Podcast Episode 167

with our guest Adam Stern

Committed: Dispatches From a Psychiatrist in Training

Brilliant Miller [00:00:07] Hi, I’m Brilliant. Your host for this show. I know that I’m incredibly blessed. As the son of self-made billionaires, I’ve seen the high price some people pay for success. And I’ve learned that money really can’t buy happiness. But I’ve also had the good fortune to learn directly from many of the world’s leading teachers. If you are ready to be, do, have, and give more, this podcast is for you.

Brilliant Miller [00:00:35] Today my guest is Adam Stern, M.D. Adam is the author of “Committed: Dispatches From a Psychiatrist in Training.” It’s a memoir Adam wrote about his time learning to become a psychiatrist, which involved overcoming imposter syndrome and learning the value of human connection. Adam is well studied in psychology, medicine, psychiatry, clinical neurosciences, all kinds of smart, academic scientific stuff. But he’s a very approachable human being. He’s currently an assistant professor of psychiatry at Harvard, and he has won several awards for psychiatry, for writing, and excellence in medical education, and he’s also published more than two dozen scholarly publications. In this interview, we talk about a lot of things dealing with doubt; after we’ve made a choice that’s important to us, after we’ve committed to a certain path in life, how to deal with it when it arises, which it almost inevitably will. We talk about the difference between being empathic and being empathetic, how those things differ and how we can become more empathic. We talk about. Especially if you’re in any of the healing modalities, like if you work with people helping them to become more complete or better versions of themselves, I think you’ll be interested in this interview. We talk about our individuality knowing what we want, breaking through to the next level for us, and helping others do the same thing. We also talk about Adam’s creative process. He’s a cartoonist, in addition to being a writer and following your passion, doing what you love for yourself, and the serendipity that often happens. Because of that, I think Adam’s story is pretty cool in that regard. You can learn more about Adam at his website. AdamSternMD.com. You can follow him on Twitter @adamPhilipStern. With that, I hope you enjoy this conversation with my new friend, Dr. Adam Stern.

Brilliant Miller [00:02:43] Adam, welcome to the School for Good Living.

Adam Stern M.D. [00:02:45] Thank you so much for having me.

Brilliant Miller [00:02:50] I don’t want to go much further before I acknowledge that I could have started that with Dr. Stern. But before we began rolling, we talked about the fact it’s OK for me to call you, Adam, in this. But will you tell me, please, what is life about?

Adam Stern M.D. [00:03:09] I think life is about a balance between the present moment and your ideas about the future, along with your ideas about the past. And so that to me is what life is all about, and I can certainly expand on that if you want.

Brilliant Miller [00:03:27] Yes. Yeah, I do want to dig into that and I want to talk about that through the context of your book “Committed: Dispatches From a Psychiatrist in Training”, which of course, you’re through your training now and your practicing. But I want to actually begin by talking about the fact that you come from a family of medical practitioners, right? Your dad was a doctor, but your dad actually discouraged you from becoming a doctor, will you talk about that?

Adam Stern M.D. [00:03:57] Yeah, absolutely. So you know, my brother and I grew up admiring our father. He is a cardiologist, still practicing. He’s a wonderful doctor. He cares about his patients. His patients seem to care about him. And the idea that you could do good in the world and that society would provide you with a comfortable lifestyle based on that. The idea that you could help people over decades navigate their health and well-being, all of those things were things that we just naturally observed and that drew my brother and me to the field of medicine, all while over the first 20 years of our lives, our father would sort of sometimes talk about medicine as being a challenging field, a field where it’s not easy to do the job without feeling the weight of the job, without feeling burnout from the administrative and logistical tasks of the job. And when we were growing up in a particular era, there was a real transition within medicine where there was the emergence of things like health, maintenance organizations, HMOs. The field was changing from the era that my father trained in. And so I think that that transition might have also led to a certain degree of feeling discouraged about his kids, potentially following in his footsteps. But as most kids do, we didn’t listen to our dad and we both went into medicine anyway. Wow.

Brilliant Miller [00:05:36] Now, I know that mental health or mental illness has a stigma, many people don’t understand it. They don’t know how to deal with it in themselves or someone they love. And it’s a field that is not as well understood, even like, you know, psychiatry is a field. It’s not as well understood in some ways where it’s not as mechanical as other aspects of medicine. Right. But what is it about this that attracted you? Your dad was a cardiologist. Your brother didn’t go into psychiatry. Why did you follow this path?

Adam Stern M.D. [00:06:09] Right. You’re absolutely right, they’ve never said this to me, but I do consider myself almost like a black sheep of the family in that I went into this field that has so much stigma around it and it’s so far from cardiology. But all that being said, what drew me to it was that I effectively at some point had to look back at my experience and decide what were the parts of my training in medical school and my even my undergraduate education? What were the things that really inspired my brain, my mind, my heart for lack of a better word? What made me excited? What made me motivated to do better? And it was always the didactic, the academic course, the clinical rotation that had to do with brain and behavior, the mind emotions. And part of that is that everybody in psychiatry patients, psychiatrists, everybody that you might come across in that field, there’s nothing really more important than what is important to them, especially when referring to patients, what their values are, what do they hope to get out of the encounter or the therapeutic alliance, the relationship, well what’s the core of who they are? That’s the most important thing in psychiatry, even for someone who might just be prescribing medications or something else. And so that idea is what really, I think drew me to the field in a way that other fields I found really fascinating. But it was, if you know, if you want to repair a bone in surgery, you could probably do that for the most part without ever getting to know, you know, the patient’s life story, you know? And to me, the life story is the most fascinating part of it all.

Brilliant Miller [00:08:06] Absolutely. We’re endlessly fascinating, aren’t we? In some ways, totally mysterious and in other ways, maybe not that complicated at all, but it’s a paradox being human, I think. So something you talk about in the book that I was intrigued by is that many people who like it’s no secret that many people who go into psychiatry are a bit eccentric. Why is that?

Adam Stern M.D. [00:08:34] Yeah, so I think that’s a good question, something that a lot of people pondered, I don’t have a real proper answer of like, well, this is clearly why, but to some degree, I think that people who would connect with that statement you just made about the human condition being complicated and paradoxical in some ways. Those of us who have a certain kind of brain for science and go into medicine, but still wonder and marvel at the human condition and how our existence in the world is not summarized by the four-chamber pump in our chest. And, you know, the filtration system in our kidneys that are cleaning our blood and creating urine and that kind of thing that are more fascinated with what makes us the people that we are. I think it sort of draws a certain kind of person. It also draws, hopefully, someone that is by nature, predisposed to be empathic, I think people who go into psychiatry who are not empathic do a really poor job, probably. I think empathy is at the core of practicing psychiatry and it probably draws a certain segment of people who have dealt with their own mental health issues, whether diagnosed or subclinical. You know, at a level where it’s just always, something’s always not at them or confuse them or made them think more within their own inner worlds. And I think that one of you know, Freud’s most advanced, most mature defense mechanisms are intellectualization. So a lot of us will study things that make us uneasy. And going into psychiatry for someone who’s had that challenge, I think there’s no better example than that.

Brilliant Miller [00:10:27] Yeah, no doubt. You know, something that you talk about in the book, too that I thought was really interesting is this you make this commitment to follow this course of study and a professional path and so forth and more than once along the way, you found yourself questioning your choice and maybe your commitment. Of course, as we know now, you stuck with it. You got through and you’re still in some ways now that you’re practicing, but something that was very challenging. And I do want to know who you wrote the book for. But also I’m imagining that many people who are curious about if this is the path for them would be attracted to your book. And so let me before we get to who you wrote it for, will you just tell me a bit about that? Maybe those doubts that you had and what it was that allowed you to persist in this course despite the doubts?

Adam Stern M.D. [00:11:24] Yeah. So I talk a bit of in the book and and a lot outside of the book about this phenomenon of “imposter syndrome” – feeling like you don’t belong. And I think that’s a somewhat ubiquitous phenomenon. But really the field of medicine and medical training in particular is primed for it itself, selects a certain kind of person who’s self-motivated. You’re surrounded by very high achieving people who outwardly seem like they’re doing fine and you don’t have access to all their doubts and self-doubts and things that they wish they could do better and the number of hours that they’re spending just to achieve the basic level of functioning within medicine. So all of that leads to a very, very wide spread. Really, I would almost call it like a ubiquitous experience within medicine that at certain points, you’re going to feel like you’re not up to the task. I worry more about some trainees now that I’m in more of a teaching role. I worry about trainees. If they don’t worry, if they feel like they know everything. Yeah, that’s not as good as a trainee who feels like maybe they’re in a little bit over their head and they can ask for help when they need it. So. But you’re right, throughout my own training, I can think of so many examples from applying to medical school to getting in and starting medical school and arriving and realizing this is going to be much different, much, much harder, and in a very different way than I was expecting. And then getting into residency, you’ve got your M.D., but then you realize you don’t actually know how to do the job that you’re now tasked with doing. You have to learn that job on the fly. And so all of those were opportunities to feel that way.

Brilliant Miller [00:13:13] You know, I haven’t been through something like that exactly, you know, where you reach a point and you think, OK, I’m arrived. I’ve arrived. I’ve got the degree, you know, other people acknowledge me, but I still don’t necessarily feel fully confident or capable. But what were there certain? Maybe there was a certain type of situation or a specific instance where something came up that maybe confirm for you that doubt? I know you talk about working with a couple of patients that had anorexia that was particularly challenging. But when you talk about maybe a specific time that really challenged your confidence or your maybe even your commitment.

Adam Stern M.D. [00:13:59] Yeah, so I can think of a couple, you know, right off the bat in terms of some are in the book and some are not, but one that I don’t believe is in the book was a moment in the first year of medical school where I was after the first few maybe months of the semester or the year I was on pace to fail a class called histology, which is the study of slides under a microscope basically like human tissue, the various organ systems, what they look like in different stains under a microscope. And that’s a very fundamental thing. It obviously has almost nothing. I mean, really almost nothing to do with what I do now as a physician, as a psychiatrist. But it was not connecting with me. And I just remember, you know, on the verge of tears talking, calling my mother. This is at age twenty four years old, 25 years old and calling my mother and saying, like, I don’t know if I can do this, you know? And, you know, with persistence and with sort of reevaluating how I go about my studies and that kind of thing. Eventually, you start to gain momentum and realize, OK, if I approach it this way, I’m able to do it. I’m not worse off than anybody else here, with enough hard work and encouragement and mentorship about the best way to do it, I can achieve this thing. And so that was a lesson, and I did, you know, and I did fine. Obviously, I didn’t go into pathology where this kind of study is like of paramount importance. But you know, that idea that if I just figure out the right way to learn this, I’m as good as anyone else here at putting in the hours and the effort to do it, then I can do that. That idea carried me forward for years, even in residency. You know, in the book, I talk about a number of different patient encounters, a lot of them happening overnight where it’s really a bare-bones crew. It’s like one or two residents taking care of the psychiatric needs of the entire medical center. And those moments where you feel like, Oh, I’m in over my head because this patient is experiencing mania, this patient is experiencing suicidal thoughts or hearing voices or paranoia. I don’t know how to – No one ever trained me in how to do this particular task of calming someone down when they’re upset about X, Y, or Z, you know, that kind of feeling of being overwhelmed. If you even go into those micro experiences, those momentary experiences of, OK, I will just keep going forward with my most earnest self trying the best I can, asking for help when I need it. Those are all very powerful tools to get through something. And once you’ve gotten through it, that’s another arrow in your, you know, in your arsenal. That’s something else that you can use in the future to remember, you know, to get better and better every time you go out and do the job.

Brilliant Miller [00:17:01] One of the things I love about that answer is that it’s just so honest like it seems so simple you were earnestly doing the best you could. You were asking for help. But in some ways, like you just talked about, a defense mechanism is intellectualization. Sometimes at least. But I’m curious, how do I phrase this question? How did you balance your training, which is very intellectual, which is academic, which is theoretical. It’s kind of divorced from a specific time and place in person with your own intuition. How did you and I realize all of us have to kind of find and feel our way through our lives? But can you talk about how you reconciled, how you knew when it was time to rely on what you had learned in a classroom or a textbook or a lecture or whatever? And what your own inner sense was telling you?

Adam Stern M.D. [00:17:50] Yeah. So that’s a really interesting question because there are all kinds of different angles that I can think about it from. But one of them is, you know, in psychiatry, there are all these hang-ups about. They’re both sort of societal impressions of what a psychiatrist is and also actual training about how to react and what to do and what not to do. So, you know, there’s a very small scene in the book where it might actually come up a couple of times in the book, where I feel like the human empathic response would be to put a hand on a patient’s shoulder to make a human connection, you know. And in our training, it was sort of like, Well, you never really want to physically contact the patient unless it’s for a medical reason, you know? And it just felt so alien and fed into all of those concerns that people have about psychiatrists being disconnected, aloof, cerebral, all of those things that we think about of the sort of stigma around psychiatry. And so I think that that there’s at least one, maybe two moments in the book where I’m able to lean into intuition more. And the formality of training a little bit less for what I think was the patient’s benefit. And I think that comes with experience. So when you’re first in a brand new situation, you’re going to be much more reliant on the instructions that are handed to you. One of the things that now that you know, about eight years out from the end of the book, eight years out from training, one of the things that I’ve gotten much better about is realizing that the rules are there to be mastered and then sometimes disregarded when you when you think it’s for the best interest of the patient. If some rules are not, some rules are hard and fast, but some, like, is it ever OK to put a hand on the patient’s shoulder with their permission? That kind of thing. If the moment is right, you can. You can bend that rule.

Brilliant Miller [00:19:49] Yeah, you know, I’m just thinking of a parallel for my life, which is basketball, where you know, somebody just starting out is taught, never leave your feet for a pass, but then you watch the superstars. They do that all the time. You know, it’s like you’re saying, you master the rules and then you learn when it’s OK to break them or when it’s maybe necessary or important.

Adam Stern M.D. [00:20:12] Right. And just like those NBA stars, you know, when you’re doing something that what you hope is a high level for me, I’m not. The last thing I want to do is compare myself to an NBA star. But when I’m in with a patient, no, you know, there’s no administration. There’s no audience watching in. You’re just trying to do the best thing for the patient, right? If that’s your compass, you know, so if an NBA player wants to perform at the top of their ability, you know, they might remember that they’re not supposed to leave their feet for a pass. But if in that moment they think I’ve been trained for this, this moment, I know it’s the moment to try to intercept that pass or what have you. You know, then that’s the time to tap to break that rule. And I feel like that is I think that analogy actually holds pretty well in any kind of performative thing where you’re on your own and you’re trying to figure it out in real time.

Brilliant Miller [00:21:39] OK, cool. Well, thanks for that. So let me ask you, who did you write this book for and how do you hope they receive it? What do you hope it does for them, or that life is different because they picked it up and read it?

Adam Stern M.D. [00:21:54] There’s the truth, and then there’s the other truth in this answer. The first truth is I wanted everyone to read this book. You know, I wrote this book for a wide audience. I wanted it to be, you know, like a big hit that that people read at book clubs. And, you know, anybody could read it. I wrote it. My natural writing style is colloquial and down to earth, and people can read the book pretty quickly and easily without having to look up too many words or anything like that. It’s not dense, it’s the opposite of dense. So that was my goal was to write the book in a way that was really accessible to a big audience. But now that the book is written, I can appreciate the fact that there is a built-in audience for anyone that’s interested in psychology. Young people that are thinking about going into some corner of the field of mental health care. And there’s an enormous field with all you know, psychiatry is just one tiny little component of this overall apparatus. But anyone interested in the care of other people starting from the person, you know, so medical professional psychological professionals, anybody within the broader field of mental health care, even within the field of academia where you, you know, there’s a lot about the culture of, you know, sort of training and feeling lost in this book.

Brilliant Miller [00:23:42] Earlier in our conversation, you mentioned empathy, you mean you use the word empathy. How can we become more empathic?

Adam Stern M.D. [00:23:50] Wow, that’s a great question, because I do think that most of us are born with a certain tendency toward empathy. Some of us, you know, I’ll just tell the very quick anecdote that as I was writing this book, I was finding myself using the word empathic that the psychiatrist are supposed to be empathic. And then I read someone else’s book where they were using the word empathetic. And I said, What’s the difference between these two words? This was like, I was like, I know that empathetic is a real word. I used to use that word all the time. How come in psychiatry, I’m only using this word empathic? And when I when I dug deep into that topic, which sadly, it went down a little bit of a rabbit hole, I learned that empathic is referring to the person being an empath, the person being sort of drawn to taking other people’s perspectives, whereas being empathetic is something you can put on and put and take off. You know, I can put on an empathetic tone and then the next sentence, I can take it off and not use that tone. But being empathic is a state of being to me. And so that’s why in the book in psychiatry in general, we talk about people being empathic. Can you cultivate it? I think to a degree you can. And I think some of that comes in the long term. You know, I think it helps if you’re raised by empathic people. I think it helps if you’re taught, you know that that the values that in our family we hold dear are X, Y and Z, caring for other people is important. Those kinds of things are useful at a training level, you know, from youth. But if you’re an adult and you want to become more empathic, which I think is is mostly your question, I think it comes from practice. I think it comes from making conscious choices to go out of your way to do that, making a habit of that. And then over time, I think people will find that they’re more able to do it naturally without even thinking about it.

Brilliant Miller [00:26:00] Thank you for that, that is an interesting distinction between empathic, and empathetic, and I like what you’re saying about being empathic as a way of being. And it’s something that we could probably cultivate, but maybe only to a point, I mean, just like we all have a height. We all have physical attributes. It makes sense that we all have kind of emotional attributes as well. But then within what we’re given, we can either cultivated or ignore it and so forth. And to me, empathy is something that’s very close to love, it’s definitely different. I think that’s why we have two words for it. But as I look at myself and I realize that I might be closer to the end of my life than the beginning of my life and how I want to be remembered and the kind of person I want to have been. And I think many people are this way. I see this in the coaching that I do, that many people do seem to make a shift from, you know, acquisition and accomplishment to a qualitative way of living even beyond any specific goal and that kind of thing. But then it’s like, OK, that’s a major life shift. But then that question of how right and you’re saying it’s a choice, and I realize this is still this kind of an abstract conversation because it’s again individual, what does this mean for each person when they walk in the door at home or they show up at work, how they are? What have you found for yourself? That has been useful, either as like a habit or a practice, something you’ve begun or you’ve stopped doing that has helped you, you think has helped you to cultivate this quality of being empathic.

Adam Stern M.D. [00:27:32] And in some ways, I think that skepticism, and I don’t think skepticism is quite the right word. what I think is the opposite of empathy is an inability to appreciate the world that you’re living in and your life in that world. And so something that I’ve started doing in the last few years is literally practicing gratitude, taking some time every day to think of specific things that can be big or small, abstract or concrete, specific things that I’m appreciative of in my life in that moment. And that has been actually, I think, very helpful in helping me cultivate and sort of optimize my levels of empathy. Because if you are irritable, if you are disgruntled about things that are going on in your life that you feel like you’re being forced to do or you’re, you know, people treating you poorly or anything like that. That’s an empathy drain. Those things will drain your empathy faster than anything else. If you feel like you’re not getting a good deal in this life, that you’re being unfairly treated in this life, and the antidote to that is to practice gratitude, in my opinion. And that’s something that I’ve started. I started doing personally a couple of years ago after I came across some of the literature that shows it has all kinds of benefits, even health benefits, things like reducing hypertension and, you know, people having a higher quality of life.

Brilliant Miller [00:29:20] Gratitude is such an interesting subject for me because. Sometimes, and I don’t know if you have this experience yourself or you work with other people in this regard, but sometimes gratitude, attempting to practice gratitude can kind of backfire. I think, right, because it’s like intellectually, I can know I should be grateful. But emotionally, I might not feel it. And then there’s this sense of like, well, why don’t I feel the gratitude that I should have, especially when I’m comparing myself while I have, food, I have clothing, right? I’m not in a conflict zone like I can know all that. But it doesn’t mean, again, it doesn’t mean that I feel it, and I remember one time Tony Robbins, who of course, espouses gratitude as a practice as well when he talks about he’ll say, “Think about what you’re grateful for and then think about why”, I guess why as trying to access the emotion more fully. But what’s your experience with this thing where gratitude can sometimes just be a concept and other times it could be something that we actually feel? And how do we get closer to the feeling?

Adam Stern M.D. [00:30:28] Yeah, my thoughts on that are that I think that a lot of cognitive processes the thoughts and sort of chains of mental, you know, sort of arithmetic you’re doing on behind the scenes. I think a lot of that can be likened to exercise. And so if you do, if you go to the gym or you go for a run or you do whatever you might do one time, it might be really challenging. If you make a habit of it, it starts getting easier and not only easier, but you start actually sort of doing it better and more naturally. And so I think that to me, something like that, there are absolutely moments where I say, OK, before I go to sleep here, I better come up with three things, not in the mood to do this, don’t feel like practicing gratitude. But I think that that’s gotten less and less the longer I’ve been doing this. And I think that it’s in part because, you know, our brains are, like you said earlier, our brains are very poorly understood in terms of when compared to things like the heart or the lungs or the kidney in terms of the very mechanics of how it all works. But one thing that’s pretty well figured out is there’s a plasticity of how our minds work and that change can happen. And practicing cognitive or behavioral techniques to change habits can leave someone in a sort of changed state so that that would be my response. I do think it’s hard, and sometimes you do fall into a trap of comparison. Well, I had a really rough day. Can I just skip this today? Kind of thing. And sometimes you do that. Sometimes I do that. But on the other hand, I do think it’s sometimes a trap to compare yourself to other people to say, Look, I’ve got all these wonderful things in my life. Why do I feel this way? Asking the question, Why do I feel this way is a powerful tool, but only if it gives you better insight into what you want to do with that feeling of how you want to address that feeling. If it’s used as a sort of a way to make yourself feel worse about why you feel that way. And usually, it’s not a useful thing, I would say.

Brilliant Miller [00:32:49] Yeah, you know, on that point, you’re right. And why is this such a fascinating question? Because sometimes it can be the most empowering question we can ask, and other times it can be just an endless regression that we use to make ourselves feel worse or stay stuck or whatever. It’s totally amazing. Well, talking about, you know, some of these qualities, gratitude, being grateful, being empathic, one of them that I’m really struck by that you share about in the book is the quality of presence. And I think it was on a whiteboard. You wrote a note “here with you”. I think those were your words. Yeah, but that was something that I got the sense. Maybe you could talk about why you wrote that, but I saw that. And that was, I think, in your fourth year where earlier in your training, maybe you hadn’t yet seen the power of just being with another. Will you talk about presence when you talk about that message on the whiteboard and what you’ve learned about it since?

Adam Stern M.D. [00:33:42] Absolutely. I think that one of the paradoxes in psychiatry and therapy, in general, is that we know that all these super different approaches to therapy and the Therapeutic Alliance, might be night and day in terms of technique, but they all have been shown to be effective in various ways. And so something like cognitive behavioral therapy is super different than a psychodynamic, insight-oriented therapy is super different than acceptance and commitment therapy. There are all these techniques and they’re all incredibly unique, and yet they’re all effective for different people. Why is that? The thing that they all have in common? This is my idea that’s probably shared by a lot of people. In other words, they would say, Oh no, I thought of that years and years ago, is that the thing that all of these approaches have in common is they’re at the core is the human connection between a therapist and a patient or just two people. Right? And so when any two people are in a room together, the thing that you can always count on is that they’re present together. I just watched some clip of Quentin Tarantino talking about the movie-going experience as being superior to watching a show, a movie on your TV by yourself, which I might disagree with, but his point was, with going to the cinema, you’re having this shared experience. You have an individual experience with the movie, but it’s within the context of this overall group. And that’s that only happens one time in the entire universe. And that’s what makes it special. You don’t know who’s going to gasp and who’s going to, you know, share your emotional reaction to a scene, et cetera. So I thought that that kind of resonated with me, that there is something powerful in being together. And the Therapeutic Alliance can only really happen when you’re feeling like you’re sharing an experience. Right? And so in the book, I talked about this particular patient, Charlie, who I saw over a couple of years in different environments and I was with him as he got progressively sicker with cancer diagnosis until at the very end of his life, which was fairly well known that it was going to come at some point. You know, he was largely unresponsive and I visited him in a social way. In his last hospital room and I couldn’t have a conversation with him, but I felt compelled to leave a little message on the whiteboard that was in the hospital room that just said that I was there, and it gave me comfort to know that that message was there all the way until he was no longer even in the hospital until after he had passed away, presumably. And. It reminded me it’s such a basic human sort of moment to me because it reminded me even of what little children do when children are beginning to go off to school or they’re beginning to go away, you know, or to a sleepover at a friend’s house or something like that. They’ll often have what in the field will call a transitional object, something that they bring with them that reminds them of home, of their family, of whatever it is that they’re venturing away from. And so that power of this teddy bear, this little trinket I’ve got, I’ve got all kinds of silly things on my office desk. Here we go. Oh, there we go. Anyway, so my point is there are all kinds of things that have meaning to me that are here and make me feel more comfortable. Leaving that tiny message on the whiteboard just made me as the person who is surviving that experience, feel OK with walking out the door because I knew I was leaving a tiny part of myself behind.

Brilliant Miller [00:37:36] That makes me think about how remarkable it is that we can be present, even when we’re not physically present, we can, you know, someone can feel closely connected. And conversely, we can be together and feel an enormous emotional distance. Right. But I just think this is an interesting thought because it’s one that I think we live with, but a) we’re not necessarily aware of and b) we don’t cultivate and how the how our lives could be improved if we did, you know that kind of thing. So thank you for sharing that I was touched by the thoughtfulness and your example in the book. You mentioned Charlie had cancer, I understand you’ve had your own experience with cancer as well.

Adam Stern M.D. [00:38:18] Yeah, I’m going to be very open and frank because that’s how I approach this topic. So content warning for anyone who’s anxious to, you know, doesn’t want to hear about cancer or end-of-life stuff. But I’m currently living with cancer, so I’m, as you can hopefully see, I’m well, I’m at the office, I’m feeling good. My last couple of scans have been very encouraging, but I’ve been living with this for almost four years.

Brilliant Miller [00:38:46] Sorry to hear that.

Adam Stern M.D. [00:38:48] Thank you. Yeah, no, but it’s I appreciate I appreciate that comment, but at the same time, it’s something I almost brought this topic up earlier, but I didn’t want to jump the gun. I, when we’re talking about gratitude and empathy and how do you become, how do you view life differently? I wouldn’t recommend this for anyone but a major life stressor like living with cancer and suddenly out of the blue. Being diagnosed with something really changed how I viewed the world in all kinds of ways. I think that maybe within the first few months, I felt less empathic. And then beyond that, I actually felt more and more empathic and I was more able to connect with people. And I also changed the way that I view every single day and what kind of things I want to do with my life. And that was, you know, I wish I were under different circumstances. I really do. But under the circumstances that I’m in or within the circumstances that I’m in, I have to say that it has brought certain gifts as well.

Brilliant Miller [00:39:56] You’ve talked about and written about depression that has come with that, and will you talk about that and how you’ve dealt with it?

Adam Stern M.D. [00:40:08] Yeah, so, you know, it’s hard to compare, you know, like my own experience with anyone else’s in particular with my concept of what clinical depression looks like or anything like that. But you know, for me personally, when I was diagnosed with this was kidney cancer. It was stage three at first in twenty-eighteen. At that moment, I looked up the survival rates for five years and it was like 50 50, essentially. And then when it metastasized in my lungs, it was down to like eight percent at that moment of four or five-year survival. Now what I didn’t know at that moment was that survival rates are backward-looking, so they’re looking at data from the last five years, not the next five years. And you’re not a curve. You’re not on that curve, right? You’re an individual. And so it’s a trap to suddenly get this diagnosis and then feel like your world is over, like the future that you thought you had. It is gone. It’s not gone. It’s just different, I should say. And so it’s a trap where very often people have to come to terms with the idea that life is different than they thought it was, but that at a certain point you realize that life has value. What lies ahead of you still has value and it can be as incredible as you know, serendipity might allow. But only if you put yourself in the position to actually engage in life if you become despondent and withdraw from your life in the face of, uh, you know, a potentially lethal illness, then you are forfeiting your hand, you’re giving up what opportunities you may have. If I had done that, I never would have. I never would have had my second little boy. I never would have written this book that we’ve been talking about. I never would have written all these essays that led to the book, all kinds of things that I look back on now as some of the most incredible parts of my life, seeing my almost five-year-old become a more fully formed person. All of those were things that weren’t guaranteed, but that I had to, you know, sort of commit to being an active participant in my life again before they could actually happen.

Brilliant Miller [00:42:40] You know, that idea of being an active participant in one’s life is also an idea that’s interesting to me because I think we kind of go in and out of those periods in our life where at least throughout any given day, that there are things that are difficult to their unpleasant and there’s an escape and, you know, avoidance and this kind of thing. But I appreciate you talking about this, and it sure brings up a lot for me. I am curious to know when you get a diagnosis like that and it changes the way you see the world in the way you live. Having lived with that, living with that now, do you think there’s any way that one can have that kind of life-changing perspective without having to go through a diagnosis? Like how can we more fully appreciate our lives or how can we more fully engage with life? Or how can we make it? How can we more fully fulfill our potential, this kind of thing without going through that, do you think is possible? And if so, how could we do it right?

Adam Stern M.D. [00:43:44] I always ask myself that same question because I run into this very paradoxical thing of like, you know, I wouldn’t wish this upon anyone. And yet I wish people had the view. You know, the view of it, you know, just temporarily just spend an hour, you know, knowing that your time is limited because that’s true of all of us, right? That’s something we all share. Nobody knows what you know is going to happen in their own lives. Some of us just have been given a sort of a glimpse of the likely path forward. But no one has a guarantee to live to 100 or anything like that. So I have asked myself that question quite a bit, and I haven’t come up with the right answer. I wish that I had. Sometimes I will be in conversations with people, and I will notice myself saying in my own inner monologue, My goodness, you’ve got to change your life, you know because you are not living according to what you want. You know, your values say that you want to be close with your children, but you’re working 80 hours a week. You know your values. Say that you want to get along better with your family, but you’re doing x, y, or Z to distance yourself from your family. Sometimes I’ll catch myself saying these things to myself. You know, I know that I want X, Y, and Z. And why am I acting in this other way? That’s counter to that. So, you know, one of the things that I would advise people, and I don’t know if this is totally feasible or if it’s wishful thinking, but I would advise people to really set out what their goals are not like concrete goals. What kind of outcomes will make them most content not like happy, joyful, but content that the life they’re living is the one they want to be living. Because one thing I know for sure and this is something that the diagnosis really hammered home for me is that there’s so much of what we do that is based on the inertia of just doing what comes next and the feeling of responsibility to do what’s asked of us. And those two things are very dangerous to me because we can build up a certain momentum and just keep going down that road, even though it might make us miserable or leave us feeling hollow or lead us down a path that we just never really wanted to be on. And we forget that we’re empowered to make choices and we can say no to things, and we can say yes to things that someone else looks at and says, Why on earth would you do that? So those are pieces of, I don’t know, they’re not wisdom, but they’re definitely insights that I’ve had since the diagnosis that I wish I could convey to people. Yeah.

Brilliant Miller [00:46:36] Thank you for sharing that. I’m reminded here again of this difference between the intellectual understanding of something and the emotion and the experience of something and how there seems to be, in my case, at least often like a glass ceiling between those. And I feel like I’m touching, you know, I’m accessing that emotion, but it’s also kind of scary. Like, it’s raw. It’s not something I’ve read about some of the Buddhist teacher Chogyam Trungpa. And he wrote a book called The Shambhala: The Path of the Sacred Warrior. And of course, he puts it very poetically about letting your raw heart be open to the world and things like this. And in moments, I feel like, Oh, I can do that, I’m willing to do that. And then there are other times that it’s like, That’s hard, man, you know, shoot. Well, thank you for talking about that.

Adam Stern M.D. [00:47:31] I just want to add, you know, there’s something to this idea that so many of people that we consider enlightened and sort of having figured it out live very basic existences. You know, there’s a certain sort of I don’t know the material aspects of our lives. Sometimes they can be wonderful and sometimes they can probably do more harm than good.

Brilliant Miller [00:47:59] Yeah, I think you’re absolutely right, and as you said, you know, many people who are perhaps enlightened do live a simple existence and even the zen saying of before enlightenment chop wood, carry water after enlightenment, chop wood, carry water. But even for those that do seem to have it figured out or know something the rest of us don’t like, I was just reading online a little bit more a couple of nights ago about Alan Watts. You know, the celebrated philosopher and Zen teacher who died of alcoholism, I think, before he was 60. And it’s just amazing and challenging. Paul was also a well-known alcoholic and so forth. And that’s not even to say of the spiritual teachers that seem to have other moral issues, but none of us in this human incarnation seem to, you know, walk on water yet.

Adam Stern M.D. [00:48:48] No, that’s you’re absolutely right about that. We’re all imperfect in our own ways. And yeah, I think you’ve got that. You’ve got that right.

Brilliant Miller [00:48:59] Something I want to talk about is is the power of questions. You share an anecdote in the book about your first, as I understand it was like your first therapeutic appointment and you began with kind of a soliloquy about what you hoped this would do for the client or the patient. And later you learned that it was more effective to start with a simple question will you talk about what you’ve learned about the power of questions?

Adam Stern M.D. [00:49:26] Absolutely. So questions can be so broad that they open up the entire world to someone else. You know, they give them the opportunity to choose whatever sort of answer that leads them down a certain path that they want, and they can be so narrow that they close off important things. So. The more that I practiced psychiatry, the more I appreciated the power of open-ended questions, at least at the beginning of a conversation, because as a psychiatrist, my goal is to figure out what’s important to the person. They might not start off with what’s important, but if you let them talk for long enough, you’re going to get there. Whereas if you fill out a form that has checkboxes of yes or no, or maybe are you having trouble sleeping at night? Are you eating OK? Are you experiencing feelings of guilt or low interest in activities? These are symptom checklists, you know? That is the fastest way to a diagnosis and the slowest way to figure out what is bothering a person or how you can help them. So I have figured out that with more experience, I’ve learned that it is good to start out a conversation by just figuring out how you can get to know someone. And that’s a very powerful thing to ask without a sort of agenda. What brings you in? What’s on your mind? You know, those kinds of things are so basic and yet so powerful for someone like me who wants to know truly how they can help.

Brilliant Miller [00:51:02] Yeah, and they’re so simple, right, that what brought you into the office today? What’s on your mind? I’ve read once about that’s the question that Facebook asks as the prompt to have you make your post and that they’ve, of course, toyed with, you know, they’ve tested different questions and found above and beyond that what’s on your mind is like one of the best.

Adam Stern M.D. [00:51:26] When I was in training and supervision, this isn’t in the book, I don’t think, but there’s a process where you with a supervisor, you’ll present your process notes like this are how this therapy session went. The patient said this and I said this, and then they responded this way, and then I responded this way. And the supervisor who’s well established and well trained can point out ways that you might have done in a different direction. Or, you know, consider how it might have impacted the patient. And it was like one of my very first sessions with a very well-respected supervisor, and I said, So how have you been doing? And right off the bat, he sort of stopped me and said, we don’t care how he’s been doing, we care what’s on his mind. And it seemed so strange. I thought. And there was another version of it that was like, What’s new? And it was even worse. It was like, no, no, no. Like, what’s new is what’s new. But that’s not why the patients there, the patients, they’re for help with something or because they need to figure something out. And what’s new might just give you a tiny little corner of that. So what’s on your mind? It’s a much more powerful question.

Brilliant Miller [00:52:41] Yeah, that that’s great. And I imagine, you know, like reading a transcript of interaction or just evaluating questions. There’s this whole other component that wouldn’t necessarily show up in that, which is then the power of silence. Right, will you talk about what have you learned about silence in the interaction with another person in a therapeutic or maybe a coaching kind of situation? What have you learned about it and how do you use it deliberately?

Adam Stern M.D. [00:53:12] Silence makes most people pretty uncomfortable, I think. In the book, I talk about this sort of seven-second rule. And so when I talk about this topic, I like to demonstrate it just briefly for anyone listening where we’re going to practice silence for like a good seven seconds, I’m going to count in my head and then I’ll come back starting now. So that’s seven seconds to me that I might have even rushed it because I was on, I was nervous, you know, to not make everybody wait too long. It’s uncomfortably long when no one’s talking. And one of the reasons that in my field, we’re trained to become used to and sort of exist within the silence and not rush into the next topic of conversation is because the silence is a tension that we all experience that sometimes can break through a layer of defenses where a patient might actually break that silence with something else that is underneath the surface. They might actually bring something up that leads you to the next thing that leads you to something important. And so conveying to a patient that you’re not afraid of the silence that it’s OK to just sit together quietly in the room for a couple of minutes. You know, if you have to, you don’t want to stagnate, but you don’t want to rush into another superficial topic when a patient might need the space to actually take a moment to actually think of, not even consciously, but just arrive at something that’s more under the surface. It’s more important to them.

Brilliant Miller [00:55:01] You know that is such a cool way for me to think of silences that it’s as a tension that can help like breakthrough or elicit something that previously wasn’t available and that you literally, that’s one of the things that’s so beautiful and fascinating to me about these interactions, and I love your term. The Therapeutic Alliance is that you can help create that. Someone can then bring something forth that was already there for whatever reason they didn’t bring forth already or maybe weren’t aware of or whatever. That’s a cool way to think of silence. Thank you for that

Adam Stern M.D. [00:55:34] One demonstration of it, if you think about any time that you are walking in a hallway and someone else is walking in the opposite direction, you’re about to pass. Even if you’re friends, you are almost never going to pass without verbalizing, Hey, how are you doing? Even though you don’t, you’re not even stopping, right? You’re just, you’re saying, How are you doing to feel this? You’re conveying hello, but you could do that with away if you could do that with a nod. But hey, how are you doing? I just love that question because it’s so false. It’s literally just there as a placeholder to convey, I see you. Yeah, I see you. You know, and we’re not going to walk by each other in silence. I think that it makes people very uncomfortable.

Brilliant Miller [00:56:23] You know, I love that you brought this up because I learned from Sadhguru, the spiritual teacher. He said that it’s his belief and I might be misquoting him, so I just want to acknowledge that, that part of the mental and wellness in our culture is based on the dissonance of that simple question is that we ask? And then, of course, we don’t. They’re not really wanting a full explanation. And so basically, we lie. And there’s this dissonance between our experience and what we’re expressing. And he said, in India, we don’t ask people how they’re doing. We just look at them.

Adam Stern M.D. [00:56:54] wow, I didn’t know that. That’s really, really fascinating. Yeah, I don’t want to make a kind of self-aggrandizing comparison, but I did write a piece for the Harvard Health blog where I was trying to say this was after the day that I was literally waiting for the results of my cancer test. I ran into a colleague and he said, Hey, how are you doing? And I said, Oh, you don’t want to know basically is longer conversation than this, and he’s a good person. He stopped and we talked a little bit, but it prompted me to think, let’s not ask ourselves how we’re doing if we don’t actually care or have the time to listen, you know? So I wanted to start a movement and I’ve tried to do this for myself, but I still sometimes fail at it even to this day, where I try to say It’s nice to see you. If it’s nice to see the person or even I see you is a harder thing to get away with to pull off. But I think that’s so interesting that in other cultures, this isn’t a phenomenon.

Brilliant Miller [00:57:55] Yeah. Well, then as I understand, even in Indian culture that literally translated Namaste got them is I see you right on it. More poetically, the divinity in me sees the divinity in you, but how beautiful. Even though it’s become colloquial and it’s a hey kind of thing, in many cases, it’s still that literally that’s what they’re, you know, saying. I love that. It’s fascinating. Yeah. OK, so we’ve talked a lot about this book in your life or your career. Before we transition to the enlightening lightning round, what haven’t we covered that you think maybe the listener would benefit from or enjoy hearing about?

Adam Stern M.D. [00:58:33] All right. I’ve got a couple of things I’m going to go through that I think we haven’t covered so one is why would someone go to medical school to then subspecialties in psychiatry? If you’re someone out there listening and you’re interested and you know you’re listening to this podcast, you’re probably interested in things like How do you live a better life? How do you, how can you achieve better, you know, levels of contentment, that kind of thing you might be considering or you might even be in a field where you’re going to turn this into part of your, your work, your life, your life’s goal? And what would a little corner of that be? Well, what kind of path should I take? And what I would say is I ended up in psychiatry really through the back door because I first I really loved psychology, and then I decided I wanted to be a doctor like my father. And then I said, Well, now that I’m on the path toward being a doctor, I realized, No, I really want to do what I’m most passionate about, connecting with people. And so I think within this little field of medicine, psychiatry is the best for me. And so that’s how I ended up in psychiatry. But there are, you know, there are degrees out there that are better at connecting with people than psychiatry, things like psychology, social work, coaches, people that are doing work that has nothing to do with my medical training, where they get to connect with people at a much more basic level or more thorough level, deeper level, all kinds of things. So I would never discourage someone from going into psychiatry if that’s what they wanted to do. But I would encourage people to open your eyes to the entire world of human connection within the professional realm. There’s a tremendous array out there that you can get exposure to and sort of get a feel for and then let that guide you in your path.

Brilliant Miller [01:00:37] I suspect that’s exactly what somebody listening to this needed to hear, and maybe they didn’t even know it.

Adam Stern M.D. [01:00:44] Thank you. The second concept that I have learned. Through circumstances, I don’t think I would have come across this if I hadn’t followed the exact path that I’d been on. For much of my life, and I suspect this is true of a lot of people out there, I lived a certain life that was where certain amount of my self-worth, to my own estimation, was based upon achievement that fit into a certain box academic achievement, writing papers that would get into medical journals even going back 20 years, getting into a certain kind of college, that kind of thing has been hardwired into me, in part because of how I had just who I am and in part because of what was instilled upon me. And it’s only until I really became an adult and had the threat of all of those things sort of lifted from me based on this illness that I’ve realized that at this moment, the things that I find most important have almost nothing to do with achievement in that way. They have much more to do with trying to align my actions and behaviors with my values. And that might be again trying to be a better dad to my kids, trying to be a better husband, to my wife, trying to be a better son to my parents. Those things carry so much more weight than they used to for me. And now it really, I’m sure, sounds silly to a lot of people out there listening, but really pause and think about your day to day life and how much of it is spent doing those kinds of things versus trying to achieve the next milestone in your academic training or what have you. And those kinds of achievements getting a public, a popular, or getting a paper published into a journal. I hope my colleagues at work are listening as I say this. They mean so much less to me now than they did 10 years ago. They’re still really important when they’re important, right? When something a project, a research study that I partaking in that I’ve participated in gets accepted somewhere and might help change the field in a way that might help patients, that is extraordinarily rewarding for me. But when I’m on a paper that gets accepted somewhere and I know that this paper probably isn’t going to move the needle, that is sometimes something that I think is time lost. And I say to myself, I’m not going to take that opportunity the next time it arises. If I can identify it in advance, I’m going to redirect that energy toward the things that I think are really important. Whatever they may be, we all have different ideas about that.

Brilliant Miller [01:03:44] Yeah, I appreciate that view. You know, maybe a kind of a corollary to that. I look at my dad, who is an extraordinarily successful entrepreneur. And I often ask, you know, could he have achieved everything he did in a fraction of the time. 70 percent, 80 percent of the time he invested, and I suspect he could have, you know, but I don’t think he asked himself the kinds of questions that you are now.

Adam Stern M.D. [01:04:10] Very hard to thread that needle to know how much is enough to achieve your quote-on-quote dreams or to get there to make it. You know, when I look at people in politics or celebrities of a certain kind or, you know, and they just continue to grind, the only way I can think of it is that that grind must be how they achieve a sense of flow, how they find some sense of peace in the world. Because when I look at the grind, sometimes I think, you know, they made it. They don’t have to keep doing it, they don’t have to keep trying so hard. But they do. And the way I think about it is that is their state of being that they must not know how to be content any other way.

Brilliant Miller [01:04:57] Now I’m with you and I’m so fascinated by this. This could be its own whole book to explore. You know what motivates us and whether people can be driven to these incredible levels of achievement by what I would call empowering emotions versus it seems like the majority of people who succeed, at least in a worldly, according to a worldly measure actually driven by very disempowering emotions. And I think a lot, and I realize that’s just my judgment, right? But my armchair philosophy. But I think about that saying by Jung about a man who will do anything, no matter how absurd, in order to avoid facing his own soul. And I think that people do do that. To achieve a lot.

Adam Stern M.D. [01:05:42] Absolutely.

Brilliant Miller [01:05:44] OK. Awesome. Well, thank you for that. How are you doing, by the way?

Adam Stern M.D. [01:05:49] I’m doing well

Brilliant Miller [01:05:50] yet. OK, well, if you’re good, then I want to go ahead and transition us to the Enlightening lightning round.

Adam Stern M.D. [01:05:56] Let’s do it.

Brilliant Miller [01:05:57] OK, so this is a series of questions on a variety of topics. My aim for the most part is to ask the question and stand aside. You’re welcome to answer as long as you want, but I’m going to work to keep us just moving through this.

Adam Stern M.D. [01:06:10] OK. All right, sounds good.

Brilliant Miller [01:06:12] All right, question number one. Please complete the following sentence with something other than a box of chocolates. Life is like a.

Adam Stern M.D. [01:06:23] Series of opportunities with all kinds of consequences. I think that we exist at this moment in time. It’s warped at all times in our perception by what’s just happened and also what we hope or worry or fear might happen. And so at that moment, we always have the opportunity based on our free will to make choices, sometimes with more choice than other times. But it’s always an opportunity, and that opportunity always comes with rewards and consequences and everything in between. That’s what I think about life.

Brilliant Miller [01:07:03] OK, thank you. Number two, here I’m borrowing the technologists and investor Peter Thiel’s question. What’s one important truth is very few people agree with you on?

Adam Stern M.D. [01:07:18] I think that. Psychiatry, to some degree, is pretending to be something that it’s not. I think that psychiatry was invented by a neurologist out of wishful thinking that we could look at the mind from a top-down process as opposed to a bottom-up process, which would take another hundred years from when when Freud was first publishing and before that, certainly there have been other psychologists from all kinds of different parts of the world. But psychiatry as a field right now is very clear. Trying to be a medical subspecialty. And partially succeeding. And one of the bargains, this is the part that I think is most controversial about what I’ll say, because everything I’ve said so far, maybe some people are nodding along like, Yeah, I get it. But one of the bargains that we’ve made to become a medical specialty is to create diagnoses where they don’t exist. That have we’ve justified them because of a certain degree of validity and reliability? If you show five psychiatrists this patient, they’ll agree that’s that they meet the criteria for this diagnosis. But what I think is that at its most granular level, most quote-unquote diagnoses in psychiatry are probably amalgams of lots of different things happening and that we can make patterns out of almost anything in medicine and as people in general and psychiatry has become very good at that. And so I think one of the risks of our field is that we have gotten away from treating individuals as individuals and that one of the redemptions for our field sometime down the road, it might be 10 years from now, might be 100 years from now, will be to look at a person as an individual and to offer what we think is best for that individual, regardless of what categories they might fit into.

Brilliant Miller [01:09:31] Well said. Thank you. Question number three, if you were required every day for the rest of your life to wear a T-shirt with a slogan or phrase or saying or quote or equip on it. What would it say?

Adam Stern M.D. [01:09:48] I suppose after this conversation, it has to say, “I see you.”

Brilliant Miller [01:09:53] I love it. OK. Question number four, what book other than your own, have you gifted or recommended most often?

Adam Stern M.D. [01:10:09] Most recently, I have been recommending the codebreaker. This is a book by Walter Isaacson about Jennifer Doudna and lots of competitors and colleagues who are unraveling this amazing natural tool and trying to expand upon it called CRISPR to edit the human genome to potentially do all kinds of wonderful things and potentially do all kinds of controversial things. You know, if we had the ability to have parents choose to have taller children or less tall children, is that a good thing? Well, probably not such a good thing. But what about eliminating things like hemophilia or, you know, genetic disorders? Well, that’s probably a very good thing. Most people would agree on that. So finding that line is a really interesting part of that book, and I’ve been recommending that to a lot of people who I think would be interested in it. And. One thing that I keep thinking about and trying to respond to this question is that there’s an old Roald Dahl book called Danny, the champion of the world. Very familiar with this book.

Brilliant Miller [01:11:20] No, I love Roald Dahl, but I don’t know this book,

Adam Stern M.D. [01:11:23] so I’m going to be very frank. I haven’t read it since I was very young in grade school, and so it might not be like, I remember it, but when I read it, I said, That’s my favorite book, you know, and it remains my favorite book for a long time. So much so that I think I haven’t reread it because I’m afraid to read it and realize, like, it’s not as good as I thought it was. But in this book, there’s a father character and a son character, and the father is off very often poaching pheasants, which like poaching birds from some large farm. And I remember as I was a small child reading this book, thinking that that’s going to be an important part of life is knowing how to poach poultry, you know, and and then as I’ve grown up, I’ve realized like that that probably represented something else in the book. It wasn’t about the poaching of the pheasants that was really the important part. It was something else. So I don’t know. That question just reminded me of that, and I think I have to reread that book. But anyway, it was when I was nine. It’s a wonderful book.

Brilliant Miller [01:12:35] Know, it’s like if your son is five is getting close to where he might also appreciate that book.

Adam Stern M.D. [01:12:39] Right, right. Maybe we can read it together.

Brilliant Miller [01:12:43] That’s great. So you’ve traveled a fair amount in your life. Of course, pandemics change travel for all of us. But what is one thing you do or you did when you travel to make your travel less painful or more enjoyable?

Adam Stern M.D. [01:13:11] Traveling with people that you travel well with is an incredibly important thing. I’m thinking, you know, this question is landing with me at a particularly bad time. Forget about the pandemic for a moment. We’ve in the last four and a half years have only traveled with a small, small, small child and we don’t travel well together, even though I adore him to the moon and back. And so traveling with people that you travel well with that you enjoy seeing the world with doing things with, that’s irreplaceable. And if someday, if my boy listens to this interview, I hope he forgives me for saying that, but just know that we do not travel the same way.

Brilliant Miller [01:13:54] Traveling with children is its own art and science, no doubt. And what you’re saying about a traveling companion? Oh my goodness. It’s like a plus one minus one. The difference between having one that you enjoy and that makes the journey go smoother versus one that you’re always waiting for, or you can’t agree on anything. Yeah, yeah, for sure. OK, question number six What is something you’ve started or stopped doing in order to live or age well?

Adam Stern M.D. [01:14:29] Right, sometimes I wonder, am I succeeding in that effort to try to live better? You know, I mean, I guess that’s a big theme of the show, but I think I’ve made a lot of changes in the last few years in the context of this diagnosis that we’ve talked about. I’ve given I used to love, you know, those incredibly inexpensive ramen noodles that you can get at any corner store. I used to love them and I just have this hang-up like, that’s probably not so good for someone with one kidney or one part of one kidney. And so I’ve given that up and I miss it every day. Ramen noodles and you know, at a more, I don’t know a philosophical level. I’ve tried really to ask myself, is this what I want to be spending my day doing? Is this what I want to be spending my energy doing? That’s a theme. You know, I’ve already talked about it a number of times today with you, but I can’t tell you how many times the answer is no. Actually, five years ago, I would have done this differently because right now I can see I don’t want to do that. I’m going to change the way I’m doing that or approaching that. So there’s a really concrete and a really more vague answer for you.

Brilliant Miller [01:15:58] Thank you. I’m reminded of something I once read that Ernest Hemingway said or wrote, Never do what you sincerely do not want to do. Like, that’s interesting. I try to phrase my advice when I give it in the affirmative, but that’s the abstain from. Yeah. So OK. Question seven. What’s one thing you wish every American knew?

Adam Stern M.D. [01:16:30] Oh, it’s hard not to answer this in the context of our current circumstances around the house, how divided we are, and how divided it feels. Yeah, I guess I would say, I guess I will answer it in that context, and I’ll say that we have so much more in common than we do. And then what separates us? There’s so much more humanity shared between us and then what? What separates us? I feel like I really wish if only we had that sense embedded in us that our lives would just be so much more harmonious and less filled with whatever descriptor you want to call this current era of, you know, division and rage and being angry with one another, even though we’ve never met, you know, kind of thing.

Brilliant Miller [01:17:26] Yeah, absolutely. Question number eight, what’s the most important or useful thing you’ve ever learned about making relationships work?

Adam Stern M.D. [01:17:38] I think that you have to meet people where they are. And so this is true personally, this is true professionally, any kind of relationship where you’re trying to connect with another individual and share an experience or share a connection and share a relationship, et cetera. If someone gives you, you know, some sort of signal that they’re not, you’re not seeing eye to eye that you’re talking past each other, that they’re not ready or that you’re not ready to do the thing you know, they’re too ready to do something that you’re not quite ready to do. You know, trying to say to yourself, Can I adjust? Can I meet this person where they are? Or is that a bridge too far? Am I able to do that therapeutically sometimes? You know, there’s this little terrible joke in the book that’s widely known in the field about psychiatrists changing a light bulb. It only takes one, but the light bulb has to want to be changed, you know, and it takes a really long time. Then, you know, sometimes patients aren’t ready to do something, but they are ready to do something else. And so even if it’s not what you prescribe, but it’s halfway there or a quarter of the way there, you take that and you try to align with them in that goal because that’s better than not going anywhere. And I think you could extend that to personal relationships.

Brilliant Miller [01:19:00] Yeah, I think so. Thank you for that. And question number nine, aside from compound interest, what’s the most important or useful thing you’ve ever learned about money?

Adam Stern M.D. [01:19:43] I haven’t learned that much. I think the more I learn, the less I know about money, but the first most important thing is that we can feel pretty content with a lot less money than we think we can. You know, I’ll just be very frank, that, you know, I grew up the son of a cardiologist who gave us a really comfortable life, which is probably a very different life than you may have grown up with, then someone else may have. I don’t want to make any assumptions, but it’s also more, you know, we grew up with more money than I currently make. And as a psychiatrist, and I’ve learned actually that. I can live really comfortably like that with less money than I grew up with. That’s sort of a mind-blowing idea because I spent the first 25 years of my life thinking, Oh boy, how am I going to match the lifestyle that I grew up with? You know, so that’s been a really interesting thing to learn. And then the second, this would also work for potentially for an earlier question of, you know, what something that people might disagree with. But more and more, I think they agree that most money the idea of money is really a construct that’s made up entirely, you know? And so we’ve all agreed to play by this rule. For the most part, that will treat money like it’s a real thing, but it’s not in the way that kids understand it. It’s something much more complex. And when I learned that idea, it somewhat shook me because you realized that you spend so much of your life’s energy trying to accumulate this thing that pretends that we’re all pretending we’re shareware, agreeing to pretend that it’s a fake.

Brilliant Miller [01:21:41] Yeah. And I think now cryptocurrency is exposing that in some, some new ways, right? It’s right. It’s pretty remarkable. Yeah, thank you for that.

Adam Stern M.D. [01:21:50] I don’t think there’s anything more clear about how you know it’s an agreement to call something valuable in the early days of crypto where it’s like, Oh, this is valuable because people are willing to pay for it. That’s what you know. And you could say the same thing for a certain currency, all currencies. So it’s incredible. But like I said, the more I learn, the less I know about this topic. So yeah, and the faster we move on, the better for me.

Brilliant Miller [01:22:19] Well, just real quick, a point of trivia on this as well. I just heard on I’ve started listening to Apple News. It’s kind of in-between USA Today and NPR and some very listenable like eight minutes. And they always end with kind of an interesting segment of some sort. And one of them last week was about how last year during the pandemic, there were five million new millionaires created globally. It blew my mind this whole thing of decoupling, you know, a resource that whatever gold or timber or something else from a currency is just amazing. And that means for the future of humanity, universal basic income or something else. Who knows? Right, OK. I’m speaking of money. One thing I have done to express gratitude to you for making time to talk with me and everyone listening is I have gone to the micro-lending site Kiva.org and I have made a $100 micro loan to an entrepreneur in the Philippines named Joy. She’s 30 years old. She has two kids. She and her husband run a fishing business, so they will use this money to buy a fishing net and materials to make a fish trap. So I hope, and by the way, I won’t receive any interest from this when Joy repays this, but it’ll go to the field partner who facilitated it to hopefully become a virtuous cycle where other people will improve the quality of their lives in the same way. So thank you for giving me a reason to make that microloan.

Adam Stern M.D. [01:23:44] That’s great. Thank you so much for doing that.

Brilliant Miller [01:23:46] My pleasure. OK, so the last part of the interview here is is about writing and creativity, your habits and routines, might ask you a question about marketing and promotion or publishing, but something that we’ve talked for 90 minutes already and we haven’t touched on is the fact that you’re not only a writer, you’re not only a doctor and a father and husband, but you’re a cartoonist. Will you talk about where? How do you see? Like, how does cartooning fit into your life and how is the life of creativity really kind of one thing if it is right?

Adam Stern M.D. [01:24:22] Well, let me first put a disclaimer that I’m a cartoonist because I say I’m a cartoonist and because I’ve drawn some cartoons, I’m not a cartoonist because I know how to be a cartoonist, you know, in other words, I have no, how do I put it, I have no gravitas within cartooning, except to say that I enjoy doing it. And where it came from was the very first time I ever did a doodle with the idea of sharing it to someone with a punchline or, you know, a gag cartoon sort of embedded was when I when my son was first born and I was up at all hours of the night in the early days. But sometimes he would fall asleep, but I couldn’t like get into a sleep because then I would be awakened like as soon as I fell asleep. It was like that kind of thing. So I got into the habit of when I was on duty with my son. I would I would stay awake and I would doodle these cartoons because I couldn’t do other things. I was like, You know, when you’re in charge of this tiny newborn, you sort of have to be on call and ready. And I was like, Well, this is just feels like I have this new iPad. I’m going to do this and it’ll be something that I can sort of entertain myself with. And then I put it down. I stopped doing it. And then when the diagnosis hit a few years later, I started actually. About 13 months later, I picked it up again. Because, like writing, cartooning is something that I do to help me process my experience of the world. It helps me make concrete something that I’ve noticed that I feel like I need to articulate in order to better understand it. And so I I’ve done all kinds of cartoons. Some of them are psychiatrically related, and some of them are completely off the wall out there having nothing to do with anything but whatever the topic of the cartoon is. And I just love it more than anyone else loves my stuff, you know? So this is something that, like the writing, I’ve always hoped I was a decent writer. Getting this book published was sort of like a Hey, maybe you or maybe you’re pretty good at writing you’re good enough to write this book anyway. Cartooning, I have no hope whatsoever that someone’s going to be like, You’ve got it, kid, you’re going to be a cartoonist. Never going to happen. But I do it anyway, and I love it. You know, it’s one of my favorite things to do.

Brilliant Miller [01:26:51] That’s awesome. I’m really glad to hear that, and I hope that people listening take inspiration from your example of doing something because you love it and having that courage. I would imagine it does take some courage to put it out there in the world, to put it online or in the case of the book, to publish it right? Because to be honest, my perspective, you shared some things in the book that were not necessarily flattering about yourself, but you did it with an awareness. And I think that many people, it’s what’s that saying that doubt kills more dreams than failure ever will? Yeah. And I’ve put this out in the world and your love for it is evidence. So thank you for that example.

Adam Stern M.D. [01:27:28] Absolutely. I think you’re right on there that, you know, nobody wants to read a book, by the way, where the protagonist is, you know, fully self-actualized and just firing on all cylinders. You know, there’s got to be, and if I was going to do an honest reflection of what my time in training was like, it had to be filled with self-doubt and lots of things that were not that flattering. And yeah, I think that that’s the only way that book could be written. But thank you.

Brilliant Miller [01:27:58] What was the moment you knew you were going to write this book?

Adam Stern M.D. [01:28:07] There is a particular moment, so it exists not at the beginning of the journey and not obviously at the end, but somewhere in the midst. By that point. I had already been contacted. So the way that this progressed was, you know, I wrote my whole life in various ways, in different formats. Once I was diagnosed, I had this weird, unique perspective as a physician and a patient. And I started looking at the medical system from the patient’s perspective and seeing all the ways it’s very strange and all the ways it’s imperfect. And I wanted to write essays about that. I wanted to write essays about what my experience as a patient was like. So I started doing that, and one of those pieces got the attention of a literary agent who asked me if I’d ever thought about writing a book. And first, this was like a wonderful opportunity that I thought about a lot, you know, over the years. I reached out to literary agents without much success or really any success. And so the idea that someone was coming to me asking me about this was wonderful. I said, yes, of course I’ve thought about this my whole life. And so then we had to come up with an idea. And we went through a whole series of different options where I thought, maybe we can sort of take the ideas I put out in these essays and and turn them into something tangible that’s worthy of a book. And the idea kept being sort of coming back as sort of insufficient, both in from the agent’s perspective, but my own as well. We needed something original. We needed something where I was an authority on that story. We needed something that was based on truth, but with some liberties taken to protect privacy. You know, we needed something that we could sell. This was the truth of the matter. So there were several months where we were bouncing ideas back and forth where I thought, this is never going to happen. I had this great opportunity to get signed up with literary agent, but in fact, it’s just that’s where the story ends. And then one day this just happens to be true that my best ideas always come to me when I’m in the shower. It’s I think it’s because it’s usually first thing in the morning, and it’s usually when, like all the rest of the noise of my life is out, blocked out and there’s not anything happening besides my own inner thoughts, you know, it’s pretty much on autopilot. And so I’m able to be by myself quietly for a moment, for ten minutes. And I thought, you know, I had a pretty interesting experience and training. Nobody really knows what it’s like to take an M.D. and turn them into a psychiatrist. That idea is a story that I can’t think of a way it’s been told in a really captivating, interesting way. And I could make it interesting by telling it as a first person narrative where I met my wife, where I experienced, you know, this sort of state school to Harvard transition with these really brilliant people around me. And they all had their own interesting stories I could do, like a Gray’s Anatomy version of this that would, I think, be compelling to readers from all across the spectrum. You know, people who don’t really like medical memoirs to people who really love medical memoirs. And so when I thought of the idea, I said, I think that’s it. And I didn’t know it was going to happen until I ran it by the literary agent. And she said, That’s great. That’s that could be a big book. And then B, I had to get my wife’s permission to tell our story from my own perspective when she said, OK. And I knew this was going to happen. That was the moment when I said, you know, the biggest hurdles are now behind me, the agent saying, it’s going to happen and my wife saying, it’s OK, that’s great.

Brilliant Miller [01:31:57] And for those who haven’t read the book, they won’t know that your wife kept your relationship very private for a long time. All right.

Adam Stern M.D. [01:32:05] In fact, yes, she had me use a pseudonym for the character that’s named after my wife. And, you know, she’s a very private person. And one of the things that delights me about this book coming out is that apparently one of the top searches associated with my name on search engines is Adam Stern wife. Like, there are people out there trying to figure out who this woman is, and I adore that.

Brilliant Miller [01:32:34] That’s funny. That’s great. So I want to reflect back on something you said, because I think there’s a lot in there and and it affirms for me, by the way, that every book, every book truly has a story, its own story of how it came to be. And in this one, one of the things that I’m just kind of dialing in on is that you were saying with the I love, first of all, that you reached out to an agent before this and never really got a response. But then you took action by writing and publishing, by sharing these essays in one of those. Eventually, it was like a line in the water that did get there. It did get the result you had wanted, but didn’t achieve until you took action, which is cool. So then it reaches out to you and then together as you’re collaborating on, what is this thing that we could write in? You’re doing the messy, difficult work of creative brainstorming and problem solving and so forth of going, well, maybe it’s these essays. No, that’s not quite strong enough. But what do we need it to be? And when you said original something in which you were in authority and something that was honest and salable like something and that kind of comes back to your original, that this transition from a psychiatrist, an MD to a psychiatrist, nobody had really written. And then I love even your handle like that shorthand of like, well, they’ll be kind of a Gray’s Anatomy version of that. So, anyway, thank you.

Adam Stern M.D. [01:33:54] I had to think because I like I said earlier when we were chatting, I think that I wanted the book to be accessible and there might be someone something in there for anyone to latch onto and really enjoy. And so I think this book had those elements, you know, it has. I hope it really has sort of like an interpersonal drama if that is what you enjoy reading and it has the guts of, you know, how do you turn someone into a psychiatrist?

Brilliant Miller [01:34:25] Yeah, yeah, I think it does. I think you hit that mark. And at the same time, you know, my experience is even once we’ve made a decision and we’ve settled on something, it’s easy to waffle, it’s easy to doubt. And so from here where you had that clarity and in retrospect, it all sounds so clean and simple, right? But how did you once you arrived at those and once you made those decisions or arrived at that clarity, how did you then as a matter, of course, get the book done? Obviously, you’re very busy with family and working as a doctor in this kind of thing. How did you arrange your schedule? What habits and routines did you use? How did you go from that idea to the published book?

Adam Stern M.D. [01:35:06] Yeah, I don’t know how it might have happened under normal times, but just as it happened, by the time the sort of the deal to write the book was done, It was really maybe a month and a half until the pandemic hit and we were sort of locked down. And then we had set up in one of the bedrooms like a makeshift office for like, so we could be working from home in various capacities. And so I would find myself at home. You know, in those days, this is like March 2020. I guess we were suddenly at home like all the time, you know, as as many people in society were. And so I had to carve out, I had to do this. If I didn’t do this, it wouldn’t have gotten done. I had to say, I’m going to write something every day, at least half an hour when I shoot for like 500 or a thousand words. And I don’t care if I write much more than that, that’s wonderful. If I write less than that, I’m going to get back on the horse tomorrow and try to do better. And it doesn’t matter if the writing is any good. I just need to write. And if I got myself to sit down and keep up the momentum, the writing seemed to get better and better. And if I lapsed and I didn’t write for a little while, which happened a few times, I’d have to sort of rebuild my momentum again. And one of the interesting things that I have found and I heard this feedback from editors and then I see it myself, is that the book gets to me. I think the book gets better and better as it goes along. So if someone’s on the fence about reading the book, I always have to say, just get past page 80, you know? It really picks up at page 80, and nobody else really identifies with that as a marker. But to me, it’s like once you know the background and the people involved, then the story gets more and more interesting. And so I think that’s a function in part of how I got into a groove of writing because I was doing it every day. It took me maybe a month to really get into that groove.

Brilliant Miller [01:37:17] Yeah, momentum is a real thing and inertia is real. Yeah. What tools and technology were useful to you, or maybe even indispensable in getting this book written?

Adam Stern M.D. [01:37:33] And one of the things that was important to me was to be able to reach out to all of my former colleagues at this point. Years later, they’re all scattered around the country. And so the idea of literally being able to be in touch with them is something like if I tried to write a book 20 years ago, maybe not 20 years ago, 30 years ago, like, I’d have to write pen and paper letters and track down these people. I wouldn’t. So I give a lot of grief to the social media out there that it’s probably doing more harm than good for us. But you know, as in it as anyone else, but being able to email my class, my former class and say, Look, I’m doing this thing, I need you to get on board. If you want me to not include you at all, let me know. I’m happy to not include you, but everyone was very supportive. They came back to me with all these anecdotes, all these stories from our time together. And you know, I wrote the book from my own perspective, but it includes a lot of content from friends from that era of my life. And, you know, that’s something that I couldn’t have done without. I think it would be a very a much inferior book without that ability to stay in touch with people from 10 years ago. You know that live all around the country, in the world. So that’s I mean, that’s not the most cutting edge technology email, but you know, it’s an important thing, I would say.

Brilliant Miller [01:38:59] Yeah, absolutely. How did you collaborate with your editor, I know some people will pass drafts back and forth, some people will just read lines, you know, working through something like Dropbox or Drive. Other people will actually go in and collaborate in real-time. What was that relationship like?

Adam Stern M.D. [01:39:16] Yeah. So I worked with a couple of different editors, actually. If you include, you know, copy editing and then proofreading. And you know, this went through, I don’t know, five different people at various stages in terms of getting to read, line and edit, and mark things. But the primary content editor was the initial editor who made the purchase for each of each books was Deb Brody. And one of the most frightening moments of this experience for me, the first time I was working to write a book for a publishing house was when I sent the first 20000 words over, you know, for context, the whole book is about 70000. And I think she advised me to send it over when I had written a chunk of it. So I said, OK, I’ll do it after thousand words. And there’s a possibility that as I hit send that she’s going to reply. She’s a very reputable person in the field. And if she replies and says, this isn’t what I thought I was purchasing, you know, this isn’t what I thought we were doing. I’m sunk, you know, like, I don’t know how I recover from that from a writing perspective. If she says you got to start from square one again, I don’t know if I have the energy for that. I poured my heart and soul into these twenty thousand words. So there was a moment there where I was terrified, but she actually came back that she really thought we’re on the right track. And she had very useful feedback about not giving certain things away early to the reader. One of the biggest challenges for me as a new memoir writer was to figure out how do I tell this story with the proper arc from real life? I have to create these arcs that the reader appreciates the most I do. I optimize the reader’s appreciation for what happened to us or with us, you know? And so that ability to help carve that narrative was really helpful from her. And then a transition to my next editor was Karen McCullough, who a wonderful editor. And she and I would yeah, I would send you drafts along the way. But large sections being done. Once I knew I was on the right track, I was much more confident. And that also helped with the writing, I think.

Brilliant Miller [01:41:33] Just pausing to think of what – remembering that, you know, the intended audience for this is those who have their own creative projects, those who are either in the middle of writing a book or it’s a dream they’ve been harboring for a long time. What advice or encouragement would you give to somebody who is either in the position of being maybe stuck in that messy middle or they’ve been reluctant to begin? What would you say that would help them get their book done? What instruction or inspiration would you offer?

Adam Stern M.D. [01:42:05] So this is in line with a lot of the content that we’ve already covered today. But, you know, like doing the project, whatever it may be, if you really, truly just want to do it for its own sake, right? So writing something for someone else is usually a bad idea. But if you want to write something for yourself and someone else, that’s a good idea. And then even if no one else ends up reading it, it’s still something that you’ve put together that you can be proud of, that you have done that you like, or that hopefully you feel was worthwhile. And tied in with that is that this whole process for me has only reinforced this idea of serendipity being, you know, this major aspect of how things happen. It’s out of our control. I can’t tell you how many moments. They were aware it was a binary, either the editor made a bid or they didn’t make a bid, either, the agent reached out to me or they didn’t reach out to me either she thought it was a good premise for a book or she didn’t where it could have gone in any direction. And this book was incredibly close to never happening. And when it came out, it either could have been well-received or not well-received or anywhere in between. But you know, I’ll give you one example is in my head, I was like, Oh man, if only maybe the book could be reviewed by a major newspaper like the Times would be amazing if the New York I grew up, you know, and I still read The New York Times a lot. I’ve written in the New York Times. I said that would be so great if they reviewed it and never reviewed it. But People magazine made it their book of the week, and I was like, That’s something I never imagined. I never thought like, Oh, if only People magazine would highlight the book. I didn’t even know People magazine highlighted books, but when they highlighted it, it opened up this entire world for people to discover it, you know? So again, something I never would have predicted to happen, that serendipitously happened. And if I had shut myself off to that experience or not taken the chances that I took or even felt like, oh, if it doesn’t succeed commercially, I’ll feel like a failure if I took that attitude, none of it would have happened. So again, getting back to this idea do the thing because you want to do it and then everything else that happens to you and the book and the process, it’s all gravy. You know, it’s all something that you can take the positive from and not be disappointed in it not living up to some idea that you had.

Brilliant Miller [01:44:41] I love that so much. And I may be putting something in your words that you didn’t say, but you talk about serendipity, and what I’m hearing possibly is grace. Like how awesome that is, that all those things, you take this action, you do it because you want to do it. And something remarkable happens.

Adam Stern M.D. [01:45:03] Absolutely. I try to live my whole life like that, I mean, really honest to goodness, like, that’s what I try. I don’t always succeed. I really don’t. But if I just, you know, have shrunk down the world to a smaller, more manageable alignment of like, what I want to be doing with my time and then good things happen from there. And my perception of those good things are less tainted by things like disappointment or envy.

Brilliant Miller [01:45:33] That’s awesome, well cool. Well, well, Adam, this has been a pleasure for me. I’m really grateful that you accepted the invitation to come on the show. I’m very grateful that you wrote the book for the conversation that we’ve had. I hope that people listening have enjoyed it and benefited from it. I suspect they will very much. What final thought, final words, would you like to end with?

Adam Stern M.D. [01:46:00] First of all, thank you, Brilliant for having me and thank you all for listening. And my final piece of advice is I see you and also go out and do it. You know, whatever the thing is that you want to do today, tomorrow, next year, ten years from now, take the chance. Do it if you want to.

Brilliant Miller [01:46:20] Awesome. OK. Again, my guest Adam Stern, author of Committed Dispatches from a Psychiatrist in Training. All right, Adam. I look forward to talking with you again whenever and wherever our paths cross again next.

Adam Stern M.D. [01:46:35] So looking forward to it.

Brilliant Miller [01:46:43] Hey, thanks so much for listening to this episode of the School for Good Living podcast. Before you take off, I want to extend an invitation to you. Despite living in an age where we have more comforts and conveniences than ever before. Life still isn’t working for many people, whether it’s here in the developed world where we deal with depression, anxiety, loneliness, addiction, divorce, unfulfilling jobs or relationships that don’t work, or in the developing world where so many people still don’t have access to basic things like clean water or sanitation or health care or education, or they live in conflict zones. There are a lot of people on this planet that life isn’t working very well for. If you’re one of those people or even if your life is working, but you have the sense that it could work better, consider signing up for the School for Good Living’s Transformational Coaching Program. It’s something I’ve designed to help you navigate the transitions that we all go through. Whether you’ve just graduated or you’ve gone through a divorce or you’ve gotten married, headed into retirement. Starting a business. Been married for a long time. Whatever. No matter where you are in life, this nine-month program will give you the opportunity to go deep in every area of your life to explore life’s big questions, to create answers for yourself in a community of other growth-minded individuals. And it can help you get clarity and be accountable to realize more of your unrealized potential. It can also help you find and maintain motivation. In short, it’s designed to help you live with greater health, happiness, and meaning so that you can be, do, have, and give more. Visit goodliving.com to learn more or to sign up today.