111. Can a Moonshot Approach to Mental Health Work?

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Speaker 10 My guest today, Obi Felton, was in charge of moonshots at Google's Innovation Lab, what's called X, or formerly Google X.

Speaker 10 X has had both big successes like Waymo, one of the first self-driving vehicles, and high-profile failures, like the attempt to provide global internet using a network of stratospheric balloons.

Speaker 12 The pressure of producing the next self-driving car and the next balloon project was absolutely immense. Like it couldn't just be any old thing.
It had to be something really incredibly amazing.

Speaker 12 That was also very undefined.

Speaker 13 Welcome to People I Mostly Admire with Steve Levitt.

Speaker 10 As if moonshots weren't enough to talk about, Obi's now heading a startup called Flourish Labs. She's trying to transform the way mental health services are provided to young people.

Speaker 10 And the whole time I've been living in Germany, I've been trying to find a German guest for the show. Finally, with Obi, I've got one.

Speaker 10 She grew up in Berlin, and she watched the Berlin Wall come down as a teen. That's one more topic I have to be sure to cover.

Speaker 10 When you worked at Google's Innovation Lab, you had a very unusual title, right?

Speaker 12 My title was Head of Getting Moonshots Ready for Contact with the Real World. Everyone thought it was a joke.
And it came about when I sat down with Astro Teller, who hired me into X.

Speaker 12 And he was running a bunch of projects at X at the time and then later on took over the whole group. He had hired me somewhat on a whim as one of the first non-engineering people in the group.

Speaker 12 We had this great conversation where he told me about these projects that were all secret at the time, even inside Google. I was working for Google in Europe at the time.

Speaker 12 So it was basically a group of engineers who were working on self-driving cars and Google Glass

Speaker 12 and a drone project and an internet from balloons project and so on. And then I asked him a bunch of questions like, is it legal to fly balloons over countries?

Speaker 12 Do you have to talk to countries to get their permission to fly over?

Speaker 12 How is this going to bring internet to everyone? Are you going to partner with phone companies or compete with them?

Speaker 12 And he looked at me and he said, those are really good questions, but no one in the team is really working on those. Why don't you come and help us with those?

Speaker 12 And that's that's what I did. I looked at everything from policy and legal matters to how might we talk about some of these projects.
How do we take them to market?

Speaker 12 Do we have a business plan for any of them? It turned out they didn't really at the time.

Speaker 12 So the title was very descriptive of what I was doing, which is thinking about what would happen when this technology would grow up and get out of the lab and make contact with the real world.

Speaker 10 I let my imagination run wild. And I try to think of my dream job.

Speaker 10 The exact job I'd think of is the one you just described, being around amazing engineers doing incredible technologies and trying to figure out how to get them to work.

Speaker 10 I can't believe you actually got to do that.

Speaker 10 I did get to do that.

Speaker 12 It is mostly really fun. The engineers were amazing.
We then hired a whole bunch more non-engineers. You know, we got real lawyers and we got real policy people and real marketing people and so on.

Speaker 12 So it wasn't just me making it up.

Speaker 10 Aaron Powell, did that make it more fun or less fun when there are real people around?

Speaker 12 That's a really interesting question. Sometimes I wonder whether it takes the magic out of it.

Speaker 12 Because while you're just working on the technology and you're imagining what the world would look like when you succeed and you solve these big problems in the world with the tech, it's much more fun and magical.

Speaker 12 And then the reality hits that it's sometimes very small things that make it hard to implement something in the real world.

Speaker 12 On the other hand, if the tech doesn't get out into the world, what is the point? I mean, I've always felt that technology is just a tool.

Speaker 12 And unless we solve problems with it that people actually care about, it's pointless.

Speaker 10 Aaron Ross Powell, Jr.: So for listeners who don't spend their days working at X or what used to be called Google X, like you did, what is X? How does it fit into Google and what's it trying to do?

Speaker 12 X is an unusual innovation lab because most corporate innovation labs were set up to move the core mission of the company forward.

Speaker 12 So if you think of the sort of mother of all innovation labs, Bell Labs, they were solving problems for the mother company.

Speaker 12 And X was actually explicitly set up with a remit to not solve core Google problems because there was already innovation going across the entire business. The founding project was self-driving cars.

Speaker 12 And that's not really anything to do with search or advertising or any of the other Google products. So they set it up quite separately and they gave it a small budget and a lot of freedom.

Speaker 12 Initially, it was all just about building interesting breakthrough technology.

Speaker 12 We started with that tech piece, but then we realized very quickly, if it doesn't solve a real problem, it's also kind of pointless.

Speaker 12 I think we learned that the hard way with Google Glass, where it was really amazing technology, but it didn't solve anyone's real problem, and therefore it failed.

Speaker 12 And so in the end, we came up with this definition of a moonshot, which is we take a problem that would affect hundreds of millions, maybe even billions of people in the world, and then we propose a radical solution that sounds very different.

Speaker 12 It maybe sounds like science fiction today, but within maybe five years, the technology can turn that science fiction into reality.

Speaker 12 And self-driving cars are a really good example of that, where for most of the 20th century, that was total science fiction.

Speaker 12 And yet, in the last 20 years, sensors are much better, compute power has multiplied, so you can take all that sensor data in and turn it into an action that the car can take.

Speaker 12 That just was completely inconceivable, and yet it's now a reality.

Speaker 10 So, let's talk more about driverless vehicles, because I think at some level, it's a huge success for Goolex.

Speaker 10 But at another level, I'm surprised by how slow the progress has been, not on the technology side, but on getting the autonomous vehicles on the road at scale and how much public resistance there's been to the vehicles.

Speaker 10 Has that surprised you also?

Speaker 12 That path was definitely a long one, but I think for good reasons, because this is a pretty radical technology.

Speaker 12 It's still a little spooky when you see the car go by and there's no one in the driving seat.

Speaker 12 It takes time for people to get used to it, to get over their fears of the technology, and frankly, for the makers of the technology to be cognizant of how it affects society and how it might fit in.

Speaker 12 If we just put really half-baked prototype of a piece of software out into the world, usually people don't get harmed.

Speaker 12 But if you put out a robot car into the world, you have to be really conscious that it's safe enough.

Speaker 10 I'm surprised how measured and calm you are as you describe this, because

Speaker 10 I'm not even involved in it. And I think about it like an economist, and I think 40,000 people a year die on the roads in the U.S.
And worldwide, I think the numbers over a million people a year.

Speaker 10 are dying on the roads. And virtually every one of those deaths is because of human error.

Speaker 12 Over 90% of accidents are due to human error. It's hardly ever the machine that fails.

Speaker 10 And I suspect that already the autonomous vehicles are way, way better than humans in all but maybe the most extreme cases. And humans make mistakes constantly behind the wheel.

Speaker 10 But still, if an autonomous vehicle makes a mistake, it doesn't even have to be a fatal mistake. If they simply snarl traffic, it becomes headlines.

Speaker 10 And I would think that would just get you angry because you've sunk your blood, sweat, and tears into this and you have a great solution.

Speaker 12 Aaron Powell, Jr.: I mean, there's the life-saving aspect, which I definitely believe that's true because human drivers cause most of the accidents.

Speaker 12 That was a reason why mothers against drunk driving were one of our early advocates, actually, in those very early days when there was a lot of resistance against self-driving cars.

Speaker 12 The other aspect is parking. If you could make taking a robot taxi cheap enough, then you wouldn't need your own car.

Speaker 12 And most cars just sit around all day long, either on the street or in a parking lot or in a garage, and it's just completely wasted space in our cities.

Speaker 12 So there's definitely benefits to self-driving cars, but I think the fear runs very deep. And there's also a lot of entrenched interests, right?

Speaker 12 Self-driving cars is probably one of the few technologies where people expect that the AI will entirely replace the whole job. And, you know, driving is a good job.

Speaker 12 It's often like the first job that someone does when they come to a country or long-distance truck driving is a very middle-class job that supports families, et cetera.

Speaker 12 So I think there's a lot of resistance from that point of view as well that you can't underestimate.

Speaker 10 Yeah, I think 2% to 3% of the entire workforce is employed driving, and that's going to be a big displacement when it happens.

Speaker 10 The Google X project that got you to move halfway across the world from London to Silicon Valley was Project Loon, right?

Speaker 12 Yeah, that's right.

Speaker 10 Could you explain the idea behind Loon?

Speaker 12 Yeah, absolutely. So at the time, I was working for Google in Europe, Middle East, and Africa, and I was actually running consumer marketing.

Speaker 12 So launching products like Chrome and Android and many that failed that you've not heard of.

Speaker 12 And I saw firsthand the impact that the internet was having on countries when they were first coming online.

Speaker 12 And Project Loon, the idea was that you would connect the whole world with a network of stratospheric balloons. So these are balloons that are flying literally on the edge of space.

Speaker 12 So they're way above air traffic. Cell towers on the ground, the economics are very much tied to how many people you can serve at that tower.
So if you're in a city, it's very profitable.

Speaker 12 If you put it in the middle of nowhere, it's very unprofitable.

Speaker 12 And that's the reason why when we started Project Loon, two-thirds of the world, and by that I mean people, had no access to the internet yet.

Speaker 12 And so the idea was what if you put that cell tower onto a balloon and you send that balloon across the whole world. So it was beautiful, it was elegant, the tech sounded really cool.

Speaker 12 Who doesn't love balloons, frankly? And one of the first things I did was write the business plan with the team and try to work out how we would actually take this out into the world.

Speaker 12 Because in almost every country, the phone company is an incumbent that's very close to the government.

Speaker 12 And so there was a real danger that if the project leaked and we couldn't make a proper announcement and we couldn't reach out to partners early enough that the phone company would just go to the government and say those spalloons that they want to send over our country just say no you know don't let them travel into our airspace and we eventually found a country that was super friendly it was New Zealand who are very forward-looking when it came to internet access because they have actually a very big rural area where there's more sheep than people.

Speaker 12 And so we announced the project in New Zealand and the Prime Minister actually came to the launch.

Speaker 10 You all worked on Loon for a long time, but it folded, right?

Speaker 12 Yeah, that's right. The economics didn't work.

Speaker 12 So that beautiful business case that we wrote early on relied on the balloons becoming cheaper and cheaper with scale, and that never really materialized.

Speaker 12 And then in the meantime, the cost of cell towers did come down. That's a hard place to be, right?

Speaker 12 If you're competing with the incumbent solution that you don't have to convince anyone to use as an alternative, becoming cheaper and cheaper, and your new kind of radical solution isn't getting cheap enough then it's difficult to compete

Speaker 10 i'd love to step back and talk about the process at x i think many people have this idea in their head that there's this wild-haired genius who dreams up solutions whole cloth like the supposed story of the apple falling on newton's head but that's not at all my experience in the real world so could we just start at the very beginning?

Speaker 10 Who generates the ideas at X? Is that the job of a small group of people or something everybody's part of?

Speaker 12 So the beginning process in X was actually very messy and almost deliberately chaotic.

Speaker 12 So there's a team called Rapid Evaluation, and the idea was to rapidly evaluate lots and lots of ideas and find out as fast as possible which one weren't going to work.

Speaker 12 So I'd say over 90% of the ideas that the Rapid Eval team looked at got thrown out pretty quickly, sometimes within hours or days or weeks, but certainly within months.

Speaker 10 Aaron Powell, where did the list of ideas that Rapid Eval looked at, where were those ideas coming from?

Speaker 12 Lots and lots of different places. That team was a team of polymaths.
So lots of them had basic backgrounds, like physics, for instance, which meant they could understand lots of things in the world.

Speaker 12 They would go to conferences, they would read papers, people would send them inbound ideas, and so on. At X, many of the ideas actually came out of academia.

Speaker 12 So when you look at self-driving cars, for example, there was a long history of self-driving car experiments being done in universities that we could build on.

Speaker 12 And there's a huge barrier often for academics to take something into the real world, especially if it's not biotech, for which there is much more established pathways.

Speaker 12 I sometimes think of X as taking the button off someone who comes up with this radical idea from the question of can this work at at all to yes, but how.

Speaker 10 Let's say there are 100 ideas that come from somewhere in Rapid Eval. How many of those 100 would make it past that first stage, the stage of a few hours or a few days of analysis?

Speaker 12 Probably no more than 10.

Speaker 10 Okay, so 90%

Speaker 10 are stillborn, essentially. So 10 ideas survive, and then what happens next?

Speaker 12 The next stage is what we call early stage projects. So in the external world, that might be like from seed funding to series A funding.

Speaker 12 And so in that early stage team, we would continue to do prototypes of the technology, but we would also start looking at things like what is the best use case for this?

Speaker 12 What might be a business case behind it?

Speaker 12 How might we eventually find something resembling, I hesitate to call it product market fit because often it was too early, but at least technology problem space fit.

Speaker 12 So it's a bit of a back and forth between figuring out what's the right tech to solve a particular problem and what are the problems that a particular tech might be able to solve.

Speaker 12 And at that stage, it's probably about 10 or 15 projects over about two years, and only about half of those survived.

Speaker 10 So about five out of the hundred ideas make it to stage three. To stage three.

Speaker 10 Anybody who's in the business of creativity needs to recognize that your ratio of five out of a hundred is not unusual. That's probably a pretty good ratio of success.

Speaker 10 What you cannot ignore is that you need need a huge number of ideas if you hope to have anything good come out the other side.

Speaker 10 At least in academics, the economists I was around didn't understand that. They thought if they had a couple projects, that was good.
That would be fine.

Speaker 10 But my own approach was to spend just an inordinate amount of time working on ideas.

Speaker 10 And My threshold for a good idea is a lot lower than X's threshold for a good idea, but I still would only have two or three out out of those hundred that would ever turn into anything interesting.

Speaker 12 I guess it's a difference in approach. Either you think you can perfect the one thing you're working on, or you just iterate really quickly to find out what doesn't work.

Speaker 12 I think that's a helpful way of thinking about it. You're not trying to fail fast.

Speaker 12 That's another one of the Silicon Valley cliches, but the goal is to learn as quickly as possible if something doesn't work.

Speaker 12 And it's more about the speed of the innovation cycles than also how quickly can you evolve an idea? Because you might have started in one place and then ended up somewhere very different.

Speaker 12 That I think is the hardest. Like when do you throw it out altogether? And when do you think, oh, this could just benefit from a pivot?

Speaker 10 Everything I know about human nature suggests that projects that are failing go on way too long. What were the specific strategies you used at X

Speaker 10 to fight that bias?

Speaker 12 There's definitely a huge bias towards just keeping going to something. Economists call it some cost fallacy.
Physicists call it inertia.

Speaker 12 Like to get an object to deviate from the path is just very difficult. There's a few tricks that we use.
There was one actually that one of my teams taught me.

Speaker 12 It was a project called Foghorn and the idea was that we would make fuel from seawater.

Speaker 12 So you pull CO2 out of the sea, which acts as a huge carbon sink, and then you would combine it with renewable hydrogen to make it into a renewable fuel.

Speaker 12 And the cool thing about that fuel was that you could burn it in any engine. So you could burn it in a car with a tiny bit of retrofitting.
You could also fuel airplanes with it.

Speaker 12 And at the same time, you would pull carbon out of the sea, which is actually good for the sea. So I loved the idea.
It was such a cool concept.

Speaker 12 So the team did a whole load of technical exploration and they found that they could make the technology work. But they had set themselves two criteria.

Speaker 12 So they had technical criteria, but they also had a business goal, which was that they wanted the fuel to be the same price at at the pump as fuel that was made from conventional oil.

Speaker 12 And as the oil price was collapsing during the project, it became very clear that there was no way we could compete. And so they had essentially hit what they called their kill criterion.

Speaker 12 And they came to me and they said, we should shut this project down. At least at that time, there was no way that we could ever make the economics work.

Speaker 12 A lot of things would have to happen, like a much higher price on carbon and so on, until it was even vaguely viable.

Speaker 12 But what was interesting about this is that the team had set their own criteria and therefore the decision to shut the project down came from them and it was a much more rational decision as opposed to an emotional decision.

Speaker 10 I've heard that one of the strategies that X uses is to work on the hardest part of a problem first because you don't want to solve all the easy parts only to fall down five years into the project on the hard part.

Speaker 12 Yeah, it's a very counterintuitive strategy to start with the hard parts.

Speaker 12 So what we did at X is we had this image of a monkey on a pedestal and the story was imagine you're trying to train a monkey to recite Shakespeare sonnets while standing on a pedestal.

Speaker 12 What do you work on first? The monkey training or the pedestal? And it's very tempting to build a pedestal first because we know how to build a pedestal, so we can make this beautiful pedestal.

Speaker 12 We're very proud of ourselves. But then what if in the second year of the project you find out it's actually impossible to teach the monkey English, let let alone recite Shakespeare.

Speaker 12 So then you're left with this totally useless but really beautiful pedestal. And so we had this premise that we would always do monkey first.

Speaker 12 So we would identify what the hardest problems were and work on those. It's hard because I don't think most of the world thinks that way.

Speaker 12 So investors are constantly be like, oh, what progress have you made this month?

Speaker 12 So it's very difficult to say, oh, I solved like a hundredth of this really hard problem. That feels like no progress at all.

Speaker 12 And sometimes you've got these sort of jumps where it's not a linear, nicely incremental, I make some progress every month, but suddenly you have a breakthrough and then it suddenly works, right?

Speaker 10 Aaron Powell, another non-obvious thing that I've tried to do in my own projects is to celebrate the failures, to treat failures as successes because they free you up to go and pursue other things.

Speaker 10 Did you have strategies for doing that?

Speaker 12 At X we tried various different things. So one is get people to talk about it at all hands meetings, because otherwise all hands just becomes a sort of show of successes.

Speaker 12 If you talk about things that didn't work, then you kind of attribute more value to that. That applies in academia, by the way, as well.
I'm on the board of a big academic publisher.

Speaker 12 They publish Nature and lots of academic journals. And of course, it's much harder to publish a null result, right?

Speaker 12 No one ever wants to publish, like, here's something that didn't work, even though that would be very useful because it would stop lots and lots of other scientists trying to do the same experiment over and over again.

Speaker 12 But if you go back to X, that Foghorn team that came to me and said, we want to shut down our own project, they had actually done a very detailed post-mortem and they presented that at the all hands.

Speaker 12 They then also published it as two academic papers so that people wouldn't try the exact same approach that we had tried.

Speaker 12 And so making it public and talking about it takes some of the stigma out of it.

Speaker 12 The other piece is that you have to acknowledge that there's some grief around it and that however rational you try and make the decision, there's always going to be emotion.

Speaker 12 People lose their jobs, people have to give up on something that they've poured their life and blood and sweat and tears into.

Speaker 12 So it struck me when I was running this team where we were starting dozens of projects a year and shutting down dozens of projects.

Speaker 12 So I was going through these life-death cycles over and over again, that there's quite a lot of similarity between grief for a human and grief for a project.

Speaker 12 And I don't want to belittle what you go through when a loved one dies. This is not to say your project shutting down is on the same level, but it's a similar process.

Speaker 12 There's a model called the seven stages of grief. And I saw the teams go through similar phases, like you're in denial, you're angry, and then eventually like you get through to acceptance.

Speaker 12 And the faster you can get through those cycles, the better actually. And if you don't go through the cycles, it sort of lingers.
It's just pushed down.

Speaker 12 And so one of the things we did is we started celebrating the Day of the Dead.

Speaker 12 And before you accuse me of cultural appropriation, it was actually the idea of two Latinas in my team came to me and said, Obi, there's all this drama, all this doored-up grief, all these projects that we've shut down, and we should be celebrating this.

Speaker 12 And so in the Mexican Day of the Dead tradition, you remember the dead, you remember all the things that are amazing about them, and you think of them lovingly, and then you let them go.

Speaker 12 So we started doing this as a ceremony, and it was incredibly cathartic. People cried.

Speaker 12 And I think if you neglect that emotional aspect, if you try and make it just rational, you're kind of missing out on a really important part of what it means to let go of something.

Speaker 10 That's interesting. I've never tried to go into that emotional space on my project.
I'm going to try that the next time. Yeah, try it.

Speaker 12 It's very hard to let go if you don't process the emotion.

Speaker 10 We'll be right back with more of my conversation with Obi-Felton after this short break.

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Speaker 10 When I heard about your job at X, it sounded like a dream job to me. And then the way you've spoken about it so far, it seems like it was a dream job for you also.

Speaker 10 But you left a few years ago to do something else. How come?

Speaker 12 So I'd say my job at X was a dream job for sure for the first few years, but it was actually really soul-destroying for me.

Speaker 12 It was this endless cycle of just launching projects, hiring people, and then having to fire them again when we shut the project down.

Speaker 12 And it took a toll not just on the teams, but also on me, which I now realize looking back. The pressure of producing the next self-driving car and the next balloon project was absolutely immense.

Speaker 12 Like it couldn't just be any old thing. It had to be something really incredibly amazing.
That was also very undefined. Whereas when I worked at marketing at Google, I had really clear metrics.

Speaker 12 Like we get 100 million Chrome users, that's successful. If we get only a million, that's not as successful.
But at X, everything was just a little fuzzier and less measurable.

Speaker 12 And then the final thing was a good friend and coach told me, You are just in the wrong job for you because there's some people who are scuba divers, they love to go deep.

Speaker 12 And there's some people who are snorkelers who love to go across a whole bunch of things. And you're a scuba diver in a snorkeling job.

Speaker 12 And what I realized was, yes, I was overseeing projects that were as diverse as, you know, we had a chip project for machine learning chip that later went to Google.

Speaker 12 We had two or three different sustainability projects like the Foghorn project I talk about, which was all about chemistry.

Speaker 12 We had another one called Malta that was about storing energy and molten salt. It was all about physics.
I had all this diversity in the portfolio, which meant I could never go deep on anything.

Speaker 12 And it wasn't my job. It was the team's job to go deep on them.
So I suddenly realized, oh, this is a dream job for other people, but it's not a dream job for me.

Speaker 12 I've been happiest when I've been building things. So I went to Astro, the head of X, and I said, look, I'm going to quit.
I'm going to go back to the startup world. And he said, what?

Speaker 12 Like, why would you want to leave? And I said, because I want to build something again. You know, I'm a builder at heart.

Speaker 12 And so he said, why don't you pick something that you're really passionate about and build something in that area? And the area I was really passionate about was mental health for personal reasons.

Speaker 12 And so the project that I picked was called Amber, and I co-founded it with a neuroscientist and with a hardware engineer. And the idea is, could we find a biomarker for mental health?

Speaker 12 So it's very difficult still to assess how depressed or anxious, for example, someone is.

Speaker 12 We looked at EEG brain waves and we looked at wearable data and other kinds of data that might give you a pointer that is more objective than just asking people how they're doing, which is largely how in today's world mental health is assessed.

Speaker 10 And that's working out well?

Speaker 12 I ran the project at X for several years and we made great progress on the technical side. So it turns out that you can actually see in someone's brainwaves how depressed they are.

Speaker 12 The experiment is you make them play a little game and then you see what happens in the split second after they find out whether they lose or they win.

Speaker 12 In most people there's a sort of spike but it turns out in many people with depression they have something called anhedonia where that spike is subdued.

Speaker 12 So you can see by the length of the wave and the amplitude of the wave you can see how depressed they are. And that's kind of magical.
It's completely objective, like you can't cheat.

Speaker 12 And we thought that would be really incredibly useful.

Speaker 12 And it turns out when we did hundreds and hundreds of interviews with people with depression and anxiety, young people, postpartum mothers and others, we interviewed psychologists, we interviewed psychiatrists, and they all said pretty much the same thing, which is, yes, we need better measurement of mental health, but it's not the biggest problem.

Speaker 12 I will never forget one gynaecologist who said to me, I know some of the mothers I see have postpartum depression, but I'd rather not find out because there's no one I can refer them to because they're just not enough therapists.

Speaker 12 It was absolutely heartbreaking. And so I realized the biggest problem is actually that we don't have enough counselors.
It's not just a measurement piece. And so we ended up shutting UMBA down.

Speaker 12 It's another one of the long list of X projects that failed. And that was the last project I ever did at X.
And I decided I wanted to stay in mental health and that's why I moved on.

Speaker 10 And so you started Flourished Labs. Can you tell me what you're trying to do there?

Speaker 12 So Flourish Labs in some way was an evolution out of that X project that I was working on when I realized that there's this massive gap between the number of people who need need care and the number of mental health professionals who can provide it to them.

Speaker 12 If you look at just the US, there are about 58 million adults who have a mental health diagnosis today.

Speaker 12 And it's actually more than half of them that get no care at all. Sometimes it's stigma that people don't seek care.
Sometimes it's that you can't afford it or your insurance doesn't cover it.

Speaker 12 Sometimes is that you can't find a therapist that's a good match for you. And that's because there's only 600,000 counselors in total and we would need more than double of those.

Speaker 12 And when you look at the way that we train counselors, to become a licensed therapist in this country, you have to do a master's degree and then you have to do many, many hours of supervised work before you even get your license.

Speaker 12 So I looked at many different ways of how could you provide care in a scalable way that doesn't rely on just training more therapists. I came back to peer support.

Speaker 12 What if we train people who have experience of mental health challenges to support other people?

Speaker 12 And it turns out it's an evidence-based treatment. So I read lots and lots of studies that over and over showed that peer support works.

Speaker 12 People get better, there's fewer hospitalizations, and it's been around for decades. There's millions of people who have been doing this as volunteers.

Speaker 12 Suicide helplines or Alcoholics Anonymous are great examples of peer support. But what most people don't know is that it's also a profession.

Speaker 12 There's formal training and you can become a certified peer supporter and you can do this as a job. The trouble is there's only very few of them today.
And that's what we want to change.

Speaker 12 So at Flourish Labs, we use technology to scale peer support. And we need to do that both on the training side.
And then we also need to get peer supporters in touch with people who need help.

Speaker 12 So we developed our own training where we can train people in a manner of weeks to become certified peer supporters.

Speaker 12 And then we have a telehealth platform that's called peers.net where a young person can go on and find a peer supporter that's a match for them.

Speaker 10 You've been focusing on the benefits of peer support for the person who's ostensibly being helped.

Speaker 10 But it's interesting in my conversations with Angela Duckworth, who is part of our Freakonomics Network and a very prominent psychologist, she believes that actually being the supporter

Speaker 10 is at least as beneficial as being supported, which is a surprising result, but makes what you're doing even more valuable and important than maybe you're even giving it credit for.

Speaker 12 She's right. There are studies where people looked at the effect of giving peer support, and that's because they were worried that it would have adverse effects on the peer supporter.

Speaker 12 If you train a young person to support another young person, are you burdening them with all that trauma, et cetera? And it turns out that's not the case.

Speaker 12 People who give other people support stay healthy for longer. You have to be in recovery to become a peer supporter and to give peer support.
And so that's definitely something to watch out for.

Speaker 12 Like if your own mental health is going down again, then maybe you need to take a break. But in general, people stay healthy for longer.

Speaker 12 You see that effect in AA, where sponsors who help other people stay sober for longer. You can see it in student mental health.
It's reciprocal.

Speaker 12 And what's interesting when you look at the macroeconomics of that is it suddenly turns what is a problem that we have millions of people with mental illness into a massive opportunity because if we can get them into that workforce and get them to help the other millions of people that doesn't just create jobs it also is most likely going to keep them healthier for longer

Speaker 10 i could see how someone could have a knee-jerk reaction and say well isn't this risky and dangerous to take people who aren't really professionals and have them give advice.

Speaker 10 But I would tell you my own personal experience makes me 1000% supportive of what you're talking about.

Speaker 10 I have had the great misfortune of having a child die, my son, Andrew, and that was 24 years ago. And having lived through that, I actually think I do know a lot on that exact topic.

Speaker 10 And I feel like my insights and experiences have been useful for others. who more recently suffered that same fate.

Speaker 10 It's exactly your model that I'm I'm good at one thing and that's what you would ask me to do, not to try to pretend that I'm a therapist who could understand a hundred problems that I've never experienced.

Speaker 12 So there's a lot of research that looks at whether peer support works.

Speaker 12 There's much less research into why it works, but you pointed at one of the things that I think is at the core of it, which is the empathy and understanding and the connection that you get with someone who's been in your shoes is really profound.

Speaker 12 That actually has a therapeutic effect. And the fact that it's more equal, that you're looking sort of eye to eye, also makes a difference to people.
The trust is often higher right out the gate.

Speaker 12 And for a few years, I served on an advisory board for the Wellcome Trust, which is one of the biggest funders of mental health on the academic side.

Speaker 12 And one of the guys on that advisory board is a guy called Pim Krupos, who is a Dutch researcher who does a lot of studies for the WHO. And I asked him, like, what makes therapy effective?

Speaker 12 And he said, about half of it is what the therapist has learned. But he said the other half is actually about the therapeutic alliance.
So do you have a high trust? Can you relate to this person?

Speaker 12 And if that therapeutic alliance is low, the therapy is much, much less effective.

Speaker 12 And so my personal hypothesis on this is that what the peer supporter doesn't have in terms of years of training, they make up in terms of that higher level of alliance.

Speaker 12 And when you look at subgroups, so for instance, people who identify as LGBTQ or people of color, they often have a harder time finding a therapist that they click with.

Speaker 12 And some of it is about the fact that most therapists look like me, they are white, middle-aged women.

Speaker 12 So if you're a young, black, gay man, you might not be able to relate to me as much as you might be able to relate to someone from your own community.

Speaker 10 It's really amazing to be sitting here talking to you about this topic because I first thought about this issue maybe five years ago.

Speaker 10 My daughter Lily had been seriously anorexic for many years, and I actually talked about that topic with her on a past episode on this podcast.

Speaker 10 As she slowly recovered from anorexia, she started an Instagram account that reported on the ups and downs of that journey. And it eventually attracted a large following.

Speaker 10 She would get hundreds of direct messages a week from people less far along than she was. And they were looking for help and guidance.
It was a full-time job trying to respond to those questions.

Speaker 10 And Instagram was a terrible platform for trying to help people. It was extremely hard for people who needed help to find her.
And it made me realize that there was a missing market, a market failure.

Speaker 10 There was no easy way for people struggling with a particular issue to get personalized advice from a peer who was further along. I imagined what a solution might look like.

Speaker 10 And I don't want to minimize what you're doing, but it's like literally exactly what you're doing. I could imagine that that would be a great solution.

Speaker 10 And I was just way too lazy and didn't have any of the right skills to do it, but you've done it.

Speaker 12 Well, I think that just proves that there's no idea that's original, right?

Speaker 12 So I'm glad to be executing on your idea, Steve.

Speaker 12 I mean, in many ways, it is an obvious idea.

Speaker 12 That fundamental idea that you can connect with someone who has gone through a similar experience and is just a little bit further ahead on the path is absolutely at the heart of the product.

Speaker 12 And we decided to focus on Gen Z, so that's teenagers and young adults, because that's the age when mental health issues often show up for the first time.

Speaker 12 So your daughter is probably sometime during her teenage years. And I believe that if you can help them deal with these issues then, it will set them up for the rest of their life.

Speaker 12 It's also where the treatment gap's the biggest. 60% of them get no care because it's harder for them to find a counselor that's a good match.
And finally, they are open to peer support.

Speaker 12 When you're a teenager or you're a college student, you're more likely to reach out to your friends for help than anyone else. There's actually studies on that.

Speaker 12 And so what if you trained your friends to then be effective at providing that support?

Speaker 12 So that's why we designed the service for that group first, even though I believe it could work for other groups too.

Speaker 12 Mothers who've just had babies, like postpartum, has huge amounts of stigma around it, and mothers often only talk to other mothers about it.

Speaker 12 I've interviewed veterans who said, I would rather talk to another veteran about my PTSD than talk to anyone at the VA.

Speaker 12 And the VA is making huge amounts of efforts to support veterans, but it just doesn't create that same connection as talking to another vet.

Speaker 10 This is what economists call a two-sided market, where you both need to have the mentors, the counselors, and you need to simultaneously have people who are looking for help.

Speaker 10 But it's really hard to find mentors when there aren't people yet looking for help. And it's really hard to find people to show up to look for help when there aren't enough mentors.

Speaker 10 Have you had luck cracking that?

Speaker 12 Well, I would say we haven't cracked it at all yet, but we're very aware of it going in.

Speaker 12 And actually, when I raised our seed round, I purposely sought out people who had experience of two-sided marketplaces.

Speaker 12 What everyone says is you have to start with the supply side, because otherwise you can't do anything at all.

Speaker 12 So we're mainly focused on university students, college students at the moment on the peer supporter side.

Speaker 12 And we get hundreds of applications applications each time we put out the job. And these are amazing applications, like people who have the experience of various mental health issues.

Speaker 12 They're incredibly diverse. Our training cohorts are more than half LGBTQ.
They're more than half BIPOC.

Speaker 12 So that actually turned out to be easier. And I think we have nearly 50 peer supporters on Peers.net now.
And we're adding new ones on a regular basis.

Speaker 12 The demand side, we thought would be really easy.

Speaker 12 Like if 35% of young adults and teenagers have a mental health diagnosis, you're not even talking about people who've been undiagnosed but actually have a diagnosis and more than 60% get no care, surely it must be easy to find them and connect to them.

Speaker 12 That turns out to be harder than we thought. First of all, No one knows what peer support is.

Speaker 12 People might be familiar with it in the context of volunteer groups like AA, but they think it's just for substance abuse.

Speaker 12 Or they might know about it for crisis helpline like Trevor Project or crisis text line, but they think it's just if you're suicidal.

Speaker 12 And this concept that peer support is something that you can do just like therapy on a more ongoing basis or maybe just once, that's a novel concept.

Speaker 12 So in many ways, we're not just building one company, we're establishing a category.

Speaker 12 So I almost wish you had done your peer support startup, Steve, because I very firmly believe that it's not going to take just one company in this space to succeed.

Speaker 12 It's going to take 10 or 15 companies until this becomes a familiar concept that people trust.

Speaker 11 You're listening to People I Mostly Admire with Steve Levitt and his conversation with Obi Felton.

Speaker 13 After this short break, they'll return to talk about failure.

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Speaker 15 Honey, do not make plans Saturday, September 13th, okay?

Speaker 10 Why, what's happening?

Speaker 15 The Walmart Wellness Event. Flu shots, health screenings, free samples from those brands you like.

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Speaker 5 We can just walk right in. No appointment needed.

Speaker 16 Who knew we could cover our health and wellness needs at Walmart?

Speaker 12 Check the calendar Saturday, September 13th.

Speaker 15 Walmart Wellness Event.

Speaker 10 You knew. I knew.

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Speaker 17 Age restrictions apply. Free samples while supplies last.

Speaker 10 In the time we have left, I want to talk to Obi about her experiences growing up in West Berlin. How strange must it be to grow up in a city surrounded by a hostile East Germany.

Speaker 10 But before that, I want to ask her one more question about running a startup.

Speaker 10 Can I ask you a frank question?

Speaker 12 Of course you can.

Speaker 10 We talked a lot about failure earlier in the conversation, but it was really about failure of a given project within a portfolio of projects, which is painful and full of grief, as you noted, but manageable.

Speaker 10 Now you run a startup and most startups fail and that kind of failure when you're the boss and a whole enterprise has to be shut down, there's something truly terrifying about that prospect, no?

Speaker 12 Yes, it's absolutely terrifying. I lived through many, many failures throughout my career.

Speaker 12 That fear of failure is never far away if you're a startup founder. And for good reason, right? 90% of startups fail in the first year.
So I guess we've made it through that hurdle already.

Speaker 12 But something sort of shifted in me recently.

Speaker 12 We had all our money in Silicon Valley Bank. So when SVP started going down, it all happened very quickly over just a few days.
I think I went through those seven stages of grief in four days.

Speaker 12 On Thursday, I was in shock and I was in denial and I was wrestling with myself of whether I should be pulling the money out. Then I finally decided to pull the money out, which felt really terrible.

Speaker 12 And by the time I'd made the decision, it was already too late. So on Friday, when they froze everyone's assets, I was angry with myself and angry with the SVB management and angry with the world.

Speaker 12 On Saturday, I was bargaining and I was in despair. And then by Sunday, my husband was like, can you stop reading Twitter and Slack and just like get off your phone?

Speaker 12 And I did. So I turned my phone off and I sat on the sofa with my dog and I just felt really connected to all the founders in the world.
Suddenly, everyone was in the same boat and it wasn't my fault.

Speaker 12 When you write an investor report every month like I do, it always sort of feels like it's my fault if I can't raise the next round. And suddenly nobody had any money.

Speaker 12 It didn't matter whether you'd raised 50,000 or 500 million. Everyone was in the same boat.
So I eventually felt really calm and I went to bed.

Speaker 12 I never turned my phone back on until the next morning, which is Monday morning, you know, by which point Silicon Valley had been bailed out. What happened afterwards is I just feel less afraid.

Speaker 12 Someone told me about this Buddhist tradition. It's a meditation practice where you visualize your own death.

Speaker 12 So you see yourself dying, you see your family and your friends around you, and you see them grieving, and then you eventually see them moving on with their lives.

Speaker 12 And it feels like that's what happened, that the company kind died already. It's a very weird experience, but I like it.

Speaker 12 I like operating with less fear because so much of what I do in the company, which is partnerships with people or raising money from investors, I sometimes feel it's all magic and make-believe anyway in an early stage startup.

Speaker 12 You know, we haven't proven ourselves yet. We don't have product market fit yet.
It's all about can you convince people of the dream and that you could turn nothing into something.

Speaker 12 It is kind of alchemy. I think maybe entrepreneurship is alchemy.

Speaker 10 You grew up in Berlin and the first 15 years of your life you were in West Berlin with a wall. Did you understand how strange it was?

Speaker 10 to be living in this city surrounded by a hostile country with a wall literally running right down the middle of the city? Or is a kid that was just a reality?

Speaker 12 No, I definitely understood it because my parents are from a small place called Zaarland on the western border. So it's on the border to France.

Speaker 12 And so for family vacations in the summer, we would drive out of West Berlin and through East Germany and then come out the other side.

Speaker 12 And there was definitely these moments when you handed in your passport to the East German Border Guard and they had this weird weird system where they would put it on a little conveyor belt from one station to the next.

Speaker 12 So you drove slowly alongside the conveyor belt to the next station. And I always had this anxiety as a kid that maybe our passwords would just disappear and we'd be stuck in East Germany.

Speaker 12 When I was 16, I went to the US. I actually was kind of bored in West Berlin.
So I decided I was going to go to America for a year. and go to high school.

Speaker 12 And I ended up in upstate New York in a small village in a family that was very different from my German family.

Speaker 12 And I had an amazing time. I spent the entire year telling everyone the wall was never going to come down.
And so I came back in the summer of 89

Speaker 12 and in November the wall came down. So it was a huge, huge shock.

Speaker 10 Imagine if you had been away and missed it. When you heard the news, were you at the wall watching it come down?

Speaker 12 Not at midnight. So I had a chemistry exam in the morning.
So I went to bed and then didn't listen to the radio in the morning and went to school and I came out of the exam at 10 a.m.

Speaker 12 And everyone said, we're going to the wall, we're going to the wall. And I said, why would you go to the wall? And they said, haven't you heard? They opened the wall last night, idiot.

Speaker 12 So I went to the wall alongside hundreds of Berlin school children and we all climbed and stood on top of the wall, which is a pretty amazing feeling.

Speaker 10 Having lived in Germany has not made me feel any less American, but it's only been a year. Over time, has your sense of German identity eroded?

Speaker 12 Even that first year. So I came back when I was 17, and then the wall came down.

Speaker 12 And I actually would say that winter was probably the only time in my life that I've experienced something approaching depression. It was because I was coming back from another country.

Speaker 12 And when you go abroad, you expect some culture shock and you expect that you're not going to fit in. But when I came back to Germany, I had changed a lot.
And I didn't just fit right back in.

Speaker 12 And then the wall came out, which was this massive macro shock where suddenly everyone was really nationalistic and jubilant and joyous about the reunification of these two countries, which to me felt really weird because they were culturally had grown apart quite a lot because it had been two generations.

Speaker 12 And so I felt very out of place and really alienated and also just countered the kind of prevailing zeitgeist, right?

Speaker 12 Where you were supposed to be happy about this and this was meant to be the biggest historical thing ever to happen in our lifetimes. So I felt very out of it.
I couldn't wait to get out of there.

Speaker 12 I went to Oxford and I did philosophy and psychology and met my husband there and came back to Berlin for a year, but already knew that I really wanted to live in London.

Speaker 12 So London really was home for many, many years. And I still think London probably is long-term home, even though we love living in California.

Speaker 10 I heard you comment once that hearing a speech by the Dalai Lama was the most memorable experience that you had at Oxford. And then you went back and spoke at the Oxford Union.

Speaker 10 That's probably about the most nerve-wracking thing you can do is to go back to a place where you've been an audience member and sat in awe of great speakers and then probably feel like a total imposter up in front of the group.

Speaker 10 Definitely.

Speaker 12 But I think I felt like a total imposter my entire life.

Speaker 12 I felt like total imposter going abroad, total imposter doing philosophy at Oxford when I barely even spoke English properly. And then my entire career in tech, I was a woman, I wasn't an engineer.

Speaker 12 So when I was at X, often I'd barely understood what they were talking about in terms of tech. Now I feel like an imposter because I'm a startup founder, but I've never founded a startup before.

Speaker 12 It's a bit like the fear of failure. It never totally goes away.
You just learn to deal with it.

Speaker 10 Obi says she feels like an imposter, which doesn't surprise me at all because I often feel that way. I absolutely feel like an imposter as a professor standing in front of a classroom.

Speaker 10 Students think I know everything when I barely know anything. The same with parenting.
I thought my parents had all the answers.

Speaker 10 My God, I never would have listened to them if I had realized how little parents know. I've always just assumed that everyone feels like an imposter, but I wonder if that's really true.

Speaker 10 I'm curious to collect some data on that. So if you have a minute, send a one-line email to Pima at freakonomics.com.

Speaker 10 That's P-I-M-A at freakonomics.com, and just write either imposter or not an imposter. I'll tally up those results, and I'll report back to the share of Pima listeners who see themselves as impostors.

Speaker 10 And now, as always, at this point in the show, I invite Morgan, my producer on, to help with a listener question.

Speaker 18 Hi, Steve. A listener named Will wrote to us about the economic principle of induced demand, where an increase in supply results in a decline in price and increase in consumption.

Speaker 18 He was curious about how it relates to traffic. For example, the typical economic assumption is that if you build more roads, you will not reduce traffic because more people will just drive.

Speaker 18 Will was curious if this is true or not. What is the consensus among economists about induced demand and traffic?

Speaker 10 So, honestly, Morgan, I've never talked to another economist about this, so I don't know what the conventional wisdom is among economists.

Speaker 10 But I think the best way to think about this is absolutely in terms of price and to think about the cost of commuting. So usually when we think about cost, we think about financial costs.

Speaker 10 We think about the cost of the gas or the wear and tear in our car that's associated with commuting.

Speaker 10 But really, the biggest cost for most people is the time they waste in traffic, which if translated into dollars is how much you'd pay not to waste that time in your car, but rather to be able to be at home or doing something you enjoy.

Speaker 10 So if you build more lanes, then that reduces congestion, which leads to a much lower price of commuting because it doesn't take as long. So you save on the time cost.

Speaker 10 One of the most basic ideas of economics is that when the price of a good falls, people consume more of it.

Speaker 10 And so indeed, many more people who before weren't willing to drive because the traffic was too bad, they get back on the road and that builds the congestion back up.

Speaker 10 Now, in any simple economic model, it can't be the case that the congestion is as bad afterwards as it was before because the reason the congestion comes back is because the price is lower.

Speaker 18 Could this be an example of where the economic model differs from reality? Because in reality,

Speaker 18 I think it has been proven that when there's more lanes added, it actually can lead to worse congestion than you started with.

Speaker 10 I mean, people can make mistakes. And it could very much be true that if everybody collectively thinks, oh my God, the extra lanes are going to change everything.

Speaker 10 And so new communities spring up along the road, then that could happen. But it is true that in economic models, people don't make mistakes.
And in real life, people do.

Speaker 10 And it's possible that happens. But I think more what people get confused about is the simple role of prices.
If you lower the prices, you're going to need more cars to be there.

Speaker 10 And if there's a relatively elastic demand for driving, then you'll have a lot more cars on the road when you lower the prices.

Speaker 10 People shouldn't think of adding lanes as primarily being about reducing congestion. They should think about adding lanes as a way to get a lot more cars to be able to drive on that road.

Speaker 10 Now, if your goal is actually to avoid congestion, There's really simple solutions. And what do you think that is, Morgan?

Speaker 18 Increase people's access to public transportation.

Speaker 10 Good job, Morgan. That's not the answer I'm looking for, though, because that actually doesn't work very well because most people don't want to take public transportation.

Speaker 10 The answer is if more people drive when the prices go down, raise the price of driving. It turns out that driving is a great example of what an economist calls an externality.

Speaker 10 Every extra driver on the road imposes all sorts of costs on other drivers that aren't taken care of by the market, right? When I drive, I increase congestion.

Speaker 10 I also increase the likelihood of crashes. And it turns out that's empirically the biggest cost.
So when you put more cars on the road, there are more crashes.

Speaker 10 And so if you add those externalities in with the obvious ones, which is that cars are polluting and they're contributing to climate change and all sorts of other pollutants in the air, then there's just too much driving.

Speaker 10 And so the logical thing an economist would say is you should price in this externality. You should charge people per mile driven, especially when the roads are crowded, when there's congestion.

Speaker 10 Of course, that has great efficiency principles, but like so many things in economics, it has really bad equity implications.

Speaker 18 Will, thanks so much for writing in. If you have a question for us, our email is pima at freakinomics.com.
That's p-i-m-a at freakonomics.com.

Speaker 18 We read every email that's sent and we look forward to reading yours.

Speaker 10 In two weeks, we're back with a brand new episode featuring Reginald Duane Betts. He spent eight years in prison from the age of 16 to 24, and then he turned his life around.

Speaker 10 He eventually graduated from Yale Law School. He's won a MacArthur Genius Grant, and he started a nonprofit called Freedom Reads.
I think this is going to be an incredible episode.

Speaker 10 Thanks for listening, and we'll see you back soon.

Speaker 11 People I mostly admire is part of the Freakonomics Radio Network, which also includes Freakonomics Radio, No Stupid Questions, and The Economics of Everyday Things.

Speaker 13 All our shows are produced by Stitcher and Renbud Radio.

Speaker 11 This episode was produced by Morgan Levy with help from Lyric Bautich and mixed by Jasmine Klinger.

Speaker 13 Our theme music was composed by Luis Guerra.

Speaker 11 We can be reached at pima at freakonomics.com. That's P-I-M-A at freakonomics.com.
Thanks for listening.

Speaker 12 I honestly don't know what I am anymore. I guess I'm still German.

Speaker 12 The Freakonomics Radio Network, the hidden side of everything.

Speaker 13 Stitcher.

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Speaker 15 Honey, do not make plans Saturday, September 13th, okay?

Speaker 10 Why, what's happening?

Speaker 15 The Walmart Wellness Event. Flu shots, health screenings, free samples from those brands you like.

Speaker 10 All that at Walmart.

Speaker 5 We can just walk right in. No appointment needed.

Speaker 16 Who knew we could cover our health and wellness needs at Walmart?

Speaker 12 Check the calendar Saturday, September 13th.

Speaker 15 Walmart Wellness Event.

Speaker 10 You knew. I knew.

Speaker 17 Check in on your health at the same place you already shopped. Visit Walmart Saturday, September 13th for our semi-annual wellness event.

Speaker 17 Flu shots subject to availability and applicable state law, age restrictions apply, free samples while supplies last.