Episode 2 of our Pain Points series with the OTHER Dr. Z!
03:51 Rachel got the Big O (Omicron) & post-infection immunity
08:31 Why a mild case still sucks, the anxiety contagion, public health communication
14:20 Placebo vs nocebo, why words make a difference in suffering
22:25 Long COVID vs long tail symptoms, cognitive distortions
27:15 “Bug chasing” & why it’s a bad idea
31:07 Depression, reductionism & the biomedical model of health
38:15 The psych bubble, role of thoughts, emotions & coping behaviors
48:27 The social bubble, role of relationships, isolation, & other factors
51:47 Depression’s complex nature & treatment tools
58:14 What is imposter syndrome & why it’s so common
1:05:20 4 steps to overcoming imposter syndrome
1:16:31 The dark side of benzodiazepines & why they’re not a magic cure
1:20:01 Alcohol, THC, medications & insomnia
1:28:09 Sunlight, stimulants & what to do if you can’t sleep
1:38:42 Napping, melatonin & treatment of underlying factors
1:41:28 Final thoughts, submitting your questions for future episodes
– [Zubin] Dr. Rachel Zoffness, the other Dr. Z, UCSF Pain and Health Psychologist and Visiting Professor at Stanford. Welcome back to the show.
– [Rachel] Thank you, dude, for having me.
– [Zubin] Snarf! Snarf!
– [Rachel] No.
– [Zubin] No?
– [Rachel] we’re not doing ThunderCats today.
– [Zubin] No ThunderCats? Oh.
– [Rachel] Not today.
– [Zubin] Oh, so we’re what we’re on like episode two of Pain Points now?
– [Rachel] Yeah, episode two of Pain Points.
– [Zubin] What is Pain Points? We take questions from you guys, from the audience and we answer them best we can with the framework that everything is biopsychosocial.
– [Rachel] Yep.
– [Zubin] It’s got a biological component, a psychological component, a social component. And in fact, you wrote a book which I got to pitch ’cause this thing is the bomb, “The Pain Management Workbook.” And what’s great about this is it’s actually action items to make you feel better.
– [Rachel] Yeah.
– [Zubin] Be better. So thank you for doing that.
– [Rachel] I got really mad about the state of pain management in America. Like I just think we’ve been mismanaging pain for many decades and that’s actually a known entity, it’s not my opinion. Even though I have strong opinions about it. You know, we have this opioid epidemic, which people are sick of hearing about, but more importantly, chronic pain is on the rise. So there are things we can do about pain. And step one is understanding pain. And no one gets taught pain. So I just stuck everything I did in a book, because a lot of it is not affordable for most people. So that’s actually why the book was born. I just wanted to make it accessible and affordable to everybody.
– [ Zubin] So people, I’ve read this book, for people who’ve actually read it and have given me feedback, it’s transformative.
– [Rachel] Really?
– [Zubin] Yeah, because you’re doing something.
– [Rachel] Yeah.
– [Zubin] It’s a workbook.
– [Rachel] Right. Yeah.
– [Zubin] That’s what I love about it. Yeah. Now, you said something there like, before we get into people’s questions, ’cause we’re gonna talk about like Omicron, we’re gonna talk about depression, we’re gonna talk about, hang on…
– impostor syndrome.
– impostor syndrome, which both you and I suffer from.
– [Rachel] I have so many questions for you.
– [Zubin] We’re gonna have an impostor off. Like who’s the bigger impostor.
– [Rachel] Oh great.
– [Zubin] Yeah. It’s gonna be like that John Travolta movie “Face/Off,” where we, you know, peel off the veneer of identity and underneath is just the scathing impostor.
– [Rachel] Sounds scary.
– [Zubin] It’s terrifying.
– [Rachel] Yeah.
– [Zubin] I love fear.
– [ Rachel] It sounds like Skeletor.
– [Zubin] No!
– [Rachel] I said I wouldn’t go there, and then I just did.
– [ Zubin] Oh no, we’re not gonna do, we’re not gonna do ThunderCats. But we are gonna do He-Man. Dude, Skeletor was the best. Remember, He-Man’s sidekick, that weird cat, Battle Cat? So…
– [Rachel] Yes! Oh, yeah. It was like a giant-
– [Zubin] Huge, like tiger.
– [Rachel] Huge mammoth.
– [Zubin] And when it wasn’t transformed, when it was just like the standard cat-
– [Rachel] Damn, I just opened the He-Man.
– Pandora’s He-Man box.
– I’m so sorry, everybody.
– [Zubin] Pandora’s He-Man Box sounds like a dirty picture. So…
– [Rachel] Oh, man!
– [Zubin] So we started on a good foot. So this little cat was a coward.
– [Rachel] Oh yeah! And then it like morphs.
– [Zubin] It morphs into this battle machine that’s ready to fight Skeletor.
– [Rachel] Something happens when you like take me back to ’80s cartoons. Like my head sort of explodes. I just haven’t thought about it since 1986.
– [Zubin] But yet it’s there in your limbic system.
– [Rachel] Somewhere.
– [Zubin] ‘Cause we’ve been conditioned by watching hours and hours, and hours of this garbage. Yeah.
– [Rachel] Yeah, right. Somewhere in my brain. Can we go back to the listener?
– [Zubin] Do we have to? I mean, yes. So we were gonna talk about benzodiazepines.
– [Rachel] Totally.
– [Zubin] Things like Xanax and Valium, and what was it?
– [Rachel] Klonopin, Ativan.
– [Zubin] Klonopin, and if we have time, we’re gonna hit insomnia.
– [Rachel] Totally. And the things we don’t get to, we’re gonna get to next time.
– [Zubin] Yeah, this is a series, right? And I keep thinking, okay, when are we gonna cancel this series when people start saying, “I don’t like this anymore”? And I keep getting messages from people saying, “This is the best thing you do so keep doing it.” So.
– [Rachel] Wow.
– [Zubin] I know.
– [Rachel] That’s lovely.
– [Zubin] And it’s because of me, it’s not because of you. Let’s be honest.
– [Rachel] It’s definitely because of you.
– [Zubin] You write a book, I mean. I’m gonna pitch the book one more time. Where can you find it? I’ll put a link. Amazon. Yes.
– [Rachel] It’s on Amazon. Yeah, it’s cheap. It’s pretty cheap.
– [Zubin] And it was like, yeah, you just want people to read it. So, and I do too. So, alright, let’s start with Omicron. Now, this is what’s amazing. This interview today almost didn’t happen because you got the big O, shame! The scarlet letter.
– [Rachel] Oh, you don’t know.
– [Zubin] The O.
– [Rachel] Oh yeah, there are people who still won’t see me, just to be clear, including some of my patients, because I tested positive three weeks ago. I’m testing negative now, just to be clear, I don’t have symptoms. But I recently had COVID. So yeah, scarlet letter.
– [Zubin] The scarlet letter.
– [Rachel] the scarlet O.
– [Zubin] Let me just recap your medical history here for people, so they understand. You are fully vaccinated and boosted.
– [Rachel] Correct.
– [Zubin] You had tested positive for COVID back in 2020.
– [Rachel] Correct.
– [Zubin] But we don’t know if it was false positive or not ’cause you had no symptoms.
– I never had symptoms.
– [Zubin] No symptoms.
– [Rachel] That’s right.
– [Zubin] You then started feeling badly, and by the way, so you said some of your patients won’t see you because you were three weeks ago tested positive?
– [Rachel] People that are just scared.
– [Zubin] You show up at my door. We immediately hug.
– [Rachel] Right. Good point.
– [Zubin] Because I know that I’m vaccinated, boosted and that you are recovered.
– [Rachel] I am recovered. And I am told, and I want to know this, one of my questions, now that I am recovered, I have heard that you get some immunity after having had it. Is that true? And how long does that last? So I have some immunity to getting it again for like a window. Is that true?
– [Zubin] Yes, it is absolutely true. And it’s not just, so there’ve been some studies on this, looking in a particular direction. So the direction of you got infected at some point and then you got vaccinated. Now, people who’ve had that particular progression have really good immunity. People who go the other direction also probably have really good immunity.
– [Rachel] Great.
– [Zubin] And by immunity, there’s two aspects of it that people should understand. One is the neutralizing antibodies that circulate in your blood.
– [Rachel] Once you’ve gotten it.
– [Zubin] Once you’ve gotten it. Those last for probably three months or so. And they really start to wane. Those are the antibodies that prevent you from getting mild or moderate infection in the first place. So at very high levels, you’re pretty safe. That’s why in the early days of the vaccine, people were like, oh, 90% effective against even infection. Right? But they wane over time. Whether it’s natural infection or whether it’s vaccine. And that’s why they talk about boosters ’cause they wanted to bump back up the neutralizing antibodies to reduce the chance of infection. But here’s the bigger question. You have a deeper immunity, right? Remember “The Lion, the Witch and the Wardrobe”?
– [Rachel] Yeah. I love that book.
– [Zubin] Aslan talks about, at the end, he talks about, you know, there’s this magic and then there’s the deep magic.
– [Rachel] I remember.
– [Zubin] That ultimately cracks the stone that he’s crucified on. It’s like this very powerful thing. That’s what memory B and T cell immunity is like. So you had vaccine-based immunity where the first dose gives you neutralizing antibodies. The second dose really solidifies the memory B and T cells that then live with you so that, it takes a few days to spin them up, but they are the ones that prevent, maybe for as long as your life, we don’t know yet, but it’s long-term, severe disease. So you got those from your vaccine. And then you got another booster from your natural immunity.
– [Rachel] Omicron.
– [Zubin] Omicron.
– [Rachel] When I got it.
– [Zubin] And Omicron also because you’re now immune to multiple parts of the virus, not just the spike protein, you get a broader immunity. And I suspect you’re gonna have more resistance to any future variants that come up. Now that doesn’t mean go out and get Omicron. Why? Because you experienced it, right?
– [Rachel] Yeah. I don’t want it again. And I’m gonna tell everyone what that experience was like. ‘Cause I think millions and millions of us are gonna be having this experience if we haven’t already. But why does my immunity wane in three months?
– [Zubin] Because circulating antibodies, those proteins, that form, that recognize aspects of the virus and bind to them and then trigger other parts of the immune system to kind of sort of gang pile on them, those are designed to wane over time. Because if they didn’t, every single virus we get exposed to triggers antibodies, our blood would be slush. It’d be full of protein.
– [Rachel] Perfect.
– [Zubin] So they come up when we need them. And then they recede. But the memory source stem cells that produce them, the B and the T cells, the B cells produce the antibodies and the T-cells provide support, they’re there for long, long times. And that’s why people like Monica Gandhi and others have said, immunity is our only way through a pandemic. And this immunity is in fact long lasting against severe disease. Which is why people like Paul Offit, who just was on my show, have said, I’m not sure we need boosters for young healthy people, because they already have this deep immunity. Yeah. So back to you.
– [Rachel] No, it’s just to say, and I suspect a lot of other people have experienced this too. When I got sick, by the way you were saying like my medical history. I am young. I am fit. I am boosted. I am vaxxed. I exercise all the time for my mental health. I’m like a runner. I’m the slowest runner you’ve ever met. But, so I got sick. And what I had been hearing was, Omicron is mild. That word mild is like at the top of everyone’s list. It’s everywhere. It’s on media. It’s on Twitter. It’s everywhere. Mild, mild. I was so sick that I couldn’t get out of bed for something like 12 days, like the fatigue and lethargy. And I don’t want to scare people because at the end of the day, I am told that really, this is what the flu feels like, and sometimes worse. And to be totally transparent, I have never had the flu, somehow. So I don’t know what the flu feels like. But to me, mild, I just think we need to like talk about what this word mild means. To physicians, mild means you’re not hospitalized. Mild means you’re not on a respirator. Mild means you’re not going to die.
– [Zubin] Mild means you’re not my problem as a doctor. You’re your own problem at home.
– [Rachel] See? And that is a major communication breakdown. And I am all about good communication that makes sense to people like me. So I, and I had also been hearing, in fairness, the common definition of mild among friends and colleagues who were like, “Oh, just a few cold symptoms for few days. And then I was fine.” Now, I was knocked on my ass, and I am like an Energizer bunny. You can not knock me down. Like I wake up early, I get a ton of shit on throughout my day.
– [Zubin] You’re Battle Cat.
– [Rachel] I am like He-Man’s cat.
– [Zubin] Right. Whereas I’m Orko, the weird little ghost guy that would follow him around.
– [Rachel] Totally. You’re definitely Orko. We can talk more about that. You’re definitely Orko.
– [Zubin] Orkogenesis.
– [Rachel] Right. Great. But, but when I couldn’t get off my couch for like 10 days, I was scared. And I want to be clear about why I was scared. Now, if this was just the flu, I would, anytime before now, I would have been like, oh, this is just what the flu does to you. It knocks you down. And then in a couple of weeks or whatever, you’re fine. You get your energy back, you eat chicken soup, whatever. Because it’s COVID, and because we have been hearing in our ears for two years, this effing thing is gonna kill you. You’re gonna get long COVID, you’re never gonna be okay again. I was petrified. I’m so annoyed that that happened to me because I am hyper logical. I’m a scientist. I listened to people like you, and I collect information. And I know logically that being my age, no co-morbidities, blah, blah, blah, chances are very high I’m gonna be fine. And what everyone keeps saying to me is COVID seems to be one of these animals where you just don’t know. Like you know everyone has a friend, and I have a patient actually, I have my first long COVID patient, who was like 34 year old, healthy dude, no comorbidities has had long COVID now for like almost two years.
– [Zubin] Wow.
– [Rachel] Yeah. I don’t want to scare people. But that’s the thing that’s happening. We know that that’s happening. But long COVID is a biopsychosocial recipe just like every everything else. And I don’t want to go down that rabbit hole right now, but there’s things going on with him, of course, in his biopsychosocial recipe that are maintaining the fatigue and the lethargy and the brain fog. But just to say, because I know that that’s an option and because I’ve been receiving all of this panicked information about it from the media, it wasn’t a casual cold for me. And it sure as shit did not feel mild.
– [Zubin] That, okay. Okay, this is worth really diving into. You were incepted to some degree by the overall biopsychosocial. So the social component of it, whether it’s the media, whether it’s hearing about it constantly, whether it’s the social component of hearing from your own patients, hey, this is what my experience was. And how will you roll the dice? Even when you’re young and healthy, some people end up in ICU with ARDS and stiff lungs and the post ICU syndrome and all these things that we’ve talked about on my show. Okay, so all of that syrup. Turns out, this happens with flu too. Like how much of chronic fatigue syndrome, how much of fibromyalgia, how much of these syndromes are long flu? Are long Epstein-Barr virus? Are long mono? We don’t know because we haven’t studied it properly. And so when you think of flu, like I’ve had mono, I’ve had flu before, I’ve been out for two weeks like you, unable to get out of bed, full-on like just feel like I’m hit by a truck. And then for a few months afterwards, I’m not right.
– [Rachel] I’ve heard that.
– [Zubin] Exactly. And so if I had had the same symptoms like you with COVID with all this milieu I would have felt like you did, “Oh my God, like, do I need to go to the hospital?” And you know, this manifests in a way psychologically, but it manifests also in a logistic way. So now the hospitals are full of people that think they’re dying, that wouldn’t normally go to the hospital, and look, you do want to go with COVID because, again, this is one of those things we’re still learning about. But the idea that we’ve created this anxiety contagion. And so your point to messaging, when we say mild, that is very deceptive, yeah.
– [Rachel] Right. It’s so deceptive, and then when you get the symptoms that you’re actually supposed to get, because, by the by, this is a virus. So you get the symptoms you’re supposed to get with a virus like this, which is like the fatigue, the lethargy, the brain fog, the head cold. Because you’ve been told it’s mild, you’re like, well, crap, do I have a not mild version? And does this bode poorly for me? And not for nothing. You know, a lot of people have heard the word placebo. And the word placebo is a little bit more complex than really what we’ve been told. Placebo is not just a sugar pill. Placebo is language also. So if someone says, as you did to me, “You’re going to be fine. This is what’s expected. You’re going to be fine.” Language matters a lot to the brain and to your physiology. So my brain heard that message and it internalized it. And, thank God, that I have friends like you and other people who said that to me. And I believed that. Nocebo is the opposite. And many people have not heard the word nocebo. Nocebo is language that conveys that you are effed. And by the way, I had a dear friend, who is a physician, who does obviously not know about nocebo. And on day 10 or so, I was feeling worse. Like literally I felt like I had been hit by a train, and I couldn’t move, which is scary for me. And like, and I texted her, and I was like, “Is this normal?” And she said, “Oh man, like day 10 that’s when people go to the hospital.”
– [Zubin] Oh dear Lord.
– [Rachel] Right.
– [Zubin] Nocebo effect.
– [Rachel] You got it. And I felt the adrenaline in my bloodstream. I felt the cortisol. Guess what cortisol does to your immune system, by the way?
– [Zubin] It suppresses it.
– [Rachel] It tanks your immune system! So when you have a virus, cortisol, by the way, is a stress hormone that your body produces when you’re feeling stressed out or anxious.
– [Zubin] Also called… Actually, no, nevermind. Keep going.
– [Rachel] Yeah.
– [Zubin] Yeah.
– [Rachel] But so when you get a nocebic message, which has a message of danger, your body produces adrenaline and cortisol, which, ta-ta-ta-da, suppresses your immune system. So if you’re already sick, chances are high you’re actually gonna get sicker and not recover. So I got so angry, I muted her. Like I didn’t tell her this, but I like muted all of her incoming text messages. She was like, day 10, that’s like emergency day, that’s when everyone comes in and they can’t breathe, and blood oxygen is low. And I was like, I actually wrote, “Don’t say anything else.” And then I just silenced her. And I reached out to my other people who I knew were not gonna give me catastrophic messages. So that’s my piece of advice number one. If you get COVID, and a lot of us are going to, maybe all of us will, make sure to filter the incoming input that’s coming into your ears. Do not solicit input from people who are highly anxious about COVID. Mute them. Mute them. Don’t call them. Don’t ask them for advice. If they are catastrophic or anxious about COVID, they’re going to have a nocebic effect on your health. So listen to people who are good, reputable sources of information, like Zubin or whomever you’re getting your information from, who have facts and who are gonna state facts, but are not gonna state facts in a panicky, sort of negative information nocebic way that’s gonna trigger your cortisol immune suppressing system. You want the opposite. Does that make sense the way I said that?
– [Zubin] I don’t think anybody’s talking about this honestly.
– Okay, let’s talk about it.
– [Zubin] This is crucial. Like what you just said, and listen, listen, you like, you’ve been through the ringer. And you know, by the way, you look great.
– [Rachel] Oh thanks. Oh great.
– [Zubin] You’re high-energy Jeb. Whereas I’m sleepy Joe.
– [Rachel] This is just adrenaline, I’m just nervous.
– [Zubin] Pure adrenaline, right. Yeah. Which is good. Again, yeah, we’re gonna get your cortisol spike. You’re gonna get a secondary infection and pneumonia. I’m nocebofizng you.
– [Rachel] Don’t!
– [Zubin] Can you feel it?
– [Rachel] Don’t nocebofize me.
– [Zubin] Do you feel it?
– I don’t want you to.
– [Zubin] What you said about-
– [Rachel] You’re fired.
– [Zubin] Listening to the catastrophizers. So it is a poisonous input in that sense.
– [Rachel] Correct.
– [Zubin] And people think words don’t matter and so on, but we are social creatures. So they do matter. And they do affect our overall health. They do affect our standing, and our mental status, and the biopsychosocial aspects of any disease, which is 100% of all diseases. So this is partially why I do what I do actually, during the pandemic.
– [Rachel] Yeah, that’s right.
– [Zubin] I have been accused by many people of underplaying aspects of this thing, and downplaying severity and using words like mild and things like that in certain contexts. But the messages I get from people are: thank you for calming me down. I was living in fear. I’m so much happier. I went and got vaccinated. I’m okay. I was a recluse in my house. Or, I panicked because this happened. And so there is a responsibility, I think, for people who do science communication, including physicians and others, and psychologists, to speak knowing these effects, not to ever be inauthentic. So never to lie. Never try to manipulate. But to say, you know that’s actually true and how do we say it matters.
– [Rachel] Right, so mild with Omicron means just to be, and you correct me, it means you are very, very unlikely to get so sick that you have to go to the hospital. You are extremely unlikely to die from it, unless you have some pretty complex comorbidities. And it’s a small percentage of people who are being hospitalized and who are dying from Omicron. Is that correct?
– [Zubin] That is what my definition of mild is.
– [Rachel] And, did I interrupt you?
– [Zubin] No.
– [Rachel] I feel like I did, I’m so sorry.
– [Zubin] But, you know, if you did, the audience is thanking you because I’ll just talk for hours and I’ll say nothing.
– [Rachel] I want you to, that’s why we’re here. Okay. But part two is if you’re just a regular layperson like me and you get Omicron, if your definition of mild is like, I’m gonna sneeze a few times and maybe have a runny nose, and then I’m gonna be done, that is true, that that’s happening for a lot of people. Like a lot of my friends are like, “What’s happening to you? I was just sick for two days and now I’m fine.” And I’m like, “I don’t know what’s happening to me. I don’t know.” But for a lot of people, because I put this on Twitter and I got like dozens and dozens of messages from other healthcare providers and physicians and everyone else, saying, yeah, this mild shit is not accurate as far as my definition of mild. And I have been sick for three weeks, and I had actually a couple of people email me and say, the fatigue and lethargy has a long tail. I kept hearing long tail.
– [Zubin] Yeah, yeah.
– [Rachel] The fatigue and lethargy has a long tail. So when the head cold and the sniffling and whatever goes away, you still might experience some fatigue and lethargy. So like full transparency. I do not sleep late. I have been sleeping til like 10 and 11 in the morning. And now, this is like day 21 for me or something ridiculous, and I’m fine. No more symptoms, testing negative, all good. But the fatigue and lethargy seemed to have a long tail.
– [Zubin] So I’m gonna validate you even more.
– [Rachel] Oh, great!
– [Zubin] So I just did a show called “TRIGGERnometry” with a couple of British comedians who have this podcast.
– [Rachel] I saw, yeah.
– [Zubin] So they never were vaccinated, but they got naturally infected back in 2020. So they thought they were okay, and they were from a severe disease standpoint. But they both came down with what was presumably Omicron. It kicked their ass. So they did a podcast about what it was like days of just terrible pain, night sweats, isolation. It made their underlying mental predispositions worse. So one of them has anxiety. He said he was just wracked with anxiety.
– [Rachel] Of course.
– [Zubin] And he went to their A&E, which is their ER, And it was just a shitshow of panic. And so, and these are hyper rational, if anything, they’re on the more the antithesis side of the COVID spectrum, saying, you know, we’re, overblowing this, like we need to live our lives, and more libertarian. And they were like, no, but this thing is, you call it mild, it ain’t right.
– [Rachel] That’s right.
– [Zubin] Yeah. And this is the thing. So influenza, the reason I get a flu shot every year and the reason I think this is why I argue for young people should still get vaccinated even though it’s not absolutely necessary. You still, if you can reduce your chances of having a flu-like syndrome for two weeks, that’s a good thing. And the vaccines do do that. Now, even with boosters, it breaks through, it happens. It depends on your inoculum. It depends on your genetics. Now, the last thing I want to say about that piece of it, because you brought it up and we have to be real, this is something where you’re threading a needle, because long COVID.
– [Rachel] Oh yeah, this.
– [Zubin] So you have symptoms for so many days now, you know, and we define long COVID is so many weeks of the symptoms lasting, and those symptoms could be anything. It could be loss of taste. It could be, the definitions are tricky. But it is completely normal to have residual symptoms. Like you said, the long tail for a long time.
– [Rachel] Yeah, any illness.
– [Zubin] For any illness, any viral illness, any bacterial illness, it happens. And some of it is, remember, some of it is deconditioning too, from being in bed for so long. ‘Cause it does happen. You’re used to a certain level of activity and then you don’t get it.
– [Rachel] Muscle atrophy.
– [Zubin] Absolutely.
– [Rachel] You’re not eating as much.
– [Zubin] There’s autophagy, you’re eating yourself, you know, like.
– [Rachel] Yeah.
– [Zubin] And so all this stuff happens. And so it’s important when we tell people, oh, you know, it’s important to note these symptoms could last, but it doesn’t mean that you’re permanently damaged.
– [Rachel] And it doesn’t mean it’s long COVID.
– [Zubin] That’s right!
– [Rachel] That’s so important. And it’s just making me realize, like, we don’t have this catastrophic name for long flu, or long pneumonia. Like my friend last night on the phone, we do like a weekly Zoom. She said, yeah, when I had pneumonia, I had lingering symptoms for three months, and no one panicked about that and they didn’t give it a scary, big name. So like maybe there’s a little bit of catastrophizing around the tail, the long tail.
– [Zubin] The long tail. Now, there is long COVID.
– Of course, long COVID.
– [Zubin] We’re not diminishing that. But you’re absolutely right.
– [Rachel] But when do we call it that? And should we normalize that your symptoms might last a couple of months? Just normalizing that experience so that people don’t think they have long COVID, if they don’t.
– [Zubin] Yeah, yeah.
– [Rachel] Because, yes, long COVID is real. And there’s this period in between, this like interstitial period, which is like, well, I’m recovered, but I still have some symptoms. Do I have long COVID now?
– [Zubin] Right, right.
– [Rachel] Which is sort of where I was. I was like, oh my God!
– [Zubin] Totally. Why wouldn’t you?
– [Rachel] Exactly.
– [Zubin] In this current milieu, you’re normal to feel that way, right? Now, one thing in your book, you do a lot of sort of CBT, cognitive behavioral therapy, type stuff. And you mention a few trigger words here that are from that space, catastrophize.
– [Rachel] Yeah, you got it.
– [Zubin] That’s one of them, right? It’s a cognitive distortion where we see the worst possible outcome and focus on it, knowing that, in fact, that’s only one of many outcomes, and it’s probably unlikely. There are others, right? Like, overgeneralization.
– [Rachel] Do you see me beaming with pride over here? I’m like beaming with pride! I’m so impressed!
– [Zubin] Ah, you know, that’s why we’re a great duo, two Dr. Zs are better than one.
– [Rachel] Dude, I was so impressed. That was summarized so perfectly.
– [Zubin] Oh, thank you.
– [Rachel] Yeah.
– [Zubin] And I learned from your book, I read your book. People should get her book. The overgeneralization, black and white thinking. These are all aspects that we can catch in ourselves.
– [Rachel] Yes.
– [Zubin] That we can also catch it in media. We can catch it in communications. We can catch it in writing styles of op-eds where, you know, you almost sometimes imagine that the person writing the op-ed is experiencing these cognitive distortions and is projecting them into the page, which is now projecting them into the world, which is now creating a biopsychosocial crisis.
– [Rachel] So let’s now normalize. When you get COVID, it’s very likely and also normal that your brain is gonna feed you a lot of BS, distorted, anxious thoughts. Because we have all been ingesting nocebic, scary information about COVID for two years now from the sensationalist media, that’s putting up the word COVID in like red and yellow with dangerous fangs, you know. So naturally and normally, if and when you get COVID, if you feel terrified, that is normal and your brain is gonna feed you a lot of catastrophic, scary thoughts that are gonna tell you, like my brain was telling me, that this is gonna be long COVID and it’s never gonna go away. And the chances are high that that’s not true. And it’s very important to catch those thoughts, and wrangle them, and talk back to them. Otherwise, they will perpetuate that spike in cortisol that might mess with your immune system. So we want to catch the cognitive component of COVID too.
– [Zubin] Yes. I think that’s very well said.
– [Rachel] Okay, great.
– [Zubin] Very well said.
– [Zubin] So, yeah. I’m glad we had that discussion.
– [Rachel] I know, me too. That’s not where I expected this to go, but that was so helpful for me.
– [Zubin] For me too.
– [Rachel] Yeah, so helpful.
– [Zubin] Because as somebody who’s communicating about this, but, you know, people are suffering, they’re suffering. This is massive suffering.
– That’s exactly right.
– [Zubin] And the goal is to relieve suffering as much as we can.
– That is exactly right.
– [Zubin] So, good. Anything else on Omicron you wanted to talk about?
– [Rachel] Just one thing. Where are we on time? Just out of curiosity.
– [Zubin] Don’t even worry about it. Time is not a problem.
– [Rachel] Alright, fine. Just one thing.
– [Zubin] Time is a concept that humans create. In reality, it’s the eternal now, so.
– [Rachel] Wow. I feel like my head explodes when you talk about that. One thing that I learned about Omicron is that because it’s being marketed as mild, there are a subset of people who, I don’t know if this is still happening, who are trying to get it on purpose.
– [Zubin] Yeah, please don’t do that.
– [Rachel] Can I? I have a story. Brief story?
– [Zubin] Yes.
– [Rachel] Dear friend named Ben, when I was in San Diego getting my PhD and he made us dinner every Sunday night with a bunch of friends, and we called it our Sunday night family dinner. And one thing that we often did was we played Scrabble.
– [Zubin] Nerds.
– [Rachel] That was not a normal game of Scrabble. You can judge me if you want, it wasn’t my idea. It was perverted Scrabble.
– [Zubin] Oh!
– [Rachel] Yeah, that’s true. And the rules, it’s not my idea! But it was really fun and really funny.
– [Zubin] You like, taint. Right.
– [Rachel] Exactly. And the rules were, you had to make a word that was like ridiculous and perverted, and you had to define it. And it had to be an accurate definition. So one word that I learned, this is coming full circle, I promise. One word that I learned is bugchaser.
– [Zubin] Bugchaser?
– [Rachel] Bugchaser.
– [Zubin] I’ve never heard that term.
– [Rachel] I had never heard it either. And it blew my mind, and then I went and looked it up. And it’s a psychological phenomenon that occurred probably multiple times, but the context in which I learned it was with the AIDS epidemic, right. There were a subset of people who were so overcome with anxiety and paralysis about getting HIV and AIDS that they deliberately would find infected partners and have sex with them to get it over with. So they didn’t have to be anxious about it anymore. And you see where I’m going with this?
– [Zubin] Yes.
– [Rachel] There’s a lot of people who have been anxious about getting COVID for two years and/or just want to get it over with. And by the way, when I finally got it, very much, I was like, thank God. I want to just get, let me just get this thing over with, get the immunity and move on with my life. I’m just so over it. Like everybody, we’re just tired of it.
– [Zubin] Yeah. Normal, very normal.
– [Rachel] Right, but there are people who are going out of their way-
– [Zubin] To try to go to an Omicron party-
– [Rachel] Bugchasing.
– [Zubin] Yeah, bugchasing.
– [Rachel] And one of my colleagues, a pediatrician, said to me, oh, we see that a lot with chickenpox.
– [Zubin] Yes we do!
– [Rachel] ‘Cause you want your kids to get it and get it over with.
– [Zubin] So, so funny, I just interviewed Paul Offit and he mentioned the same exact scenario, the chickenpox parties. Before vaccine, you do want your kids to get chickenpox because it’s much more dangerous to get it as an adult. For us, we would rather get Omicron when we’re young and healthy than when we’re 80 and whatever. The thing is we have a vaccine. And when the varicella vaccine came out for chickenpox, people were still having chickenpox parties. Now, you’re subjecting your child to a risk, as small as it is, of hemorrhagic varicella, or encephalitis, or pneumonia that can be fatal. In the pre-vaccine era, up to 10,000 kids were hospitalized every year with chickenpox related complications. So what we’re saying with Omicron is I know the desire to do that. It’s normal desire. You’re not a bad person for wanting to go out and get omicrox. But don’t. And it doesn’t mean you have to hide or do any of that, but don’t go out of your way. And if you’re gonna make that statement, like, “Oh, I want to get Omicron,” I hope you’re vaccinated.
– [Rachel] Oh yeah.
– [Zubin] Because, again, the vaccines aren’t perfect. That’s why we are still careful. It doesn’t mean you have to triple mask and do all that if you don’t want to, but it’s just about understanding risk. So going out and getting Omicron, don’t advise it.
– [Rachel] That’s so good. Just want us to knock out-
– [Zubin] I’m glad you’re alive.
– [Rachel] Thank you. I am also glad I’m alive.
– [Zubin] Yeah, ’cause it would have sucked for the show if I were just talking to myself.
– [Rachel] Okay, Zub.
– [Zubin] Okay, Rach.
– [Rachel] Oh, no, I hate when someone say that.
– [Zubin] You’re gonna Zub me, I’m gonna Rach you.
– [Rachel] That’s fair. I was telling Zubin that I get messages sometimes from people I’ve never met, who Rach me. Like, “Hey, Rach.”
– [Zubin] I get that too.
– [Rachel] Hey, Zub.
– [Zubin] I’m like, you’re a little too familiar. I don’t know I sound like Trump, hey, you’re being a little too familiar. That doesn’t sound like Trump at all. Depression.
– Sounded like The Godfather.
– [Zubin] It did.
– [Rachel] Can we talk about depression?
– [Zubin] Ya.
– [Rachel] It’s ubiquitous in the United States. I mean everywhere. And especially during the pandemic.
– [Zubin] Raise your hand if you’ve ever been depressed. Raise your hand if you’ve been diagnosed with major depression.
– [Rachel] I have not.
– [Zubin] I have not. So it’s a spectrum.
– [Rachel] So here’s the interesting thing about depression. There is a book out there called “Saving Normal.” Have you read “Saving Normal”? I’m gonna give it to you.
– [Zubin] I’ve heard about this, yes. I haven’t read it though.
– [Rachel] “Saving Normal,” it’s a fascinating book that goes into how arbitrary truly our definitions of normal and abnormal really are, and how the definition of depression and the criteria in the book we call the DSM, which defines criteria, is influenced by many, many, many things, including Big Pharma. That is absolutely a true story. And “Saving Normal” was written by one of the gentlemen who helped write the DSM. And he goes into how these definitions came to be. And for anyone who is interested in health or mental health, you will be utterly astonished to learn that this thing we call major depressive disorder is quite arbitrary. There’s not a lot of science in our current definition of illness, mental illness, what is normal and what is abnormal is always changing. And we have to be very careful when we talk about disease and labeling people who have been diagnosed with this thing, depression, as mentally ill. Now, I want to be clear that I am not saying that depression is not a mental illness. Of course, it’s real. Yes. I am not saying that. But I want to talk about the definitions. First of all, the other issue and then you can maybe get to our questions. The other issue with depression is that we have all been sold this completely BS idea that depression is a purely biomedical thing. And by that I mean people who are depressed and go to their doctor get told, “It’s not your fault. Your brain is just broken. But it’s not your fault. It’s a flaw in chemistry, not a flaw in character.” That, when I lived in Manhattan, when I was getting my master’s degree at Columbia, I would look out my window every day, and on this big building in like 12-foot letters, I’m not joking, put up by a Big Pharma company, “Depression is not a flaw in character. It’s just a flaw in chemistry.” It’s a brilliant message because here’s what it does. It takes the onus off of you. Like, oh, it’s not your fault. But it does place the onus squarely and directly on your dysfunctional broken brain. Now, that is a big lie. And I want to make sure I’m saying this clearly. People with depression, you are not broken. You are not broken. That is a big lie that you have been sold. Is depression real? Yes. Is it debilitating for many people? Yes. Are there treatments out there that work? 100%. neurotransmitters are involved in depression. neurotransmitters are those chemicals that live in your brain and regulate mood and sleep and appetite and all those delightful things. But those are not the only component of depression. You have something to say, I know you do. I can see it in your face.
– [Zubin] No, I’m just, I’m vibing with this so much. I have a lot of thoughts. Keep going.
– [Rachel] Okay, well, what I wanted, what I was thinking was I want to hear all of your thoughts. Do you want to read some of the questions we got about depression or no?
– [Zubin] Absolutely. And before and before I do, I want to say one thing. So what you’re describing is a reductionism.
– [Rachel] Correct.
– [Zubin] And it is actually in service of Big Pharma’s interests, which are to sell pills.
– [Rachel] Correct.
– [Zubin] I like the de-stigmatizing component that it’s not your fault, but in reality, nothing is your fault because we are what we are. But that doesn’t mean you don’t take responsibility for making yourself better. And so the reductionism is a fascinating piece. There’s a guy named Iain McGilchrist, who’s a psychiatrist, neuroscientist in Great Britain. Who’s written a book called “The Master and His Emissary.” And it is about the right brain and the left brain. Not the pop psychology nonsense, like I’m a right brain, kind of creative. And I’m a left brain scientist. It turns out that’s not what they do. That’s not what they do at all. But what is felt to be the case is that the right brain sees the world in a holistic, connected, relational way. And the left brain actually evolved as the right brain’s servant, as its emissary. Because what it does is it reduces wholes into little parts and grasps at them and tries to drill down and make sense in a reductionist way. He argues in the book that as human societies progress, they start to fail because we go from a right brain-left brain balance, where it’s true, the master right brain and his emissary are working in concert to see things holistically and work together, to a left brain dominant society, where we reduce everything to its bureaucratic lowest common denominator. And I think that’s what we’re seeing with depression treatment. And thinking about it, well, it’s just a chemical imbalance.
– [Rachel] Right.
– [Zubin] Yeah. Doesn’t help anyone.
– [Rachel] Right.
– [Zubin] And then you have this huge bureaucracy in medicine that manages the chemical imbalance with a rubber stamp. Here’s some Prozac here, some Paxil, here’s whatever, not even looking at the biopsychosocial holistic part of the whole thing.
– [Rachel] And we’re gonna talk about what that means, depression being biopsychosocial. ‘Cause that was actually the question we got.
– [Zubin] That’s perfect. So let’s start with the first question then. “I’ve been on and off anti-depressants for 25 years. Every psychiatrist tells me meds work. Why aren’t I better?” Harold M. via Twitter.
– [Rachel] Will you read the next one also?
– [Zubin] And, “My depression ebbs and flows, and I’ve been on meds for more than a decade. Help me understand depression with your biopsychosocial magic. Please,” says Danny.
– [Rachel] Right. So just so I want to be clear what this biomedical model of health is. This is what is predominant in medical schools, and the biomedical model of health focuses on just biology. Will you say as a former med student, ’cause I did not go to med school, what a biomedical model of health looks like a little bit?
– [Zubin] A biomedical model of health reduces the sort of four quadrants of human existence to one quadrant, which is it. So the body, its chemicals, its functions, it’s a left brain approach. It’s saying, let me not look at a whole, but let me just look at the parts, and by fixing parts, by moving parts, we will fix the whole.
– [Rachel] Right.
– [Zubin] Yeah.
– [Rachel] That’s right. So what you and I have been talking about for a while now is this idea, which is more like fact, which is that health is always more complex than just that, human beings are more than just body parts. Right? We’re more than just chemicals and organs. So there’s the bio domain of health. It’s this three-part thing. There’s bio, which is our biology. Then there’s psych, which is like thoughts and emotions, and behaviors, and memories and trauma. And then their social or sociological, which is like the everything else bubble, right? Socioeconomic status and access to care, and race and ethnicity, and-
– [Zubin] Cultural issues.
– [Rachel] Family and culture and context and your larger environment, right? So it’s all these things always working together in a complex interplay.
– [Zubin] Which, by the way, you can reduce in the spirit of reductionism in the biomedical model. You can reduce to I, we and its. So the bio is its, the we is the social, technological stuff, and the I is the internal state.
– [Rachel] Great. Great. What I want everyone to know is that while bio is a very important part of depression, of course, and the bio of depression is like genetics and it’s hormones and it’s immune functioning. And it’s like sleep and diet and exercise, and it’s sex. So females more than males are prone to depression for a million reasons. We can go into the social component of that. And it’s also like time of year and the amount of sunlight you get. Like winter tends to be a trigger. So all the bio things, like neurotransmitters hormones, those genetics, all real. There is no gene for depression. Tan-ta-ta-da! There is no gene for depression. There’s no depression gene. So I have patients come to me and say, “My mom has depression. So I’m screwed.” If my mom has a gene for depression, I am going to be depressed. Talk about nocebo. Right, so we want to be careful. And by the way, yes, it has shown that depression can run in families. But let’s talk about that for a second. Can you think of other reasons why, if a parent is depressed and a child grows up in that home, why that child might end up feeling depressed other than it was passed down by a gene?
– [Zubin] Well, we are social creatures. Children are particularly empathic. They’re picking up on the signals of the parents. There may be abuse and other cyclic actions that are triggered by the depression. And I’ll say this in the spirit of true integration, there’s cultural stuff, social stuff, the way the child then behaves as someone who has some stigma of that, how they’re treated socially, can feed back into that. And then I think that’s all in the setting of maybe there are multiple genetic pieces that collude to put you at slightly higher risk, that then is fulfilled by your environment.
– [Rachel] Wow. Do we give out gold stars on this show?
– [Zubin] If so-
– [Rachel] Can we get those next time?
– [Zubin] I can get half of one.
– [Rachel] And then we can wear them on our forehead.
– [Zubin] That’s a good idea. Maybe we could get a little device that just goes chi-ching! I wanted to do that multiple times when you were talking. Yes, yes, yes.
– [Rachel] Awesome. Great. That was beautifully said. So yes, there are a number of genes it is hypothesized that might contribute. And it is never, ever, ever genetics alone. It is never, ever, ever brain chemistry alone. That’s not how it works. Again, depression lives in the middle of this biopsychosocial recipe. Like exactly what you just said. So we already did the bio. Let’s talk about the psych for a minute. The psychological contributors to depression include the thoughts you have in your head. So when I see people who are depressed, they think things like this is never going to get better. I am broken. Nobody loves me. My life is meaningless. There’s no purpose. Now, if you’re thinking thoughts like that, how do you think you’re gonna feel? I literally just ate the microphone. ’cause I got so excited.
– [Zubin] Rogan is always asking people-
– [Rachel] Eat the microphone. Yeah, I kinda just ingested it, yeah.
– [Zubin] So what you described are those cognitive, thoughts, keep going.
– [Rachel] Cognitive components of depression feed this cycle of depression, because it’s always all the things. And guess what? Here’s a fact. Thoughts affect physiology. So yes, if you are hooked up to a machine, by the way, this is called biofeedback, which gives you feedback about your biological processes. If you’re hooked up to a machine, and you’re thinking catastrophic, terrifying or depressing negative thoughts, the machine that is reading biological processes will show you that there are changes in heart rate, changes in body temperature, changes in muscle tension and blood flow. And even blood oxygen. The things that change when you think a thought are physiological. So I just want to prove to everyone that depression is biopsychosocial. So we have thoughts. Thing two in the psych bubble, our emotions. So if you are feeling stressed or overwhelmed or anxious, or having lots of sad feelings, or you’re feeling very angry, emotions are also gonna feed into the depressive cycle. As everyone knows, when you’re really anxious and really stressed out, it’s hard to be in a good mood. So emotions are always perpetuating the cycle also. We have self-esteem in the psych bubble too. If you imagine, like, if you’re struggling with low self-esteem that can contribute to a depression recipe.
– [Zubin] So, oh man, this is like a three hour show in itself. It’s so good. I wish… Oh, so, okay, okay, okay. Just a couple of things before you go on. So thoughts contributing to depression, that’s easy to wrap your head around, because you can say, okay, these catastrophizing, these identity issues around self-esteem, absolutely, because that’s a story. It’s another thought complex. We tell about ourselves “I’m worthless,” and these are distortions too. Because I did this, I’m forever this.
– [Rachel] Right.
– [Zubin] All these kinds of ways of saying. What’s interesting is the emotion piece. So this is where I’m gonna put the blame squarely, again, on thought. I think thinking, and it’s a Zen saying, thinking is the disease of the human mind, and this is why emotion, raw emotion can come up. But what it does is it triggers a thought cascade, a story cascade, an identity cascade, a self-esteem cascade. And that feeds back and actually reinforces the emotion through resistance. It’s like, no, no, no, I shouldn’t be feeling this. This anger is bad. I’m a bad person. Then the stories, and then the depression is worse. So yeah, so anyway, sorry not to interrupt, but that’s something that just came to me that actually accepting raw emotion as it is and letting it be is a very hard thing for humans to do. ‘Cause we tell stories about it. Yeah.
– [Rachel] Agree. And I thought, yeah, that was very helpful connection. Because I think what you and I really want to do is just connect all the things. We have this false divide between brain and body, but actually the truth of it is that all the things are connected all the time.
– [Zubin] Yes. Body-mind-environment, it’s all one thing, yeah.
– [Rachel] Correct. Right. So we’ve got our bio bubble. We’ve got our psych bubble. And just to say, also in the psych bubble of this biopsychosocial model of depression, is behavior, coping behavior. So how you act when you have depression is going to affect the cycle of depression. So what I mean by that is when we are depressed, sometimes we naturally and normally isolate, stop moving, stop going outside, stop exercising, stop seeing friends. You know, we hole up and become hermits. We sleep all day. And guess what? That kind of coping you bet your ass is gonna make you feel more depressed because now you have no life. You’re not seeing your friends. You’re not going out. Sunlight, by the way, we are diurnal animals. Sunlight is critically important for serotonin, which is the neurochemical that crashes in depression. We need to be moving our bodies because exercise stimulates this neurotransmitter called serotonin that is implicated in depression. And in fact, the medications that we dispense for depression raise levels of serotonin. So coping behaviors, the behaviors we choose to engage in can also either tank our serotonin or raise our serotonin. So even though depression is fighting you and telling you to stay home and stay on your couch and not see anyone, the most critical part of treatment, in my very humble opinion, is fighting it, getting off your couch, making plans, standing outside in the sun, making sure you’re connected with your community, finding ways to move your body. So coping also changes depression and that lives in this psych bubble.
– [Zubin] Absolutely. Well, one thing I’ll even add, I don’t know how valid this is, but it seems to be valid. There’s a kind of self-soothing that we’ve learned as young kids that we, it used to be like you reach out with certain actions and behaviors to your parents to get soothed. Like I’m suffering. Let me show you how I’m suffering, and the parent soothes you and then you calm down. But as we get older, we internalize some of those processes. So in our mind, we start to go, “God, I’m suffering so much. I’m so old. I’m so sad. I can’t get out of bed. I won’t get out of bed.” And there’s a kind of an internal self-soothing algorithm where we think, okay, this is gonna make us feel better by really just wallowing in this. So you don’t get out of bed, you don’t move. You know, by moving, by getting out of bed, it’s almost like admitting, oh, maybe the suffering isn’t as bad. Maybe I won’t get soothed in this way. And I wonder if there’s a conditioning there that sometimes it’s good to make explicit, I don’t know. It’s just something that kind of comes to me sometimes.
– [Rachel] So I think that’s actually really true. And it does feel like soothing, except that it’s a trap.
– [Zubin] It’s a trap!
– [Rachel] Right.
– [Zubin] That’s the thing. The point is it’s a trap. It’s quicksand. It’s something we learned as kids, but it doesn’t work when it’s internal.
– [Rachel] Right, and also that kind of self-soothing is great and fine, like nurture yourself, take time to rest and eat good food, and then break the cycle.
– [Zubin] That’s right. It’s a different type of self-soothing.
– [Rachel] It’s very critical to break. And I want to get to part three because, you know, otherwise we will do seven hours on the biosocial which would be fascinating.
– [Zubin] Which is fine.
– [Rachel] But so then there’s the psychosocial bubble or the social bubble of depression. And that really is everything else. So socioeconomic status. And we can talk about what happened during COVID, where people lost jobs and lost homes, and there was food insecurity, and what that does to your mood. And social isolation, human beings are social animals. In the presence of other people our brains produce chemicals that make us feel good. Serotonin, I keep mentioning serotonin because that’s an antidepressant. So in the presence of other people, your brain produces serotonin. It also produces dopamine, which is this reward chemical that makes you feel good. It also produces oxytocin, which makes you feel connected to other people, makes you feel warm and fuzzy.
– [Zubin] I produce man milk when I release oxytocin.
– [Rachel] And some of Zubin’s breasts produce man milk, which is very impressive. Your brain also produces endorphins when you’re with other people, which is a natural painkiller and an endogenous painkiller. So in the presence of others, your brain literally makes you feel good to encourage you to engage in social behavior. Guess what happens when you’re isolated? Like the last two years.
– [Zubin] All of this, all got sucked away.
– [Rachel] All the chemicals crash and you feel worse. So if you have depression and you’re socially isolated, COVID has probably been real bad for you. Because we’ve also lost our normal coping strategies and our support systems. Like for some people it’s church, and for some people it’s Thursday night, you know, board games and whoever, whatever it is,
– [Zubin] Perverted Scrabble.
– [Rachel] Maybe it’s perverted Scrabble at Ben’s house where he’s making you homemade ice cream. And like, I really miss those evenings, I’ll just say. But in this social bubble, there’s also like parents and family dysfunction and a lot of stuff that happened during COVID too was an increase in abuse and domestic violence. And, you know, relationships are toxic as we all know. So there’s a lot of things that live in this social bubble. Like, as you know, your relationships affect your mood. There’s also, we’re not talking about grief and loss and death. Like I have a dear family member who lost her daughter to a terrible accident in a hospital. And she was diagnosed with depression. By the way, that’s grief and mourning and loss. And they put her on SSRIs which are a medication for depression, and surprising to no one, they didn’t make her feel better because it’s not that her brain is broken, it’s not that it’s a flaw in chemistry. It’s that when you lose a child, it is a terrible, terrible trauma. And there’s a lot of ways of treating that. And by the way, I want to make clear, I am not anti-medication. I have heard from many people that antidepressants have been very helpful for them, but what I am pro and what I want to promote is that it’s never just one thing. It’s never just the bio. If you really want to treat depression, you have to go after the whole biopsychosocial recipe. You want to look at the bio. Yes, of course you do. And you want to look at the psych. You want to look at the thoughts, and the memories, and the other emotions besides sadness that are happening for you. And your coping behaviors, what you’re doing and whether or not it’s working. And you want to look in the social bubble, what’s going on in my environment that is perpetuating my depression? Do I have toxic relationships? Is there abuse? Is there poverty? Is there racism? What is happening in my larger context that might be messing with my mood and what can I do about it? So I hope that makes sense that the actual real treatment for depression, the actual real treatment is not and never will be just a pill. That is not the treatment for depression. It is a biopsychosocial illness that requires a biopsychosocial treatment. And that is true 100% of the time. And I actually recently got into a fight with a physician at Stanford who has a website that I think is horrible. And if you search for it, it’s like this Stanford depression definition. And it says some cases of depression are almost entirely genetic, and some cases of depression are not at all genetic. And anyone who understands science will tell you that it is always biopsychosocial.
– [Zubin] All the things.
– [Rachel] Literally, always. But that just tells me this gentleman was trained in the biomedical model and no one ever told him that the psych and the social are just as important. Like you’re telling me that a child who grew up in an impoverished abusive household, where they were beaten every day and they developed depression, it just might be that 95% of them, it was like a genetic thing. Just maybe it was genetic. Like, no. Maybe there was a genetic predisposition and the environment is the thing. Like it’s always genes plus environment. That’s how, that’s what humans are.
– [Zubin] Exactly right. How many gold stars can I throw at you for that whole thing?
– [Rachel] It just makes me so mad.
– [Zubin] So the other thing is, you just think about like, you know, somebody who survives the Holocaust and they’re resilient in a way that some of that is genetic. Some of those kids who survive those very traumatic upbringings grow up to be very resilient. Well, okay, so some of that’s genetic, some of that is they had some luck. Some of that they had helped. Some of that is what they had for breakfast. It’s this very complex thing.
– [Rachel] Resilience is biopsychosocial too.
– [Zubin] Yep. It sure is. And that it relieves some of the shame issues for people because they understand no, it’s actually quite complicated. It’s not that simple, but that doesn’t absolve me in whatever agency I have of taking some degree of control or at least perception of control to do some things. And that’s what I mean, again, I’m gonna keep pimping this thing. If that’s what you do in the book, it’s a workbook you’re supposed to go and actually answer, go in and fill in these things, look at your thoughts, journal these things out, you know. You know, I read “Feeling Good,” the book about CBT.
– [Rachel] Yeah, Burns.
– [Zubin] Really great.
– [Rachel] Yeah. Burns started the CBT movement. Cognitive behavioral therapy is a gold star treatment for depression. Cognitive behavioral therapy..
– [Zubin] It really is great. Now, what I’ll say is this, it’s not the only thing, right? It’s a piece.
– [Rachel] There’s no panacea.
– [Zubin] There isn’t. If you read the book, you might think, oh, this is it. But the truth is it’s one piece, and it may not be the perfect fit for everybody. You’re required to, listen to that, they’re doing some kind of-
– [Rachel] Drilling.
– [Zubin] Remodeling up there. I feel like I’m at the dentist’s.
– [Rachel] That’s the sound that triggered for me too.
– [Zubin] Do you think Battle Cat turned into his wussy cat whenever he goes to the dentist?
– [Rachel] Maybe. Do you know what we got? We got some questions actually about dentists and dental anxiety.
– [Zubin] Did we?
– [Rachel] Yeah. I don’t think, I think-
– [Zubin] We’ll save them for another time.
– [Rachel] I think we’re talking sufficiently loud that it won’t really be heard.
– [Zubin] You wouldn’t. I think it’s just actually a nice touch.
– [Rachel] Yeah. The dental drill?
– [Zubin] Yeah. It’s giving me, it’s funny. So I’ve got to tell you a quick story, a little side.
– [Rachel] Okay.
– [Zubin] Because I’ve been meditating a lot, which is probably a little bit of seeking behavior. Meaning, it’s a little bit of like, oh, I can control this process of spiritual awakening, when you can’t. It really just kind of happens. You can put yourself in the way of it. So I put myself in the way of it by meditating sometimes four hours a day. Like I’ll get up really early, go to bed really late. So I was in that state of concentration. I went to the dentist, the dentist was like, oh, you know, you have, these sort of receded gums. I’m really gonna try to clean under them quite a bit. So you might feel a little discomfort. It was like somebody was drilling into my brain, it’s what it felt like. So I said, okay, I can either capitulate here. Like, so, okay. And then I thought, I actually thought about you. I was like, biopsychosocial, I thought about meditation. I thought about, ’cause this is pain. Pain is a signal for my brain saying, Hey, wee ooh, wee ooh. Something’s up.
– [Rachel] Danger.
– [Zubin] I knew intellectually, she’s not hurting me, not damaging me. She’s the dentist, for gosh sake. So I said, okay, let me witness this pain as that. And I dove into it, like I became this vibrating sensation. It no longer was pain. He no longer had a story. It was this vibrating sensation of energy. And when I was done, it was funny. I think I may have had like, I shed a tear come down involuntarily. But I was not suffering. And I told her, she goes, “Well, how was that?” And I said, “Oh, there was a lot of pain, but it was okay.” That’s all I could say. And that’s how it felt.
– [Rachel] Wow.
– [Zubin] It was crazy.
– [Rachel] Yeah.
– [Zubin] But you know, it’s funny now, if we talk about, and you hear these guys drilling, there’s an anticipatory component. It’s like, oh, I’m gonna have to go back. She’s probably gonna do that again. Like, will I be able to drop into that state? And then the mind starts to tell stories. It’s crazy.
– [Rachel] But that’s what an amazing story you just told in my mind about like the cognitive component of pain and the amount of control we have over it. And as you were talking also about depression, it just reminded me that one of the things we really want to do is give people their power back and help them remember that they have some power over pain and they have power over depression. And the way you hack pain and the way you hack depression is by going after the different components of this biopsychosocial recipe. So if you’ve done the bio already, and most people have, and you’re still experiencing pain, or you’re still experiencing depression, the good news is there’s this whole bio domain and there’s this whole psychosocial domain that you can go after to exact some control over your pain recipe or over your depression recipe and change the recipe and change your experience. And that’s what I liked so much about it is that it gives a lot of hope and power back to people who are living with all the things.
– [Zubin] Oh, so you are giving people many more options.
– [Rachel] That’s exactly right.
– [Zubin] Which gives them agency and empowerment. Exactly.
– [Rachel] Exactly. Like what can I change in my behavior? What can I change in my environment? What can I change in my thoughts?
– [Zubin] Absolutely.
– [Rachel] What can I do to change my emotions?
– [Zubin] If I was sitting in that dentist’s chair and I didn’t have the tools that I’d had, by luck, by serendipity, right? That I would’ve just been like, “I quit.” And then she would have had to do the whole thing with the deep cleaning and the numbing and all that. I didn’t have to do all that. But it was, and this is not an isolated experience that just some people have. I think anybody can do this.
– [Rachel] Anybody can do it.
– [Zubin] But they need to be empowered and taught how to do it.
– [Rachel] Have the tools.
– [Zubin] Right. Have the tools.
– [Rachel] Let’s do impostor syndrome.
– I love it. Speaking of empowered, yeah. So impostor syndrome, this is something that you and I have touched on before. Here’s the question, “Why does impostor syndrome always show up when good things happen in my life?” says Percy A. What is impostor syndrome? And why is it that people who actually would be described by others as very successful, often are crippled by this?
– [Rachel] So I’ve been dealing with impostor syndrome a lot lately. Like, here’s what impostor syndrome sounds like to me in my head. Who do I think I am? Why would anyone listen to me? And everyone’s gonna find out I’m a big, fat, funny fraud. What does it sound like for you?
– [Zubin] Exactly that. In fact, for me, it shows up in so many subtler ways too, because if I’m meditating and it suddenly occurs to me a thought arise to something I said on my show that wasn’t quite the way I wanted to express it. I’m like, well, of course, I’m an idiot. Why is anyone listening to me anyways? I’m totally worthless. And then it becomes a thing. So impostor syndrome, this deep sense of I’m not supposed to be here. This is right, I’m not worthy of this, whatever, people shouldn’t be listening to me.
– [Rachel] So for me, this came up recently, and I know you know this after I was on a podcast called Ologies.
– [Zubin] Great podcast.
– [Rachel] Ologies has been my favorite podcast for four years. I discovered it four years ago when it was a little, tiny, it’s just a nerdy science podcast. And Allie Ward is her name. And she interviews all these ologists. So like, mycology is the study of mushrooms and cosmology is the study of the cosmos. And, you know, I love pain communication, and I believe deeply that everyone deserves to understand pain and that we’re not gonna treat it unless everyone understands it. So I pitched to her this episode called Dolorology.
– [Zubin] Painology.
– [Rachel] Which is an actual word, and it’s the science of pain.
– [Zubin] I love it.
– It’s a science of pain. And I didn’t hear from her for four years ’cause she’s very busy and also cool. But what happened over those four years is that that little podcast became super, completely famous. And I’m glad she ignored me for four years.
– [Zubin] She’s the number two science podcast most of the time. I know this because I beat her one week with The VPZD Show, she got number two, and then we faded back to number eight or something.
– [Rachel] No way! Congratulations, by the way.
– [Zubin] Thank you.
– [Rachel] Yeah. But she’s been at this a long time, and she finally wrote back to me and said, okay, we’re gonna do a pain episode. And it went viral, but I still, as you can tell, I still have a lot of disbelief around this. So it was shared a quarter of a million times in like a week. And when I found that out, I was like, “Wait, what?” Like, shit, everyone’s gonna find out that I’m an impostor. So it really came up real hard for me. And I got anxious about it actually. I was like, should I tell her to take it down? Like, who do I think I am that I get to be on Ologies? And that I’m disseminating this information. Now, I want to say this, and I know it’s gonna make me sound like a cocky A-hole so I want to be like careful about it, but I also want to say. The facts are, I was trained at Brown and Columbia. I have a PhD from UCSD. I have four degrees. I did a post-doc and an internship. I teach at Stanford and UCSF. I know I’m a nerd, and I don’t do it for accolades, I do it because I’m a nerd and I want to learn, and if I could go to school the rest of my life, I would. Like I’m not trying to be cool. Like I just really, deeply love learning and communicating science. As you know, like, it’s just I was always a nerd. Like I was a library mouse nerd. I didn’t have friends. I was not cool. No one wanted to hang out. So I’m not saying, but when you look at this, like when I look at you, you’re so successful, and so brilliant, and so well-trained, right? And you still have the thought.
– [Zubin] I’m aa steaming piece of shit. Yeah.
– [Rachel] What is that? What is that?
– [Zubin] Okay, so this is the heart. This is the heart of impostor syndrome. In medicine it’s very common.
– [Rachel] Yeah. Why?
– [Zubin] Very, very common. And I suspect, now there there’s many… Look, I’m speculating, but I would say this. I think the more you know about something, the more you’re passionate about something, the more you understand how little you know.
– [Rachel] Oh yeah, that’s right.
– [Zubin] And then that becomes this kind of cycle of self-doubt. Because you’re like, oh, I know how complicated this is. And here I am out there saying, oh, this, that, and the other thing.
– [Rachel] Right.
– [Zubin] And there’s that dental drill again. It’s giving me like, I’m starting to feel it in my gums. There’s this idea then that, well, I’m not worthy of saying it. So what happens is someone with very little knowledge, who doesn’t yet trigger the impostor syndrome, will go and say it, because they have instead Dunning-Kruger syndrome where they don’t know what they don’t know. And they’re in a different part of the cycle of knowledge. So ultimately then, I think the most successful people who know the most about something, who are subject matter experts feel the deepest kind of impostor syndrome. Because they’re like, dude, I don’t know. You know? Or they make another cognitive fallacy where they assume others know at least as much as them. Like this is my problem. Like sometimes I won’t do a show because I’m like, well, that’s just dumb. Everybody knows that, I’m not gonna talk about the symptoms and signs of COVID. And Logan, my producer early in the pandemic, he’s like, “Dude, do the thing on the symptoms and signs of COVID.” And I was like, “That’s so dumb, dude. People aren’t that dumb. They’re gonna know it.” Whereas in reality, I’m thinking, you know, I don’t want to look stupid by saying something so obvious. So I do the video, it gets like 25 million views.
– [Rachel] Of course, people don’t know.
– [Zubin] Because people don’t know, because it’s not in the training of the average layperson to know that. So again, and then the impostor syndrome and all of that.
– [Rachel] Right. So, because I want to learn the things about the things, and by the way, impostor syndrome has been very uncomfortable for me. It has made me like, maybe not want to do certain things. I’m like, maybe I shouldn’t do this thing with Zubin, who do I think I am?
– [Zubin] You are…Yes. And yet, you push through it every time.
– [Rachel] Despite sweating through my clothes and feeling like I’m gonna throw up.
– [Zubin] And you know, it’s a kind of suffering for you, but for me, I see it as, okay, so this it’s kind of the way we do business, you and I. Like I know you’re gonna get nervous. I know.
– [Rachel] And I’m gonna try to bail.
– [Zubin] And you’re gonna try to bail. And then I’m gonna be like, dude, let me tell you all the ways that you help people. And then you go back to the mission, which is your mission. This is the thing, you’re just a conduit for it. You’re not even a thing, Rachel? I hate to like take you down.
– [Rachel] It has nothing to do with me at all.
– [Zubin] No, you’re a hole in the universe that channels this truth.
– [Rachel] Agree, agree.
– [Zubin] And you know it in the deepest intuitive levels.
– [Rachel] Very much, yes.
– [Zubin] Which is why you keep showing up, even though it takes years off your life.
– [Rachel] Oh, dude, it takes years off my life.
– [Zubin] And post-COVID.
– [Rachel] Right.
– [Zubin] With your long tail of fatigue.
– [Rachel] With my long tail of fatigue. But I do feel a lot better right now and very energized ’cause I feel like this work is important and the information is important.
– [Zubin] I’m gonna make a meta comment on that. I sense the switch happens the minute we start going.
– [Rachel] I agree with you. I feel it too.
– [Zubin] And I feel it too. ‘Cause I’m also just like, okay, we got to, you know, every time before I show I’m always nervous.
– [Rachel] Oh, you are? What?
– [Zubin] Yeah, yeah. I’m always just like, you know, because there’s a few things. I have to run all this equipment too. I have to guide a conversation, which means I need a level of attention and engagement, otherwise it’s inauthentic. And I also have impostor syndrome.
– [Rachel] Dude, okay, so let’s tackle that. I think I’m gonna help you with impostor syndrome.
– [Zubin] Nice.
– [Rachel] Yeah.
– [Rachel] So I went down this rabbit hole, and I looked up impostor syndrome and the treatment of it. I wanted to know what it was. I wanted to know how common it was, and I wanted to know what to effing do about it. And I found a gentleman named Jordan Harbinger.
– [Zubin] Who is a mutual acquaintance. ‘Cause I was on his show.
– [Rachel] And I apparently I’m not gonna be on his show ’cause I pitched a show for him, it’s true. It’s true. But he’s a really nice dude.
– [Zubin] He is a smart, passionate guy. And he lives down here.
– [Rachel] He does?
– [Zubin] Yeah. He’s in like San Jose somewhere, yeah.
– [Rachel] I didn’t know that. Okay, so his show is called the Jordan Harbinger Show. And the episode that I found was on impostor syndrome, and I read a whole bunch of articles. And what I liked about his show was that at the end of it it listed resources, which is what you do too. And had all the articles on impostor syndrome that he had cited. And again, back to that thing where I’m a nerd, I was like, I’m gonna consume all of it. So here’s what I discovered. There are four steps to knocking impostor syndrome out.
– [Zubin] Nice!
– [Rachel] To be clear, sort of like with pain, it’s not like you’re never gonna have it, but when you have it, you’re gonna know what to do about it. Step one. Ready? Acknowledge that it’s happening. Acknowledge it. Don’t pretend it’s not happening. Don’t avoid it. Acknowledge that it’s happening and talk about it. And know that it happens to everyone. By the way, impostor syndrome happens to everyone at some point. Usually when they’re moving in a forward direction in their lives.
– [Zubin] Ah, okay.
– [Rachel] So know it’s happening and acknowledge it. And like, if you can say to someone that it’s happening, even better, ’cause you’ll get validation from the other person. Like, oh yeah, I’ve had impostor syndrome too. And then you’re like, oh, I’m not all alone with.
– [Zubin] This is why I talk about it, I think, unconsciously. I’m like, did you get this too? Do you get this too?
– [Rachel] And this goes back to social medicine. Social medicine is real. When you tell someone about a thing that you’re suffering with, and they validate it, your suffering goes down. You’re like, “Oh God, Zubin has impostor syndrome also. Well, then I feel a little less bad ’cause that guy knows all the things.”
– [Zubin] I know, right. It’s just, it’s not easy being the perfect Battle Cat and He-Man all rolled up in one with a little side of Orko.
– [Rachel] Yeah, and it must be hard for you.
– [Zubin] I’m actually 99% Snarf genetically. That’s why I really like your biopsychosocial model because I’m like, genes don’t determine my snarfness.
– [Rachel] I wonder if depression runs in the Snarf line? I hope not.
– [Zubin] They strike me as very pessimistic, nattering nabobs of negativity, the Snarf. So it may be, I think it’s biopsychosocial.
– [Rachel] Nattering nabob of negativity.
– [Zubin] It was one of Nixon’s henchmen who said that about the liberal media. He was like the nattering nabobs of negativity would say this about-
– [Rachel] It’s so good. And I love the alliteration on that one.
– [Zubin] It’s good. Back to you.
– [Rachel] Right. Okay. But so acknowledging and normalizing. It’s happening, this impostor syndrome thing, is happening to me, and I know that it happens to everyone. I’m gonna talk to someone about it and normalize it. That’s thing one. Step two is externalizing. Externalizing means there’s a thing happening inside of you and you attach to it sometimes so it becomes part of your identity. But you don’t want to do that. I’m gonna give you an example. Instead of thinking, I am an impostor, which is fusing with a thought and having it become part of your identity, you want to externalize it and instead say, not I am an impostor, I am having this experience of impostorism. I am having this experience of impostor syndrome.
– [Zubin] That is that spirituality 101 too. That’s meditation 101.
– [Rachel] Is it?
– [Zubin] You disidentify from the experience and instead notice that it’s an occurrence and awareness. So not, oh, I’m in pain. You say, no, no, no. I’m having an experience of pain.
– [Rachel] That’s right, that’s right.
– [Zubin] And then you can even go farther and say, you know, awareness of the pain and the pain are not two things, it’s just pain. That’s all.
– [Rachel] Right. And it’s the same with depression. Instead of I am a depressed person, it’s I’m having this experience of depression. All the things are connected..
– [Zubin] So impostor syndrome, you disidentify from it, but you experience it. You say, okay, I acknowledge the experience.
– [Rachel] I’m having the experience, but I’m not, it’s not that I am an impostor. It’s not my identity. I’m just having the experience. And then step three is reframing it. What do I mean by reframing it? Impostor syndrome happens during times of human growth. It’s actually a sign of success. It’s a sign that you’re stepping out of your comfort zone. You’re challenging yourself and you’re pushing yourself. And if you’re having an impostor syndrome moment, it actually is, if you’d like to reframe it, which I recommend because it’s helping me immensely, it means that you are moving forward in your life, and you’re stretching yourself a little bit, and you are growing and succeeding. And what I learned from Jordan Harbinger is impostor syndrome happens to people who are high achieving. And, of course, it does ’cause you’re trying to, you are trying to grow and you are trying to step into these like shoes that don’t fit you yet, but you’re hoping that they do. So acknowledge it, externalize it, reframe it.
– [Zubin] Reframe it. So, that’s brilliant. And that is meditation 101 too. And I’ll add even another spin on it that is probably wrong, but I’m gonna say it anyways.
– [Rachel] Do it.
– [Zubin] In a way, what we resist persists, right? And so by saying, oh man, I’m having this impostor syndrome. Now, why am I having this now? I’m about to give a talk. It’s gonna totally derail my whole talk. And I’m just gonna worry about it. And so you’re resisting it. Instead, if you say, oh, there it is, impostor syndrome. Oh yeah. I’m gonna reframe it. Yeah, it’s because I’m about to do something cool that is a challenge for me. And I’m appropriately, oh, you know what, what is impostor syndrome? It’s a part of my unconscious, a little child in there that’s trying to get my attention and be like, hey, you’re gonna try something that’s really hard.
– [Rachel] Feeling a little scared.
– [Zubin] I’m feeling a little scared.
– [Rachel] And insecure.
– [Zubin] And so you just want to take it and be like, it’s okay, it’s all right. It is gonna be a little scary, but that we’re gonna do it together. It’s okay. I’m glad you’re here for me, right?
– [Rachel] I love that.
– [Zubin] So then it’s not this adversarial relationship with this part of you.
– [Rachel] Totally. Yep. Like, oh, this is a good thing. And it’s a byproduct of success. And how proud of myself am I, that I’m stepping out of my comfort zone and doing this thing anyway, even though it’s making me uncomfortable.
– [Zubin] That’s right. That’s right. Yeah, I love it.
– [Rachel] Good.
– [Zubin] Man, that was really helpful.
– [Rachel] Wasn’t that cool?
– That was really cool.
– [Rachel] I know, I read all the things, I thought it was so fascinating, and it turns out I actually originally thought that women suffered from it more than men. Guess what? Not true.
– [Zubin] Really?
– [Rachel] I know it’s not true. I don’t think it’s true. Men and women equally. That’s what I read.
– [Zubin] It makes sense. It makes sense. Although you would argue, well, the biopsychosocial components of women are different than men. So maybe there would be a difference. But I think this is a fundamental human thing, like goes right to the core of identity, the core of some evolved, deep conditioning. Like it’s almost, you know, we talk about genetics, right? As this kind of like inherited thing. You can reframe genetics as a kind of a, I hate to use this word because it sounds like New Age mumbo-jumbo, but a kind of karma, a kind of an inheritance of a pattern that goes from the ancient, like beginning of the universe all the way to now. So what is impostor syndrome? It’s a pattern of energy that has kept us safe in some way. We don’t overextend.
– [Rachel] Yeah, right.
– [Zubin] Because that little guy in there is like, bro, you’re not, that’s not your-
– [Rachel] Rein it in a little bit.
– [Zubin] Rein it in. And so to some extent, it keeps you from doing really stupid stuff, but then it becomes a problem when you’re trying to stretch. So it’s always a balance. I love it.
– [Rachel] Yeah, and I think the real trick, as you just touched on with impostor syndrome, is if it’s preventing you from doing things, then it’s a problem.
– Then it’s a problem, yeah.
– [Rachel] So if you feel it and you do the things anyway, you’re on it.
– [Zubin] Which is what you do.
– [Rachel] Which is what you do.
– [Zubin] We both kind of do it, but you, I think you have to overcome more in the current because you’re pushing yourself in a way that, first of all, you’ve been doing it for a long time. You have every expertise in this, but you haven’t done it as much as I have in terms of pushing yourself for that long.
– [Rachel] No way.
– [Zubin] Because 10 years ago, I started this thing in 2010, when I did TEDMED in 2013. Like I was, I’ve never been so scared.
– [Rachel] Oh my god, I can only imagine.
– [Zubin] I mean, it still gives me a little bit of panic thinking about it. And after that, every time I did a talk, it was just everything that you say, sweating, and panic, and wanting to throw up, and all of that, and that lasted for years.
– [Rachel] No, don’t tell me that.
– [Zubin] Well, but it’s also because I never really had the tools or the approach to address it. I would just go, this is just something that happens every time. And you know, every time I do a talk, I’d be like, it was so damaging to me physiologically, that I would be like, I’m never doing this again. I’m never doing this again. And the next one would be, I get invited, and I’d get a rush of like, yes! Oh, I love talking! And then I would remember, oh no, wait, no. It sucks.
– The physiology of it.
– [Zubin] Yeah, yeah, yeah.
– [Rachel] Right. And by the way, just like a quick reminder, that like anyone who thinks that emotions just live in your head and are not physiological, well, this is like the perfect example of how emotions actually come out in your body and can make you physically ill.
– [Zubin] Totally!
– [Rachel] And can perpetuate any sort of syndrome that you already have.
– [Zubin] Absolutely, they are feelings for a reason. You feel them in the body.
– [Zubin] I think I told you this last time, like energy in motion, emotion. Yeah. It is. It in its raw sense, it’s a bodily sensation that we then tell a lot of stories about, that then become, then we make it heady.
– [Rachel] Totally.
– [Zubin] But the rawest part of the emotion is a sensation. Boy, you know, thinking back to those times, right before you go on stage, when you feel those physiologic responses, I mean, what if you just dive into the sensation? That’s what I do now sometimes. ‘Cause I’ll still get a little trans and you just feel it. You just go, there it is. There’s my friend panic or rapid heart rate. You know what’s craziest?
– [Rachel] Talking about it is making my heart go crazy.
– I know. Me too, me too. So there’s a thing that happens with me now where all that panic is compressed into a 30-second period. So it used to be like, I’d feel it over like, God, even the night before and all days. And now what happens is I’m totally chill until they go, our next speaker is this guy, and he’s done this, and this, and this. And it’s crazy. You feel it, you feel this rush, the heart rate speeds up. It’s going like 110. I’m sure my blood pressure is like high. I’m starting to feel it in the chest, in the stomach, the butterflies, all of that. The impostor is coming out. Like, dude, you have no business being here, get the hell out now, run.
– [Rachel] Exactly.
– [Zubin] Fight or flight. But then, because I’ve kind of acknowledged it and practiced it and I’ve been through it, and I’ve done it, it starts to fade and I go on stage and I do my thing. And actually, if anything, it gives you that little kick in the pants.
– [Rachel] Jolt. The adrenaline. Okay, that’s good to know. I aspire to get to that.
– [Zubin] You’re 99% there.
– [Rachel] I am not.
– [Zubin] You are.
– [Rachel] I am not 99% there.
– [Zubin] Look at what a natural you are when you talk about stuff you love.
– [Rachel] Alright, great.
– [Zubin] Alright, we’ll stop.
– [Rachel] Yeah, compliments are hard for me. ‘Cause impostor syndrome, that’s why compliments are hard for me. That’s actually why, okay, anyway.
– [Zubin] That’s why I always send you all the compliments.
– [Rachel] Okay. What’s the next thing? Do we have time for another thing or?
– [Zubin] Of course, we do. We’ve been going for about an hour and 16 minutes.
– [Rachel] So one more thing.
– [Zubin] Absolutely. Let’s do benzos.
– [Rachel] You wanna do benzos?
– [Zubin] Or you wanna do insomnia?
– [Rachel] I don’t know.
– [Zubin] I think we should talk about benzos. Well, you know what? Benzodiazepines are so important. I almost want to put it at the beginning of another show.
– [Rachel] Let’s save it. Save it.
– [Zubin] And I’ll just say this, because I know we promise we talk about it. I’m just gonna say this, for people who think these drugs, Valium, Xanax, there’s a million of them, right?
– [Rachel] Klonopin, Ativan.
– [Zubin] Thank you. They are like essential, you know, pieces of our puzzle. Yes, everything is important. These drugs are particularly poisonous, toxic, addictive and suffering inducing. And if you think that you’re gonna wave a magic wand with these drugs and fix your biopsychosocial problem of anxiety or whatever it is, you are being fed a bill of goods and the suffering these drugs cause is at least as bad as opioids. Maybe worse. And if you look at people like Jordan Peterson, who’ve come out of addiction to these, who were in rehab for, you know, months for this stuff. And we’ll talk about it. Like they’ve come through a hell. You will understand that these drugs are not a joke.
– [Rachel] Not a joke. Yeah, let’s do it next time. ‘Cause I think there’s so many things to say about it. But what I hear all the time from people who are living with anxiety is that, it’s prescribed like candy. Benzodiazepines are prescribed like candy. And again, Xanax, Klonopin, Ativan, you know, we’ve all heard of them, I think. Because doctors really, and I think it’s not doctors fault. Like the doctors are sold this idea. ‘Cause physicians want to ease suffering. Of course, that’s why we all go into healthcare. We want to ease suffering. But I think physicians are sold this lie that these pills are gonna ease their patients’ suffering. And Big Pharma has billions of dollars to market this idea that these pills really are the cure. And by the way, they aren’t. They are not. They are toxic. They are addictive. There’s a rebound effect. So as soon as you go off them, you feel worse than you did before. So, and I also just want to make clear and say, I am not a doctor. I am not your doctor and Zubin is not your doctor. So we can’t give anyone medical advice, and I always want to say that, but I am also not recommending that you go cold turkey off these drugs. ‘Cause it will be so, so bad for your body.
– [Zubin] You can die.
– [Rachel] You can die.
– [Zubin] Withdrawal from these drugs can be fatal.
– [Rachel] But we do want to make sure that people know that these are toxic medications. They are not panacea. They’re not a magic pill and not a magic cure, but they are dispensed like candy. So I know that was sort of a teaser for next time, but we will go down that rabbit hole a little bit more.
– [Zubin] We’ll go deeper. And I’ll say this, they work in the short run.
– [Rachel] Correct.
– [Zubin] Magically.
– [Rachel] They do!
– [Zubin] Like, oh my God, my anxiety is gone. My panic attack stopped. And what price is that deal with the devil that you pay with these drugs? Now, again, I wanted to say one other thing about this, that is not to say there aren’t rare cases where people benefit from PRN, benzodiazepines, et cetera, in the context of a broader treatment strategy for whatever. So I don’t want to lessen that and I don’t want to second guess some psychiatrists and psychologists who are using these drugs in those ways. And I know that we’ll get messages from patients who are on them chronically and say, without them I die and so on. It’s true. Without them, you will withdraw and die. That is true. But I feel very strongly that we, if these drugs never existed for humans, well, it would be a problem, because we use them in anesthesia and peri-op periods and things like that. But they are problematic.
– [Rachel] Yeah. It’s real bad.
– [Zubin] Okay. So that’s said. Insomnia.
– [Rachel] Insomnia. Have you ever had insomnia?
– [Zubin] All the time
– [Rachel] But like why? And when?
– [Zubin] Okay, so it’s evolved for me, when I was younger, I’d get it all the time. And I think it was just can’t stop the brain, racing thoughts, not feeling tired, but then also feeling tired. And different types of insomnia. Waking up in the middle of the night, not being able to go back to bed. Waking up early, not being able to initiate sleep. I’ve had them all.
– [Rachel] All the kinds.
– [Zubin] All the kinds. Right now my predominant type of insomnia, when I get it, it’s more rare, is early awakening. Yeah.
– [Rachel] Yeah. I think that’s common as you get older. That’s what I hear.
– [Zubin] See, you know, I mean, I have no firsthand experience with getting older because I’m timeless.
– [Rachel] you are timeless.
– [Zubin] I’m the eternal now. Yeah.
– [Rachel] Yeah, well, the question really was how do you treat insomnia? That was our friend Stephanie from Twitter.
– [Zubin] Stephanie O. from Twitter. Yes.
– [Rachel] Yeah. I also-
– [Zubin] Benzos, right?
– [Rachel] Oh god, those are prescribed for insomnia. Benzos are prescribed for insomnia. And as soon as you go off them, your insomnia rebounds and gets significantly worse. It is just a fun party out there.
– [Zubin] It’s like drinking yourself to sleep. is similar GABAergic mechanisms of alcohol and benzos to some degree.
– [Rachel] So you’re saying alcohol does not work for sleep?
– [Zubin] It does not. It will maybe knock you out, but your sleep cycle is disrupted. Your REM sleep is disturbed. Your restorative sleep is damaged. It’s not a way to be.
– [Rachel] Right, it’s a way to knock yourself out, but not to get good sleep.
– [Zubin] That’s right. And benzos are the same way.
– [Rachel] And also I think with alcohol, there’s like a lot of awakenings, right? Like it’s not like a restful full night. Like you sleep-
– [Zubin] Correct, that’s right.
– [Rachel] Unless you’re like really hammered.
– [Zubin] No, that’s right, that’s right. And the same with actually THC. So some people say, well, I swear it helps me sleep. But if you actually look at the sleep patterns are not great.
– [Rachel] That is so good to know. I did not know that.
– [Zubin] It is interesting. Oh, you know, one of the things I want to say that actually relates insomnia and the benzo issue. I want to make sure people know the suffering that underlies the need for benzos, the panic, the anxiety, the insomnia, the fear, whatever it is, we shouldn’t diminish that by saying we hate benzos. We should say, you know, we should be very clear. There’s a reason these drugs are so popular, that we’re suffering. People are suffering. So let’s address the suffering. Yeah.
– [Rachel] I appreciate that. It’s a really important point.
– [Zubin] Yeah, yeah. So back to insomnia. This is a kind of suffering too.
– [Rachel] Yeah, so am I allowed to ask when you have insomnia, what do you do?
– [Zubin] Well, so what I do is, first of all, I’ll realize sometimes, oh, I did something wrong during the day. Like I ate, I drank coffee afternoon or something. So I look at my caffeine intake.
– [Rachel] You like, shoot, stimulants.
– [Zubin] Yeah, stimulants. Dark chocolate is a problem because it has caffeine. People don’t realize the things that have caffeine. Certain teas and things like that. So I’ll wake up in the middle of night, and I’ll be like, oh God, why, why, why? And then I’ll be like, oh God damn it. I went to a Chinese restaurant. I had a pot of oolong tea, not knowing, ’cause what they gave me to drink. And now I can’t sleep, well, duh, and I can feel it in the heart rate.
– [Rachel] Here’s the bio components of insomnia, by the way.
– [Zubin] There you go. So yeah, exactly.
– Caffeine, stimulants.
– [Zubin] Caffeine, stimulants, late exercise or stimulation before bed.
– [Rachel] Late exercise, absolutely will stimulate your body.
– [Zubin] Screens late, before going to bed, this blue light that’s stimulating us.
– [Rachel] You got it. It changes the sleep chemicals and your circadian rhythms. Also the bio.
– [Zubin] So I’ll go through that little differential diagnosis, and that’ll keep me more awake ’cause now I’m thinking. And then it becomes a pattern of, oh, I just remembered something I should have done or shouldn’t have done, or I said in a show that I shouldn’t have said, or this person that attacked me on Twitter, and now becomes, now it’s cognitive. So now I’m anxious. So I’m feeling the anxiety physically, I’m feeling it in the chest. I’m sorry.
– [Rachel] So this is our psych bubble of insomnia. I’m thinking these thoughts that I’m ruminating. I love the word ruminating. ruminating is like-
– [Zubin] So accurate.
– [Rachel] Yeah, ruminating is when you think a thought over and over and it’s like, you know, if you’ve ever watched a dryer, and it’s just like drying your clothes, just going around in a circle over and over. And the same piece of clothes, like the same yellow shirt, you just keep seeing it over and over again. That’s ruminating. So when you’re lying in bed and you have the same thought over and over and over and over again, it’s not helping you, not solving anything.
– [Rachel] Your brain is just chewing on it.
– [Zubin] It’s chewing on it. And the brain, again, let’s forgive our minds. There are these little, sometimes they have these little children components that are like, if I just keep at this, I’ll crack this. The feelings that that actually are associated with like this anxious feeling in the chest, maybe the only way to deal with this is by thinking about it constantly, thinking about what’s triggering it. And the truth is, well, it may be that just relaxing that and feeling the sensation ’cause it wants to be felt, might be better. But again, so yeah, so the rumination, very, very common with me in particular ’cause I’ll ruminate about it. And now I’m much better. ‘Cause I’ll recognize these patterns. So all the introspection and the work that I do on myself at least has that benefit, where I’m like, oh, this is what’s happening, okay. So at that point, what I do is sometimes I’ll say, okay, I’m not sleeping. So now I’m in bed and I’m conditioning myself to not sleep in bed.
– [Rachel] You know all the things.
– [Zubin] So and, again, this is from personal suffering. So it’s like, okay, I’m gonna get out of bed. I’m gonna go sit somewhere quietly. Maybe I’ll meditate. Maybe I’ll read something until I feel like the body says it’s time to go back to sleep. And so that’s sometimes what I’ll do. With anxiety, when that happens, I’ll meditate on the feeling of anxiety and that transmutes it. Too crazy, it’s now works almost every time. Sometimes it’s overwhelming. Sometimes you just can’t, and you’re just like, no, I just got to, this is just gonna be this way tonight.
– [Rachel] That’s exactly right. So emotions sometimes are part of an insomnia recipe and that’s in our psych bubble too. So emotions like stress and anxiety, when there’s stuff going on in your life, of course there is, or you’re feeling really sad that can keep you up or wake you up also. Or you’re feeling really angry and frustrated, that can wake you up or keep you up also. So there’s this cognitive component. There are the emotions of it. So biopsychosocial always all the things, insomnia too. So agree 100%, really appreciate your example. And I want to give like a quick hack for what to do for insomnia ’cause that’s Stephanie’s question, what to do for insomnia? Now, there are people who will tell you, you know where I’m going with this? That you should just-
– [Zubin] Do one thing, take a pill.
– [Rachel] Take a pill. For your insomnia. But what research shows is that actually the medications will disrupt your natural sleep-wake chemicals in your brain. And actually over time will make your sleep worse and not better. So benzos, benzodiazepines, are not good for sleep. What are your thoughts on things like NyQuil and Benadryl and what are the casual over the counter? Like Ambien.
– [Zubin] Very similar to benzos in the sense.
– [Rachel] What’s the research on that?
– [Zubin] I don’t know the research but I’ll say this. Sometimes they can help you get to bed. That’s true. Just very intermittently, maybe a good tool, especially if you’re, you know, you really need to sleep for the next day or whatever, but they have this probably the same components. Especially, you know, Benadryl can have a very dysphoric, kind of hallucinatory component, and Ambien, again, these are dependency-forming medications.
– [Rachel] Yes, they are.
– [Zubin] And sometimes they really don’t help the early awakening issues. They help you get to bed, but they don’t help the underlying thing. It’s the underlying turmoil.
– [Rachel] Yeah, that’s right.
– [Zubin] That we’re not, and that’s why I think, again, you can really feel into people who are suffering, and you’re telling them, oh, well, now there isn’t a magic pill. It’s actually complicated. And you can just feel the suffering.
– [Rachel] And everyone’s like, oh, don’t tell me that, just knock me over the head with the hammer.
– I know. Exactly.
– Oh, I’ve had that feeling. Will someone just please hit me over the head.
– [Zubin] Me too, me too. Yeah.
– [Rachel] Totally.
– [Zubin] Like why? And then there’s also the why, the why. Why is this happening?
– [Rachel] Well, and you and I have just said the why, like there’s some stuff going on. There’s stuff going on in your life. There’s like emotional turmoil. There’s cognitive turn turmoil. And there’s environmental. Like there’s stuff, like we are living, and there’s physical stuff. And we are living through a pandemic. We are living through one of the most stressful experiences that humans can live through. Like no one will deny that all the things going on right now have been very stressful and dysregulating for everyone. It’s triggered a lot of anxiety, a lot of stress, a lot of issues for everyone. So a lot of compassion.
– [Zubin] Division. Yeah.
– [Rachel] So I want to give some solutions.
– [Zubin] Please.
– [Rachel] You’ve named some already.
– Watch the stimulants.
– One is reducing stimulants. That’s right. If you’re someone who’s dealing with insomnia, no more coffee. Just don’t dial. If you’re someone who drinks coffee regularly, dial back, wean off gradually, slowly.
– [Zubin] I had to do that.
– [Rachel] Off the stimulants. ‘Cause they’re surely not helping your sleep cycle. That’s thing one. Thing two, the first thing that you do in the morning is you get some sunlight in your pupils. And by the way, I don’t mean stare at the sun. We don’t want to burn out your retina, but getting sunlight in your eyes stimulates all sorts of sleep-wake chemicals. So it breaks down the sleep chemicals, and it stimulates the wake chemicals. And to be even more nerdy, bear with me here, there’s a part of your brain that I happen to love called the suprachiasmatic nucleus. It makes me think of-
– [Zubin] My boy SCN.
– [Rachel] It makes me think of, God, what was that song from “Mary Poppins”? Like-
– [Zubin] Supercalifragilisticexpialidocious?
– [Zubin] You and I are, that word, every time I read it, I think of Supercalifragilisticexpialidocious every time.
– [Zubin] It’s the same thing, suprachiasmatic nucleus.
– [Rachel] So the suprachiasmatic nucleus is this part of your brain that lives at the top of your optic nerves. And it’s programmed by sunlight because human beings are diurnal, which means we are awake during the day, function and activities during the day, and we are asleep at night. And this little part of your brain is programmed by sunlight. And you may have noticed that if you set your alarm every single day for 7 a.m., what happens over time, and you get up and you get sunlight every day. What happens over time is you don’t need the alarm anymore. Your brain will wake you up at 7 a.m. if you do it long enough. And that’s because your SCN has gotten programmed by sunlight. You have an internal alarm clock. It’s called your SCN. It’s very cool. So if you are dealing with insomnia, you want to go out, you want to set your alarm at some time, and you want to go outside and get some sunlight in your pupils. ‘Cause your pupils are your eyes, which are connected to your brain. Technically, part of your brain, your optic nerves, and they program your suprachiasmatic expialidocious part of your brain. Mary Poppins. That’s thing two. Thing three. Try and set asleep time and awake time. And by the way, the reason I know all this stuff is ’cause I treat pain, and sleep and pain have an intimate relationship. And so I always want to hack sleep because it’s part of pain. It’s part of anxiety. It’s part of depression. So sleep time and awake time. So it’s very helpful to have asleep time and awake time, again, ’cause that part of your brain loves to be programmed. And the human body’s always striving for homeostasis, which is a fancy word for balance. And the human brain really likes regularity and balance. And when you have asleep time and awake time, it is really helpful for all the things, anxiety, depression, pain, everything and sleep. So sleep time, wake time, your body knows when it’s getting up and it knows when it’s crashing and going to bed. So like 7 a.m. wake time, 11 p.m. sleep time. And we just aim for that. Doesn’t mean you have to be rigid about it. We just aim for it. The next thing is the thing that you said that you do, which is so brilliant, and I want to say the science of why. When you’ve been laying in bed, the rule of thumb for me is like 20 minutes or more. And I don’t want you looking at your clock. Do not. You’re gonna turn your clocks around. I don’t want anyone looking at their clocks because as soon as you look at your clock and you’re like, “Ah, it’s due in the morning! And I’m not asleep!” What happens to stress and anxiety? It goes up.
– [Zubin] Panic. And as stress and anxiety go up, likelihood of sleep goes down. So no looking at clocks, turn your phone over, turn your clocks around, put tape over the oven, stove, light, whatever. Don’t look at any clocks. I don’t want you knowing that it’s four in the morning. It will only stress you out. But when you’ve been laying in bed for something that feels like 20 minutes or so, get out of bed. Get out of bed. ‘Cause here’s what happens. You said this, you’re laying in bed, you’re like, I’m not sleeping. Why am I not sleeping? When am I gonna fall asleep? I need to function tomorrow. I have the show to do. I’ve papers to write. My kids need me. I have to show up. I have million responsibilities. I’m gonna get fired. All the thoughts that come into your head when you’re not sleeping, I’m gonna be dysfunctional. The longer you lay in bed, the more of those thoughts you have, the higher the stress and anxiety goes, the lower the likelihood of sleeping becomes. That’s part of it. Part two is you mentioned Pavlov, do you want to tell everyone who Pavlov is?
– [Zubin] So my boy Pavlov was an operant conditioning guy, I think, where he basically, classic conditioning, where he had these dogs and he would notice that if he fed them when he rang a bell, they would become conditioned to know that what the bell meant feeding. So then he could just ring the bell and they would just start to salivate.
– [Rachel] Exactly. That’s exactly right. Sorry for putting you on the spot.
– [Zubin] No, no. It just took me back to the old school.
– [Rachel] I know, it’s like you learn it so early in training, but it’s like you have to go back 20 years of like. It’s true. That’s right. And dust the dust it off and, right. So Pavlov was this wonderful scientist guy. And he wondered if things that were not actually naturally related could become related. So we know that when we give dogs meat, they salivate, ’cause meat is delicious unless you’re a vegetarian and then you don’t want to eat it, which is totally fine.
– [Zubin] In which case legumes are delicious.
– [Rachel] In which case tofu, and legumes, and what is, what is the fake meat called?
– [Zubin] Chilled monkey brains?
– [Rachel] Okay.
– [Zubin] Impossible stuff.
– [[Rachel] Right, so he would feed the dogs meat and they would salivate, feed them meat, salivate. And eventually he was like, gosh, I wonder if I can make these dogs salivate to something not delicious, something that has nothing to with meat. So he decided to use a bell, and we can all agree that dogs do not eat bells. Bells are not delicious to dogs. So he would ring a bell, give dogs meat. Ring bell, give meat. Ring bell, give meat. Ring bell over, and over, and over again. And over time, as you astutely mentioned, what would happen is he would ring the bell, and the dogs’ brains had paired these two unrelated things, meat with bell. In real life, those things are not related, but learning occurred, brain changes occurred over time. And so when he would ring the bell, the dogs would salivate. Guess what happens when you lay in bed not sleeping and feeling anxious? Your brain pairs bed with stress and anxiety. The longer you lay in bed, feeling stressed and anxious about not sleeping, the more your brain will pair bed with not sleeping, which is the opposite of what you want when you get in bed. What you want your brain to pair your bed with is drooling unconsciousness.
– [Zubin] Yes.
– [Rachel] So, yeah, go ahead.
– [Zubin] Yeah, it’s like a Bluetooth connection. Like you don’t want to Bluetooth to pain and bed and unhappiness. Yes. You want to Bluetooth to bliss filled unconsciousness.
– [Rachel] Exactly. So you want to get into bed only when you’re sleepy, not when you’re tired, and there is a difference. I’m tired now. Tired and sleepy are not the same. Sleepy is I feel like I’m about to fall asleep. Tired is like maybe you throughout your day. Sleepy as I’m about… So you only get into bed when sleepy. And if you’re not asleep within 20 minutes and you feel yourself getting stressed out, you want to break that cycle. You don’t want to pair your bed with being stressed. You get out of your bed and you have some things in your living room or whatever that you’re ready to do. It can be a coloring book. I like adult coloring books. You can make fun of me if you want to, I don’t care.
– [Zubin] Did you say adult coloring books?
– [Rachel] Oh God, that sounded so bad. Oh my God!
– Because I’m all in.
– [Rachel] That sounded so bad.
– [Zubin] Is that a thing?
– [Rachel] Coloring books that are not for children. It’s like Zentangles. Oh my God, I did not mean anything rated R. Oh God!
– [Zubin] What part of the human anatomy needs color?
– [Rachel] Oh my God. I’m so embarrassed. Right, it’s not pornographic coloring books.
– [Zubin] I don’t know. I can’t tell because-
– [Rachel] Oh my God, because the lights are so-
– [Zubin] I’m red agnostic, not quite colorblind, but I’ll say this. Why is it that you and I always end up in these weird situations? Because I’ve had a few messages from people like, you’re such a sexist. You always make these dirty jokes with Rachel. But you don’t do it with Marty Makary. I’m like, yeah, I don’t know why that is.
– [Rachel] You should talk to him about adult coloring books next time you see him. Just bring one in.
– [Zubin] He’ll probably do an op-ed in “The Wall Street Journal” about it.
– [Rachel] By the way, I brought you a rated R coloring book. No, it’s like Zentangles. There are coloring books that are not like comic book characters is what I’m trying to say.
– [Zubin] Zentangle sounds like a problem with manscaping or womanscaping.
– [Rachel] Fine, but here’s a million things that one can do when one is tired. That is not gonna stimulate you.
– [Zubin] Oh, sorry, that last part.
– [Rachel] What did I do?
– [Zubin] I was gonna say, I know some things you can do in the bed that aren’t, but no. See, this is what happens!
– [Rachel] This is your problem.
– [Zubin] It is my problem. It is. It’s the unconscious 10-year-old in me. That’s like, ha ha.
– [Rachel] So you want to get out of bed and do calming things that will soothe your system. So you can listen to calming music. You can read a dumb magazine. You can have a boring book. You can listen to a boring podcast. You do not want to be stimulated. So no murder mysteries, nothing exciting in any capacity.
– [Zubin] Okay.
– No rated R coloring books.
– [Zubin] So no Good Housekeeping magazine is what you’re saying?
– [Rachel] It depends on what stimulates, different for everyone.
– [Zubin] I mean, I saw “Step Brothers.” I’ll just leave that for the audience who knows “Step Brothers.”
– [Rachel] Oh dear. I hope the general gist of what I’m saying is coming across, despite the fact that I’m like stepping over myself here.
– [Zubin] It is, it is.
– [Rachel] So just have some calming things ready for you. And then when you can’t sleep, it’s less stressful. You’re like, okay, I knew that this might happen. I’m totally ready. I’m prepared. I’m gonna go to my couch and I’m gonna do some reading and some sewing and whatever it is that you do, listening to some music, and then after 20 minutes or so, you’re feeling sleepy, you get back into bed.
– [Zubin] Go back.
– [Rachel] That’s right. And you lay down, and if it happens again, ain’t no thing. And I’ll tell you from firsthand experience, I have had insomnia my whole life ’cause I get stressed out about things, especially during grad school. And I would just know I’m gonna have some nights like this, where I’m in and out of bed. And like, it really isn’t fun. But let me tell you, your brain wants you to sleep and your brain is going to put you to sleep eventually. And that is a very important thing to know that even if you have a couple bad nights like this, as long as you’re regimented about this and doing all the things, and you have asleep time and awake time, and you’re not napping. By the way, no naps. You’re not napping all day in the middle of the day. Eventually your brain is gonna regulate.
– [Zubin] Okay, this is great because it actually diffuses some of the catastrophizing and the thoughts that happen. ‘Cause that is one of the problems. I’m not sleeping. Now I’m ruined, I’m forever broken. I’m not gonna be able to catch up. So no, not true.
– [Zubin] And then not napping thing is interesting because I’ve heard that as well.
– Rachel] No naps.
– [Zubin] Because what you’re doing is, again, you’re just spreading out the sleep and instead of doing it when you really need to, yeah.
– [Rachel] Yeah. So I’ll tell you the why. There’s a chemical, I believe it’s adenosine, in your brain that builds up over the course of your day. And when it reaches a certain critical level, that’s when you fall asleep. Now, what happens when you take a nap in the middle of the day is you lower the level of adenosine. So you need to build it up to, it’s delayed, the building up of it is delayed even later. So if you take a three hour nap in the middle of the day, you’re not gonna fall asleep until two in the morning. And then you’re gonna try and wake up at seven or eight, and it’s not gonna work.
– [Zubin] And this is parenting 101. The kid sleeps too long during the day, doesn’t get to sleep at night, yeah.
– [Rachel] You got it.
– [Zubin] And and so, okay. You may be talking about this, but what about things like melatonin and these sort of-
– [Rachel] Yeah. Yeah, that’s a great question. So my understanding is melatonin can be helpful. I mean, look, like at the end of the day, my TLDR, too long, didn’t read, short brief summary is like, your brain has all the chemicals it needs to help you get to sleep. Like if you’re using all the things, you can hack insomnia. So getting sunlight, setting these behavioral parameters. But yes, melatonin can be really helpful, especially, is my understanding, especially if you’re jet lagged, and there’s been research that shows that if you have migraine and headache, melatonin can also be helpful for sleep and headache. That’s what I’ve read. But in general, like you have all the chemicals. Your brain has the chemicals it needs and your brain is eventually gonna sleep. And if you’re not sleeping, it’s your body’s way of telling you there’s some shit that needs to be worked out. Like you’re thinking about some stuff, or there’s something going on in your life. Right?
– [Zubin] It makes sense.
– [Rachel] There’s something’s happening.
– [Zubin] So the way I often conceive about these processes. And again, some of it comes from meditation, some of it comes from reading about neuroscientists talking about these ideas that there are these subminds that are processing information unconsciously. At some point, that information gets pushed into consciousness. And the sooner that happens, the sooner it’s processed, and those subminds can stop. If you have been dealing with a bunch of stuff, like you said, it’s been a hard day. The stuff’s going crazy. There’s stress, whatever. It’s processing, whether you’re awake or asleep, it does it still. So it’s what you don’t really ideally want is in the middle of the night that submind to be like, “Hey, by the way, remember that thing?” And then you’re like, ah, and then you’re awake. So that means that sometimes you just have to deal with your shit, which takes work. It’s not as easy as taking Klonopin or Ambien. It’s hard and we’re tired, but it is the only sustainable solution. And understand that it’s not magic. So you make it better, and then it may come back again.
– That’s exactly right.
– Just like depression, just like anything.
– That’s exactly right.
– [Zubin] Can’t be discouraged, we can’t be like, I’m broken. It’s never gonna, yeah.
– [Rachel] That’s right. Yeah. Rad!
– [Zubin] Dude, this was radical. I extended the word rad.
– [Rachel] Okay.
– [Zubin] Because-
– [Rachel] ‘Cause you’re an extender of things.
– [Zubin] ‘Cause two words. Science. I think we did a thing. This was a lot of fun.
– It was a lot of fun.
– [Zubin] So we covered pretty much everything. We didn’t dive deep into benzos, but we kind of said the main thing, which is-
– [Rachel] I do want to say to everyone, like we get a lot of questions and they’re wonderful and don’t be mad at us that we don’t get to everything ’cause it’s just impossible. But there’s so many great questions we’re getting. Can we tell people where to submit? And by the way, we like the questions, and they’re gonna get integrated into all the stuff we keep doing.
– [Zubin] Rachel is a massive nerd and keeps like a big spreadsheet with all your questions. So nothing is lost.
– [Rachel] And then I do research and I look up all the articles. I’ve lists of articles and I send them to Zubin, and he’s like, “Bro, I don’t want to read these.”
– [Zubin] I’m like, “Why are you giving me homework, girl?” Like, “I thought you were supposed to teach me.” She’s like, “No, it’s a conversation. You’re supposed to be a doctor.” And I’m like, “You’re supposed to be a doctor.” And then both of our impostor syndrome gets triggered
– [Rachel] And we’re like, we’re both phonies. Who do you think we are?
– [Zubin] And then we’re crying on the phone. And then what do we do in the show? Yeah, let’s talk about perverted Scrabble and adult coloring books, exactly. And Zentangles.
– [Rachel] Oh, no, what have we done?
– [Zubin] You gave me your COVID.
– [Rachel] I definitely didn’t. I don’t have it anymore. If you get it, it’s not from me. Sorry!
– [Zubin] Dude, totally. It’s from my kids. Everyone in their schools is Omicron positive.
– I am sure it’s true.
– [Zubin] So it’s just the matter of time. Also, the way you send us messages is [email protected], and use hashtag, what is it? Pain points. And we’ll take your message. I’ll forward it to Rachel, she’ll put it in the spreadsheet. I won’t be able to answer your question, okay? On an email because I get so many questions, and I can’t do medical advice individually. We’re not giving medical advice here. This is educational and informative. Consult your own doctor.
– [Rachel] I’ve been also getting a lot of questions on Twitter, which I think eases your burden a little bit. And I am @DrZoffness on Twitter, @DrZoffness on Twitter.
– [Rachel] So you can either tweet at me or just DM me, both of those are fine. Just don’t DM me anything creepy or weird.
– [Zubin] Zentangles.
– [Rachel] Totally, and on Instagram also people have been finding me and writing. I’m @therealdoczoff on Instagram. I couldn’t think of a better name. I don’t know why I picked that one. It’s a little embarrassing.
– [Zubin] It’s perfect ’cause it sounds like you’re a celebrity, and there are fake doc Zoffs.
– [Rachel] @therealdoczoff. There’s no fake Doc Zoffs out there!
– [Zubin] That’s impostor syndrome by proxy. Like you’ve just created a celebrity that now has to have impostor syndrome.
– I sort of did it ironically ’cause I saw everyone doing the real this and the real that. And I was like, eye roll.
– I should have done that.
– [Rachel] No, I was like rolling my eyes at that. Like, oh, okay, you’re the real one, sure.
– [Zubin] And now you’ve done it.
– [Rachel] Well, I did it to be sort of like ironical, like that so funny.
– [Zubin] You’re basically Alanis Morissette, but with a PhD.
– [Rachel] Do you know that people say that? They’re like, “You look like Alanis Morissette.” And I’m like, “I don’t think I do, but all right.” I can sing about rain and irony.
– [Zubin] That is an irony, but rather just a series of bummers.
– [Rachel] That’s right. Series of bummers.
– [Zubin] And I’ll put links to all your social media stuff, to the book, in the show notes.
– [Rachel] You guys, Zubin followed me on Twitter.
– [Zubin] I sure did.
– [Rachel] He followed me on Twitter. I’m like real now, I’m like a real person now.
– [Zubin] The next thing I did after that was I deleted my Twitter app.
– Oh you did? That’s smart.
– [Zubin] I finally did it. Because I guess a good way to go out on this, because we’re approaching almost two hours-
– [Rachel] Oh God, no!
– [Zubin] No, no. We’re great.
– [Rachel] No, let’s divide it into two.
– [Zubin] It’s an hour and 40 some odd minutes. No, no. Why?
– [Rachel] Too long.
– Let people slug through it.
– [Rachel] It’s too long.
– [Zubin] Actually, no, no, because my wonderful new assistant actually does time codes now. So they can just click right to the part they like. Yeah, I finally did what I’ve always said I wanted to do, which is not cancel Twitter entirely, because, I mean, you can reach a lot of people on Twitter. It’s a very powerful tool. But rather I no longer look at Twitter.
– [Rachel] Oh, smart.
– [Zubin] I leave my thing there and I’ve deleted the app. I’ve deleted the bookmark because I would get sucked into these arguments and conversations. And then it’s a 2 a.m. wake up like, remember what that guy says about you on Twitter. Maybe there’s a component of truth to it. And then you’re like, impostor comes out. He’s like, yeah, bro, you really don’t know what you’re doing. It’s like, oh man. And so I said, you know what? The people who really care, who think that I’m wrong about something, will email me.
– [Rachel] Yeah. Sure.
– [Zubin] And they will tell me in a very clear and long way, as opposed to a virtue signaling tweet, where you’re like, “Look at me, I hate ZDogg.” And then I’ll learn from it. I don’t need Twitter for that. So there you have it. But I still follow you. I just don’t read anyone’s tweets. Is that okay?
– [Rachel] Totally fine.
– [Zubin] Do you hate me now?
– [Rachel] No. It would take more than that. I don’t care about Twitter.
– [Zubin] What would it take? What could I do? I guess we’re still rolling. Alright, this is a conversation we can have off camera. Guys, I love you.
– [Rachel I’ll think about it.
– [Zubin] Thank you, Dr. Z.
– [Rachel] Thanks, friend.
– [Zubin] One little pitch to you guys is if you like what we do, become a supporter of the show, ZDoggMD.com/supporters. And if you give, if you want to put a tip in the tip jar that supports all this junk here so that we can stay like sponsor-free, go to PayPal.me/ZDoggMD, and any of those little tips, I will respond to directly with an email thanking you. And if you have a comment there, I will respond to it. Alright, guys, I love you. Thank you. And we are out. Peace.