- [Logan] One second. All
right, I think we're live, Z.
- Don't make me get in my zone.
Don't make me check on my phone.
Ball so hard ZPAC wanna find me.
I don't know where we are
right now, Tom Hinueber.
We're talking about mental illness
and I already feel unwell, mentally.
- Well, yeah
- [Z] You know.
- Yeah.
- [Z] You know.
Guys, guys, today's
show is real important.
I'll tell you why. Margot Kidder died.
Margot Kidder, for those who
don't know, was Lois Lane
in the classic Superman series.
The first Superman series,
I think the first three or
four, she was Lois Lane.
And she was a big part of
my childhood, Tom Hinueber.
She was beautiful. She
was smart. She was strong.
Even though Superman was a
douche, she kinda kept up,
and did her thing. She was a reporter.
She was a feminist before
being a feminist was a thing.
- How are those Superman
movies still so much better
than the ones they made with all the CGI?
- Dude, I'm tellin' you,
it's just like the original
Star Wars episodes are better,
you start throwing CGI,
it doesn't feel right.
It's just like health 2.0,
it doesn't feel right to us,
clickin' the boxes and
staring at the computer.
It's not medicine anymore, right?
So, Margot Kidder got rather
more famous for something
that went wrong with her.
And that was a mental
breakdown that she had in 1996,
where she was found in the
backyard in a house in Glendale,
which we all know is the Armenian
capital of the free world.
- It's Little Armenia, Z.
- Lil', Lil' Armenia, and
by the way, everyone thinks
that I'm Armenian 'cuz
my last name's Damania.
They wanna add an "n" onto
to it, so I'm "Damanian,"
and I grew up in Central
Valley of California,
which was Little Armenia, and
so I feel like an honorary
Armenian.
- You know, it's funny,
I have an Armenian aunt.
So, little white privilege
Tom Hinueber actually grew up
eating [Phonetic Zahk Tar
Za] and stuff like that.
- That's amazing.
You can finally assign
yourself to an actual,
legitimate genocide. That's amazing.
- (laughs)
- Um, so, which, by the way
that was a real genocide.
I don't care what you say,
Turkish people. You're liars.
- Turkish people are dicks, Z.
- [Z] They kind of are.
- They really are.
- They really are. I
have no idea if they are.
I know Dr. Oz is Turkish,
and I hate Dr. Oz
so maybe that's a thing.
Anyway, so, Margot
Kidder, speaking of ADHD
and metal illness, Margot
Kidder famously had that
breakdown in '96 and they way
that the press treated her
at that time was
absolutely unconscionable.
They literally made her out
to be this crazy, ex, has-been
star who had hit rock-bottom,
was found in this backyard
with the caps missing from
her teeth, totally disheveled,
wearing rags. And what
came out later is that
she'd been suffering with
mental illness for a long time,
was diagnosed with what they
were calling manic depression,
or bi-polar and had multiple,
sort of mini-breakdowns
over the course of her
career, even at the peak
of her powers, but no one knew about this.
And the stigma of mental illness
was applied to this lady,
who had, again, this amazing acting career
and she was treated like crap.
In fact, one of my favorite
shows, "The Family Guy"
actually did something
really horrible to her.
Can we roll that clip Logan?
Do you have that clip?
- Of course.
- Margot Kidder was here.
- Oh, we loved you in the Superman movies.
You were just wonderful.
- (Screams)
- I mean, so, look, I
love "The Family Guy"
as much as the next
guy, but that sort of...
Okay, imagine this, Tom,
like what if Freddie Mercury
is dying of AIDS, and
they do the similar clip
where it's Freddie
Mercury writhing in pain
from an opportunistic
infection in a hospital bed,
and "The Family Guy" does that clip.
Would that not have generated outrage
of an order of magnitude that
would've wrecked the show?
- Yeah. It definitely would've.
I hate that clip. It's
just, that's mean, man.
And it's like, where's
the joke? There's no joke.
- Here's the thing, Tom
Hinueber is one of the meanest
people I know, and that's why I love him.
For him to say that, means that this is
a particularly mean clip.
And again, you have
family members who suffer
from mental illness. My
mother is a psychiatrist.
I treat a lot of patients
and have that suffer
from mental illness. The
stigma is huge, but part of
the reason we wanna talk about
this today in particular,
apart from the Margot Kidder
story, which, I think in later
life she became an
advocate for mental health.
Which is why we have a link
at the bottom here to donate
to the National Alliance on Mental Illness
'cause we want to support
people who are supporting
destigmatizing mental illness.
This idea that we in healthcare
suffer disproportionately
from mental illness, including
PTSD, suicidality, burnout,
emotional detachment, and
then other mental illness,
and the stigma in healthcare
is so strong that we can't talk
about it for fear of being fired.
We can't talk about it as
physicians for fear of licensure
renewal. They ask you specific
questions in certain states.
Are you diagnosed with a mental illness?
Have you been on medications?
These kind of things are ...
what they do is set up a stigma
so that people don't seek help.
Then we have higher than
the normal population levels
of suicide, of...
- [Tom] Z, fix your mic.
- What's wrong with my mic?
- [Tom] It turns into
your beautiful chest.
- It's not easy having
world-class chesticles.
- [Logan] It's not.
- It really isn't. And, you know what?
My fans appreciate
that. All three of them.
So, this idea then, that
we're so stigmatized
that we can't even seek
help has been huge.
Now, this came to a head actually, ZPAC.
So, I did a little
experiment on Mother's Day.
Apart from posting the
interview I did with my wife
about the biases against and challenges
of mothers in medicine,
I did a "Ask Me Anything"
on Reddit, and for some
reason it went super viral
and had over 270,000
interactions and views,
and went to the top of the Reddit AMA.
And that's weird. I had
all these friends of mine,
I haven't talked to in
years who were texting me,
"Hey, you're Reddit famous."
I'm like, we have a million
followers on Facebook,
but we do a Reddit AMA
and suddenly we're famous?
But, this idea, I think at
the top of the Reddit AMA
was a comment about burnout, suicidality
in medical professions and
that got the most up votes
and generated a discussion.
And people were tweeting,
"Hey, ZDogg's doing this AMA
on Reddit and you guys should
check it out."
But I actually read it
and got very depressed
because I realize how deep
the struggle is for frontline
clinicians in the country
struggling with burnout,
suicidality, mental illness
and completely stigmatized.
And that made me think
we should really talk
about this today.
- [Tom] Like you said, I
grew up with a mother who's
severely mentally ill.
And I'll tell you this,
there's no casserole coming to your house
when your mother is mentally ill.
But when your mother
has cancer or something,
you are getting love and
support from the community.
And it's always this, like
weird thought of like,
well, those people are mentally weak.
It's like, well, should I
call your genetic lineage
biologically weak? Because
that's what it seems like to me,
if we're gonna use the same logic.
- You're spot on. I
mean, this is a disease
of an organ in the body ... the mind.
If you have heart disease,
they do GoFundMe campaigns.
They do telethons.
Jerry Lewis does telethons for kids
with developmentally delay.
Do you get the same
destigmatization with mental health?
No, because people think
it's a moral failing.
It is not.
And the truth is, look,
I've talked about this idea,
because we've talked about meditation,
we've talked about
mindfulness on the show before
and my own sort journey down that path
and how hard it is, and how
training your mind is hard.
Now, imagine, we've talked
about these little sub-minds
that process data and do emotions,
and have hopes and fears,
and dreams. And the elephant
and the rider and all that.
Imagine if you have a
sub-mind, or two, or three
that don't give up. They're
constantly ruminating
on horrible thoughts.
They constantly are
projecting a self-image
that is inaccurate, bad, hateful,
hurtful, filled with guilt
and regret, and this is constantly
on loop all the time.
Then you put that person
in a healthcare environment
where they're getting
stimulus of the worst kind.
Things that would give
a normal person PTSD,
we see every single day,
including all the pressures
from our colleagues,
administrators, and patients,
and each other, and ourselves
to perform better,
faster, more efficiently.
And you put that kind of mind
that's already struggling
in that situation and it
is going to be a disaster.
We have huge levels of
suicide and burnout.
I re-posted an episode with
my mom, who is a psychiatrist
talking about patients she's
lost to suicide, to homicide,
and how difficult that is.
And, I'm telling you, she was
holding back on that episode.
When she talks to me about
it, it's even more candid
and it's so hard, right?
But we stigmatize all of it.
If we treated the mind as
an organ, and as a disease
process, but also, be
careful of over-medicalizing.
So, we don't want to throw
medications at everything.
Sometimes really good
cognitive behavioral therapy,
really good psychotherapy,
and just changing our
environment, changing our
own personal way that we deal
with things, that takes work.
And it's not necessarily a medication.
It's not drugging someone to death.
And sometimes drugs are very important.
We can't lessen the importance of that,
but this idea that we're just
over-medicating everyone,
that's not the idea here.
The idea is that we
destigmatize the disease.
We find the best way to treat
that particular patient.
For me, being a Type A neurotic
with OCD, I found meditation
has been a tremendous thing
because I'm not severe enough
to require medications.
My own ADHD is mild enough
that, if I meditate I'm able to
focus and practice attention
and peripheral awareness
in a balance. And that works
for me, but it's hard work,
and I need support, and I need resources
and that kind of thing.
Now, imagine you're working 12-hour shifts
again and again and again.
There's no support.
There's stigma everywhere.
Everyone's telling you to suck it up.
And then you have the public stigma,
where people like Margot
Kidder are treated as crazy.
It's a no-win situation.
The title of this is
"What We Can Do to Help Our Colleagues."
Step one is listen to them.
Destigmatize it. Make it okay
to say I have a problem and I need help.
Change our licensing stuff.
Allow for support from
employment assistance programs,
our employers, et cetera, to
have time to actually treat,
manage, and prevent mental illness.
And then start early, like
pre-meds for doctor types
in nursing school and all
that to say that this is not
something you're alone.
You can have support and we're
gonna change our culture.
But it's gonna take a
lot of us to do that.
- There was a book I read
awhile back, and it was called,
"A First-rate Madness," and
sort of the thesis of the book
was that the best leaders
are somewhere on the spectrum
of mental illness because
they have higher levels
of empathy or caring and understanding
because they themselves have suffered.
- [Z] Right.
And then it's often when you find mentally
healthy leaders are leaders
- [Tom] who do the most
harm in a population.
Think of somebody like a George Bush.
- [Z] (laughs)
- You know what I mean?
Or a Donald Trump, who's mentally healthy,
- [Z] Right.
at least at his own diagnosis.
- Well and then that's right,
the intersection of art,
creativity and mental illness.
- [Tom] Right.
- The people who go into healthcare
are pretty creative types.
Like, I'll tell you, our
second year class play was...
The amount of creativity
that came out of this group
of UCSF medical students,
who, by the way, listen,
these are not balanced people.
These are not people who are
coming in this with a high
degree of mental stability.
These are the cream of the
crop of gifted students
who are neurotic. They are
driven. They are pushed.
All these other things.
Then you throw'em in a room.
My first year at UCSF,
I remember thinking,
am I back in high school?
These crazy, intense cliques would form.
Everybody's hyper-competitive,
but pretending
not to be hyper-competitive.
There's a big, sort of performance anxiety
and posture syndrome and all those things.
It's enough to break the
healthiest person's mind.
Now, you take people who
are already at the edge
of creativity, intelligence...
We did a show with Blair
Duddy on gifted kids...
These guys are already
right at the edge, right,
they're pushing the limits.
And you can easily push
them over the edge.
Now, we have two people at
NYU, two medical people,
a student, I think, and a
resident who died by suicide
in the last couple months,
and everyone's acting like
this is such a surprise.
This is exactly the
system that we've built
that's gonna generate this.
And the fact that we don't talk about it.
One of our goals here on this
platform is to give a platform
to these topics that no
one wants to talk about,
that we all know is happening,
but we need to put it out
to the world so that muggles,
non-medical people see it.
Our policy-makers see it,
and our academics and people
on the front lines see
it and go, you know what,
tomorrow I'm gonna do something different.
Or at least, it's in my sub-mind now,
I'm gonna ruminate on this
and we're gonna come up with something.
- I guess something that I've
though about, reflected on
for a long time is, and
I've admitted to myself,
is that I'm not in control of my thoughts,
like you were saying. You
know, like, these thoughts
just arise like something
would arise in my body
if there was a physical
problem with my body.
If there were mentally
unhealthy thoughts that were,
maybe societally we viewed
them as mentally unhealthy,
right, that wouldn't be my
fault, that would just be
something that was arising for me.
- That's a huge step towards
understanding the stigma
of mental illness, that thoughts arise.
And not only that, but
loops of thoughts arise.
And anybody who meditates
at all can see this.
You're quiet, you quiet
your mind and you see them
just arising, like, just
clouds across the sky.
And that's why there's been
a lot of research, actually
lately on psychedelics going
back to psilocybin, LSD,
high dose psychedelics,
MDMA, which isn't technically
a psychedelic, but it's
close, under guided conditions
people can actually
almost reboot their mind.
And these ruminatory
patterns of unbidden thoughts
and ruminations can actually
be broken and you actually
get a thirty-thousand-foot
view for the first time.
It's equivalent to meditating
in a cave for 30 years,
you know, having a guided
psilocybin experience
at high dose, at least to hear
people who've done it's explanation.
- [Tom] It's so interesting,
too, because it is cultural.
We put them in a box as mentally ill.
This is just, sort of, their
reality, and their experience
as a human being and we're
putting them over here in the box
as like, no, you're malfunctioning.
There's this shamanic tribe,
and I forget where it is,
like Papua New Guinea, or
something, and their name
for somebody who's
schizophrenic is, "one who walks
with the dolphins." And it's
like, what does that mean?
I don't know, but they're a
society that takes a lot of
psychedelic drugs. So they're
like, this dude's having
visions, he must be touched by the gods.
He must know something we don't know.
Let's listen to him. And he's
revered in their society.
You know what I mean?
- It's a whole different framing.
It's a whole different framing.
And you know, somewhere in the
West we lost a bit of touch
with that sort of aspect of
the spiritual, creative aspect
of what we're calling mental illness.
Now that doesn't mean that...
So if you have that mindset
it's very hard to function
in our current society.
'Cause you can't get things done.
You can't organize your
thoughts, and of course
there's the extreme.
Margot Kidder said that
when she had this break
she was wandering. She wandered
into Downtown Los Angeles
and was taken in by a
couple of homeless people
who recognized her as someone
who's fellow mental illness,
and took care of her and protected her.
And it goes to show that
sometimes game recognize game.
If you suffer yourself, your
level of empathy and acceptance
of others who suffer may be higher.
So we could all do a little bit with that.
Now, I'm not a big fan of empathy
because feeling someone's pain...
If you felt a schizophrenic's
mind, you would not tolerate
it for long, and it would
actually lead to yourself
you would burn out. You would
make incorrect decisions.
You would believe some of the delusions.
That's why family members
with high empathy of people
with mental illness can
suffer something called
folie a deux, where they
share some of the delusions
of the mentally ill family member
because the empathy is tight.
- [Tom] There's a condition
tied to schizophrenia
called allophrenia, where
you can actually start
to hallucinate, yourself.
- [Z] Ah. Interesting.
And the idea, again is that
we are very suggestible,
and that our mind is complex,
and it is consisted of sub-minds
that are always feeding
our awareness this data.
We can improve those things.
Medications, therapy, cognitive
therapy, talk therapy,
just getting out of certain environments,
set and setting.
That's why people who used
to drop acid in the 60's
sometimes would just have
horrible things happen
because their set and setting was bad.
In other words, their
mindset was bad going in,
so now they're open to
all this crazy stuff,
and their setting, where they
were was not a non-paranoid
inducing sort of setting.
But in guided settings
with the right mindset,
these might, we're seeing
evidence that these drugs
might help us understand even
the nature of mental illness
and how the mind works.
There's a lot to do.
So, Tom Hinueber, other thoughts?
- Well, taking it back
to medical practitioners,
there's a lot of things that
are considered mentally healthy
or normal, like staying up all night,
- [Z] (laughs)
- Or just clicking through
these boxes, never asking why
you're doing any of it.
Shoving your own compassion,
empathy deep within yourself
to just do the thing you need
to do to get through your day.
And then we're surprised when
people burn out and break.
These are not normal behaviors.
- [Z] We've set people
up in healthcare to fail.
You know, there was a guy on Rogan,
the sleep specialist from Berkeley,
- [Tom] Right.
Yeah, and he talked
about the origins of why
residents stay up all night
can be traced to a doctor
in the 1800's who was a
cocaine addict and expected
all his residents to keep pace with him.
So he would stay up for 36 hours
'cause he was high on coke,
and he expected his residents
to keep up with him.
So the culture was set then
by a cocaine-addicted doctor,
which is a mental illness in itself.
Cocaine dependency is in the
DSM-5, right, as a disease.
You're now expecting
medical students to behave
in this model, and it
persists to this day.
Things are slowly changing, but we have to
change them faster.
Uh, what do you think, Tom Hinueber?
- Cocaine's a helluva drug.
- It's a helluva drug.
- [Z] Cocaine is a helluva
drug. Charlie Murphy.
So, guys, this is what you can
do to help raise awareness.
First of all, people
who've donated to NAMI,
the National Alliance on
Mental Illness, $230 raised
from eight people. Thank you.
Keep clickin' that box.
Do me a favor, hit "Share" on this thing.
Share it with someone you care about.
Frame it a certain way, like,
"We need to destigmatize this."
That will go a long way.
It also helps Facebook's
algorithm to realize
that our content is good and
just and needs to be shared,
and helps it disseminate.
I don't know, ZPAC, we love you.
Thank you for supporting
our AMA on Reddit,
everything we do on Facebook,
and for being a part of the tribe.
Also, Logan just created a
"Make Medicine Great Again"
line of merchandise.
So, if you want to support our videos,
go to shop.ZDogg.MD.com and
make medicine great again.
I don't know, Tom Hinueber,
what do you think?
- There isn't a single mental
illness that's a weakness.
They're just a condition
in the human experience.
- Normally the show ends with,
"I hate you so much, Tom Hinueber,"
but it's hard to hate
you for saying something
that actually makes sense, for a change.
I hate Logan so much.
- [Tom] He walks with the dolphins.
- You dance with chickens, Logan Stewart.
- [Logan] I do. I do, Z.
- I love you, ZPAC. We out.
(hi hop music)
- What? Dancing with
chickens isn't like, a thing?
- [Logan] Gotta dance with chickens, Z.
- I'd dance with... I'd
do the chicken dance.
(hip hop music)
- [Z] By the way, have you seen my...
- Have you seen these?
I walk around talking to
myself, wearing these,
talking to Steve Jobs' ghost.
- [Tom] That's a behavior
that's considered normal
that may not be.
