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Dr Rangan ChatterjeeDr Rangan Chatterjee

HACK YOUR BRAIN In 3 Simple Steps To STOP NEGATIVE THOUGHTS! | Rahul Jandial

One of the world's leading neurosurgeons, Dr Rahul Jandial, explains the simple things that we can all do to stop negative thoughts, reduce stress and optimise our brain health.

Dr Rahul JandialguestDr. Rangan Chatterjeehost
Aug 20, 20211h 43mWatch on YouTube

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Transcript

  1. 0:00 – 0:00

    Intro

    1. RJ

      [instrumental music]

  2. 0:00 – 1:31

    Meditative breathing to calm the “anxiety storm”

    1. RJ

      That leads to twitchiness, frenetic thoughts, irritability. It's physiologic. There's certain things that should be released in your body, but those have been, uh, repurposed in a negative, destructive way. You'll be in the best position for you as that individual to think clearly and to have the most emotional regulation you can. [instrumental music] The lessons we learn from athletes and ballerinas and other people apply to everybody. And so when we speak about what people can do, uh, when they're stressed out on an LA freeway, um, when they're about to go into a meeting with a boss and you're anticipating something not going well, when you're coming home and your relationship hasn't been good, the time-tested method and the one that we now know... See, I don't want to just tell you things without telling you how I know and why I have the privilege to have even asked that question. To me, it's meditative breathing. It's a very powerful way to quell that anxiety storm that those instinctive structures have done. I'm gonna see my boss, and those subcortical structures are firing and they're unhappy. Much like you'd see a snake or you're at the edge of a cliff, there's certain things that should be released in your body, but those have been, uh, repurposed in a negative, destructive way where we feel that at work, we feel that at home, we feel that when we look at certain social media. How do we tamp that down? Just like we would slowly walk away from a

  3. 1:31 – 2:56

    Why breathing works: the vagus nerve and brain–body signaling

    1. RJ

      fear of heights, how do we walk away from just the general anxiety that's filled our life during the day? And I deeply, uh, believe, and particularly now because there's hardcore data, and I'll go into this a little bit, is meditative breathing. I don't know what mindfulness is. I don't know what your mind is thinking or my mind is thinking or your mind is thinking. But I know that, that the brain is connected to the lungs and the heart through this thing called a wandering nerve. It comes down. And that, that the brain can send signals down to your heart, and Buddhist monks can slow down their heartbeat. I know when I put a little coil on there for people with epilepsy, kids with epilepsy, a vagal nerve stimulator, and we send electricity, the electricity can actually go upward into your brain-

    2. RC

      Wow

    3. RJ

      ... and quell epilepsy. Epilepsy seizure is an aberrant, uh, electrical activity of your brain. Think of it as an arrhythmia of your heart is epilepsy of the brain. It's called a vagal nerve stimulator. It's been around for a while.

    4. RC

      Yeah.

    5. RJ

      This is something you can look up right now. We put electrical coil on this nerve, and it calms electricity. It's not even in the brain. But meditative breathing, deep breathing, an in, in a count of four to go in, a count of three or two, one to hold, and a slow release. If you do that just a little bit before you engage in that next stress-provoking task, it too works like a vagal nerve stimulator, without us having to do a little surgery, to calm the electricity in your brain. And you're saying, "Wow, okay, that sounds... Where did

  4. 2:56 – 5:20

    Clinical evidence from epilepsy monitoring: breathing shifts brain waves

    1. RJ

      you get that?" Well, well, you know, you know, meditation's been going on for a long time. We've seen Buddhist monks do certain things, and others, deep divers are a great example of that. But we, we know this now because a study came out last year, and children and young adults, and actually all people, if they have epilepsy, an aberrant electrical activity of the brain, arrhythmia of the brain, if... Usually it treats with medicine. Sometimes they find a little nodule we cut out. It's usually not cancerous. But sometimes we don't know where it begins. [lips smack] And it's hard to know what to do without understanding the origin of it. So they come in, and they ha- they have brain surgery. We make a big incision. We remove the skull, and we put a grid on the surface of the brain. It's not deep brain surgery. It's surface brain surgery.

    2. RC

      Yeah.

    3. RJ

      There is a difference. And then the wires come out of their head, and they have to stay in the hospital for a week, and that's recording them 24/7, waiting to catch that, that, that firefly, that, this origin of the seizure. Where is it? 'Cause then with radiation, you can zap it and you can cure them of it, okay?

    4. RC

      Wow.

    5. RJ

      So it's meant to be therapeutic. But what are they doing for that week when they're just kicking back, getting bored? So in come all the neuroscientists from San Diego, the highest per capita is out there, actually, on the ocean cliffs-

    6. RC

      [laughs]

    7. RJ

      ... of San Diego. They come in and say, "Hey, can we hang out with you?" And the recording's going on.

    8. RC

      Wow.

    9. RJ

      And they actually ask them, "Let's do certain tasks." And then they d- went through, like, meditative breathing with these patients and these kids and these young people, and they're watching the electricity change and get closer to that alpha wave, get closer to the calmer electrical signals in their brain after just deep, slow, deliberate breathing. And that's accessible to us all without having to pay for it. So-

    10. RC

      Yeah. But that's the great thing

    11. RJ

      ... that way-

    12. RC

      It's free, right?

    13. RJ

      Oh, yeah. I m- The book is not, is, is meant to be all the magical things that are right there. I mean, you could... When you pull into work before a big operation, I'll take a few minutes and just [inhales] and just slowly breathe.

    14. RC

      Yeah.

    15. RJ

      Medi- And you can find an app, and it sh- It's a count of four in, hold for a couple, and a count of four out. And then what happens is you don't have to count as much. Um, it, it becomes a habit. It becomes a part of your routine. It's free. You don't have to do it for 30 minutes. You're not gonna be walking on coals and all the exaggerated peop- uh, exaggerated things, uh, people think about. It is a resource available to you that has been harnessed for s- for millennia, and that now you have crazy brain surgeons-

    16. RC

      Yeah

    17. RJ

      ... providing you the electrical proof if you're a skeptical kind of person. To me, that's magic.

  5. 5:20 – 8:31

    Making “just breathe” practical: simple patterns, apps, and everyday timing

    1. RC

      Yeah. Absolutely. And, and I think, you know, it, it brings a lot of weight to this, to this term "just breathe." I mean, it's, it's-

    2. RJ

      Mm

    3. RC

      ... deceptively simple, but it really works. And I know this year I've been giving a lot of, um, talks to companies about wellness and how they can improve productivity. And what's really interesting is that, uh, a breath that I sort of use with my patients, something I've written about a lot, is the three, four, five breath when you breathe in for three-

    4. RJ

      Mm-hmm

    5. RC

      ... you hold for four-

    6. RJ

      Mm-hmm

    7. RC

      ... and you breathe out for five.

    8. RJ

      Yeah. Perfect.

    9. RC

      And when I'm talking to people, a group, I'll, I'll, I'll often, we'll collectively do just one of those breaths together-

    10. RJ

      Mm

    11. RC

      ... which takes about 10 or 12 seconds.

    12. RJ

      Yeah.

    13. RC

      And I ask people straight away, "How do you feel?" Uh, have, can you feel a difference-

    14. RJ

      Mm

    15. RC

      ... just on one breath? And about 80% of people put their hand up, and that's just one breath.

    16. RJ

      Mm.

    17. RC

      You do that a few times-

    18. RJ

      Mm-hmm

    19. RC

      ... as I say to them, five of those three, four, five breaths takes one minute, you will put your body in a different state because breathing is like information for your body, and it's responding. So-

    20. RJ

      Yeah

    21. RC

      ... it's interesting that, you know, you as a neurosurgeon before a big operation will use breathing.

    22. RJ

      Yeah. Thank you for that, and thank you for, um, allowing people to find things about themselves, uh, that can help themselves. You know? 'Cause that in itself is power also. And, you know, I c- I'm from the States, and I'm from Los Angeles, and it has become a bit commercialized, that people think medit- uh, it's actually breathing. I- e- the meditative component is, I like to call it meditative breathing because it lets people know it's gonna help them meditate, whereas a lot of people say, "I don't know how to meditate. What do you mean? Just think about Mount Everest, or do I have to buy yoga pants and be in Malibu and-

    23. RC

      Yeah

    24. RJ

      ... and drink green juice?" It's just become so, uh, uh, so distracted from the esse- the essence of it, which is deliberate breathing, just breathing. And what happens is, i- if for people who are thinking, "Well, gosh, that can't work," is well, you got nothing to lose.

    25. RC

      [laughs]

    26. RJ

      You're, you've, you're equipped with it, and I think many people, I'm not saying 100%, they'll find that that's a wonderful habit to add to their life to turn down the anxiety. Even if it just creates a pause before you go into an anxiety pr- provoking situation and lets you get your thoughts in order as well as, uh, get your instincts under control so you don't go in there say something outlandish or over the top, it's a great break in the day. It's a few minutes, and I like to do it, uh, before I go to bed. I like to do it before a big case. I like definitely do it before a meeting or a conversation. And sometimes, like bef- when I came here, I didn't wanna do it. I'm, uh, you know, I, I don't want people to think I'm some yogi master with all the [laughs] ... I don't have any of it. I am breaking the rules and going hard in London. I am not doing meditative breathing before this 'cause I wanna just be loose, and I wanna be disinhibited. But if I were anxious, and this doesn't provoke anxiety in me-

    27. RC

      And, and I hope I'm not stress-inducing you-

    28. RJ

      No

    29. RC

      ... being on this show. [laughs]

    30. RJ

      I love it. I mean, I, this is... You know, you're, uh, you're offering me a creative avenue. That's, that's the bucket in my mind that this interaction right now-

  6. 8:31 – 11:31

    A vivid medical example: hyperventilation’s impact on the brain

    1. RJ

      It's such an easy way and a smart way to get close to the flow state, turn down the anxiety. And I'll give you one last example. You're saying, "Okay, eh, I s- I believe him. I don't believe him. I, you know, I j..." Okay, take you to a gnarly story again. There's this rare, uh... You know, f- uh, the perturbation of the system is what sometimes reveals the, the mechanics, you know? So there's a disease called moyamoya. The Japanese, uh, people get it more than the rest of the world. Nobody knows why. I had a patient, a kid, and basically you have these four arteries popping off your heart going into your brain, and sometimes right when they pop through the skull, rather than breaking into this beautiful tree of small blood vessels, they get, uh, they get clogged at a young age. And these kids, um, develop this fine blood vessels, this vasculature that's very sensitive, uh, to breathing. And when we, when we have surgery that needs to be done on those patients, we have to tell the anesthesiologist at, at the end, "Don't let this kid cry," because if they cry and hyperventilate and breathe too fast, the signals will be sent to the fine blood vessels to shrink. Hyperventilation, skittish breathing, is a squeezer of blood vessels that can clot off the work of our surgery in kids. This is a prove... I, I, like, it's been 20 years. Don't let kids cry after moyamoya repair at a children's hospital. All the neurosurgeons can talk about it. So there's biology to slow breathing working through the vagus nerve.

    2. RC

      Yeah.

    3. RJ

      And then there's also biology to, to rapid breathing and hyperventilating being, uh, not good for the brain in certain conditions. So there is basis to breath controlling mind.

    4. RC

      Yeah. Incredible. Um, I'm gonna move to practical tips for us, what we can do in our lives as adults to help-

    5. RJ

      Yeah

    6. RC

      ... improve our brain health. But before we go there, you, when... Kids are coming up a lot. Yes, that, that example you just gave, I've had the pleasure of meeting your 14-year-old son who's just-

    7. RJ

      Thank you

    8. RC

      ... he's, he's lovely, really, you know, it's just incredible just to say hi. And, and for me, actually, it's really nice to see you traveling with him on a PR tour, and it makes me think. It's something I've thought about for years. God, I'd love to take my kids with me, but often we think, "Actually, no, it's better for me just to go and do my work and then come back." But, but actually just seeing and hearing you say how rewarding that experience is for you and your son, i- i- it, it makes me think about, um, reevaluating how-

    9. RJ

      Thank you

    10. RC

      ... I do these things, so thank you for that. But I wanna go d- deep into kids here.

    11. RJ

      Yeah.

    12. RC

      So you, in the, at the start of your book, I think, it was interesting to me how your knowledge as a neurosurgeon has in some ways shaped-

    13. RJ

      Mm-hmm

    14. RC

      ... what you do with your children. And it's really to do with that attitude to risk.

    15. RJ

      Mm.

    16. RC

      Some of the things that we might perceive as risky, you allow them to do, I think, I think it was climbing in trees, for example.

    17. RJ

      Mm-hmm.

    18. RC

      But some of the other things that others might allow them to do, like crossing a road-

    19. RJ

      Mm-hmm

    20. RC

      ... you're pretty strict on. I wonder if you could elaborate.

  7. 11:31 – 18:34

    Parenting through a brain-science lens: stimulation, touch, and early stress

    1. RJ

      Yeah, [laughs] that's... So first of all, my wife, uh, uh, unexpectedly got pregnant. Now, I say unexpectedly because she was an OBGYN in training, and I was a neurosurgeon in training, and she's like, "I'm pregnant." I said, "Well, that was 100% your jurisdiction. [laughs] I thought you had that under control." So we had kids when we were in training back when those hours were 40-hour shifts, so it was nuts back then, right?

    2. RC

      Wow.

    3. RJ

      I mean, she was... So we, and my siblings and her siblings were not the oldest, but we had kids first, and there was, like, a generation gap where I hadn't, I hadn't s- seen kids being raised for a while. And so she and I just kinda made up our own stuff. You know, she's, uh... So we brought in a lot of, uh, what I call diversity of interactions, partly by necessity, partly by choice. Uh, we put them in a lot of different schools. Uh, we put them in a lot of different faith-based schools, secular schools. We took them to a lot of different places. They ate a lot of different food, a lot of different music. Grandparents, nannies, we did all those things. And- Part of what motivated me is when I, my, had my kids when I was also in the children's hospital, and I remember reading this study, uh, uh, and people were suggesting, and I think later on an orphanage in Belarus proved it, uh, such a sad case, but an, an illustrative one. So I always like to tell you my story-

    4. RC

      Yeah

    5. RJ

      ... and it can be sometimes too intense and maybe even a bit macabre, but that lets you know, like, why, why, I mean, why would we ask this guy about kids? Well, first I got three teenage kids. Uh, I, I do children's brain surgery around the world, uh, usually in East- Eastern Europe and Cen- South America. Uh, but the kids in an orphanage that were left alone and not tended to, the, the beautiful undulating pattern of that brain, which is like a... The reason it's like that is, like, imagine taking a giant pizza and squeezing it like an accordion to put it into a box. It gives you more canopy square footage or square-

    6. RC

      Yeah

    7. RJ

      ... kilometers, if you will. And what happened was they started losing the ridge 'cause they-

    8. RC

      Wow

    9. RJ

      ... they needed less parts of their brain. The brain is an energy hog. If you don't use it, it's tw- it's three pounds and it uses 20% of the blood flow. 20% goes to that thing in our skulls. So it's not advantageous to feed parts of the brain that you're not actually using. It'll start to wither. And I-

    10. RC

      He- hence your use it or lose it.

    11. RJ

      Yeah, but in a, in a, in a, in a way that that's an active process at the structural physical level. Parenting in a, in a way that would preserve the, the flesh inside my children's skulls was important to me. And then at a microscopic level, I was getting my PhD then, and we were seeing this thing called synaptic pruning. So i- in some ways, the, the biology of the brain is very landscape architecture. We use words like pruning and dendr-

    12. RC

      Yeah

    13. RJ

      ... and dendrites. And you are born with more brain cells, all of us, than you're intended to keep.

    14. RC

      Right.

    15. RJ

      And the ones you keep a- as a toddler, when you're young, are, are the ones that were tickled, that were engaged. And we know that, again, because if somebody's born with an eye that doesn't work, that part of the brain starts with brain cells, but if it's not using it, it'll let those things wither. So my parental approach, and I don't e- I don't know if it's working or not, it's not even about the outcome. I did, I took the best approach I co- I could.

    16. RC

      Yeah.

    17. RJ

      I just took them to all different stretches of experiences. I had them doing, uh, you know, free running for one, one summer. They, they, they dabble with some music. We've traveled all over the world for pleasure, languages, food, constant interaction. And, and, and for example, what better thing for my 14-year-old son to come here and find himself, uh, having the confidence-

    18. RC

      Yeah

    19. RJ

      ... and the ability to navigate London coming from Los Angeles? That's my gift to him, uh, as, as a father. I'll let school do the algebra [laughs] and the geometry and the, and the grammar. I actually don't do homework with them. It's kind of a weird thing. I'd rather just chat with them like we're talking. I'll take a pull, interesting article and I'll be like, "Let's talk about this. I just wanna hear how you think."

    20. RC

      Yeah.

    21. RJ

      "Just keep up with me and talk to me. Teach me."

    22. RC

      It, it's interesting. Loads of new ideas there. What about, what about the, you know, the orphanage you mentioned?

    23. RJ

      Oh.

    24. RC

      What was going on there? So why were their brains, you know, adapting in the way that they were?

    25. RJ

      Yeah.

    26. RC

      Was it a lack of touch?

    27. RJ

      Yeah.

    28. RC

      Was it, you know-

    29. RJ

      All of it. Uh, that's, it's funny, lack of touch. The 40 hours when I was doing those shifts, I, I missed my kids. It was for a few years. And they were telling us not to have the kids in their bed, and I'm not trying to come up with policy or give-

    30. RC

      No, no, I get it

  8. 18:34 – 25:01

    Risk decisions for kids and the brain cost of outsourcing navigation

    1. RJ

      Yeah. No, it- I worked at a children's hospital, and I saw how kids die. So I [laughs] apologies to the audience, this is just who I am. I always learn from things, and I have intense experiences. But we saw kids choked, they fell out of second story windows, they were burned, and they got hit by cars, all these ridiculous SUVs, giant vehicles and fast roads. And so when they were younger, I wanted them to be safe because, uh, pediatric mortality frankly is, you know, that's the first thing you wanna avoid. So that's why I didn't d- I didn't mind if they fell out of a tree, and they've, they've taken [laughs] they've taken some scrapes. The one that's here now has got a scar from his forehead, he drove in- you know, rode his bike into a garage. Because I, again, I saw from children's hospital that's stuff they heal from. And so that's why I didn't, at that time, want them to be crossing the, crossing streets and stuff like that. In the neighborhood people were-

    2. RC

      'Cause you're looking at death.

    3. RJ

      Yeah.

    4. RC

      Not an injury you're hearing from.

    5. RJ

      F- first you gotta get them to th- live. You gotta feed them and get them to live, and then you can do all those things we talked about by diversifying. And what are we robbing our kids from by letting them push the navigation app? So that's interesting. It, it's okay [laughs] in my opinion, I don't want them to be memorizers. It's okay for them to have all the capitals of American [laughs] states that, that we used to have to memorize in their pocket. I'm like, "I don't care if you get a good grade on that. That's not really what I... I'm not trying to grow robots." So that kind of memory and loss of capacity I'm kinda okay with. But there's another type of memory called working memory, uh, where they can juggle a lot of things. "I gotta get to school, I got this text." Multitasking, that's really a skill. That's what, that's what we all wanna do better in a, in a calm fashion, right?

    6. RC

      Well, there's some neuroscientists will say that y- it's impossible to multitask. I, I've read that from many neuroscientists. There's a book, I don't know if it's The Organized Mind where it says it.

    7. RJ

      I've seen that.

    8. RC

      But I, you know-

    9. RJ

      Yeah, and I just completely disagree. You know, the high- highly functional people I know, my kids, they can do a lot of different things. Not necessarily eight projects on the kitchen table at the same time, but I mean multitask eight different things that need to get done during the day without dropping the ball-

    10. RC

      Yeah

    11. RJ

      ... and connecting them in a seamless fashion. I think that's, that's called working memory. I think that's important. The particular thing-

    12. RC

      So it could be we're talking about different things.

    13. RJ

      Yeah.

    14. RC

      Yeah.

    15. RJ

      So exactly. So it, it, uh, just raw memorization of phone books, I don't mind if they leave that, lose that. Able to get through the day and not drop the ball and know what comes first, what comes second, priorities. As you know, when the acutes came in you had to take care of the... Triaging is-

    16. RC

      Yeah

    17. RJ

      ... working memory. And then, but the navigation one I have, I'm particularly opinionated about. I don't like them to press the route app. And you say, "Well, where does that come from? Why, is he just, is he making that stuff up, or where does he get that?" The temporal lobe actually has, uh, grid cells, G-R-I-D. Neuroscientists have found that there are cells in particular clusters of tissue in the temporal lobe that help you with spatial navigation. And so what I tell my kids is, "Come on, you [laughs] gotta be good at this," because this sta- this spatial navigation is that cognitive reserve that you build now, is what people lose in dementia. When people have Alzheimer's they can't find their way home. It's in that same space. So building up spatial navigation is good for you now, it's good for when you're older, it's good when you're a surgeon, it's good if you're driving, and those grid cells are important to cultivate. So what we do, uh, and many people do it their own way, but for my sons, if we're going somewhere in Los Angeles, uh, or even around the world, let's just look at the map. You can press route if you want, but then you gotta put it away. 101 South, 10 East, exit this, make a left. So I want them to think about the sequence of navigating, uh, an environment. And if you think about it, it was probably useful thousands of years ago-

    18. RC

      Yeah

    19. RJ

      ... in the savanna. Like, which cave, which rock? That's a very important skill to have, and it's deeply rooted in neuroscience and biology in our brain.

    20. RC

      Yeah. I, I love it. It reminds me a little bit, and, and I, I, I've gotta be honest, my tendency is to go a bit extreme on things sometimes. When I apply them to myself, I'm really kind and compassionate I hope to my patients, and a lot more relaxed. With myself I can be quite tough sometimes. And, um, when I used to do a lot of, uh, house visits or house calls I think you guys call them, uh, from, from general practice, um, I remember I, my car did not have a sat nav at that time.

    21. RJ

      Mm.

    22. RC

      Still doesn't actually. [laughs] And I was quite resistant to using them, so what I would do is when I knew I've gotta go and visit these three patients, I'd write down their address, I'd look on Google Maps as to roughly where they were in relation to the surgery, the, where I was working.

    23. RJ

      Mm-hmm.

    24. RC

      And I sort of go-

    25. RJ

      Try to hold onto that

    26. RC

      ... I'd lock it into my head, and then I'd go to my car and sort of try and picturize it and go, "Let me see if I can figure it out and get there." And I guess what I didn't realize I was doing, uh, is that I was working out these grid cells.

    27. RJ

      Yeah, yeah.

    28. RC

      Which I feel pretty good about myself now that I was doing it. But no, it's, it's interesting, isn't it? That it-

    29. RJ

      All my suggestions I want there to be a scientific basis.

    30. RC

      Yeah.

  9. 25:01 – 27:28

    A 24-hour framework for adult brain health: fasting, food, breathing, and movement

    1. RJ

      And I thought about how to explain that so it's not too much of a listicle for people. And let's, let's do a 24-hour day about, um... I'm just, I'm just thinking about this now, and I'm just gonna take you through things you can do, um, y- if you have the luxury. So first of all, food. I mean, people are starving in this world, and food scarcity and bad food. I, I'm respectful of that. That said, um, if you wake up, consider skipping breakfast a couple of times a week. In neuroscience journals, and from what we know about the biology of it, that intermittent fasting, going 16 hours a couple of times a week without eating glucose will, your liver will run out of its glucose reserves. It'll burn fat into these things called ketones. The brain is a hybrid vehicle. It's not all gas. It's not all electric. It likes both. And so if you have dinner at 8:00, and it's Monday evening, consider having, uh, your next meal be midday the next day. That's an easy way to get to 16 hours. It doesn't mean you're fasting for days and days. There is neuroscientific literature that intermittent fasting is good for attention and focus. Okay, now it's lunchtime, and you're thinking about what to eat. Before that, I would consider taking five minutes, um, to just breathe deeply like you're doing now. Just take deep breaths a couple of times a day, three times a day for three minutes. Make it easy. See how that works for you. Just the pause might be helpful. Now it's time to eat. The food you choose is important, and [laughs] I... There's delicious food to eat that's actually good for your brain. And how do I know that? Well, we don't have a pill for Alzheimer's, but we do have the MIND diet, which is essentially Mediterranean food, um, that if you look at a group of thousands of people over a long period of time, they had less dementia. So now that you've figured out the cadence of eating, which is intermittent fasting, skipping breakfast a couple of, uh, days a week, now that you've brought in, uh, pre-lunch three minutes of just deep breathing, that's meditative breathing, choose plants, choose nuts, choose occasional fatty fish. The fatty fish has omega-3s, which is an essential component of your f- of, of your brain. It's the wrapping around all those connections that keeps those electrical signals firing faster.

  10. 27:28 – 30:48

    Diet nuance and exercise specifics: vegan questions and strength training

    1. RC

      A- a- and on that point, given the growing tendency to follow a vegan diet-

    2. RJ

      Mm-hmm

    3. RC

      ... in your opinion, can that be problematic?

    4. RJ

      Yeah. Uh, I don't think so bec- This is a good question. I was asked this at, uh, at Stella McCartney's yesterday, and there are good nutritional sources, uh, for B vitamins as well as omega-3s. I don't have the, the names of those jars, but-

    5. RC

      So they, they can supplement.

    6. RJ

      Yeah.

    7. RC

      If they're choosing to go vegan-

    8. RJ

      Yeah

    9. RC

      ... they-

    10. RJ

      They can-

    11. RC

      You would recommend they supplement with something containing omega-3-

    12. RJ

      B vita-

    13. RC

      ... and, and B-

    14. RJ

      Well, B vitamins. But if they supplement omega-3s from fish oil, then they're not vegan anymore.

    15. RC

      Sure.

    16. RJ

      But there are other supplements. And what I als- also say is the benefits of being vegan, if you can pull it off, are so great that a little bit less omega-3s because you're not eating fish, I think it far out, uh, you know, far, far exceeds that.

    17. RC

      Is that, is that... Are you saying that relative to the standard, uh, of course, you live in America, so the standard American-

    18. RJ

      Yeah

    19. RC

      ... or the standard Western diet-

    20. RJ

      Yeah

    21. RC

      ... relative to that, are you suggesting an inc- increasing plant foods is generally a good thing?

    22. RJ

      Absolutely. Not only is it, it's, uh, good [laughs] for the animals that you're not killing, it's good for the planet, but it's actually what your body prefers. It's healthier for you. And if you wanna eat meat, uh, consider the Mediterranean diet, where it's fatty fish and, and poultry. Pass on the beef. Pass on the fried food. Pass on the, um, processed food. Now, if you do have a burger [laughs] , you're not gonna undo what you did. Just make those things an indulgence rather than a habit. So now you're at lunchtime. You've chosen the Mediterranean diet, more plants, less meat, the right kind of meat, a- and your day goes on. And then the question is: What's next to improve your health? A bit of exercise is great. The brain likes exercise because it is flesh. Don't, don't clog the plumbing to your garden, because swaths of your garden will wither. So people have strokes and injuries. It's because blood flow is not getting into their brain. That's the way to hurt the structure of your brain. So what's good for the heart is good for the brain. Then the other thing it does is it bathes itself in these, uh, neurotrophic factors. That's what my science is on, BDNF, brain-derived neurotrophic-

    23. RC

      Okay

    24. RJ

      ... and so that's what my grants are on. When the brain exercises, it showers itself. It's not like thigh muscles release, uh, healthy brain chemicals that swim up there. It's got its own pharmacy. You give it the right behavior and interaction, it'll reward itself. So exercise keeps the plumbing open to the flesh of the brain as well as releases molecules that serve as mirac- miracle grow for the brain. A couple times a week is a good place to start.

    25. RC

      Do we know what specific exercise is good for the brain and good for BDNF levels, or, or is it a mix?

    26. RJ

      We don't. Well, some people are starting to suggest, uh, some strength training is an essential component.

    27. RC

      Sure.

    28. RJ

      So if you're just running a marathon, you might wanna throw in some light weights. But more, a little bit more exercise than you're currently doing-

    29. RC

      Is a good thing

    30. RJ

      ... is, is what the brain's gonna say, "Hey, I like this direction. I'm gonna shower myself with BDNF."

  11. 30:48 – 33:46

    Challenge and creativity: unfamiliar reading, learning, sleep transitions, and note-taking

    1. RJ

      ... is a first step. Next thing you know, you're walking. Next thing you know, you're taking the stairs. Uh, so these are simple things. These are free things. And, um- So exercise, and then the day, the day moves on and you're getting to the evening. Uh, if you can, I like to read something completely unfamiliar. I've got a stack of old magazines and just flip through. Just, just n- new content for your mind. And I think it's, since it's thinking flesh, and of course it likes blood, it likes to be irrigated, of course it likes a certain kinda diet because of the components it needs, but it also wants to think. If you ask Usain Bolt, I mean, how do you get your thigh muscles stronger? He'd say, "Take some stairs." Well, how do you get your brain to be healthier? Think. And everybody's level, next level of thought and challenge is individual. We don't all have to do the same puzzles. We don't all have to have the same career, but get out of your comfort zone, if you will-

    2. RC

      Yeah

    3. RJ

      ... just with the thoughts. So flip through something different on your phone. Read something different on your phone. Develop a new habit. I think that's important. And then for those of us who have, um, creativity as an ambition, and I have the luxury of having, uh, creativity as an ambition because cutting out a cancer from somebody's brain is a three-dimensional thing. Uh, understand, trying to guess what Mother Nature is, how Mother Nature is working in science is a creative thing. W- I'm not a technician. Uh, I'm not a, I'm not an intellectual, frankly, in the end. I, I'm an instinctive person who wants to harness his creativity. So, um, you know, people are microdosing. People are doing different things, but we're, you know, those, that requires pharmacological intervention. I don't support that. What I would say is we're all wildly creative in our dreams, and people are finding that when you, uh, on the transition from awake to asleep and from sleep to, uh, waking up, it's called hypnagogic and hypnopompic. There's actually those same alpha waves that we've been talking about. Just for 10, 20 minutes as you drift, uh, into sleep and your tasks are done, and Salvador Dali mentioned that, and like he uses sleep as a psychedelic tool for creativity to solve problems. It's not gonna happen every time, but I like to look at my riddles at the end of the night in my, and, and I have a notes app, and I write a few things, and I wake up, and I write a few things. That transition is like sort of a strange portal to your subconscious, and again, based on science, if you put some electrodes on a brain, at that time you have those alpha waves that we talked about, awake but focused and calm, and you also have these other waves, these delta waves, that waves that are, um, light sleeping, early dreaming. It's the only time where you have both awake and asleep waves.

    4. RC

      And, and I've heard in one of your articles, uh, sorry, I've read in one of your articles that you say leave a pen next to your bed-

    5. RJ

      Mm

    6. RC

      ... so that you can actually take advantage when those creative thoughts come just before bed or just when you wake up. You, you can actually just jot them down and-

    7. RJ

      Yeah

    8. RC

      ... and, uh, yeah, that's, that's incredible. You, you said learn new things.

    9. RJ

      Yeah.

  12. 33:46 – 37:40

    Learning and brain plasticity: languages, music, and the non-dominant hand

    1. RC

      Um, how important can learning a new language be?

    2. RJ

      Oh, it's an essential thing, and whether you get it right is actually secondary. [laughs] It's the, it's the process of trying to learn.

    3. RC

      Yeah.

    4. RJ

      So language, music, the act of learning makes your brain say, "God, I gotta pull from different pathways. I gotta get to different corners of my mind." It's actually an energy-consuming activity, and, and that's what engages the, the greatest corners and recesses of your mind is to learn new things, particularly music, particularly languages, social interactions. We know these things, and now I'm just trying to give you a biological basis-

    5. RC

      Yeah

    6. RJ

      ... that brain's efficient if it wants to fall into its rut, and breaking the rut in a constructive way is gonna be good for your brain globally as your mind, thoughts and emotions, as well as the flesh. It, that's, that's one strong way to stave off dementia.

    7. RC

      Yeah, a- and that's very powerful. You know, keeping your brain active, trying new things, and I think what you said was super empowering. It's not about whether you can actually master that language.

    8. RJ

      Yeah.

    9. RC

      It's not about whether you master playing the piano.

    10. RJ

      [laughs]

    11. RC

      Just the process of trying to-

    12. RJ

      Yeah, yeah

    13. RC

      ... that's gonna do all the groundwork and, and-

    14. RJ

      Yeah

    15. RC

      ... all the sort of heavy lifting in the brain, which i- which is super empowering. Doing things with your non-dominant hand.

    16. RJ

      Mm.

    17. RC

      I'm asking, A, 'cause I'm interested, but B, it's something that I often do with my son. Like I've, we've been playing, uh, table tennis. Do you call it table tennis-

    18. RJ

      Mm

    19. RC

      ... in, in America-

    20. RJ

      Mm-hmm

    21. RC

      ... or ping pong? Um-

    22. RJ

      Both

    23. RC

      ... we, we've, you know, we've been playing that in the back garden, and, um, sometimes we'll try and play with our left hands.

    24. RJ

      Mm-hmm.

    25. RC

      We're both right-handed.

    26. RJ

      Mm-hmm.

    27. RC

      And, and Daddy says to him, "Hey, yeah, this is really good for your brain, this. You know, try and do it with your left hands."

    28. RJ

      Yeah.

    29. RC

      What's going on there, and is it good for your brain?

    30. RJ

      Yeah. It is. I'm a two-handed surgeon. Neurosurgery requires the use of left and right, so to facilitate that, I had a mentor when I was younger say, you know, "Put your right arm in a sling for a little bit just, just, just to be crazy, just to be, just to see how that goes." And over a few weeks, it's awkward, but your left hand, if it's your non-dominant hand, it can catch up quite a bit. And that, that effort to learn how to use parts of your body that, that you weren't, you know, relying upon is what I learned about from my patients. You know? When they have injuries, when they come in with stroke or they've had a brain tumor removed, sometimes they have weakness in their arms and legs and their ability to speak. They have these, um, central nervous system issues and, and they have to rely on what's left. Um, and that is a very powerful thing because when they come back to clinic three weeks later or you see them three months later, they're quite facile, and that is brain plasticity. That is brain rehab. Relying on extremities, relying on thought, relying on communication that you wouldn't have originally had. So when I use my mouse with my left hand, I force myself to do that or chopsticks, and I encourage my kids to do that. What it's doing is the left hand, for me that's non-dominant, is controlled by the right side of the brain. That part of the brain, if you don't engage it, will also start to wither a little bit.

  13. 37:40 – 40:07

    Four practical priorities: move, eat differently, train the brain, pursue happiness

    1. RC

      Yeah. Incredible. Rahul, look, just to finish this off then, I know we've gone through tips, but if- I'm gonna push you a little bit here.

    2. RJ

      Sure.

    3. RC

      Um, I always like to leave the listener with some really actionable, practical tips that they can apply in their own lives immediately to improve the way that they feel or improve the way that their brain functions. So what are your top four tips-

    4. RJ

      Sure

    5. RC

      ... for people listening to this that they can think about applying to their own life?

    6. RJ

      [smacks lips] Um, one would be, uh, get vertical. That's the most essential thing. When I see our patients who can come out of a bed and stand, they, they grow. You can see a withering flower come back to life if they can get vertical. Being standing and moving is very important for your frame.

    7. RC

      Okay.

    8. RJ

      Wherever you're at, just do a little bit more. Two, make subtle but important changes in your diet. Get rid of the red meat and fried food. Add in some more of the Mediterranean diet. You're still gonna enjoy what you're eating. You can have a glass of wine. Salmon, red wine, yogurt, fruit. It's not a tough thing. It's just changing the direction of what you're eating. Uh, the other things that I would do is I would consider, I would consider getting some of these apps. Now, it's an interesting place to start. I don't know which ones I'm recommending, but there are brain training apps.

    9. RC

      Yeah.

    10. RJ

      Brain training works. Certain governmental agencies are using it. We use brain training as brain rehab in our patients. Find some puzzles, find some content, read a book, do something unusual. Uh, that will also be good. And the fourth one I would say is, you know, try to find happiness. It's the most elusive thing, but we also know that people who have mental health issues or people who are depressed, their brains start to change. They are brain injured from the way they are thinking. So if it's within your power to be happier, to pursue relationships and crafts that make you happy, that will probably be the best thing for your brain.

    11. RC

      You mentioned balance between thoughts and emotions, and I think that's a really interesting concept to unpack a little bit.

    12. RJ

      Mm-hmm.

    13. RC

      I've heard in a previous conversation that you've had that you said that depression, anxiety, OCD, and overeating all come-

    14. RJ

      Mm-hmm

    15. RC

      ... from a similar part of the brain, and that again, with these conditions, there can be a problem with this balance. So-

    16. RJ

      Right

    17. RC

      ... I wonder if you could explain some of that, please.

  14. 40:07 – 48:49

    Thought–emotion balance: when vigilance helps and when it hijacks life

    1. RJ

      Yeah. So I mean, this is, um, it's gonna take a little while for me to set up, but I, if, you know, if-

    2. RC

      Hey, if you've got time.

    3. RJ

      [laughs] Okay. But it's very important, um, to me, um, that we've lost the nuance in our understanding. So let's just take a few simple examples. Inflammation's bad. Is it? I don't know. I mean, certain types of inflammation are bad, yes. If you are constantly stressed out and you've-- that's also generating an inflammatory response, that's horrible for you. Certain types of inflammation are necessary. But now let's get deeper with emotions and feelings and anxiety and these sort of things, right? There's a certain amount of anxiety that is appropriate. You should have situational anxiety. That's by design. That's protective. But when there isn't a threat and you're too vigilant and too anxious, not only is that unnecessary [laughs] and wasting precious calories if, if, you know, you're in the savanna or, you know, thousands of years ago, it actually is unhealthy for your brain and mind. You're not living well. Because you're anxious, but there isn't a cue for that. If you're anxious on the s- the day of the scan, hey, that's, that's what you're s- that's normal.

    4. RC

      Yeah.

    5. RJ

      That's what you, you want. Otherwise, then-- otherwise, I get worried that you're not really understanding the gravity of the situation. So, so there, the, the, the thermostat or the dial or the balance is very important to understand, that there is no... Let's take another one. Addiction. That's a, that's, the balance is off. But those same pathways, the same chemicals, uh, the branching in, in the gardens of our mind that, that lead to addiction are also the ones that get you after your friend's spinal surgery to get up and try to walk. Also the ones that get you to try to go to the cancer center despite the odds, right? So that reward is a double-edged sword.

    6. RC

      Yeah.

    7. RJ

      Anxiety and vigilance is a double-edged sword. Inflammation is a double-edged sword. That's the efficiency of the design. It isn't-- It's not on/off. It's, it's, it's tone. It can be modulated. Uh, that way everything inside us can help or hurt. With that comes responsibility. So now that we, if we think about, um, let's get back to, uh, you know, OCD, anxiety. Let's think about these things. These are... The simplest way I can prove to you that they are a product or an outcome or That come from the ether of our emotional brains, and it's a simple term, but I'll get into that, is that when we manipulate them with little electrodes called deep brain stimulation, you t- you... We don't tickle the surface right under the skull. We don't tickle the, the frontal lobes where cognition, executive function, thought, um, creativity even is. We, we tickle deeper to the emotional brain, limbic system structures. Words you've heard before, amygdala, hippocampus, these kind of things. Structures that, uh, animals have also.

    8. RC

      Yeah.

    9. RJ

      So tho- that tells us that w- that the, the emotional brain is not in balance with the thinking brain in some of these situations. And so let's, let's get deeper into that. So when the reptilian brain, which is through your mouth, it's through your mouth and, like, in this direction, uh, it, it didn't morph into the emotional brain. The emotional brain is, uh, sort of like a babushka doll or a mushroom. It was on top of it. You can see three structures. If you took a side picture of an MRI, there's, like, the cortical canopy. We call it the cortical canopy. What a beautiful word. And it, and it's like an accordion because it's just so big it had to be wrinkled to pack into the skull. Cortical canopy, underneath it is the emotional brain, behind it is the reptilian brain. Reptilian brain is triggering breath when you're unconscious and basic functions. Emotional brain is, should I jump when I'm at the edge of a cliff? Should I pull back when I see a snake on the ground? You don't think about that. You react to that. And then the cortical canopy, the prefrontal lobes, they give the emotional brain context. Now, stay with me here. How is it that we don't keep jumping at a rubber snake? Just it's als- first time, right?

    10. RC

      Yeah.

    11. RJ

      And then we say, "Wait a second." That's the interplay between cognition, the frontal lobes, and the emotional brain. There are actual pictures of branching of neurons between these regions.

    12. RC

      Wow.

    13. RJ

      And that is, that, that, that growing that garden, tending to that garden, however you do it, I don't have a simple answer for that. But if you know there's a physical interface between your thinking brain and your emotional brain trying to find that dance, then what you see is you f- you feel empowered. You feel empowered that maybe I can have a new perspective on fear. Maybe I can have a new perspective on PTSD through therapy and through other things we can talk about. Maybe this anxiety is something [inhales] by controlling my breathing, I can tamp down. So that's, that's powerful that you can, you can dance with your emotional brain. You don't have to get rid of it, 'cause life without emotion is not lush. But you don't have to have the emotional brain take over your behavior and decisions and get you into trouble. And the last thing I wanna say about that is the last example for people to know that this is possible, if you go to a movie and you get scared, it's the same, uh, amygdala, which is simplified. The amygdala is not the fear center, it's a vigilance center. It just pays attention to uncertainty. But the same emotional brain goes off whether you're being actually chased by an ax murderer in the street or watching one in a movie theater. But when you watch in a movie theater and that adrenaline pulses through and your emotional brain, [gasps] you actually, like, you get scared, but you don't run away because that's your frontal lobe branches coming down to your emotional brain saying, "Don't, don't run away. It'll be embarrassing. This is actually just a movie." That's context. So the, whether w- how we stop jumping at the plastic snake on the second time, how we know the difference between a real attack and a fake attack on a movie, there is thought and emotion, those two examples, uh, beautifully working with each other. The emotion protects you in the beginning where thought would be, uh, too much of a delay. But then thought also says, "You know what? Maybe these emotions are not, haven't earned their place in our lives." So that is emotional regulation. Um, and that, th- that being off is anxiety, OCD, uh, those sort of things. That's my understanding of it.

    14. RC

      I mean, firstly, I just love the, the awe and wonder with which you speak about-

    15. RJ

      [laughs]

    16. RC

      ... the brain. Like it is-

    17. RJ

      Yeah, man. It's a trip

    18. RC

      ... it, it's just incredible 'cause you've obviously studied it, but you've seen it. You've seen all these parts. I love hearing you describe the anatomy and you're sort of pointing through your mouth. It's-

    19. RJ

      Yeah. I mean-

    20. RC

      This is n- this is not, like, stuff you just read in a book. You, you-

    21. RJ

      [laughs]

    22. RC

      ... you literally know where it is and it's, it's, yeah, it's wonderful to hear actually. It certainly-

    23. RJ

      Mm

    24. RC

      ... gives it a certain something. Um, when the balance is off between those two parts of the brain, uh, and you said there's no simple answer-

    25. RJ

      Mm-hmm

    26. RC

      ... um, you know, we can have all kinds of issues like depression, anxiety-

    27. RJ

      Mm

    28. RC

      ... OCD, you know, eating too much, you know, all these kind of things where maybe that the, the cortical canopy isn't sort of-

    29. RJ

      Mm-hmm

    30. RC

      ... tamping it down and understanding the context here. Uh, we don't need to-

  15. 48:49 – 1:07:12

    From therapy tools to medications: a ‘garden’ model of brain chemistry and electricity

    1. RJ

      And I think the, the things that I can answer with go back to the original part of our conversation, um, that turning your thought inward on whether these emotions are justified is step one. Um, and controlling your breathing, especially for anxiety i- is, is the go-to move there. Now- Can you just think down, um, OCD, uh, depression? Not really. Because now you're in an, you're in an altered, you- you've- you're in an altered balance that becomes a feed-forward. The, the inward-directed thoughts about your life, time to reflect daily, the breathing to control the anxiety, those are prevention and maintenance things coming up. Uh, if you find yourself in a, in a depression, uh, that's hard to do because now the balance is, is turned so far off that it's spiraling and gaining momentum, and that's where you need to have a, you know, you need to think about medicine, therapy, um, physical activity. So it, it really matters what we're talking about. Is it a daily maintenance of mental health, which we all need, right? I mean, we, I mean, we, we know so much about the heart and our skin, but from a young age, daily maintenance and tending to our mental health is important. But if you come in and you have significant mental health issues, there's a different approach for that. Now let me g- let me give you some biology about significant mental health issues. Let's say you have anxiety and somebody prescribes you Valium. Um, Valium is a benzodiazepine. It's an anxiolytic, okay? It can also make you stop breathing. It's dangerous. It's, y- the... But I wanna go back to that interface between thought and emotion. Inside our skulls, with a microscope it would look like two trees with branches going into each other. I mean, it's... You can see it. It's not a ma- it's not an, it's not something you imagine. Well, when those neurons branch and connect to each other, they don't touch. They, they... When the, when two neurons come to each other, they pause and they spray chemicals, chemicals you might have heard about. Dopamine, serotonin, these sort of things. So when you take Valium for anxiety or seizures, what it's doing is it's manipulating GABA, the chemical that chills things down. So you've, you've exogenously put in a medicine that goes to those branching interconnections and quiets the electricity, so you... 'Cause it's, it's, it's glitching out and you feel calm. And I think when people start to see that, okay, that's how this medicine, where it goes, how it works, it's powerful. Because the other thing that turns down that glitchy electricity [inhales deeply] is meditative breathing. And I, I need people to know when I, when I, when I talk about breathing, I can explain it down to the chemicals being sprayed by those branches. Breathing or Valium do the same thing at the, at the molecular level in your brain. And you say, "How do you, how do you know?" Well, the first book showed that. When we do some surgeries, we put electrodes in and to look for seizure. I mean, we have hardcore surgical and, and biological data for that. Now let's take another example. So you, you take an antidepressant. Well, what is that? I mean, what, what is... Well, well, just like we were talking about reward getting you to get up in the morning to go and get your treatments or leading to addiction, mood can make you feel good or bad, okay? That makes sense. But when people are depressed, there's a, uh, a paucity or lack... You know, serotonin isn't just right. So when you take, if somebody takes Prozac, we're back at those branches of brain cells and what they're spraying at each other between one neuron. There's 100 billion and they have 10 bi- 10,000 connections each. What a SSRI is, selective serotonin reuptake inhibitor, Prozac, whatever it is, is when serotonin is sprayed from one neuron to another, the vacuum to evacuate it is turned off by that medicine, so you have more ambient serotonin and your mood gets better, and it takes time for that to happen globally. That's why antidepressants take, you know, a couple of months. So I'm not asking people to go on antidepressants or not, but just to start to think of your brain as an electrical and chemical garden. And so when you breathe, you affect the electricity and chemistry of your brain. When you take Valium or Prozac, you affect the chemistry of your brain. And when, uh, people wear those helmets and, and those things on their head, they're trying to learn about the electricity of the brain. So everything, if we have an understanding of anatomy, chemistry, the, the chemicals are being sprayed, and then electrical currents are being generated like a, like a jellyfish and y- but the pattern is more like aurora borealis. You can start to think about when I do this or I take this, how does it fit within the garden of my mind and the garden of my brain? I think it's important when people know how it works, they're more likely to implement that measure.

    2. RC

      Yeah, for sure. Uh, I'm gonna certainly hope that everyone listening and watching will understand the importance of being able to manipulate and control your breath-

    3. RJ

      Mm

    4. RC

      ... um, it, to help them in, in their day-to-day lives. Rahul, if we think about this second book, certainly second book here in the UK, I know you've had other publications, uh, i- in America. It's a very different book. It's a very reflective book, and I, I like the way you've structured the chapters with, around different topics. You know, loss, grief, performance. You know, they, they... It's, it's a beautiful way of getting these ideas out there. The chapter that I, I sort of got stuck on and kept reading was the one on self, I think chapter seven.

    5. RJ

      Mm.

    6. RC

      And I wanna talk about the self Because I thought you had an interesting way of talking about it, describing it, seeing it through-

    7. RJ

      Mm

    8. RC

      ... different operations and how people saw themselves after some, some pretty brutal operations actually. Um, so there's a couple things there. You know, you have said in the book that it is a combination of body, mind, and autobiographical narrative. You said our sense of self rarely changes through life. So, you know, what is our sense of self? What is different about it from the mind? What is different about that from the brain? And what have these various procedures and operations taught you about it?

    9. RJ

      Yeah, that's a, that's a big question. And, and what I would say is there is no right or final answer, that this was my best effort to shed new light on a topic that has, you know, been relevant and, uh, inquired about since antiquity. The word neurophilosophy a decade ago caught me by surprise. Neurophilosophy. They put neuro in front of everything now, like neuroeconomics, neuro... [laughs] But neurophilosophy caught me by, uh... and it was actually in San Diego where I did, uh, my PhD. What is neurophilosophy? So the concept of identity and self, people have written about that for a long time. But in a certain operation where the brain is like a, a walnut, there's a bridge in the middle, there's hemispheres, we do something called disconnection surgery, and that's to keep electricity from one side from going to the other side if it's, um, you know, if it's, uh, related to epilepsy. So epilepsy is aberrant electricity. It's too much. If we can't cool it off with Valium and things that cool down the electricity, then at least we prevent it from going to the other side of the brain where a person will be, you know, knocked out and lose consciousness. But when you do those disconnection surgeries, sometimes people don't recognize... They, they were-- Normally, they don't recognize halves of their body, and different types of injuries have done this too, and Oliver Sacks has written about this a little bit. So what happens, um, when you ha- take a small sort of band of neurons that connect the two hemispheres of your brain and you dissect through that and the person can no longer recognize a part of their own body, right? Not phantom limb, not this kind of stuff, but they have, uh, uh... they just can't recognize own, their own part of their body. And they had-- Somebody had written, like, "Well, maybe this corpus callosum, this structure, can be argued as the seat of self and identity. You disrupt it, and people don't recognize halves of their body." And I thought, "Okay, that's interesting," but my patients have shown me something else. Um, and so I try in this chapter to add to that. That's, that's established. You can read about that. Um, and so what I've seen is there is sort of the body's relevance, uh, to a sense of self. There's the mind's relevance to the sense of self, and I'll take you through three examples. And then there's also sort of, uh, having a sense of self of your own life and journey, your autobiographical memory, that you are on this journey and somehow you don't remember the details of 20 years ago, but you're still that person moving through all those life events. Uh, the first one that really rocked me was, uh, a very challenging operation where the cancer was taking over the pelvis and half the body was removed. It's called a hemicolectomy. And when you read about those operations and how those patients do afterwards, uh, there's a lot of suicidal ideation. Uh, it's in a pursuit for a cure. Sometimes they are, sometimes they aren't. But this one patient taught me that, that the connection between body and mind is not just something figurative, that it's literal, and the connection of his lower half of his body to his mind, when he lost that bottom half, when he chose to have that bottom half of his body surgically removed, it, it altered his h- sense of self. Not just a, a limb, not just an amputation, uh, not an appendage, uh, but the bottom half of his body. And what I learned from him was that everybody's got a unique sense of self when it comes to their body, and it shed a lot of light about people who they do self-harm, they do tattoos, they do piercing. There's a lot of ways that how we feel about ourselves is connected to the ways we manipulate our bodies or feel connected to our bodies. And for him, not all patients, but many, um, losing the pelvis and below was just too much. It was, um, it was something he regretted and something I regretted. I mean, he, he's, you know, he signed consent for the surgery and there was a whole team involved, and it's in the book. But after that, he went into a depression that just couldn't be fixed, and, um, medicines didn't work. Nothing worked. And that gave me a, an interesting insight on, wait, the body and the mind, at some point, that is important. Other people are paralyzed, they haven't had this issue. So something about they can't move their body and it's connected, they feel whole.

    10. RC

      Mm-hmm.

    11. RJ

      But this guy, he could move his arms. He just lost belly button below, but that, that dismembering of half of his body left him in a psychological state that he could not reconcile with his former self. Whereas I've seen a lot of patients who are paralyzed, they don't have that same experience. So that was one- Example that shed light. And just briefly, the other example was operating on the insula. The, the brain actually can be opened up without being entered, and there's a little island of cortical canopy in there. And operating in that area, people wake up not only not recognizing other parts of their body, usually the other side, but denying its existence, like throwing their own arm out of the bed. And, and then you start to think about a sense of self as that's interoception, the cohesion with which we, uh, experience our body, as well as the extent we'll go to even throwing part of our body out of the bed to keep our, our, our perception of reality intact. And so if you manipulate the insula, and then this gets... Thanks for letting me go a little deeper into this. When you manipulate the insula, there's the-- the brain looks fine. The mind has decided, "This arm isn't mine." It's not like the part of the brain that controls that arm is, is damaged. The insula, in wanting to feel whole, will actually, um, disregard the physical inputs coming from the whole half of the body, and that's called confabulation. That can happen with a certain type of drinking and stuff like that. Like, people will create lies to keep a, um, a perception, um, psychological perception of being whole and intact. So those are the, the two main examples that I can give you that I think shed light on-

    12. RC

      Yeah

    13. RJ

      ... body and mind.

    14. RC

      I mean, that, that last example, what you said there i- is just incredible because you're saying structurally-

    15. RJ

      Mm-hmm. Beautiful.

    16. RC

      Beautiful.

    17. RJ

      It's perfect.

    18. RC

      Intact, no problem. You know, we know everything required to do this particular function, it is all there. It's looking pristine.

    19. RJ

      Mm-hmm.

    20. RC

      Yet another part of the, the brain or the mind, I guess, is sort of-

    21. RJ

      Mind. Mind

    22. RC

      ... the mind is bringing a bit of nuance and context and going, "Hey, hey, structure's okay. That's cool. But you know what? I'm not happy. I need to make some changes to how I'm experiencing-

    23. RJ

      Mm-hmm

    24. RC

      ... my life and my body for whatever reason." It's, it's-- it is, it is incredibly... It's a bit scary. It's inspiring.

    25. RJ

      Mm.

    26. RC

      It's-- I guess it all speaks to the incredible-

    27. RJ

      It's magical

    28. RC

      ... it's, yeah. But the-

    29. RJ

      It's magical

    30. RC

      ... incredible power that-

  16. 1:07:12 – 1:25:39

    Peak performance under pressure: surgical rituals, resilience, and breath as crisis control

    1. RC

      of these big operation days?

    2. RJ

      That's a, that's a great question to open up with. I think, first of all, just to give context, uh, most surgeons don't do dangerous operations, so I chose to be a cancer surgeon. I chose to take on the big cases. That's what drives me. That's what is a meditative state for me when I have to focus that much. So I have a lot of gratitude for my patients for trusting me. That said, I always wanna bring my A game to the case, to the operation. So the night before, there is a ritual, um, and it, it involves a little bit of physical exercise because often not realized by people is that a long operation is a physical endeavor. I mean, you're hunched over, I'm wearing a headlight, I've got loops on my eyes. You're, you're moving, you're in awkward positions. So I, I will do some light weight training the night before. Nothing that wears out my, my hands and forearms, but just postural stuff. And what that does is it's sort of like a pre-game prep, so I bring a physical, uh, preparation to that. And then mental or psychological, [smacks lips] uh, the ritual is the last 10 minutes before I fall asleep, I'm running through the shape of the cancer and the dangerous anatomy that it's ensconced in. So you have to dissect out a cancer from not normal anatomy, right? When the cancer grows, it distorts the blood vessels, so it doesn't look like an anatomy book. So you have to imagine around this corner you might bump into this. Around this way if I hit this vessel, what's my next maneuver? So I do a pre-falling asleep, uh, run-through of the shape, the process, and then I let, I sort of let my dreams and my, you know, put my mind to work at night, and that's the way I focus for the case the next day.

    3. RC

      Hearing you describe your, you know, your, your pre-game ritual i- is, it's quite reminiscent of sportspeople, you know-

    4. RJ

      Mm

    5. RC

      ... who may have a certain ritual to allow peak performance the following day. I've heard this from golfers before, from-

    6. RJ

      Mm

    7. RC

      ... from all kinds of athletes.

    8. RJ

      Mm.

    9. RC

      But you don't tend to hear it as much from people in non-sporting professions.

    10. RJ

      Yeah.

    11. RC

      A- and I would imagine all of us on some level could benefit from looking at our day-to-day work with the same kind of microscopic precision that, that you do. Yes, the stakes are high for the job that you've chosen, but I guess it's all relative 'cause in our own lives-

    12. RJ

      Yeah

    13. RC

      ... we all want peak performance in whatever we're doing.

    14. RJ

      Yeah, that stress you're feeling the next day, whether it's trying to navigate a fight with a lover or trying to navigate a conversation with a boss or get to work on time, stress and pain, these things are personal dimensions. So the approach to a challenge, the lessons apply to all of us, whatever our individual challenges are. And, uh, it is like sport. I think that's often, uh, not understood, that surgery is a physical task. That's why it was called an operating theater. It's a performance. Some of us are better at it. It's not always the same 100 steps. Some people are slicker and have softer touch and can get the work done in 60 steps. So I love that technical aspect of it. But whatever the challenge, I have found, I have found a little bit of physical activity mixed with a little bit of thought. Not total step-by-step preparation for, you know, not engineering or sort of micro-planning the next day, but something about being physically active the day before improves my sleep. Something about running through what the next day will bring gives me sort of a background preparation. Because what I do, you can't always anticipate what's gonna happen, but that's life for most people. And so I think the pre-falling asleep window is a unique portal to some of the subconscious things we do in our dreams, in our sleep. And if, a- as a sort of digression, creativity, a lot of people have used the, the falling asleep period and the waking up period as a one, as a way to sort of introduce fresh approaches and new thinking to a problem that they've been struggling with. So I ... You know, whether it's Einstein or the guy that des- you know, designed the Louvre, um, you know, Inception, the movie was based on that. So I try to take real science, biology, [smacks lips] um, electrophysiology to guide my process. Now, people may have other ways of doing it, but I like it to be anchored in something, um, uh, scientific.

    15. RC

      The way you describe it, it sounds very much to me as though you have experimented with-

    16. RJ

      Mm

    17. RC

      ... different techniques over the years before sort of falling upon this one that currently gets you into peak performance. So I guess I'm interested, is it quite unique what each individual needs to do? And then can that approach change and evolve over time as we change and evolve, you know, over time?

    18. RJ

      Yeah. I mean, I think you have to stay adaptive, but we're talking about a certain thing here where I have an anticipated challenge. But what this last year has shown us is what do we do when we've had no preparation, no anticipation? And, and I think that takes a different set of skills. So there's crisis management in something you're going in prepared for, and then there's crisis management for a crisis you've never anticipated. Uh, and I think those, uh, require two different skill sets. One, you can have some rituals that become a portal to your peak performance or your, you know, optimum technical ability or optimum stress management for yourself, whether that's through breathing techniques or a ritual before you go to sleep. That's what I do in an operation. But what happens when there's a crisis you don't anticipate? That's harder. Uh, that's harder to be prepared for. But what you can draw on is sort of the ... It's, it's often a, um, overused word, so I just wanna add some nuance to it, but, uh, resilience, there's two types. And re- peak performance, resilience, emotional regulation, all these things tie in together, but I really liked taking apart the term resilience in this book. And so there's the physics and engineering definition where you take You know, there's a, you know, you get deformed and you return to original state. But the psychological definition, and going back to crisis management for things you haven't seen before, the psychological definition is fascinating to me. So there's two types of resilience, processive, uh, resilience and systemic. Let's start with systemic. Systemic resilience means you got it in you. It's what you bring to the fight. That's-- Systemic resilience is what I bring to the operating room on Wednesdays. Systemic resilience is what we had in us before 2020 rocked the world. But that's not your final story because there's also processive resilience, and that's what the fight brings out in you. So I think that's very powerful for me because it leaves us thinking, no matter where you are in your life, whether you're getting rocked and whether you're struggling because of something difficult going on, or whether you're feeling triumphant, that tomorrow is always possible because of processive resilience. What the fight, what the struggle will bring out in you that you may not even recognize in yourself. And I bring that to crisis management. When I go to the OR, it's planned. I've seen it. I, I plan for the uncertainty. But relationships, raising children, life-

    19. RC

      Yeah

    20. RJ

      ... that requires a, a resilience that you have yet to demonstrate based on the struggle in front of you. When I think of it that way, I feel very optimistic regardless of the place I might find myself in today.

    21. RC

      Yeah, it's a beautiful way at looking at the, the two kinds of uncertainty that we face in life, that predictable uncertainty and the, and the-

    22. RJ

      Mm-hmm

    23. RC

      ... unpredictable. And-

    24. RJ

      Very good

    25. RC

      ... I guess I wonder when I hear that, does your diligent practice of attention to ritual, attention to your performance for that predictable uncertainty in the operating room, does that transfer over to help you be more resilient to that unpredictable uncertainty? You know, are there-- Is there a unified skill set there? Is, is some of, is some of that skill transferable across? And therefore, does that mean all of us should, in some ways, try and do certain practices on a daily-

    26. RJ

      Mm-hmm

    27. RC

      ... weekly, monthly basis to prepare for when those uncertain events happen as they always do?

    28. RJ

      It's an excellent question. Um, a difficult one. Um, but I think one where I can just offer you my understanding. Um, so the crises, crisis management, whether in the operating room or outside of the operating room, uh, there is a physiologic response that happens in our skulls, you know. The chemicals, hormones, electricity, blood flow. There's a-- it's not just, um, wiring. It's the-- it's an ecosystem, and there's a response that happens. And what I've learned from the operating room is when I get into a tricky situation, the first thing I do is just prevent myself from hyperventilating. I think everybody thinks, "Oh, you're born with nerves of steel." No, you train yourself to be calmer, to allow that calmness to release the ability to come up with good solutions and behavior that you, you-- that's not reactive, that's not freaked out. So what the operating room has taught me is the cadence of breathing, and I think a lot of people are thrown off. They're like, "This brain surgeon talking about breathing." You know? It's like... But that's-- There's, there-- Again, there's physiology about that. And if I may, um, when we freak out, for whatever reason, we breathe faster. And in the past, it was probably a saber-toothed tiger, and we'd appropriately freak out, and it was usually accompanied by running or movement. And as you know, when our muscles churn, we make carbon dioxide, which is the stuff we blow out and the things that, you know, plants absorb. But-- So we hyperventilate to, to get rid of that, that metabolic waste from the muscles churning. But if we hyperventilate or freak out and we're not running, we're just in the operating room, or we're sitting in our car, or we see something on our phone, well, now you're, you're blowing off or, you know, evacuating carbon dioxide that you haven't built up from churning muscles. And that kind of hyperventilation, um, which actually lowers the levels of carbon dioxide in your blood, okay? That's-- That leads to twitchiness, frenetic thoughts, irritability. It's physiologic. Hyperventilating without also accompanied physical activity makes us nervous, um, gets in the way of our thinking. And so when we know that that's the biology and the physiology, I mean, you can measure it, um, then the first step in crisis management in the operating room is [inhales] just slow it down and get it through my nose. Just, just two, three seconds in, two, three seconds out. My, my mind is racing, my mind is all over the place, but what I'm doing is not exacerbating my inner panic through hyperventilation. So the first thing I do, [inhales] just slow it down, my breathing, and then just keep thinking, keep, keep, keep thinking. And I didn't always do that. I'd fog up my glasses when I was operating, and now people after the pandemic know what it is to have-

    29. RC

      Yeah

    30. RJ

      ... mask and gla-- And imagine operating through that, right? You're f- you're, you're nervous, you're panicking, you're learning how to operate. You're, and you're s- you, you're getting in the way by hyperventilating. Not only are you making yourself twitchy, you're fogging up your, your-- the glasses you're operating, looking through as you operate. So I have to really get my breathing under check, and that's a thought process. Now, I don't have to worry about fogging up my- my glasses because of my breathing. But that is my go-to move for crisis management in the operating room. Now, back to your question. Um, unanticipated challenges and crises, you can't prepare for them the night before, right? That we can't do. But wherever you are in your moment and you feel that fear or panic or anxiety grip you, the, the weapon you have against that, it's not gonna be equally effective in everybody. But your, the biology and the physiology that you can control with thought is to get that breathing under control, get that breathing under check. Whatever you do through that, and you may still make a bad decision. I'm not trying to get to people having outcomes. But you'll be in the best position for you as that individual to think clearly and to have the most emotional regulation you can.

  17. 1:25:39 – 1:43:24

    Breath ‘neurofeedback’ and living with intention: lessons from cancer patients’ seasons

    1. RJ

      Uh, thank you. You know what? I think that's essentially the concept of when you hear the word neural feedback. You know? When you do something right, you get a positive response. Um, yeah. So this is a real world situation. This isn't just, you know, me talking about ideas and concepts. Um, when I started training- The mask, we, we, we'd put tape over the mask a- and that way if, if we hyperventilated during [laughs] the difficult part of the case, uh, the hot air wouldn't go up to our glasses that have the magnifying loops on them. And now at this age, I'm 48, and at this, you know, uh, level of practice that I have, I actually don't use the tape much, um, or at all now because I rely on that, um, the, when my glasses fog up, it actually tells me, "You're breathing too fast." So it's become my own little, uh, neurofeedback technique that, "Hey, you're breathing, you're breathing too fast. Your glasses are fogging up. Slow it down." So I'm having this internal dialogue with myself as I'm navigating the people in the operating room as well as I'm, when I'm operating. And I think that's the other lesson is that by not hyperventilating, you allow your thoughts to turn inwards. And so you can have that inner dialogue about navigating the emotions, the thoughts, the breathing at that moment. And I think that behavior control is really powerful. It, it's, it's something that has to be trained, so the operating room taught me that. Now, I don't do it as a ritual, um, daily. But in, in moments where I feel anxious or strained or stressed, and it's, whether it's appropriate or inappropriate, um, I, I will-- I, I notice myself only breathing through my nose. And you know, people say, "Well, it's through your nose or mouth." What, the, what's important is that you inhale slowly and you don't dump, you don't just exhale quickly. There's a deliberate nature and cadence to the breathing.

    2. RC

      Yeah.

    3. RJ

      And I find that in and out through the nose helps me set that just right, and I use it, uh, not on schedule, but as needed outside of the operating room.

    4. RC

      Yeah, I've had, um, quite a few guests now, Brian McKenzie, Patrick McKeown, James Nestor, uh-

    5. RJ

      Mm

    6. RC

      ... on the show. We've, we've spoken at length about breathing, uh, the, the, some of the physiological benefits of nasal breathing. Um, and it's interesting what you've landed upon yourself that you know helps you. We'll get more into things that we can do around stress, adversity, resilience, things we can do for our brain, I think maybe later on in the conversation. Um, I'd love to turn my attention to your new book, uh, Life on a Knife's Edge, which wasn't what I was expecting after your last book, and I've gotta say it was a really pleasant surprise. It's so personal. The storytelling is incredible, and I thought some of the concepts in it are well worth exploring in our conversation today. Um, so sort of as a primer, I've, I've been thinking a lot about you over the last few days in preparation for this and, you know, your job, you know, as a neuroscientist and as a neurosurgeon. And, and I thought, and I wonder what has your job given you with respect to an insight on this incredible organ? Not only have you studied the organ, you are literally looking at that organ-

    7. RJ

      Mm

    8. RC

      ... in an operating theater several times a week. What sort of insight does that give you about how powerful this organ is that the rest of us who don't have the opportunity possibly fail to grasp?

    9. RJ

      I would take that in a slightly different direction. I'll show you how I get there. You know, when I first started, I mean, um, [laughs] just seeing s- you know, just seeing somebody's f- forehead removed and seeing, like, the glistening white frontal lobes with those beautiful arteries so, so fine and tortuous, I just-- it was mesmerizing. I al- I almost thought, "Is that impossible?" Um, so the first now, you know, the first part of my career, I was fascinated by the actual craft, the work, the anatomy, the, the structure itself. But along the way, there's been an evolution in my, um, focus, if you will, or purpose even, that, um, I saw it as really a window to study humanity. Now, it's-- I've operated on thousands. I mean, imagine opening thousands of skulls. And as you know, that means I've met a lot more people. You don't operate on everybody that comes to see you, and you don't operate every day of the week. So I've met over 10,000 people, operated on more than several thousand skulls and brains and things like that. You could look at it that way. Or you could see it as, think about all the different people I've met, and I've met them all in their crises. I've met them all in their most difficult times in their lives, and they've let me come aboard, uh, and partner with them and, and journey with them for a little bit. And so I started to see the ways in which they coped. I started to see the ways in which they suffered badly. I started to see some that were triumphant in, in moments where I think I would just flail. And so what I've learned as a brain surgeon and neuroscientist is sort of the, the human story of, of these, these people who see growth in their own lives based on their description when we would perceive it as calamity, a cancer diagnosis, a scan where the cancer has spread. And they sh- have shown me that, not always, but that difficult times, you know, they hold a reservoir for growth. Nobody wishes they, they go through difficult times like these, but those are the lessons I've seen, and that's sort of what I get into with the stories in the book. Is the optimism and the heroism and the, um, and just sort of the transcendence of the things that usually encumber us, the little thought, the little steps, the little frustrations. So in some ways they're set free. It's not, it's not something they choose for themselves, but when that finish line comes into view, because I take care of advanced cancer patients, they live differently, and they often wonder why did not we have these focuses, you know, focus on these kind of things, quality of life, before the cancer diagnosis. So I've gone from a surgeon to a neuroscientist to somebody who now really appreciates the human story through my patients.

    10. RC

      It's fascinating that your job, you know, y- you say that it enables you to study humanity.

    11. RJ

      Mm.

    12. RC

      And I wonder, given that you see incredibly sick patients and challenging patients and people who really might be at the end of the road, and actually this is the last gasp hope when-

    13. RJ

      Mm

    14. RC

      ... they come to see you, does that give you a skewed view of humanity? If your professional life is full of a certain type of person in, in need, do you think that is a useful lens through which to see all humanity, or does it potentially, you know, skew that view where you only see one particular aspect of humanity?

    15. RJ

      Yeah. No, it's, it's definitely a skewed view. Um, I've taken care of thousands of patients and I've helped hundreds of people pass away, um, end of life. Uh, it's definitely a skewed view. But what I would say is it offers us insight and perspective to a fate that one, that we will all face. You know? That, that the finish line and death and mortality is unavoidable. And the lessons I have learned from people who are facing it, some young, some old, but there is clarity in those moments that I want to share with people, um, who have yet to face that, that final moment or those final struggles. And so it is definitely a skewed perspective, but a rare one, I think, that can shed light on, uh, how to live fully and how to live your life, uh, realizing that, uh, it does end one day. And I think those insights are positive and optimistic and triumphant. They're not negative. They're not, um, pessimistic. And so they, they inspire me. They enlighten me with their-

    16. RC

      Yeah

    17. RJ

      ... uh, descriptions of what they wish they would've done differently now that the end is within sight.

    18. RC

      What are some of the insights that you've learnt that have changed you and changed the way that you live your life? Because it's that, it's that frustrating thing about the human experience that we often need to confront our own mortality-

    19. RJ

      Mm

    20. RC

      ... before we start truly living. Yet I wonder, because you have seen that so many times, has that infused into your brain and you thought, "You know what? I don't wanna wait till I'm confronting-

    21. RJ

      Mm

    22. RC

      ... my own mortality. I wanna start living now."

    23. RJ

      Yeah. I, I didn't get there. I mean, it takes age, it takes your own life experiences. There is no, there is no shortcut. Um, just because I take care of cancer patients doesn't mean I think of death all the time. In fact, only recently have I started to put, put it together and have a synthesis of what I've been seeing and experiencing, and I'm 48 years old. Um, but what, what it means for me is not just to live well or live fully, because that's sort of a personal dimension. But what are the lessons we can take from the approach cancer patients implement when they're facing those crises? So I can't bring people to, "Hey, life's gonna end one day. Make the most of it." That's not, that's not my intention. Um, and people have had struggles in many different ways. I used to be... I do pediatric neurosurgery. I've seen parents lose children. I've done trauma surgery. I mean, there are insights from all of those patients. But the techniques, the approaches that I see cancer patients employ, utilize, to me, that's fascinating. So let's take one example. After the cancer diagnosis, you have to get scans all the time. I mean, it's every three months for life. And I always think how [laughs] how scary must that be to be in that scanner? What are they gonna find? Has it come back? Has it grown? Is it the same? It's a lot of uncertainty to face that, not just having a trauma that you survive and say, "That's in the rear view. Remember five years ago, we got in a car accident. It was a very difficult experience." Their, their trauma unfolds every three months. And so what I saw was they started to do sort of a compartmentalization of the three months, and I started guiding my patients about that too. Like, "Listen, three months, [laughs] when you see that invitation for the MRI from Rahul Jandial, it's gonna, it's gonna dis- it's gonna be disruptive. Of course it is. You can't be mindful when you see the MRI request come in. You can't be centered. It's gonna rock you a little bit. So what we do is we, we try to limit that disruption so it doesn't eat into the 11 weeks in between. So we come up with this plan. You're gonna get a request. That week is gonna suck. [laughs] You're gonna have to come in, wait in long lines, just-" Be miserable, let it be disruptive, put yourself first, we'll get in the scanner, and you'll see me afterwards or I'll call you, and let's just brace for that week. But what we do is we protect the time before and after that. So there's a structure in which they say, "Okay, it's gonna be a rough week because I have a scan and I have something called scanxiety, and, and that's a difficult time." So we compartmentalize, 'cause you can't just say, "Don't stress out." That's not fair, especially with their situation.

    24. RC

      Yeah.

    25. RJ

      So they have little release valves and time points when they allow themselves to stress out, um, that, "Hey, I've got a, I've got a brain scan this week. It's gonna be a rough week for me," and that's okay. But after and before, let's protect that time to live fully. So that's, like, one technique I learned from cancer patients that, uh, I try to apply to my life as well.

    26. RC

      There's a certain intentionality, isn't there-

    27. RJ

      Mm

    28. RC

      ... living like that. And it-

    29. RJ

      Yeah

    30. RC

      ... as you describe that, I'm struck by, you know, how many of us just live on autopilot. We don't really think about what we're doing day to day. We're just existing. Before we know it, it's the end of the month. Before we know it, the season has changed. But what I'm hear-

Episode duration: 1:43:24

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