The Therapeutic Alliance Starts With Me

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SPEAKER_01 0:00

I think a lot of people probably see a psychiatrist once in their life. And if it's a good experience, maybe they get better. And if it's a bad experience, they say, you know what, I knew it wouldn't work. I don't even know why I did it in the first place. I knew these people were just pill pushers. And I just think it's too sacred an interaction to not be doing everything I possibly can to improve the quality of these interactions for everybody, really.

SPEAKER_00 0:28

Welcome to Psydeactic. I am Dr. Owen Leary, a recent graduate of a child and adolescent psychiatry fellowship program. Today is Sunday, August 2nd, 2026. I have been doing this podcast for about five years. And now that I am at a new phase in my career, I've been thinking a lot about things that have happened in the past. I remembered an interview I did with Dr. Mark Mullen about two years ago. The point of the interview was to introduce other people to his podcast, Psychiatry Bootcamp, which is one of the best resources for early career psychiatrists that's out there. But during the interview, we got into some territory that I did not expect. I sat on this content for a couple years thinking about it. And I think it's finally time to share it with everyone. So many of the themes we discussed. Returning to this idea of the therapeutic alliance. Why did we become psychiatrists in the first place? What do we need to never forget? What makes us love what we do? This episode explores the themes of the therapeutic alliance. An alliance is not a thing that a patient has or that a provider has. It's a thing that they form together. It's something that they share. And the only way you can have an alliance is if both parties are committed to something. The psychiatrist needs to love what they're doing. The patient needs to want to be there. Somehow this can happen. And we explore some of the ingredients that are necessary to form this sacred alliance. But I'm not going to waste any more of your time. Here is Dr. Mark Mullen.

SPEAKER_01 2:25

I think if you go into psychiatry and you think that you can operate the same way that a surgeon or an internal medicine doc would, that's a real disservice to your patient. Our diagnoses are different, our frameworks for understanding things are different. The way we understand our medications are different. And I think we need to respect that and appreciate it. I really wanted to start from a place of all I know is that I know nothing. And we're going to give you some nuts and bolts here, but we are not even scratching the surface of what it means to really be a psychiatrist and make some of these decisions. What is our role here? Is there anything we're doing that could be dangerous? Are we making sure that we're protecting normal human functioning, not over-medicalizing normal human problems? Um, because I think that that's a real problem right now. And I think that if you don't have the appropriate training to understand what frameworks we're using, the tools we have, and the limitations of those tools, you wind up giving someone five labels that mean different things. And each label has an FDA-approved first-line treatment. And so now you have a person who is one person with a unique set of problems, but they have five diagnoses and therefore they're on five medications. And I think I just see it too often in clinical practice. So I wanted to make sure that no one listened to Psychiatry Bootcamp and then went out there and kind of practiced that check checkbox psychiatry. That was my worst fear.

SPEAKER_00 3:48

Yeah, I've I've noticed that too. Systems are overwhelmed with psychiatric patients. Uh, and the way that insurance companies are structured and how we have to do billing creates a strong pressure to use screening instruments as diagnostic tools because of the time limitations instead of taking the time we need. And I think that drew me to psychiatry in the first place was how much time they let me spend with my patients and how I got to know them. But for models of care that we have, that's not feasible a lot of times. There are a lot of studies out there that show the number one factor, no matter what kind of psychiatry you're doing, is the therapeutic alliance. Getting to that takes time, and it's it's really the art of psychiatry.

SPEAKER_01 4:36

I think it takes brave leaders to defend kind of the spirit of psychiatry, the ethos of psychiatry, the fact that connections in and of themselves with other humans can be healing, the fact that many humans are resilient and over time they may get better on their own. But there's a lot of different entities at play in the world of healthcare that have interests that are different than simply providing the best care possible, right? There are large entities who have a vested interest in making sure appointment times are quick, making sure that we can solve a problem with a pill instead of having to invest hours of human resources into it. And so I think it's really incumbent upon us to defend that ethos of our field and say, it's really easy to practice bad psychiatry. I mean, it really is. We have very limited objective tests for how our medications are working, if people are getting better, right? It's really not hard to fill out some checklists and prescribe a pill that somebody takes. I think it's really hard to practice excellent psychiatry and to build connections with people who are not predisposed toward building strong connections and to have a strong enough connection that that person will trust you and trust your opinion and be honest with you so that you can get an accurate assessment and a treatment plan that has a chance of working. And I think it's infinitely difficult. So we need, you know, brave leaders to push back against some of these entities and say, you know, wait a minute, we need to spend time with our patients. We need to understand them on a level that goes way beyond the PHQ nine.

SPEAKER_00 6:04

I know that for certain certain physicians who practice with patients who um are trying to do things like improve their health in general or lose weight, if they have certain goals, they don't accomplish those goals in the office. They they accomplish those goals in their life. And resources that help to help them to uh do something they can do, be accountable to something and enjoy it. You know, I think a lot of that can be incorporated more into behavioral health practice uh to get people connected. And the world right now seems the more connection we have, it seems like the less connected we are. And it's a it's a strange problem.

SPEAKER_01 6:44

I think that we are over-diagnosing, I think that we are over-prescribing. And I think that we are grossly under-diagnosing people that really need our help and grossly under-prescribing for people that we could drastically change their lives if we were able to build a therapeutic alliance and get them on a medication that they need. I think that it definitely cuts both ways, and that's what I try to keep in the forefront of my mind in my clinical practice. Is this someone who we are over labeling, over-prescribing, and we need to normalize their human experience and provide some empathy? Or is this someone who we are shamefully neglecting as a society and I need to do everything I possibly can to help them get better? I think that uh the population of patients that we see ranges extremely broadly from distress that should not even be diagnosed or even have a treatment plan. It should just be normalized and say, yeah, this is a really difficult thing, and it's really difficult to be a human being. And I'm happy to talk with you while you go through it or refer you to a therapist who can. Um, and then I think there are definitely people on the other side of the spectrum where they're going to be incarcerated or dead within a year if we do not really get on our horse and intervene in this person's life. So that's the lens that I try to take.

SPEAKER_00 7:57

Johns Hopkins especially talks about this thing called the perspectives in psychiatry. It's one of the books that I read as part of a it was it was didactics, but it was voluntary didactics. It tries to bring together all sorts of different dimensions that a patient might experience. You know, it talks about the the more innate things like even someone's IQ and their ability to understand and interact, you know, with with their world and how effective they can be at that, and you know, what kinds of things might overwhelm a person like that versus a person who is extremely high functioning, dealing with a ton of anxiety, but you know, still able to go to work every day and do their job. And then think about a patient's life story. I think when most people go to a therapist or a psychiatrist, they kind of have this idea that they're gonna tell them their life story, you know, that that they're gonna get to tell them the story of them. And I think very few times is there enough time for them to be satisfied and desire.

SPEAKER_01 8:53

Yeah, I think we do underappreciate that. And I think that there's really no one size fits all approach to anybody. I think to your point about people's expectations coming in to see a psychiatrist, we really need to honor that. You know, from a common factors approach, this is what we would call the therapeutic ritual, right? And rituals have been important throughout all of human history. Any society you look at has had really important, meaningful spiritual rituals. And in our society today, when you're not feeling well mentally, one of those rituals is coming to a person with expertise in the area, whether it's a therapist, a counselor at school, maybe it's a priest or clergy, maybe it's a psychiatrist, but you come and you sit in front of this person and you pour your heart out, and this person gives you a response that is in some way um this person gives you a response that helps you to feel understood and not alone and able to get better. And I think that ritual in and of itself is incredibly powerful, and we need to be respecting that and harnessing that as much as we possibly can.

SPEAKER_00 9:56

Part of me thinks that, like, if I were ever a program director, the very first um set of didactics I would send someone through would be how to establish a therapeutic alliance, like not how to prescribe medicines, not how to um not what what to therapy would be best for this kind of patient, but how to get the patient to trust you and and how to um not just in not in a manipulative way, but in a way that you can now really start to understand them. Um, and because that is like the effect sizes are enormous compared to anything else that we do. And in and in fact, the effect sizes of the other things we do highly depend on that as well.

SPEAKER_01 10:32

Exactly. And that I couldn't agree more. And to be honest with you, that is the first change that I made as a clerkship director was I looked at the entire clerkship and I said, this whole thing should be about the therapeutic alliance. That is what I want all these featured doctors to know about psychiatry. I don't really care if they ask about caffeine use at every visit. I do care if the person that they are treating feels like this doctor cares about them, understands them, can listen to them, has expertise. And I I could not agree more that that needs to be the foundation of all training in psychiatry.

SPEAKER_00 11:03

Yeah, and there's so much because the story we tell is so huge and there's so many details we could ask about a patient's life. Um, things like you mentioned caffeine, and there's all these things that if if you live, if you work in an institution where a reviewer like the Joint Commission comes in, they're going to look at people's notes and they're gonna say, Well, you didn't ask about this, and you didn't ask about this, and you didn't ask about this, and then that becomes the priority. Instead of having a very comprehensive view of the patient, is like, well, you'd have to check all of these boxes. But in my practice, I have found that to be mostly noise and not much signal. Um, and finding the signal, I think, has a lot to do with letting the patient tell you what that is.

SPEAKER_01 11:48

1000%. Couldn't agree more.

SPEAKER_00 11:50

You've mentioned um, you mentioned this word a couple times when I was chatting with you. You said a humanistic approach. And um what do you mean by that?

SPEAKER_01 12:02

I think uh to be honest with you, to unpack that, I have to tell just a little bit of my own story. Um when I saw mental health care for the first time, I very my experience was I told my story to someone, and they immediately reduced me to a set of check boxes and gave me a diagnosis that I was not particularly interested in. And I felt like it was not a very therapeutic interaction and could have been done better. And that is, you know, if I could if I'm psychoanalyzing myself, I'm sure there's a lot of transference there, and I don't even know how much of it was real, but I did think to myself, gosh, I never want my patients to feel this way. I always want them to know that I'm really interested in their emotional life, and I'm really interested in the way they understand things, and I'm really interested in what they find to be meaningful in life and what their goals are for their life and what their priorities are. And I'm much less interested in five or six out of nine SIGNE caps as an example, right? That tells me some clinical information and it can certainly inform treatment planning, but I can get that on a checklist. It doesn't tell me who you are as a person, it's just a number of symptoms. And I just think I've seen it too often where psychiatry is practiced based on number of symptoms and approved pharmacologic interventions. And I just think that we need voices in the field who are advocating to do it with a little bit more nuance.

SPEAKER_00 13:31

You know this already, but you're not unique in that perspective. I I've hear so many times patients coming in and saying, um, I felt like a number. Uh, I've had friends who you know come to me now that I'm a psychiatrist, a lot of people tell me all their stories, but uh many of those include I went to a psychiatrist and all they did was prescribe me medication and and that's it. And don't be like that.

SPEAKER_01 13:52

And again, back to the therapeutic ritual point, people often come to us, not always, as we know, but often wanting to change, ready and willing to change, at a point where they're like, things in my life need to change. I need to change my behavior, I need to change the way that I understand things because things are not working, and that's why I'm coming to see a psychiatrist. And I think that when we do not fulfill that therapeutic ritual, when we do not build an alliance, when they do not trust us, they don't feel like we really care who they are as a person, we are squandering a beautiful gift that we need to be honoring, which is someone, you know, trusting us to help them better their life. And that moment doesn't come around very often. I mean, I think a lot of people probably see a psychiatrist once in their life. And if it's a good experience, maybe they get better. And if it's a bad experience, they say, you know what, I knew it wouldn't work. I don't even know why I did it in the first place. I knew these people were just pill pushers. And I just think it's too sacred an interaction to not be doing everything I possibly can to improve the quality of these interactions for everybody, really.

SPEAKER_00 14:58

I'm glad that that perspective is still out there.

SPEAKER_01 15:02

I think unconsciously, people know by the time they get to a psychiatrist, this pattern that I'm in is not working. And they're as close as they're ever going to be to breaking that pattern if they can get the help they need. And we need to know that when we go into the interaction, that this is a really high-stakes interaction, and they have to navigate it really carefully.

SPEAKER_00 15:20

Right. Yeah, that reminds me of what I was thinking about that, yeah, people are coming for a reason, and most of them don't want to be there, and they probably took a long time to get there. And many of our uh the things that we treat have sort of is one of the symptoms is a negative outlook or an inability to trust or, you know, and and to just to overcome that and show up shows so much, unless they were brought in by police or something like that. But like even then, you still have to develop an alliance, right? They showed up and and that required for them that that was probably something that was agonizing. I want to respect that for sure. I just realized that I haven't really asked you to talk about your professional bio, introducing yourself to everyone in terms of you know where you grew up intellectually and uh and where you are now.

SPEAKER_01 16:13

I did undergrad at Spring Hill College, which is a small liberal arts school, went to St. Louis University for med school and then to Creighton for residency. And I think that that sort of Jesuit ethos really is something that I connect strongly with and is important to me. So I'm really happy to be at a school that has those values and to be able to work with the students from that lens as well. So that's a little bit more than you'd find on an internet bio for me, a little bit more than I usually disclose, but that is something that is uh important to me.

SPEAKER_00 16:42

Do you mind giving people who don't know a little bit of a quick, probably oversimplified view of what a Jesuit ethos is?

SPEAKER_01 16:50

Sure. So I was raised Catholic. I come from a Catholic family, um, and I've been at Catholic schools my whole life. The Jesuits are an order of Catholic priests, Catholic missionaries that has been around for a long time. They're often called the Marines of the Church, and um, they are sort of famous for their whole person approach to education with spirituality at the center. And what I'll say is that Jesuit spirituality is very inclusive. It is not strictly people who practice Christianity that can find their spirituality and feel respected at Jesuit institutions. It's a place that holds space for the fact that there is meaning to this world, there's meaning to our lives, and we should be seeking purpose and connection with others, and we should be doing things that unify humanity and do not divide humanity into groups to be pitted against each other. And that is really a philosophy, um, indeed a theology that I think is really important to me to have that at the center of what I am doing, so that I can always point to that at my work and say, no, no, no, this is what we're doing, right? We're bringing people together. We are solving difficult problems with love, right? This is this is what we're about. We're about uh wellness of the whole person, mind, body, spirit. We are about respecting people that are not respected in other areas of society. This is why we're here, right? And that's just kind of where I came from. So that's part of it, is that's what's comfortable for me. But another part of it is I really want to be at institutions that are very mission-focused. And I think the Jesuits have had a mission that really aligns with my values.

SPEAKER_00 18:28

Now that now that you're snowed in and I basically have you trapped behind a computer that you can turn off at any point in time. But but uh you're saying things that getting me excited uh and making me think of questions, thinking of patients as a whole person, uh, and in uh sometimes the word spiritual like makes people like, ugh, because you know, there's certain aspects of that that people might have in their own lives where they think of the word spirituality and they think of some sort of very you know strict sort of religious type of uh attitude. But there's a broader definition or conceptualization of spirituality, I think you you're talking about that could be used in clinical practice for patients. And I was wondering if you could maybe expand a little bit on how to incorporate a more sort of spiritual view and what that might look like, even for maybe a provider who is an atheist.

SPEAKER_01 19:27

Yeah, totally. I think you know, this is a lot of what I do clinically. It's a lot of what I believe personally, and it's not on the internet anywhere about me. You know, it's complete psychiatry bootcamp is completely void, devoid of this sort of language. I don't really explore it, and I don't really plan to. So this will be uh sidactic exclusive, I suppose, on me. Um, but I think that, you know, well, you can look at Victor Frankel, right? You can look at Man's Search for Meaning. And I think the antidote to human suffering is meaning, purpose, mission, feeling like you matter, feeling like your life is important, um, and frankly, love, you know, and I think that when we're working clinically wearing our white coats, often we shy away from things like love and what keeps people going, right? But how many suicide risk assessments have you done where the only reason that this person is going through this life that is horrible and has not ended their life yet is they love their children. I mean, I think if I do a hundred suicide risk assessments, 98 of those people tell me, you know, I really am not having a good time in life, but boy, do I love my children. Boy, do I love my family, and I can make it work for that. And to me, that's really powerful. So I don't shy away from the word love with my patients. I don't usually tell my patients I love them. And I think when people are going through difficult things, you know, and some of this is just basic supportive psychotherapy, but it's what does keep you going that does sound really hard. Um, is there anything that you anchor to that gives you meaning, even when you're going through things that you don't feel like you could get through? And I think a lot of humans, even if they're atheists, will point to something, often it's relationships, and say, I have meaning here and I can put up with a lot of distress, symptomatology, because I feel like what I'm doing matters and I have a meaningful existence as a human. And one of the things that I love about consult is that people that are medically admitted that need to see a psychiatrist are really sick. You know, it's often post-suicide attempt, or maybe they just got a new diagnosis of a life-threatening problem. And when people are really sick, you start asking yourself some pretty existential questions, you know, and those are the questions that I love to explore with my patients because I think they're things that really matter. Um, and it is scary because I don't ever know what sort of territory the patient's going to lead me into, but I know that I can always be supportive, I can always meet them where they're at, and I can always Always back up a little bit and turn to something that I feel like we can agree on and that is a little bit less controversial. But spirituality is an important part of my practice, I'll just be honest with you.

SPEAKER_00 22:10

Yeah, thank you for that. Um, I'm not gonna leave you just hanging there. So, you know, I'm I am an atheist, but uh I grew up in uh religious tradition. It was a very kind of conservative tradition in the Midwest, and we weren't even allowed to do things like clap our hands in church. That was too much, you know, kind of no dancing stuff like that. And uh so when I was younger, you know, that was kind of my view of what religion had to be. But the older I get, the more I realize how much meaning like you I think you said the word like what makes your life meaningful. And meaning is so important when we look at things like burnout, people can work. I they say, oh, we're working too many hours, oh we're we're um not taking enough breaks. And those things are important, but people who view their work as super meaningful, that doesn't bother them as much, right? They're they're will they're able to do things that people who don't see their work as meaningful can't do and overcome obstacles that uh other people would be like, I'd be so burnt out. And they're and they're like, what do you mean? I love my job, you know, like uh that sort of thing. So finding meaning in and helping a patient to think about what makes their life meaningful, I think is a super important thing for uh any therapist or psychiatrist to help foster in a patient.

SPEAKER_01 23:28

You got it. And to be clear, I think spirituality and especially organized religion is way too often weaponized in the world in the US. It's way too often used to exclude people, to make rules about what you can and can't do, what you should and shouldn't do. And to me, that sort of immature spirituality and weaponized religion has no place in clinical practice. There is no room for that, there is no tolerance for that. Um, but I think we do need to feel empowered to move into meaning and spiritual realms.

SPEAKER_00 23:58

We got into some stuff I did not anticipate here at the beginning of our conversation. Same. Those are the best ones, I think. Um there's a sense, and I don't think psychiatrists talk about it a lot, but uh it's one of the I think it's an emotion really that people can have, but that sense of wonder like about the world. Like when you when you see something and it's just amazing and you want to know more, and it's it's its own kind of distinct thing. We have very few words for actual emotions in the English language. And and uh so that's uh I think that's a one of the weaknesses of the language we use in practice, in my practice anyway. My wife talks about uh she's a native Spanish speaker and how Americans use the word love for everything. And she's like, but but we have multiple different words and they all mean different things, and you know, you you all translate them love, but that's not what it is. And and I can remember growing up, and one of the things that uh I was I was taught in uh in a religious context was the difference between different words um for love, like the word eros, which is more like the romantic stuff. In fact, my son's name is Eros, so that's kind of um, and then there's like the uh the more like uh Phileo, like Philadelphia brotherly love type love. And then there's like more of an agape, which is kind of a transcendent kind of love, where it's it's uh it's a love, uh almost kind of an unconditional, no matter what kind of love. But those those are not the only three kinds of love people can have either. Um you mentioned talking to patients about love and the loving relationships they have in their life. And I think that is super important. One of the things that crushes people more than anything is when a long-term relationship ends, even if it's been going really bad for a long time and it's been so obvious to everyone else that it should have ended years ago, the letting go process is something just in it, it's so hard for people to do. Figuring out how people can still view themselves as a whole person, love themselves, feel loved in the in when something that is really just tangled up in their identity is being torn apart from they're being torn apart from that.

SPEAKER_01 26:18

It's awfully aspirational, but I'm glad that we have a space to talk about it.

SPEAKER_00 26:23

Right. Um, people just being able to talk about it more than it's hard. Yeah.

SPEAKER_02 26:28

Yeah. Yeah.

SPEAKER_00 26:29

Wow. Do you have any questions for me, Mark? I mean, I've been, I know that wasn't really the frame that we're operating in today.

SPEAKER_01 26:37

So you're you're generating an enormous amount of content. And I guess my question is why? You know, I mean, you have a day job, you're not getting paid for your podcast, and yet you've been very prolific. Uh, why do you do it?

SPEAKER_00 26:52

We talked earlier about like love. We talked like I'm I'm just fascinated. One of the reasons I chose psychiatry is because there was so much unknown about it, um, which is frustrating at times. I found myself during my residency thinking, maybe I should just quit this because there's um I think maybe every resident thinks that at some point. Uh, because I I would I felt like all every attending I would talk to would have a different perspective on it. And they would, they weren't directly critical of the other attendings, but they were basically saying what that other person said is is wrong. You should listen to me. And and for that was super frustrating for me. But I still wanted to love what I was doing. And I wanted to be able to study, and I found it very difficult to, and for me, because I was even having a hard time learning in didactics, because maybe maybe I have some issues. I've never been diagnosed with ADHD, but many people in my family have. And um, I can't like sit and just take stuff in. I have to be actively involved in a process. So if I assign myself work, and I know that sounds weird, but something I enjoy doing, you know, it's like a hobby. Some people uh make train sets and they watch them go round and round, and I read journal articles and try to write stuff about them. And so it uh it it helps me to be engaged with content that I love in a way that's kind of fun. I used to write songs instead of read paper. So I I used to sit on my porch at night when I was a uh undergrad and a grad student in evolutionary biology, and I just bring out a guitar. I wasn't good at playing the guitar, but I would I would play it and I tried to learn some banjo and some mandolin. But I wrote, I wrote, I've written probably two or three hundred songs in my life. Um, because I'm like, well, if I want to learn how to play, maybe I should just write some songs, you know, start about super simple, super simple, just kind of silly, silly songs, and then worked into more, I think more serious stuff. So I just enjoyed it. It was fun. And I have the same kind of enjoyment while I when I download a new paper and I start to read it and I and I come across a concept, and I'm like, I don't understand that at all. I don't know why, but for me, that's not like I need to put this down. That's uh okay. What does somebody else have to say about that? Because this didn't make sense to me, but I think I should understand it. Yeah, it's weird. It's just what motivates me.

SPEAKER_01 29:25

Um so in part it's to do sort of deeper dive think pieces to help yourself fall in love with psychiatry again when you're kind of getting beaten down in the middle of training, and then also just sheer practicality of people actually learn from podcasts. They unlike textbooks, which collect dust on bookshelves, people might actually listen to a podcast and learn something. So it sounds like it was a kind of a combination video.

SPEAKER_00 29:50

Yeah, thanks for summarizing it so well. And I'm glad that I did it. Uh I keep doing it. So voluntarily.

SPEAKER_01 30:01

What is one thing you want every Sidactic Podcast listener to know about you?

SPEAKER_00 30:09

I just divulged that I've written a few hundred songs. I mean, I don't know if I've ever said that before. But then there are things that I kind of want people to know about me, but I wouldn't say. I'm trying to I think I think if anything pops to the surface right now, um it's a it's a good question. I want them all to know that I used to have dreadlocks. Um, I was a very different person than I am today, you know, like in my youth. I've gone through, I don't know, phases is not the right word, but I've gone through uh periods of rapid change in my life and periods of exploration. I went to college right out of high school because my mom showed up and made me go. Uh, she's like, they're enrolling today. I'm like, okay, so I did, but then I ended up dropping out because I missed some tests because I ended up working late and my alarm didn't go off. And then I was like, oh, screw this. So I dropped out of college. I ran off uh to live in another town with some guys who were mostly in college and kind of did the hangout. It wasn't really a fraternity, but it was kind of like one for a few months. And then from there, I ended up going down to New Mexico because my younger brother had dropped out of high school and ran away from home. And he had ended up down there and it and uh he was getting married. He invited us to his wedding, and it was really cool because I went down there and we were by this river out in this valley in New Mexico. Um, and all these people just started coming out of the woodwork. They just started arriving, some people on with mules and donkeys, people with Loincloss, like people with big backpacks just setting things up, bringing stuff down. One guy made a big batch of some alcoholic thing where he mixed a whole bunch of stuff together, but it was in, you know, and and it was in the middle of nowhere. There's no like going to the grocery store to get stuff. It was and there was this huge community out there that I had never seen before, and that's fascinating. So I ended up going down there and staying down there for um around a year or so before coming back. So that's a very short version of like one part of my life where things changed a lot, you know. I didn't have a direction, and and I found this community that just fascinated me and went to go learn more. And I'm glad I did. I think it helps me as a psychiatrist when I if I had just kind of grown up and gone through from one part of school to the next to the next to the next, I might think that someone who did something like I did, just because they did that, was maybe mentally ill, right? I see that kind of perspective in other people where they're just like, that's so weird to me. There must be something wrong with you. Right. And and for me, I I feel like I don't start there at all. I'm like, oh, that was that's kind of cool. Tell me more.

SPEAKER_02 32:52

Yep.

SPEAKER_00 32:53

Um, because I have some experiences in my life like that.

SPEAKER_01 32:57

So um you have a lot of wonder and awe. I feel like you you look at something and you say, that's beautiful, and you just sort of gravitate toward it and stare at it and analyze it and experience it. And then maybe you something else catches your attention and you do that. You you seem to be a real explorer.

SPEAKER_00 33:15

I I think that's probably a good word for it. Yeah, an explorer. Like I can't sit still. Um yeah, that wonder and awe. I I'm I hope I don't lose it. My dad, when he got older, was kind of a curmudgeon and then my my my son still calls him the grumpy, you know, grumpy grandpa. I can't, and and I I don't want to be that. But uh I hope I hope I'm not you're on the right track. Thank you. Thank you, Mark. Appreciate it. Uh any more questions? No, I think I'm good. All right. Yeah, this this went longer than I expected. We talked about more, yeah. Yeah, I there's a humanity. I think when you you know that humanity you talked about humanism, I was confused about things like the biological perspective and the um psychoanalytic or psychodynamic and then the cognitive behavioral and the and all of these separate sort of factions or camps or denominations within psychiatry. And then there was the more ecumenical idea where, oh, we can just all just get along. But in fact, we've not we can't necessarily, because sometimes the things one people say actually contradicts others. So it's it's uh it's a landscape with a few minds in it, you know, you have to be careful sometimes, and it's fascinating. But at the same time, you know, we are more and more coming together. And in the future, the thing that I hope to see and maybe even contribute to a little bit is a way to do that, you know, a way to do that that takes what can be demonstrated as the strengths of each approach and give them some conciliance with with each other.

SPEAKER_01 34:56

And in areas where they are directly at odds, are we maybe talking about different patients, or maybe we're talking about different problems, you know? Like, yeah, yeah, supportive psychotherapy is not gonna work for OCD. You know, doesn't mean it's bad, just means we're talking about different patients. So it'll be I I'm not very hopeful that things are gonna be different when we end our careers than they are right now. But I feel like all you can do is put your shoulder in and try. But thanks for crushing my dreams. Yeah, no, yeah, it's not gonna happen. You may as well just go work for a phone company or go deny insurance reviews or something. So that's right. Now that we're off the record, I can tell you that.

SPEAKER_00 35:34

Thank you for hanging out with us today. I would just want to leave you with a few thoughts. Now that I've been doing this for a while, the reason that I brought this content back was because there's so much about what we do that is uncertain. But there are a few things that are truly meaningful. And I think it can be very distracting to us to go through day after day after day looking for an answer when maybe we shouldn't be looking for the answer. We should be looking for the meaning, but I don't know.