#988 - Dr Rahul Jandial - Brain Surgeon: Inside The Dreaming Brain

You just taught me there are left-handed surgical instruments.

What's that mean?

For left-handed surgeons, the way some of the graspers click,

it's released with a maneuver where your thumb pushes something outward.

For left-handed surgeons, that can be sort of clunky.

So they make instruments where it's outward.

For the left-handed surgeon, it's actually

inward towards the midline.

And for the right-handed surgeon, it's this way.

So there are

right-handed instruments for different surgeons, needle drivers, really, where you click onto a needle and it clasps.

So, you don't have to keep pressure on it, then you can do your maneuver.

Steak knives also have serrations that lean one way or the other.

I just learned that.

I didn't know about that at all.

I don't know.

I was just looking at it because I've got a buddy who's left-handed, and he's like pointing all this left-handed stuff out in the world.

Don't use that one, it's going to cut completely incorrectly.

What I did learn was:

when you have a steak, I mean, I have to imagine this is slapbang in the middle of your area of expertise, but you want to never cut with the grain of the meat you want to be cutting cross grain yeah so that that that takes me to what's beautiful about surgery is like it's it's not like legos it's not like you know hammers and chisels it can be with you know orthopedic surgeries and spine surgery but when you have somebody who can lightly with a pit uh with a tweezer a pickup we call it lift something up and you see some membranes that are holding two planes together all right let's say you have two planes of tissue and they're held together with this fine web of membranes.

You lift it up and you take a scissor upside down, you just spread lightly, and the membranes fall apart, and the tissue comes apart.

You're not really trying to tug and pull.

If you do that with finesse, when the patient wakes up, they feel less injury, they feel less pain, less anesthesia, the operation goes better, less blood time.

So everybody thinks surgery is all the same steps.

Do these 1,000 steps?

No, it's sculpting, it's art.

There's a finesse to it.

And at some point, when you see somebody's good at something,

it's like ballet.

It's like something's being released.

They're not like, and now I will do this step.

And that's the part I love about it is talent.

It's more talent than smarts.

I love watching people in between doing the thing that they're supposed to do.

So a good example of this is drummers.

If you're ever watching a drummer play live, he loses a stick or he snaps or something like that.

And he'll just immediately switch and he'll be playing with one hand and he'll just reach over and he'll grab another one.

Or if a guitarist's and bing, off goes a pick like that.

And you'll watch him without even thinking about it.

He'll do something, grab a pick from there, roll it between his fingers, and go back.

And it's that liminal space.

I'm just so comfortable with my working environment.

And that's really cool to see.

So that word, that's an interesting word for me, liminal, because

that's kind of the thing I've been thinking about a lot.

It's not the easiest thing to explain to people, but I think that

in nature,

let me give you an example of what I call a liminal space.

I used to dive a lot.

I gave it up at a scary accident.

I almost ran out of oxygen real deep off of Asian coast there, a Palau.

And

I was like, I've got kids.

I'll do this when I'm older.

And now I'm older and I'm like,

I don't have the energy.

But the place that I loved diving the most was the Cenotes of Yucatan, like where it's all flat.

Maybe the asteroid landed there and killed all the dinosaurs and that kind of thing.

But they have caverns and there are underground rivers that meet the saltwater.

So when you go from freshwater to saltwater, in our body, saltwater is a massive thing that has to do with cognition and balance.

And a lot of fundamental things are controlled just by the salt in our blood and brain.

And but when you, when you're diving and you're in freshwater and then it's called a halocline and you're now freshwater is meeting saltwater, there's like five yards, it almost feels like five meters where it's blurry.

So the transition from one state to another, chemical, psychological, it doesn't happen in a millisecond.

There's a liminal state.

And so when you take a look at the brain in 24 hours, I see at least four or five liminal states.

When you're falling asleep, it's not a complete,

I am awake and now I'm asleep.

There's a little window there about 15 minutes.

Lucid dreaming, when you're asleep, asleep, and I can verify it, and you have a little return of awareness.

To me, those hybrid liminal transition states give us an insight.

I mean, it's hard, right?

Because I'm a brain surgeon.

This is, people expect everything from me to be proven, but I'm finding a lot of insight and understanding from these different liminal states.

And then you can bring a narcolepsy in the middle where people suddenly fall asleep.

They have interesting thoughts.

When you wake up, a third of the world feels sleep paralysis and have like these feelings of a goblin on their chest, enough to where the stories are built around different cultures.

So to me, those

transition hybrid states of cognition, of feeling, of experience, I think that that's where the that's where my head is really at these days.

This might be getting you out of your skis a little bit, but

someone asked me this question the other day, and I thought it was such a great question.

What is something

that you intuit or act as if is true or might believe,

but you cannot prove with evidence or science?

Is there anything that comes to mind with that?

Well, I mean,

for me, the first thing that crossed my mind was love.

It's this, you know, the term used to be ineffable.

And so like beyond explanation, but you know it's true.

Beyond articulation, but it really

motivates you or touches you.

Spiritual experiences, right?

Epiphanies, a hunch.

Like these are repeated experiences that people are reporting, right?

And dreams could fall into that that a little bit, but

there are repeated things that we are writing about through history and time.

Aristotle wrote about lucid dreaming.

Now, that sounds like, well, come on, lucid dreaming, but it's rigorous.

So, Aristotle wrote about it thousands of years ago, a return of awareness within a dream, which sounds like, how could you ever prove that?

And 20, 30 years ago, and increasingly now, lucid dreaming is being proven rigorously in sleep labs.

So, I think that's one example.

But when I hear that, what it tells me is don't deny those insights.

Don't rely on them blindly.

Don't be manipulated by somebody trying to dazzle you with those kind of things.

You know, cults.

Sexy rhetoric.

Yeah.

Cults

catch you in a vulnerable moment.

My patients are vulnerable.

The sexy rhetoric isn't just

that this will heal you, but I was, you know, there were, there were a lot of like stem cell clinics that were affecting children's hospitals in San Diego.

Children's hospital in San Diego is real close to the Mexican border of Tijuana.

You know, we're in Austin, so you're familiar with that.

And there, there were patients, families who were going there to get stem cell treatments that were,

it wasn't that they were proven.

We knew they were sham.

They weren't hurting them, but they weren't helping them.

And sometimes those

moms and kids would choose that over therapy that was moderately effective.

So I think there has to be some, there have to be some safeguards to vulnerable people being manipulated.

Yet I'm fully ready to embrace intuition, hunch, those kind of things like where my dog has an instinct and hunch that comes from our limbic system that exists within us,

sort of the emotional centers of the brain, the deeper structures of the brain, that we shouldn't deny those and creative people learn to tap into those.

So the challenge for me is always how to liberate our understanding, my understanding,

without it getting too woo-woo and leading to plus and such a good point, man.

It's such a good point.

I really think about this a lot.

What level of rigor and skepticism should we have without closing ourselves off to alternative approaches to things?

And I would say I lean on the rationalist, materialist kind of evidency side of stuff.

I tend to have a real

anti-conspiratorial leaning to me.

But that's been to my detriment a lot of the time because I think

I've probably said no to stuff that my gut would have convinced me of saying yes to.

Like my brain has overruled my intuition.

And I'm kind of trying to allow that to be tapped into a little bit more and trying to get that to reverse.

Well, and so that's interesting.

So

liminal states, these hybrid states that exist in nature, deltas where salt water meets fresh water, where our waking brain goes to our dreaming brain.

That's a cognitive delta, if you will.

That's a theme that I'm working on in my mind.

The other thing I'm working on is what we're discussing now is that to look at our capacities

as a thermostat, it's a modulation.

Inflammation's bad, bad, bad.

And that's not true.

We need some inflammation to fight off bee stings and other things.

But how is that thermostat set right for our lives?

We fight off infections,

but if the inflammation is too strong, it's like friendly fire.

It can cause autoimmune disease.

So rather than saying inflammation is bad or good, that this product is anti-inflammatory.

No, I actually need inflammation sometimes.

I need stress sometimes.

I need these capacities that have kept

our species going

sometimes.

But when they're running rampant without the necessary stimulus for them, then we have to identify it and use our coping strategies and maneuvers and the things that the wellness industry is presenting to bring them back into the

ecological validity, which is real-world scenario, where should my thermostat be?

You mentioned dreams there.

Is Freud totally obsolete?

Did he get anything right when it comes to dreams?

He got one thing right for sure.

And before

him, it wasn't really clear that dreams were coming from the brain.

That's a cool story too, because

so he's about 100, 110 years old, but before he was the one like, look, it's your desires gone wild, your dreams, it's just freaky time in dreams, and it's, but it was coming from your brain.

And it was only at that time, it wasn't clear that

this creature, this human being lying on the ground, mostly limp, body is cool, brain must be off because they're not moving.

So how could that inactive flesh, how could that inactive, like the hibernating screen on your laptop, right?

Like, how could that conjure up all of that crazy wild adventures, dream state, dream experiences?

So it was a guy named Berger was looking, he was trying to actually understand.

So like the old school people who are trying to understand things, they were open to hunch and instinct and not to say paranormal, but something that they liked exploring things that couldn't necessarily

be fully articulated, but that didn't stop the exploration, the search for the meaning in it.

He felt like there was this potential for mental telepathy.

And in looking for that, he put stickers on the surface of patients' scalps.

And at that time, they were just learning that like a wire to a sticker on your scalp didn't mean you had, you couldn't just, you could just send electricity in, but you could also record.

And so he's the first one that came up with the EEG that later turned into the EKG.

An EKG is the three main nerves on the surface of the heart giving you a squiggle we're all familiar with.

An EEG is 96 stickers recording the electricity generated by 100 billion neurons that are like microscopic jellyfish, right?

It's just a recording of the electrical phenomenon going inside.

And

when he recorded that EEG,

he didn't, he let it run.

And at night, surprisingly, there was still electricity.

And that sat for like 20, 30 years.

But that was the first time people are like, wait a second, the brain is still going off when we sleep?

So much so that at certain parts of the day and certain parts of when we're in our sleep dreaming brain,

the electrical activity is so strong that they call it paradoxical sleep.

That

while you're asleep, Just based on how wild your electricity is, you can't actually tell if you're asleep or awake.

It's that that hot.

So it's not a quiet time.

And so that's what Freud did: say, dreams come to the, from the brain.

And now we've come to understand that the brain is always on.

It's on a 24-hour roughly cycle.

You go into a cave and you get the people into the cave and they're still on a 24-hour cycle, right?

Circadian rhythms.

Like we're all built on this rotating planet, like Venus flytraps open and close, tides open and close.

We're on a 24-hour cycle, but the brain, electrically, physiologically, the amount of glucose usage, when we sleep, the brain is not resting.

And now that allows us to say, well, what is it doing?

The most vibrant thing that the dreaming, sleeping brain is doing is conjuring up dreams.

Okay.

Why do we dream then?

Well, that's a massive question.

You know, I mean,

I would say the answer should come from the information we now have.

Okay.

So it's not chilling out.

It's burning hot.

And this one, I got to unpack it a little bit.

When I just said, look, the waking brain and the dreaming brain are equally vibrant electrically, but they must be different.

So one of the main things that happens when you go from the waking brain to the dreaming brain state is certain continents

in our brain, not like a spot, but a network called executive network.

Now they're trying to call it action network, but

This is a very specific part of the brain of the prefrontal cortex, and it needs a little bit of explanation.

It's called the dorsolateral prefrontal cortex.

The frontal lobes are like this.

It's kind of on the outside.

It's the executive network.

It's the conductor that coordinates it all.

It's responsible for calculation, processing, quick judgment, not a lot of instinct.

And it tamps down other regions, such as the imagination network and those deeper limbic structures that are.

our hunch are how our my dog can tell when i'm trying to say yeah i'm um hey come here you know like trying to give him a treat to trap him to put him back in his pen because we're going out for the night.

That instinct comes not from the dorsolateral prefrontal cortex or of the prefrontal cortex.

So when you go from the dreaming brain back to the waking brain or waking brain to the dreaming brain, that region is dampened.

It's never on or off.

It goes from being like 51% active relative to the imagination network to 49%.

So the dreaming brain has a dampened executive network and a liberated imagination network and movement regions

and emotional networks.

So when we see the shifts and

as the executive network comes down, it's compensated by the imagination network.

So you get that equivalent electrical activity.

So when you think of it that way, Dreams, why we dream, has to be explained with what is going on with the dreaming brain.

It's hyper-visual, It's hyper-creative.

It goes into tremendous social situations.

And my big idea about it is it's not what others have said, like it's threat rehearsal.

If you run from a woolly mammoth in your dream, you're better off if you ever encounter one.

Or it's a nocturnal therapist.

We work out our emotions at night.

It doesn't fit the complexity.

We have PTSD flashbacks.

So what I think is happening is certain regions of the brain that are generally tamped down for us to perform the tasks of the day are allowed to be liberated in the safe space of our temporary paralysis of our dreams.

Because in the brain, if you don't use certain neurons in certain capacities, they will wither.

If I patch a kid's eye for therapeutic purposes, where it lands in the occipital lobe will physically wither.

And so I think

we dream to maintain our emotional and creative complexity as a systematic process where the brain takes turns in a 24-hour cycle being executive network dominant and imagination network dominant.

So,

all those capacities are there for us for the next environmental event we're not prepared for.

Aaron Powell, so if you spent your entire day as a caveman logging all of the different fruits that you'd gathered over the last week and making sure that your cave is clean and working out where you're going to go to catch the next mammoth, all of that is very executive, it's very top-down, it's creative in some ways, but not intuitively creative.

But you have

maybe not given yourself.

The urgent always overtakes the important, and the urgent is very rarely going to be a creative pursuit.

Task on versus task off.

Yes.

Task on is outward and that's the executive network.

Of course it requires a little imagination and everything to navigate.

That's why it's never completely on or off.

And then task off is daydreaming.

dreaming itself is the most task off thing.

And the brain wants to run rampant.

I mean, it's wild.

If you look at some of the electrical activity, the glucose usage, it is not a quiet time.

And so we can't deny that a process that makes us lie down,

burns that much energy when energy is hard to get.

and has lasted through generations and generations is essential.

So my feeling is that any collection of neurons, whether in a dolphin, like dolphins do one brain at a time, well, half brain at a time, so they can keep paying attention.

They'll sleep one hemisphere at a time.

Wow.

Penguins do like, they do micronaps.

They do like 10.

Flamingos do something weird with sleep as well.

Well, all the creatures, they have different ways.

But when you get a collection of neurons, they got to sleep.

And what happens when you sleep is not rest.

It's a different type of neuronal activity.

Your body might be resting.

Your heart might slow down a little bit.

The liver's cool.

Body's cool, but the brain's on fire.

And just to just to put it out there as a surgeon, when I've moved livers between moms to kids,

you could take a piece of liver from a mom and move it to a kid.

I've transplanted hearts in training.

We're not really reconnecting the nerves again.

The bodily tissue is a little bit autonomous.

Sleep is not really for the body.

I'm not saying that sleep isn't good for you.

I'm not saying sleep shouldn't be a performance goal.

I'm not saying that.

I'm saying when our bodies sleep, it's our brain that builds the sleep pressure.

And when we sleep, what does the brain do?

That's the most vibrant thing it does?

It dreams.

So I think dreaming is an essential feature of preserving a healthy brain and healthy mind.

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is

Is there something interesting about the fact that we're conscious of our dreams?

Because you could imagine a world in which

the body shuts down, the brain shuts down, and you don't have any conscious recollection of the fact that this thing happened.

It was kind of, I guess, what you're suggesting is there are certain capacities that the brain needs and may need in future.

They're maybe not quite as common as some other pathways that we use more frequently.

And dreaming is one way for us to ensure that those myelin sheaths are kept nice and

lubricated.

They're moving quite

accessible when we need them.

Yeah,

they don't wither, they don't atrophy.

However, the fact that we're conscious of this, the fact that we can recall it, that there is a phenomenological, emotional experience of going through this, is that bit adaptive in

your opinion, or is that some spandrel side effect, like a light bulb that gives off heat as well as light?

What do you think about the fact that we actually know that we have been through this thing?

Because I could imagine a world in which you could retain the capacity without having the experience of being through it.

Yeah, that's it's a massive question, it's a fantastic question.

And my opinion is to tell a few stories about how some of these things happen.

So,

back to liminal states.

I don't think any process in the brain, waking brain, dreaming brain, is a rigid on-off process.

So,

my feeling is

when we remember some dreams,

they're like solar flares that have leaked into our memory.

And we wake up, we're accidentally sort of holding on to the residue of massive dreaming activity.

That's my hunch.

And the way to think about that is

the concept of self and autobiographical memory.

So when people talk about self, self-worth, self-this,

the concept of self is created by a type of memory.

There's procedural memory, tying your shoelaces, semantic memory, stuff our phones record, you know, dates and stuff, episodic memory, like the episodes of our life.

And what happens is they're stitched together by a capacity called autobiographical memory.

And

the thought here is from people who have certain types of psychoses, when they can't separate out their dream and waking state, certain patients with schizophrenia, it becomes quite confusing for them.

So I think the dreaming process is richly active in all of us.

The degree of recall is different between us and different in different stages of our life.

And so when we do remember a dream in the morning or we wake up and we remember a dream, go to the bathroom and sometimes fall back into the dream, that these are just

sort of the residues of a vibrant dream state that is breaking into our consciousness.

I don't think that

it's by design.

I think it speaks to the capacity that we're never fully dreaming and never fully awake.

And the best example of that is not sleep entry that Salvador Dali talked about, or sleep exit, we talked about sleep paralysis, but in the middle, certain drugs that we give our patients for Alzheimer's will make them have more lucid dreams.

So the awareness of the dream state can happen when you're falling asleep, when you're waking up and you're holding on to some of the dreams, and there are habits you can do to hold on to them more.

But also in the middle of a dream, people can train to lucid dream.

I know that sounds like, okay, there's a neurosurgeon talking about that, but it's rigorous.

Galantamine is an acetylcholine

antagonist that we give to...

improve certain functions in Alzheimer's patients, and they report a dose-dependent increase in lucid dreaming.

So I think the dream state and the consciousness state, they're like two dimmers and they're overlapping a bit.

And so when we remember something in the morning, rather than thinking that it's by design, I think it's sort of like an opportunity to have an insight into ourselves at a very emotional, very visual, very sexual time.

Yeah, why do dreams often end up being so emotionally intense, do you think?

Well, because when you look at the areas that are activated preferentially in the dream state, it's the limbic system, which are the emotional centers.

When you look at the dreaming brain, the regions that are activated, if you will, it's the visual centers, it's the imagination network.

And then equally,

you're dampening the executive network so these big jumps of ideas and creativity and associations are not

discarded by the executive network as they would be during the day.

It allows for that.

Let me give you one specific example that I thought was really fresh when I was asked to prepare this book was

when you look at thousands and thousands of dream reports, not yours or mine, but like mine feel wild, yours must feel wild.

But you start to see that very few people report doing math in their dreams.

I'm not saying like somebody's going to call in or write and say, yeah, but it's not like nightmares, 100% reported.

It's not like

erotic dreams, sexual dreams over 90%, teeth falling out, being chased, flying.

These are common dreams, right?

Math is very rarely reported.

And what I like is: okay, if I take hundreds of years of patterns of dream reports, basically surveys, or Aristotle's comment about

lucid dreams, now with modern neuroscience, it makes sense.

If the executive network is

dampened that does calculation, it kind of makes sense to me that very few reports of math

occur in dream reports.

Like that fits.

Executive network goes down, reports of math go down, imagination network is liberated, people report creative and wild dreams.

So it ties together what people are reporting for years.

Why

teeth falling out, falling, flying?

You know, three dreams that I would guess almost everybody listening to this has had.

And before electricity and after electricity,

from the horse and carriage all the way to the electric car.

Like we needed to wait for airplanes to be there to think that I could fall out of an airplane or for buildings to be sufficiently high that you would fall from a skyscraper.

Exactly.

So that, so if we're getting mental health

is tied into certain families, nightmare, one type of dream, nightmares, clusters in families.

So nightmare disorder can happen.

Territorial.

Well,

or...

You know,

that's a complex word.

I mean, you can have things cluster.

I mean, you know, maybe those people are living in difficult situations.

So it's hard, but there is a dream that clusters in family, just like certain mental health conditions would.

And the fact that we share the same dreams with people living in wildly different cultural times,

something's built in.

And that again speaks to, I think,

the new understanding we're having in the last 20, 30 years as we can have people be in brain scanners and fall asleep.

Have you got any idea about what makes for universal nightmare?

Is this just something?

I got a big theory about it.

And so,

you know, this book was

this book was important for me.

It was, I had written a few others.

One was, you know, and then Penguin UK in London said they've always wanted a book that looked at dreams and dreaming from a certain perspective of somebody with a complicated life story, somebody who's had the professor chops, but also could tell a story.

And I really took it, you know,

it was wonderful, actually.

It kind of liberated me.

Part of that process was me rolling around Dodger Stadium in L.A.,

going to pubs in London and sort of throwing this out because it had to be for everybody, right?

It's not meant.

And the question I would get asked the most, like, if dream, wait, if dreams are good for us, why do we have nightmares?

It was just sort of a, you got it.

And so that was chapter two.

Nightmares are, it's a tough thing to explain because it obviously, like, why, you know, if, if, why would it, why would it cook that up?

And so the way I think about it is

you have to look at the mind as

something that needs cultivating in children, just like walking and talking.

And so just like we're not fully formed and we have to be taught to walk and challenged to walk and talk and engaged, at the same time, in the mind, there are certain cognitive developments that are happening.

So, in they're called longitudinal studies, they had families allow their children to be woken up for like 22 years and report like what they're dreaming about at different times.

And like, when they were two or three, like, it's just like it's a blanket, it's it's not very dynamic, it's not

a lot of movement.

And then, around four and five, six,

nightmares arrive for every child.

It's rare to find.

I did a lot of pediatric neurosurgery, still do.

I have three sons in their 20s.

They have to be told that nightmares always arrive in children, healthy children, unhealthy children.

Some of my patients who had brain injuries, it seems to be a part of the mind's development that's built in.

It arrives for everybody.

And then almost invariably, very few kids have nightmare disorder.

It doesn't linger into the next day and ruin their day like it does for adults.

So it's sort of like a wave of thinking, a species of dreams that arrives.

And then around 11 or 12, you have erotic dreams that arrive, whether kids are having sex or not, or teenagers are thinking about sex or not, they arrive.

And the last one I see is sort of the maturity, like adolescence.

The brain looks the same, but we change who we are.

So I think there are three waves of sort of the development of the mind.

And what happens around that age of four, five, and six is also the development of something called the default mode network.

Like, until then, children have a hard time reading minds.

They can't tell if smiling uncle means well or means harm.

And that capacity arrives at the same time as nightmares.

And so, my big hypothesis, it'll be hard to prove, is that nightmares create a sense of self versus other

by having these harrowing, difficult experiences.

It sort of creates creates

that the world around me is separate from who I am.

And this engagement with monsters and different things creates this default mode network that allows us to start to see ourselves as separate from the world around us and to be a little bit more critical in evaluating the threats and the people and their intentions around us.

That's my big thesis.

And that would make sense adaptively because before age four, five, six, kids are so un-independent that the need to be able to distinguish between I am here and that is something else is kind of pointless because you're not let out of the sight of mom or dad.

Yeah, you're in the rap still.

You're very close.

You're not being led.

I mean, I think that's a good point.

The other point is that

it's just like every

every kid has to be told it was only a, it's only a dream.

It's only a nightmare.

And that there's this, just like we talked about liminal states in the beginning, like in psychosis, people can't separate out,

you know, awake versus dreaming.

And that to stitch autobiographical memory, we need to know these are awake thoughts and these are dream thoughts.

And dream thoughts should not disrupt your awake thoughts.

That there are these things that happen in your mind, but they're not actually the daily steps that link your life together, right?

That in children.

I don't know if before nightmares, they know the difference between waking thoughts and dream thoughts.

Like maybe nightmares inform the child it was only a dream.

So, it's always been a puzzle to me.

Until then, do they not know that what they experienced in their thoughts while sleeping was actually not real?

Could be discarded.

I guess that the creativity network in kids is so much more alight even when they are awake.

You watch in the space of an afternoon, a child's a firefighter and a postman and an astronaut and a sports star and a rock star and asleep and then awake again and back to being a postman.

And yeah,

I dream of being able, I literally do dream of being able to have that level of creative access again.

And I think so that nightmares are serving something fundamental because they arrive in all of us.

It is the universal dream.

We can all talk about

what they serve and the purpose.

And the last thing I would say about that, to be a nightmare, it has to wake you up.

It's not a bad dream.

Like you wake up the next day, you're like, ooh, that was a rough night.

Nightmares have to wake you up, sear your memory to be considered a nightmare.

It's the dream that has to wake you up and be vividly remembered.

So I think there's some mental cultivation going on with this process that we all share.

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Do you think it's important to remember our dreams?

Have they got deeper wisdom to tell us, or should we just allow them to be a sandbox that sort of lives on its own?

I

I think based on what I've learned,

I think it's the ultimate wellness habit that goes underutilized, you know,

because

first,

and just to give you some examples, you know, the sleep entry period, this liminal state where based on measurements, we can show you're kind of awake, you're kind of dreaming, sleeping.

I mean, people like Edison in Inception, Inception, the movie was the falling chair was a concept based off of Dolly or Edison, where they'd be working on some creative project and

he'd have a key in his hand and a little metal basin.

And when he'd fall asleep

on the rock while rocking on the chair, he'll fall forward, the key would drop, and then he'd write down his thoughts.

He felt that there was

something that could be extracted from that dream entry, sleep entry state.

Lucid dreaming is something we could talk about later, but that seems to be something that people report wellness with.

People, athletes, people who are visual spatial tend to have more lucid dreams.

I think that's an interesting thought that we can

learn that ability.

There's a little bit of sleep disruption about it.

And then when we sleep exit, which is a time I use quite a bit, is I have the luxury of not always hitting the alarm.

And I take those last five, 10 minutes of thoughts and I write them down first

before going on social media or looking at my email.

And that seems to be an idea generator for me.

I think there are sort of those practical elements that you can do.

But if for me, just at a philosophical level, when my brain with my memory, with my imagination, not somebody else's memory, not somebody else's imagination, runs in a different mode, hyper-emotional, hyper-imaginative.

and something leaks out of that that I can hold on to, I think it's worth taking a look at.

And even just the process of reflection, I think could hold some insight.

But I would tease that out.

It would be that the dreams that leave a strong emotional residue with a central image,

I think it's okay to say, why did I have that dream?

You know, be your own therapist in that capacity, because it's coming from your imagination and your mind.

The concrete example I will give is some people who are feeling well, feeling like they're coping well, will have a return, will have nightmares pop up in their lives, which serve as sort of a thermometer.

And so the nightmares, if they're progressive, like headaches, occasional nightmare is whatever it is.

Occasional headache is whatever it is.

But if there's a progressive uptick in nightmares, that can happen while the patient is having, the person's having such a fantastic life during the day.

So that can be sort of a warning sign.

or a signal that maybe you're not coping well.

So I think we're just starting to get into those those features of maybe people's dream life should be part of the vital science.

When I started training, it was like bread pressure and temperature.

Now we ask about pain, we ask about wellness, we ask about living situation at home.

I don't think in the world of mental health,

it would be a stretch to start asking and engaging people with their dream life.

Dream experiences predictive of something in health.

You mentioned an uptick in nightmares across the whole whole board.

Somebody's dreaming more, dreaming less.

They remember it more.

They remember it less.

More lucid, dreaming less, whatever.

More nightmares.

Are there any correlations between that and someone's overall health?

Good question.

The dream pattern related with overall health would be nightmares.

So two types of nightmares.

Pediatric nightmares, we talked about age 4, 5, 6, which I think are cultivating the mind.

They don't really lead to nightmare disorder where the next day is ruined.

And then nightmares in

adults, they can happen once in a while.

That doesn't seem to be a problem.

But four or five percent have nightmare disorder where it disrupts the next day.

And in that situation, whether it's in PTSD or whether it's in trauma or whether you're going through a difficult situation, tracking nightmares, their uptick or their improvement can be sort of a measure of how people are doing.

But as far as

what I've read about dream recall, dream patterns, that changes throughout our lives.

So

a lot of adults say they don't remember many of the dreams.

My cancer patients, when they get to end of life,

they tend to have these genre dreams are called end-of-life dreams.

They tend to be of reconciliation.

They tend to be more hopeful than you would suspect after getting surgery and chemotherapy.

So

your dream

within our lives, from nightmares to erotic dreams,

to the way we dream as adults, to drugs that change the way we dream and how much we remember all the way to end of life dreams.

If you don't think you have a lot of dream recall now, that doesn't mean it won't be there for you.

It can't be cultivated.

You just have to track dream experiences and

prevalence throughout a whole lifetime.

And you start to see that they come in waves, which I find, which is

interesting.

How real is dream interpretation?

I don't think it's real at all.

I mean, because I, you know, I mean, I can't do it for myself.

You know, like.

So So what hope is there of a lady in a shawl being able to do it on your behalf?

Well, I mean, I think just we have to look at it conceptually.

And I think we were just talking about that.

It's my imagination.

It's my memory.

So like, let's.

How do you know what this snake means to me?

Not just what it means to me, what it meant to me five years ago.

I'm not the same person I was five years ago.

Like a bridge.

Let's take a bridge, for example.

For some of my patients, it's,

you know,

they might be thinking about suicide or it could be reconciliation with a loved one.

It could mean so many things within that context.

How can a bridge for you and me mean the same thing?

But past that, a bridge for me means very different things

within the context of my own life.

I don't think a static symbol can reveal a dynamic mental life.

Well, this would fit in with your perspective that it's kind of a

gymnasium training ground sandbox for the mind.

High intensity training for the mind.

Yeah, that we

maybe we shouldn't give all that much credence to it maybe the brain is just kind of running away with itself because isn't it strange people have intrusive thoughts all the time

uh they see somebody stood next to the edge of the road and they think i wonder what would happen if i pushed them in i mean i'm not going to do it but

i wonder what would happen if i pushed them in oh god this would happen and that would happen wouldn't that be thrilling and

you go okay are you making some sort of inference about the sort of person that you are for having had that thought?

Most people would say, no, you know, I just have intrusive thoughts that occur during the day, and you go, okay.

Can't go to jail for thoughts.

So,

your intrusive thoughts when you're awake and conscious are not that indicative of the sort of person that you are.

And yet, you're telling me that the dreams that you have when you're not conscious are worthy of interpretation.

That I've never thought of that before, but yeah, we're prepared to give,

we're prepared to dissect something which we have way less control over when we're asleep.

But then, on the other side, you know, the devil's advocate position would be:

there are very few windows that we have into the subconscious.

The subconscious can often tell us things about ourselves that maybe we have repressed, not been prepared to feel.

And perhaps there is some deeper wisdom to be gleaned from when we're asleep.

I agree with that, but I don't agree

that

you know, um, the lady in the shoal.

I don't agree that it can be

made universal,

right?

I dream of a bridge.

You dream of a bridge.

And it's filled with emotion.

It's a vibrant bridge.

Okay, go ahead and explore it.

You explore it for yourself within the context of your life.

And I'll explore it in the context of my life.

For me, it might mean suicide.

For me, it might mean San Francisco, where I went to college.

For you, it might mean something else.

So I think

the dream residue being a window to our own individual at that moment, subconscious, hyper-emotional, hyper-visual, hyper-sexual state, yes.

But a symbol that captures it

between two people, let alone between your former self, I just don't understand how that can happen conceptually.

What about erotic dreams?

What have we come to learn about what fuels it?

I mean, why not?

I mean, it's firing.

I mean, you know,

why not?

I mean, that's,

it's, this is, that was chapter three because remember, we were talking about like, I wanted to hit everything up up right off the top.

Why we dream nightmares, really?

Nightmares?

And then erotic dreams.

It's fascinating because it's another thing that happens before the erotic act.

Kids don't have kids who have never seen a monster and have a puppy, they'll have nightmares.

They're wild.

That's coming, that's descending through our psychological inheritance.

Erotic dreams, people have them before the erotic act.

It's almost like an instruction guide.

And what's fascinating to me is

there's not a lot out there.

90-something percent, when you go from sexual dreams to erotic dreams, over 90% report having them.

The terminology difference.

I don't know.

I think it's more inclusive.

So we start when you do surveys in other cultures, they're more willing to sort of say yes.

Erotic dreams.

The term seems to be more it's easier for them to say yes to that.

Right, okay, because it's sexual.

A little less porn vibe.

Yeah, and it would also imply maybe hugging, cut, kissing,

that's not exactly they're not doing it with their partner perhaps.

Well, and then the next thing is when you ask and and as we get into more online surveys, this is going to be great and more people are included, but like 80% report infidelity.

And then the infidelities with a small group of people, like a repugnant boss or like family, it's weird.

The tribe, the characters, the characters in the,

you know, the cast and crew is narrow.

The acts are wild.

And so when you take that data, healthy relationships have infidelity dreams, unhealthy relationships have infidelity dreams.

That's those are sort of the surveys out there.

And that leads to a lot of cool conversations.

But from a neuroscience point of view, is

this the part that really trips me out

is

that around the time of erotic dreams, even before

the pituitary is dripped the hormones that release all the hormones, a cascade in our body that leads to the sort of changes of maturity, is that

the same fingertips that do touch can now

do caress.

And it's not like a new nerve got built in there.

It's the capacity to perceive sensuality changes where the sensory nerves land in the brain.

It goes to the opposite side to a motor sensory strip in the sensory region.

So around the time of erotic dreams,

we developed the ability to have erogenous zones where a light touch on a back can be a turn on rather than just bumping into somebody in the subway.

That capacity doesn't really exist at age six or seven, and no new nerves are being deposited.

It's a perceptual change in the brain.

That's interesting.

Yeah.

So to me, I like thinking about, I don't have a, I don't have any big answers for that.

I just want people to walk away from that and say, so those changes, the ability to be aroused, happens around the time of erotic dreams.

And often it's before you're actually mature.

So it just seems to me, again, that erotic dreams are arriving almost universally in adolescence to prepare for the act of procreation and to create the drive in our mind that we later carry out in our bodies.

That's the way I see it.

I wonder whether,

well, I mean, this is almost certainly going to have been the case throughout history.

If you've got a particularly

prudish society, Victorian England,

they still get it popping.

Well, of course, you're not going to be able to, but

I wonder how many people that had these erotic dreams back then

would have

they would have been a real source of shame for them because I'm my my I'm I'm cursed, my subconscious is contravening the norms of my culture and and God is looking down on me, especially if you're told that you know God is watching if you masturbate, God is watching who you're attracted to, uh, you know, infidelity is one of the worst things that you should ever do.

You should be loyal to your husband or your wife.

And uh, and these dreams are like 80% infidelity, and it's all with people around you.

you

it's your boss you know what i mean it's the boss you hate yeah yeah i think i i think it must have led to a lot of inner conflict and so that when i when i write about erotic dreams and you look at it in different cultures you know what my feeling is this is a this is a way that our just like we learn to walk and talk nightmares do something because they're a universal dream.

Erotic dreams do something.

They happen in all cultures.

They've happened over hundreds of years.

They're happening with internet porn.

They're happening in Victorian ages.

And that to start, really start to think of the patterns, the patterns of our dreams are not infinitely wild.

That's the, and then, and then what really teaches me is the patterns of our day are not infinitely wild.

We build and break habits in similar ways.

We fail in similar ways.

Like the brain is not infinite.

It does have some

boundaries in the way it works in the dreaming.

The very least guardrails.

Yeah.

Or, for example, dreams are not infinitely wild in the sense that you don't do math in your dreams.

So there is at least one boundary, right?

And then they tend to have certain patterns.

And now I'm using that to think about

that we fail in different ways while we're awake in our lives.

And if you look at 10,000 people, the ways that people fail and succeed also start to follow some patterns that I think can guide us to like, hey, our brains and minds work a certain way.

And when we learn about that, then you can say, where are are we in this?

How is our thermostat?

Is a victory today just getting out of bed

and not saying, hey, wellness,

I got to feel well, or just, I got to get out of bed and get on the bus and get to the cancer center.

Like, so I want to personalize that whether you're the addict, this is just a side rift, man, but whether you're like,

there are these people in recovery who are really good with horses in the Kentucky Derby, whether you're into horses and racing or not.

But some of the horses can tell somebody who's been through something and has earned and trained themselves to be calm.

Like they have a better rapport with the animals.

No way.

Yeah, it was featured when it came out.

And so then, and then there's like, then, you know, like, I was in San Francisco and I saw this person really struggling to not use, you know, just really just fighting that.

And then I got a buddy in London who runs like this North Saharan seven marathons in a row, you know, just to show everybody he can.

And

when he's pushing to complete that seventh marathon, or that the person using is really pushing to to not inject, I think it's actually the same brain processes and patterns that are working inside.

And if we can learn how those work,

how those can be deployed, how those falter, then we have a universal toolkit.

And that's what this dreaming book, that's what I told you earlier, was like, it's really important for me, is because it's helped me actually understand that if the dreaming brain follows patterns, which seems infinitely wild, right, that you brought up, then, okay, so then our waking brain, we follow follow certain patterns

and we're not incarcerated by it.

But if we learn those rules,

rules of survival, rules of

how our day can be empowered or watch out for that booby trap and that falter and watch out for this attentional magnet because it's going to trip you up, like you could have a

you could have a toolkit.

You could have a guidebook to your own.

to your to your to your own mind.

And that's where I want to take things going forward.

And that's what the Dreamy Book has taught me.

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What do you make of the prevalence of the repugnant boss in

erotic dreams?

I don't know if it's a power dynamic, you know, or it's

you know, I don't know, or the family.

I mean, my idea was sometimes,

yeah, the repugnant boss, but what the

narrow list of characters, I thought, a hypothesis.

Again, there's many things we can talk about that can't be proven, but

evolution at bottlenecks.

Like, there were times when,

like, it's crazy if you think about it, like, how many different, how many species there were at one time.

And

maybe Homo sapiens were

down to a few hundred thousand or a few thousand at that time.

And maybe it was an evolutionary advantage to only procreate within the tribe.

Like, that's a very hypothetical scenario.

But

there's a field called evolutionary psychology that our cognitive archaeology, that the way we think

was an advantage that led us to

thrive in competition with other hominids.

Because, you know, people are like, oh, bigger brain, the brain is shrinking.

Stop that.

Neanderthals had bigger brains.

But something with our minds was the advantage.

It wasn't just the size compared to Neanderthals.

And that's why I love evolutionary psychology.

And the way we're thinking now is something we've inherited that was advantageous hundreds of thousands of years ago,

but we have to now adapt that to the modern life.

Okay, so if we're thinking adaptively here, I'm also a huge EP fan.

Yeah.

So

if we're thinking adaptively, the repugnant boss

or the family member, very well, maybe

we're not particularly well used to having 200,000 people available on Hinge or Tinder or in our local city that are our age and hot to trot.

There's usually only a very, very small group of people that are here.

And perhaps the sleep dream of that is, well, what if I test this out?

How does that make me feel?

What does that mean for me?

Because there aren't that many other people that are available and probably should see if this is actually going to work or not.

I mean, I mean, it's possible.

I mean, now,

as far as the characters in our erotic dreams, whoever writes this book next

is going to have a lot more surveys from a lot of different types of people speaking a lot more openly about these things.

And then they're going to have to figure out like,

you know, I mean,

celebrities are part of the erotic dream.

They're considered part of the tribe, like Brad Pitt or whatever, like celebrities show up.

Something to do with status, maybe.

Or familiarity that you see them so much, you feel like they are familiar.

I don't know.

We're just riffing.

But I'm curious to see that with social media and stuff, how influencers, do they show up in a similar capacity as conventional celebrities that I grew up with?

Let me warn you right now, you do not want the pillar talk of a podcaster in your dream or not.

People are going to call in and they're going to write in.

No, thank you.

Look, look, you went.

I'm a pugnant boss, Chris.

Yeah, you slept with a podcaster.

What did you expect to happen after?

God, it's three hours and he's still going.

He's still going on about the biggest gun of World War II.

Will you shut the fuck up?

Hey, look, I mean, you asked for that.

You knew what you were getting into.

On the erotic dreams thing, I don't know whether we have enough longitudinal data to work this out.

I'd be fascinated to see what impact the prevalence of porn

has had in changing the sort of erotic dream.

Men cycling through even more partners in one sexual fantasy.

Are they being influenced by what they see on screen?

I certainly know that if I read it...

Well, if I...

That's a massive book.

Get just 10 years.

Somebody just needs to rock that.

I like to read fiction before I go to bed, and I've been...

I have an admission to make.

I've been getting into chick stuff, a lot of chick stuff.

Frida McFadden, The Housemaid, Housemaid's tale um

uh alex michaelades who wrote uh the silent patient it's like thrillers like written by chicks but not necessarily only for women really good really sites come from every easy easy reading

usually a woman in her early 30s that's kind of looked over who

fixes some sort of crazy murder thing that happens that impacts my sleep like fuck dude like i go to bed and i've got but it's usually

interesting it's a particular so you think okay if the thing that I read before I go to bed I'm also watching the tour de France unchained on Netflix at the moment for some reason I'm not having many cycling dreams if these two things are happening we have to assume that people who the volume pawn a lot the volume how is that not impacting erotic dreams I think that's the

I think that's the experiment uh that's uh

that's ongoing and somebody

younger than me will see that that's the opportunity here to look at that.

And in the context of dreams,

super physiologic stimuli is another concept.

Like,

you know,

you can't look away because it's just so, it's just like a coked up version of something.

And so you may have some finesse and emotional regulation, and you may be able to sort of in your own competition at wants to be like, oh, I'm not going to look over there because, yes, I feel desire and lust for that that image, but that pops up once or twice.

But when it's just like on loop,

and you can't, I'm surprised it's porn addiction is only 5%,

all right, given just the supra physiologic stimuli that it is.

But yes, the impact on dreamscape, the modern world's impact on dreamscape is as big as the when there were rumors that when black and white television went to color, that dreams also became to color.

There's some urban legend about that.

Like, I mean, the world was in color, but when, when color magazines and color TV came out, there are small reports that our dreams were more in color.

Wow.

So that's a, but the point is,

whether somebody can further explore that or not, but right now, this is, this is a, this is a PhD thesis for somebody right now if they want to run it.

How unsurprising that the things you consume will influence the way that your subconscious works at night.

But sometimes not.

Right?

Like it's an inconsistent process of feeding your dreams.

And that's what I like about it is that you think like this,

you think your dreams are only going to have the thing that you're worried about and it doesn't.

So it has, it's metaphorical.

Like you might have a lot of anxiety about

something and then your dream is filled with anxiety.

But it's like.

It's like Vietnam veterans, when they were going through divorces, they would have their PTSD come back.

They weren't dreaming about fighting with their lovers or spouses.

So dreams arise in a way that's metaphorical and requires interpretation by the person who's having the dreams.

What do you think that says about where the inspiration for dream material comes from?

I think it's a constant.

So I think during the day, we are, just stay with me now.

If we took a brain and we flattened it out and we said, well, they were continents, right?

Thinking of the brain as this spot or that spot, sometimes if we injure a certain spot, like a nail, I used to take care, I did a lot of trauma, nail gun injuries, they'd come in with like a nail stuck in, you know, or they'd have a fall and a blood clot would come out.

You would say you take out a certain part and they would lose a certain capacity.

You say, oh, this is what does this.

It's not like that.

It's like Heathrow or London.

You know,

if you have...

an issue at LAX, it's going to disrupt something globally, but it's not that LAX does flights.

LAX is a hub that controls flight throughout the planet.

Similarly, there are spots in the brain hubs that control broad processes throughout the brain.

And what I like about it is that these injuries have informed us about

how the brain works.

And when you have an injury in that dorsolateral prefrontal cortex, which is these little spots here that's the conductor of your whole brain while you're awake, those people struggle with math.

And so it's okay.

It plays a role in that.

And if you flatten out the brain and you have these different continents and lobes and structures, hypothetically, you have certain parts that are ramped up during the day during an executive network.

They're not in one area.

They're connected by a lot of things.

Like,

where's the economy?

I mean, it's in the cities and Wall Street.

It's everywhere, but there are some hubs.

So the executive network is one.

It's like in Las Vegas where Bellagia, where those waterfalls go up.

Think of the executive network as those neurons and their connections, they're like 51%.

They're running shit right now.

And the imagination network is 49.

And

when you dream, it kind of flips.

You have 49, 51, hypothetically, okay?

But

when you're daytime and it's executive network, you're still pulling from imagination to run, to get the task done.

You're still thinking, if I went left, if I went right, it's called counterfactual thinking.

If I go this way, last time I got hurt, you know, you're still imagining plus executive network.

And what happens with dreams is when the executive network falls back, your brain uses imagination in its own mental workspace.

And the biggest example of that is dreaming.

So think of the brain as always on, and

there's always a balance between executive network and imagination network.

And the examples of the most dominant time when your executive network is happening is under threat when you have to navigate a crisis.

And the biggest example of when your imagination network is most dominant, let's say 54 to 46 is when you're dreaming.

But everything in between is a dance between

execution and idea.

And what I like, this is just a side riff.

Like they did this thing about analyzing poetry or book cover designs, and they would put these people in fMRI machines.

And the idea generation is mostly imagination network.

But to figure out if you came up with a good idea, you had to toggle back to dominant executive network.

Otherwise, you just got a bunk idea, right?

And so

I don't want people to walk away thinking that we're liminal states, that we're all one or all the other.

And

there's a thermostat in our life and how to cope, but there's also a balance of executive network and imagination network.

And there are things creative people do to bring in the imagination network, but imagination requires executive function.

And really great executive function still requires imagination.

What are some of the ways that people who want to activate their imagination network more effectively when they're awake can do that?

Oof.

All right, so I got some stories for this one.

There are some examples

that speak to, again, a damaged executive network liberating a lot of imagination.

One example is alcohol.

It dampens the executive network.

And some people feel that they're more creative on alcohol.

And it's dose-dependent.

You know, not 10 drinks, not one drink.

I mean, alcohol has to be really handled with care at different doses.

It makes you feel different things.

Number two, frontotemporal dementia that Bruce Willis has.

These patients in Alzheimer's clinics, when they have a certain injury to that part of the brain, there are publications that people go on and look it up.

They show them and they're like artistic abilities.

They can paint a lot better.

Dementia, an injury to the executive network leads to a liberation of

hidden artistic, like painting, drawing talents.

So those are two examples.

Some people get hit with lightning bolts.

And even if it's one person, the electrical shift can release,

can change that executive network to.

No way.

Yeah, yeah.

I mean, they're out there for savants.

So when I say this, I want people to look it up, you know.

And that's also one flew over the cuckoo's nest where that movie made a portrayal of shock therapy as very negative.

And it generally was.

But now we create.

We send in electricity and create a seizure to break people out of suicidal thoughts and stuff.

So there are a lot of things, and those people sometimes have more creative ideation.

So we know that there are

hidden creative abilities in all of us.

And the executive network

is reining them in to get the task done, to drive on the freeway, to be on the tube.

So how can we extract those?

I would go back to sleep entry,

where that's a window where Salvador Dali thought you have good idea generation.

Sleep exit is also

a time where the executive network hasn't fully come back online, online, if you will.

So, your ideas will,

I have a lot of ideas during that time, bad ideas, good ideas, but it's an idea generator.

And then during the day, what you have to realize is you're not going to hit

undirected thought is actually the thought you want when you're trying to be creative.

It's hard to have a triple espresso and then drop creative stuff.

It's the liminal time waking up, meditating,

exercising,

focusing on something like a flow flow state, partially, but not, you know, not exclusively.

Driving, doing the dishes, playing pickleball, but partially engaged.

And then something, and then some, and then it, you can't demand it.

You have to cultivate it.

You can't liberate it.

You can't white-knuckle creativity.

It's

highly, highly irritating.

Another espresso.

Yeah, running back.

Fuck it.

Yeah, that's certainly something I've found to be true.

Sitting down and demanding yourself to be creative is a reliable way to ensure ensure that you're not creative.

You have to flirt with it.

I mean,

that's why it's not a gift everyone has, but it can be cultivated.

You mentioned there about some of the transcranial electric stuff.

As a neurosurgery person in that world, what do you make of

what do you make of this sort of new revolution?

I know that depression, anxiety, some compulsions are being treated with this now.

Yeah, what do you make of this?

It's real.

Right.

But it's also very easy to go on Amazon and get one for $4.99 where they got the little headband and

being positioned in the same way.

So the stuff where it's real is rigorous, it's intense.

It's at massive elite centers.

Usually, 30 days of back-to-back treatment as well.

Yeah, and not a 30-day refund like on Amazon, right?

So

every time

neurosurgeony was a funny word.

We have to be able to talk about things like instinct and hunch because that leads to the fullest capacity, right?

Smarts plus instinct.

Who doesn't want that?

Sports has the best thing, like, you know, under pressure, how people perform.

That can't be white-knuckled either.

The brain has to be thought about in scale.

You cannot answer all of these questions with the brain.

Like people talk about it, it's like you can't, it's not a homogeneous organ.

It's not a liver.

If you dice up the liver at different areas and you put it on a magnifying glass, it's the same cell essentially for the most part.

The brain has so many different cell types, so many different architectural components floating inside a,

you know,

it's buoyant, it's floating astride liquid.

It doesn't actually sit on the skull, you know, and like, so it's a, it's an ecosystem of little electrical molecular machines like tiny jellyfish that are spraying electricity and chemicals at each other.

And as we talked about before with those stickers, you can record electricity.

You can also deliver electricity, and that would be shock therapy.

And now what's less disruptive is delivering using magnets.

So for people who are familiar with physics, I'm not.

I took all the classes to go to medical school, but electromagnetic fields, they can influence each other.

So you can pulse a magnet through the skull and it can change the local electricity of a certain region.

So you can actually

put a magnet on the surface, no incision required,

and pulse to the motor strip and make somebody's arm move.

Because back to, it's an electrical currency that leads to

dreams.

You know, it's measured at night with dreams.

It can be tickled.

And so, now what Stanford's doing some good stuff with it in other places is, well,

what if you have obsessive-compulsive disorder?

Somebody else makes the diagnosis.

The term is not used casually, let's say.

It's not like, oh, I'm obsessed, but somebody really is like, man, I turned that doorknob 120 times today.

So they're looking at

the pulse can be used to dampen the dorsolateral prefrontal cortex and it can be used to heighten.

So if you pulse that area

every day for 30 days and you dampen it a little bit and at the same time somebody gets therapy and you do cognitive reappraisal.

Like the parts of therapy that I like are some of the ways where you're basically training yourself

and you say, hey,

that's not dirty.

Don't worry about it.

Or that door is locked.

You don't need to wash your hands 80 times a day.

Like you've been struggling with that fight the whole time.

People with OCD, they know they shouldn't.

And now if you pulse that area, that's kind of made it, you know, difficult for them to control, that combination is leading to results that we haven't been able to find by just giving medicine.

So it's real, but the thought that

you can buy this and then do it for yourself.

Self-administer.

Yeah, or with

a device that looks the same, but is not delivering the same technology.

But that is the future of mental health is a combination of therapy, magnetic pulsing, occasional medicine, and that as a cocktail, not just like three different types of antidepressants, which were helpful for people, but a mixture of talk therapy, a mixture of exercise, talk therapy, magnetic pulsing, all non-invasive.

And if you can get a 10, 20% improvement in what we're already, what was going on right now, I think that's fantastic.

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You've triggered dreams while people were awake during brain surgery.

Yeah, what's that?

Tell us about, dude.

I mean, it's this is how the

I mean, this was a story back in,

I noticed in my 20s when I was in training.

So, um,

so there's this thing, you know, some patients benefit from being woken up with their skull open in surgery.

How could you benefit from that?

Because

whereas this dorsolateral prefrontal cortex, we kind of know where it is, whereas the movement area, like the hand region, we kind of know where it is, you know, just based on an MRI, it's consistent in you and me and others.

Language is in a neighborhood.

It's in the left temporal lobe, right around here.

And

there is no specific address for it.

It's different in both of us.

And so to figure out

where language is, so you don't hurt it as you're trying to enter the deep brain through that area, you have to map the brain.

And so what we're trying to do is to get to it.

So

the neurons, the bodies of the jellyfish, molecular jellyfish, are all on the surface.

And then their axons and tentacles converge into the middle of the brain.

So the cortex, the canopy, the treetops is where

all the thoughts are happening, if you will.

And so what we're trying to do is identify the parts of the treetop right here, the cortex, that when you stun the activity in this tiny little area, it doesn't lead to any issues with them talking or understanding.

And

this isn't just like they'll still be able to text.

You can hurt the whole capacity of language.

So

the only way to do that is to wake them up in surgery.

And you numb the scalp, you put them under anesthesia, you open the skull, it's like ice fishing.

Then there's a little covering on the brain called the dura matter.

It's like

a sort of

skydiving parachute material.

You can pick it up and stitch it at the end.

You open it up, and there it is.

It's beautiful.

It's stunning.

It's white, speckled with blood vessels.

And then

you let them wake up slowly over 30 minutes.

The propofol is lightened, and then somebody engages them, and you have them count and sing, and sometimes even play the guitar.

Like UCLA has got a YouTube video of somebody doing that, like bigger capacities, right?

Not just like pinch your finger, but and so they'll sing, like they'll sing or they'll count and they'll do it in multiple languages.

One, two, three, four, five, six, one, two, three, four, five, six.

And then

you'll take a little spot, a little electrical pen,

faint as bit of electricity.

And the brain can't feel when it's being touched.

It only feels through the nerves it sends out.

So when you dissect the brain on an awake patient, they have no idea what's going on.

And

you tickle the spot

and you stun those collection of neurons there, maybe the size of like a tiny P,

and they keep counting.

One, two, three, four, five.

And you say, okay, I can go through this little piece.

to the deeper brain and I won't hurt their language abilities.

So you put a little white piece of confetti on there or a number.

And then you go next to it and then you'll find areas that cause speech arrest.

You'll say, it'll be like one, two, three, four, and you'll buzz it.

They'll go one, two, three, three, three, three, three, three, three.

That's for real.

You guys can look all that up.

That's been going on for 60, 70 years.

And you say that caused speech arrest.

You put a little red piece of confetti.

So at the end, the surface of the brain, as you're going deeper, looks like Swiss cheese.

And you've, you've identified the portals through which you can dissect to take out the deeper tumor

and not injure their language.

Why is language such an important indicator?

Ooh, that's a big question.

I mean,

I think it kind of makes us who we are.

I mean, it was sort of a differentiating thing for mammals

is language and then all the complexity that comes with language.

But

it is housed in a neighborhood.

And unlike the frontal lobes,

there's not a lot of redundancy.

So the motor strip is the same.

Apes, you know, humans, the same.

Language, it's kind of a fuzzy address.

One frontal lobe can be injured with a spike, with a tumor, and people are mostly fine.

I mean, they go home, they drive, they go to work.

So there's a maximum redundancy in these.

The prefrontal cortex is

an important word.

It's front of the front.

It's the things that...

that pushed our foreheads forward.

And it has three very interesting components, the dorsolateral prefrontal cortex, which is mostly out here, dorsal up, lateral.

It's just fancy.

Then there's an orbital frontal cortex, which is sort of sits above the eyes.

And that does a lot of like, when people are injured there, they can't change their political views or they don't get like social faux pas.

Like there's a lot of complex social things that happen up here with a lot of redundancy.

And then language and feelings of spirituality and stimulating here where people like have nightmares, smell burnt toast.

That's that's temporal lobe, and that's that's a fuzzy area without a lot of redundancy.

And then the motor strip is a very precise area.

So there are different regions you have to learn how to dissect around and through.

And some of them can have a little bit of damage and you still function relatively well.

And some of them even a tiny bit of damage and it's wrecked.

And that's the craft is.

How do I get to the deeper brain?

How do I, which without damaging anything that doesn't have redundancy?

Yeah.

How do dreams differ in people that have got brain injuries or really severe trauma?

That's a good question.

The range of injuries vary.

The range of drugs vary.

I couldn't figure out like the dreams on drugs was just so wild.

I couldn't find a pattern.

I mean, you know, people smoke weed.

They don't remember much.

Are they having fewer dreams or fewer, less dream recall?

And then there were stimulants and antidepressants and all the different combinations.

I couldn't find a consistent pattern for it to become a chapter.

I think that'll be for the next author.

And similarly, in brain injury,

there wasn't really a consistent pattern.

With exception to one,

the thalamus is sort of like this.

The pineal gland that they talk about being the third eye,

we remove that.

Melatonin goes away.

We remove that.

Patients are fine.

So I'm not saying that people shouldn't believe in that concept, Descartes, and third eye, but the pineal gland is essentially a vestid, it's like an appendix, but the central, like the size of an egg, there's something called a thalamus, which is sort of the gate for

all the sensations coming up and it refines the movements going out.

When you have injury in that area,

they tend to have a lot more lucid dreams immediately afterwards.

So like, like, it's, it's almost like there's too much arousal permitted in the sleeping state because the thalamus is injured, right?

The gatekeeper has stopped keeping the gate.

Right, because the gate is, again, nothing is ever off.

If there's an alarm that goes off or you smell smoke, you're going to pop up out of your sleep and dreams.

And that, what is let through, and they used to do all kinds of weird things like have people sleep and they put their hand in a glass of water or a bucket and see what that changed.

The point there is a thalamus is

the gatekeeper that lets certain things through.

If that part is injured,

let certain things through and says time to wake up there's an alarm if you injure that part you get a more more lucid dreaming awareness seems to creep into the dreaming state a little bit more readily

could you see in some ways the thoughts that people have in their dreams being more real or more accurate to their sense of self than their waking thoughts They're unencumbered by the executive network, tamping everything down, their sense of self, the story that they have arced together.

This is who I am and this is what it means to be me.

I had a conversation with Dr.

David Spiegel about hypnosis, and it sounds not too dissimilar, that maybe in some ways we're liberated.

So, yeah, I wonder whether, yeah, some of the thoughts we have in dreams could be more real than the ones that we have when we're awake.

Well,

I don't know, but I will tell you that

some dreams require no interpretation, right?

You're stressed out about giving a talk, you show up naked at the podium.

Your end-of-life dreams, those tie up.

But as we discussed earlier, let's not hold dreams to a standard we wouldn't waking thought.

Like, we have all kinds of junk thoughts and thoughts that we don't want to hold on to, thoughts that don't reflect who we really are.

And I think similarly for dreams,

it's a wild landscape.

What it is, is your brain in a hyper-emotional, hyper-visual, hyper-sexual, hyper-imaginative state that is creating experiences at the neuronal level, not at the, you're paralyzed, you're not living them out, but it's from your memory.

It's from your life story, right?

It's drawing upon all of that imagination that's liberated from the bank of memories and experiences you've had.

And I think in that way, it's personal, it's individual, and maybe it doesn't give a truer insight, but it gives a different insight.

So you got to think about your life when you're awake, when you're waking up, when you're falling asleep, hold on to that dream that stuck along, stuck around a little bit longer,

and just use all those portals to put, to stitch the story of: are you liking where you're at?

And maybe you need to change, or maybe you need to be at peace with yourself.

I think the main thing that it makes me think is that it's a reminder we have way less control than we think we do.

I love that.

I think that's the main thing.

Shit is firing.

We are not driving.

I mean, and during the day, too, right?

I think that goes back to the, but if we learn the ways in which at this time, I have less emotional regulation.

At this time, I have more emotional right.

Like if we knew, it's not that we have a lot less control, but it's almost like riding, it's like the stream of conscious.

Like there are some boundaries and you are, you are sort of riding on a river.

You're being tossed around, but you have some, you can drop a hand and control and pivot and move around a little bit.

So I think if it allows for

failure not to be permanent, allows for triumphs not to be permanent, and it allows for us to say

that it's okay to not have a linear goal of self-improvement and growth mindset.

Like to me, it's cyclical.

There's the winter in our life.

Victory is sometimes just getting up.

Victory is sometimes not, you know, just not falling apart if you get a cancer diagnosis or your child gets ill.

So I'm trying to come up with universal ways of understanding how our brains and minds work.

So it applies to

the elite 900 running a hundred mile athlete or the person saying, you know, I don't want to use this oxycontin that I got after surgery.

I'm trying to give this up, you know, that it's the same universal processes at play.

It takes the judgment out of it, too.

Going a bit more broad than just dreams, someone that spent a lot of time looking at the brain.

What are the myths

that are widely held about the brain that annoy you the most?

What do you wish people would stop believing?

That's a great.

I wish they would

stop talking about it as the brain,

as if it's a homogeneous

singular entity, the brain, the heart.

And

I think it requires just one level more.

And the way I would say is I'd love for people to have a sense of scale in their explanations and podcasts and stuff.

Is it at the neuronal level?

Is it at the network level, executive network or imagination network?

Is it at the lobe level, the anatomical level, temporal lobe and language?

Is it at the global electricity level,

seizures, dreams?

And so when people say, well, the brain prefers this, the brain thinks this, like the, it doesn't make sense to me because

it's not descriptive of the tremendous diversity in this ecosystem, in our skull.

So I would love to see one more level of,

not proof, but a little

precision, depth of explanation that goes beyond the brain as if it's like muscle or liver.

Yeah, yeah, yeah, yeah.

Right.

So that then that way you'll know if people have really thought it out.

That's one.

And then the number two is this myth that we only use 20% of our brain.

No, I mean, the whole brain lights up, but to do one thing, we may only use 20%

because it's really an energy hog.

So the brain wants to be efficient and fall into patterns.

And the last one is that it's limitless, you know, your body's limitless.

Your mind is limitless.

Actually, no,

I think you can be closest to limitless in your behavior

if you realize that there are patterns and proclivities and tendencies that all human brains and minds have.

And to try to identify when somebody does it well, what are their coping strategies?

When somebody's struggling,

the way in which they falter with their goals,

maybe I don't, I'm not falling apart now, but there's a lesson there for me because I don't know what's coming down the road.

I haven't gotten knocked down yet.

And that's called ecological validity, where it has to constantly be tested in real world scenarios.

So to me,

the learning that the brain is not

limitless and the brain creates a mind that is reciprocal.

Brain makes the mind.

Mind can change the brain a little bit.

And then the biggest conundrum why the mind doesn't always translate to behavior.

You're like convinced, I'm not going to do this or I'm going to do this.

You just can't get it done.

That bridge between mind and behavior is also another area that I'm looking at.

And that's where the coping strategies go.

Rather than saying, oh,

don't drink.

don't smoke, it would be nice to say when the thought of smoking a cigarette comes in your mind, these are the processes going on.

Break it at the cognitive level with step one, two, three.

Avoid the intentional magnet.

Do this.

Don't look at it.

Definitely don't let that smell come into your nose.

Okay, now it's in your body.

You had a whiff of smoke that your partner's having.

Now your body's jonesing for it.

Your hair is sticking up.

Bring in these strategies here, somatic therapies, deep breathing, like to know the ways in which we falter and then to apply strategies because the brain has,

is not limitless.

It falters in a certain way, triumphs in a certain way.

A little bit more prescriptive to the way, what stage in your

failure or triumph you're at would give a little bit more precision to rather, because it can get overwhelming.

I would never tell my cancer patient, like, you know, just be well or you can do it.

They have to be coached through the process.

So I'm trying to come up with a universal toolkit to understand,

this is what I'm feeling.

This is the way most brains and minds and people falter when they're at this stage of addiction, of desire.

And at this step, I want to use these strategies.

Okay, now I'm going to get the cigarette.

Okay, now I want to use mitigation.

Give away the pack.

You know, like,

but not to just give a global strategy, don't smoke.

Don't smoke, but if you're being pulled in that direction, here's the game plan.

That's what I want to build, a universal toolkit.

Do you think

the neuroscience industry is overselling some of the new tech that's coming along, fMRIs, brain scans of all different types.

We can detect onset of Parkinson's CT scan with contrast, all of this stuff.

Are they making promises that the sort of insights can't cash?

I think so.

It started like 20, 30 years ago.

We needed these scans to do surgery.

To do brain surgery.

So

I'll tell you this is another story.

My professors,

when you had a blood clot, they would see like somebody's eyeball was, you know, pupil was big, and they would call it exploratory trephonation.

With a hand drill, just start with the patient's family's consent.

34 years ago, there were no CT scans, and they would just make random holes till they hit blood, like drilling for oil.

Then a CT scan came out and changed everything.

You could see which side the blood clot was on.

It's fantastic, right?

They're coming out of hospitals for neurosurgery.

Then we try to figure out like function, and that's where fMRI started.

And because MRIs don't have radiation, you can elect to be in there.

You can get MRI every day.

CAT scan has radiation.

And so neuroscientists started putting people in there.

And what I would say is, what's happened is the term is being thrown around, brain scans,

but

the information, nobody's explaining it.

That

this area is activated.

But what if you activate the area that

stops a function?

That's different than activate an area that grows a function, right?

So there's a modulation of the brain.

You don't not all activation is good.

Not all inhibition is good, right?

And so

those nuances are not getting out.

But the term brain scan can be used by any author now.

And I'm not saying that I mean, everybody's an expert in the brain, right?

Because we have one.

So

I'm not saying that we should limit that, but the question should be one step further.

And what is the meaning of that?

A brain scan shows this.

And the way to understand, in my opinion, what the meaning is, is to ask, how is that experiment set up?

Right?

Like, just to say, so you have a thousand people who think of puppies in an fMRI, and then you have a thousand people who don't think of puppies and think of snakes in fMRIs, and then you're looking at the differences, puppies' effects on mental health versus snakes' effects on mental health.

That experiment can't be set up because you can't stop the person thinking about puppies thinking about snakes, and you can't really control the person thinking about snakes thinking about puppies.

There's no way to set that experiment up.

So, when it says brain scans show this, I think if I were an interviewer, I'd say, well, how is that experiment set up?

And I think that way we would get past some of the fluff that's out there because

there has to be an experiment that justifies the answer.

And then just throwing out brain scan, I don't think is enough.

What role does lifestyle really play when it comes to cognitive decline?

Massive.

I'm seeing a lot now.

I'm a big behavioral genetics stan as well.

I think that heritability has got a

fettered past, but it's real important.

And I think that more people should learn about behavioral genetics than do.

I think

there's a lot being laid at the feet of lifestyle because it's something that we do have control over in a meritocracy

where people feel like they want to be able to author their own life.

This idea that you are being puppeted by some stuff that happened literally before you were born, like as you were conceived,

is very disempowering as an idea to a lot of people, but I also think it's super informative.

And if you can kind of get past the initial discomfort of, ha,

there's some stuff that I didn't choose that I'm at the mercy of.

But on the flip side of that, lifestyle as well.

So talk to me about cognitive decline and its contributing elements, lifestyle, genetics.

How do you come to think about it?

DNA is not destiny,

especially when it comes to the brain and mind.

Like, I mean, DNA might be destiny for like heart attacks and stuff like that, or certain, there are certain medical conditions that are very linked to genetics, epigenetics.

But

whether you have a proclivity

or tendency to have Alzheimer's or dementia or not, whether you want to stave that off because you don't want to know based on a new Alzheimer's test, or whether you've been given a diagnosis and you're trying to work through it,

the treatment is all lifestyle and behavioral.

The medicines are limited.

They exist for early diagnosis and Alzheimer's, but the treatment is all lifestyle.

The way I think about it is

five key things to do, or a handful of key things to do

is one, you got to keep the arteries open.

We've been talking about

the beautiful brain.

You have four arteries coming up.

They get into this beautiful branching pattern.

It's exquisite.

Parts of them loop over each other.

It looks like a chandelier.

We call it the candelabra.

And they get narrower and narrower.

So you got to irrigate the flesh.

So whatever is good for keeping heart arteries open and kidney arteries open is also good for keeping brain arteries open.

Exercise.

Yeah, or taking the anticholesterol pills that are long established and mostly safe, like pretty safe, you know.

So exercise, yeah.

But exercise does a couple of them.

So you got to keep the plumbing open to irrigate these neurons.

Number two is

you have to eat a certain way.

And I know there's a lot of diet stuff out there and that's a whole theme.

But the thing that over decades has been proven

to

preserve or even increase cognitive health, cognitive function, is

the mind diet, which is the closest thing to it is pescatarian.

It's mostly plants, fatty fish.

And the reason fatty, so I like to take it one step, one step deeper.

The reason it's fatty fish and omega-3s is you mentioned the word myelin before.

And so the little, the, the, the neurons and the axons, the way they make the electricity communicate faster is that the cable is wrapped with a fatty sheath that's called myelin.

And then the electricity actually jumps across the little gaps they have, and it goes faster than if it is not myelin-coated.

And thought can actually deposit myelin, preferring that thought to happen again.

That myelin sheath is made from omega-3s.

So there's a specific fat that's needed for myelin, and that's omega-3s and fatty fish.

You can get it in flax seed and other things, too.

So, keeping the plumbing open, giving the brain the material it needs.

Now, we're at the, at the scale level, right?

Okay, and then you, then you go in a little deeper.

Um,

the timing of eating is interesting.

I do think there's some pretty strong neuroscience evidence of intermittent fasting.

I know there are a lot of diet things out there, but

skipping breakfast,

if you have the luxury of skipping breakfast, skipping, going to 16-hour windows will, uh, if you don't eat, you're not going to just drop dead.

And the brain, the brain is a

hybrid vehicle.

The brain can live off of neurons, can you know, thrive and use glucose or ketones.

And so, after 16 hours, your liver will churn out ketones if you haven't eaten.

So, that's how you live past the 16-hour window if you don't consume anything.

And that switching back and forth

in intermittent fasting, the cognitive tests now, now we're getting from flesh to mind,

people seem to have more focus.

People seem to have more, it's not about weight loss, but intermittent fasting, it's letting the brain have glucose and ketones a couple of times a week.

That's interesting.

So, your suggestion here is that all ketones, someone that's doing a full ketosis or carnivore-style diet, or somebody that's doing a classic sort of omnivore-style diet, which when you're grazing, typically you're not going to drop into ketosis unless you forget to eat carbs for a couple of days or something.

You're suggesting that there is a

principal brain benefit and neurological benefit to the switching between these two fuel sources.

Correct.

That's interesting.

Weight loss is separate.

Yeah, yeah, yeah.

And autophagy and the yeah, but also, I mean, there's a lot of ways to lose weight.

But this is, we're talking about how to stay sharp,

keeping the flesh healthy, keeping the plumbing open, those arteries, you know, vascular health.

Exercise could do that.

What we eat, giving your brain the right materials, and the mostly plants will clear out the sludge and the antioxidants.

You know, the plants work because they have antioxidants and tannins and these things that clear the sludge that these little molecular machines called neurons make, right?

That's why plants are good for your brain.

Are there any that you prioritize?

In plants?

Yes.

I don't think it really matters.

It's hard.

Again, I can't find the experiment where they got a thousand people eating spinach and they got a thousand, but I can tell you over 30 years, whether it's Blue Zones or the Mediterranean diet, now specifically called the mind diet, it's Mediterranean diet.

And those people, they get a lot less Alzheimer's than people who don't.

So I can't distill it down to that, but Michael Poland, you know, he's great.

Mostly plants and some fish.

And then the indulgence of the burger or the caviar or the vegan, you know, burger patty.

It's all up to you, but the staple is pescatarian.

Then we talked about the timing of eating, what to eat, the timing of eating.

And then

I think the other one that's just on the timing of eating thing, outside of the intermittent fasting thing, is there anything else to say on that?

It's primarily at some points, a couple of 16 hour fast fast fast fast fast falls.

A couple of 16 hour fasts per week is probably a good idea.

Yeah, and relatively easy to do.

You can have black coffee in the morning.

I feel great when I do, when I fast, I feel really, really great.

Yeah.

And that's another theme I'm trying to tie in, like, things that I've worked for the ancients, you know, whether it's, again, back to Aristotle or fasting and different things.

Again, for people who have the luxury of this, right?

Most, there's a lot of food insecurity.

I'm just giving you the conceptual answers.

And then

the fourth thing is movement.

So exercise is

his movement, but for my patients, what we've seen is that when you're vertical, like people think like it's got to, you know, you got to have, you got to have the gear, you're out there, you just, you look like you're auditioning for the Equinox commercial or whatever.

Like, that's great.

I'm knocking that.

But for most people, just standing, for my patients, the trajectories of patients who can stand and get up from a toilet and stand and get to the couch is so much better.

Being vertical requires postural muscle activity.

So, what I would say is walking and movement

are also cognitive protective.

And you mentioned exercise.

Now, so exercise and movement does a couple of things.

One, it keeps those arteries open that we talked about.

As far as the food, number two, what to eat, pescatarian.

Third, and mind diet.

People can look all these terms up.

Third, when to eat, intermittent fasting for ketones and the cognitive benefits.

Thinking benefits, not structural.

Fourth is exercises that it that this ecosystem requires nutrients, not neurotransmitters that are being sprayed between neurons,

but in the milieu, in the garden, if you will.

And there are things like growth factors.

Obviously, BDNF is a popular one.

I had a grant from the Department of Defense studying it.

I'm familiar with it.

What I want people to know is when you exercise, it's not like it's released from,

you know, like your thigh muscle and swims up to your brain and says, hey, I'm helping you out now.

That these chemicals are housed in the brain.

And exercise is the cue, is the signal for your brain to release them on themselves.

BDNF is released from the brain for the brain when you exercise.

And I think that's, I think that's powerful.

Outside of cardiac and weight loss, I'm just talking about a little bit of movement a couple of times a week.

And all of a sudden, it starts to feel like, hey, I can do these things.

They're pretty low bows to entry.

But, but high impact and proven.

And then the last one is you got to think, man.

You got to challenge yourself.

I mean, if, you know, if

you say bowl, you ask them how to run faster, say you train, you train your biceps.

I mean, it's a thinking flesh.

If you don't push it to the next level of complexity and thought and challenge, not too hard where you quit.

Just like video games.

If it's too hard to get to the, if to level up, we tap out.

If it's too easy, we're not engaged.

So finding whatever you're engaged in, in, from puzzles to complex conversations, that it needs to be challenged with thought, with ideas, with creativity, with reading those novels you're reading at night.

So the

fresh content that's engaging and requires you to think,

think differently.

think wildly, think

in ways you haven't before, I think that's an essential part of

That doesn't mean everybody who was a professor lived longer, did better than

people who are just rocking out and not approaching it that way.

But creative ideation, I think, is as valuable as just raw processing power.

It's not all about doing math and puzzles.

I think challenge yourself to be creative

is an intelligence in itself.

What about the impact of stress on brain aging?

Well, I mean,

this is a big question now.

So, this whole thing about cortisol is like, okay,

I don't have an answer for that.

I know people who live in a constant stress.

It seems like

constant stress is bad for you in a lot of ways.

I also know thrill seekers, surgeons, athletes, every time they do something exciting, cortisol is up.

Okay.

And they don't have accelerated

brain aging.

So I don't have an answer for whether cortisol is doing it, whether stress is doing it, whether it's just a rough life, whether it's struggling with thoughts you can't control, which revert back to your brain and injure your brain.

I don't have an answer for that.

But I think with the story I would tell you about that is there's a tumor called pheochromocytoma, and it sits on top of the kidneys and it releases all this, all these, what basically look like you're extremely stressed out.

And is that how it feels as well?

That's the extension question, my man.

They don't come in like, ah,

that is the essential question, my man.

That's a banger.

That's totally.

So I don't have the answer, but I'm leaving you with things.

I hope I want to know the answer.

But the brain contextualizes all of this surge of stuff that's happening.

Interesting.

Do you know Rick Hansen?

Are you familiar with Rick?

Neuroscience guy.

He wrote Hardwiring Happiness.

I read that and spoke to him, and he became a good friend.

And then the more neuroscientists that I speak to, the more I realize that a lot of the stories that we tell ourselves are kind of repurposing mechanistically what's happening in the mind.

But the weird thing is nobody talks about the story you tell yourself about your knee injury, right?

You know,

someone snapped their ACL and it's not about thinking your ACL back into content.

We understand that there's a mechanism that's going on in here and that that really needs to be fixed.

And that there's a pretty well-established process that you go through in terms of rehab, and it's progressive overload.

Tendons really love to be under time and attention.

So, you're going to do this, and you're going to get range back, and there's a combination of stretching that you get with strength.

And the more range that you get, the less, you know, all of this stuff.

It's mechanistically very well understood.

But the thing is, there is no

massively phenomenological sense of having an ACL.

There is one for everything that happens in the brain.

And

I really got into psychology, human nature, you know, Angela Duckworth or James Clears of the world, Morgan Housels, you know, a lot of people that write very astutely about human nature and about psychology.

And I go into evolutionary psychology, which is even maybe one step further removed, right?

That's like the source codes and a lot of accusations of just those stories and things like that.

And that's really cool and compelling.

The more that I spend time thinking about this stuff, the more I try and come back to mechanistically what's happening in the brain Because it really does feel like, for instance, with gratitude from Rick's

understanding here, he basically sees happiness as your ease of access to being grateful about what's going on.

And

he has a very simple process that is well understood and just reflects the mechanism of what goes on in the brain.

of have an experience, enrich it, and absorb it.

And it's just this little acronym that you go through.

I thought, that's so great.

That feels, to me, one of the problems that a lot of people have when they read stuff to do with human nature and psychology is it feels so fucking wishy-washy.

You're like,

give me something to grab onto.

It's like my puppy's example.

But let me just jump in right there.

I like that.

And

what really just gets me jacked in a positive way is when I see that

our behavior and our minds work in a way that's actually reflected at the neuronal level.

You know, so like if you stress stem cell reservoirs just enough,

they'll make one of themselves and release a new neuron.

So they're always replenishing them.

They never, they're inexhaustible in that way, right?

They're stem cells.

But if you stress them out too much, they'll go into senescence or they'll die.

And then you start to realize, wait, that's kind of how

life is, right?

And then you, then I like to take it all the way to like International Space Station.

There's not enough gravity, those bone cells

in space in our thigh bone, when they come back on the ground, they got a rehab for a week or two.

The lack of gravitational stress leads to withering of osteocytes for astronauts.

And so, the same concepts in bone cells in space or stress in the human brain: that there is a necessary amount of stress that leads to growth.

But if it's too much, we fracture.

If it's not enough, we don't blossom.

And I like to take those concepts to then coping.

And so, for example, like this thing about resilience was tripping me up for a little while.

Like, what does that mean?

You know, like, be resilient.

Like, I always try to think, like, I got to be able to say this to my sons.

I got to be able to say this to a newly diagnosed brain cancer patient.

And what I learned from that is

it's sort of this systemic and processive resilience, which is basically like the resilience you bring to the fight, you know, the strength you bring to the fight, and then the process, what the fight reveals in you.

And what I like about that is that each cell, each person, each human is in their own individual path and has accumulated a set of experiences.

And my hope is universal coping skills.

And they're ready to engage the world in front of them.

And that could be a lottery, that could be falling in love, that could be being diagnosed with cancer.

And they're coming equipped with some skills and in that cyclical nature of stress and growth that happens repeatedly in our bodies like that's actually what's happening in our lives there's a sick cyclical nature of a springtime in our cells and our body a winter in our cells and our body and life and that there is no like linear trajectory towards wellness or a moment of arrival or a final clarity because you just don't know what the challenge or the gift in front of you is.

Well, certainly one thing that I can say with almost absolute certainty is that you do not develop capacity to deal with things while you're dealing with things.

Your capacity to deal with things is almost always developed in advance and revealed during.

So

it's one of the best justifications for mindfulness that mindfulness is preparing for the worst day of your life.

That's what meditation is.

Meditation is preparing for the worst day of your life.

It's the day that you lose your job and your dad passes away on the same morning.

It's the day that your partner gets a cancer diagnosis and you find out that you're no longer employed, whatever it might be.

If you're in the thick of it right now, I've been in the thick of it for a good bit of the last 18 months.

You're doing your very best to not go under.

And then you fight, fight, fight.

And then when you get a break, and it's really, actually, this is interesting.

It's only difficult times that reveal to you, holy fuck, I couldn't really make much progress during that.

I was just trying to survive.

The urgent outweighed the important so much that all I could do was kind of try and hold it together.

Okay, so what's the implication of that?

When you do not have something that's super urgent in front of you, when you're not putting out fires, it's a really, really, really good time to develop some more capacity.

Psychological resolve.

Yes, that's the time that you try to get your meditation habit in.

That's the time that you work on your health.

You refine your training for the fight that has yet to come

with a toolkit that I'll never finally make.

But I mean, that's what I'm trying to get at.

And back to the cells.

Cells go through a period of dormancy.

And at that point,

not dying is actually the victory.

And then there's a springtime, just like in nature.

And this happens in our biology.

And I think it happens in our psychology that you're talking about.

And that those moments, there's a temporal nature uh there's like reflection and going back and saying okay what are the lessons i learned how would i handle it better forward i love all that i'm actually trying to come up with when you feel like you're drive drowning or about to fall apart in that short temporal window are are there things we can do at that time um how do we interject right then yeah the time sensitive maneuvers yeah i like

I very much like being able to step in on stuff that's acute.

It's all well and good talking about building up your resilience and all the rest of it.

But if you're in the fucking fight, you go, hey, I can't go back six months ago and start a meditation practice.

Tell me what to do right now.

Right.

And so what I would say is, if,

you know, I would say is that

urges that hijack the body are very fascinating to me.

When the thought is now recruits the body, there's a whole new fight.

Now, whether that's addiction, whether that's desire,

because now

there's a feeling that if I don't go in this harmful direction,

that I will feel ill.

So now you're not just trying to stop a thought.

Let's take the example of having a cigarette again.

It's not just, oh, don't have a cigarette, don't have a cigarette.

It could cause cancer down the road.

It's bad.

It's bad.

You promised everybody you wouldn't.

They might smell it on you, whatever you're thinking.

Don't look at it.

Look at those shiny boxes of the gas station, right?

But then when you have that waft and it goes from the nerves in your olfactory bulb to to your frontal lobe and now you're just like oh man that's reminds you of so much people have physiologic changes so now the fight is controlling your mind and body and i believe the maneuvers are different when it goes from your mind to your body and the management of bodily urges um is

uh requires bodily techniques uh breathing techniques are uh the same ones I use in surgery.

Sometimes when I was learning and you feel like that, ooh, around that corner, that tumor is going to run away from you.

I mean, you got to,

you got to not, you got to, it's going to, either you're going to freak out or you're not going to freak out.

And the simplest thing I can tell you is like, when you hyperventilate, it creates a feeling of anxiety.

Well, you got to take it the other way.

The first maneuver is just control your breathing.

Nobody knows.

The room is just like, da, da, da, da, da, da.

And you're just like, whoa, whoa, whoa, whoa, whoa.

You know, this could run away from me.

And so I have my own maneuver that I do in that moment is just stop talking.

and there's something I call out.

I say, I need 15.

And they're like, okay, everybody pay attention

back to your positions.

That he might say, I need this from the wall.

I need this from the wall.

And the whole thing is just

get that breathing paced.

I'm not talking about one nostril.

I'm not getting into all that.

I'm just trying to tell you physiologically, if I pace my breathing, I can slow down this swell of fear and panic that's in my guts when things run away from me.

I try to use the same thing with a lover and with a conflict, but that's a specific toolkit that has a physiologic basis that I can explain that the ancients use is in the acute moment.

And I'm hunting now, you know, the next year or so, but are there other maneuvers that

we're all equipped with that can work while you're,

you know, while you feel like

you're falling apart or you're drowning or you're struggling, you know, at that moment, not in Riverview, not in the future, I will.

Right now.

Right now, what do I do?

Is there anything you've ever seen in surgery that shook your belief in signs

um

not in surgery

um surgery is a physical performance it's ballet

but um

i have had um

I have had patients in the psychological sciences.

I've had patients where I just look, I'm like, I don't know.

I don't know how the great majority of cancer patients get dressed, come in, and are ready to get the worst news in your lives every three months when we do the scans.

It's come back or didn't go away.

I mean, it's just, it's just so heavy.

And

what the fight brings out in them or the coping skills they've brought, and it's inconsistent.

I'll get to the more philosophical ways of it.

It's inconsistent.

Somebody comes in, they've got the wellness techniques, they're the CEO, they get hit with that C word, it's you don't know what you're going to get.

And then somebody comes in, they're struggling with something, they look disheveled, you're like, this person's not going to handle this well.

It brings out something in them.

So I think this feeling that

arrival in some sort of wellness and

achievement or clarity understanding of life is misguided because we don't know what's coming next.

I think it's cyclical.

Develop your skills, time-sensitive skills in the review, being prepared for what's forward.

That's the way I've been approaching it.

And as far as shook my belief in science, I would say something recently has

liberated my view in science, that it's through science we can have understanding that we might not.

So there are these near-death experiences.

Those electrodes are being recorded.

People in Canada and studies starting to come out that when the heart stops for the first few minutes afterwards, the brain just deploys all its chemicals and electricity.

So whereas other other organs whimper to death, like the brain is struggling, the heart stops.

And then, if you measure the electricity, because you can actually have a DNR, you can say, look, if I have a heart attack, don't touch me.

Do not resuscitate.

And they're still monitoring.

You still get a live feed of the brain electricity.

So you would think the heart stops, then the brain electricity stops, but it goes for a minute or two afterwards.

And it's wild.

It's fierce.

It's not like beep, beep, beep.

It's a sure.

So that's a measurement.

What does it mean?

That's for everybody to explore.

But to me, that's like, okay, so there's, there'll always be just amazing neuroscience information coming from hospitals and patients.

That's a little bit more than just scanners.

Right.

And when those people are resuscitated,

and why do they all universally say, I saw it's a film strip of my whole life.

And, you know, there's a consistent pattern of what happens if you drown or if you have a near-death experience and are resuscitated in whichever manner, they come back reporting the same thing.

Film strip of their life, wide stories, they saw loved ones.

And when you look at the electricity, it's very consistent with dreaming and memories.

So, to me, I love the fact that now we might be able to explain why near-death experiences are a consistent perception or experience for people.

So, I love seeing that stuff come out.

Yeah, I'm interested in what

working with terminal patients has taught you about living life well.

Everything.

Yeah, everything.

You know, it has thousands now.

I mean,

I'm 52,

massive experience.

I've had three adult sons, massive life experience.

But since 25, I've been taking care of some of the sickest people in the hospital.

Brain injury for 10 years.

Half your life?

Yeah, I was a kid when I started, you know.

I mean,

I look at people in their 20s.

I'm like, woof.

I was like 26 or 27.

I wrote about it for a Vice article.

I would drew care.

I mean, I helped families land their patients, I mean, their family members, and remove the breathing tubes and say their last rights and wishes and all the different cultural elements that come into it.

And ICUs, I was 27 years old, and I started to see

there were patterns

in the ways

the brain and mind respond when the finish line comes closer.

It's not trauma.

You're gone.

You don't know it.

It's okay, three years, two to five, seven.

You can't quantify it, but you know it's coming now.

It's in sight.

And

they had a universal,

all of them say the same thing again.

When that finish line comes into view, And it's the lessons I think everybody else talks about, but they have a similar thing about reconciliation, forgiveness, about having spent more time with their children.

Usually it was like busy, busy dads at that time, my 20s, you know, and I and I incorporate that.

I had a lab.

I raised my kids, didn't take them just to the baseball games, but the practices, spent a lot of time to them, and that they seemed unencumbered.

They weren't so

the little things don't get to them as much.

And the question then becomes, how do we take those lessons without actually having, you know if hypothetically the finish God willing is 25 years away from me how can i actually live it like it's five years from now and that's the lesson that my cancer patients have taught me is one um

start now with what you would if you had you know that you do a five-year curves and two build your coping skills because the ones that i saw do well

they had techniques

i mean i'm just coming coming back to this and like i learned one from one, like every three months, the scans, just imagine, brain scan, two, three hours, six hours.

Who knows what it's going to, you show up in clinic.

It's another hour to wait to hear it for somebody.

And they, so they would do this thing where, like, look, the 11 weeks in between,

I can.

I can hold on to myself and say, this is not the time to be stressed, but I need to have a week when I'm just completely losing it.

Like, you can't just not be stressed about that.

But they were able to compartmentalize it to have like 11 good weeks and then another shitty week because, oh my God, I got another bigger brain scan and see Dr.

John Deal.

And so I started to see those techniques they were using to make the most of their cancer journey.

Support network is nice, but the support network can be surprising.

It's not always who you think it is.

You know, once that cancer word arrives, relationships break up, surprising relationships form.

And so,

you know, no triumph is forever and no tragedy is forever.

But if you come equipped with your own personal and psychological toolkit,

you know, we make the most of this run.

Heck yeah.

Dr.

John Dielle, ladies and gentlemen.

Why should people go?

You're going to want to keep up to date with everything you've got going on.

Just,

I don't know.

I'm a surgeon at City of Hope Cancer Center.

I think that's the easiest thing:

look up Dr.

John D'Alle at City of Hope, and then, you know, things will pop up.

But appreciate you having me on.

I appreciate you, Timan.

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