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How can a deeper understanding of mental health help us see our world, and ourselves, differently? Hosted by therapist Kurt White and journalist Mary Wilson, each episode of Unravelling explores a complex mental health topic with insights from both professionals and people with lived experience. Whether you're trying to make sense of the world or just the slice of it inside of your head, Unravelling is here to foster a more compassionate and informed perspective on life.
The content of this podcast is for informational purposes only and should not be considered medical advice. Always consult with a qualified health care professional for any health concerns. Take care of yourself out there.
Mary:Welcome to Unravelling. This is a podcast that sees the world through the lens of mental health. I'm Mary Wilson, a journalist.
Kurt:And I'm Curt White, a social worker and psychotherapist.
Mary:And Curt, I'm very happy to be recording another episode of Unraveling here in your lovely office.
Kurt:Well, thank you. I'm happy to be here too.
Mary:And everyone who does come into your office remarks on your array of plants. You have a lot of lovely artwork, even some neon signs. You also have, a lot of planning up on the walls, including a big whiteboard that is color coded, a list of your major projects that we're working on, and even a full year calendar where you lay everything out. And, all these things are very helpful to you in all the different tasks and roles that you have.
Kurt:Yeah. Well, working in hospitals, it often means you wear a lot of hats, and I I, to keep track of it all. I I need some help sometimes. You know? Maybe help from other people, but also help from simple technologies like writing things down and more complicated technologies like reminders and prompts and things like that.
Kurt:All all ways that help me to keep all of this in my head so that I don't get too overwhelmed and don't forget things.
Mary:Sort of an extension of your brain here on the walls.
Kurt:Yeah. We often don't think of it that way, do we? But I mean, it really is kind of that way. And and that's that's understood to be something that's actually necessary in healthcare and in medicine, right? Surgeons use checklists to keep track of the many, many things that they have to do.
Kurt:Because if you skip one step, someone's life might be in danger, right? Not true for me and you, but, you know, in terms of the work that we do. But but but we're still using similar kinds of strategies to keep things in our brains.
Mary:And what about when it comes to therapy? What does all of this mean for someone who is working on healing? Well, I've wondered that myself
Kurt:and had a long wish to talk to someone that might help us piece together things from the sort of world of the limits of human cognition, you know, and the ways that our thinking and feeling brains are tied into our social selves. I think I've had the thought that we often think of the individual as the center of things in our lives, but I don't really think that that's true. As a sort of group person, I've really come to think of the ways that we live off of and with others as being central to the way that we organize our activities.
Mary:Yeah. And we have a really great expert who is going to explain all of this to us, Doctor. Anthony Weiss, who has a background in neuroscience and in ethics.
Kurt:Yeah. Talking to him, it was great fun. Doctor. Anthony Weiss is a psychiatrist. He is the Chief Medical Officer at Beth Israel Deaconess Medical Center, an Associate Professor of Psychiatry at Harvard Medical School, where he works in the Center for Bioethics.
Kurt:He has written broadly about a number of topics. He is an educator and organizational thinker whose work explores principles of how mind and brain work together to inform ways that we lead and care for one another. I really hope you enjoy this interview as much as I did.
Mary:Yes. Let's take a listen.
Kurt:Well, doctor Weiss, welcome to Unravelling.
Dr. Weiss:Thank you. It's great to be here.
Kurt:Absolutely. I'm very interested to talk to you, you are a psychiatrist but you've also written and thought about a lot of things that maybe psychiatrists are not always quite as interested in. And I'm interested to get into a lot of that today. And some things that do exist within the field of psychiatry which are not talked about quite as much like milieu environments and ways that people interact with one another and psychologically and otherwise use each other to help in a variety of ways. What is it that got you interested in this variety of ways of looking at the human experience.
Dr. Weiss:Yeah, thanks. I fell in love very early on in my medical training with the brain. I think it's fascinating and how the brain works, how we remember, how we think, how we have emotions, how we connect with each other is one of the reasons why I ended up going into psychiatry, neuropsychiatry, behavioral neurology, the areas that I've specialized in. And as we think about the way in which the brain works, the brain is actually computationally limited. We we think about, you know, you only use 10% of your brain or something like that.
Dr. Weiss:Well, yes. And maybe we'll talk about that actually may be evolutionarily necessary to some degree. And as a result, the brain needs to develop some solutions to allow us to deal with the massive and inordinate complexity in the world, a world that is ever changing, a world that is dangerous, a world that we need to adapt to, and our brains ultimately are trying to keep us alive. So to do that, they need to understand or what I call make sense of the world. And the way in which, the brain does that is actually by comparing what's coming in, through our senses, our experiences to something of a map.
Dr. Weiss:We'll call it the mind or our mind map or something like that, but it's the way in which we think the world should be working. What we think about different things in the world. And it's this comparison that ends up being very important because the brain doesn't like surprises. Actually, I I think most people don't like surprises. Even if they tell you they like surprises.
Kurt:Even there's a biologically, there's something about surprise that is not not so welcome. Is that right?
Dr. Weiss:Yeah. And so this idea of the chaos in the world, the the complexity of the world, and the way in which it's minimized by, understanding the world and and projecting a map onto the world and then trying to reduce the difference between what is actually experienced in the map is what the brain is doing. This is a model really developed by Carl Friston, out of The UK, and he calls it active inference. It's a way in which we not only experience the world, we experience the world through these maps, and then we take action in the world to either change the map in our mind or to change the world to bring it more in line with our map. Well, the computation that's necessary to make sense of the world comes at a cost.
Dr. Weiss:There is no computational free lunch. Our brains require energy, and we actually don't think about it very much because it's almost like it's like your refrigerator. It runs so quietly, and yet it's it's sucking a lot of energy. That's like the brain. The brain actually requires more energy than any other organ in the body pound for pound.
Dr. Weiss:So it's I think it's about 2% of our body mass or body weight, but it takes 20% of our resting energy. And unlike other organs where there's some storage, there's not a lot of storage of energy up in the brain. That's actually a really fascinating area of research. Are there brain cells like astrocytes that store maybe a little bit of reserve energy? But for the most part, we're dependent on the blood flow coming up to the brain, and we use it as we get it.
Dr. Weiss:In essence then, our computational ability of the brain is is bounded. It's limited by the energy it requires.
Kurt:I'm interested in these maps also, and and exactly what they are and how we develop them and where they come from. I get the sense that the function of it is to simplify some of that complexity, is that right?
Dr. Weiss:100%, yeah. So the maps, the way in which we see the world, the fact that I know that this table is solid or the fact that, you know, I'm drinking coffee right now, I know I have a sense of what that's gonna taste like, and I can I can tell immediately, this doesn't taste right or this tastes good? This is good coffee, by the way, Kurt, so thank you. Some of that is, built up over time. You know, whether we are born with a blank slate or not, open question, you know, whether, you know, Carl Jung talked about some ways in which we pass on information across time to generations.
Dr. Weiss:One way in which we do pass on information across time is through our tools. And that's actually one of the ways in which we can almost offload the compute power of our brain is by offloading it into our tools. So for example, writing. Imagine you wanna remember something. You can use the compute power in your head, your hippocampus and your memory circuits, or you could write it down.
Dr. Weiss:Right. Right?
Kurt:Yeah.
Dr. Weiss:Yeah. And we do this all the time. Right? And so the writing in that case and the notes that you've made are actually an extension of your mind onto the paper through writing. Right?
Dr. Weiss:But essentially, we can then share that information with each other across generations. You know, I can read a book written, you know, a hundred and two hundred years ago and learn from that as if I'm learning from the mind of someone who was in existence two hundred years ago. And in that way, their mind becomes my mind. Their map becomes my map. Their way of seeing the world, understanding the chaos in the world becomes my way of of seeing the world and understanding it.
Dr. Weiss:And that's what we've done for millennia now.
Kurt:Yeah. Well, I'd say it was actually an interest of mine and as an undergraduate to study the difference between primary oral cultures that have not had writing systems and cultures that have developed writing systems and how do they organise themselves similarly and differently. What are things like information? What does it even mean? Right?
Kurt:And turns out to be really fundamentally quite different. It's a wonderful book called, Holter Ong, I think, technologizing of the word or something like that. Well he really gets into this. And there is a kind of, you don't actually really have a history in the sense that we would mean it if you don't have writing because everything is so ephemeral, it just disappears the moment it's no longer needed. And facts and information are used basically only to solve present moment problems with references to history that are not factually accurate.
Kurt:And I find that very different. It's like a completely different world.
Dr. Weiss:Yeah. It's it's incredibly fascinating. You know, actually, goes back to Plato.
Kurt:Mhmm.
Dr. Weiss:So if you if you look at Plato's book,
Kurt:the The
Dr. Weiss:The Phaedrus. Yeah. Yeah. Essentially, Socrates was telling a story about King Themis, who probably was a fictional Egyptian king. It was like a god king.
Dr. Weiss:And someone was bringing a new innovation to King Themis, and they were bringing him writing. And Themis said, what you have brought me is a pharmakon. And he used that term, which I think is really important, because it represented both a a cure and a poison. It was a dual innovation. So the writing, king Themis, Socrates, and Plato saw as being an important innovation to record your thoughts, to pass on your thoughts.
Dr. Weiss:But they felt like you were going to lose touch with the information because you didn't need to deeply memorize it. You have to remember at this time, memorization was an incredible skill and important so that you could have conversations about the world and and remember important details. And so they saw this innovation, this technology, if you will, as a pharmakon, which is a concept that I've, you know, picked up on, and I think that's true when we're talking about very complex tools like AI, right, or computers, you know, calculators, computers, AI, and increasingly, we're we're seeing a lot of people doing that. Right? Offloading decision making even, you know, is is the milk in the fridge, it says it's five days old, is it okay to drink?
Dr. Weiss:Well, I could ask you or I could ask chat GPT. We can also offload to each other. And I just said, I could ask you I could ask you about the milk in the fridge. Right? So in essence, in that case, I'm relying on you to do some calculations.
Dr. Weiss:Five days old. You know, let me smell it, you know, and so you're gonna you're gonna do some calculations on the milk. You are gonna bear the energy cost for that now, but I can benefit from you. Right? So if if I have poor decision making skills, I actually might lean on you more and more and more to help me.
Dr. Weiss:Right? To help me with decisions, to help with my memory, and we do this all the time. We we don't need to have brain injury or mental illness or anything like that. We we do this as humans all the time. The way in which we connect with each other, we're connecting our computational minds with each other, right, and creating a supercomputer, if you will.
Kurt:Do you think it's something that was evolved for for humans? Is it a necessary necessary survival skill or an advantageous one at least? Or is it just a sort of happy accident of the ways that our brains offload things that we can do something with? But do you have a sense of that?
Dr. Weiss:I have my own opinion on that, but I'd I'd be very interested in maybe some of your listeners or or others will have some some insights into this from other books or other thinkers because I suspect people have thought about this. So there two pieces to the question. One is, is the brain evolutionarily developed to have limited compute power? If the brain had unlimited compute, and it was all of the neurons in the brain were firing, let's say, I think I think the brain would overheat. There's a small amount of heat generated from the use of of of ATP.
Dr. Weiss:Right? It's an electrochemical gradient that's built up, but there's also it's enter it's actually literal energy. Right? And so your brain is in an enclosed skull that's insulated. And, you know, again, this is highly speculative, but I do wonder whether evolutionarily, our brains are adapted to that environment inside the skull so that it doesn't overheat.
Dr. Weiss:Because if the brain overheats, the the temperature of the brain is extraordinarily important. Even small changes in cerebral temperature, temperature of of the blood in in the brain or the brain itself has incredibly detrimental problems, impacts, effects on on brain the brain's ability to operate. Right? And so I think there's an exquisite balancing mechanism there to allow us to compute as much as we can, to be able to survive in the world, but to not overheat the brain. So then what?
Dr. Weiss:Is it a happy accident that we can offload to others? I don't I don't think so. I think it's an adaptation or, again, maybe it's evolutionary that we are able then to speak, communicate. You can hear me. You can understand me.
Dr. Weiss:We have language. We have the ability to, you know, display affect. Your your listeners can't see that, but right now I'm smiling. You're smiling. Right?
Dr. Weiss:To share and communicate with each other. And that's critical so that I can trust you, communicate with you. You can hear me, trust me, and we can attack the world together.
Kurt:Yeah. Yeah. Well, I've long been interested in that from a, like, a developmental psychology point of view. I mean, there are some things that are kind of unique about humans among mammals, And one is the sort of long dependency period that we have, I joke it lasts until you're 30 now, right? But I mean you know, little kids aren't good for very much.
Kurt:They don't survive on their own. They're not like little wolves that can kind of figure it out pretty darn quickly, right, after a very brief period of time. And so you need that we, there is a sort of a social need to work together to make sure that individuals, enough individuals reach it, to reach full adulthood to sort of keep the population going. And I sort of wondered about that there's this pressure to do things in groups. When we talked before ahead of the podcast, said a lot of your work is interesting to me through all this group lens also.
Kurt:Because I really think that this fundamental unit of interacting is not really an individual, but it's in pairs and in groups that we really exist in the way that humans exist.
Dr. Weiss:Yeah. Yeah. No. I think I think you're spot on. And and the period of of mother infant bonding is incredibly important.
Dr. Weiss:Freud knew that, you know, we've known that for for millennia. But you can see why the trust built up there between two humans is incredibly critical in then establishing that, yes, if I connect with this other person, if I, as I as a baby now, connect with this other person, I can trust them, and they help calm me. They help calm what's going on inside of me, whether that's my hungry stomach or whether that's the fear of of an uncertain world, and they can help keep me safe. Right? And so that starts very early, and, you know, of course, if that if that does not happen or if there's disruption in that, that has incredibly detrimental effects on our ability then to trust each other and to be able to navigate the world.
Dr. Weiss:And and sadly, we see that all the time with adverse childhood experiences and the impact it has on on relationships and and all all of that. The idea of the group as being more maybe even more fundamental than the individual is also very fascinating. I was reading a book yesterday. It was written by Trigant Burrow. This was, I think, written in 1927.
Dr. Weiss:I'm not gonna get all the details right. He essentially argued that Freud got it wrong, and that Freud's focus on the individual and the dynamics within the individual are wrong in that he thought that we were all actually connected, mentally connected, and that neurosis was actually at the societal level, right, which is a topic that Freud kinda touched on, civilization.
Kurt:He got interested in it later. Later. Yeah. Yeah.
Dr. Weiss:But Trigant Burrow actually fundamentally believed it, and he didn't I think even Freud would say that the neurosis at the societal level is the sum of neuroses at the individual level. Burrow didn't think that. Burrow thought literally that the neurosis comes from something amiss in our joint I'll call it the joint computer. Right? Yeah.
Dr. Weiss:So
Kurt:I love that. So what is a milieu? What do we mean by that?
Dr. Weiss:Yeah. You know, it's interesting because we we we humans have known for a while that some sort of communal living or some sort of structured environment is actually healthy. And you think about, let's say, a monastery. A monastery, you know, where, there's a clock, a mental clock, if you will, of prayer. Right?
Dr. Weiss:Consistency, whether that's, you know, a Catholic monastery or whether that's a a a Buddhist temple, you know, where there's, you know, consistency in how things are done on a daily basis. Right? And shared eating times, shared sleeping times. And I think all of that then helps to regulate to regulate us as humans. You know, we can we can regulate ourselves, or we can rely on the social regulation that's provided by the structure, the milieu.
Dr. Weiss:That concept then got developed into the retreat model, actually, now that we're here on Brattleboro Retreat. First in England, and I'm not I'm not an expert in in the history here, but I think York Hospital. Yeah. York. Yeah.
Dr. Weiss:Took Took. Right? Mhmm. So he he thought, you know, communal living might be beneficial to the mental health and well-being of the people that living there. Yeah.
Dr. Weiss:And then that got adapted here, and I think there's something real and fundamental about that. And that's carried over. You know, think about, you know, many people will pay to go on retreat. Meditation retreat, a yoga retreat. Right?
Dr. Weiss:And think about what that what that actually is. You're offloading a lot of the complexity, simplifying simplifying. Many of these places literally forbid electronic gadgets. Right? No no iPhones.
Dr. Weiss:No no computers. Simplify the world. Slow down. And allow the community to determine decisions. Right?
Dr. Weiss:So you will go now, now it's 10:00, we're gonna go, we're gonna go, you know, do meditation, or we're gonna go to group therapy right here, here at the inpatient environment, or it's it's noon, that's lunchtime. And you can't go back to your room, you gotta sit here in the lunchroom, you know, and if you eat, that's great, we'd love you to eat, but it's structured. Many people, when they're in great distress, these beautifully balanced regulatory systems of the brain fall apart. The sleep wake cycle, the appetitive cycle, and you need to reentrain those, and they're reentrained socially an inpatient setting. So you're literally giving them food and and kind of forcing them, if you will, to to get back on a good sleep schedule, to to restore energy, and you're allowing them to offload.
Dr. Weiss:Offload complexity, offload, you know, decision making, offloading affective regulation to others, you know, unburdening themselves, all of that. So I think incredible value from from the inpatient milieu. Now why don't we all spend all of our lives on an inpatient psychiatric hospital? Well, I think it's a pharmakon, because you could, I mean, you could spend all your life in that environment, but that's ultimately potentially going to regress you or it's ultimately potentially not gonna build up the skills and tools you need to go back out into the complexity of the world. Mhmm.
Dr. Weiss:Right?
Kurt:Yeah. And I think also there's a kind of an inherent restlessness in the human soul too, isn't there? We like to we like to complicate things the moment we get a chance to do it. Right?
Dr. Weiss:That's interesting.
Kurt:Yeah. As I do think we have the need to connect and feel safe, but we don't wanna stay there. We wanna, you know, the eagle stirreth her nest, know. Do you know the thinker, Johann Huisinger? He was a historian who wrote a book called Homo Luden's Man, the Player, Man at Play, where he's really talking about cultural play in a way that like the question is what do we do collectively with our surplus energies?
Kurt:And that we build things and tear them down and make ideas out of things and revel in them for a while, believe in them and then tear them down again. And it's kind of a beautiful sort of definition of like actually maybe this is the thing much more about who we are.
Dr. Weiss:Yeah. That that's fascinating because
Kurt:and I
Dr. Weiss:think that's I'll have to read a bit more of of what Friston thinks about that because that that's where the active inference model, I don't know if it necessarily falls apart, but I think it needs to be modified because we don't want to just have a map of the world and then once everything gets to be there, okay, let's eat the same food every day. Very few people do that, you know.
Kurt:And memory I think, right? I think there's some good evidence that the ways that we subjectively experience time passing has to do with the amount of novel experiences we actually have. And so like with this kind of feeling you can get in mid adulthood of like, oh my god, like the years are ticking by, decades past like years, you know, which is like, oh my gosh, you know, well that's it. And I think people say, well, that's partly because your your life has become such a routine, even an enjoyable one, that there's nothing that marks the the differences.
Dr. Weiss:And that
Kurt:if you do more novel different things, it marks the differences and it feels like more time has passed subjectively.
Dr. Weiss:Yeah. That's fascinating. Yeah. And what is the drive? Why why is it that we want to not only minimize surprise?
Dr. Weiss:I said people don't like surprise. Well, I think that's generally still true. But we sometimes do seek surprise. We seek complexity, novelty. This is the first time I've been up here to Brattleboro retreat.
Dr. Weiss:I I was excited to come up here to see what is it all about. You know, what's what's it like up here? You know, what's going on in Vermont in June? You know? I'm gonna go to a bookstore after this, seek seek out some some novelty.
Dr. Weiss:Right? It is interesting that we do that. Yeah. And then that must be adaptive at some level. How it is, you know, TBD, let's
Kurt:TBD, I like Think
Dr. Weiss:more about that.
Kurt:So how do the constructs of things like mental distress and mental illness have to do with this model that we've been describing?
Dr. Weiss:Yeah, so you know, again, as we think about the overwhelm, you know, so if if you get to a period or a place of overwhelm, and and the model I I really like to think about is, this model of allostasis, developed by Peter Sterling. He did fundamental vision science with, the Nobel Prize winners there, Hubel, I think his name was, at Harvard. And over the course of of Sterling's career, he started to see the way in which the brain actually regulates us, not as setting a set point in the body, but rather, to make it adaptive. So for example, our temperature in our body is not always 98.6 degrees. Right?
Dr. Weiss:It changes. Now is that change pathologic? No. In fact, the body may actually run hot for a period of time because it's actually probably better for the body for whatever reason. Right?
Dr. Weiss:Or it might run a little cold. The brain also knows, you know, I I just ate a meal. I I need to get more blood to the gut. Right? So it's a dynamic allostasis.
Dr. Weiss:It's a it's stability through change is the term that Sterling coined. Well, these beautifully regulated allostatic mechanisms of the brain, they themselves require energy. And when there's too much complexity and, not enough energy, they start to fall apart. Okay? And what does that look like?
Dr. Weiss:Well, that looks like someone who has insomnia. That looks like someone who doesn't want to eat very much. They have anorexia, or that looks like someone who's not moving all hot. They're sluggish, right? That looks like someone who doesn't have the energy to pay attention to all of the information coming in, right?
Dr. Weiss:So now all of a sudden, that looks a lot like, well, it looks a lot like major depression, you know, the symptoms of major depression. Right? And so this is how I I view major depression is through overwhelm of these regulatory mechanisms of the brain and the overwhelm of the ability to make sense of the world, the complexity. And I I personally, again, think that people then try to adapt. And so what you'll start to see is people will start to shut themselves off or shut down, or they'll try to simplify the world.
Dr. Weiss:They'll hide under their covers. You know, they'll stay in their bed. All of that, probably a simplification strategy at some level, but all of that functionally impairing and probably heading down a bad spiral because the more you stay in your bed, the less you're gonna be able to develop the skills needed to get back out into the world, similar to the impatient milieu. Right? So these end up being extraordinarily functionally empowering and a bad downward spiral.
Dr. Weiss:And for any of us who have experienced mental illness, that downward spiral is is very, very true. And finding a way to get out of that rut is critical, right? And that's where, again, inpatient care sometimes for people who are severely in that rut is the one strategy we can use to really try to offload, reset, and to get them back to just a little bit of surplus energy to allow them to then start to build up their regulatory systems and to then ultimately build up their ability to deal with the complexity in the world.
Kurt:Yeah, I love that. And I think, and inpatient care in a way, although, you know, I know you're gonna talk with our staff about that in a short while, and it's a place where we do a lot of that. So it's a special interest of ours. But maybe it's not obvious to even people who are very familiar with it, why and how it's helpful, like it's a thing we've done for a long time, we know that it can keep people safe, some don't think it's a great idea, it's hard to be away from home and behind locked doors even for relatively short periods of time. But there is this phenomenon that you've described, and I've noticed too, anyone who's worked an inpatient will have noticed it, that people get better far before things like drugs would have meaningfully helped them knowing the drugs and what they do for the most part.
Dr. Weiss:That's right, yeah, yeah. They get better before they develop some deep insight into their life.
Kurt:Or insight before. Develop a new skill, it takes a long time
Dr. Weiss:to It develop takes a long a time, yeah. But there's early change, early improvements that occur, and I actually think those are part of the benefits, the value of the inpatient milieu and the structure of it. You know, it's interesting, when I trained at McLean Hospital, I was there, I started there in '96, and it was an interesting time because McLean was undergoing, at that time, a massive shift from length of stay that was really months, to length of stay that was, you know, ten days, five days. Right? Yeah.
Dr. Weiss:So some of the older attendings at that time were really struggling, I'd say, with the adaptation to say, well, you know, what do you mean with, you know, ten days? Like, what what possibly? So you you can see that our our thinking around the role and temporal role of the inpatient stay has changed over time. Maybe we've gone too far, you know, I don't know, you know. But right now it does have a limited role in people who are really at the bottom of that spiral, and it can be very, very beneficial for some folks.
Kurt:And what about for folks that are not at the level of needing inpatient care? It seems like there is still a way that we might be able to use this idea of like offloading some of our overwhelm onto others, hopefully in a productive and voluntary way, right? I mean, like it occurs to me like not long ago I was having a hard time and one day in particular, I texted a couple friends and said, I think I just need you to say something nice to me. We don't have to get into a whole thing about it, but I just and it helped a lot, actually. Right?
Kurt:Something something something I needed that could I couldn't do for myself. Someone else could help me do. Right? And so
Dr. Weiss:100%. Yeah. And in fact, you know, when you think about most therapists are are, you know, barbers or, you know, hairdressers or, you know, or friends or our spouses, our partners, you know, and we rely. We just literally we simply rely on other humans to help us navigate what is an extraordinarily complex world. And I think it's that connection, whether that is through technology, like a text message, or through person to person.
Dr. Weiss:You you go through a rough patch, You you might, take a day off. You might, you know, spend some time, you know, doing a hobby. You might relax and reset your brain with some music. You might, talk to a friend. And for most people, it's that that's all you that's all you need, and now you're on, and you're able to recover.
Dr. Weiss:But for some people, that bad day turns into another bad day and another one, and then pretty soon you're on that downward spiral, and I think that's where, again, treatment can be useful. That treatment can be certainly for the vast majority of people outpatient with medications or therapy of different types or you know there's different types of treatment. There's partial hospital with group therapy. Yeah. Yeah.
Kurt:But Wonderful treatment, I will say. Yeah. For sure. Really. Because it's short term, and people really change quite a lot in those periods of time.
Kurt:I mean, they have that it's I think a little bit of an unknown to a lot of folks in the world, an underrated kind of thing.
Dr. Weiss:What do you see as the value in group therapy? How much of the value comes from the group leader versus the other people in the group? It must be a shared a shared offloading and kind of bidirectional flow, maybe multidirectional flow back to the person who's benefiting. Right?
Kurt:It is I think the well, group therapists argue about these things, but which is part of the fun of it. But my personal view is that it's much more about the group itself and the member to member interactions or as Scott Rotan would call the horizontal interactions rather than the vertical. Now the leader is there partly to help make sure that people can do that and to help get obstacles to doing that out of the way. And you know, like Wilfred Bjorn said, like, part of the obstacle to group is that it's actually overwhelming enough that people start to use all of their shortcuts basically, what he called in that context, the basic assumptions. And they start to try to turn the overwhelm of group into other things.
Kurt:And then they get frustrated and confused because it doesn't really work to do that. Like, oh my God, I've got five people here that all have their own lives and interactions and it can get chaotic. And so people try to make it about dependency, like the leader will fix it. And then they try to make it about fighting. And then they try to make it about pairing.
Kurt:And then they try to make it about and all of these are attempts to try to turn a group into a non group basically. And the leader can help a group work through those obstacles so that they can really be of use to one another, including as they're working through those kinds of things. And a working group, right, a group that has cohesion, right, that's the measure of essentially therapeutic value of the group. The cohesive group is going to help you with whatever problem you have. The cohesive task group gets its task done, right?
Kurt:And so you've got to get, the leader helps the group get to cohesion basically. It's very important, People sometimes underestimate the leadership. But a lot of it is internal and hidden like a lot of therapeutic work.
Dr. Weiss:Yeah, it's critically important. Yeah, and I hadn't thought about that and when you because as we offload to each other, that a can pharmakon because again, if I offload everything to you and I say, well, you just deal with it. Okay. Well, that sets up a dynamic between us where, okay, now you're expending energy on my behalf. Right?
Dr. Weiss:Okay. So that can set up power dynamics, that can set up sense of anger, like frustration, like, why am I doing all this? Or why isn't Tony doing anything? You know, that sort of thing. Right?
Dr. Weiss:And so, to manage that, I need to also trust you. Right? Yeah. That you're not gonna, turn that dependence that I have on you back on me in a way that's gonna harm me in some way. And as people are entering into group therapy, I can imagine that that's that's an issue at scale.
Dr. Weiss:Know, right? And so having having a group leader there to help smooth out the flow I've thought a lot about friction. Yeah. Yeah. So, you know, you can imagine, just a thought experiment, but let's say there was a wire between our brains.
Dr. Weiss:Right? So that our brains were literally connected. You'd think about, well, is the energy flow in that wire seamless, or is there friction there? Right? The minute there's friction there, the energy required for me to extend my mind to you is actually gonna be worth less or it's, you know, it's not gonna get as much entropy reduction or or complexity reduction as it would be if I just did it myself.
Dr. Weiss:And so making sure that the connections between people, let's say, in a group are I don't know if seamless is is maybe that's the ideal, but the flow is friction friction low friction. Maybe it's not frictionless, but low friction, and that there's not a lot of sparks and fire, maybe just a small amount of sparks and fire, but not too much. Right? That must be a very complex task.
Kurt:Yes. It is. It requires a lot of practice, training, and supervision, and that's why most therapists are not group therapists, actually. I think it's and a lot have no interest in being. And that's okay, like there's lots of things to do as therapists that are not group.
Kurt:But you can really be helpful to people in groups if you can orient to that whole other level of interaction in a different way. And I feel a little remiss, I should have thought of therapy earlier, being a therapist. I do think that that is a kind of an offloading that has a particular boundary, right? I mean you said it is a pharmakon. If we go to a friend for reassurance once, that's great.
Kurt:But if we're feeling depressed and needed every five minutes, maybe that's not so great, right? Then the friend begins to feel burdened and overwhelmed and then you have a relationship problem. But a therapist has a there's a boundary around that and it's okay to use them in different ways. And my analyst in Chicago told me a story once about he was trying to tell me to do a similar thing, but he said a person who was burdened by memories and thoughts of a mother that they had a lot of trouble with, and this person had a painted portrait of the mother in the house. And my analyst said to him, bring in the portrait.
Kurt:And so he brings in the portrait and he says, now shove it under the couch. And he said, leave it here. Leave it here. And I think that's kind of like the message is, you know, a little concrete in that instance, but like powerful, like I can help you with this. I
Dr. Weiss:can hold
Kurt:that And for at a certain point, he took it back, right? He didn't need it in that way. I'll hold
Dr. Weiss:it temporarily while you're building up skills and right.
Kurt:And you don't have to worry. And I think therapists do that metaphorically all the time. And I think it's a little bit lost these days in the way that when we talk about this or that technique or this or that model or this, all of which are good things, Haya. But I think there's something much more fundamental in the ways that relationships can be of use to people that is, I think you're really getting at with what you're talking about.
Dr. Weiss:Thank you. Yeah. Yeah. And I think the object relations therapists or, you know, folks that had an understanding of how we interact, you know, either as a dyad or in multiples are so important now as we think about how are we interacting now with tools like ChatGPT or chatbots, right? AI chatbots for therapy is incredibly valuable, but the value comes in a way that you can become dependent on the tool, right?
Dr. Weiss:Cognitively dependent, if you're offloading all of your decision making, should I leave my partner? You know, your chatbot will tell you, you know. So or you we become emotionally dependent on these. We call them by name. You know, many of us give little names to our chatbots.
Dr. Weiss:Right? And we can also, there's probably an addiction piece there as well. Like we become addicted to our phones or addicted to the technology. So, you know, I think there's a way in which these object relations therapists really saw that and saw the value of boundary setting and saw the way in which attachment is important, but attachment with with some some boundaries.
Kurt:Yeah. Yeah. Well, where should we all go from here about all of this in this world that doesn't seem to be slowing down in its complexity? How should we be orienting to this?
Dr. Weiss:Yeah. I personally, you know, think that focusing on energy, focusing on our own health actually is fundamental, and it sounds very simplistic, but I really do believe that mental health begins with the health of what we're taking into our bodies, the food we eat, the sleep we get, the energy, you know, the exercise. It's like literally, you know, things your your grandmother probably said, right, all in moderation. I think there's some real wisdom in that, real wisdom in that. Now it's easy to say that now.
Dr. Weiss:Obviously, there are people at the bottom of that spiral where, you know, that can help, but not only so much. Right? But for those of us who are, fortunate enough to be in a reasonable state of mental health, focusing on regulating and staying on track, paying attention to those things is critical, because you only have one brain, and the brain needs energy, and the world is not getting any less complex, right? And so you can maximize, to some degree, the inherent ability of your own brain. There is a bit of use it or lose it.
Dr. Weiss:Maybe things like travel, maybe things like doing puzzles, know, maybe things like having conversations, dynamic conversations, reading books, actually is valuable because it keeps the brain working at its constrained capacity. So I think those are important. And then finding ways to offload, you know, finding your own ways to offload, whether that's offloading to hobbies or tools, relaxation, rest, music meditation, or yoga, or, you know, whatever it is that allows your mind to offload, I I do think there's value there. And then finally, I I think interpersonal connection. You know, I I do I still see real value in connecting with real people and having someone in your life that you can share the complexity of the world with.
Kurt:Well, Doctor. Weiss, I certainly feel very energized. My brain is full. You've I feel in the best way. I'm just so full.
Kurt:And thank you for joining us.
Dr. Weiss:Yeah, thank you for having me. I really appreciate it.
Kurt:Thank you again to Doctor. Anthony Weiss for that really interesting, stimulating interview. Joining me again is Mary. Hi, Mary.
Mary:Hello. Yes. I really enjoyed that interview. I was sort
Kurt:of wondering about this. How's your brain doing these
Mary:days? My brain, it is juggling a lot. Always something with a three year old and one year old now from potty training to remembering to order food and, you know, getting the baby to sleep when she wants to stay up all night because she's teething. Oh, yeah. Doing some work too for you.
Kurt:That's right. All of these projects on my board are you're in them all with me.
Mary:That's right.
Kurt:So did any of this resonate and relate about this idea of regulating with one another and with technology and the ways that we can succeed in doing that and to deal with this world that's so infinitely complex, as he says?
Mary:Yes. Yeah. I think so. Making the lists, having a great partner who can help me regulate and help me deal with those lists and hopefully check some things off once in a while. But, yeah, there's so much out there, and there's just more and more, as he mentioned, with being on our phones and the social media, and it's not gonna get, any less complex anytime soon.
Kurt:No. It really isn't. And I think he's really pointing to something very fascinating. We've talked on this program before about ways that we deal with the internal struggles that we have and how do we meet those challenges. Ways that we deal with a world that is often painful and unsupportive and maybe in the history that we've lived through or a trauma or just a sort of unwelcoming, prejudiced world.
Kurt:But he's really talking about an interesting intersection. Right? That there might be limits to what we can do to fix the to fix. Right? Or to sort of change the inside or to change, fix the world.
Kurt:But maybe we can do quite a lot at this point of intersection to think about how can we take what we have and give us the most resource that we can have to meet the challenges of this infinitely complicated world. I find that just really interesting.
Mary:Yeah. And it was hopeful at the end. He gave us some practical strategies that I will try to take to heart.
Kurt:That's right. Yes. I'd like to book some travel and make sure I eat well. It's funny, isn't it?
Mary:Don't forget about the puzzles.
Kurt:Don't forget about the puzzles. Absolutely.
Mary:Well, thank you, Kurt, for bringing us that great interview. Our thanks again to Doctor. Weiss.
Kurt:Thank you, listeners, for joining us and helping us co regulate with you.
Mary:See you next time.
Kurt:Unravelling is brought to you by Brattleboro Retreat. Our producers at Charts and Leisure are Andrew Adkin, Hans Buteau, and Jason Oberholzer.
Mary:And you can find us on social media by searching Bratteboro Retreat. Bratteboro Retreat is committed to exploring diverse perspectives on mental health. While we invite hosts and guests to share their insights, the views expressed are their own and do not necessarily reflect the policies or positions of the hospital or its staff.