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Chef AJ: Depression Causes and Treatments | Chef AJ LIVE! with Dr Doug Lisle and Dr Jen Howk
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perfect hey everyone and welcome to chef aj live i'm your host chef aj and this is where i introduce you to amazing people like you who are doing great things in the world that i think you should know about you know there have been many dynamic duos throughout history from anthony to cleopatra to batman and robin but none so dynamic as my guests today who are the face of esteem dynamics a wonderful website where you can glean so much knowledge and information and even book a private session with either of them but they are so generous with their time they come back once a month when they can to answer your questions please welcome back our favorite guests dr jen hawk and dr doug lyle thanks for coming on we really appreciate our time with you yeah it's good to be here doug gets to make his bad joke this time thank you aj glad to be here all good well i'm sure you guys know maybe even in your private practice that the holidays are coming up and people a lot of people are freaking out it's a big deal to a lot of people both in terms of worrying about going off plan and not being able to get back on or seeing family members and and how to navigate these holidays so it figures that the first question is from morgan it's kind of long i'll read it fast holidays are upon us i've been estranged from my mom for almost five years except for snail mail here and there my mom has borderline personality disorder and she is specifically impacted by a plethora of lifestyle diseases thanksgiving week my four siblings are going to be in the area and i'm feeling open to getting together with them and my mom with my husband and kids not for a full thanksgiving gathering something more casual when i think about seeing my mom my insides literally quake and i break out in a sweat i only sort of want to see her however i think that seeing her in a group setting where the expectations her interactions are low and i can leave if i need to may be a better case scenario the experience of her has always been crushing to me any tips on how to navigate a reunion without letting it steamroll me i'm sure you've heard some variations of this question before well i have a few things i would say and then and then jen jen i'm sure is going to have things i miss but first thing is is that probably it is is it important and useful to figure out exactly in what way uh that you are going to extricate yourself and when so it's a really good idea to have this to be a pre-planned not very long encounter whatever it is maybe it's 90 minutes somewhere maybe it's you know we're eating pumpkin pie somewhere at some place who knows what it is the um and second of all the it's going to be it's a positive thing and that we're going to learn something because it's probably a bad idea okay so we we have to rather than being so anxious about it the attitude is look i'm probably making a mistake here so uh this is probably it's probably going to be an unpleasant pain in the house it's probably the same old mom and it's groundhog day all over again but we're gonna set it up you know it's been five years and uh about every five years you should sort of test a hypothesis like this because you know it's your mom and how much longer is she going to live etc so we're going to give her you know one you know one more we're going to give her one more look this decade and we're going to take one more bite of the apple of the knowledge and find out if we can get tossed out of our personal eden again and we might okay so that's why though we need to to have a very good slick socially appropriate plan for how we're going to slither out and leave finally the last thing is is that you can call it borderline personality disorder but that's just modern psychiatry not knowing what's really going on it's actually highly disagreeable and unstable that's all it is so it's no more mystical than that and it sounds like our lady here inherited some of the instability which is why it is that she's very anxious she didn't inherit the disagreeability or she'd be the same you know full-fledged matter mother is so but you've got the instability in there which is what's making this challenging but remember that the real fundamental difference between you and your mom is the fact that she's very disagreeable with the instability so what causes people to be disagreeable they're very touchy about their status and so remember that all all that you pretty much need to do to literally dodge every every baseball that she throws at you cjn a sports there's this sports already and we're nine minutes in although i have to say i'm surprised it's baseball and not not basketball so you know we're really expanding our repertoire here more moving toward greater inclusivity all the time inch by inch point is is that your uh all you have to do to survive is to realize your job is to figure out how to flatter your mother okay and you know don't go over the top and make it ridiculously obvious but your first move when she attacks you uh for some reason because there's a bunch of baggage on the table and she she can't can't can't help herself then your job is to send back positive signals that's it you can send back enough positive signals for this thing to probably hold together for an hour and a half just about the time you feel like you know what you can't stand it because it's tilted too unfairly in her direction and you just need to even score a little bit that's when you are actually uh constructing your own fiasco if you stay right on tack and say say exactly you know you go you walk the line and the line is flatter flatter flatter flatter flatter flatter flatter it's the flattery line okay if you walk right on top of that flattery line with your mother and that's what you do you can survive the hour and a half and everything is fine if you don't if she insults you and we bite her hand back uh then we're gonna get a fiasco that doesn't mean you failed it just means you're human so but the point is this is very survivable uh you're walking in there basically ready to give your mother nothing other than positive feedback with the small amount of interchanges that you're going to have you're otherwise going to avoid okay what are we going to flatter her with she looks great her shoes are great her hair is great the ear wax coming out of her left ear is great everything about her is great okay so everything looks great so yeah etcetera that's all we're going to be doing is positive positive positive feedback that you should be able to survive you can survive joseph stalin if you do that well enough okay and not be the guy that gets your head chopped off so we should be able to survive this with your mother and yet you will have all those anxious feelings and feelings of dread and feelings like this was a bad idea because it probably is a bad idea but no problem then we won't do it in it for another five years and this will satiate you okay every now and then i eat watermelon and on an empty stomach because i i love watermelon and yet if i eat it on an empty stomach i'm in agony for about 20 minutes so about once a year i can't keep my snout out of it because for some reason there it is and i'm thinking well i'll just eat a little bit of it and then i do it again so hopefully if i live long enough i'll do this another 30 times and uh and so hopefully you know your mother lives long enough that you get to do this another few times but let's make it every five years instead of every year yeah no that's that's awesome i will say that as as somebody who has both successfully and unsuccessfully tried to deploy the flatter flatter flatter strategy um it's not always possible like you you could be in a situation where even like this is this requires a fair amount of emotional stability and agreeableness to pull off and and so if you can't do it it's not the end of the world so i've been in situations where i can do it i've been in other situations where my i feel so status deficient already that i just don't want to give the other person the satisfaction it's just impossible for me even though i recognize i had a co-worker like this who if i went in and complimented her her necklace and her new phone case or whatever and i started off like that it just greased the wheels of the whole interaction she was so much easier to deal with you don't get an infinite amount of time from one compliment you have to keep it you have to keep it up you have to keep feeding them sugar and i would get to a point where she would just say some snarky [ __ ] thing and i just couldn't keep i couldn't keep doing it i was like no i know this will make my life easier but i can't give her the satisfaction of winning because i am not willing to sacrifice all the status in this interaction it's not it's not a problem that's just when you go back to what doug is saying where you're mathematizing the misery this is the the concept we use here where it's a finite amount of time you're you're only there for this one dinner this one interaction it's not forever um and it's an important piece of information to plug into your your calculus going forward um and he he also touched on the other concept which is so important which is this uh we came up with this description of groundhog day to describe interactions with most people including family members and co-workers and friends um where pretty much every interaction is very predictable and similar because personality is so stable the the personality characteristics that people are born with stay with them throughout their lifetime and the kind of relationship that you have with any other person is really just a function of the the very stable personalities that the two of you were bringing to that interaction and because the underlying personalities don't change the nature of the interaction is unlikely to change very much so it's it's groundhog day whether it's a good a good day or a bad day it's pretty consistent and predictable with most relationships unless they're really big exogenous crazy external events that um affect the dynamic but if it's just business as usual you pretty much know what to expect but it is good to confirm it now and then well you know it's funny i agree with both of you because when i've taken dr lyle's advice in the past and thrown status at people it's worked like a charm but i also agree with you dr hawk that with some people just can't do it can't always be done yeah you know it's just oh we know who that person is don't we aj yeah absolutely but you know it has worked in in situations where where people but it's hard and you know this is one of the things you said dr lyle i've actually never heard you say it at least you know in a broadcast with me and i wrote it down what causes people to be disagreeable is is is the very something about their status i've never heard you say that yes it's the status deficiency and uh and so that's what causes all of us to get defensive and pissy and um and so that's that's what it is and yet the disagreeable people are in they're walking around inherently more status deficient they're already feeling that way yeah they're feeling like they're not getting their due whether it's from the clerk at macy's or the waitress or or or their workplace or even their mate in other words they're always they're always edgy about that situation and so that's yeah that's the fundamental dynamic that's sitting under there well i know who i'm talking about aj and yeah and in one of these cases that person really didn't get there too so it makes sense yes yes yeah now you know i want to say is there any problem you guys can't solve and like what you said is if it seems like not a good idea it probably isn't a good idea she's sensing that this is going to not be great to go then we'll learn something and then we'll go on one more bite of watermelon think of it as an experiment great so here's a question for robert can you please ask the doctors are there lifestyle changes that you can recommend from a person who suffers from severe depression and they're saying they already exercise meditate try to work on sleep they and have social time journaling gratitude and they're taking wellbutrin and they still have depression i suggested that he has a session with you but maybe just talk about depression a little bit because a lot of people are experiencing it with the upcoming holidays um yeah depression is a is a normal state of the nervous system under failure feedback uh and so in other words you're you're depressed literally if you're playing poker and you've been on a a winning streak and you're 230 dollars ahead and then you suddenly lose 50 bucks if we watched inside your nervous system right then we would watch a change in your neurochemistry toward you know you thought you were going to win that hand and then you're disappointed and then you experience a loss now some psychiatrists somewhere would say oh no doug that's not depression yes it is it's the same thing there's no there's no in principle difference um between uh between what's going on there neurochemically and what's going on in some person that's been miserably depressed and suicidal for the last six months it's the same thing that's happening what you're what what what you're watching is the nervous system is attempting to signal to you that your circumstances are significantly poorer than you think that they should be so let's let's look at uh uh look we're gonna look at uh one year uh the young man is uh 21 years old and he is uh been drafted uh low in the draft in the nba see we're back to basketball oh my god let's go okay so now another another nine minutes right he's uh he's no comment sports metaphors all right but the point is is that he's he's not sure he's gonna make the team and now he makes the team and he's extremely happy okay four years later he gets demoted from star you know from the starting lineup to the bench and he's depressed and he's moping and he's bitching to his wife and he's bitching to his friends and he's snarling about wanting a trade okay he and he's got 30 million dollars in the bank so now we we see that in other words what counts what's causing the individual to be depressed are not the objective circumstances because four years earlier he would have looked at those circumstances and said are you kidding me uh you're gonna pay me 10 million dollars a year and i'm going to be the sixth or seventh man uh i would be ecstatic if that is what my future looks like four years later he's depressed about it okay and he's getting his little eap free consultations that they give so that he can save his 150 on his insurance plan for his therapy okay because after all he can't hardly afford it because he makes 10 million dollars a year all right so why is that guy depressed he's just as depressed as some high school kid who just you know lost the love of his life there in the 11th grade it's the same feeling and what that feeling is is the discrepancy but what between what your brain thinks you should be getting for feedback from the world and the feedback that you're actually getting it's the discrepancy that drives the feeling of depression it's the same thing that happens when that guy puts fifty dollars into the pot in that poker game and he's got you know uh a uh full house and he's so excited he's just damn sure he's gonna win this thing and it turns out no somebody else has a hand one notch better and that moment where he's like oh man okay is that same feeling except we extend it out for something that's more important than 50 how important is it to lose your love of your life in the 11th grade well i know and it's a lot worse than 50 okay and so and and so does the basketball player know it's a lot more status loss than 50 it's a much bigger deal so this person's depression is caused by the same thing that depression has caused around the world in both animals and people and that is a discrepancy between what you think the circumstances ought to be and could be and should be versus what they are so the solution isn't found in green beans and applesauce that's not where it is okay so if you do your diet decently then we aren't unnecessarily suffering health-wise and if you're getting some exercise you're not dealing from some lack of oxygenation to the brain or some you know periodic endorphins to come that's not the big deal i can eat crappy food and have not exercised in a month and be ecstatically happy why all i have to do is get good steam feedback from markets you know some some cute gal flirting with me it's like whoa what do i care that i've got that i've got crappy food in my stomach and i feel out of shape i get positive feedback like that my nervous system is going to light up of course it is that's how it's designed okay or god forbid john mcdougall compliments me about something not get all happy about it all right so the point is is that this is how we're built and so this person's the center of their depression is not going to be found in lifestyle processes per se those are a foundation for not exacerbating the suffering uh and contributing to maybe a self-discussed process of of you know self-destruction that can sometimes happen when people are just giving out when they're frustrated no what we need to do is we need to look at the domains of your life that are driving the depression it's either your romantic arena which you don't have to have a romance god forbid what you have to have is you have to have evidence that your strategy for attempting to attain such a thing is reasonable and sound and has some reasonable probability of success that's all you need you don't need the success itself in in trade you don't need to have a job you need to know that you have a strategy that is reasonable that you could get such a thing okay um oh and finally in the uh in friendship arena same thing so if any of those arenas trade romance friendship uh we should be looking there to see what are the what in which of those situations is our what we're getting from the world is here but we think it should reasonably be here it could be that in two of those three domains things are fine but in one of those domains it's frustrating enough that there's significant depression that's involved okay people can have their marriage going well and their career going well but they're at odds with their best friend and they're being rejected by their best friend that they're not going to be in their best friend's wedding and they're like what the hell is that and they can be really upset about it okay so examine what that is and uh if what i'm saying lines up to your uh to what's actually happening inside your mind right now uh great if it doesn't then that's a there's a mystery there that we don't that i'm not understanding uh and that's fine but the but ultimately it's very likely that that's true and that if you need help that's what jen and i are here for is for exactly ferreting out what the fundamental roots of this depression are and then trying to come up with a strategy that's a little bit differently than the strategy that you're using now because the strategy that you're using now is not resulting uh in enough positive feedback or or evidence of increased you know uh likelihood of success that it's driving further you know depression to to result so that's what i would say i think that's it i sent him your podcasts where you guys talked about depression and i suggested to book a session yeah yeah yeah i would say the only thing i'd add that's great that's the sweeping sports metaphor and all uh coverage of how this works uh i will you know kind of harkens back to the last question where there are certain individuals who are more susceptible to this than others you know so it's it's again you could take two people and give them the same kind of feedback from from the romantic arena or from the work arena um and so it doesn't it it's it's sort of this relative perception of what you expect should be happening versus what is mixed with your personality predispositions and kind of just how you're wired in general so different people can experience the same event and the same kind of change of fortune and have a very different kind of reaction to it whether it's they're more likely to be depressed by it or they're more likely to feel anxious about it or they're more likely to have just more robust resilience to it this is where individual differences really matter a lot but one of one of the kind of high overarching concepts that we always want to communicate to people is there can be a kind of negative feedback loop that people get into when they are feeling some depressive feelings um about some area of their life or in general they just kind of feel stuck in general you know we'll hear that phrase a lot um and very often the key is that the exact thing that you don't want to do because you're you're so sensitive to this this process that we call failure feedback you're so sensitive to the prospect that you're going to be rejected if you try to go on more dates because you've experienced all of this rejection already that that that's kind of the last thing that you want to do but really the the answer very often lies in this process of kind of pushing yourself out of your comfort zone and and starting to take those risks that are exactly the thing that you are most allergic to at the moment because of the way you're feeling um and and taking the chance on perhaps experiencing some more failure feedback but eventually also getting some positive feedback and that's that's very often the only way out of this and so kind of building the courage to do that with some support from us or someone else um is is often the key to making some progress great one last thing that i would say about this person's on wellbutrin and that is that um if this person's smart enough to be listening to this podcast the person's a doctor a medical doctor good then they're smart enough to read anatomy of an epidemic okay and so if you read it now we have an epidemic you're going to find the entire concept of antidepressants being challenged at its core and um i can i can tell you that recently uh about six months ago a good friend of mine who's a very very you know totally sharp academic and and no spring chicken you know were peers she's been she's been around the block many times and read tremendous amounts of literature and was absolutely sure that i was wrong about this okay and i said we're not arguing further until you read it now to be an epidemic and then we're going to have a conversation i had a big fat mia culpa you know about 10 days later like oh my god i can't believe this it's a shocking book it really is a shocking book yeah yeah yeah robert robert whittaker anatomy of an epidemic that's the name of the book um and uh yeah it's really something opens your eyes yeah i read it thank you you recommended to me years ago actually listened to it on ncd it was so and gina who's watching live listen to what she says because maybe she needs to read the book before you debate her is if i understand correctly dr lyle says depression is only situation and not chemical that's where we differ there is severe depression related not related to situation here now this is what jen's trying to refer to um and that is that let's let's back up the camera this is a worthwhile discussion to have and to to try to uh clarify this for people i we're going to begin at the beginning just here for a minute this isn't going to be long but i want to explain why it is that i'm saying what i'm saying i want you to understand what do you think the cause is um what is the purpose if you put your hand on a hot cup of coffee that you're that your hand is in pain what do we think the reason for that is the reason for that is to get you to dry your finger away from that it's a high source of heat that is the purpose okay the purpose of you when you go outside and it's colder than you think it is and you start to shiver the purpose of that and that whole experience is to get you to understand that it is very important for you to get to a source of heat and so that your that your body temperature is raised the purpose of the hunger drive is to see to it that you don't starve to death and the purpose of thirst is to make sure that the fluid balances remain you know reasonably ideal for your health and function okay so here's the point the purpose of all feelings all feelings underline this and making bold caps the purpose of all feelings is to orient the organism for adaptive action that is the point okay modern psychiatry is going to say oh no it's just there's something you're just having a feeling because you got weird [ __ ] going on in your neurochemistry wow that's a tremendously bold statement for which they don't have any evidence at all okay so somebody that says oh the reason why people are depressed they got a serotonin balance of their brain not true okay there's no evidence to support that that's a hypothesis that was cooked up by 20th century late 20th century psychiatry and it is not true and you can read that story in anatomy epidemic so now is it possible that when you feel extreme pain in the in in your finger that there's actually nothing wrong with it it's just a bunch of nerves going haywire yes okay how many times is that likely to be true not very often if you've got extreme pain in your finger it's very likely that there's something wrong because the entire point of having the ability to experience the pain is for it to be accurate and right okay are there times when it's not right yes there are there are times how often is that going to happen it better not be very open uh very useful because then it's if the evolutionary design is so lousy that it's giving you really bad feedback about major dysfunction that has absolutely nothing to do with the functioning of that whole situation that wouldn't make very much sense you would in fact be pretty sure that when you feel really cold it's cold and when you're hungry you're hungry and when you're tired you're tired okay in other words all feelings and that's going to include emotion so people somehow think that emotions they don't even know what they're for right so i went through school and i had a phd in clinical psychology in 1992 okay and at the end of that actually in 91 so in 1991 i got my phd in clinical psychology guess what i didn't know what feelings were for okay so when i actually told robert whittaker the depression is a failure feedback device that guy was stunned he had never heard that concept because robert as educated as he is in the field didn't have he hadn't integrated the concept but feelings are are evolutionarily designed for highly specific purposes okay so depression isn't just a malaise it is absolutely a designed feature of the organism to try to get you to change your strategy uh in particularly important domains of life and the three most important domains of life for human competition and therefore sensitivity to feedback are going to be romance friendship and exchange okay that's going to be what it is so you could be on a desert island by yourself and be failing to get food and you're going to be both hungry and depressed about it okay so the uh and you're going to be frustrated and anxious but what i'm trying to get get across here is feelings are are specialized they're the result of the activation of neural circuits designed by nature to have very specific experiences to come in and say oh well depression there's depression that's just chemical well what the hell does that mean why would it happen that way can it happen yep it can't happen but it's going to be rare people it's going to be damn rare now as jen was saying there are is going to be just as there's people that have more voracious appetites okay and there's people that like that like to be warmer so you check their skin temperature and they just always have a sweater on and there's other people that like no cool it off so there's individual differences in how these feelings uh work and the baseline uh feature of human psychology is that on average human psychology feels mildly positive okay in other words that's actually the way it works so when you ask the average human being at the average moment of their life how are they feeling they're not feeling neutral they're feeling somewhat positive which is very interesting characteristic it looks like that's built into life itself it's an incentive for living okay otherwise it's like what's the point and so there's a natural incentive for the base rate of the system to be mildly positive now you can imagine that there's going to be a difference so alan goldhamer even though he doesn't look like it is very happy i don't know why he's so strange but he is okay he's naturally just he's in there so his base rate for happiness is like i can probably tell it's probably 10 higher than mine so we're on a bell curve and that's just that's just kind of how that is all right his son is the same way by the way bizarrely so they that's inherited so what jen's talking about is there's people that are down here on the bell curve like so their their natural base rate isn't very high now in fact their natural base rate could actually be below the midline just like every nothing is terrible is happening but they just don't feel that good those people tend to be uh it tends to be the genes that also cause anxiety so high anxiety high depression those are the same suites of genes there are thousands of them that are responsible and so they're winding up uh those people can be sort of anxious and kind of depressed for quite a lot of their lifetime okay now the um we would not say you could say well that's chemical well well it is but it's such innate neurochemistry based on the interaction of ten thousand different genes so it's not like we're going to come in with some single drug enough to wrap it it's the natural baseline of that person it'd be like saying we're going to come in with something if susie susie's always cold and has to wear a sweater even when it's 74 degrees inside the house we're going to give her some drug because there's something haywire in her brain of its neurochemistry that makes her that way like what are you out of your mind we wouldn't do anything of the kind we recognize that that's her nature and we're not going to fix that nature to make her look more normal that's just who she is alan wants to actually have his office in a in a freezer locker he likes it super cold that's just how he is he would actually have his office at 62 degrees if anybody around could stand it okay that's we wouldn't say we'll give him a shot for god's sakes give him a combination of serotonin and norepinephrine and some damn other five other neural chemicals and get them drugged up so that he can be normal like the rest of us no that's just how he is so if you happen to be someone who's chronically on the on the uh on you know anxious depressed midline uh no evidence at all that psychiatry has any solution for you the person's comment is a chemical well it's chemical in a sense of course it is every feeling and every experience and every biological action that involves life is chemical okay now are there other things that can cause suppression that are quote chemical yeah like for example you could have a low thyroid you know in other words there are occasional medical biological processes people can be going through menopause or they can have hormonal shifts yeah those things happen uh but and sometimes they have a cause that maybe somebody can do something about usually not usually the body sort of heals itself in its own way in its own good time as long as we get decent nutrition exercise and sleep the uh but the what you're hearing from me is a long fairly heavy-handed soliloquy about the people that are that are that have bought into the underlying um theory under on underlying psycho harm and i think that theory has been challenged and found deeply wanting and i think the evidence is not supportive of this uh do i think that there are people over here at the low end of the bell curve of their natural chemistry that they have so many depressive and anxious circuits that their lives are actually pretty miserable just by virtue of being alive i'm sure that's true and i'm also quite confident that the psychiatric meds are useless for that i mean that's the other piece right like if the meds worked as as you know suggested and they're supposed to but that's the whole other argument in whitaker's book and elsewhere is that they actually don't work as they're supposed to so if people did want to correct their their particular chemical situation because they were at a lower baseline of of good feeling in general then that would be one thing and we could kind of have a conversation about that but the the outcomes don't match up with those intentions um and that's just an important part of the conversation to have as well that's why we that's why from our standpoint the only thing that you can do about this situation is is situational the only thing that we that's all we can do we can't go in and change 10 000 genes that result in an unbelievably complicated interaction of the process of your your own personal neurochemistry that caused you to be sitting down at the 15th percentile for the happiness velcro okay that there there's well butrin isn't going to fix that so and that that's uh sort of the two books for somebody this smart to read to really sort of synthesize this argument this number one whitaker and second is to read blueprint like women so the abnormal is normal that's what i keep thinking with this conversation i mean ploman really describes that the wherever you are in this bell curve this phrase normal comes from the sort of a word play on a bell curve is also called a normal curve um and so there is natural variation there's naturally if we were to take a thousand people in seattle and put them in a room that was 65 degrees they would fall on a bell curve of how comfortable they were at that temperature most people might be kind of on the chilly side some people would be a little too warm some people be freezing um and that's exactly what you see with sort of baseline affect and mood um and and so if you're way out on the edge of the normal curve you're abnormal because there aren't that many people like you you're not as common as the other people who have a different sort of baseline whether it's a tolerance for temperature or a hunger drive or um propensity for depression or anything else but you're still normal you're supposed to be there you're supposed to be part of that distribution there's nothing pathological or wrong with you and there's nothing that we need to correct for to to make you more like the middle of the bell curve that's making a value judgment about the metal of the bell curve saying oh this is the best way to be just because it's the most common way to be um and that is a really backwards way of looking at human nature and ploman does a beautiful job of talking about that yeah it might be pleasant to be more normal you know what i mean depending yeah uh a awful lot of a lot of my clients are actually quote they've got a lot of the genes for anxious and depression that's why they're that's why they're talking to us they just happen to be up in the top two or three percentile and as a result of that there's suffering that goes with that oh well in other words our job is to maneuver their environments around to try to mitigate that as much as possible uh but the truth is is that uh it just just because you're out i mean as jen is saying it's just a you're just a part of the normal distribution it can be inconvenient and frustrating if you're mentally [ __ ] and you're at the second percentile for iq that is a that is a a set of circumstances that is unpleasant and it's going to handicap you in many ways but there's nothing wrong with you okay there's no there's nothing wrong that's just the luck of the draw okay so that's a that's what's driving this and if it's not driving the depression and what's driving the depression or are these failure feedback cues and some frustration and domains and that's that's what psychotherapy can do to the extent that psychotherapy can do anything the only thing it can do is it can make you uh essentially give you better strategies for addressing the challenges where your feedback from the world isn't where it is that you think it could be or should be okay we can we can pursue that discrepancy it could be that you're wrong and you actually need to be here you think that you're going to be the number one trumpet in the philharmonic one day because you're number four right now and you're frustrated and you think you should be higher but we may discover that no in fact you're about where you belong by doing everything possible to to to triangulate your competitive efforts okay you may shift to the other philharmonic and find out whether or not it's the director's fault or whether or not you've got a screw loose so the point is is that the we don't know what's going to happen whether we're going to raise your performance and therefore eliminate your depression that way or we're going to get you used to the fact that we've used that everything possible to get you higher where you thought you could be but you can't and now you make peace with it and people say oh that doesn't sound like a good thing i don't think i could make peace with it no it's like oh yeah kids do it every day every day literally 85 percent of eighth grade boys think that they're going to be professional athletes okay the one in 10 000 that will be the case so that means 1500 out of 10 000 are not delusional because they don't think they're going to be professional athletes but 8 499 out of the last 8 500 are going to be disappointed okay when they're disappointed it doesn't devastate their life or cause much depression a few of them it will but once they got very close and didn't get there or the ones that are are so far down the bell curve that they're going to be upset at the very smallest perceived slight in life so that again both of those things matter the sort of actual nature of the situation and your underlying uh predispositions yeah and if you mix the two together if you take somebody who like always feels like they're they're they just are never getting what they deserve um and they come what they believe to be very close then they're going to be bitter about that for life it's going to come up every time they go to the neighborhood bar i mean there are rom-coms made about this right there's a there's the character who sits at the bar who's 46. and he's talking about his is highlight reel from when he was a senior football player yeah how it got derailed by the coach that didn't see his greatness oh i always say i just i could have been somebody like it should have been different you know it was everybody else's fault and screw them and if they hadn't screwed up my life like i'd be i'd be a great i'd be tom brady look i made a sports analysis i was congratulating myself [Music] right yeah i mean those people do exist and and we recognize them i think most people there's a reason they're a cliche in movies it's because they are sort of unusual they they're wired in a particular way that sort of just makes them uh especially resentful about things that most of us would be like hey them's the breaks you know it doesn't always life doesn't yeah it's kind of unfair and um kind of sucks but i've moved on uh some people don't move on and the abnormal is normal yeah i'll just i just want to say that there's a lot of comments in the chat and these are said with love by the way that they appreciate the thorough answers and now they know why it's taking so long for the book to come out [Laughter] yeah you should you should be a fly on the wall when we're working through a new concept it's hours it's it's it's weeks and weeks and weeks of back and forth all right morgan who was the first question answer is also watching live and thank you both very much for the opportunity to to be able to ask the question and have it answered you know i first of all i agree with you and i've read all the books you recommend i i've known a few people though and these are people that are not unstable they have great emotional stability that have had really horrific things happen to them like the murder of a child that i've seen get depressed you know and i don't think that's that's not failure feedback is that it is that's exactly what that is really so yeah in other words they've experienced the they've experienced a loss right so they failed to protect that individual so this is what this is what this is so their mind has to go back over and over and over and over and over 10 000 times what could i have done differently was there something that i could have done yeah that's a that that's what that is uh aj it's again this mismatch between what you think the world should look like versus what is in front of you and if that's a big gap if you've been taken aback by by real life suddenly not lining up with your expectations that's going to cause extreme emotion in some direction you could be so over rewarded by that you're like i can't i won the lottery like i didn't expect that to happen this is a really unusual uh permutation in my reality so i'm gonna have a big emotional response and something like this is a similar um big emotional response but on the in the other direction and so these things tend to self-correct over time as you go through and you you run the scenario and you discover that um you know what what happened your role in what happened was uh you know properly calibrated after you've thought about it enough but there are going to be there's a bell curve there too where some people need to run more of those cycles than other people who get over it very quickly yes right so people kind of return to their baseline personality at some point most of the time yeah yeah that's i love what you said about not don't medicate the personality i had the stanford psychiatrist anna lemke who's from the documentary social networking on and she said the same thing so not not all psychiatrists are for these medicines amazing you just you just i never heard that phrase did jen say that and you copped it aj that's great well i know anna lemke said it i i i she wrote a book called dopamine nation i had her on the show and and she said that at one point either she was on them or considering them for herself and she didn't like the idea of having to medicate her personality beautifully said that we're gonna that means gonna stick in our heads yeah i mean that's that's what this all is that's what that's what medication for add adhd for kids is that's what that's what all of this is and so stepping back and really taking a look at it and reading books like dopamine nation and anatomy of an epidemic gives some much needed perspective here great thank you brian dr lyle said as i this is from mark by the way dr lyle said as i understood it that his cholesterol runs 225 to 250 and that he is not concerned about it because his diet is great and other markers are good is the same concept applicable to blood pressure my bp runs high i've been on a whole food plant-based diet for over 10 years sos free since i stayed at true north five years ago fasted there four times blood pressure is lower than it was before the diet in the fast but it still runs in the 140s or 150 systolic often cholesterol in the 140s i've decided not to worry about it i still go back to true north very fast every couple years for a variety of reasons but i'm not gonna spend my time worrying about the bp is this the right decision mark exactly the right decision so let's look at this so uh just uh quickly here if i can there's two uh different but the blood pressure is uh like cholesterol blood pressure is seen as it's a it's a marker for trouble so that's why there's a correlation between higher blood pressure and then greater amounts of vascular disease that's a correlation that is not a causal factor and so correlation holds pretty well because in general the dietary features that drive higher blood pressure will also drive the vascular disease that's exactly analogous to cholesterol so the cholesterol is correlated correlated but not causal with respect to heart disease so the the it's the animal protein that comes with the animal food that also comes with cholesterol but when you eat it drives up your cholesterol so if i were to uh but if you're not eating the animal protein with the cholesterol in it but your cholesterol is naturally high that's just caused by your own liver and your own individual biology okay so again uh this is this is precisely analogous so if this person is let's suppose that their cholesterol runs high and let's uh excuse me their blood pressure runs high um but it's not for any pathological reason it's just that that's where it runs the um it the in principle it could be a derivative of some pathological condition that would have nothing to do with diet okay um and we would hope that isn't true and we would hope that cardiologists can can uh you know do their little tests and then put their stethoscope on your heart and find nothing strange that's driving that uh that relatively high blood pressure but the blood pressure in terms of a causal agent about where we see the correlations that are that scare us are going to be in in in strokes so that's the big issue and it's going to turn out there's two different kinds of strokes one of them is where you throw a clot and the other one is where you burst a blood vessel because the pressure is too high okay so throwing a clot that's going to happen when you have vascular disease as a result of a bad diet okay if a person has a very good diet then we're not going to have any any indication of vascular disease i.e if their c-reactive protein is very low as it should be then we don't have any reason on earth to be worried about throwing a clock none whether your blood pressure is 110 or your blood pressure is 160 it doesn't increase your likelihood to throw a clot what your blood pressure is it's a statistical relationship that if you happen to have 160 blood pressure probably you have a shitty diet and therefore you probably have bowser disease which is why you're far more likely to throw a clot but blood pressure doesn't cause you to throw a blot it's a correlate okay that represents almost all strokes in fact it represents about 90 of all strokes are throwing clots so this person has eaten a diet where they are uh they're not going to throw a clot so um so that that we have now parked 90 of the threat that quote high blood pressure is associated with the remaining 10 percent is going to be um hemorrhagic strokes where a blood vessel bursts as a result of not being able to structurally handle the pressure of the high blood pressure now at 140ish very low odds of having something like that happen however statistically you are a higher odds of having that happen than if your blood pressure's at 120 but where it really gets exciting just so that people know is up around 170 180 190 so when people have blood pressures of say 200 over 100 they're pretty likely one day sometime in the next 10 years to have a hemorrhagic stroke uh there it's like wow you are putting so much pressure on those pipes that something's gonna burst okay i mean probably hopefully hopefully not the big one you may have a small stroke but you know if your blood pressure is 200 over 100 and it's been there for a few years look out in the next decade because if we look at the chart and i don't know what the odds are but they're pretty decent okay that would be like having cholesterol 350 and you're eating burgers with you know all all four hands and feet and and you're 100 pounds overweight and it's like you know what you're a walking heart attack candidate well you're a walking stroke candidate at 200 over 100. you're not a walking stroke candidate hemorrhagic stroke candidate at 140. okay so when you look at the relationship between blood pressure scores and strokes remember that at 140 and the reason they're screaming about it they want to lower it down to borderline high blood pressure 130 why they want to sell you medications and what those medications do is they're forcing the blood pressure down artificially by putting pressure on the kidneys to reduce your fluid balance and as a result they're doing absolutely they're reducing the likelihood of hemorrhagic stroke they are not reducing the likelihood of embolisms this is true for all blood pressure if your blood pressure is at 180 when you take blood pressure medicine and you force it down to 150 which is very aggressive on the body to do that that 30 points will reduce your likelihood of hemorrhagic stroke but remember how i said that hemorrhagic strokes only 10 of the strokes so you're reducing the likelihood of only 10 percent you are not reducing the likelihood of embolisms which is 90 of the stroke risk okay so in other words so the blood pressure medication as you would expect is almost totally worthless because it's only working on the small percentage of the strokes so blood pressure medication will show positive effects for increased life expectancy only when we make sure that we we are aiming at the very highest levels of blood pressure okay so there's like no scientific justification the best of my knowledge for using blood pressure medication to pull blood pressures down when blood pressures aren't consistently at least 160 okay and even then even then it's it's weak so for this individual my attitude is uh the only thing i'm worried about is that you're doing such a good job and you're at 140 i'm kind of not sure why okay that's a it's a little surprising to me uh but i i sure as hell wouldn't be thinking about medicating it i would be thinking about making sure you have a consult with somebody uh uh smart savvy about this god forbid now he's gonna now he's gonna i'm finally gonna get an email from peter sultana to say don't say my name again for the rest of your life [Laughter] okay but you've got a true north website if you want a consultation with somebody that would be very wise about this uh peter sultana would always be my number one choice and there's other doctors there but if you've got a quirky medical problem that you're not sure of and you're not sure which direction to go get a consultation and uh the true north website is a is a good place to look for a doc that is going to be plant-based and smart yeah and these are virtual consoles i mean 20-minute quick chats that you can do from from afar so you're not going in there and it's not a full medical appointment it's just a conversation about something just like this that from from some from an md um or an nd perfect thanks john who's watching live says this is one of the most interesting valuable and shareable sessions i've been part of thank you oh terrific it's all the sports analogies that's great well i want to respect your time if you want to stop now we can or there there are two more questions but you know we can get you back let's knock them out we won't let me talk okay famous last words [Laughter] you know if you don't mind i'm just gonna ask a really quick question i should have asked it earlier people have so much trouble with their family and at the holidays was this the case in the stone age like has this always been the case that people have trouble with their family relationships i mean i don't think we know i don't think we have a lot of great anthropological you know sociological data about stone age relationships we have some but we're we're not looking at kind of annualized holidays like we have now where it's this thing it's this big thing where you make a trek and you go and this is the only time you see these people that you have kind of an iffy relationship with anyway i mean what we do know about the stone age is that it was the same people all the time that everything was there were no there were no kind of special moments i mean of course there were ritualistic religious ceremonies and things like this um but not like we have now where there's this big commercialized uh you know occasion for everybody to kind of be on their worst behavior and drink a lot and and everything else that goes with the holidays so i think there's a there's a whole bunch of things that go on with the holidays in the modern era that we're not at all present in the stone age that lead us into this kind of artificial self-reflection that goes on um and also engagement with and proximity to people that are most of the time pretty problematic that we're steering clear from that we feel obligated to spend time with because it's the holidays so you put all those things together we're already having kind of an existential crisis because this is the time of year that we do that um and then we have to hang out with all of our our problematic drunk cousins and that just throws a lot of people into into you know pretty predictable crisis so yeah but as for stone age life i you know a lot of that we're just kind of we're we're guessing as to what some of those dynamics would have looked like great thanks okay so here's a question from we didn't let you talk did you want to say something about that dr lau okay perfect fiona asks how would you explain the motivation behind truly non-observer dependent acts of kindness which are 100 anonymous could this somehow be linked to our own internal esteem mechanisms it's called a mitzvah in judaism oh yeah mitzvah well mitzvah is a uh a clever way to hide a little easter egg or um for people to find later and then we get a bunch of credit for it so the it's an investment it's basically like a stake in a startup company so you're where if you are an early investor um you can get a thousand-fold return where if you're a late investor maybe you get a five to one return if a it's a good investment so that's that's what's going on there uh the the adaptive unconscious of the human being knows that that is a that is a possible big win uh to do it that way so it doesn't have to be uh undoubtedly there are people that are consciously and deliberately aware that they are sowing the seeds of the discovery of their mitzvah i have no doubt that that happens often okay uh however it is also very possible uh and would be evolutionarily sound to have that happen on occasion but there would be uh both individuals sitting on different places in the bell curve uh for their personalities as well as sets of circumstances that probabilistically lead to the fact that you're going to do something wonderful and it very very well may be discovered at some point in the future okay and so that uh you could have an evolutionary design of great deep patients uh that that that could run that cb analysis and understand that if that gets tripped over later if i do five of those i do 10 of them in the next 10 years and any one of those gets discovered three years after i do it the value to me is going to be huge the reason why is if people ever discover these they they make the inference that you are actually out there quietly uh basically you are a net uh you are a net producer uh you are a net giver in other words you are not altruistic and if you could if you could get the reputation of being a net altruist literally you give more than you take uh in other words you you obviously are doing exchanges in the village all along that are probably fair and reasonable but you are quietly putting your thumb on the scale and turning around and giving more when you don't need to well if you get that reputation then you are inherently more valuable than the guy standing right next to you that doesn't do that so it's actually a super d uh super elegant deceptive deep strategy of advertising your your value to the village so that's what a mitzvah is and um sorry there's no that doesn't mean it's a bad thing it just means that's what it is and so uh and you could feel very good you know sowing a little mitzvah out there it can make you feel like yeah i've got a little stock i've got a thousand i got a thousand shares of stock in that little startup company out there that may turn out to be nothing or it may turn out to be apple computer but i got in early so it can be a nice feeling if you can afford it uh to do such things and some people have the psychology that makes them afford that very easily and they they like it they like that feeling so that's what that is there's also there's yeah well that's very very welcome i'm sure there's also just kind of a subjective with a lot of this type of thing a feeling that it's a it's a down payment towards some sort of karmic some sort of mystical karmic outcome that you're you're just basically uh you maybe it won't tally up in the end but if you do find yourself at the pearly gates or or you're being assigned whatever sort of creature you're gonna reincarnate as you know it might count toward the overall balance in your favor i think that's a lot of kind of in the background um and then the the suggestion that it is an internal audience phenomenon i think there's a validity to that too they're sort of i am confirming for myself that i am the kind of person who does this kind of thing and that means that i am a good valuable person in the village and and so even if this never becomes known it might become known i might let it slip in a couple of years you know someone might discover it or someone might suspect that it's me but even if it doesn't it feels good for me because i'm i'm showing my internal audience that i'm a good person these things are totally part of the equation yeah they're all distraught this whole notion of karma is exactly what this is karma is a totally legitimate probabilistic engine of the steam processes in the stonehenge village and so it's of course very reasonable that we would it's not unreasonable at all but we have it would have a conscious concept of it right and by the way everybody if i've ever done anything good if god forbid i ever forget because i make sure somewhere i'm going to tell yeah no i i i'm not in the dark about any of your good genes yeah i'll send you a fruit basket except he doesn't like presents he said no he doesn't but i find that when i do random acts of kindness it makes me feel good in the moment sure well it would have to i mean this is again feelings or feedback you you feel good because you're doing something that is advantageous for your your survival and reproduction in the grand scheme of things so that you've been you've been engineered to produce a good little feeling for doing something that puts you at an advantage great thanks all right so the last question is obviously from someone that listens to your podcast because i don't understand it at all but it is can the frowned upon practice of being a snob based on the assessment of a potential pair bonds background lineage be an evolutionary mechanism to protect against genetic mistakes and a potential mate well i have to like draw i think that translates to is is there sort of an ep justification for racism in dating basically is that or sort of like background lineage i i assume to mean sort of race or class or ethnicity so is there sort of a justification for ruling people out on that basis that's how i interpret that question yeah maybe so um well thoughts jen yeah yeah i mean that's it that's a big that'd be a good podcast podcast question you know i'm obviously i'm painting it with a very wide brush to kind of make it more just just to interpret it for the purposes of this conversation i think any kind of um when you're in the dating market and you you are implicitly ruling people out or in based on any kind of of attribute whether it's a race class gender background anything you are you are doing so based on um specific individual preferences that could be emanating from your personality or or they could be this kind of i think what you're getting at this kind of tribal preservation sort of phenomenon um where you're you're trying to stay in the in group and i think we try you know people having a lot of people have an inclination to stay in the in group um defined in all kinds of different ways so some people might define that uh like you grew up in a certain way some people might define that and you look a certain way um i i think that is a strong human tendency but not a not necessarily a universal one and not expressing itself the same way in every single relationship all the time so it's a really complicated question and we could definitely get into it on the podcast and go deep with the evolutionary logic of that but um uh that's that's kind of the general take i would i would sweep at it right now do you have any other thoughts on that yeah i'd have to like i have to chart that question out yeah you know what i'll just i'll send it to you guys and then you can choose to answer it on a podcast i didn't even understand it so thanks well this has been fantastic we got through all the submitted questions guys submit them in advance if you want priority any just parting thoughts on the upcoming holidays because a lot of people are going to be tempted with bad food and bad family often at the same time yeah yeah my attitude two things number one eat your piles of wet starch and number two you got a bunch of stuff around your house the day after just throw it out just grit your teeth and realize that when you throw out 100 worth of food that's one of the best investments that you're going to make this year okay so that's uh be willing to throw the crap out that's that's a useful thing to know yep i do i have a um in case anyone listening is interested and wants that extra support i have a women's group um every sunday that is underway now but going through um right after new year's called getting real which we we're dealing with a lot of pleasure trap family dynamic type stuff um so you can sign up for that on my website which is jen hawk.com and i'll post that in the chat well guys thank you so much i learned so much today i really appreciate it anytime thanks for having us well thank you and thanks all of you for watching another episode of chef aj live please come back in two hours for a bonus show when i have mark schatzger talking about his new book the end of craving take
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