The Peter Attia Drive - Qualy #33 - How silent bravado and incessant striving can lead to a functional (and actual) death, and why Paul is critical of the current state of psychiatry

Episode Date: October 1, 2019

Today's episode of The Qualys is from podcast #15 – Paul Conti, M.D.: trauma, suicide, community, and self-compassion. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/   Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/  Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

Welcome to the Qualies, a subscriber exclusive podcast. Qualies is just a shorthand slang for a qualification round, which is something you do prior to the race, just a little bit quicker. Qualies podcast features episodes that are short, and we're hoping for less than 10 minutes each, which highlight the best questions, topics, tactics, etc. discussed on previous episodes of the drive. We recognize many of you as new listeners to the podcast may not have the time to go back and listen to every episode, and those of you who have already listened may have forgotten. So the new episodes of the quality is going to be released Tuesday through Friday,

and they're going to be published exclusively on our private subscriber-only podcast feed. Now occasionally we're going to release quality episodes in the main feed, which is what you're about to hear now. If you enjoy these episodes, and if you're interested in hearing more, as well as receiving all of the other subscriber exclusive content, which is growing by the month, you can visit us at pteratia-md.com-forward-slash- subscribe. So without further delay, I hope you enjoy today's quality. You're alluding to obviously something I know is very difficult and we've talked about it a lot. I don't know that we need to necessarily go into great detail here, but in the span of a year, if I recall, you lost your brother and your best friend.

Yeah, my brother died by suicide and about a year later, one of my closest friends, so this same, a close group of friends growing up, and it's sort of like we had in medical school, but there were a group of us. And one of those very, very close friends from childhood also died, and he didn't die by suicide, but there was sort of that same kind of desperate reclessness that I saw this common root in those two deaths and you

know they confused me and infuriated me and you know it made me feel very helpless and vulnerable and wanting to be able to understand better and to kind of fight against this thing that made it so hard for people to get help, right? And to be vulnerable, and that was really the commonality, is like both of the people who died had real and significant needs inside of them that came about naturally, right? And like something you one would never criticize a person for having those needs, right? Or those struggles, but there just was an avenue of getting real acknowledgement and help for any of that. So that kind of

silent bravado and silent struggle, you know, became very real to me that like, oh, that leads to death, right? I mean, it doesn't all the time lead to death, but it leads to death way more often than is even remotely acceptable. I mean, I think as we've discussed, it sometimes it can lead to death immediately, like in these cases, and sometimes it can lead to a functional death, which is you're still technically alive, you know, you still respire, but you're effectively dead. And in many ways, that's probably the more endemic,

more sinister, more destructive over the long term given its sheer volume problem, right? Absolutely. I think the deaths that we see in front of us as like actually, okay, that person is not breathing anymore are there a viscerally moving hallmark of what is so pervasive in our society. And I do think that I didn't understand that then, that in many ways, the way our society is structured

and the way our metrises of achievement are structured really beckons us to death and life, to losing touch with the basics of our own value system and essentially to incessence striving and not incessence striving to achieve, although we may see it that way, but incessence striving to not pause and to not feel the vulnerability that I think is so pervasive now. I mean, even in the 20 years, you know, since we went to medical school, I mean, you think about how pervasive media is, right? I mean, even in the 20 years, you know, since we went to medical school, I mean, you think about how pervasive media is, right?

I mean, how there's just marker after marker after marker after marker that says that you're not good enough, you don't have enough, you're too vulnerable, you know, there could be terrorists. That can be time your kids could be killed. We could die. I mean, it's one stimulus after another that tells us not to stop and to really value ourselves by the things that we really value. We get through med school and true to your word, you get a psychiatry residency spot. You decide to stay at Stanford in part because your wife was still, you're soon to be wife.

You guys weren't married yet, but your girlfriend was a couple years behind us in med school. And you end up spending half your time at Stanford, and then your wife matches at Harvard, so you go and finish your residency at Harvard. So whenever I'm telling patients about you, and I'm probably bastardizing all of my knowledge, which is so limited in this field, but I say, you know, one of the things about Paul that's so unique is he did half of his training at Stanford, which is probably one of the foremost institutions when it comes to understanding the neurobiology and the pharmaconeurobiology and the pharmacology of psychiatry.

And then does the other half at Harvard, which is sort of a more old school, but, you know, a place that specializes so much in the psychotherapy. Is that an act? Am I making that up when I say that? Because I've just decided to take the liberty and say that about you. It sounds good, so please keep saying it. No, no, actually I think that there is truth to that.

And there's even more truth to that. The longer I get from it and the more I reflect on it, I think that I am not a very positive or hopeful person about the state of the field that I'm in, which I think does not broadly enough train people in brain biology, not just in the use of medicines, but in what those medicines actually do, and on a very real level, what are those medicines doing as interventions in the brain,

in the many, many systems of the brain, in the cascade of effects that occur in the brain, and we don't think about structural neurobiology, we don't think about neurochemistry in general. So, there's that part of the field that often gets ignored, and then the other that often gets ignored. And then the other side is the psychology. There has been a debate of should psychiatrists still be trained in psychotherapy?

And I see this come up, and I just think that it's a fact for a way of putting it crazy to consider having people that are schlepping medicines to other people that aren't thinking about what it's like to really try and understand someone and what are the paradigms of understanding other humans, right? The kind of things that are valid and have a scientific basis for them, but that are not hardcore brain biology. And I was very, very fortunate to learn so much neurobiology at Stanford and to have that integrated into my training. But when I got to Harvard, I was struck by

that several very prominent influential people there, who were influential over, for example, whether I graduated, right? Were really shocked at how much brain biology I knew, and really shocked at how much psychology I didn't know. And even though I had sought out some of this on my own, being in a place that was kind of steeped in an older analytic tradition really helped me

kind of embrace this belief that understanding psychology and certainly from the perspective of what's psychodynamic, right, the things that influence and motivate us that are in our unconscious, you know, the gigantic part of the iceberg that's underneath the water, but that is most deterministic of our behaviors are unconscious. You know, the gigantic part of the iceberg that's underneath the water, but that is most deterministic of our behaviors and our choices and our feelings and being able to integrate that with the brain biology upon which it rests, I think, is, I think

it's the way to at least try and have the most broad set of abilities to try and help people. And in some ways, it was very fortuitous for me to split my time between those two places and to find a couple very very good people who took it upon themselves to try and teach me in a short period of time. What maybe I should have learned over a longer period of time. I hope you enjoyed today's quality. Now sit tight for that legal disclaimer. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional healthcare services, including the giving of medical advice. And note, no doctor-patient relationship

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