"Why You’re Always Bored, Unhappy & Stuck" – Reinvent Your Life With This | Dr. K (HealthyGamer)

1. 0:00 – 2:35

   Comfort paradox: why easier lives can make us feel worse

   1. RCDr. Rangan Chatterjee0:00

      Why is it in a world where people are more comfortable than ever before, have more material things than ever before, are so many people struggling and unhappy?

   2. AKDr. Alok Kanojia0:16

      Well, so it's, it's a great question, right? So the, the first thing I would ask is what is the correlation between having material things and comfort and happiness? So I think I, I basically have kind of three answers for you, okay? The first answer is we have to understand that the human body and the human mind don't wear out with usage. They actually rust without being used. So if you look at comfort, right? So if I start taking the elevator every day instead of the stairs, what will happen to my body? It'll actually start to get deconditioned. So I think what we're seeing in society is a whole scale deconditioning of certain neuroscientific circuits. So we have all of these technological tools, all of these comforts that make things easy for us. But if you're sitting at home on your couch, you're getting food delivery, you're working on your laptop, and you never have to physically move, even though everything can be brought to you, that actually makes you worse, not better. So there's a really interesting, um, mechanism here, which is if we look at serotonin production, and increased serotonin transmission is associated with improvements in depression and anxiety. We're not quite sure if deficient serotonin production causes depression or not. There's some debate in the academic community. But generally speaking, if your serotonin levels are high or your serotonin transmission is high, you feel better. So then the question becomes, what results in serotonin production? And actually overcoming adversity, doing hard work, accomplishing something, is what causes a serotonin improvement. So I think what we're starting to see a lot of is that people-- technology is basically deconditioning us mentally. We're taking the elevator every single day. We're becoming sort of mentally kind of weak, honestly. That's one of the reasons why we're seeing everyone feels like they've got ADHD. ADHD is kinda on the rise. And so as our brains are becoming more deconditioned, we're starting to struggle more.

   3. RCDr. Rangan Chatterjee2:24

      Yeah. So one, one reason is because this lack of usage is rusting our minds.

   4. AKDr. Alok Kanojia2:34

      Absolutely.

   5. RCDr. Rangan Chatterjee2:35

      Yeah.

2. 2:35 – 5:53

   Brain vs mind: subjective experience and measurable tissue

   1. AKDr. Alok Kanojia2:35

      Right? So not just our minds, our brains too, which are two discrete things.

   2. RCDr. Rangan Chatterjee2:38

      Okay. How do you distinguish the brain and the mind?

   3. AKDr. Alok Kanojia2:43

      So, so your mind is, is the subjective experience of thoughts, emotions, and things like that. Your brain is a lump of tissue, neurons, blood vessels, astrocytes, myelin, all this kind of stuff. So oftentimes people think that the brain and the mind are the same, but that's not true. So if you sort of think about it like we can measure your brain. I can do something called an fMRI study, which measures blood flow to different parts of the brain. I can do something called an EEG study, which measures electrical activity across the brain. But there is nothing that I can do to measure a thought, right? Like, every person who's listening to this podcast right now is probably having a thought, but the existence of thoughts is not measurable 'cause they, they have no, they have no material. So the brain is sort of the, the material side. Like, it's like matter, right? It's like stuff that you can touch. It can be physically injured by a traumatic brain injury, and, and the mind is the subjective experience of, like, being human.

   4. RCDr. Rangan Chatterjee3:49

      Yeah.

   5. AKDr. Alok Kanojia3:49

      Or part of it anyway.

   6. RCDr. Rangan Chatterjee3:51

      Yeah.

   7. AKDr. Alok Kanojia3:51

      And those two things are different. And they, they connect. They talk to each other. So if you think in a certain way, it will alter your neuroscience, and if you alter the neuroscience, it will change your thinking. So there's a two-way street there.

   8. RCDr. Rangan Chatterjee4:05

      Yeah. No, I love that. Uh, g- now, going back to this idea that our bodies, our minds, our brains are rusting, I think we intuitively understand that through the lens of physical health, okay? Because that drum has been beat for many years, that we need to be more physically active, and, you know, the truth is, is that movement has been engineered out of our lives, so we've become more physically comfortable. But I think it's really interesting that we've also become more mentally comfortable as well. Now, as you were talking there, I was thinking these ideas of comfort are, are really, really interesting, aren't they? Because, uh, I mean, I wrote about this recently, that I was on a train to London, I would say a couple of years ago now. So I live in the northwest of England. High-speed, comfortable train to London, and the person I was traveling with got really, really frustrated because the app that basically allows you to order your drink from the cafe four carriages down wasn't working.

   9. AKDr. Alok Kanojia5:16

      [laughs]

   10. RCDr. Rangan Chatterjee5:16

       And I thought, "This is remarkable." 10 years ago, a service like this did not exist. You know that if you want a drink and you don't have it with you, on the train you have to get up, walk three or four carriages, choose your drink, pay the money, and walk back to your seats. Okay? No one had a problem with that back then. But now the knowledge that there is an app that can make your life easier, and then the app not working caused a friend of mine [laughs] quite an intense degree of frustration, right?

   11. AKDr. Alok Kanojia5:51

       Yeah.

   12. RCDr. Rangan Chatterjee5:51

       Which is fascinating, isn't it?

3. 5:53 – 8:28

   How technology deconditions attention and fuels ‘ADHD-like’ symptoms

   1. AKDr. Alok Kanojia5:53

      Absolutely, right? So I think you're touching on so many things, Rangan. So the first is, like, expectations have changed.

   2. RCDr. Rangan Chatterjee5:59

      Mm.

   3. AKDr. Alok Kanojia6:00

      So there's sort of like a spiritual side to this and a neuroscience side to this. So let's talk about neuroscience first. So what are the ways in which we are, we have become mentally deconditioned?So the first thing that has become mentally deconditioned is our attention. So in the past, what would happen is when I went to school, right, I would have to force my mind. My mind wants to wander. It wants to wander over here, it wants to wander over there. I would have to force it to focus on something. I'd have to force it to focus on a textbook. I have to force it to focus on something at work. So most of the hours of the day, we had to kinda harness or rein in, we'd have to put our mind on a leash and tell it where to go. So if you look at technology, do you have to force your mind to be on TikTok? Do you have to force your mind to be on YouTube? No. So the way that, what technology has done is, is it has created so many natural pulls for our attention that we no longer have to force it to do anything. In fact, what's happened is we now have a mind that has been off the leash for so long. So when I'm on TikTok and I get bored of something, all I have to do is just swipe up, right? I, and now YouTube Shorts has a swipe function. I'm sure Instagram Reels has a swipe function. So now the second I get bored, I don't have to force my mind to do anything. It gets to run over w- whatever it wants to. If it gets bored over here, we're gonna switch over to YouTube. If it gets bored with YouTube, we're gonna switch over to Instagram. So the mind does not need its attention to be directed, and this is what people experience, right? So any time you're using technology, you tell yourself, "Hey, this is a waste of time. I need to stop." But you can't control your mind. It's like your mind has become this bear that is off the leash and runs wherever it, it wants to. This is why we create doom-scrolling, right? So, like, people are just sitting there scrolling on their phone for hours and hours. The average cellphone use is somewhere between four and a half hours to up to eight hours a day. Like, this is, like, really common for people now, and that's because our attention, the ability for us to tell our mind where to go, which is what attention is, right? Pay attention. Shift your mind from this distraction over to what you need to focus on. Our, our atte- our capacity to restrain attention is, is literally becoming weakened or atrophied.

   4. RCDr. Rangan Chatterjee8:28

      Yeah.

4. 8:28 – 10:43

   Emotional regulation loss: when devices soothe feelings for us

   1. AKDr. Alok Kanojia8:28

      Primarily through technology use. That's one of the things. Second thing that we're really getting, this is terrible, i- is emotional regulation. We are losing the capacity to regulate our emotions, which is literally wh- what we saw in this example. So this person can't get a drink delivered because of an app. In the grand scheme of the 75 years that they're on this earth, what difference does that make? They can get their asses up and walk a couple of carriages or not, and it's, like, not that big of a deal. But what's going on in this person's brain is the emotional centers of their brain have become hyperactive, and the reason they've become hyperactive is because we've relied on technology to do our emotional regulation for us. Any time you use basically a technological device, it can be video games, it can be social media, it can be scrolling on your phone, it can be pornography. All of these technologies basically suppress our emotional circuitry. So when we have something from the outside shutting off something in our brain, our brain loses the capacity to regulate itself.

   2. RCDr. Rangan Chatterjee9:42

      Mm.

   3. AKDr. Alok Kanojia9:42

      Right? A really good example of this is it's not just our brain. So let's say that I'm, I, I'm used to air conditioning and climate control 24 hours a day, seven days a week. I'm in perfect weather all the time. If I go into an environment that's a little bit hot or a little bit cold, I will feel uncomfortable. And on the flip side, there are people who live in countries where, where there aren't air conditioning, there isn't heating, and their capacity to tolerate higher or lower temperatures is way better because their body can regulate their temperature i- in a subjective way more effectively. So we're all losing our capacity to emotionally regulate. We're seeing this a ton with parents. Kids are getting, throwing temper tantrums when you take away their video games. Like, you know, everyone's kinda getting more frustrated with each other.

   4. RCDr. Rangan Chatterjee10:31

      Yeah.

   5. AKDr. Alok Kanojia10:31

      So we're, we're losing the capacity to emotionally regulate, and when we lose the capacity to emotionally regulate, we would predict increases in depression, increases in anxiety, and we're absolutely seeing that.

5. 10:43 – 12:47

   Why cold plunges and meditation are trending: reconditioning the system

   1. RCDr. Rangan Chatterjee10:43

      Yeah. It's absolutely fascinating. We think about this relationship with comfort or discomfort and our physical and mental wellbeing. Couple of things came up for me there. Number one, you mentioned temperature-controlled houses, okay? Air conditioning or central heating, whatever it is, this idea that we no longer need to tolerate differences in temperature, okay? And then the first thought that came into my mind was the modern, um, what's the word? The modern kind of trend for cold plunging. Now, to be clear, I, I know there are benefits of cold plunging for some people. It can be an incredible practice. But it's interesting, isn't it, that as we've got to these more temperature-controlled lives, there is a desire with many people to experience the cold. Do you know what I mean?

   2. AKDr. Alok Kanojia11:32

      100%, Rangan, and I think that's, that's not a coincidence. So-

   3. RCDr. Rangan Chatterjee11:36

      Exactly

   4. AKDr. Alok Kanojia11:36

      ... along with the rise of, of cold plunging, we're also seeing a whole scale interest globally in meditation.

   5. RCDr. Rangan Chatterjee11:45

      Yeah.

   6. AKDr. Alok Kanojia11:45

      Right? So I, I think just like when the body is thirsty, it craves water. So what I think a lot of people are discovering, they don't necessarily understand the neuroscience and the physiology behind it, but what they're discovering is, as my mind becomes deconditioned, if I do things that are mental conditioning, my life will improve. So now what's starting to happen is people are living lives of comfort. They're living lives where their mind is easily distractible, hard to pay attention, difficulty with emotional regulation.And when people stumble into practices that fix these problems, they love it. They absolutely love it.

   7. RCDr. Rangan Chatterjee12:26

      Mm-hmm.

   8. AKDr. Alok Kanojia12:27

      Right? So if you're someone who takes the elevator, it feels a little bit uncomfortable to take the stairs, but even after you, if you go work out or you go take a walk, you kinda come back and you're like, "Wow, I like, I feel so much better. Even though I feel tired, even though I feel achy, there is some part of me that feels better because something feels a little bit more balanced."

6. 12:47 – 17:03

   Choosing discomfort builds willpower circuitry (anterior cingulate cortex)

   1. RCDr. Rangan Chatterjee12:47

      Yeah. It's interesting. I internalized this rule a few years ago. Basically, I was thinking a lot about comfort and my own relationship with comfort and discomfort. And I thought, "Okay, Rangan, you need to, or not you necessarily need to, you might benefit from putting some things in place that allow you to experience discomfort more regularly." And a very simple one that was transformative for me, and has been for many of my patients in the past, is this idea that I'm always going to take the stairs barring exceptional circumstances. So it was a one-time decision, a rule that I internalized. I've gotta say, for about five years or so, it's been life-changing. And I think the reason it's been life-changing is not just for the physical benefits. Sure, if I'm going up four flights of stairs to get to the supermarket car park with my bags, of course there are physical benefits, hormonal benefits, insulin sensitivity, et cetera, et cetera. But I honestly think, Dr. K, for me, the main benefit, or the biggest benefit is psychological, this idea that I chose discomfort when I didn't need to.

   2. AKDr. Alok Kanojia13:58

      100%. So it's more than that. So not only is it psychological where you chose discomfort, it's neurological too. So when you do that, there's this part of your brain called the anterior-

   3. RCDr. Rangan Chatterjee14:09

      Yeah

   4. AKDr. Alok Kanojia14:09

      ... cingulate cortex, which is kinda like where willpower comes from. It's where internal conflict is managed in your brain. So when you feel like taking the elevator and you choose to take the stairs instead, the anterior cingulate activates, you fight a war within yourself, and then you end up hopefully taking the stairs. So when you do that, and I see this all the time in my clients as well, when they start embracing discomfort instead of avoiding it, their life becomes way better. And the reason for that is not just because, l- as you mentioned, there's physical health benefits of taking the stairs, but you are training your capacity to do the right thing which feels bad instead of the wrong thing which feels good. And there's another really interesting manifestation of your anterior cingulate being boosted, which is in your language. So earlier when you were sharing that example, if people re- rewind, they will hear you say, "It's a rule that I made myself do." You said something like, "I need to take the stairs." And you immediately caught yourself.

   5. RCDr. Rangan Chatterjee15:14

      Yeah.

   6. AKDr. Alok Kanojia15:14

      And you said, "I don't need to. It's something that I would like to do," or something like that. Did you-

   7. RCDr. Rangan Chatterjee15:20

      Yeah, or choose. Yeah, exactly.

   8. AKDr. Alok Kanojia15:21

      Yeah, right? So what you did right here is-

   9. RCDr. Rangan Chatterjee15:23

      And, and I saw you smile as I reframed that as well, which is interesting for me.

   10. AKDr. Alok Kanojia15:26

       Yeah. Ri- right? So, so what's happening that in real time is you have this habit formed in your brain of pushing yourself, 'cause you're, you're a doctor, right, Dr. Chatterjee? And if we're doctors, good Indian doctors like ourselves push ourselves really hard, right? We have to be successful. We need to work really hard. We're sort of trained in this way. It's not just Indian doctors, right? A lot of people push themselves really hard. "I need to do this. I need to do this." And then the anterior cingulate comes in and, first of all, raises awareness to some of these, like, toxic productivity kind of habits where we-

   11. RCDr. Rangan Chatterjee16:03

       Mm-hmm

   12. AKDr. Alok Kanojia16:03

       ... we beat ourselves up. And then also, in real time what you're doing is, like, reprogramming yourself. "I need to take the stairs. No, no, no, I'm gonna choose to take the stairs. It's good if I take the stairs." And so that mental reprogramming, reprogramming your habits, also comes from the anterior cingulate cortex.

   13. RCDr. Rangan Chatterjee16:21

       Yeah.

   14. AKDr. Alok Kanojia16:22

       So it, it, it's kind of really fascinating, but j- the simple decision to choose to take the stairs on a daily basis, unless there's some kind of emergency or something like that, can actually help you program all kinds of other habits, because we are leveling up our brain's capacity to change our habits.

   15. RCDr. Rangan Chatterjee16:41

       Yeah. Yeah, I love that, and I love this idea that wherever you choose to embrace discomfort in your life, it's not only that your ability to do that thing improves. So me doing that doesn't just improve my ability to keep choosing the stairs, it has knock-on benefits into other aspects of my life as well.

7. 17:03 – 23:36

   Transdiagnostic roots of mental illness: distress tolerance and perfectionism

   1. AKDr. Alok Kanojia17:03

      Yeah. So this is where things get a bit technical, but there are three or four things that are called transdiagnostic categories in psychiatry, and these are things that contribute to basically all mental illness. So th- th- what people sort of figured out, the way this research worked is they were looking, they, they noticed that a lot of people who have depression also have anxiety. And they were like, "Why is that? Is there a root cause for both depression and anxiety? Is there a root cause for both depression and addiction?" And what they discovered were three or four things that are basically the root causes of all mental illness, and one of them is distress tolerance. So your capacity to tolerate distress. If you have a high distress tolerance, your likelihood of developing an addiction, your likelihood of developing an anxiety disorder goes way down. Your ability to set boundaries gets way stronger with distress tolerance. So if you can handle discomfort, 'cause I work with a lot of people who are addicted, and their big problem is they can't handle discomfort. If I feel anxious, I'm having trouble sleeping, I feel like I've got insomnia, let me get high so I can fall asleep. If I'm anxious, I need to, uh, get high. If I'm going and socializing, I have social anxiety, let me take a couple drinks of alcohol to calm myself down. So literally their capacity-To tolerate distress is low. And when your capacity to tolerate distress is low, you lean on things outside of you to manage your internal environment, like YouTube, like TikTok.

   2. RCDr. Rangan Chatterjee18:41

      Yeah.

   3. AKDr. Alok Kanojia18:42

      When we're, when we've had a hard day and we're feeling frustrated, what do we, what does our brain crave without even realizing it? After you have an argument, no one goes and sits quietly and ponders the nature of the argument. Everyone w- walks out of the room, pulls out their phone, and starts scrolling, and that's because our brain knows that this is going to regulate my emotions. It'll calm me down. But that's harmful over time, right? So you're, you're developing distress tolerance. It's fantastic.

   4. RCDr. Rangan Chatterjee19:09

      Yeah. It's kind of interesting that you mentioned root cause there, and one of the things that I guess I love about your online content and your videos is this blend of East and West, okay? So you're a Harvard-trained medical doctor. You've also spent time training to be a monk in India, right?

   5. AKDr. Alok Kanojia19:32

      Mm-hmm.

   6. RCDr. Rangan Chatterjee19:32

      And I think there's this beautiful balance and combination between West and East, something that I very much lean into and, for much of my career, ha- have very much tried to integrate those two philosophies together in a harmonious way. I think you do that so beautifully well. When you said about the root causes of various mental illnesses, [lips smack] I, I kind of, I thought, "Okay, well, then, it, it... There's a, there's a real issue here, isn't there, between the way we look at illness in the West and in the East?" These are very, very broad terms, okay?

   7. AKDr. Alok Kanojia20:08

      Mm-hmm.

   8. RCDr. Rangan Chatterjee20:08

      But Western medicine, allopathic medicine, tends to be, in my experience, quite reductionist and looks at all these diseases o- as separate things. We give them labels and, you know, depression is different from anxiety, which is different from, you know, something else. And the same thing with physical health. "Oh, no, you've got... Th- those gut symptoms are, um, this condition or this condition or that condition." Whereas Eastern philosophy, and I guess things like traditional Chinese medicine and Ayurvedic medicine, would be very much more holistic and go, "Well, what... You know, this symptom is a sign of some kind of systemic imbalance in the body," right? So through the lens of Western medicine, yeah, great, we're looking at those different mental illnesses, and you're saying, yeah, there are, there are sort of some root causes. One of them is distress tolerance. And I guess we could apply that same principle to a lot of physical health issues, where we could say, well, the root cause is actually chronic unresolved inflammation.

   9. AKDr. Alok Kanojia21:10

      Sure.

   10. RCDr. Rangan Chatterjee21:10

       So instead of treating these conditions as separate things, we could actually get to the root cause and go, "Okay, what's pro-inflammatory in this patient's life?"

   11. AKDr. Alok Kanojia21:20

       Mm-hmm.

   12. RCDr. Rangan Chatterjee21:20

       "How can I reduce that? How can I increase the anti-inflammatory nature of their lifestyle," for example. And I would similarly see downstream benefits in a variety of different conditions.

   13. AKDr. Alok Kanojia21:33

       Absolutely.

   14. RCDr. Rangan Chatterjee21:34

       Does that all make sense so far?

   15. AKDr. Alok Kanojia21:35

       100%, right? So we know that there's an inflammatory hypothesis for depression as well.

   16. RCDr. Rangan Chatterjee21:40

       Yeah.

   17. AKDr. Alok Kanojia21:41

       Right? So whether someone has IBS, whether they've got a- seasonal allergies, whether they've got depression, reducing their inflammatory burden absolutely improves all of those things.

   18. RCDr. Rangan Chatterjee21:52

       Yeah. So it's interesting that, you know, y- I think you said there were three... Did you say there were three root causes of mental illness?

   19. AKDr. Alok Kanojia21:59

       Three or four, yeah.

   20. RCDr. Rangan Chatterjee21:59

       Three or four. So one of them is distress tolerance. What were the others?

   21. AKDr. Alok Kanojia22:03

       Yeah, so perfectionism is another big one. So when we're, like, very, very hard on ourselves, that's one of the other trans- transdiagnostic causes. There's debate over, uh... So I... There, there are a couple that I've seen. Those are the two biggest that I think have the strongest level of evidence, is distress tolerance and perfectionism. There's debate over what the other two really are.

   22. RCDr. Rangan Chatterjee22:25

       Yeah.

   23. AKDr. Alok Kanojia22:25

       So we're not 100% sure. But some people, and this has to do with factor analysis, so if... I mean, this gets a bit technical, but when you do factor analysis, you'll basically come up with, like, four major factors. I think distress tolerance and perfectionism I think are the two that are the most significant.

   24. RCDr. Rangan Chatterjee22:43

       And those two are, of course, the two that we can make a quite simple and logical case that the [chuckles] modern world and the way we live today is ramping up, right? We no longer need to face discomfort or that boredom, which for many people is intolerable. And of course, perfectionism has been on the rise. You know, when I looked at the research of this, I thought, "Oh, this must be, uh, down to social media." But the research suggests it's from the 1980s that perfectionism has been on the rise, certainly the research I've been looking at, which is really interesting, this idea that, you know, where are these cultural ideas coming from about what it means to be a successful human. You know, the billboard idea of success and happiness, those two things are being ramped up in the modern world, and it, and of course that will be linked with all kinds of different mental illnesses.

8. 23:36 – 27:57

   East vs West mental health: DIY inner observation vs expert-delivered care

   1. AKDr. Alok Kanojia23:36

      Yeah. So I, I think it's, it's great that you mentioned, you know, this, um, this sort of perspective on, on physical health of, of being reductionist versus holistic. If I can talk about that principle of East versus West in, in mental health for a second. So when we're talking about physical versus mental health, you know, you mentioned inflammation. So I think there's one huge difference in the way that the West approaches the mind and the East approaches the mind, okay? So in the West, our system of medicine is me doing something to you or you doing something to me, right? So our, our idea of health or the practice of medicine in the West is, like, you know, a doctor prescribing a medication. And we do this in psychiatry too, where if you are mentally unwell, the right answer is for an expert to come and fix you through something like psychotherapy or psychopharmacology.The big difference between West and East when it comes to mind is o- o- in, in the Eastern side, they were do it yourself, DIY, right? So all of the Eastern interventions for the mind, or a lot of the Eastern interventions of the mind, what we call yoga and meditation, are designed to be done by the person who has the mind. So they're, they're designed, all the interventions of the East are for you to do for yourself. In all of the interventions of the West, literally we have these, you know, gigantic research or RCTs, randomized controlled trials, on this kind of psychotherapy, dialectical be- behavioral therapy, cognitive behavioral therapy, acceptance and commitment therapy, motivational interviewing. We have all these trials on different psychotherapies to help human beings with their mental problems. The big problem with all of those things is they have to be done by a therapist.

   2. RCDr. Rangan Chatterjee25:25

      Mm.

   3. AKDr. Alok Kanojia25:25

      Whereas if you look at yoga, you look at meditation, what they did is they said, "Hey, if there's something going on in my mind, I know it sounds kinda bizarre, but no human being can read my thoughts," right? So this is a huge weakness that we have in psychiatry. This is one of the reasons why I think mental illness is getting so much worse. Because if we look at physical medicine, I can understand what's going on in your body even better than you can. I can X-ray you. I can do a CT scan of your brain and see if there's a mass in there. I can measure-

   4. RCDr. Rangan Chatterjee25:58

      Mm

   5. AKDr. Alok Kanojia25:58

      ... your blood and detect things. I can detect an iron deficiency that you may not be able to detect. But when it comes to the mind, we have no way of measuring the mind. The only way to detect the mind is through your own observation, which is why, one of the reasons that, you know, I, I'm a psychiatrist, but I, I do so much of meditation and yoga, and we can talk about that, by the way.

   6. RCDr. Rangan Chatterjee26:20

      Yeah, for sure.

   7. AKDr. Alok Kanojia26:20

      We can talk about how to find happiness and comfort and all those kinds of things in a way that anyone who's listening to can apply themselves, right? You don't need an expert to apply it, because you're the only one who can observe your mind. You're the only one who can change your mind, right? So when it comes to the level of mind, the individual is the one who actually has the most power, and in the East, their interventions of mental health have you fixing your own problems because it is technically impossible for someone else to do it for you.

   8. RCDr. Rangan Chatterjee26:53

      Yeah. No, I love that distinction. I'm totally on board. And I guess one of my biggest frustrations throughout my medical career, particularly in the early days when you're trying to fit in and you're like, "Ugh, you know what? I've been told to practice like this, or this RCT, this randomized control trial, tells me for a patient like this, this is the treatment I need to give." I've always thought, "Yeah, but I'm not sure that is the right thing for this individual with their-

   9. AKDr. Alok Kanojia27:22

      Yeah

   10. RCDr. Rangan Chatterjee27:22

       ... life experience and their preferences and their culture." And, and that, I think that's one of the reasons why I like your work so much, is it, it's, it seems to very much have this grounding in both. Because it's very easy to go, "Oh, you know, all Western medicine is not so good," or, "All Eastern medicine is not so good." And it's like, well, hold on a minute. They've all got strengths. They've all got weaknesses. In fact, let me put it to you. Dr. K, ha- having sort of studied both sides of this, what would you say are some of the strengths and weaknesses of both Western medicine and Eastern medicine?

9. 27:57 – 32:00

   Reliability vs individualization: strengths and limits of both systems

   1. AKDr. Alok Kanojia27:57

      Speaking broadly, the basic problem with Eastern medicine is reliability. So if I go to an Ayurvedic doctor, what can I expect? I have no idea, right? So if treatment ... Le- let's say that treatment is, you're saying, like, treatment is highly individualized, right?

   2. RCDr. Rangan Chatterjee28:13

      Sure.

   3. AKDr. Alok Kanojia28:13

      Which means that w- w- I need to do one specific treatment for you, one specific treatment for your friend, a third specific treatment for your spouse, let's say. Now, if I'm a doctor and I do three different treatments for three different people, and let's say none of them get better, is the problem that their diseases are really, really hard to treat, or that I'm a bad doctor? How will we ever know, right? So the, the problem with individualized treatment is that it becomes incredibly hard to measure efficacy. It becomes incredibly hard to measure reliability. So as a simple example of this, you know, I, I gravitated towards certain things. I'm a Reiki healer. I'm an energy healer. I'm a trained energy healer. It's not something that I do as a part of my practice. And the reason for that, I almost never refer people to energy healers, because in my experience as a clinician, I've seen some energy healers who can do, I think, some medically impossible things, and I've seen the majority of energy healers who are not able to do that. So there's, there ... Anytime we are super, super individualized, reliability becomes a problem, and this is why allopathy has dominated the world.

   4. RCDr. Rangan Chatterjee29:27

      Mm-hmm.

   5. AKDr. Alok Kanojia29:27

      Right? So the reason that we have allopathic medical schools in basically every country on the planet is because there is a minimum level of reliability-

   6. RCDr. Rangan Chatterjee29:36

      Yeah

   7. AKDr. Alok Kanojia29:36

      ... with medicine. If I give you a statin and I give someone else a statin or something like that, we've even calculated, you know, the number needed to treat for a statin is somewhere between, like, eight and 40. I'm rusty on the statistics. So we know exactly, we can look at a large population. So even though there's a difference between a population and you, we can make broad predictions which, generally speaking, are correct on the allopathic side. The problem is that those, the, the, the answers that allopathy gives us will never perfectly apply to an individual.

   8. RCDr. Rangan Chatterjee30:12

      Yeah.

   9. AKDr. Alok Kanojia30:13

      Right? So allopathy is a population-based medicine. It's like we're gonna do what on average works for everybody. So what that means is i- i- it's great because, you know, if I, if I give a bunch of kids Adderall, on average, their school performance will improve. But the problem is that it's not individualized, so it will never be ideal to an individual patient.

   10. RCDr. Rangan Chatterjee30:37

       Yeah.

   11. AKDr. Alok Kanojia30:39

       I think that, uh, specifically when it comes to psychiatry, like I said, I think that Western medicine is missing something very crucial, which is that if you look at therapists, how does a therapist know what's going on in your mind? They ask you questions, right? And as I ask you questions, you give me answers, and then I use those answers as ways of trying to understand what's going on in your mind. But for you and anyone else listening, what is the difference? What is the gap between your thoughts and your words? It's huge.

   12. RCDr. Rangan Chatterjee31:15

       Yeah.

   13. AKDr. Alok Kanojia31:17

       So the basic weakness in psychiatry is that we're working on the mind, but no one else knows your mind as well as you do.

   14. RCDr. Rangan Chatterjee31:27

       Yeah.

   15. AKDr. Alok Kanojia31:27

       So, so when I practice clinically, you're spot on that I combine the two. I don't... I mean, I have seen sustained remission because, you know, we don't... The word cure is, is, is, has all kinds of problems when it comes to mental, mental illness. But I, you know, 70% of my pa- patients who come in on pharmacologic medications will be off of them and stable within 12 to 18 months. So w- I, I think there are so many things that we don't understand about how to create a healthy mind, that if you teach people these techniques, the need for medication goes away.

10. 32:00 – 43:23

    Sponsor break + intentional tech use: understanding effects so habits fall away

    1. RCDr. Rangan Chatterjee32:00

       Yeah. One of the most important pillars for our health is, of course, nutrition. But I think because of our busy, stressed out lives, so many people are struggling despite their best intentions. So many patients over the years have told me that they know what they should be doing, [laughs] but they're struggling to actually do it, and that's why I'm a fan of AG1. AG1 is a daily health drink that contains over 70 vitamins, minerals, and other ingredients that are designed to make nutrition really easy. It's been in my own life for over six years now. It's simple, it's tasty, it's convenient, and it forms a part of my morning routine. People will routinely tell me that taking AG1 regularly has improved their focus, their cognition, their energy. Some people even tell me that they drink less coffee when they're taking AG1. And there's research out there showing us that taking AG1 regularly can improve specific markers of your gut health, which is really good for your immune health. So if you're looking to upgrade your own nutrition in a simple, tasty, and convenient way, try AG1. To get a free bottle of vitamin D and five free travel packs, go to drinkag1.com/livemore. Now, I'm a huge fan of VIVOBAREFOOT shoes. I've been wearing them for about 12 years now, and one of the main reasons I love them is because when I'm wearing Vivos, I feel fully connected to the ground beneath my feet. What do we want? We want feet that move naturally, and because Vivos are wide, thin, and flexible, your foot can move in the way that it's meant to. A lot of modern shoes are stiff, they're narrow. They start to manipulate the way your foot functions, whereas in Vivos, your feet can do what they're meant to do, and that means they help your feet become stronger. There was this trial that showed within four months of wearing Vivos, your feet are around 60% stronger. Your feet are your foundation, and when you've got problems in your feet, it goes all the way up the chain. It can go to your ankle, to your knee, to your hip, to your back, and even to your shoulder and neck. And as a doctor, I have seen back pain, hip pain, and knee pain actually start to get better when people start to wear barefoot shoes. To get 20% off your first order, go to vivobarefoot.com/livemore.

    2. AKDr. Alok Kanojia34:34

       A- and even when we talk about, like, technology use, like, y- you know, we're a Healthy Gamer, which means that we're not saying you need to stop using technology. What we're saying is you need to understand how technology affects your mind, how it affects your brain, understand what's going on within you so that you can make some intentional changes, and then the, like, addictive technology usage will fall away on its own.

    3. RCDr. Rangan Chatterjee34:56

       Yeah.

    4. AKDr. Alok Kanojia34:57

       Right? That's what we see time and time again in our community.

    5. RCDr. Rangan Chatterjee35:00

       Yeah, no, I, I love that. It's really interesting because, of course, if we think about these broad terms, allopathic medicine versus more, I guess, holistic Eastern medicine, yeah, you know, allopathic medicine has more kind of robust trials saying, "On average, for this population, we're gonna see this," right? So that has a... That's a pro. Again, that same, uh, fact can also be a weakness because if you're not one of those averages, that same thing is no longer a strength, it's a weakness. Vice versa, you're a, you're a holistic practitioner. You're paying attention to the story, the unique life experiences. You understand that that trial that was published in Nature last month may or may not be relevant for the individual in front of you, yet you can't prove it. So on a kind of wider scale, when we're trying to analyze outcomes for, let's say, insurance or here in the UK for the National Health Service, then it becomes slightly problematic. So these things can be both strengths and weaknesses, the same thing, depending on through which lens you look at it. At the same time, I would say one of the other sort of through the lens of mental health and psychiatric conditions, if you, if the only way that you can feel good or get better is with that pill from that doctor, right? There is a reliance that then is created, right? So there's a dependency, which is one of the weak- for me, one of the weaknesses of, I can't say allopathic medicine as a whole, but the way it's often practiced, I should say... is that we don't always give our patients a sense of agency, right? It's like, no, no, no. The, yeah, you've got this thing.

    6. AKDr. Alok Kanojia36:47

       Mm-hmm.

    7. RCDr. Rangan Chatterjee36:47

       Let, let me tell you what's going on, and this is what you take, or this is the person you see, which, sure, may work temporarily, but in the long term... I mean, you know, I've been a, a, what is it now? 23, 23 and a half years since I qualified as a medical doctor. I would probably say that the number one thing I've learnt and I've experienced is that you have to give that patient a sense of agency before they walk outside that door. I think for me, that's always been one of the most important things. So few things there. I don't know if you have any comments on what I've just said, whether you agree, disagree, but I'd love to hear your perspective.

    8. AKDr. Alok Kanojia37:22

       Yeah. So I mean, I, I, I, I, I love what you said. I, I think I would add some nuance to it. I don't disagree. So let, let's start with this idea of, like, medication doesn't fix anything. So generally speaking, I agree with that. And we also know that, for example, SSRIs, which are a very common treatment for depression or mood disorder, um, trigger the ... Basically, all treatments of depression have one common root, which is they trigger the increase of BDNF, which is brain-derived neurotrophic factor. So one of the reasons why SSRIs, they take four to eight weeks to work. Like, you don't feel them right away. So it's not, it's not that you're becoming dependent on a pill, it's that the pill is triggering growth in your brain in some way, right? So BDNF, like, causes remodeling of the brain. It causes, like, growth of astrocytes and microglial cells and things like that. So it's almost like stimulating growth, and a lot of people who get started on an SSRI can actually be pulled off, like, very successfully given certain circumstances. So I think that there is some evidence that some medications in psychiatry you can use for a limited amount of time, and then you no longer need them. The problem is that for many people and many practitioners, they end up in the scenario that you described, which is that once you get started on a pill, th- they're just gonna keep you on it, right? And there isn't this, um, uh, there isn't this drive to sort of fix things at the root, and a really good example of this is, like, stimulant medication for ADHD, which, it, which shows that basically, like, the, the problem with stimulant medication, like metham- I mean, uh, amphetamines, like, uh, dextroamphetamine and things like that are, or methylphenidate, is that these medications make people feel way better, but their symptom improvement with ADHD is only 30%. So they feel like they're non-functional without the medication, and the medication changes their lives. There's a great, um, there, there's a great, uh, uh, p- meta-analysis that just came out, maybe in BMJ actually, that showed that basically, like, the symptom improvement from stimulant medication for ADHD is about 30%, and if you do cognitive behavioral therapy for 26 to 52 weeks for ADHD, the improvement is 69%, and the improvement from cognitive behavioral therapy lasts two years or longer, whereas the benefits of stimulant medication lasts for about six months. So we absolutely see this scenario where people will take medication. They subjectively feel way better, but they are not nearly as functional as they think they are. And if they go this more permanent route, through something like psychotherapy, if they start meditating, things like that, then they will get substantially better. So in general, I agree with your point. The one thing [laughs] I know it sounds so crazy, but the one thing that I may disagree with is you're saying empower your patients, which I'm all for. So patient empowerment is great, but if you work with a population of people who have ADHD and love their stimulants, empowering patients by giving them lots of stimulants is sometimes not the right idea. [laughs]

    9. RCDr. Rangan Chatterjee40:37

       Yeah. Well, just to be clear, when I say empowering patients, it's not about empowering them necessarily with drugs or stimulants. It's this idea that actually ... I, I have this belief, this strong belief that when a patient leaves, a patient, a client, depending on what profession you're in, right, when they leave your door, when they, when they walk out of the consultation, they have to believe that there's something they can do in their life that makes a difference. And this goes back to what you said before about things like yoga and meditation and other things that we can do to process our thoughts, to, you know, experience our mind in a variety of different ways. We have to believe, surely, as human beings, that we have some degree of agency over our lives, and that's certainly one of the things ... I'd say one of the biggest things I have tried to give patients throughout my clinical c- career, is that sense of agency and empowerment.

    10. AKDr. Alok Kanojia41:39

        Yeah. You know, when patients come into my office wanting stimulant medication for ADHD, the whole problem is if they don't get it, or if they do get it, when they walk out the door, they don't believe that there's anything else that they can do, right?

    11. RCDr. Rangan Chatterjee41:54

        Right.

    12. AKDr. Alok Kanojia41:54

        They believe this is the only thing. So even if they get the medication or don't get the medication, with the way that you clarified, in either case, they feel completely disempowered when they walk out the door, even if they get what they want.

    13. RCDr. Rangan Chatterjee42:07

        Okay. So how do you handle that? So let, let's take that as a scenario, okay? You've got this patient who wants that stimulant medication, and I know there's, it depends on the patient and a whole host of different things, but are there any sort of principles there that you kind of go through that can help us understand how, in that scenario, empowering that individual may not be the best approach?

    14. AKDr. Alok Kanojia42:32

        Yeah. So I, I think the empowerment, the way you define it, is great. I, I, I-

    15. RCDr. Rangan Chatterjee42:35

        Okay

    16. AKDr. Alok Kanojia42:35

        ... I think that's good, which is, like, helping this person understand, hey, there's something you can do. So I, I think it's ... I, I'm a little bit lucky this way because generally speaking, people come to me because they want to do more than medication.I'll absolutely get what we call medication-seeking patients who want stimulants, and I'll, I'll tell them straight up, like, you, you know, I'm happy to prescribe stimulants, but as part of a treatment plan, like a comprehensive treatment plan. And if that's what you want, I'm the right doctor for you. If you're looking for someone who just is gonna prescribe you medication and you're gonna walk out the door, and that's the kind of treatment you want, that's also okay. There are many millions of people on the planet who don't wanna do psychotherapy, don't wanna meditate, don't wanna do yoga. I just don't think I'm the right doctor for you.

11. 43:23 – 54:56

    Remission vs cure in mental illness: episodic nature, unknown causes, and maintenance

    1. RCDr. Rangan Chatterjee43:23

       I wanna talk about some of these practical techniques that you've sort of hinted at. But before we get there, just a couple of words you said before which, um, sort of stuck in my head, sustained remission. I thought that was really interesting, this idea that many of the patients in your practice with mental illness, you and your team are able to put into sustained remission. You said we don't use the word cure. Now, I thought that was quite interesting, and I, I just wanted to get your thoughts on that. And I guess this probably is partly to do with the difference between physical health and mental health.

    2. AKDr. Alok Kanojia43:58

       Yep.

    3. RCDr. Rangan Chatterjee43:59

       Um, but let's say, I don't know, let's say you had a pneumonia, okay? So you, you, you, you go see a doctor, you're diagnosed with a pneumonia. It's put on your records, and you get given antibiotics to treat your pneumonia. At the end of that course of antibiotics, on the assumption that your cough and your fever and your sputum has gone, we don't say that your pneumonia is in remission, okay?

    4. AKDr. Alok Kanojia44:31

       Right.

    5. RCDr. Rangan Chatterjee44:32

       Right. Um, so the point I'm trying to get to is, is it different or do you see it differently with mental illness? Um, for example, if someone, for example, when they were 19 years old, because of a variety of different life experiences, ended up being diagnosed with depression by their, by their primary care physician or their psychiatrist, and they did a series of things. They were empowered by their practitioner, and they meditated, they did yoga, they didn't use technology the first hour of the day, and they got to know themselves better, and they never, ever had another episode again that would be classified as depression. Is it still fair to say that's a sustained remission?

    6. AKDr. Alok Kanojia45:23

       So it, it's exactly what you said. Like, your, your example is perfect, too. So let's understand. So when I say people are in sustained remission, let's understand the time point that I'm at. So someone comes into my office, right? Happened all the time, right? I was in Boston, so I'd get kids from Harvard or MIT or Emerson or whatever, a huge college town. 19-year-old comes in with an episode of depression. Three years later, there's no depression, right? So I worked with this person for three years. They're now 22. Have they been cured? Are they gonna get another episode when they become pregnant? Are they gonna get an episode after they give birth? Are they gonna have an episode when they have divorce? We don't know. So if they never have another episode for the remainder of their life, could we call it a cure? Maybe. But the whole point is that we don't know, right? So the nature of mood disorders is that they are episodic. They're not there all the time.

    7. RCDr. Rangan Chatterjee46:15

       Mm-hmm.

    8. AKDr. Alok Kanojia46:15

       So they come and they go. Now, the, it, this, it, it, it... The example that you use for pneumonia is also fantastic because we know the pathophysiology of pneumonia. We know what causes pneumonia.

    9. RCDr. Rangan Chatterjee46:27

       Mm.

    10. AKDr. Alok Kanojia46:27

        Pneumonia is caused by a certain kind of bacteria. If we eliminate the bacteria, the pneumonia will never come back. The problem with depression is that we don't know what causes it.

    11. RCDr. Rangan Chatterjee46:39

        Agreed. We know the pathophysiology of pneumonia. At the same time, there are some patients who are more susceptible to getting regular pneumonias, right? So yeah, the, the, the, the, the bacteria goes away after taking the antibiotic, but they may be the type of patient who gets two a year, right? Whereas someone else might get one every 10 years.

    12. AKDr. Alok Kanojia47:02

        To- totally with you, right? And that's where now we get into the shades of gray. So let, let's forget about pneumonia for a second. If we wanna go further gray, let's talk about asthma.

    13. RCDr. Rangan Chatterjee47:10

        Yeah.

    14. AKDr. Alok Kanojia47:10

        Right? So asthma that, uh, you know, is somewhat controlled, let's say, on, like, an inhaled glut- glucocorticoid or something like that. And then even if they stop the, the, get- getting the glucocorticoid, let's say they're off of everything, but they don't have an asthma attack for one year, does that mean that they're cured, not cured? The pathophysiology of the smooth muscle reaction that happens in their lungs is still potentially there, right?

    15. RCDr. Rangan Chatterjee47:32

        Mm.

    16. AKDr. Alok Kanojia47:33

        So there's all kinds of shades of gray, and in mental illness, too. Let's take the case of trauma, okay? So we have a whole guide to trauma where we kind of walk, uh, go into this, but so we look at trauma. Trauma has effects on every dimension of your being. The first thing that happens is your physiology becomes rewired. Your sensitivity to threat and danger increases. So there are situations in life that are not really dangerous, but your nervous system is so ramped up that it looks at a normal thing, and it sees danger there. So a good example of this is I, I did a lot of work with veterans, and, you know, if a door slams, their nervous system is wired-

    17. RCDr. Rangan Chatterjee48:20

        Yeah

    18. AKDr. Alok Kanojia48:20

        ... to pick that up and think, "Oh my God," like, "there could be a bomb going off," or, "That's a gunshot." So there is a nervous system change, okay? So one thing that we can do is we can rewire the nervous system, and that's what sustained remission even from PTSD looks like. One piece of that is your nervous system has been wired in some way, and we can rewire it. Now, once we rewire it, there's no need for, like, medications like prazosin-

    19. RCDr. Rangan Chatterjee48:47

        Mm

    20. AKDr. Alok Kanojia48:47

        ... or anything like that, right? So once we've, like, altered the wiring back to the way that it should be in a healthy range, we don't need medication anymore.It's not just that. In trauma, we also have problems with emotional regulation.

    21. RCDr. Rangan Chatterjee48:59

        Yeah.

    22. AKDr. Alok Kanojia48:59

        So this is not the central nervous system and, you know, our heart and lungs and adrenaline cor- and cortisol. This is like our amygdala becomes hyperreactive. So this is the part of our brain where we experience fear and an anxiety. So we can also do certain kinds of meditation techniques, yoga, cognitive behavioral therapy, cognitive reframing to literally increase the strength of the connections between our frontal lobe and our amygdala.

    23. RCDr. Rangan Chatterjee49:26

        Mm.

    24. AKDr. Alok Kanojia49:26

        So this is strengthening the part of your brain that allows you to calm down. So once we've done that rewiring, this is basically speaking a permanent change, or can be-

    25. RCDr. Rangan Chatterjee49:37

        Yeah

    26. AKDr. Alok Kanojia49:37

        ... hypothetically a permanent change. And then it moves up to one level. So now that my threat perception has been normalized, I'm not seeing danger in every sh- every, every corner. Now that my ability to regulate my sadness and my anger has improved, now my relationships will start improving.

    27. RCDr. Rangan Chatterjee49:54

        Yeah.

    28. AKDr. Alok Kanojia49:55

        Right? So now when I'm, when my partner doesn't text me back, instead of getting paranoid because my amygdala is hyperreactive and there's adrenaline pumping through my s- my system, I'm able to chill out, and then I can learn particular ways to relate to someone else. So trauma also changes the way that we connect to other human beings.

    29. RCDr. Rangan Chatterjee50:13

        Yeah.

    30. AKDr. Alok Kanojia50:13

        If we're traumatized by our parents, the people who love us, we get all messed up, honestly.
12. 54:56 – 1:09:34

    Meditation demystified: action vs state, and why ‘it doesn’t work’ is common

    1. RCDr. Rangan Chatterjee54:56

       You mentioned meditation and why it can be such a powerful practice for a whole variety of different conditions, whether it be mental or physical for that matter. And I think there's lots of misconceptions about meditation. So a lot of people hear, "Oh, I should meditate." They try. They often say, "Oh, it's not for me," or, "It didn't work," or a whole host of other things. So Dr. K, from your perspective, what is meditation and how can people start to engage with it in their lives?

    2. AKDr. Alok Kanojia55:29

       It's a great question. So this is where I think the biggest problem with meditation is that we use one word to describe what is up to eight different Sanskrit states or more. Probably, there's probably 20 or 30, maybe even 100 words for meditation in the Sanskrit language, and they each describe different mental states or states of consciousness. So here's the most important distinction. There are two words that loosely get translated as meditation. One is dharana and the other is dhyana. So dharana means focusing technique. So dharana is a verb. So when I say, "I sit down to meditate and it doesn't work for me," there are two things we're talking about. One is an action and one is an effect. Does that make sense?

    3. RCDr. Rangan Chatterjee56:20

       Yeah.

    4. AKDr. Alok Kanojia56:20

       So when some people sit down to meditate, they say, "It doesn't work for me," what are they talking about? They mean, "My mind is scattered. I have no peace. Everyone's talking about peace, everyone's talking about stillness, everyone's talking about a no mind state. I, I can't do any of that. It's not working for me." So not working is an effect.

    5. RCDr. Rangan Chatterjee56:34

       Yeah.

    6. AKDr. Alok Kanojia56:35

       It's different from an action. So the best analogy for this, so dhyana is a state of mind, of a certain state of consciousness which is very, very positive. We'll get to that in a second. But dharana is sitting down to meditate, and dhyana is the state of consciousness that if you are lucky, you achieve while you are meditating. The best example of this, so you're a doctor, right, Dr. Chatterjee?

    7. RCDr. Rangan Chatterjee57:00

       Correct.

    8. AKDr. Alok Kanojia57:02

       Um, I'm having difficulty with sleeping. Can you teach me how to sleep?

    9. RCDr. Rangan Chatterjee57:08

       Yeah, it's a great one. No, of course I can't teach them how to sleep, but I can teach them-

    10. AKDr. Alok Kanojia57:12

        I'm confused. Are, are... Have you never slept before?

    11. RCDr. Rangan Chatterjee57:16

        [laughs] Yes, I have slept before.

    12. AKDr. Alok Kanojia57:19

        Can you teach me how?

    13. RCDr. Rangan Chatterjee57:21

        I can teach you some of the things that you may want to focus on, some actions that you can do which may lead to the outcome of sleep, but I can't actually go and take you directly to sleep.

    14. AKDr. Alok Kanojia57:33

        Great. So what are some of the actions?

    15. RCDr. Rangan Chatterjee57:35

        Okay. So again, it depends on you as an individual, but it could be that I start off in the morning and talk about the importance of natural light first thing in the morning to help you with your circadian rhythm.

    16. AKDr. Alok Kanojia57:46

        Great.

    17. RCDr. Rangan Chatterjee57:46

        I may talk to you about when do you stop drinking caffeine. Okay. You enjoy-

    18. AKDr. Alok Kanojia57:51

        Great

    19. RCDr. Rangan Chatterjee57:51

        ... caffeine, great, but there's a long half-life. Maybe you wanna just stick to it in the morning. I may talk about your mind being overly stimulated in the evening and help you understand is there some sort of shut off time where you can move from work time to relaxation time. And-

    20. AKDr. Alok Kanojia58:07

        Beautiful

    21. RCDr. Rangan Chatterjee58:08

        ... light exposure, the time you have your last meal, et cetera, et cetera.

    22. AKDr. Alok Kanojia58:12

        Great. And if I do all of those things, will I fall asleep?

    23. RCDr. Rangan Chatterjee58:15

        I can't say that for sure, but it's gonna increase the probability.

    24. AKDr. Alok Kanojia58:19

        There we go.

    25. RCDr. Rangan Chatterjee58:20

        [laughs]

    26. AKDr. Alok Kanojia58:21

        Right? So that's the first thing to understand is that meditation is not about sitting and breathing. I can wake up at 5:00 AM, I can stop caffeine, I can have zero caffeine during the day, I can meditate, I can exercise, I can have no blue light exposure to my pineal gland before, you know, a couple hours before sleep, and then I can still not fall asleep. So meditat- first thing to understand is meditation is the same way.

    27. RCDr. Rangan Chatterjee58:47

        Yeah.

    28. AKDr. Alok Kanojia58:47

        There's the action that you take, and then there is the state of consciousness that you achieve. When people say, "Meditation doesn't work for me," they are not able to attain the state of consciousness. They're not able to fall asleep. They can do all the right actions, but they don't get the result. So this, this is the first thing to understand.

    29. RCDr. Rangan Chatterjee59:05

        Mm.

    30. AKDr. Alok Kanojia59:05

        Second thing to understand is as you beautifully said, right, when you're trying to help someone sleep, it depends on you. So the biggest problem in the world today with meditation teachers is that we've started having trained meditation teachers. We've started offering certifications for meditation. Do you know historically how many years it took to become a meditation teacher?
13. 1:09:34 – 1:22:32

    Stillness training (Gayasthiram): turning discomfort into breath-based refuge

    1. RCDr. Rangan Chatterjee1:09:34

       Yeah. One of the practices I've heard you talk about before is where you sit in complete stillness for, I think, five minutes.

    2. AKDr. Alok Kanojia1:09:47

       Mm-hmm.

    3. RCDr. Rangan Chatterjee1:09:48

       And one of the things I, I love when I've heard you, uh, describe that practice in various conversations and interviews that I've seen is that you talk about this idea that at some point it gets so uncomfortable that the most luxurious and pleasurable thing in the world becomes your breath. And I thought that was a really beautiful and evocative concept for people to get their heads round, the, the, the kind of the beauty of the breath, as it were, in the sense that a lot of the time, you know, we get told to focus on our breath, but it's like, "Oh, yeah, I don't wanna focus on my breath. Like, you know, it's a bit of a pain, but I know I heard it in a podcast that they said focus on my breath." But you kind of flip it with this sort of practice where actually you get to the point where you want to focus on the breath. So I wonder if you could explain what that practice is. Does it come under the umbrella of meditation, or is it separate to meditation? And who might wanna consider trying it out?

    4. AKDr. Alok Kanojia1:10:46

       Okay. Great, [laughs] great question. So the practice is something called Gayasthiram, which means s- like, holding the body still. So when you hold your body perfectly still, it's gonna be okay for a little bit, and then it's gonna quickly become not okay.

    5. RCDr. Rangan Chatterjee1:11:06

       So when you say still, do you mean literally you're not moving a muscle?

    6. AKDr. Alok Kanojia1:11:10

       Well, you're gonna have to be respirating.

    7. RCDr. Rangan Chatterjee1:11:12

       Yeah.

    8. AKDr. Alok Kanojia1:11:12

       But try to keep that to a minimum as well. But if you have an itch, don't itch it. If you feel like shifting your leg because your leg is falling asleep, don't shift it.

    9. RCDr. Rangan Chatterjee1:11:20

       Mm-hmm.

    10. AKDr. Alok Kanojia1:11:20

        Uh, you know, so over time what'll happen is you're not used to sitting still, so you're... And you won't be sitting, like, perfectly balanced. So over time, muscles will, will... Muscles are contracting to hold you in place, right? That if we have to sit up, we're contracting our back, we're contracting our trapezius, our shoulders. There's all gonna be all kinds of sensations that over time get worse. This is the point. So don't do it to the point where you're, like, you know, hurting yourself. But it, it'll feel uncomfortable, intensely uncomfortable. And as it becomes more intensely uncomfortable, you'll be sweating. It'll require your full attention to hold it, right? So a, y- a good example of this is if you sit, uh, against, a sit on the wall. I don't know if you, you know what that means, where you're kinda, you know, just sitting against the wall.

    11. RCDr. Rangan Chatterjee1:12:04

        Yeah, yeah, yeah.

    12. AKDr. Alok Kanojia1:12:05

        Yeah, right? So it's a good abdominal exercise. But, like, if you hold an uncomfortable position, it becomes painful. And the way that I was taught meditation is by understanding the principles. So people say focus on the present, focus on your breath. These are things that you don't have to focus on. You can do a certain practice where you have no choice but to be in the present.

    13. RCDr. Rangan Chatterjee1:12:28

        Mm.

    14. AKDr. Alok Kanojia1:12:29

        As you engage in Gayasthiram, the longer you are still, at the beginning you can think about, oh, I'm gonna eat. I have this meeting tomorrow. But as the int- as you continue being perfectly still and the itch on your nose becomes so unbearable, you will literally not be able to think about anything else. And then the only relief that you will have is your breath. And then you will start to breathe. Because it's all of these sensations. Your somatosensory cortex is gonna be going wild. It's gonna be sending you all of these signals to move, move, move. The only way you can distract yourself from those signals is to breathe.Some people figure it out, some people don't. I'm kind of giving y'all the answer. But you'll sort of figure it out on your own, is the only way to tolerate it is to breathe. And the more deeply you breathe, the more you will be able to tolerate. And then you will fall into the breath. Breath will feel like it is like you're, you know, it's like you're, you're starving, and then you're getting this, this one breath of air that is bringing you some degree of peace. And the feeling is truly ecstatic. And it'll take five to 10 minutes. Your only refuge will be the breath. And so the beautiful thing about this practice is everyone says meditation is hard. I can't focus on the breath. I get bored. I get distracted. I can't be in the present. My mind is running all over the place. That's because no teacher has taught you what to do so that these things come naturally. They're not to be forced.

    15. RCDr. Rangan Chatterjee1:14:01

        Yeah.

    16. AKDr. Alok Kanojia1:14:02

        Right? So it's about figuring out a technique that naturally puts you in the present, naturally has you focusing on the breath, and this is the cool thing. Just like we talked about over an hour ago, this carries over. So once your brain knows how to find relief in the breath-

    17. RCDr. Rangan Chatterjee1:14:20

        Mm-hmm

    18. AKDr. Alok Kanojia1:14:21

        ... it will start automatically finding the relief in the breath. When you feel anxious, when you have difficulty sleeping, when you feel sick, you will take a deep breath and you'll be able to work a little bit better. You may notice that my voice is a little bit hoarse right now. I'm sick. And yet some of the practices that I engage in on a daily basis, you saw the meditation cushion at the beginning, allow me to be more functional because now my body knows, right? Like, I know how to r- maintain focus and things like that. So all of this being present focused, all of the stuff about sort of finding relief in periods of hardship will increase your-

    19. RCDr. Rangan Chatterjee1:14:57

        Yeah

    20. AKDr. Alok Kanojia1:14:57

        ... distress tolerance and will allow you to tolerate the difficulties in life, manage the difficulties in life way easier.

    21. RCDr. Rangan Chatterjee1:15:06

        Yeah. Amazing. Thank you for sharing that. Sorry to interrupt. To make sure you are taking action after watching this video, I have created a free special guide to help you improve your sleep and reduce fatigue. Now, in my clinical experience, most people who are struggling to sleep are doing something unconsciously in their day-to-day life that is negatively impacting their ability to sleep at night. So in this free guide, I share with you five of my very top tips, tips that I have seen transform the lives of many of my patients. So if you wanna get ahold of this guide, all you have to do is click on the link in the description box below. Um, secondly, with, with respect to that practice, it's a really, it's a really thought-provoking practice I think for, for many people listening right now I imagine, because you're right. Too much of the attention is on... You know, it's like what we said about meditation before. You know, we think meditation's gonna give us a clear mind without understanding, no, no, it's an action. You take the action. You may get that secondary outcome. You may not. But take the action. And I, I love this practice whereby instead of saying, "Oh, I must focus on the breath, I must focus on the present moment," you will be left with no option but to do so within a few minutes. With that in mind then, and with what we said earlier in mind, this idea that many of us now have been conditioned for comfort or conditioned away from discomfort, it feels to me as though that is a practice that could be applicable to anyone. Is there anyone... I mean, I, I, I mean, I'm already keen to go, "Well, I wanna try that tomorrow morning. I wanna actually give that a go and see what happens when my muscles feel tense, or my nose wants to be itchy," or whatever it might be. Is there anyone who shouldn't do a practice like that? Or do you think it's quite a fun or, or useful experiment for most people to try at some point?

    22. AKDr. Alok Kanojia1:17:10

        Yeah, I mean, I, I, I think it's useful for most people to try at some point, right? But so generally speaking, Gayush theorem should be done sitting up straight. So if you've got spinal problems or back problems or things like that, like we don't wanna, you know, trigger, like, muscle spasm or things like that, so you always wanna be careful. Talk to your doctor. But generally speaking, I think Gayush theorem is a great practice for someone to try. And go into it is beautiful. It's, like, so easy to do. Just go into it recognizing this is gonna suck for me. Let's see how far I can go. Now, you have to be a little bit careful there because ego can come in, and you can just be like, "Oh, I'm gonna go longer. I'm gonna go longer."

    23. RCDr. Rangan Chatterjee1:17:44

        Mm.

    24. AKDr. Alok Kanojia1:17:44

        "I'm gonna go longer." If that's what happens in your mind, you're doing the practice wrong because now think about what's happening in your mind. It's about going further, going further, achieving, achieving. You're not paying attention to the present. You're not focusing on your breath now. The breath isn't a relief. It's very, like there's a conquering energy to it of, "I wanna be hardcore." That'll lead to ego, so you have to be a little bit careful about that.

    25. RCDr. Rangan Chatterjee1:18:06

        Yeah.

    26. AKDr. Alok Kanojia1:18:07

        And there's, there's all kinds of nuances, but generally speaking, I'd say, you know, if you're listening to this, find a safe place if you don't have any health conditions or anything like that, and try to sit still for 10 minutes without moving a muscle. If you fail, it's okay. That's not the... Failing or succeeding is not the point. Even if you fail or succeed, the issue is that during the practice itself, there will be such an intensity of experience. Your brain will be doing all kinds of stuff. Even if you fail, for the three minutes that you were suffering and succeeding, your brain is wiring for distress tolerance.

    27. RCDr. Rangan Chatterjee1:18:41

        Yeah.

    28. AKDr. Alok Kanojia1:18:42

        The next time you don't get your drink on the train because the app is broken, you've managed this Gayush theorem for three minutes and that was torture, you're gonna have no problem with not getting your drink.

    29. RCDr. Rangan Chatterjee1:18:56

        Yeah.

    30. AKDr. Alok Kanojia1:18:57

        Life will literally become easier.
14. 1:22:32 – 1:35:29

    Breaking bad habits through inaction: ‘urge surfing’ and response prevention

    1. AKDr. Alok Kanojia1:22:32

       So now the question becomes how do we understand that, right? So you're saying if you train this. So I'm gonna give y'all... So I, I know you mentioned a technique that I've taught elsewhere. I'm gonna give you a fresh one-

    2. RCDr. Rangan Chatterjee1:22:42

       Okay

    3. AKDr. Alok Kanojia1:22:42

       ... that's never been taught before, okay? This is a really fascinating technique that can u- be used to erase any bad habit. It's so simple. So if we understand what a habit is, a habit is a desire or a natural inclination to move in a certain direction, right? I have a habit for caffeine. I have a habit for alcohol. I have a habit to, I don't know, pick my nose, whatever. We have all these kinds of bad habits. So I know this is gonna sound kind of weird, Rangan, but like if I wanna stop drinking alcohol, what do I need to do?

    4. RCDr. Rangan Chatterjee1:23:19

       Okay. Well, there's a number of ways you could tackle this. Okay. Um, oh, okay, very simply, all you have to do is not put the alcohol in your mouth.

    5. AKDr. Alok Kanojia1:23:29

       Perfect. If I wanna stop picking my nose, how do I do that?

    6. RCDr. Rangan Chatterjee1:23:34

       Just never, ever put your finger in your nostril.

    7. AKDr. Alok Kanojia1:23:37

       Perfect. Right. So here's the crazy thing. What skill is that? How would you group together all of those things?

    8. RCDr. Rangan Chatterjee1:23:50

       You set an intention and you take action. You say, "I'm no longer gonna pick my nose," and you no longer do it. You say you're always gonna take the stairs, and you always take the stairs. There's an alignment between your intention and your action. Uh, certainly that's one way I would look at it.

    9. AKDr. Alok Kanojia1:24:08

       Yeah. So, so it is a way of looking at it is right in one sense and 100% wrong in the other.

    10. RCDr. Rangan Chatterjee1:24:12

        Okay.

    11. AKDr. Alok Kanojia1:24:12

        Because what we're talking about is not taking action, right?

    12. RCDr. Rangan Chatterjee1:24:16

        Of course.

    13. AKDr. Alok Kanojia1:24:16

        How do I not pick my nose? It is practicing inaction-

    14. RCDr. Rangan Chatterjee1:24:20

        Yeah

    15. AKDr. Alok Kanojia1:24:21

        ... to break any bad habit, right? So a bad habit is an action, right?

    16. RCDr. Rangan Chatterjee1:24:25

        Yeah.

    17. AKDr. Alok Kanojia1:24:26

        So you're right that it, it, very similar, right? So if, if you're trying to build a good habit, then you set an intention and you take an, a, an action. If you're trying to break a bad habit, you set an intention and you don't take an action. Like literally.

    18. RCDr. Rangan Chatterjee1:24:39

        Mm.

    19. AKDr. Alok Kanojia1:24:39

        Very simple. So now the question becomes how can we practice inaction?

    20. RCDr. Rangan Chatterjee1:24:47

        Okay. So can I just work this through with an example?

    21. AKDr. Alok Kanojia1:24:51

        Yeah, 100%.

    22. RCDr. Rangan Chatterjee1:24:51

        Yeah. Okay. So let, let's say snacking, right? Because snacking is something that a lot of... Or sugar. People struggle with this, right? So, um, let's say someone's sitting there or I'm sitting there, and I have an urge to put a cookie in my mouth, okay? And I've decided that this is a habit I want to break. Okay. So okay, so I feel an urge to pick up the cookie, but as you've just illustrated with that needing the toilet example, all these urges are temporary. They don't last forever. They come and they go.When I get that urge, I'm practicing inaction. At that point, I'm going, "No, I'm gonna sit with that urge. I'm not going to pick it up and put it in my mouth." And I guess through a process of observation, you'll find that actually after a short period of time, that urge actually vanishes and it's no longer there.

    23. AKDr. Alok Kanojia1:25:45

        That is fantastic, right? A couple of things. One is we use this technique in addiction psychiatry called urge surfing-

    24. RCDr. Rangan Chatterjee1:25:51

        Okay

    25. AKDr. Alok Kanojia1:25:52

        ... which is this idea that urges will come and go, right? So the, the whole problem with human beings is that things don't last forever. My happiness from my wedding day does not last for the rest of my life, right? Like, we don't need a perfect wedding day because it's only one day, but a lot of people get caught up in it.

    26. RCDr. Rangan Chatterjee1:26:09

        I completely agree with you, and I've said that many times as well. I'd rather have a poor wedding day and a great marriage.

    27. AKDr. Alok Kanojia1:26:15

        Right. Okay. So urges are temporary. There's a problem though, Rangan, which is that since I have trouble with snacking, when I get the urge to eat a cookie, I can't control it, right?

    28. RCDr. Rangan Chatterjee1:26:28

        Okay.

    29. AKDr. Alok Kanojia1:26:28

        That's the whole problem.

    30. RCDr. Rangan Chatterjee1:26:28

        Yeah. Okay.
15. 1:35:29 – 2:03:06

    Happiness as the default: desire creates mental activity that disrupts peace

    1. AKDr. Alok Kanojia1:35:29

       Now let's go to happiness.

    2. RCDr. Rangan Chatterjee1:35:31

       Yeah.

    3. AKDr. Alok Kanojia1:35:31

       So what is happiness, Rangan?

    4. RCDr. Rangan Chatterjee1:35:36

       Inner peace.

    5. AKDr. Alok Kanojia1:35:38

       What does that mean?

    6. RCDr. Rangan Chatterjee1:35:40

       Okay. Um, okay. There's two ways I'd like to answer this, okay? Um-

    7. AKDr. Alok Kanojia1:35:46

       Great

    8. RCDr. Rangan Chatterjee1:35:46

       ... the first way is that I believe that happiness is a skill that can be cultivated.

    9. AKDr. Alok Kanojia1:35:53

       Okay.

    10. RCDr. Rangan Chatterjee1:35:53

        That happiness is not something we directly go for. The model that I use for happiness, or have used, is there are three components. There's alignment, when your inner values and your external actions start to match up. Uh, contentment and control, okay? A sense of control. Not controlling the external world, things that you can do that give you a sense of control, okay? So if you work on those three things, and there are practices you can do to work on those three things, the side effect is that you're gonna be happier more often, okay? So that's the practical way that I view happiness, but when you asked me what is happiness, 'cause I think about this all the time.

    11. AKDr. Alok Kanojia1:36:34

        I can tell.

    12. RCDr. Rangan Chatterjee1:36:35

        I think this is a state, I say inner peace, but I guess to expand upon that a little bit more, I mean the state of minimal reliance where I am no longer or not dependent on the world around me, the people around me, the comments around me, to be a certain way in order for me to feel a certain way. So it's this minimal reliance on the external world, and I guess in many ways maximally reliant on myself. It also echoes with what you were saying about this ability to just sit in stillness. Inner peace to me is if you can sit in silence for an hour and not get frustrated and not necessarily need to distract yourself, I would argue that you are, you know, quite a bit on the way to getting-

    13. AKDr. Alok Kanojia1:37:27

        Okay

    14. RCDr. Rangan Chatterjee1:37:27

        ... that inner peace.

    15. AKDr. Alok Kanojia1:37:28

        Okay, great. So here you are with these, like, three things, like alignment, autonomy, or agency. So the key thing is that you figured out a method that if you apply this method and you cultivate these skills, you will get some result, right? But here's the thing. The skills are not the happiness. The happiness is the result of the application of the skills, right?

    16. RCDr. Rangan Chatterjee1:37:50

        Yeah.

    17. AKDr. Alok Kanojia1:37:51

        Okay. So let's get rid of all the skills, because that's not what happiness is. I asked you what is happiness, not how to achieve it. You're already giving me how to achieve it, which I don't disagree with at all. There's a ton of research that I'm sure you've done. If you haven't, I can back up everything that you said with piles and piles of research about why it's effective, how it's effective, what happens in your brain, what happens in your psychology. It's a fantastic methodology, I mean that. But that's not what happiness is. What is the end result of all of that? Ideally, happiness. So let me ask you a different way. How do you know you're happy?

    18. RCDr. Rangan Chatterjee1:38:26

        I love these questions. Okay. I absolutely love them. How do you know when you're happy? Okay.

    19. AKDr. Alok Kanojia1:38:31

        Yeah.

    20. RCDr. Rangan Chatterjee1:38:33

        Okay.

    21. AKDr. Alok Kanojia1:38:34

        But what?

    22. RCDr. Rangan Chatterjee1:38:35

        A la- okay, a lack of desire.

    23. AKDr. Alok Kanojia1:38:37

        Okay, great. So now let's look at desire. So the moment that I have a desire, I wanna eat a cookie. Am I still happy? If I'm ordering something from the train car app and I'm not getting it, am I happy?

    24. RCDr. Rangan Chatterjee1:38:51

        No.

    25. AKDr. Alok Kanojia1:38:52

        No. I have a desire that is unfulfilled, therefore I am unhappy, right?

    26. RCDr. Rangan Chatterjee1:38:58

        Yeah. Okay. [laughs]

    27. AKDr. Alok Kanojia1:38:59

        So people go through life wanting things and not getting them, and they are unhappy. Correct?

    28. RCDr. Rangan Chatterjee1:39:08

        Correct.

    29. AKDr. Alok Kanojia1:39:09

        And this is what we see with technology, right? You said that in the '80s, perfectionism was on the rise. So in the '80s, we started getting these billboards. Beautiful. These billboards of people who have stuff that we don't have. The advertising industry wants to teach us that there are things that we don't have, that if we got those things, we would be happy, right?

    30. RCDr. Rangan Chatterjee1:39:29

        Mm.
16. 2:03:06 – 2:05:24

    Final guidance: stop chasing sparks—practice stillness and accept unhappiness

    1. RCDr. Rangan Chatterjee2:03:06

       It was so much fun. And just finally, for that person who has, has been listening and they've heard something that's just sparked something inside of them, it sparked something where they feel, "Yeah, you know what? I'm, I'm kind of, I have been feeling lost. I have been feeling a little unmotivated. I have been feeling as though I'm someone who's full of desires and I can never satisfy them all," and they're looking for some kind of final words of wisdom from you, what would you say to them?

    2. AKDr. Alok Kanojia2:03:43

       So if someone's listening to this conversation, you feel a spark, "Oh, this resonates with me. I'm too full of desires. I'm uncontent. I'm, I can't control my mind. What should I do?" Nothing. In the past when you've had this feeling and you've chased this feeling, where has it gotten you? See, the moment we feel discontent and we feel a longing to act, and then the discontent goes away, and then we no longer follow through. So oddly enough, what I'd encourage everyone, like, I mean, so if you're listening to this, examine your own life. And when you feel a little spark of something, what do you usually do? You usually chase it, and then it fizzles. So don't live your life based on these sparks. I mean, should you pursue something? By all means, go and learn, read a book, whatever. I'm not saying practically don't do anything. But don't do it reflexively. Take a moment and just do nothing. And interestingly enough, that may help you 'cause if chasing your sparks has not led you to where you wanna go, try not chasing them. Try being still. Try doing absolutely nothing and see where that leads you.

    3. RCDr. Rangan Chatterjee2:04:58

       I love it. Dr. K-

    4. AKDr. Alok Kanojia2:04:59

       [laughs]

    5. RCDr. Rangan Chatterjee2:04:59

       ... it has been an absolute pleasure. Thank you so much, and I, I really hope we get to do this in person at some point in the future.

    6. AKDr. Alok Kanojia2:05:07

       Yeah. Looking forward to it, man.

    7. RCDr. Rangan Chatterjee2:05:08

       [upbeat music] If you enjoyed that conversation, then I think you are really going to enjoy this one.

    8. SPSpeaker2:05:13

       We live in an age of rings and pings and dings and app notifications, social media alerts. We're rewiring our brains. Technology's a tool for us to use, but if technology's using us, then, then we become the tool, right?

Episode duration: 2:05:25