Dr. Paul Conti: How to Understand & Assess Your Mental Health | Huberman Lab Guest Series

[Music]

welcome to the huberman lab guest Series

where I and an expert guest discuss

science and science-based tools for

everyday life

I'm Andrew huberman and I'm a professor

of neurobiology and Ophthalmology at

Stanford School of Medicine

today's episode marks the first in a

four episode series all about Mental

Health

the expert guest for this series is Dr

Paul Conte Dr Paul Conti is a medical

doctor and psychiatrist who completed

his medical training at Stanford

University School of Medicine and then

went on to become chief resident of

Psychiatry at Harvard Medical School he

then went on to found the Pacific

Premier Group which is a collection of

psychiatrists and therapists who are

expert in treating all types of

psychiatric disorders and life stressors

across the four episodes of this series

on Mental Health Dr Conti teaches us

about the structure of our own minds and

how to think about our own minds as a

way to enhance our mental health he

explains how our subconscious mind and

our conscious mind interact to drive our

emotions our decision making and our

behavior and while any series about

mental health requires that from time to

time we discuss personality disorders

and psychiatric challenges the main

discussion in today's episode and in

fact all four episodes in this series

are about what it means to be mentally

healthy and how to build one's mental

health through specific practices either

done alone or with a therapist today's

episode addresses several key questions

as well as provides protocols for you to

address questions about your own mental

health for instance you will learn what

constitutes the most mentally healthy

version of yourself you will learn to

assess and indeed you will learn

protocols for addressing levels of

anxiety levels of your confidence how to

think about your beliefs and internal

narratives how to think about your

self-talk and restructure your self-talk

we discuss common challenges such as

overthinking we talk about the role of

defense mechanisms and other aspects of

the conscious and unconscious mind

interactions that can lead us toward or

away from the healthiest versions of

ourselves you'll notice that during the

first five minutes or so of today's

discussion Dr Conti describes a

framework of what he refers to as the

structure of self and the function of

self and he describes several pillars

for understanding what those are I'd

like to highlight that while that short

portion of our discussion does bring up

a number of terms that are likely to be

novel to you they certainly were novel

to me that as our conversation proceeds

you will really come to appreciate just

how simple and yet powerful that

framework is it will help you understand

for instance the relationship between

your conscious mind and your

subconscious mind in ways that you can

really apply toward enhancing your

mental health in addition to that Dr

Conte has generously provided a few PDFs

which illustrate that framework for you

and that are available completely zero

cost by going to the links in the show

note captions so you have the option to

download those PDFs and to look them

over either prior to or during or

perhaps after you listen to these four

podcast episodes as a final note before

beginning today's discussion

want to emphasize my sentiment which I'm

confident will soon be your sentiment as

well which is that Dr Paul Conti shares

with us immensely powerful tools for

enhancing mental health that at least to

my knowledge have never been shared

publicly before in fact as somebody who

has done more than three decades of

therapy I've never before been exposed

to a conversation about the structure of

the mind and the subconscious mind as

well as tools and protocols for

enhancing mental health as powerful as

these for me the information was

absolutely transformative in terms of

reshaping my thought patterns my

emotional patterns and indeed several of

my behavioral patterns and I'm confident

that the information that you'll glean

from today's episode and throughout the

series will be positively transformative

for you as well before we begin I'd like

to emphasize that this podcast is

separate from my teaching and research

roles at Stanford it is however part of

my desire and effort to bring zero cost

to Consumer information about science

and science related tools to the general

public in keeping with that theme I'd

like to thank the sponsors of today's

podcast

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and while that Weekly therapy was

initiated not by my own request it was

in fact a requirement for me to remain

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to appreciate just how valuable doing

quality therapy is in fact I look at

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access a free 30-day trial again that's

wakingup.com huberman and now for my

discussion about how to understand and

assess your level of mental health with

Dr Paul Conte Dr Paul Conti welcome

thank you I'm very excited for today's

episode and for this series because I

like so many other people out there have

a lot of questions about myself and

themselves and not just about ourselves

but how the different personality types

out there the healthy types the

narcissists the you know all the things

that we hear about these days

gaslighting all these sorts of things

what all of that really is

perhaps we can dispel some of the myths

that exist during the course of this

series I'm sure we will sure you will

and also

raise certain important questions that

we should all ask ourselves in terms of

trying to understand who we are and how

we can be the best versions of ourselves

how we can experience the most happiness

also the the most richness in life

because of course life isn't just all

about being happy so to start off this

question I want to raise a parallel with

something I think for most people is is

more concrete which is physical health

you know

um while there isn't an ideal physical

self that's been defined by the medical

community we know for instance that

there is a range of blood pressures that

are considered healthy there's a range

of body mass index that's considered

healthy although that's a little

controversial because it depends on how

much muscle how lean people are Etc but

you know I think it's reasonable to say

that the healthy individual is not going

to get exhausted walking up a flight of

stairs that they could bend down and

lift an object without hurting

themselves they might even have some

additional strength or endurance Etc

within the physical health domain all of

that is fairly well scripted and there

are protocols that people can follow to

improve their physical health we've

covered many of them on this podcast

before

when it comes to mental health and it

comes to concepts of the self

Things become much more abstract for

people in fact I think most people

including myself are kind of wandering

around in the dark wondering whether or

not we are the best versions of

ourselves whether or not we're thinking

about ourselves and the world around us

in the best ways so to start things off

you tell us

what is the healthy version of self I

mean what what should we all be aspiring

to you've worked with people who uh

presumably are healthy and people who

have severe pathologies of

different psychiatric types right

bipolar narcissistic sociopathic uh and

everything in between

so for me and for the listeners what is

a healthy self what should we be

striving for a healthy self approaches

life through the lens of agency and

gratitude if you look at happy people

you know people who like their lives

right no matter what stage of Life

they're at right no matter what their

socioeconomic status is you know race

religion there's so many things that we

we think matters right and and and they

matter to a lot of things do they matter

to is someone happy or not right they

they are not factors right the factors

that tell us is this person enjoying

life are they going to take care of

themselves are they happy they're here

are they engaged productively in the

world is agency and gratitude and if we

have those two things then it's

interesting you almost never see someone

go wrong right and even if if they're

difficulties even if there are if things

happen in life that that can make some

unhappiness right it doesn't take away

the person's engagement in life the

person's enthusiasm for life and I think

if you look at even traditions of

understanding how are people happy

whether it's in Psychiatry or it's

through literature or through a

religious lens it is always people who

approach life through the lens of agency

and gratitude

could we go a little bit deeper on

agency and gratitude sure when I hear

the words agency and gratitude I think

agency and ability to affect the world

around me in the ways that I want and I

think gratitude being thankful and we

did an entire episode all about

gratitude practices some of the

neuroscience and neuroimaging and

neurochemical changes that occur in the

brain and body when people exert a

gratitude practice but I have a feeling

that when you talk about agency and

gratitude you might be talking about

something slightly or maybe even quite a

bit different than the way that I'm

defining it yeah I would say agency and

gratitude are these amazing rewards

right that sit on top of the highly

complex brain function inside of us and

the highly complex psychology in all of

us so if we think about a self right

that I identify a self right I'm an eye

right if I'm going to approach the world

with agency and gratitude that's sitting

on on top of a lot of healthy things

right and the idea that okay there are

ways in which we can be mentally

unhealthy right but to start with like

what is going on inside of us right and

what does it look like when we're

healthy so there's a structure of the

self right there's function of the self

and if we look at the structure and the

function and the parts the components of

structure and function we can come to

understand okay what is going on in us

what might we change for the better how

do we build empowerment right is it

empowerment is is the the the

ability to navigate the world around us

and to bring myself to bear in ways that

are effective and from empowerment

arises the sense of agency right I have

agency because I am empowered right and

also from a healthy structure of self

and function of self we end up with

humility right we come through that with

a sense of our our place in the world

and our power in the world to to

navigate as we choose but also a sense

of the world around us that's far more

complicated right than just we are

extends Beyond us to other people to the

climate around us to the health of the

whole planet right we we feel a sense of

humility that I'm here and I can do good

things I'm fortunate to be here and I'm

part of this bigger ecosystem right all

the way up to the scale of the ecosystem

of earth right and if we feel that

humility then we approach the world

through the lens of gratitude so the

idea that a healthy structure of self

and a healthy function of self leads to

empowerment and humility and then upon

that we are we are sort of imbued with

agency and gratitude and that leads us

forth to happy lives okay so it's clear

to me why having agency and gratitude

would be wonderful perhaps even the goal

state that we should all be seeking to

achieve

and it also makes sense to me as to why

empowerment and humility are important

components that feed into our ability to

have agency and gratitude yes right

because all of that

at least to my mind sums to in a very

clear statement about having agency and

gratitude is the best way to approach

life that all makes perfect sense to me

and yet I've never really thought about

it that way and I think most people

haven't ever been told this right I mean

what should we be seeking agency and

gratitude yes so we've heard endless

number of podcasts including this

podcast about physical health and we've

been told by physicians and everybody

else that you know we should seek to

have a relatively low blood pressure we

should seek to have a relatively low

heart rate that our cholesterol should

be at a certain level

Etc So within the physical health domain

you know there are strong clear messages

about what we should all be striving

toward and in a similar way to how we're

discussing the self and psychology you

know I don't think anyone seeks to have

low blood pressure or low heart rate

because that's what they want per se

they want those things along with some

capacity for endurance the ability to to

you know lift an object so some strength

Etc because of the way that those

metrics of Health allow them to move

through the world in the best possible

way in other words having some degree of

endurance allows you to walk down the

block maybe a lot further or to walk up

several flights of stairs or to have

some strength allows you to pick up

objects and effectively move through

life right

you're telling us that having a sense of

agency and gratitude

and that agency and gratitude are

undergirded by empowerment and humility

and that's the best way to move through

life the most effective happiest if you

will way to move through life

well then I think we have to ask

ourselves the same thing we would ask

about physical fitness which is what

goes into creating a sense of agency and

gratitude empowerment and humility you

know what are the action steps because

if I want more endurance I know to get

on an exercise bike or or a treadmill or

go out for a run a few times a week or

more if I want to get stronger I'm going

to lift objects that are difficult to

lift until they're easier to lift I mean

so pretty straightforward in the

physical domain but in the in the mental

health domain in the psychological

domain it does become a bit more

abstract I think in part because no

one's ever told us certainly no one's

ever told me what you really need and is

agency and gratitude in order to have

the best possible life so I very much

appreciate that you're telling us this

and I'd love for you to tell us what are

the action steps that go into creating

these things that we're calling agency

gratitude empowerment and humility now

there's actually quite a strong parallel

between the physical health Dimension

and the mental health Dimension so so as

you're saying like why do you put in the

time the energy the learning right to be

physically healthy right it's a lot of

effort and and we put so much of

ourselves towards it if we decide that

we value that right why do we do it

right because as you said it's the best

way to approach life like there may be

something that I want to do I I want to

run a race right or I you know I want to

climb a mountain right but ultimately we

take care of ourselves physically

because we don't know what's coming next

in life and we want to be prepared for

it good bad and otherwise right and the

same thing is true of mental health so I

can feel grateful for something I can

feel grateful that I'm still breathing

right now right I can exercise agency I

can pick up that cup and take a drink

right but that doesn't mean that I'm

living life through the lens of agency

and gratitude which is consistent with

every opinion if you look

psychologically through the lens of

literature through the lens of sociology

and psychology agency and gratitude make

happiness right they're ways of

approaching life and just like physical

health is undergirded by by

cardiovascular health heart health

muscle strength right there's an

undergirding of agency and gratitude and

empowerment and humility are ways of

describing okay what arises right from

understanding ourselves taking care of

ourselves that then gives us the agency

and gratitude so we have empowerment we

have humility but where does it all come

from right so just like we have to

understand the physical body and what to

do to it in order to be healthy right we

also have to understand the mind right

the self that wants to be healthier and

that comes through understanding the

structure of the self and we have enough

science through the lens of neurobiology

and Psychiatry to understand the

structure of self and then the function

of self right how we work right how we

interface with the world so it's

actually not more complicated than

physical health it's just that we don't

spell it out that way right we come at

it through the lens of pathology of

what's wrong and who has some diagnosis

and you know we're looking for the

problematic instead of saying like what

do we look like when we're happy right

and then going and digging down into the

mechanics of it all right and if we're

not in that state right to go and look

at that and to make changes just as if

you were very very physically healthy

right but you know your heart rate

couldn't go up that much without you

feeling very very fatigued we'd say well

look you're doing a lot of the right

things right but let's work more on on

your heart right we would go look at the

specifics of it because that's how we

understand it and we just don't apply

the same science logic common sense to

mental health as we do to physical

health but it's time for that to change

because we have the knowledge and

ability to do just that

when we had Dr Andy Galpin on this

podcast to do a series on physical

health and fitness essentially he said

something that really stuck with me

which was that the number of different

workouts that people can do out there

body weight workouts work with weights

with machines you can run far you can

run shorter distances more quickly you

know you can do planks you know sit-ups

so many variations on exercise routines

but what he very clearly stated was that

there are only a few core adaptations

that the body can undergo that lead to

these byproducts that we call lower

blood pressure enhanced endurance

improves strength improved neuromuscular

function improve brain function for that

matter

it sounds to me like there are a lot of

parallels in creating the healthy

psychological self

so what are the core components that I

and others should think about in terms

of understanding I think you describe

them as the structure of the self and

the functions of the self again just to

draw a parallel if we were talking about

physical health we'd say okay there's

connections between nerves and muscle

that allows us to move our limbs if you

apply a certain amount of resistance you

get a certain adaptation which is the

the neuromuscular connection gets

stronger the muscle might get bigger or

just stronger Etc

flexibility you know you just push your

range of motion just a little bit into

discomfort you do that we it so happens

to be the case that you do that for just

a couple of minutes each day over the

course of about a week or so you get a

significant increase in flexibility okay

so it's all very clear in the physical

domain in the psychological domain I

hear you telling us that the action

steps that we all should be taking in

order to be the happiest version of

ourselves by achieving agency and

gratitude

is to explore the structure of self and

the function of self

so if you could tell us about what is

the structure of self like what goes

into Andrew being Andrew and Paul being

Paul and whoever The Listener is into

being who they are what is that and what

is the function of self how how does a

psychiatrist think about that how should

we think about that okay if I could

start maybe to set the stage for that

right by pointing out that as we go up

the hierarchy right of Health right

everything should get simpler right not

more complicated right if you think

about physical health right there's so

much complexity on the initial levels

right so we think about you know your

physical health status versus mine right

it's going to be different right we're

going to have different cardiac function

and muscle function and pulmonary

function and if we're going to be

healthy we could do a lot of different

things right there might be a whole set

of choices that would work well for you

different choices that would work for me

and we can gauge intensity timing

frequency right it's very complicated

when we're on and the the lower levels

of the hierarchy as we get higher up

let's say you and I both do the right

things right then what happens we both

have endurance right we both have some

strength we're both robust right things

are getting simpler because we're we're

approaching the unique idiosyncrasies in

all of us right and we have to look at

that and look at that in a very specific

way but what we're trying to get to is

is something that's common for all of us

so stamina for example in physical

health and endurance right and agency

and gratitude in mental health right so

then if we go and we look and we look at

the structure of the self and the

function of self we find that there's

more complexity but that it is also

understandable I mean there's tremendous

complexity in the body just as there's

tremendous complexity in the mind and we

can understand what is the structure of

self what is the function of self and we

can look at that and assess that in the

same way we would physical health

parameters so that we arrive at the

place we want to be be it endurance or

agency or gratitude so structure of self

right we all have an unconscious mind

right and we pay so little attention to

this part of us that really is the

biological supercomputer right so

millions of things are going on all the

time like in every Split Second so for

example I can say these words right you

can listen to the words you can say

things back and I can listen right there

are millions and millions of things

going on under the surface much of which

comes from either biological

predispositions right or habits over

time right thought processes patterns

right so this unconscious mind this

super computer is doing all of these

things like you know at the speed of

light right there are electrical and

chemical signals and you know multiple

Pathways as common as complicated as

super highway systems that then get

Consolidated and communicate with others

right and then what comes up from all of

that is the conscious mind so imagine an

iceberg right and it's a really really

big Iceberg right and and we see the

part above the surface right that's the

conscious mind right but there's a huge

part of this Iceberg maybe 95 of it

that's underneath the water right

there's this hulking mass that we don't

see that's the unconscious mind right

and it's feeding up to the conscious

mind which is a much smaller part of our

brain function right but it's the part

that we're aware of right it's sitting

on top of all the unconscious things

which are extremely important but then

we become aware so that we can engage in

the real world in order for us to have

this conversation the millions of things

per second have to be going on

underneath the surface so that you and I

as conscious eyes right as conscious

selves Can Ride Along on top of it so

that's the part of the iceberg that's

above of the water it's the conscious

itself then imagine that the conscious

self is girded by by a a set of

um you know long uh tendrils that come

out from under the water right that

their defense mechanisms that are

unconscious to us that sort of gird the

conscious mind so do we rationalize

automatically do we avoid automatically

do we act out automatically are these

things in Us in ways that we can observe

and change but that are there to try and

protect the conscious mind from the the

slings and arrows of the world around us

right so if you imagine there's the big

part of the iceberg under the water the

unconscious mind the conscious mind is

riding on top of it but the conscious

mind that part sticking out of the water

is vulnerable right so imagine that

there's a defensive structure then that

arises from the part of the iceberg

that's underwater that is there to

defend and protect the conscious mind

So when you say to defend and protect

when you say that the conscious mind is

vulnerable

what do you mean do you mean that it's

vulnerable to physical attack or that

it's vulnerable to us realizing that

we're just a bunch of neurons that are

clicking away underneath like in other

words where does the vulnerability of

the conscious mind really reside

um not physically where does it reside

but you know what am I so worried about

in terms of my safety I mean right now

we're in a room I feel pretty safe

um I don't think you're going to attack

me verbally or physically I suppose it's

possible that could happen but it seems

like a very distant possibility So when

you say that these defenses are there to

protect us from some sort of awareness

what awareness are we trying to avoid so

the the vulnerability of the conscious

mind is to fear confusion despair right

there's so many things that that we can

fear right some people are afraid of

snakes or spiders some people are afraid

of death some people are afraid of

health issues that could come to them or

to people they love we can get confused

and not know what decisions to make and

how to navigate the world and how to be

who we want to be to ourselves and to

others right we can feel tremendously

vulnerable and despairing if we lose

others or you know we start to see

things happening in the world around us

that that we don't like right we start

to feel like what will happen to the

planet we live on whether it be War

where I live will my children be safe

right there's so much that we need to

protect ourselves again so that

vulnerable part of of us right the part

of the iceberg sticking out above the

water needs a defensive structure around

it to protect it against the

vulnerability of fear confusion despair

right and because the conscious mind is

is sticking out of the water with a

defensive structure around it right it

is the the raw material from which we

create our character structure so the

character structure is all of that the

part under the water the part above the

water the defensive structure so imagine

like a nest around all of that and

that's the character structure that we

utilize to interface with the world

right so the character structure is it's

like the thing that I'm using right it's

like if you're driving somewhere in a

car right the car is the thing that

you're using to go there right the

character structure is the thing that

we're using to interface with the world

so for example how trusting am I versus

suspicious right how readily do I come

to make friends with people right how uh

how much do I act out if I'm frustrated

right how much do I

um you know exclaim something negative

right as opposed to holding it inside of

me how much do I rationalize if

something isn't going well do I want to

look at it and maybe see that it is so

that I don't have to face it right how

much do I avoid problems in the world

around me how much do I exercise

altruism right these are all the ways in

which we're engaging with the world

around us and this determines the self

imagine that the self then grows out of

this now Nest from the the character

structure that we use to interface with

the world and the decisions that we make

so if our character structure is is the

thing through which we engage with the

world then we're enacting right what is

inside of us right what we've determined

through our unconscious mind our

conscious mind our defense mechanism

there's a certain us that that comes at

the world in a certain way and if we're

more or less trusting more or less

avoidant we rationalize more or less

these are the factors that determine

like where do our lives go right because

on top of all of this imagine that the

nest of the character structure around

all of this grows from it the self right

the product of the feelings inside the

things that we know about ourselves and

don't know about ourselves the decisions

that all of it leads to so I may choose

to be for example more trusting and that

may bring an opportunity to me that I

wouldn't have otherwise had right I may

choose to be more trusting and and it

may bring risk to me that I wouldn't

otherwise have had so we want to be as

healthy as we can as knowledgeable of

ourselves in the world around us so that

it's safe for us to have a healthy

character structure through which we can

engage in the world around us with a

sense of prudence right taking

reasonable risks right not too little so

that we shut ourselves down and maybe

end up despairing not so much that that

scary things can happen to us and we end

up fearful right but the idea that if we

know ourselves well the character

structure is healthy right because it's

built upon a structure of self and a

function of self that are healthy and

out of it is coming empowerment right

and empowerment and humility right that

then lead us to agency and gratitude

right the idea here is that this is the

character structure that we create that

can then interface with the world in a

way that's good for us and good for the

world around us that leads us to to be

able to live in much more Harmony inside

of ourselves and outside of ourselves

so if I understand correctly defense

mechanisms that grow up out of this

portion of the iceberg that we're

calling the unconscious mind they

protect our conscious self in ways that

can be adaptive or that can be

maladaptive in other words defenses can

be healthier they can be unhealthy yes

and perhaps in a few minutes we can get

into what a healthy versus an unhealthy

defense looks like but the way you

describe character structure sounds to

me like

an array of contextual dispositions I

don't want to add unnecessarily

um complex language but it sounds to me

like a bunch of dispositions like like

if I'm walking into the office where I

know everybody and I see familiar faces

there's no reason for me to be on guard

if I trust those people but if I'm

walking down a street at night that I'm

not familiar with and and I'm starting

to get the sense that you know this

neighborhood might not be the best it

makes sense for me to be on relatively

high alert so different dispositions

depending on different conditions I

can't help but mention my Bulldog

Costello who had basically three

dispositions it was asleep but in all

seriousness the second one was

um kind of bored the Bulldog face is

kind of board or if something was given

to him that he liked or if we were doing

something he liked Delight he basically

had three dispositions as far as I could

tell I think one of the reasons we like

dogs so much or that many of us like

dogs so much is that their decisions are

very predictable take them to the park

he's happy unless you happy to be ill

that day which was rare you know feed

him he's happy right there wasn't a lot

of uh I don't like this particular meal

or I don't like this particular park or

this Bichon frize doesn't smell so good

to me you know there's a it was so

simple and yet people are very complex

right I I can look at myself and say

okay like what is my character structure

or character structure is certain things

I like certain things I dislike certain

things really irritate me

certain environments and people I just

delighted okay so is the definition of a

healthy character structure one in which

the dispositions match the context

perfectly I mean I don't know how any of

us could be like that but is is that

sort of the ideal much in the same way

that

um you know we could probably arrive at

at an ideal

degree of stamina that one could have I

mean some people want run Ultra

marathons you know 100 miles or more

somebody want to run a marathon some

people like me don't really desire to

run a marathon but I want to be able to

run a mile if I need to without being

completely exhausted and injured so you

know when we when we ask ourselves about

character structure

are we asking ourselves about

context-driven dispositions and you know

how do we start to evaluate that for

ourselves I think because we're more

complicated I think it's not

dispositions as much as its

predispositions right so so in the

example that you gave right you have a

certain predisposition to be either

trusting or wary right and and you're

and that's healthy in you right so when

you come into a setting where there's

not a a good reason to feel mistrustful

to feel anxious to feel vulnerable right

then you feel at ease right so you walk

into the work setting they're people you

know they're people you like everything

is okay right you have a different

predisposition when the context is

different right so if the context could

bring a lack of safety then you'll

respond accordingly with the lack of

safety right but but it's possible

certainly those predispositions can be

in unhealthy places right so for example

you might have been traumatized in a

certain way or you might approach the

world in a certain way because a prior

experience that you may not register as

trauma but it may be that within you is

a predisposition to be mistrustful so

you could walk into a room of people

that you know of people who've never met

you any harm and still feel unsafe right

now this happens most often after trauma

but there are other ways people can get

to that where the predisposition isn't

so healthy the converse is true too

right there are people who can have too

much of what's called an omnipotence

defense and then they don't recognize

danger when danger is around them so the

idea the character structure that Nest

right that's built around the defensive

structure and the conscious mind that's

sitting on top of the part of the

iceberg the unconscious mind underwater

right it's that Nest that is interfacing

with the world through a whole set of

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think most of us are familiar with

assessing and assigning names to the

character structures of others and at

least for most of us we do that with no

professional training or authority right

we say that person is great they're

super nice the person's a jerk they're

like weird you know etc etc

I think very few of us are familiar with

assessing our own character structure

right right and I have to presume that

some of what happens when somebody comes

to you as a psychiatrist or to a

psychologist is that certain questions

are asked and certain narratives are

told that start to reveal to the

clinician the character structure and

perhaps from there some of the possible

defense mechanisms and uh you know

structure of the person's unconscious

mind and conscious mind that obviously

are unaware to them but would be clear

different clinician

much in the same way that if somebody

goes into the doctor and says you know I

don't feel well they can start probing

with questions or are they going to put

you know take a take a re listen to

their breathing right into their heart

right I mean you could help the

stethoscope and figure it out these are

the probes whereas the psychiatrist the

psychologist uses words and language to

probe yes so

what are the sorts of aspects of

character structure that we can be aware

of in ourselves you know I mean in other

words should we be asking what type of

character do I have depending on one

circumstance or another

um should we ask ourselves what sorts of

defenses we have and maybe this would be

a good opportunity to um address this

issue of what are healthy versus

unhealthy defenses because it sounds to

me if I understand correctly that the

defense mechanisms are a very strong

component in determining what our

character structure is right because the

defense mechanisms are unconscious right

the character structure that Nest around

the defenses and the conscious mind

through which we interface with the

world right is very very complicated so

there is many character structures as

there are human beings right so it's

very very complicated but there are

factors that are consistently relevant

across people and get identified as such

so so one example would be isolation

versus affiliation right so does a

person tend to group with others right

or does the person tend to avoid

grouping right and and go about uh

thoughts tasks approaches to life in in

a more a singular manner right so it's

just one element not making value

judgment about it because it can be good

or bad on either end of the spectrum

right so we're just saying what are the

factors so am I more affiliative or do I

tend to isolate and be more singular

that's just one example right another

example could be things like for example

use of humor right does a person use

humor and in what way right does a

person use humor to deflect uh

discomfort in negative situations does a

person use humor in order to belittle

others or to belittle themselves or does

a person not use humor right so these

aspects of character structure and so

much research has been done on this over

the years to determine what is most

Salient right in this this thing that we

use in order to interface with the world

around us out of which grows our self

that makes good sense and and it makes

me want to revise a little bit what I

asked about before which is I said that

when it comes to an exam of physical

health we measure blood pressure measure

um breathing Etc maybe even a blood test

look at some biomarkers but what you're

describing is a little bit more

analogous to The Physician uh addressing

a patient who's having some physical

discomfort or malaise and saying tell me

about your day you know what do you do

when you get up in the morning if the

person says well you know I I drink a

you know a quarter pint of Vodka it's a

very different answer than you know I'd

go outside and get sunlight in my eyes

drink a glass of water and maybe have a

cup of coffee right right you know

um or if somebody says I have six

espresso if I understand correctly the

character structure is better revealed

by

exploring the action States

isolation versus engagement

um as opposed to a read of one specific

biomarker yes um characteristic

structure brought to life

right yes

immediately I'm thinking about movies

and books where we learn so much about

somebody

through observing the way that they

interact with people in in very um very

potent ways so for instance I can think

of countless movies where you learn a

ton about somebody in the first scene

simply because of the way they react to

somebody who you know Cuts them off on

in traffic they just explode okay well

then we think of that person as reactive

from that point on unless there's a

significant amount of material to revise

that but it's in the action of of

getting explosive and cursing Etc as

opposed to if they just kind of laugh it

off or laugh at themselves or blame

someone within their own vehicle or

something like that so is are those the

sorts of things that a clinician like

yourself is listening for when somebody

says you know I don't feel well and you

say well tell me about what's going on

lately and they start describing what's

going on in their life and are you

listening for those places where the the

defense mechanisms can are start start

to reveal themselves the character

structure starts to reveal itself

through these action steps that the

person seems to be taking is that yeah

yeah I mean maybe one way of looking at

character structure is that it's it's

potentialities and positions right that

there's so much that that's latent that

then interfaces with events like a

person stuck in traffic how does that

person respond if that person weren't

stuck in traffic there wouldn't be a

response to it right so so there are

potentialities their predispositions and

then we live through enacting them as

we're moving then through life right and

the the attempts to understand so using

the physical health parallel right if

you came in and you said I don't feel

well right you know we might run a lot

of tests right we might get an MRI or a

CAT scan or even put in the stethoscope

and listening to us inside of you those

we can say are unconscious things like

you know you're not aware of what the

Imaging may show or the blood test may

show or how your lungs may sound when

someone puts a stethoscope on them right

so so a clinician if you're trying to

understand and help someone then you do

want to look for those things right you

want to look for the things that are

underneath the surface but that that can

be very very important right you also

want to look at everything that's on the

surface right so if you're if you're

engaging with someone you're engaging

with the self right the self that grows

out of the character structure Nest

right so by engaging with and and doing

one's best to understand the self then

you learn about what is underneath of it

right so I may then learn well how do

you respond in certain situations right

just like I could ask you questions or

well when do you not feel well right so

you're asking a person questions because

the idea is to understand elements of

the character structure so how do you

respond in certain situations what's

going on inside of you right what do you

understand about yourself and what do

you not understand about yourself right

how do you bring yourself to bear in the

world around you so there's a similar

process going on but here we're trying

to understand the self and the

understanding of the self can help us

understand the components underneath of

the self because that's where we're

going to go to make things better right

the idea is there shouldn't have to be

Miss history or certainly not mystery

any more than there is in physical

health I mean you know rarely someone

comes in and they're really not feeling

well and and a whole set of everything

that should be done is done right Labs

physical examination history Imaging

right and and you still just don't know

right I mean sometimes that can happen

but it's very rare and the same should

apply here that if we're examining a

self right and we're looking for the

components out of which that self comes

right then we should be able to

understand well enough to go back to the

components of self and to make change so

that the self is in a better place right

and and that self can then be empowered

can feel humility right can then come at

life through the altruism and gratitude

that we see because again you show me

someone who's coming at life through

altruism and gratitude and is not happy

with their life and you'll be showing me

something I've never seen before

something entirely new so if we want to

get there we want to know how to get

there and there are ways as there should

be that parallel physical health that

aren't mysterious that we can come at to

make understanding and change

I'm wondering about the role of anxiety

in all of this

the reason I ask about anxiety is that

you said that so much of character

structure is determined by a set of

predispositions and potentialities

and earlier we were talking about

example of either being afraid or

unafraid in particular environments or

feeling like we can walk into a

classroom and learn or whether or not

we're overly concerned about what people

think about us or both right it could be

a mix

whether or not we can Embrace novel

environments in safe and adaptive ways

whether or not we can grow from them

as opposed to whether or not we can be

overtaken by them or perhaps even

injured harm psychologically physically

or both

anxiety to me is is a very basic

function I think about it in terms of

the autonomic nervous system and degrees

of excitability and

Etc and ability to sleep at night and

ability to wake up feeling reasonably

good but not have a panic attack but

anxiety to me does seem like a key node

in all of this meaning

you know most people including myself

I don't walk around thinking about my

character structure I don't walk around

thinking about how I'm going to behave

in a bunch of hypothetical environments

think about the fact that

most mornings I wake up and I feel

pretty good to be quite honest not as

good as I would like to feel and then

absolutely because anything's wrong but

because I think I'm wired to be a little

bit more on the anxious side and to

predict what's going to happen next and

what needs to be done and so until I'm

actually engaging in certain behaviors

that anxiety hums a little bit high for

me the gears turn a little bit faster

perhaps than I would like when I wake up

in the morning but once I engage I feel

like that the speed of that gear turning

matches the demands of Life pretty well

I feel um agency okay

um

so if you don't mind could we explore

this this feeling of anxiety or lack of

anxiety that I think people are pretty

familiar with within themselves at

different times of day and under

different conditions because to me it

seems like it

um an interesting lens to to explore

this notion of character structure and

defenses is anxiety a healthy defense or

an unhealthy defense or does it simply

depend on the circumstances

well we all have some degree of anxiety

in us right we all have some awareness

that like we're navigating the world and

like not everything is is perfect right

this is not Nirvana so there's some

anxiety within us and the thought is

that that anxiety can keep us Vigilant

about the things we should be vigilant

about you know health and safety right

but that too much anxiety Then becomes

counterproductive and we can look at

this in a very regimented way right so

so some anxiety makes sense right it

keeps us being careful it keeps you

because you're being careful as you're

pulling out of a driveway for example

sample right so okay it can be it can be

absolutely fine but let's say you bring

something to clinical attention that

isn't absolutely fine right let's say I

didn't know you and you come in we have

the example that that we that you used

before where where you you walk into

work and there's a group of people that

you that you know well and like right

let's say you told me when I walk in

there I I feel very anxious right I

don't feel like things are okay right so

then we would go through we said that's

not good right maybe it's impacting your

professional life things are not going

well like you really want this to change

because it's impacting your life in a

negative way and we say okay let's look

at that from the perspective of

structure of self right so first

unconscious right is it that just

genetically are you built with just

higher levels of anxiety right so we

could learn okay have you always been

anxious like this is has this always

been in your life since you were a

little kid no matter what so we're

looking for biological nature so to

speak variables we might also look for

things that that have happened to you

that are lodged in your unconscious mind

right is there trauma that you haven't

processed right that now is underneath

the surface but is spinning off more

anxiety right let's say you tell me oh

it wasn't that long ago you started

being anxious ah like did something

happen like did you walk into a group of

people and I don't know you tripped and

you felt bad about something right and

then then you get more anxious right so

are there things going on underneath the

surface that are impacting you like

let's let's look into that right because

that's the biggest part of the iceberg

right then your conscious mind we could

start thinking about okay what what's

going on what are you actively thinking

about right so this is where sometimes

cognitive behavioral techniques can can

come into mind like are you thinking

like oh no I'm scared it isn't going to

go well right like are you having

thoughts or the thoughts and making you

more anxious right what's going on in

your conscious mind right I would also

be very interested in the defenses

around you so for example do you tend to

avoid right has this been getting worse

for three months but but you just your

mind wouldn't acknowledge it right and

by the time you have to acknowledge it

now it's really bad right or do you not

avoid and like this started just started

happening and you want to nip it in the

bud right so I would be interested in

the defense mechanisms right that are

girding your conscious self and I would

be interested in the character structure

what decisions are you then making like

are you going anyway right are you

having trouble so sometimes you avoid

are you then making decisions that make

you late and that causes problems how

does it impact you once you're there are

you engaging differently with people

doing your work differently so I want to

understand the character structure and

ultimately you understand all of this by

probing the self that's riding along on

top of it and then what is the

experience of that self like do you see

that okay this is a problem and I want

to address it but like look I know that

I'm good at what I do and you know I

mean this isn't some like awful thing

about me I just have to deal with it

right or is yourself impacted when you

start thinking maybe I can't do this

anymore I'm not good enough or you know

we want to understand what's the

experience of the self right and if we

do all of that how is it that we don't

get to a place where we can understand

that anxiety right and we can make

things better so just like in physical

health okay maybe we can't but that is a

dramatic outlier if we bring ourselves

to Bear we would say you should not have

to have this in you right because it is

something negative it is making

unhappiness for you it is taking away

from empowerment right and it's also

taking away from humility right because

if someone's beating up on themselves

you're beating up on yourself about it

then that's not humility right then that

that's being sort of falsely persecutory

right this is not an honest humility to

that it leads us away from health so

it's like we don't want it to be this

way right because that is working

against agency and gratitude so we can

understand it and we can go after it and

make it better

one of the most common questions I get

on the internet and I get a lot of

questions is

what can be done to improve confidence

you know and I've thought a lot about

that question and you know what is

confidence in the context of what we're

talking about now is one reasonable

definition of confidence our ability to

trust our predispositions and our

potentialities enough that were we to

encounter scenarios a through z

we feel pretty good that we would

respond the right way in a way that

um wouldn't threaten our conscious mind

at a core level right you know that we

wouldn't

um I used to use the term and joke a lot

in my laboratory uh with the the phrase

you know dissolve into a puddle of our

own tears right it's kind of this like

hyperbolic explanation of of what I

think many people fear like they're

going to be called upon to answer a

question publicly or give a speech or

they're gonna be at a critical moment in

a relationship or something and they're

and just everything is just going to go

so badly wrong that it's just gonna

dissolve them as a person it's

impossible right dissolving a bottle of

our own tears is impossible but I think

that's a fear that a lot of people live

with because we can get into this a

little bit later and we will I'm sure

you know this notion of like protecting

one's ego is it seems really vital to

being a human being some level like we

don't we don't want to dissolve into a

puddle of our own tears so is confidence

the ability to trust ourselves in a

bunch of different contexts

and at the same time I I do have to

raise the this notion of narcissism I

think um uh you know this word gets

thrown around a lot lately but it seems

to me that any

um truly psychologically healthy person

would also not want to be the idiot that

thinks that they're better than they

actually are that's a

um what are your thoughts on this well I

agree with the things that you that you

said about confidence except I would add

two factors that I think are like really

big big factors right right one being

State dependence and the other being

phenomenology right so think about the

state dependence first right when we're

talking about confidence it's it's not

uniform right or it's not automatically

uniform right so if so if you were to

tell me oh I lack confidence right then

I want to understand is that across the

board is like is that a way that you

feel about yourself that like I I'm not

good enough at anything for example

simple right or do you lack confidence

in a specific area right and this is

often the case right and it's a huge

difference right it says that person has

the Machinery of confidence so to speak

right they have the potentialities and

the predispositions for confidence right

when that character structure that's

self-built upon it is in engaging with

the world right but they're not able to

bring it to bear in certain in a certain

special situation so to speak so for

some people for example the way we most

often see this is like the carve out of

romance right where because it's so

emotionally Laden right and like

rejection can feel so bad right that we

can see people who are very confident in

many many aspects of life but they are

very diffident about romance and they'll

say different oh it never works out for

me or no one will ever like me right and

and you see like that's not how that

person actually feels right about

themselves as a whole human being right

which which is then we are coming at how

to make that better in a way that's very

robust right we might say something like

hey here's the good news is you have the

tools and the Machinery that you need

right you're confident in so many ways

right in fact maybe in all ways except

this one so let's go take a look at like

why is that special

right and then and that where are we

we're back to is it something in the

unconscious mind is it is something in

the in the conscious mind about how that

person is engaging right so we we have

to understand what the state is and if

the lack of confidence is State

dependent if the person is not confident

across the board then again we go back

to the same we always go back to the

same places to look right but then you

might more think okay is there an impact

of childhood trauma or early life trauma

that that took away from that person you

know their ability to to gain confidence

right because if you have no confidence

across the board there's a deeper

problem right because there would be

something anyone can be good about and

feel confident in right so the state

dependence is very important as is

phenomenology so what is your experience

of being confident if you tell me

well I'm let's say in a different

version of this example you say you know

actually I'm quite I feel quite

confident when I when I walk into a room

of of people I say okay I want to

understand more about that too right

because if I ask questions about that

and you say well I feel confident

because you know look I'm I'm a pretty

smart person I can think on my feet I

can I can deal well with with people if

something doesn't go right I can recover

from it like I've got you know it's why

I feel confident you know and say okay

that sounds pretty good if you say well

I feel confident because I know that I'm

better than everybody right now we have

a problem right right like that's not

going to go well in other you know in

other uh aspects of life and engagement

like this you know it's not going to

lead to humility and gratitude like so

so where's that coming from and again

maybe there's a deeper problem right as

you say about narcissism right which can

be a a reaction right which is a

reaction to vulnerability right so then

there's was a reaction information and

now the person is actually deeply

diffident right but presents is very

very confident and with a sense of

superiority and that that's not a recipe

for for happiness right so so in the in

approaching it we we do want to

understand all the things that you said

what are the factors and the the set of

predispositions and the set of

potentialities but then what's the real

world experience of that across

situations and what is the person's

experience of that inside which is why

if we're going to understand and help

people like that's the understand part

right you know it's why the conveyor

belt medicine you know it doesn't work

right in situations where we're dealing

with human beings like mental health

right we have to understand something

about people to understand whatever

they're telling us means otherwise you

have no context so you have no knowledge

another very common set of questions

that I get that I believe is very

directly related to this is about

beliefs and internal narratives you know

people ask me all the time

how can I change what I believe about

myself

and they also ask how can I change the

script in my head how do I typically

it's how do I shut down a particular

narrative in my head it seems to fit

very well in thinking about structure of

self because as you pointed out you know

the the self or the structure of self

includes the unconscious mind you know

what's going on below the surface of the

water in this Iceberg model what's going

on in the conscious mind that the

conscious mind is protected by these

defense mechanisms that grow up from the

unconscious mind

from that comes a character structure

and then this thing that we call the

self right right but when it comes to

beliefs and internal narratives those

seem to me things that people are pretty

well aware of in fact the very example

that people are asking me this all the

time how to change beliefs internal

narratives means they are aware of them

it also suggests that

for many people out there their beliefs

about themselves and their internal

narratives are not healthy or at least

they don't feel are serving them well or

that they are intrusive

I don't know how open people are about

their beliefs and internal narratives

when they come to you in the in your

clinical practice but

um if you could tell us a little bit

about beliefs and internal narratives

and uh whether or not they are important

to rewire and and reset

this part is extremely important right

so imagine for example that I'm saying

to myself over and over again that I'm a

loser right or I'm not good enough right

I mean imagine trying to go through life

and someone else we're saying that to

you all the time right I mean it's worse

when it's inside your own head right so

what's going on inside of us our

internal dialogue our internal

narratives are extremely important and

here's where we run into a very big

problem is that we live in an era and in

a culture that is very attuned to Rapid

gratification right and all of this that

we're talking about can change but it

does not change quickly and it's amazing

to me me when you know you'll see under

Insurance paradigms often right no

matter what's going on with someone they

have 10 sessions of cognitive behavioral

treatment right if there's something

like we're trying to change beliefs it's

a guarantee of failure right because

beliefs don't change that fast right so

imagine for example that we you know you

and I chose a word a random word and we

decided to say it 500 times right we'd

each be saying it tonight right it's not

going to be out of our minds by tonight

but because we what took a random word

and said it 500 times right so imagine

that there's something that's highly

emotionally Laden and we've said it

thousands and thousands and thousands of

times right that's not going to go away

quickly right but it can go away and

during the process of it atrophying

right our lives can get better right

this is the opposite of hopeless right

it's actually very very encouraging but

in a world that's rapid gratification

right like how do we fix this how do we

fix this now that doesn't acknowledge

this we hear all the time that a person

has failed therapy right like this is

said all the time that person failed it

what does failed therapy mean right I

mean I think therapy failed that person

right but we we label like oh a person

isn't better right but there are things

going on inside of us that could take

months and months or years to make

better now again that's okay if we're

aware of what's going on just the very

fact that we understand and we're making

change right it helps us feel better

about ourselves and more confident right

that we can change all of this but we

have to approach it in the right way so

let's say that I'm telling myself over

and over again

um you're not going to get there right

and let's say a place I want to go

professionally right or no one's ever

going to really want you right if if I'm

looking for a romantic partner right so

so imagine these things are going on and

they're going on over and over again and

you can imagine now that it's intruded

into the unconscious mind it's going on

in my conscious mind my defensive

structure is Shifting in negative ways

I'm becoming more avoidant like nothing

about this is good and I want it to

change and I wanted to change to

something that says like you can do it

right or you're lovable right or you can

be a good partner to someone so I want

to change it right so imagine now when I

start to make that change I'm blazing a

path right and and I'm blazing a path

where there wasn't a path before right

and I can blaze a path and I can go

through that path but that path is going

to be nothing like maybe the four-lane

highway right adjacent to me where the

thing that I've been telling myself for

years and years and years born of trauma

right is is you know is going back and

forth right I mean it's got a four-lane

highway I'm cutting a path right but

over time you cut that path more and

more you tread that path more and more

you take energy towards that path it

becomes better now let's imagine like

the path is well lit and it's 12 feet

wide and maybe we can pave the path so

more more traffic so to speak goes down

it and we're taking energy away from

that four-lane Highway and maybe it

starts to be overgrown a little bit and

there are cracks in the road like we can

change all of that but we have to

understand what's going on and and

identify it like what is going on inside

of me uh what do I make of it right how

do I understand the process of change

how do I increase my empowerment during

the process of change if we come at it

the right way all of this can be changed

it's not hardwired in us it's just very

very strongly reinforced the same way

our brains are built this way so look we

don't forget our own names right you

know we don't forget where we live you

know back when we were hunting and

Gathering and we don't we don't forget

you know where where the good fruits are

right I mean this goes on in human life

now like we have to remember things it's

very very important if something is has

high emotional balance and we've thought

it a lot that we don't forget it but

that mechanism gets hijacked by things

that are not good for us and we can take

it back but not if we don't understand

what are the tools or the questions that

you uh give or ask of patients in order

to help them along that pathway because

I totally agree that changing beliefs

and internal narratives is very very

hard just one quick example that meshes

with the physical health realm I have a

friend and colleague he's a very

accomplished scientist who is very

overweight for a long period of time he

finally made some behavioral changes

that allowed him to lose I think it was

in upwards of 80 pounds a significant

amount of weight felt much better looked

much better

he just delighted in his ability to do

that but then started to reveal to me

that he was deathly afraid that he was

going to lose control and start eating

the way he was before and stop

exercising in a way that would return

him to his previous weight and feelings

of malaise

and I said well all the things you're

doing are in the direction of Health

none of what you're doing speaks to the

possibility of this all crumbling this

was the dissolve into a puddle of my own

tears kind of narrative but at this

point coming from him

and he just said I know but despite

doing all the right things I'm still

incredibly afraid that it's going to

happen it was as if that the beliefs and

the internal narratives hadn't changed

despite the fact that he was engaging in

the world differently and more

positively uh I haven't checked in with

him recently to find out where he's at

with this now several years later he has

kept off most of the weight not all they

gained a little bit back but he's still

far healthier than than he ever was so

hopefully he's experienced some relief

but you know what do you tell a patient

who is saying you know I've got this

Loop in my head that tells me I'm not

good enough or that even when things are

going well they're going to return to

that state that I fear so much once

again this kind of like you know lack of

agency right just lack of agency lack of

agency lack of empowerment

what what sorts of practical tools can

can one give themselves or that you

would provide to somebody no matter what

is behind what's going on in that

person's mind it's addressable

but you don't know what it is and how to

address it until we ask the question of

what's going on inside right so if he's

afraid that he's going to gain all that

weight back right and he has a history

that if significant negative things

happen he throws self-care to the wind

right then we'd come at it through that

pattern right because he would have a

very you know he'd have a good reason to

be worried right because of this pattern

of something bad happens and I can't I

don't take care of myself for six months

you know maybe someone I'm just making

this up and maybe someone in his life is

ill or he's fearing a death you know and

if it's just something that would say

that's a very legitimate fear to have

like let's let's talk about that like

let's look at where that comes from

right what got that person into that

pattern in the first place right by

understanding the pattern and by working

together right can we can we Stave that

off right but it could be different the

person might say well I'm really I'm

having a lot of food cravings right and

we be like okay what does that mean

where's that coming from or maybe he's

depressed and when and he's getting

depressed and when he's depressed he

can't stop eating more right so you know

you would look or it might just be plain

old fear like this is so good right that

that I'm worried it will go away right

then we might want to reinforce like

okay like you know you're a person who's

able to use circumspection and

perseverance and preserve goodness right

so like you do that and you do that

really well so let's let's make sure

we're doing that here right so you know

a lot of times a person is worried but

that worry is coming through the lens of

Health like they're healthy right so

then we look at okay can we Sue that way

where again where's that coming from

right we can come at it and reinforce

the positive

but if there is something negative

there's a trauma-driven cycle there's

depression there are Cravings we can

understand that too so so I come back to

this idea that there's answers to just

about everything and in a very

regimented scientific way it's not that

hard

to come to them right just like in

Physical Medicine like we have the prime

we have the tools that we need to bring

to bear but you have to understand the

person again if you come in and say I'm

not feeling good and someone else comes

in and says I'm not feeling good the

doctor better not do the same things

right it says how are you not feeling

good okay let me understand that and

then let me map that also to you

whatever underlying state of health you

may have or diagnosis you may have the

same is true in mental health if we just

apply that then it's remarkable the good

that we do which I've seen very

consistently across 20 years of doing

this not only in my own practice but

like who are the people who do really

really well trying to understand and

take care of people including sometimes

not doing too much and realizing like

hey this person is okay like there's a

state of health here but this person is

worried how do we reassure them right

how do we help someone living a good

life live a better life right if we're

going to do all of this we have to

approach people as individuals it's just

I mean the science tells us that and

Common Sense tells us that too but if we

do that that a person can get to the

place they want to be I'd like to

address a different person as an example

a hypothetical person okay and I'm

certain there are many many of these

people out there

these are the sorts of people that think

okay there's a self and a mind and a

unconscious mind Etc but you know at

some level

why not just do what needs to be done in

life like the people that don't want to

explore the self you know because to me

it seems so absolutely clear that just

as it's important to have a certain

level of endurance strength flexibility

so that one can extract the most joy and

agency and gratitude and empowerment and

humility from life

that it makes sense to explore the self

to ask you know where am I internally

strong where am I internally weak you

know where might I perceive myself as

strong where as I'm actually weak right

these seems like these seem like very

important if not crucial questions to

ask but I know that there are certain

number of people in the world think

all of that is just kind of a waste of

time right it's all about doing stuff

it's all you know why explore the self

you know and um I think

the rest of us are looking at that

person often and thinking well you're

exactly the kind of person that needs to

do this because of the ways that you

grate on other people but but not always

right sometimes these people just appear

to be just very effective they're all

about the outward expression of what

they're doing and I certainly don't know

how other people feel waking up in the

morning and going to sleep at night and

throughout the day but to the person

that

feels like introspection and exploring

maybe even Excavating for trauma that

they haven't been in touch with or

haven't dealt with yet but the person

that feels that all of that is

it's kind of not really worth the effort

and that's all about action you know

what can we say to that person or those

people

put differently does one need to change

and need to believe in the power of

these sorts of approaches

in order for them to work uh we often

hear that people don't change until they

want to change and um and could we also

say perhaps that even for the people

that feel like they're functioning

extremely well in all domains of life I

know no such people and I know some very

high achieving people as you do too I

know no such people uh the only people

who seem to exist in that sphere are the

Nars the clear narcissists that to them

just seem like they're doing great but

everyone else can't stand them by the

way narcissists no one else can stand

you

um

what do we say to to those individuals

because I think it's a big swath of

humanity and I think it um it accounts

for a lot of suffering in the world

including their own suffering yeah so I

would make an appeal to common sense

right so imagine you take someone who

doesn't know anything about health they

don't know they don't know how to

exercise don't know how to eat well they

just don't know and they're very really

unhealthy right they're overweight they

have low energy they have sleep apnea

they don't need to have any and and and

you why not just say to them well like

just go be different

like in fact be different now

why aren't you different right now right

like

of course we would never do that because

it's a it's absurd oh and by the way it

also would be cruel right so it's absurd

and it's cruel so we would never do that

right let's say now you let's say we

fast forward some period of months say

make it up right and we see that person

and wow they are much healthier they

have much more energy they've lost

weight they're physically fit

a lot will have gone on in between those

two snapshots of that person that person

has to learn a lot right how does one

take care of oneself right then more

specifically how do I take care of

myself right what healthy foods you know

will I like what healthy foods will I

will I eat how will I put that on the

table what kind of exercises can work

for me how will they work for me how do

I strengthen muscle how do I strengthen

the heart how do I increase lung

capacity right there's learning there's

diligence

um you know there's stick-to-itiveness

right there's resilience that's how the

person gets there right it is no

different and it's mental health right

if we say wow you feel you feel

diffident across the board or you feel

Superior across the board or whatever it

is like life isn't going well and you

don't have things you want and you know

the self-talk is negative and we say

well look what just be different right

now right I mean it's remarkable that

people will say that at times not just

in a way that's

denigrating an awful for others but to

themselves too right I mean I hear

people say this most often to themselves

like why am I not just different right I

want to be different or what's wrong

with me that I'm not and and like yeah

it's like everything else like you have

to apply understanding and work and

effort like the good news is you can get

to whatever change you want I mean a

person can get to whatever reasonable

change

that person wants like you know I'm 54

years old I'm not going to climb Mount

Everest I'm not a mountain climber right

but if I want to like I want to run to

climb some mountains I want to get out

there and do some things I can go do

that right the same thing is true with

our mental health goals but not at the

snap of a finger not by Magic right it's

through applying the same science and

Common Sense a combination of Science

and common sense that we apply to other

things that's why we go through this

procedure of unconscious mind conscious

mind the structure and function of the

self because that's how that's how it's

done that's how the after snapshot looks

different than the before fundamental

Health perspective as well

that's very helpful and I think it's

going to be very helpful to a lot of

people in thinking about what to think

about what sorts of questions should to

address maybe even whether or not to get

therapy and hopefully we'll remap their

Notions of therapy I mean of course this

critically relies on the therapist being

good to excellent

um and I think in the previous

um sit down we had around the uh in the

episode on trauma specifically you

mapped out a number of the features of

quality therapy so we can refer people

to that if they're thinking about it's

time stamped in that episode you know

what to look for in a therapist what how

to assess whether or not it's going well

or not whether or not to move on or or

stay put with that therapist and so on

you've been telling us a lot about the

structure of our of the self

unconscious mind conscious mind defense

mechanisms character structure self

we haven't talked so much about the

function of self I realize it's been

woven in here or there yes

um

could you tell us about the function of

self the functions of self verb actions

I mean are these things that we are all

doing right now that reflect our

character structure

are these things that um we can change

more readily than trying to snap our

fingers and say okay I'm now going to be

a more altruistic person because I can

decide that right now but then

ultimately I have to engage in some

altruistic behaviors

to to lend support to that again same

with the parallel that I can't just snap

my fingers and say lower blood pressure

you know I have to do some meditative

practices some cardiovascular training

and things of that sort uh what what is

this function of self thing what goes

into the functions of self okay so so

just stepping back to the framing right

so there's these two pillars upon which

we build our lives the structure of self

and the function of self and we've been

talking as you said more about the

structure which is more the nouns of it

like there is an unconscious what is in

that unconscious for example there are

defense mechanisms uh uh how are we

using them like it's not all nouns but

it's more what are those things and then

we start talking about how we put them

into practice the function of self is

much more the verbs right so if the

structure is more nouns the function is

more the verbs right the actual

engagement right so so that would start

with an awareness of I so a function of

self has to start with an awareness like

there's a person there isn't there is a

me that is separate from others right

and I have responsibility for this eye

right like it is me no one else is

guiding it like it's me I know there's a

me

okay then on top of that we start seeing

defense mechanisms in action right

because we're thinking about function

right we're aware that there's an eye

but the first thing that starts

happening to that eye are unconscious

things right so the defense mechanisms

because we're not choosing them right

they start doing things automatically so

if for example I have a defense of

avoidance right then I'm not thinking

you know if it's I'd like to meet a new

person but I automatically am shying

away right then that's not it's not good

right it's a factor right but it's a

factor I'm not aware of until I start

this process of introspecting right so

the defense mechanisms are then kind of

determining the lay of the land right so

in that example I'm sorry to interrupt

but it yeah it's starting to interrupt

but in that example

um the the Turning Away you describe as

reflexive so you're talking about

someone perhaps who would like to have a

romantic partner or meet somebody

have a companion and they go to the

grocery store and somebody says

something as they're reaching for the

milk and you know there's that moment of

opportunity where they could say

something back but instead they just

kind of go oh yeah thanks and then they

they kind of move away and then they the

narrative in their head might be oh gosh

that that was silly or but they don't

really think about the the alternate

possibility or there might be no

narrative

they had off to the produce section and

then they go home and and someone says

oh did anything happen if they're good

you mean he went to the grocery store no

right because it's all unconscious right

okay right now again we can can we

explore that and change that yes right

but it's important to understand that

whatever that nest of defense mechanisms

is like that's what I've got right now

right and I'm living through that right

now right that's it's performing a

function right just because it's an

unconscious function does it mean it's

not a very very important function I can

see in that example how it protects the

conscious mind from risk because there's

always the possibility of rejection

there's a possibility of over

interpretation of what the other person

is talking to them for right like is the

person interested in them or whether or

not this is just you know friendly

banter

um the sort that anyone would have next

to anybody that is not special to them

so I can see how the the uh the

unconscious turning away is protective

against all the negative possibilities

and in some sense is pretty rational

because the the probability that that

one interaction could ratchet up to a a

life of companionship and and romance

with somebody is in uh exceedingly small

really although you could imagine a set

of data points where you string together

you know like five second Clips you know

all like the time something like that

has happened right so maybe this is a

person that you know intermittently like

people are interested in them or saying

hey they're saying hello or showing

interest you could string all those

together and the person hasn't noticed

one of them right and then could have a

very negative C nobody no one wants me

no one's interested in me or whatever

the person is saying but but like it's

different if you see from the outside

like it's objectively different but that

person doesn't know and that's why after

being an awareness there is an eye the

next thing that I think of in the in the

function of self is is the defense

mechanisms in action

what are some other examples of defense

mechanisms in action because I think

there's immense interest in this you

know the idea that we have

unconscious processes in us that are

reaching up out of the iceberg and

preventing us from seeing our life and

ourselves the way that it actually is

occurring and perhaps preventing us from

achieving these ideals of agency and

gratitude empowerment and humility you

know I mean these seem like very

powerful and important forces and and I

and I know many other people out there

want to understand whether or not

what we're doing and what we're feeling

and experiencing whether or not that is

serving us well or not so I think the

the place to start is to say that

there's something very very complicated

going on right the the part of the

iceberg underneath the surface right

that biological supercomputer that's

running at a million thoughts and a

million actions and a million internal

processes a second right is constantly

shifting our defensive structure so so

it's complicated and you can almost

imagine that like one leaves and another

comes in and they're shifting and

there's a little bit of one and some of

another like so it's a very complicated

process but we can look at it and

understand so so an example of a defense

mechanism that's very common and can

cause us a lot of problems is projection

right so give two examples of of

projection so so one is the experience

of sitting in a car right and being

stuck in traffic being a little bit late

right and feeling beleaguered right I

mean this has happened to me more times

than I can count but at some point I

started through my own therapy looking

at like what's going on in me right when

I'm doing this right so the thing about

the be feeling beleaguered right as if

what does that mean like there's

something called traffic that exists and

has a mind and wants to thwart me right

is it individual cars is it the people

in the cars right what's going on is

that I'm having a perception of

hostility I feel beleaguered right but

it's it's anger and frustration inside

of me right I'm I'm the one feeling

angry and frustrated there's there's

there's no one and nothing but me that's

feeling anything about this right but I

have this sense of the world around me

being hostile because I'm projecting my

anger outward right now I think this

isn't good because instead of sitting in

traffic and saying look maybe it totally

makes sense that I'm stuck in traffic

and that I'm not happy like maybe I I

should leave a little bit earlier and I

wouldn't be late or if I'm going to work

should I live closer to work I could

make a whole set of decisions that I'm

not making right or maybe I know I

thought it was going to be a 15 minute

drive and like it was an accident right

and okay there are things that I can't

control I'm not supposed to control

everything right if you think about what

can I control being aware of that and

what can I not control right then it can

make the situation much better so this

doesn't happen with this frequency and

it also takes away the anger and the

frustration right so I I think that's a

good example because it it happens a lot

it's very very common but projection

then also happens with people right so

let's say you and I work together and

we're we're going to do something

collaborative together and

I'm just not having a good day and

something negative happened before I

came to work and you know I'm not at my

best and I'm a little bit I'm a little

bit irritable and frustrated right this

happens all the time where then the

person sits down with someone and then

I'm being irritable and frustrated which

doesn't feel good to you right and and

you may become irritable and frustrated

right and then I say oh look he's

irritable and frustrated right but even

if you don't the fact that I feel that

way right that projection often would

lead me to think that it's you who's

that way here I come wanting to do this

job and you're not at your best it's me

who's not at my best right but we do

this all the time and then we make

incorrect or inaccurate attributions

right so so projection is an example of

a defense mechanism that can cause us a

lot of

trouble right a lot of trouble another

can be displacement where if I'm feeling

anger or frustration say in a certain

realm then I the idea of feeling it at

work and then kicking the dog right like

it's not good that we do that we're not

acknowledging what's going on inside of

us at work what we could change what we

could make better and the dog doesn't

want to be kicked right and the dog is

often you know also the family right and

it could be physical or could be through

words right but the idea that with that

there's something negative being

generated in us but but inside we're

we're perceiving that it's coming from

somewhere else right I mean the thought

is all things to lead us astray right

when they're negative defenses right

there can be positive defenses too such

as altruism right that that someone

could do something negative to me right

and instead of me passing that along I

could decide no I'm going to do

something I'm going to do something nice

for the next person I have an

opportunity to do something nice for

right like that's a defense and

sometimes we could think of it and

decide that way but they're people who

react that way like there's something

negative that happens and they respond

with something that's that's different

from that so defense mechanisms can work

against us they can work for us they're

complicated they're combinations of them

but we can look inside and say for

example if I'm using projection all the

time right and I think everyone around

me is kind of always angry and

frustrated right and there's always bad

traffic right but then as we start to

talk about it more it becomes apparent

that there's a lot I'm angry about right

but I'm not aware of it then then

reflection or therapy right or a good

friend we're talking to can help us see

right that hey this is going on inside

of me right and that can really help us

same with use of humor like if I'm using

humor and um I'm kind of decompressing

uncomfortable situations or things that

make me feel uncomfortable maybe that

greases the wheels of social progress

but maybe over time I come to you humor

in a way that's self-denegrating right

well that's not so good anymore but I

may not be aware of the shift just

because I could maybe be funny in

certain situations that I'm now not

using that for myself anymore I'm using

it against myself and by talking to

people by reflection like we can be

aware of the defensive structure that's

going on inside of us and then there's

not an automaticity to it if you point

out that I'm using projection a lot I

can start to be aware of that just like

if someone let's say you were with me at

the grocery store right and someone says

something nice and I shy away and you

say Hey you know you didn't weren't even

aware someone said hello to you and then

I said I want to be more aware of that

like I want I don't want that thing to

happen unconsciously so maybe now I

think okay anytime someone I don't know

says something I'm going to just stop

and think like what's going on here

right is that person being friendly to

me is it is are they just you know it's

just a person exchanging money the cash

rate so like what's going on so we take

what's on unconscious and we make it

conscious so that we can change it

sounds to me like exploring and thinking

about our reflexes is what's really key

here

um

the example of displacement that you

gave you know kicking the dog I couldn't

help but um smile not because I think

it's a good thing to do I never once

kicked my dog by the way folks terrible

thing to do also he was the size of a

boulder it would have injured me more

than would have injured him but I never

would do such a thing however in

Academia there's this

um phenomenon that's very common that

that I refer to as trickle-down anxiety

where the person running the laboratory

is inevitably under a tremendous amount

of stress grants and papers Etc and

graduate students and postdocs will

immediately be familiar with what I'm

describing but

um for those of you that haven't gone to

graduate school

um this will be a little bit foreign but

you'll think of other examples where

when the lab head is under stress

it's incredibly common for lab heads to

walk through the laboratory and start

asking about experiments and telling

people to do additional experiments and

basically just assigning busy work to

people or pressuring what simply cannot

be moved along any faster and when I was

a graduate student I worked for somebody

who was the exact opposite of this

phenotype when I was a postdoc frankly I

worked with someone who's a little bit

of that phenotype um although I still

liked working for him very much but I

used to have a response that at least

for me was adaptive which was I would

always say I'm working as fast as I

carefully can because no scientist ever

wants somebody to cut Corners no good

scientist anyway

um But trickle-down anxiety is common in

every occupation I think we see this

sort of displacement all the time where

someone's anxious and so they go start

creating anxiety for other people I mean

you can just as you're describing I was

just seeing how pathologic that is for

everybody involved so the the academic

the trickle-down anxiety that you were

just talking about is it's a related but

but it's a different defense mechanism

and it's projective identification right

which is which is causing others to feel

the way that you feel in order to get

your needs met is this a form of

projection and actually perhaps you

could um clarify the definition of

projection versus displacement versus

projective identification okay so

projection is when you don't own it so

so it's not me who's mad it's you right

so I don't own that I'm mad at all right

I just think that it's you even though

I'm the one who's mad right displacement

is what comes out of us or what we're

our attribution can shift right it's

it's not this person who's making me

angry it's that person because that's a

safer person right to to be angry at

right or if I'm then going to take out

my anger right instead of metaphorically

kicking a person who might who might

respond to me in a way I don't want

maybe I kick the dog that's helpless to

respond back right that's displacement

projective identification is there's

there's an expression of an emotional

state inside of a person that then

becomes contagious to other people even

though the person isn't trying to do

that the person says I'm going to make

you anxious that's not a defense

mechanism anymore right so here's an

example I think I think this is the best

exam sample of projective identification

so for a little bit of time at work I

would occasionally lose my keys right so

now I'm trying to go and I can't find my

keys right so they say oh I don't know

where my keys are right so I start

expressing something right and I'm

anxious and I'm tense right now people

around me hear that right and what do

they start feeling they start feeling

anxious and tense the way that I do

right and now they're like well now they

want to now they want to find my keys

right they want to help me so that I

stop spreading anxiety and tension into

the whole environment around me right so

then they help me find my keys I say

thank you my own emotional state comes

down and upon reflection I think look I

don't want to do that right I got my I'm

getting my needs met

by making other people feel in a way

that's like not a good or comfortable

way to feel so here's a way around that

like put my keys in the same place every

day right so then I can avoid that

because it doesn't feel good to me like

then if I get out to my car like I find

you know I'm a little bit I'm breathing

a little heavy like I don't doesn't feel

good because I was just agitated right

and I did that to other people too right

so it's an example of how projective

identification works and it's kind of a

simple example but it shows it's

happening all the time you know all

these things are happening all the time

but we can become aware of it then I

don't lose my keys I don't have to feel

bad about I don't have to activate

myself for no reason and I don't have to

activate other people for no reason so

so thinking and reflecting like change

that thing for the better and it can do

it with much bigger things too thank you

for those clarifications

I'd like to touch on humor for a moment

obviously humor is a wonderful thing or

can be a wonderful thing

I've also seen a lot of examples of

where very smart and or accomplished

people because those are not always

um uh the same thing

use sarcasm

as a form of humor and it can be very

funny but I have to imagine based on

everything I'm hearing from you today

that there's a form of sarcasm which is

an unhealthy defense I'm thinking of the

person that no matter what someone else

says that's positive or or no matter

what someone does that could be viewed

as positive they find some way to

diminish it by like through sarcastic

humor right I I see this a lot and I

think closely nested with sarcasm is

cynicism

in fact I have a family member I won't

name who they are to protect the not so

innocent who used to be very cynical

um and I want to ask you what is the

thing about cynicism and they said well

I have had a particular genre of of

schooling growing up a formal schooling

where if anyone behaved um too happy

expressed too much happiness rather

too much delight they were viewed as

stupid like as if to be happy is to um

to be unaware of of the sophistication

and the importance of things in life

right

um and I hope that this is unrelatable

to most people listening but

um I do think that sarcasm is is a

double-edged blade in this sense and

that cynicism is is perhaps um a

double-edged blade as well but that it

might even be worse than sarcasm because

it's a way of really reflecting back

what's

by definition what's not good about life

what's not good about what's happening

and and it does seem protective right it

protects one from disappointment if

you're already disappointed how could

you be further disappointed it's also

seems to me like a bit of a power move

it's like you're gonna be happy well I'm

gonna take that away forever from

everybody like as something that's like

for myself I mean

um does any of this actually hold in the

inside of the clinical literature

um because again I enjoy a good

sarcastic joke yeah in fact there's a

collaboration around a sarcastic joke it

can be truly funny to everybody but

um sarcasm and cynicism

um I feel like are often used to cut

down what would otherwise be

um benevolence or or bonding experiences