SIO388: Get Psyched! More Dr. Decisis QnA

Transcript

This transcript was generated automatically and may contain errors — the audio is the record.

0:00:13 Thomas: Hello and welcome to Serious Inquiries Only. This is episode 388. I'm your host, Thomas Smith, and I'm joined once again by Dr. Alan Smirbeck, aka Stormy Decisis. How you doing?

0:00:24 Alan: I am awesometastic.

0:00:27 Thomas: Love it. I am excited for this part two. So many good questions. That first Q &A, very fascinating. That was Dear Old Dads -esque of in the terms number of questions we actually got to, but that's okay because there's a lot to talk about.

0:00:38 Alan: And to be fair, I also got beaten up at a car wash, so really we're covering a lot of ground.

0:00:45 Thomas: Yeah. All right. Well, let's are. If you want it, we can remind people about the Little Libraries Project if you'd like to.

0:00:51 Alan: Yeah, sure. So, know there's places in the country where books are being banned or challenged, they're being removed from school libraries or schools or libraries, and so I've got a few listeners who very very kindly volunteered. They live in areas where books books are being banned. If we send them books, they're going to put them in little free libraries near the school or the library. I have set up Amazon wish lists that I've just populated with some of the most commonly banned books. If you want to go on there, books are generally $5 to $20. If you wantto go in there and send a book to one of them, then they can You can put it in the little free library and make it accessible to the community.

0:01:30 Thomas: Most excellent. Love it. And the Oh, links will be in the show notes, but yeah, throw them out again.

0:01:34 Alan: It's all in lowercase, tiny .cc slash lbandbooks. So t -i -n -y dot c -c slash l -b -a -n n -e -d b -o -o k -s. And then there's three links. So there's L -band books, K -band books, and S -band books. Each one of those takes you to somebody's Amazon wish list and you can send them a book.

0:02:03 Thomas: Excellent. Love It So Much. Awesome that you set that up. Forward to hearing more about the success of that project. Super cool. Let's get back to our questions from Patreon.com/ SiriusPod. Big thanks again to the patrons for asking them. Have to twist anybody's arm. These questions came pretty, quickly.

So that shows you that people are really interested in has kind of shortened some of these or abridged them to make sure they are only covering stuff that Stormy can actually answer because, you know, a little bit of complications there with some don't give medical advice kind of stuff. Don't talk about certain things. So just a heads up. Stormly, some of them you just abridge because they're are too damn long, we but won't talk about that. Don't take any offense questioners. It makes for a process.

Smoother right. So Timothy I asks, anecdotally, but across many anecdotes, it seems that the younger generation is having more anxiety issues and apparently more diagnoses of neurodivergence than previous generations. What might be causing this? And this is something we've already talked a little bit about on the diagnosis episode, but is there any more to to elaborate on you think yeah

0:03:04 Alan: I mean, one possibility is that there's actually more of the problem. And I think with anxiety, that certainly could be. You know, things to be anxious about today that they didn't 10 years ago or that they're more anxious about now. So when I was growing up, there really weren't a lot of school shootings, you know.

0:03:16 Thomas: Global warming, uh, Yeah. Hmm.

0:03:21 Alan: And even if you don't experience a school shooting, a lockdown drill is pretty scary. Scary, although I I think we sometimes underestimate how scary the past is.

0:03:30 Thomas: Yeah, good point.

0:03:33 Alan: Think you guys talked on Dear Old Dads about the fact that, uh, know, you got physically beaten, beaten up in school, right? You had, you there were bullies who physically assaulted you. And nowadays in schools, they're very, very, hold a really tight lid on physical bullying.

0:03:49 Thomas: I'll believe it when I see it.

0:03:51 Alan: So, I'm just saying that there are

0:03:53 Thomas: No. I know. I thought you were gonna say, you know, there were times where the Cold War, people were worried about, like, just a nuke could be dropped at any moment. Like, that's that's pretty stressful. There are a lot of old people from the older generation that were like, yeah, that was that that sucked.

0:04:06 Alan: Certainly wouldn't suggest that that can't be the case, that there is an actual change in the levels for what we would call the neurodevelopmental disorders, which is a lot of what people mean when they say neurodivergence. Things like ADHD, autism, learning disabilities. Are very highly genetic. The environment doesn't do a lot on them. Those are, it's probably not an increase in the actual amount. Would say that a lot of it is difference in awareness. I it It is that circle growing larger. So there was a time when someone who was only very mildly impaired or someone who had some very atypical presentation, they just have, you know, one or two symptoms, but they don't really have a lot of the core symptoms, we really wouldn't have given them a diagnosis.

And now some people are getting those diagnoses when they're not like a really great match for the core. Um, then I think there are more people seeking these diagnoses for a variety of reasons. Sometimes it's getting them access to services. And sometimes it's part their personal understanding of themselves. And I don't think that particular motive was driving very much 20 years ago of people saying, like, I really want a diagnosis of ADHD or autism, because that's part part of how I need to understand myself.

Don't think that particular motive was very big. And so I think that might be changing. So I think there might be someone who wouldn't have sought a diagnosis years ago who is seeking it now.

0:04:24 Thomas: Yeah.

0:05:37 Thomas: Mean, importantly, like a lot of ingredients, but like, there are several reasons why more diagnoses doesn't equal more cases, right? Like,

0:05:45 Alan: Right. I think also our of what constitutes severe enough to be treated. So when it comes to anxiety, I mean, a certain amount of anxiety is normal and healthy. You You want to be a little afraid of getting hit by a bus. That's what makes you look both ways before you cross the street. So it might be that, you know, people today, their notion of what is tolerable, of what is normal and healthy has shifted. So they have the same level of anxiety as people in previous generations. But when you ask them, like, do you worry excessively, their motion of what's excessive is different.

0:06:18 Thomas: Yeah.

0:06:18 Alan: Uh, that out is extremely difficult and I can't do it.

0:06:23 Thomas: But also, who cares? If the diagnosis is good, then the diagnosis good. I guess you'd want to know if we were misdiagnosing people systematically, but I don't know. Do you see any evidence for that exactly? I mean, is that something you kind of worry about as a professional?

0:06:40 Alan: I do sometimes worry about the bubble getting too big, the circle getting too big. You know, like I said, part of the point of having the circle is that it helps, you know, when we do research on or we determine a treatment works for people, we want to be able to of generalize it to the rest of the circle. And so something that works for severe ADHD might have very little relevance to people who are just a bit disorganized. And something that helps people who aren't just a little bit disordered might have little relevance. Just a bit misorganized might have absolutely no benefit for severe ADHD. And a little of that is okay. But when, example, if all the ADHD research was focused on people who are just a bit disorganized, then the severe people are getting left behind.

0:07:21 Thomas: Yeah.

0:07:21 Alan: Don't know that that's happening. I actually don't think it is.

0:07:25 Thomas: Right. Here's a good one that, you know, should have been question one. Keeping the plate spinning. Stormy, Alan, Dr. Storm, Dr., Dr. Smirbeck, Dr S. What would you like the listeners to call you? And they say, I know you and Thomas have agreed on Thomas calling you Stormy. I can't remember if we actually did or of just me being dumb. But so this is for the listener. What you?

0:07:43 Alan: I had to use my real name in this because I'm posing as an expert, and so I Figured you guys need to be able to verify that. I really liked the Stormy Decisis moniker, uh, so I don't have an answer, you can call me whatever you like. Uh, Think Dr. Decisis. I

0:07:48 Thomas: Yeah. Oh, cool. Good. I Decisis is good too. It sounds like a villain name.

0:07:59 Alan: Feel Like that, that sounds like a, a very particular rapper. Yeah.

0:08:03 Thomas: Oh that's good too! I was gonna say that sounds like Spider-Man villain for some reason. I don't know why.

0:08:08 Alan: No, I could definitely be a Lot of Spider-Man villains have have-graduate degrees. I've

0:08:09 Thomas: Dr. DeCisis. Yeah, yeah. Well it's often experiment gone wrong, you know, So that means they're in the lab. So they have that. So I don't know what your experiment would be. You took too many, like, I that are supposed to cure a certain you. Oh, you've unlocked your full brain power. You're using that, you know, because we all just use 15 % of our brain, of course. So that's Dr. Decisus right there.

0:08:29 Alan: The Same Way that A Traffic light is using one-third of its potential. Yeah, if if all of your brain cells fire at once, we call that a seizure and you die.

0:08:43 Thomas: I've actually, as much as I've, you that myth debunked, I actually don't know that I've heard it in those terms. And that makes even more sense. That's awesome. Awesome. I'm so glad you said that. I just don't, I don't even get that far. Cause it's like, no fucking, obviously we're not only using 15 % of our brain, but so if people like tried to make that claim based on, oh, of the total, you know, electric activity that could be going on or something, is that how they've been doing that?

0:09:04 Alan: Yeah, If They're Saying like, only 10 of your neurons are firing, I'll be like, yeah, man. If They all fired, that's, that's a seizure. That's Bad, you Don't want That.

0:09:08 Thomas: Yeah. Oh man. Yeah. That's like saying I've got a hard drive and only 10 % of the bits are ones or something. It's like Like, yeah, if they're all ones, then like, that's nothing.

0:09:18 Alan: Yeah. Yeah, you don't want that. No.

0:09:22 Thomas: That's funny. Oh, that'S awesome. Glad we got that out of there. And so for the record, sounds like, I'm Were you expressing a preference for Dr. Decisis? Okay. Well, I always want to make sure to at least use your full name with your honorific, couple you times per episode, just out of respect, but I'm glad you're okay with me referring to you as Stormy. Right. Keeping the Plate Spinning also asks, what advice would you have given yourself or someone just getting into therapy that you wish you had gotten in the beginning? Oh, I like that.

0:09:30 Alan: And anything's fine. I The best advice is you can switch therapists and You want to do that relatively early because you or five sessions is actually a very long time, and if you just don't click with the person, there's nothing wrong with switching. And. And therapists shouldn't take offense at that. And you can just say to your therapist, you know, I don't think we're clicking and I'd like to find someone new. Who do you recommend? Not offensive to say that. And so if you have somebody who you just don't click with, you don't have to have, you know, a really hardcore reason, like they've been horrible to you. If you're just like, you know, this just isn't working.

0:09:55 Thomas: Oh, yeah. Yeah. Yeah,

0:10:26 Alan: Switch. There's nothing wrong with switching.

0:10:26 Thomas: Here's My question you then. Follow-up question. Think people might worry, and I don't know if if this is bullshit or not, would would you worry that like, oh, what if that's just someone not liking the answers they're getting, like how would you differentiate that? Yeah.

0:10:42 Alan: Of it, is a mismatch is just like, you know, this person, like, find really, really cheerful people to be off -putting. And when somebody's Like, you know, I just, like I just don't like that. And so if I'm dealing with a therapist who's like, hello, how are you? And I'm like, oh my god, please. Um, at the same time, if they're saying things that you don't like, I would urge to then stop and think, you, you not like it because it's challenging to you? Do you not like it

0:10:43 Thomas: Okay.

0:11:11 Thomas: Are You triggered? Lit? No, sorry. Yeah.

0:11:23 Alan: Because tend to say stick around if you don't like the it's being said, um, or you just kind of aren't getting along with this person, then especially early on, don't be afraid to switch. But Know if they're saying something challenging, I think that's a good time to reflect and be like, no, do I not like what I'm hearing, or, know, and why don't I like it, do I not like it because it's, it's challenging me, or it hits a little too close to home. Uh,

0:11:34 Thomas: Yeah. Yeah. I would say feel free, you don't have to endorse this opinion if you don't want, but I think it's important to remember that therapists are humans, humans too, you know, and they, they're not all amazing, you know, they might not listen well. They might, that's the one, the one time I felt like, oh, I don't, I think I need to change therapists. I just felt like they, they were kind of not fully listening to what I was saying and just kind of jumping, jumping their point or to their version quickly. And so if you, if you feel like you're in it, who knows, it couldn't, might not be their fault. Maybe it's my fault, but either way you said, you know, it could be a mismatch, you you know, and that doesn't necessarily mean good or bad, but just as there are many humans in the world that you might not click with, that can definitely apply to therapists too.

0:11:58 Alan: Yeah.

0:12:32 Alan: And the fact is, there's no legal requirement that therapists use evidence-based treatments. Um, Can be sued if they do something harmful that is drastically opposed to expected practice, but that's sort of a minimum standard, so Um, you first start talking with a therapist, there's absolutely nothing wrong with asking them what, what methods they use, what techniques they're comfortable and familiar with. There's nothing wrong with telling them you want evidence-based treatment.

0:12:37 Thomas: Oh, that's a big one. Yeah.

0:13:02 Thomas: You want to tell us like what ones to look out for that we should, you know? Do you have any opinions on that?

0:13:05 Alan: And so behavioral therapy, behavior therapy, dialectical behavioral therapy acceptance and commitment therapy, those four are going to be evidence based for most things. So, anybody who says they come from any of those four backgrounds, you're probably okay.

0:13:19 Thomas: Okay. Gotcha.

0:13:26 Alan: That's going to work for most things. Kinds of things, probably the most common, I mean, I think you guys know if they say they're Freudian or psychodynamic, which is the sort of modern name for Freudian, that's not evidence -based. That's not to say it'll never work for anybody, but that's not evidence -based. You'll hear most often is someone saying they're eclectic, and that means that they draw from lots of different things. And that's not a terrible problem, but of course it means they're going to blend things that are evidence - based with things that aren't.

0:13:38 Thomas: Oh. Yeah, yeah.

0:13:59 Alan: And to some some extent, therapy is an art and a science. So oftentimes, the science is cognitive, behavioral, dialectical, and acceptance and commitment therapy. Art is getting you to do those things. So if someone's saying, like, hey, I use humanistic techniques to get patients to do those things, but you can tell them, you could be like, well, you said you're eclectic, but what I'd really like to be receiving is cognitive behavioral therapy. Do you feel comfortable offering that. And you can ask them and you can tell them what you want. And they may say, no, that's really not what I do. Or they may say, you know, no I don't have the training to offer that. Again, that is a perfectly fine time to say, this isn't going to work.

0:14:13 Thomas: I Yeah. Sense. And I was just going to say too, like, even if something's, even if a technique is evidence -based, it doesn't mean every sentence they're uttering is evidence based or the way, the precise way they're doing it could be, you know, that could vary, right? I mean, like kind of their precise methodology could vary somewhat. And so, you maybe if they're eclectic in the, in their approach in that way, they could still be using something evidence -based, right?

0:15:04 Alan: They could be using evidence -based stuff for evil. Someone could use cognitive behavioral techniques to try to convince you to stop being gay.

0:15:07 Thomas: Yeah, that's a good point. Yeah. Yeah, there's no guarantees. Yeah, gotcha.

0:15:14 Alan: You know, they could be using evidence -based techniques for an evil thing. And so, yeah, I mean, I kind of assume, I'm guessing your listeners kind of know, like, if somebody's like, oh, well, that's my goal. You'll be like, Oh, well fuck you. But, so I think if somebody is going in and they're like, well I'm eclectic and I, you know, I, or I just do what I've learned, what works. Don't be afraid to say, Hey, want this this specific evidence -based therapy, do you feel comfortable and ready to offer me that?

0:15:18 Thomas: Right. Yeah! Might want to just mention, and I've talked about, you know, kind of my problematic and upbringing when I was younger. I would say that because, well, you Know what? It's hard to say causality, but I strongly suspect because of the manner in which I was raised, you and like the some of unhealthy thought patterns I had because of my dad, I and this is embarrassing to admit, I've it could could also be, by the way, I'll give the media some credit.

It could also be because of bad media portrayals of therapy. But for some reason, I had this stupid view of therapy as like almost means you're not smart. Like if you need therapy, you're not smart and you need this smart person to like tell you things that you can't figure out. And I looked at it as this stupid, you kind of zero sum, like either, the therapist has got to be like this genius that's way smarter than you or else what could they possibly tell you?

And I would have told my idiot self who, you know, this was when I was like teens, you Know, I would've just, well, there's nothing you could tell me at that moment. You know, I, I wouldn't tell, I don't tell me that moment, Hey, I'm just fucking grow up, man. You got a lot, you got a, a lot of growing to do and

0:16:41 Thomas: It wouldn't work.

0:16:41 Alan: I Think that one way to think about that is, how often do you know what you should do and then not do it? Therapists, it's not that they know what they should do necessarily, but they're helpful in helping you get to the point of doing it. Um, more little bit of thing for getting into therapy is, um, as honest as possible with your therapist. So if you go like on Reddit and there's like the Am I the Asshole, and they'll be like, well, am I the asshole because, uh, my girlfriend just called me a a for no good reason and she's like, I'll be like, okay, but really, why did your girlfriend call you a bastard?

Like, what did you do or say anything and She just, or did she just, you know, and so, I, all want to be seen positively. And so if you go into your therapist and you start telling the story in a way that makes you look good, then you're Not giving the therapist the information they need. And sometimes that means admitting to, um, motivations, like, you actually, you know, the reason I said that was because I wanted her to feel sorry for me. All, therapists have heard all kinds of shit. They're not going to judge you. But it's way more helpful for you to admit that than for you to be like, no, I didn't mean that at all. I didn't do that. The more you can be direct and clear and actually say what happened is going to be more helpful.

0:17:19 Thomas: Yeah. Yeah exactly.

0:18:03 Thomas: Yeah and by the time I worked on myself to where I could go to therapy, therapy, I was so out the other side of that. Like I start therapy day one, I've spilled my entire guts and I've cried hysterically over it. Like, I'm like too honest now, actually. I get into it too much immediately. So, but that was just as a result. I've come a long way. That's a big 180 that I've done. Ryan asks, Dr. Stormy, everyone has ups and downs and struggles. When do you think it's appropriate for an individual to seek therapy? Are there situations in which you advise to not seek therapy. You.

0:18:37 Alan: You're welcome. That's a really interesting one because most the research will say that there at least some kind of therapy that is probably helpful in most situations. Are problems that are not severe enough for your insurance to pay for you to have therapy. So in general, you have to have a diagnosable disorder. So if, for example, you're just really feeling down during your divorce, but you don't have major depression, you just really feel down during you're divorce, your insurance might not pay for that.

0:18:37 Thomas: Yeah. Yeah. Okay.

0:19:08 Alan: And really sucks, but I wouldn't say you shouldn't seek therapy, I should just say that you should consider the financial angle. Um, main situations where I would advise people not to seek therapy are more about particular therapists or therapeutic techniques, so there are things that, like, for example, if um, uh, suspect you have repressed memories, I would advice you not to see a therapist who specializes in repressed memory because the techniques they use, evidence has shown, actually create false memories.

0:19:41 Thomas: Yikes.

0:19:42 Alan: So I wouldn't advise you to stay away from therapy entirely, but I would advise you stay away form that kind of therapist. So, I don't know that there's anything where I would say that no therapy is better than, I definitely say that there are times when certain types of therapy are definitely more harmful than helpful. I also, I'd also like to point out that when it comes to medication, we know the side effects. We measure them really carefully. When it comes to talk therapy, we almost never do.

0:20:13 Alan: So we actually know the side effects of therapies. I think most of them are pretty safe and the side effects are mild and temporary. But some of them, like trying to recover a repressed memory, can have a very, very severe side effect of generating a false traumatic memory.

0:20:30 Thomas: But is that a therapy that is even something, anything you should ever do? Is that?

0:20:35 Alan: You should never, ever do that. There are therapists who still believe in repressed memories, and it's actually not a tiny minority. It's more like 10%. So, for certain things like that, if someone's going to practice a really grotesquely inappropriate thing, then absolutely that you're better off having no therapy than having that. That.

0:20:54 Thomas: Setting that aside, I mean, do we know that therapy is effective? I'm sure we do, But how do we know, just talking about the actual evidence techniques, how do we know that's effective if we have no picture of this, what could be a quote-unquote side effect?

0:21:09 Alan: So I've actually worked on pharmaceutical trials, and to do the side effects, when I would bring someone in, I'd actually go through every, like, do you have headaches? Have you been nauseous? Like, everything. And so when it comes to psychotherapy trials, what we usually have are measures of your psychological functioning at the beginning and your psychological functioning atthe end. But we don't actually usually systematically collect all that side We don't say like, hey, do you have headaches after your sessions? We might record it if someone tells us that. But very few psychotherapy studies actually systematically collect that data.

0:21:44 Thomas: But that's like side effects, like, is that like different than, you actual efficacy stuff? Like, oh, I feel more depressed now or less depressed.

0:21:56 Alan: That is different because you can have a side effect, but it still works. So exposure therapy for a phobia sucks. You will feel like absolute shit while you're doing it. But in the end, you don't have a phopia. But I would say that the feeling like shit while while you're doing it as a side effect. And that one we actually do measure, but

0:22:05 Thomas: Yeah, right. Gotcha. Gotcha. Guess my question is, if if were creating more depression than it's solving, that's not something that you would wouldn't be measured because it's a side effect that would have been captured in the.

0:22:26 Alan: That we would measure because if we started, we'd measure your depression outcomes. But if the depression therapy were, you also making, I know, giving you stomach aches, we're not really measuring that. So I think repressed memory therapies is a great example of something where there's actually a terrible side effect that outweighs any benefit. For most talk therapy, the benefits outweigh any side effects, but I was just saying we shouldn't assume there are none. A classic is mindfulness meditation can induce panic attacks in some vulnerable people because you get lost in your own thoughts, and for some people, if you're very vulnerable to panic attacks, you start to panic. Doesn't mean mindfulness meditation is bad. It's just it's got a warning label on it.

0:22:27 Thomas: Right. Hmm. Huh. Yeah. Sense. All right. Crikey. Dan Jordan. How do you how do you make your brew? Parentheses coffee asks on brand. They ask coffee, tea or neither and how. How Do You Take Your Neither? Yeah. With not milk.

0:23:25 Alan: Yes, ephemerally, sort of gossamer thin strands of moonlight. Will drink chamomile tea on occasion. I never developed a taste for coffee or tea, so I don't drink either of those.

0:23:30 Thomas: Yeah. OK. That's The weirdest thing. How do you live without caffeine? I don't get it. Do You just like wake up and yeah

0:23:39 Alan: Um. Know. I actually I don't drink soda either. I don't like anything carbonated. I never drink anything carbonate. I don't like it.

0:23:46 Thomas: So you just don't consume caffeine of any kind. Oh, yeah

0:23:50 Alan: Um eat chocolate. And actually at one point they were selling caffeinated gum at the hospital where I worked to, like, to the med students, and I chewed that for a while, and then one day they didn't have it in stock, and I felt like incredibly tired, and I had a horrible headache, and I decided maybe I should stop chewing caffeinated gum. And so, no, that's it.

0:24:13 Thomas: Yeah.

0:24:14 Alan: By the way, caffeine doesn't actually improve your mental acuity. It has modest effects on wakefulness, but that's it.

0:24:20 Thomas: Does wakefulness, not not improve your mental acuity. Hmm.

0:24:24 Alan: As you get tired, your cognitive skills weaken. You're awake, but you're still mentally not all there. So doesn't do as much as people think it does. I

0:24:34 Thomas: So even though it's improving wakefulness, it doesn't indirectly improve, improve mental acuity by

0:24:41 Alan: Alert. It improves alertness. So in a task where you have to just, like, um, quickly as possible click a red light as it pops up on the screen, but if you had to, um, through a page, and every time there's a circle to the right of a square, circle it, so that's a bit of a more, more complicated task, um, caffeine doesn't help you with that.

0:24:42 Thomas: Yeah. Not fall asleep.

0:24:59 Thomas: Really? Oh, that's very interesting. Okay. Cool. Wow. I love how, you know, they've studied a lot of stuff and you seem to know about it. That's cool. Right. Timothy Thayor asks, how severe does a mental health issue have to be to have, say, a DOT medical certificate certificate revoked? What is that, a

0:25:24 Alan: I of transportation. I'm gonna guess that's like, uh, some to say that you're medically fit to do something transportation-wise, like drive a truck or fly a plane. I don't know. But it is true that people in certain high-risk positions have to get medical approval to say you're not likely to have a heart attack and pass while you're doing this job.

0:25:35 Thomas: Know anything about it, yeah, or like caesar seizures, or yeah.

0:25:50 Alan: It comes to mental health reasons for that being revoked or being denied. That can happen. I'm not, I can't reassure you that it never does. I think the obvious example would be a alcohol use disorder. If you say, you know, I to have a drink when I wake up. If I go 24 hours without drinking, I get the shakes. That person's capacity operate, you heavy machinery or something would reasonably be called into question. Of the typical emotional things like anxiety and depression generally wouldn't, but I want to be clear that I don't know the exact requirements of that certificate, so I don't know. Can tell you that something you can do is say, hey, if I were to tell you this, what would you say to a doctor? You can say that. That. Once evaluate a man who, he was an air traffic controller and he got hit by a car and he wanted to go back to work. Yeah.

0:26:36 Thomas: Yeah isn't it ironic? That's it's like an air traffic controller? Yeah.

0:26:50 Alan: Well, But then he wanted to go to work as an air trafic controller. And the airline was like, they were going to give him like a full pension and everything because they did not want him coming back because there'd be, be terrible liability. Um, he really wanted to come back, and so we did a full neuropsych evaluation on him, and most of his cognitive skills were pretty good, like he'd suffered a head injury but he seemed to have recovered, but he was incredibly irritable and nasty, like he was referring to, um, co -assessor with an ethnic slur, um, you know, he hadn't been that way before. The thing yeah

0:27:25 Thomas: Hell. Hell. Of a way to start an examination.

0:27:28 Alan: No, he was, um, but, but he was performing pretty well on these tests, but of course irritability is a possible effect of head injury, and what we, at supervisor came in to talk to him because, you know, he was, like I said, saying really awful things, and my supervisor said, so, I feel, here, you're feeling a little irritable today, and the man actually tipped over the table and said, I'm not irritable, and we're like, okay.

0:27:36 Thomas: If he's like, oh, no, don't worry. I was a a fucking racist before the head injury, too.

0:27:57 Alan: Um and and so our recommendation was that specifically, due to his emotional problem, not due to this cognitive impairment, but due to emotional dysregulation, that he not returned to his job as an air traffic controller.

0:27:53 Thomas: Oh, wow. That's a, yeah, you've convinced me.

0:28:09 Thomas: Wow. Yeah.

0:28:10 Alan: Uh, so it is possible for that to be, um, for emotional reasons. You know, I, I don't think it would have been safe for that man to have such a high-stress, high-pressure job.

0:28:16 Thomas: Wow. Yeah. He gets pissed all of a sudden he's crashing planes into each other. Breaking Bad.

0:28:25 Alan: I mean, a really intense and scary job. But again, I think in most cases for, like, anxiety and depression, they'd much rather you be direct and honest and get help than set up a system where you feel like you have to hide it, it. I do want to be clear that I don't actually know the specific requirements of the Department of Transportation. So I

0:28:45 Thomas: All right. Right. David Back's Spino Breaker asks, how does one convince themselves to get help if you only feel like you need help occasionally?

0:28:53 Alan: Thought that was a really interesting question because there are a lot of very serious problems that present themselves this way. A lot of people with substance use disorders, you when you're hungover, you're like, oh man, I really need to treat this. But then later in the day, you'RE like, you KNOW what? It's not that bad. Mean, I mean, that's really, really common for people with substance. Or, you know, you get drunk and you get in a really big fight. You have just a verbal fight, but you say some stuff you really didn't mean. And later you're like, oh man, I really need to work on my drinking. But then, you Know, a few days after that, you're like, ah, it's not a big deal. So this is a very real problem where you only feel like there's a problem occasionally because it flares up, but there really is a serious underlying issue.

In that case, being honest with yourself about, you this likely to recur? And is it recurring? So, you're like, wow, I got really hung over and I'm never going to drink again. Did you actually stop drinking? Or how often have you said, well, I'm just not going to let that happen. Again. And then it happened again. So I went out drinking on my 21st birthday, had a terrible hangover, and I really haven't drunk to that excess ever again.

0:28:55 Thomas: Yeah. Yeah. Yeah. Also known as every college drinking experience. I'm never doing this again. I am never. By the time it's five o 'clock. I think I could do it tonight. Yeah.

0:30:16 Thomas: What

0:30:17 Alan: I do drink alcohol, but I'm just not motivated to drink to excess.

0:30:17 Thomas: Are you, Mormon? No coffee, no drinking. Blanking. Oh, gotcha. Yeah. Yeah,

0:30:25 Alan: And so I can say to myself, yeah, I said I wasn't going to do it again, and then I didn't do it yet. But if you say, I'm not going to do it again, and then you do it again and again and again. Or there are people who absolutely lose their temper and say horrible things, they throw things, they do terrible stuff, and they're really sorry and they really wish they hadn't done it. And they're not generally mean people. So the question is, when you said you weren't going to do it again, how many times have you said that? So I think that kind of honesty with yourself can help you think like, is this an intermittent but very serious problem? Or was this genuinely a one -time thing?

0:30:29 Thomas: Yeah.

0:31:05 Thomas: And into the mix our health care system. And I really feel for this because there's a lot of stuff, maybe not mental health, but just like health stuff where I'm like, ah, got it. I should probably get this checked. And it's like, oh, it went away. And then you're like, going yeah, through the trouble of not only doing doing the appointment, but then trying to like tell the doctor something, but it's not currently happening, but you also have to be like, yeah, it does happen. It's just, there's a lot of barriers.

0:31:25 Alan: It's actually a really big problem in substance abuse treatment. Because, so let's say you get a DUI and you get arrested. And then you spend five days in jail. Those five days, you don't have alcohol, right? And so you may not be eligible to go into detox. Because you You went five days without drinking. Yeah.

0:31:40 Thomas: You're not drinking. Yeah. Cured. Oh, wow. But you've been literally kept physically from doing so. I feel like that should be an ingredient in the calculation.

0:31:52 Alan: Exactly – the requirements for a lot of substance treatment can be really, really problematic like that. And so, yeah, I mean, that's a difficult place to put people in, but that's a systems problem. Problem. Have enough of an alcohol problem that you drink and drive, I should get treatment, even you've gone five days without drinking. It doesn't matter. You were drinking and driving. You absolutely need treatment.

0:32:01 Thomas: Yeah? No kidding.

0:32:12 Thomas: Right. Yeah yeah. General contact unit problem Problem Child, I was wondering when we'd get to GCU Problem Child asks, that study you debunked about the adult lives of people raised by queer people. Has anyone tried to do a study like that? You know, actually real. So studied that, but in a way that didn't suck. There

0:32:37 Alan: Yes, there have been many, many studies like this, and many that there's what we call a meta -analysis, which is mathematically combining combining lots and lots of studies. It's like Voltron. They're stronger together and they turn into a...

0:32:44 Thomas: You go. Love those. Just had that with the don't attract study.

0:32:53 Alan: So meta-analysis shows that sexual minority families actually on average do a little bit better than heterosexual families. And the reason is mainly they're wealthier. So if you've got two dads men make more money than women and if you've got two moms, lesbians are somewhat more likely than heterosexual women to work in male dominated fields, and those pay better so if you got a lesbian mom who's let's say an auto mechanic, um, makes more money then a nanny, and auto mechanic and nanny very similar, let's like a high school degree, right, um, auto Automechanics makes more money. So women are somewhat more likely to work in male-dominated fields, they make more money, so sexual minority families have a bit of a financial advantage. They're also less likely to have unexpected children,

0:33:07 Thomas: Oh, that's Interesting. Interesting. Right. Oh.

0:33:21 Thomas: Interesting. Yeah. Right.

0:33:48 Thomas: Yeah, makes sense, yeah.

0:33:50 Alan: Not like, oh, we were so drunk last night and we filled out these adoption papers, you know.

0:33:55 Thomas: Oh, that's right, we had the of planned lesbian origin or whatever.

0:34:00 Alan: So that study way back then was almost all of those children were conceived through heterosexual intercourse. Somebody had sex with someone of the opposite sex. We're having more who are having children through surrogacy or insemination or adoption. Things don't happen by accident.

0:34:09 Thomas: Not

0:34:21 Alan: More likely to do those things when you're financially ready to. So shows

0:34:19 Thomas: Usually you That Republicans turn your kids gay for the economy. It'll something, I, I don't know.

0:34:30 Alan: That for the most part, there's no differences, but there's actually a slight advantage for the gay and lesbian couples, probably because they are wealthier.

0:34:39 Thomas: Right. Another one from GCU Problem Child. Mother told me she cried after I was diagnosed because the person who gave diagnosis told her people like me usually can't ever learn to look after themselves and tend to end up institutionalized. That happened in 1997. Was it still normal for mental health professionals to say that about neurodivergent people in the late 90s?

0:34:59 Alan: I definitely wouldn't say it's normal. Definitely don't want to make a prediction like that unless we have really good evidence that it's true. The first step is you have to actually be right. And then you have to decide what to say and how to say it. And you definitely wouldn't tell someone whose child was just diagnosed that they're this horrible future or that they'RE going to have, you definite thing. It is actually the case that at some point for some families, you do need to let them know what possible outcomes are so they can start planning. So if I have a kid who's 10 years old, has no speech, does not really respond to spoken language, is not yet capable of eating with a spoon, doesn't use gestures at all to communicate, odds are very, very good that that person's going to need, they're not going to live independently. Independently. And you need to start planning for that.

0:35:06 Thomas: Mm-hmm. Yeah.

0:35:51 Alan: If this person's going to live in a group home, their waiting lists are like at least two years.

0:35:51 Thomas: Yeah. Wow. To, like, make someone, you feel bad. It's, like. A useful thing to tell people.

0:36:01 Alan: Actually met parents who have that kid. They're 10. They have no speech. They don't understand language. They haven't used language. And like, well, we've been thinking about what kind of apartment he's I'm like, no, no. We need to be thinking about this. Similarly, sometimes they want to know why their kid isn't doing the same academic tasks. And they might be like, well, I want my kid in algebra with everybody else. And the thing is, while your kid is in algebra, he's not learning anything. Because if we have a kid who, again, who, for example, doesn't understand a concept like more or less, they're not getting anything out of algebra. But more importantly, they are losing an opportunity to learn a skill. They could be spending that time learning something that would actually enhance their independence and happiness and dignity, like how to drink through a straw. Yeah. There is actually a point where it may be the better thing to do to, you tell parents some of these predictions.

0:36:36 Thomas: Yeah.

0:36:50 Thomas: Trigonometry. No.

0:37:00 Thomas: Yeah.

0:37:01 Alan: But you certainly don't spring it on them. And you certainly don't want to say it when there isn't very strong reason to believe it's true. Um, one other thing that that is an important motivation is sometimes parents of children with severe disabilities um get kind of lost in the fantasy that there's going to be a magic wand, and one that prevents them from loving the child and connecting with the child they have now.

0:37:25 Thomas: Yeah.

0:37:25 Alan: Um, and it can lead them to a lot of dangerous pseudoscience. So if, if you believe that, um, know, you just need to find the magic cure and your child will be typical, then some people go in and try some very dangerous things. And so, you know, helping them understand that this is not, it's not like you have a typical child who's just kind of hidden behind a wall, and we just need to find our way through that wall. And so again, you want to be a dick about it, but sometimes that discussion to happen for the sake of the child's health and safety. I

0:37:30 Thomas: Yeah. Yeah. Yeah. I Also will say, and and this is, you know, I'm not saying anything about uh or your mom GCU, but I a little skeptical of people's accuracy in reporting what doctors told them in this way, just because I've seen way too many religious people. They're like, "Doctors said, yeah, doctor walked in, they said, I never, don't even try to walk again, you're never gonna walk again, not gonna happen, not in a million years, bucko, you're not gonna walk again." And I'm like, like, then I prayed twice and I was walking. And you're like, did the doctor really come in and say that? That seems aggressive. I don't know. It could be. Maybe there are a lot of shitty doctors. Yeah, I don't know.

0:38:32 Alan: Definitely think if it's an emotional moment and the person says, well, the majority of people with this diagnosis have this outcome, not necessarily going to be sitting there doing just statistics in your head. You might hear, oh, no, there's this tragic thing, right? And I think it's possible the doctor learned their information. The doctor might have learned things 20 years ago in med school. And so if this was in 1997, if they learned something in 77, well, at that point, we were only diagnosing autism in very severe cases. And so they might think it's out of the realm of possibility that a doctor did say that,

0:38:43 Thomas: Yeah, yeah, yeah. Yeah. No,

0:39:14 Alan: But I think it is also very possible that a Doctor may have said something a little more measured, but the parent didn't hear it because they were upset and maybe the Doctor wasn't that kind.

0:39:15 Thomas: Yeah yeah, of course. Or there maybe just be like a Christian movie doctor that does this as a service. Hey, do you have like a broken leg and do you need a doctor to be like, never, you're never walking again. So that then you can pray and then sell your bullshit. Maybe that service exists. I don't know.

0:39:36 Alan: It's very possible.

0:39:37 Thomas: All right. Oh, hey, question from Dr. Brian Gillis. Asks, "In university, I met someone who had an identical twin." Did you meet their twin? You don't. The classmate who was born by C -section was much more high achieving than the twin who had a vaginal birth. Oh, wow. There was speculation that the vaginal birth compressed the twin's head and affected brain development. Has there ever been any research on how birth method affects affects brain development? Yeesh, that's uh, that's fascinating.

0:39:37 Alan: Possible. Um, This is not like my area of my expertise, but I can tell you that whenever there are, so there's most disorders, and especially the neurodevelopmental disorders, but pretty much everything becomes more likely, um, you have all kind of what we call perinatal insults. So if, uh, your Mother smoked Yeah. If someone was just Like A Dick And they were just mean to you. No, but like if your mother smoked while you were in utero, or birth stalled and so there was oxygen deprivation while the baby was in the vaginal canal, if that, they were kind of stuck There for a little bit, raises the risks of all kinds of things, prematurity and so on. And if anything, C-sections are considered be more on the risk side of things than vaginal Birth, um, There's a vaginal birth complication like stalled labor or something, or myconium poisoning or whatever, um, things are problems, but in general, I mean, a C-section is a major operation.

0:40:25 Thomas: Someone's Roasting You, yeah, well, Then You're Coming Out, yeah.

0:40:41 Thomas: Huh.

0:40:54 Thomas: That's Interesting, yeah.

0:41:06 Thomas: Yeah.

0:41:06 Alan: Um, The way The The The World's first chainsaws, yeah.

0:41:07 Thomas: Yeah, usually something Else Is Going wrong, First, don't Say it, I don't want, don't Do it, I, oh, here. I think I know this, actually.

0:41:13 Alan: No, They Actually they're Not for C -sections Uh, Because you, a C-section, you're cutting through soft tissue. They Cutting Through the pubic bone for stalled labor. Yeah, so that's fun. No, a C -section is a major operation. And so that means, first of all, generally speaking, the birthing person has to be anesthetized, which means the fetus is exposed to anesthesia. The birthing person, you know, their heart rate and their blood pressure are going wild because again, you're cutting their belly open. It's a big deal. So in general, we would consider the C -section more stressful to the fetus than vaginal birth. As far as the vaginal birth compressing the head, no heads are made to be squished. Baby heads, baby heads are soft and they are made TO BE SQUISHED and that's not going to squish the brain.

0:41:19 Thomas: Yeah. Oh, gosh. Yeah, yeah. Was just gonna say, I'm glad, I'm glad you say that, because Phoebe's birth was, pretty was traumatic with that kind of thing, and I, when you say that, I almost went into, you know, a little bit of an anxiety of like, oh my god, am I now gonna worry that every issue Phoebe has is because of this traumatic birth that she had? If if you've never had kids, they are tubes when they're born, they actually come out, I'm, I, they, yeah, they're alien head, they, seriously, they'RE not, they get compressed, um, pretty hard, yeah.

0:42:21 Alan: Yeah, their heads are weird shaped. And that doesn't harm the brain at all. And the other thing about those perinatal traumas is when I said that they raise the risk, they raise risks, each one just a teeny bit. And so it's one of those things where if we look at people with ADHD, yes, they are somewhat more likely to have moms who smoked than people without without ADHDR. It doesn't mean that there's a really strong correlation. It's just one thing that tends to be associated with slightly higher risk for lots of things. So it's not something that's worth super worrying about.

0:42:30 Thomas: Yeah. Hmm.

0:42:59 Thomas: That makes sense. Phew, Ugh, because, I mean, my kids are going to have some sort of mental health, anyway, challenges, and so I, would I've, be hard to not just think of things in those terms all of a sudden, always, you, tough to deal with those, like, well, it's a tiny percentage, but then you, you want to tell a story to yourself of like, no, this is why this happened, hundred percent, you question though. That would be a boy. That'd be an uncomfortable thing to try to deal with. Kaiser asks, question for Dr. Smirbeck, because the average person probably doesn't need to be as concerned as researchers do with the accuracy of drawing circles. What are the realistic concerns with pop psych on TikTok? Would you you say those concerns aren't novel relative to the concerns of pop psych pre -TikTok, either in terms of pervasiveness or substance?

0:43:18 Alan: Oh, You're right that the average person doesn't need to be, um, as specific as researchers, but no, I would actually say that some of the bad advice on TikTok or another pop psych, um, or whatever actually can be really harmful. So in general, for a lot of of emotional disorders like anxiety, depression, OCD, giving in to the disorder makes it worse. So if your depression is telling you that you really want to stay in bed all day, staying in bed makes it even worse.

0:44:15 Alan: And so what you hear in a lot of these places is, you know, they'll say, like, well, take care of yourself and this sort of self -care. And the kind of self - care they're describing is generally to not do the things that are upsetting or difficult. And that will ultimately make it worse. It is necessary to do that. But that's where it's really helpful to have a clinician to help you draw that balance.

0:44:14 Thomas: Yeah, that's for sure.

0:44:40 Alan: So something I saw in there was, you know, a common thing with OCD is like worrying you left the stove on. And so what someone said was what you should do is just before you leave the house, take a picture of all the knobs. And then if you worry you left the stove on, you can look at the picture. And that will reduce that worry, one but that will make your OCD worse because that's giving into your O... Yes. Yes.

0:44:38 Thomas: Yeah. Hard to make that call yourself. Hmm.

0:45:02 Thomas: Really? Okay.

0:45:05 Alan: We'll think we talked about having a record on exposure therapy when we talk about trigger warnings. And when we do, I'll explain how all that works. But no, that will make your OCD worse, but it'll make you feel better right then. So if you absolutely have to get out of the house because you got a doctor's appointment, maybe you should do that.

0:45:08 Thomas: Yeah. Yeah.

0:45:23 Alan: But it's going to feel good, which means you're going to want to do it more, and then you're going to do a whole bunch, and that actually makes your OCD worse. So is you have this really unpleasant thought, like I'm going going to burn the house down. And then doing a compulsive behavior like checking or flipping a light switch gets rid of that unpleasant thought and you feel relieved. Well, checking that picture, that photograph, is just another compulsion. And the problem is that when you do a compulsion, you feel released, which means you want to do the compulsion even more, and that's just making your OCD worse. So I do actually think that some of this pop psych stuff, yeah, yeah, I do actually think it can be dangerous.

0:45:31 Thomas: Yeah, you're Hmm. Yeah yeah.

0:46:05 Thomas: Yeah, uh, "Your Patrons are Belong to Us" asks, "Dr. Stormy, I love a movie with an engaging psychological plot line. Think 1996 is Primal Fear. Do you have a favorite psychology themed movie that created just enough drama or tension while staying close enough to the actual science that you weren't screaming 'what a load of phooey' at screen the whole time?"

0:46:28 Alan: Psychological stuff, real psychology does not go well in fiction. Because in fiction, you want an understandable reason for things. So you know, Ulrich the Bloodletter went mad after witnessing his family's death. That's a story. Ulrich the Bloodletter Went Mad Because He Had a Genetic Predisposition to Schizophrenia is not a very interesting story and in fact any like kind of mental illness story in tv it almost always has um social cause like a trauma when in reality that's not very often the cause like most people with a phobia of flying have never experienced a dangerous flying related event um

0:46:34 Thomas: Yeah. Yeah. Hmm. Yeah.

0:47:12 Thomas: Just because statistically they almost never happen. Oh.

0:47:15 Alan: So that doesn't mean I can't just enjoy them like I really enjoyed uh night which is about dissociative identity disorder which is, you know, a whole complex issue right there, um, but I can enjoy them. Um, of my favorite movies, it's called The Soloist, of a memoir of a real event of this journalist met this homeless man with schizophrenia who was playing a two-stringed violin and really well. And he starts talking with this man and finds out that the man went to Juilliard and was doing so well before schizophrenia struck. And, here's the thing, I love this movie. Most people don't like it because it goes nowhere. Because schizophrenia, no, it's a fictionalized movie. It's based on this memoir. But here's The Thing, they they actually get the man access to a cello, which is his instrument, and it's It's a wonderful thing. But it's not like that cures his schizophrenia. He's still profoundly impaired. He's actually still homeless because he's too paranoid to go into a shelter. Say, well, there is no plot arc. Nothing improves. Nothing changes.

0:47:20 Thomas: Yeah. Yeah. Huh. Wow. Hmm.

0:47:56 Thomas: Spoilers. So this is a movie, it's not like a documentary or something, right?

0:48:11 Thomas: Yeah, yeah. Yeah.

0:48:21 Alan: That's realistic to schizophrenia. So I love that movie. If things were realistic, I don't think they'd be very interesting stories in a lot of cases. And

0:48:22 Thomas: No kidding, I Feel like you could do it, people just need to try harder. I don't know.

0:48:32 Alan: I'm nice to the writers, but do think that, yeah, most psychological stories on TV, they're going to trace the cause of something back to a event, which is not usually how it works. And then the course of any kind of treatment usually has a peak moment of insight, because that's how narrative arcs work, when in reality, insight is not actually how therapy usually works. You because it turns out that you, if you come to the realization like, "Oh, I'm a really angry person because the way my dad treated me," you're still a really angry person and you still have to have, you know, weeks and months of anger management stuff. So, um, Soloist is my favorite psychology themed movie, not all of them. Yeah.

0:48:35 Thomas: Yeah.

0:48:59 Thomas: Robin Williams doesn't scream at you for a minute and then you're cured. Yeah, well, now my question is, what seriously awful movie could we do? We should do Goodwill hunting. That movie is so terrible. Oh, man. What about that? What do you think? Right. If you don't want to do it, I need to find someone else who wants to do it.

0:49:31 Alan: Haven't never seen it, but I, I could, but I do understand that the, the climax of the movie is, you know, him kind of coming to understand that he was abused as a child or something.

0:49:32 Thomas: Oh, my gosh, Stormy. Stormy? In so many words. We definitely need to do that one. I think you should watch it and see if you want to see it because it's delightfully terrible. I would love it. And Elliot Smith, my favorite songwriter of all time, they used some of his songs for the soundtrack. Track. So I always love that, but couldn't have been paired with a weirder thing. Anyway, definitely doing that.

0:49:48 Alan: Okay.

0:50:00 Thomas: That So we'll call it there. Thank you so much for the great questions. Stormy, Thanks so much for the nice, juicy, meaty two -parter, the was a lot of fun. Gave us still more to talk about, really. And I will now, my life will not be complete unless we do Good Will Hunting. So you really need to check out that movie. It is so terrible, but fun, terrible in a funny way.

0:50:00 Alan: All right.

0:50:21 Alan: All right, well, now I have a homework assignment.

0:50:24 Thomas: Yeah, yeah, that's your homework assignment. And one the Little Libraries project. Check out the show notes for those links and looking forward to that. So mucho, Stormy, for setting that up and to everyone who's participating.

0:50:37 Alan: Thank you very much for having me. This is a ton of fun.

0:50:39 Thomas: Pleasure. Thank you so much. See you next time, everyone.

0:51:00 Thomas: Your kids gay for the economy it'll