A Breakthrough Treatment for Depression | David Carreon, MD

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Episode Transcript:

David Carreon, MD: [00:00:00] Getting out of bed is incredibly difficult if you have depression, and so the things that would heal you, you can’t do. And so it’s, you know, insult to injury. And then you also have an amplified sense of guilt. And so you beat yourself up for not doing the thing you can’t do. And, you know, that makes you feel even more discouraged. It’s just this vicious cycle. Once you’re in the spin, it’s hard to get out of by yourself. But that said, the key principle is whatever energy you’ve got, if it’s the ability to walk to the mailbox, or if it’s the ability to run ten miles, like use it. And the other thing to recognize is that sometimes that varies wildly. It’s a hard thing when you don’t have the energy to do the thing to make you feel better.

Jonathan Fields: [00:00:36] So depression can be a brutal experience. It can make you feel like there’s just something fundamentally missing from your life, some vital spark that has been extinguished, leaving you feeling numb, joyless, disconnected from who you know yourself to be, and more and more from those around you as well. One of the toughest aspects is often the feeling that this feeling that you have, it’ll never end, and that you’ll never feel alive and connected like yourself again. And this has become a really pervasive experience for so many people. And typical treatments have varying levels of effectiveness for different people, and often they tilt towards some blend of therapy and medication. And for many, these can be godsends, but they can also come with side effects. And for still many others, they either don’t work at all or they only kind of work part-way. Which is why I was excited to talk to my guest today, Doctor David Carreon. So he’s a psychiatrist on the leading edge of transforming how we understand and treat depression. As a co-founder of Acacia mental Health in Silicon Valley, he has helped some of the most treatment-resistant cases achieve just remarkable turnarounds using groundbreaking brain stimulation technologies combined with ancient wisdom. In his new book, The Opposite of Depression What My Work with Suicidal Patients has taught me about life, hope, and how to flourish. He dives deep into this really purposeful territory, and with the background that includes studying and teaching at Stanford, where he earned his MD. David brings a unique sort of multidimensional lens to mental health. His clinical work focuses not just on alleviating symptoms, but on restoring the freedom to fully inhabit one’s true self and live a life of profound meaning and purpose and yes, even joy. So excited to share this conversation with you. I’m Jonathan Fields and this is Good Life Project.

Jonathan Fields: [00:02:37] Excited to dive in. It’s such an interesting topic. We’ve heard the word depression used in so many different contexts, and I feel like it’s become this increasing part of the conversation around, just how are you doing? And I feel like depression is also become a bit of an umbrella term where people aren’t necessarily entirely sure that they’re referencing the same thing when they use the word. You know, we’re going to dive into depression, the opposite depression, some all sorts of ideas around this. What are we actually talking about when we’re talking about depression?

David Carreon, MD: [00:03:06] It’s a really a really great and profound question. I mean, this is something that goes back at least to job. You know, you have a good number of the core symptoms of depression described in the book of job. And then all through human history, people are struggling with different names and different constructs of melancholia, black bile. And then more modernly, there was the attempt to systematize it. We didn’t have the biology worked out, but at least we can agree on what we’re calling a thing. And so the the hope of the in the 1960s, 1970s, 1980s was maybe we can at least agree on which symptoms are called depression, which symptoms are called anxiety. And so at least in the psychiatric profession, major depressive disorder was born. And it’s a five of a set of nine symptoms that you might have. One you have to have either depressed mood or what’s called anhedonia, the inability to experience pleasure. And so within the profession, that’s what it is. But I think you make a great point, which is this is a term that goes well beyond some technical dialogue between experts in a field that nobody cares about. This is how we are beginning to frame our daily life. It sort of entered the vernacular in a way that is different than when I got this news, and I felt sad. I felt that, you know, I got this news, I felt disappointed. No, I depressed is the word that’s chosen. And so I think that there’s a pull towards medicalization of the human experience. And so part of my interest in psychiatry personally was, well, if this is how the world is being made sense of maybe understanding what it is within the profession, so I could speak to what is or what is not every day depression.

Jonathan Fields: [00:04:43] This has been described and named, although the name wasn’t always depression, but you know, going all the way back to job. And was it if we trace it all the way back as far as we can see, this mentioned in reference and as you described, like many of the sort of like the checkboxes, like we’re there and they’ve been written about in previous times in our history. Was this described as something that was, quote, wrong with you to be fixed or just a state that we experience that is part of the human condition? That is okay.

David Carreon, MD: [00:05:16] Well, I think it’s, it’s it’s definitely spanned the realm historically of what sorts of things have been said about it. I think one of the things to note about psychiatry, at least with within the discipline, is that it’s a theoretical, that it is. It’s not even attempting to put forward a theory of why this is happening. It’s just a description. And from a certain perspective, that’s how all science starts. You know, you look back at the early 1900s and the neurologists, this particular physical finding went with that particular prognosis. We give it this particular name. But yeah, there’s definitely, um, I don’t know, almost an unconscious or unspoken trust in, say, the 1970s that depression was biology and that this was, you know, you have a biological thing that’s wrong with you and you need pills. You over there, that’s just tragedy of life. And you’re sad and it’s psychological. And I’m not sure that was ever fully true, but at least that’s part of the the history handed down. And, you know, different errors are putting emphasis on perhaps spiritual forces or supernatural forces that are affecting you. Or perhaps it is biological, but with a pre-modern understanding of, well, there’s too much black bile and not enough of the other kinds of bile or the other kinds of humors. But yeah, I think the question of how we explain what’s wrong with us is and what to do about it.

David Carreon, MD: [00:06:32] Yeah. Is this something that we accept? And, you know, sometimes we might use the word grief. I’ve seen this come up a little bit more recently. People, especially within Christianity, like to use the word grief. I’m grieving over X or I’m in grief about this or and again, I think it’s it’s wanting to avoid the the term depression but still say same sort of a thing. That’s a syndrome that’s more acceptable than depression. But what are the limits of grief versus depression, versus normal ups and downs of human experience that need to be? And I think what we’re trying to say is important, though. Some things need to be accepted. Some things, yes, we are. You know that in this in this state that we’re in, things are not as they should be. There is sadness. There is a an experience of life. And then there’s things that I deal with which are at least presumably things that are pathological, things that are wrong, things that are diseased, things that are excessive, things that are not helpful. And that’s that’s at least in my functional use of the word depression. When I say somebody is depressed, I’m thinking more this, that they need that professional help of some kind.

Jonathan Fields: [00:07:32] Maybe this is not a possible question to answer, but you might. My immediate curiosity is where is that line?

David Carreon, MD: [00:07:38] Uh, in especially in people that get better and that are starting to then an emotion hits. That’s one of the hardest questions to answer for me is like, yeah, something bad happened and you feel sad again. Is this the beginning stages? You know, is this the tumor that was cut out and the beginnings of another one that we need to really be aggressive about? Or should we just let you be sad? And it’s like, well, you know, I don’t want to miss call it, but it’s difficult. And, you know, it is a very difficult judgment call. But we have to have and this sort of gets to another point, norms of what our emotions and what are they for. And there’s a sense in which we can say something is excessive. We can say that something, but that’s not something you could say with much precision. That’s a very difficult thing to say, but it is something that without it, it’s it’s impossible to do the job that I do. Not that my job is possible, not that any of this job is possible, for that matter. But it’s a great question.

Jonathan Fields: [00:08:28] And I guess it’s partly an open question and probably very much dependent on the individual at any given moment in time. But it is always a curiosity of mine, sort of like when do you know when you’re just really sad or you’re really bummed, you’re really upset, you’re really frustrated, or you’re grieving something that is worthy of your grief? And when does that cross into, okay, this is something which actually needs to be dealt with in a different way. It is now worthy of some kind of intervention.

David Carreon, MD: [00:08:58] Yeah, for the average person, there’s a couple of things. There’s the example of, um, counting, uh, the experiment of can you count how many marbles are in a big jar? So you have a big jar and it’s like, you know, I don’t know, something approximating 500 marbles. And you ask somebody how many marbles, and they’re going to say, I don’t know, and they’re going to throw out a guess. One person is very bad at that task. Like the chance you’re going to guess the exact right number of marbles is about zero, or is like 1 in 1000 or something, but you get a bunch of people to make that same estimate, and it converges very precisely on the right number. We’re all seeing something. We’re all having our own heuristics and guesses about what what it is or what it isn’t. And so in a sense, I think that an individual’s depression being problematic, you can identify that better in a group or better with help than alone. It’s very difficult to look within yourself and say, this is perfectly appropriate amounts of sadness and grief. Now there’s some flags, which I would say, especially from my philosophical perspective, are pretty clear flags. I think that suicidal thinking is never a good or healthy thing. Now. Is it an acceptable thing? Is it understandable thing? Is it a thing that I’d like to help with? Of course.

David Carreon, MD: [00:10:08] But is that a thing that’s like. Oh, well, I’m just feeling a bit suicidal today. No, that’s a sign that, yeah, you should talk to somebody. And that said, it’s like a surprisingly high number of people have that experience. But nonetheless, that’s something that is like, yes, I do think, you know, it is appropriate to go seek help if that’s ever happening with any amount of regularity. And the other thing that is kind of a cop-out answer from, um, the professional side is it’s causing disability. It’s interfering with your ability to function in your social or occupational roles. And like, okay, that’s fair, but it’s a tragedy of, you know, someone dying who is a loved one. Yeah. You’re not going to be as productive at work. And that’s okay. It’s appropriate. And again, I think it gets back to that. You know, if it’s the next day, that’s fine. If it’s ten years, okay, that you might want to get some help with that. And so somewhere between that is like, yeah, what is excessive and what is not. We try to put these arbitrary lines on it. But I think a community, particularly a spiritual community or people that are that know you well, might be able to help with that distinction.

Jonathan Fields: [00:11:08] Um, it also brings up, um, I knew somebody at one point who was clinically diagnosed with something that I don’t know if this was actually what was shared with them, but that was named as functional depression. This was somebody who was going on with their life, like going through all the motions, like doing the work. And yet there was this pervasive thing that was always like just sitting with them the whole time for years until finally they felt like, let me see if this is actually just the way I am, just the way that life is for everybody, or if there’s something going on here. And in fact, there was something going on and and it was something that was, quote, Processable. So the disability part of that. Yeah, I kind of raise an eyebrow with that also because I wonder how many people are just they’re doing they’re checking the boxes of what would be considered. Okay. So like I’m functioning in daily life and yet they’re suffering at the same time.

David Carreon, MD: [00:12:03] Yeah, it’s a great point. And I think that again, with the sort of odd definition of five of nine, that means that you can have two people with the same label that have one singular symptom in common, at least in theory. And so, yeah, some people have all of the, you know, psychological and, uh, you know, low energy inability to be productive, suicidal thinking. And then other people have none of those symptoms are also, you know, but don’t have pleasure and, uh, have problems with appetite, problems of sleep, you know, and there’s these two clusters of symptoms, and these people have the same label. Is that even the same condition? But, yeah, it’s it’s, uh, it is definitionally for the time being until we get better biology and better neuroscience.

Jonathan Fields: [00:12:42] Yeah. So often also, we especially, I think, when we struggle to really clearly define a term or a state, looking at the opposite helps us understand it. And this is this is kind of interesting because this is this is what you to a certain extent done like the name of your your recent book, The Opposite of Depression is really saying, okay, so if this is X, what is y. And I think a lot of people, if they hear, well, what’s the opposite of depression, the word that pops into their mind immediately is oh, happiness. Not so fast.

David Carreon, MD: [00:13:09] It’s one of the things that I saw with my patients. So, you know, I, I focus on the most treatment-resistant patients who have depression, possibly in the world. And I’m sort of certainly on the shortlist. People fly in from around the world to to get the treatments we provide. And so I see some really depressed people and there are some conditions that, like disable a part of you, you know, a broken arm, you can’t move your arm. And if you can’t move your arm then, well, of course you’re, you’re, you know, you’re not functioning to your full capacity. And depending on what you do for work, that really is either inconvenient or incapacitating for what your job is. But but depression is this, this unique way of kind of disabling the whole of you, or like, getting to the soul or the core or, you know, something deep inside and is is kind of across the spectrum. These nine symptoms represent some of the deepest and most core parts of a person, kind of broadly speaking. And so when I see patients recover, it’s incredible to see them like become themselves. And that’s actually one of my favorite things that people say, I feel like myself again, that there’s this identifiable state of like myself that’s the opposite of depression, that that depression removes the selfness, as it were, of a person.

David Carreon, MD: [00:14:16] And so when it’s restored, they can feel it, they can see it. And so the function of the person is taken from depression. And so yeah, you can see when people are flourishing. Yeah, they very much have not happiness all the time. But properly functioning emotions, when things are sad they feel sad. When things when happy things happen, they feel happy. And yeah, maybe that baseline is high, is elevated, is, you know, things are going well. But sometimes it isn’t that there are plenty of people that are doing well in life that aren’t smiling as they walk down the street. That’s not necessarily how it works, but that the omnipresent sadness or this omnipresent, you know, single-tone life is not what they have. There’s a variability. And I think that’s part of how we’re designed is to have that variability. And when that’s absent in a condition like depression, it is a disorder, an illness.

Jonathan Fields: [00:15:06] It is so interesting. Right. Like returning somebody to flourishing or feeling more like themselves and not necessarily like perpetually skipping down the road with a smile on their face. That’s not the sort of like the the everyday state for a lot of people, even when they’re feeling like you’re like, how are you? I’m like, I’m genuinely good. I’m not giddy. I’m not like just constantly happy. Um, I wonder if this goes back to some of the study that that, from my understanding, was done on twins also, which really sort of teased out this notion of when you look at happiness, you know, like that fabulous self-help platitude like happiness is a choice. It gets kind of squishy because in part, yes, but in part, you know, there is a certain genetic point or set point. And I’ve seen arguments about whether that’s movable or not, but a certain amount of your happiness is kind of like genetically determined. Yes. There’s a whole bunch of environment and behavior and stuff like that that can really make a difference. But also it’s not 100% within our control. And if we set this societal standard that says, okay, the goal is you’ve got to be up here like 93.4% happiness every part of the day. And if you’re missing that there’s something wrong, then we’re like piling shame on top of not being able to meet that metric and imagine that’s even worse.

David Carreon, MD: [00:16:17] It is definitely important to think about the genetic contributions to the to both sides of it. And, you know, most traits are something between, you know, 30 to 70% heritable. Almost any anything you could think of from, you know, lifetime income, like how much you make in your life, whether or not you’re going to be a violent criminal, whether or not you’re going to get depression, whether or not you’re going to be an alcoholic. All of these things have a huge genetic component. And that’s from one perspective concerning. But what does that mean to have a genetic component? It’s some people are gregarious. You know, if both of their parents are extroverts, then they’re probably going to be an extrovert. And you know that that’s, you know, even if they happen not to have the influence of their parents, you know, they, you know, raised by someone else, like, of course there’s going to be some sort of genetic influence. And from another perspective, extroverts who are out with a bunch of people all the time more likely to fall into alcoholism than people that never go out. Yeah, probably it’s going to be something like that where it’s some it’s probably some trait that we can identify that’s connected to something else. But to your point, people who and you know, again, it’s the sort of old philosophical question of, you know, when I look at something and see red, is that the same thing that you see as when you see red, it’s like, yeah, probably.

David Carreon, MD: [00:17:26] But it’s an interesting philosophical question, especially when we get to happiness. Like, how do you know if somebody is happy? You ask, on a scale of 0 to 10, how happy are you? And they put like seven and you put five. It’s like, am I really happier than you? Or there is no other way for us to like, quantify it. And so yeah, there are there are in fact, some people that will put sevens more than fives on these surveys. And yeah, I guess that kind of tracks with, um, you know, how much they’re smiling or whatever, but I’m eager to get more, uh, have the research, uh, show more, uh, more objective ways of of quantifying these things, you know, just from a scientific standpoint, but from a life standpoint, it’s much more important. Are you fulfillment, satisfaction, meaning, purpose, and maybe fulfilling your role or doing what you’re you’re called to do is maybe even more important than not? Maybe I believe that strongly to be more important than, um, whether you happen to be happy more often.

Jonathan Fields: [00:18:14] Yeah, that makes so much sense. I mean, if you ask that same person, you know, like, broadly, are you living a good life? Many of those people would say, yeah. Even though if you said, you know, like, how happy are you in the last seven days, they may not check a lot of boxes there. There’s an interesting distinction also, and this is you mentioned the word pleasure before. And that is certainly one of the indicators, the inability to feel pleasure. And this is one of the things that you write about. And there’s also this distinction that often happens between pleasure and happiness. And often pleasure is looked at as, oh, that’s the bastard child of happiness, you know, like it’s not the real thing. And yet we all want it so often. And take me a little bit deeper into the concept of pleasure here.

David Carreon, MD: [00:18:52] One of I think that the most important insights that I, I think I believed before doing this work and that I really doubled down on since it, which is a lot of these experiences that we have are a lot closer to seeing than they are to believing or calculating something with pleasure. I believe I like chocolate, I believe I like ice cream or whatever it is. Sure, that’s a belief, but the more important part of it is the experience itself of enjoying the thing. And and that’s either present or it’s not. And it’s just like sight. Like some people are blind or some people temporarily are blind, but it’s much closer to the to a direct experiencing of something than it is to other types of human cognition. Pleasure is one of those things. And so, yes, and depression we see anhedonia where people can’t do that. And yeah, that’s really hard when you just don’t get any pleasure out of anything. And it also it’s a guide, you know, we use our eyes to, to see. We avoid obstacles. We go where we want, we’re able to see the world around us and sort of construct a almost a 3D universe, a topography of where we’re going to walk, you know, avoid that curb, go up that hill, whatever it is. So too, with pleasure, with our ability to sense pleasure, we also can create this topography.

David Carreon, MD: [00:20:06] If I were to do this thing, that would be an elevate. That would be a hill that would feel great. If I write this book, I’m going to feel good. It’s going to take a lot of work. It’s going to be an uphill climb, but if I do, it will feel good at the end of it. That’s great. That’s something that I, I was able to see because I didn’t have anhedonia and then pursue it because I knew that there would be minor, you know, minor points along the step where I feel minor pleasure and a lot of pleasure once I finish the thing. So pleasure is something that is good to pursue. And I think that this old idea that these senses of pleasure, for example, should be linked to something deeper, something broader. So when we think about the other, other senses, other things that we can also see, neither the other two categories that I think this is, this goes back to like old Greek stuff, the good, the true and the beautiful. And so being able to see that this is also in line with the truth, this is also in line with the good, my my values, my moral values. I’m writing a book. I’m not doing some heinous crime.

David Carreon, MD: [00:20:56] No. If it’s in line with actually good values, that’s when things are really going well. Going right. And so, yes, pleasure can be good, but when pleasure is disconnected from a larger set of values, when it’s disconnected from what we believe to be true, or what’s a what’s a truth that we’re living in, then it becomes problematic when you’re pursuing it for the sort of spike in crash. Well, let’s again, if you think about the long term, it’s not going to be more pleasure. It’s going to be less, You know, the drugs are a great example. They feel fairly I had been told they feel great in the short term and then terrible if you continue to do them. And so, you know, there’s there’s a good story about um, the uh, people call the, the dopamine system. That’s a little oversimplified, and we get into that if we want to. But but yeah, that you, you know, you, uh, you know, blow out your dopamine system or, you know, probably your, um, pleasure system, which is a different neurotransmitter, the endorphin system. And yeah, you’re not going to be able to experience that same degree of enjoyment or pleasure as you did before because you kind of overused it. And so what’s a good long-term strategy for maximizing pleasure?

Jonathan Fields: [00:21:56] And we’ll be right back after a word from our sponsors. Which brings up another interesting question around pleasure. And it’s linked to depression. Like if one of the things is okay, like the, the absence of or the inability to feel it, how do we distinguish between that and what has sort of emerged in literature and been popularized as hedonic adaptation, that thing where like, there’s this thing we love to do and we get the high and we feel awesome, but if we do it over and over and over and over again, we are, you know, like we we are habituating beings that over time we don’t get the same hit. Like, you know, it’s a little lower low until it just doesn’t give us the same thing. How do we know when we are just adapting? We’re habituating to something and that’s, quote, normal versus oh, actually, there’s something going on here where I literally have lost the capacity to feel something.

David Carreon, MD: [00:22:46] I think this gets back to what I was saying about community and maybe even like community over, over time, that these are really hard questions. And, you know, it’s very easy to fool oneself that I’ve really arrived. And it’s like, okay, well, that’s great. Two people do that. How about ten? How about a million? If we think about if we want everyone to flourish now again, maybe that’s a good question of values. Do we want everyone to flourish? Do we have that obligation or should it just be us? But what is the game? What does a system, what is a way that we can work together where many people are moving towards flourishing? And this is the United States, the the founders having this idea of life, liberty and the pursuit of happiness that we want a government that allows us to pursue happiness because it’s kind of hard. That’s a really hard question. How do we all and again, I think they meant happiness in the more flourishing sense than the, you know, hedonic spike sense. But yeah, these are deep questions. How do you know if you’re just habituating? I think that is a good sign that maybe, you know, maybe try to pursue something, something more. And this is also something that with the community, with other people, like, am I just being lazy? Have I gotten to a plateau but not the mountaintop? And I think this idea that, you know, almost religious idea that like, well, are you a maximally in this state of enjoyment and maybe enjoyment in this deeper sense? If not, then keep working, keep looking, keep realizing what of myself is inadequate, what of my habits are insufficient to achieve this level? And you know, a lot of what I talk about is sort of ways that we can with more secular approaches, experience goods like exercise, you know, turning around negative thoughts, uh, pursuing beauty in the, in the world around us.

David Carreon, MD: [00:24:22] And that could get you pretty high if people did nothing other than that, the world would be a dramatically more flourishing place. However, there are some people that seem to be able to transcend this despite all terrible circumstances. They might be in saints or heroes or wise people through the ages are able to get into these modes where it doesn’t matter what you do to me, they just transcend it and they experience these states of like literal joy, like smiles on their faces as terrible things are happening because they’ve transcended the mundane. So, yeah, I mean, I’d say parallel paths, like they’re just there seems to be something that humans are capable of, of the transcendence. And at the same time, the day-by-day work I’ve seen as this in AA too. There’s some people that work, the program, they work, the program, they go to their meetings. They’re just continuing to going to meetings. They, you know, they relapse, they go back to they relapse, they go back to me. And it is a slog. And after five years, they’re sober and it’s like amazing. And they have to just keep going to meetings and keep gritting their teeth. And they and it’s yeah. And it’s hard work, but they’re sober and it’s worth it. And it’s great. Their life is so much better than it was before. But it’s a lot of work.

David Carreon, MD: [00:25:23] And then there’s others who just have a transformation and they’re better and it’s gone. Um, the patient that, you know, it’s just like, yeah, I, uh, you know, turned my life over to my higher power. And like, yeah, I don’t have any desire at all for alcohol anymore. That’s not fair. Like, these people are working, and you just turn your life and it’s like it’s gone. It’s like. Yeah, and. But then he relapsed. And then that didn’t happen again. He, you know, in this particular case, he had this one-time experience of like complete, I don’t know, super like radical healing without any additional work. But then the second time he really had to work at it. So again, that the world is a complex and a mysterious place, that there are these pathways and being open to, I guess, grace when it comes, but also like it often doesn’t, or at least in the, you know, workaday world. We just have to, you know, do the best thing we know how to do and not get lazy. I think that’s the other thing. Now, if you’re depressed and listening to this like you’re not lazy, you think you’re lazy, your brain is telling you’re lazy. That’s not I’m saying you probably need to treat yourself less harsh. And this gets maybe to another topic on guilt. What’s an appropriate way to judge oneself? And the answer is, you know, really depends on the circumstance. And are you over-judging yourself, which almost every depressed person does? Or is it that, yeah, I kind of gotten complacent and I climbed the hedonic treadmill and I’m kind of bored.

Jonathan Fields: [00:26:37] Yeah. And you do make you make this really interesting distinction between constructive and destructive guilt effectively. And like, how are you going to I look at it almost from like this seed of saying, okay, so here’s an experience that has an energy to it. You know, there’s an activation energy to it. What is it going in, what direction is it going to activate you. And you contrast that with what you were just sharing. Like a lot of what you’ve been describing, there’s an element of seeking. You know, there’s an aspirational like, I there’s something out there that I want to move toward. But my sense is always been that in the experience of depression, even though you may see that thing that you want to move toward, the movement, toward it is the thing that is really hard to access. Like, how do I actually go from being here, feeling the way I’m feeling, looking out there and saying, I want that, but I can’t. There’s something inside of me that is not allowing me to do all the things that would get me from where I am to that place out there.

David Carreon, MD: [00:27:33] Yeah. Several of the symptoms are in this direction, so one idea is pleasure. I anticipate if I do this thing like a workout, for example, I will feel good about it. If you’re depressed, you’re not going to feel good about it. It doesn’t. You don’t feel anything. You don’t feel pleasure anymore. So like the idea that, hey, maybe I can motivate myself for the, you know, the intrinsic reward of the thing that’s not going to work. You also have, you know, psychomotor slowing. So like physically slower. I mean, I remember one patient in particular, I literally thought he had a movement disorder like Parkinson’s because he walked so slow. We cheated him with the intensive, uh, magnetic treatments. We activated the part of the brain. And, uh, I, you know, asked my, my team, like, who’s the new patient? That’s that’s Mr. Smith. It’s like I recognized him by his gait. And his gait changed so radically between, you know, days that I saw him, that he looked like a different person. So you’ve got that symptom that makes it harder to move, and then you’ve got this sort of more squishy idea of energy or lethargy and like, getting out of bed is incredibly difficult if you have depression. And so the things that would heal you, you can’t do. And so it’s, you know, insult to injury on this. And so then and then you also have an amplified sense of guilt. And so you beat yourself up for not doing the thing you can’t do.

David Carreon, MD: [00:28:40] And you know, that makes you feel even more discouraged. So it’s just it’s just this vicious cycle that’s, um, you know, once you’re in the spin, it’s hard to get out of by yourself. But that said, whatever amount of energy you’ve got, the key. And the other thing that is the key principle of my practice and book is whatever energy you’ve got, if it’s the ability to walk to the mailbox or if it’s the ability to run ten miles, like use it and there really is okay, maybe you can have a little bit more energy the next day. If you do use the energy you do have. And the other thing to recognize is that sometimes that varies wildly. Some days you might have energy and others other days you don’t. And so if you set like a fixed standard, I’m going to do this much every day. It’s like you might have the capacity that some days and not others. And that’s discouraging. But setting sort of tiered goals of like, I’m at least going to walk to the mailbox every day, and if I feel good, I might go for a walk. And if I feel great, I might go for a run. Great. But not getting not getting too discouraged. It’s a hard thing when you don’t have the energy to do the thing to make you feel better.

Jonathan Fields: [00:29:37] Yeah, I do want to drop into some of the body-based things that you actually just referenced earlier. But before we get there, you also just referenced some of the work you’re doing with TMS. For those who don’t know, is shorthand for trans – if I’m getting a right, transcranial magnetic stimulation, which is fascinating, fascinating work. Take me into this more because I think it’s really interesting. And I’m so curious, sort of like, what are you seeing in this work right now?

David Carreon, MD: [00:30:03] Transcranial magnetic stimulation was an approach that was invented in 1985, where you are able to activate a part of the brain or, depending on how you tune the machine, deactivate it. And so the idea is we are able to put this magnet. It’s kind of about the size of a palm of your hand, of the face of the magnet is over the part of the brain that we want to activate. And this very powerful electromagnet is apps are, you know, depolarizes about a cubic centimeter of brain. And, you know, you do that in a particular pattern. You can sort of send signals down the wires of the brain starting at that location. This was shown in the late 90s and early 2000 to be a very effective right, at least at that time an effective antidepressant. And from 2008 to about 2018, it sort of grew in acceptance, grew in availability, and even grew in insurance coverage. And so more and more people are able to get access to this treatment for the treatment of depression. And we sort of realized, okay, well, if you tune the machine in this way, if you increase the number of pulses, if you increase it, we’re able to optimize the parameters. And then in 2018, Doctor Williams, Doctor Noel Williams of Stanford developed an approach called Saint, where he did a high dose to a personalized target. He did a brain scan, located exactly the right place to stimulate, and then did a lot of stimulations over five days, and in the first study got 90% remission, absolutely astonishing remission rates in people who had really tried everything. Was this long.

Jonathan Fields: [00:31:31] Term did it last?

[00:31:32] They’re doing long term studies now. But yeah, I mean, in my clinical experience it often does. And the numbers ended up being closer to, you know, 50%, 50, 60% in the at the one-month time point. And most of those people end up staying better, roughly speaking, for for at least a year. And then Retreatment works great. But the idea being, this is the first time in, um, the history of psychiatry that we had a treatment that could be potentially scalable, where we started with the brain, we used the brain, the individual person’s brain, to direct the treatment. Now, you know, it’s 2024. Shouldn’t this just be how we do psychiatry?

Jonathan Fields: [00:32:09] Right, that’s the question spinning in my head, I’m like, why is this not like the front-line treatment?

David Carreon, MD: [00:32:14] Yeah. And I mean, it’s that’s the question in my head too, which is and part of the answer is inertia. The powers that be in systems that be are rather resistant to change for various good and bad reasons. But yeah, it’s astonishingly effective. It’s very fast. Um, it’s currently expensive. And that’s part of the reason why it’s, you know, Prozac is three bucks a month and it’s hard to it’s hard to beat Prozac. So Prozac, you know, on a cost basis. Yeah. You know, but that comes with all kinds of side effects. So the TMS we believe to be less have less long-term side effects than having to be on an antidepressant long term. But the more important that there is hope for depression is one major takeaway. But the other takeaway is, wait a minute. We can modify any arbitrary circuit in the brain, up or down.

Jonathan Fields: [00:32:56] That’s wild.

David Carreon, MD: [00:32:58] There’s a lot of stuff in the brain that’s that goes wrong besides depression. And so sure enough. So there’s some studies on obsessive-compulsive disorder. So that also is FDA-cleared. There’s, uh, studies in addiction and that’s also FDA cleared. And there’s probably about a dozen other conditions, from Parkinson’s to chronic pain to a variety of other things that live in the brain, that are treatable with this new approach. And with these newer methods of targeting, we’re getting better and better at treating it. I think that we’re at the beginning of a revolution, a pivot point in the history of psychiatry and neurology, where it’s no longer these general sort of bay of the whole brain and serotonin approaches. It’s like, no, this is the circuit that’s wrong. This one needs to go up. We don’t need to increase the whole temperature of the serotonin system to to affect us. We just want to hit this one. And so more targeted, more personalized treatments are becoming available every day. And so I think that it’s an incredibly exciting time in psychiatry. Even when I was growing up, I’m not that old. And even I was going into psychiatry, I was like, ah, well, I really like talking to people and I like the deep questions. And so maybe, you know, this is the field for me. And it’s like, wait a minute, wait a minute. We’re actually having breakthroughs in this thing. This is this is an exciting time to be a psychiatrist and particularly in the neurosciences.

Jonathan Fields: [00:34:07] Yeah. I mean, it’s so fascinating to me because on the one hand, you can talk to some folks in the field and they’ll say, like, there’s really nothing new that’s been happening for 40 years now. And then you talk to you and you’re like, no, wait a minute. There’s there’s really groundbreaking stuff happening. You talk to folks who are, um, researching psychedelics, MDMA and things like this, and they’re like, okay, so really early days, a lot of studies are still needed, but there are some stunning things happening there, too. And like these interventions, they also strike me as so part of me, you know, a long-time entrepreneur. So part of my curiosity is how do we improve the human condition? Part of my curiosity is like, how does this become a sustainable model that, like everyone can access, you know, when you have some sort of pharmaceutical or something like that where basically it’s like you take this thing often for years, sometimes for life. There’s a great quote, business model around it. When you’re talking about something where it’s, oh, this is a one-time or like a one-week intervention, and maybe it lasts forever. Maybe once a year you come in for a tune up, generally a much poorer business model behind that. So like the entities that support, you know, the quote, industry of wellbeing, it’s much harder for them to get behind it. So I would imagine there’s a certain tension that you’re navigating every day when you’re doing this work.

David Carreon, MD: [00:35:18] Yeah. No, it is a very difficult set of questions. And yeah, I think that there are understanding the financial incentives of the you know, the medical system is is an incredibly important thing. And I was watching a Senate subcommittee hearing, as one does. Um, and and it’s taken me years as the CEO of the company and trying to think about the business strategy of how do we get this out to more people and how do we develop the scientifically, but how do we also make this more accessible and scalable? Understanding how money works in healthcare. And it is dirty. It is. I thought it was dirty, like starting out. I was like, oh yeah, you know, you know, greedy fat cats and all, you know? But it’s like, no, it is like it’s become this, like Frankenstein nightmare monster of wealth extraction that is, you know, consuming ever more of everybody’s paychecks every month as it continues to just gobble up more and more. It’s like it’s incredibly efficient. And frankly, I used to think that it was like some, you know, that the the CEOs of these companies were just sort of like, you know, wringing their hands and thinking, ah, yes, we’re exactly going to plan. Nobody knows what’s going on. It’s so complicated. But all of that diatribe to say, yes, it’s complicated to figure out how how to make this thing that really is potentially going to change.

David Carreon, MD: [00:36:29] It has the scientific potential to change flourishing, uh, affect mental illness, affect neurological illness in ways that have not been thought of before. But it’s much harder to extract profit from if you’re a payer. Now, that said, the people who have been paying the money for health care are largely the fortune 500, and they’re getting sick and tired of getting taken advantage of by these these health care companies. So we’re at the beginnings of a sea change, I think, in health care payment. Because again, to be a little cynical, this is a little bit more than a little cynical. You could steal from poor people all you want. Nothing’s going to change. You start stealing from rich people. Things are going to change real quick. And I think that we’re at the point where the people who are stockholders and stakeholders and leaders at some of these bigger companies are seeing, come on, you know, big health care groups like this is absurd. This is going to need to change. But so there’s an appetite for change. But the system is so complicated. Many now have tried and failed to do anything of utility in this incredibly complex system where lives are in the balance. Like you don’t want to mess this one up.

Jonathan Fields: [00:37:31] Yeah, it must be interesting. And like, you know, sitting where you sit on the one hand, you know, like, you know what? You know, you have tools, technology-like ways to intervene that you see are just really helpful and really effective and to feel at the same time a bit hamstrung, like, how do we scale this out to millions and tens of millions, hundreds of millions of people? How do we make it affordable for everybody? And everybody wants it, but they’re sort of, you know, there’s the level of friction. Um, in the middle is kind of stunning. I hope you’re right. I hope there is. You know, we are in this sort of like moment of, uh, at least the early days of change, you know, while we’re waiting for that, you know, while this you have these, these ideas, you know, like, there are still things that we can do. Medication is certainly one of the options a lot of people pursue. But you also brought up, you know, like these fairly straightforward, accessible to everybody things. You know, you mentioned exercise and we’ve certainly seen a ton of research on the effect of exercise and and mood and state of mind and affect sleep. I think everybody has sort of like heard, you know, recently how just profoundly important this is to not just your physical functioning, but your psychological functioning. Food is an interesting category. These are all three things that you write about in the body section of your book. I feel like it’s emerging now as like, oh, wait a minute, this is about our psychology too.

David Carreon, MD: [00:38:52] Yeah. Turns out we’re embodied creatures and that the, uh, you know, that the brain is connected to the body and, uh, you know, what goes on in your tummy affects your brain. And so, So yeah, eat garbage and you don’t feel good. And it sounds like, you know, your mom could have told you that. Uh, but, like. No, but really like and, like, understanding the, uh, starting to understand more and more about the physiology of, like, how exactly does that happen? And, you know, having the appropriate nutrients and even some of these more carefully controlled studies. And so there’s, um, Mediterranean diet is, uh, probably the best-tested diet. But, you know, what exactly is that? Is it, you know, what are the aspects of it that make it magical? Lots of open questions. But like, it’s not a bunch of junk food and fast food and ultra-processed food, or it’s at least less of that. But yeah, you’ve got less mental illness, you’ve got less depression, you’ve got faster recovery from depression, you’ve got less likely to become depressed. It’s kind of and less likely to like, physically die. Like eating good food is good for you. And there’s a sense in which we’ve always known that. But I think that especially in a world that is busy, this is something else that I’ve.

David Carreon, MD: [00:39:55] I don’t quite know how to quantify this, this sense that we’re always rushing, the sense that we’re always busy, the sense we don’t have time for anything. And like you look at the studies of like number of hours worked or you know, how we’re using our time, it’s like it’s not obvious that we have less time now than we did 40 years ago. But there seems to be something in our daily experience where I just don’t have time to cook. It’s like, yeah, I feel that like, you know, as much as this is, you know, doctor, heal thyself. Like, how often do I make a nice, you know, a nice Mediterranean meal? Last night I did, so I can brag about that, but it’s not as often as I’d like that I have the time or that, you know, we as a family have the time to sit down to a nice, uh, you know, prepared meal because we’re too busy, you know, maybe social media, maybe the pace of life. But it seems like there’s a the sense that we just don’t have enough time anymore. And we once did.

Jonathan Fields: [00:40:45] I think that makes a lot of sense. You know, I think a lot of people say like, well, okay, so I get that food. It’s going to help. I get that sleep is going to help. I get that exercise is going to help. But but just like you’re saying, I’m like, life’s moving too fast. How am I? Where am I going to fit in? How am I going to fit it in? Um, and I get that. I completely understand that. I think we’ve we’ve all lived that and felt that maybe like if you’re listening right now, you’re living and feeling that in this moment you can’t conceive of saying, well, I’m working two jobs and I’ve got a family to support and a single parent. And like, there’s like where, where and how is this going to happen? And I feel like that is one of the major frustrations from so many people is like, they look at some of the basic things and say, yes, I get that this will help, but how like in my life, the way it is right now. Like I don’t see the margins for this.

David Carreon, MD: [00:41:30] Yeah, and I’d say a few things. Number one is if you’re working two jobs, then this might not be true of you, but many of my patients in Silicon Valley could create the margin had they prioritized it. It’s not a financial thing. They just chose this particular lifestyle. So ask the question, is this necessary? The answer may well be yes, of course. I literally cannot afford rent unless I work two jobs, and this is just how it has to be. But like if you’re like many of my patients, the answer is yeah, no, you could you could make some changes there. And don’t assume that you can’t. I think that’s another thing that people sort of fall into this trap of like, oh, I could never tell my boss that I’ve got to be home at 6 p.m. or whatever. It’s like, you know, you might be able to. The other thing is, a little goes a long way in reviewing the research for the book, the difference between zero minutes of exercise. And then they had a category of, you know, one to a few minutes per week. It’s like the difference between 0 and 1 minute of exercise per week is like drastic. Now again, probably it’s the you know, one minute it’s not that different than zero, but like ten minutes a week or 30 minutes a week is like that is a big difference.

David Carreon, MD: [00:42:31] And so trying to take the stairs when you’re at work instead of an elevator or spending two minutes in the morning doing calisthenics or something, or there’s the, you know, five-minute workout from some years back that showed similar effect. I had a patient who was not able to walk, and so she got one of those under her desk. You know, she had lost, I think it was £100 in a year. I she traveled and came back. And then, you know, I saw her and she like looked like she lost a lot of weight. I was concerned like, you know, the symptom of depression. Like you must be feeling terrible. No, doctor feeling great. It’s like what happened and. Oh, I just got this under. And so she was kind of going like this. She was kind of rocking back and forth during the interview, like when I was on zoom with her, it was middle of Covid, she said. I said, it’s just, oh, I got this under, uh, desk, little bicycle, like micro bicycle. And she just does that all day long, and she’s just on this little bicycle under her desk all day long, and that’s what she does. She lost £100 in a year. And it’s like, if you can’t walk, this lady can’t walk because of a problem in her back. It’s not going to ever get better.

David Carreon, MD: [00:43:27] So yeah, I did not, in fact, have my own, you know, Under-desk treadmill that she was able to lose £100 on despite not being able to walk. So all to say these changes a little goes a long way. And there was another study. I can’t quite remember the details, but it was people who worked as housekeeping at a hotel. Yeah, they just told them about, hey, look, you know, the thing that you do every day that actually counts as exercise and the education that this exercise presumably made them, like scrub faster or harder, or maybe take the stairs or something and they like lost substantial amounts of weight and were were healthier afterwards. So there’s the sense of like even the things that you’re doing physically to move, move a little bit faster or have it in mind that, hey, this counts. And even that mindset shift can help in people that are that are feeling rushed. And one more thing I’ll say is an old word that which is Sabbath or rest. So, you know, ancient tradition going back to certainly Moses ten commandments, early pre-roots of Western civilization. They got this idea that it’s not just, yeah, don’t murder people. And I remember when I was, uh, when I was in college, engineering, pre-med. And so, like, I did not have time in college to take rest. Everybody studied all the time because, you know, for both engineering and pre-med, let alone both.

David Carreon, MD: [00:44:40] So I was studying all the time, and then I was, you know, I was reading my Bible as I, as I do. And I came across the Ten Commandments and I was like, okay, yeah. Not murdering anybody. You know, I’m doing pretty good on this one. And, you know, so, you know, going down the list and, you know, not stealing and, you know, honoring God and all that. So and then it was keep the Sabbath. It’s like, don’t work. Don’t work. One day in seven. That’s got to be like one of the minor commandments. And it’s like, no, this is like right next to murder. Like, don’t murder people. Take a Sabbath. I wasn’t even trying to do that one. I didn’t even know that was like a moral duty. Yeah. Stop working on Sundays. And it was the most magical, amazing thing ever. This, this, you know, that that experience you get when it’s the first day of summer and you just can’t think of a responsibility. It’s not even, you know, that that nagging list of stuff you got the back of your mind of like, ah, yeah, I should be whatever. It’s like. That list is gone. That list is is, uh, prohibited from on high. I cannot work on that list. This is for other stuff.

David Carreon, MD: [00:45:37] This is for spending time with people, for going to church, for throwing a Frisbee. It was great. It was the most restorative thing. And I’ve. I’ve kept that. I’ve kept doing that practice. And for a, um, for me and throughout my medical training, it’s been absolutely transformative to have some time that. Yeah, as busy as I am, it’s not going to encroach on a, you know, on a on at least this day. This day is, is set apart for that. So yeah, I mean we should be doing that with, you know, eight hours a night of sleep as almost a metaphor. We should be doing that for sleep. We should be doing that perhaps even in cycles in our life with sabbaticals, periods where we’re, you know, we’ve got vacations and that sort of built into our, our year, but sometimes perhaps even longer periods where you just change the pace. And I guess this gets back to the hedonic set point. You don’t want to fall into these old traditions, and if you’re working the same thing every day, it’s easy to just single track mind. And if you stop and say, okay, who am I? Who am I when I’m not working? Who am I when I’m not busy? It really gives time and space to consider one’s identity. And if you are defining yourself by your work, yeah, that’s a problem. That’s real hard.

Jonathan Fields: [00:46:39] Yeah. And also it gets to what you were talking about earlier, which is a sense of, you know, when you’re working with patients and they start to like they start to lift and like how they describe that feeling, I’m more like myself like, but like you actually have to remember who that self is, you know, to be able to actually recall what it feels like. And it’s like. And the more you create space to step into that, oh, like, this is me. This is me when I’m like at my best, when I’m at peace, when like, I’m when my essence gets to show through. I think we lose track of that so much out of that. What you described as like that sense of busyness. And we’ll be right back after a word from our sponsors. One other question, and this is something you write about, and it’s this notion of blessedness, and certainly the feeling of blessedness and its relationship to mental health, which I think is fascinating.

David Carreon, MD: [00:47:30] Yeah, there’s a limit that you could get to, you know, everything is going well with your body. Everything is going well with your mind. You’re not believing false things about yourself. You know, the negative chatter is is died down. You know, maybe you’ve controlled yourself in a sense, the perfect stoic. You’ve disciplined yourself, you’ve organized your life. And yet how high could the Stoics rise? They at least don’t let the gods see you, you know, cry like. Yeah, I mean, that’s kind of vindictive. And, you know, screw you gods. It’s like, that’s as high as you could rise is, you know, not not letting it show that, yeah, you’re going to die. That. No, you can control a lot of things. You can’t control everything. And that’s not like happy. That’s minimizing the consequences of the negative. And that’s great. And again if that’s if that’s the limit that we can go. That is so much human suffering to be eliminated if everybody lived like that. But that’s not as high as humans can rise. You know, I tell a story, or I recount the story of a woman who was in a convalescent home and she just, you know, end of her life, riddled with cancer, alone, blind, unable to walk.

David Carreon, MD: [00:48:36] And, uh, a man came to visit her, a pastor, and he thought he was doing a good deed. He was going to, you know, visit the poorer people in the convalescent home as a, you know, as was his duty and, uh, you know, was going to minister to these poor souls that were in such misery. And he gets to her and she realizes that this person is living a life of joy. She can’t see, she can’t walk, she’s being fed whatever the state can afford to feed her. Like every one of the things I say she should be doing, she’s not doing because she can’t. Because she’s in this, you know, terrible physical state. He asked her, like, what do you think about all day in the blind, in the dark, with no ability to talk to people, lonely for, you know, not having friends for, you know, a decade. It’s like prison. It’s like, worse than prison. And she said, I think about my Jesus and how good he’s been to me. And she starts singing to him. And it’s like, that’s a state of blessedness, of joy, of, of life, that even with all of the things and maybe even because of all of the things that I have and that most people have, you know, we don’t often get to and this is, um, in the possibly the most famous sermon ever given, Jesus said, blessed are those who mourn, for they shall be comforted.

David Carreon, MD: [00:49:45] And so there’s this sense of when you go into there’s this sort of topsy turvy world, when you when you go to the very limit of that direction, you are lifted up. And so in her case, and in I suppose anybody’s case, there is this pathway that’s somewhat, um, to some degree mysterious where you give up your life to gain it. And in her case, turning to Jesus, turning to, I suppose, following the example of someone who had everything, at least according to the Christian story, was God was the King of the universe and came down to live as a, you know, as a a poor, oppressed citizen of, well, not even citizen, poor, oppressed denizen of Rome and lived his life in this, um, you know, obscure village for, for many decades. And that’s how you overcome to a greater degree and achieve the state which I call blessedness.

Jonathan Fields: [00:50:34] Yeah. I mean, it’s so it’s so interesting. And I’ve seen some of the research on, you know, that measures again, use this word loosely happiness or flourishing and religiosity. And as a general rule, all the research that I’ve seen is the more religious you are, the more satisfied you are with your life, the happier you are, the more you feel like you’re flourishing, even if you’re living under really very constrained conditions. I think people have tried to tease out, well, what’s happening there, and they look at, well, you’re part of a community like a very well-defined, tight-knit community. And we all know relationships are really important, and you have a set of beliefs that basically help you identify like if X, then Y, like if this happens in your life, in the family’s life, in culture. Here is the answer. Here’s the behavior that you do. Here’s the practice. So to a certain extent it minimizes a sense of uncertainty. It’s like okay, yes. I nod along with that, that that makes sense to me. So we’re looking at all these sort of like, like research-based things and then but is there something bigger going on that is literally like not quantifiable now and will never be quantifiable? It is a sense that it just is. And I’m fascinated by that question. Yeah. I mean.

David Carreon, MD: [00:51:42] I think a lot of people will, you know, show me the evidence or are I’m pragmatic, I follow the evidence where it leads and it’s like, well, there’s this one mode of being that seems to be better on most measurable domains of of flourishing, of the good life, of whatever we want to call it. And you ask them and and they ask them, you know, what is this all about? And they, they point up or they point to God, or they tell you a story about something profound that I think that for a lot of a lot of folks, it’s like, you know, what do you do with that? Like you shrug. And I was listening to a m, another, uh, podcast even this morning. And it was, uh, the podcaster talked about how, you know, faith was a gift that I haven’t yet been given. And it’s like, yeah, this is great, but, like, what do I do? Just go to church? And there’s some really interesting research on that question, which is, so there’s a researcher at Stanford, uh, Tanya Luhrmann, who studies various anthropologists, you know, are famous for going to, uh, you know, obscure villages and strange customs and traditions and peoples. And, uh, so she went to a very strange tribe of she got famous for, for visiting psychiatrists. So she went to a psychiatry residency and studied us.

Jonathan Fields: [00:52:45] Very strange tribe indeed.

David Carreon, MD: [00:52:47] Very strange, very strange tribe. Uh, and then she went to, um. And so she also, uh, wrote a book a few years back called When God Talks Back, where she, you know, lives in, you know, works at Stanford, in Palo Alto, in Northern California. And she traveled all the way to the other side of Palo Alto to visit this, uh, this group of charismatic Christians. And so she visited this church and then lived with them and went to the Bible studies with them and tried to understand how they saw the world. And one of the things that she emphasizes, and this is in line with other sorts of cognitive science work, is that the default state of a human is not like we start atheist and then somebody teaches us to be a theist. It’s something different. It’s not that we start like Christian or, you know, Islamic, that those are things that very clearly have to be taught. It’s a belief in God or God’s belief in there being a spiritual realm. And then we sort of shape that sort of prewiring into our civilization, shapes it either into secularism or into Christianity or Islam or whatever it is. And so her point was that, or what she discovered was that it was a repetition that every Sunday these people would come together, they would sing songs, they would hear a sermon, they would move together, they would sing together, They would speak in tongues.

David Carreon, MD: [00:53:56] You know, all of these sort of practices and rituals helped them reinforce this particular way of belief. And so in a sense, yeah, we can say that faith is a gift that just sort of strikes us like lightning. And sometimes that happens, but most often it’s just like everything that we’ve been talking about, it’s embodied. It’s embodied in a human physical community that people meet together every week in this particular place. If you go and learn their ways and see their customs and go visit, you know, most of them are more than happy to have you, um, to explore. But it’s also something that’s really difficult to do outside of a community. It’s almost like it’s this emergent phenomenon. Again, there are very important exceptions to this of the hermits or of, uh, of individual monks that will go off into the wilderness and, like, have these experiences. But almost everybody has to experience that in a community. And yeah, and that the community imbued with the set of odd beliefs and strange practices. But all of that goes together and it’s almost like you can’t separate it.

David Carreon, MD: [00:54:47] It’s like the, you know, the drug companies big Pharma likes to figure out like, oh, well, you know, here’s this plant that does this thing. What if we extract out this one compound and then we can sell that for a bunch of money? It’s like, well, okay, you can’t like, extract out the theology of Christianity or the praying five times of Islam and like, inject that into a atheist and think that’s going to do anything like it’s a system. You kind of got to take it, at least mostly as it is, and find your place in it. And, you know, these are big tents. There’s a lot of, you know, whether you’re going to be a, you know, a ecstatic, uh, person who’s experiencing the ecstasies of prayer or whether you’re going to be a, you know, dusty theologian reading books like those are within the same community, but it is a community. But all that to say, it’s something that people can do and should explore, I think and I think that, um, seeing that more and more even in people that, you know, I would never have thought would explore that side of things, I think that we’re seeing the end of what pure and maybe hardcore atheism can do.

Jonathan Fields: [00:55:44] Yeah. I mean, it is really interesting. I think we, you know, we’ve seen all the data, you know, the growth of the nones, the people who who consider themselves spiritual but non-affiliated. And then the question, I think for a lot of them that they’re asking now is, you know, like, how am I doing? And if I actually do want to feel like I’m part of something bigger, what does that look like for me? You know, like, maybe I don’t want to go back to the way that it was taught to me or the community that I left, but I have this sense that I want to be a part of something, that there is something bigger, whatever that may be. And I do see a lot of questioning now and a lot of like reimagining, like, what is this in the context of my life and the way that I want to be in the world. And it’s it’s an interesting moment, just as sort of like those questions drop.

David Carreon, MD: [00:56:26] Yeah, I think that’s exactly right. And this is, um, and I think even the, uh, the, uh, spiritual but not religious category itself has had a wave and is declining that. And, you know, we look at the research too. It’s it’s belief in God matters much less than was your butt in a pew somewhere last Sunday. That question seems to be much more important than what you happen to believe about God. And so again, like, you’re right, it’s the community. It’s the whole apparatus of experience of being connected to this thing that exists. And the Bible or 2 or 3 are gathered. Okay. Maybe it’s and then I think, um, there’s a quorum, um, in Judaism for a synagogue. So, you know, that there’s this appreciation that it’s not just an individual can have it, but an individual isn’t the thing. But but yeah. Like that’s that’s certainly where it can start. But how you know, is it the traditional ways that can be plugged back into is it something new. Is it a new variant within this? Is it some different religion? I think these are important things we need to start wrestling with in a more aggressive way, particularly because to that point of, uh of uh, what’s your your religious participation? The strongest protective factor for suicide, of all the things I’ve ever heard of is going weekly to mass 50-fold reduction, 50-fold reduction in suicide completion. There is nothing more powerful than that particular thing. If I knew nothing else about a person besides they went to mass, that is the most protective thing they could say. More protective than I’ve never attempted suicide or I’ve never, you know, had. No, it’s like this is a huge thing. And so if we would were thinking about what is flourishing, what is the opposite of depression, you know, how do we prevent suicide? Like if we see something that reduces it by 50-fold, if we want to at least think about, hey, maybe that’s got something to it, or maybe there’s components of that. If we want to try to separate it, we shouldn’t be ignoring that effect. If that says something profound about our human experience when it is that big, that big a difference.

Jonathan Fields: [00:58:18] Yeah. That’s it’s so fascinating. Um, so curious to see where all of this goes over the next decade or two as well. And, um, it feels like a good place for us to come full circle as well. So in this container of Good Life Project, if I offer up the phrase to live a good life, what comes up?

David Carreon, MD: [00:58:33] I think I’ll go back to, uh, Westminster. To glorify God and enjoy him forever.

Jonathan Fields: [00:58:38] Mhm. Thank you. Hey, before you leave, you love this episode, safe bet you’ll also love the conversation we had with Bessel van der Kolk about trauma. You can find a link to his episode in the show notes. This episode of Good Life Project was produced by executive producers Lindsey Fox and me, Jonathan Fields. Editing help by Alejandro Ramirez. Kristoffer Carter crafted our theme music and special thanks to Shelley Adelle for her research on this episode. And of course, if you haven’t already done so, please go ahead and follow Good Life Project. in your favorite listening app. And if you found this conversation interesting or inspiring or valuable, and chances are you did. Since you’re still listening here, would you do me a personal favor, a seven-second favor, and share it? Maybe on social or by text or by email? Even just with one person? Just copy the link from the app you’re using and tell those you know, those you love, those you want to help navigate this thing called life a little better so we can all do it better together with more ease and more joy. Tell them to listen, then even invite them to talk about what you’ve both discovered. Because when podcasts become conversations and conversations become action, that’s how we all come alive together. Until next time, I’m Jonathan Fields signing off for Good Life Project.