Suzanne O'Sullivan (on over diagnosis)

Suzanne O’Sullivan (The Age of Diagnosis: How Our Obsession with Medical Labels Is Making Us Sicker) is a neurologist, clinical neuropsychologist, and award-winning writer. Suzanne joins the Armchair Expert to discuss why epilepsy is a very neglected area of medicine, that we can change the quality of our movements and how our body feels by our scrutiny of them, and how contagious collapse phenomena are a dime a dozen. Suzanne and Dax talk about the scientifically nonsensical myth of the sonic weapon, the psychosomatic wave of TikTok tics, and the real difference between hypochondria and psychosomatic impairment. Suzanne explains the sophisticated miracle of Kazakhstan sleeping sickness, the increased prevalence of masking in conditions like autism, and the argument for the benefit of supporting people without medicalizing them. Follow Armchair Expert on the Wondery App or wherever you get your podcasts. Watch new content on YouTube or listen to Armchair Expert early and ad-free by joining Wondery+ in the Wondery App, Apple Podcasts, or Spotify. Start your free trial by visiting wondery.com/links/armchair-expert-with-dax-shepard/ http://www.wondery.com/links/armchair-expert-with-dax-shepard/ now. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Dax Shepard?

  Welcome, welcome, welcome to Armchair Expert Experts on Experts on Experts on Experts.

• 0:04Speaker 01

  Whoa, so many.

• 0:06Dax Shepard?

  I'm caught in a loop still because we just did a personality test that seemed to be loop, a loop.

• 0:11Speaker 01

  Yeah.

• 0:12Dax Shepard?

  I feel like we answered the same five questions.

• 0:14Speaker 01

  It's meant to throw you.

• 0:15Dax Shepard?

  Yeah, did a good job. Today, we have a guest on a fascinating topic that I think a lot of us talk about all

• 0:21Speaker 01

  Oh, yeah.

• 0:23Dax Shepard?

  Are we getting overdiagnosed? Are we medicalizing everything? Is everything a pathology?

• 0:29Speaker 01

  This episode was really interesting because we talk a lot about overdiagnosis, but also about kind of

• 0:34Dax Shepard?

  Psychosomatic?

• 0:35Speaker 01

  Psychosomatic contagions.

• 0:37Dax Shepard?

  Yes, yes, yes, yes, yes. This is across the board fascinating because she's here to talk about her new book. Well, first of all, Dr. Susan O'Sullivan, she's an award-winning writer and neurologist. And her new book, which we're going to talk about a lot, is The Age of Diagnoses. How Our Obsession With Medical Labels Is Making Us Sicker. But her previous few books are also fascinating. We get into those, and that's about psychosomatic illnesses and contagious illnesses. All of it is

• 1:05Speaker 01

  So I told a lot of people about this.

• 1:07Dax Shepard?

  Me too.

• 1:08Speaker 01

  So interesting.

• 1:09Dax Shepard?

  And so funny, too, because we just immediately contradict ourselves. And then we get another expert on and learn about a new

• 1:14Speaker 01

  Yeah.

• 1:14Dax Shepard?

  Pathology.

• 1:15Speaker 01

  It's good for us to have all the information.

• 1:17Dax Shepard?

  To hold two conflicting ideas in the head at one time is a sign of intelligence. Please enjoy our ever charming guest from Ireland, Dr. Suzanne O'Sullivan. We get support from Quince.

• 1:30Speaker 01

  Okay, can we talk about the fact that the holidays are already here? It's crazy. I feel like I blinked and now we're in gifting season, which I'm not really mad about because I do love giving gifts. And Quince is making it so easy to find something great for everyone on my list, including myself, because let's be honest, self-gifting is a love language.

• 1:49Dax Shepard?

  Quince is seriously the gift that keeps on giving. Their high-quality staples are made with premium materials like 100% Mongolian cashmere, 14-karat gold, and Italian leather. Full-on luxury quality at prices that won't wreck your holiday budget.

• 2:05Speaker 01

  It's the dream. The cashmere sweater, starting at $60, down jackets, wool Outerwear, cashmere accessories. You and everyone on your list are staying cozy and looking incredible all season long.

• 2:16Dax Shepard?

  Well, I'm gonna tell you this. It just got chilly for the first time this year in California and I'm so excited and I'm wearing my Quince cashmere right now.

• 2:23Speaker 01

  It's great.

• 2:24Dax Shepard?

  Yeah, and I am going to gift this to some of my friends. I hope they're not listening.

• 2:28Speaker 01

  Quince is also more than clothing. They've got fine jewelry for your significant other, leather bags for your bestie, hotel quality bedding to set up your guest rooms, chef-grade cookware. That's an amazing thing they offer here and it's such a good gift because people don't like buying cookware for themselves, but it's very important. And they also have five-star luggage, another good gift that people don't like buying for themselves.

• 2:51Dax Shepard?

  Give the gift of quality this holiday season. Download the Quince app for app-exclusive offers or go to quince.com. Get free shipping on your order and 365-day returns. Now available in Canada and the UK too. And when Quince asks where you heard about them, let them know it was Armchair Expert. It's the best way to support the show. This episode is brought to you by McDonald's. The Quarter Pounder with Cheese with Medium Fries and a Drink is now $8.

• 3:22Speaker 01

  What?

• 3:23Dax Shepard?

  Okay, I need to talk about something that doesn't get enough respect. The Quarter Pounder with Cheese. This is not a casual burger. This is a crafted burger. We're talking 100% fresh beef cooked right when you order it. No artificial flavors, no fillers, no preservatives, just beef doing what beef is supposed to do. And here's a detail I love. There's a cowbell sound in the kitchen. When somebody orders a Quarter Pounder with Cheese, a cowbell goes off and the grill master throws a fresh patty down. That's like having your own entrance music at McDonald's. I want a cowbell for everything in life. The onions are hand-topped by someone who just knows the right amount. Two slices of cheese laid out in a star pattern, so every single bite gets cheese and two pickles side by side, so you're never in a pickle desert.

• 4:07Dax Shepard?

  Every bite is accounted for. Someone engineered this thing with love. I love a Quarter Pounder.

• 4:13Speaker 01

  Me too. That's my order. It's a Quarter Pounder with Cheese. I love it. I didn't know they put so much. Effort that they did a star formation. I should have known because you can taste.

• 4:24Dax Shepard?

  You can taste it. Yeah. The love. Don't tell anyone this, but I'll put two of them back.

• 4:29Speaker 01

  Yeah.

• 4:29Dax Shepard?

  I'm sitting.

• 4:30Speaker 01

  I'm not surprised.

• 4:31Dax Shepard?

  The Quarter Pounder with cheese with fries and a drink. Now $8 for a limited time only, only at McDonald's. For a limited time only, prices and participation may vary. Prices may be higher in Hawaii, Alaska, and California and for delivery. Fresh beef not available in Alaska and Hawaii. Offer not valid for delivery.

• 5:05Dax Shepard?

  So you've been here since Friday. Did you do anything fun?

• 5:07Speaker 02

  I was the absolute ultimate tourist. Ooh. I did everything that you'd expect a tourist to do. First I did the Universal Studios tour.

• 5:14Dax Shepard?

  OK, great.

• 5:15Speaker 02

  I was very surprised. So because I'm only here for a brief period, I paid for like the most expensive tour. And it was six hours around the studios, what I thought. I didn't realize it was a theme park. I didn't know that.

• 5:26Dax Shepard?

  But you didn't even know? You thought you were just gonna see the sound stages and the lot.

• 5:30Speaker 02

  I did for six hours. And the very first thing that happened was they put me on the Harry Potter ride.

• 5:34Speaker 01

  Oh, yeah.

• 5:36Dax Shepard?

  How was that?

• 5:36Speaker 02

  The effects and everything are amazing, but it was just very disorientating when you were expecting something entirely different.

• 5:43Dax Shepard?

  Now, are you wearing green as a nod to your Irish heritage? Or you just always find yourself in green?

• 5:48Speaker 02

  I wear a lot of green, but I do identify very strongly as Irish. I mean, I'm from Ireland.

• 5:53Dax Shepard?

  You have the most Irish last name. You got a Sullivan and an Owen.

• 5:56Speaker 02

  Yeah, exactly. It's 100% Irish, but I've lived in England for a long time.

• 6:00Dax Shepard?

  Well, you've written maybe more, but I'm aware of three books. And I would love to just tap dance lightly through some of them before we get to the new book, because I do think there's definitely gonna be concepts in the new one that were laid out and built on the back of these other ones. And this is gonna get Monica so excited. I think we should first talk about, you're a neurologist. You have so far masters in creative writing, which is impressive. But you specialize in epilepsy.

• 6:28Speaker 02

  I have. Epilepsy. Oh, do you?

• 6:30Dax Shepard?

  Well, let's find out. Let's find out. The first book is All in Your Head: True Stories of Imaginary Illnesses. So let's just start with some actual data, which is your guesstimation, and you acknowledge it's an estimate. But of all the people that come in that have had seizures, a symptom of epilepsy, 30% of them are not epileptic.

• 6:52Speaker 02

  Correct.

• 6:52Dax Shepard?

  And then you found also that's largely true for cardiologists when people come in with chest pains. It's common for people with heart palpitations that about a third of people that are experiencing symptoms, often it doesn't align with the actual underlying disease.

• 7:09Speaker 02

  Yeah, so I run seizure clinics and most people who are referred to me, they've been having a variety of different kind of convulsions or other types of seizures. Usually they come to me with a pre-existing diagnosis of epilepsy. And in the best week or the best year, a fifth of those do not have epilepsy. The seizures they're having have a purely psychological cause. So their brains are shutting down for a purely psychological reason. And that's something that we as neurologists see all the time. That is so common. As I always explain to patients, our brains shut down in certain overwhelming situations all the time. You know, that sort of you're really overloaded with information. You're listening to the radio. You're trying to hear a sports result or a particular thing and you miss it like 10 times.

• 7:51Speaker 02

  And you keep rewinding and rewinding and rewinding and missing the same thing multiple times.

• 7:56Dax Shepard?

  Yeah.

• 7:56Speaker 02

  That's dissociation. That's what our brains do to protect us in moments of being overwhelmed. It's like everything in the body. Some people have too much hair, people have too little hair. Everything goes a bit wrong in some way. And this thing called dissociation, which is designed to just help us to control the overwhelming amount of information in our environments, sometimes goes wrong. And when it goes wrong, it can cause people to faint. It can cause people to collapse. It can cause people to have convulsions. And it's so common that this would be part of the bread and butter of a neurologist's job.

• 8:27Dax Shepard?

  How do you distinguish those seizures from epileptic seizures?

• 8:31Speaker 02

  For a neurologist who deals with seizures, it's phenomenally easy because they don't look anything alike and they don't behave in. The same way, I won't go into the small details, but epileptic seizures tend to be incredibly brief. They last a few seconds or a minute. They behave in a certain way, whereas these seizures that you get for psychological reasons tend to last for much longer and have a sort of different pattern of behavior. I think it's very difficult for a non-specialist doctor to tell the difference. But if you've heard people describing epileptic seizures enough times, you can tell the difference very easily.

• 9:04Dax Shepard?

  If we were to observe the brain with an FMRI, maybe it's already been done, do we see any difference in how it plays out electrically?

• 9:13Speaker 02

  Absolutely. First of all, if you do a brainwave test where you just put the stickers on the head where you're measuring the brainwaves, an epileptic seizure is caused by a burst of unwanted electrical activity. You will see that electrical burst when the person has a seizure. If you do an EEG in someone having these psychosomatic seizures called dissociative seizures, even when they're unconscious and completely unresponsive, you see a normal waking brainwave

• 9:37Dax Shepard?

  pattern. So the brain's very busy in some quadrant.

• 9:40Speaker 02

  It looks awake, but for some reason, people are not able to access that awake part of the brain.

• 9:46Dax Shepard?

  So they're like maximum disassociated in a sense?

• 9:49Speaker 02

  Absolutely. If you looked at the brainwaves of someone in one of those seizures, they look normal.

• 9:52Dax Shepard?

  Wow.

• 9:53Speaker 02

  If you look at the brain in a different way, so you mentioned FMRI, so that's where you look at blood flow activity in the brain. If you look at that, you will see slightly different patterns of activation in people having these seizures to otherwise healthy people, because you will see increased connectivity, say, between the emotional parts of the brain and the motor parts of the brain. So something is going on that shouldn't be, but it's not necessarily a brain disease per se, but rather this emotional part of the brain is connecting in some way to the motor part of the brain to produce these symptoms in a way that it shouldn't.

• 10:25Dax Shepard?

  So you're seeing 30% of the people come in, or 20% on a great year, where these are psychosomatic. And I think we have a paradigm, which is very dismissive of psychosomatic, in the same way that people are dismissive of placebo effect. People have this association that placebo effect is not real. Of course, it's real. It doesn't have the causality we thought it had. So do you think that by writing a book about psychosomatic disorders, You ran the risk or you would be afraid people were thinking you're dismissing them as opposed to, I like what you say, which is the symptoms are the symptoms. They're the same. Why do we have compassion for one cause of the symptoms and not the other?

• 11:07Speaker 02

  The purpose of writing the book was very often this something affects really young people. And I was seeing these young people who are having hundreds of seizures every week. And I would explain to them what was wrong with them. And it was like I was reinventing the wheel or something. I am seeing it every day, but they can't even believe that such a thing exists in the world.

• 11:26Dax Shepard?

  Do you feel like they felt invalidated by that?

• 11:28Speaker 02

  Absolutely. Well, I always say to people, imagine your next door neighbor's in a wheelchair. You understand that they've got multiple sclerosis or motor neuron disease. And obviously you've got a huge amount of sympathy for that and support for that. And then next week, someone tells you, well, actually their nervous system is normal. This has a purely psychological cause. Even the most caring and understanding a person, there's something in us that kind of says, oh.

• 11:52Dax Shepard?

  None of us like feeling bad. It's an emotion that's uncomfortable. So if we can say it's your fault, I think it relieves us of that responsibility to be compassionate and understanding. It's like, well, they're choosing to be this way. Or it's their fault.

• 12:08Speaker 01

  I think a lot of it's like they need attention.

• 12:10Speaker 02

  I think that's where the problem arises is that people think that they need attention. Even though you can tell people it's not consciously generated, people secretly think that people are doing it on purpose and that they're doing it for attention.

• 12:24Speaker 01

  And they know they're doing it.

• 12:25Speaker 02

  And they could stop doing it if they wanted to. And again, I say to my patients, so many analogies in life for this. Imagine something terribly frightening has just happened to you. Your heart rate goes up to 120 beats per minute. It's really happening. You're not doing it on purpose. If I told you, snap out of it, slow your heart down, you wouldn't be able to do it. So it's the same with these sort of seizures. When my heart races because I'm frightened, it's not because I have a heart disease, but neither am I doing it on purpose and neither could I stop it.

• 12:51Dax Shepard?

  And it has a self perpetuating physiology, right? Which is once my heart rate is so high, I'm actually going to be in my amygdala whether I want to or not. I can't bring on my frontal cortex, really.

• 13:03Speaker 02

  How these things get worse. It happens once and then the next time you face a similar situation, you become really focused on your body and thinking, I hope that awful thing that happened to me before doesn't happen again. And it's all feeding back into itself. So I think that's another thing that people misunderstand is they think that psychosomatic conditions are less serious than others. In fact, they can be in many ways more serious. Say a fairly average patient with epilepsy, this is a huge range of differences, but let's say they might have a seizure every month if they're quite bad, or once a year if things aren't so bad, or once every 10 years if they're pretty good. A person with non-epileptic or dissociative seizures can have a hundred a day. And yet, because they have a psychological origin, we're kind of think that's less serious.

• 13:48Dax Shepard?

  You can't put the latter patient on Kepra or a medicine that would help them.

• 13:54Speaker 02

  It will work. It may work as a placebo. Yeah, so often I will find stumbling block for them is someone has told them it's epilepsy. They go on the epilepsy drug and the seizures stop for three months, say. But the epilepsy drugs won't solve the problem if it's not epilepsy. So then generally the seizures will come back.

• 14:10Speaker 01

  Okay, you want me to, should we?

• 14:12Dax Shepard?

  Yeah, absolutely, yeah. Dad, honest with you, I don't think one thing or another. I do think both sides should be explored as passionately.

• 14:19Speaker 01

  I agree. Okay, so you can tell me.

• 14:21Speaker 02

  First of all, I'm very unlikely to tell you because I would have to ask so many deep personal questions that I wouldn't ask.

• 14:27Speaker 01

  But we do that. That's what we do here.

• 14:30Dax Shepard?

  We're not going to force you to try to diagnose one of us. We know that's unethical.

• 14:33Speaker 01

  You don't have to diagnose, but I had a seizure nocturnal. I woke up, I was sleeping by myself. I didn't know, but I was like, I feel crazy. I'd peed in the bed.

• 14:42Dax Shepard?

  You had a lot of muscle sore.

• 14:44Speaker 01

  Really bad muscle soreness. I thought maybe I had a kidney issue. So I went to the doctor. They took a urine test and they're like, nothing's wrong with your kidneys. We don't know what it is. They gave me a steroid shot for the muscle pain. That was that.

• 14:57Speaker 02

  I'm just gonna stop you there. So the bottom line was, you woke up, you'd wet the bed, and you had aches and pains. Did you suspect a seizure then?

• 15:04Speaker 01

  No, I was very disoriented.

• 15:06Dax Shepard?

  That was chalked up to a mystery for a year.

• 15:09Speaker 01

  Exactly. A year goes by, and then I'm on vacation with girlfriends, and I have another seizure in sleep again. And they're there. So they see what happened. Then I go to the hospital. They do an MRI, it's all fine. And then when I got back home. I saw a neurologist, he looked at the scans and he said, based on the fact that they were a year apart, they were at night, uh, it's epilepsy. And I've been on Keppra ever since. So that was in 2020. So I've been on it for five years. I haven't had one.

• 15:43Speaker 02

  That's epilepsy, yeah.

• 15:44Speaker 01

  Okay.

• 15:45Speaker 02

  Yeah, there's no doubt in my mind.

• 15:47Dax Shepard?

  That's nice, right?

• 15:48Speaker 01

  I always knew it.

• 15:50Dax Shepard?

  Oh, yeah, yeah. Again, I didn't not know it.

• 15:53Speaker 02

  The bad question is, why did you doubt it?

• 15:54Speaker 01

  I am a hypochondriac. I feel fair to say that.

• 15:57Dax Shepard?

  Yeah, I wouldn't say that aloud, but yeah, I think she has a bit of hypochondria. I didn't doubt it. I just am curious.

• 16:04Speaker 01

  Well, now that we know that it could maybe not be.

• 16:07Speaker 02

  No, that's fairly typical of how epilepsy behaves and seizures and sleep. But I think the important thing is that this is the conversation I would like people to have. Because very often the conversations I'm having with patients are, they're saying, but it must be epilepsy, but it must be epilepsy, because it feels so impossible to them that the brain could do this without a disease. And what I would love, you know, it's much like if you're deciding, does someone have migraine? Or do they have something else? You just have a conversation about, it could be this, it could be this. And people are fine with the alternatives. But most of the conversations I have are, people are almost begging to have epilepsy because they know how stigmatized the alternative is. So this is exactly what I would like to see happening, is you've got two possibilities

• 16:49Speaker 02

  and both are equally respected, so that either can be considered.

• 16:54Dax Shepard?

  Right. There's no shame in one of the diagnoses.

• 16:57Speaker 02

  Exactly.

• 16:57Speaker 01

  Yeah.

• 16:58Dax Shepard?

  So, well, I guess what I'm curious about is, do we understand the mechanisms that can create symptoms psychosomatically? Talk about Matthew, maybe from the book?

• 17:09Speaker 02

  We don't fully understand. Now, when I was studying training as a neurologist, so let's say in the 1990s, we didn't have a clue about this stuff, but we are beginning to develop theories, but they are only theories. But an awful lot of it really is around the concept of what we call predictive coding. So how your brain processes information. It isn't absorbing information as if we were video recorders or something. Our bodies behave as we expected to behave. In the case of Matthew, I'm going back a bit now with remembering the

• 17:38Dax Shepard?

  2015, I'm asking you to go back a decade.

• 17:40Speaker 02

  Yeah, I can hardly remember what I had for my breakfast, apart from that. So Matthew had some tingling, I think, in his legs. I've forgotten exactly how it started, but it started with some disturbed sensation in his legs. And then he was reassured by his doctor, who didn't find anything wrong with him. But he wasn't really reassured and he felt that he had a more serious problem than that. That tingling in his legs then progressed into a feeling that he wasn't coordinating or using his legs correctly. And that then progressed further until he got to the point where he wasn't able to walk and he was completely wheelchair bound. Now, as a neurologist, when you examine someone who cannot move their legs at all, there is a big distinction between what you find when you examine someone who's got,

• 18:21Speaker 02

  say, a spinal cord disease or brain disease and something psychosomatic, because the nervous system is arranged in a very complex way. And when you can't move your legs because you've got a brain disease, it looks one way. If it's a spinal disease, it looks another way. So when I saw Matthew, it was very obvious to me, his reflexes were normal, lots of things were normal, and yet he couldn't move his legs.

• 18:42Dax Shepard?

  And MS specifically, if I remember right, the myelin sheath is eroding around the nerves is the issue. So can we observe the myelin sheath?

• 18:49Speaker 02

  First of all, you can tell from the history how multiple sclerosis behaves, its flitting symptoms that move around the body. And then, basically, you would be able to see certain signs in the legs, such as a particular kind of spasticity or stiffness in the muscles, reflexes that are very brisk, patterns of sensory loss that fit with the brain. And then when you do brain imaging, MRI, you can kind of see the result of the loss of myelin rather than the loss of myelin itself. In Matthew, none of these kind of abnormal signs, when you examined him, apart from not being able to move his legs, everything was normal and brain imaging, et cetera, was all normal. It was very obvious that this had a psychological cause. So the question Matthew would have for me is, how could I not be able to move my legs?

• 19:34Speaker 02

  You're telling me my nervous system is healthy. Why can't I move my legs?

• 19:37Dax Shepard?

  Oh, it must be another layer of anguish on top of everything else.

• 19:42Speaker 02

  Well, I think it's very unbelievable for people.

• 19:44Dax Shepard?

  Yeah.

• 19:45Speaker 02

  There are kind of, again, analogies for this in life. If you think about Your foot or your feet for even a moment, they feel different than if you're not thinking about them. Because our bodies are awash with all of these sensations at all times that we could feel if we paid attention to them. But because our brains can only handle so much information, we just eradicate that white noise. So we can pay attention to the conversation we're having or important things in the room. So first of all, it takes very, very little for your body to feel different. All you have to do is pay attention to it and you will notice stuff.

• 20:19Dax Shepard?

  It's like when you start thinking about your heartbeat. You can almost immediately give yourself a palpitation just by considering it.

• 20:24Speaker 01

  If you're starting to have a panic attack, if you start thinking about having a, it gets so exacerbated.

• 20:28Speaker 02

  Because these things are supposed to be automatic. You've been learning them your whole life. But Matthew became aware there was something wrong with his feet. So the minute he pays attention to his feet, they feel strange. And then what does that do? It makes him pay even more attention to his feet. It becomes a kind of a looping thing that gets out of control. So that's how you change the sensation in your body. But then think about motor activity. So I always give examples like sports people. So only some sports people can take penalty tries. You might be brilliant at something when no one's looking at you, but the scrutiny of the crowd completely affects your ability to coordinate your muscles. Or I give examples like walking on a cliff path somewhere.

• 21:09Speaker 02

  Any other day you just walk, you don't think about it. But if you're walking somewhere where there's jeopardy.

• 21:14Dax Shepard?

  If someone's asked you to walk along a six inch line on the ground, you could do that to eternity and never miss a step.

• 21:21Speaker 02

  Exactly. We can change the quality of both our movements and how our body feels by the scrutiny that we pay to our bodies. Very often these things happen because we are paying so much attention to the body. And then we expect the body to behave in a certain way and therefore it does. So it's not actually that unusual for people to have problems a little bit like Matthew's. That's an extreme example, but for a neurologist dealing with these kind of issues, it's also a common example.

• 21:46Dax Shepard?

  A depressing side of this is that in the folks you work with, 30% of which are having psychosomatic seizures, only 30% of those people will have success.

• 21:58Dax Shepard?

  Treating it with CBT, which is our best option currently.

• 22:02Speaker 02

  If you talk about dissociative seizures, people think, oh, that's less serious than epilepsy. Seventy percent of people with epilepsy will become completely free on medication, but only thirty percent of people with dissociative seizures will get better. It is phenomenally hard to make people with these problems completely better. And I think a little bit of that is because it's been such a neglected area of medicine. There are great scientists working on it now, but during my training period, there was nobody.

• 22:29Dax Shepard?

  As soon as the doctor has decided it's in their head, they're kind of off their plate. Go see someone else. I only know how to prescribe you these medicines or send you to this physical therapist. There's no tools on the table for a doctor.

• 22:42Speaker 02

  Exactly. As a neurologist, so I've told you how often I see this kind of seizures, but I'm in no way trained to treat them. If it's such a big part of my day job, I should be better trained to treat them. But there would be a real expectation for many neurologists that if you see someone and you rule out a brain disease, then it's sort of like, that's fine. Then you can discharge that person. And that's a big part of the reason why I became interested in it. Because I was a young woman and a lot of the patients were young women my age. I was finding myself in a position of potentially sending people home, having lots of seizures.

• 23:16Dax Shepard?

  Is it gendered?

• 23:17Speaker 02

  It is more common in women. So about two thirds of the patients who develop psychosomatic conditions, seizures in particular, are women.

• 23:24Dax Shepard?

  So the part I still would love to know the mechanics of is if I wanted with all my might to give myself a seizure, I don't think I could replicate the level of seizure you're seeing. What happens in the brain? Do we know?

• 23:38Speaker 02

  I don't think we really understand it. We can liken it to things in daily life, but do we really know how that is possible? Well, I don't know is the answer to that question. I mean, with regards to some of these things, we talk about how predictive coding. So predictive coding is how we process information. So if I show you this object, you've never seen it before, and I tell you what it is, then you recognize it, but the next time you see this, you will be able to manipulate it in your brain. So the next time you see it from this angle, you don't have to have learned. What this looks like from this angle in order to recognize it. So our brains aren't just.

• 24:15Dax Shepard?

  They're modeling machines.

• 24:16Speaker 02

  Exactly, and they're manipulating everything that comes in to try and make sense of it. We're making sense of the world according to our experience. So this kind of prediction machine that is the brain is making a best guess at what the body should do in this situation and how the world should look in this situation. And you know what? It makes mistakes. That's the bottom line. And these are some sort of mistakes that come out of these faulty predictions or prediction errors.

• 24:41Speaker 01

  I mean, has anti-anxiety pharmaceuticals ever tried for this?

• 24:46Speaker 02

  Other than in a placebo way, medication doesn't really work for this. What can often work is much simpler than that. This probably will shock you a little bit, but I have seen patients who are having a hundred seizures a day and one conversation in which you explain what is happening will stop the seizures there dead and on the spot.

• 25:05Speaker 01

  Oh, wow.

• 25:06Speaker 02

  Because what you've done then is you've broken the pattern of the expectation. Actually, the one thing that can make these better very quickly for some people, as long as they haven't been there for that long, is just for them to understand what's happening, to be less frightened of it and then distract themselves. Because often it's a kind of a snowball. So you feel the dizziness and then you think, oh, what comes after the dizziness? I don't mean this in a conscious way, unconsciously. So I just say to patients, you feel the dizziness. So next time you feel the dizziness, look for everything in the room that is green or list all your favorite football teams. Just do something that breaks the pattern.

• 25:41Dax Shepard?

  OK, so the third book, The Sleeping Beauties and Other Stories of Mystery Illness, you have a story in there about contagious seizures in schoolgirls in Colombia.

• 25:51Speaker 02

  Yeah. This is a story that could have begun anywhere in the world, actually, but it happens to be set in Colombia. So I visited this little town in Colombia, beautiful town near Cartagena, about 2012, in a school in Colombia. It was a very hot classroom. The windows were closed. It was overcrowded. A girl collapsed. We presume she fainted. And following that, multiple people in the class collapsed all over the school. They heard the commotion coming from this class. So suddenly, you know, everyone's rushing out into the corridors. You can imagine what a heightened situation this was. In that single day, in that one classroom, there were multiple people fainting, collapsing, having convulsions, rushed to the hospital. Those stories are a dime a dozen.

• 26:36Speaker 02

  You will find similar examples to that exact story happening in the US, happening in England, on a semi-regular basis throughout the world. Usually, that stops very quickly. So it's a very frightening situation. What's likely happened is that one person has fainted and then other people have sort of collapses in sympathy, really, with that person, sudden emotional overwrought situation.

• 26:58Dax Shepard?

  Well, if you were uncomfortable with the heat and the lack of air, and then you witness it take someone else out, now a new reality is on the table, which is, I might pass out from this.

• 27:09Speaker 02

  Other people may simply have fainted also. Young people who have low blood pressure, especially girls, because they have lower blood pressure, sudden fright, your blood pressure drops, you faint. So probably the first person fainted, maybe the second person fainted. Eventually, it was more of an emotional contagion, more likely. We call that poison.

• 27:26Dax Shepard?

  Well, it was correlation, not causation.

• 27:28Speaker 02

  Exactly. And then that rumor then spread around the town. I spoke to some of them who had even recovered completely. You know how you make these things better is you're positive. So I'm saying to these young women, you look great, you're better, isn't that wonderful? And they would say, but I know the poison is still inside me, this sort of attitude. And there was a real malign influence moved to the town. There are anti-vax people, and if they get a whiff of somewhere where they can recruit new members to the anti-vax movement, people from all over the world heard of these seizures and went to the town and stoked the fear. So something which should have been gone in 24 hours, it was still ongoing years later.

• 28:06Dax Shepard?

  Wow, because it became weaponized by the anti-vax movement.

• 28:10Speaker 02

  Absolutely. And these poor girls, they were so terrified. Let's say you've got some doctor from Germany, America, wherever, coming into your town and saying you've been poisoned, and you come from this kind of deprived area in Colombia, who are you to believe? Also, you're in a country where perhaps you trust this outsider more than you trust your local government. I'll give you another one, which is. The belief in the sonic weapon. Somebody who is clearly intelligent and educated and works for a embassy in Cuba hears a noise in the middle of the night and develops symptoms with hearing loss and dizziness and ringing in the ears and believes that they have been targeted by some sort of weapon, which was actually perfectly reasonable in some regards because the embassy had been closed in Cuba for a long time and these sort of things do happen.

• 28:55Dax Shepard?

  And they were a Russian proxy.

• 28:57Speaker 02

  Exactly. I think the sort of Russian spies, I don't have the terminology for all of this stuff, but they do have a reputation for going into people's houses, moving things around to mess with people's heads and so forth. Though, I mean, it was perfectly reasonable for this person to think that something had happened to them. The difficulty again was the idea that there was such a thing as a sonic weapon took off within the embassy community. It's exactly where these mass psychogenic illnesses happen, in these contained communities, potentially under threat, that are quite insular. So people really began to believe in this concept that there could be a sonic weapon that were being directed at individuals. The problem is that scientifically it makes no sense because sound doesn't damage the brain in that way. You know, if you've got a big explosion that's big enough for everyone

• 29:41Speaker 02

  to hear it and to displace your whole body, well then, sure, your brain could be damaged and so could the rest of your body. But sound cannot be directed at a brain to damage it. Sound just travels along nerves into the brain. So scientifically, it made zero sense whatsoever, but unfortunately, people really bought into it.

• 29:59Dax Shepard?

  Sixty Minutes even did a segment on it and I was very disappointed. I love Sixty Minutes. My bigger issue was, and this is disrespectful to the people suffering from whatever it is they're suffering from, but I was like, okay, so Russia has this crazy weapon and they deployed it on you. Not to be mean, but truly, if we made a hierarchy of who would be most advantageous for them to cripple, we wouldn't start with the ambassador in Cuba. It just also was illogical in the motivation.

• 30:24Speaker 02

  The whole thing was so illogical. You've got to feel for these people's position because I think Marco Rubio was saying things about this weapon. They were being called in and they were being told by the highest forces in their country to hide behind walls and to be frightened.

• 30:37Dax Shepard?

  They're trying to retrofit embassies. Yeah, it really took off. What is the Tourette's like syndrome that was spreading through New York high schools? Do you know about that?

• 30:45Speaker 01

  I've heard this.

• 30:45Dax Shepard?

  You've heard about this?

• 30:46Speaker 01

  Yeah.

• 30:46Dax Shepard?

  Oh, I know nothing about this.

• 30:47Speaker 02

  These are the TikTok tics essentially. So there were a few quite active people on TikTok who were demonstrating their Tourette's syndrome. It led essentially to an outbreak of not exactly Tourette's, but Tourette's like syndrome throughout the world. So young people began presenting to doctors with Tourette's like symptoms. But they obviously didn't have Tourette's because often these psychosomatic conditions, they are your idea of what a seizure would be like, or they are your idea of what Tourette's syndrome is like more than they are like the actual thing. That swept the world, but the problem with these things is that most people will be fine because most people, this will be a passing thing. It'll happen to them and it'll disappear.

• 31:28Speaker 02

  But vulnerable people will go to doctors and have tests and this can all get very out of control. So for a small number of people, it's probably been a persistent problem.

• 31:38Dax Shepard?

  And we didn't delineate, but I want to now because I'm now remembering, even Monica, so you draw a very hard distinction between a hypochondriac and someone with a psychosomatic condition. A hypochondriac is worrying about getting things, but they don't have the symptoms. And a psychosomatic person has got a big plate of symptoms.

• 31:57Speaker 01

  I wonder if, because I often say this, I'm like, yes, I'm a hypochondriac. It's not like I'm like, ah.

• 32:02Dax Shepard?

  You're a lazy hypochondriac.

• 32:04Speaker 01

  I gotta go to the doctor and get tests. Don't you think a real hypochondriac?

• 32:08Dax Shepard?

  Is in the doctor all the time?

• 32:09Speaker 01

  Yeah.

• 32:10Dax Shepard?

  That's a good question.

• 32:11Speaker 02

  Again, that's coming back to my current theme of overdiagnosis, which is when does worrying about your health become hypochondria?

• 32:16Speaker 01

  Exactly.

• 32:17Speaker 02

  It's when it stops you living a normal life and it disables you. So it's perfectly okay to worry about your health and to be a person who thinks, what's that, what's that? We all have a different kind of personalities and we all have different foibles and so forth. If it isn't disabling you, I wouldn't call it hypochondria.

• 32:34Speaker 01

  Oh, I love this.

• 32:36Dax Shepard?

  This is a very validating, yeah. You're getting a clean bill of health from this whole thing.

• 32:41Speaker 01

  Okay, that makes sense. No real consequences.

• 32:43Speaker 02

  That's precisely the thing, isn't it? We're really into using medical words to describe our personalities.

• 32:50Speaker 02

  In the way we feel now, it's a trend. And then, once you start using the medical words, then suddenly you find yourself potentially being diagnosed with something. Right. But the line in the sand has got to be disability and impairment. And that's something I think people need to think about when they're kind of using medical terms in a casual way.

• 33:08Dax Shepard?

  Yeah. Great. So that's next. Before we get to the new book, I just want to know about the sleeping sickness in Kazakhstan. What was that?

• 33:15Speaker 02

  This little town in Kazakhstan called Krasnogorsk. It's literally in the middle of nowhere, really hard place to get to. In, again, about 2012, 2010, a woman working in the market there, she couldn't be woken up. They noticed that she appeared to be asleep or unconscious. Her name was Lyubov. The other people in the market tried to wake her up. They couldn't. They took her to the hospital. Nobody could understand what it was. Although it was a small town, it had good healthcare facilities. So they did all the usual kind of scans and stuff and everything was fine. They said, maybe you've had a stroke, which, to be honest, wasn't a great diagnosis because stroke wouldn't really present like that.

• 33:50Dax Shepard?

  This is now she has woken up?

• 33:52Speaker 02

  Yeah, she's woken up. They say, you probably had a stroke. You go home.

• 33:55Dax Shepard?

  No sweat. You had a stroke. Go home.

• 33:57Speaker 02

  Exactly. That's what they do. I should have applied. They had done as much as they could do.

• 34:03Speaker 03

  Stay tuned for more Armchair Expert, if you dare.

• 34:09Dax Shepard?

  We are supported by Squarespace. So here's something I think about a lot. Most people I talk to on this show, the ones doing really interesting things, they all had a version of their work that existed before anyone else saw it. It was just theirs, notes, ideas, projects they were tinkering with. And then, at some point, they made the decision to share it. That's the part that's scary, right? Going from, I'm working on something, to, here's what I made. Rob went through the exact same thing, building our site on Squarespace. And what made it doable was that he didn't have to become a web developer overnight. He just had to show up with the idea. Squarespace handles the rest. Beautiful templates that actually look like you hired someone, built in SEO so people can find you, email campaigns, scheduling, analytics, all under one roof. No code, no patchwork of random tools.

• 34:54Dax Shepard?

  And honestly, the thing I keep coming back to is how low the barrier is. If you've got something you've been building quietly and you're ready for people to see it, Squarespace makes that leap feel a lot less traumatic. Head to Squarespace.com/dax for a free trial. And when you're ready to launch, use offer code DAX to save 10% off your first purchase of a website or domain. We get support from our sponsor Lilly. For adults with obesity or with excess weight and weight-related medical problems, it's time to find out about Foundo or for Gleepran. Foundo is a once-daily prescription GLP-1 medicine used with a reduced calorie diet and increased physical activity to help adults with obesity or some adults with overweight

• 35:36Dax Shepard?

  who also have weight-related medical problems to lose excess body weight and keep the weight off.

• 35:41Speaker 04

  Foundo should not be used with other GLP-1 receptor agonist medicines. It is not known if Foundo is safe and effective for use in children. Don't take Foundo if you're allergic to it or if you or someone in your family had medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2. Stop and call your doctor right away if you have an allergic reaction, a lump or swelling in your neck, or severe stomach pain. Serious side effects may include inflamed pancreas and gallbladder problems. Tell your doctor if you experience vision changes, if you're nursing, pregnant, plant to be, or taking birth control pills, and before scheduled procedures with anesthesia. Taking Foundo with an insulin or sulfonylurea may cause low blood sugar. Side effects include diarrhea, nausea, and vomiting, which can cause dehydration and may cause kidney problems.

• 36:21Speaker 04

  Once-daily Foundo is available by prescription only in 0.8mg, 2.5mg, 5.5mg, 9mg, 14.5mg, and 17.2mg tablets. Learn more at foundo.lilly.com or call 1-800-LILY-RX. Now is perfect to talk to your doctor about Foundo.

• 36:39Dax Shepard?

  This episode is supported by Helix.

• 36:42Speaker 01

  Okay, can we talk about how November is basically survival mode between the holidays, the travel, the hosting, the cooking, the everything? Sleep is the one thing keeping me from completely unraveling.

• 36:53Dax Shepard?

  It really is the foundation, and I think people underestimate how much a bad mattress is quietly ruining their day. You wake up stiff, your back's angry, you're already behind before your feet hit the floor.

• 37:04Speaker 01

  That was me before Helix. I took their sleep quiz, which is so fast, it took me like two minutes, and they matched me to a mattress that actually fits how I sleep. Not a guess, not a firm or soft coin flip, it's a real match. I have a midnight mattress, and I really like it. I was noticing it because I actually had to sleep in one of my other beds recently that doesn't have a Helix mattress on it, and I really couldn't. Could tell a big difference in my sleep.

• 37:26Dax Shepard?

  Temperature was all over the map.

• 37:28Speaker 01

  It was a mess. I need a new one.

• 37:30Dax Shepard?

  Look, they've got over 20 mattress models. So whether you sleep hot, need extra back support, or you've got a partner who moves around all night, there's one built for you. Plus free shipping and a 365 night happy with Helix guarantee. That's a full year to decide.

• 37:44Speaker 01

  Helix has been named the most awarded mattress by Forbes, Wired, and more. So it's not just us being enthusiastic. The experts agree.

• 37:51Dax Shepard?

  Right now, Helix is running their Black Friday sale with up to 30% off. Go to helixsleep.com/armchair for up to 30% off your Helix mattress. That's helixsleep.com/armchair for up to 30% off your Helix mattress. Helixsleep.com/armchair. We get support from ZipRecruiter. Oh, get recruiting. So I went down this rabbit hole the other day on real holiday jobs that exist and I couldn't stop. Somebody out there is hiring a ham glazer, a professional ham glazer. Another place is hiring a lead elf, implying a whole hierarchy of elves I had never even considered. Here's the thing, these jobs need real skills. People like that are hard to find.

• 38:35Dax Shepard?

  And whether you're hiring for one of these roles or any other role, the best way to find qualified people who are genuinely excited about your role is on ZipRecruiter. And right now you can try it for free at ziprecruiter.com/dax. Plus ZipRecruiter has a new feature that shows you the most interested qualified candidates first. So you meet the right people faster. No wonder ZipRecruiter is the number one rated hiring site based on G2. Let ZipRecruiter find the right people for your roles, seasonal or otherwise. Try it for free today at ziprecruiter.com/dax. At ziprecruiter.com/dax, meet your match on ZipRecruiter.

• 39:23Speaker 01

  What they really don't want to say is, "We don't know." I think a lot of doctors don't want to say that.

• 39:28Speaker 02

  See, I'm not sure that's what they don't want to say.

• 39:30Speaker 01

  Oh.

• 39:30Speaker 02

  I think that saying, "You don't know," when you don't know, isn't that hard. So if someone comes to you and says, "I've got a pain in my toe," and you don't know, there's not really any recriminations from saying, "You know, I'm sorry. I've looked at everything I can. I don't know what that is." Patients don't get angry at that. I think the thing people don't want to say is what they think they do know, which is that perhaps it has a psychosomatic cause.

• 39:53Dax Shepard?

  But this is in your head.

• 39:54Speaker 02

  A lot easier to say, "You don't know," than to say that.

• 39:57Speaker 01

  Yeah.

• 39:57Speaker 02

  So I don't know what her doctors actually thought, but they said possibly a stroke. They did do lots of tests. It was a bit casual in saying they sent her away, but they did care for her. But shortly after, the nurse were affected. And as it spread, the symptoms changed. And that's kind of what happens with these things. They spread from older people to children. And when it went to children, they started having different symptoms, like hallucinations and things.

• 40:20Dax Shepard?

  Oh, my goodness.

• 40:20Speaker 02

  I mean, this town, I read about this in the newspaper, and you should have seen the pictures of this town. Imagine the most depressing town in the middle of the Kazakhstani steppe, sort of dilapidated buildings. And all of the people were pictured beside rusty swing sets.

• 40:34Dax Shepard?

  Yeah, yeah, yeah, yeah. I have an exact image of what the scene is.

• 40:38Speaker 02

  Adominably depressing. When the sleeping sickness happened, it was a big mystery for the country. The government did loads of investigations. They sent engineers and people to the town. It was a uranium mining town. So they thought maybe a toxin was coming from the uranium mine and really went into overdrive investigating this. But also, loads of foreign journalists came. So this town went from being a town of 300 people to being a town that was kind of awake with activity of all these people visiting it. So when I read about it, I just thought, "Well, I would fall asleep in that town. It looks terrible." I sort of assumed that this happened because it was such a depressing place to live.

• 41:14Dax Shepard?

  I want someone to do work on this, and maybe they already have, but someone in the social sciences needs to think about the impact of... Forty years ago, you could be in this Kazakhstan town. And you wouldn't really know it was that bleak. The only swing sets you had seen were rusty. Maybe you saw some movies from the West. I wonder what the impact of being aware of what everyone else is living like on planet Earth with the internet, where so many symptoms might be a result of that. It's like, what are we doing here? And this is miserable and I'm gonna just not wake up.

• 41:45Speaker 02

  Yeah, because the world is so small now.

• 41:47Dax Shepard?

  And you're very aware of what you don't have now, whereas I don't think you were in the past.

• 41:52Speaker 02

  Let me tell you the end of that story because then I visited the town. So I'd seen how depressing it looked and I thought, well, I'll go and interview the people and see if I can kind of understand this a little bit better. And I met the people who'd been in the sleeping sickness. And the first woman I met, lovely lady Tamara, beautiful, well into her seventies, but had kind of bleached blonde hair and she was really making an effort. She was lovely. And she basically was telling me that this town was paradise to live in. What? It really was not paradise. It went down to something like minus 50 in the winter and they had no running water, most of them. The town had been dying slowly. They had no electricity. I visited the hospital and there was a bath full of water where they could come and get a bucket of water if they needed it, kind of thing. This town was not paradise.

• 42:37Speaker 02

  And I just thought, this is bizarre. But then the more people I met, the more I realized that I was not understanding the story, which was that this town, once upon a time, actually had been paradise for these people. So basically, it was a secret uranium mining town for the Russians during the Soviet era. These people all came from Russia and they were basically mining families. And they had been put on a bus one day in somewhere like Siberia and told, you're going to Kazakhstan. They didn't have much choice in it and they got on this bus and they drove to Kazakhstan. I don't know how long that took. They stopped in multiple bleak places and thought, oh God, I hope this isn't it. And eventually they came to this actual paradise town in Kazakhstan where they had

• 43:21Speaker 02

  built brand new apartment blocks. They had a brand new hospital. They had a facility for looking after the children. There was fruit and vegetables in the shop that nobody in the Soviet Union ever saw. Saw and the reason it was set up that way is because they wanted to keep this mining town secret. They wanted these people to stay in the town.

• 43:40Dax Shepard?

  No turnover.

• 43:40Speaker 02

  To be happy. So I had thought the people were delusional when they said this town was paradise. But actually, it had been.

• 43:46Dax Shepard?

  Relative to where they came from.

• 43:48Speaker 02

  Oh, yeah. And then what happened was the Soviet Union broke up and the uranium mine shut down. And one by one, all these amazing facilities they had were lost. Most people left the town. There had been thousands living there, but this stalwart three hundred stayed. And I think they stayed kind of thinking, this was once paradise. I raised my children here. This place means a lot to me. They told me stories about having picnics by the riverside and it was all very beautiful. They thought that it would eventually go back to being paradise.

• 44:18Dax Shepard?

  Right.

• 44:18Speaker 02

  But instead, what was happening was it was just becoming more and more decrepit. What happened when you got the sleeping sickness, the only way to cure you was to leave the town.

• 44:27Dax Shepard?

  Yeah.

• 44:28Speaker 02

  I think it was just a really phenomenally sophisticated way of making that really hard decision. In the end, I thought it was a kind of a love story for this town, you know, it meant so much to them and leaving it was so painful. Sometimes these psychosomatic disorders, we think of them as illnesses, but sometimes they are a way of our brains helping us through a problem.

• 44:49Dax Shepard?

  Their survival mechanisms in some way. Seems to have a genius about saving us.

• 44:54Speaker 02

  Dissociative seizures, very often they've happened for the first time at a time of great stress. There's only so much you can handle and this is your brain protecting you from the thing you can't handle. Then it all goes a little bit awry.

• 45:04Dax Shepard?

  Or your body will make your back hurt so much, you can no longer do the job that's killing you mentally. The body will somehow protect itself.

• 45:11Speaker 02

  Absolutely.

• 45:12Dax Shepard?

  Okay, so the new book, The Age of Diagnosis, How Our Obsession With Medical Labels Is Making Us Sicker. Now, I sought out an expert like you because you'd have to be asleep to have missed. Sleeping disease. This wave of self diagnosis that we all are giving ourselves, the current one, and we'll just put an earmark in it, is every single person I know, and I convinced myself of it maybe, has ADHD. Right now, that's the one. We'll get to it, but let's walk through why this felt like a natural progression in the books you were writing and why you felt like it's time to shine a light on this.

• 45:51Speaker 02

  Yeah, everything I write comes from the patients I care for. I'm in full time NHS practice. I'm seeing patients every day, and the patients I'm seeing have changed over the decades. A lot of my patients are very young. I will see people in their twenties, and they're coming to see me now, and they will have a list of nine, 10 different diagnoses.

• 46:10Dax Shepard?

  But they've given themselves, or they've accumulated from medical?

• 46:13Speaker 02

  No, they've accumulated. This is a kind of a collusion between society and the scientific world and the medical world.

• 46:18Dax Shepard?

  The doctors live in the same culture that has its powerful impact on us.

• 46:22Speaker 02

  Hundred percent, and we are responding to the needs of the culture in which we live. So it's a kind of collusion of multiple different sections of society. But basically, I see these young women, I always say women, but it's not only women, but it is slightly more women. And I think perhaps I became interested in because I could kind of relate to these people in this situation being dismissed. They'll come and they'll have ADHD, autism, a condition which people may or may not know called POTS, Postural Orthostatic Tachycardia Syndrome. If you haven't heard of it, you will soon.

• 46:52Dax Shepard?

  It's best you don't.

• 46:53Speaker 02

  No, it's coming.

• 46:54Dax Shepard?

  It might be best you never hear it, and then you can't get it. Then you won't get it. You can't get what you don't know.

• 46:59Speaker 02

  Exactly. I'll stop listing them, but they'll have 10 diagnoses that often come in a little batch together. What's really noteworthy, I was chatting about this with a colleague recently, is basically, we didn't see people with this constellation of diagnoses 10 years ago, but we also didn't see these people with a constellation of undiagnosed symptoms that fit with these diagnoses 10 years ago. So it's not like you can say that 10 years ago, or 20 years ago, or 30 years ago, there were loads of people suffering in this way, and no one knew what it was. And now there are names for it. People are developing groups of symptoms that people didn't have 30, 40 years ago, and we're giving it names.

• 47:35Dax Shepard?

  Right. So you say like worldwide, 537 million people are living with diabetes. That's incredible. That's half a billion. 783 million are predicted to be affected by 2045 with diabetes. We kind of have three explanations on the table that would make sense. One is we're sicker. A second explanation would be we are just finally able to diagnose all these people because we now have the language and it's in the DSM and it's in these other places. And maybe we're getting healthier because now we're getting treatment. And you're offering a third explanation.

• 48:10Speaker 02

  When you talk about medical over diagnosis or you say you're writing a book about medical over diagnosis, everyone thinks of the autism, ADHD things, but you've already raised diabetes. This actually over diagnosis kind of epidemic applies to both physical and mental health problems. So it applies to cancer, it applies to diabetes, it applies to asthma, it applies to high blood pressure, high cholesterol, as much as it does depression, ADHD.

• 48:33Dax Shepard?

  Yeah, I was shocked to read in your book that asthma diagnosis have gone up 48%. That's fricking Teddy Roosevelt had asthma. This isn't a new diagnosis.

• 48:43Speaker 02

  There's different ways that this happens. The two main ways that it happens is one, you are kind of diagnosing things that don't need to be diagnosed. So if we take diabetes as an example, we now have this state of prediabetes. So you don't have diabetes yet, but you're almost getting it. It's not really a diagnosis in itself, but it's becoming one.

• 49:02Dax Shepard?

  Everyone I know is panicked about their prediabetic.

• 49:05Speaker 02

  Basically, the way these things come about is that we as doctors and scientists are encouraged to make sure we keep as many people healthy as possible and therefore to find as many people who might be at risk of disease as possible and treat them. So we are incentivized to find as many people who might get diabetes as we can. And an absolutely religious belief in the assumption that finding diagnosis early and treating it is the right thing to do. So what we'll do is we'll say, okay, to be prediabetic used to mean that you had to have a fasting blood sugar of six, but you know what? I think that's too high. We might be missing some people. So we expert committee get together and we say, let's change that parameter and say you can have prediabetes at 5.6. Nothing has changed in science.

• 49:50Speaker 02

  Nothing has changed in our bodies or in society. The only thing that has changed is that in order to make sure we are missing as Few people at risk of diabetes as possible. We are going to change the number at which you can be diagnosed. And the idea then is obviously you identify all these extra people with pre-diabetes. And that particular change, if applied to the entire population of China, would have meant that 50% of men in China were prediabetic and something like a third of people in the US would be prediabetic. So these thresholds are being set phenomenally sensitively. The thing we're not great at is proving that that actually is making people healthier. And there isn't an awful lot of evidence to suggest that by adjusting thresholds in

• 50:34Speaker 02

  order to identify prediabetes at an earlier stage, you're actually preventing lots of people from getting sick further down the road, well, actually probably aren't. And we tend to move these goalposts and consider success to be how many new sick people can we find, rather than the more important endpoint, which is what difference has that made to these people's long-term health? What we very often don't do, say in the case of cancer, we'll say, well, we screened 1,000 women for cancer and we saved one life, but we potentially treated 10 people for cancer who didn't need to be treated. And what was the impact of that? What was the impact emotionally, physically, psychologically, everything? We're very good at capturing more and more disease, but we're not terribly good at measuring

• 51:19Speaker 02

  the implications of that down the road.

• 51:21Dax Shepard?

  Yeah, how successful that was. Yeah, let's talk about diabetes a bit further. I guess when I was growing up, if you were suffering from the condition of diabetes, you were having amputations. You were dying quite prematurely. Have we reduced the amount of people getting amputations or dying prematurely?

• 51:39Speaker 02

  I don't know specifically about amputations, but have we reduced the number of people who are ultimately developing diabetes? No, diabetes is still rising. And that's always my issue with these things, is now we've got this whole new population with prediabetes, which isn't really a disease state, but a kind of a warning. And if identifying those people and then giving them advice really worked, we should ultimately have fewer people with diabetes and fewer people with serious diabetes, but we don't. So what are we doing? Why are we doing it? What has been the impact for those people newly labelled prediabetic?

• 52:12Dax Shepard?

  Yeah, you say many of the diagnosis aren't what they seem. The quest for certainty turns borderline medical problems into ironclad diagnosis, pathologises the normal and hurt those who are most vulnerable. In other words, we are not getting sick or we are attributing more to sickness. Break that down a little bit.

• 52:32Speaker 02

  Autism was developed as a concept in 1943. And when it was developed, the people who were affected by autism had very severe communication problems, so so severe that they would have no interest in people at all. So there were very, very disabled young people. And it began in infancy, it began at a very young age, it was obvious from an early age. And the people who had it could not function normally in the world. Now, at some point in the 1960s, Lorna Wing, a scientist, she said, well, I think perhaps this thing called autism, we're probably missing cases of it. We can see these really severely affected children, you don't have to look very hard to see them. But I think if we look in these schools, we can see there are other children

• 53:14Speaker 02

  who are being poorly served by society because perhaps they have a milder version of this. And I think that's really valid because when I was in school in 1980s, there was no people with special learning needs. There must have been people who were being neglected.

• 53:27Dax Shepard?

  Oh, certainly. You kind of go back in your mind and you go like, oh, right, yeah, that kid was ADHD and that kid was this. We had no terms for any of it.

• 53:34Speaker 02

  Exactly. And there was no support systems. And imagine how differently those young people's lives could have gone if people had realised they just learned differently.

• 53:42Dax Shepard?

  It's such a complex issue. I'll add that I just interviewed Bill Gates two days ago. And I said to him, he knows everything. He was consuming all things. He read all 21 volumes of the encyclopedia at nine years old. I'm like, when did you first hear autism? And did you connect with that concept? And he said, I was aware of it, but at that time, they were such extreme examples that I would have never put myself in that bucket. Because again, these were people who were non-verbal.

• 54:13Speaker 02

  Does he put himself in it now?

• 54:14Dax Shepard?

  Yes. He says recently, and that's what's interesting, is he reckons. Recognizes he is on the spectrum of it. And then the natural question is, would he have been served with that title or not? That's the big unknowable.

• 54:28Speaker 02

  This is the difficulty is so let's say someone realized that some children were not being properly supported. And they've changed the diagnostic criteria so that slightly subtler signs are sufficient to make the diagnosis. The problem we have now is that has continued since into, I would say, to a certain degree, going to be a little bit harsh, the realms of the ridiculous, because you've got to the point now where you not only are looking for signs that are so subtle that they are barely perceptible. We are also including something which people are calling masking. And masking is you don't appear in any way autistic, but you feel autistic on the inside. This concept of masking or camouflaging make complete sense for people with severe autism.

• 55:13Speaker 02

  There's a program on TV. I don't know if you've seen it. It's called Love on the Spectrum.

• 55:16Dax Shepard?

  Yes.

• 55:17Speaker 02

  And I was resistant to watching it at first because I thought it would be kind of mocking or something.

• 55:20Dax Shepard?

  That's how I felt. But it's beautiful.

• 55:22Speaker 02

  There's really lovely examples of masking in that where you kind of see that the people are being taught. When you go on this date, have back and forth conversations, you can see them masking in the sense that they're learning the social rules and applying them, but it doesn't really look completely natural ever. The masking is obvious.

• 55:39Dax Shepard?

  One I like to add is when the movie Rain Man came out, the man it was based on was interviewed with his father. And Leslie Stahl did the interview from 60 Minutes, and this was in the eighties. And he was very hard to conduct an interview with. He also memorized every book in the Salt Lake City Library. And he could read with his eyes separated both pages at the same time. So she did a follow up story on him like 10 years ago, went and revisited him. He's still at the library reading and the dad's still there. And he greets her and he's making eye contact with her and he's interacting in all these ways. And when he's not there, Leslie says to the dad, he seems to have improved a lot. Has there been some treatment? And he said, well, make no mistake, he's exactly the same.

• 56:24Dax Shepard?

  He has just learned more tricks over the years. He knows to force himself. To look at you and he knows to say, yes, Leslie. And so that's all that's happened. You haven't seen an improvement in the condition.

• 56:34Speaker 02

  That's sort of masking or camouflaging.

• 56:36Dax Shepard?

  That's real masking.

• 56:36Speaker 02

  Yes, that's learning the social rules and applying them, but often it's hard to sustain. It can be exhausting for people of autism and it often is very difficult. But these concepts like masking have been taken to the point now where someone can be masked all the time so that they never look like they have a social communication problems and that still qualifies as a diagnosis. So we're being asked to make diagnosis in people who don't show the typical features of autism, but the self-reporting of it. Yes, more people needed to be diagnosed for sure and there were children who needed help, who were not getting help and who benefited from the relaxing of the diagnostic criteria. But now the diagnostic criteria are relaxed to a point

• 57:18Speaker 02

  that it's not fair to the very, very mild people who are being labeled. I'm not worried about Bill Gates at all. He seems to be doing fine for himself.

• 57:26Dax Shepard?

  Yeah, yeah, yeah, yeah.

• 57:26Speaker 02

  I'm worried about children. So you've got a 16-year-old child who perhaps has some social communication problems, but they're quite mild and they're able to compensate and they're able to mask to the degree that they can function normally, albeit maybe they're nervous and they don't enjoy things and they're exhausted afterwards, but they can function. What happens to a person like that when you tell them that they have autism? You're essentially telling them that they're neurodevelopmentally abnormal, that there are things they can't do because their brain's not normal. That is a self-fulfilling prophecy for a child. We've all gone through those difficult periods and we've had to learn to overcome our shortcomings. But if you tell a child that they have a neurodevelopmentally abnormal brain, you're really running the risk that you have this labeling effect

• 58:11Speaker 02

  where you concentrate on the things you can't do. You become the thing that you've been labeled as.

• 58:17Dax Shepard?

  It's so nuanced because what's interesting is I think the diagnosis of autism's almost more for all of us neurotypical people, in quotes. Because what it does do, and I've witnessed it around me and I myself know I'm guilty of it. If someone says this dude's autistic, when you meet him, just know he's autistic. I can go into all these other things that might trigger me when I'm interacting with them. And I have a level of compassion now that I didn't have, which is just a shortcoming of my own. Monica and I have talked before, it's like, really, the end goal for all this would be to be compassionate to everyone with all their idiosyncrasies. But that label helps us. It helps us write off stuff that would otherwise irk us.

• 58:58Speaker 01

  They can't help it. When you can't help anything about your personality.

• 59:01Dax Shepard?

  But it is a complementary situation because now I have lower expectations of you and you have lower expectations of you.

• 59:09Speaker 01

  Exactly.

• 59:09Dax Shepard?

  So it can be also a self-perpetuating.

• 59:12Speaker 02

  And it also isn't as straightforward as to say you can't help that. Part of maturing is learning to adapt. You know, I was a very shy child. You would never imagine that I would be sitting here in the future. What if my shyness had been pathologized?

• 59:26Dax Shepard?

  Yes.

• 59:26Speaker 02

  It disincentivizes people from trying to overcome their difficulties. It reinforces symptoms instead of helping people to kind of get over their problems. And I know that you're saying if someone tells you that they're autistic, you think, okay, well, I understand you a little better now. But I don't think that's everybody's attitude. I think there's also people who, if they hear that someone's autistic in the mild range. I should say that when I'm talking about this, I'm really talking about people who are in that borderline zone. There's always value to being diagnosed if you have significant problems. I'm talking about the value of being diagnosed if you're in that borderline zone. Some people might be understanding, but other people will be quite judgmental of that. It's also very worrying that the milder and milder the diagnosis get,

• 1:00:11Speaker 02

  the more we're trivializing this disorder for people who are really disabled by it. People with mild autism, again, this very borderline area of autism, have very loud voices now. Because we see there's a lot of people in the public eye who have these diagnoses. And it gives people the idea that they know what these things are. I doubt they've seen many people who have what I would call significant moderate to severe autism. Because they don't get to be on telly and they don't get to be on podcasts.

• 1:00:37Speaker 01

  They're often non-verbal. It is so ubiquitous, you almost have to delineate. There's that new podcast, Telepathy Tapes, and it is about nonverbal autistic children. But you have to, oh, it's about autism, but you know, really extreme. You have to say that as opposed to just before, that's what it meant.

• 1:00:54Speaker 02

  And the sort of tone of conversation sometimes can be quite difficult for people in that severe category. Because there is a sort of conversation that says it's okay to have these mild autistic traits. You shouldn't overcome them, you should embrace them, be your most authentic autistic self. But I've talked to the families of people with severe autism. If they didn't help the children in the family to overcome their difficult behaviors, they would be institutionalized, they would not be safe in the world. And they find it really quite disparaging to have people going, be your more authentic autistic self. Because really what their children need is a lot of support and to learn to control the sort of outbursts that they can sometimes have. I don't want to say to people, well, I don't truly believe that

• 1:01:39Speaker 02

  in the very, very mild category, everyone diagnosed with autism really is autistic. I'm not absolutely convinced. However, I don't think that's the most important question that I need to answer. I think the question that needs to be answered is, is it benefiting them to be labeled? Because no one can say where the line between being autistic and not autistic is. There is no such line, so it will always be difficult. I want to ask people who support the more inclusive diagnosis, how is it helping people? Because as far as I can see, it's not helping people at all. If it was helping people, we've been expanding the concept of autism since the 1990s. So we're now like a good 30 years into this. And the story I'm being sold is that, you know, if we can recognize children

• 1:02:24Speaker 02

  and give them these diagnoses and give them support, then we'll be creating happier, better adjusted adults. Are we, as far as I know, mental health problems are rising significantly. And there is no evidence at all that giving people with a very borderline diagnosis a medical label is actually helping anybody.

• 1:02:43Dax Shepard?

  I think, as you said earlier, this is a collusion of many, many facets. And so one that I can immediately see is parents whose children exhibit behavior that is embarrassing to them in their own ego, because they are an extension of your identity. I think they themselves are comforted by some medical diagnosis as opposed to just living with the embarrassment that, yeah, sometimes your kids are really embarrassing. That's part of the fucking ride. It's not you. You don't need to go find some diagnosis. So you can tell everyone, she's this, he's that. And then you alleviated yourself of that.

• 1:03:20Speaker 02

  I think that's a bit harsh.

• 1:03:22Dax Shepard?

  You do?

• 1:03:22Speaker 02

  Yeah, I do.

• 1:03:23Dax Shepard?

  Oh, I see so many peers excitedly sharing the diagnosis their kid just got.

• 1:03:28Speaker 02

  I think it's a little bit more that everyone's desperate for their children to do as well as possible and they're desperate to do the best for their children. And this at the moment is perceived as a way of doing everything you can for your child because they'll get the maximum amount of help and support possible. First of all, our society is too perfectionist. You know, this kind of concept that we'll all succeed. Well, we can't all succeed. It's simply not realistic. And the idea that if you try really hard, you will ultimately get the thing you want. Well, it doesn't actually work that way.

• 1:04:00Dax Shepard?

  You have better odds of getting what you want if you try really hard.

• 1:04:02Speaker 02

  Yeah, you need to try really hard, but I was shy. I worked to overcome it, but maybe I might not have managed that at some point. And that's the point you need to recognize. The things you can overcome and the things you can't overcome. And I think we still have this expectation of our children are struggling in school, that if we get them the maximum amount of help and if we push them hard enough, that they will become the person we believe they can be. And maybe we'd be kinder to our children if we accepted that sometimes children are mediocre at certain things. And instead of concentrating on that thing.

• 1:04:33Dax Shepard?

  Funnels into one of the topics of your thing is this kind of false notion of the norm.

• 1:04:38Speaker 02

  I think that's the message that needs to get across to parents is irrespective of what their motivation may be. I think that people perceive diagnosis as, at the least, something that will help their child. What people are not understanding is that diagnosis is not inert. You don't just diagnose someone and then it's all rainbows and sunshine from then on in. There'll just be help and nothing bad comes with it. There are substantial harms with giving people a medical label. Other people expect less of them, as you've said, so underestimate them. They underestimate. Themselves, they become more aware of the symptoms. Like, no one ever said to me, "You're very shy." I was just aware of it. But perhaps if you have these things pointed out to you and pathologized,

• 1:05:21Speaker 02

  you become more aware of it and kind of dig into it. So I think a parent may be well meaning. We, as a society, must find a way of supporting children without labels. And parents who seek out labels for their children must understand what a dangerous thing that is to do, to label your child at such a young age.

• 1:05:40Dax Shepard?

  What's happening with Huntington's disease?

• 1:05:43Speaker 02

  I just think this is a really powerful story to teach us about how your experience of your body is altered, about beliefs about your health. So Huntington's disease is a degenerative condition. It's very, very unpleasant. It usually begins in someone's 30s or 40s with psychiatric symptoms and behavioral changes. It's a neurodegenerative condition. So you get frontal lobe symptoms like impulse control, and then you start getting involuntary movements. They're called choreiform movements, like funny writhing movements.

• 1:06:13Dax Shepard?

  Yeah.

• 1:06:14Speaker 02

  And then ultimately, you lose control of your speech and of your swallow. So you have both a psychiatric decline and you have a physical decline. It's an inherited condition, and they discovered the gene for Huntington's in 1994, I think it was. If your parent has a Huntington's disease gene, then you have a 50/50 chance of getting it. I think this is a fascinating concept, because there are people walking around knowing that they have a 50/50 chance of getting this disease and knowing that there is a test that they can get that will tell them whether they have it or they don't have it. And of all those people who could have that test, only about 10 or 20% of people actually have the test.

• 1:06:54Dax Shepard?

  Oh, interesting.

• 1:06:55Speaker 02

  They have this opportunity to know this enormous part of their health future, and they don't take it up. I spoke to a lady called Valentina. Her mother was adopted, so didn't know this was in the family. Valentina was 28 and pregnant when she discovered her mom had Huntington's disease. So the minute she discovered that, she knew she had a 50/50 chance of getting it, and she knew that her unborn child had a 25% chance of getting it. Obviously, it was devastating. She had siblings who had children. The family were very anxious, and their first impulse was to think they would be tested. They met genetic counselors, and then it was pointed out to them that the minute you test, your whole life changes if it's positive, and it's a devastating diagnosis, so they put it off. Now, what happened to Valentina in the following years is although she hadn't

• 1:07:38Speaker 02

  tested, she became absolutely convinced she had Huntington's disease. She could just tell she had it. Organization problems and anxiety and anger outbursts are common at the beginning of Huntington's disease. She began having arguments with her husband, or if she went to the airport, she couldn't organize her documents. If she was walking, she'd walk into walls. So she was aware that her symptoms were accruing, but she was frightened to have the test, to have it confirmed, because the minute it was confirmed for her, her children were at much higher risk. And she just couldn't face the idea of looking at her children and thinking, I'm going to die and you've got a 50/50 chance of going the same way. So she actually waited about 20 years to have the test, and she only had the test when

• 1:08:19Speaker 02

  she was so disabled by these symptoms that she realized she just had to have it confirmed. And when she went and had the test, it was negative. She didn't have it.

• 1:08:29Speaker 01

  Oh, my God.

• 1:08:30Dax Shepard?

  Oh, my God. Well, in that case, I wish she had had the test.

• 1:08:35Speaker 01

  Obviously, yeah.

• 1:08:36Speaker 02

  But you see, that works both ways.

• 1:08:38Speaker 01

  But that's how strong it is.

• 1:08:39Speaker 02

  You see, because all of her little symptoms didn't all go away. She still got flustered in airports, but it didn't get out of control. And that was what was happening, is she's noticing little things. And because she thought she has Huntington's, then she was examining her body and thinking, what's going to happen? Because she'd seen her mom get sick, she knew exactly what was going to happen next.

• 1:08:59Dax Shepard?

  Yeah.

• 1:09:00Speaker 02

  So she was really focused. But imagine if 20 years ago she had the test and it was positive, then every one of those symptoms, none of which were due to Huntington's, would have persisted. That's the difficulty with knowing you're at risk of a disease that might not happen for 20 years. The symptoms will start long before the disease starts. And every ordinary thing that happens to you, that happens to all of us, every time you lose your keys, every time you trip over a paving stone.

• 1:09:27Dax Shepard?

  Yeah, it's confirmation bias. You're excluding a ton of data and focusing on a very tiny bit of data to validate what you already have a hunch is true.

• 1:09:35Speaker 02

  Exactly. And it shows the power of thinking you have a disease. And that's why it's so important to this discussion about prediabetes, or autism, or ADHD. If you think you have the disease, some people will display the features of the disease, and that can be really hard to overcome.

• 1:09:53Speaker 03

  Stay tuned for more Armchair Expert if you dare.

• 1:09:59Dax Shepard?

  This episode is brought to you by ServiceNow. Look, I have my dream job. I get to talk to folks I admire like crazy and ask them virtually any question that I want to. I can't imagine a better way to spend my time. But even dream jobs have some not so dreamy parts. The stuff that gets in the way of the actual work. Now that's where ServiceNow's AI specialists come in. They don't just tell you what you should do about your busy work. They actually do it. Start to finish. Cases closed. Requests handled. No extra work for you. So you and your team can focus on what matters most, which for me is, are they obsessed with male bodies on the same level as I am?

• 1:10:41Speaker 01

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• 1:10:42Dax Shepard?

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• 1:10:55Dax Shepard?

  Well, even when I see on Instagram, because it's everywhere, ADHD is the thing. And I see these videos and of course, it's like astrology. Like if you say enough adjectives about me, you're gonna find some that are fitting. So I'll see the couple of things that are identical to me. Like if I start brushing my teeth, I've got to immediately do something else. There's no way I can stand there and just brush my teeth. And I'll see that one, but oh yeah, that's me. But I've also ignored the six they said that I have no connection to whatsoever.

• 1:11:22Speaker 02

  And also we're back to something we said at the start about when does worrying about your health become hypochondria? It becomes a medical problem if you're impaired or disabled. And these are the subtleties of diagnosis that people don't really understand. I could look a list of ADHD symptoms and have them all, but they have to obey certain parameters for me to have an actual medical problem. And the parameters they have to obey is they have to be there in every environment. You're not just autistic in school, you're autistic at home, you're autistic in every environment. And they have to be there to a degree that you are disabled by them. We've become very casual about this sort of like, I'm on the spectrum or

• 1:12:00Dax Shepard?

  I have ADHD.

• 1:12:01Speaker 02

  Well, listen, we all have. Some of the traits of these things, but we do not have a medical problem unless we are impaired. And it's the impairment that makes it a medical diagnosis. And that's what everyone in TikTok is really failing to appreciate. Also, I can't remember whether it was ADHD or autism, but there was something like 11 billion TikTok videos about, I think, autism. And when they scrutinized top 133, 27% of them provided accurate information and the other 73% were just full of inaccuracies. But that's interesting too, because those inaccuracies are seeding themselves into medical culture as well.

• 1:12:37Dax Shepard?

  Well, it's funny, when I see the ADHD clips, which I see all the time, it triggers something that happens a lot in AA, which is I'll be listening to someone share an AA and they'll say like, I this, this and this, my alcoholism. And I often go like, no, that's your humanism. You're being a human right now. And similarly with ADHD, I'll go, that's just being a human in a highly stimulating world. Yes, you have that. I don't deny that, but that's normal and natural and we all have some degree of that.

• 1:13:06Speaker 02

  Exactly. And I think we're just getting worse and worse at drawing the line between what's a normal amount of it and what is an abnormal amount of it.

• 1:13:14Speaker 01

  Do you think part of the problem is with social media? I feel like people want a thing that makes them specific. They want a thing that makes them special. They want something to be able to talk about, be an expert in. I wonder if the uptick.

• 1:13:28Dax Shepard?

  They want to excuse some of their shitty, unappealing behavior, like, yeah, I always am interrupting, but I have ADHD. Don't you also think they want an excuse for some stuff?

• 1:13:36Speaker 01

  Yeah, I'm sure that's part of it, but I also think there is this like inclination to have a thing now, to present to the world.

• 1:13:45Dax Shepard?

  Like you don't even have a personality if you don't have a thing.

• 1:13:47Speaker 01

  Exactly.

• 1:13:48Speaker 02

  I struggle a little bit with that because I'm seeing people who are, I'm the 15th doctor they've seen and they've got 10 different diagnoses. And I'm seeing a slightly different populations than the TikTok population.

• 1:13:59Speaker 01

  That's what I'm talking about.

• 1:14:00Speaker 02

  And I think it's difficult because you can make generalizations about what's happening on TikTok. And then I assume the people who come to me are suffering and perhaps I don't agree with the labels. And perhaps I don't agree with specific diagnosis, but. Do appreciate that if they've made it all the way to my clinic, then they're not well. And there's a problem, you know, it can be very difficult for them to hear us saying things about looking for attention. There is something nice about being part of an illness group. It makes you feel validated.

• 1:14:28Speaker 01

  They feel validated.

• 1:14:29Dax Shepard?

  Seen.

• 1:14:30Speaker 01

  Yeah.

• 1:14:30Dax Shepard?

  But the distinction you're making is great. Of all the people I'm seeing on Instagram declaring themselves, my guess that I feel strong about is like 90% of those people have never seen a doctor for it.

• 1:14:42Speaker 01

  No.

• 1:14:42Dax Shepard?

  And they have no program of treating it.

• 1:14:44Speaker 01

  They don't want to treat. That's my whole point. They don't want anything to change necessarily. They just want to say, I have this or I'm this.

• 1:14:53Speaker 02

  Most of them in that sort of category, next year there'll be something else on TikTok.

• 1:14:58Speaker 01

  Right.

• 1:14:58Speaker 02

  These social trends occur on social media, but the difficult thing is that a small proportion of people, these diagnosis will stick and that becomes really problematic.

• 1:15:08Dax Shepard?

  What's going on with chronic Lyme and long COVID?

• 1:15:12Speaker 01

  Oh God, yeah.

• 1:15:13Speaker 02

  Lyme disease is caused by a bacteria which you get from a tick when the ticks come from deer. Lyme disease is just essentially an infectious illness, but there is a subset of Lyme disease called chronic Lyme disease. The, I think they're called the National Institute of Allergies and Infectious Diseases would define chronic Lyme disease as a set of symptoms that has nothing at all to do with a Borrelia bacterial infection and nothing at all to do with Lyme disease. There's a large number of people throughout the world who have been labeled as having a form of Lyme disease called chronic Lyme disease, which probably is not an infectious illness. Now, the difficulty is that Lyme disease can cause symptoms that we all get, like fatigue, aches and pains and things like that, which quite frankly are symptoms of everything.

• 1:15:58Speaker 02

  What happens in society is when people are suffering with those kinds of symptoms and they're struggling to get a diagnosis, they will take the diagnosis that's salient at a moment in time. And chronic Lyme disease is a very salient diagnosis at the moment. It's for people who are struggling without a diagnosis, it can explain a lot. And it allows people enter a community where they can get support and they can get treatment with antibiotic. Which don't work, but gives them the sense that they are being treated. Lyme disease is a very good example of how medicine is an art. You know, it's not a matter of someone comes to see you and you think they have a bacterial infection. So you do a blood test and they either have it or they don't. Tests are so much more sophisticated and hard to interpret than that.

• 1:16:41Speaker 02

  You know, every single blood test we do, every single brain scan we do comes with a hundred caveats. If you live in a Lyme disease area, it was a study in the UK in a place called the New Forest, where there's loads of Lyme disease and foresters who work there, something like 25% of them will test positive for Lyme disease if you test them. Doesn't mean they have Lyme disease, just means they've been in this area for a long time. You have these kind of variables and this is a problem in Lyme disease. If I wanted to make a lot of money, I could diagnose a lot of people with Lyme disease by doing that blood test and telling them you've got an abnormal blood test and therefore you have Lyme disease.

• 1:17:17Dax Shepard?

  So some people have Lyme disease and really no symptoms.

• 1:17:20Speaker 02

  Well, it's not they have Lyme disease, they've been exposed to the bacteria. They've had an immune reaction and antibodies and they never got sick and therefore they fought it off. Perhaps they had a really mild case, they didn't notice. People are kind of aware that perhaps mental health problems and things may be a little over diagnosed now, but they don't think quite so much about how the parameters of physical diseases have changed and led to over diagnosis. It's fine that we do what we do as long as people are able to go to their doctor and ask the right questions and understand the issues.

• 1:17:48Dax Shepard?

  Long COVID, this is one that I just intuitively, when I hear it, I'm a little skeptical of.

• 1:17:53Speaker 02

  How it came about is so interesting really, because as a hashtag, it appeared on Twitter. An Italian woman tweeted hashtag long COVID on the 20th of May, 2020, raising awareness about chronic symptoms after COVID infection for the mildly affected.

• 1:18:08Dax Shepard?

  You say March of 2020?

• 1:18:10Speaker 02

  May.

• 1:18:10Dax Shepard?

  May, okay, so only three months in.

• 1:18:12Speaker 02

  Well, that's precisely, you know, we're already predicting disability for millions and we haven't even had time really for chronic illness to develop. But this concept that a mild illness could lead to chronic disability took off after that hashtag. It was shared throughout the world and this story spread, the concept that the mildly affected could Develop long term symptoms. You know, it went from Twitter to mainstream news to medical newspapers with phenomenal speed with no scientific study whatsoever, with just it being sort of a word of mouth.

• 1:18:44Dax Shepard?

  We would have to be years out to ever actually declare something long COVID.

• 1:18:49Speaker 02

  There was so much that was counterintuitive to this being related. Let's just say that, of course, there are people who have chronic symptoms. If they were hospitalized, I volunteered in ITU during the pandemic. I saw how bad things were. You would not be surprised if a very sick person would have chronic symptoms. Also, all viral illnesses cause chronic symptoms in a small proportion of people. There is really good evidence that most people, however, long COVID probably didn't get it related to the virus, but rather to the kind of idea of long COVID. Firstly, it's a different population. So people in hospital were older people with diabetes. They were mostly men. People with long COVID were younger people, healthier people, and mostly women. And studies that have emerged have been very interesting, like loneliness is a precursor for long COVID.

• 1:19:35Speaker 02

  A study in Germany followed healthcare workers from the beginning of the pandemic and people who had an expectation of symptom severity developed long COVID. So if you expected to get it, you got it. Depression.

• 1:19:47Speaker 01

  I kept hearing brain fog. I'm like, we're in a pandemic. Our brains are foggy.

• 1:19:51Dax Shepard?

  Yeah, we're down. We've knocked out 80% of the stimuli we're used to.

• 1:19:55Speaker 01

  Exactly.

• 1:19:56Speaker 02

  And that point is so important because what they were doing in the studies at the beginning on long COVID is they were surveying people. They were self diagnosed and a self diagnosed person is more likely to get long COVID. And they all had huge constellation of symptoms, but there was no control group. And later, when they'd had time to do the science properly, and they were now comparing people with long COVID with people who were in the pandemic who didn't get COVID, they also had hundreds of symptoms.

• 1:20:22Speaker 01

  Exactly. Of course, it was all crazy times psychologically.

• 1:20:25Speaker 02

  So science of long COVID was very poor at the beginning and the general public was scared witness by this concept that they could get chronically ill, even if they weren't hospitalized. And much like other people I've described, like the lady with Huntington's disease, if you think you're going to get chronically ill, then. A small proportion of us will get chronically ill. I don't want to be dismissive of it because it served a very important purpose. There were people dying and that was terrible. And there were people losing loved ones and that was terrible. And there were people losing jobs and that was terrible. But there were also a lot of other people who were suffering and there was no space for them. Where did they go? People at home alone with nobody to talk to, who weren't necessarily physically very ill. Long COVID gave them a voice.

• 1:21:10Speaker 02

  It gave them a group. It gave them place to go and it gave them a name for their suffering that other people gave more respect to than just, we're all in a pandemic and I'm having a horrible time. Nobody had any sympathy for that.

• 1:21:22Dax Shepard?

  Yeah.

• 1:21:22Speaker 02

  So it served an important social purpose.

• 1:21:24Dax Shepard?

  How do we correct? How do we keep all the upside of figuring out a lot of these diseases and providing help for people? And how do we shave off this large group that's also shouldn't be seen as having a pathological disease?

• 1:21:40Speaker 02

  I think it's kind of a multifactorial. Lots of people have to change a lot of things that they're doing. First of all, as a medical community, we need to really challenge this assumption that early diagnosis works. Because we've been diagnosing cancer, blood pressure, diabetes earlier. We're not making anyone any better. I think we do need, and this might sound a bit strange, to dial back on some of the mental health campaign awareness work that we're doing. Because there was a very interesting study out recently that showed that raising mental health awareness in schools actually added to emotional distress rather than subtracting from it. We perhaps would do better to teach people what normal looks like and learn how to support children without labeling them.

• 1:22:21Speaker 02

  Why can't we recognize that a child is struggling a bit in school and can do with learning differently without calling them neurodevelopmentally abnormal? So I think maybe we change the names. Support people without labels would be really useful.

• 1:22:34Dax Shepard?

  Yeah, you get into the structural logistical issues there. It's like there are X amount of resources given to those added hours of teaching and test taking. And then it's kind of the same way the insurance reimbursement works. We've got to get this one thing so we can get this other thing we need.

• 1:22:51Speaker 02

  I mean, you're right. I don't think. It's very simple. It would require a huge overhaul of systems in order to allow us to support people without medicalizing them.

• 1:23:01Dax Shepard?

  Right.

• 1:23:02Speaker 02

  Also, we've got no support systems outside of medical institutions. Where do people go who are suffering? A doctor is a place you can still go. Perhaps we need better support systems for people that are not surrounding medical institutions.

• 1:23:16Dax Shepard?

  Yeah.

• 1:23:16Speaker 02

  They don't feel the need to be labeled to belong to a group and to get support.

• 1:23:20Dax Shepard?

  Yeah, if there was just a place you could go to that was funded, that was like, I feel shitty.

• 1:23:24Speaker 01

  Therapy, or is that still to?

• 1:23:26Speaker 02

  I think that's still sort of medicalized. People just want to belong to a community. And the UK, the church isn't quite so prominent. It's slightly different in the US. In the UK, I'd say that system of being supported by your church has really been lost. But, you know, I'm not advocating for that idea, but there is something to be said.

• 1:23:43Dax Shepard?

  We want church without all the collateral charges that came with it. Yeah, without God, without priests, without pedophiles. I love this topic, and I think it's actually kind of brave. But I do think you do it with a ton of compassion, even tackling psychosomatic disorders in the way that you have with compassion and actually a call to treatment for the people.

• 1:24:06Speaker 02

  It's difficult for people to hear some of the things that I'm saying, and I do understand that.

• 1:24:13Dax Shepard?

  It'll be threatening to a lot of people's identity.

• 1:24:15Speaker 02

  You know, I think that a lot of people in the world are aware that something isn't going right. Mental health problems, something like one in five people in the world now has a mental health diagnosis, and there is something definitely wrong there. Sometimes it can be frightening to be honest about what you think is going wrong. But I think a lot of people have a lot of suspicions that aren't being voiced, and we do need to have these discussions more openly.

• 1:24:37Dax Shepard?

  Well, Dr. O'Sullivan, this has been wonderful. I'm so grateful that you made the long trip to be in rain and be at Harry Potter.

• 1:24:44Speaker 02

  I was absolutely thrilled and delighted to be here. I'm honored. So, thank you so much.

• 1:24:48Dax Shepard?

  Oh, yeah. Everyone, check out The Age of Diagnosis. Incredible book, incredible message. Thank you.

• 1:24:57Dax Shepard?

  Hi there. This is Hermium Hermium. If you like that, you're gonna love the fact check with Miss Malaka.

• 1:25:04Speaker 01

  It's a little chilly.

• 1:25:06Dax Shepard?

  Wow. Talk about a reversal reversal.

• 1:25:08Speaker 01

  Double reverse.

• 1:25:09Dax Shepard?

  This is a reverse back.

• 1:25:10Speaker 01

  Oh, my God, reverse back.

• 1:25:11Dax Shepard?

  Cause last fact check, I was in a sweatshirt. You were in a T-shirt. Ah, you were not cold.

• 1:25:17Speaker 01

  Yeah.

• 1:25:18Dax Shepard?

  Now you're freezing. I'm in a tank top.

• 1:25:20Speaker 01

  I know.

• 1:25:21Dax Shepard?

  And I'm hot.

• 1:25:22Speaker 01

  I had walked yesterday.

• 1:25:24Dax Shepard?

  Oh, and you didn't walk today?

• 1:25:25Speaker 01

  No, I didn't.

• 1:25:26Dax Shepard?

  And I just exercised with.

• 1:25:28Speaker 01

  That's the answer.

• 1:25:29Dax Shepard?

  Resistance training. The aliens would be really confused by weightlifting.

• 1:25:35Speaker 01

  Oh, yeah.

• 1:25:36Dax Shepard?

  Because initially they'd be like, oh, this heat, that monkey has to get that thing up and he's gonna move it somewhere. Oh, he's now he's setting it down. Or maybe it was too heavy. No, he's picking it back up again. Where's he gonna take? No, he's setting.

• 1:25:48Speaker 01

  Yeah, they don't get it.

• 1:25:49Dax Shepard?

  Just repetition, useless movement.

• 1:25:52Speaker 01

  Do you think the aliens have to worry about bone density?

• 1:25:55Dax Shepard?

  There's zero gravity. They don't even need really muscles.

• 1:25:59Speaker 01

  So jealous. Um, speaking of, well, this episode, which is for Dr. Susanna Sullivan.

• 1:26:05Dax Shepard?

  Dr. Suze.

• 1:26:06Speaker 01

  Yes. Um, it's connected to this episode, but it's also a ding ding ding for a future episode. I'm starting to panic that I have something.

• 1:26:15Dax Shepard?

  Oh.

• 1:26:17Speaker 01

  And.

• 1:26:17Dax Shepard?

  Interesting.

• 1:26:18Speaker 01

  It might be psychosomatic.

• 1:26:20Dax Shepard?

  Yeah, I would have thought your conclusion after Dr. Suzanne O'Sullivan.

• 1:26:25Speaker 01

  Uh huh.

• 1:26:26Dax Shepard?

  Would have been, I'm not gonna ignore that, all that stuff. But it, you're saying it got worse?

• 1:26:32Speaker 01

  Well, it didn't. It didn't get worse. I was like, oh, yeah, I'm fine. Nothing's like really getting in my way, you know?

• 1:26:39Dax Shepard?

  Yeah, yeah.

• 1:26:39Speaker 01

  But then we have another expert coming up.

• 1:26:44Speaker 01

  Easter egg. And there is something brought up in that episode.

• 1:26:52Dax Shepard?

  I'm as lost as the listener.

• 1:26:53Speaker 01

  Perimenopause.

• 1:26:54Dax Shepard?

  Oh, perimenopause.

• 1:26:55Speaker 01

  Well, I wanna kind of.

• 1:26:55Dax Shepard?

  Yeah, yeah. No, we've been saying we're gonna have one for a long time. That's okay.

• 1:27:00Speaker 01

  I know, but I want, I don't wanna get into the details because it's, it's not, I think I have perimenopause. It's, I think I am getting frozen shoulder.

• 1:27:08Dax Shepard?

  Oh, you're probably just shoulder hurts.

• 1:27:12Speaker 01

  Maybe.

• 1:27:13Dax Shepard?

  Can you track, can you trace it to any activity?

• 1:27:15Speaker 01

  If I must.

• 1:27:17Dax Shepard?

  Okay, what would be your guess?

• 1:27:19Speaker 01

  I mean, sometimes I do some little lifting.

• 1:27:22Dax Shepard?

  Some lifting?

• 1:27:23Speaker 01

  Yeah.

• 1:27:24Dax Shepard?

  Did you lift weights?

• 1:27:25Speaker 01

  Yeah, sometimes I do.

• 1:27:26Dax Shepard?

  And then your shoulder hurts?

• 1:27:28Speaker 01

  Well, no, it also happened when I was home.

• 1:27:32Dax Shepard?

  In Georgia?

• 1:27:33Speaker 01

  Yeah.

• 1:27:33Dax Shepard?

  But you don't call that home anymore.

• 1:27:35Speaker 01

  Oh, God, it's so confusing. It happened when I was home, something happened when I was home that made me think, oh, gosh, I might have this thing that my mom had and my grandmother had.

• 1:27:47Dax Shepard?

  Yeah, but what age did your mom have it?

• 1:27:49Speaker 01

  Let me ask.

• 1:27:50Dax Shepard?

  I think it's Riley.

• 1:27:51Speaker 01

  Okay, let me ask. I have a crazy SIM.

• 1:27:55Dax Shepard?

  Okay.

• 1:27:57Speaker 01

  It's bad. Like, I feel bad saying it.

• 1:27:59Dax Shepard?

  Okay.

• 1:28:00Speaker 01

  And I think people might be mad at me.

• 1:28:01Dax Shepard?

  Okay.

• 1:28:02Speaker 01

  For saying it, but I have to.

• 1:28:03Dax Shepard?

  You must, you must.

• 1:28:04Speaker 01

  This is wild.

• 1:28:05Dax Shepard?

  Gotta get it off your desk.

• 1:28:06Speaker 01

  So because of the SAG Awards, there was a bit in there about Gossip Girl.

• 1:28:11Dax Shepard?

  Yeah.

• 1:28:12Speaker 01

  That I wrote. And because of it, I was mimicking the opening of the pilot. So I started the pilot to hear the voiceover to write it.

• 1:28:20Dax Shepard?

  The Gossip Girl pilot?

• 1:28:21Speaker 01

  Yes. And so it was just on.

• 1:28:25Dax Shepard?

  OG, original Gossip Girl or the reboot?

• 1:28:27Speaker 01

  Original.

• 1:28:28Dax Shepard?

  Okay, great.

• 1:28:28Speaker 01

  With Kristen.

• 1:28:30Dax Shepard?

  Correct.

• 1:28:30Speaker 01

  So then, when I listened, I just kind of had it. I kept it going.

• 1:28:34Dax Shepard?

  Yeah.

• 1:28:35Speaker 01

  So I've been watching it at night.

• 1:28:37Dax Shepard?

  Oh, wow, you're, you're in.

• 1:28:38Speaker 01

  I'm back in, I've just.

• 1:28:39Dax Shepard?

  Had you watched it when it was airing?

• 1:28:40Speaker 01

  Yeah.

• 1:28:41Dax Shepard?

  Oh, you did?

• 1:28:41Speaker 01

  Uh huh.

• 1:28:42Dax Shepard?

  That was one of your shows?

• 1:28:42Speaker 01

  Mm-hmm.

• 1:28:42Dax Shepard?

  Okay.

• 1:28:43Speaker 01

  So I was doing a little re-watch, casual re-watch, which was nice and nostalgic, liked that. And I just got to this part with Michelle Trachtenberg.

• 1:28:54Dax Shepard?

  Oh, wow, okay.

• 1:28:55Speaker 01

  And, and I was watching, she was on, you know, a bunch of episodes, but this was her first time on it. And I was, and I thought, whoa, I haven't, like, seen her in a while. And she has a really. Great part on that show and she plays a horrible villain. Who is scary and manipulative and scary. And so, so I've been thinking a lot about her and even yesterday I said to Jess, I said, I'm rewatching Gossip Girl. And did you see it?

• 1:29:30Speaker 01

  Michelle Trachtenberg has such an interesting part in it.

• 1:29:33Dax Shepard?

  Yeah.

• 1:29:34Speaker 01

  And then she passed away today.

• 1:29:36Dax Shepard?

  Yeah, that is weird.

• 1:29:37Speaker 01

  It's really sad. I mean, I don't know any of the details.

• 1:29:41Dax Shepard?

  Nor do I. By the time this is out, maybe there will be some details.

• 1:29:45Speaker 01

  Yeah.

• 1:29:45Dax Shepard?

  But I just go through a checklist in my mind because I like everyone else, or I think we all want to make sense of the world. It's like.

• 1:29:52Speaker 01

  I know.

• 1:29:53Dax Shepard?

  If it's nonsensical, it's very scary.

• 1:29:55Speaker 01

  Exactly.

• 1:29:55Dax Shepard?

  If it makes some kind of sense, I can deal with it. And so I, yeah, I just go 39 is too young to die of all the other things.

• 1:30:03Speaker 01

  Yeah.

• 1:30:03Dax Shepard?

  And then I just start doing like probabilistic guesses.

• 1:30:07Speaker 01

  I know, me too. We all do, I think. And I mean, when things are ruled out, like a car accident or things like that, yeah, we start making.

• 1:30:14Dax Shepard?

  But I remember people, we were pretty early or I was, or I felt no tension for me personally to guess that Matthew Perry had OD'd. But people were really mad at me about that.

• 1:30:26Speaker 01

  Well, you knew him. I mean, that's fair.

• 1:30:29Dax Shepard?

  And it's just, it's my disease. I like, I know.

• 1:30:33Speaker 01

  She did have a liver transplant.

• 1:30:35Dax Shepard?

  Oh, she did. Oh.

• 1:30:37Speaker 01

  It was really sad. So tragic.

• 1:30:42Speaker 01

  And what? That's so weird.

• 1:30:46Dax Shepard?

  Oh, yeah, yeah, yeah, yeah, yeah.

• 1:30:48Speaker 01

  I mean, I haven't, I haven't thought about her in a really long time. And then yesterday, I said it, said her name out loud for the first time. I don't.

• 1:31:02Speaker 01

  My rings back up. That's what Jess said. He says, you really need to be careful.

• 1:31:06Dax Shepard?

  You need to be a little more careful.

• 1:31:09Speaker 01

  What am I supposed to do?

• 1:31:12Dax Shepard?

  Just watch new stuff. Just watch new stuff.

• 1:31:16Speaker 01

  Oh my.

• 1:31:16Dax Shepard?

  I'm rewatching something too. I started something over again.

• 1:31:19Speaker 01

  What?

• 1:31:19Dax Shepard?

  Which I don't really do. I've done Patriot three or four times. But I'm unsatisfied with the amount of Goggins I'm getting in White Lotus.

• 1:31:28Speaker 01

  Oh.

• 1:31:29Dax Shepard?

  It's like it's a, it's a tease hit of Goggins.

• 1:31:32Speaker 01

  I'm not caught up.

• 1:31:33Dax Shepard?

  Okay. Did you watch the first episode? There's only two. Yeah. So it's like. You know, it was like when someone would offer me one Vicodin. And like, I would just go, I would pass. I would go, well, do you have four?

• 1:31:50Speaker 01

  Interesting.

• 1:31:51Dax Shepard?

  And if they'd say no, I go, oh, okay. Thanks for the offer, but I don't want a hint of the feeling I'm going for. I'll just get really agitated.

• 1:32:00Speaker 01

  I understand that.

• 1:32:01Dax Shepard?

  This is no Knock on White Lotus. It's great.

• 1:32:02Speaker 01

  Yeah.

• 1:32:03Dax Shepard?

  It's just an ensemble.

• 1:32:04Speaker 01

  Of course.

• 1:32:04Dax Shepard?

  And I just, I want some gorgon.

• 1:32:06Speaker 01

  So you wish he wasn't even in it?

• 1:32:08Dax Shepard?

  No, no, no, I'm not gonna put him on, I'm not gonna fully map on the Vicodin analogy. But I did start Fallout over again.

• 1:32:17Speaker 01

  Oh, nice.

• 1:32:18Dax Shepard?

  Last night. I'm like, I need to see him for like 17 minutes with no nos, tons of dialogue, making moves.

• 1:32:25Speaker 01

  Yeah.

• 1:32:26Dax Shepard?

  Yeah. And it's, and I watched it recently, but I'm, it's, it's great. O'Sullivan has come up a lot in my life since we interviewed her.

• 1:32:34Speaker 01

  Me too.

• 1:32:35Dax Shepard?

  Yeah.

• 1:32:36Speaker 01

  I loved this episode, but I loved what it made me start thinking about and questioning. And I think everyone is over diagnosed.

• 1:32:45Dax Shepard?

  I think everyone's over diagnosed. And then also it put, I'm glad she asked this like second round of questioning about psychosomatic disorders. Cause I think I was, I kind of, I think I would have guessed about the number she said. Like, it wasn't shocking to me that 30% of all neurological seizures are psychosomatic. Or that 30% of.

• 1:33:06Speaker 01

  That was shocking to me.

• 1:33:07Dax Shepard?

  I know so many people who go to the, I, I personally, I know a lot of people who've gone to the doctor having a heart attack and it's not that, it's anxiety.

• 1:33:15Speaker 01

  Yeah, but a seizure is so.

• 1:33:18Dax Shepard?

  Yeah, you would think like you can't trick it. But then again, I don't, I don't, I've never thought they were tricking them. That's right. Like that's Munchausen where you're, you're faking something. I've, I've thought, no, people are experiencing this. I don't doubt that.

• 1:33:31Speaker 01

  Right.

• 1:33:32Dax Shepard?

  But I didn't go the step further, which I like that she did, which is like, yes, they're psychosomatic. They're not, the cause of them aren't this other thing.

• 1:33:40Speaker 01

  Yeah.

• 1:33:40Dax Shepard?

  But the, the results and the symptoms are actually the same symptoms. They're just as serious. And in fact, more so in, in epilepsy.

• 1:33:48Speaker 01

  Yeah.

• 1:33:49Dax Shepard?

  As she said, an epileptic would probably have one seizure a year, or maybe one a month would be a lot.

• 1:33:53Speaker 01

  Well, medication will help.

• 1:33:54Dax Shepard?

  Hundred seizures a day.

• 1:33:57Speaker 01

  No medication.

• 1:33:58Dax Shepard?

  Yeah, her going, I think I was in the past, like, yeah, that's psychosomatic. You can't do anything about that.

• 1:34:06Speaker 01

  Yeah.

• 1:34:06Dax Shepard?

  Like, it's in your head.

• 1:34:07Speaker 01

  Yeah.

• 1:34:08Dax Shepard?

  So what do we, what would we do? But the notion that she's really screaming, we need treatment for psychosomatic illnesses. They're, it's the same experience.

• 1:34:17Speaker 01

  Exactly.

• 1:34:18Dax Shepard?

  Yeah.

• 1:34:19Speaker 01

  Well, she said, for some people, it helps to know that that's what's happening. And that makes sense. That's almost like a DBT.

• 1:34:27Dax Shepard?

  CBT, DBT.

• 1:34:28Speaker 01

  Yeah.

• 1:34:29Dax Shepard?

  BBT, BBD.

• 1:34:30Speaker 01

  Uh huh.

• 1:34:31Dax Shepard?

  Boys to men. BBD.

• 1:34:33Speaker 01

  A and W.

• 1:34:34Dax Shepard?

  Bellevue. But it's only works 30% of the time.

• 1:34:39Speaker 01

  I know.

• 1:34:40Dax Shepard?

  Which is a bummer. But again, the same with that, um, um, recovery for addicts.

• 1:34:45Speaker 01

  Yeah.

• 1:34:45Dax Shepard?

  Nothing's above 30%.

• 1:34:47Speaker 01

  Yeah.

• 1:34:47Dax Shepard?

  But for me, I'm at least gonna go try the thing that I have a 30% chance at. And for me, it worked. So I think people should still

• 1:34:55Speaker 01

  Try.

• 1:34:56Dax Shepard?

  pursue it, whether it's 30%.

• 1:34:58Speaker 01

  I agree. I wonder how many neurologists know, I mean, do you think they all know this?

• 1:35:06Dax Shepard?

  They must, because

• 1:35:08Speaker 01

  Yeah.

• 1:35:09Dax Shepard?

  As she said, she would start talking to other specialists.

• 1:35:12Speaker 01

  Yeah.

• 1:35:13Dax Shepard?

  Asking the pulmonologist, asking the cardiovascular, asking the

• 1:35:16Speaker 01

  Yeah.

• 1:35:16Dax Shepard?

  And they immediately were like, oh yeah, it's like 30% that aren't actually having the thing.

• 1:35:20Speaker 01

  So weird. Cause like, I had not heard that at all. And I had gone to an, it's not like he said, well, let, let me see if they're psychosomatic. Like, that was not a thing.

• 1:35:32Dax Shepard?

  Right.

• 1:35:33Speaker 01

  At all.

• 1:35:34Dax Shepard?

  Um, but what's, what is unfortunate, and it probably, I'm surprised this didn't come up, because you can delineate the difference. So you can observe the brain having an epileptic surge, uh, seizure versus a psychosomatic seizure, and there's a clear difference.

• 1:35:49Speaker 01

  Yeah.

• 1:35:49Dax Shepard?

  Same with the heart stuff.

• 1:35:50Speaker 01

  Yeah.

• 1:35:51Dax Shepard?

  Same with the breathing stuff, all of it. The mental stuff is not observable.

• 1:35:56Speaker 01

  Yeah.

• 1:35:57Dax Shepard?

  We cannot tell the difference between whether you have psychosomatic depression or any of these disorders.

• 1:36:03Speaker 01

  Yeah.

• 1:36:04Dax Shepard?

  Um, we can't tell if you have some base biology or biochemistry or anything.

• 1:36:11Speaker 01

  Yeah.

• 1:36:12Dax Shepard?

  So what do we do about those?

• 1:36:14Speaker 01

  Like the over diagnosis of ADHD.

• 1:36:16Dax Shepard?

  You could have all the symptoms of ADHD. It would be weird to me that this tracks almost perfectly across all of the different, um, medical conditions. And then it would stop at ADHD.

• 1:36:28Speaker 01

  No.

• 1:36:29Dax Shepard?

  Right?

• 1:36:29Speaker 01

  Yeah. It is, it is.

• 1:36:31Dax Shepard?

  So third, I would argue probably conceivably 30% of people with ADHD, they definitely have the symptoms of ADHD.

• 1:36:38Speaker 01

  Sure.

• 1:36:38Dax Shepard?

  But they don't have ADHD as we think of it.

• 1:36:43Speaker 01

  Yeah, but also because we just decided what that was.

• 1:36:47Dax Shepard?

  Yeah.

• 1:36:47Speaker 01

  Like I, it's not, I mean,

• 1:36:49Dax Shepard?

  Yeah, what level are you distracted?

• 1:36:50Speaker 01

  epilepsy and diabetes are like clinical and medical. And ADHD is, but now we've diluted it into that like,

• 1:37:00Dax Shepard?

  Everyone has it. Right.

• 1:37:02Speaker 01

  And that's just personality traits. I'm going to get in so much trouble for saying that, but I think a lot of it is us taking personality traits that are,

• 1:37:09Dax Shepard?

  And making them disorders.

• 1:37:11Speaker 01

  Yeah, that are our favorite personality traits and calling it a disorder.

• 1:37:16Dax Shepard?

  Yes, but, but she was quick to acknowledge too, even the markers in the heart, let's call them the hard sciences of biology, like taking a blood sugar level.

• 1:37:27Speaker 01

  Yeah.

• 1:37:28Dax Shepard?

  That's a metric.

• 1:37:30Speaker 01

  Yeah.

• 1:37:30Dax Shepard?

  But even if they set it at three or nine or 23 or, that is arbitrary to some degree. They've all decided like, when do we think this really tips into?

• 1:37:41Speaker 01

  Exactly.

• 1:37:42Dax Shepard?

  Something very destructive for the body. And they set a, a number. Then you get into like, okay, attention deficit.

• 1:37:51Dax Shepard?

  What level of fragmented attention?

• 1:37:54Speaker 01

  Requires?

• 1:37:55Dax Shepard?

  Is, before we get to a pathology.

• 1:37:57Speaker 01

  The bar should be that it's disabling.

• 1:37:59Dax Shepard?

  Yes, disabling. Unless you're gonna separate identical twins and raise one with a label and one without a label. And I say this in total good faith, I just wanna know what the best

• 1:38:09Speaker 01

  Yeah.

• 1:38:09Dax Shepard?

  outcome is.

• 1:38:10Speaker 01

  I agree.

• 1:38:11Dax Shepard?

  I'm not really against or for any of it, really. I just would like to know what's the best outcome.

• 1:38:16Speaker 01

  I mean, I think also unfortunately, that's nebulous. It's for, for one person, having a diagnosis is probably very helpful. For another, it could get in their way. I mean, it, it's hard to know.

• 1:38:28Dax Shepard?

  The risk I think I'm most afraid of is that you inadvertently limit someone's potential.

• 1:38:34Speaker 01

  Yeah.

• 1:38:35Dax Shepard?

  Because you accept that this condition has these limits.

• 1:38:39Speaker 01

  I agree.

• 1:38:40Dax Shepard?

  And just setting a limit before it's really discovered is just a little precarious and dangerous.

• 1:38:46Speaker 01

  It's so personality driven. I mean, my brother, I saw my brother last night, which was really nice.

• 1:38:50Dax Shepard?

  Yeah, how was it? What'd you get? Did you go out to eat?

• 1:38:52Speaker 01

  Went to dinner.

• 1:38:53Dax Shepard?

  Where?

• 1:38:53Speaker 01

  All time. It was really nice.

• 1:38:55Dax Shepard?

  Yeah.

• 1:38:55Speaker 01

  But we talked a little bit about this. I, I think he felt like he wasn't good at school.

• 1:39:02Dax Shepard?

  Uh huh.

• 1:39:02Speaker 01

  And then, so then he, I think, subconsciously, and he was like, maybe even a little consciously, just said, fuck it.

• 1:39:09Dax Shepard?

  Yeah.

• 1:39:10Speaker 01

  Like, if I can't do it-

• 1:39:11Dax Shepard?

  You're probably in the mix of that equation, I think. I think he's also going, I'm not gonna be Monica.

• 1:39:17Speaker 01

  Yeah.

• 1:39:18Dax Shepard?

  So-

• 1:39:19Speaker 01

  Maybe.

• 1:39:20Dax Shepard?

  I'm not even gonna try to be Monica.

• 1:39:21Speaker 01

  Yeah.

• 1:39:22Dax Shepard?

  Cause I've decided I'm, I've given up on that. And to even try to improve myself would be seemingly like trying to be her and I can't be her.

• 1:39:29Speaker 01

  That's possible. I mean, he's, yes, he's so different from me. He made a many different choices.

• 1:39:35Dax Shepard?

  I have fucked up my younger sister in lots of ways. I wish I hadn't, but-

• 1:39:39Speaker 01

  Yeah, and I don't, is it fucking them up or just making them? It might just make them have their own, like, really feel the need to define themselves.

• 1:39:48Dax Shepard?

  But like Nikki's life was hugely impacted by having a sister 18 months younger than her that was being told she was beautiful everywhere they went. Like, that just fucked her up. It's not the younger sister's fault.

• 1:40:02Speaker 01

  Of course not, no.

• 1:40:03Dax Shepard?

  But I think living in immediate proximity to somebody is, is, you know.

• 1:40:07Speaker 01

  I guess so. I mean, I think my brother was spared a lot of it because of the eight year gap. Like I was out by the time he was 10, you know?

• 1:40:17Dax Shepard?

  Yeah, but he certainly knew. I'm sure your parents said Monica got these grades or she.

• 1:40:22Speaker 01

  They might. Well, they definitely were shocked at what was going on.

• 1:40:26Dax Shepard?

  Yeah, yeah.

• 1:40:26Speaker 01

  By things that weren't, shouldn't have been shocking.

• 1:40:29Dax Shepard?

  Yeah.

• 1:40:30Speaker 01

  So, yes, I do think maybe the bar was set.

• 1:40:33Dax Shepard?

  Do you think maybe just, because I would have just gone like, yeah, he's a boy.

• 1:40:37Speaker 01

  I said that.

• 1:40:38Dax Shepard?

  You did.

• 1:40:38Speaker 01

  I was like, it's gonna be fine. It was building on itself. Like, the more he felt like he wasn't

• 1:40:46Dax Shepard?

  Falling behind.

• 1:40:47Speaker 01

  doing the right thing, then he would do something else that was not the right thing and something else and something else. Like, it was, it's, yeah. But you know what's also funny is they were so worried, of course, and he's doing great. Just got a promotion. Like, he's great.

• 1:41:01Dax Shepard?

  Yeah.

• 1:41:02Speaker 01

  It all is fine. Everything's fine.

• 1:41:04Dax Shepard?

  This is like, you know, I have a few different friends in my life who, and one just totally admittedly, and I fucking love him, and his honesty and saying is like, he's hell been on getting his kid out of one school into this other school and the kid's evaluated and the other school's like, I think he needs more time at this school and he's taking that personally. And, you know, at a certain point, he, he had the sobriety to go, I want this.

• 1:41:33Speaker 01

  Yeah.

• 1:41:34Dax Shepard?

  My son doesn't want this.

• 1:41:36Speaker 01

  Yeah.

• 1:41:36Dax Shepard?

  I'm, I'm, will run riot. I'm trying to control everything in the world. And it's so true. It's like,

• 1:41:43Speaker 01

  Yeah.

• 1:41:44Dax Shepard?

  you don't have to end up in these places. You don't have to end up in the fucking school and you don't have to end up with good grades.

• 1:41:50Speaker 01

  I know.

• 1:41:51Dax Shepard?

  It's, it's just, it's just one version of how you can go through life.

• 1:41:54Speaker 01

  I know.

• 1:41:54Dax Shepard?

  And I know people have done every version and it has no prediction on their happiness or their fulfillment or their sense of purpose.

• 1:42:01Speaker 01

  I know. I agree. And that's also a ding ding ding of this episode, because that's sort of what she was saying. She's like, the expectation is that everyone's supposed to hit 100 at everything. She's like, it's not realistic.

• 1:42:14Dax Shepard?

  Yeah.

• 1:42:15Speaker 01

  And then we say there's a disorder that's causing them to not, you know, reach the highest potential. And it's just like, that's just life.

• 1:42:21Dax Shepard?

  Two of our best friends, or mutual best friends are, will tell you at the drop of a hat, admittedly, they hardly got through school. They both would be like, we can't, we didn't know anything at school. And they are, I would list, and all the people I've met in my life, they're among the most successful humans I've ever met.

• 1:42:37Speaker 01

  I agree.

• 1:42:38Dax Shepard?

  They have more friends than anyone I know, they have more fun, they're better parents. They've totally made a great living and have a great life.

• 1:42:44Speaker 01

  A hundred percent.

• 1:42:45Dax Shepard?

  And who is a flying fuck? They're a bunch of people we know, you know, much smarter, did way better academically, and they're not having nearly as big of a life.

• 1:42:54Speaker 01

  No, I know, I know. I agree.

• 1:42:57Dax Shepard?

  When you and your dad have a drink, what do they have?

• 1:42:59Speaker 01

  They don't really, I mean, if we're all at dinner, my dad will get beer, I will get wine normally. My mom sometimes will get a cocktail, like a sugary cocktail.

• 1:43:11Dax Shepard?

  Sure, like, um, some kind of paradise?

• 1:43:14Speaker 01

  Yeah, exactly. Sangria.

• 1:43:17Dax Shepard?

  Yeah.

• 1:43:17Speaker 01

  Loves a sangria. And my brother will get like a tequila soda or a

• 1:43:24Dax Shepard?

  Sure.

• 1:43:25Speaker 01

  whiskey something, you know?

• 1:43:27Dax Shepard?

  You and your dad are the drinkers.

• 1:43:28Speaker 01

  Yes.

• 1:43:29Dax Shepard?

  Yeah.

• 1:43:29Speaker 01

  Yeah.

• 1:43:30Dax Shepard?

  And will you and your dad ever get kind of drunk?

• 1:43:32Speaker 01

  Yeah.

• 1:43:33Dax Shepard?

  Yeah.

• 1:43:34Speaker 01

  Well, he does, and so I guess I am, I'm sure I am too. Not drunk, not drunk, but like loose.

• 1:43:43Dax Shepard?

  Yeah, yeah. Loose.

• 1:43:45Speaker 01

  Yeah. But my mom, I'm so critical of my mom.

• 1:43:50Dax Shepard?

  Yeah, that's standard.

• 1:43:52Speaker 01

  And he's so critical of my dad.

• 1:43:54Dax Shepard?

  Yeah, very standard.

• 1:43:55Speaker 01

  I know it was funny because, because Jess was there and he was like, oh, a daddy's girl and a mama's boy, like, duh, classic.

• 1:44:04Dax Shepard?

  Textbook.

• 1:44:05Speaker 01

  And my brother was like, oh yeah, I guess, I guess it is. It's not special. But yeah, it is.

• 1:44:12Dax Shepard?

  It's a lot easier to project onto the same gender.

• 1:44:15Speaker 01

  Yes.

• 1:44:16Dax Shepard?

  Yeah.

• 1:44:17Speaker 01

  It's tough.

• 1:44:18Dax Shepard?

  Yeah, my mom, you know. Currently, I'll give my mom a good run. I was, I was, I would give my father the hardest of runs.

• 1:44:26Speaker 01

  Yeah.

• 1:44:27Dax Shepard?

  Oh, I don't know how he loved me.

• 1:44:28Speaker 01

  It's hard. I mean, my mom and dad are on a cruise right now.

• 1:44:32Dax Shepard?

  They are. Where are they going?

• 1:44:34Speaker 01

  Oh, I forget all these places.

• 1:44:37Dax Shepard?

  In the water.

• 1:44:38Speaker 01

  I don't know, they're somewhere. And they sent a picture, or my mom took a picture and sent it to my brother and I on the group chain. And then I woke up to this and my, all I saw was my brother say, why aren't you smiling? And then he had like laughing emojis and I looked and then yes, my mom had taken like a selfie of the, of her and my dad.

• 1:45:00Dax Shepard?

  Yeah.

• 1:45:00Speaker 01

  My dad is smiling and she is, looks.

• 1:45:03Dax Shepard?

  She's probably nervous about taking the picture.

• 1:45:05Speaker 01

  So yes, I do think that's what it is, but like.

• 1:45:08Dax Shepard?

  She had a lot on her plate.

• 1:45:09Speaker 01

  Of course, my, my brother is laughing and I'm like, yeah, why can't you just, why aren't you smiling?

• 1:45:17Dax Shepard?

  You had the same reaction.

• 1:45:19Speaker 01

  Yeah, I have the same reaction, but his is like, he can, he's like, that's silly.

• 1:45:23Dax Shepard?

  Funny. Yeah, yeah, yeah, yeah.

• 1:45:24Speaker 01

  But I am like, oh, mom, why?

• 1:45:28Dax Shepard?

  Come on, mom.

• 1:45:29Speaker 01

  I know.

• 1:45:30Dax Shepard?

  Yeah, I would have thought, and I'm like, oh yeah, Nirmie's nervous about having to take this selfie.

• 1:45:33Speaker 01

  I know, which is exactly what it is. And she said, oh, I wasn't paying attention. And I was like, yes, what do you mean? Like then you, it's like, of course you were paying attention because you took the picture. That's the.

• 1:45:43Dax Shepard?

  Well, she was paying attention to how to operate the camera, not how to pose in a picture. Yeah. She forgot she was in the picture because she was taking it.

• 1:45:50Speaker 01

  They sent another one yesterday and everyone was smiling.

• 1:45:52Dax Shepard?

  For a smile.

• 1:45:53Speaker 01

  Yeah.

• 1:45:54Dax Shepard?

  Because you're doing to her what they do to women historically, smile more.

• 1:45:57Speaker 01

  I know. Why don't you smile more?

• 1:45:58Dax Shepard?

  You know, you should smile more.

• 1:46:00Speaker 01

  I know. I feel bad, but you know what? This is the way it goes.

• 1:46:02Dax Shepard?

  That's good advice for everybody, not just women. Everyone should smile more.

• 1:46:05Speaker 01

  I agree.

• 1:46:06Dax Shepard?

  Yeah, it's infectious.

• 1:46:07Speaker 01

  It can work the outside in.

• 1:46:09Dax Shepard?

  Right.

• 1:46:10Speaker 01

  But yeah, so I felt bad about that, but what can we do?

• 1:46:15Dax Shepard?

  Yeah, we gotta try to do our best.

• 1:46:18Speaker 01

  We're all just really doing our best.

• 1:46:34Speaker 01

  That was nice to spend some time.

• 1:46:38Dax Shepard?

  And he's off to Big Bear.

• 1:46:39Speaker 01

  He's off to Big Bear with some friends.

• 1:46:41Dax Shepard?

  And did you find out if they're gonna ski?

• 1:46:43Speaker 01

  They're gonna ski.

• 1:46:44Dax Shepard?

  They are gonna ski?

• 1:46:45Speaker 01

  Yeah.

• 1:46:46Dax Shepard?

  And he, your brother has as well?

• 1:46:47Speaker 01

  No, and so now, so, okay, this is another thing. I'm like, why? Why do we do this? Why do we fall into these roles? So, it's so exhausting. It's so exhausting to be like, I'm nervous about him skiing. I'm nervous about him getting to Big Bear at night.

• 1:47:09Dax Shepard?

  Oh, you have all these fears for him?

• 1:47:11Speaker 01

  Yes, cuz he's my eight-year-old young, he's my little brother. Like, it's never going away. And we all, and he mentioned it too at dinner. He said, "You still think of me like that." And I, and I said, "Well, when you're around me, you still act like that."

• 1:47:27Dax Shepard?

  Oh, boy, okay.

• 1:47:28Speaker 01

  It was, it was a good conversation. We were like, smiling, unlike my mom. But, because even when he was trying to park, he like called. Things he wouldn't do if he was meeting somebody else. He reverted to, we're all reverting.

• 1:47:44Dax Shepard?

  I think for Carly and I, it's really interesting because I have such a clear role in our family when we're all together. And that's not the role I wanted in life.

• 1:47:54Speaker 01

  Yeah.

• 1:47:55Dax Shepard?

  And I have purposely become a much different person than I am when I'm fulfilling my role. And so, we were just all together, like, a week ago in San Francisco.

• 1:48:06Speaker 01

  Yeah.

• 1:48:07Dax Shepard?

  And Carly has done a very good job at joining me in my new role. She doesn't force me to be the old role.

• 1:48:16Speaker 01

  Right.

• 1:48:18Dax Shepard?

  And I think that maybe is-

• 1:48:19Speaker 01

  What's the old role?

• 1:48:20Dax Shepard?

  The old role, the old role is depressurizing every situation.

• 1:48:28Speaker 01

  Okay.

• 1:48:29Dax Shepard?

  Lowering the temperature at all times. Intercepting criticisms of different people and making jokes and really just trying to distract the right person who's having a thing, you know? Yeah. That makes my, I hope doesn't sound like I'm throwing my family under the bus, but whatever, that's my role. And I find it quite exhausting. And it's not me. I want to be the person that's deciding how I want to feel. You want other people to depressurize you. Sure, yeah, that would be preferred. Yeah. I don't think I require that too much, but at any rate, I think Carly's done a really good job of recognizing what my role is outside of the main family, adjusting to that.

• 1:49:14Dax Shepard?

  And she herself has her own role, right? I think she was the baby of the family, comparison, sickness. Yep. My oldest brother was my mom's partner, business partner. They built this incredible business together. I'm like at UCLA doing great or whatever, and then getting on TV. It's a lot. Yeah. So I think in her own life, she's been able to be the star of her life, which is fantastic. Yeah. And I try to make her the star of our life as much as I can when we're together. But when we go back, we both snap right in. Yeah. And we had snapped right in for three days, and then we got home and both of us were inordinately exhausted. Like, she took a five-hour nap, was up for two hours, and then slept the entire night through. I too was exhausted. Yeah.

• 1:49:58Dax Shepard?

  And then the following day, I said to her, man, I get exhausted. I'm out of shape for that, my role. And when I have to do it, it's just very exhausting. She's like, oh, my God, yes, same. I was like the baby of the family all over again, and, you know, vying for attention and all the... Oh, interesting. All the things. Yeah. It's a lot. It's a lot. You're not, you've only watched one episode of White Lotus. Yeah. You know, this one family on the show is just vomitous, right? They're just... The North Carolinians? Yes, they're repugnant. And

• 1:50:33Speaker 01

  But they're funny. Well, so far.

• 1:50:35Dax Shepard?

  They're funny.

• 1:50:35Speaker 01

  Yeah.

• 1:50:36Dax Shepard?

  The next episode, you'll see, you're like, oh, my God, you gotta spend your whole life in that dynamic.

• 1:50:41Speaker 01

  Right.

• 1:50:42Dax Shepard?

  I flash forward to like, man, if you have shit kids and you did a bad job raising them and they're assholes and you're an asshole, you deal with that for, you know, it doesn't go away. And you see, stay in this little cancerous puddle of shit talking and fighting and bickering. I'm like, oh, my God, I would hate if that.

• 1:51:00Speaker 01

  But they, I don't think they hate it. Because if it came from, if it comes from the top down.

• 1:51:06Dax Shepard?

  Well, it's just normal for them.

• 1:51:08Speaker 01

  Right, exactly.

• 1:51:09Dax Shepard?

  So, yeah, I don't even think they're so aware of how yucky this situation is. But it's like every kid's grossed out by the other one and judgmental of the other one.

• 1:51:18Speaker 01

  I'm excited to see where this goes, but I'm also confused.

• 1:51:22Dax Shepard?

  It's very weird. Yeah, it's getting, it's only getting weirder.

• 1:51:25Speaker 01

  Oh, my God.

• 1:51:27Dax Shepard?

  Yeah.

• 1:51:27Speaker 01

  Yeah, we just, it's just.

• 1:51:29Dax Shepard?

  It's just normal.

• 1:51:30Speaker 01

  Normal.

• 1:51:31Dax Shepard?

  And you can kind of become numb to it. You have to exit it for a while to, for me.

• 1:51:35Speaker 01

  Yeah.

• 1:51:36Dax Shepard?

  To recognize, like, I wouldn't have been able to describe what my role was until I moved to California.

• 1:51:40Speaker 01

  Exactly, yeah.

• 1:51:41Dax Shepard?

  And I return home and I'm like, oh, right.

• 1:51:42Speaker 01

  Yes.

• 1:51:43Dax Shepard?

  My brother's getting a little heated. I gotta, I gotta get in there with some magic sauce.

• 1:51:49Speaker 01

  I know. I know. I think the same thing. I would have never been able to pinpoint

• 1:51:57Speaker 01

  unless I, without leaving, that like, oh, I'm just making, I feel like I need to make sure everyone is safe.

• 1:52:07Dax Shepard?

  Yeah, yeah.

• 1:52:09Speaker 01

  I would never have been able to put two and two together about that.

• 1:52:12Dax Shepard?

  Right.

• 1:52:12Speaker 01

  Without.

• 1:52:13Dax Shepard?

  So you feel yourself. It's also a great gift, I'll add.

• 1:52:16Speaker 01

  Yeah.

• 1:52:17Dax Shepard?

  I think of how much my relationship with my brother has played out in my professional life. Like Ashton's a great example. Bill Gates is a great example. There's been these folks that I can weirdly be beta, because it's, it's implicit that I'm beta with my older brother. Like, I grew up that way.

• 1:52:37Speaker 01

  Yep.

• 1:52:38Dax Shepard?

  I'm a bit like Delta, though. I'm also kind of, I'll fight, but.

• 1:52:42Speaker 01

  Like, are you beta?

• 1:52:44Dax Shepard?

  Let's just say I've learned how to flatter people that are above me.

• 1:52:49Speaker 01

  Yeah.

• 1:52:50Dax Shepard?

  And honor them and be deferential to them. And then.

• 1:52:55Dax Shepard?

  Come in and still be out of the role with my comedy. If that makes any sense, like very deferential, but then weird zinger that like a beta wouldn't try.

• 1:53:06Speaker 01

  Yeah.

• 1:53:07Dax Shepard?

  That ends up allowing me to rise up a bit and join them more as a peer. Like I'd have these moments with my brother, of course, as any younger brother probably has is like, there would be peership quite often.

• 1:53:21Speaker 01

  Yeah.

• 1:53:21Dax Shepard?

  Often we're both racing go karts and it's equally as fun and it's the thing.

• 1:53:25Speaker 01

  Yeah.

• 1:53:25Dax Shepard?

  And then there's another dynamic where he's the older brother and I'm annoying and I gotta shut up. But I could break through and we'd have very peer to peer moments.

• 1:53:32Speaker 01

  Yeah.

• 1:53:32Dax Shepard?

  And I got good at manufacturing those or, or instigating them.

• 1:53:37Speaker 01

  Yep.

• 1:53:38Dax Shepard?

  And so I was thinking when I was with Bill, it's like, I have this weird thing where I revere him so much and I couldn't be more deferential. I'll also tease him.

• 1:53:48Speaker 01

  Yeah.

• 1:53:48Dax Shepard?

  Right? And so I got that from practice with my brother.

• 1:53:54Speaker 01

  Yeah. That's so, now that you're saying it like that.

• 1:53:59Speaker 01

  I think, cause you know, you do, I mean anthropology and all of these reasons, there's a million reasons why, but you have, you pay attention a lot to status.

• 1:54:11Dax Shepard?

  Yeah.

• 1:54:12Speaker 01

  And alpha, beta, all these things.

• 1:54:14Dax Shepard?

  Yeah.

• 1:54:15Speaker 01

  It's very much on your mind a lot.

• 1:54:17Dax Shepard?

  Mm hmm.

• 1:54:17Speaker 01

  And in the way you think about the world.

• 1:54:19Dax Shepard?

  Mm hmm.

• 1:54:20Speaker 01

  And.

• 1:54:21Dax Shepard?

  Can I add really quick why?

• 1:54:24Dax Shepard?

  My dream is to be peer to peer with everyone.

• 1:54:26Speaker 01

  Yeah.

• 1:54:26Dax Shepard?

  I don't want to be silencing myself because I don't have the status.

• 1:54:32Speaker 01

  Yeah.

• 1:54:32Dax Shepard?

  To be myself.

• 1:54:33Speaker 01

  Yeah.

• 1:54:34Dax Shepard?

  So it's like, yes, I'm in a race to be able to just be myself.

• 1:54:37Speaker 01

  Yeah. No, yeah.

• 1:54:39Dax Shepard?

  Yeah.

• 1:54:39Speaker 01

  But I think that's weirdly because you are a younger sibling. Like I don't have that.

• 1:54:48Dax Shepard?

  Yeah, you were built in alpha.

• 1:54:50Speaker 01

  Right. I, but I don't think, I'm not thinking about that ever though.

• 1:54:56Dax Shepard?

  Right.

• 1:54:56Speaker 01

  And I'm never thinking like. Oh, I'm in, I've never, I just, it's not even a part of the, my processes.

• 1:55:06Dax Shepard?

  But can I say one thing I can observe about you?

• 1:55:09Speaker 01

  Yeah.

• 1:55:10Dax Shepard?

  When you aren't.

• 1:55:11Speaker 01

  Yeah.

• 1:55:12Dax Shepard?

  When you're in a very rigid status structure and you're not equal, it really rubs you the wrong way.

• 1:55:20Speaker 01

  That's an interesting question.

• 1:55:21Dax Shepard?

  So I don't know if you know why it's so uncomfortable to you, but I think that's why is you just had baseline, you were the alpha, you, you were older.

• 1:55:29Speaker 01

  Mm hmm.

• 1:55:30Dax Shepard?

  And then you get in these situations where people have much higher status than you and you're like, oh, what the fuck is this?

• 1:55:34Speaker 01

  But well, depends because it might, I mean, I don't know what you're referring to. You can tell me, I'm happy to hear it. But I think what I'm allergic to is people feeling like they are above. Because I, I'm like, for me, I'm like, I don't under, I don't understand what that is. We should all be peers. Like, I don't feel like that around Bill Gates. I wasn't like, oh, God, I'm like uncomfortable talking to him or that didn't, that doesn't scare me.

• 1:56:08Dax Shepard?

  Well, that, no, I,

• 1:56:09Speaker 01

  I guess I'm also not trying to get his like approval.

• 1:56:12Dax Shepard?

  I don't think, it's not about being scared to talk to him. You recognize he has earned the right to take up the most space. If we're sitting and we're talking about biology or literally any topic in the world.

• 1:56:27Speaker 01

  Well, no, see, that's where I disagree with you. I don't think literally any topic in the world, he has the right to talk the most. On so many topics, he does because he has an expertise there. But I don't, I'm not in a room with somebody and think just because they have done X, Y, and Z, or become this, or famous, or.

• 1:56:51Dax Shepard?

  Well, that's not a real thing, but knowledge is. So me and Neil deGrasse Tyson, the three of us are hanging out.

• 1:56:57Speaker 01

  Yeah.

• 1:56:58Dax Shepard?

  I shouldn't take up any amount of the time talking about astrophysics. It's ridiculous because he is, that's his thing.

• 1:57:04Speaker 01

  That's his thing.

• 1:57:05Dax Shepard?

  And Bill, uniquely, you and I can't cover it. There's maybe one or two topics.

• 1:57:11Speaker 01

  Talking about his tie that was on the floor, his Tom Ford tie.

• 1:57:14Dax Shepard?

  Yeah.

• 1:57:14Speaker 01

  I am more than happy to take up space in that conversation.

• 1:57:18Dax Shepard?

  That's right. And that's one you have and we could count them. I might have automotive knowledge over him.

• 1:57:24Speaker 01

  Yeah, great.

• 1:57:25Dax Shepard?

  But in general, you and I aren't going to be around anybody ever. Who who has a more comprehensive knowledge of all things.

• 1:57:34Speaker 01

  Yeah.

• 1:57:34Dax Shepard?

  Like that man. You and I are gonna have a couple of things.

• 1:57:38Speaker 01

  Sure.

• 1:57:38Dax Shepard?

  When you and I meet a normal person, it's very equal. We probably know equal amounts about the world.

• 1:57:44Speaker 01

  Yeah.

• 1:57:44Dax Shepard?

  But Bill knows the entire history of the planet.

• 1:57:47Speaker 01

  Yeah.

• 1:57:47Dax Shepard?

  Geologically and chemically.

• 1:57:49Speaker 01

  I'm not uncomfortable with him having that knowledge and me not.

• 1:57:53Dax Shepard?

  I'm not either.

• 1:57:54Speaker 01

  I think it's great. He should he should keep, let's engage about it.

• 1:57:58Dax Shepard?

  Absolutely. And you're deferential because you know better than to enter the conversation about the green revolution or biology while he's giving information because it would be a waste of everyone's time. You're not gonna add more than he can add to it. There's a reality to the space that can be taken up and who should take it up? Because who has the expertise? That's just a reality of life.

• 1:58:21Speaker 01

  I mean.

• 1:58:22Dax Shepard?

  If it's fashion, you should be talking.

• 1:58:24Speaker 01

  But it depends on, I I guess it's like if I'm in a one-on-one conversation or the four of us are together.

• 1:58:32Dax Shepard?

  Group dynamic. That's where it's really relevant.

• 1:58:34Speaker 01

  Dynamic with four people on a plane. It's not like he's, it's not like he's on a stage.

• 1:58:42Dax Shepard?

  No.

• 1:58:43Speaker 01

  And he's giving a lecture. This is, these are people in conversation.

• 1:58:47Dax Shepard?

  Yeah.

• 1:58:48Speaker 01

  I think it's totally allowed for anyone to ask a question, to bring up a topic, to say a thing. I don't think it's like, well, we have to sit here in silence and let Bill just talk for four hours because he's the smartest person here. I don't think that at all.

• 1:59:02Dax Shepard?

  You're being pretty extreme about it. Like, shut up and let Bill talk for four hours? I'm saying if we're talking about software, if the conversation is about software.

• 1:59:11Speaker 01

  Yeah.

• 1:59:12Dax Shepard?

  You and I should have much less to say than Bill Gates has to say. We could give some experiential experience.

• 1:59:18Speaker 01

  Agreed.

• 1:59:19Dax Shepard?

  You know, some firsthand anecdotal account of how we feel about interacting with software. But he should probably do most of the talking about that.

• 1:59:27Speaker 01

  Yeah, I don't disagree with that.

• 1:59:29Dax Shepard?

  Great. So we agree on it on software. And what I'm saying about Bill is you can pretty much then add any category of knowledge and that's consistent with him. He's uniquely like this.

• 1:59:41Speaker 01

  Yeah. I'm not arguing with you about that. I don't under- but I don't feel, I don't feel inadequate.

• 1:59:49Dax Shepard?

  I don't either. This isn't a question of value. I think you're, you're having a conversation about value as humans and I'm having a conversation about deference to knowledge.

• 2:00:00Speaker 01

  Yeah, but you're saying I'm uncomfortable in those situations, but I don't feel uncomfortable in that situation.

• 2:00:05Dax Shepard?

  I'm talking about someone doesn't have a chair for you at the thing and wants you to sit somewhere and it's like, it levels you.

• 2:00:10Speaker 01

  Yeah, that to me is not, that, that's like a human respect thing. That's not about who should have, who should have, who has knowledge or who has something to say. It's if, if you're, you come to a party and there's no chair for you there.

• 2:00:27Dax Shepard?

  Yeah.

• 2:00:28Speaker 01

  I don't think that's unique in feeling like, ah, that doesn't feel good.

• 2:00:33Dax Shepard?

  Right, but if, if the table you wanna sit at happens to be a table of people on television at the Golden Globes and you feel disrespected that you're not allowed to sit at that table, even though you're not that thing.

• 2:00:49Speaker 01

  Yeah.

• 2:00:50Dax Shepard?

  That would be, in my opinion, in denial of reality. Which is like, it's a table for people on television, on a show about television.

• 2:01:03Speaker 01

  To be fair, that's not, that hasn't happened.

• 2:01:05Dax Shepard?

  No, but what was the thing that you didn't have, it was a?

• 2:01:08Speaker 01

  It was a, it was a gala of sorts or something that I was with Kristen. She was invited. She told them she was bringing me. She was bringing, I was her assistant at the time.

• 2:01:20Dax Shepard?

  Yeah.

• 2:01:21Speaker 01

  So yes, no, I wasn't like, yeah, I should be invited to this gala. That's the difference. I wasn't like, oh yeah, I belong here. I came as her guest.

• 2:01:30Dax Shepard?

  Uh huh.

• 2:01:31Speaker 01

  And then, yeah, there wasn't a seat and they had to move one and put one in the middle of the thing and it was very uncomfortable. That has not, that wasn't, I wasn't like, well, I deserve to be at this table and why isn't there a seat for me? It was, oh my God, this is so uncomfortable. I'm, I'm obviously not supposed to be here. It's become way more obvious now that there's a chair blocking everybody that they scooted over that Mariska Hargitay is like, you can share my seat with me. Like, that's uncomfortable. That's not because I think.

• 2:02:06Speaker 01

  I should have been invited all along, or I should have been.

• 2:02:11Speaker 01

  That's, there's a difference there. I mean, maybe you're different. I think anyone in that situation.

• 2:02:18Dax Shepard?

  I think I have a ton of experience with that situation. Which is like my whole childhood, I tried to sit at a table that he decided sometimes I was old enough to, and sometimes I wasn't.

• 2:02:30Dax Shepard?

  Or I wanted to join in an activity that sometimes I was old enough for and cool enough for, and sometimes I wasn't. So I have a ton of experience that, with that.

• 2:02:39Speaker 01

  Yeah, but you don't like it, just like I don't. Like, if you had gone, if you've even said it, you're like, even at the, at the Golden Globes, like, when there's a shot on Kristen, what do you do? Do you get in it? Do you stay out of it? It's, it's uncomfortable when you don't know your place. That's normal to think like, this is uncom- this is weird.

• 2:03:00Dax Shepard?

  Yeah. Yeah. So I, I just know that, um, I'm very used to being low status and being disinvited. And so it doesn't, it's not new to me. It's not novel.

• 2:03:11Speaker 01

  It's not new to me either, as far as

• 2:03:17Speaker 01

  feeling like I'm not enough, growing up, feeling like I'm not enough.

• 2:03:22Dax Shepard?

  Yeah.

• 2:03:22Speaker 01

  So I have to do these things to be enough.

• 2:03:26Dax Shepard?

  My thing with Bill Gates is, I don't have a, there's no, there's no right or wrong, there's no value for me, there's no, um, there's no injustice. I, I'm going to shut up when we're talking about things that he knows a lot more. And also, I'm going to recognize, I have comedy and he doesn't. So I'm going to take up a lot of space comedically, because it's real. I deserve to take up a lot of space comedically, and everyone likes to laugh, and he likes to laugh too. And so I know what zone I should be being a tall poppy in. And I know which ones I shouldn't.

• 2:04:07Speaker 01

  Right.

• 2:04:08Dax Shepard?

  And I think that's a good skill set for people to have.

• 2:04:12Speaker 01

  Yeah.

• 2:04:13Dax Shepard?

  I think it's Dunning Kruger if you don't have it. I think if you think you should be educating Bill on software or any other topic mostly.

• 2:04:20Speaker 01

  Yeah, I mean, I don't know anyone who's. I don't think anyone would do that.

• 2:04:24Dax Shepard?

  A lot of people don't recognize that you should evaluate whether you're adding value to something.

• 2:04:31Speaker 01

  Sure, of course.

• 2:04:32Dax Shepard?

  Well, I don't know, of course. Like, if it's just everyone has the right to talk equal amounts in all situations.

• 2:04:38Speaker 01

  Well, part of it is social awareness. There's social awareness.

• 2:04:41Dax Shepard?

  That's what I'm arguing for. I happen to be framing it in status because that is a big elephant in the room in social awareness. If you are three months into the job and you're at the board meeting and you're gonna take up all the time when the CEO's been doing it for 25 years, that is, you're blind to the reality of that situation.

• 2:05:01Speaker 01

  Mm-hmm.

• 2:05:02Dax Shepard?

  And I think you, I don't think it's wrong that some people take up more space at times than others. I don't think everyone's entitled to equal space. That's what, maybe that's the underbelly of what I'm rejecting about your argument, is that everyone deserves equal space at all times.

• 2:05:18Speaker 01

  Well, I didn't, when did I say that?

• 2:05:20Dax Shepard?

  Well, you're saying, "I'm gonna talk, everyone should talk the same, there shouldn't be so..."

• 2:05:23Speaker 01

  I didn't say "the same."

• 2:05:24Dax Shepard?

  Okay.

• 2:05:25Speaker 01

  I said, "Everyone should be able to, in a conversation, provide a question, an anecdote, a..." Not be afraid to talk. I don't think people should be afraid to talk.

• 2:05:36Dax Shepard?

  No.

• 2:05:36Speaker 01

  I think you should know when, in any conversation you're having with anyone, doesn't matter status, doesn't matter anything, if you're the only one talking, if you're making everything about yourself, if you're, that you don't have social awareness. That's a big problem for people.

• 2:05:52Dax Shepard?

  Yeah.

• 2:05:52Speaker 01

  But I don't, the status element of that is, is, to me, irrelevant. It's understanding a social dynamic when you're in it and being able to read that.

• 2:06:03Dax Shepard?

  I think you and I often use words, we have different definitions for words and then we keep bumping up against each other. Like, the way I use alpha is, you have a very negative connotation of alpha.

• 2:06:14Speaker 01

  A lot of people do, yeah.

• 2:06:15Dax Shepard?

  Yeah, great. Ton of people do. I have a very anthropological definition of alpha and beta and all these things.

• 2:06:22Speaker 01

  Mm-hmm.

• 2:06:23Dax Shepard?

  And I think status, for you, is like, that's a negative word.

• 2:06:28Speaker 01

  Yeah, I think, I think chasing it is, is, leads people to be crazy.

• 2:06:34Dax Shepard?

  And I think what you're, I think what you're saying is popularity.

• 2:06:38Speaker 01

  No.

• 2:06:39Dax Shepard?

  Okay. So for me, status is not negative. It's a reality of social creatures. It's not negative or positive. It is the actual structure of of social hierarchy.

• 2:06:51Speaker 01

  Yep, I agree.

• 2:06:52Dax Shepard?

  So it's like, it's not good or bad. It's it's a real thing that all social animals adhere to.

• 2:06:59Speaker 01

  Mm hmm.

• 2:07:00Dax Shepard?

  And then in any given context, status is achieved in different ways. On a basketball court, it's one way.

• 2:07:06Speaker 01

  Totally.

• 2:07:07Dax Shepard?

  In an intellectual conversation with Bill Gates, it's that way. In a investors meeting, it's money. In some other domain, it's looks.

• 2:07:16Speaker 01

  Sure.

• 2:07:17Dax Shepard?

  Yeah.

• 2:07:17Speaker 01

  Yeah, all that's true. I agree. I think status, status to me is problematic when you are chasing it and manipulating your way in it's not by effort or prowess, but by manipulation, you will, you want to be at the top of that totem pole.

• 2:07:39Dax Shepard?

  I think everyone should pursue status. I think your life is better the more status you have in any given situation. And I think what you should not do is misuse status. I think the real issue maybe that people have in conflating these is they're thinking of how people misuse and mistreat others because they have status, which I would be in lockstep agreeing. That's the problem. People being dismissive of people not hearing people.

• 2:08:11Speaker 01

  Yeah, that's a problem. But there is a huge problem in social climbing. It's disgusting and it is repellent. People who who are around it.

• 2:08:21Dax Shepard?

  Are we disgusting for trying to be the number one podcast?

• 2:08:25Speaker 01

  That's it. That's a skill.

• 2:08:26Dax Shepard?

  Yes, everything's a skill. If you want status in the math 55 class at Harvard, you have to get the highest on the test. That will give you the status of smartest mathematician.

• 2:08:37Speaker 01

  No, what I'm speaking of for a lot of people now is followers.

• 2:08:42Dax Shepard?

  See, that's I think you're always using status as popularity. I think that's why we fight.

• 2:08:46Speaker 01

  Well, in this world, it's connected.

• 2:08:51Dax Shepard?

  But status in the math class is the highest test. Status in the podcast world is your ranking.

• 2:08:56Speaker 01

  Yeah.

• 2:08:56Dax Shepard?

  And you should always try. That's why I'm saying you should try to climb status. That means you're the best at the thing you're doing.

• 2:09:02Speaker 01

  Try to be your best at what you're doing. I agree.

• 2:09:05Dax Shepard?

  Yeah.

• 2:09:05Speaker 01

  But I'm talking about social climbing.

• 2:09:09Speaker 01

  That's a different beast.

• 2:09:11Dax Shepard?

  I don't think you should try to be the most popular person in your friendship group.

• 2:09:15Speaker 01

  Yeah, or in the world. Like, that's the, that's, that you have the most followers, or the most approval, or the most likes, or the most famous friends.

• 2:09:26Dax Shepard?

  I'm trying to help us, because I think when we're arguing so much, you think I'm making a, I'm in support of chasing popularity.

• 2:09:35Speaker 01

  Right.

• 2:09:35Dax Shepard?

  And I'm not.

• 2:09:36Speaker 01

  Yeah.

• 2:09:37Dax Shepard?

  And I'm not talking alpha like you bark orders at people.

• 2:09:40Speaker 01

  Oh, yeah, I know that.

• 2:09:41Dax Shepard?

  I'm talking about who in the room do you most trust to make the decision about X, Y, or Z?

• 2:09:46Speaker 01

  Yeah.

• 2:09:47Dax Shepard?

  That's alpha, and it can change in every context.

• 2:09:50Speaker 01

  I, I agree. When we had Allison on about conversation, and we talked about group conversations, yes, that's, she's like, at any given moment, somebody has the status.

• 2:10:03Dax Shepard?

  Yeah.

• 2:10:03Speaker 01

  But part of it is understanding, everyone does have status in different domains.

• 2:10:08Dax Shepard?

  That's right.

• 2:10:09Speaker 01

  Even when we talk about like a CEO or something.

• 2:10:11Dax Shepard?

  Yeah.

• 2:10:12Speaker 01

  I actually think it, it has to be very, you have to be very aware when you are the CEO, or the person on top, that everyone defers to you as having the most status because you're in charge.

• 2:10:23Dax Shepard?

  Yeah.

• 2:10:24Speaker 01

  But let's say you're talking about something very specific, and probably you don't know as much as the, your employee or something.

• 2:10:32Dax Shepard?

  You have to police yourself a ton, if you have status, to not presume status in all domains when you don't have it.

• 2:10:41Speaker 01

  Yeah, and allow other people.

• 2:10:42Dax Shepard?

  But when you say chasing status is repugnant, like, you and I would have, like, we're totally crossing paths at that point.

• 2:10:48Speaker 01

  What?

• 2:10:49Dax Shepard?

  When you say chasing status is repugnant.

• 2:10:52Speaker 01

  Yeah.

• 2:10:52Dax Shepard?

  We're like totally crossing lines. Like, we're talking about completely different things.

• 2:10:56Speaker 01

  That's fine.

• 2:10:57Dax Shepard?

  Yeah.

• 2:10:57Speaker 01

  Okay, hold on. A couple of facts for Suzanne. Okay, sonic weapons. Sonic weapons affect, can they, can they affect the brain? Yes. Acoustic weapons? Use sound waves to injure or incapacitate an opponent by emitting very loud noises that they can cause pain, nausea, dizziness, and even permanent hearing loss. You said you want a one in the bathroom.

• 2:11:21Dax Shepard?

  To make me shit.

• 2:11:22Speaker 01

  Yeah.

• 2:11:23Dax Shepard?

  I basically had that today.

• 2:11:26Speaker 01

  You had a sonic boom?

• 2:11:27Dax Shepard?

  Well, I did three servings of Metamucil yesterday, spaced out throughout the day. Well.

• 2:11:34Speaker 01

  Were you constipated?

• 2:11:36Dax Shepard?

  I was underwhelmed with what I was getting.

• 2:11:39Speaker 01

  Yeah, me too.

• 2:11:40Dax Shepard?

  I almost prefer constipation to 40% output. I'm like more bothered by 40%. I'm like, what is going on?

• 2:11:49Speaker 01

  I know.

• 2:11:49Dax Shepard?

  So I went really, really hard yesterday. And then, you know, I have a routine in the morning, as you know.

• 2:11:57Speaker 01

  Yep.

• 2:11:57Dax Shepard?

  But I was like mid meditation, I'm like, am I going to have to quit my meditation?

• 2:12:02Speaker 01

  Wow.

• 2:12:03Dax Shepard?

  We know you got to get through your meditation, but it was dicey. And I'm like, there's no way I can journal through this.

• 2:12:09Speaker 01

  Wow.

• 2:12:09Dax Shepard?

  Yeah.

• 2:12:10Speaker 01

  Well, that's good. You fixed your problem.

• 2:12:11Dax Shepard?

  Yeah.

• 2:12:11Speaker 01

  We wouldn't recommend three servings of Metamucil. I think go by the jar. No, go by the prescription amount on the jar.

• 2:12:19Dax Shepard?

  I might do three more today. I have very high status right now in evacuation.

• 2:12:24Speaker 01

  You do, because mine isn't going well today. Um, Teddy Roosevelt did have asthma. As you said, he was a sickly boy.

• 2:12:33Dax Shepard?

  But cured by his time on the ranch.

• 2:12:35Speaker 01

  Exactly. And then I think his was psychosomatic.

• 2:12:38Dax Shepard?

  Yeah, maybe.

• 2:12:39Speaker 01

  Because if he got cured by the ranch, which is outside and lots of dusties.

• 2:12:43Dax Shepard?

  Uh huh.

• 2:12:43Speaker 01

  Doesn't make sense.

• 2:12:44Dax Shepard?

  Working with animals, he was on horseback.

• 2:12:46Speaker 01

  Dander.

• 2:12:47Dax Shepard?

  Dander, pet dander.

• 2:12:48Speaker 01

  Yeah, right. Okay, have we reduced the number of amputations from diabetes? Yes, we have, but.

• 2:12:55Dax Shepard?

  Asterix.

• 2:12:56Speaker 01

  Asterix, because care is much better.

• 2:13:00Dax Shepard?

  Right.

• 2:13:01Speaker 01

  For like, to catch before you're going to have to have an amputation. It doesn't mean we've done better, really. As far as lowering diabetes problems by diagnosing it more.

• 2:13:12Dax Shepard?

  This is like the gun, the death by gunshot data is misleading.

• 2:13:15Speaker 01

  Exactly.

• 2:13:16Dax Shepard?

  We've just got really good at treating gunshot wounds. Just many people are getting shot.

• 2:13:20Speaker 01

  Yep. Videos associated with the hashtag autism hashtag accrued 11.5 billion views collectively.

• 2:13:26Dax Shepard?

  Billion?

• 2:13:27Speaker 01

  Yeah.

• 2:13:28Dax Shepard?

  Billion, whoa.

• 2:13:29Speaker 01

  An examination of the top 133 videos providing informational content on autism, which totaled 198.7 million views and 25.2 million likes, showed that 27% of the videos were classified as accurate. Well, 41% were classified as inaccurate and 32% as overgeneralized. She got that stat, she nailed it.

• 2:13:51Dax Shepard?

  That's a, that's a disheartening stat.

• 2:13:54Speaker 01

  I know.

• 2:13:54Dax Shepard?

  If you're getting your medical information from TikTok.

• 2:13:57Speaker 01

  Yeah, exactly. And then she also said one in five people in the world has a mental health diagnosis, correct again, according to the National Institute of Mental Health.

• 2:14:07Dax Shepard?

  In the world?

• 2:14:08Speaker 01

  One, United States.

• 2:14:10Dax Shepard?

  Oh, I was gonna say, that seems high for the world.

• 2:14:13Speaker 01

  United States, one in five.

• 2:14:15Dax Shepard?

  Indians aren't fucking with all these diagnoses, yeah.

• 2:14:17Speaker 01

  I don't know.

• 2:14:18Dax Shepard?

  Our guest Blaze is like, there's not a single CBT certified therapist in a country of a billion people.

• 2:14:24Speaker 01

  But he's, but there's a high rate of suicide, that's why he's going there, so they, there is.

• 2:14:29Dax Shepard?

  I just don't think they've been diagnosed yet.

• 2:14:30Speaker 01

  Yeah, maybe not.

• 2:14:31Dax Shepard?

  They'll get there. There's a great signal in developing.

• 2:14:36Speaker 01

  It's true.

• 2:14:37Dax Shepard?

  Yeah, you'll stop having kids and you'll have a ton of mental health issues.

• 2:14:40Speaker 01

  Exactly.

• 2:14:41Dax Shepard?

  All to aim for.

• 2:14:42Speaker 01

  Well, they've had a ton of mental health, so then this is another one of the, like, they have mental health stuff, a lot.

• 2:14:49Dax Shepard?

  Yeah.

• 2:14:49Speaker 01

  But it's, it's not diagnosed, but is that better? Cause it's still, it's all the same if people are suffering, I guess.

• 2:14:57Dax Shepard?

  I think it ends up being mutually assured annihilation at some point, where it's like everyone has a diagnosis and everyone stops caring.

• 2:15:03Speaker 01

  Yeah, so one in five adults have a diagnosed mental health condition. That's, I'm in there. So, that's it.

• 2:15:13Dax Shepard?

  That's it.

• 2:15:13Speaker 01

  That's it for Dr. Susano Sullivan.

• 2:15:15Dax Shepard?

  All right.

• 2:15:16Speaker 01

  Okay, bye.

• 2:15:17Dax Shepard?

  Love you.