like, "I am not this person." Right? Because I would start feeling like, oh my gosh, I could see this person is suffering and this and, and like it's easy to lose those boundaries. So to be able to say like, like I'm standing, I'm here, that person is there. The, in fact, the only way I'm gonna be able to help them is I have to know [chuckles] that I'm not that person, but it wasn't easy. And I remember one of my, uh, co-interns, and I remember he and I really talking about that and we were trying to do it for, for one another. Like, okay, like calm down a little bit. Like you're, you're not this person. Let's, let's step back from it, catch our breath and try and help the person. He probably remembers we did it for one another. And I think it, uh, for me it starts with that because that's a physical separation, right?

    29. PAPeter Attia2:30:53

        Mm.

    30. PCPaul Conti2:30:53

        And then the idea that I can mentalize a lot, meaning like think a lot and feel things. We can all do this, but like you do this when you're a therapist, you're feeling what other people are feeling. You're feeling for them. It's easy to keep that in your mind too much.

Episode duration: 2:33:56