Dr Rupy: Dr K, why is it so hard to put our devices down even though we know it's not good for us? I really want to understand the neurochemistry of why I'm addicted to my phone.
Dr K: Yeah, so that's a great question. So let's start with this. When you say it's not good for you, which part of you knows it's not good for you?
Dr Rupy: I think it's both the rational side and the subjective side because I know when I've gone down a rabbit hole or I've binged on social media, I don't feel great.
Dr K: Yeah, right? So I think these are the parts of the brain, these are your cortical structures. So these are the parts that make us human, allow us to analyse things, allow us to think far into the future. The part of your brain that doesn't want to put the phone down is completely different. Those are the dopaminergic circuits of the brain. This is your nucleus accumbens. So I think what's really confusing for a lot of people is they'll say I know I shouldn't spend so much time on my phone, but which part of you knows and which part of you does like spending time on your phone?
Dr Rupy: And what part of me does like spending time?
Dr K: Yeah, so I think if we look at our brain, right, we have different parts of our brain that compete for different things. So there are some parts of our brain that will tell us what we should do. These are ideas of the way we've been conditioned. We have some of these long-term goals, I should work out, I should eat healthy, I should be doing all of this stuff. These are goals that we want to achieve, but we're not willing to pay the price to achieve those goals. And often times that price is sort of dictated by other parts of our brain. At the top of the list is something called our nucleus accumbens. So this is the part of our brain that gives us a sense of pleasure and motivation. And that is also our dopaminergic centre of the brain. So anytime the nucleus accumbens activates, we experience pleasure, and then the next thing that we immediately do is develop a craving for future pleasure. So when we use our phones, it activates the nucleus accumbens. Our brain is like, oh, this is great. This is rewarding. This is something that we should be doing. A very primitive circuit in your brain that fundamentally tells you what is good and what is not good to do is what activates when we use our phone. So then the next day when we wake up, we may be thinking, oh, I have to get up, I have to do this, I should go to the gym, whatever. But this other primitive part of our brain is telling us, oh, we want to get a reward, so let's go ahead and use our phone.
Dr Rupy: And it's that reward which is really interesting, right? So is it true that if I, the more I use my phone, the more I activate this system, the more I become reliant on it essentially for the same dose of dopamine?
Dr K: Absolutely, right? So the really scary thing is not just that the phone activates the system, it's that once you, so you have a limited amount of dopamine in your brain when you wake up in the morning. So the really insidious thing is that when you wake up and if I use my phone and I use 20% of my dopamine, there's less dopamine left over for other activities.
Dr Rupy: Huh.
Dr K: So I don't know if you've ever done this, but even if we're talking about phone or I play video games, but if I work for six hours and then I play video games for two hours, it's a lot of fun. But if I start my day by playing video games for two hours, work feels absolutely boring. It feels terrible. It feels like it's a complete waste of time. So a lot of people don't realise that when they wake up in the morning, you have a limited amount of dopamine. So you have a limited amount of pleasure and you also have a limited amount of motivation. And if you spend it all on your phone, then there's going to be very little left over for things that if you were completely away from your phone, let's say you're on vacation and you're camping and you do the dishes in the morning and you make yourself breakfast, that is in and of itself rewarding if there are no technological devices around. So I think the really scary thing is that tech steals dopamine from activities that are good for you and spends it all on stuff that is basically a waste of time. The other problem is that as you do this over and over again, your brain is habituating. It's learning, oh, now we hate work. Now we hate doing the dishes. Now we hate all of these things. There's no reward in it, therefore there's no motivation in it, there's no pleasure in it. But there is a lot of motivation, a lot of pleasure, and a lot of reward when it comes to using our phone.
Dr Rupy: I want to get to some of the practical suggestions that you have for sort of breaking our reliance on phones a little bit later, but I don't think I've ever heard it explained in that way. It's almost like, perhaps to use like a gaming analogy, you have these dopamine coins and if you spend them early on in the day, you don't have any more coins later on.
Dr K: Absolutely. Yeah. If you're flipping it, perhaps, so if you spend those dopamine coins later on on something that you know, I'm using the word should here, but like you should be less reliant on like, you know, gaming or social apps, then perhaps it's a better experience.
Dr Rupy: Yeah, absolutely. So I think the way to think about the dopamine in your brain is like a lemon full of juice. So when I first cut open a lemon, if I squeeze just a little bit, I'll get a lot of juice out. But when I only have 20% of the juice left in the lemon, I have to squeeze really, really, really hard to get those last drops out. So that's the way that our dopamine works. When it's full, if my dopaminergic stores are full and I do something like get ready for work or plan for the day or prep for a meeting, since there's so much dopamine, even doing boring activities will release some dopamine. We'll enjoy it some and this is the really important thing, it will motivate us to do it tomorrow. The problem is that when I play a video game first thing in the morning, it's like taking that lemon and squeezing it really hard. And then there's very little left over for what comes next. This also explains why working before doing something fun is still pretty fun, but playing before you do some work is going to really exhaust you, right? Because you've squeezed all the lemon, the juice out of the lemon.
Dr Rupy: I love how I'm using the gaming analogies and you're using the food analogies. Switching roles.
Dr K: If you want to use food analogies, I'll use gaming analogies.
Dr Rupy: It's all good. I like the role reversal. Okay, so that's the nucleus accumbens. There are a whole bunch of other parts of our neuroanatomy that are involved in dopamine reward and some of these circuits that you talk about in your book, Healthy Gamer. Walk us through how this impacts other areas of the brain if you would.
Dr K: So there are a couple of other things that tech does that will affect other parts of our brain. So I actually think that people tend to be too focused on dopamine and there's a ton of other parts of your brain that are active. So the next biggest thing at the top of the list that I think a lot of people don't realise is that if I ask you if you spend four hours on your phone, what is the experience like? Many people will say it's not fun. I'm just kind of passing the time, right? And so what a lot of tech does is it actually suppresses our emotional circuitry. So many people who become addicted to something, if you look at the basics of addiction, in order for a substance to become addictive, it has to do basically two major things. One is that it gives you pleasure, but the second is that it takes away pain. So if we look at our phones, what will happen is if you're having a bad day, if you're stressed out, if you're worried about something, and you pull out your phone and you start scrolling, what happens to those worries? They start to disappear at least while you're scrolling. And this is where people really get into trouble because if I'm worried about something and I basically spend an hour scrolling through my phone, then it'll suppress my emotional circuitry. This is also something that people I think subconsciously like but is actually really damaging, is that we can only experience so much emotion in a day as well. You know, there are certain days, if you think about a funeral or something where you're just emotionally spent, you've got nothing left in the tank. And this becomes a real problem because if I suppress my emotions and I kind of deactivate that emotional circuitry, then it's often times emotions that are also really powerful motivators. So dopamine is really good at motivating action, but the second part of our brain that motivates our action even more than dopamine, the only part of our brain that can beat the dopaminergic circuitry is actually emotion. So you can be sitting there playing a video game, but if I break into your house and start trashing your bookshelf, you will get incredibly angry, you will stop playing the video game and you will defend yourself. So emotions, things like guilt, things like anger, things like sadness, these are all powerful motivators to action. That's why when we feel emotion, we feel like doing something. Sometimes with sadness, it's like, I feel like disappearing, right? It's actually a motivation to pull away from other people. So what tech really does, and this is why it's so crippling, this is why it's become such a big problem for so many people, is that it messes up our dopaminergic circuitry, but then it also disables our emotional circuitry. And once we feel numb, once we feel tired, then we don't have that energetic drive, that emotional drive to actually move towards our goals. We don't feel inspiration. The other last thing that I'll mention is that this is something that a lot of people don't realise. See, when you numb your emotions, you can't selectively numb them. You can't just say, okay, this tech is going to numb my sadness, but not my joy. So what all the brain really knows how to do or what tech really does is it turns down the volume on all of our emotions. This is why if you spend a lot of time on your device, by the end of the day, you just don't feel like doing anything. You don't feel inspired, you don't feel excited, and that's not just dopamine.
Dr Rupy: Yeah, yeah. I mean, the sort of global numbing, it's a really interesting concept and it's certainly something that I feel that I've experienced in a subclinical sense, not something that's been crippling to my day-to-day. But I think everyone can sort of resonate with this idea that their phones or their tech addiction is having a negative effect on them. And just as I use that word, tech addiction, I know that there is controversy over whether this is actually a true addiction. I mean, you're a psychiatrist, I'm sure you've had tons of experience with people who are addicted to physical substances. Do you equate the two? How do you wrestle with the sort of discussion or the debate around this topic?
Dr K: I mean, so for me, there's no doubt in my mind that tech is addicting and that people can develop technology addictions. I think we have sufficient evidence at this point. Some people will make the argument that technology addiction is simply a coping mechanism for another underlying thing, that you can't really get addicted to video games. So I think if we just go through this kind of from the top of the list, the first is that there's no doubt in my mind at least that pornography addiction exists. That's a tech addiction. We also know there are things like shopping addictions, video game addictions, cell phone addictions, social media addictions. And the reason that we sort of, there's no doubt in my mind now is, first of all, it's just getting way worse. So the rates of video game addiction are somewhere between probably 9 and 15%. Alcohol addiction is like 6%. And this is what's really scary is that a lot of people think that gaming addiction is something that happens only to young people, but the number of seniors that I've met that will spend hours and hours and hours on an iPad playing an iPad game is astronomical. I was just talking to a patient of mine who their mother was complaining, oh, I never see the kids, I never see the kids. And she'll take her kids to see grandma and grandma's just on the iPad the whole time. You know, they'll have meals together, but in the morning, grandma wakes up, she sits in her chair. That's just her routine. So I think we're really starting to see tech addiction in seniors quite a bit. And there's a lot of predatory practices towards seniors using technology. But I think there's absolutely like the rates of addiction are growing. We also now have enough neuroscience research to where we know how some of these technologies are activating the brain and there's enough overlap with substance use addictions like alcohol or marijuana. And then the last thing that we really look at in psychiatry, if you're trying to decide, okay, does my kid have a problem with video game addiction, yes or no? And this is all laid out in how to raise a healthy gamer. You know, a lot of parents don't know, is this like a new normal, right? Like does my kid have this problem or not have this problem? Will they grow out of it? Will they not grow out of it? And the most important thing is whether it impairs your function. So in psychiatry, if something interferes with your life, and if we're talking about tech addiction, interferes with academics, interferes with work, interferes with your mental health, your physical health, things like that. So if it interferes with family relationships, personal relationships, then chances are it's a problem.
Dr Rupy: That was actually going to be my next question is looking out for specific signs of tech addiction either in yourself or in a loved one. I mean, I guess it's the things that you just listed out there, like how much it affects your day-to-day.
Dr K: Yeah, so I think that this is the scary thing is that addiction is becoming normal. So what's so scary from a philosophical and societal sense is that we used to think that, okay, am I addicted? Well, am I like one of these 5% of people who really has a problem? But now what's happening is technology is so invasive. And this is the other thing that I think a lot of people don't quite grasp is how quickly it's developing. I think the first iPhone came out in like 2007 or something, right? It's crazy. It hasn't even been like 20 years. Or it's been about 20 years. And so the rate of technological change, the rate at which these billion-dollar companies are improving their product, optimising their product, the rate at which they're improving the addictiveness of it. I think we saw this with a big explosion with TikTok where like TikTok showed up and everyone started using it. And now you have Instagram Reels, now you have YouTube Shorts. So everyone's sort of is like following this short form kind of flow. And I think what technology companies are doing is making their products more addictive, whether they realise it or not. I mean, I don't know that they're nefariously trying to addict everyone, but what they're trying to do is, okay, now this user is closing YouTube and spending more time on TikTok. How do we get them back? Right? And so everyone is, there's almost this like digital arms race where these major platforms are all competing for your attention. And the unfortunate thing is no matter who wins or loses, you're going to have less time to yourself.
Dr Rupy: Yeah, yeah. And that's a scary reality. I mean, there is this argument from the tech side of things that you just turn the phone off. You can turn off your notifications, you can turn off your device, you can choose not to use it. It doesn't have that same, you know, it's something that you can physically remove from your life. And actually, to riff off a point that you made earlier, it's actually because of a problem more upstream. You weren't loved as a child, you have circumstances outside of your control, finances, or you're not in a good job. This is why you're addicted to your phone because you're looking for that release. I mean, how do you navigate that argument? How do you respond to people making this sort of simplistic point that you can just turn these things off and it's actually not the tech's fault?
Dr K: Yeah, so I mean, I think that that's, it's not wrong, but I think that, you know, assigning, so in medicine, as you know, Rupee, most things are multifactorial. Right? So if someone says you can just turn off your phone, that's true, theoretically, like you can turn off your phone. But this is where I think it's really tricky because our phones are now how we work. So can you really turn off your phone? This is what I see in the people that I work with who are addicted to technology is that the worst thing that has ever, the most damaging app on your phone is actually like Outlook. Right? Because the moment that your phone became used for work, like this is the real problem, is we have one device for entertainment and pleasure. And then what a phone developer does is they realise, oh, like if someone can quickly switch from Outlook to TikTok, they're going to pick this phone. Right? And if, for example, I had to log out of my phone and log into my work login or whatever or something like that, no one would ever use that. And we see this in such subtle ways where now we have things like Face ID, right? So you don't even have to click something. You don't have to like tap in your six-digit code. So what all these device managers are trying to do is like make it easy so that if you have a simple impulse, you jump to your phone. And people may criticise and may say, oh, this is because you had family problems or whatever. That's true. So I think, you know, when I work with people, you sort of work on the root causes and you work on the addictive substance itself. Like when I have a patient who's addicted to alcohol, it's not, it's actually not good enough to just stop going to bars. That's not going to fix the problem. You know, you need to do whatever the deeper work is and you need to avoid bars. Those are both parts of the solution. I've never seen, you know, someone who doesn't do both of those things. You have to do both sides of the work. And I think you can't just blame the device. It's easy for people to say, oh, this isn't an addiction. You can just do this. But my favourite thing is when people who don't have problems tell people who do have problems, it's an easy problem to solve. You just need to do this.
Dr Rupy: Yeah, yeah, yeah. I completely, it's like, you know, people who find it hard to date and it's like, well, you just got to go put yourself out there a bit more. You know, you've got to get on the apps, you've got to, you know, speak to people in bars and stuff. And actually, that might be part of the issue, but like you said, it's multifactorial. There's a whole bunch of other pieces to this puzzle and it's very, very complicated in the in the context of addiction to any substance or device. I did a silent retreat earlier this year. I don't know if you've ever done one of those or whether it's part of your practice.
Dr K: Yeah, I mean, I've done meditation and silence for extended periods of time, but usually with a single teacher. And I think these like 10-day silent retreats where a group of people gather, they usually do one technique. I've never done one of those.
Dr Rupy: Gotcha. So I did that light, so I did three days. So it was three days of no talking, no listening, no reading, no writing, no any, no stimulation or just keeping a very, very low stimulating environment for. And during this time, you know, you experience boredom, mind wandering, we did meditation, we did very, very gentle hatha yoga, which was great. And I came back and one of the first things I realised was my attention was incredible. I was able to spend time with my newborn who was six months at the time, so this is early this year, and I didn't feel this sort of like nervous energy to grab my phone and check something or check my Gmail. And you're right, like Outlook and all these things, because they're all on one device, it just makes it incredibly convenient, you know, to just swipe through to all these different devices. So, but the issue with that I had is that, you know, weeks, months later, the old habits sort of creep back. And I'm just wondering if there are any practices that would be universal, i.e. for most people, that we could practice to have a better relationship with a device that we know to be harmful when used in excess or when used unintentionally, erroneously.
Dr K: Yeah, so it's such a great question. So, you know, it's this is a problem that I've been working on for a while because when I started streaming on Twitch, you know, we quickly had this like large audience of people who are, how do we use technology in a healthy way? And people were also noticing that we're all getting like a little bit more ADHD. And so I taught a lot of meditation on stream. I would give lots of lectures on things like neuroscience and habit formation and things like that. And then finally I sort of realised like we need to build like a toolkit to help people. And we were trying to figure out what we're going to call this thing. And we ended up calling it Dr. K's Guide to Doing Stuff. It's basically like all the info that you need to like do stuff again. It doesn't have a fancy name. It's like if you're having trouble like getting your stuff done. And so it's also a lot about ADHD and we teach a lot about principles of ADHD, which is sort of what you're alluding to with this meditation stuff. So it's not really about like, you know, this is the medication you need to take. There's some stuff about how to understand medication and things, but really it's a guide that teaches you, first of all, how your mind works, second, how your brain works, those two are not the same. And then as well as a lot of like practical tips on how to organise your space. And it teaches a lot of interesting principles. I'll share a few with you today. So the first is that concentration is a skill. So when we meditate, a lot of people think, oh, I'm bad at meditation because my mind is wandering. That doesn't mean you're bad at meditation. So every time your mind wanders and you bring it back, right? You're like, oh, I'm supposed to be focusing on my breath, but I start thinking about a grocery list. Let me come back to the breath. That is actually like doing a push-up in your brain. That is your brain having an impulse, having a distraction and pulling yourself back from the distraction. So if we think about our lives today, you know, I'm supposed to be doing this, but my mind gets distracted. So I have to yank it back, I have to yank it back, I have to yank it back. The best way to practice yanking it back is meditating. And this is where once again, a lot of people think, oh, I'm bad at meditating because they think that meditation is about sitting silently, effortlessly for eight hours a day or something like that. No, the more you suck at meditation, if you get distracted, the more you should do meditation. That's like you're getting a really hard workout. So you can start with for five minutes, 10 minutes at a time. That's totally fine. The more you do it, the more concentrated your mind will become. Another really, really important thing is to recognise and we teach some of these like principles. This is from some of my monk training years, many years ago. But I think we don't realise how careless we are with our perception. So if you look at perception is really what controls attention. A lot of people don't really think about that. They think like, okay, I want to focus on this, therefore I'm going to focus on this. That's something we call dharana or concentration ability. But if you look at how does your phone addict you? There are studies that show if that you change your phone to grayscale, remove all the color, which is a setting that you can turn on, it reduces cell phone usage by about 30%. One simple thing that you can do. Just change it to grayscale, cell phone use will drop by 30%. Here's what people don't expect. When you change it to grayscale, you will hate it. Most people will turn it back to colors within hours. Just something there's just less dopamine that gets secreted. All the stuff on the phone is the same, but it just it feels like, you know, if your tongue is completely numb and you're eating food, that's what it feels like. So altering your notifications, altering the colors, altering the sound, that can all help immensely. So this is the other big principle that I'll share is that this gets a bit technical. But the basic problem with a cell phone, when I was like in school, like in college, I was I was in college, I started college in 2001. And I would go to the library and I would get distracted. But that wasn't a big deal because I'd have a textbook and a notebook. I get distracted, my mind wanders for five minutes and then I come back to it because there's nothing else to do. Right? There's like old school pen and paper. Now the problem is a 30-second distraction costs you an hour of your time. The moment you flip out your phone and if you if you just it face unlocks, you see a notification, then you get sucked down this pipeline before you even realise it. So this is where a huge thing that people need to realise is that access to your phone, getting those perceptual inputs will trigger behaviours. So this is where we have all these habits and habits are triggered by the external environment. Right? So I, you know, I had a patient once who who chain-smoked and what they would do is they'd they'd start smoking and then they'd fidget with their lighter. And then what they would do is they'd put their lighter in the packet of cigarettes when they're done fidgeting and done smoking. But now what they're doing is when they're done smoking, they're putting their lighter away, there's another cigarette right there. And it's as simple as like putting your lighter and your cigarettes in two separate places that can actually have a good behavioural change. So I think a lot of people, you know, really don't realise that the way that you structure your environment will dictate how you think. And if we look at people like advertising, what is advertising? They're bombarding your senses with this particular thing and that's where desire really comes from. So if you really think about how you can alter the perception, the, you know, your perceptual inputs from your phone, like things like notification, grayscale, sound, things like that. And we lay that all out in the ADHD guide and the guide to doing stuff because once you teach people, here's how your brain works, here's where motivation comes from, here's how your environment, you know, sort of addresses like creates motivation or hampers motivation, then it really helps people a lot.
Dr Rupy: I'm intrigued with your perspective on this as a psychiatrist. Do you think, and of course, it's multifactorial, but do you think the digital devices and gaming in general is having a significant impact on the rise of ADHD?
Dr K: Absolutely. So I think it gets a little bit complicated. So I think we're seeing something subtly different. So ADHD is a neurodevelopmental disorder, which means that there is a part of that that's like genetic, but then the way our brain develops will sort of like result in ADHD. And about 20% of people will even grow out of ADHD as their brain continues to develop. So I think what we're starting to see is almost like a new diagnosis, which is like technology induced attention disorder. So this is something I've I mean, I just literally tied those together right this second. But what I'm really seeing is that see this is when you're when your brain is when you're growing up, Rupee, and if you've got kids or whatever, right, it sounds like you've got a young kid. Your child's brain is forming right now. It's growing in a particular way. So in the same way that if you give your child plenty of calcium, their bones will grow strong. So our brain, the children, a child's brain is really like it's like, you know, freshly poured concrete where if I draw a picture in it, it's going to kind of stay that way for a long time, not forever, our brain can still change. So I think what we're really starting to see that's really scary in schools is we're starting to see an alteration of the way that the brain develops. So we have a whole generation of kids who are struggling to maintain focus. Everyone is using ChatGPT for their assignments now. They can't pay attention in school, they can't motivate themselves to do something. It's so scary. I have friends who are professors who are kind of saying there's a generation of students who are just unbelievably lazy. Like they just won't like 30% of the class will not turn in an assignment when it's due. And then a week later, half of them won't even ask for extensions. They'll just like just kind of ignore it. And it's really weird. This probably happened something related to COVID too. But I think as we use technology, it's shaping the way that our brain works. And one really good example of this is our attention span. So if you look at like, you know, YouTube used to be like video essays, right? So I'd have some 35-minute, well-scripted essay about something. And as our content is becoming more and more short form, and I don't know if you've ever seen these like kid brain rot videos. Have you seen these?
Dr Rupy: No, I haven't seen those.
Dr K: So these are, it's like fascinating to like watch. You'll see how how painful it is for you. So what they these these are compilations of like random like memes and clips that are like 15 seconds long and it's just one after the other after the other after the other. And kids will stay glued to this stuff. For like it'll be a 90-minute video of like 15-second clips. So what tends to happen when kids are using all this short form content like TikTok, YouTube shorts, reels, whatever, is that our brain no longer needs a long attention span. So we don't have to pay attention to something for an hour because everything is in 15-second clips, three-minute clips. Then the brain does something really, really useful. It's designed to be efficient. So if it doesn't use it, it loses it. This is why we forget languages. So what's happening right now is that we're seeing an atrophy of our attention and our concentration capability. When you're using YouTube or any platform and you're bored, you don't have to force yourself to pay attention to that video. What do you do? You immediately click to the next video. You keep on clicking and clicking and clicking until your attention gets glued onto something. So if you sort of think about what's going on in the brain, you are not forcing your attention to stay on anything. You're letting your attention like a bird just fly whatever direction it wants to go. And this will then lead to a high amount of distractibility, a high amount of impulsivity. So there's almost this technology induced attentional disorder that I'm starting to see so much in people and it has certain features that are a little bit different from ADHD.
Dr Rupy: I don't know if that's too much or too little or what.
Dr K: No, no, no, that's that's perfect. My follow-up question to that was, is the treatment for technologically induced ADHD that we're now calling it just for the purpose of this pod, I don't know whether it's going to be the ICD or the DCM anytime soon, but is the treatment the same or is it again about creating boundaries from the devices and less of a pharmaceutical approach that we currently have for ADHD?
Dr Rupy: Yeah, so I think the treatment is different. So the treatment depends, I mean, you know, you know this, Rupee. So treatment depends on ideology, not on symptoms. Right? So what is the cause? We want to treat the root cause as much as possible. So this is why, you know, we built the guide to doing stuff because what I saw is that there's a generation of people, you know, a few million people in our community that are struggling to just do things. Like they have all these aspirations, they just can't do things. So I think it's really multidisciplinary. It involves a couple of pieces. So if you have a real neurobiological diagnosis of ADHD, then, you know, stimulant medication or something like that can absolutely play a role. I find that people just taking stimulants, you can sort of they can still help, right? We see a lot of uh, unprescribed stimulant use in college when people like need to focus or study for an exam. So it can help. But what I would really say is you fix the problem at its root. So what's happened is our brain has basically, it's kind of like if I take the elevator every day, you know, taking the stairs becomes hard. My my legs won't, you know, I won't build muscle, I'll lose muscle because my body looks at this and says, we don't need these, therefore let's let the muscles shrink. So I think what we really need to do is reverse that process. So I think meditation is a good place to start where you force yourself to concentrate. There are absolutely like environmental and behavioural things that you can do, like all these things that we talked about grayscale and stuff like that. There's also other stuff that I'll teach there though, which is that the space in which you work, forget about the cell phone for a moment, should also be clear of visual distractions. The more stuff you have in your visual field, if I can kind of explain this, this is going to be a quick tangent. So speaking of India, so, you know, many years ago, I still remember the story. I was walking through the wilderness with a teacher of mine. We're walking down the road and we're engaged in this spiritual discussion. So my mind is fully focused on the spiritual discussion. And then in the road ahead of me, I see a snake, a cobra. And so immediately what happens is I stop thinking about the spiritual discussion, right? So what's happening is some part of my brain sees the snake and then flags my conscious mind and says, hey, Alok, there's a snake there. So if you really look at the way that your brain works, there's this really interesting mechanism of perceptual processing, which is that when I'm sitting here and talking to you, my eyes are interpreting everything around me. It's constantly scanning the objects in my vicinity for sources of threat, sources of danger, things like that. So one of the really interesting things is if you have, you know, a lot of trouble focusing, if you're in a clean environment, there's a good chance that you'll be able to focus way better. And the reason for that is because now your brain is actually processing, some of your RAM is being taken up by just processing visual stimuli around you. And so if you clean, literally clean your room, and people may have noticed this, right? Like whether you're cooking in the kitchen or getting some work done, if you have a cluttered space, it can be hard for many people to focus. And that's literally because your brain is constantly processing everything that you can see to see if there's a threat. Now, the really fascinating thing is if you have someone who's neurobiologically like ADHD, sometimes they need more stimulation. So people, my patients who have ADHD, I'll tell them to meditate with their eyes half open instead of closed. So there's this weird thing in ADHD where you require a certain amount of stimulus in order to stay focused. If there is too little stimulus, your brain generates distractions because it's trying to reach this interesting stimulus threshold in order to focus. So people with ADHD sometimes will study better with music, will study better with a TV on, will, I'll often times when when my patients have ADHD and we're doing like therapy, we'll go for walks. So some proprioceptive and like physical movement just provides them with some degree of like input which allows their mind to actually focus paradoxically. So this is why if you kind of, you know, if you tell an ADHD kid to focus on something, they'll start fidgeting. And that's their brain requiring some kind of input in order to kind of achieve optimal focus.
Dr Rupy: Gosh.
Dr K: So there's a couple of principles like that that people can really lean into.
Dr Rupy: And is there a process whereby you titrate down the stimulus to, quote unquote, normal levels of stimulus where they can operate in a clean environment? Or is that just their baseline level of functioning and that's actually optimal for them?
Dr K: I lean more into that. So I think that that, you know, this is where it gets tricky. It's a beautiful question because how much do you kind of try to optimise for today and what is the long-term direction that you want to go? I find that with people who have ADHD, you probably want to find your optimal. Like there's some level of stimulation just seems to be optimal for them. That's what the science really shows. So I think this is kind of like where you should do, kind of get as much yield as you can as quickly as possible. And then gradually you can move in that direction. But often times what I try to do is, you know, we teach a lot of like self-awareness and kind of EQ boosting skills and things like that. And then you'll sort of know. Right? So a lot of times people will ask me, okay, like do I need to get rid of this? And I'll just ask them, well, what do you think? You know, is this really a problem? No, actually it works for me. Like I can listen to music and it's totally fine and I'm achieving what I want to achieve. It's not really impairing my function. I wouldn't shoot for some, you know, spiritually enlightened meditative ideal of like ultimate concentration. I'd say do what works for you.
Dr Rupy: Yeah, yeah, yeah. This is really interesting, right? Because in your, in the start of your book, you talk about your own personal experience of this because you're not coming at this from a purely academic lens. You're coming at this from a position of someone who's experienced it and really sort of like taking yourself out of the deepest addiction to gaming. I wonder if you can expand on that and perhaps give us an insight into what your setup looks like. Like how you've optimised your surroundings and your life to be a well-functioning, well-rounded Harvard-trained psychiatrist.
Dr K: Sure. So, yeah, I mean, that's so funny because you're saying how have I optimised my environment? And I was 20 minutes late today because I didn't realise I had this podcast. And literally, you know what happened is I have, so we set up, this is actually kind of a funny story. We set up a separate calendar because now there's like six or eight people who will like add things to my calendar. So there's like a group calendar that's run by Healthy Gamer. And that calendar doesn't have notifications turned on on my phone. So I'm usually not late to stuff because I'll, you know, but I don't have a notification, so I just didn't realise. I was like, wait, why didn't this show up? Um, so it's still a work in progress, number one. Okay. So and I laugh because you said, you know, you're not, you don't come at this from a purely academic sense. I would say the academic sense is the minority of where I'm coming from this from. So for people who don't know, I was terribly addicted to video games, like starting in high school. And for me, a big part of it was like I was a gifted kid. I was, I was a young Indian boy whose parents were two doctors and, you know, my grandmother from the time I was six was like, Alok, you are going to be a very good doctor one day. You're going to make a great doctor, great doctor. And then when I was like 15, people would ask me, Alok, what do you want to be when you grow up? And I would say, I'm going to be a doctor. And then here's the crazy thing. People would get impressed. They're like, wow. And it's like, I haven't even done anything yet, right? You just tell people, oh, I want to be a doctor one day and they're like, they're so impressed by that. So I started to develop like this this really big kind of ego. I was pretty smart, so I didn't, I didn't really learn how to study. I didn't need to study. This is another big problem we see in our community, which is that, um, I had a supervisor once tell me that gifted kids are special needs kids. Like literally, if you have a high IQ, your needs are going to be different from other children. And this is something that we see so much. I mean, I've had so many patients, absolutely brilliant and have a similar story to mine. So I didn't need to study in second standard, third standard, fourth standard, fifth standard. And then I hit the seventh grade and I didn't know how to study and I was like learning geometry. And it was like suddenly like I needed to read a textbook. So I remember like opening up a textbook and being like, okay, this is how I study. No one ever taught me how to study. So my grades started to decline quite a bit. Started failing classes in college, started retreating into video games, would play video games for like 16, 20, 24 hours at a time. Um, you know, stopped going to class, like was really like optimising my degeneracy. I remember I would order fried rice by the pound. So I'd get like two pounds of fried rice. Um, you know, mixed fried rice so that it has a little bit of veg and a little bit of protein and things like that, right? And I'd get two, uh, I'd get like four 20-ounce bottles of soda. And then I'd like, I'd like fuel, like that would be fuel. Like I would be fuelling myself for like a gaming marathon. And so that's what life was. So I kind of failed out of college, went to India, and then spent, I absolutely fell in love with it. So, so was just so angry with myself for how I couldn't control myself. I knew I should go to class, I knew I shouldn't, I knew I should go to bed, I knew all these things, but I just couldn't control myself. So what I learned in India was a fundamental technique of self-control. I started to realise, okay, why is it that I can't force myself to do this? Where do my desires come from? Why can't I control them? How do I focus my mind? So I decided to become a monk, spent about seven years focusing on that. Um, met my wife, fell in love, whole celibacy thing was not going to work out. So ended up and then honestly, people ask me, you know, I didn't say this in my med school interviews, but they're like, you know, why did you become a doctor? And honestly, one of the big reasons is because my wife wanted to be married to one. She was like, I want to, I want to have a husband who's a doctor. So I was like, all right. So ended up going to medical school. And so, you know, the perspective that I bring to the table, which I think was your original question is, there's an academic part, but there's absolutely a part of lived experience. And now the way that I organise my life is I recognise that there are some things, I probably would have been diagnosed with ADHD when I was a kid. Um, definitely in college, like no doubt if I'd seen a, you know, a professional. But the interesting thing, remember, is that ADHD is about impairment of function. And at this point, my function is not impaired. And this is where I think that in the West, we do a pretty bad job at this, I think. We try to normalise everything, right? We say that this is healthy and this is sick. There are not multiple variants of healthy. Right? It's not like there's like, so we kind of say, okay, if your cholesterol level is this, or a great example is like we say weight, this is overweight or not overweight. There are things like BMI, right? Where we'll say, okay, well now it's like weight dependent on height, but now we know about things like central adiposity. So it's not just your BMI, there are all these other indicators. We don't have a whole lot of individuality in our what we believe is healthy. The way that we define health in the West is if you're not grossly unhealthy, then we call it healthy. Right? But what I really learned in India, which was really fascinating is that there are a lot of normal variants of health. And in my case, my attention span, so if I'm doing the same thing every day, I will get exhausted after four to six hours. If I have proper stimulation and I have a lot of variety in my day, I can work for 16 hours. I work six to seven days a week. I tend to work somewhere between four and 12 hours a day. And the only way that I can maintain that is if I get the right kind of stimulus. Podcasts are a great example. I have 16 podcasts scheduled over the next four months. That would be a lot of work except if I was doing the same thing, it would be boring all the time. So there's a lot of techniques that we can learn about how we work and what really brings the best out of us. And once you start orchestrating that kind of stuff. So I think if a lot of people are highly prone to distraction, what I recommend is that they don't try to focus on one thing. They actually try to add a certain amount of variety. So, you know, if you get like bored easily, then like sequence your things properly. I also tend to find that sequencing things in the right order matters a lot. We talked about this earlier where it's like playing games and then working is a terrible idea, but working and then playing games. So one thing, for example, that I'll do is I'll always schedule my patients at the end of the day. So if a human being comes into my office, even if I'm tired, I can kind of sit with them. But if you ask me to write a book chapter after I've been doing six hours of like psychotherapy, I'm emotionally drained, there's nothing creative left. So I tend to like write first thing in the morning, any kind of creative projects that I have, I film first thing in the morning, then I can do meetings and stuff in the afternoon. And if I have filming or streaming that usually wraps up by two. And then I'll schedule my patients in the evening, which most of my patients like because they don't like to take time off of, you know, the middle of the work day. And then if I have time left over, then I'll game. But but usually I know the other thing that I tend to do that sometimes surprises people is if I don't feel like working, I usually won't work. So there are there are times where like yesterday, for example, I was supposed to get some work done, but I had had a rough night and things like that. So I just I just let myself not work. The work is going to get done, right? So as long as you don't give into that too much, but and then I don't know if you've you've had this experience, Rupee, but you know, sometimes it takes you eight hours to do two hours of work. And sometimes you can get eight hours of work done in two hours. So I think when you really study your yourself and you start to realise when you're truly productive, how to cultivate those moments, and then cultivating those moments on a regular basis is how I end up working like six to seven days a week, right? It's really about just finding the right kind of energetic connection with how you feel and the kind of work that you can do. One really important principle here is that people don't realise that when we procrastinate, we don't procrastinate from all tasks usually. We're usually procrastinating from a particular task or one or two things. So if I really don't want to work on this, I don't know, like let's say this like research proposal, I can absolutely, you know, renew my license. Like I can do some stupid admin task if I don't want to do this heavy cognitive task and I can avoid, you know, this kind of work with another kind of work. So you can usually get a lot of stuff done actually even when you're procrastinating.
Dr Rupy: Yeah, yeah. I completely agree. It's definitely been my experience as well with procrastination. It's amazing just how many busy tasks you can do when there's one big one looming in front of you. And you know, as I speak to you, I get this sense that you've, you know, you're a fully fledged adult. Uh, you're you've become very intuitive. You talk about energy, you talk about, um, you know, where you choose to spend your time. And I think that's after like, you know, years of honing the skills and actually, you know, uh, sort of binging on gaming and and being in remission from gaming addiction. But when you think of this through the lens of a parent, I know you have two young daughters. I've got a young son now. Everything that you've talked to me about in terms of the stealing of attention, it's very, very scary. And I want to sort of create the right environment where my son can be intuitive about the use of digital devices. I want to create an environment which is safe for them. How do you think about this new era of technology through the through the lens of being a parent?
Dr K: Yeah, so it's great. So I love doing this with my kids. So I did something with them where early on, so now they're pretty good. Um, so I think a lot of parents make the mistake of teaching restriction instead of restraint.
Dr Rupy: Yeah.
Dr K: So parents will control the child's environment so that the child cannot engage with technology. So now there's like a big push to, you know, limit cell phone use and give it to them at 16 and things like that. Those I think are good, a step in the right direction. But my attitude is really simple. Technology is going to get more addictive, not less. The philosophy I have is my job as a parent is to prepare my child for the world that they will grow up in, the world that they're going to live in. So if technology is only going to get more addictive, how can I prepare my child? And I see this all the time with like kids who go crazy, they'll have overly restrictive parents growing up, they go to college, no bounds on their behaviour. I sort of fell into this, joined a fraternity, started partying a lot, started playing video games, right? Mom and dad were like pretty strict or dad was super strict. And so I didn't know how to handle the freedom. So now what I do with my kids is I teach them restraint with technology, which sort of means they have like, we don't, there's no passwords or anything on any of our technological devices. You know, we don't keep it in their room. That increases usage by about 50%. But they can basically like use it sort of whenever they want to. It's available for them to use. But what something I started doing when they were five is, you know, they'd wake up in the morning, what do you all want to do? Do you all want to watch TV? And they're like, we want to watch TV. Okay, fine. So 45 minutes go by, I say, okay, should we like do something else now? And they're like, no, no, no, no, no, no, no. So sometimes I'll let them, we'll let them watch two hours of TV. They start fighting, they start jumping around. They're not actually watching the TV anymore. They don't want to stop, but they're not paying attention. They're certainly not having a good time. So then I'll turn things off and then I'll ask them, how are we feeling right now? Are we having fun? Are you guys having fun? They're like in tears because they started fighting because they were fighting over a pillow or whatever. And so then you start to teach them self-reflection. What impact is this having on you? Then what I would do is I'd let them watch for an hour next weekend and then I stop it and I say, we're going to go to the playground. We go to the playground, we play an hour in and then I ask them, what do you all want to do? Should we go home and start watching TV again? They're like, no, we want to stay with our friends. Can we have five more minutes, 10 more minutes, 15 more minutes? Then what we do is we talk to them and they're like, okay, so last weekend we did two hours of TV and how was that? And now we did one hour of this and one hour of that. How was that? So you start to show them, right? So let's stop and think, what impact is this technology having on you? How do you feel? Right? So now we've also taught, I've taught my kids the acronym halt, hungry, angry, lonely, tired. This is what gives us the cranky pankies. So and they're other like really little things where sometimes I'll let them watch like TV or whatever or play games in the morning, but there's a couple of key rules. You got to eat first because it'll suppress your hunger signals. You're going to get into, you know, a glucose deficit and then you're going to be like super cranky. So if you get dressed, if you have you fix your hair, you brush your teeth, fixing hair is a big thing in our house. And you have a proper breakfast, then if you guys really want to, you all can, you all can play, you know, video games or whatever, like at 9:30 in the morning, you just have to do your stuff first. Make sure you do your stuff first. Then if you guys, if it's 9:30, if you wake up at 8:00 a.m. and you get everything done, and it's it's like amazing. You know, I came downstairs and my daughter made herself eggs and got dressed and then she was like wanting to watch TV. And she's like, can I watch TV? I was like, you made yourself eggs? And she's like 10. I'm like, sure. And you know, and I feel really good about it. Their technology usage has gotten way better. We also tend to be pretty lax in certain circumstances. So when we go on vacation, it's like, okay, we're going to take devices, we're going to take battery chargers. How much do you all want to play? Like, you know, and so I think sort of showing them that there is a time to use technology and even use it quite a bit. But but sort of instead of technology bleeding into every moment of their lives and playing on a daily basis, it's like, okay, we're going to have a party on Friday night. I learned this about myself recently. I used to think I didn't like parties. I realised what I don't like is guests. I love having a party with just my kids. We'll go to the grocery store, we'll cook a healthy meal. We'll make like, you know, a pot of like tortilla soup and get like nachos and dessert and things like that. We get cookies ready to bake. 8:00 p.m. rolls around on a Friday and we're having a gaming night. We're going to play games for four hours. We're going to have a nice healthy meal. 10:30 rolls around, let's bake cookies, like they're ready to go. Right? And so this is like people ask me, what does healthy gaming look like? I hope that's healthy. And then they, you know, and then when is bedtime? When you all pass out. You know, and then Saturday morning rolls around, are we going to watch TV the next morning? Absolutely not. We're going to fold the laundry, we're going to make breakfast, we're going to play pickleball. Right? There's like, and those are the kinds of ways that I I try to raise my kids, like with a lot of awareness. It's not the enemy, but it comes at a certain time and place.
Dr Rupy: Yeah. I mean, it sounds like a really healthy way about it. And I'm really surprised, honestly, at the answers because I'm definitely someone who, if I hadn't talked to you about this, would have fallen into the trap of just pure restriction. Like, these are addictive, they're harmful to my kid. I'm going to ensure that he is protected from them as much as possible. But I guess that's the wrong approach considering they're going to be so insidious within society. He's going to have to develop a relationship with it at some point.
Dr K: Yeah, so it's interesting how my kids have changed over the last couple of years. So as we've done a lot of like intentional gaming, where it's like we don't hold, it's like what games, like I'll I'll get them games. I'll do a lot of research, you know, I'll be like, hey, I got this game because I think you'll like it. We play together as a family. That's a big part of it. Um, it's interesting because they're getting into all kinds of other stuff way more. So they've started reading a ton. And and they we recently watched Avatar the Last Airbender, which is like this amazing cartoon. And so, you know, we finished the series and now they want the books and they're like going through the books. And so it's it's interesting. They're a lot more active with things like pickleball, crafts. Something weird has happened. Like maybe we just got lucky. I'm serious because sometimes, you know, I think sometimes parents don't realise how unlucky you can get with your kids. And if I can just share a quick story about that. You know, when I was an intern, so first year of psychiatry, and I'd be working on the inpatient unit and you'd see like some 19-year-old kid or 16-year-old kid who's just an absolute mess. And then you ask yourself like, you know, how did this kid get so messed up? And then the parents come in and you're like, oh, that's how they got so messed up. You know, parents are like narcissistic, parents are like, you know, very demanding, parents are really like, you know, have very poor emotional regulation skills, things like that. But what's really scary, Rupee, is that for every crazy parent that came in, you'd get a kid who was really struggling who has the nicest parents on the planet. Parents are calm, they're trying really hard, they're really attentive, they respond to email, they show up, they bring their kids' medical records, they talk about what they've tried. And they are, you know, the parents are amazing. And I think sometimes we grossly, we blame parents so much and credit parents so much for how good their kids are. And honestly, what I've seen is that sometimes you get a kid who's just brain is wired a little bit differently, you know, something has happened where they're just, you know, we'll get conduct disorder, which is like early stage sociopathy. You know, you'll have these seven-year-olds who have perfectly loving parents who will be like torturing animals in the backyard. You know, and so sometimes like, honestly, my take is it's the luck of, it's the luck of the draw, it's karma.
Dr Rupy: Yeah, yeah, yeah.
Dr K: And so if you're a parent and you're struggling out there, it does not mean you're doing a bad job. Like sometimes kids are just hard. And being a parent is hard.
Dr Rupy: Absolutely. You have this incredible way of weaving in Ayurvedic principles and and words within your work. And I'd love to explore this a bit more because you've already mentioned a couple, you know, dharana, karma, you mentioned yourself as as vata. Let's talk a bit about this Vedic philosophy because as a Western-trained doctor, like yourself, you know, it is sometimes quite hard to wrestle between the Eastern and the sort of like conventional medical philosophies. I mean, certainly there's a lot of like, um, discredit for people trying to use or trying to blend both worlds together. I mean, how have you navigated this and where did this interest come from in the first place?
Dr K: I could do a whole podcast about this. So can I be a little bit long-winded here?
Dr Rupy: Be as long-winded as you like, man.
Dr K: Okay. So when I was, um, you know, I was lucky enough to train at Harvard Medical School and one of the things that I really appreciate about it is how much, how much expertise they have. So there's like 6,000 psychiatry faculty. And so the ability to learn from someone who's an expert in evidence-based complementary and alternative medicine was huge. So we had this, we hosted this integrated medicine conference at Harvard many years ago. And one of my mentors was on the panel and an Ayurvedic physician or a homeopathic or naturopathic physician asked the question, why do you think it is that Western medicine, like allopathic medicine, is so much more accepted than like these alternative medicines? And so this is a guy who's a allopathic psychiatrist, but super open-minded, runs a mind-body institute at Mass General Hospital. So excellent researcher. So he says the biggest problem with alternative medicine is that you all don't let your treatments fail. So in the West, we are really good at saying, hey, we have this development, we're no longer going to do that, it doesn't work. It actually harms people. We're going to pull these drugs off of the market. Like thalidomide is a really good example. Awesome nausea medication for cancer, but if you give it to a pregnant woman, their child will be born without arms or legs. So we're like, hey, we screwed up. The biggest problem with a lot of these Eastern medicines is that they don't, if I ask an Ayurvedic physician, which of your treatments is the most efficacious and which one is the least efficacious, they won't be able to answer that question. Same for an acupuncturist. There are all these different acupuncture regimens for all these different diseases. Which one is better? Like, you know, what is the relative efficacy? So it's reached such a point where there's like this ego war between regular medicine and alternative medicine. I feel like a lot of alternative medicine doctors don't want to give any ground, whereas I just don't think it's statistically possible for all of their treatments to be equally effective or for all of their treatments to be effective period. And so they're not willing to give an inch and therefore I think they lose a mile. So that's the first thing is to understand that not everything works. And it's not that Ayurveda works or doesn't work. It's that Ayurveda just like allopathic medicine has a lot of different concepts that have varying degrees of success or applicability. The thing that I like the most from Ayurveda is the idea of multiple normals. So there's a certain cognitive fingerprint that people have. There are different cognitive types. And this was something that research that was quote unquote debunked, but I really don't think it has been. So many years ago in the West and allopathic medicine, people sort of, there was a doctor who categorised people into three body types. Ectomorphs, endomorphs, and mesomorphs. So this is sort of like, you may notice that some people have a quote unquote fast metabolism. They can eat whatever they want to and they won't gain weight. Some people have a slow metabolism. We also call these people big-boned, right? So these are people who like, despite eating salads every day, their BMI will still be like above normal. Just the way that their metabolism is is different. So you've got like skinny people, you have like kind of big-boned people, and then you have people who are like very naturally muscular. Like I can go to the gym a lot, but my ability to put on muscle is going to be like pretty low. So we know that there are multiple variants of human beings. What I love about the Ayurvedic system is that they also describe cognitive variants. So my mind is vata, and what that means is that my mind is like the wind. So if you've been listening to this podcast, you'll notice that I don't go from A straight to Z. I'll make these tangents, I'll forget what I'm talking about. This is just the way that my mind works. So my mind picks things up quickly, but also forgets things quickly. So when I'm, you know, when I'm teaching, I was faculty at Harvard and like, if someone asked me, what are the DSM diagnostic criteria of bipolar disorder, I wouldn't be able to tell you. I can absolutely teach bipolar disorder, but if you ask me to remember a list of things in a book, I won't, I can pick out bipolar disorder, I can absolutely teach it. I understand things very conceptually. And so, but if you ask me to list things out, I can't. Um, there are some people whose memory is kind of like an elephant. They're sort of slow to learn, but also slow to forget. So that's kind of a kapha memory. That's like an earth type memory. Vata is sort of like the wind. So my mind is like the wind. And the other cool thing about Ayurveda is they notice that these qualities like the wind are not just in your mind. So if you all are watching this podcast on video, I don't know if that's an option, but you'll notice that I move my hands a lot when I talk. I'm kind of like all over the place. I move my hands a lot. I fidget quite a bit. These are all features, even like my teeth are going to be a little bit crooked if you're vata. I'm going to have angular features, so like my nose is sharp. So there's certain genes, and there's some data to support this, although it's really in its infancy, that there's certain genes that will manifest in your mind in a particular way, in your body in a particular way, you know, even in your musculature. So I think the key thing that I really like from this Eastern perspective is that there are multiple types of normal. So some people do really well working very intensely with a lot of breaks and changing things up. Some people are slow to start. You know, they have slow acceleration but really high top speed. So once they get going, they can work for eight, 10, 12 hours. They have incredible stamina but aren't super fast. So I have very low stamina but very high acceleration. And then some people are kind of in the middle. So when I like, uh, you know, I did a workshop for Google a few years ago and one of the key things that I was trying to teach people is like, what is your working style? What is your frequency of breaks? You know, and there's like different things like that, like what are your periods of work to where you can work optimally?
Dr Rupy: Yeah.
Dr K: And so I think those, that's like a big thing about sort of figuring out, you know, what works for you. How does your mind work? What is the pace and cadence that brings out the most productivity?
Dr Rupy: Yeah. I mean, I think we're seeing this a lot within conventional medicine as we tend, we sort of veer towards N of 1 medicine. We're less reliant on, um, large randomised control trials or epidemiological evidence to dictate a person's treatment plan. I mean, we definitely see this within nutrition. Some people will thrive on a ketogenic diet. Other people, you know, ketogenic diet will send their LDL-C cholesterol sky high and we have to, you know, adjust or put them on a slightly different type of ketogenic diet if we're using it for therapeutic purposes. Um, I mean, there is there's definitely sort of like a regression to the mean in terms of like the majority of people who would benefit from these basic guidelines, but there are outliers. And I think that's something that is encapsulated within Eastern philosophy a lot better and it's just generally well recognised.
Dr K: Yeah, so I think, so I think if something is true, Rupee, any system that, you know, is good will end up there. And that's what we're seeing in allopathic medicine right now. We're starting to see a lot more individualised, personalised medicine, right? So people are, um, you know, there's a, there's a cardiologist down in Florida here in the US who specialises in cardiovascular disease for South Asian people. So, you know, we have really bad heart disease and there's something genetic about like the size of our vessels. So like our, our apparently our vasculature is just smaller than like Caucasian people, which means that there's a smaller area to get clogged before we get, and so a lot of these standard treatments, these evidence-based treatments need to be adjusted a little bit for the genetic makeup if you're like South Asian. So I think we're starting to see in Western medicine, which I find incredibly exciting, that people are really trying to customise, okay, like what is your, what is the, um, MTHFR gene? You know, do you have like a mutation there? There are different like, uh, genetic mutations that will predispose you to medications working better or worse, right? And I think somehow the Ayurvedic folks, they didn't figure out exactly what we know, but they figured out a really good way of individualising what you need. So they don't focus on what your symptoms are. So a really good example is like asthma. So asthma will have a couple of different roots in the Ayurvedic system. Asthma can sometimes come from the stomach. And we know that asthma is associated with like acid reflux and stuff from epidemiological studies. But, you know, asthma can be a lung problem, it can be a stomach problem, it can be different kinds of problems and they'll target things with diet in different ways. I think that's another huge thing that we're picking up on here in the West, which is that, uh, you know, first line treatment for mental illness in Ayurveda is dietary change. And I've seen it be very efficacious. And it's only many years later that we're starting to figure out that, and this was my experience as a clinician, you know, if I had a patient that I started on an SSRI who had a mood disorder like major depressive disorder, my ability to pull them off of the SSRI depended on how adherent they were to their Ayurvedic diet. If they stuck to an Ayurvedic diet, I could pull them off of an SSRI in six to 12 months without too much of a problem. If they were not adhering to the diet, the chances of relapse were way higher. And now we know that there are certain gut bacteria that are protective against mood disorders. There's literally a bacteria called Ruminobacteria. That is indicated, uh, in anxiety disorders. So people who have anxiety disorders have a very high likelihood of having Ruminobacteria at a high level in their gut.
Dr Rupy: Gosh.
Dr K: So these Ayurvedic diets, I think select for certain gut bacteria. And we also know that gut bacteria are what produce our neurotransmitter building blocks. So I think the Ayurvedic diet, the way it works for depression is that it produces a lot of tryptophan producing bacteria, which then becomes serotonin in our brain. And so we can give people artificially enhanced serotonin transmission through a serotonin SSRI, selective serotonin reuptake inhibitor, or what we can do is give them a diet that helps them grow the right bacteria that produces a lot of endogenous serotonin.
Dr Rupy: I think most conventionally trained docs will get on board with this, especially now that nutritional medicine is becoming a bit more mainstream. And when you look at nutrition, um, or you look at Ayurveda through the lens of nutrition, everything sort of makes sense. You know, unprocessed diet, clean food, tons of fibre, good quality fats, loads of plants, herbs that are high in polyphenols, great for your gut microbes, etc, etc. And I think people can probably just about get their head round, um, categorising certain folks according to systems, whether they're a bit more kapha or vata. I think where people will struggle more so, and this is where I'd like to get your perspective on this, is the the real spiritual side. And I'm not just talking about meditation, I'm talking about the real sort of like the energy, the chi and all that kind of stuff. And I, I believe in it. This is the thing. This is I, I welcome it and it's been part of my upbringing for many years. But from a doctor's perspective, from, you know, I mean, I trained at Imperial College, they're very well known for their, you know, research and evidence-based medicine, all that good stuff. It's an uncomfortable sort of position to be in where like my heart is one way, but actually I can't prove that spirituality is actually having a, uh, a determinant effect. Do you know what I mean?
Dr K: Yeah, sure. So I mean, oh boy, okay. So I'm going to just start saying some random things.
Dr Rupy: Yeah, let's do it.
Dr K: Okay, so before this whole Healthy Gamer thing picked up, back when I was a young attending, um, and you know, junior faculty at the Harvard Medical School, my area of interest was developing evidence-based meditation protocols to target particular mental illnesses.
Dr Rupy: Okay.
Dr K: So you have all this weird spiritual theory about chi and energy and things like that. And so we also know now, for example, like there's a lot of scientific verification of meditation, right? We know that it affects our parasympathetic nervous system, our sympathetic parasympathetic balance, which by the way is surya and chandra, sun and moon, you know, like, uh, yin and yang, right? So like they knew that for thousands of years, they just they use different words for sympathetic and parasympathetic.
Dr Rupy: Sure, yeah, yeah.
Dr K: But there are cooling pranayams, cooling breathing practices, and there are heating breathing practices. So one of the things that I would do, for example, is if I have a patient who has a major depressive disorder and has trouble getting out of bed, I would give them a surya practice, a sun practice, an energising practice. If someone was having a panic attack or an anxiety disorder and they need to calm their mind down, I would give them a cooling practice. And it worked incredibly well. So this was stuff that work that I was doing, um, in residential addiction treatment facilities and in my clinic. So I was kind of developing these protocols based on this like, we have this Eastern theory, right? Of like what is wrong with you. And then there's a way to map that on to our Western diagnosis. And that tended to work incredibly well. Um, you know, someone, uh, one of the other faculty there, for example, was doing a specifically a trial on heart chakra meditation for depression and found that heart chakra meditation was superior to mindfulness for depression.
Dr Rupy: Really?
Dr K: Right? So we're starting to see very little specificity of these different meditation techniques because they're not all the same. They all activate our energies in different ways. And there's very, very limited preliminary evidence that this stuff works.
Dr Rupy: Okay, okay.
Dr K: Um, we see this a ton in terms of like our community, like, you know, specific meditations for ADHD or depression or anxiety, trauma, for example. And then we even have lots of evidence-based support for some of these meditation techniques. So there is, um, something called the third wave of psychotherapy. So the first type of psychotherapy was like psychoanalysis. This is like Jung and Freud. And then we had all the behaviourists who showed up. So this is cognitive behavioural therapy, which is what's like really common nowadays. And this is beautiful, but there was, um, a psychologist named Marsha Linehan and she was someone who had borderline personality disorder. Absolutely brilliant person. Went through treatment herself and found that it was like didn't do enough for her. So then she started studying meditation and found that meditation helped her in a way that therapy hadn't. She then developed a protocol for something called dialectical behavioural therapy, which is cognitive behavioural therapy plus some of this stuff she learned while meditating about how to see the world and all these like principles and things like that. And now DBT has been such a successful treatment that it's become like really commonly used. So now what's happening in the third wave of psychotherapy is we're basically, there's acceptance and commitment therapy, dialectical behavioural therapy, mindfulness-based cognitive therapy. Basically, there's a new wave of therapies that is arguably superior to what we used to have and they're incorporating some of these meditative perspectives and practices. So it's so fascinating because the way that DBT works, they actually do a lot of grounding techniques. So they don't do emptying your mind. Emptying your mind if you have trauma is a terrible idea. So when you have trauma, your mind walls it off kind of like an abscess. And if you just have a completely empty mind, a lot of those negative memories will start to come up and will overwhelm you. So it's really fascinating because if we look at DBT, which is really effective in trauma, they're not trying to empty their mind, they're actually grounding your mind on a particular focus. So a really simple DBT grounding technique is to hold an ice cube. And if you're having a panic attack or if you're spiralling in your head and you hold an ice cube, what happens? The ice starts to feel cold and then it starts to hurt and then it demands your attention. You can't think about your panic attack anymore because you are so focused in this thing. So it's a beautiful way to teach someone, to train someone's mind to focus on just one sensation. Snap them out of their way of thinking. So at this point, kind of here's where we are, right? So there's all these Eastern practices. We have growing evidence that this stuff works. But there are major aspects of Eastern theory that have no scientific support.
Dr Rupy: Okay.
Dr K: Right? So we're starting to see, okay, maybe there's some stuff to energetic stuff. There's a great trial in the New England Journal of Medicine by one of my mentors on Tai Chi and rheumatoid arthritis. Which basically found that Tai Chi is superior to exercise when, oh sorry, osteoarthritis. Um, when treating arthritis. So we now we have several studies that show that yoga and Tai Chi are superior to exercise. And the big difference is that these two practices use like this energetic system to develop their, you know, their movements and stuff. So is the energetic system real? There's no evidence that chi or prana exists, that life energy exists. But when you design a practice based on these theories, it outperforms physical exercise.
Dr Rupy: Huh.
Dr K: Right? So that we know. Like there's a lot of data there. There's arguably a very recent study, a meta-analysis showed that some of these mind-body practices are not superior to exercise. I just saw one of those. So there's maybe some debate there, but I think generally speaking, the preponderance of evidence is that this stuff is better than exercise. So then that leads us to an interesting question. If yoga is superior to exercise, how? Because we can't detect the energy. That doesn't really exist. So what exists, what doesn't exist? That's kind of where we are. My personal take is that this is where things get really off the rails. So I don't know if this is going to sound crazy, but Rupee, do you have thoughts?
Dr Rupy: I do have thoughts.
Dr K: Is there any scientific evidence that you have thoughts?
Dr Rupy: Is there any scientific evidence? I guess if you were to put me into a functional MRI and flash images at me, you might be able to detect, um, energy.
Dr K: What would I detect in a functional MRI?
Dr Rupy: Um, so functional MRI measures blood flow to particular parts of your brain.
Dr K: Yeah. So you'd be able to measure that. Would you, um, if you hook me up to an EEG, you might be able to measure some electrical signals, some firing.
Dr Rupy: Sure, we can is an electrical signal a thought?
Dr K: No, no, no, no. So we can we measure your thoughts?
Dr Rupy: No, no, no. You can't, you can't, no, you can't measure my thoughts. You can measure perhaps the output of my thoughts, but...
Dr K: Hold on. This is really important, okay? So we can measure electrical activity in your brain, we can measure blood flow in your brain. We have no idea if you have thoughts.
Dr Rupy: No, you can but you could, if I signal to you I'm having a thought, you'd be able to detect the hallmarks of said thought, but not that the actual thought itself.
Dr K: Absolutely. So we correlate, yeah, certain physical parameters to thinking. But we cannot detect thoughts.
Dr Rupy: You can't detect the type of thought I'm having. If I'm having a thought...
Dr K: Well, there might be some architecture about whether I'm having a worrying thought or a happy thought.
Dr Rupy: But how do we know that the, so let's say your amygdala has blood flow to it, right? Yeah. How do we know that you're worried when you have blood flow to your amygdala?
Dr K: Um, how do we know that the amygdala is where worry comes from? How did we discover that scientifically?
Dr Rupy: I couldn't tell you exactly how we discovered it.
Dr K: Yeah, it's really fascinating. So we measured the blood flow and then we asked you, how are you feeling right now? And then you said, I'm feeling worried. So the only reason we know the amygdala is where fear comes from is because we ask someone, hey, how are you feeling? What are you thinking? Does that make sense?
Dr Rupy: Yeah, that makes sense.
Dr K: So we're never measuring the thought. What happens is we measure blood flow to this part of your brain, then we ask you, how are you feeling? And then we tie those two things together.
Dr Rupy: Yeah, so it's correlation. You're right. Yeah, yeah.
Dr K: It's correlation, but we cannot measure thoughts at all. We have no idea. We have no measurement of consciousness. It's impossible to measure. Thus far, it's impossible to measure.
Dr Rupy: Sure.
Dr K: Now, this gets to this really crazy idea of like, does consciousness even exist, which is debated. So some people will say it's an illusion, it's created by the brain. There's all kind of philosophical conundrums there. But kind of where I am, I know this sounds insane, but okay, so there's all this like scientific stuff, which we can measure, can't measure. I feel pretty confident that we've laid out the limits of what that is, right? So we can't detect energy, but we can detect the evidence-based effects of energetic practices. Sure. Right? So this is where things get weird. So I think we know that consciousness does not have a material quality. Right? There's no like ruler for consciousness, there's no weight to consciousness, there's no weight to thinking. So this is just a shared delusion that every human being on the planet has. Like I know this sounds insane, but does any human being besides you think? You actually have no idea. Right? Because what you see and what you hear is like your consciousness is interpreting. You just assume that I'm a thinking creature, but we could all be like living in the matrix, it could be an illusion, a simulation. You would never know. This could be a dream, right?
Dr Rupy: Yeah.
Dr K: Really fascinating tangent. I once had a, do we have time for tangents?
Dr Rupy: We have time for tangents. Absolutely.
Dr K: So this is where it, so sometimes when you practice medicine, I love it because you meet patients and they just completely change your perspective on the way that life works. So I was doing a rotation in the neuro ICU. And one of the things I really liked about training at Mass General is it was like, we're in a general hospital, there's a neuro ICU there. So I saw this patient who had been in a car accident, who had been in a coma for a couple of weeks. And they come out of the coma, they're progressing well in their physical therapy, their recovery actually looks pretty optimistic. Um, you know, their parents, their their wife and their kids are thrilled that they're awake, like, you know, their job is like pretty supportive. And so we get called for a consult because someone says like, hey, we think this person is depressed. And then I go and I go talk to this person and I try to assess them for depression. Sitting with them, they feel like they're depressed. But if I ask them, how's your life? You know, what's your understanding of your recovery? It seems like I'm going to make a good recovery. I know there's a lot of hard work, it hurts a lot, but like I'm making progress. I'm able to walk a couple of steps now. How are things going with your family? Oh, I'm blessed. I have two children that love me. You know, my wife has been incredibly supportive. How are things going at work? They told me to take all the time I need. I'm a junior VP, you know, my mentor is really excellent. So like, what's the problem? So I go see this person every day and I'm kind of assessing them for depression, assessing them for, like following their treatment plan, like what am I missing? What am I missing? So finally, on the sixth day that I go see this person, this is cool. Like I love, you know, psychiatry. So I just go and I talk to them, I'm like, bro, you seem fucking depressed. And I can't figure out why. And then he kind of like, we have this moment. And this is why I love being a psychiatrist because you have these moments with patients. And he's like, can I tell you something crazy? And I was like, yeah, man, like what's going on? So he says, while I was in the coma, like he said, like I'm grieving. So while I was in the coma, like I lived a life. I had a whole life. I was married, I had a different set of kids. And then when I woke up, I realised I'm never going to see those people again. I realised that those people are gone forever and I miss them. I miss them so much. The dude started like crying and he's like, you know, I miss this, my wife, I miss my two sons. He has two daughters. And it's like, like I miss, like I'm never going to see these people again. And he's just, he's like crippled with grief because he has this whole like lived experience in a coma.
Dr Rupy: Gosh.
Dr K: And so I was like, I don't even know, like how do I, how do I help someone who's grieving a coma illusion? You know? And the pain and the hurt is real, really just fascinating scenario. So it really got me thinking about the nature of consciousness and the nature of experience and some of these things in sort of Eastern philosophy, like this concept that life is an illusion. And so if we sort of think about consciousness, we don't know that anyone else is conscious. And we have no way of measuring consciousness, right? We can measure blood flow, we can alter consciousness all the time physically. And this is one of the arguments by why consciousness isn't a real thing because if I give you anaesthesia, I can affect your consciousness very easily, right? Um, but here's what I've learned through meditation. I know this is going to sound absolutely insane, okay? So if you guys thought I was smart and I had won your credibility, I'm about to flush it down the toilet. So it hit on me recently that there's a whole other dimension of existence, which is non, in the consciousness plane. So we have the material dimension, and I don't mean like alternate dimensions, I mean dimensions in terms of physical. Like there's, you know, width is a dimension, time is a dimension, mass is a dimension, I think. So these are like different physical categories of things that we can measure. The super cool thing about these like esoteric practices and meditation is that these are basically telescopes for consciousness. So you can start to discover things, experience things, see things, travel places, just in the consciousness, not in your mind. This is gets a bit technical. So it's not thoughts and emotions, but you like experience things. And so a really great example of this is, um, with psychedelics. So we know a couple of really fascinating things. One study on DMT found that 94% of people who use DMT will encounter otherworldly beings. They encounter these presences. Like 94%, 92%, not 94%. A small study, maybe about 40 people. But like basically, if you use certain substances, you will encounter these like things. But they don't exist in the material dimension. Arguably, they're just a figment of your imagination, but there's no way we can verify that, right? Because we can't even verify that you have thoughts. We have no way to detect a thought. And yet every human being on the planet has this delusional belief that everybody else is thinking, right? We don't really know who's thinking and who isn't. So what I've started to realise and this is important from a scientific perspective because I try to understand this. It's just we have no way of measuring what happens to us consciously. We can measure blood flow, we can measure electrical activity, but we can't measure a thought. And so as I've done some of these more esoteric practices, and I think psychedelics is really interesting because it's basically like a telescope. So when you administer this substance to a particular human being, to a random human being, the likelihood that they have this conscious experience is quite high. We also know that if you look at the therapeutic value of psychedelics, we can predict whether a psychedelic usage will help you heal your trauma or not based on the type of psychedelic experience you have. So if you just see colors and shapes and things like that, there's going to be very little healing. If you specifically have an ego death experience, so if you have an experience of you as a person dissolving and you become connected with the rest of the universe, then your clinical status will improve. And if we look at the way that trauma works, trauma shapes us as a person. If you abuse a child, the child will think I'm a terrible human being. They carry that with them. That's why they run into so many problems. Why is it that children who are abused seek out abusive partners? The likelihood that you date an abusive partner is very high if you were abused as a child. Why is that? It's because deep down they have an identity that I'm a bad person, I'm not worth it. It's okay to abuse me because I'm not great. So whereas someone else may break up with someone when they show early signs of abuse, based on my understanding of my identity, my parents treated me like crap, deep down I'm a piece of crap, I deserve this. So when your partner treats you that way, it feels normal to you. So how do these people heal? They have specifically ego death experiences. There are studies on this. And so as we dissolve the ego, we start to experience these other weird things, we connect to the divine or call it whatever hogwash you want. But we absolutely know that that is what has a therapeutic value. So there's also, this is also where we get to meditation where like we also know that, you know, deep experiences of meditation will deactivate this part of our brain called the default mode network, which is the part of our brain that thinks about us. So it's the self-reflective part of your brain. Anytime you're thinking about yourself, the default mode network is active. The other really interesting thing is that when you're depressed, the default mode network is hyperactive. Someone who's depressed, oh, I'm terrible, my parents would be better off without me, I'm such a burden to everyone at work, you know, like they're constantly thinking about themselves in a self-referential manner. So as we induce these ego death kind of experiences through psychedelics, which are successful at treating treatment refractory depression, or through meditation, so there's this whole like realm of weird spiritual stuff, which there's very little scientific, zero scientific evidence for, actually, let's be honest. But there is a really sneaky thing, which is that stuff related to that realm, we can detect in the real world. We can detect blood flow in an fMRI, we can detect improvements in treatment refractory depression. We can ask someone, you know, you can encounter these otherworldly beings. And you know, in our community, we've got, you know, a few million degenerate gamers, actually we have a lot of successful people now, like engineers at Google and stuff. And many of them will use psychedelics. And they even talk about encountering these creatures called machine elves. And like, I know it sounds weird, but there's like these specific kinds of creatures they'll encounter. And there are studies on this stuff. So it's like super wild. I think a lot of that weird stuff from this Eastern spirituality is absolutely real. And this is what I truly, truly love about it. The only way you are going to know whether it is real is for you to experience it. Because consciousness, any conscious experience cannot be translated, measured, or downloaded from one human being to another. So what I find incredibly exciting about it, you know, one of the things that I disliked when I was growing up is that the world was explored. So I love the idea of space because like it's unexplored territory. And in the realm of conscious exploration, that's one place that no one else can explore for you. So if you want to go and encounter otherworldly beings, I have like more and more stories that I could tell you from patients if you want to hear, like there's a couple of really creepy ones that will really like make my hair stand up on end. Um, of just people experiences that people have had. But...
Dr Rupy: Yeah, yeah, yeah. I'm going to pause and give you a chance to weigh in.
Dr K: No, no, no. I mean, I find this stuff absolutely fascinating. And I, you know, the reason why I sort of framed this question because I wrestle with it because of the very fact that it's very hard to prove. I take your point about consciousness and the inability to prove thoughts. And we just have the some evidence that thoughts are occurring, but actually these are just correlations with the investigative tools that we have. I also, I think it's very acceptable for people to understand that at a surface level, meditation can give you access to a heightened parasympathetic response, lower blood pressure, lower heart rate, improvements in your HRV, all those kind of things. But at that spiritual level, when you go deeper, deeper, and you actually access, whether you want to call it a new realm, you shut down the ego, you turn off the DMN, the default mode network, in the same way you can mimic that with, um, psychedelics. I think people can get round to that as well. But then there's like, you know, it's further, it's going even further into that spiritual sense. And it's very hard to prove. And like as a, as a conventionally trained doctor, when you're taught this sort of this model of of scientific proof and evidence, it's like it's just hard for for us to wrestle with. And probably hard for the audience to understand if they haven't had lived experience of it themselves.
Dr Rupy: Yeah, so let me tell you a couple. So for me, it became clear once I started working with people.
Dr K: Okay.
Dr Rupy: So, um, and the, so I'll tell you all a story. So I was, so part of my job was also teaching like meditation and mindfulness and wellness and stuff like that to the house staff at Mass General. So there, you know, a few hundred residents, I would teach them meditation workshops, resilience building skills to help them with burnout and things like that. So I was teaching a particular group of residents. And at the end of the, and so they tend to like that kind of thing. Um, which is I guess why I'm successful on the internet arguably. But so, so one of the dudes comes up to me afterward and he's like, hey, I know this sounds crazy, but like, would you be willing to see my wife as a patient? And I was like, I guess, I mean, I don't know. Let me just make sure there's not like an ethical thing or whatever. So I started seeing his wife and so this is an amazing young woman, diagnosed with anxiety, maybe like right around the onset of puberty. Um, has has received excellent psychiatric care, is still on an SSRI, still struggles with some anxiety, but is overall doing well professionally, is happily married, has a young child. And so we start, she's interested in this kind of stuff, interested in spirituality. So we go for, and she's been seeing a psychiatrist for like a decade. So it's stable, had some trouble in college, but is now like doing pretty well. Her psychiatrist is back where in her hometown. She has, you know, sees them maybe twice a year when she goes home. Is basically stable on a particular treatment regimen, has some symptoms, but is doing okay. So we do therapy for a while, we're like, she's curious about this stuff, I teach her how to meditate, things like that. And then one day she's like, you know, I'll I'm asking her like, what is it like you still have this anxiety? And this kind of bothers me because stable on medication and still having some symptoms is like not kind of good enough for me. It's like, let's see if we can really get you to peace, right? Like I want you to be at peace. Um, so we're kind of talking about this stuff and we're talking about, you know, what does your anxiety feel like? And then she says like, you know, can I tell you something that I've never told anyone? And I'm like, absolutely, which is weird because she's had a psychiatrist since she was like 12. So she tells me that, you know, the anxiety feels like I'm trapped. And I said, what does the trap, what does trapped look like? Do you have like a sense of it? And so she says, I'm underneath the floorboards and I hear booted feet on top. And I know that if I make a sound, they're going to find me. And if they find me, it's all over. So this is, she has a very, very vivid memory of this experience. And she can recall it in a ton of detail. She's underneath the floorboards, it's really dusty down there. She can't make a sound. There are booted feet on top, there's muffled voices. And it is such a powerful memory, except it never happened to her. So now I'm sitting there and I tell her, right? I'm like, okay, it's clear that we stumbled on, she's like crying about it. It's a really powerful emotional moment. And so I tell her, I'm like, okay, here's what I think is going on and here's what scientifically could be going on. And so what I tell her is like, I think this is a past life. And she's like, I know it is. I know. I know this happened to me before. I can feel it. And then I tell her, well, like if we think about it scientifically, maybe you were three years old, you were watching a movie about Nazi Germany and some kid was hiding and maybe that traumatised you, right? So there's absolutely all kinds of non-past life explanations that someone has this memory. It could be an experience that then her mind like creates this vivid imagery, right? Mind does that all the time in dreams where it creates like vivid imagery about what we're experiencing. So there's this is not, this is where I think people get really messed up because someone will say, oh, here's evidence that there's past lives. No, it's not. There's all kinds of alternate hypotheses. There's no evidence that this is a past life. Right? There's zero. But what I found as a clinician is when I start doing psychotherapy and metabolising traumatic experiences for my patients who have memories that did not happen in this life, their clinical improvement is drastic. So as we work through this trauma that never happened to her, she is way better in a way that she's never been before. And the thing that really like creeps me out, right? So now I'm trying to approach this scientifically. It's like, okay, so this person comes in with this experience. What really happened? We have no idea. But let's just metabolise the emotional energy of it, right? So we know that people who get traumatised or whatever, they have all kinds of memory distortions anyway. It's not like we remember things accurately. You just deal with whatever the patient brings into the room and you metabolise it. Whether it's a dream, whether it's a fear, whether it's, we don't really care. There's a certain methodology that's evidence-based that we use. It doesn't actually make the, it doesn't give us evidence of past lives. It's important to understand. But once I, once I did this once, then I started doing it more. And the thing that has blown my mind as a clinician is the rate of clinical improvement when I start working with people in these ways. And this is not something that I mention when people come into my office. Like it's not something I mention at all. I don't want to bias them. I don't want to give them like ideas, oh, you have past lives, oh. You know? But it's like, okay, like tell me about this. And now I ask certain sneaky questions where it's like, you know, do you have particular vivid images of things that are very emotional for you? And like it doesn't matter if it never happened to you. That's what I'll tell them. It's like, you know, if it didn't happen, don't worry. And the number of people who say, yes, like I have these like vivid, uh, you know, like images of particular things. So what is that? I don't really know. But I have all these experiences and I mean, I can tell like there's one other like mind-blowing experience that I had with a patient, which I can share. But and this is like creepy stuff, like makes my hair stand up on end. And then I wonder, am I like biased in some way? Am I like, you know, just selecting for these people? Am I like, you know, drinking the Kool-Aid in a way I'm not supposed to be? I really don't think so, but I think it's a fair concern to have when you hear stories like this, but I've just seen too much stuff with patients where it's like, if you really are open, open-minded and you just listen and you let the patient walk into the room and bring whatever they came with without judgment, complete non-judgment.
Dr Rupy: Yeah. Yeah, yeah.
Dr K: The more I'm moving in this direction.
Dr Rupy: Absolutely. Well, I think the fact that you can actually catch yourself and ask yourself the question as to whether you are drinking the Kool-Aid or priming your patient in some way is evidence of you actually being very scientific and actually trying to look for alternative explanations, right? You're not just, you know, okay, this is evidence, oh, this is evidence that past lives exist. So I think that's something that is, um, validating. And I think, you know, the audience would accept that. Um, I think, you know, there's so much that needs to be explored. I really want to get you in a room with, do you know Jeffrey Rediger? I think he was at Harvard as well. He wrote a book called Cured. He was a, he's a psychiatrist. We've had him talking about the miraculous remissions of disease, whether that's autoimmune or whether it's cancer, and actually exploring, you know, what are the things and spirituality was a real, real strong indicator or a strong association with these folks. And then we had Professor Anil Seth on the podcast talking about consciousness because that's this is his area of study. Um, and uh, Tara Swart, who I think she was recently on the Doac podcast. She's a good friend of mine. Uh, and, you know, since her partner passed away, she's noticing signs that she believes, again, as a psychiatrist, it's interesting that you're all psychiatrists, as a psychiatrist is, uh, her, her, uh, her husband who passed away a couple of years ago trying to communicate with her from another world. So, you know, it's just interesting to see like a number of professionals coalescing around this idea that sounds fanciful, but there's something there. And whether it is a figure of our imagination, whether it is our mind trying to conjure this sort of this, um, or trying to manifest this, I'm not too sure. And I don't think anyone can prove that for sure. But they warrant discussion. And I'm really glad that you're able to have this conversation with us folks as well.
Dr K: Yeah, so, so I've got so much to say. Can I share one more story?
Dr Rupy: You, you go for it.
Dr K: I had a patient who, um, started using substances when they were like 13. So a case of polysubstance use, they're 27 years old. So about 14 years later, they've tried all kinds of treatment, tried residential treatment, in and out of treatment centres, just not doing very well. So they, they tell me, hey, I want to, I want to go to, I want to go to a foreign country and I want to go through a particular addiction treatment program that involves psychedelic substances. So I get a little bit concerned about this, but they say like, I want to go do this thing and then I want to come to your clinic and get treatment there. So we develop a treatment plan where I'm not quite sure what they're going to do. I don't know what the medical risks are and stuff. So I kind of tell them, look, if you want treatment, like here's what I know is like good and safe. Come spend 30 days at this residential treatment facility I'm at. And they say, well, I want to do this other thing first and it's kind of like your life, whatever, just like keep me posted, be careful. You know, let's like just be a little bit thorough about it. So we developed this plan where they're going to travel to a foreign country, go through a two-week like psychedelic detox, addiction treatment thing, then they're going to come to McLean where I was working and they're going to spend 30 days there for more evidence-based treatment. So they go there and I they kind of call me and they're like, you know, hey, like things are going really well. And I said, okay, so like, you know, tell me about it. So they say like, okay, I used the substance and then I saw a vision of myself and I was covered with these like blue leeches. And I realised like that's what the addiction is. And then like the the there was this kind of energy that flowed through me and the leeches fell off and now I realise like I'm cured. And this actually scared me because I'm like, oh shit, this person is not going to come for treatment. They believe they're cured. Often times when addicts think they're fixed is like really when their addiction is about to spiral out of control. So I was like, okay, so I just kind of asked, right? I wasn't like, I didn't say, oh shit, I was like, so, you know, what does this mean? We have this plan that you're going to come and he said, oh yeah, like I'm absolutely going to come. This is the spiritual healing, but I recognise that there's a physiological level of addiction and a neurological level of addiction that still needs to be worked on. So I absolutely want it. And I was like, oh, that's pretty cool. So then they call me again and they say, you know, it's going really well. I feel healed. You know, I met someone. And I said, what do you mean you met someone? He's like, I was having, you know, this vision and it was really scary and it was painful. And there was someone there and I they felt good, they felt kind, they were there supporting me. And then I asked them, I was like, who are you? And he says, I'm Thomas. And then he says like, I don't know who you are. And he says, I'm your brother. And he's like, I don't have a brother. So comes back, um, going through treatment and then I'm we have a family meeting where, you know, sometimes in psychiatry, we'll like call the parents and we'll like talk to them private and then we'll all talk together. So, you know, I talked to his mom and it turns out that his mom had a miscarriage before he was born. And they named the child Thomas.
Dr Rupy: Oh my gosh.
Dr K: And it was a boy. And so like when this happens, it just is so creepy. And and so like once again, like there are scientifically plausible explanations of this. Maybe there's like a note that the kid read. Maybe when the child is three years old, mom is talking about it, right? But like mom having a miscarriage of a boy that's named Thomas, there are all kinds of plausible explanations why a six-year-old, you don't remember anything when you're six. So maybe this stuff is implanted in the subconscious, comes out through the psychedelic experience. Like it could be, right? So I think there's always, this is my issue with all the spirituality stuff. There is almost always a scientifically plausible alternative explanation. This is not evidence that souls exist or anything like that. I think we've got to be super precise there.
Dr Rupy: Yeah, yeah, yeah.
Dr K: But if you ask me, I think that shit's real. Right? Like just to be because like like and this is the thing is, you know, I don't think, I mean, maybe I'm there actually is a selection bias. So people come to me because they're a little bit non-traditional, because they're a little bit more spiritually focused. So there's absolutely a selection bias for the patient population that I'm seeing, right? So that's something also that we need to acknowledge. Um, but at this point, there's just too many of these patient experiences that I have with this weird stuff going on to where I really think this stuff is real. And then that combined with my own experiences of like, you know, there's certain meditations where you can experience your past lives more easily and things like that. And it's like really hard to describe, but it's just, you know, you have memories. It's really simple, actually, it's simple to describe. You have memories of things that never happened to you. And it's not imagination. Qualitatively, it's different. I mean, I know the difference between, you know, there's like lived experience that you have and then there's like imaginations and what ifs. And those are very different things internally.
Dr Rupy: Yeah, yeah.
Dr K: Um, so I think there's a lot of fun stuff to explore and it's like a super exciting time where we've got psychedelics, we've got fMRI machines, we've got PET scans, we're studying meditation, you know, like it's a super exciting time to be alive and exploring this stuff.
Dr Rupy: Absolutely, especially as a psychiatrist. Um, Alok, honestly, I could speak to you for another couple of hours. Uh, I've actually got to bounce. I'm meant to be in a meeting at 5:00 p.m. But this was super fascinating. I really want people to explore your work on YouTube, the book, obviously, and everything else. I'd love to have another chat about this again. I know we're going to be comparing notes and stuff and I want to introduce you to a few people as well. But I appreciate you, man. I appreciate being this honest as well. This is like, yeah, it's heartwarming for me. So, yeah, I appreciate it.
Dr K: That's awesome. So it's been an absolute pleasure to be here. I'd love to do part two. I love talking to you, Rupee, and I love your work on too.
