BRAIN SURGEON Reveals How To STOP NEGATIVE THOUGHTS & Reduce Stress | Rahul Jandial

so i've operated on more than several thousand people and i've met them all in their crises and they have shown me that difficult times they hold a reservoir for growth [Music] you are a world-class brain surgeon you deal with incredibly complex patients you do high pressure operating whether stakes really could not be higher what do you do the night before and the morning off one of these big operation days that's a that's a great question to open up with i think first of all just to give context most surgeons don't do dangerous operations so i chose to be a cancer surgeon i chose to take on the big cases that's what drives me that's what is a meditative state for me when i have to focus that much so i have a lot of gratitude for my patients for trusting me that said i always want to bring my a-game to the case to the operation so the night before there is a ritual um and it involves a little bit of physical exercise because often not realized by people is that a long operation is a physical endeavor i mean you're hunched over i'm wearing a headlight i've got loops on my eyes you're moving you're in awkward position so i i will do some light weight training the night before nothing that wears out my my hands and forearms but just postural stuff and what that does is it's sort of like a pre-game prep so i bring a physical uh preparation to that and then mental or psychological uh the ritual is the last 10 minutes before i fall asleep i'm running through the shape of the cancer and the dangerous anatomy that it's in constant so you have to dissect out a cancer from not normal anatomy right when the cancer grows it distorts the blood vessels so it doesn't look like an anatomy book so you have to imagine around this corner you might bump into this around this way if i hit this vessel what's my next maneuver so i do a pre falling asleep run through of the shape the process and then i let i sort of let my dreams and my you know put my mind to work at night and that's the way i focus for the case the next day hearing you describe your you know your pre-game ritual is it's quite reminiscent of sports people you know who may have a certain ritual to allow peak performance the following day i've heard this from golfers before from all kinds of athletes but you don't tend to hear it as much from people in non-sporting professions yeah and i would imagine all of us on some level could benefit from looking at our day-to-day work with the same kind of microscopic precision that you do yes the stakes are high for the job that you've chosen but i guess it's all relative because in our own lives we all want peak performance and whatever we're doing yeah that stress you're feeling the next day whether it's trying to navigate a fight with a lover or trying to navigate a conversation with a boss or get to work on time stress and pain these things are personal dimensions so the approach to a challenge the lessons apply to all of us whatever our individual challenges are and it is like sport i think that's often not understood that surgery is a physical task that's why it was called an operating theater it's a performance some of us are better at it it's not always the same 100 steps some people are slicker and have softer touch and can get the work done in 60 steps so i love that technical aspect of it but whatever the challenge i have found i have found a little bit of physical activity mixed with a little bit of thought not total step-by-step preparation for you know not engineering or sort of micro planning the next day but something about being physically active the day before improves my sleep something about running through what the next day will bring gives me sort of a background preparation because what i do you can't always anticipate what's going to happen but that's life for most people and so i think the pre falling asleep window is a unique portal to some of the subconscious things we do in our dreams in our sleep and if as a sort of digression creativity a lot of people have used the the falling asleep period and the waking up period as a one as a way to sort of introduce fresh approaches and new thinking to a problem that they've been struggling with so i you know whether it's einstein or the guy that just you know designed the louvre um you know the inception the movie was based on that so i try to take real science biology um electrophysiology to guide my process now people may have other ways of doing it but i like it to be anchored in something scientific the way you describe it it sounds very much to me as though you have experimented with different techniques over the years before sort of falling upon this one that currently gets you into peak performance so i guess i'm interested is it quite unique what each individual needs to do and then can that approach change and evolve over time as we change and evolve you know over time yeah i mean i think you have to stay adaptive but we're talking about a certain thing here where i have an anticipated challenge but what this last year has shown us is what do we do when we've had no preparation no anticipation and i think that takes a different set of skills so there's crisis management in something you're going in prepared for and then there's crisis management for a crisis you've never anticipated i think those require two different skill sets one you can have some rituals that become a portal to your peak performance or your you know optimum technical ability or optimum stress management for yourself whether that's through breathing techniques or a ritual before you go to sleep that's what i do in an operation but what happens when there's a crisis you don't anticipate that's harder that's harder to be prepared for but what you can draw on is sort of the it's often a overused word so i just want to add some nuance to it but resilience there's two types and peak performance resilience emotional regulation all these things tie in together but i really liked taking apart the term resilience in this book and so there's the physics and engineering definition where you take you know there's a you know you get deformed and you return to original state but the psychological definition and going back to crisis management for things you haven't seen before the psychological definition is fascinating to me so there's two types of resilience processive resilience and systemic let's start with systemic systemic resilience means you got it in you it's what you bring to the fight that's systemic resilience is what i bring to the operating room on wednesdays systemic resilience is what we had in us before 2020 rock the world but that's not your final story because there's also processive resilience and that's what the fight brings out in you so i think that's very powerful for me because it leaves us thinking no matter where you are in your life whether you're getting rocked and whether you're struggling because of something difficult going on or whether you're feeling triumphant that tomorrow is always possible because of processive resilience what the fight what the struggle will bring out in you that you may not even recognize in yourself and i bring that to crisis management when i go to the or it's planned i've seen it and plan for the uncertainty but relationships raising children life that requires a resilience that you have yet to demonstrate based on the struggle in front of you when i think of it that way i feel very optimistic regardless of the place i might find myself in today yes a beautiful way of looking at the the two kinds of uncertainty that we face in life that predictable uncertainty and the unpredictable and i guess i wonder when i hear that does your diligent practice of attention to ritual attention to your performance for that predictable uncertainty in the operating room does that transfer over to help you be more resilient to that unpredictable uncertainty you know while is there a unified skill set there is is some of some of that skill transferable across and therefore does that mean all of us should in some ways try and do certain practices on a daily weekly monthly basis to prepare for when those uncertain events happen as they always do it's an excellent question um a difficult one but i think one where i can just offer you my understanding so the crises crisis management whether in the operating room or outside of the operating room there is a physiologic response that happens in our skulls you know chemicals hormones electricity blood flow there's a it's not just um wiring it's there it's an ecosystem and there's a response that happens and what i've learned from the operating room is when i get into a tricky situation the first thing i do is just prevent myself from hyperventilating i think everybody thinks oh you're born with nerves of steel or no you train yourself to be calmer to allow that calmness to release the ability to come up with good solutions and behavior that you that's not reactive that's not freaked out so what the operating room has taught me is the cadence of breathing and i think a lot of people are thrown off they're like this brain surgeon talking about breathing you know it's like but that's there's again there's physiology about that and if i may um when we freak out for whatever reason we breathe faster and in the past it was probably a saber-toothed tiger we'd appropriately freak out and it was usually accompanied by running or movement and as you know when our muscles churn we make carbon dioxide which is the stuff we blow out and the things that you know plants absorb but so we hyperventilate to get rid of that that metabolic waste from the muscles churning but if we hyperventilate or freak out and we're not running we're just in the operating room or we're sitting in our car or we see something on our phone well now you're you're blowing off or you know evacuating carbon dioxide that you haven't built up from churning muscles and that kind of hyperventilation which actually lowers the levels of carbon dioxide in your blood okay that's that leads to twitchiness frenetic thoughts irritability it's physiologic hyperventilating without also accompanied physical activity makes us nervous um gets in the way of our thinking and so when we know that that's the biology and the physiology i mean you can measure it um then the first step in crisis management of the operating room is just slow it down and get it through my nose just just two three seconds in two three seconds out my mind is racing my mind is all over the place but what i'm doing is not exacerbating my inner panic through hyperventilation so the first thing i do just slow it down my breathing and then just keep thinking keep keep thinking and i didn't always do that i'd up my glasses when i was operating and now people after the pandemic know what it is to have masks and glass imagine operating through that right you're you're you're nervous you're panicking you're learning how to operate you're and you're you're getting in the way by hyperventilating not only are you making yourself twitchy you're fogging up your your the glasses you're operating looking through as you operate so i had to really get my breathing under check and that's a thought process now i don't have to worry about fogging up my my glasses because of my breathing but that is my go-to move for crisis management in the operating room now back to your question um unanticipated challenges and crises you can't prepare for them the night before right that we can't do but wherever you are in your moment and you feel that fear or panic or anxiety grip you the the weapon you have against that it's not going to be equally effective in everybody but your the biology and the physiology that you can control with thought is to get that breathing under control get that breathing under check whatever you do through that you may still make a bad decision i'm not trying to get to people having outcomes but you'll be in the best position for you as that individual to think clearly and to have the most emotional regulation you can yeah i mean there's there's so much there to unpack i think the key point that i'd love to just really just emphasize for everyone listening or watching is that you are a leading neurosurgeon when the stakes are high when the pressure starts to mount up you start to focus on your breathing through your nose three seconds in three seconds out that is what gets you through and able to perform or one of the things i should say and for people who are skeptical of breath work and the power of controlling your breath like that i think the example you just demonstrated should shatter any skepticism remaining in someone's go look right daniel is doing it when he's operating well maybe you might want to think about it when you're having a row with your partner or when the kids are starting to wind you up and you're starting to react or whatever it is that's what i think is so one of the powerful things about what you just said thank you brother and that and it's free yeah you know that's just that's the thing is i just struggle so much you know i live in los angeles and i the wellness capital of the world man [Laughter] and uh i think i saw you on tv down here at the local tv station that i do stuff at one time and they asked me about jesse yeah he set me up with a wonderful opportunity and interview and interaction in london so they were they were glad to have you and um ktla yeah yeah i've been doing that for 12 years that's where i got my start and it bounced off and ricocheted into different things but you know la los angeles is fascinating because i'm going to come back to this breathing you know we it's not just hollywood actually if you look at it it's such a huge place and only the hollywood hills and small pockets are what most people have in mind when they think of los angeles but there are also major major university centers ucla usc jpl caltech city of hope uh even cedars then you go south to get to irv i mean there's just a lot of powerhouse academics going on and and i think that's where i saw that that breath and breathing both both edges i saw it being sold at niche meditation yoga clubs they charged people for it and i thought you know that's too much because this is a power that we're endowed with and then on the other side i saw it being applied to teaching patients how to calm down before their they get their cancer diagnosis or in their mri machine every three months waiting to see has the cancer spread so you see like the spectrum of of what how breath and breathing control is presented but absolutely i mean if i don't if i don't get my breathing right i'm not at my best and i don't mean just like oh my fingers are you know people are like i'm not talking my fingers don't shake that's not the point my thinking my focus the balance between my thought and emotion you don't want all thought when you're operating you have to have guts but if it's true if it's all emotion it's not tactical so that fine thermostat that for all of us right that balance between thought and emotion the way to find that balance to turn those knobs to control those knobs is to get breathing under control that's a i mean i can show you and draw out the physiology with fancy little molecules and we can put little tubes you know mask and show you breathing and measure it this is not uh this is not something i'm talking about figuratively i'm talking about literally if you hyperventilate and you're not physically active you're just gonna freak yourself out even more in the moment of stress you apply a certain technique to help you is that something you practice outside the operating room is that do you have a daily practice that to to get better at it so that when you need it you can apply it better or is this just something you've picked up over time that was one point the other point which is from your new book which i'm definitely going to get into shortly because it's absolutely brilliant what i've read of it so far there's this section where you talk about surgeons and how they often use a bit of tape at the side to prevent the fogging up but you don't use that tape because the message i was getting is that you use it as a almost like an alarm sign if you're starting to fog up it's telling you i need to control my breathing so i found that i found those two aspects really really interesting i think you know what i think that's essentially the concept of when you hear the word neurofeedback you know when you do something right you get a positive response yeah so this is a real world situation this isn't just you know me talking about ideas and concepts when i started training the mask we put tape over the mask and that way if if we hyperventilated during a difficult part of the case the hot air wouldn't go up to our glasses that have the magnifying loops on them and now at this age i'm 48 and at this you know level of practice that i have i actually don't use the tape much or at all now because i rely on that um when my glasses fog up it actually tells me you're breathing too fast so it's become my own little neural feedback technique that hey you're breathing you're breathing too fast your glasses are fogging up slow it down so i'm having this internal dialogue with myself as i'm navigating the people in the operating room as well as when i'm operating and i think that's the other lesson is that by not hyperventilating you allow your thoughts to turn inwards and so you can have that inner dialogue about navigating the emotions the thoughts the breathing at that moment and i think that behavior control is really powerful it's it's something that has to be trained so the operating room taught me that now i don't do it as a ritual um daily but in in moments where i feel anxious or strained or stressed and it's whether it's appropriate or inappropriate um i i will i notice myself only breathing through my nose and you know people say well it's through your nose and mouth what the what's important is that you'd inhale slowly and you don't dump you don't just exhale quickly there's a deliberate nature and cadence to the breathing and i find that in and out through the nose helps me set that just right and i use it uh not on schedule but as needed outside of the operating room yeah i've had um quite a few guests now brian mckenzie patrick mcewen james nestor uh on the show we've we've spoken at length about breathing uh the some of the physiological benefits of nasal breathing um and it's interesting what you've landed upon yourself that you know helps you we'll get more into things that we can do around stress adversity resilience things we can do for our brain i think maybe later on in the conversation um i'd love to turn my attention to your new book uh life on a knife's edge which wasn't what i was expecting after your last book and i've got to say it was a really pleasant surprise it's so personal the storytelling is incredible and i thought some of the concepts in it are well worth exploring in our conversation today um so so that's a primer i've been thinking a lot about you over the last few days in preparation for this and you know your job you know as a neuroscientist and as a neurosurgeon and and i thought and i wonder what has your job given you with respect to an insight on this incredible organ not only have you studied the organ you are literally looking at that organ in an operating theatre several times a week what sort of insight does that give you about how powerful this organ is that the rest of us who don't have the opportunity possibly fail to grasp i would take that in a slightly different direction i'll show you how i get there when i first started i mean um just seeing you know seeing somebody's forehead removed and seeing like the glistening white frontal lobes with those beautiful arteries so so fine and torturous i just it was mesmerizing i almost thought is that even possible um so the first now you know the first part of my career i was fascinated by the actual craft the work the anatomy the the structure itself but along the way there's been an evolution in my um focus if you will or purpose even that um i saw it as really a window to study humanity now it's i've operated on thousands imagine opening thousands of skulls and as you know that means i've met a lot more people you don't operate on everybody that comes to see you and you don't operate every day of the week so i've met over 10 000 people operating on more than several thousand skulls and brains and things like that you could look at it that way or you could see it as think about all the different people i've met and i've met them all in their crises i've met them all in their most difficult times in their lives and they've let me come aboard and partner with them and journey with them for a little bit and so i started to see the ways in which they coped i started to see the ways in which they suffered badly i started to see some that were triumphant in in moments where i think i would just flail and so what i've learned as a brain surgeon and neuroscientist is sort of the the human story of of these these people who see growth in their own lives based on their description when we would perceive it as calamity a cancer diagnosis a scan where the cancer has spread and they should have shown me that not always but that difficult times you know they hold a reservoir for growth nobody wishes they they go through difficult times like these but those are the lessons i've seen and that's sort of what i get into with the stories in the book is the optimism and the heroism and the um and just sort of the transcendence of the things that usually encumber us the little thought little steps the little frustrations so in some ways they're set free it's not it's not something they choose for themselves but when that finish line comes in a view because i take care of advanced cancer patients they live differently and they often wonder why did not we have these focuses you know focus on these kind of things quality of life before the cancer diagnosis so i've gone from a surgeon to a neuroscientist to somebody who now really appreciates the human story through my patients it's fascinating that your job you know you say that it enables you to study humanity and i wonder given that you see incredibly sick patients and challenging patients and people who really might be at the end of the road and actually this is the last gasp hope when they come to see you does that give you a skewed view of humanity if your professional life is full of a certain type of person in in need do you think that is a beautiful lens through which to see all humanity or does it potentially you know skew that view where you only see one particular aspect of humanity yeah no it's it's definitely a skewed view i've taken care of thousands of patients and i've helped hundreds of people pass away end of life it's definitely a skewed view but what i would say is it offers us insight and perspective to a fate that one that we will all face you know that that the finish line and death and mortality is unavoidable and the lessons i have learned from people who are facing it some young some old but there is clarity in those moments that i want to share with people um who have yet to face that that final moment or those final struggles and so it is definitely a skewed perspective but a rare one i think that can shed light on uh how to live fully and how to live your life realizing that uh it does end one day and i think those insights are positive and optimistic and triumphant they're not negative they're not um pessimistic and so they they inspire me they enlighten me with their descriptions of what they wish they would have done differently now that the end is within sight what are some of the insights that you've learned that have changed you and changed the way that you live your life because it's that it's that frustrating thing about the human experience that we often need to confront our own mortality before we start truly living yet i wonder because you have seen that so many times has that infused into your brain and you thought you know what i don't want to wait till i'm confronting my immortality i want to start living now yeah i i didn't get there i mean it takes age it takes your own life experiences there is no there is no shortcut um just because i take care of cancer patients doesn't mean i think of death all the time in fact only recently have i started to put put it together and have a synthesis of what i've been seeing and experiencing and i'm 48 years old but what what it means for me is not just to live well or live fully because that's sort of a personal dimension but what are the lessons we can take from the approach cancer patients implement when they're facing those crises so i can't bring people to hey life's going to end one day make the most of it that's not that's not my intention and people have had struggles in many different ways i used to be i do pediatric neurosurgery i've seen parents lose children i've done trauma surgery i mean there are insights from all of those patients but the techniques the approaches that i see cancer patients employ utilize to me that's fascinating so let's take one example after the cancer diagnosis he has to get scans all the time i mean every three months for life and i always think how how scary must that be to be in that scanner what are they gonna find has it come back has it grown is it the same it's a lot of uncertainty to face that not just having a trauma that you survive and say that's in the rear view remember five years ago we got in a car accident it was very difficult experience their their trauma unfolds every three months and so what i saw was they started to do sort of a compartmentalization of the three months and i started guiding my patients about that too like listen three months when you see that invitation for the mri from rahul john y'all it's gonna it's gonna this it's gonna be disruptive of course it is you can't be mindful when you see the mri request come in you can't be centered it's gonna rock you a little bit so what we do is we we try to limit that disruption so it doesn't eat into the 11 weeks in between so we come up with this plan you're gonna get a request that week is gonna suck you have to come in wait in long lines just be miserable let it be disruptive put yourself first we'll get in the scanner you'll see me afterwards or i'll call you and let's just brace for that week but what we do is we protect the time before and after that so there's a structure in which they say okay it's going to be a rough week because i have a scan and i've had something called scanxiety and that's a difficult time so we compartmentalize because you can't just say don't stress out that's not fair especially with their situation so they have little release valves and time points when they allow themselves to stress out um that hey i've got a i've got a brain scan this week it's going to be a rough week for me and that's okay but after and before let's protect that time to live fully so that's like one technique i've learned from cancer patients that i try to apply to my life as well there's a certain intentionality isn't there living like that and as you describe that i'm struck by you know how many of us just live on autopilot we don't really think about what we're doing day to day we're just existing before we know it's the end of the month before we know the season has changed but when i'm here yeah but what i'm hearing from these patients is that because of the three monthly scan they have to i guess like an athlete in some ways um live with intention no that's the stressful part like that could be if for an athlete the performance that that's when you're having your race but whilst you're training you're going to have some build weeks you can have some rare sweets you know i'm super conscious i'm i'm not trying to say being an athlete and suffering from it's the same thing at all just to be super clear but there's something about that rhythm that they they have a certain rhythm to life because of these fixed points brother that's that's you captured it well this the word season so um i'm just going to go on a random riff here i hope you don't mind it's not that's what the show's all about you go for it look man the the the problem is thinking in terms of something being linear or wires and what i what i have learned from patients and what is true neurobiology i mean you take a piece of brain you put it under a microscope the neurons branch towards each other we call it arborization the ones you don't engage the brain trims them we call it pruning so seasons and gardens and ecosystems is the right way to think of your brain and that's something cancer patients too there will be a season of growth but there also be a winner that doesn't mean the winner puts you back it's not two steps forward and one step back it's you're pulsing through your life there are moments of triumph but that's not forever maybe that's springtime and there are moments of tragedy or difficulty and that's not forever either so if we really start to see our brains and i just wish i could show people they're like it's like 100 billion electric jellyfish cram crammed into a skull that's floating in clear liquid spraying chemicals and electricity like it's aurora borealis if we knew we are like that in our skulls i think we would see our mind and reactions and behavior differently and i think the word season is spot on there are seasons of of growth and there are seasons of you know sort of winter and loss and there are also sort of seasons within the brain where things are dormant there are brain cells that are dormant until you have a certain stress and that's the cue for them to activate if the stress is too high they stay dormant if there isn't any stress they stay dormant so if we start to think of our our brains as gardens it fits more with the patterns of life that cancer patients have a very difficult diagnosis what do you do next just suffer for the three years ahead or the 13 years ahead so they they bring in this concept of the seasons of their year difficult moments surgery chemotherapy radiation that was a difficult season after that they have some vitality and a good window to see family and travel that springtime in their life i think if we do it that way our stumbles and our difficulties don't feel like setbacks they just feel like something that we we push through we brace through uh we manage through that crisis for this next springtime in our life that will arrive that that approach in their minds serves them well what about the patients who are not going to be coming back for the three-month scan for those who it literally is the end of the roads what can what have you learnt from their outlook and therefore you know what can we learn um from hearing their stories well that's harder you know um because last year there was nobody at their bedside in hospitals in america they that you couldn't have you come in for cancer surgery or even end of life things were happening on facetime and stuff like that so i um [Music] you know it's hard to say i mean i've i've i've helped over 100 people at the end of life journey and most of them um have left their intentions um written and most of them have family or friends that guide those final decisions but i would rewind maybe three months before that moment where they come to the place in their in their mind where they realize they don't want more treatment they're not surrendering they're not giving up but they're realizing that the hospital as far as treatments and there's still pain control and hospice and but that the hospital cannot serve them anymore in their journey and that's actually a pretty intense moment because then they have to say okay now there is no partner for these final moments you can have loved ones those sort of things and uh in their eyes at those those discussions i have in clinic or in those conversations it's interesting that most often i see them sort of running through a film tape of their life and how quickly it has gone by you know where they were born the key places they lived their family friends achievements failures and um that's an intense interaction to see that that at some point you have to say medicine and surgery i don't choose that anymore and that that time with them has been very illuminating for me personally that that time will come from me as well and i don't live in fear or darkness actually it creates an optimism like i this morning i got up and i was like man i'm thankful to be here today and what am i gonna do with this today i take my days less for granted after seeing patients look up as my father did and you can sort of like almost like a windshield you can see like the journey of their life and when i see that in patients i think there's no time to waste and that's very important for me that there's no time to waste yeah it must be very humbling you know you're someone who has achieved a lot in the conventional western medical model and therefore to hear or what was it like when you heard patients for the first time saying to you yeah you know i'm i'm kind of i'm done with surgery and medicine this is not the path for me was there a struggle on some level because that's what you had been trained to do your medical school residency your exams your peers tell me about that because that sounds like a super interesting moment in one's career where you maybe start to look at your training or certainly what you're here to do through a different lens that's a great question that is the evolution of a surgeon in the beginning i thought my skill had more potential to help than it does and so i would i would guide patients towards surgery surgery that they can get at other places but i always believe that surgery could do something um helpful and then when you take care of enough patients you'd also see that surgery has risks and complications too and that is the the nuance that's taken 15 20 years to learn is that for each patient um what do i offer how do i explain and whereas you can always cut things out you know that's the person that's left after i'm done with surgery that matters to me i always did but especially now so for example i take care of women who have breast cancer that spreads to the brain now when they have like a 12 or 13 year old because they get breast cancer some you know in their 40s and they're they're at a different point in their life they're individuals and that's where you have to study humanity to be a a cancer surgeon because your tool should not be offered or applied to everybody but when they say to me he's my son is 14. i mean i just really just you know i'd love to see him graduate high school so now that menu for them i say okay i just want you to know there are a lot of treatment options and there's some surgical options that will help and keep you going and these sort of things so we lean a bit different in my toolkit in armamentarium on the other hand if i have somebody who's 78 84 we i do talk to them about that some of my patients after choosing surgery have had issues and never left the hospital not because the surgery didn't go well the surgery it's just that medical complications after surgery in people in their 70s and 80s that's what uh keeps them from getting out of the hospital and yeah and so from within that range i would say there's another whole spectrum of considerations and i actually feel good about look man i first thing is you can choose nothing at all that's what i say to my cancer patients you you are driving and here are the different ways different approaches but you really have to become an expert in in people and their stories and what they want and what they're fighting for to be the best surgeon for them yeah more than just something technical you know as a fellow medical doctor i'm not a surgeon but i i share a very similar view to you that is also my experience you know you need to understand humanity you need to understand people you need to be respectful you need to treat people with kindness with compassion with real respect that's what medicine for me actually is all about and it's it's really fantastic for me to hear that um you know coming from a neurosurgeon and someone who i respect a lot it's really it's really wonderful that was one of the wonderful things about about reading your new book actually is the the humility that's there and i've got to say humility is not something typically people associate with surgeons you know right and that is a prejudicial thing to say just to be generalization i get that but within the medical profession and also out with the medical profession there is a certain stereotype of surgeons particularly high-powered surgeons like brain surgeons but what's interesting for me as i reflect on that is one of my best friends a guy called steve is a spinal surgeon on the south coast of england and the compassion and empathy that he shows his patients is second to none um and he's a very very well respected competent highly technical surgeon but those people skills i think elevate him in certainly in my eyes and his patients eyes and with you as well there's this real compassion there's this real understanding that empathy with your patience is important that you have to treat the person that individual rather than necessarily the scan and it's striking to me that there is that generalization out there yet my good buddy steve who i know well and now you you guys are showing real humility and compassion and um yeah what why do you think that might be that's uh you know surgeons are known to be more interested in the procedure than the patient um and when i was learning there's just so much to learn that it can appear that way and i think for me i think for me i i never thought i'd become a physician i mean i didn't i think we talked about it last time you know i dropped out of university for a little while fumbled my way back in went to medical school uh became a surgeon became a neurosurgeon became a neuroscientist it's just been haphazard going forward i'm extremely grateful for the tremendous career and life that i have now i have a big life i don't know if it's a good life or a bad life but it's a big life i'm talking to you in london i do things in eastern europe and south america and asia i i think what makes me connect with my cancer patients is that i bring a lot of my own life to my interaction with them it's okay for them to see that their surgeon has also struggled or having difficult times or had a parent pass away or i connect with them about that and people say well how do you do that it's not storytelling it's not here read these five questions to get a high patient satisfaction they read your energy they read your eyes they read you they just they just get it and i think as a cancer surgeon it's also sometimes in the beginning i felt depleted sometimes because you can't just walk into a room and talk to a patient who has cancer in a some formulaic way hey nice to meet you how are you doing you know that's not that's not the guy i am that's not what they deserve um but at first i used to i felt like maybe i was losing some of the empathy and the more i tried to just bring um not my problems but my complexities and share them also with them that uh about my family about the way i'm thinking my journey it became a strange sort of reciprocal therapy session they're going through a lot i was like look i'm going through a lot and i would just share what was going on in my life good and bad and and that was the that was the thing is um to be a cancer surgeon i mean what greater connection you meet me you meet someone you say nice you know go ahead and open my skull take me through the last few years of my life that to me is an incredible uh privilege just but from the curious side an opportunity how do you connect in 20 minutes do you hold their hand before they go back to surgery how do you how do you make them feel so i've learned to say things because oh my gosh with these masks and things going on can you imagine they were like who are these people around me and i would always say them you know the minute before you roll back to surgery after having seen a lot of different people you'll see me there i'll hold your hand and i'll look in your eyes and i'll do the whole operation myself you know i'm there with you and that was something that they you know so you start to see that they have concerns like who's my surgeon who's gonna be in there so i would i would try to address that um i would give their family a call before and after certain you know certain rituals that surgery doesn't start for like an hour and a half later and for many of them that were praying they're praying at 7 30 but the surgery by the time i get started is you know 8 45 because you have to set things up so i would let them know that i'll be beginning around eight they just feel connected that this person is attentive and the other thing i i learned to show them share with them is um i am with you and i don't know where your journey goes because they're cancer patients you know it's not a knee replacement where i can tell you're gonna be walking you're gonna be fine i don't know where your journey goes but you i always tell them you'll never feel stranded and i've even learned to use like physical cues after watching like the sound of metal and different people with sign language like there's a lot to some there's a lot to capturing a patient and so there's the body language you'll never be stranded i do this you know and there's a certain way i hold their hand and just just that there's a certain firmness just for a moment and there's a there's a there's a way i've developed to connect with them and i thank them for teaching me that you know i thank them for teaching me that that's what works there's always flexibility in how i do it but it's a difficult position therein and uh i feel so grateful that they let me into those moments in their lives i mean it's wonderful to hear what you do i i can imagine how comforting that is for a scared patient about to go into theater and you sort of beforehand you're looking them in the eye you're telling them i'm going to be here with you i'm the one doing your operation you know that the comforts you know that sort of connection i think it's the missing link in medicine yeah it's not what we get taught it's not what tends to be valued but you know you're a few years older than me but in my 20 years experience of seeing patients the number one thing that i can do for a patient is to connect with them because everything i can offer them comes on the other side of connection now i appreciate you are hands-on you are sometimes removing tumors from the brain there's a technical skill that is involved there but how important do you think in your role that that connection is not only to how a patient feels but also like to the outcome of what happens that's a fascinating question that so there people are looking at pre-operative which means before surgery uh meditation faith all these things have been shown before and after surgery um to lower the need for narcotics so clearly they feel less pain uh taking a little deeper into the biological level that when you go into it doesn't matter if you're gonna be getting the sleeping medicine and all of that or the the anesthetic that if you go in with your stress response activated that um that maybe the medicine doesn't work as well and there's even some small paper suggesting that maybe cancer cells swim a little better when the body is under stress in that moment beforehand now that's not completely proven but we are looking in that way and so bringing them in calmly uh is is essential and i'll give you a more specific example sometimes we do awake brain surgery so that takes a lot of coaching before when you see them in clinic look you're gonna wake up it's gonna be a bit weird um your skull will be open and i'll be talking to you as i'm operating that's a lot to walk into just even when i still try to describe it or i'm not laughing out of any eddie like something disrespectful i'm just thinking if i was on the other side i'd be like what what are you talking about you know but to operate in the language region on the left temporal lobe that is required you're risking their humanity but if you don't do an awake brain surgery but coming back to connecting that's a lot to walk people through and then you wake them up under when they're in the operating room the scalp is numbed up the skull is off and they're talking to you and you're tickling the brain it doesn't feel on its own so you can tickle it it only feels through the nerves you can touch the surface of the brain and the person doesn't notice it and you walk them through counting and reading words and different things and you have to have a connection to take them through that and so it doesn't have to be only an awake brain surgery i try to bring that to all of my patients um but that connection also you know i don't know if you can just teach empathy in a class i used to always say make these medical students do other things before yeah you know we're gonna work in a coffee shop live and work a little bit because you have to bring your own life experience i mean i was 35 consenting 75 year olds for brain surgery well i mean you got to bring something from your own life that isn't just college and university in medical school and that's important i wonder if that's why your approach seems to be so different because you had that unconventional path to neurosurgery you know most people who end up being who end up you know performing well certainly in medicine and in surgery you know often they went to the right schools and they knew from a young age maybe their family did the same job and they go to the the right college the right university they're sort of they're on this sort of path and they often end up getting there and of course not everyone but that is certainly that happens but you didn't do that you worked in different jobs you were a security guard while your school buddies were off at college right so this is that is not conventional so i i just wonder how much of that plays into what you bring to new york the security guard thing is funny that not only were they off in college i was a security guard at the cafeteria in their college so one day and they were like hey i was like hey i mean one day you're in class and the next day i've got my like uniform on and i was like this is bizarre but i you know i'd never you know what other people think of me is none of my business is one of my you know and at that moment i was trying to hold on to that but i saw it as an adventure you know everybody keeps talking about like adjustment but i saw this life and i still see this life as an adventure um and that unconventional path i mean and then you know then i i took the long road and has been unconventional but during those times i was seeking unique interactions i mean i worked at i mean volunteered at an alzheimer's clinic i worked at marie callenders as a busboy in los angeles i mean i was seeking those opportunities out i mean i think i've been a student of human nature since i was young and then i went into beca then the career thing and now i'm back to being a student of human nature and i realize i've been uh you know i the master class has been my career as a cancer surgeon so um that's fascinating to me that i fell forward into these things i feel very again fortunate for my life but going back to you know the system selects for people who are spending all day all night in the library the marks required to become a physician and surgeon is so high but you actually can't have fun most people are not going to have fun and pull off the marks so it kind it's kind of a weird thing that you're almost selecting for bookworms in some sense and then you're saying here's here's the hospital where you'll find everything from addicts to ceos ceos that are addicts addicts that are coming in and out you know it's just such a wide range of humanity and then you're putting bookworms in there i think that there's a flaw yeah in that um and maybe they just need to say hey listen six months you're gonna have to do some odd job you gotta get out there a little bit before we throw you in the hospital you know i don't have a solution but i see i see where there might be an issue a connection between physicians and patients yeah i mean i've shared this on the show before but sorry to interrupt if you're enjoying this conversation there's loads more like it on my channel please do press subscribe and hit that bell now back to the conversation i went to medical school like maybe two weeks after i turned 18. young you know you can come out five years later so you know i i think i know you were on julia samuels podcast recently julie is a good friend um and you know i remember chatting to her about this when she was on the show i said listen i was seeing patients when i was like 23 years old like i didn't have any life experience to offer to bring to the to the table like they were telling me about personal stuff they were a lot older than me things were going on and look i certainly did the best that i could but i genuinely think i was too young too they're teaching you well you know what they've always taught me i've i've said this in all of my books that my my patients have taught me yeah a hell of a lot more than i've taught them and that is something that i've noticed with your language throughout this conversation you have said on multiple occasions what i learned from them what i learned from them it's something that comes up through your book as well and i love that sort of humility and that sort of idea that actually we are learning just as much if not more from our patients than they are from us look the i think towards the end i have i say something about now it's almost you know because i'm evolving i'm changing it's been an intense couple of years i've had some everybody's going through difficult times um i guess that's one of the the one of the things i've also learned from them there may not be a time in your life when things aren't difficult so but you can't stop living and enjoying it's sort of both for me the seasonal concept works well like there are times of growth and then there's times of you know where winter and there's times of you know fall and i that helps me understand the the almost cyclical nature of things in our lives but they say hey yeah i mean i'm living with cancer what am i supposed to do in fact because time is limited i've got to party rock out travel see people i'm living with cancer i mean gosh that is such an interesting phrase so why can i not live when i don't have cancer you know i just so such insightful stuff you get from them and back to thanking them in the last now i'm like why are you thanking me yeah i should thank you for letting me come into this moment in your life for a few months or a few years and i'm you know there's this concept of vicarious trauma traumatization where people see trauma or you know nearby and they're affected by it but i feel the opposite i feel like i've had vicarious fortification i have learned through my patients struggles without actually having to bear the real weight of the diagnosis and the treatments right i'm there with them i'm learning with them i'm partnering with them i'm getting wiser from them so i thank them i thank them for allowing me to learn from their lives i mean and think about the sheer number of patients oh my gosh i was i was writing this book i was like thousands yeah 48 and at least shook hands people are like look you know the different way to think about it i pro i've met over 10 000 people for for at least 15 minutes i mean there's a lot of volume of human interaction right maybe skewed but not all of them there's other before i was a cancer surgeon we see people for routine things and then i've opened thousands of human bodies and what's interesting is not the anatomy is that the interactions with them before and after don't get me wrong i had to think about the anatomy and the procedure and the craft and getting talented at it but along the way it's it's their journeys yeah before and after the surgery that matter in some ways you know you we we get the we get the the best deal out of it right we go along with their journey we we we get to share we get to learn but we don't have to deal with the quite severe consequences sometimes do you know what i mean it's it's 100 so you know i was just talking to my buddy about that uh the other day i said i mean for so 100 so first um when that first start and i wonder where this you know the the the complexity and the uh of the current things that i'm thinking about with my patients my life you know i think it comes from from trying to put meaning to the sheer number of people i have uh cared for and how many of them have um passed away and i haven't and so the way i explained it to a buddy who's not we're just we're just talking i said you know i just for a while you know all i do is all i do is parachute into crash you know crashing airplanes pull up the nose for a little while then i bail out and the airplane crashes you know i extend life i don't cure and for a while that started eating at me you know just the sheer number of invitations to funerals and thank you for caring for my mom and she's in heaven you know just after a while the drawer fills up with those cards and you start to feel guilty that they're not they're they're they're gone but you aren't um and so i think those internal struggles about what i do with that that's what this book is it's uh you know it's an excavation of my emotions and thoughts uh but not separate from what they're going through sort of uh sort of interconnected uh are the lessons and the insights yeah what what's so wonderful about it is the the specificity of the stories yeah is what i think will speak to everyone it gives it that general broad appeal because it's in each of those stories even if you've never had cancer or you've never had one of the sort of severe operations that some of these patients have undergone you tend to see one part of yourself somewhere along the journey thank you brother yes it's and it's you know i'm you know i was going to say i'm a fan of storytelling we're all fans of storytelling that's what we're wired to you know learn from and connect with and you know it really is it's a brilliant read which i think will will cause anyone to reflect a bit differently about themselves and their life and just put things in perspective you know one of the favorite guests on the podcast so far james nestor i can see looking at your book that he gave you a wonderful quote for the cover wondrous and wild i loved this book you know that's a great compliment from from someone like james who's possibly written one of the best books on breath certainly in the last five or ten years or so i read that yeah um yeah it's it's great look i want to shift gears a little bit um early on in the conversation you mentioned balance between thoughts and emotions and i think that's a really interesting concept to unpack a little bit i've heard in a previous conversation that you've had that you said that depression anxiety ocd and overeating all come from a similar part of the brain and that again with these conditions that can be a problem with this balance so i wonder if you could explain some of that please yeah so i mean this is a it's going to take a little while for me to set up but i if you know if you've got time okay but it's very important um to me um [Music] that we've lost the nuance in our understanding so let's just take a few simple examples inflammation is bad is it i don't know i mean certain types of inflammation are bad yes if you are constantly stressed out and you've that's also generating an inflammatory response that's horrible for you certain types of inflammation are necessary but now let's get deeper with emotions and feelings and anxiety and these sort of things right there's a certain amount of anxiety that is appropriate you should have situational anxiety that's by design that's protective but when there isn't a threat and you're too vigilant and too anxious not only is that unnecessary and wasting precious calories if you know you're in the savannah or you know thousands of years ago it actually is unhealthy for your brain and mind you're not living well because you're anxious but there isn't a cue for that if you're anxious on this the day of the scan hey that's that's what you're that's normal yeah that's what you you want otherwise and otherwise i get worried that you're not really understanding the gravity of the situation so so the the the thermostat or the dial or the balance is very important to understand that there is no let's take another one addiction that's a that's the balance is off but those same pathways the same chemicals uh the branching in in the gardens of our mind that that lead to addiction are also the ones that get you after your friend's spinal surgery to get up and try to walk also the ones that get you to try to go to the cancer center despite the odds right so that reward is a double-edged sword yeah anxiety and vigilance is a double-edged sword inflammation is a double-edged sword that's the efficiency of the design it isn't it's not on off it's it's it's tone it can be modulated uh that way everything inside us can help or hurt with that comes responsibility so now that if we think about um let's get back to you know ocd anxiety let's think about these things these are the simplest way i can prove to you that they are a product or an outcome or they come from the ether of our emotional brains it's a simple term but i'll get into that is that when we manipulate them with little electrodes called deep brain stimulation you you we don't tickle the surface right under the skull we don't tickle the the frontal lobes where cognition executive function thought um creativity even is we we tickle deeper to the emotional brain limbic system structures words you've heard before amygdala hippocampus these kind of things structures that animals have also so though that tells us that that the the emotional brain is not in balance with the thinking brain in some of these situations and so let's let's get deeper into that so when the reptilian brain which is through your mouth it's through your mouth and like in this direction it it didn't morph into the emotional brain the emotional brain is sort of like a babushka doll or a mushroom it was on top of it you can see three structures if you took a side picture of an mri there's like the cortical canopy we call it the cortical canopy what a beautiful word and it's like an accordion because it's just so big it had to be wrinkled to pack into the skull cortical canopy underneath it is the emotional brain behind is the reptilian brain reptilian brain is triggering breath when you're unconscious and basic functions emotional brain is should i jump when i'm at the edge of a cliff should i pull back when i see a snake on the ground you don't think about that you react to that and then the cortical canopy the prefrontal lobes they give the emotional brain context now stay with me here how is it that we don't keep jumping at a rubber snake just it's also first time right yeah and then we say wait a second that's the interplay between cognition the frontal lobes and the emotional brain there are actual pictures of branching of neurons between these regions and that is that that that growing that guard and tending to that guard and however you do it i don't have a simple answer for that but if you know there's a physical interface between your thinking brain and your emotional brain trying to find that dance then what you see is you feel empowered you feel empowered that maybe i can have a new perspective on fear maybe i can have a new perspective on ptsd through therapy and through other things we can talk about maybe this anxiety is something by controlling my breathing i can tamp down so that's that's powerful that you can you can dance with your emotional brain you have to get rid of it because life without emotion is not lush but you don't have to have the emotional brain take over your behavior and decisions and get you into trouble the last thing i want to say about that is the last example for people to know that this is possible if you go to a movie and you get scared it's the same amygdala which is simplified the amygdala is not the fear center it's a vigilance center it just pays attention to uncertainty but the same emotional brain goes off whether you're being actually chased by an axe murderer in the street or watching one in a movie theater but when you watch in the movie theater and that adrenaline pulses through and your emotional brain you actually like you get scared but you don't run away because that's your frontal lobe branches coming down to your emotional brain saying don't don't run away it'll be embarrassing this is actually just a movie that's context so the whether how we stop jumping at the plastic snake on the second time how we know the difference between a real attack and a fake attack on a movie there is thought and emotion those two examples uh beautifully working with each other the emotion protection the beginning where thought would be uh too much of a delay but then thought also says you know what maybe these emotions are not haven't earned their place in our lives so that is emotional regulation um and that that being off is anxiety ocd uh those sort of things that's my understanding of it i mean firstly i just love the the awe and wonder with which you speak about the brain like it is it's a trip it's just incredible because you've obviously studied it but you've seen it you've seen all these parts i love hearing you describe the anatomy and you're sort of pointing through your mouth it's yeah this isn't this is not like stuff you just read in a book you you literally know where it is and it's it's yeah it's wonderful to hear actually it certainly gives it a certain something um when the balance is off between those two parts of the brain uh and you said there's no simple answer um you know we can have all kinds of issues like depression anxiety ocd you know eating too much you know all these kind of things where maybe that the the cortical canopy isn't sort of taking it down and understanding the context here uh we don't need to just because the emotional brain is feeling this we don't need to act on that very good what are some of the things that we might want to do in our lives to help us potentially sort of recalibrate that balance and make us better at regulating our emotions and i think the the things i can answer with go back to the original part of our conversation um that turning your thought inward on whether these emotions are justified is step one um and controlling your breathing especially for anxiety is is the go-to move there now can you just think down um ocd uh depression not really because now you're in a you're in an altered you you're in an altered balance that becomes a feed forward the the inward directed thoughts about your life time to reflect daily the breathing to control the anxiety those are prevention and maintenance things coming up if you find yourself in a in a depression that's hard to do because now the balance is is turned so far off that it's spiraling and gaining momentum and that's where you need to have uh you know you need to think about medicine therapy physical activity so it really matters what we're talking about is it a daily maintenance of mental health which we all need right we know so much about the heart and our skin but from a young age daily maintenance intending to our mental health is important but if you come in and you have significant mental health issues there's a different approach for that now let me let me give you some biology about significant mental health issues let's say you have anxiety and somebody prescribes you valium um valium is a benzodiazepine it's an anxiolytic okay it can also make you stop breathing it's dangerous but i want to go back to that interface between thought and emotion inside our skulls with a microscope it would look like two trees with branches going into each other i mean it's you can see it it's not a ma it's not it's not something you imagine well when those neurons branch and connect to each other they don't touch they they when the when two neurons come to each other they pause and they spray chemicals chemicals you might have heard about dopamine serotonin these sort of things so when you take valium for anxiety or seizures what it's doing is it's manipulating gaba the chemical that chills things down so you've exogenously put in a medicine that goes to those branching interconnections and quiets the electricity so because it's it's it's glitching out and you feel calm and i think when people start to see that okay that's how this medicine where it goes how it works it's powerful because the other thing that turns down that glitchy electricity is meditative breathing and i need people to know when i when i when i talk about breathing i can explain it down to the chemicals being sprayed by those branches breathing or volume do the same thing at the at the molecular level in your brain you say how do you know well the first book showed that when we do some surgeries we put electrodes in and to look for seizures i mean we have hardcore surgical and and biological data for that now let's take another example so you take an antidepressant well what is that i mean what is what just like we were talking about reward getting you to get up in the morning to go and get your treatments or leading to addiction mood can make you feel good or bad okay that makes sense but when people are depressed there's a uh opacity or lac you know serotonin isn't just right so when you take if somebody takes prozac we're back at those branches of brain cells and what they're spraying at each other between one neuron there's a 100 billion and they have 10 10 000 connections each what a ssri is selective serotonin reuptake inhibitor prosit whatever it is is when serotonin is sprayed from one neuron to another the vacuum to evacuate it is turned off by that medicine so you have more ambient serotonin and your mood gets better and it takes time for that to happen globally that's why antidepressants take you know a couple of months so i'm not asking people to go on antidepressants or not but just to start to think of your brain as an electrical and chemical garden and so when you breathe you affect the electricity and chemistry of your brain when you take valium or prozac you affect the chemistry of your brain and when uh people wear those helmets and and those things on their head they're trying to learn about the electricity of the brain so everything if we have an understanding of anatomy chemistry the chemicals are being sprayed and then electrical currents are being generated like uh like jellyfish and but the pattern is more like aurora borealis you can start to think about when i do this or i take this how does it fit within the garden of my mind and the garden of my brain i think it's important when people know how it works they're more likely to implement that measure yeah for sure i'm going to certainly hope that everyone listening and watching will understand the importance of being able to manipulate and control your breath to help them in their day-to-day lives well if we think about this second book certainly second book here in the uk i know you've had other publications uh in america it's a very different book it's very reflective book and i i like the way you've structured the chapters with around different topics you know loss grief performance you know it's it's a beautiful way of getting these ideas out there the chapter that i i sort of got stuck on and kept reading was the one on self i think chapter seven and i want to talk about the self because i thought you had an interesting way of talking about it describing it seeing it through different operations and how people saw themselves after some some pretty brutal operations actually um so there's a couple of things there you know you have said in the book that it is a combination of body mind and autobiographical narrative you said our sense of self rarely changes through life so you know what is our sense of self what is different about it from the mind what is different about that from the brain and what have these various procedures and operations taught you about it yeah that's a big question and what i would say is there is no right or final answer that this was my best effort to shed new light on a topic that is you know been relevant and inquired about since antiquity the word neurophilosophy of a decade ago caught me by surprise neuro philosophy they put neuro in front of everything now like neuroeconomics but neural philosophy caught me by uh and it was actually in san diego where i did my phd what is neural philosophy so the concept of identity and self people have written about that for a long time but in a certain operation where the brain is like a a walnut there's a bridge in the middle there's hemispheres we do something called disconnection surgery and that's to keep electricity from one side from going to the other side if it's you know if it's uh related to epilepsy so epilepsy is aberrant electricity it's too much if we can't cool it off with valium and things that cool down the electricity then at least we prevent it from going to the other side of the brain where a person will be you know knocked out and lose consciousness but when you do those disconnection surgeries sometimes people don't recognize they they work normally they don't recognize halves of their body and different types of injuries have done this too and oliver scyx has written about this a little bit so what happens um when you take a small sort of band of neurons that connect the two hemorrhoids for your brain and you dissect through that and the person can no longer recognize a part of their own body right not phantom limb not this kind of stuff but they have uh they just can't recognize their own part of their body and they had somebody had written like well maybe this corpus callosum this structure can be argued as the seat of self and identity you disrupt it and people don't recognize half of their body and i thought okay that's interesting but my patients have shown me something else um and so i try in this chapter to add to that that's that's established you can read about that um [Music] and so what i've seen is there is sort of the body's relevance to a sense of self there's the mind's relevance to the sense of self and i'll take you through three examples and then there's also sort of uh having a sense of self of your own life and journey your autobiographical memory that you are on this journey and somehow you don't remember the details of 20 years ago but you're still that person moving through all those life events the first one that really rocked me was a very challenging operation where the cancer was taking over the pelvis and half the body was removed it's called the hemicorpectomy and when you read about those operations and how those patients do afterwards there's a lot of suicidal ideation it's in a pursuit for cure sometimes they are sometimes they aren't but this one patient taught me that that the connection between body and mind is not just something figurative that it's literal and the connection of his lower half of his body to his mind when he lost that bottom half when he chose to have that bottom half of his body surgically removed it it altered his sense of self not just a limb not just an amputation not an appendage but the bottom half of his body and what i learned from him was that everybody's got a unique sense of self when it comes to their body and they shed a lot of light about people who they do self-harm they do tattoos they do piercing there's a lot of ways that how we feel about ourselves is connected to the ways we manipulate our bodies or feel connected to our bodies and for him not all patients but many um losing the pelvis and below was just too much it was um it was something he regretted and something i regretted he's you know he signed consent for the surgery and there was a whole team involved and it's in the book but after that he went to a depression that just couldn't be fixed and um medicines didn't work nothing worked and that gave me an interesting insight on wait the body and the mind at some point that is important other people are paralyzed they haven't had this issue so something about they can't move their body and it's connected they feel whole but this guy he could move his arms he just lost belly button below but that that dismembering of half of his body left him in a psychological state that he could not reconcile with his former self whereas i've seen a lot of patients were paralyzed they don't have that same experience so that was one example that shed light and just briefly the other example was operating on the insula the the brain actually can be opened up without being entered and there's a little island of cortical canopy in there and operating in that area people wake up not only not recognizing other parts of their body usually the other side but denying its existence like throwing their own arm out of the bed and and then you start to think about a sense of self as that's interoception the cohesion with which we uh experience our body as well as the extent we'll go to [Music] even throwing part of our body out of the bed to keep our our our perception of reality intact and so if you manipulate the insula and then thanks for letting me go a little deeper into this when you manipulate the insula there's the the brain looks fine the mind is decided this arm is a mind it's not like the part of the brain that controls that arm is is damaged the insula in wanting to feel whole will actually um disregard the physical inputs coming from the whole half of the body and that's called confabulation that can happen with your type of drinking and stuff like that like people will create lies to keep a um a perception a psychological perception of being whole and intact so those are the the two main examples that i can give you that i think shed light on body and mind i mean that last example what you said there is just incredible because you're saying structurally beautiful intact no problem you know we know everything required to do this particular function it is all there it's looking pristine yeah another part of the the brain or the mind i guess is sort of mind the mind is bringing a bit of nuance and concepts are going hey stretch is okay that's cool but you know what i'm not happy i need to make some changes to how i'm experiencing my life and my body for whatever reason it's it's it is it is incredibly it's a bit scary it's inspiring it's i guess it all speaks to the incredible magical it's yeah but the incredible power that and also then speaks to potentially the untapped potential we all have for our minds right yeah i love that the the examples are just to expand the way we see ourselves that with intact flesh what the flesh creates the white flesh of the brain creates the mind the mind will actually come back at it and say i'm i'm not going to accept certain signals and that's fascinating to me that that flesh creates thought and certain thoughts can go backwards and change the flesh that i mean if you think about like emotional regulation breathing exercise you're choosing to do these things that in turn change the structure from where these thoughts arose so that the brain mind even more than mind body the brain mind relationship is a reciprocal one if you you know the common example is you drive a london cab or you know that part of that tuft of your brain gets thicker so certain behaviors and activities and rituals and things you do to improve your life come back and fortify at the physical level what's going on in your brain and that's the that's the power i want people to feel is that working on emotional regulation working on meditative breathing working on taking 15 minutes a day to reflect will structurally uh modify those branches and connections between thought and emotion making it easier to deal with stuff in the future because you're building up that part of your brain so that that reciprocal brain mind mind brain is the reason why we should try we should try to be better because it changes uh us at the physiologic and at the molecular at the cellular levels incredibly powerful if you think about your efforts at improving your life will actually change the the nature of your brain and people say come on that doesn't make sense well well look at children they don't walk and then they walk so right i mean there's a lot going on there well why stop at that look at adolescence they're not mature and they become mature but why stop at 25 what if what if the same potential for improvement and self uh you know self improvement and actually changing the physical structure at the at the microscopic level of your brain was possible throughout your life with these efforts at self-improvement at coping at connecting i think that's incredibly powerful and again my patients have seen that in them and i can show you the slides of what the brain looks like under a microscope where these things visibly happen this isn't something like a gas in the in the sky yeah i mean it's incredible and that's one thing that science is really showing us over the last few years that we don't necessarily have to accept inevitable decline as we age there's plenty of things that we can do that will you know certainly stop or slow down the decline and potentially even reverse it in some cases right so what are some of the things that we can start doing and what kind of difference will that make so if if my children were to ask me this question or a patient or a loved one or a friend or or even a foe it doesn't matter the answers from what we know are clear so i'll tell you what and then why and please and allow me to explain why i feel that when people understand why they're more likely to follow through with the change otherwise it's you know it's sort of like fad psychology or do these three steps and life will be better and when it isn't there's this frustration that things that work for others aren't working for me so with that caveat with that disclaimer that your life is individual and your inner inner life and your inner experiences are yours i don't know where you are at the state of the station in your life triumphant struggling somewhere in between whatever season that said the brain is flesh okay so to keep flesh healthy in the body it needs to be irrigated blood is delivered by blood vessels if those blood vessels are clogged the flesh that it irrigates much like a sprinkler to a part of the part of the lawn will wither and die off so poor it's not heart health i just want to be very clear poor vascular health if your blood vessels going into your brain are clogged and not delivering all the blood flow they can parts of your brain will start to die little swaths of it will start to die i see it on mris and people as they get older microstrokes white matter changes these sort of like technical things so the first thing is if we're talking about brain health and mental health you got to keep the flesh irrigated okay how do you do that a lot of other people can tell you that some people day cholesterol medicine you exercise you keep your blood vessels healthy same thing for heart blood vessels same thing applies for brain blood vessels now let's zoom in so okay so we're just going to take this from you know just like the solar system but i'm going to go i want to go flesh to molecules so keep your keep the white flesh healthy i think that people understand um then let's zoom in what neurons look like okay so we've gone from like the beautiful garden from a distance and now we're actually looking at one plant one neuron neurons send chemicals and electricity all around the speed with which that electric electricity travels is improved by having the tentacles of those jellyfish if you will wrapped in a certain fat insulation just like your wires or cables that you're looking at are wrapped in something not just to protect you but sometimes also to improve the conduction the speed that's where fatty fish omega-3s come in the myelin sheath that's what it's called wrapping those tentacles or those neurons the 100 billion requires a fatty substance and you don't have you can be vegan and get this so fatty fish twice a week like salmon or chia seeds and other things will provide the nutrients okay first you got the irrigation to the garden that's blood vessels vascular health now you've got the nutrients that fertilize and keep keep the not fertilized actually i want to see them that help build the branches of those plants in your garden those neurons in your garden so that's a certain dietary thing you want to do mostly vegetarian with with fatty fish or if you're vegan with something that supplements omega-3s that's that's that's the second thing you want to do now at the third thing you want to do is you want to fertilize that garden that ecosystem in your skull and the best fertilizer is exercise so exercise not like something comes up from your muscles and lands in your brain your brain has its own pharmacy when you exercise it starts spraying all the the the brain the neurons with things like growth factors like bdnf and so now you're you're globally tending to the garden and then the fourth thing you want to do is the most important thing is think and challenge yourself if you get into habits and ruts and don't keep expanding the corners of your life and thought what happens is parts of that garden become dormant you don't need them you can get home on the tube or on the freeway with just using a small part of the garden why would you engage at all it's very inefficient so you actually have to consciously thought has to say i want to try new things learn new things you don't have to get good at it but the process of learning of challenging yourself changes the concentration and patterns of the chemicals that are being sprayed between those neurons and to me that's the most powerful thing that thought is the ultimate ultimate tender cultivator of of the human brain and the mind and i can't tell you how your journey will go whether you'll reflect or you know take time to reflect turn your attention inward you know deep meditative breathing i don't know how you'll put it all together but i just want people to know that's how that's how it is those are the skull contents if you will and i'll conclude with to me the understanding is the gift um the possibility is the gift and now if everybody has that in their mind when they deploy it when they rely upon it is up to them and that's what i've learned from my patients and from the science i've been working on in my own life journey yeah i mean it reminds me a little bit of the conversation i had yesterday evening actually with my mum right so my mum lives about five minutes away she's she lives by herself she's certainly not as mobile as she used to be and i feel that there's been a decline recently because i think there's been a lot of help like i go round and give her breakfast most days and the last few days i've noticed mom's not going to get things herself she's waiting for people to come and i had a i made sure i was in a in a good state of mind yesterday in the evening but i thought let me have a calm conversation i tried to explain i said hey mom listen look i i know it's easier if i get you this or you know my brother gets you this but at your age and the way your health is i actually think you'd go a few days of us getting stuff for you and your brain's just gonna go i don't need to do that anymore yeah and i said mom and i saw a difference this morning actually i went around and she actually said no i'm gonna get it and i was it was really nice but i guess you would sort of you would say that that was the right thing you would sort of you know you definitely subscribe to that use it or lose it yeah unless you're trying to hide from your mom and you're using this as an excuse but i don't think you are i think though the most important thing is that with uh with moms and loved ones you know if we said you know we know with kids we don't want to baby them otherwise they won't develop or cultiva you know mature i think with older folks isolation is a big issue so if you know spending time is great for them the connection is great for them but doting on them in the way where you're doing their activities of daily living for them i think that gets in the way and that's exactly what you're hitting on great you know ground level life example like they got to go to the patients like look you got to go to the bathroom on your own i know it's easier to have a commode next your bedside no you got to walk to the kitchen you got to walk to the bathroom don't sit on that that part you have to keep them where they are if not more yet with older folks uh loneliness and isolation can weigh in so let her do her stuff and then just hang out with her yeah for sure good stuff man well rahul look i've i really enjoyed our conversation um i i really big fan of both of the books here in the uk uh i really hope people rush out to get your new one life on a knife's edge um this podcast is called feel better live more when we feel better in ourselves we get more out of life you've you've beautifully gone through some practical things that people can actually do in their day-to-day lives but i thought a really nice way to to close off this conversation is your sort of final higher level thoughts and wisdom because what i really get from the new book and our conversation today is yeah the the things we do day to day yes they are important of course but the way we think about our life the way we prioritize our life the way we can learn from people who feel that they may be at the end of their life i feel there's some real powerful wisdom there so i wonder if you could just share some of your closing thoughts on that for my audience thank you first of all i'm honored just to be asked that question you know um again i i would like to share that um the life at its depths also reveals its heights meaning that people who are struggling can also dram demonstrate tremendous powers and strength and growth that they didn't know they had in them and to witness that has been powerful and the second thing i would say is that no triumph for tragedy is forever and i have seen that in in families going through very difficult stuff and so if we see our lives and the moments in our lives as seasons um enjoy where you're at and if you find yourself in a difficult place you know that too shall pass and there will be a new season after that those are the lessons i've learned rahul thanks for making time for the conversation today and i hope i get a chance to speak to you in person at some point in the future thank you if you enjoyed that conversation i think you are really going to enjoy the one i had with the former monk j shetty on the simple things that you can do to train your mind it's right there give it a listen and let me know what you think the monk mindset is about pursuing your truest goals your truest self and your most authentic aligned goals

Channel: Dr Rangan Chatterjee

Views: 150,974

Rating: 4.9162884 out of 5

Keywords: the4pillarplan, thestresssolution, feelbetterin5, wellness, drchatterjee, feelbetterlivemore, ranganchatterjee, 4pillars, drchatterjee podcast, health tips, nutrition tips, health hacks, live longer, age in reverse, self help, self improvement, self development, personal development, motivation, inspiration, health interview, rahul jandial, rahul jandial interview, destroy negative thoughts, how to reduce stress, reduce anxiety, stop negative thinking

Id: zKbjm9ZB5cA

Length: 104min 4sec (6244 seconds)

Published: Wed May 26 2021