The Truth About Pain and Happiness, featuring Dr. Chris Good

When something hurts, our first instinct is to make it stop. But what if stopping it makes us suffer more? In this episode of Office Hours, I'm joined by Dr. Christopher Good https://www.instagram.com/dr.chris_good, a pioneering spine surgeon and president and CEO ofVSI https://www.spinemd.com/. We discuss what he's learned from a career treating back pain, one of the most common sources of chronic pain. He shares how he helps patients set realistic goals and why managing pain requires both acceptance and action. As always, we give practical steps to live fulfilling lives even when some pain remains, and how to use that pain for good. *** Are you interested in helping others through the science of happiness? I have a new three-day program—⁠learn more here⁠ https://www.arthurbrooks.com/happiness-scale-certification. — Brought to you by: • Noble Mobile https://noblemobile.com/arthurbrooks—With Noble, there is only one plan: The No-Bull Plan. It’s simple. It’s transparent. And if you use less data, you get cash back. Get an exclusive offer at:https://noblemobile.com/arthurbrookshttps://noblemobile.com/arthurbrooks. — Where to find Dr. Christopher Good: • YouTube: https://www.youtube.com/c/VirginiaSpineInstitute • LinkedIn: https://www.linkedin.com/in/drchristopher-good • Instagram: https://www.instagram.com/dr.chris_good • Website: https://linktr.ee/dr_good Where to find Arthur Brooks: • Website: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://arthurbrooks.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://arthurbrooks.com/ • In-person Retreats: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://retreats.arthurbrooks.com/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://retreats.arthurbrooks.com/ • Newsletter: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.arthurbrooks.com/newsletter⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.arthurbrooks.com/newsletter • X: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://x.com/arthurbrooks⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://x.com/arthurbrooks • Instagram: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/arthurcbrooks/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.instagram.com/arthurcbrooks/ • Facebook: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.facebook.com/ArthurBrooks/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.facebook.com/ArthurBrooks/ • YouTube: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.youtube.com/channel/UCGuyFRjJQFGCKzfHTBvWM6A⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.youtube.com/channel/UCGuyFRjJQFGCKzfHTBvWM6A • LinkedIn: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/arthur-c-brooks/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.linkedin.com/in/arthur-c-brooks/ • Email: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠[email protected]⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ mailto:[email protected] — Timestamps: (00:00) Intro (05:00) The problem with Aristippus’s philosophy on pleasure and pain (13:15) Pain and the fear-avoidance model (17:07) The two kinds of pain (19:41) Wisdom from Buddhism on suffering vs. pain (22:44) Learning to accept pain (25:34) Introducing Dr. Christopher Good (27:38) Dr. Good’s background in spine care (30:47) How Dr. Good’s father’s injury sparked his interest in spine care (35:51) Why back pain is so common (38:30) Dr. Good’s approach to helping patients set realistic goals (42:50) The biopsychosocial model of medicine (45:26) How Dr. Good’s work has changed him (50:10) The importance of pairing acceptance with agency (58:44) Lessons from pain management for our relationships (1:01:52) Dr. Good’s plans for aging well (1:07:29) Q&A: Finding happiness while dealing with health problems (1:09:01) Q&A: Supporting a loved one with severe chronic pain (1:11:12) 5 big lessons from the conversation — Referenced: • The Meaning of Your Life: Finding Purpose in an Age of Emptiness:http://themeaningofyourlife.com/themeaningofyourlife.com http://themeaningofyourlife.com • Arthur’s newsletter:https://www.arthurbrooks.com/newsletter • The Happiness Scale:https://learn.arthurbrooks.com/the-happiness-scale • Anhedonia: https://my.clevelandclinic.org/health/symptoms/25155-anhedonia • Pleasure systems in the brain: linkinghub.elsevier.com/retrieve/pii/S0896627315001336 http://linkinghub.elsevier.com/retrieve/pii/S0896627315001336 • ... References continued at: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.arthurbrooks.com/office-hours⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://www.arthurbrooks.com/office-hours

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

• 0:00Speaker 00

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• 0:26Arthur Brooks?

  Today's episode is about the pain that you will have in your life inevitably. You need to feel pain. If you didn't feel pain, you'd be dead in a week. Eructically, for a lot of people, the goal in most cases of pain in our lives is not elimination. It's management. It's understanding pain that we have, why we have it, and managing it as opposed to going to all these great lengths to eliminate it, in both the physical and the psychological case. There are cases in which pain can be high and suffering can be low, because you're not just trying to lower the pain, but you're lowering your resistance to that pain. This is a two-part episode, one where we look at the theory and ideas behind pain

• 1:09Arthur Brooks?

  and happiness, and then we talk to somebody whose job it is to help relieve people's pain, and when he can't, to help people live with the pain that can't be relieved.

• 1:28Arthur Brooks?

  Hey friends, welcome to Office Hours. I'm Arthur Brooks. I'm the host of your show about love and happiness, how you can bring more of it to your life and more of it to the lives of other people. We do work on the show that ranges from philosophy to neuroscience to psychology and behavioral economics, and even a whole bunch of biology, which is what we'll be talking about in this show today. Today's show is about pain. I know, this is a show about happiness. Why would I talk about pain? Well, you'll see. The truth is that most people get interested in the subject of happiness, not because they're super happy, but because they want more of it. They're thinking about the lack of happiness in their lives, or alternatively, there's too much unhappiness and they want to understand that.

• 2:11Arthur Brooks?

  Often, unhappiness has a lot to do with the pain that they have in their lives. Physical pain, psychological pain, emotional illness sometimes, like depression and anxiety. These are very common parts of life and we need to understand them. We need to understand how a fully functioning life has a lot of pain and suffering in it, not so that we can try to eliminate it, but so that we can understand it, manage it, in many cases, accept it. Today's episode is about the pain that you will have in your life inevitably. Well, depends on you, exactly what form it takes, but how you can live the best possible life with the most possible happiness with the pain and suffering that's in your life.

• 2:55Arthur Brooks?

  I'm going to do two things in this show. I'm going to start with a small mini lecture about suffering and pain and its link to happiness. There's a big literature on this, which I'll talk about. That'll take me 10 or 15 minutes. And then I have a guest, a guest I've been looking forward to for a long time, Dr. Chris Good. He's a spine surgeon. He's a very famous spine surgeon in the Washington DC region, and the reason I know him is because I have back problems. And I learned that this was really the best person to talk to, and I got to know him. Now, getting to know him has been really valuable for me, because he's not just a back surgeon, he's somebody who's really interested in behavior and social science and all the stuff that we talk about on this show.

• 3:37Arthur Brooks?

  We've become friends, we've actually exchanged ideas, we've exchanged things to read, even some tips on the biology that is his stock and trade. So you're going to get to know him. I'm looking forward to that, because this is a two-part episode, one where we look at the theory and ideas behind pain and happiness, and then we talk to somebody whose job it is to help relieve people's pain, and when he can't, to help people live with the pain that can't be relieved, for whatever reason. You're going to see the techniques for doing so, and out of that, we're going to get some very important life lessons. So today, you're going to learn about pain and happiness, and you're going to get life lessons for being a happier person from a spine surgeon. That's today's show.

• 4:21Speaker 02

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• 5:05Speaker 02

  It pays you to use less data. It gives you an incentive to unplug. Noble Mobile is the phone plan that finally aligns incentives with what's good for you. Use less data, earn money back, and when you do, you'll be living once again in real life, and you're going to like how it feels.

• 5:22Arthur Brooks?

  So before we get to the interview portion of today's program, I want to talk a little bit about what philosophers and behavioral scientists have taught about the relationship between the inevitable pain that we suffer in our lives and how we can lead the happiest possible lives, how we can have the greatest well-being. And I want to start actually with a philosophy that a lot of people have had all throughout history about how to be happy, and it involves pain, because it's all about pleasure and pain. Now, probably the greatest example of this comes from the Greek philosopher Aristippus. If you haven't heard of him, he's not as big as the great Stoics, for example, but

• 6:04Arthur Brooks?

  he was one of Socrates' most gifted students, and he had a pretty simple philosophy of life. Here's what he said, "The art of life lies in taking pleasures as they pass, and the keenest pleasures are not intellectual, nor are they always moral." That gives you a little bit of insight into this guy. He was known for, you know, old wine and young women, and he was always trying to feel good. His whole philosophy of life was, the better you feel, the more pleasure that you get, the better off you're going to be, and the less pain that you have, the happier the person you can actually be as well. "If it feels good, do it," is basically the main part of his philosophy. He was basically the first hippie. You know, he could have bit at Woodstock, "If it feels good, do it," you know, they used to say in the 60s.

• 6:47Arthur Brooks?

  My dad used to say, "That's the end of America." You know, he was kind of right. And the truth is, I say that as a scientist. Why? Because it's very clear that if feeling good all the time is your main goal, well, that's not the road to happiness, that's usually the road to rehab. You need something better than that. Go back to earlier programs that we've recorded on this podcast about the difference between pleasure and enjoyment, and you'll remember that enjoyment really does lead to happiness. One of the macronutrients of happiness is actually pleasure plus people plus memory, thus rendering it an experience that's fully conscious, fully human, and actually can be managed. Here's the deal, you don't want to be managed by your pleasures.

• 7:32Arthur Brooks?

  You want to manage your pleasures. You also want them to be social and memorable, and that's what that whole body of thinking is all about. So we'll put in the show notes the link to that. If you want to know how to turn your pleasures into enjoyment and get happier as opposed to having to ruin your life, well, that's where you need to go. But the second part of Aristippus' philosophy is, if it feels bad, make it stop.

• 7:56Arthur Brooks?

  Is that smart? That's what I want to talk about here and in today's program. Now, to understand this pain-happiness link, this connection between the two, we need to go back and talk a little bit about the pleasure side first and the human brain. This idea of pure pleasure all the time, feeling good constantly, that hedonism, that might sound great, it might sound like a whole lot of fun, but we know with modern neuroscience that it leads to a whole lot of problems, basically for the following reasons. Pleasure is nothing more than a signal that your brain is giving to you that something is an opportunity and you should approach it, because it could be something really good for you.

• 8:39Arthur Brooks?

  It's something about passing on your genes by getting mates, or getting really, you know, an easy source of calories, because something is really, really tasty. Your brain has evolved to love sweet, rich foods, for example, because that's, and to give you pleasure from eating them, because that pleasure is an indication you're getting cheap calories. And so, whenever you've got that pleasure, it's a signal of something that at some point in our ancient past was going to be good for you, to pass on genes, survive the winter, et cetera, et cetera. Now, that actually isn't pleasure that comes from the brownie you're about to eat, or, you know, the slot machine you're about to play. The pleasure doesn't actually come from that.

• 9:23Arthur Brooks?

  The pleasure comes from the neurochemistry that proceeds from putting that brownie in your mouth, and that has everything to do with dopamine. Everybody understands what dopamine is. Actually, most people don't understand what it is. It's not a pleasure chemical per se. What it does is it stimulates the anticipation and sense of reward. So it's not intoxicating you like some sort of opiate. What it does is it says, "There's a reward ahead," gives you something really good to look forward to, and that was a reward. Aren't you happy about that? The dopamine is kind of a complicated thing, as a matter of fact. If you didn't have it, life would be horrible. And people who don't have enough of it, they suffer from one of the most common aspects

• 10:04Arthur Brooks?

  of clinical depression, which is known as anhedonia, the inability to feel pleasure. Anhedonia, it's got its own word, of course. You know, one of the characteristics is, if you go to the doctor and you say, "You know, everything I used to like, I don't like it anymore," that anhedonia ordinarily means that you have a deficit of dopamine, and if you're put on any psychiatric medication after that, most likely it'll be something that increases dopamine directly or indeed indirectly. Here's the thing, though, that's part of a system so that you will learn things that get you mates and get you through the winter and help you survive, get proper calories. It's all about learning. You want that neurochemical reward structure, so that you'll learn something new, or you

• 10:48Arthur Brooks?

  can get the food that you want. So, for example, you're in the Pleistocene, the Middle Pleistocene, 250,000 years ago, you're a good old caveman and you're walking out. Looking for food and you go down to a watering hole you've never been to before. You find some gazelles around it, huh? Hot diggity. That's really good deal. I mean, you're going to get a big neurochemical reward, not from the gazelles, but from the dopamine in your brain that said, ha, ha, right? Really great. The next day, you're thinking about it. As soon as you think about it, you get a little bit of dopamine just thinking about it to impel you to go down to the watering hole again. But here's the thing, if it turns out you see the same couple of gazelles as yesterday, that's okay. You see more, bigger reward.

• 11:31Arthur Brooks?

  If you don't find any, you're kind of bummed out so that you'll learn not to keep going back to that watering hole. It's all about incentives. It's all about carrots and sticks that are going on, to mix my metaphors, inside your head. Here's what I want you to take away from that, however. If feeling good, if feeling really, really good is your goal, then you're going to need to get more and more gazelles. You're going to need to find a watering hole that has progressively more gazelles because otherwise it's just going to kind of feel like nothing. And when you don't get them, you're going to feel like garbage, which is why you get escalation, why you get addiction. Now, I'm not talking about gazelles here.

• 12:09Arthur Brooks?

  I'm talking about drugs and alcohol and gambling and pornography and internet use and all the stuff that can hijack your brain and which you always escalate the behavior, which is why it's so dangerous. Now, here's the point that I'm trying to make, because I'm about to get back to pain soon enough, is that when you actually seek pleasure and nothing else, paradoxically, you won't get it. You'll stop getting it. The search for unmitigated pleasure actually leads to grayness in life. Now, this is really important conclusion, and a lot of it comes from the work of Anna Lemke, who's a psychiatrist at the Stanford Medical School and teaches at Stanford University. She wrote a really good book called Dopamine Nation.

• 12:54Arthur Brooks?

  If you want to learn more about it, I'll put it in the show notes. Go read that book. And she writes this, "The paradox is that hedonism, the pursuit of pleasure for its own sake, leads to anhedonia," remember that word? "which is the inability to enjoy pleasure of any kind." So if pleasure's your goal, you won't get it. What a tyranny, right? That's the reason you need to turn it into enjoyment. You need to lead a balanced life, et cetera, et cetera. Okay, but back to the real issue at hand. The reverse is also true. Remember Aristipus, he said, "Feel good all the time and don't feel bad if you can." Get rid of pain. If it feels bad, make it stop.

• 13:32Arthur Brooks?

  The reverse of the dopamine paradox also happens in the human brain, which is this, if pain is your anti-goal, your goal in life is to eliminate pain, you're going to get more of it. That's what the literature is really clear on. And that's a, once again, it feels like a real tyranny, but it isn't. All these things, what they are, is a declaration of independence for you. They're an opportunity for you to live your best life. So you don't have to be governed by your dopamine system. You can live in the space of your moral aspirations. I'm trying to empower you here. This has been very empowering for me to understand this. I mean, psychology is biology, and the biology will help you lead a better life.

• 14:15Arthur Brooks?

  I hope that's something that you're finding a lot by watching office hours, as a matter of fact. That's why I do the show, for Pete's sake. One of the ways that scientists have shown this, that if pain, elimination of pain is your goal, you'll get more of it, comes from literature on something called the fear avoidance model. And I'll put a really good article called "The Fear Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence" from the Journal of Behavioral Medicine. Really nice article from 2007, very highly cited. And the fear avoidance model is one in which we get into a cycle where I hate the pain and I'm afraid of it because I don't like it. And so I start actually behaving in a particular way that's not in my interest for avoiding

• 15:00Arthur Brooks?

  pain. Why would you do that? Well, because when you think about it, a lot of the things that we do to eliminate pain in the short run actually leads to more pain in the long run in our lives. And that's both true psychologically and physically. Let's take the physical case to begin with. Let's say back pain. And I'm using the example of back pain for a reason because we have a spine surgeon, who's a guest on the show. But also, it's because this is a super common kind of pain. It's one of the most common kinds of pain that people actually feel. That when people, when you throw your back out in the vernacular, when you're doing something that makes your back hurt, your tendency is to want to become inactive, just like sit there, not move around, because the movement per se is painful, but that leads to disability.

• 15:45Arthur Brooks?

  Why? Because it leads to weakness and it leads to gaining weight and all the things that are actually going to make your pain worse. The truth is that the fear avoidance model shows that the more you're afraid of pain per se, the more you're going to behave in a particular way that's counterproductive that will lead you to actually suffer through more pain in the long run. That, by the way, has everything to do with what we've seen in physical pain, in the opioid crisis in this country. The opioid crisis is, I mean, it's so bad, it's like, it's like science fiction, man. I mean, it's from 2000, just to 2010, which was the heart of the big opioid epidemic in the United States. The prescriptions for opioid analgesics to treat pain increased by 104% in this country.

• 16:29Arthur Brooks?

  And this led to tremendous amounts of addiction, black markets, et cetera. That's what stimulated the resurgence of heroin in our country. When the crackdown in opioids came along, they became less available. Well, guess what? Entrepreneurs largely in, from other countries around the world, from China and Mexico, sort of flooding American towns and flooding effectively the heartland with heroin, which does the same thing. It functions in much the same way as these opioid drugs. I mean, that's the perfect example of the pain avoidance model. I go to the doctor, my back hurts. I don't want it. I don't want to, you know, do the hard work of actually dealing with it psychologically and dealing with it physically.

• 17:14Arthur Brooks?

  So I take the drugs and I get addicted to the drugs and then I don't have the drugs and I get addicted to narcotics and the rest is history. We've had hundreds of thousands of drug overdose deaths that have everything to do with this fear avoidance model. Now, we also have fear of mental pain. The fear avoidance model works in terms of our mental pain as well. And mental pain is no joke. I've talked elsewhere on this show about the fact that there's two basic kinds of pain. There's sensory pain, has to do with inflammation and nerve endings, and there's affective pain, which is the "I hate it" part of pain. That affective part of the pain, it involves a part of the limbic system called the dorsal

• 17:59Arthur Brooks?

  anterior cingulate cortex, and it exists because you need to feel pain. If you didn't feel pain, once again, this is a signal, you'd be dead in a week. It's a big problem if you don't feel pain. And people who don't feel pain normally, all kinds of bad things happen to them. This affective pain is, you know, if you hurt your back or burn yourself on a stove, you get that, but you also get it when you have psychological conditions that are giving you pain. If you're depressed, for example, you're anxious. If somebody you love leaves you, if God forbid, somebody you love dies, that actually will give you this affective pain. And it's the same thrifty part of the brain that's involved in pain under any circumstances. But if you're afraid of it, if you're afraid of that affective pain, if you're afraid of

• 18:44Arthur Brooks?

  the pain that's a tendon on things that you don't like in your life, you'll start to avoid it. And the pain avoidance per se actually leads to counterproductive results and, counterintuitively for some people, more pain. So for example, and I see this a lot, people are really, really, really afraid of the pain that comes from rejection and from loneliness. This is one of the biggest problems that we see with young people today, where they don't date at all, they don't have relationships at all. And I'll ask them, "Why? You're in your twenties. You're available." And sometimes they'll say, "I can't meet anybody. Can't meet anybody. You know, I'm not having any luck on the apps or whatever it happens to be." But a lot of the times, when I have somebody in office hours, not the show, like literally

• 19:28Arthur Brooks?

  office hours at the university, they'll say, "I don't know how to do it. I'm just really afraid of rejection." That's a pain avoidance. That's this fear-based model that we're talking about here. And what happens? You become isolated and you get lonelier and you have more pain. So what will alleviate the pain that you have and the fear that you have in the short run, AKA not dating, actually leads you to have more fear and pain in the long run, which leads to more deleterious consequences. But here's the thing, here's what we really need to understand about pain. Pain is natural. It's normal. It's a beneficial signal that there is some sort of a threat.

• 20:12Arthur Brooks?

  There's something we need to do such that the threat doesn't actually become a bigger threat for us. That's why we've evolved to have these pain centers in our brains, to be sure. Paradoxically, for a lot of people, the goal in most cases of pain in our lives is not elimination, it's management. It's understanding pain that we have, why we have it, and managing it, as opposed to going to all these great lengths to eliminate it, in both the physical and the psychological case. So what we need to talk about for happiness is the management of pain. Now, one of the things I'm going to bring up with our guest, with Chris Good, spine surgeon, is, believe it or not, I'm going to ask him about a Buddhist formula for suffering.

• 20:56Arthur Brooks?

  Now, it's actually not purely Buddhist. I mean, people have talked about this in different traditions for thousands of years. But I just happen to have learned it from His Holiness the Dalai Lama, and the Tibetan Buddhists use this a lot. And here's what it is, for understanding the management of pain. Suffering and pain are not the same thing. And I'm going to come back to it in the interview. Suffering equals pain multiplied by resistance to pain. Do the math, right? And I'm going to ask the producers to put that formula up on the screen. Suffering equals pain multiplied by resistance. And that means if you look at it mathematically, there's two ways to lower your suffering. You can lower the pain, or you can lower your resistance to the pain. Now, okay, I know you're not the Dalai Lama. He's a special person. He's a Bodhisattva.

• 21:41Arthur Brooks?

  He's living with a Buddha nature. I mean, he's- You can do a lot of stuff that I can't do, put it that way. I guess if you take this to a mathematical, logical terminus, you could get rid of all of your suffering while having tremendous pain by having no resistance to it, by taking that to zero. I can't do that. But what this really tells me in my life, this has been so freeing for me, is that I can choose a lot of my suffering despite the fact that I can't always choose pain. My back hurts and sometimes things really bum me out, right? And what do those things have had to do with? Well, circumstances, many of which are outside my control. I mean, I can, I have a lot of agency.

• 22:23Arthur Brooks?

  There's a lot of ways that I can live my life with, you know, exercising and diet and proper relationships where my pain is lower than it otherwise would be. But pain is inevitable because I have, I have unpleasant interactions with other people and I have a limbic system that gives me basic negative emotions from time to time, working as it should. And then I have two options. I can do what I need to do to lower that pain, in some cases, good. But when I can't, I can manage it through acceptance of that pain. What does that mean? Well, that's one of the things that we're going to discuss with Chris and that's one of the things that I want you to be thinking about as we go through this.

• 23:05Arthur Brooks?

  What are the unavoidable areas of pain in your life? Or perhaps that you think they're unavoidable things in your life? How can you lower your resistance through acceptance of pain? There are all kinds of, by the way, I'm not, this is not just some new age philosophy here that we're talking about. It's not even religion that we're talking about. This is really, really solid mental health treatment. There are at least two forms of cognitive behavioral therapy dedicated to accepting pain that you can't change. You can't lower. Let me tell you about two of them. Number one, mindfulness-based cognitive therapy. I'll put a nice link into the, into the show notes.

• 23:48Arthur Brooks?

  Mindfulness-based cognitive therapy teaches patients to accept distress as painful, but that is neither catastrophic nor impossible to deal with. That's the important thing. It's one of the things that pain specialists say, that people come in and say, there's nothing that I can do. And the biggest problem they have is desperation, actually, and fear, once again. So that's a whole area of psychotherapy. So this is not just woo-woo that we're talking about here. We're going to talk, we're talking about acceptance of pain. Another is acceptance and commitment therapy, which is a whole different area, a different kind of treatment where patients are encouraged to acknowledge and accept their pain, but then to shift their attention toward things that they can change and things that they do love and parts of their life that really are

• 24:32Arthur Brooks?

  very, very positive and very lovely parts of their life. Well, that's an important thing for us to be thinking about and I want you to be thinking about in your own life. There are lots of sources of pain, right? There's psychological pain, there's physical pain, there's unforeseen pain, there's chronic pain. Yeah, me too, everybody has that. How do you understand it in your life? What are you actually doing to manage it as opposed to eliminating it? Are you fruitlessly in an eliminationist strategy? Are you Aristopas? Are you, if it feels bad, make it stop? If you are, you're probably suffering a lot more than you need to. And I say that because, once again, you will bring more pain to yourself

• 25:17Arthur Brooks?

  by behaving in such a way that in the long term, you're fighting against what you're trying to do in the short term, for all the reasons I talked about. Second of all, you're leaving all kinds of techniques on the table, like these cognitive behavioral therapies. I just mentioned very briefly and you can read about more in the show notes. And last but not least, you're not thinking about this beautiful formula where suffering and pain are not inevitably linked in a linear fashion. On the contrary, there are cases in which pain can be high and suffering can be low because you're not just trying to lower the pain, but you're lowering your resistance to that pain. Are you doing that? How? Well, now I'm looking forward to introducing you to today's guest.

• 26:00Arthur Brooks?

  Dr. Christopher Good is a double board certified orthopedic spine surgeon. He's also the CEO and president of VSI Spine Solutions. That's a, VSI stands for Virginia Spine Institute in Northern Virginia. He's been advancing spine surgery and regenerative medicine, really at the forefront of what people are doing to understand back pain and relieving it. And he's been doing that for more than 20 years with a focus on helping patients recover fast and stay active for as long as they can. He has helped lead the world's first robot-guided spine surgery and he continues to pioneer safe and precise treatments. He's also in leadership roles in all sorts of business groups

• 26:42Arthur Brooks?

  around the Washington DC region with the National Spine Foundation. He's a member of YPO, the Young Presidents Organization. He's an entrepreneur, which is one of the reasons he's running this big business. He has a simple goal in life, which is to redefine spine health so people can stay active, mobile and pain-free throughout their lives. But I'm also going to show you in this interview that he has another mission in his life, which isn't so simple, to help us all lead better lives, even if we do have inevitable pain in these lives. I think you're going to really appreciate this interview. Dr. Chris Good, welcome to Office Hours.

• 27:18Speaker 03

  Thank you for having me. It's really a pleasure.

• 27:20Arthur Brooks?

  I'm delighted to have you here. I'm delighted for lots of reasons. So you know, you and I have become friends over the last couple of years and you're also my doctor, which is important. But you're well-known for this incredible work that you do, really the cutting edge of technology. And as we've gotten to know each other, you've gotten to know my work and I've gotten to know yours. We've talked an awful lot about not just spines, but about life and how the psychology is the biology, which is one of the, one of the mottos actually of this program, that if you're going to understand psychology and behavioral science, you need to understand something about the brain, about, about how your body works as well. And I know that's super interesting to you as well. So let's get a little bit of background before we do this. What do you do all day?

• 28:04Speaker 03

  That's interesting. Well, first and foremost, I'm a husband and a father and a son. My job, I've always identified as a spine surgeon. Although from you and your show, I've learned that I need to re-evolve that because I will no longer be a spine surgeon one day. So I now, I'm a spine surgeon, but I'm also a CEO and a leader and a researcher and a teacher. As a spine surgeon, I typically see patients in the office, which is talking to people, explaining their x-rays, understanding what kind of symptoms they have, what options are there.

• 28:44Speaker 03

  But I also guide rehab, I'm a pain management doctor, really, giving medications and things.

• 28:50Arthur Brooks?

  Because you see people in excruciating pain.

• 28:52Speaker 03

  Oh, yes. I mean, spine, we get into it, but spine problems can cause tremendous pain, disability. And especially when someone is fresh into an injury. I mean, we see people 10 out of 10 pain, incapacitated, can't walk and we have to find ways to control that while sometimes we don't even know what's happening in there.

• 29:10Arthur Brooks?

  Yeah, and chronic pain.

• 29:11Speaker 03

  Well, chronic pain even more. You know, the reality is almost all of us, at least 80% of Americans, will have some low back pain in their life. But thankfully for most of us, that's a short-term flare-up thing. But around, you know, eight, nine percent of patients will have chronic, ongoing back pain, months and months or years and years. And those people really need higher level treatment, lots of care, medicines, all those kinds of things.

• 29:34Arthur Brooks?

  Because it's structural. It's something that needs to get fixed. So you spend a couple of days a week in the office, talking to patients, counseling people, getting to know people, a lot of mental health care in that way. And then you spend a couple of days a week in the operating room, right?

• 29:52Speaker 03

  Yeah, half day a week, I do regenerative medicine, which is taking growth factors from your own body and then putting them somewhere to try and stimulate a healing response or take away pain. I really think this is a tremendous future of where medicine is going to go. And then two days a week, I'm in the OR doing neck surgery, back surgery, like structurally trying to fix patients' problems.

• 30:14Arthur Brooks?

  Yeah, that's where you're dealing with the robots and doing surgeon stuff, right?

• 30:18Speaker 03

  Sure.

• 30:19Arthur Brooks?

  Yeah.

• 30:19Speaker 03

  Sure.

• 30:20Arthur Brooks?

  And then half a day a week or a day a week, you're an entrepreneur. I mean, you're a CEO, you run the company.

• 30:26Speaker 03

  For sure. I think, you know, we have a big organization and so my, it's actually a wonderful organization, 35 years. And my most important job is to maintain that culture and inspire and teach and protect that for our patients to have access, but also for, it's a very special model that we get to practice in. And I have to protect that for my team so that we get to continue to practice that way years into the future.

• 30:52Arthur Brooks?

  Yeah, so there's a lot of hats that you're wearing, dad, husband, son, surgeon, mental health professional, CEO. You're doing a lot of these different things and you're kind of, you're whip-sawing between these different things over the course of the week, which is It's really, it's a really interesting and a really complex thing that you're doing. So how did you get into this? I mean, I'm really interested in origin stories. You know, how do you start doing what you're doing? People do these kind of unusual things. How'd you become a spine surgeon?

• 31:17Speaker 03

  Yeah, so I often say, you know, the field of spine surgery chose me, not the other way around. When I was 10 days old, I grew up in Colorado, a little mountain town. My dad was a huge outdoorsman, managed a ski area. He fell out of a chairlift, like in a rescue kind of situation. He fell 30 feet, landed and crushed his spine.

• 31:35Arthur Brooks?

  So he landed on his feet?

• 31:36Speaker 03

  Landed on his feet and did this.

• 31:38Arthur Brooks?

  Just compressed the whole, right?

• 31:39Speaker 03

  Yeah, I would love to see his x-rays, but you know, I can imagine he had probably what we call burst fractures in his thoracic and lumbar spine, which is when the bones compressed together. So, you know, my mom throws me to my grandpa and off they go in a helicopter. And he has a surgery. Now, this is in the seventies, so back surgery then was very rudimentary, right? All they could do was open up his back. And where all these bones were broken, they crushed up bone graft, like grout, and just put it in there and they closed him up. And they put him in a body cast, hoping that if he just laid there for three months, these bones would all weld or fuse together.

• 32:16Arthur Brooks?

  In some way, shape or form.

• 32:18Speaker 03

  But, but the reality is like that, that at best maybe had a 50% success rate of fusing. And so it didn't work clinically well for him. And so I grew up like, I had a wonderful childhood with him. He wasn't paralyzed, but you know, chronic pain, pain medication, steroids. Eventually, he was a very thin fit guy, became, you know, obesity, osteoporosis, addictions, seizures from the medicine. So that like, I've seen.

• 32:46Arthur Brooks?

  It really hurt his quality of life.

• 32:48Speaker 03

  Yeah.

• 32:48Arthur Brooks?

  And you saw him in a lot of pain. You grew up with a dad who was in a lot of pain.

• 32:52Speaker 03

  I, I did, but I also like, he still did a lot and had, we had a great life. But he did ultimately, as all these complications developed, he became sick. And so he ended up passing away, when I was in sixth grade, from all the sequelae from his injury.

• 33:07Arthur Brooks?

  So you got a crash course in real life of the connections between well-being and pain.

• 33:14Speaker 03

  For sure.

• 33:14Arthur Brooks?

  Yeah.

• 33:15Speaker 03

  And but as we'll talk about today, I also saw, I can't do this anymore. I can't do that anymore, but life is still good. There's a lot I can do.

• 33:23Arthur Brooks?

  That's right. That's right. And so when you decided, did you know when you were a kid that you were going to fix backs?

• 33:27Speaker 03

  Yeah, I told him, I'm going to be a spine surgeon one day.

• 33:30Arthur Brooks?

  I'm going to fix you, dad.

• 33:31Speaker 03

  I had no idea what that meant. We had no doctors in the family. I had no experience, but.

• 33:35Arthur Brooks?

  You're the first doctor in the family.

• 33:37Speaker 03

  Yeah, I had, I had an uncle who was like a PhD doctor.

• 33:40Arthur Brooks?

  Yeah.

• 33:40Speaker 03

  But I never really knew him well.

• 33:42Arthur Brooks?

  A nerd like me. He'd cut people.

• 33:43Speaker 03

  Toxicologist, so, but, but yeah, we didn't have, we're not a medical family. We're teachers in, in my family and teachers and blue, like blue collar kind of workers. And so I had no idea what it was, but I just, each step along the way, as I, I worked hard and I always like, I found the right mentor. I took the opportunities and literally, you know, I got into an early acceptance program for med school, had a wonderful mentor, did some really important research and got into some of the, the top training programs, just straight through. It was always kind of meant to be.

• 34:15Arthur Brooks?

  Right. So you were meant to be a spine surgeon and, and, and now you're a CEO. Now you're really, you really are an entrepreneur. You're part of YPO, the President's Organization, which is for, you know, you have guys who are, you know, running construction firms and, and restaurants and all that. And, and you're running a VSI.

• 34:33Speaker 03

  Yeah, I was, I was, my, our founder was a YPO person.

• 34:37Arthur Brooks?

  Yeah.

• 34:37Speaker 03

  And then I joined and when I took over for him as he retired and it's, it's been amazing. And it's, it's, you know, in medicine, we've always kind of looked down on business people and doctors don't like the idea of this is a business. But if you look at what's going on in the field of medicine, now business people kind of run almost everything. It's very rare to have a practice like ours where doctors own things and control things. And, and it turns out when doctors own and control things, in my opinion, they don't just make decisions based on balance sheets or profit, you know, and, and having doctors involved in leadership, I think is really, really important because we are willing to make sacrifices for patient care, right? People aren't SKUs. I, I've learned a tremendous amount though, from the business community,

• 35:21Speaker 03

  because all these great leaders are focused on their culture and their team members and how they lead. And I think that's something that isn't, is, we wish all doctors naturally had that, but it's not a focus of training or certainly not what I went through. And so I've worked to get that kind of balance in other ways.

• 35:39Arthur Brooks?

  How many doctors do you have at VSI?

• 35:41Speaker 03

  Just brought on a new doctor two days ago. So we have four surgeons, we have four non-surgical, so neurology, pain management, rehab. And then, you know, PA team, we have 10 or 12 physician assistants and then physical therapy, athletic training. So in terms of medical practitioners, a big team so that we can try and take care of everything across the whole spectrum of what.

• 36:04Arthur Brooks?

  It's a, it's like a V-hive every time I go in there. I mean, there's a lot, really, really a lot going on. And, and, and what I want to talk about is, is the, the reason that people actually come to you. Most people come to you, I'm going to guess, not because they say, I wonder if something's wrong with my back, because their back starts to hurt and they're starting to deal with pain. And this is one of the most common kinds of pain. It's very interesting in my field. Even in public policy, back pain is a really interesting thing. I mean, something that most people don't know is that for the longest time, disability insurance was not available for people with, with, with two major and common conditions, which were depression and back pain. Why? Because that would have exploded the number of people that are on permanent disability. And point of fact, when those were opened to people with depression, back pain, permanent disability,

• 36:49Arthur Brooks?

  it, it increased in number by something like a factor of six. And that's one of the reasons that so many people have that. Back pain is so ubiquitous. Why is it that Homo sapiens have so much trouble? Is there an engineering problem that we've got? What is it?

• 37:03Speaker 03

  Well, we do have a unique set of spine problems because we walk on two feet. But like, I think it, it's almost better to think of like, what is natural, right? Like, if you're going to live 80 or 90 years, right? And you're going to move and do things, right? We, we need to kind of understand like, getting wrinkles, getting wear and tear, getting degeneration. You know, that's, that's part of life, right? Like, that's just how it goes. But it, but when it comes to back pain and spine problems, we really do need to have a big, like, open dialogue on this because as you said, like, low back pain is the second most common reason a person will see their doctor. We're talking like 30 million doctors visits a year.

• 37:47Speaker 03

  And, and, you know, over 100 million lost workdays every year as a result of these problems. Now, the good news is that for many of us, our bodies will have some deterioration as the years go on and will live very, very well with so. So the deterioration is a normal part of life. If you just pick a bunch of 20 year olds off the street who feel great and MRI them, maybe 40% of those people will have some degeneration on their MRI. Okay, asymptomatic. Now, if you, if you pull a bunch of 80 year olds, almost 100% of them have those kind of degenerations. So this is a normal part of life. Some people, it triggers back pain, neck pain, pinched nerves and disability. Other people remain asymptomatic throughout.

• 38:30Speaker 03

  So there is a lot of positivity, especially when I'm seeing someone first time flare up, you know, they're injured. Most of these people, we really want to be positive and say, okay, like, we're going to get you through this. Everything's okay. And then focus mainly on what are the things that we can identify about you that you should be doing differently, better choices you can make, better ways you can take care of yourself to try and make sure you continue to be one of the lucky ones into the future.

• 38:55Arthur Brooks?

  But you see a lot of suffering. I mean, this is a funny thing about the medical community. Nobody goes to the cardiologist and says, I think your old ticker is great. I'm just here to say hi. I mean, you're, you're, you're seeing the doctor for a particular reason. I, I met you originally because my back was in a lot of pain. I was trying to figure out what was wrong with it. And, you know, there's ongoing issues that we're going to have to cope with. And the really interesting thing about it was, I mean, it hurts, man. It hurts. It's a problem, but my quality of life doesn't necessarily have to suffer very much despite the fact that it's pretty clear that I'm going to have some back pain for the rest of my life. And that's really what I want to talk about because, you know, it's, you know, you, you have a gift with people. I've seen you interact with a bunch of different people.

• 39:36Arthur Brooks?

  And one of the things that I've noticed is that you have to tell people not the best news all the time. And you want people to have a high quality of life despite the fact that they're going to have to live with pain. And so managing suffering is really critical and you're doing a lot of mental health treatment. So tell me a little bit about that. When somebody comes to you in a whole lot of pain and, and you know, you're not going to be able to make it go away. You're not going to be able to eliminate it. How do you deal with that?

• 40:02Speaker 03

  I will tell you, I start every single new patient visit with the goal to figure out if there's a way to make the pain go away. Because there are some people that have a structural problem that is solvable and the pain goes away and they, they do great in the long run. So I start, that's the setup for some disappointment probably, but I set, I start every single visit with that goal in mind. Now, the reality is sometimes I look at someone's structures immediately and I can tell this is a complicated situation. And while we may be able to make a lot of progress, improve quality of life, improve function, we're never going to, like, we're never going to just feel normal. And so there is, there is a lot of like counseling and, you know, expectation setting and those kind of things.

• 40:45Speaker 03

  And one thing that, one thing that, that we are trying to do is, you know, our, our, our logo is this. We call it our victory V. And the, the whole point of this is trying to help people set small goals or determine things that they would, that they can do that would make their life better, victories, and then celebrate when we get them there, right? So not everybody's going to climb Mount Everest after their treatment. But if we can say, okay, I'm a, I just want to get through the kids game. I want to, I want to ski again, you know, depending. But then being able to set those goals and declare that victory when they achieve it, I think goes a really, a long way, right? And whether that's, whether that's back to work, it's going on some trip, it's being present for your kids.

• 41:30Speaker 03

  The more we're able to appreciate and understand the positive things that are still happening, I think the more it helps us, not only motivate us to work hard to get there, but to potentially cope with the residual things that we may still have to deal with, right? And it's hard to not look back. I mean, it's so funny. I see sometimes, it's not funny, but I see somebody who hasn't moved for a decade and I ask them like, what do you, what do you do? Like, what kind of physical activity do you do, sports or hobbies? And they will still tell me they're a marathon runner or, you know, whatever. And, and literally the last time they did that was 20 years ago. And they, they still identify as that they remember that, which.

• 42:10Speaker 03

  You know, clearly that's not who they are now. And I think there's a lot of value to evolving that view of yourself to the point where like I have, you know, some realization about, you know, where I'm actually at. And while I can't do what I used to do, I can still, I can still do meaningful things. I could still find joy, right? If I, I can't run a marathon, but you know, I can walk a mile a day, or I can, I can get to the top of, you know, Old Baldy or whatever. Those are important things. We help people to kind of.

• 42:42Arthur Brooks?

  For those watching, Old Baldy is a local place. We live in the Washington DC.

• 42:46Speaker 03

  Local mountain, it's pretty hard to climb. Yeah.

• 42:47Arthur Brooks?

  Yeah, that's right.

• 42:48Speaker 03

  It's a goal I commonly set for.

• 42:50Arthur Brooks?

  I'm not Old Baldy. He's not calling me Old Baldy. Okay. That's like, yeah. And what you're practicing, actually, in the mental health world is called acceptance and commitment therapy. So there are people who actually get licensed and what you're basically saying that you do with your patients all day long, which is to say, I'm going to understand what I can mitigate physically and what I can't. And then we're going to focus on the things that I actually can do that give me joy. I mean, you're, but you're, you're, you're a mental health professional, whether you're trained in that specifically or not. Were you given mental health training when you were in medical school? Or did you have to learn this as, you know, dealing with people in pain and giving them a good quality life?

• 43:22Speaker 03

  So I went to the University of Rochester and they were on the forefront of what they called the bio psycho social model of healthcare. I graduated in 2002. And so this was the very beginning of like, all of this social stuff. And so I didn't get a lot of it, but we were at least attuned to that being part of what doctors could do and be aware of. And the advisory deans in my medical school, I think three of the four were psychiatrists.

• 43:51Arthur Brooks?

  Is that right?

• 43:52Speaker 03

  So I certainly, I certainly didn't get any form of business or economic training like I should have. And I didn't get a lot, but at least being a U of R, like I always had that innately like in me. And I, I'd like to think nowadays, we're doing a much better job of training people because so much of bonding with the patients, getting them to believe that you're going to be able to help them and motivate them. You know, that's not just memorizing some structure or learning, learning the anatomy, you know, those kind of, you know, medical school type of thing.

• 44:26Arthur Brooks?

  How important is bedside manner?

• 44:28Speaker 03

  It's critical. Surgeons get a, get a pass on a lot of things, right? Like surgeons, you kind of like the fighter pilot, right? The guy's a jerk, but he's top gun. I'm okay with that. But that only really works if you have a very simple surgery that a hundred percent makes the patient happy with no bumps in the road, you know? But lots of surgeries, you know, are hard to recover. There's multiple steps and you've got to hold people's hands along the way. And having that, that ability to communicate with people, to bond and trust is super duper, you know, important. When I hire a new surgeon, I ask my friends who've been in the OR with them, how are their hands? Right?

• 45:08Arthur Brooks?

  Right.

• 45:09Speaker 03

  But I spend 10 times more effort calling the nurses. How does he treat people on the floor, places, places they've worked before? What kind of human are they? How are they going to interact with patients and with our team? I think that's, you know, how did your mom raise you right? I think those are our critical factors, right? Technically doing a surgery right or prescribing the right medicine is really, you know, just, just one very kind of, it's an important piece, maybe the most important piece. But, you know, all this other part of it is, is really important to get success.

• 45:41Arthur Brooks?

  Yeah. But what has, you know, being a spine surgeon, seeing a lot of people in pain, trying to fix a lot of problems, dealing with chronic problems that you can't fix, but you can manage, what has it taught you as a person about how to, how to manage everything else in your life?

• 45:57Speaker 03

  I, I have learned lots of quotes and tried to read lots of people to like, use other people's work to help me inspire others. And I think that's, that's, I mean, I think so far in our relationship, you've helped me a lot more than I've, I've helped you in terms of all the advice.

• 46:14Arthur Brooks?

  Oh, man. My back's a lot better.

• 46:15Speaker 03

  But, um, you know, I think that that's, it can be hard, right? I definitely, especially if I'm going to take someone on surgically, like I am very invested in that outcome.

• 46:27Arthur Brooks?

  Right.

• 46:27Speaker 03

  And then how they do. And if I do a surgery that doesn't work as well as I want it, or doesn't, you know, we don't, we have complications whereby I, I do, you know, I lose sleep and I take that very, very hard. And part of that is also had, I've evolved over time, like what kind of care, which type of surgeries I may personally want to take on and do based on where, what am I best at? What kind of risk am I willing to take? Not only what kind of risk, because a patient willing to take, what kind of risk am I willing to take with them?

• 46:58Arthur Brooks?

  Right.

• 46:58Speaker 03

  You know what I'm saying? And, and that's evolved, you know, a lot over.

• 47:01Arthur Brooks?

  How, how do you think it's actually changed you as a person to actually be dealing with the things that you're actually seeing?

• 47:06Speaker 03

  I'd say the things that have changed me the most as a person, as a doctor, are some of my own experiences, right? I've, I've started to share with my patients and a little bit, you know, like the spine problems are, are genetic. And in my family, we make bad decisions, like falling out of chairlifts and my uncle fall off a cliff. Like we do that.

• 47:27Arthur Brooks?

  A lot of falling.

• 47:28Speaker 03

  And we have, we have, you know, genetic issues. And, and so, you know, I have, you know, degeneration of the discs in my back, leading to a scoliosis curve, which I have thankfully done very, very well with over the years, but have started to work really, really, really hard to earn feeling good. And the blessing is a lot of the biggest advancements that we have had in how we treat people have come from our own problems, our own treatment. When my senior partner had to have a surgery, what he needed after and how we treated his rehab and everything, it totally opened our eyes. Like, for example, you know, a lot of, a lot of times if somebody does a surgery and then two weeks, four weeks later, come back and see the doctor, right? Patient's sitting at home, stiff, sore, taking pain

• 48:11Speaker 03

  pills. And like, we're not rehabbing people until they come back to the doctor way down the road. Well, when my partner had his surgery, he was in that, in with our PTs the next day. And we're like, why aren't we doing this for everybody? You know? And it's led us to be much more proactive. When I had my first injection, you know, that numbing medicine hurts like the dickens. Well, there's some things we can do to mix medicines together so it doesn't do that. Well, I only had to have one really painful injection before I changed the way we do that. Each of these experiences are really, you know, I think showing, you know, benefit to other people down the road as, as I've personally gone through.

• 48:47Arthur Brooks?

  How do you think it's changed you as a husband and father to be? Cause you know, it's funny because, you know, people bring their work home with them a lot. And, you know, I talked to cops, firefighters, two of my kids are mil, are Marines, military. And, and it's, it's, you know, these weird scary jobs, you're seeing people in a whole lot of pain. It can make you less sympathetic, it can make you more empathetic. How do you think it's changed you, for example, as a dad?

• 49:13Speaker 03

  Well, so my wife is medical, right? So she, she gets it. Like she was in the, she's has stayed on with our kids, but she was in the OR, she understands the stress. And so that is, that is huge.

• 49:25Arthur Brooks?

  That's true. Cause you met her in the business, right?

• 49:27Speaker 03

  Yeah. Yeah. So it was a, you know, your typical like inappropriate story. I was an intern. She was my student on a rotation at Cornell and we met like, um, you know.

• 49:37Arthur Brooks?

  I'm not scandalizing.

• 49:39Speaker 03

  During that time, I think, I think my kids definitely have seen just all through. They've, they've come to the hospital with me. They've made rounds. They come to the office. And so I think they have a pretty good understanding. And, and I think like an OR day to me is a, is a different day. Like I prep for an OR day like an athlete, you know, preps for a big game. So like sleep, nutrition, just avoiding distractions. And so they're really.

• 50:05Arthur Brooks?

  And you're super in shape for all these reasons, right? Cause it's a very, very physical thing that you're doing, right?

• 50:10Speaker 03

  Yeah. And, and I feel this responsibility to be 10 out of 10 dialed in every day I walk into the OR. And, you know, if you look at what kind of effort that takes, if you're 30 versus 50, well, you know, I've read your book, right? Like I have the benefit of wisdom and experience now, but physically I've had, I've had to work much harder to maintain the energy and the ability to have the focus and the strength. And so, you know, when I found out I had scoliosis, since I found out, I've lost 40, 45 pounds. My workout regimen has completely changed. My diet, my sleep routine has changed. Part of that is I'm desperate to do everything I can for myself, but I also like, I'm trying to practice

• 50:51Speaker 03

  what I preach. And I think that really helps my message with patients, because a lot of my patients I've known for decades and they're like, wow, you, you look, you look pretty good. You've lost weight. You've done this. And I'm like, yeah, now we need to talk because, you know, I, this is what I believe in. This has been helpful to me and these are the things we need to do for you.

• 51:08Arthur Brooks?

  And everybody has problems. And everybody's got agency. That's the big message for this, right? I mean, it's like you're going to see people who are having a lot of problems. And a lot of these problems can be solved if people actually take control over their own lives, control over their own health, right?

• 51:24Speaker 03

  For sure. It's possible to like, accept, but still have agency at the same time, right? Like, I understand this is what I have. I wish I didn't, but I do. I accept that I may have some of these symptoms, or I may not do some things I wanted to. But there are still things I have control over. I still have the ability to modify the future. And I think that can be, you know, really, really inspirational.

• 51:47Arthur Brooks?

  Yeah.

• 51:47Speaker 03

  So our rate of getting people off cigarettes and losing weight is tremendously high. Most people don't understand nicotine cigarettes, they kill the little blood vessels in your body, which cause, everybody knows that causes cancer one day. That's scary, but it also causes deterioration of your discs, of your joints. It makes you old. It makes you hurt. And so when somebody come in and their back is killing them, and the main reason is the smoking over the years.

• 52:14Arthur Brooks?

  Yeah.

• 52:14Speaker 03

  You know, when we start to attach those things and counsel people on that, it's a really powerful way to get somebody to quit.

• 52:21Arthur Brooks?

  It's incredibly good news.

• 52:21Speaker 03

  It's not that I don't want to die one day. It's like, oh yeah, you have, you have control over this. What are the top five things you could do to get feeling better?

• 52:28Arthur Brooks?

  Right.

• 52:28Speaker 03

  It's quit smoking five times. Or if, for people who are really carrying a lot of weight, like morbid obesity, it's lose weight, lose weight, lose weight, lose weight. And I look at these things, like this is outside, like, I'm a spine surgeon, right? I'm not a, but I spend a huge amount of time talking to patients about these things. Because I, if somebody's, if somebody's morbidly obese, I really think this is a life threatening condition for you. It's going to shorten your life. It's going to decrease the quality of your life. You're not going to be there for your kids. And as the spine surgeon who's dealing with you because you're hurt, hearing that from me, it's not just, oh, lose some weight from your doctor. It's like, this is critical if we're going to make your pain better. Or right now, I could not safely get you through a surgery. But if we do these things right, we're going to work with you. We're going to control your pain, do injections.

• 53:13Speaker 03

  We're going to get 50 pounds or 100 pounds off your body. Then there's a successful treatment on the other side that I could offer you in a reasonable way. And so those are really, you know, those are a lot of the discussions we have.

• 53:24Arthur Brooks?

  That there's things people can do.

• 53:25Speaker 03

  I, I really love that. I'm going to start thinking of that. I may be delivering it that way. I have some really great news for you because you have some control over that.

• 53:32Arthur Brooks?

  So I have some bad news and I've got some great news. And the bad news is something's hurting your back. Well, duh, that's why you're here. The great news is there's a bunch of stuff that we can actually do. Which by the way, you're already doing that. I've seen you do that. Which is so empowering and so important. And, and in a way, a lot of people actually need pain, this is, I've seen this in my own work. People need some pain in their life to actually understand the agency that they have over their own lives. They have no stimulus to actually take agency and they feel helpless, out of control, depressed. But when something actually gets some grit in the wheel, when something actually throws them out of equilibrium, then they realize there's more that they could possibly do. It's weird, but, but suffering is beneficial in this way, right?

• 54:16Speaker 03

  This is a hard one for me. Like, like, I think that for sure, having some negative, like you're making some bad decisions and something bad happens and you suffer and you learn a lesson and you do better. Like, love it, right? Or, or my back is, is killing me, so I went to the doctor and I learned to quit smoking and now I'm not going to die of cancer. That is easy to see. In terms of the, kind of the Stoicism, Marcus Aurelius kind of flow of the world, I've always tried to look at that and try and say, okay, how can this back problem that I have, how do I turn this into a better thing? How do, how do I turn this negative into a positive? I think there are some patients, I'm able to use that to really motivate them, but, but I think, I think it's a challenge, right?

• 54:59Speaker 03

  Trying to put a positive spin on it. Sometimes I, I fall flat. You know what I'm saying?

• 55:05Arthur Brooks?

  Well, it, it, it makes sense because some people are in so much pain that telling them, good news, you're going to get a lot of moral benefit from this is going to be a hard message for sure. Uh, let me give you a formula. I'd like you to react to this. This is, um, my listeners know that I've done a lot of work with the Dalai Lama. And the Dalai Lama has, and, and most Tibetan Buddhists, they think about suffering as very separate from pain in the following way. And this is a Western formula as well, but I've just heard it a lot from the Tibetan Buddhists. Suffering equals pain multiplied by resistance to pain. Because pain times resistance equals suffering. And so what this tells you is that when you're, when you have a lot of pain, you've got two levers

• 55:48Arthur Brooks?

  such that you can not have it automatically transmit into high levels of suffering. You can lower the pain, or you can lower your resistance to the pain. Now, in some cases, lowering the, the pain is completely appropriate. I mean, yesterday I was having trouble. I had four Advils. And part of the reason is because I had to do, you know, like almost every other day, I had to do a big keynote someplace. I had to walk around on stage for an hour and give a lecture to, you know, better part of a thousand people. And I wanted to be fully present. I didn't want to be thinking about the fact that my back hurts. So I took a bunch of Advil, which I do about once a week. I try not to take it every day. And that was to lower my pain. But there are a lot of days, today it hurts a little, had to sit on the plane. And one of the things that I did was I'm not going to, I'm not going to take all the Advil today.

• 56:33Arthur Brooks?

  So I lowered my resistance to the pain. I accepted it.

• 56:36Speaker 03

  You accepted it.

• 56:37Arthur Brooks?

  I accepted it and that kind of resistance. So that's what I want. I would like you to react to that a little bit and think about how you talk to patients, how you design your life as somebody who, almost every person who comes to see you has some pain and you don't want them to suffer, or you don't want them to suffer unnecessarily. So how, how do you, how do you, how do you work with that formula if you think it's right?

• 57:00Speaker 03

  Well, I think it would be a rare human who could lower the resistance to zero. So that the suffering is zero, right? Like, I understand the math, but I, I think that it, but I like the idea that you do have some control in that reaction and you have some agency there. And lowering the resistance can lower the suffering. I think that relationship is, is, is clearly true and, and makes a lot of sense. But I, I think what I'm, I, I, I also tend to think a lot in terms of like, maybe relief, right? Like, if, if, if this is, if this is where we're at, what are the things that we can do

• 57:44Speaker 03

  to, to give relief? What are the things that we can do to improve, you know, improve function? And, and again, I think as, as, you know, kind of, you can accept while still taking action, right? And I think that's where

• 57:57Arthur Brooks?

  You don't have to choose.

• 57:58Speaker 03

  It's like, okay, I'm, I'm, I, I get it. I'm not resisting this. I'm not just sitting here suffering and catastrophizing and avoiding everything in my life, which is kind of a natural thing to do. But to start to say, okay, I understand I have this pain, but I can also intellectually get to the point where I know this is not catastrophic pain. I'm not about to be paralyzed. I can still do good things and have a good life in the setting of that pain. And like, you know, that's where, to me, that's the, that's the resistance going down. Uh, and I think you can make a huge, huge difference with that. I commonly say like, comparison kills joy. I hear from patients all the time, who's worse or better? And I'm like, hey, like, we all have our own things. But whether you're

• 58:40Speaker 03

  annoyed by your back pain or your whatever problem, or you're, you know, severely affected, I still think that equation really holds true and has, has a lot of value. Whether you're, you know, a student, like, really studying hard in suffering in your academics, do better down the road, or whether you're someone dealing with, you know, disabling back pain.

• 59:01Arthur Brooks?

  So having the repertoire of both is a good thing to do while not ignoring one or the other. Now, I, it's funny because I, I talk to people a lot. One of the biggest things that people ask me about is relationships. This is one of the biggest sources of pain. What's actually more painful than people's backs is their marriages. And because it's hard, you know, mating in captivity is no joke. And, and, and, and mental versus physical pain, there's a really interesting relationship between them. Physical pain has two parts to it. I mean, there's the stuff that has to do with inflammation and nerve endings. But then there's the part where you don't like it. Literally different parts of your brain are activated. Sensory versus affective pain, you know, et cetera, et cetera.

• 59:40Arthur Brooks?

  And, and so it's, there's a lot of similarity on the affective part between your back hurting and your marriage hurting. And so I talk to people about this a lot. And when they understand how you might give them analgesics, non-narcotic analgesics to lower the pain, you might also talk to them about how to live a better life so they can accept the parts of the pain that they can't avoid. I'll talk to people about their marriages in this particular way, talk about them, about their relationships in this particular way. And by the way, it's really helped me. I mean, uh, it's, I'm in my 35 years, Chris, and, and I will never solve my marriage. It's an unsolvable because it's a complex, not a complicated problem.

• 1:00:21Arthur Brooks?

  It's not an engineering problem. It's a, it's a dynamic human problem, which is why I love my marriage. And why I can't put it in chat G P T, you know? How can I get my wife not to be annoyed with me? Right? And actually, there are ways that I could get my wife not to be so annoyed with me, but that's beside the point. And so one of the things that I've learned from this is that there are things I should do to lower conflict. But there's a certain amount of conflict that I should accept. As you know, that's the, the cost of doing business to be in love. Right? It's what it comes down to. And that's really helped me a lot, as a matter of fact. And one of the ways that I got that was having a little bit of chronic physical pain in my life and trying to apply this formula. That I had learned, but it works in every part of life.

• 1:01:03Arthur Brooks?

  I think it works in every part of life and, and that's an important point, I think, for happiness.

• 1:01:07Speaker 03

  You know, I never thought about it that way, but um, I'm coming up on 20 years this, this next year and um.

• 1:01:13Arthur Brooks?

  Congratulations. I know you love your wife.

• 1:01:15Speaker 03

  Thank you.

• 1:01:16Arthur Brooks?

  I'm married to your wife. She's awesome.

• 1:01:17Speaker 03

  She is. She's certainly my, my better half and I definitely married up for sure. But I, I've realized in working with you and some other people like. As I've started to understand like how to not react to things that I don't need to react to and how to try and like maybe. Be a stronger person. So I don't need to let some comment lead to bigger things like. That actually is all basically lowering the, it's the exact same equation in terms of resistance. That's really interesting. That's been one of the really great things over the last couple of years for me is to say, okay, like. I understand I'm having this emotional reaction right now, but I don't need to.

• 1:01:55Speaker 03

  This is normal. Like, and if I don't, if I don't have that resistance and I don't have that reaction, then it doesn't spiral into more and more and more. So we're disagreeing better.

• 1:02:05Arthur Brooks?

  Yeah, exactly right. Exactly right. Well done.

• 1:02:07Speaker 03

  Wise man once said.

• 1:02:09Arthur Brooks?

  So how old are you, Chris?

• 1:02:11Speaker 03

  Uh, I just turned 50 this past year.

• 1:02:13Arthur Brooks?

  Nice. It's the five handle. It gets more fun as time goes on. I mean, the, the data are really clear that generally the, the, the, the lowest point in happiness is early 50s. Most people think they're going to get happier. Um, they actually get less happy, mostly because enjoyment tends to be low when you're in the thick of things with kids at home and running a business. Meaning is high, but enjoyment tends to be kind of low. And then after early 50s, then it really comes up all the way till about 70 and then half the population keeps getting happier. Then half the population starts back down again. So tell me your plans um, so that we can, because you're, you're about to get some good years, better years because if, if you're like. I mean, your results may vary, but they probably don't. The data are, are pretty clear.

• 1:02:57Arthur Brooks?

  And, and, and the plans that you're making so that you've got this, you know, this renaissance that goes on and on and on and on and on. Are you going to keep working for decades?

• 1:03:05Speaker 03

  Well, I'm not going to be a spy surgeon for decades. You know, I do think there.

• 1:03:08Arthur Brooks?

  Is it a young man's game?

• 1:03:09Speaker 03

  Well, it's a young or a middle aged man's game. I, I think it is very rare. For someone to get up in their late 60s or 70s and go to the O R and do as good a job as they once did. And so as soon as I feel like I am not at that 10 out of 10, I will modify now. There are lots of ways to do simpler surgeries, do more regenerative medicine. You know, in, in terms of, you know, a lot of your advice in terms of strength to strength, I've really started to look at this and say, my, maybe I'm, you know, if you think of 30 plus year, 30 year doctor career is a pretty average. So I'm in the middle, you know, more and more and more taking pleasure from designing cool things, working on robotics, building a culture of a team.

• 1:03:52Speaker 03

  Teaching new people, teaching surgeons. And I see because of my scoliosis, my runway until I stopped doing big surgeries may be shorter, right? And so I'm trying to aggressively prepare for that. I'm trying to figure out when that time happens. How does that end up being a positive thing for my organization, my patients? How do I be a motivator and be successful with that? Uh, but then, you know, you can, you can lead and teach and write and, and do that for a much longer period of, of your years, right? Using your wisdom and your accumulated knowledge. So I think I'm going to have a long career. I think, I think I, I, my surgical career is probably into my 60s if you look at kind of the average.

• 1:04:33Arthur Brooks?

  Right. And then, and you'll be a teacher from there on. You'll be a mentor. You'll be a coach. You'll be somebody who's empowering. And, and, and that's what, you know, the research clearly says you'll be using your crystallized intelligence to, and that, which is the most satisfying thing to do. That performance, even when that does suffer, that becoming a teacher of performance. And recognizing the next great generation of talent is our highest and best use.

• 1:04:54Speaker 03

  It sounds great. Right now, I think if all I was doing was teaching, leading, like, I think that would be great. I think I could be really good at that because I'm still trying to be essentially a full time doctor and patients come first. You know, and I'm trying to like, right now, there's this struggle that I think as time goes on and that becomes more the priority. I think there's a sweetness to that that I'm hoping is, you know, just more time to enjoy it and really do a great job out of it.

• 1:05:21Arthur Brooks?

  The people who suffer um, in that transition are the ones, are the, the fighter pilots whose entire identity actually comes from having the stick. And flying fast as opposed to I'm a full person that can do a whole lot of stuff. And I'm sure that there, there are surgeons who don't see anything but surgery. I mean, there's just no other thing that they think that they were actually born for it. But you've already exhibited the evidence that you don't think that. I mean, you're already the CEO of a big company. And employing tons of people and motivating them on a company retreat and all, you know, this kind of thing. So.

• 1:05:51Speaker 03

  In 2019, we developed this new robotic system. We did the first surgery in the world. And I, I, I was dialed in. I had my practice figured out. My patient care was going amazing and that was all I was doing. And man, like, I have, like, my life is so much more challenging now than it was then. My patient care side in general, I love it and my patients do amazing. It's all these other newer challenges and growth areas that are, are the focus, but doctors work hard. It's pretty frustrating these days, the administrative side, like there's a lot of, there's a lot of challenges in our field, right? And so it's pretty rare that someone takes joy out of like going to work, seeing as many patients as possible, doing as many surgeries as possible.

• 1:06:34Speaker 03

  Until whatever day like I, I wear out and I, I hang it up. And I, I just, I don't see that for people. And if you look at our field, the rates of. You know, depression, you know, suicide, like they're, they're higher than the general population considerably. Uh, and, and I see that more and more. Most doctors will tell their kids, don't be a doctor.

• 1:06:55Arthur Brooks?

  That's true. I've seen that.

• 1:06:56Speaker 03

  I don't agree with that. I think my mentor said. If you have multiple things you could do that would make you successful and happy, choose the one that's not a doctor. If the only thing that you can see that would fulfill you is being a doctor because of the, the special nature of it, fine. It's a, it's a great career. But you know, it comes with more and more of the kind of frustrating challenges. We didn't go to be doctors to. And fight insurance denials and pre authorizations and administrative work and checkboxes. And I'm protected from that a lot, thankfully, but in, in a lot of models, it's become like this kind of volume. Thing and it's, it takes away from patient care and quality of life.

• 1:07:34Arthur Brooks?

  Yeah. So the advice for your kids or for young people out there is has a whole bunch of, it's like a weird triple negative. Don't be a doctor unless you can't not.

• 1:07:42Speaker 03

  That's absolutely right.

• 1:07:44Arthur Brooks?

  A triple negative, which means a positive sort of, no, it's actually a negative still. Before we finish, um, I've got, we've got some audience questions that, that are for, that, that people have written in.

• 1:07:52Speaker 03

  Excellent.

• 1:07:53Arthur Brooks?

  Yeah, for sure. And then I'm going to sum up a little bit on some of the life lessons, not, not just the back pain lessons, but the life lessons from Chris Good. Mario R. writes in, is it possible to be happy in the midst of. Great suffering and disability, or is the absence of illness a necessary condition for a fully flourishing life?

• 1:08:12Speaker 03

  Well, yeah, I, I have many patients that are very, very happy. Despite, you know, very, very severe medical problems. And so it, it is not mutually exclusive, like that you, the abs, you do not have to have the complete health. To feel good. In fact, very few people feel good until they grow old and then die one day. And so I think it is, it's mandatory for us to try everything we can to build that for ourselves. And I, and I don't think it comes, some people it comes naturally. I mean, I see some people, I mean, my grandpa was like that. He just crushed it. He didn't need any counseling. He needed to work at it. He naturally was driven and just did that for himself.

• 1:08:53Speaker 03

  But I think for, for most of us, it's a matter of saying, you get this bad news, you, you start having things that aren't quite the way you want to. How do I deal with that? How do I still live a life of meaning? How do I still have happiness while this other thing is going on? But it, but it, it, it doesn't mean you can't.

• 1:09:10Arthur Brooks?

  Right, right. So the, the data that we clearly see on this. Is that mental illness is a much bigger problem for happiness than physical illness. And people who are physically ill, who suffer a lot, do incredibly well for happiness if they have good love relationships. The love is everything. Okay, this is from anonymous who wrote into the website. I have a loved one who was born with a very rare vascular condition that causes extreme pain. I would love to find out tips and tricks to not only physically deal with the pain, but also mentally. When the pain is bad, which is periodic, there tends to be lashing out and self-loathing. How can they work toward becoming healthier emotionally?

• 1:09:47Speaker 03

  So some of the hardest situations are when there's not one structural problem, but there's a global medical problem or a global inflammatory or vascular problem because all the different parts of your body are involved. You know, I can't go away from it as a doctor, like making sure that you're in the best doctors and you're having the best treatment for whatever that condition is, is important.

• 1:10:08Arthur Brooks?

  Right.

• 1:10:08Speaker 03

  But I think in that situation, there's a lot to be said to really recognizing like, for example, cognitive behavioral therapy, right? Getting plugged in with somebody who's a specialist in that area to say, okay, we have this situation, we're going to optimize medically, but how are we going to help you live the best life we can? How are we going to teach you skills to cope with this?

• 1:10:30Arthur Brooks?

  Which is the resistance side, not the pain side.

• 1:10:32Speaker 03

  For sure.

• 1:10:33Arthur Brooks?

  Yeah.

• 1:10:33Speaker 03

  It sounds like there probably isn't a doctor on earth that can make that pain go away. Now hopefully they can provide some relief, lessen it. But on the other side, there's a great deal that people can do as we've really been discussing. And a lot of today, we're getting into kind of some of the quotes and some of the aspirational side of it, but getting in the nitty gritty and having somebody that you're talking with on a regular basis and they're learning you and understanding where you're at, helping you develop skills. And then when the next bad flare up happens, you're talking to them, what did I do? What worked, what didn't? And they evolve with you. Having that expert, I think is every bit is important in this situation we're talking about as the vascular doc.

• 1:11:15Arthur Brooks?

  Yep. So, and this is really important because once again, you know, getting back to just the little, to our Dalai Lama formula, if you're only working on one side, on one variable in the equation, you're leaving value on the table. And that's kind of true for all of us. So let's kind of go through the big life lessons. There's plenty of back lessons that we've learned today, which is great. But lesson number one, you tell me whether or not I'm getting this right. We all have problems. It's normal. That's part of life. It's part of normal life. That's an important thing to remember, right?

• 1:11:45Speaker 03

  Hundred percent.

• 1:11:46Arthur Brooks?

  Yeah. If you don't have problems, it probably means you're dead and that's not the best alternative.

• 1:11:52Speaker 03

  No. And if you didn't have challenges.

• 1:11:54Arthur Brooks?

  Yeah.

• 1:11:55Speaker 03

  If you didn't have challenges, you wouldn't have growth, you wouldn't have any happiness, right?

• 1:11:58Arthur Brooks?

  Yeah.

• 1:11:59Speaker 03

  If we try, I mean, as you're the expert on this, but as we try and, as we try and only find pleasure and we try and avoid pain at all costs, it leads to less and less happiness and satisfaction and ultimately more pain. And so that avoidance of all forms of discomfort and pain is one of the worst kind of choices that we could make and that are many people in our society are kind of on right.

• 1:12:22Arthur Brooks?

  That's right. That's for sure. The second point is that we can take it from you. Practically anybody who's watching this right now, you've seen somebody in more pain than them having a great life.

• 1:12:36Speaker 03

  Hundred percent.

• 1:12:37Arthur Brooks?

  Right?

• 1:12:37Speaker 03

  Hundred percent. And, and I think, again, comparison can kill joy, so that's not to make you feel bad.

• 1:12:44Arthur Brooks?

  Right.

• 1:12:44Speaker 03

  It's more to try and inspire you to say, we all know those people. Like, oh my God, how, how is that person like that? Well, what can we learn from that person? What can we emulate, replicate and kind of set those goals for, small goals for ourselves to try and build over time.

• 1:13:00Arthur Brooks?

  The third big life lesson that I'm taking away from you is that when something bad is happening, don't focus just on the, on the, on the bad news, but on the truly great news that comes in behind it, which is that you have more agency than you think. There's lots of things that you can do. Is that right?

• 1:13:15Speaker 03

  Absolutely. It's hard in the moment, right? Fire or flight kicks in and it's very easy to lose track, but you try and step back and say like, am I on fire? Is there a bear chasing me? The answer is no. Okay, then I have a minute to set back and to try and think about, how am I going to feel about what I'm going through right now, a year from now?

• 1:13:34Arthur Brooks?

  Right.

• 1:13:35Speaker 03

  And, and is this a permanent life-changing thing? And, and then understanding that we, we don't have control over the things that happen to us, but you know, we obviously have, have some input in terms of how we choose to feel about those things, how we react to them moving forward. And as you kind of harness that agency, there's a lot of power there.

• 1:13:55Arthur Brooks?

  Right.

• 1:13:56Speaker 03

  That I think allows you to overcome a lot of these problems, but also to, to live with them without them ruining your life.

• 1:14:02Arthur Brooks?

  Yeah. The last lesson, which is really a very, very empowering lesson that I take away from this is that when things are going wrong, when we're experiencing pain, when we're experiencing setbacks, we have this negativity bias that's hard baked into our pleistocene brains that says pay attention to the bad because you know, that's supposed to get your attention. Fear, anger, disgust and sadness, the basic positive emotions are supposed to be the alarm system so that you'll avoid bad things. And by the way, that's kept us alive, but those are not your only choices. There will be times in your life when you, there are things you can't do. You know, I can't, you know, run a marathon like I would have been able to when I was 25 years old because you know, just too much pain in my back.

• 1:14:44Arthur Brooks?

  I can focus on that and become bitter, or I can focus on the things that I can do. Those are the small victories that we talked about before, but those small victories can be very large victories, can't they?

• 1:14:55Speaker 03

  Yeah, I mean, a hundred percent. And the only other thing I would say is there's so many people out there emotionally suffering, physically suffering or whatever. I do think it's, you need to go in and you need to get help and you need to find out what's going on. We see people all the time, like I just saw one, I didn't even, one of my partners took care of her, but she finally came in out of all this fear and all this disability and she got an explanation of what was going on in there. And she understood it and she had a simple injection that made her feel better at that moment. And she went to her car and she just cried and cried. And so often if we're looking at, you know, suffering, resistance, et cetera, well, if

• 1:15:36Speaker 03

  we don't know why, whether it's, whether it's seeing a mental health professional or a doctor or a spine surgeon or whatever, if we haven't gone in and talked to an expert to say, what is going on? How do I understand this? What are my options? What is my agency? Perhaps we're just suffering needlessly and we're not even, you know, maybe there's a way to actually fix the problem. That's obviously my first goal, but also you're not becoming educated to understand what are my options? What is my agency? Right? Sometimes the fear and the ongoing disability is worse. And so I think really encouraging people in any kind of pain, emotional pain, physical pain, combination. I mean, the vascular example we talked about to really say, hey, let's get in and find

• 1:16:20Speaker 03

  the right people, experts in these areas and understand what we're dealing with. You know, when I had my pain, I got some back pain, I didn't want to work it up. I eventually saw that I had scoliosis. I don't want to tell anybody. I don't want to tell anybody on my team. I was afraid my patients would be like, oh, he's weak, you know, those kinds of things. And like the quote that helped me a lot was like, if you name it, you can tame it.

• 1:16:40Arthur Brooks?

  Yeah.

• 1:16:40Speaker 03

  Right? So that's a psychiatrist from UCLA.

• 1:16:43Arthur Brooks?

  Yeah.

• 1:16:43Speaker 03

  That was so empowering for me to be like, hey, like I'm going to talk to my team about, I'm going to be honest, I'm going to ask for their help. And like getting it out there and sharing instead of like, it was so, it was so empowering for me to then be able to ask for people's help. They go out of their way. I learn more about it. I got opinions. And so I think that's where so many of us are, again, mental and physical. Is just suffering, but not really finding out the information, finding out the option.

• 1:17:12Arthur Brooks?

  Let's put on lesson number five then.

• 1:17:14Speaker 03

  Don't smoke. I'm sorry, I would not be doing my job if I didn't say that.

• 1:17:19Arthur Brooks?

  Absolutely. And don't eat like an 11 year old for God's sake. The lesson number five is you want to help relieve somebody else's pain and share your run. These are great life lessons. And I mean, life lessons from a famous back surgeon. Where else are we going to learn it? Thanks for joining me.

• 1:17:35Speaker 03

  Thanks for having me. Brilliant, really transformational for me for, to learn so much for you. And I can't tell you how many of your books and your quotes and things I've given out to patients. And so I love getting all these different subspecialties together and sharing and learning from each other just elevates everyone.

• 1:17:52Arthur Brooks?

  Thanks.

• 1:17:52Speaker 03

  I really appreciate it.

• 1:17:53Arthur Brooks?

  Pleasure, Joel and Chris Good.

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