047: Mental health, social media, & the power of mindfulness with Dr. Towery, MD

Ever wondered how your identity shapes your mental well-being? Join us for a heart-to-heart conversation with Stanford-trained, board-certified psychiatrist, Dr. Jacob Towery, as we navigate this intricate relationship. We unwrap the many layers of mental health, from whole-person care to the interplay of the attention economy with technology, and provide you with practical tools to alleviate depressive and anxious thoughts. Bonus: get to know Dr. Towery's playful side as we underline the value of fun in reducing pressure and finding inner peace.

Social media - a boon or a bane for your mental health? We tackle this pressing issue head-on, throwing light on how our everyday interactions with digital platforms could be contributing to the growing mental health epidemic in the United States. Amidst the COVID-19 pandemic and its associated loneliness, we discuss the potential dangers of social media overload and the pressures on our attention. Listen in as we reveal strategies to manage this digital deluge and safeguard your mental health.

Challenging conventional wisdom, we take a deep dive into the chemical imbalance hypothesis, debunking the myth that depression is purely a serotonin issue. Immerse yourself in an illuminating discussion on the power of cognitive behavioral therapy and other mindfulness practices in understanding and managing depression. Ending on a hopeful note, we redefine trauma and healing, emphasizing the importance of safe spaces for sharing stories, addressing beliefs about trauma, and promoting positive reframing techniques. Join us and gain a fresh perspective on mental health and identity.

To connect with Dr. Towery:

• jacobtowerymd.com
• Check out his book: "The Anti-Depressant Book" (The Anti-Depressant Book: A Practical Guide for Teens and Young Adults to Overcome Depression and Stay Healthy)

Transcript

Kasia Stiggelbout: 0:07

Hello and welcome to Nourish. My name is Kasha and I'm an entrepreneur, a longtime meditator and a student of Chinese medicine. My mission with this podcast is to share the tools and practices to help you integrate your whole self into every aspect of your world. As someone who is both a Taipei high achiever and a deeply spiritual, vulnerable and empathetic being, I know firsthand how it feels to be living a double life showing up one way at work a different way alone and struggling to reconcile the two. This disintegration of authenticity is one of the biggest causes of burnout, health flares and anxiety. For me, understanding how the mind-body connection is crucial to health and success, cultivating a strong sense of inner self and applying the healing philosophies of Chinese medicine and Zen Buddhism to my life has allowed me to lead from a completely heart-powered place, letting go of other people's judgments and finding peace in allowing my multi-dimensional being to shine. My hope is that this podcast may inspire you to do the same. I want to call out. It is a practice, it is a journey, but I believe it is the most important thing that we can do for our bodies, minds and our ultimate potential. Enjoy, hello, dear friends, and welcome back to the podcast.

Kasia Stiggelbout: 1:47

Today I have such a special guest for you all Dr Jacob Towery, who is a Stanford-trained board-certified psychiatrist who works with adolescents and adults.

Kasia Stiggelbout: 1:59

Today's topic is mental health. Y'all with one in 10 youth in the United States experiencing depression that severely impairs their ability to function at school, work, at home, with family or in their social life, and with about 20% of adults experiencing mental illness that's equivalent to over 50 million Americans this is a very pertinent topic. We cover whole-person care, dr Jacob Towery's perspective on how diet, lifestyle, relationships and your environment can affect mental health. We debunk the theory that depression is just a chemical imbalance. We dive into the attention economy and how technology is harming our mental health and what to do about it. The power of releasing external pressures for a healthier state of mind. And, finally, we dive into a pretty controversial topic, and that is how important is it to understand the root of your traumatic experiences, your triggering experiences, in order to heal, how to release and reprogram depressive and anxious thoughts? This episode is an absolute must listen. I am so honored to have Jacob on the podcast today and, without further Dr. Towery, , welcome, welcome.

Dr. Jacob Towery, MD: 3:23

Thank you for having me, Kaja.

Kasia Stiggelbout: 3:24

It is such an honor. I'm going to repeat what I said right before we started recording you are truly the future, in my opinion, of psychology, psychiatry and just how to revolutionize mental health, and I just want to thank you for the incredible work that you're putting out there, and just the way you continue to evolve, personally as a practitioner but as a human being is just so inspiring, truly.

Dr. Jacob Towery, MD: 3:51

Thank you, that feels very good to hear.

Kasia Stiggelbout: 3:54

So I have a lot of questions for you, but before we do that, I'm going to kick it off with a question that I ask every single guest, and that is what are three words that you would use to describe yourself?

Dr. Jacob Towery, MD: 4:05

I would say, curious, kind mischievous.

Kasia Stiggelbout: 4:11

I haven't heard that last one before. I like it. I like it and I always find kicking off with this question to be so perfect because I feel like it offers us a different lens with, I guess, in terms of perceiving the person that we're speaking to. Right, I feel like, based on the bio you submitted, which was started off with, I'm a person, or like in third person, like Dr Jacob Chowry is a person and talking about your favorite colors and all that stuff, I feel like you would really really appreciate that and I feel like this kind of gives us a different feel for who you are as a person. In that mischievous bit I wouldn't have picked up on even in the short amount of time that we've talked. So I love it. So, in addition to being mischievous and kind and all those incredible things, you're a person, as you shared.

Dr. Jacob Towery, MD: 5:06

I am, yeah, don't tell other people, though that's kind of a secret, so don't let it make it onto the podcast.

Kasia Stiggelbout: 5:12

Oh, absolutely. We won't let anyone know. It'll be our little secret here as we publish this live, and I so appreciated you actually kicking off your bio with that because, in addition to being a person, I had to dig this up because you didn't share this with me. All right, what's coming?

Dr. Jacob Towery, MD: 5:28

I don't know.

Kasia Stiggelbout: 5:29

Dude, you're a Stanford train board certified psychiatrist and you work with adolescents and adults and I adore the fact that, despite you know on paper these incredible credentials, you actually kind of kicked it off with something a bit deeper when you introduced yourself. And before we dive into all that mental health stuff, I actually wanted to ask you about that. Now, is that intentional? Do you do that every single time? Was it just special for me? Like, tell me about the choice.

Dr. Jacob Towery, MD: 5:58

Yeah, it was special for you. I have often just kind of done like the boring, like went to these schools and did these things and blah, blah, blah that everybody does. But I was like I'm feeling a little playful, like I think I'll just do it different and I think I might more often do it the way. You know that we're doing it here, because I think it's good to question things, I think it's good to question identity and just have more fun.

Kasia Stiggelbout: 6:22

You know, I think we might end up getting into this potentially. But you talk about identity and I think the typical bios are so centered on outward perception and your credentials are very clearly on paper impressive all of your achievements, the hard work you put into that. But I think that all too often focusing on that can actually create a lot of pressure for people, and I can definitely relate to that as somebody who has changed my identity, so what I thought I would define myself as was no longer the case, and so I really appreciated this like different perspective.

Dr. Jacob Towery, MD: 6:58

Yeah, thank you. I mean, it's not that I think people's credentials are irrelevant. They can certainly be very relevant, like if I was going to a surgeon, like if I needed an operation, and I was like, so tell me about you. And he was like, well, I really like playing the guitar and like I, you know, I've played blues music. I've never gone to medical school or like held a scalpel, but like I'm a really good guitarist, I'd be like I'm picking somebody else right.

Dr. Jacob Towery, MD: 7:22

So I'd want to know things that help me assess, like, is he likely to kill me or not, or is she likely to kill me or not? So credibility, you know, can matter in certain instances, but I think it's just so tempting to get into. You know those questions to define us. You know what patch of planet earth did you come out of your mother's vagina on and what institution did you go to after high school and who pays you money and how much money did they pay you? And like that's it. Okay. Now I know everything about you. And it's like, well, really Like, do you, do you know everything about the person? How are they to the wait staff at restaurants and how honest are they when no one's around and are they fun to be in their presence, right? So there are a lot of other things I think about a person that are very important, and I think it's good to just question how do we describe ourselves and how do we think of other people and question all of it.

Kasia Stiggelbout: 8:14

I so, so, so appreciate that truly, and I think you make a really valid point, which is one that I love reminding folks on this podcast, which is we are multi dimensional beings. Right, you and I met at the wisdom 2.0 conference, which really explores kind of the future of technology and consciousness and spirituality, and that is just one of the many things that you are into beyond the incredible work that you do, and I think it is so important to allow people to have more than one dimension to their identity, because if you get laid off, if you change careers, that can be such a jarring experience. Or for adolescents, right, if your entire identity is like what school are you going to? I can imagine and I remember the pressure of that.

Dr. Jacob Towery, MD: 9:07

Yeah, totally, and I'll bounce off of that If there are any kind of therapists listening or coaches listening. But particularly for therapists, what when I teach other therapists? Something I like to emphasize is don't just ask your patients about their symptoms. Don't just ask about their depression and their anxiety and their psychosis and their OCD and think now you know them right. I spend a whole hour with people. I just met a wonderful young teenager this week and I spent a whole hour just asking.

Dr. Jacob Towery, MD: 9:34

I want to know you as a person, independent of your symptoms. We'll get to that, we'll come to that, but let's spend a whole hour. I just want to get to know you. Who are you as a person? What are you into? What are you excited about? What are you passionate about? What kind of music do you listen to? Are you into movies? What kind of books do you read? Who are your friends? What do you care about? Right, you know, I want to know a lot about these people, not just as a set of symptoms, and I think it makes psychiatry more fun, I think it makes therapy more fun. I think you get to know people on a deeper level. So for any therapists out there, or budding therapists, I think it's worth thinking about people as a whole entity and not just a set of symptoms.

Kasia Stiggelbout: 10:08

I love that and that is a perfect segue to a lot of what we're going to be discussing, which is mental health, and perhaps we actually start there. I'm curious to you know you kind of shared a bit about your approach to mental health as a whole and how viewing the human from a wider lens and seeing the many dimensions is very, very important, and I've seen, I've heard you talk about that, we talked about that. Can you share a bit of your perspective as to why that's so important and if there, you know, if, kind of like, your philosophy of viewing the patient as a whole can make an impact on even how you diagnose or how you treat?

Dr. Jacob Towery, MD: 10:50

Yeah, that's a great question. So I think there's at least two reasons I think it's worthwhile to think of people as a whole. One is you have to connect with your clients. If you're going to be a therapist, if you're going to be a coach, if you're going to be a lot of different things, you have to connect with your client. And I think that the more you know the person as a human and the more you're curious about them and the more you're interested in them and the more you convey to them that they're important to you and that you want to know them.

Dr. Jacob Towery, MD: 11:14

Like I try to memorize all of my clients, like maybe top five best friends and like keep that in my mind. So like when they tell me a story, I can keep up and I can ask about such and such person, and I want to convey to them like you are important to me, you're worth taking up space in my mind. And I want to remember, if they tell me they're into some artists I don't know, I'll go and listen to that artist on YouTube or something and come back and tell them what I think of them. And so I want my clients to know that they're important to me as humans and that I care about them. And I think if I just asked about checklist symptoms, it would be hard to accomplish that. So that's number one.

Dr. Jacob Towery, MD: 11:48

Number two in psychiatry it's very easy to reduce people to like a set of neurotransmitters right, like, is their dopamine too low, or is their serotonin too low, is their norepinephrine too high and which medication should we give to adjust it? And then okay, it's been 15 minutes and they're gone. I think that is kind of a silly way to do medicine. In psychiatry. My shortest visit is 50 minutes. My average visit is 110 minutes.

Dr. Jacob Towery, MD: 12:12

So I want to know the whole person because, yeah, neurotransmitters are important I'm not anti-neurotransmitters, they have value and medications can be useful and I want to know how much sleep is this person getting and are they meditating and how often are they exercising and are they spending time in real life with other humans, or are they just on their phones in the room by themselves and are they doing hobbies and are they learning how to change their thoughts and learning how to change their feelings? Because they're a whole person and there's a lot of things that are going to impact their well-being, their health, their happiness, and I want to be kind of hitting on all levels and have a multifactorial approach so I can help people get well quickly.

Kasia Stiggelbout: 12:51

Mike drop. We can just end it there. This is really great, dr Dab. It's been fun. It's been fun no, seriously, though. I mean. As I was preparing for this interview, I was looking at the stats and, according to Mental Health America 20, about 20% of adults are experiencing a mental illness. That's equivalent to over 50 million Americans, and one in 10 youth in the United States are experiencing depression. And this is like 2019 to 2020 stats, so I am imagining it's even worse based on some of the news articles that I'm reading. And these are conditions that, for example, depression. It's severely impairing people's ability to function at school, at work, at home, with family or in their social lives. And there is so much research and so much kind of discussion about what is kind of a mental health epidemic in this country and I'm curious what is your take on this? And I mean I know this is a loaded question, but as a practicing clinician seeing a lot of people who struggle with mental health day in, day out, what do you think is influencing this crisis?

Dr. Jacob Towery, MD: 13:58

Yeah, I think there's a few things. One is, I don't think there's been a time in history where the demands on our attention were greater, right, like I went to a festival last weekend and I just put my phone on airplane mode for a few days and I did no emails and no news and no texting, basically, and no phones, blah, blah. And then I came back, you know, like Sunday night, and there were like a million text messages and there were voicemails and my email inbox had like tons of things in it and you know there's so many things vying for our attention, right, there's other people vying for our attention. There's news articles vying for attention. There's so many apps that are trying to get our eyeballs and get time on screens and that's just separate from like regular life demands, like being a person, right, like that's something from like going to school or going to work or having a partner or having friends. That's just in addition to everything else. So I think for many people that's really overwhelming and the ability to narrow one's attention and the ability to be selective about our input and how we spend our time is really critical, and I think that's hard.

Dr. Jacob Towery, MD: 15:08

I think, with all the social media and the cell phones. That's really difficult. I think that also then contributes to more isolation. I can't even tell you how many people I have sitting on that couch, but they're like, yeah, I spend about six or seven hours a day on my phone and I'm looking at score scores and I'm looking at Instagram and I'm doing the TikTok and I'm looking at Be Real and, you know, checking out the news and all these things, and that's time that they're not interacting with another person one on one, they're not going surfing, they're not going out to the movie theater, they're not reading a paperback book that might change their life. So I think that's a huge issue is screen, social media isolation.

Dr. Jacob Towery, MD: 15:51

I think COVID was really hard on a lot of people. A lot, a lot of people found it difficult. I'm a very extroverted social person, so, in addition to getting long COVID, which had its own host of problems, I couldn't be with a lot of the people I wanted to be with and that was very hard for me and I think that was hard for a lot of people to have this very reduced social contact. So I think we're still you know, we're just coming out of COVID, so I think it's going to be a lot for people to get back to. I think there's a lot of expectations of people, right. There's a lot of expectations of performing in all these different arenas. I think that's hard for a lot of people and there's probably plenty more, but those are a few of the things.

Kasia Stiggelbout: 16:29

Welcome to our society. It's just like literally mapping out the way that we live today. So I wanted to dive in a bit into this attention concept because I so relate to this and you know. Looking at, for example, social media, I actually have set some pretty firm boundaries recently and I recognize how much that changed. Not just what I was thinking about in terms of spending a lot of time on social kind of inherently led to comparison and fear of judgment, strangely enough, just because it was like, instead of thinking about the immediate five people that I see day to day, it's like I had this whole world open up to me of people that I was exposed to and experiencing and there was comparison and there was fear of judgment. But I also noticed my mind kind of getting rewired to the pace at which I was scrolling, which was just absolutely fascinating, and so kind of detaching from that allowed my life to kind of slow down a bit, which gave me, strangely enough, a lot of peace, right.

Kasia Stiggelbout: 17:30

But I know that for a lot of people that detachment can also potentially cause anxiety. You talked about leaving for a weekend and turning off your phone and then coming back and just getting this flood of messages. How did that feel, I'm assuming at least like for me, coming back from vacation, it feels pretty stressful to witness that, and so it's almost like there's a kind of chicken or the egg scenario of, like what is going to be creating this experience of anxiety or, you know, kind of that sense of disconnection, because you're so immersed in, you know, all that stuff that's pulling your attention your email, your feed, your text messages, and so having that be the way that our society lives and operates, like how do you navigate that Right? Because, again, detaching can cause anxiety, but also staying attached can cause anxiety and all sorts of symptoms associated with that.

Dr. Jacob Towery, MD: 18:26

Yeah, a lot of good questions there. One congrats on getting off of social media. I don't think it's at all strange that with you slowing down and spending this time on social media, you're finding more peace. I think that's wonderful. So I think there's a few things people can do.

Dr. Jacob Towery, MD: 18:39

One is be very conscientious about what notifications you let bug you. Right, because these apps by default want to notify you that you just parked, or they want to notify you that someone threw a ball and it went in a circle, and they want you to know that. Right, very important. How many times the ball went in the circle? I don't need to know that immediately. I don't need to ever know that. Actually, right. So they want to notify you about everything. Oh, a new email or new text, you know everything. Most of those things you don't need to know urgently, you may not even need to know ever. Period. You definitely don't need to know that someone posted on Facebook or on Instagram. You don't need to know that. You don't need to know it urgently.

Dr. Jacob Towery, MD: 19:19

So I think people can benefit from being very selective, like I get notifications about if I have a new phone call, voicemail text, I think that's about it. Maybe Parket Mobile tells me if I'm about to, you know, expire my parking, but that's about it. Otherwise, I don't let any social media notify me about anything. I don't let my email notify me. So I recommend people be very selective because if you get a badge on your phone that says you have one thing that hasn't been taken care of or two things they haven't been attended to, it's so difficult to not dive in and be like this is asymmetrical and I don't like that number that says I haven't done the thing, I want to get the thing done and it sucks you in and it wastes your time for the most part. So I think people can be aggressive about notifications. If you have email, you know, which probably means you're above the age of like 10, you know, or even like five probably these days.

Dr. Jacob Towery, MD: 20:06

Aggressively unsubscribe I love unsubscribing from things. I probably do it almost every day that I'm on email. Aggressively unsubscribe You're going to get signed up for all these ridiculous things that you don't want. Aggressively unsubscribe, even if you're like well, what if in six months I want to hear about what such and such store has to offer or some event that this thing I've never gone to might no, just unsubscribe, like you'll have plenty of opportunities to do things and just unsubscribe from all of it. So be very selective. I think it's called I get Parkinson's principle, and for those principles I remember reading in four hour a week. I think this is Parkinson's principle, which is for a lot of tasks.

Dr. Jacob Towery, MD: 20:45

The amount of time you spend on them can expand or contract depending on how much time you allot to them. Email is a great example of this. If you just on a Saturday, went into your email, you could probably spend four hours knocking out, you know, taking care of like 20 or 40 emails. But on the other hand, if you gave yourself 15 minutes, you could probably still get to all those emails and you'd spend way less time on them. So I try to be very selective about when I go into my email and I, on purpose, have a hard stop, like I'll do it right before I see patient. So I have a hard stop. I'll give myself maybe 10 or 20 minutes and then that's it. I got to get my email box down to zero and I just got to plow through Great, thanks, yes, okay, okay, okay, okay, sounds good, see you then.

Dr. Jacob Towery, MD: 21:28

Very Kurt friend, that lots of smiley faces, you know. So people don't think I'm mad at them or upset with them, but it's like sounds good, smiley face. See you then. Smiley face, yes, smiley face, thanks, good Bye. Yes, I'm in, just plow through, get them done, spend 10 or 15 minutes and then you're done for the day. Don't come back to it Now.

Dr. Jacob Towery, MD: 21:46

Admittedly, some people have jobs where they can't get away with that, but for me, if I find my email once a day or four times a week, it's fine, and I think a lot of people can do that.

Dr. Jacob Towery, MD: 21:55

And just being very selective about even when you let yourself get on your phone, like for me, getting on my phone to do something that's just entertaining is like after I've meditated, after I've eaten breakfast, after I brush my teeth, after I've exercised, after I've gotten my work done.

Dr. Jacob Towery, MD: 22:11

Only then, only then, if there's still any free time, might I indulge in Facebook or reading the news or something. But it's like it's later on in the priority list and I think for a lot of people it's like wake up, grab my phone and then everything else will come later, and then you're going to get behind it, you're going to get overwhelmed, you're going to be late for things, you're going to be stressed, because the phone can suck you in like a vortex for an unlimited amount of time. So I think in Buddhism they talk about this kind of guarding the sense gates. Right, we have to guard the sense gates. If you just let yourself be open to any stimulus and any diversion, you're going to waste a lot of your life. So I think if the hooves us all to be intentional about how do we spend our time, what do we want to cultivate, what do we want in our life and be wary of the phone, the phone, I think, can suck us in and waste a lot of our time.

Kasia Stiggelbout: 23:00

So beautifully said. And the time that we waste, that is our life, literally.

Dr. Jacob Towery, MD: 23:05

Like.

Kasia Stiggelbout: 23:06

I don't remember the exact number, but we have only a certain number of on average, minutes, hours, days, right, and when you spend six hours a day on your phone, like those are moments that you are not going to get back, and I think you so eloquently kind of applied the principles from Buddhism to day to day life. That filter concept is so powerful and that's really what mindfulness and meditation teach us, right, which is just to become aware of where is your attention going. Because these tools, as somebody who worked in this industry they spent a ton of money designing them in a way that is addictive, like the way slot machines are addictive. I mean, I feel almost embarrassed, but I do remember I won't mention several startups that I worked at brought in world-renowned consultants from psychology that taught us how to build in mechanisms that would encourage people to continue to engage, and that is just hijacking your mental system right there.

Dr. Jacob Towery, MD: 24:10

Yes, yeah, it's so true, I love referring people to the social dilemma as that documentary Netflix, but people really underestimate the amount of brilliance that has gone into designing apps and designing products to keep you engaged. And they're better at it, they're just really good at it, and so most of us, my self included, are really just not a match for those people. And if you intend to go in there for like two minutes, you could look up an hour or two later and be like, where did that time go? Right, I just wasted all that time. So I think we have to all we don't have to. It benefits us to get really careful about when we're on our phone and what mechanisms we have, like having a hard stop, like I have to go at this time, and being careful with it, because I'm a little ambivalent about the word addictive, but it's basically either addictive or really close to addictive, and people can waste a lot of time on their phone.

Kasia Stiggelbout: 25:08

So well said. So I want to actually shift gears a bit to you kind of shared a bit about some of the some of the causes of mental illness perhaps anxiety, depression and I want to actually zoom in on depression for a minute, because this is kind of an interesting set of. I guess it's a condition with a set of symptoms that for the longest time for example, I personally have always been very familiar with anxiety, but depression seemed foreign to me until recently, and I would love to get your thoughts on how much of and I guess this might be difficult to quantify some more your perspective, how much when it comes to depression, how much of depressive symptoms are linked to, let's say, lifestyle, food versus something chemical that is actually happening in the brain, and how do you kind of pull those things out? Because sometimes it can be really really hard to recognize, right, you feel the cloud, you're in it, you're experiencing these symptoms, but it can be hard to identify the root and what levers to pull. So I'd love to get your thoughts.

Dr. Jacob Towery, MD: 26:17

Yeah, I'm glad you asked that, kasia. So the chemical imbalance hypothesis that was really popular in the 1980s has really largely been disproved. So I'll just go over that really quickly. So back in the 80s there were these experiments where they inferred oh, I guess people have low serotonin. But it was based on really like. It wasn't very logical. It was like oh, there's a metabolite of serotonin called 5-HAAA, 5-hydroxyindoleacetic acid and if you take out cerebrospinal fluid from people that have killed themselves, you find there are certain levels of 5-HAAA compared to other people. So people thought okay, maybe this has to do with serotonin, and if you deprive people certain amino acids like tryptophan, then they can feel sad. And so people went okay, well, we've got these data points. That must mean that people with depression have low serotonin compared to other people, because if we give them Prozac then they do better. So it must be that they had low serotonin. Now they have normal serotonin.

Dr. Jacob Towery, MD: 27:23

That is a gross oversimplification. It's not even close to explaining what's going on. The brain is much more complicated than that. There are networks in the brain, there are parts of the brain that communicate with other parts of the brain, but it's almost never that someone has a low serotonin, like if you actually. We're not even close to the technology of this, but if you could go into someone's brain and suck out their serotonin, you're not going to find that Bob has this much and Jenny has this much, and that explains it. It's not even close to that. So I think the chemical and balance hypothesis has gotten way too much press and it's a gross oversimplification. And the vast, vast, vast majority of time the thoughts that the person is having and believing are going to be the most causal mediator of the feelings that they're having. So I have a bias.

Dr. Jacob Towery, MD: 28:12

I'm a cognitive behavioral therapist and I do some other things too. I'm into meditation, mindfulness and lifestyle things, but for the most part, with depression, you're almost never going to meet someone with depression who has thoughts like I'm a pretty great person. Life has lots of joyful things to offer. There are so many exciting things I could go out and do. I may not be good at this, but I could become great at that. It's only a matter of time and effort. I have wonderful people around me and I have a roof over my head. This is incredible. It can rain and I won't even get wet.

Dr. Jacob Towery, MD: 28:45

Right, you're not going to meet people that have all of those sets of thoughts and are also laying in bed all day and isolating and feeling profoundly depressed. You're just not going to see those people right, because when people are depressed, they have thoughts like I'm a loser, I'm no good, I'm a jerk, life sucks, it's never going to get better. There's nothing I can do about this. The world sucks, the other people in my life suck. I'm too lazy. There's nothing I can do right. They're going to have those kinds of thoughts. I see it over and over and over.

Dr. Jacob Towery, MD: 29:15

I've seen hundreds of people with this constellation of thoughts. Interested and willing. They can learn the technology of how to write down thoughts that are distorted and change those thoughts, and they can replace those thoughts with things like yeah, I'm not that great right now at playing the piano, but one that doesn't matter that much. And two, if I really wanted to, I could become good at the piano. I could take lessons or I could watch it on YouTube or I could play around with it or I could ask a friend to come and help me and I could become better at the piano. I could buy a $10 book and I could follow it and I could become better at the piano, and that's okay.

Dr. Jacob Towery, MD: 29:51

Or yeah, I did this thing and I screwed up, and that's okay. Everybody screws up. I've never known anyone above the age of I don't know five that hasn't screwed up. We all screw up, that's okay. I can learn from that, not try and do the same mistake over and over and then get better, and that's all right. It's not a big deal, or sure, I have flaws, so does everybody. If there's things I want to work on, I could work on them. I don't have to get all caught up in this right, so people can learn how to change their thoughts, and that's a lot of what I do with people is I help them change their thoughts. I also help them see one of the best things I got from David Burns, who's one of my main mentors at Stanford, is that and this idea you're seeing this in more and more things this idea I'm about to talk about you see this in acceptance and commitment therapy. You see this in team CBT, which is the model that I do.

Dr. Jacob Towery, MD: 30:37

You see this in a lot of different things is you can go over with a person. What is this thought that you keep having, or this feeling you keep experiencing or this behavior you're doing? What is this show that's awesome or beautiful about you, that's actually serving you in some way or reflects your great values, right? So, for example, I had a wonderful young person I was working with just yesterday who had thoughts like I'm a loser, kind of equivalent thoughts, and that showed that she's very humble, right, she's not arrogant, she's not cocky. This shows that she's very humble, right and for practically any thought or any feeling or any behavior, if you're thoughtful about it, you can see wonderful things that it shows about a person.

Dr. Jacob Towery, MD: 31:20

And the paradox is, the more you celebrate the wonderful and beautiful things that it shows about you, that you're having a feeling or a thought over and over doing behavior, the easier it is to let go of that or to dial it down. And so that's part of the work is you kind of celebrate what is this thought doing for me or what is this feeling doing for me, and then decide, well, do I want to keep this? Do I want to change it? Do I want to dial it down? And then, with the help of a good therapist who knows, like Team CBT or even books right, you could just go by like David Burns has a book feeling great. That's good. There's a lot of good. I'm biased. I have a book, but that's out there.

Kasia Stiggelbout: 31:57

We'll be hyperlinked below. Just throwing that out there. Hello, hello, but go on.

Dr. Jacob Towery, MD: 32:01

But if you have like $10 or a library card, right, you could get access to really powerful technology and learn how to change your thoughts. But I think one of my takeaways is if you have depression or if you have anxiety or if you have a phobia or if you have social anxiety, this doesn't mean or PTSD, this doesn't mean you're doomed to have this for the next 50 years. Maybe you have it for the next couple of days or weeks, but if you get good resources, this could be a thing of the past and in a short amount of time you could be feeling profoundly better. You could have a very different relationship with these thoughts and these feelings, and I see that over and over and over.

Dr. Jacob Towery, MD: 32:35

That's part of what makes my work satisfying and rewarding is people can make change quickly. So if you're out there and you have one of these conditions I've listed and you think I guess I'm stuck with this forever, you're not stuck with it forever. You don't have to be. If you want that to change and you're willing to put an effort and be persistent and use the right tools, you can make powerful changes relatively quickly.

Kasia Stiggelbout: 32:55

Oh my gosh. First of all, Dr Towery, are you up for hire to be like my internal voice? Because, when.

Kasia Stiggelbout: 33:02

I heard you talking, I was like, oh my God, I need that kind of narrative to be president of my life. It's amazing. That's the first thing that could be like. You know, you're like side hustle, Not that you need one, but just kind of thinking that.

Kasia Stiggelbout: 33:17

So I absolutely adore this, and I was smiling as you were speaking because I think that there's something so empowering about the concept of being able to change that inner dialogue and kind of that inner dialogue that is powering what feels like a cloud of apathy or pain or helplessness A lot of the emotions, at least, that I've experienced when I've been going through bouts of depression. I am curious, though, because there's been quite a powerful narrative around, for example, trauma and understanding and getting to the root of some of the causes of, let's say, the narrative that is rolling through your mind, and I'd love to know from you how important is it to get to the root, to quote reprogram, that which I know a lot of people are talking about as opposed to focusing on all right, it is what it is. Let's kind of shift the dialogue as opposed to understanding it deeply.

Dr. Jacob Towery, MD: 34:21

Yeah, so trauma is a very loaded concept in psychiatry and I'm going to choose my words carefully, because people have really strong feelings about this and they want to tell you their strong feeling and they want to tell you that you triggered them. So you know, I actually don't even love the concept of trigger warning. But if you love the concept of trigger warning, then here's a trigger warning. I'm going to say things and you might not like what I'm going to say, so you can just turn me off or you can, you know, just hear what I have to say and see if you survive. But if you're dead, you know, in 20 minutes I'll take full responsibility, Unless you're like a heart attack or something, and then I'm just like natural causes Okay, that was dark, that's okay. So with trauma, so I work with a lot of people with PTSD and it's very important, if you're a therapist, to be very I mean, I'm being cheeky with you. I have a fun cheeky side, but, like when I'm doing trauma work with people, I'm more serious.

Dr. Jacob Towery, MD: 35:14

A mischievous side I have a mischievous side and I'll let that out with people as appropriate. But you know, when I'm doing trauma work with people, I'm very serious and I'm connecting with people and I want people to feel that my office is a safe place where they can tell me horrible, horrible things that have happened. And then I listen non-judgmentally and I try and validate their experience and validate that this wasn't their fault and validate that this was really terrible, that this happened. And just that act of a person telling their story in an environment where they feel safe, that act itself can actually change the memories, that the memories get restored and they can actually be different than they were before. So that in itself can be very helpful. And then, particularly if someone has had a really, you know, trauma with a capital T being sexually assaulted, being mugged, being beaten, you know, you know all of these kind of traumas with a capital T having their life threatened, killing someone else right, we can. People can have distorted thoughts about the trauma. So this is actually even part of the definition of PTSD now is people can have thoughts like the world is unsafe. I can't trust anyone. What happened is my fault. I'll never get better. My nervous system is permanently damaged, right. They can have all sorts of distorted thoughts that, thankfully, are changeable. So people can learn the technology you know, with a good therapist, of changing those thoughts and replacing them with thoughts like, yes, what happened to me is horrible and I can learn how to recover and feel better. Or yes, some people are not trustworthy 100% and there are people in my life that actually are worth trusting. Or yes, people are capable of harm and I can try to avoid people that are super harmful and sociopathic, but there are also people out there that are kind and compassionate and I can find those people and spend more time with those people, you know and there's a million other iterations of that but basically people can change their perception of what happened, who they are, what the future is like.

Dr. Jacob Towery, MD: 37:24

It's not that the trauma never happened. It's not that you're negating the trauma. You can actually even. You know we talked about positive reframing a little earlier. I didn't use the term positive reframing, but you can even highlight for someone how resilient they are, right? I remember working with this girl who'd been in like 11 foster homes and been like raped by multiple people that had fostered her, and I was like you are so strong, right? I can't remember if I actually said it, this was years ago where I was at least thinking like you are so strong that you're here today alive and you've been through that, right. Or you can talk to the person about how strong they are, that they've gotten through this horrible thing and they're still here, right.

Dr. Jacob Towery, MD: 37:59

So it's not that the trauma is unimportant, but I don't love when people talk about getting to the root of the problem, because I think usually the root of the problem is the thoughts that people are having, because two people can have an identical trauma and have a very different response to that trauma and very different lives going forward.

Dr. Jacob Towery, MD: 38:22

We see this all the time with things like 9-11 and big natural disasters. People can have horrible, life-threatening things, but what they tell themselves about that trauma and that experience is really what counts the most. So when we talk about getting to the root of things, I think it's people need to be willing to question okay, I've had the trauma with a capital T or the trauma with a little T, right, it could be someone betrayed you. It could be someone said something really cruel, right? What thoughts you tell yourself about what that means is going to have a profound impact on how you feel, and I could give a million examples of that. But when people talk about the root, getting to the root, I think accepting the idea that your thoughts are going to be the most proximal cause of your feelings, and being open to questioning your thoughts, as not necessarily facts can lead people to have a really different, more healing, healthy experience out in the world if they're willing to question their thoughts and replace them with ones that are more adaptive.

Kasia Stiggelbout: 39:23

Oh my gosh, that is so empowering. So empowering Like I cannot even thank you enough for that, frankly, because sometimes and at least this has been my personal experience, but I imagine I'm not alone getting to the root can even feel in many ways so impossible, right, like maybe repressed memories or distorted memories, or you get there and you cannot change the experience, but you're still experiencing the emotions, or you don't even connect that the emotions and the triggered reaction you're having today is related to XYZ from the past, and so much time can be spent trying to make sense of that, while it's not changing, at least in my experience, my day to day life. That is so powerful.

Dr. Jacob Towery, MD: 40:15

Yeah, thank you 100%. And I mean, depending on how woo you want to get, the root of the cause could be.

Kasia Stiggelbout: 40:22

I like to get there so we can go.

Dr. Jacob Towery, MD: 40:24

Yeah, I can get pretty woo-woo, but I mean the root of the cause, if you talk to certain people, is your birth trauma, right? So there are people out there saying you experience trauma by going through the birth canal and that's why XYZ, and you can take other people and say you know why you're having this thing. You're having it's because in a past life you did this thing or this thing happened to you. Well, how are you going to fix that, right? How are you going to fix what happened? You know there's a bad like. I think that happened 700 years ago, right? So, and also notice, everyone in the past life was like a king or a queen or an emperor no one's ever. Like. Why are you past? Like, oh, it's like a chimney sweep, right? Like? No one ever has visions of that, right, they're always. You know these big things. So think about that. How would that work math wise? But you know this idea that it's birth trauma. It's like, well, if everyone had the same thing, do you even call it birth trauma, right? Like if everyone who went through a birth canal had their head squished and you even call it birth trauma? And how does that then have explanatory properties? Because, like, some people have this and some people like this, but everyone had practically the same experience, so I don't know that it's very useful.

Dr. Jacob Towery, MD: 41:25

So I think and I've had people that had trauma and can't remember it because, like they were so little, they were like two or you know they were four, and they know something happened and there's even objective evidence that something happened, but they don't remember it. So what do you do with that? It's very hard, but, like you were saying, in terms of day to day, right, everything that's happened to me in my past doesn't have to have power over my experience with you in this moment. Right, I might have stories about the past and if I want to get into story, I can, but I could have an enjoyable connecting experience with you right now, totally independent of any event that happened in the past. And that's where I think the power of meditation and mindfulness comes in is that at any moment, you get to start fresh and you get to drop in and you get to be in the here and now and you get to have the experience that comes with slowing down a little, being connected, and that can be a lovely experience, no matter what your previous life held, and so it's so easy for all of us to get into story. This person wronged me. This thing was unfair. I can't be happy because this happened.

Dr. Jacob Towery, MD: 42:31

Those are stories, those are ideas, those are narratives and if they're serving you, you can hold on to them and you can buy into them. I'm not telling anyone they have to let go of a narrative, but it's good to question these narratives. It's good to question these stories because a lot of them are not that helpful. A lot of them hold us back, a lot of them limit us and with the help of a good therapist or a good self-help book, you can start to be like oh it's interesting that I have this story about who I am because of what happened to me, or who I have to be. That's just an idea, it's not actually a reality.

Kasia Stiggelbout: 42:59

So powerful. There was a podcast I was listening to by Khalil Rafadi. He wrote this really powerful book called I Forgot to Die. He founded Sun Life Organics at the age of, I think, like 41 or something like that, after being a heroin addict, and he had gone through all sorts of very traumatic experiences, and he talked about basically choosing and I think this is a very well-known story which I'm going to look up and hyperlink below. But it's as though we have two wolves within us the good wolf and the bad wolf and when you wonder which one will win if they're fighting with each other, it's going to be the one that you feed. And that is just so powerful and I love that you are sharing the way that this can apply in a clinical setting and in our day-to-day lives. That just really offers a lot of deep comfort for me and, I think, a lot of listeners. So thank you.

Dr. Jacob Towery, MD: 43:59

Good, yeah, I mean that's one of my principal messages is for all humans out there, no matter what has happened in your, I mean I want to pause myself. It's not that I want to be invalidating to people's experiences, because here I am, this cis, straight, able-bodied white male doctor. I have practically all the privileges. I'm even a couple right. I have practically all the privileges, maybe one or two I don't have. I don't have like a super yacht or any helicopters, but other than that, I practically have all the privileges. So it's easy for me to be like, yeah, who cares about your past? Everything's going to be fine.

Dr. Jacob Towery, MD: 44:30

That can be super invalidating and that's not what I'm trying to say. I recognize that people have had much more horrible experiences than I've had and a much harder day-to-day life than I have, and every day can be a struggle with people's perceptions. All of that is true and I'll take myself out of it. I have had patients that have had horrible, horrible, horrible things happen to them and on a daily basis, have people perceive them in ways where they're kind of lower, and people can still, with all of that, learn to change the thoughts that are going through their mind, change their feelings, change their relationship with how they view themselves and how they experience their feelings and how they view the world and can have a much more healthy, enjoyable relationship with life, and I think that's available to pretty much anybody, which is a cool thing.

Kasia Stiggelbout: 45:21

And that is truly what I would hope for for everyone, especially those who have suffered from generational, ancestral, in this lifetime traumas, because there's so much suffering that has already taken place, and so I think it is so beautiful to imagine that there is a possibility to heal yourself in some way from that in a tangible manner. Jacob, I could speak with you for hours, but we're actually running up on time I would love for you to share with our audience. Where can people find you? Where can people find the anti-depressant book, which is just like an obvious name right there, and do you have anything exciting coming up that you'd like to share with people? And I'll hyperlink everything below as well.

Dr. Jacob Towery, MD: 46:09

Sure, If my book was traditionally published and really successful, I would say you can find it where books are sold. You actually can't find it where books are sold. Most bookstores don't carry my book. I self-publish and it's just not that popular. But you can find it in a handful of bookstores locally near where I live, because I've gone around and been like do you want to carry my book and you can find it on Amazon. So there's this thing on the internet, Amazon. You can go there. It's like 10 bucks. That's the easiest place to find it if you don't live around Palo Alto.

Dr. Jacob Towery, MD: 46:36

My website, jacobtowerymdcom, has stuff for people that are interested in seeing me. Asa client. What am I up to? I'm kind of excited. I'm doing a pilot project just in a couple weeks, at the end of June. It's a pro bono, intensive for three people with depression and I'm going to have three co-therapists, slash observers so I can turn it into a teaching thing and help the people that have depression. We're going to do like 14 hours and then it's a pilot project to see if it goes well. Could we scale it and help like 100 people for free with depression and get everybody in a room and do it over a number of days and do like 14 or 15 hours and like how much can we help people transform in a short amount of time? So that's kind of exciting to me and we're going to redo.

Dr. Jacob Towery, MD: 47:22

We did this thing called finding humans less scary for people with social anxiety and we took I think we had about 90 people who came from different parts of the country and locally and we were all in a room together and we did like two full days like 15 hours of social anxiety stuff. So we're going to do that again in March for free, and then the pro bono depression thing. So that's that and surfing are kind of the things I'm excited about now. So you can't access me through surfing. If you go down to cows and Santa Cruz, we can surf together and I'll admire your good surfing and I'll get better surfing. And yeah, in the pro bono stuff, Wow, I love that.

Kasia Stiggelbout: 47:55

And with your positive inner voice, jacob, I'm sure you will become an excellent surfer, or at least like survive surfing.

Dr. Jacob Towery, MD: 48:03

Thank you.

Kasia Stiggelbout: 48:04

Very soon. This was such a pleasure. Thank you so much for joining me today.

Dr. Jacob Towery, MD: 48:10

You're welcome. Thanks for having me.

Kasia Stiggelbout: 48:11

Thanks everyone for tuning in. See you next time. Thank you so much for tuning into this episode of nourish. If you enjoyed this conversation, please leave a review. Five star reviews help the podcast grow and I'm so grateful for that. I publish new episodes twice a month, so hit the subscribe button to be notified and, if you want to stay connected in between episodes, join my community on Instagram and TikTok at nourish underscore podcast. All right, that's all I got for you today. See you next time.