Dr. Mike Talks with Harvard Psychiatrist Dr. K

yeah so thank you so much for for joining us today dr mike yeah of course thank you so much for having me i'm really excited to have this conversation um oh really what what is this con are we what are we talking about well i think we're talking about how the mind and the body are actually mind-body not two separate words so um i'm hopeful that you know i can sort of bring up the subject of how interconnected these two subjects are and then get your take on your experiences maybe personally maybe professionally if you agree or disagree with some of the statements that i make i always like for these to be as personal and conversational as possible but if you have a different way of doing it in mind i'm all yours yeah so sometimes when people come on or actually usually when people come on we'll have like something more of a personal conversation where you know i think a lot of people are interested to hear actually like your story and and kind of um sometimes people will come on and we'll have uh you know particular questions that um or sometimes they're facing challenges and and potentially want to work through some of those but i i recognize that you know as both being like medical professionals like we could have a conversation about something instead of doing a more traditional like personal interview kind of thing so i'm really game for both um it really depends on you know what yeah i'd love to have a conversation about the subject of the the mind body connection and from there if we have personal anecdotes to work those in uh i i'm open to sharing some stuff so that's cool so let's get started so tell me about the mind body connection yeah so for me um just to give a little background i'm a board-certified family medicine doctor uh but i happen to be a d.o not an md which is an equally licensed medical licensed degree in the united states and basically the premise of our education in comparison to that of md education is we really try and put forth a holistic patient forward approach to everything and anything that we do in the field of health care this could mean something as simple as a patient coming in with acid reflux symptoms and instead of simply fixing the acid reflux to a medication we would do that but in addition to look at some of the risk factors that that patient might have in their everyday lives that are predisposing them to continually having this acid reflux condition and as a result we kind of take a bigger picture approach when it comes to treating patients using that background i've started treating a lot of patients for pain because what would happen is any time a colleague in my hospital in a nearby hospital in urgent care would run into a patient who's having chronic pain issues or perhaps an acute pain condition they would end up sending them to me as a referral for osteopathic treatment because in addition to this patient first philosophy that we have in do schools we also learn an extra hands-on technique called omt and it's not really one technique it's more of a therapy it's more of a way of thinking it's not magical it may look somewhat like physical therapy like chiropractic medicine but in theory it's more medical in nature in that we use the body's own mechanisms that no one disagrees with in the medical community to try and help patients out with their pain or perhaps with the dysfunction that's causing them a concern so an example this could be a patient having recurrent tension headaches as a result of spasms in their neck uh a proper and osteopathic exam could go into what their work ergonomic situation is like are they sitting in the right chair where where's their monitor in relationship to their eye level then putting our hands on the neck feeling where the dysfunction comes from checking the joints above and below meaning that if it's the neck uh we're checking the thoracic region as well and not just forgetting that the cervical spine is connected to the thoracic spine and there's impacts of that checking for shoulder dysfunctions seeing if a patient is using one shoulder over another because of another injury that exists and then figuring out a way to treat that condition whether it's through using the body's own reflexes to relax this spasm because the body has a lot of these innate reflexes in it where it uh essentially turns on some muscles and turns on other muscles i'll give you an example if you ever try pushing against a stationary object like a wall or a pole and you know that object's not moving what your mind tends to do is actually send signals to those muscles that are being activated during this isometric contraction where the muscle is not lengthening not shortening is to relax because it doesn't like to waste energy on something where there is no eccentric or concentric motion happening so we use that body's response to an isometric contraction in order to induce relaxation and increase range of motion in spasm areas that's fascinating i wonder if actually that i i never connected the isometric contraction i wonder if actually that is partially responsible for the clinical superiority of exercises like especially yoga which are essentially isometric contractions right because you take a position and you hold it and whether that because i know that yoga is sort of superior to physical exercise in terms of recruiting like or shutting down the hpa axis and i never thought i never realized that there was actually a mechanism that involves isometric contraction that induces relaxation but that sort of because i've been always curious why yoga sometimes outperforms exercise in clinical trials and this is the first time that i've ever heard of a potential physiologic mechanism through which it acts fast yeah and there's another level why yoga is probably superior in a lot of instances because of breathing the hpa axis is directly affected upon our sympathetic or parasympathetic state and we can control that state based on how we control our breathing and this is where i can throw in a personal anecdote i'm horrible at controlling my breathing i tend to hold my breath a lot maybe not when i'm doing weight lifting but if i'm bending over to tie my shoe i catch myself holding my breath to focus on tying the shoe even though it's such a simple task but when we do that we actually start decreasing our ability to heal our ability to breathe properly and yoga really institutes proper breathing mechanics where it's diaphragmatic breathing belly coming out lower ribcage spreading out to the sides and you can practice this not even just doing yoga through a mindfulness session and that's where i think a lot of the benefits of yoga comes from probably those two instances and while isometric contraction is really crucial in yoga eccentric contraction which a lot of times is missed out on when you're doing weight training i'll give an example so if you're pushing a weight like you're doing a bench press uh the eccentric contraction is when you're bringing the weight down where the muscle essentially slowly lengthening but still contracting to control the the lengthening process yeah that is a very good way to rehabilitate your muscles injured muscles it's actually the best form of rehabilitation so if you have like a achilles injury a calf injury these types of eccentric contractions is what your physical therapist is likely to focus on first so yoga in in contradiction to like when we push our weights down and then drop them real quickly and then push them back up really focuses on that eccentric isometric phase the breathing phase and that's where you get so much of the benefit obviously in addition to the mindfulness component of it so i'm glad you brought up yoga i don't know if eccentric contractions is also something in the back of your mind or something you've heard before what are your thoughts on that no so i'm i'm not so i'm not familiar with this degree of um you know physiology around muscle contraction like it's certainly not it's not something that i've like studied extensively so it's fascinating to hear i mean i if you asked me what an eccentric contraction was i wouldn't even i wouldn't even know it's interesting because when i think about yoga though i think you know most of yoga is not actually about movement it's about stillness so if i had to put my money somewhere i'd say that you know the isometric component of yoga generally speaking outweighs the eccentric component but at the same time you certainly have compared to regular exercise a very significant amount of eccentric muscular movement right because it's about slow movements that involve like gradually moving from one place to the other um you know so you definitely have that it's interesting i i wasn't i never connected those dots like i didn't realize um you know i have some theories about how yoga works and stuff like that but i just didn't have the resolution of understanding of muscular physiology to really connect those dots that was fascinating yeah i think that highlights why osteopathic medicine is so cool because we think so holistically in our approach that when a patient comes in with musculoskeletal pain of the neck while we are thinking about this approach we're simultaneously thinking about the anatomy of the region for you know real like medical interventions whether it's medicinal uh injection based surgical approaches and it's not that i do all of these approaches but i keep them in the back of my mind when i'm trying to figure out which patient is best suitable for these options and in thinking this way and seeing so many patients who were in pain over and over and over again i began to see a relationship between the mental health state of my patients in addition to their um pain that they were experiencing or physical symptoms that they were experiencing and while it's very easy to conflate this correlation and say oh well of course someone that's in pain is going to be in an unhappier mental state who's going to be happy when they're in pain that is in fact true but what i started seeing in doing thorough histories of my patients is that the mental health state preceded the physical pain and once the mental health state was treated because it was largely overlooked in their past treatments that's when the physical pain went away because i would have patients come in and they would start saying you know their elbow pain was bothering them for six months they've had mris cat scans x-rays you know doctors would do special tests and there was nothing to be found anatomically but this is not to say that this patient is making this up what the reality is they were still subjectively feeling this pain it was debilitating to them because it prevented them from doing their work or enjoying their life so it was real it just the source wasn't anatomical and a lot of times our healthcare system falters here because if they can't point to something on an imaging scan we right away start writing this patient off or we stop being able to help them because it's not reimbursable well by insurance companies because we can't say look this is what they have this is why we're doing x for z and i did a lot of research into this field and i came across a great book called the divided mind by dr john sarno the late dr john sarno actually and his field of research is he's by training or he was by training a physical medicine and rehabilitation specialist the pm in our physician so he wasn't the mental health specialist by any means and he actually worked and taught at nyu medical school um at nyu medical center just by me and through his research he actually found that helping patients deal with some of their most repressed childhood potentially current negative life situations mental health situations treating those actually yielded better results for his pain patients his chronic pain patients his acute injury patients and he started doing research on this where it wasn't just okay let's see this patient let's see if they improved he actually started doing mri studies can i jump in for a second by the way should i call this mike or dr michael mike is fine mike is fine um so let me ask you what do you think is the mechanism of that how does that work um i don't know i don't have a good answer for it yet there are definitely proposed mechanisms his research focused on for example if you had a true injury let's say in your low back and you had a pulled muscle in the past what he saw in mri studies at mri research that individuals when they were in a stressful state the body actually limited the amount of blood flow to those areas in order to decrease their stress and this was a high level of stress of thinking about those repressed thoughts those acute stress thoughts and instead focused on a physical problem that low back pain and it functioned as a distraction to not overwhelm the body the mind and this was a theory and this is a very out there theory and some physicians disagree with this theory it was the route he chose to explore it's actually not that out there in fact there's good evidence to support that because if you look at self-injurious behavior so self-injurious behavior that's not suicidal like cutting and burning and things like that these are actually not injuries that if you really look at self-injurious behavior it's fascinating because from an evolutionary standpoint what people do is the thing that causes the least damage to their body and also hurts the most so if you look at cutting it's very superficial cuts and so if you think about what's that person actually doing and if you talk to people who engage in self-injurious behavior what you actually find is that they their goal in the self-injurious behavior is almost meditative in nature that that eliciting a cut slowly like time and time and time again actually distracts them from emotional feelings and the intensity of the pain is so great that they literally cannot think about anything else so what we tend to find is that you know when i work with people who have self-injurious behavior and an addiction that if you control the addiction like let's say they're in a rehab the self-injurious behavior will get worse because they need a coping mechanism because they can't use like alcohol or marijuana or like other things to cope so it's really fascinating because i've never you know i i'm not familiar with with dr sarno's work but like there's actually a decent understanding that people will actually induce that principle of utilizing pain as a distraction from the mind um absolutely it doesn't actually sound that out there to me it's like that's actually well i probably misspoke when i'm saying that it's somewhat out there in that we definitely know that that sort of distraction method exists as you said the mechanism with the mind altering blood flow is the mechanism that is somewhat questionable interesting so that it's it's less of the patient doing it and more like it's like an automatic physiological you know neurophysiological like we're not going to fix this injury to protect our mind yeah that that certainly does seem uh you know less understood that's that's cool so but that's one of the mechanisms i mean for me the way that i think about it as an osteopathic physician is that not only do we have electro co connections in our body from neurons but we also have neurochemical connections with neurotransmitters with hormones that are impacted upon our stress levels the way that we feel and if we're constantly that hyper parasympathetic state i know that my patient isn't going to have good circulation of their neck because what happens when we're in a hyper sympathetic state we're locked in so everything is tightened there's less circulation happening just because of this state but then you're less likely to look at your surroundings look up and down and therefore you have less range of motion and when you have less range of motion you basically develop like a frozen shoulder situation just of your neck and therefore you propagate the injury moving forward so a lot of the work that i do with my patients even though they're coming in for a physical symptom is exploring some of this mental health side of what they're doing and i'm by no means a mental health specialist i'm not a psychiatrist i'm not a psychologist well you're an iphone i'm an fm doc but i broach the subject with them and i gauge their interest level in continuing this line of communication and once i see that they have a layer of interest and they want to pursue and they've seen some good initial outcomes we then connect them to a mental health specialist who can actually continue this work with them but unless i'm going to be the one screening for it catching this early they're never going to see the mental health specialist in order to get there so that's why i find the beauty of family medicine and osteopathic medicine combining in a place where i actually have patient contact at a time when they're experiencing this pain and probably when they're most motivated to seek help even though they may have come in for a sore arm and yet we're now talking about their childhood and how things are going in life it's a conversation they didn't expect yeah absolutely mike do you mind if i ask you like a couple of questions just a little bit about your your training and stuff yeah so i've noticed that you've highlighted the fact that you're an osteopathic physician like several times and you're short sort of sharing principles of osteopathy um can you just help me a little bit uh understand a little bit about you know what's the reason that you kind of highlight things that way that you kind of draw that distinction yeah so when i was uh in high school i had options of where i wanted to go for college and then thinking about medical school in the future because i knew it was something i was passionate about and when my father actually immigrated from russia to the united states at age 40 i was six years old at the time he actually went to medical school and residency all over again in the united states and he happened to go to an osteopathic school the same school that i attended and i got to witness him learning omt the principles of being a do and it became part of my innate knowledge of how i treat patients it's become something that i'm very proud of because historically in the united states there has been some stigma around osteopathic physicians as being perhaps too alternative or not thinking about medications enough and a lot of this stems from what osteopathic physicians are not physicians osteopathy practitioners are across the globe for their for example in some countries in europe and in asia they are not fully licensed medical doctors and they do only perhaps perform omt and that is such an important distinction to be made because here in the united states we are fully licensed we can practice across any specialty we can get board certified any specialty when we do our residency training our now programs are combined all of them this just happened not too long ago my program where i did my family medicine training i was trained alongside mds and do's and after a while we forgot who was an md and who is a do because our principles align so much that we took away what they learned in school they took away what we learned in school and it really became merged so much so that if i'm being honest the differences in md and do education is shrinking year to year because the mda curriculum is learning how well this holistic approach works that they've incorporated into their own uh honestly mike that's that's why i was a little bit surprised by you highlighting because i like in my mind like whether someone is an md or do um you know i i don't like i fully understand uh that you know osteopathy has a different perspective that you all learn omt and we don't i in my experience honestly of do versus md school is that you all learn everything that we learn and you guys learn extra stuff yeah you know i think it also came from the idea that the entrance exams and grades initially to get into osteopathic schools were somewhat lower in that they were taking non-traditional applicants perhaps those who are going into their second career uh immigrant applicants and as a result people just looked at the scores and said oh well if i want to be competitive and go to the highest specialty possible you know plastic surgery ophthalmology i'll have a better shot by becoming an md and that sort of changed the patient the student selection for who went to each school but now i think it's changing because now we see do medical students and do doctors across all these specialties and you know at some of the highest positions in the united states the former president uh personal physician the current president's personal physician both were do's one is obviously still a deo and um the the head of medicine for nasa as a do we we really are now starting to expand into being everywhere but i still bring up the concept of osteopathy because it's really my foundation as to why i think holistically it happened because of my education and in seeing how my md colleagues were trained it's not that they got a lower form of education they're brilliant physicians it was just with a slightly different focus but i honestly think that focus is changing and it's shifting for the better what what would you say is the difference in the focus that your md colleagues got they had an intense understanding of the physiology and the pathophysiology behind conditions but less of the psychosocial components less of the communication component and i can give a very concrete example here when i went in as a third year student uh into my clinicals into my internal medicine rotation in inner city brooklyn i was very comfortable performing physical exams because from year one as a do you're uh working on your other classmates doing osteopathic manipulative therapy so you're getting used to what it's like to feel normal structures on a body you're getting used to interacting with different uh people different shapes different sizes etc so when i came in i was very ready to talk to a patient to feel what was going on to feel perhaps a tumor earlier than other colleagues of mine so i i think that that helped me in a way to be a better physician and again every school is different every residency program is different i only highlight this because that stigma that existed probably 10 20 years ago more so than it does today against ceos to really highlight the fact that not only are we so similar each year we're becoming more and more similar absolutely man so i mike i'm noticing that you know a lot of your it sounds like you've thought a lot about what you're sharing today like it sounds um you know very well organized i i can sort of see that the teacher inside you coming out um and and so i'm a little bit honestly curious about because it sounds like you sort of you know it sounds like you kind of figured things out bro i appreciate you saying that um i probably should prepare more for when i give presentations but i like for it to come from an organic place because as i present information like this i'm actually at the same time while i'm presenting it trying to re-understand and process it myself so that if i say something that doesn't make sense it's because i'm actively trying to listen to myself speak kind of a way that i uh fact check myself especially when making youtube videos and social media content so i tend not to like to prepare for things like this because i wanted to be like you're a patient or you're a friend of mine who's asking me these questions and we're just having a conversation about it yeah absolutely so i'm not i'm not getting the sense that you're over prepared at all but i i just i'm hearing a certain organization to your you know the way you're kind of talking and like it really sounds like i'm talking to a teacher it reminds me of being in class like in medical school where you know i and i i totally get that you don't know everything but at the same time what i'm hearing is a very um you know strong and consistent representation of when you work with a patient when you kind of think holistically you've noticed that there are very real mental components that will contribute to someone's physical pain um and i mean i you know i i don't i kind of i'm with you yeah i mean i i love that we're on the same page on that because for me i've always been a curious individual i think my uh either my college or medical school application uh title was essay title was why am i always hungry and it was hungry for knowledge and whenever i see a patient i always treat every interaction as uh like one interaction and then i think about it later what could i do to improve that interaction or what i could do better to be a better doctor and i think about the unanswered questions i have and i think about that not just for osteopathic principles but also for like if a patient comes in for strep throat why am i giving antibiotics for strep throat the the scary reality is if we ask most doctors why we treat strep throat i think most doctors won't know the answer to that question like they're going to say oh to get better faster or they'll say oh because that's cardiac complications bro right yeah cardiac complications rheumatic fever and the reality is if you don't take uh antibiotics the symptoms will only on average be 16 hours longer so it's not like patients think oh i need to get my antibiotics so i can get better quicker not really going to happen and we're really preventing complications like you said cardiac rheumatic fever any potentially kidney complications but most doctors don't know that they think they're just treating the bacteria where the bacteria here is not so much a threat as if it spreads it becomes problematic and even then it's a thin line as we study more and more how often should we be doing this what's the risk versus benefit in doing this and we're starting to continually explore our knowledge here that's why i fell in love with medicine because we're continually learning we're continually fact checking ourselves because even in an era like this where misinformation's so prominent people are like the science is wrong no science is never wrong scientists are wrong doctors are wrong the science is never wrong the science is the process that helps us figure out that we were wrong or that our hypotheses were wrong so i love reading about that studying that and applying it to my everyday sort of patients and such mike i find that the things that i'm the most curious about are actually like more you as opposed to your patient interactions because it's fascinating to hear um you know maybe it's because i'm a psychiatrist but speaking holistically like here we are having a conversation about mind-body connection and what i'm sort of seeing is the person underneath like so you're asking the question but what i'm really find myself kind of curious about is like who is the person asking the question i mean just so far you know because i think you like i said i think you've explained everything really well i mean you clearly know what you're talking about and so what i'm kind of curious about because you sort of don't leave questions unanswered in the way that you speak i think you do a really good job of of you know kind of laying things out offering examples things like that sharing personal anecdotes and it really gets woven together like quite beautifully but what i find myself being curious about is you know who is the person who wrote that essay what was it like to have a dad who was an osteopathic physician and you kind of said that like you grew up with this stuff right and so i'm kind of thinking a little bit about like if we want to change medicine to be a little bit more holistic like honestly the stuff that i want to ask you like i'm sure i could ask you questions about you know how you approach acid reflux but to be honest what i'm the most curious about is actually like you yeah i know i mean absolutely if you want to venture into that i'm happy to talk about anything i consider myself uh one of those people on social media that treats life like an open book so uh whatever questions or whichever direction you want to take this you're the host you lead the way yeah so if i ask anything that you think is kind of out of line or you don't feel comfortable answering you know just feel free but like i was just curious so it sounds like you you i mean you moved to the united states at the age of six can you tell me a little bit about what what you remember about russia and yeah i don't remember much um i just remember leaving very abruptly um my one story that i remember that i tell quite often is a really funny story i remember i guess my entrepreneurial sense was even very healthy back then where my dad went to the food market and bought some pears home and corn on the cob home and i was eating some corn on the cob in the playground and some of the older kids were like oh we want some corn and i'm like well i have some corn upstairs they're like oh we'll buy it from you at a markup so i ran upstairs and then i realized we had no more corn left because my whole family ate it so instead i brought outside pears and i said okay i'll sell you these pairs and i started selling pairs at like 5x the cost which is still not that much money obviously uh to everyone on the playground grandparents kids older kids etc and i brought home and i showed my dad the money i'm like look and like very surprising to me my dad yells at me and says how dare you rip people off um get you have to go back and give everyone back their money and i gave everyone back their money some people wouldn't take it back they were like no you sold me the pair i knew what i was getting and you keep it and he came with me and we went to those people's houses and he made me give it back and they laughed and they took their money back but um i don't know why that story stuck in my head i guess it might have been a dramatic experience of sorts but that is what sticks with me most uh from my russian experience i mean i'm not hearing traumatic what i'm hearing the word i'd use is formative perhaps yep right so like sometimes i understand why you kind of go towards traumatic because a lot of times we think of dramatic experiences as formative you know they shape the way that we look at things but i i mean what what do you think it was that your dad was trying to like like teach you there like what'd you come away with i think he was probably going for fairness equality making sure that i'm never unethical or moral in my dealings and i think it definitely stuck i mean in the work that we do on my social media channel i think i don't know if it's directly because of that situation obviously but the way that i was raised definitely affects the way that i run social media as a business entity like i don't know like a lot of you know youtubers sell merch and while i think it's great to make money from your audience i feel like i'm already so blessed with the success that i've had we like to do it all for charity or we have a patreon and again we're taking money from the audience instead we decide every month where collectively as a group where we're going to donate that money and i like to do good as much as i can in addition to you know succeeding on my own like i i would want it to be a universal success as much as possible i i'm not in favor when i say that the communist model by any means we left russia for a reason but um if people are working for it i want them to succeed as much as possible and witnessing my immigrant family go through it i think that definitely instilled some strong morals in me and that was a formative experience for sure what do you mean by watching your immigrant family go through it um well coming to the united states you know we're very poor we lived on welfare for the first few years here in the u.s especially when my father was in school my mom was a phd math professor at an esteemed university in russia when coming here she didn't speak english so she was sweeping floors to make ends meet she was saving money on bus fare like the dollar bus fare or what it was at the time and would walk two three miles to work every day like there was this russian saying that i frequently revisit in my videos called cheers and it means going through i can't that's the very literal translation of it but um it's almost like nike's just do it i guess my dad was a fan of nike back in the early 90s can you help me that sounds like a cool saying can you explain what what the meaning of it is going through i can't yeah so when things get going it's basically pushing through the struggles uh you know there's plenty of great quotes out there michael jordan one sticks out of my head of if there's an obstacle in front of you think about going through it think about going over it think about you know digging underneath uh i'm probably butchering that quote but i'm paraphrasing uh i see so like that's sort of working through i can't like yeah like you don't wanna say i can't this is hard don't let that emotion stop you from whatever it is you're seeking to accomplish wow so it sounds like you're you know your parents worked really hard and and really had uh i mean it's got to be tough to go through my parents um both my parents were medical doctors thankfully they didn't have to repeat medical school but they you know they did residency over here um and and i i mean it must have been tough for your dad to repeat medical school and go through residency again i try and put myself in his shoes and say okay like i'm a doctor now what's going to take in 10 years for me to be so unhappy living in the united states that i'm going to move to another country let's say china and learn chinese and while i'm learning chinese go to a chinese medical school and then a residency like i don't know how bad it needs to get and how motivated i have to be 10 years from now to want to do that but it shows the level of dedication that he had for the success of myself and my sister for us to have a good childhood and grow up with opportunities because that's essentially why he came here and why we brought her family here and faced all these risks and you said you kind of grew up with that holistic perspective at home like um you know do you have a sense of whether your dad like because i assume he went to like a md school in in russia and so do you have a sense of like you know how his perspective changed or what it means to grow up with a holistic perspective at school i mean at home yeah i don't know if he ever went into depth uh i think it happened through an osmosis type of knowledge transfer where he would be practicing omt for his boards or for his exams and he would be practicing on me and at the time i was an athlete i was doing taekwondo for about eight nine years i was going to tournaments regularly getting injured and him working on me and also helping me focus on school and giving me these mental health sort of boosts by telling me i need to go through i can't i think that sort of presented that holistic picture and whether it came from the medical school that he was attending or that's who he was as a person before it's hard for me to say can you tell me about taekwondo yeah so that was a a really long part of my childhood when i was six right away they enrolled me in this program um it was like three four days a week a lot of training uh i was getting pretty good at it too where i was deciding or at least considering trying out for the u.s olympic team wow and yeah i won some like national tournaments and stuff for sparring and i was really excited about it but then with school and i moved to a different city i kind of lost track with it and started playing other sports i became like the captain of my high school soccer team played that for a while and then when i went into my seven year combined undergrad med school program uh when you were an undergrad they didn't allow you to play sports because you were taking so many credits it would break the ncaa rules so i didn't play any collegiate sports except some intramural stuff here and there wow how mike i'm i'm fascinated i mean how do you understand why i mean how does someone become you know a national taekwondo champion [Music] captain of the soccer team like like how do you do that i mean i don't know i was just i it wasn't some pre-thought out plan that i had um i think i'm athletic genetically i'm tall i'm lean so um i was training from an early age i think any time that you know you have some good genetics and you put the dedication in you're going to have good outcomes um i didn't achieve you know olympic success or do any of this stuff so i don't want to take the credit for any of this but it was fun i i genuinely enjoy sports and i think i sort of have taken some of the principles from sports and applied it to my medical training and even the way that i treat patients whether they're one year old or 101 year old i try and treat them like athletes you know like even parkinson's patients we now treat like athletes we create a rehab program as if they're rehabbing from a you know an acl injury in order for them to be uh moving better swallowing better working with a speech language pathologist for their swallowing working with a physical therapist to improve their gait and i really believe in the sports philosophy i think there's a lot of great takeaways from it as well as some negatives you know like sports psychology is a really interesting field of research that i'm uh constantly looking at connections to the mind body from sports is always something i'm really interested in and that sort of interest and constantly moving i think translates well to the medical field interesting and and can you tell me a little bit it sounds like you went to a combined uh seven year undergrad med school program how did you decide to do that yeah so i knew i wanted to become a physician when i was in high school i witnessed uh you know as kind of popular as it sounds my father going through the whole journey and seeing that i really enjoyed it that it was a respectful field i was good at science i liked learning about the human body like i said i was somewhat athletic so that was part of the journey and i said what's the quickest way i can do it because i was always in a rush like i never had any patience for anything and because my father went to that program he was aware that there was this seven-year program that existed sorry he went to that medical school and um i applied and i luckily got in and instead of going the undergrad route i was accepted into this very competitive program where there were about let's say 88 acceptance uh people's 88 individuals accepted to the program and then upon completion of medical school for the seven years like 13 14 individuals finished so you had to maintain a very strict gpa in undergrad you have to get an mcat score to continue into the medical school portion and also life gets in the way i mean in seven years things change for people you know when you're 16 17 18 years old you're making a decision what you want to do for your rest of your life people change and grow yeah so i it's interesting because you say that you you knew you wanted to be a physician in high school can you help me are these two personal by the way or is this cool no no absolutely not yeah of course please um how did you know you wanted to be a physician yeah i mean like i knew as much as a 16 or 17 year old would know anything like i didn't know but uh i thought it was a good choice and that it was something i enjoyed i thought it was a good choice because it lined up with my skill set communicating with patients having an interest in the human body being able to focus to actually study on these topics because my mom being a math professor i hated math you know like luckily she tutored me so much so that i crushed the sat because of her i almost got a perfect score on the math portion but if you told me i had to study math on my own it would never happen um so science was just a like a really happy line that matched up with my uh skill line that worked really well for a career and seeing what the intricacies were like like a lot of students say they want to go into medicine but they have no idea what medicine is i knew i went with my dad to his residency when he when there was a bring your child to work day i saw what his on-call rooms were like i saw what looked like when he was studying with his power points his textbooks so like i kind of got an inside look at the journey and i got the good with the bad he never forced me to become a doctor in fact he said you sure you want to do this probably not ideal our health care system is broken i'm doing this because i'm old and there's nothing else to do you can do anything but uh he he always spoke very highly about his connection with his patients and how it's never a dull day and the career sold itself for me wow so med school then how did you decide on family medicine or what yeah yeah so i initially wanted to pursue the field of surgery going into medical school and i during my first two years that still held true during my third year surgical rotation it was about 12 weeks and i spent that time in lutheran medical center a very high trauma area it was a level one trauma center and i scrubbed into like 60 surgeries at the time maybe 70 surgeries and i was like i want to make a good impression because this is a program that accepts some of our medical school applicants so maybe i want to go here and the more and more i did it i realized it's not where my skill set was it wasn't where i found myself to be most happy while i enjoyed the technical prowess of becoming a surgeon i disliked the fact that i didn't get continuity with the patients that i didn't get to communicate much with them because the reality is they're asleep for the majority of the time so um i spent a lot of time doing family medicine as well because that's part of your required rotations and then i found myself just addicted to the field that i constantly wanted to do it more and more my fourth year i had like five different family medicine rotations as my electives i was also really passionate about sports medicine i considered making that as part of my fellowship training after residency and i started even during my residency my first year covering sporting events high school college football games um and i i was really passionate about that as well especially being an osteopathic physician and you know i just kept exploring more and more family medicine was the field for me fascinating yeah i think the the most important lesson i took away from my surgery rotation was that if you round super early in the morning no one wants to talk to you and it's something that i actually sometimes would use when i'd be like moonlighting so i'd cover like you know weekends at hospitals and stuff and you know shift starts at 6 30. so a lot of times we're like oh you know like you can start rounding around eight or nine you know the patients will be awake then i was like uh i'm gonna round it like seven well speaking of mind and body isn't that like messed up that we do that to patients who are healing in the hospital we don't let them sleep and then we round on them at 5am and they're like not getting better because they're not resting we're we're pretty evil in hospitals and oh that's the worst food ever i i think i think hospital care is important and i think that's part of the reason why you know people get so much better after they leave is because you know um and speaking of you know giving people healthy food this is a if i can share a story one of my favorite stories from residency is on the inpatient psychiatry unit um uh at mass general hospital they were doing like you know they're trying to be healthy right so like they're they're like their food has gotten a lot healthier over time and it's actually like the cafeteria is like pretty good okay um so relatively healthy like relatively tasty and so we had this one person that was hospitalized who had a lot of behavioral problems we had to keep on calling security you know inpatient psychiatry um i'm sure you remember a little bit about how it can be sometimes and and so one of my colleagues was just absolutely brilliant and and she was just incredibly compassionate this patient is just really combative um and and so she sort of asked him like you know like what like is there anything we can do like what do you hate about being here you hate being here we can't let you leave i'm so sorry about that is there anything that i can do and so somehow i think she like figured out that he wanted like chicken fingers so what she did is get him a pediatric menu right because like the adult menus have like salads and like you know like you know wheat bread with like lean protein kind of sandwiches so she got him a pediatric menu and like the the behavioral disturbances just tanked he was just like as long as he got his chicken fingers and pizza and stuff like that and then the funny thing is like the rest of the unit like started to revolt because they're like why does he get chicken figures and i just get salad and so then we had this like like unit why they're like i want my chicken fingers like where's my attendees at you know and so it was it was a real problem our our unit like you know the person who ran the unit was like really frustrated with the situation because he's actually someone who's very into like diet and you know all about like mind body kind of stuff and like we have to you know we have to you know offer patients like healthy foods and so some people you know we just sort of i think some people ended up you know it was like 10 days on the unit for a week and then people started to get discharged and then sort of evened itself out but yeah yeah well that's like a form of risk reduction right so like you know eating chicken fingers isn't great but if it's going to prevent patients from harming themselves or harming others maybe chicken fingers aren't so bad absolutely right i think that's that was ultimately the approach is that it's way better than injecting them with medication that they don't want like just give them some you know give them some tenders um i love that you call them attendees that's awesome yeah that you know attendees i don't know if you you're how familiar you are with 4chan familiar with 4chan uh i've heard of it that's like a reddit-esque forum right i don't know people are going to be insulted or flattered by that comparison i don't know so fortunately yeah yeah so 4chan is um it's a message board that's entirely anonymous so there are no accounts and or maybe i don't know if there are accounts or not but like since it's all anonymous it tends to um get a lot of flack for actually there's a lot of like weird and relatively toxic stuff there because and so a lot of like memes and and things like that come out of 4chan and one of the big things that that came out of 4chan is actually attendees and i don't know if you were following any of this gamestop kind of stuff yep we're actually doing uh um we're actually in the process of doing a research paper on um prevalence of different mental health conditions on 4chan um and i wonder have you ever heard of something called arfid i know it's like a relatively new diagnosis it's like a wait are fit you said arfid yeah it's like a restrictive it's a restrictive feeding disorder it's like a new kind of eating disorder so kind of on the frontier is relatively new diagnosis but the interesting thing is that um people who have arfid who basically can't eat certain foods because they can't tolerate like the texture um so sometimes kids will be like you know picky eaters and some people grow out of it but especially some people on the autism spectrum seem to have like a lot of um arfid-like qualities the one thing is every single patient i've had with arfid loves tendees it's like the one thing that they can eat so like it does like you know it's not it seems to be like that attendees are what people eat also every patient that i've had with autism actually i don't know about every patient actually yeah that i can fairly say likes attendees too and and so we're really curious about whether there's actually like a a correlation between the prevalence of arfid and and whether you hang out on 4chan so we're we're studying and those are the kinds of studies that unfortunately the nih isn't funding you know well it's unclear whether you know it it serves humanity to know whether the prevalence of rfid is greater on 4chan or not i don't really know but it's a research question that we're fascinated in so we're going to try to study it i love it okay and that should be a fun study to get results from i'm sure you're going to get a meme out of it yeah so i think it's going to be all memes like it means is one of the major outcomes of the study there's going to be like prevalence of arfid and production of memes are going to be the two outcomes that we look at but anyway yeah i don't know where i was going with that um i learned something i didn't know about our fit and now i know that attendees are the go-to for patients that are yep potentially struggling with texture and yeah so f you know as an fm doc like i don't know you know how pediatric your your population is but for picky eaters like some of them may have actually arfid fed so just kind of going back to so it sounds like you you did a seven-year combined program and then um went into family medicine and can you tell me a little bit about like social media and how that started for you because as i understand you're huge um it it happened in a weird way during medical school i had an instagram profile and i never had social media prior to instagram but then when i was studying for my boards actually i was studying alongside my friend who was in nursing school studying for his nclex and he was taking pictures outside of the small library window of clouds and i'm like what are you doing like stop distracting me like you're taking pictures i hear the flash i hear the clicking sound and he's like no dude there's this new app it's called instagram where if you take a picture of the sunset and you do hashtag sunset uh you'll get a bunch of likes and all these people come visit your profile and i was like that sounds silly like you're just bored so later that day i come home i'm like oh it's kind of a cool app let me try and i posted a picture of my siberian husky at the time and they got all these likes and one of the likes stood out to me was from a professional like i think alpine skier that i watched in the olympics the prior olympics and i said wow look how cool this is this app can bring people together let me like use this as sort of my blog if you will day-to-day activities put pictures on it there was no stories at the time so just kind of like posting on there and without any real goals but with the potential that it could somewhat help my medical career in the future whether it was for marketing connections et cetera et cetera and i did the entrepreneurial mindset exactly that i just thought like connecting with people by the thousands is going to be beneficial in one way or another and it also didn't hurt growing up i didn't get a lot of compliments or like female attention and now on social media i was probably in the best shape that i was at the time i was posting on social media i was really into bodybuilding i was getting a lot of compliments there for that i'm sure that played a role in continuing to to do that um and uh i was doing that for a while yep so sorry what role do you think that played um positive dopamine hits continue to come back um there was definitely a point in time where it affected me in a way where i became like arrogant with the fact that i had you know 5 000 followers or something and my friends uh they are quick to humble me and they pointed out that i was becoming that person and i had to do some introspection i actually deleted the app for a while not like my profile off the app but the app off my phone and really questioned why i was doing it was there something unhealthy behind it and i definitely saw that i was talking way too much about it all the time and it became something that like i didn't like about myself that i was becoming so i said okay i need to like tone down the amount of time i'm talking about social media realize that my value is not tied to the self-worth of how many followers i have that if people like me it's because they like me not because of the followers and i learned that lesson fairly early on yeah bro you're fast forwarding past all the good parts so like here's what i'm hearing like if it like like just think about this for a second okay because like people getting wrapped up in social media people becoming arrogant as you said people becoming that person there are a lot of those people out there and if there's one thing that i think actually could be very educational for people it's like not everyone is able to do that right like in fact it's i i'd love to ask you a few more questions but if you know if you yeah no no that's fair game um i think my sort of skill like i'm always kind of making fun of the fact that i'm not the smartest person in the world and that i wasn't the top student in my class but i think where my skill lies in being introspective and constantly reevaluating my actions and my thoughts so if you'd like to ask about that well yeah so so who would who did you become when you say you became that person what started to happen what does that person look like yeah um it would basically be every conversation that i had was about the social media and my value ranking system of the people in my life became about who had followers yeah i don't know if you're familiar with black mirror or the tv show on netflix yeah there was one episode where they kind of like rated each other a ranking system yeah and like no joke it was eerily similar to what was becoming sort of in my mind to a degree where like if someone would talk to me i would feel perhaps above them because i had a certain following and keep in mind i'm 19 years old at the time so like i i'm still a student like i have no money i'm broke and this is the only thing where i had some value that i was like oh my god i'm cool because of this and i realized i was tying all my self-worth to it and everyone else's self-worth to it because it was simple in that the dopamine hits came when likes came that you could easily quantify like people based on their numbers but that's not reality because people aren't just numbers so it was a false system but it was an easy system and yeah i just talked way too much about it and i showed off way too much about how many likes my posts got or how many followers i had and i didn't like who i was becoming i didn't like that i was doing that so often and i learned that lesson early on but that's not to say that i didn't relearn that lesson over and over and over again like even over the last year um not so much that i was becoming arrogant but over the last year i found myself again tying my happiness levels or my fulfillment levels to numbers on social media and that's something i talk about not doing all the time and yet i did it so often even this last year so it's a constant process of learning and can you tying things back to things that you learned before that that sounds like really really like helpful to understand like because what i'm hearing is that you know you kind of fell into that trap once and you kind of worked your way through it you know and then but at the same time you can still fall into the trap again yeah for sure and it might be a slightly different trap like it might be the numbers again but not so much with arrogance the next time but with happiness or success or fulfillment what have you so the trap is always there can you help me understand that and you mentioned like over the last year like what yeah so i have a cool probably one an example that you'll really relate to well uh being in the field of psychiatry um the the treadmill of hedonism where we constantly are on this treadmill chasing extrinsic levels of happiness um so whether it's money fame what have you uh is something i try and stay away from as much as possible i try and get fulfillment from my deep personal relationships from the volunteer work that i do my patients etc however youtube specifically youtube is savagely pushing the treadmill onto you and doesn't let you leave the treadmill because youtube is this unique algorithm that essentially is this evil personal trainer that doesn't let you get off the tread bill because when you create a piece of content that does well it doesn't allow you to celebrate that success because the next video has to either equate or even supersede the success of the next one otherwise the algorithm will just stop recommending it and the feedback mechanism of what makes you happy falls off very quickly so while in other platforms like if you did well you continue doing well youtube you're either growing or you're shrinking there's no like in between and because of that you find yourself on this treadmill all the time chasing success and you never really get to take a proper break unless you have a great understanding of how all of this works psychologically and knowing yourself so i like to make the comparison between traditional television and youtube in this way and i'm borrowing part of this concept from a good friend of mine who runs this channel called infographic show he talks about deserved views versus earned views and when we talk about like game of thrones if season one is a hit everyone will tune in to season two because it deserved those views youtube is savage in that you could have a great 10 videos but if your 11th video gets a lower watch time or has a lower click-through rate youtube doesn't care that you crushed it on the last 10 videos your views will just get destroyed in the algorithm which is great for the viewer because the viewer is only getting the top tier content but as a creator you're constantly under the gun because all of your views have to be earned none of them are deserved so good in the concept that the viewer gets the best content good and that it's created a level playing field that it doesn't matter if you have one subscriber or a million subscribers any piece of content can get recommended and get get viral success bad for the creator in terms of burnout bad for the creator that you never really get a chance to disconnect or celebrate your successes unless you are really really organized and psychologically well understood individual can you that's blew my mind first of all thank you so much for sharing that and i'm i'm so curious like what what so what does that do to you right so you talked about youtube you talked about how you basically like can't ever stop growing otherwise you'll fall off and what does that do to you how does that how does that affect fulfillment success things like that well i've been doing youtube for probably just over four years now and never missing a posting date you want to continue that your growth was really good you want to continue that inadvertently you end up tying your self-worth to your subscriber count or your view count or your growth count and as a result if that for whatever reason pauses fades decreases it ultimately starts affecting your mental health and unless you are in a very healthy healthy psychological mindset like i'm talking about where you can be in that buddhist state where you're like everything is transient even if something bad happens it won't be long and if anything good happens it won't be for that long so i'll be happy here sad here and i'm so balanced you're going to suffer as a result and for me despite how balanced i come off or happy i come off in my posts and all of that this last year was absolutely a struggle you know pandemic has affected everybody to a degree but watching sometimes content drop off or going through some difficult times in life watching the youtube channel suffer affected me way more than it should have and as a result i had to function in much the same way i did when i was 18 19 years old when i was becoming arrogant and tying my self-worth to it back then and how how what how did that you kind of say you talk about it like it's inevitable what like what was your experience of so i'm i'm i'm just inferring here that over the last year your youtube channel growth slowed down yeah well not only did it slow down but also you know burnout is real like uh like i said you don't get deserved views you get earned views and when you know you do that without taking any breaks and that's essentially what i've been doing for four years saying like i will outlast i will persevere going through i can't you know my dad's advice um i i've been pushing really hard in addition to residency because all of this started towards the middle of my residency and i made sure to make that a priority so never took a day off residency um to do anything social media related so while finishing that also doing this at the same time it just it was such a long process that it caught up with me in that i was like really getting burned out like the classical symptoms of burnout where you derive less joy from the things that once brought you joy sleep was messed up anxiety was high where i actually had to seek therapy throughout the pandemic and i learned a lot you know i learned a lot going through them because it's something i advocate for my patients and now it was the time that i realized i do need help and i need to figure out what was going on and i think this was a cool takeaway that i learned from therapy which is uh you're very familiar with cbt cognitive behavioral therapy you know attacking your irrational thoughts putting in a more rational thought to at least decrease the grasp or the depth of how sad you feel or how depressed you feel and i would do that quite well for the last 10 years or so i would say or at least well enough to help me manage but over the last year what i found was that i was doing the cbt on myself so often that i was reliving the negative experiences over and over again where like you know if you watch a movie a scary movie and like or an action movie your brain on a functional mri lights up the same areas of your brain as if you were experiencing that pain or that that fear so i was essentially doing that to my brain over and over again by trying to force cbt on myself and only when speaking to a mental health professional realized that i need to actually disconnect from that and i need to disconnect from social media and i need to not constantly be refreshing my feeds and that while they're going through i can't could be a great coping mechanism and hiding or disconnecting like disconnecting viewed as hiding could be perceived as a negative coping mechanism if i'm not facing reality but that wasn't what was happening i was facing reality but i was doing it so much so that it was actually having a negative effect so the coping mechanism of hot hiding or disconnecting was actually a strong positive that i was missing out on and that was something i learned that i wouldn't have learned had i not uh sought out help yeah that's thank you so much for sharing that mike can i just kind of recap what i heard there please yeah so so it's interesting because you know when i when i listen to you mike when i when i you know what you give off is like unrivaled success right like it's like you know you're it's it's the immigrant story like growing up like you know this i mean you're you're driven you're focused you're caring um and you know like national oh yeah like like even even the even the humility is so amazing because you're like yeah like it's not like i was an olympic athlete i was just a national champion you know like nvd and and and so it's like because you seem to you know really succeed a lot man like you know like succeeding from a young age like seven year medical programs are not easy to get into they're [ __ ] way more competitive than md schools for sure i'm pretty sure about that i mean i i mean i actually don't know the statistics but my understanding of the accelerated you know programs are that they're hard to get into um and like like you said because they have like a high drop-off rate right because it ain't easy a lot of people drop out so they're very selective with who they take and then fm residency and then social media and it's kind of like whether you like whether it starts with offering to sell corn and making a profit on pairs right you find a way right you follow through or you you what did you say you work through i can't yeah and and so it's really interesting to see kind of what that mentality how it's helped you a lot and also like it sounds like you've sort of paid a price for never letting yourself say i can't can't take a break got to keep growing i can do this you know like and and even the way you when you were talking about cbt you said attack your rational thoughts and i was like yeah that's that's going to be a problem i mean i think if we're talking about you know balance in the mind and the buddha state that you're talking about attacking your mind is not how you get there you can absolutely succeed it's how you can get success and this is what i've seen time and time again it's that you know when people you know really like don't let themselves fail it's it's a very brutal way of of living it's a very successful way of living but it's it's brutal on the self um you know it's hard because yeah i don't think you're quite listening to other parts of your body listening to other parts of your mind because you're not going to be a quitter you know that's not that's not who you are um and so it was really fascinating to hear i i think i i feel like i learned a lot and thank you so much for sharing that yeah i think any coping mechanism if it's successful in the beginning uh if you overuse it it's ultimately going to have drawbacks so you know this isn't a problem unique to me or unique to people who've had success i think every human goes through something like this just in different ways in different situations just for me i've always been like this energized kind of person people call me energizer bunny growing up my friend uh here in new york he's like you're like a cockroach they can't kill you you just keep going like you never get tired i would work a 36 hour shift and i would go play basketball with my agent here in new york so like yeah like i've always viewed that as a batch of honor or something that identified myself as but at the same time i need to be aware of the pitfalls of always being on or of always being super friendly and accessible even like right now so if i go outside in new york and let's say i want to take my headphones and listen to an audio book and chill out on the grass on the west side highway with my dog without a doubt now it's come to the point that someone will come up and maybe ask for a picture which isn't a big problem but we'll want to get into a conversation and i want to talk to people i want to meet people but sometimes you just kind of want to be by yourself and vibe out on a book and now i'm learning the reality of it not that it's not a show-off thing people want to come up and get to know you and talk to you and they get excited and i would have gotten excited if i was 18 and i was meeting someone i was following so i understand it but now understanding that i can't always be available and i can't always be super friendly or just say yes to everybody that is a completely foreign experience to me because i hate saying no i don't like saying no but for my own mental health i have to sometimes now set some boundaries which i've never set in my life before well yeah sounds like it's a lesson you had to learn the hard way it's not a hard way because there's way harder lessons learned uh in life for my patients from my friends that i've seen uh you know struggle with serious serious problems and it's not to downplay the seriousness of my problem it's just that's exactly what you're doing it's it's just there's things that are cause real suffering and there's problems like each problem has a scale and i would say this is a true problem and it's truly affecting me um but on levels of severity and how bad things could get i know maybe this is my own coping mechanism at play and that's exactly what it is yeah well done with the introspection there right because it's interesting how you invalidate your suffering i think that's what got you to four years of burnout because i think that's actually mike like i'm sorry if this is going off the rails in terms of what you're okay with but like that's how you get burnt out right because you're there's a signal in your mind and you've learned how to say like actually i am okay having boundaries but why did it take you four years it's because when you say like even now when you say to me like oh my god i sound like such an [ __ ] right like that's how it feels to be like because you want to be a nice person you don't want to be that arrogant prick who's big on social media and doesn't have the time of day like you recognize because you're a physician that every human is a human doesn't matter how many like followers you've got on social media like you've got one heart you can get an mi i can get an m i we can both get strokes we can all get cancer you know i think medicine is great in terms of teaching you that all humans are equal and bizarrely i think that's what's actually trapping you right because not all humans i mean when i i just took a walk before we streamed today and i walked around for 15 minutes i've been recognized a total of four times on the street you know and so that it's still fun at that frequency it's like four times over two years is great makes you feel good but i still get to take walks you know it's like it's something that most human beings get to do and i'd be really careful with yourself because you know sure the suffering that other people go through is greater but like be careful there because i think that's makes you a good physician it's also going to burn you the [ __ ] out when it comes to social media no you're absolutely fundamentally in every way right um it's the reason why it's confusing is it's unnatural this type of notoriety is not a natural human thing and it's not something even like i guess like you could look to celebrities in traditional formats actors singers etc but like really from medical professionals or regular people there's not a lot of people i can go to for advice especially in the beginning when i was starting all the social media things so i'm kind of trailblazing in a weird way so that's why i'm always you know there's people who are growing in the medical space i keep my dms open to them again sometimes at my own peril where at midnight where i should be sleeping i'm having an hour conversation helping a fellow medical influencer navigate how to not get taken advantage by a brand so like i want to do that as much as possible so i'm trying to figure out how to manage all that but it's a journey and i'm going to make mistakes and you know as long as i learn i feel like that's okay and by the way the comparison thing isn't also just looking at uh what other people are going through it's also things that i've gone through in life and you know well i don't want to get too much into childhood stuff but like during medical school i did lose my mom to medical uh to cancer and that was a very tough thing to not again it was tough for me for sure but the toughest part for me was watching how it affected my father who did this whole process who you know sacrificed so much of his life and was finally getting on his feet as a doctor him and my mom had all these plans watching that break down that hurt and you know leaving long island where i was living on campus at the time and moving back in with my dad that presented all sorts of challenges and i saw how difficult that was so when i look through what i'm dealing through now dealing with now there definitely is a layer of like an understanding of this is less serious than that so it's not that i'm just saying oh people have it harder so my broken bones shouldn't count it's i've experienced 10 broken bones and this one broken bone is probably not as bad yeah so what i'm hearing there is that there's a healthy amount of perspective as opposed to invalidation yeah right like i don't want to say healthy why wouldn't you say healthy well no it is a healthy mechanism but i wouldn't say that this is perfect all the time like i don't again i don't want to give myself so much credit that i'm like oh all the time i'm able to make this healthy comparison between my past struggles and my current struggles i absolutely look at other people and see that they're struggling more than me and i invalidate my own experiences i do that that's for sure i was just really confused why can't like bro like why can't you give yourself credit for growing no no i i take the credit i just don't want it to come off like i know everything because it's not true why okay i'll explain why it's important um i think it's important because i want people to see that while i'm doing this job that you labeled healthy and i appreciate that it's not always healthy i'm a lot of times am invalidating my feelings so while i do have this sense of healthy perspective and all that i also make a lot of these mistakes of comparing myself and invalidating my feelings so people can understand that if they do that too they're not failures this is what everyone does including myself can i just think for a second yeah sure you're probably like this guy is crazy no on the contrary i think um you know so here's here's what i'm i'm seeing mike you're not crazy you're at the top of the bell curve and the problem here is that which i think which and apologies because i kind of think of you as a colleague but what i'm going to say now may come across as like i know better than you but um you know i think we each have our respective areas of of specialty so i think you got to be careful because like i don't know what how do i say this there's just something about how hard you try to consider other people right so like you think so much about how what you're saying is being perceived which may be like related to social media but i don't think i think that would be a little bit unfair i think it's just like you you want people to understand that it's okay to fail you want people to understand that like you struggle too and that's not you could you could say that there's a piece of that that's like oh like image conscious right like in and you don't want to come across as arrogant there may be a piece of that but i'm getting a lot of genuine like you care about sending the right messages to people and not propagating actually like a lot of the messages that social media seems to project which is that there are the chads right the taekwondo champions soccer captains seven year medical school program people on youtubers like you're all of those things and then they're like the normal people over here and so i i think it's it's very clear to me that you're trying to share that you're not actually any different right that it's the introspection it's the work it's the effort and that's what you really want people to come away with get that but there's a subtle thing there which is like you're caring so much about other people like what about you yeah that's the the way that i would first of all 100 accurate so very well done reading me and clearly you're a specialist and a professional in this space no surprise there um for me i sum it up in this i become very good at being comfortable with being uncomfortable i'm [ __ ] at being comfortable with being comfortable so part of that from all of that is essentially how you explained it so yes there's a layer of i don't want to come off arrogant and there's like a brand image conscious thing that i'm doing but also it's because i my ultimate mission and why i'm doing social media and where i derive my intrinsic value is by putting out the accurate message and especially to help people who are truly suffering with things that are confused and want good information so yeah hmm are you happy mike yeah i'm fulfilled oh man there's such a did you see that show i'm such a tv geek and movie geek i relate everything back to shows i don't know if i've watched too much tv in my life but there's a show called magic city um tell me about it the worst show that i'm like using as an example for such a high-level conversation about mental health but it's a show about gangsters uh starting up gambling from cuba in florida and they're trying to get it passed and all that but they asked one of the mobsters like are you happy and he says howdy duties happy i'm content and i don't know why that line stuck with me but instead of content i think i'm fulfilled what is this so help me understand what fulfillment is uh fulfillment is i like to think of it in a situation so if today is my last day on earth do i feel like i've accomplished everything i could have until this point and am i am i satisfied and the answer is yes and i feel like if i could be in that mental state as much as i can in my life i'm happy like that that's how i sort of grade it so fulfillment is about accomplishment before you die satisfaction with what you have accomplished and when i say accomplished i really mean it in a holistic way in an osteopathic way if you will good relationships with my family good relationships with my friends being an ethical and moral person helping the world while having success on my own right that's how i think of accomplishments as opposed to you know seven million followers or whatever it is can i think for a second how we doing on time by the way i don't know so we usually run for about two hours at a stretch i think that's like the bandwidth that i have but and we're coming up on an hour and a half um i'm good i'm used to uh long interactions with my patients so um so fulfillment is happiness yeah i mean like it's are we looking for uh an oxford definition of happiness and the funny thing is i love the field of positive psychology so uh martin seligman um i'm gonna butcher his name me highly checker the the author of the book flow i think kick set me highly i think is how you pronounce it but not even gonna try because it's so bad on my part if i ever end up i probably bless you i apologize so i've i've read a lot of these authors and i've tried to figure out what happiness means and i don't know like you know martin selig's whole thing is flourish instead of happiness he changed the term in his books for me i think happiness is fulfillment i think happiness is also probably more accurate as a state of mind in a single moment as opposed to like is your life happiness like i don't think you can say that i think happiness is like how you feel in this given moment one to ten bull and right now i can be happy because we're having a very fulfilling conversation but if i stub my toe in 10 minutes and you ask me then i'm not going to be so happy so i think happiness is like a point of time reference where fulfillment is sort of a more grand scheme adjective or now yeah so i i'm not i'm not so sure i agree with you there i love it please share with me why so here's here's what i'm hearing okay what i'm hearing is that you're not sure what happiness is so your mind has figured out in an almost like a rational way like you've asked like not i don't want to make it sound intellectual i think it's a little bit more philosophical or spiritual in nature you're like what is the nature of happiness and when you kind of looked at like here's what i'm imagining okay like you kind of looked at your life and you were like you know because i think even the way that you define fulfillment comes with the construction of if i died today would i have regrets could i be proud of what i've accomplished right could i be proud of the life that i've built like i'm on this earth i've been given certain challenges i've been give given certain privileges did i do a good job and if the answer to that question is yes then you feel fulfilled is that fair yes with just the small stipulation that yes is not a binary answer it's kind of like a percentage if you will of how much yes yeah absolutely right so like there are these certain things that you can say like you know did mike like do a good job did he leave the world a better place and like you know then he left it and i totally get that but i think it's it's a it's a little bit of a philosophical answer and then it's interesting because then on the flip side you also talk about an experiential answer right which is that in a particular moment i can have a particular state of mind my sympathetic and parasympathetic nervous system or like in a right kind of balance you know i'm in a state of eustress like in kind of a flow straight state where it's not boring but it's also not overly stressful and i can feel like a temporary moment of happiness but that that happiness is transient by nature so when you talk about the buddha when you did this thing over here right so like when you talk about that it sounds to me like that's really the one thing that you sort of don't quite haven't grasped fully yet like you're aware that it's possible you know that people kind of do it i'm not saying that you haven't grown and you haven't learned how to carve out balance in your life but it feels like like mike everything you do is so damn effortful you work so hard at it it's funny you're saying the exact opposite of what like the attendings who have trained me say they say mike always takes the path of least resistance he works smarter not harder it's like the exact opposite of the feedback i've been giving my whole life so it's interesting that you say that yeah so that means on the one hand maybe i'm completely wrong right because if it's if it's completely contrary there's there's truth to both sides as always and and no no well maybe i'm just wrong right i just could be talking about you because you're not wrong you're not wrong in the sense of like but i sometimes feel that on an unfair characterization of my work when like i remember my ex-girlfriend's father said something like oh mike's really smart like he figured out a way to not work so many hours in the hospital great i'm like are you insane like do you know how many hours i work on social media and how stressful this is and all this yeah sometimes i do feel like it's an unfair characterization but at other times i agree with it i mean so here's like even when it comes to happiness like you talk about being introspective you've worked at happiness well it's not like it's not like work sounds tedious i enjoyed what i was doing i forgot how effortful effortful you exerted effort right that's like i'm noticing that you thought about it you know i'm not saying it's bad like i'm not saying it's not enjoyable but like there was energy expended let's put it that way agreed and and so i think that there's actually something in between those two states so on the one hand there's like the construction of can i be proud of my life and then on the other hand there's the variant emotion of like transients maybe it's not quite emotion i think it's a little bit more than that but i think that if you if you really pay attention to buddhism and what that sort of being content is like when you talk about being psychologically like let's say grounded to the point or yeah like you know tethered enough to where the fluctuations of social media which from a dopamine perspective neuroscience perspective they're going to knock you off track right it's the equivalent of sailing in stormy seas for your ego and your sense of like happiness like that's just what it is that's what social media does that's why it's so successful because they figured out how to like flip all these switches in our brain that you know make us creating content and never quitting and giving a wonderful experience to the user at the sacrifice to ourself and so i think finding that place of buddha is actually there's something in between which is actually a space of detachment where it's sort of like i know it sounds kind of weird but like you know acknowledging realism nope not nihilism detachment and so this is where you know and i think it kind of comes back to like when and i i think you will probably understand this actually so when you make some youtube content i think there are a lot of different drivers in your mind one is like the entrepreneurial like how do i make successful content and then there are times though that i think that you probably put out a piece of con or you've got conflicting things okay so there's a tension between what would be successful and like what feels spiritually or holistically like the right kind of content there's some balance between that and and so i think if you think about the spiritually the when you lean towards the holistic content what you actually have to do is like detach from the consequences of what's gonna happen with the content when you make a piece of content you're like this may not do very well but i'm just gonna let that go if it doesn't do so well it's actually not that big of a deal like i acknowledge it's gonna do well i'm not gonna get bent out of shape that it's not gonna that it's gonna do well but i'm gonna do this because it's like aligned with my values and it's like what i want to do does that make sense absolutely and if i could just like from here not to ruin your train of thought really quickly throw in here i think about that a lot and i think about from a practical perspective what it would mean if i would switch and just go to making the content that pleases the soul if you will and i also think about how on a practical sense what it means to survive what it means to you know be financially well off to be able to help others and do all these things and i think about the value that comes from perhaps making uh like a memes video that may be on memes 28 i'm not so excited to do memes 29 but i know that it'll bring in a ton of viewers that will watch the meaningful content that will then enrich their lives so i think all these things are kind of i think content creators struggle with this a lot but here's the interesting thing if you made content for the soul i think you'd be unhappy interesting okay so because here's the important thing it's not choosing content for the soul or choosing content for success it is the detachment from the decision that is the source of happiness i don't know if that makes sense but like when you make content for the soul it's not making content for the soul that is actually the source of happiness it's the internal process that you go through to let go of the successful content that is the source of happiness is that true does that like is it possible like i agree that that could be the case could it also be the case that there is a source of happiness that it's you enjoy doing that for the soul not just deciding not to do the other thing uh i know this is gonna sound weird right it's gonna sound really weird what i'm about to say no so this is where and then this is where we have to be really careful right because i'm talking about happiness as if it's true so what i'm going to say like so let me qualify that's that statement okay so i think this is the problem is because people like do what they love right like and they think that that's the source of happiness that's not that's not how it works i think bizarrely happiness is actually a relatively simple thing that i think would like there's a reason we kind of quote him right because i think he figured it out and the reason that a religion cropped up around him is because he actually like actually figured it out in sort of a scientific way that what is the nature of happiness and the nature of happiness is actually detachment and and you know if you kind of think a little bit about why was it so hard for your dad when your mom passed away it's because he was so attached to all of the things that they were going to do right like and so it's kind of interesting but if you think about you know i know it sounds kind of weird but like the more you get tangled up with something and i think you probably understand this too because it sounds like you've gone through the process of disentangling yourself from your social media identity like over and over again and so if we really think about it each of those times if you look for a common thread i think what you're gonna see is that you got caught up in it right like who mike was mike wasn't over here mike got taken over by dr mike and the more that you get entangled with dr mike you can be successful actually in both situations but one of them is going to come with suffering and one of them is going to come without suffering does that make sense yes my pushback or question would be first of all i would say i would venture to say that there's probably not one right way to live life like there's like who is the ultimate judge of what happiness is if someone finds happiness in not following a buddhist mentality they could be doing the right thing for them right so like i try not to judge other people's definition of happiness um when it comes to attaching yourself to something and then feeling tremendous sense of loss like you mentioned with my father i this is not based on any on any evidence but perhaps there is a layer of beauty in that that is happiness that is not defined by neurotransmitters or numbers on a happiness rating scale yeah absolutely this is why detachment is separate from the axis of emotion right so like appreciating like you're 100 right and i think it's sort of like is not actually i don't take that as pushback i think that point is actually exactly what i'm trying to say it's the distance from the thing the loss you can feel sadness and you can still find contentment and happiness in sadness which is weird so this is the axis that buddha was talking about which is sort of like if we think about watching sad movies right so your movie buff so if we think about the experience of movies like have you seen parasite yes okay so like no spoilers but like parasite is an emotional roller coaster and the emotions that you feel are largely negative like they're not in the positive valence you know it's not you know a story of you know puppies and siberian huskies and things like that it's like it's emotionally brutal and yet why do we enjoy it because the axis of positive and negative emotion is is separated once we have that detachment to a certain degree right right like but yeah go you wanted to say something about why it was no it's going to answer your question of like to me why we feel sadness watching parasite is the same reason we feel happy sorry the reason we feel happiness after watching parasite despite it being a sad movie is the same reason we feel happiness after eating an incredibly spicy pepper it's like you had this potential threat so the capsaicin attaches to your receptors you feel this pain the pain goes away you realize there was no damage endorphin rush combined with surviving this painful experience brings you happiness that's interesting so parasite your brain functional mri is going off and experiencing all these negative things the movie ends you realize you didn't go through this horrible situation and you feel better i also relate this to addiction with gambling you lose all of your money you've mortgaged your house you've lost all this stuff after you lose you realize you're still alive and life goes on you get an endorphin rush and that is why frequently people are addicted to gambling and actually addicted to losing because there's such a rush in losing and yet still surviving correct me if i run on that i'm gonna have to think about that let me see if you've tumbled down the entire foundation of how i understand this stuff give me a second i don't think so so here's here's what i'll say okay so i think what you've done a beautiful job of doing is illustrating the mechanism of like rebound relief you know so there's an interesting experiment i can't think of the reference right off the top of my head but i know i've got it sitting on my google drive so they took they took like you know 100 people and they had them put their hand in cold water and like the water was of different temperatures so like it was like painfully cold and then like even more painfully cold but the experiment that they looked at was that you know it if you have the most painful experience like painfully cold water and they start to warm it up at the end and even though they never get to the warm uh like they never reach like the the less cold water people will rate that second experience as more favorable than absolutely being in warmer water so i think there's absolutely a principle that you're tapping into which is like a neuroscience mechanism through which the relief of a negative experience can be like reinforcing in some way with you i think that's very good point from a neuroscience perspective i still think though that that is a mechanistic neuroscientific thing that doesn't quite translate if anything maybe i gave the wrong example but i think what i'm kind of talking about is actually like a state of consciousness or a state of mind it's a perspective that i think we can all experience that essentially when we look at like the the karmic religions they talk about something called enlightenment which is a state of persistent happiness it's actually they don't use the word happiness they use the word bliss and so if you think about this experience that has been described by people like over and over and over again there has been something of a scientific study and this is where you kind of say i try not to judge and that's where i kind of say well like i don't know if i really agree with that because as a scientist i do believe as a scientist a psychiatrist and studying some neuroscience i do believe that happiness is while there is an individual determination and every person's life is different i do think as a scientist that if you study a hundred happy people a hundred sad people that you will find common elements that lead to this experience that human beings have and i think that like buddhism is essentially i mean it's a religion sure but it's essentially like a group of people who sat down and like studied the science of happiness in a personal and individual way and it's been my experience that when when i work with people that teaching them this like i don't think that i have had a single person who has not arrived at the same conclusion if they have done the work do you think that's that selection bias at play like that they did the work so we've pre-selected the people that are going to do the work so these are the people that are going to get the benefit absolutely it do i think it's selection bias at play no is it possible it's selection bias absolutely right so like this is where i would like so let's let's you know let's think about it you know if i give someone antibiotics for let's not use strep throat let's say pneumonia right is it selection bias at play that the like could selection bias be at play it's studying the efficacy of our antibiotics for pneumonia of much lower likelihood because it's randomized and right behind it absolutely right so like like it's much lower likelihood but you know i would also argue that you know it's unclear because we haven't done well actually we sort of hold on let me think about how to respond to this so as an individual practitioner by definition i'm going to have a lot more selection bias than any rct at the same time i think that you could argue that a religious tradition has selection bias to it but i think it's really tricky because when you have a sustainable answer that generations of people have found have been like successful it's hard for me to tease apart what part of that is selection bias and what part of that is like an actually correct treatment it's like you're saying i was gonna say like if you let's say you have a cure for pneumonia like 100 cure but the compliance rate is only 5 with this treatment is that a successful treatment yeah how would you define it yeah so i would call that a successful treatment right the problem is in the compliance i would as a family medicine doctor i'm with you and i think that's fair because i think you have to bake in compliance but this is where so also as like you know as a psychiatrist i i mean i i'm with you i i completely understand i still remember in my first pharmacology lecture they were like any monkey can prescribe blood pressure medication it takes a doctor to get a patient to take it when they have to wake up twice in the middle of the night to go pee that's the job the real doctor's job of a doctor is compliance and this is also where like if you think about as a psychiatrist i get that as a fm doc but like if you think about what do i treat what i treat is the compliance issue i don't treat them you know like 90 i'm an addiction psychiatrist all you know my treatment is focused on compliance so if we think about you know meditation is an effective treatment like is meditation and effective treatment to reduce negative symptoms of schizophrenia yes is it hard to get people to meditate is it an effective holistic intervention possibly not but if we look at the actual treatment does it work yes and i'm with you that that an intervention and this is where maybe i'd qualify a little bit that the interventional intervention globally may not be effective if it only has a five percent compliance rate but is the is is the tree well you know i'd so i'd separate out those two things and i'd say that that's where like 90 of the work that i do is getting people to be compliant yeah like for me we have such great evidence behind you know behavioral therapy uh it working sometimes as well uh as anti-depressant medications usually rest in tandem obviously when you look at the evidence but let's think about it from my perspective as a family medicine doctor i have a patient who comes in and is experiencing depressive symptoms and i diagnose them with major depressive disorder a lot of my patients suffer with low motivation levels they struggle to shower to get out of bed to go to work to take care of their family to enjoy things that once brought them pleasure although what you see on a commercial for pharma ad and these patients are suffering i then give them a referral to see you or a psychologist and now they have to be motivated enough to call the number on the back of their insurance get five providers one who's no longer taking new patients one who's no longer in network one who has a six month waiting period and we we then say these individuals who end up finding this care do well how do we study the people that have never even got in and i don't know maybe they would have had the same impact as the people who got in but to me when i look at the individuals that i help a lot of times i'm only helping the people who actually end up getting the motivation to go for these treatments so how do we sort of merge those two groups yeah so this is where i think this conversation is changing a little bit which i love so this is where like i'm a big fan of like meeting people where they're at so i think the biggest problem in medicine what you're the problem you're describing and if we talk about if a treatment works a hundred percent of the time but only five percent of people do it i think that's the problem that needs to be fixed right so the question is like and this is the problem with the rct because like this is this is why like i know that in western medicine the rct is the gold standard treatment i think it's a terrible standard of treatment i think it's the fact that the rct is the gold standard of what we use in medicine creates these problems because the whole point behind an rct which is a randomized controlled trial is that it removes all of the like real world or the real world from the equation well so when you test versus effectiveness right so so this is where like in psychiatry we there's actually a couple of really great studies that are naturalistic studies so what they did is they followed patients over time and like put them on certain medications and they actually factored in like if this medication has this side effect what's the likelihood that the person will stop taking it and so i personally i've found the naturalistic studies to actually be superior to rcts in this way because it mirrors a real world thing where we're following patients we're giving them something like clozapine right and then like sure it's the most effective drug for like schizophrenia but it also causes people to like drool constantly and gain 200 pounds and so how effective is it in in the real world like i think that's a better way to study it and this is where i think if we want to solve that problem like that's sort of why we you know a lot of people like will criticize us and i think that criticism is fair that we offer like mental health support services at healthy gamer like we help parents and we help people but we do it as coaching instead of therapy and what's part of the reason for that it's because there are so many barriers and like we actually try to meet people where they're at which is i think how you fix it right so you're right that the 95 compliance issue is the big problem so how do you fix that i think it's like stepping away from the rct the reason i brought it up even to bring us back to the previous conversation the tie-in that i saw was we're talking about this very difficult to grasp concept for most myself included of being detached but not detached emotionally as you described in the buddhist model how do we get there in a way that is compatible and practical with our current everyday life when we are not living on a mountaintop without distractions without this thing constantly going off great great question and so this is where the answer is going to be weird and you're 100 right it's actually not compatible you can't actually do both okay so this is this is this is the story of buddha right so like buddha was a prince and he was wealthy and powerful and all this other crap and he was unhappy and then like in his journey he first like he just peaced out like he left his wife left his infant son and just went on this journey of self-fulfillment and then like decades later he's he's going back through his his capital city former capital city because he gave up his kingdom he's walking down the street and he sees his wife and his kid and his wife lets him have it she's like you piece of [ __ ] you abandoned us you left you have a responsibility to your child you gave it all up you suck at life and she's right right and then so he says you know you're right i do have a responsibility it's my job to pass on what i understand to my child so he shows his wife his bagging bowl and she's he's like let me make up for it you've had him for 20 years i'll take him for the next 20 years we'll wander around india i'll have my begging bowl and i'll teach him everything that that i i'll do my father's duty and she's like uh-uh no no you crazy he's a prince there's no way i would let him follow around your broke ass the first thing though it's it's interesting mike because you're right it's not actually compatible if we really talk about true enlightenment it's not in a sense compatible with regular life if you are if you are measuring by the level of accomplishment of regular life so for example if you were enlightened would you be as successful of a youtuber as you are jury's still out theoretically i think you can make a strong case and i won't argue against you that the answer is going to be no in my experience so and this is where things get really down the rabbit hole is that the more personally detached i've become the more i realized so i was planning on becoming a monk like i studied to become a monk for a few years and then decided to not do that and then ultimately realize that like being a monk is not about living on a mountaintop it's like all internal and so whether i'm married or not married or you know whether i enjoy you know like soda i like it's all the work is entirely internal and there i've i've found really promising results that you can learn to be detached and because mike i think you've done it dude you've dis-intake like you've been wrapped up in it right and as you disentangle yourself the really bizarre thing is that i think you will actually become more successful because these things as you become aware and detached like this is where i got to say this to you like i think it's amazing that you're you identify as a person who's got to work through can't and it's responsible for so much of your success and it's become maladaptive the higher you go that which is adaptive starts to become maladaptive which is a beautiful lesson that you've learned and so like if we really kind of think about it like as you start to detach i think you'll actually become more successful because i think some of those ways that you view yourself you say to yourself i am not going to be some i'm not going to let my dad down like he taught me these really important lessons he taught me all these things and that's who i am and the higher you go the more that's going to cause you problems and bizarrely like those helped you they helped you become a national taekwondo champion they helped you become one of the most successful medical influencers in the history of medical influencers and at the same time the next step up is actually like pulling away from some of those things and as you become detached i think i know it sounds weird and then you ask the question you asked me a question which is how do you do that and there are ways so we can go into that but i want to i want to give you a chance the mysterious ways no they're not they're not that mysterious it's just i i wanted to pause for a second give you a chance to respond you know disagree no agree and i think this we're coming to this similar conclusion that i did when i was doing my therapy which is you know you call detached she called a disconnect it's all aiming towards the same principle uh you know we get caught up in nomenclature in science probably too often um so i completely agree and i think i've already seen the benefits of doing therapy and disconnecting some and watching a video underperform and not have it affect me negatively be like oh yeah that sucks but let's figure out the next one or what what's my take away from this so that we can learn from it so yeah i absolutely think that that is the case um to me thinking it in a bigger picture sense like the concept of mindfulness or like meditation i've tried with a like me being a person who's tried a lot and accomplished a lot the failure i have with mindfulness and like sitting and breathing and doing this is like insane like how much failure i've had with it so it's not to say that no one can do it it's just to say as someone who's i consider myself a dedicated person i cannot for the life of me do this i start wondering is this a practical solution for most people the answer is absolutely yes so let me ask you a question right so you are are you working like uh do you work in an academic setting or like community setting like you guys are residents and stuff rotating yes so like i have i'm in a community health center but i work with residents i actually have a resident shadowing me right now for this perfect youtube channel so if we think about it like if you have a dedicated student who's smart driven focused and they're not learning medicine where's the problem maybe they don't want to learn medicine no they do want to learn medicine they're trying really hard you know it's kind of weird medicine's not for them no medicine could be for that's what they would think right that's exactly what the person would think and that's exactly what you think about mindfulness it's not for me that's what i'm hearing from you so i'm with you there but the fault is with the teacher so if you've got all the right stuff right you're driven you're focused you're dedicated like whose fault is it it's the attending's fault if they're not learning medicine and so this is where like i turn to you and i'd say i completely get where you're coming from because this is what i hear time and time and time again i suck at meditation meditation's not for me and that's where i'd say like how qualified are your teachers how did you try to learn yeah i've self tried to self learn well there you go right so like meditation is something that traditionally has been taught by very qualified teachers and so i don't think you're bad at meditation i i gotta say this mike and this could could also be a selection bias like 95 of people who i teach meditation to first of all half i'm successful in teaching meditation to 95 of people that i work with half of them feel like meditation is not for them the first time they come into my office and the reason is because they don't have good teachers and the reason is because we have a propagation of meditation resources without meditation teachers the reason is because people meditation teachers are taught in one tradition right so like how do you become a certified meditation teacher you go to a particular person you learn their particular branch of meditation and then they are the their any to any student comes to them they say this is the the way to meditate and if a teacher says this is the way to meditate and it's not suited to your cognitive fingerprint then the student walks away thinking i suck at meditation and meditation is not for me because look at this like you know tibetan monk who's like an expert on meditation if they're such a good teacher that like people don't acknowledge that there are different traditions of meditation it's sort of like if we force you to become a surgeon you would think that you were bad at medicine but the whole point is that like you're an fm doc through and through right and so like becoming a successful doctor has to do with the tradition that you're trained in in the tradition that you practice within as opposed to like you know you're not a bad doctor it's just if we force you to become a surgeon like does that make sense it does um the question that i have is um if we like for example maybe not me let's say i have a friend he's five foot one and he he wants to play basketball and by your methods any teacher a a good teacher would be able to teach him how to play basketball very well but genetically he's slow he's clumsy he can't play on a even moderately competitive level no matter how great the teacher is that's physical limitation yep for me i feel like when i uh practice meditation i can pick up on it and i've gotten some benefit from it absolutely i see it but maybe i'm not the one that's going to be the collegiate meditator does that absolutely absolutely so but but listen the five the five foot one guy can learn how to play basketball hundred percent can learn how to play basketball he may never be in the decide what to do with it right so like but i feel like i've learned what meditation is how to sort of do it but then like it didn't give me enough value to continue doing it is that without visible absolutely right so it may not be for you like you can teach a five foot one person how to play basketball you can 100 do that i'm not saying they're gonna enjoy it i'm not saying they're gonna play in the mba and enlightenment of buddhism like to have meditation and mindfulness part of it is that intertwined with it sort of the solution no sort of but let's think about a couple of distinctions in the analogy the goal of teaching you meditation is not to get you to play in the nba enlightenment is not for everyone not everyone is temperamentally appropriate to it so when i work with someone who's got down syndrome and i teach them meditation my goals are different from if i work for you with you right so like like the kind of meditation that i'm not going to teach it's not one standard for all people which is the problem with the nba analogy and i think may actually be your problem with meditation because what you're doing is if you really pay attention you're setting an objective standard and you say i suck at meditation because i am not able to live up to the objective standard that's the problem because you're meditating against an objective standard instead of meditating to like like meet you where you're at it's it's right back to like you know recommending therapy to a patient because there's an objective standard that's rct supported evidence-based works here's the referral and it doesn't go anywhere the same problem with you because you're saying oh i should get this out of meditation this is the way that i should meditate isn't it supposed to do this forget all that crap if you want to learn how to meditate we start you got a few more minutes yeah i do okay can i can i give it a shot okay okay so the first question is why do you want to meditate to reach a state of detachment with an emotional component still present okay so okay so i feel like i'm the riddler right now oh no on the contrary you just dug yourself into the biggest pit you ever could okay so this is what i want you to do you want to feel an emotion and be detached from it you want practice at that you want me to teach you how to do that yeah i want you to be a shitty meditator i want you to meditate every day i want you to feel like a failure i want you to feel like this doesn't work this doesn't help i'm doing it wrong and i want you to separate so you we can pick any meditation technique and it's perfect because all you're going to do is you're going to practice feeling like a bad meditator so anyway go up to 100 uh you know women ask them for their phone numbers get rejected by all of them and then you get okay with rejection and you have no fear to talk to anybody else i think there's some overlap but if we're really talking about what meditation is if you want to practice something if you want to practice being detached from something i'm going to this is what we're literally going to do i'm going to teach you one meditation technique that you're bad at you'll ask god for patience and god gives you the most frustrating situations over and over that's what you're giving me so you're gonna you're gonna do any kind of meditation that you've learned that you suck at then what we're gonna do is notice the feeling of sucking at it then i'm gonna give you a quick breathing practice and you're just gonna sit with it all and like i know it sounds kind of weird but the worse you feel like you're doing at it just notice oh see how bad i am see how much it isn't working and i know it sounds kind of weird but the more you're able to see because what happens is if you get tangled up in being bad at it you're not going to be detached you're going to be attached does that make sense yeah how do you find the motivation to continue doing something you're bad at that's my question very good so this is the perfect technique for you right so like like this is where and the short answer is that you you become detached because if you're detached whether you're good or you're bad doesn't matter like the five foot one guy who plays basketball how does someone who's five foot one play basketball they let go of being in the nba who cares if i'm a failure i just love shooting hoops man that's how you do it you detach that's what i'm saying it's like the actual answer to your question it's the actual answer to happiness how do you find the motivation you let go of the success and you do it for the sake of the thing because you enjoy doing it not the five or one gentleman is enjoying learning how to play basketball as opposed to making a goal to play in the nba and so it's it's a chicken or egg thing because as he lets go of the goal to play in the nba he will enjoy the basketball more see that's that's the thing i need proven to me yep because you're saying by saying i will get nothing from meditation or i will fail at meditation starting with like a really low set point like almost a negative set point of expectation i will then start enjoying it only one way to find out okay yeah i mean yeah no this is tricky you have to be really tricky here okay because if you say to yourself it won't work mike if you say to yourself oh i'm going to start enjoying this by suffering through it it's not going to work because you're good at that right you're good at making temporary sacrifices for success in the end no no no you're going to fail if you do that so what do i do you have to do it with knowing it'll never work you have to you can't trick yourself because that's it's gonna be the same [ __ ] thing because then what's gonna happen is you're gonna you're gonna start to meditate you're saying it's not to work but i'm going to start enjoying it at some point i'm going to walk up to 100 girls and and then i'll get good at it because in the back your mind you're going to know i'm going to get good at it and then what's going to feel like a failure you're going to do it 100 times and you're not going to be good at it and then you're going to feel like a failure oh it's not working it's not working it was supposed to work but it's not working it's not working it's not working so you see what i'm saying there you gotta be careful sneaky sneaky i i understand the the complexity of it it just to me it's i i'm gonna try i'm honestly gonna give it a try uh to me it sounds like there's like knobs like okay turn down expectation turn down expectation of not having an expectation and it's like i don't like who i don't know like i don't i don't think i have that good control over my mental state but i'll try yes you understand it perfectly mike and when you can turn down knobs all the way to infinity that is enlightenment yeah i mean i'm more than willing to try it okay so now you're gonna teach us some meditation okay you get it you get it bro you're you're on this you you're you're good you figured it out seriously i'm i'm very optimistic for you it's gonna suck i'm sorry and it's not gonna amount to anything see but i know you're lying you know it's gonna amount to something no i don't i don't you do i heard you i heard you give the intellectual statement earlier no because because as long no no no because as long as you believe that i think it's going to be successful you think it's going to be successful and then it's going to fail so it's not going to do i lie to myself nope you just do the practice and then you practice you notice like the more knobs you see the better you're gonna get at it okay okay and then i'm actually tricking you into a completely different direction but we'll worry about that later okay so this is what i want you to do i want you to just share with us yeah a meditation practice that you've tried you're doing great bro love it um like uh just anything four four second inhale eight second exhale diaphragmatic breathing beautiful okay so what we're gonna do is let me just think for a second okay so this is what we're gonna do all right so we're gonna do four seconds of inhalation followed by eight seconds of exhalation we're gonna do like let's say five rounds of that and what i want you to do as you're breathing is notice that there may be thoughts in your mind of this isn't working or this doesn't feel like working or whatever and then as you notice those thoughts just like notice them like prepare for it right it's like this person's got an sd elevation on the ekg when i look at the echo this is what i'm going to be looking for right so we're going to like look for it and then as it arises you're just going to see it and then after the five rounds of breathing i want you to see how long the feeling of this is a waste of my time i'm not doing it right this will work in the end just see how how long those feelings kind of last and then what i want you to do is try to find the moment where inhalation becomes exhalation after the five rounds after the five rounds uh-huh i'm not sure i grasp what that means that's that's good so like you know we have an inhalation and then we have an exhalation right you can observe that there's a period of time where you're inhaling and you can observe the time that you're exhaling and in between that as long as you don't hold your breath there's gonna be like a moment where one becomes the next and i want you to try to catch that moment okay okay hey you want me just now yeah let's do it now we're gonna do it together so can you count for us like for the first round like show us i i like to do it mentally but i guess i can do it okay okay okay then do it mentally can i count with the first round please yeah okay a guided session i like it okay okay so we're so i'm gonna i'll count the first let's uh i'll count the first round and then continue i'm fine with it if you prefer it that way let me just think about how i want to do this no we're going to do just the first one okay okay this is what i do to my patients when i want to check their reflexes on their knee and they won't let me do it so i make them pull their hands up and look up at the ceiling and then their reflexes come back that's what you're doing to me it's a scene right through me okay all right so i've met my match okay so we're gonna we're gonna just take start with just take a moment to feel the weight of your body in the chair okay so now we're gonna take a deep breath in expanding your diaphragm pushing out your stomach one two three four and then exhale for eight seconds one two three four five 6 7 8. and now again breathe in one two three four and breathe out one two three four five six seven eight and now continue at your own pace we'll practice for about 60 seconds just continue breathing i'll prompt you when to stop us please go ahead and finish the breath that you're on and now just observe yourself see if there are sensations of feeling like you didn't do a good job like you should have done better and we'll let you just pay attention to thoughts and feelings as they arise for another 45 seconds or so and now i want you to take a deep breath in and exhale and again exhale and then a third time in and out as the final breath as you finish your expiration go ahead and or exhalation go ahead and open your eyes tell me what happened when you stopped counting and i started to have to count for myself i cannot count i lose track of the numbers so that happens i started worrying about my 5 45 meeting i thought about some emails that i should have received today that i didn't okay that's that's the majority of the thoughts okay so you have a goal for meditation now i'm gonna be a teacher and i'm gonna teach you one more technique okay okay this is what you i think you need so i'm going to teach you a technique called nari shodhana or alternate nostril breathing have you ever learned this before okay can you do this with your right hand so bring your index yep very good now just let the thumb out perfect yeah it could be like that that's fine okay i think it's pretty good yeah yeah it's so what we're going to do is i'm going to take my right thumb and i'm going to block my right nostril and i'm going to breathe in through my left allergies are making this a little hard okay and then once you have a full breath of air once you inhale then we're gonna switch and exhale out the other side and now we're going to inhale again through this side switch and exhale good inhale don't switch it inhale it's gonna be tough because you've got allergies switch and exhale inhale switch exhale you got the rhythm of it so let's pause for a second maybe tough with allergies i understand that but i want what i want you to do is inhale with through one nostril switch and complete the breath out the other side then you start with the same side again and switch on a full full total lung capacity filled to the brim okay okay i hate that i know what you're doing what am i what am i doing i'm not doing anything now seriously sorry go ahead sorry go ahead what am i doing tell me you're not doing anything no you're you're uh you're distracting my mind you're giving me an activity to do good okay so close your eyes 60 seconds alternate nostril breathing why is this so hard for me to do it's okay you can you can do with my pinky okay pinky is great yeah okay okay so start with the right right nostril blood good in switch out in switch out in switch out good now the training wheels are coming off you do it at your own pace we're going to do it for 45 seconds i'll keep track of the count you just focus on not screwing up the breath my okay go ahead and finish the breath that you're on how was that good what does good mean i feel like my breathing is slowed down i also feel like my brain is wondering if i have a deviated septum or true allergies and why my left nostril is so congested but i i also hate that i appreciate what you're doing like in the sense of like my brain is like oh this is a distraction method so this is what you're doing and it's it's rationalizing it i wish it wouldn't but yeah so control it so yep so don't control it just continue the practice okay so like your problem mike is that the meditation you're trying is too easy so you need something called a powerful alumni and this is where i have to i have to beg your if this doesn't work for you i have to beg the opportunity to have another shot at it okay okay i'm gonna i'm gonna try it what's up what's the prescription how often when you i want you to practice for five minutes whenever you like i would say three times a week five times a week but just yeah three five minutes five times a week okay okay and and this is where so what you need is a powerful alumna an alumni is the sanskrit word for support you need something that there's so much going on in your mind you're actually so good at multitasking you can juggle so many things at the same time that you actually need a very intensive technique that will demand all of your attention so i'm going to leave you with one other technique don't try this one yet but just as an example you need to stand with one foot you need to balance on one foot with your eyes closed that's going to be your form of meditation you can't try any of this new observation stuff because your mind is going to fill that vacuum you need a very powerful focusing technique and i the why why this makes a lot of sense to me specifically at a practical level is for example if i was to and my headphones listen to an audible book right now sitting here there's no way i could listen to it but while i'm driving to the hospital and i'm busy with the stimuli of driving and doing all these things i can grasp the most complex subjects whereas like if i'm just sitting i have no idea what the speakers this is a deficiency of your prior teachers because your mind needs to be occupied so the way that you keep your mind from wandering is by keeping it focused on one thing alluringly enough imagine you're doing pediatric physical exam on a kid what do you do right you're like oh hey why don't you play with my stethoscope while i look in your ears you're right you recognize what i'm doing you get the principle and it still works it's not about manipulation it's about providing a technique for your mind that it can sit in one place and giving it what it needs to it's like training a dog where you give it a treat first and then it learns how to fetch then it no longer needs the treat so we need to train your mind to be able to do this we'll give it the alumni the support it needs at the beginning and then as you get better at it you're not going to need the alumni and then you'll know how to meditate hoping that is the case okay my balance also sucks so if i fall uh is there malpractice coverage here there is not because it is not a medical conversation it is not medical advice i am not your doctor now i hate our legal system yeah there is not malpractice coverage for standing on one foot on the west side highway of all places i was literally just discussing with my producer about doing a video about giving medical advice and how complicated it is like when my friends call and say like hey i'm dizzy what should i do and i i just had that in the back of my mind because we just had this conversation but it was just crazy how complicated so i applaud you for doing this on social media and on twitch and youtube yeah of course thank you very much so dr mike it's been a pleasure i know you've got a uh with something in what sounds like 20 minutes so i want to give you enough time thank you so much for coming on i i really enjoyed this um do you want to just tell people very quickly where they can find you i mean i assume everyone already knows but yeah well i'm the only uh apparently dr mike or at least the the one that comes up most when you search so if you just search dr mike on youtube instagram twitter facebook all that good stuff so just search dr mike and if you ever have a topic you're curious about like cholesterol or what happens when you swallow gum just search dr mike gum dr my cholesterol all those videos will pop up for you that's awesome thank you for the opportunity yes this has been an enlightening session i didn't reach enlightenment which is not for everybody as you say but it was a very enlightening session and uh i love having these types of conversations so thank you for that opportunity yeah good luck to you man yeah and give me a chance if it doesn't work okay oh i i'm your i'm your discord friend now that's it okay so now i'm gonna hit you up okay cool take care man bye all right thanks all right he's a fantastic guy you know i think i i mean i saw some stuff earlier i i think you know some people don't like him and you know no one's perfect as he's said before but man the dude is really fantastic like just super genuine dude

Channel: HealthyGamerGG

Views: 221,459

Rating: 4.9430866 out of 5

Keywords: mental health, drk, dr kanojia, healthygamergg, healthy gamer gg, twitch, psychiatrist, dr mike, mikhail varshavski, dr. mike, doctor mike

Id: T_31hFh1XKM

Length: 137min 59sec (8279 seconds)

Published: Fri May 28 2021

Reddit Comments

[u/sweptself]

I'm a newbie meditator but two things I tried when watching the video seemed more "possible" for me to do, the diaphragm breathing and the alternate nostril breathing but since I've never delved deep into controlled breathing are things like this safe? could you do then whilst doing yoga? my current plan is to do ten minutes of each per day for the time being to see which "fits" better is one more suited for early in the day vs at night?

[u/SongYouRemindMeAbout]

The topics of discussion are all interesting to me so I will definitely be giving it a listen even though I have unsubscribed from Dr Mike and don't watch any of his stuff anymore because of his entire COVID 19 circumstances.

The hypocrisy of the situation given he had preached so many times about the importance of taking COVID seriously and the entire "alert, but not anxious" and all of that coupled with him partying on a yacht with a bunch of other people and then glossing over it with excuses and not addressing it as a video on his main channel still is frustrating and so lacking in self control and discipline. Maybe it's unfair, but if he was just a more normal celeb and not a doctor I wouldn't feel so annoyed by it.

https://youtu.be/nDb6-9-MTw4?t=3521

[u/Tiancolm]

Would love to see a crossover with Dr Jordan Peterson.