Brain Surgeon: Dream Patterns, Liminal States, & Subconscious Exploration - Dr Rahul Jandial

You just taught me there are left-handed surgical instruments. What's that mean? Um, for left-handed surgeons, the the way some of the graspers click, um, it's released with a maneuver where your thumb pushes something outward. >> Mhm. >> For left-handed surgeons, that can be sort of clunky. So, they make instruments where it's outward. For the left-handed surgeon is actually uh inward towards the midline, and for the right-handed surgeon, it's this way. So there are left and right uh handed instruments for different surgeons. Needle drivers really where you click onto a needle and it clasps so you don't have to keep pressure on it and then you can do your maneuver. Stake knives also have serrations that lean one way or the other. I just learned that. >> I didn't know about that at all. >> I didn't I know. I was just looking at it because I've I've got a buddy who's left-handed and he's like pointing all this left-handed stuff out in the world. >> Don't use that one. It's going to cut completely incorrectly. What I did learn was um when you have a steak, I mean I I have to imagine this is slapbang in the middle of your area of expertise, but you want to never cut with the grain of the meat. You want to be cutting cross grain. Yeah. So that that that takes me to what's beautiful about surgery is like it's it's not like Legos. It's not like, you know, hammers and chisel. It can be with, you know, orthopedic surgeries and spine surgery. When you have somebody who can lightly with a uh with a tweezer, a pickup we call it, lift something up and you see some membranes that are holding two planes together. All right, let's say you have two planes of tissue and they're held together with this fine web of membranes. You lift it up and you take a scissor upside down, you just spread lightly and the membranes fall apart and the tissue comes apart. You're not really trying to tug and pull. If you do that with finesse, when the patient wakes up, they feel less injury, they feel less pain, less anesthesia, the operation goes better, less blood time. So, everybody thinks surgery is all the same steps. Do these 10,000 steps. No, it's sculpting. It's art. There's a finesse to it. And at some point, uh, when you see somebody's good at something, it's it's like ballet. It's like something's being released. They're not like, "And now I will do this step." And, uh, that's the part I love about it is talent. It's more it's more talent than smarts. I love watching people in between doing the thing that they're supposed to do. So, a good example of this is uh drummers. If you're ever watching a drummer play live, he loses a stick or he snaps or something like that and he'll just immediately switch and he'll be playing with one hand and he'll just reach over and he'll grab another one or if a guitarist's playing and bing, off goes a pick like that. And you'll watch him without even thinking about it. He'll do something, grab a pick from there, roll it between his fingers, and go back. And it's that liinal space. It's I'm just so comfortable with my working environment. Yeah. >> And uh that's really cool to see. >> So that word that's an interesting word for me, liinal, because um that's kind of the thing I've been thinking about a lot. It's not the easiest thing to explain to people, but I think that um in nature, let me let me give you an example. What I call a liinal space. I was uh I used to dive a lot. I gave it up. I had a scary accident. I almost I almost uh ran out of oxygen uh real deep uh off of Asia Asian coast there a Palao and um it's I was like I've got kids I'll do this when I'm older. Now I'm older and I'm like ah I'm I'm you know I don't have the energy but the place that I love diving the most was the cenotes of Yucatan like where it's all flat. Maybe the asteroid landed there and killed all the dinosaurs and that kind of thing but they have caverns and there there are river underground rivers that meet the salt water. So when you go from fresh water to salt water in our body, salt water is a massive thing that has to do with cognition and balance and a lot of fundamental things are controlled just by the salt in our blood and brain. And but when you when you're diving and you're in fresh water and then it's called a halocline and you're now fresh water is meeting salt water. There's like five yards it almost feels like 5 meters where it's blurry. >> So the transition from one state to another at chemical psychological it doesn't happen in a millisecond. There's a liinal state. And so when you take a look at the brain in 24 hours, I see at least four or five liinal states. When you're falling asleep, it's not a complete I am awake and now I'm asleep. There's a little window there about 15 minutes. Lucid dreaming when you're asleep asleep and I can verify it and you have a little return of awareness. To me, those hybrid liinal transition states give us an insight. I mean, it's hard, right? Because I'm I'm I'm a brain surgeon. And this is people expect everything for me to be proven. But I'm finding a lot of uh insight and understanding from these uh different liinal states. And then you can bring in narcolepsy in the middle where people suddenly fall asleep. >> They have interesting thoughts. Um when you wake up a third of the world feels you know sleep paralysis and have have like these feelings of a goblins on their chest enough to where the stories are built around different cultures. So to me, those transition hybrid states of cognition, of feeling, of experience, I think that that's where the that's where my head is really at these days. This might be getting you out over your skis a little bit, but someone asked me this question the other day and I thought it was such a good a great question. What is something that you intuitit or act as if is true or might believe but you cannot prove with evidence or science? Is there anything that comes to mind with that? Well, I mean uh for me the first thing that crossed my mind was love. It's this you know the term used to be ineffable and so like beyond explanation but you know it's true beyond articulation but it really motiv motivates you or touches you spiritual experiences right epiphies a hunch like these are repeated experiences that people are reporting right and dreams could fall into that a little bit but there are repeated things that we are writing about through history and time. Aristotle is Aristotle wrote about lucid dreaming. Now that sounds like well come on lucid dreaming. Uh but it's rigorous. So Aristotle wrote about it thousands of years ago a return of awareness within a dream which sounds like how could you ever prove that and 20 30 years ago and increasingly now lucid dreaming is being proven rigorously in sleep labs. So that I think that's one example. But what when I hear that, what it tells me is don't deny those insights. Don't rely on them blindly. Don't be manipulated by somebody uh trying to dazzle you with those kind of things. You know, cults, >> sexy rhetoric. >> Yeah. Cults um catch you in a vulnerable moment. My patients are vulnerable. The sexy rhetoric isn't just uh you know that this will heal you, but I was you know there were there were a lot of like stem cell clinics that that were affecting children's hospitals in San Die Children's Hospital San Diego is real close to Mexican border of Tijuana. >> Uh you know we're we're in Austin so you're familiar with that. And there there were patients families who were going there to get stem cell treatments that were uh it wasn't that they were proven. We knew they were sham. They weren't hurting them, but they weren't helping them. And sometimes those moms and kids would choose that over therapy that was moderately effective. So, I think there has to be some there have to be some safeguards to vulnerable people being manipulated. Yet I'm fully ready to em embrace intuition, hunch, those kind of things like where my my dog has a instinct and hunch that comes from our lyic system that exists within us. Uh sort of the emotional centers of the of the brain, the deeper structures of the brain that we shouldn't deny those and creative people learn to tap into those. So the the challenge for me is always how to liberate our understanding, my understanding without it getting too woo woo and leading to fluff. >> It's such a good point, man. It's such a good point. I I really think about this a lot. The what level of rigor and skepticism should we have without closing ourselves off to alternative approaches to things? And I I would say I lean on the rationalist materialist kind of evidency side of stuff. I tend to have a a real um anti-conspiratorial uh leaning to me. But that's been to my detriment a lot of the time because I think my I've probably said no to stuff that my gut would have convinced me of saying yes to. like my brain has overruled my intuition and I'm kind of trying to allow that to be tapped into a little bit more and trying to get that to reverse. Well, and so that's interesting. So, um, liinal states, these hybrid states that exist in nature, deltas, where salt water meets fresh water, where a waking brain goes to our dreaming brain, that's a cognitive delta, if you will. That's a theme that I'm working on in my mind. The other thing I'm working on is is what what we're discussing now is that to look at to look at our capacities as as a thermostat. It's a modulation. Inflammation's bad, bad, bad. I say that's not true. We need some inflammation to fight off beastings and other things. But how is that thermostat set right for our lives? We fight off infections. Uh but if the inflammation is too strong, it's like friendly fire can cause autoimmune disease. So rather than saying inflammation is bad or good that this product is anti-inflammatory. No, I actually need inflammation sometimes. I need stress sometimes. I need these capacities that have kept my our species going uh uh sometimes. But when they're running rampid without the necessary stimulus for them, then we have to identify it and use our coping strategies and maneuvers and the things that the wellness industry is presenting to bring them back into the ecological validity, which is real world scenario. Where should my thermostat be? >> Mhm. You mentioned dreams. Then is Freud totally obsolete? Did he get anything right when it comes to dreams? He got one thing right for sure. Um, and before before him it wasn't really clear that dreams were coming from the brain. That's a cool story too because um so he's about 110 years old but before he was the one like look it's your desires gone wild your dreams it's it's just freaky time and dreams and it's but it was coming from your brain and it it was only at that time it wasn't clear that this creature this human being lying on the ground mostly limp body is cool brain must be off cuz they're not moving. So, h how could that inactive flesh, how could that inactive like the hibernating screen on your laptop, right? Like how could that conjure up all of that crazy wild adventures, dream state, dream experiences? So it was a guy named uh Burger he was looking he was trying to actually so like the the the old school people who were trying to understand things they were open to hunch and instinct and not to say paranormal but something that they liked exploring things that couldn't necessarily uh be fully articulated but that didn't stop the exploration the search for the meaning in it. He felt like there was this potential for mental telepathy. And in looking for that, he put stickers on the surface of patients scalps. And at that time, they were just learning that like a wire to a sticker on on your scalp didn't didn't mean you had you couldn't just you could just send electricity in, but you could also record. And so, he's the first one that came up with the EEG. That later turned into the EKG. An EKG is the three main nerves on the surface of the heart giving you a squiggle we're all familiar with. An EEG is 96 stickers recording the electricity generated by 100 billion neurons that are like microscopic jellyfish, right? It's just a recording of the electrical phenomenon going inside. And when he when he recorded that EEG um he didn't he let it run and at night surprisingly there was still electricity and that sat for like 20 30 years. But that was the first time people are like, "Wait a second, the brain is still going off when we sleep." So much so that at certain parts of the day and certain parts of when we're in our sleep dreaming brain, the electric the electrical activity is so strong that they call it paradoxical sleep that while you're asleep, just based on how wild your electricity is, you can't actually tell if you're asleep or awake. It's that hot. So it's not a quiet time. And so that's what Freud did was say dreams come to the from the brain. And now we've come to understand that the brain is always on. It's on a 24-hour roughly cycle. You go into a cave and you get it that people go in the cave and they're still on a 24-hour cycle, right? Circadian rhythms like we're all built on this rotating planet like Venus fly traps open and close, tides open and close. We're on a 24-hour cycle. But the brain electrically, physiologically, the amount of glucose usage when we sleep, the brain is not resting. And now that allows us to say, well, what is it doing? The most vibrant thing that the dreaming sleeping brain is doing is conjuring up dreams. >> Okay, why do we dream then? >> Well, that's a massive question, you know. I mean, um I would say the answer should come from the information we now have. Okay, so it's not chilling out. It's burning hot. And this one, I got to unpack it a little bit. when I just said look the waking brain and the dreaming brain are equally vibrant electrically but they must be different. So one of the main things that happens when you go from the waking brain to the dreaming brain state is certain continents in our in our brain not like a spot but a network called executive network. Now they're trying to call it action network but this is a very specific part of the brain of the prefrontal cortex and it needs a little bit of explanation. is called the dorsal lateral prefrontal cortex. The frontal loes are like this. It's kind of on the outside. It's the executive network. It's the conductor that coordinates it all. It's responsible for calculation, processing, quick judgment, not a lot of instinct >> that and and it tamps down other regions such as the imagination network and those deeper limbic structures that are our hunch or how our my my dog can tell when I'm trying to say, "Hey, um, hey, come here." You know, like trying to give him a treat to trap him to put him back in his pen because we're going out for the night. that instinct comes not from the dorsal lateral prefrontal cortex or of the prefrontal uh cortex. So, so when you go from the dreaming brain uh back to the waking brain or waking brain to the dreaming brain, that region is dampened. It's never on or off. It goes from being like 51% active relative to the imagination network to 49. So the dreaming brain has a dampened executive network and a liberated imagination network and movement regions and emotional networks. So when we see the shifts and as the executive network comes down it's compensated by the imagination network. So you get that equivalent electrical activity. So when you think of it that way, dreams, why we dream has to be explained with what is going on with the dreaming brain. It's hyper visual, it's hyper creative, it's uh it goes into tremendous social situations. And my big idea about it is it it's not what others have said like it's threat rehearsal. If you run from a woolly mammoth in your in your dream, you're better off if you ever encounter one. Or it's a nocturnal therapist. We work out our emotions at night. It doesn't make it doesn't fit the complexity. We have PTSD flashbacks. So what I think is happening is certain regions of the brain that are generally tamped down for us to perform the task of the day are allowed to be liberated in the safe space of our temporary paralysis of our dreams. Because in the brain, if you don't use certain neurons in certain capacities, they will wither. If I patch a kid's eye for therapeutic purposes, where it lands in the occipital lobe will physically wither. And so I think the what we dream to maintain our emotional and creative complexity as a systematic process where the brain takes turns in a 24-hour cycle being executive network dominant and imagination network dominant. So all those all those capacities are there for us for the next environmental event we're not prepared for. So, if you spent your entire day as a caveman logging all of the different fruits that you'd gathered over the last week and making sure that your cave is clean and working out where you're going to go to catch the next mammoth, all of that is very executive. It's very top down. There's creative in some ways but not intuitively creative. But you have maybe not given yourself. The urgent always overtakes the important and the urgent is very rarely going to be a creative pursuit. Task on versus task off. Yes. Task on is outward and that's the executive network. Of course, it requires a little imagination and everything to navigate. That's why it's never completely on or off. And then task off is daydreaming. Dreaming itself is the most task off thing and the brain wants to run rampant. I mean it's wild. If you look at some of the electrical activity, the glucose usage, it is not a quiet time. And so we can't deny that a process that makes us lie down burns that much energy when energy is hard to get is and has lasted through generations and generations is essential. So my feeling is that any collection of neurons while they're in a dolphin like dolphins do one brain at a time, well half brain at a time so they can keep paying attention. They'll they're they'll sleep one hemisphere at a time. Wow. >> Penguins do like they do micro naps. They like 10. >> Flamingos do something weird with sleep as well, right? >> Well, the all the creatures they have different ways, but when you get a collection of neurons, they got to sleep. And what happens when you sleep is not rest. It's a different type of neuronal activity. M the your body might be resting. Your heart might slow down a little bit. The liver's cool, body's cool, but the brain's on fire. And just to just to put it out there as a surgeon, when I've moved livers between moms to kids, you you could take a piece of liver from a mom and move it to a kid. I've transplanted hearts in training. We're not really reconnecting the nerves. Again, the the the the bodily tissue is a little bit autonomous. Sleep is not really for the body. I'm not saying that sleep isn't good for you. I'm not saying sleep shouldn't be a performance goal. I'm not saying that. I'm saying when our bodies sleep, it's our brain that builds the sleep pressure. And when we sleep, what does the brain do? That's the most vibrant thing it does. It dreams. So, I think dreaming is an essential feature of preserving a healthy brain and healthy mind. In other news, this episode is brought to you by Momentous. If your sleep's not dialed, taking ages to not off, you're waking up at random times and feeling groggy in the morning, Momentous Sleep Packs, how did I miss both of those, are here to help. 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That's l i v m o m n o.com/modern wisdom and modern wisdom a checkout. >> Is is there something interesting about the fact that we're conscious of our dreams? because >> you could imagine a world in which um the body shuts down, the brain shuts down and you don't have any conscious recollection of the fact that this thing happened. It was kind of I guess what you're suggesting is there are certain capacities that the brain needs and may need in future. They're maybe not quite as common as some other pathways that we use more frequently. And dreaming is one way for us to ensure that those myelin sheets are kept nice and and and lubricated. They're moving quite >> accessible when we need them. They don't they don't wither. They don't atrophy. However, the fact that we're conscious of this, the fact that we can recall it, that there is a a phenomenological emotional experience of going through this, is that bit adaptive in your your opinion or is that some spandrel side effect like a light bulb that gives off heat as well as light? Uh what do you think about the the fact that we actually know that we have been through this thing? because I could imagine a world in which you could uh retain the capacity without having the experience of being through it. >> Yeah, that's it's a massive question. It's a fantastic question and my opinion is to tell a few stories about how how some of these things happen. So, um back to liinal states, I I don't think any process in the brain, waking brain, dreaming brain is a is a rigid onoff process. So my my feeling is when we remember some dreams um they're like solar flares that have leaked into our memory uh and we wake up wake up we're we're accidentally sort of holding on to the residue of massive dreaming activity. That's my my hunch. Um and and the way to think about that is um the concept of self and autobiographical memory. So when people talk about self, self-worth, self this the concept of self is created by a type of memory. There's procedural memory, tying your shoelaces, semantic memory, stuff our phones record, you know, dates and stuff, episodic memory, like the episodes of our life. And the what happens is they're stitched together by a capacity called autobiographical memory. And the thought here is from people who have certain types of psychosis when they can't separate out their dream and waking state. Certain patients with schizophrenia it becomes quite confusing for them. So I think the dreaming process is richly active in all of us. The degree of recall is different between us and different in different stages of our life. And so when we do remember a dream in the morning or we wake up and we remember a dream, go to the bathroom and sometimes fall back into the dream that these are just uh sort of the the residues of a vibrant dream state that is breaking into our consciousness. I don't think that um it's by design. I think it speaks to the capacity that we're never fully dreaming and never fully awake. And the best example of that is not uh sleep entry that Salvador Dolly Dolly talked about or sleep exit. We talked about sleep paralysis. But in the middle certain drugs that we give our patients for Alzheimer's will make them have more lucid dreams. So the awareness of the dream state can happen when you're falling asleep when you're waking up and you're holding on to some of the dreams. Uh and there are habits you can do to hold on to them more. But also in the middle of a dream, people can train to lucid dream. I know that sounds like okay there's a neurosurgeon talking about that but it's rigorous uh galantamines and acetylcholine u antagonist that we give uh to improve certain functions in Alzheimer's patients and they report a dose dependent increase in lucid dreaming >> so I think the dream state and the consciousness they're like two dimmers and they're overlapping a bit and so when we remember something in the morning rather than thinking that it's by design I think it's sort of like an opport opportunity to have an insight into ourselves at a very emotional, very visual, very sexual time. >> Yeah. Why did dreams often end up being so emotionally intense, do you think? >> Well, because when you look at the areas that are activated preferentially in the dream state, it's the lyic system which are the emotional centers. When you look at the the dreaming brain, the regions that are activated, if you will, it's the visual centers. It's the imagination network and then equally you're dampening you're dampening uh the executive network so these big jumps of ideas and creativity and associations are not um discarded by the executive network as they would be during the day. It allows for that. Let me give you one specific example that I thought was really fresh when when I was asked to prepare this book was um when you look at thousands and thousands of dream reports, not yours or mine, but like mine feel wild, yours must feel wild. But you start to see that very few people report doing math in their dreams. I'm not saying like somebody's going to call in or write in and say, "Yeah, but it's not like nightmares, 100% reported." It's not like um erotic dreams, sexual dreams over 90%, teeth falling out, being chased, flying. These are common dreams, right? Math is very rarely reported. And what I like is okay, if I take hundreds of years of patterns of dream reports, basically surveys or Aristotle's comment about uh lucid dreams. Now with modern neuroscience, we they make sense. If the executive network is is dampened that does calculation, it kind of makes sense to me that very few reports of math occur in dream reports. Like that fits. Executive Network goes down. Reports of math go down. Imagination Network is liberated. People report creative and wild dreams. So it ties together what people are reporting for years. Why teeth falling out, falling, flying, you know, three dreams that I would guess almost everybody listening to this has had in >> and before electricity and after electricity from the from the you know horse and carriage all the way to electric car >> and >> it's not like we needed to wait for airplanes to be there to think that I could fall out of an airplane or for buildings to be sufficiently high that you would fall from a skyscraper. >> Exactly. So that so if we're getting mental health um is tied into certain families nightmare one type of dream nightmares clusters in families. So nightmare disorder can happen >> terrible well or you know it that's that's a that's a complex word I mean you can have things cluster I mean you know maybe those people are living in difficult situation I so it's hard but >> uh there is a dream that clusters in family just like certain mental health conditions would share the same dreams with people living in wildly different cultural times >> something's built in and that that again speaks to I I think uh the new understanding we're having in the last 20 30 years as we can have people be in brain scanners and fall asleep. >> Have you got any idea about what makes for universal nightmare? Is this just something? I got a big I got a big theory about it. Um and so so you know this book was um um this book was important for me. It was I had written a few others. One was, you know, and then Penguin UK in London said they've always wanted a book that looked at dreams and dreaming from a certain perspective of somebody with a a complicated life story, somebody who's had the professor chops, but also could tell a story. And I I I really took it, you know, it was uh it was wonderful actually. I it kind of liberated me. Part of that process was me rolling around Dodger Stadium in LA and going to pubs in London and sort of throwing this out because it had to be for everybody, right? It can't it's not me. And the question I would get asked the most like if dream wait if dreams are good for us, why do we have nightmares? It was just sort of a you got and so that was chapter two. Um nightmares are it's a tough thing to explain because it obviously like why why you know if if why would we why would we cook that up? And so the way I think about it is um you have to look at the mind as um something that needs cultivating in children just like walking and talking. And so just like we're not fully formed and we have to be taught to walk and challenged to walk and talk and engaged at the same time in the mind there are certain cognitive developments that are happening. So in they're called longitudinal studies. They they had families allow their children to be woken up for like 22 years and report like what they're dreaming about different times and like when they were two or three like it's just like it's a blanket. It's it's not very dynamic. It's not uh not a lot of movement. And then around four and five, six, nightmares arrive for every child. It's rare to find I did a lot of pediatric nurse surgery still do. I have three sons in their 20s. They have to be told that nightmares always arrive in children, healthy children, unhealthy children. some of my patients who who had you know brain injuries. It seems to be a part of the mind's development that's built in. It arrives for everybody and then almost invariably very few kids have nightmare disorder. It doesn't linger into the next day and ruin their day like it does for adults. So it's sort of like a wave of thinking that a species of dreams that arrives and then around 11 or 12 you have erotic dreams that arrive whether kids are having sex or not or teenagers are thinking about sex or not they arrive and and the last one I see is sort of the matur like adolescence the brain looks the same but we change who we are so I think there are three waves of sort of the development of the mind and what happens around that age of four five and six is also the development of something called the default mode network. Like until then, children have a hard time reading minds. They can't tell if smiling uncle means well or means harm. And that capacity arrives at the same time as nightmares. And so my big hypothesis, it'll be hard to prove, is that nightmares create a sense of self versus other uh by having these harrowing difficult experiences. It sort of creates um that the world around me is separate from who I am. And this engagement with monsters and different things creates this default mode network that allows us to start to see ourselves as separate from the world around us and to be a little bit more critical in evaluating the threats and the people and their intentions around us. That's my big thesis. And that would make sense adaptively because before age four, five, six, kids are so unindependent that the need to be able to distinguish uh between I am here and that is something else is kind of pointless because you're not let out of the sight of mom or dad. Yeah, you're you're in the rap still. You're very close. You're not being led. I mean, I think that's a good point. The other point is that um that it's just like every every every kid has to be told it was only it's only a dream. It's only a nightmare. And that there's this just like we talked about liinal states in the beginning like in psychosis people can't separate out uh you know awake versus dreaming. Um and that stitch autobiographical memory. We need to know these are awake thoughts and these are dream thoughts and dream thoughts should not disrupt your awake thoughts that there are these things that happen in your mind but they're not actually the the daily steps that link your life together right that in children um I don't know if before nightmares they know the difference between uh waking thoughts and dream thoughts like maybe nightmares informed the child it was only a dream so it's always been a puzzle to me Until then, do they not know that what they experienced in their thoughts while sleeping was actually not real? Could be discarded. I guess that the creativity network in kids is so much more alike even when they are awake. You you watch in the space of an afternoon a child's a firefighter and a postman and an astronaut and a sports star and a rock star and asleep and then awake again and back to being a postman. And yeah, I I dream of being a I literally do dream of being able to have that level of creative access again. >> And I think so that nightmares are serving something fundamental because they arrive in all of us. It is the universal dream. We can all talk about what what it what they serve and the purpose. And the last thing I would say about that to be a nightmare, it has to wake you up. It's not a bad dream like you wake up the next day, oo that was a rough night. Nightmares have to wake you up, sear your memory to be considered a nightmare. It's the It's the dream that has to wake you up and be vividly remembered. So, I think there's some mental cultivation going on with this process that we all share. 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And if you don't like it for any reason, they'll give you your money back. You don't even need to return the box. That's how confident they are that you'll love it. Plus, they offer free shipping in the US. Right now, you can get a free sample pack of Element's most popular flavors with your first purchase by going to the link in the description below or heading to drinklnt.com/modernwisdom. That's drinklnt.com/modernwisdom. Do you think it's important to remember our dreams? Have they got deeper wisdom to tell us or should we just allow them to be a sandbox that sort of lives on its own? I I think based on what I've learned, I I think I think it's the it's the ultimate wellness habit that goes uh underutilized, you know, um because um first uh and just to give you some examples that you know the sleep entry period this liinal state where based on measurements we can show you're kind of awake, you're kind of dreaming, sleeping. I mean, people like Edison and Inception. Inception, the movie was the falling chair was a concept based off of Dolly or Edison where they'd be working on some creative project and uh uh and they'd he'd have a key in his hand in a little metal basin and when he'd fall asleep uh on the rock while rocking on the chair, he'll fall forward, the key would drop, and then he'd write down his thoughts. He felt that there was something that could be extracted from that dream entry sleep entry state. Lucid dreaming is something you know we could talk about later but that seems to be something that people report wellness with people athletes people who are visual spatial tend to have more lucid dreams. I think that's an interesting thought that we can um uh we can learn that ability. There's a little bit of sleep disruption about it. And then when we sleep exit, which is a time I use quite a bit, is I have the luxury of not always hitting the alarm and I take those last 5 10 minutes of thoughts and I write them down first uh before going on social media or looking at my email and that seems to be an idea generator for me. I think there's sort of those practical elements that you can do. But if for me just at a philosophical level when my brain with my memory with my imagination not somebody else's memory not somebody else's imagination >> runs in a different mode hyper emotional hyper imaginative and something leaks out of that that I can hold on to I think it's worth taking a look at and even just the process of reflection I I think could hold some insight but I would tease that out it would be that the dreams that leave a strong emotional residue do with a a central image. Um I think it's okay to say why did I have that dream? You know, be your own therapist in that capacity because it's coming from your imagination and your mind. The concrete example I will give is some people who are feeling well, feeling like they're coping well, will have a return, will have nightmares pop up in their lives which serve as sort of a thermometer. And so the nightmares uh if they're progressive like headaches, occasional nightmare is is whatever it is, occasional headache is whatever it is, but if there's a progressive uptick in nightmares that can happen while the patient is having the person's having such a a fantastic life during the day. So that can be sort of a a warning sign or a signal that maybe you're not coping well. So I think we're just starting to get into those features of maybe people's dream life should be part of the vital signs. When I started training it was like blood pressure and temperature. Now we ask about pain, we ask about wellness, we ask about living situation at home. I I don't think uh in the world of mental health it would be it would be uh a stretch to start asking and and engaging people with their dream life. >> Are dream experiences predictive of something in health? You mentioned there an uptick in nightmares across the whole board. Somebody's dreaming more, dreaming less. They remember it more. They remember it less. More lucid dreaming less, whatever. More nightmares. >> Are there any correlations between that and someone's overall health? >> Good question. The dream pattern related with overall health uh would be nightmares. Um so two types of nightmares. Pediatric nightmares we talked about age four five six which I think are cultivating the mind they don't really lead to nightmare disorder where the next day is ruined and then nightmares in uh in adults they can happen once in a while that doesn't seem to be a problem but four or five% have nightmare disorder where it disrupts the next day and in in that situation whether it's in PTSD or whether it's in trauma or whether you're going through a difficult situation tracking nightmares their uptick or the improvement can be sort of a a measure of how people are doing. But as far as uh what I've read about dream recall, dream patterns that changes throughout our lives. So uh a lot of adults say they don't remember many other dreams. My cancer patients when they get to end of life, uh they tend to have these things genre dreams are called end of life dreams. They tend to be of reconciliation. They tend to be more hopeful than you would suspect after getting surgery and chemotherapy. So your your dream p within our lives from nightmares to erotic dreams uh to the way we dream as adults to drugs that change the way we dream and how much we remember all the way to end of life dreams. Uh if you don't think you have a lot of dream recall now that doesn't mean it won't be there for you. It can't be cultivated. You just have to track dream experiences and and prevalence throughout a whole lifetime and you start to see uh that they come in waves which I find which is you know which is interesting. >> How real is dream interpretation? >> I don't think it's real at all. >> I mean because I you know I mean I can't do it for myself you know like >> so what hope is there of a lady in a shawl being able to do it on your behalf? Well, I mean, I think just we have to look at it conceptually. I think we were just talking about that. It's my imagination. It's my memory. So, like, let's how do you know what this snake means to me, not just what it means to me, what it meant to me 5 years ago. I'm not the same person I was 5 years ago. Like a bridge. Let's take let's take a bridge for example. For some of my patients, it's uh you know, uh they might be thinking about suicide or it could be reconciliation with a loved one. It could mean so many things within that context. How can a bridge for you and me mean the same thing? But past that, a bridge for me means very different things within the context of my own life. I don't think a static symbol can uh reveal a dynamic mental life. >> Well, this would fit in with your perspective that it's kind of a gymnasium training ground sandbox for the mind. That >> high intensity training for the mind. >> Yeah. that we maybe we shouldn't give all that much credence to it. Maybe the brain is just kind of running away with itself because isn't it strange people have intrusive thoughts all the time. >> Mhm. >> Uh they see somebody stood next to the edge of the road and they think wonder what would happen if I pushed them in. I mean I'm not going to do it but >> not yet. >> I wonder what would happen if I pushed them in. Oh god this would happen and that would happen. Wouldn't that be thrilling? You go okay. Are you making some sort of inference about the sort of person that you are for having had that thought? Most people would say no. You know, I just have intrusive thoughts that occur during the day. And you go, okay, >> can't go to jail for thoughts. >> So your intrusive thoughts when you're awake and conscious are not that indicative of the sort of person that you are. And yet you're telling me that the dreams that you have when you're not conscious are worthy of interpretation. um that I've never thought of that before. But yeah, we're we're prepared to give >> we're prepared to dissect something which we have way less control over when we're asleep. But then on the other side, you know, the devil's advocate position would be there are very few windows that we have into the subconscious. The subconscious can often tell us things about ourselves that maybe we have repressed, not been prepared to feel. And perhaps there is some deeper wisdom to be gleaned from when we're asleep. I agree with that, but I don't agree that, you know, um the lady in the shaw, >> I don't agree that it can be uh made universal, right? I dream of a bridge. You dream of a bridge. And it's filled with emotion. It's a vibrant bridge. Okay, go ahead and explore it. You explore it for yourself within the context of your your life and I'll explore it in the context of my life. For me, it might mean suicide. For me, it might mean San Francisco where I went to college. For you, it might mean something else. So, I think the explor the the that the dream residue being a window to our own individual at that moment subconscious hyperotional, hypervisual, hypersexual state. Yes. But a symbol that captures it uh between two people, let alone between your former self. I just don't understand how that can happen conceptually. >> What about erotic dreams? What what have we come to learn about fuels? >> I mean, why not? I mean, the it's firing. I mean, you know, why not that I mean that's uh it's this is that was chapter three because remember we're talking about like I wanted to hit everything up up right off the top. Why we dream? Nightmares. Really? Nightmares and then erotic dreams. Um it's fascinating because it's another thing that happens before the erotic act. Kids don't have kids have who have never seen a monster and have a puppy. They'll have nightmares that are wild. I mean what? That's that's that's coming that's descending through our psychological inheritance. Erotic dreams, people have them before the erotic act. It's almost like an instruction guide. And and what's fascinating to me is the there's not a lot out there when you go from sexual dreams to erotic dreams, over 90% report having them. The terminology, I don't know. I think it's more inclusive. So when you start uh when you do surveys in other cultures, they're more willing to sort of say yes. The term seems to be more It it's easier for them to say yes to that, >> right? Okay. Because it's >> a little less porn vibe. >> Yeah. And it would also imply maybe >> hugging, cut, kissing. That's not >> exactly. They're not doing it with their partner perhaps. >> Well, and then the next thing is when you ask and as we get into more online surveys, this is going to be great. And more people are included, but like 80% report infidelity and then the infidelities with a small group of people like a repugnant boss or like family. It's weird. the tribe, the characters in the characters in in the uh the you know the the cast and crew is narrow, >> the acts are wild. And so when you take that data, healthy relationships have infidelity dreams, unhealthy relationships have infidelity, that's those are sort of the surveys out there and that that leads to a lot of cool conversations. But what from a neuroscience point of view is um this the part that really trips me out is um is is that around the time of erotic dreams even before you know the pituitary is dripped the hormones that release all the hormones that cascade in our body that leads to the sort of changes of maturity is that the the same fingertips that do touch can now do caress. Yes. And it's not like a new nerve got built in there. It's the capacity to perceive sensuality changes where the the sensory nerves land in the brain. It goes to the opposite side to a motor sensory strip in the in the sensory region. So around the time of erotic dreams um we develop the ability to have erogynous zones where a light touch on a back can be a turnon rather than just bumping into somebody in the subway. that capacity doesn't really exist at age six or seven and no new nerves are being deposited. >> It's a perceptual change in the brain. >> That's interesting. >> Yeah. So to me I I I like thinking about I don't have I don't have any big answers for that. I just want people to walk away from that and say so th those those changes the ability to be aroused happens around the time of erotic dreams and often it's before you're actually mature. So it just seems to me again that erotic dreams are arriving almost universally in adolescence to prepare for the act of procreation and to create the drive in our mind that that we later carry out in our bodies. >> That's that's the way I see it. I wonder whether I mean this is almost certainly going to have been the case throughout history. If you've got a particularly um prudish society, Victorian England, uh >> they still get it popping. Well, of course they you're not going to be able to, but I I wonder how many people that had these erotic dreams back then would have there would have been a real source of shame >> for them because I'm my my I'm I'm I'm cursed. My subconscious is contravening the norms of my culture and and God is looking down on me. Especially if you're told that, you know, God is watching if you masturbate. God is watching who you're attracted to. Uh, you know, infidelity is one of the worst things that you should ever do. You should be loyal to your husband or your wife. And uh, >> and these dreams are like 80% infidelity and it's all with people around you. >> It's your boss. You know what I mean? >> It's the boss you hate. Yeah. Yeah. I think it I think it must have led to a lot of inner conflict. Mhm. >> And so that when I when I write about erotic dreams and you look at it in different cultures, you know, my feeling is this is a this is a way that our just like we learn to walk and talk, nightmares do something because they're a universal dream. Erotic dreams do something. They happen in all cultures. They've happened over hundreds of years. They're happening with internet porn. They're happening in Victorian ages. And that to start really start to think of the patterns the patterns of our dreams are not infinitely wild. That's the and then and then what really teaches me is the patterns of our day are not infinitely wild. We build and break habits in similar ways. We fail in similar ways. Like the brain is not infinite. It does have some uh some boundaries in the way it works in the >> very least guardrails. >> Yeah. or for example dreams are not infinitely wild in the sense that you you don't do math in your dreams so there is at least one boundary right and then uh they tend to have certain patterns and and now I'm using that to think about that we fail in different ways while we're awake in our lives and if you look at 10,000 people the ways that people fail and succeed also start to follow some patterns that I think can guide us to like hey our brains and minds work a certain way >> and and when we learn about that then you can say where are we in this? how how is our thermostat is is a victory today just getting out of bed or and not saying hey wellness I got to be I got to feel well or just I got to get out of bed and get on the bus and get to the cancer center like so I want to personalize that whether you're the addict this is this is just a side rift man but whether you're like there this uh there are these people in recovery really good with horses in the Kentucky Derby whether you're into horses and racing or not but somehow the horses can tell somebody who's been through something and has earned and trained themselves to be calm like they have a better rapport with the animals. >> No way. >> Yeah. Yeah. It was it was featured when it came out. And so then and then there's like then you know like I was in San Francisco and I saw this person really struggling to not use you know just really just fighting that. And then I got a buddy in London who runs like this north uh Saharan seven marathons in a row, you know, just to show everybody he can. and when he's pushing to complete that seventh marathon or that the person using is really pushing to not inject I think it's actually the same praying processes and patterns that are working inside >> and if we can learn how those work how those can be deployed how those falter then we have a universal toolkit and that's what this dreaming book that's why I told you earlier was like it's really important for me is because it's helped me actually understand that If the dreaming brain follows patterns, which seems infinitely wild, right, that you brought up, then okay, so then our waking brain, we we follow certain patterns. Um, and we're not incarcerated by it. But if we learn those rules, uh, rules of survival, rules of our of of how our day can be empowered, or watch out for that booby trap and that falter, and watch out for this attentional magnet because it's going to trip you up. like you could have a uh you could have a toolkit, you could have a guide book to your own to your to your to your own mind and I that's where I want to take things uh going forward and that's what this dreaming book has taught me. A quick aside, you are probably not eating enough fruit and vegetables and you know it and this is going to help. Good news. AG1 just released their nextG formula. And for the first time ever, they've also released flavors: berry, citrus, tropical, and original. It's a more advanced and clinically backed version of the product that I've been drinking every single day for years. 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And if you sign up right now, you can get a year's free supply of vitamin D3 K2, five free AG1 travel packs, and the 90-day money back guarantee, plus international shipping by going to the link in the description below or heading to drink1.com/modern wisdom. That's drinkag.com/modern wisdom. What do you make of the prevalence of the repugnant boss in Erotic Dream? >> I don't know if it's a power dynamic, you know, or it's uh, >> you know, I I don't know. Or the family. And I mean, my idea was sometimes um, yeah, the repugnant boss. But what the the the narrow list of characters, I thought, a hypothesis. Um, again, there's many things we can talk about that can't be proven, but evolution had bottlenecks. Like, there were times when, like, it's crazy if you think about it, like how many different homminid species there were at one time. And, um, maybe homo sapiens were down to a few hundred thousand or a few thousand at that time. >> And maybe it was an evolutionary advantage to only procreate within the tribe. Like, that's a very hypothetical scenario. But there's there's a field called evolutionary psychology that our cognitive archaeology that the way we think >> uh was an advantage that led us to uh to thrive in competition with other other homminids because you know people like oh bigger brain the brain is shrink stop that Neanderthalss had bigger brains but something with our minds was the advantage it wasn't just the size compared to Neanderthalss and this that's why I of like evolutionary psychology that and the way we're thinking now is something we've inherited that was advantageous hundreds of thousands of years ago but we're still but we have to now adapt that to the modern life. >> Okay. So if we're thinking adaptively here I'm also a huge EP fan. So, um, >> if we think adaptively, the repugnant boss, uh, or or the the family member very well, maybe we're not particularly well used to having 200,000 people available on Hinge or Tinder or or in our local city that are our age and hot to trot, there's usually only a very very small group of people that are here. And perhaps the sleep dream of that is, well, what if I test this out? How what how does that make me feel? What does that mean for me? Because there aren't that many other people that are available and probably should see if this is actually going to work or not. Oh, I mean I mean it's possible. I mean, now um as far as the characters in erotic dreams, whoever writes this book next is going to have a lot more surveys from a lot of different types of people speaking a lot more openly about these things. >> And then they're going to have to figure out like, you know, I mean, celebrities are part of the erotic dream. They're considered part of the tribe like Brad Pitt or whatever. Like celebrities show up feel >> something to do with status maybe >> or familiarity that you see them. so much you feel like they are potential. I I don't know. It's it's we're just riffing. But I'm curious to see that with with social media and stuff, how influencers do they show up in a similar capacity as conventional celebrities that I grew up. >> Let me let me warn you right now. You do not want the pillar talk of a podcaster uh in your dream or not. You know, >> people going to call in and they're going to write in. >> No, thank you. No. Look, look, you went >> Repugnant boss, Chris. >> Yeah. You slept with a podcaster. What did you expect to happen after cuttinged three hours and he's still going he's still going on about the biggest gun of World War II? Will you shut the [ __ ] up? Like, hey, look, I mean, you you asked for that. You knew what you were getting into. Um, on the on the erotic dreams thing, I don't know whether we have enough longitudinal data to work this out. I would be fascinated to see what impact the prevalence of porn has had in changing the sort of erotic dream. Uh, men cycling through even more partners in one sexual fantasy. Um, are they being influenced by what they see on screen? I certainly know that if I read Well, if >> that's a massive book, get just 10 years. Somebody just need to rock that. >> I I like to read uh fiction before I go to bed. And I've been I have an admission to make. I've been getting into chick stuff. A lot of chick stuff. Uh Freda McFaten, The Housemaid, Housemmaid's Tale. Um, uh, Alex Michael Lades who wrote, uh, The Silent Patient. It's like thrillers like >> written by chicks, but not necessarily only for women. >> Really good. Insights come from everywhere. >> Easy, easy reading. Usually woman in her early 30s that's kind of looked over who fixes some sort of crazy murder thing that happens that impacts my sleep like [ __ ] dude. Like I go to bed and I've got but it's usually interesting. It's a particular So you think, okay, if the thing that I read before I go to bed, I'm also watching the tour to France Unchained on Netflix at the moment. For some reason, I'm not having many cycling dreams. If these two things are happening, we have to assume that people who horn a lot >> the volume, >> how is that not impacting dreams? I think that's the I think that's the experiment uh that's uh that's ongoing and somebody younger than me will see that that's the opportunity here to look at that and in this in the context of dreams the it's super physiologic stimuli is another concept like >> you know the the you can't look away cuz it's just so it's just like a cod up version of something and so you may have some finesse and emotional regulation and you may be able to sort of in your own competition at wants to be like I'm not going to look over there because yes I feel desire and lust for that that image but that pops up once or twice but when it's just like on loop and you can't I'm surprised it's porn addiction is only 5%. All right, given just the supra physiologic uh stimuli that it is. Um but yes, the impact on dreamscape, the modern world's impact on dreamscape is as big as the when there were rumors that when black and white television went to color that dreams also became to color. There's some urban legend about that. Like I mean the world was in color but when when color magazines and and and color TV came out there are small reports that our dreams were more in color. >> Wow. >> So that's a but the point is whether that whether somebody can further explore that or not but right now this is this is a this is a PhD thesis for somebody right now if they want to run it is >> how unsurprising that the things you consume will influence the way that your subconscious works at night. But sometimes not, right? Like it's it's an inconsistent process of feeding your dreams. >> And that's what I like about it is that you think like this you you think your dreams are only going to have the thing that you're worried about and it doesn't. So it has it's metaphorical like your you might have a lot of anxiety about uh something and then your dream is filled with anxiety. But it's like it's like Vietnam veterans when they were going through divorces, they would have their PTSD come back. They weren't they weren't dreaming about fighting with their lovers or spouses. So dreams arise in a way that's metaphorical and requires interpretation uh by the person who's having the dreams. >> What do you think that says about where the inspiration for dream material comes from? >> I think it's a constant it's so so I think during the day we are just stay with me now. Um, if we took a if we took a brain, we flattened it out and we said they were continents, right? Thinking of the brain as this spot or that spot. Sometimes if we injure a certain spot like a nail, I used to take care I did a lot of trauma nail gun injuries. They come in with like a nail stuck in, you know, or they'd have a fall and a blood clot would come out. You would say you take out a certain part and they would lose a certain capacity. You say, "Oh, this is what does this." It's not like that. It's like Heathrow or London. You know, if you have an issue at LAX, it's going to disrupt something globally. But it's not that LAX does flights. LAX is a hub that controls flight throughout the planet. Similarly, there are spots in the brain hubs that control broad processes throughout the brain. And and what I like about it is that these injuries have informed us about how how the brain works. And when you have an injury in that dorsal lateral prefrontal cortex, which is these little spots here that that's the conductor of your whole brain while you're awake, those people struggle with math. And so it's okay, it plays a role in that. And if you flatten out the brain and you have these different continents and lobes and structures, hypothetically, you have certain parts that are ramped up during the day during executive network. They're they're not in one area. They're connected by a lot of things like like where's the economy? I mean it's in the cities in Wall Street. It's everywhere but there are some hubs. So the executive network is one it's like like in Las Vegas where Bellagio where those waterfalls go up. Think of the executive network as those neurons and their connections. They're like 51%. They're running [ __ ] right now. And the imagination network is 49. And and and when you dream it it it kind of flips. you have 49 51 hypothetically. Okay. But when you're when the when you're daytime and it's executive network, you're still pulling from imagination to to run to get the task done. You're still think if I went left, if I went right, it's called counterfactual thinking. If I go this way, last time I got hurt, you know, you're still imagining plus e executive network. And what what happens with dreams is when the executive network falls back, your brain uses imagination in its own mental workspace. Uh and the biggest example of that is dreaming. So think of the brain is always on and there's always uh there's always there's always a balance between executive network and imagination network and and the examples of the most dominant time when your executive network is happening is under threat when you have to navigate a crisis and the biggest example of when your imagination network is is most dominant let's say 54 uh to 46 is when you're dreaming but everything in between is a dance between idea, you know, execution and idea. And what I like this is this is just a side riff like they did this thing about analyzing uh poetry or book cover designs and they would put these people in fMRI machines and the idea generation is mostly imagination network. But to figure out if you came up with a good idea, you had to toggle back to dominant executive network. Otherwise, you got a bunk idea, right? Mh. >> And so the what I don't want people to walk away thinking that we're liinal states that we're all one or all the other and it's a there's a thermostat in our life and how to cope. But there's also a a balance of of executive network and imagination network. And there are things creative people do to bring in the imagination network. But uh imagination requires executive function and really great executive function still requires imagination. What are some of the ways that people who want to activate their imagination network more effectively when they're awake can do that? >> Um, all right. So, I I got some stories for this one. There are some examples that speak to again a damaged executive network liberating a lot of imagination. One example is alcohol. It dampens the executive network and some people feel that they're more creative on alcohol and it's dose dependent you know not 10 drinks not one drink I mean alcohol has to be really handled with care at different doses it makes you feel different things uh number two fronttotemporal dementia that Bruce Willis has these patients in Alzheimer's clinics when they have a certain injury to that part of the brain there are publications if people go on and look it up they show them and they're like artistic abilities they can paint a lot better dementia and injury to the executive network leads to a liberation of uh of of hidden artistic like painting drawing talents. So those are two examples. Some people get hit with lightning bolts and even if it's one person the the electrical shift can release um can change that executive network to no way. >> Yeah. Yeah. I mean they're they're out there for savants so people could so when I say this I want people to look it up you know uh uh and that's also one flew over the cookies cuckoo's nest where that movie made a portrayal of shock therapy as very negative and it generally was but now we create we send in electricity and create a seizure to break people out of suicidal thoughts and stuff. So there are a lot of thing and those people sometimes have more creative ideiation. So we know that there are hidden uh hidden creative abilities in all of us and the executive network is is is reigning them in to get the task done to to drive on the freeway to be on the tube. So how can we extract those? I would go back to sleep entry um where that's a window where Salvador Dolly thought you have good idea generation. Sleep exit is also an I is a time where the executive network hasn't fully come back online. if you will. So, your ideas will I have a lot of ideas during that time. Bad ideas, good ideas, but it's an idea generator. And then during the day, what you have to realize is you're not going to hit undirected thought is actually the thought you want when you're trying to be creative. It's hard to have a triple espresso and then drop creative stuff. Uh it's it's the liinal time waking up, meditating, um exercising, uh focusing on something like a flow state partially but not, you know, not exclusive, >> driving, doing the dishes, playing pickle ball, >> but partially engaged and and then something and then some and then it you can't demand it. You have to cultivate it. You can't liberate. >> You can't white knuckle creativity. It's highly highly irritating. >> Another espresso. Let's let's >> Yeah, run it back. [ __ ] it. Um, yeah, that's that's certainly something I found to be true. Um, sitting down and demanding yourself to be creative is a reliable way to ensure that you're not creative. >> You have to flirt with it. I mean, that's why it's not that's why it's not a gift everyone has, but it can be cultivated. You know, >> what's you you mentioned there about some of the transcranial electric stuff as a neurosurgeon person in that world. What do you make of what do you what do you make of this sort of new revolution? I know that uh depression, anxiety, some compulsions are being treated with this now. Um >> Mhm. >> Yeah. What do you what do you make of this? It's real, right? >> But it's also very easy to go on Amazon and get one for $4.99 where they got the little headband and being positioned in the same way. So the stuff where it's real is rigorous. It's intense. It's at massive elite centers. Yep. >> And a week usually 30 days of backto-back treatment as well. >> Yeah. And they and not a 30-day refund like on Amazon, right? So every time I neurosurgery was neurosurgeon was a funny word. Um >> we have to be able to talk about things like instinct and hunch because that leads to the fullest capacity, right? Smarts plus instinct. Who doesn't want that? Sports has the best thing like you know under pressure how people perform. That can't that can't be white knuckled either. The the brain has to be thought about in scale. You cannot answer all of these questions with the brain. Like people talk about it's like you can't it's not a homogeneous organ. It's not a liver. If you dice up the liver at different areas that and you put it on a magnifying glass, it's the same cell essentially for the most part. The brain has so many different cell types, so many different architectural components floating inside a u you know a it's buoyant. It's floating or stride liquid. It doesn't actually sit on the skull, you know, and like so it's it's an ecosystem of little electrical molecular machines like tiny jellyfish that are spraying electricity and chemicals at each other. And as we talked about before with those stickers, you can record electricity. um you can also deliver electricity and that would be shock therapy and now what's less disruptive is delivering uh using magnets so for people who are familiar with physics I'm not I took all the classes to go to medical school but electromagnetic fields they they can influence each other so you can pulse a magnet through the skull and it can change the local electricity of a certain region so you can actually uh put a magnet on the surface no incision required. Um, and pulse to the motor strip and make somebody's arm move because back to it's an electrical currency that leads to uh >> dreams, you know, it's measured at night with dreams. It can be it can be tickled. And so now Stanford is doing some good stuff within other places is well, what if you uh what if you have obsessive compulsive disorder? somebody else makes the diagnosis. The term is not used casually, let's say. It's not like, oh, I'm obsessed. But somebody really is like, man, I turned that doororknob 120 times today. >> So, they're looking at the the pulse can be used to dampen the dorsal lateral prefrontal cortex. Oh, and it can be used to heighten. So if you pulse that area every day for 30 days and you dampen it a little bit and at the same time somebody gets therapy and you do cognitive reappraisal like the the the parts of therapy that I like are some of the ways where you're basically training yourself uh and you say hey that's not dirty don't don't worry about it or that door is locked you don't need to wash your hands 80 times a day like you you you've been struggling with that fight the whole time people with OCD they know they shouldn't. And now if you pulse that area that's kind of made it, you know, difficult for them to control, that combination is leading to results that we haven't been able to find by just giving medicine. >> So it's real. But the thought that you can buy this and then do it for yourself, >> self- administer. >> Yeah. Or with with um with a with a device that looks the same but is not delivering the same technology. But that that is the future of mental health is a combination of therapy, magnetic pulsing, occasional medicine, and that as a cocktail, not just like three different types of anti-depressants, which were helpful in for people, but a mixture of talk therapy, a mixture of exercise, talk therapy, magnetic pulsing, all non-invasive. And if you can get a 10 20% improvement in what we're already what was going on right now, I think that's fantastic. Before we continue, if you haven't been feeling as sharp or energized as you'd like, getting your blood work done is the best place to start. Which is why I partnered with Function because they run lab tests twice a year that monitor over 100 biomarkers. 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What's that tell us about >> do I mean this is how the I mean this was a story back in uh I noticed in my 20s when I was in training. So um um so there's a thing you know some some patients benefit from being woken up with with their skull open in surgery. This that's >> how could you benefit from that? Because whereas this dorsal lateral prefrontal cortex, we kind of know where it is. Whereas the movement area, like the hand region, we kind of know where it is. You know, just based on an MRI, it's consistent in you and me and others. Language is in a neighborhood. It's in the left temporal lobe right around here. And there is no uh there is no specific address for it. It's different in in both of us. And so to figure out um where language is so you don't hurt it as you're trying to enter the deep brain through that area you have to map the brain and let me and so what we're trying to do is to get to it. So uh the neurons the bodies of the jellyfish molecular jellyfish are all on the surface and then their their axons and tentacles converge into the middle of the brain. So the cortex, the canopy, the treetops is where all the where all the thoughts are happening, if you will. Um, and so what we're trying to do is identify the parts of the treetop right here, the cortex, that when you stun the activity in this tiny little area, it doesn't lead to any any issues with them talking or understanding. And this is a this isn't just like they'll still be able to text. You can you can hurt the whole capacity of language. So, uh, the only way to do that is to wake them up in surgery. And there's a you numb the scalp, you put them under anesthesia, you open the skull, it's like ice fishing. Uh, then there's a little covering on the brain called the duromat. It's like a uh it's like um, you know, like a sort of a skydiving parachute material. You can pick it up and stitch it at the end. >> You open it up and then there it is. It's beautiful. It's stunning. It's white, speckled with blood vessels. Um and um and then you then you let them wake up slowly over 30 minutes. Uh you the propall is lightened and then somebody engages them and you have them count and sing and sometimes even play the guitar. Like UCLA's got a YouTube video of somebody doing that like bigger capacities, right? Um not just like pinch your finger but and so they'll sing like they'll sing or they'll count and it'll do it in multiple languages. 1 2 3 4 5 6 1 2 3 4 5 6. And then you'll then you'll take a little spot, a little electrical pen. It faintest bit electricity. And the brain can't feel when it's being touched. It only feels through the nerves it sends out. So when you dissect the brain on an awake patient, they have no idea what's going on. And you tickle the uh you tickle the spot and they and you stun those like collection of neurons there, maybe the size of like a tiny pee, and they keep counting. One, two, three, four, five. and you say, "Okay, I can go through this little piece to the deeper brain and I won't hurt their language abilities." So, you put a little white piece of confetti on there or a number >> and then you go next to it and then you'll find areas that cause speech arrest. You'll say, it'll be like 1 2 3 4 and you'll bud go 1 2 3 three three three. That's for real. You guys can look all that up. That's been going on for 60 70 years. And he said that caused speech arrest. You put a little red piece of confetti. So at the end the surface of the brain as you're going deeper looks like Swiss cheese and you've you've identified the portals through which you can dissect to take out the deeper tumor uh and not injure their language. >> Why is language such an important indicator? >> Oo that's a big question. I mean I think it's uh um I think it it kind of makes us who we are. I mean it was sort of a a differentiating thing for for mammals uh is language and then all the complexity that comes with language but it it is housed in a neighborhood and unlike the frontal loes uh there's not a lot of redundancy. So the motor strip is the same. Apes, you know, humans the same. Language, it's kind of a fuzzy address. One frontal lobe can be injured with a spike, >> with a tumor, >> and people are mostly fine. I mean, they go home, they drive, they go to work. >> So there's a maximum redundancy in these the prefrontal cortex is a it's a it's an important word. It's front of the front. It's the the things that that pushed our foreheads forward and it has three very interesting components. The dorsal lateral prefrontal cortex which is mostly out here dorso up lateral it's just fancy. Then there's an orbital frontal cortex which just sort of sits above the eyes and that does a lot of like when people get injured there they can't change their political views or they don't get like social phauxawa like there's a lot of complex social things that happen up here with a lot of redundancy and then language and feelings of spirituality and stimulating here where people like have nightmares smell burnt toast that's temporal lobe uh and that's that's a fuzzy area without a lot of redundancy And then the motor strip is a very precise area. So there they're different regions you have to learn how to dissect around and through. >> And some of them can have a little bit of damage and you still function relatively well. And some of them even a tiny bit of damage and it's it's wrecked. Yeah. >> And that's the that's the craft is how do I get to the deeper brain? >> Um how do I which >> without damaging anything that doesn't have redundancy. >> Yeah. How do dreams differ in people that have got brain injuries or really severe trauma? >> Um, that's a good question. The um the range of injuries vary, the range of drugs vary. I couldn't I couldn't figure out like the dreams on drugs was just so wild. I couldn't find a pattern. I mean, you know, people smoke weed. Uh they don't remember much. So, are they having fewer dreams or fewer less dream recall? And then there were stimulants and anti-depressants and all the different combinations. I couldn't find a consistent pattern for it to become a chapter. I think that'll be for the next author. And similarly in brain injury um um there there wasn't really a consistent pattern with exception to one the uh the phalamus is sort of like this the pineal gland that they talk about being the third eye. I mean we we remove that melatonin goes away. and we remove that and patients are fine. So I'm not saying that people shouldn't believe in the that concept and dart and third eye but the pineal gland is essentially a vestid it's like an appendix but the central like the size of an egg there's something called a phalamus which is sort of the gate for all the sensations coming up and it refineses the movements going out when you have injury in that area uh they tend to have a lot more lucid dreams immediately afterwards. So like like it's it's almost like uh there's too much arousal permitted in the sleeping state because the phalamus is injured, right? >> The gatekeeper has stopped keeping the gate, >> right? Cuz the gate is again nothing is ever off. If there's an alarm that goes off or you smell smoke, you're going to pop up out of your sleep and dreams and that what is let through. I used to do all kinds of weird things like have people sleep and they put their hand in a glass of water or a bucket and see what that changed. The point there is a phalamus is uh is the gatekeeper that lets certain things through. If that part is injured, uh the lets certain things through and says time to wake up. There's an alarm. If you injure that part, you get a more more lucid dreaming. Awareness seems to creep into the dreaming state uh a little bit more readily. Could you see in some ways the thoughts that people have in their dreams being more real or more accurate to their sense of self than their waking thoughts? They're unencumbered by the executive network tamping everything down. Their sense of self, the story that they have arked together. This is who I am and this is what it means to be me. Uh I had a conversation with Dr. David Spiegel about hypnosis >> and it sounds not too dissimilar that maybe in some ways we're liberated. So yeah, I wonder whether yes, some of the thoughts we have in dreams could be more real than the ones that we have when we're awake. >> Well, um I don't know, but I will tell you that um some dreams require no interpretation, right? You're stressed out about giving a talk, you show up naked at the podium. Uh your end of life dreams, those tie up. But as we discussed earlier, let's not hold dreams to a a standard we wouldn't waking thought. like we have all kinds of junk thoughts and thoughts that we don't want to hold on to, thoughts that don't reflect who we really are. >> Um, and I think similarly for dreams, it's it's a wild landscape. What it is is your brain in a hyper emotional, hyper vvisual, hypersexual, hyper imaginative state that is creating experiences at the neuronal level. Not at the you're paralyzed or you're not living them out, but it's from your memory. It's from your life story, right? It's drawing upon all of that imagination that's liberated from the bank of memories and experiences you've had. And I think in that way, it's personal, this individual. And maybe doesn't give a truer insight, but it gives a different insight. So, you got to think about your life when you're awake, when you're waking up, when you're falling asleep. >> Hold on to that dream that that stuck along stuck around a little bit longer. Um, and just use all those portals to put to stitch the story of are you liking where you're at and maybe you need to change or maybe you need to be at peace with yourself. >> I think the main thing that it makes me think is that it's a reminder we have way less control than we think we do. >> I love that. >> I think that's the main thing. >> [ __ ] is firing. We are not driving. I mean, and during the day too, right? I think that goes back to the but if we learn the ways in which at this time I have less emotional regulation at this time I have more emotional right like if we knew it's not that we have a lot less control but it's almost like riding it's this like the stream of conscious like there are some boundaries and you are you are sort of riding on a river you're being tossed around but you have some you can drop a hand and control and pivot and move around a little bit so I think if it allow allows for uh failure not to be permanent. It allows for triumphs not to be permanent and allows for us to say um that it's okay to not have a linear goal of self-improvement and growth mindset. Like to me it's cyclical. Uh there's the winter in our life. Victory is sometimes just getting up. Victory is sometimes not, you know, just not falling apart if you get a cancer diagnosis or your child gets ill. So I'm trying to come up with universal ways of understanding how our brains and minds work. So it applies to the the elite uh 900 running 100 mile athlete or the person saying you know I don't want to use this Oxycontton that I got after surgery. I'm trying to give this up. You know >> that it's the same universal processes at play. It takes the judgment out of it too. Going a bit more broad than just dreams. Someone that spent a lot of time looking at the brain. What are the myths that are widely held about the brain that annoy you the most? What do you wish people would stop believing? >> That's a great I I wish they would start uh stop talking about it as the brain as if it's a homogeneous singular entity, the brain, the heart. >> And I think it's uh I think it requires just one level more. Um, and the way I would say is I'd love for people to have a sense of scale in their explanations and podcasts and stuff. Is it at the neuronal level? Is it at the network level, executive network or uh imagination network? Is it at the lobe level, the anatomical level, temporal lobe and language? Is it at the global electricity level? Seizures, dreams. And so when people say, well, the brain prefers this, the brain thinks this, like the I it doesn't make sense to me because um it's not descriptive of the tremendous diversity in this ecosystem in our skull. So I would I would love to see one more level of not proof but little precision, >> depth of explanation that goes beyond the brain as if it's like muscle or liver. >> Yeah. Yeah. Yeah. Yeah. >> Right. So that then that way you'll know if people have really thought it out. Uh that's one. And then the then number two is this myth that we only use 20% of our brain. No, I mean the whole brain lights up. But to do one thing, we may only use 20%. Because it's really an energy hog. So the brain wants to be efficient and fall into patterns. Um and the and the last one is that it's limitless. You know, your body's limitless. Your your mind is limitless. Actually, no. It's I I think you can be closest to limitless in your behavior. Um if you realize that there are patterns and proclivities and tendencies that all human brains and minds have and to try to identify when somebody does it well, what are their coping strategies when somebody's struggling uh the way in which they falter with their goals? Um maybe I don't I'm not falling apart now, but there's there's a lesson there for me. because I don't know what's coming down the road. I haven't gotten knocked down yet like and that's called ecological validity where it has to constantly be tested in real world scenarios. So to me the the learning that the brain is not limitless limitless and the brain creates a mind that is reciprocal brain makes the mind mind can change the brain a little bit and then the biggest conundrum is why the mind doesn't always translate to behavior. you're like convinced I'm not going to do this or I'm going to do this and you just can't get it done. That bridge between mind and behavior is also another an area that I'm looking at. And that's where the coping strategies go. Rather than saying, oh, don't drink, don't smoke. It would be nice to say when the thought of smoking a cigarette comes in your mind, these are the processes going on. Break it at the cognitive level with step one, two, three. Avoid the intentional magnet. Do this. Don't look at it. Definitely don't let that smell come into your nose. Okay, now it's in your body. You had a whiff of smoke that your partner's having. Now your body's jonesing for it. You your hair is sticking up. Bring in these strategies here. Somatic therapies, deep breathing like to know the ways in which we falter and then to apply strategies because the brain has uh uh is not limitless. It it falters in a certain way, triumphs in a certain way. So a little bit more prescriptive to the way what stage in your you know failure or triumph you're at would give a little bit more precision to rather because it could it can get overwhelming. I would never tell my cancer patient like you know just be well or you can do it. They have to be coached through the process. So I'm trying to come up with a universal toolkit to understand this is what I'm feeling. This is the way most brains and minds and people falter when at this stage of addiction of desire and at this step I want to use these strategies. Okay, now I'm going to get the cigarette. Okay, now I want to use mitigation. Give away the pack, you know, like but not to just give a global strategy. Don't smoke. Don't smoke. But if you're being pulled in that direction, here's the game plan. Uh, that's what I want to build a universal toolkit. >> Do you think the neuroscience industry is overselling some of the new tech that's coming along? fMRIs, >> brain scans of all different types. We can detect onset of Parkinson's, CT scan with contrast, all of this stuff. >> Are we are they making promises that the sort of insights can't cash? >> Mhm. I think so. It started like 20 30 years ago. We needed these scans to do surgery to do brain surgery. So I tell you this is another story. My professors they when you had a blood clot they would see like somebody's eyeball was you know pupil was big and they would call it exploratory tffonation with a hand drill just start with the patient's family's consent. 30, 40 years ago, there were no CT scans and they would just make random holes till they hit hit blood like drilling for oil. Then a CT scan came out and changed everything. You could see which side the blood clot was on. It's fantastic, right? They're coming out of hospitals for neurosurgery. Then we try to figure out like function and that's where fMRI started and because MRIs don't have radiation, you can elect to be in there. You can get MRI every day. CAT scan has radiation. And so neuroscientists started putting people in there. And what I would say is what's happened is the term is being thrown around brain scans. But u the information nobody's explaining it. Um that this area is activated. But what if you activate the area that uh you know stops a function? That's different than activate an area that grows a function. Right? So the there's a modulation of the brain. you don't not all activation is good not all inhibition is good right and so that those nuances are not not getting out but the term brain scan can be used by any author now and I'm not saying that I mean everybody's an expert in the brain right because we have one so I don't I'm not saying that we should limit that but the question should be one step further that and what what is the meaning of that a brain scan shows this and and the way to understand in my opinion what the meaning is is to ask how is that experiment set up right like just to say so you have a thousand people who think of puppies in a fMRI and then you have a thousand people who don't think of puppies and think of snakes in fMRIs and then you're looking at the differences puppies effects on mental health versus snakes effect on mental health That experiment can't be set up cuz you can't stop the person thinking about py puppies thinking about snakes and you can't really control the person thinking about snakes thinking about puppies. There's no way to set that experiment up. So when it says brain scans show this, I think if I were an interviewer, I'd say well how is that experiment set up? And I think that way we would get past some of the fluff that's out there because uh it has there has to be an experiment that justifies the answer and then just throwing out brain scan I don't think is enough. M what role does lifestyle really play when it comes to cognitive decline? >> Massive. >> I'm seeing a lot now. I'm big behavioral genetics stan as well. I think that heritability has got a feted past. Uh but it's real important and I think that more people should learn about behavioral genetics than do I think it's there's a lot being laid at the feet of of lifestyle because it's something that we do have control over in a meritocracy. uh where people feel like they want to be able to author their own life. This idea that you are being puppeted by some stuff that happened literally before you were born, like as you were conceived, um is very disempowering as an idea to a lot of people. But I also think it's super informative and if you can kind of get past the initial discomfort of there's some stuff that I didn't choose that I'm at the mercy of. Um but on the flip side of that, lifestyle as well. So talk to me about cognitive decline and its contributing elements, lifestyle, genetics. How do you come to think about it? >> DNA is not destiny. Um especially when it comes to the brain and mind like I mean DNA might be destiny for like heart attacks and stuff like that or certain there are certain medical conditions that are very linked to genetics epigenetics but um whether you have uh a proclivity uh or tendency to have Alzheimer's or dementia or not whether you want to stave that off because you don't want to know based on a new Alzheimer's test or whether you've been given a diagnosis and you're trying to work through it. The treatment is all lifestyle and behavioral. The medicines are limited. They're um they exist for early diagnosis and Alzheimer's, but the treatment is all lifestyle. The way I the way I think about it is five five key things to do or or a handful of key things to do. Um is one, you got to keep the arteries open. We've been talking about the the the beautiful brain. You have four arteries coming up. They they get into this beautiful branching pattern. It's exquisite. Parts of them loop over each other. Looks like a chandelier. We call it the candalabra. And they get narrower and narrower. So you got to irrigate the flesh. So whatever is good for keeping heart arteries open and kidney arteries open is also good for keeping brain arteries open. Exercise. >> Yeah. Or taking the the anti- cholesterol pills that are long established and mostly safe. Like pretty safe, you know. So exercise. Yeah. Um but exercise does a couple of them. So, you got to keep the plumbing open to irrigate these neurons. Um, number two is uh you have to eat a certain way. And I know there's a lot of diet stuff out there and that's a whole theme. But the thing that over decades has been proven uh to preserve or even increase cognitive health, cognitive function is um is the mind diet and which is the closest thing to it is pescatarian. It's mostly plants fatty fish and the reason fat so I like to take it one step one step deeper. The reason it's fatty fish and omega-3s is you mentioned the word mileelin before and so the little the the neurons and the axons. The way they make the electricity communicate faster is that the cable is wrapped uh with a fatty sheath that's called myelin and then the electricity actually jumps uh across the little gaps they have and it goes faster than if it is not mileelin coated. Uh and thought can actually deposit myelin preferring that thought to happen again. uh that myelin sheath is made from omega-3s. So you there's a specific fat that's needed for myelin and that's omega-3s and fatty fish. You can get in in flax seed and other things too. So keeping the plumbing open, giving the brain the material it needs. Now we're at the at the scale level, right? Okay. And then you then you go in a little deeper. Um the timing of eating is interesting. I I do think there's some pretty strong neuroscience evidence of intermittent fasting. I know there a lot of diet things out there, but >> skipping if who if you have the luxury of skipping breakfast, >> skipping going 16-hour windows will uh if you don't eat, you're not going to just drop dead. And the brain the brain is a uh uh a hybrid vehicle. the brain can live off of neurons can, you know, thrive and and use glucose or ketones. And so after 16 hours, your liver will will turn out ketones if you haven't eaten. So that's how you live past, you know, the 16 hour window if you don't consume anything. And that switching back and forth um in intermittent fasting, the cognitive test now, now we're getting from flesh to mind. Um, uh, people seem to have more focus. People seem to have more, it's not about weight loss, but intermittent fasting, it's letting the brain have glucose and ketones couple of times a week. >> That's interesting. So, your suggestion here is that all ketones, someone that's doing a full ketosis or carnivore style diet or somebody that's doing a classic sort of omnivore style diet, which when you're grazing, typically you're not going to drop into ketosis unless you forget to eat carbs for a couple of days or something. Uh you're suggesting that there is a principal brain benefit and neurological benefit to the switching between these two fuel sources. >> Correct. That's interesting. >> Weight loss is separate. >> Yeah. Yeah. Yeah. Autophagy and >> Yeah. But but also I mean there's a lot of ways to lose weight. Um but this this is we're talking about how to stay sharp. >> Keeping the flesh healthy, keeping the plumbing open, those are arteries, you know, vascular health. Um exercise could do that. what we eat, giving your brain the right materials and the mostly plants will clear out the sludge and the antiox, you know, the plants work because they got they have antioxidants and and tannins and these things that clear the sludge that these little molecular machines called neurons make, right? It's that's why plants are good for your brain. And >> are there any that you prioritize >> uh in plants? >> Yes. >> I don't I don't think it really matters. It's hard. Again, I can't find the experiment where they got a thousand people eating spinach and they got a thousand. But I can tell you over 30 years, whether it's Blue Zones or the Mediterranean diet, now specifically called the Mind Diet, it's Mediterranean diet. And those people, they get a lot less Alzheimer's than people who don't. >> So, I I can't distill it down to that. But Michael Poland, you know, he's great. Mostly plants and some fish. and then the indulgence of the burger or the caviar or the or the vegan, you know, burger patty. It's all it's all up to you. But the staple is pescatarian. Then we talked about the timing of eating, what to eat, the timing of eating. And then um I think the other one that's >> just on the timing of eating thing, uh outside of the intermittent fasting thing, is there anything else to say on that? It's primarily at some point a couple of 16 hour ketones. Couple of 16 hour fasts per week is probably a good idea. >> Yeah. And and relatively easy to do. You can have black coffee in the morning. >> Um I I feel great when I do when I fast. I I feel really really great. >> Yeah. And and that's another another theme I'm trying to tie in like things that have worked for the ancients, you know, whether it's again back to Aristotle or fasting and different things. Again, for people have the luxury of this, right? Most there's a lot of food insecurity. I'm just giving you the conceptual answer. Um and then the you know the the fourth thing is is movement. So exercise is is is movement. But uh for my patients what we've seen is that when you're vertical like people think like it's got to you know you got to have you got to have the gear. You're out there. You're just you look like you're auditioning for the Equinox commercial or whatever. Like that's great. No knocking that. But for most people, just standing for my patients, the trajectories of patients who can stand and get up from a toilet and stand and get to the couch is so much better. Being vertical requires postural muscle activity. So what I would say is walking and movement um are also cognitive uh protective. And you mentioned exercise now. So exercise and movement does a couple of things. One, it keeps those arteries open that we talked about. Uh as far as the food well number two what to eat pescatarian third and mind diet people can look all these terms up. Third when to eat intermitt and fasting for ketones and the cognitive benefits thinking benefits not structural. >> Fourth is exercises that it that this ecosystem requires nutrients not neurotransmitters that are being sprayed between neurons but but uh in the millu in the garden if you will. And there are things like growth factors. Obviously, BDNF is a popular one. I had a grant from the Department of Defense studying it. I'm familiar with it. What I want people to know is when you exercise, it's not like it's released from uh you know like your thigh muscle and swims up to your brain and says, "Hey, I'm helping you out now." that these chemicals are housed in the brain and exercise is the cue is the signal for your brace brain to release them on themselves. >> BDNF is released from the brain for the brain when you exercise. >> And I think that's I think that's powerful outside of the cardiac and weight loss. I'm just talking about a little bit of movement couple of times a week and all of a sudden it starts to feel like, hey, I can do these things. Yeah, >> they're pretty low bows to entry, >> but but high high impact and proven. >> And then the last one is you got to think, man. You got to challenge yourself. I mean, if you know Usain Bolt, you you know, you ask him how to run faster, say train, you train your biceps. I mean, it's it's a thinking flesh. If you don't if you don't push it to the next level of complexity and thought and challenge, not too hard where you quit, just like video games. If it's too hard to get to if to level up, we tap out. If it's too easy, we're not engaged. So, finding whatever you're engaged in from puzzles to complex conversations that it it it needs to be challenged um with thought, with ideas, with creativity, with reading those novels you're reading at night. >> So, the fresh content that's engaging and requires you to think uh think differently, um think wildly, think uh in ways you haven't before. I think that's an essential part of also that doesn't mean everybody who who was a professor lived longer did better than you know people were just rocking out not not not approaching it that way but creative ideiation I think is as valuable >> as just raw processing power it's not all about doing math and puzzles uh I think challenging yourself to be creative I is uh is an intelligence in itself >> what about the impact of stress on brain aging >> well I mean uh this is a this is a big question now. So this whole thing about cortisol is like okay um I don't have an answer for that. I I know people who live in a constant stress. It seems like ba constant stress is bad for you in a lot of ways. I also know thrill seekers uh surgeons athletes every time they do something exciting cortisol is up. Okay. um and they don't have accelerated brain in you know brain aging. So I don't have an answer for whether cortisol is doing it, whether stress is doing it, whether it's just a rough life, whether it's uh struggling with thoughts you can't control which revert back to your brain and injure your brain. I don't have an answer for that. But I think what the story I would tell you about that is there's a tumor called fio chromosytoma and it sits on top of the kidneys and it releases all this all these what basically look like you're extremely stressed out. Um >> and is that how it feels as well? That's the essential question, my man. They they don't come in like ah that is the essential question, my man. That's a banger. That's to So I don't have the answer, but I'm leaving you with things. I hope I want to know the answer, but the brain contextualizes all of this surge of stuff that's happening. >> Interesting. I I do you know Rick Hansen? You familiar with Rick? Neuro neuro uh science guy. He wrote hardwiring happiness. >> I read that and spoke to him. He became a good friend. And then the more neuroscientists that I speak to, the more I realize that a lot of the stories that we tell ourselves are kind of repurposing mechanistically what's happening in the mind. But the weird thing is >> nobody talks about the story you tell yourself about your knee injury, >> right? You know, someone someone snapped their ACL and it's not about thinking your ACL back into contact. We understand that there's a mechanism that's going on in here and that that really needs to be fixed and that there's a pretty wellestablished process that you go through in terms of rehab and it's progressive overload and tendons really love to be under time and detention. So, you're going to do this and you're going to get range back and there's a combination of stretching that you get with strength and the more range that you get the less you know all of this. It's mechanistically very well understood. But the thing is there is no massively phenomenological sense of having an ACL. There is one for everything that happens in the brain. And I really got into psychology, human nature, you know, Angela Duckworth or James Clears of the world, >> Morgan Hels, you know, a lot of people that write very astutely about human nature and about psychology and I go into evolutionary psychology, which is even maybe one step further removed, right? That's like the source code and that a lot of accusations of just those stories and things like that and that's really cool and compelling. The more that I spend time thinking about this stuff, the more I try and come back to mechanistically what's happening in the brain because it really does feel like for instance with gratitude from Rick's uh uh uh understanding here, he basically sees happiness as your ease of access to uh being grateful about what's going on. And he has a very simple process that is well understood and just reflects the mechanism of what goes on in the brain of have an experience, enrich it and absorb it. And it's just this little acronym that you go through. I thought that's so great. That feels to me one of the problems that a lot of people have when they read stuff to do with human nature and psychology is it feels so [ __ ] wishy-washy. You're like I I give me something to grab onto. It's like my puppy's example. But let me just jump in right there. Um, I like that. And what really just gets me jacked in a positive way is when I see that our behavior and our minds work in a way that's actually reflected at the neuronal level. >> Mhm. You know, so like if you stress stem cell reservoirs just enough, they'll make one of themselves and release a new neuron. So they're always replenishing them. They never they're inexhaustible in that way, right? They're stem cells. >> But if you stress them out too much, they'll go into scinessence or they'll die. >> And then you start to realize, wait, that's kind of how life is, right? And then you then I like to take it all the way to like International Space Station. and there's not enough gravity. Those bone cells uh in space in our thigh bone when they come back on on the ground, they got to rehab for a week or two. The lack of gravitational stress leads to withering of osteoccytes for astronauts. And so the same concepts in bone cells in space or stress in the human brain that there is a necessary amount of stress that leads to growth but >> if it's too much we fracture y >> if it's not enough we don't blossom and I and I and I like to take those concepts to then coping and so for example like this thing about resilience was tripping me up for a little while like what does that mean you know like be resilient like I I always try to think like I got to be able to say this to my sons. I got to be able to say to a newly diagnosed brain cancer patient. Y >> and and what I learned from that is um it's sort of their systemic and processive uh resilience which is basically like the resilience you bring to the fight, you know, the the strength you bring to the fight and then the process what the fight reveals in you. And and what I like about that is that each cell, each person, each human is in their own individual path >> and has accumulated a set of experiences. And my hope is universal coping skills and they're ready to engage the world in front of them. And that could be a lottery, that could be falling in love, that could be being diagnosed with cancer. and they're coming equipped with some skills uh and in that cyclical nature of stress and growth that happens repeatedly in our bodies like that's actually what's happening in our lives. There's a cycl cyclical nature of a springtime in our cells and our body, a winter in our cells and our body and life and that there is no like linear trajectory towards wellness or a moment of arrival or of of final clarity cuz you just don't know what the challenge or the gift in front of you is. Well, certainly one thing that I can say with almost absolute certainty is that you do not develop capacity to deal with things while you're dealing with things. >> Your capacity to deal with things is almost always developed in advance and revealed during. So, uh this one of the best justifications for mindfulness that mindfulness is preparing for the worst day of your life. That's what meditation is. Meditation is preparing for the worst day of your life. If it's the day that you lose your job and your dad passes away on the same morning, it's the day that your partner gets a cancer diagnosis and you find out that you're no longer employed or whatever it might be. If you're in the thick of it right now, I've been in the thick of it for a good bit of the last 18 months. You're doing your very best to not go under. Yeah. >> And then you're fight. And then when you get a break and it's really actually this is interesting. It's only difficult times that reveal to you, holy [ __ ] I couldn't really make much progress during that. I was just trying to survive. The urgent outweighed the important so much that all I could do was kind of try and hold it together. Okay. So, what's the implication of that? When you do not have something that's super urgent in front of you, when you're not putting out fires, it's a really, really, really good time to develop some more capacity. >> Psychological resolve. >> Yes. That's the time that you try to get your meditation habit in. That's the time that you work on your health. You refine you're training for the fight that has yet to come with a toolkit that I'm I'll never finally make, but I I mean, that's what I'm trying to get at. And back to the cells. Cells go through a period of dormcancy. >> Mh. And at that point, not dying is is actually the victory. And then there's a springtime just like in nature and this happens in our biology. And I think it happens in our psychology that you're talking about. And that those moments there's a temporal nature. Uh there's like reflection and going back and saying, "Okay, what are the lessons I learned? How would I handle it better forward?" I I love all that. I'm actually trying to come up with when you feel like you're dry drowning or about to fall apart in that short temporal window. Are are there things we can do at that time? Um how do we interject right then? >> Yeah, the time-sensitive maneuvers. >> Yeah, I like >> I very much like being able to step in on stuff that's acute. It's all well and good talking about building up your resilience and all the rest of it, but if you're in the [ __ ] fight, you go, "Hey, I can't go back six months ago and start a meditation practice. Tell me what to do right now." Right. And so what I would say is if uh you know the I would say is that uh urges that hijack the body are very fascinating to me. um when though when the thought is now recruits the body there's a whole new fight whether that's addiction whether that's desire >> because now there's a feeling that if I don't go in this harmful direction uh that I will feel ill so now you're not just trying to stop a thought let's take the example of having a cigarette again it's not just oh don't have a cigarette don't have a cigarette it could cause cancer down the road it's bad it's bad you promised everybody you wouldn't they might smell it on you whatever thinking, don't look at it. Look at those shiny boxes of the gas station, right? But then when you have that waft and it goes from the nerves in your old factory bulb to to your frontal lobe and now you're just like, "Oh man, that's reminds you of so much." People will have physiologic changes. So now the fight is controlling your mind and body and I believe the maneuvers are different when it goes from your mind to your body and the management of bodily urges um is uh requires bodily techniques. Uh breathing techniques are uh the same ones I use in surgery. Sometimes when I was learning and you feel like that around that corner that tumor is going to run away from you. I mean, you gota you you gotta not you gotta it's gonna either you're going to freak out or you're not going to freak out. And the simplest thing I can tell you is like when you hyperventilate it creates a feeling of anxiety. Well, you got to take it the other other way. The first maneuver is just control your breathing. Nobody knows. The room is just like d and you're just like whoa whoa whoa whoa whoa. You know this could this could run away from me. And so I have my own maneuver that I do in that moment is just stop talking, you know, uh or and there's something I call out. I say, "I need 15." And they're like, "Okay, everybody pay attention back to back to your positions that he might say, I need this from the wall. I need this from the wall." And the whole thing is just just get that get that breathing paced. I'm not talking about one nostril. I'm not getting into all that. I'm just trying to tell you physiologically if I pace my breathing I can slow down this swell of fear and panic that's in my guts when things run away from me. I try to use the same thing with with a lover and with a conflict, but that's a specific toolkit that has a physiologic basis that I can explain that the ancients use is is in the acute moment. And I'm hunting now, you know, the next year or so. But are there other maneuvers that uh >> that we're all equipped with that can work while you're um you know, while you feel like uh you're falling apart or you're drowning or you're struggling, you know, at that moment. Not in Riverview. Not in the future. I will. >> Right now. >> Right now, what do I do? >> Is there anything you've ever seen in surgery that shook your belief in science? >> Um, not in surgery. Um, surgery is a physical performance is ballet. But um I have had um I have had patients in the psychological sciences. I've had patients where I just look I'm like I don't know the the I don't know how the great majority of cancer patients get dressed come in and are ready to get the worst news of their lives every 3 months when we do the scans. It's come back or didn't go away. I mean, it's just it's just so heavy and the the what the fight brings out in them or the coping skills they've brought and it's inconsistent. I'll get to the the more philosophical question. It's inconsistent. Somebody comes in, they've got the wellness techniques, they're the CEO, they get hit with that C-word. It's you don't know what you're going to get. And then somebody comes in, they're struggling with something, they look disheveled. You're like, "This person's not going to handle this well." it brings out something in them. So I think this feeling that that arrival in some sort of wellness and achievement or clarity understanding of life is misguided because we don't know what's coming next. I think it's cyclical. Develop your skills time-sensitive skills in the review being prepared for being what what's forward. Uh that's the way I've been approaching it. And as far as shook my belief in science, uh I would say something recently has uh uh liberated my view in science that it it's through science we can have understanding that we might not. So there are these near-death experiences. Those electrodes are being recorded. People in uh Canada and studies starting to come out that when the heart stops for the first few minutes afterwards, the brain just deploys all its chemicals and electricity. So whereas other organs whimper to death like the brain is struggling the heart stops and then if you measure the electricity because you can actually have a DNR you can say look if I have a heart attack don't touch me do not resuscitate and they're still monitoring you still get a live feed of the brain electricity. So you would think the heart stops and the brain electricity stops but it goes for a minute or two afterwards and it's wild. >> It's fierce. It's not like Yeah. It's a So that's a measurement. What does it mean? That's for everybody to explo explore. But to me, that's like, okay, so there's there'll always be just amazing neuroscience information coming from hospitals and patients. That's a little bit more than just scanners, >> right? And when those people are resuscitated, and why do they all universally say, I saw it's a film strip of my old life. And you know there's a consistent pattern of what happens if you drown or if you have a near-death experience and are resuscitated in whichever manner they come back reporting the same thing film strip of their life wide stories they saw loved ones. And when you look at the electricity it's very consistent with dreaming and memories. So to me I love the fact that now we might be able to explain why near-death experiences are a consistent perception or or experience for for people. So, I love seeing that stuff come out. >> Yeah. I'm interested in what working with terminal patients has taught you about living life. Well, >> everything. Um, yeah. Everything. Um, you know, it's has thousands now. I mean, uh, I'm 52. Massive experience. I've got three adult sons. massive life experience. But since 25, I've been taking care of some of the sickest people in the hospital. Brain injury for 10 years. >> Half your life. >> Yeah. I was a kid when I started, you know. I mean, I look at I look at people in their 20s. I'm like, woo. Um I was like 26 or 27. I wrote about it for a Vice article. I withdrew care. I mean, I help families land their patients, I mean, their family members and remove the breathing tubes and say their last rights and wishes and all the different cultural elements that come into it in ICUs. I was 27 years old and I started to see uh there were patterns um in the ways uh the brain and mind respond when the finish line comes closer. It's not trauma. You're you're gone. You don't know it. It's okay. Three years, two to five, seven, you can't quantify it, but you know it's coming now. It's in it's in sight. And um they had a universal all of them say the same thing again when that finish line comes into view. And it's the lessons I think everybody else talks about, but they have a similar thing about reconciliation, forgiveness, about having spent more time with their children. Usually it was like busy busy dads at that time, my 20s, you know, and I and I incorporate that. I had a lab. I raised my kids. Didn't take them just to the baseball games, but the practices spent a lot of time to them. And that they seemed unencumbered. they weren't so the little things don't get to them as much. And the question then becomes how do we take those lessons without actually having you know if hypothetically the finish god willing is 25 years away from me how can I actually live it like it's 5 years from now and that's the lesson that my cancer patients have taught me is one um start now with what you would if you had you know that you do a 5year curves and two uh build your coping skills uh because the ones that I saw do Well, uh, they had techniques just I'm just coming coming back to this and like I learned one from one like every 3 months the scans let's just imagine brain scan 2 three hours 6 hours who knows what it's going to you show up in clinic it's another hour to wait to hear it for somebody and they so they would do this thing where like look the 11 weeks in between um I can I can hold on to myself and say this is not the time to be stress stressed, but I need to have a week when I'm just completely losing it. >> Like, you can't just not be stressed about that. But they were able to compartmentalize it to have like 11 good weeks and then another shitty week because, oh my god, I got another get a brain scan and see Dr. John De. And so I started to see those techniques they were using uh to make the most of their cancer journey. Support network is nice, but uh the support network can be surprising. It's not always who you think it is. you know, once that cancer word arrives, >> relationships break up, surprising relationships form. >> And so, um, you know, no triumph is forever and no tragedy is forever. But >> if you come equipped with your own personal and psychological toolkit, um, you know, we make the most of this run. >> Heck yeah. Dr. John, ladies and gentlemen, where should people go? You want to keep up to date with everything you've got going on? >> Just uh, I don't know. Just just, uh, you know, I'm I'm a surgeon at City of Oak Cancer Center. I think that's the easiest thing is look up Dr. John Dell at City of Hope and then you know things will pop up. But appreciate you having me on. >> I appreciate you too, man. >> Thank you very much for tuning in. If you enjoyed that episode, you will love this one with Mr. Naval Ravakan. It's first episode in six years. Come on, press