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Ep. 101: Suvrat Bhargave, MD – You’re More Than What You Feel

February 25, 2020 Sucheta Kamath Season 1 Episode 101
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Ep. 101: Suvrat Bhargave, MD – You’re More Than What You Feel
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Full PreFrontal
Ep. 101: Suvrat Bhargave, MD – You’re More Than What You Feel
Feb 25, 2020 Season 1 Episode 101
Sucheta Kamath

Uncertainly, unceasing demands, and all around unrest can provoke the feelings of restlessness, a state of irritability, and intense worrying and general dissatisfaction. But clinically speaking, these feelings of being on the edge are the signs of anxiety and often when they exceed the threshold of bearability a sense of unending despair can follow.

On today’s podcast, psychiatrist, author of the book “The Moment of Insight”, educator, and celebrated speaker, Dr. Suvrat Bhargave from the Center for Family Psychiatry, discusses the true nature of the “growing pains” of children for whom the world is a large mass of unknown. He says anxiety is within the range of human experience and human emotion and by cultivating inner awareness, one can bring about important and meaningful changes and remind children that “HOPE is the possibility of something good”.

About Suvrat Bhargave, MD
Suvrat Bhargave, M.D. is a renowned and respected educator, author, speaker, and board-certified psychiatrist, specializing in child and adolescent psychiatry. His uncanny ability to relate to a multi-demographic audience has allowed his practice to reach an unparalleled level of success based on empathy, education, and empowerment. His book, A Moment of Insight: Universal Lessons Learned from a Psychiatrist’s Couch, offers practical strategies and thought provoking narratives to not only understand and persevere through challenging dilemmas, but to see greater purpose during these times. He demonstrates this through poignant patient stories and personal accounts.

Affectionately known for his “relatable expertise”, Dr. Bhargave is highly sought after to lecture locally and nationally on a broad range of topics pertaining to personal growth, effective parenting, relationship satisfaction, and mental health conditions. After completing his residency training and specialty fellowship from Duke University, Dr. B (as he is lovingly called by his patients) continued his practice in hospitals, community health, and private practice settings. Throughout the years, he has been most inspired by the impact his caring nature, education, and treatment have had on others to facilitate change and to experience fulfillment through gradual but dynamic moments of “insight and awareness”. A passionate advocate for healing and empowerment, Dr. B is compelled to bring a world of change to each person one moment at a time. To learn more about Dr. B and invite him to speak at your next event, visit.

Websites:

Books

Show Notes Transcript

Uncertainly, unceasing demands, and all around unrest can provoke the feelings of restlessness, a state of irritability, and intense worrying and general dissatisfaction. But clinically speaking, these feelings of being on the edge are the signs of anxiety and often when they exceed the threshold of bearability a sense of unending despair can follow.

On today’s podcast, psychiatrist, author of the book “The Moment of Insight”, educator, and celebrated speaker, Dr. Suvrat Bhargave from the Center for Family Psychiatry, discusses the true nature of the “growing pains” of children for whom the world is a large mass of unknown. He says anxiety is within the range of human experience and human emotion and by cultivating inner awareness, one can bring about important and meaningful changes and remind children that “HOPE is the possibility of something good”.

About Suvrat Bhargave, MD
Suvrat Bhargave, M.D. is a renowned and respected educator, author, speaker, and board-certified psychiatrist, specializing in child and adolescent psychiatry. His uncanny ability to relate to a multi-demographic audience has allowed his practice to reach an unparalleled level of success based on empathy, education, and empowerment. His book, A Moment of Insight: Universal Lessons Learned from a Psychiatrist’s Couch, offers practical strategies and thought provoking narratives to not only understand and persevere through challenging dilemmas, but to see greater purpose during these times. He demonstrates this through poignant patient stories and personal accounts.

Affectionately known for his “relatable expertise”, Dr. Bhargave is highly sought after to lecture locally and nationally on a broad range of topics pertaining to personal growth, effective parenting, relationship satisfaction, and mental health conditions. After completing his residency training and specialty fellowship from Duke University, Dr. B (as he is lovingly called by his patients) continued his practice in hospitals, community health, and private practice settings. Throughout the years, he has been most inspired by the impact his caring nature, education, and treatment have had on others to facilitate change and to experience fulfillment through gradual but dynamic moments of “insight and awareness”. A passionate advocate for healing and empowerment, Dr. B is compelled to bring a world of change to each person one moment at a time. To learn more about Dr. B and invite him to speak at your next event, visit.

Websites:

Books

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Producer: Alright, welcome back to Full PreFrontal where we are exposing the mysteries of executive function. As always, I am here with our host Sucheta Kamath.

Good morning, my friends, this is going to be a fun conversations. I know you guys are old friends.

Sucheta Kamath: Yes, it’s going to be so great and it’s great to be with you, Todd, and today, I was thinking about, as I got ready for this conversation, as a speech and language pathologist, when I did my undergrad and masters, we never had any type of training to deal with difficulties that we might have with patients or clients, but I know I have talked to a lot of my colleagues who are psychologists and psychiatrists and they themselves go through some therapy from themselves, and I have always found this as a very, very fascinating concept because teachers, speech language pathologists, counselors, we are all in the business of helping people but we often thing that because we are helping, we have to really stay away from their pushback or their difficulties or them blaming the clinician, for example, for the root of their problems. So, in that context, friendships have really been very, very important, and it’s always a fantastic thing to have a psychiatrist as a friend because you can just literally get cheap therapy, but the second thing that’s really important to me, and Todd, you and I have talked about this on this podcast, is I have a very deep spiritual life and I am a practitioner; I totally believe in introspection, and spirituality, too, means it’s to not just finding meaning but also connecting with every person with great intention, and that is what is so exciting to me about this conversation that I’m about to have with a very dear friend, and finally, I’ll say this, that each person, I highly recommend that we should have a street committee, a group of consultants that are on standby that we should look for, reach out to who will give you advice, who will anchor you, and who will always be comfortable saying, “No, you’re being stupid.”

So, this dear friend is that, so it gives me great pleasure and honor to introduce my very dear friend, and his name is officially pronounced Suvrat Bhargave, but I think he also is fondly known as Dr. B. He is a renowned and respected educator, author, speaker, and a board-certified psychiatrist who specializes in child and adolescent psychiatry. His uncanny ability to relate to a monthly demographic audience has allowed his practice to reach an unparalleled level of success based on empathy, education, and empowerment, and I cannot speak enough about his tender heart and deep compassion for every person that is sitting in front of him. His book, A Moment of Insight, which I’m very excited that we will talk a lot about that, universal lessons learned from a psychiatrist’s couch offer practical strategies and thought-provoking narratives to not only understand and persevere through challenging dilemmas but to see greater purpose during these times. He demonstrates this through poignant patient stories and personal accounts. A few things about him is he’s a passionate advocate for healing and empowerment. He is here to offer a message of hope to his patients in the world and he really believes in changing each person one moment at a time, and of course, we will think about to get in touch with him, but you can find more about him and invite him to speak at the next event. He is a superstar when it comes to talking to parents and educators, so you should visit his website which is called drbhargave.com.

So, welcome to the show, and by the way, for this interview, I’m going to call him Suvi, I hope you don’t mind.

Welcome.

Dr. Suvrat Bhargave: Oh, thank you so much for having me and I’m going to just go ahead and say it, I’m going to call you Suchi as well because that’s who my friend is, and I’ll tell you, it’s an interesting thing to listen to your friend talk about you in the way that you just did. It reminds me how many layers there are to our relationship, and I also say this: when it comes to that street policy that we all need, that person who really will always be there and sometimes call you out on your stuff, you are so that for me, so I’m thrilled, I’m thrilled to be here.

Sucheta: And, just a quick anecdote to our listeners, we are really revealing ourselves now, but Suvi and I, when Oprah retired from her official show, so he and I, we go long, long ways. We have done a talk show together, a radio talk show, and he has a secret life as a host of many types of shows, but he also has a radio show that is currently going on, and so we actually applied, right, to be in that reality show to become the hosts, right?

Dr. Bhargave: Right, I can’t believe you’re going there but sure, let’s go there, yeah, we did. We had some notion in our head that somehow, Oprah was going to agree to do two shows instead of one and for both of us on the air and we would [00:05:20].

Sucheta: Well, I’m really rooting for you to get on her show and I get to tell my friends that that’s Suvi, I know him.

Well, welcome to the show and I always ask my guests, since this show is about executive function which is your self-administrative skills, how we stay goal-oriented, manage our behavior and emotions, and attitudes as we are trying to achieve goals that we have set out for ourselves, and if we don’t have the wisdom to have those goals for us, then have the wisdom to follow somebody who says that these goals are important to you. So, in that context, would you tell us a little bit about your own executive function and what did you discover about yourself as a learner and a thinker?

Dr. Bhargave: It’s such a great question that we should all probably ponder. At what point do we really become or really value our learning? And even as I hear you say that, in my head, I’m thinking back to a time when I wasn’t learning or actively processing and trying to figure things out, and I say in the book and describe myself as having been a child with anxiety, and the other word for anxiety is doubt, it’s the disease of doubt, and so questioning was such a part of my life for as long as I can remember. I don’t know when I wasn’t questioning the world around me and I knew that for the first part of my life as a disadvantage. I mean, I used to look at my peers my age and I would think to myself, what is it like to not think this much or what would it be like to not question this much? So, it’s hard for me to remember a time when I wasn’t questioning and conditioning myself to collect data and make it make sense, and so in terms of my executive functioning, I would say early childhood. Early childhood is my when I first really became aware. What I didn’t really do as well at that point was I don’t know that I observed my thoughts which I’m sure we will get into later, but in terms of the actual exploration and recognition of the voice within me that was trying to piecemeal and put the world together, very early age, very early.

Sucheta: Thank you for drawing a distinction between these two things which is so interesting, and knowing you and we have talked about learning, and in your book you write about this as well, but having a deep understanding that people have thoughts, ideas, beliefs, and becoming aware of how they parallel your own thoughts, ideas, and beliefs is a very important social psychological emotional development, but to think about your own thinking, and then kind of ponder and redirect is a whole gamut of metacognition, so that, of course, is a painful process because then you also discover some other flaws that your thinking processes or behaviors have.

So, let’s start talking about your work. You see patients in your practice who are struggling and we might even call it suffering, but the simple experience of ongoing discomfort or misery does not propel people to make changes to their lives. How can suffering be a vehicle to move oneself forward?

Dr. Bhargave: Yeah, yeah, the title of the book, A Moment of Insight, to me is the piece that is important in terms of where do you finally turn it around or have a chance to turn it around and start to make a difference? So, suffering in and of itself, I think sometimes, you can find yourself actually getting stuck in it, and so the idea of moving forward requires something more than suffering, and everyone of us has suffered; we have all, at some point, felt victimized, had things that were not in our control that either happen to us or caused us to feel certain things or go through that, so I think the crucial moment is that moment of insight, and that moment of insight that I talk about in the book is where you do have the awareness, so it kind of goes back to what you just said, the difference with the two. It’s when you do have a second of awareness, it is where you do observer for one second your own perceptions and realize that a certain way of thinking or feeling, or behaving, whatever it is in that moment, that it isn’t working for you. So, you can go through the motions and still not have that realization, but as soon as you can look in on yourself and say, wow, this way of thinking or feeling, or behaving is not working for me, then you can start to make change happen.

So, one of the easy things about being a psychiatrist is that I get to witness that, I get to witness that in front of my eyes and for some people, it’s something that I might have said that got them to pause. Sometimes, it’s something that came out of their own mouth but they had not really stopped to hear it, and that made them pause, but whatever it is, I have gotten to witness it over and over again, and it’s really interesting, Suchi. Sometimes, it’s just a tilt of the head that lets me know that a shift just happened. Sometimes, the person actually says out loud, “Wow, I haven’t thought of that,” but whatever way it presents itself, that’s the piece that I find very exciting for the person sitting with me because I know that that is a potential now for there to be a change and a way of getting out of the suffering, if you can just be on the outside and see it.

Sucheta: You know, you surprised me when I got the pre-publishing copy of your book. In so many ways, you are unique in your practice and your approach to psychiatry. You are a rare breed of psychiatrist who actually does do some individual work other than just medication which is such a joy for me, but you also are somebody who actually, as you said, watched that journey long enough that the transformations are visible to you, and then you make those then visible to them, so that brings me to this idea that of all psychiatric ailments that I see in my patients who have executive function challenges, anxiety seems to take the crowning glory. You say in your book, I quote, “For most, anxiety is all of these things: feeling tense, worried, fearful, pressured, panic, inadequate, and obsessive,” and I just love that you summarized everything that my patients feel. A person who is highly dysregulated, perpetually scattered, late and disorganized, seemingly calloused, uncertain about goals often is accused of being disengaged and incompetent. For this person, anxiety is just a simple byproduct of having executive dysfunction. They may even appear like a swan in a lake – calm on the outside but massive unrest inside, so talk a little bit about anxiety and how do we think about anxiety? And you write beautifully about this, there’s so much hope for people who feel anxious, and not having anxiety is literally not being a human, so where is the balance?

Dr. Bhargave: Right, right. That’s a good point. It’s worth saying that from the beginning of any discussion about anxiety, is that anxiety is within the range of human experience and human emotion, so there is no one existing right now who has not had moments of anxiety, but for those of us who identified ourselves as having been anxious, people might still suffer with anxiety, it is more intense than you would imagine it ought to be. It lasts longer in your actions than you would imagine it should, it happens frequently in your life where you find yourself doubting. So, I think people who are anxious on some level do know that there’s something about the way that they respond that is greater than it should be for them or in some ways, getting in the way of how it should be, but I don’t think most people know to call it anxiety. I can say that I didn’t – that word, I wish that word had been introduced into my vocabulary at a younger point in my life because I might have recognized it as something other than my own deeper self telling me that I have reason to doubt myself and everything around me, but if you can see it as a phenomenon, as its own force, then you have a chance of not internalizing it and responding to it in a way that we think is instinctive, right? It’s almost like anxiety walked in the door and it’s up to me to recognize when it walked into the room.

So, I always tell people that what I’m hoping to educate others about what anxiety is, whatever word makes sense to you, but I do want you to know that it can look differently at different times. So, for some, it means being tense and on edge, and for others, it means being excessively worried. For some, it means being fearful, and for others, it means a sense of dread. For others, it means being obsessive, but it’s all still anxiety, and anxiety being the insidious force that it is, it will come at you at a different way just when you figured it out one way, so then it will [00:13:43] another way.

Sucheta: Thank you for clarifying that, and I think if I can ask you to tell us a little bit more about this idea that aren’t emotions showing up to get us to act? So, what is anxiety telling you to do and how can one interpret that in the right way? And as you said, anything with excess is regular human experience expands into a range of disability, right?

Dr. Bhargave: Yes, absolutely. It such a great way to make that distinction because you are right, up to a point, anxiety serves a purpose, right? I mean, I always say anxiety got me through medical school, so a little bit of a nudge to oh my goodness, I need to study, what’s coming up causes me to act, and that’s the thing. Anxiety, when it shows itself into our space and we feel it, our body does react and most of us have heard this phrase: you fight or you sleep, right? Your fight or flight response and it is meant to do that. It is meant to cause us to react, so again, if I have a task, I should act, I should study, I’m about to cross the street, I should look both ways. If I am walking down a path, I should be on the lookout for a bear that might pop out of the woods, that type of thing, if that is such a thing. So, it is a system that is meant to serve a function. The problem for people who have anxiety is that we often experience that alarm system in a very false way, so the way I explain it to young children is, it’s a false alarm that makes you think that there really is something right now in this moment that is happening that you need to respond to and in some way prepare for, in other words, fight or flee when there really isn’t, so for young kids, the way that I explain that is, again, if I’m about to cross the street, everyone understands, I should look both ways – the alarm goes off, right? But if I am walking in a wide open field, a wide open pasture and the alarm goes off, anxious people start looking, we start looking and then we start rationalizing and bringing emotion into our thinking, and we start rationalizing, and we do start running with the what-ifs and look, I can make it. Any situation seems like there is imminent danger. I can tell myself that there are big trackers that actually do come on open fields and it could’ve been here and I might’ve missed it, and it might have come over me, or I could remind myself that even though it feels the exact same as what I have come to understand as an alarm, this one is a false alarm. There really isn’t anything happening right now in this moment, and that’s very hard. I mean, in my example, it doesn’t sound so hard, but when you felt the presence of anxiety in your life, really from the moment that you really had conscious awareness of your thinking, you develop a habit of responding to it, and I think that’s what anxious people have a hard time then flowing against, that pattern of one what-if leading to another what-if, leading to another what-if, in preparation for something that is about to happen or the idea that I’m not good enough, and then you take that small threat and you unravel it to the point where I can’t do anything right.

So, for many of us, I think, that just became a habit.

Sucheta: I think the very important distinction that you drew for us is that when it is incessant and it’s not directly proportionate to the precipitating factor and it lingers longer than it should, and more importantly, as you see particularly with the kids that you and I serve, that there is a reason for them to be anxious, they are disorganized, so if they begin to panic that oh my God, I haven’t studied or I don’t have a book, they have a legitimate reason, so it’s not that they are even making it up, but just because somebody is anxious, they will not take the right steps and that is where there is a disconnect that anxiety doesn’t serve and does not end in itself, and that’s why I think your message is so clear about whoever is helping the children need to kind of – and I don’t know if the parents can do that, but who can really do the job of pointing out that the fear is irrational or the worry is unreasonable? Because you can’t tell an anxious person that, right?

Dr. Bhargave: No, no, no. Not right away, anyway. I mean, eventually, this is the goal for anyone who is dealing with anxiety, to be able to coach themselves into asking, is this a real alarm or a false alarm? But yeah, I think the adults in the life of young people, those who are involved in taking care of and guiding young people, so that could be a teacher and certainly, the parents or anyone who can serve that function, and so what I ask parents to do in that situation is if you see that your child is panicking and you’re trying to help them distinguish, then there’s two questions that will help you really kind of sort it out. The first question is, is there something happening right now? Is there something in this moment that you are responding that is happening right now, right? Because if there is, again, we probably need to act. If the child comes into your room and says, “I had a bad dream. Someone’s going to break in the house and take me,” well, is there something happening right now? Because anxiety would have us anticipate in what-if and prepare for the future, or perhaps even ruminate over the past, but if there is something not happening right now, then chances are, it’s a false alarm, and then the follow-up question with that would be is there something more to do about it right now?

Sucheta: Great, great, yeah.

Dr. Bhargave: And that follow-up question really came to me from a young girl that I saw in my practice many, many years ago who was actually having what I could tell up in that moment in the session was a panic attack and I said to her, “Let’s practice this. Is there something happening right now?” fully expecting that she was going to say no because it was just us sitting in the room, and to my surprise, she said yes, and I said, “Well, what’s happening right now?” and she said, “Well, my teacher’s husband is in the hospital right now and he’s very sick, and what if something happens to him?” So, the follow-up question of is there something more we can do about that right now kind of came in as a secondary question, but again, it helps you distinguish a real alarm from a false alarm because anxious people would like to think that they could control every variable or if they work even harder, and [00:19:29]

Sucheta: Exactly!

Dr. Bhargave: Right? That in some way, it’s going to be different, and you’re taking on something that is not yours to take on and that’s what anxiety does. It makes you want to do 110% and you can’t do 110%. You can do 100%, you could do what’s within yours to control, and then after that, you have to surrender the outcome.

Sucheta: And of course, the wisdom is that you don’t even know how to do 100%, but we won’t talk about that.

Dr. Bhargave: Yeah, that’s right, that’s right. Anxious people who are trying to do 110% don’t even know that even 100% is very difficult, but when I say give it 100%, anxious people think that they are perfectionistic people because that is another word for anxiety – I think that they are settling and I have to remind them, 100%, and even from when I remember the math, that is the whole body, right? That’s it, that’s all you can do, so you are not settling, you are doing your best.

Sucheta: That’s lovely, so one of my favorite things about your work and your writing is that you are a physician and a practitioner, but you do not shy away from talking about the intersection between psychiatry and spirituality where both call upon this idea of self-discovery and self-surrender. They both help get a sense of agency and build meaning, and let go when necessary, particularly in unfavorable circumstances. So, talk to me about this intersection. You do write that in your book, that one place the psychiatry and spirituality intersect is the notion that with the heaviest burdens, there is no place in anyone’s life for shame, so I would love for you to explore that a little bit with us.

Dr. Bhargave: Yeah, I know, I would love to do that. So, and going back for a second to our friendship, I think it’s really interesting, as I think about how everything in life serves a purpose, you and I became friends many, many years ago, who would’ve thought that we would have such a wonderful deep spiritual discussions that it has been a common thread for our relationship as well? I also similarly had never expected that psychiatry would be a form for me to have a spiritual understanding. You think of psychiatry as being a field of medicine that is related to our thinking and our healing, but it’s much more than that. It really is tied to spirit, and all of these struggles that come about from psychiatric illness, I believe are also a way, a possibility, a conduit to be able to really start exploring, well, why do these things happen at all, right? And who am I when these things keep happening and how can I maintain some sense of consistency in my life even when life is going up and down and up and down, and up and down? So, I found that in having really deep discussions with people at their toughest times, we would actually start asking those questions, and the beautiful thing about asking questions many times over and over again within as many discussions as I’ve been able to have in 20 years is you ask enough questions, ultimately, you find some answers. So, psychiatry reveals some really great answers. So, I think in terms of the spiritual cross-section between psychiatry and spirituality, the very first place where it shows up time and time again and session after session is that concept of shame that you talk about or that you were referring to my book as well.

Sucheta: That you talk about, my dear friend.

Dr. Bhargave: That I talk about, yeah, that I talk about. Shame is such a common piece of baggage that everyone brings into the sessions that I have as a psychiatrist, whether it’s the shame of having to come in to see me or is the shame of what they are feeling or it’s the shame of what they have gone through, or it’s the shame of what they themselves have done. This idea that in some way, I am not good enough because of what I have thought or done, or felt is to me the biggest part of treatment. If we don’t tackle shame, there’s no room for hope.

Sucheta: Wow, yes. As I was preparing, this is my third time reading your book and on the way back, I was listening to Conan O’Brien’s podcast, and David Letterman came on the show and they both were talking, and to spare everybody from complex talkshow history, but it was so interesting that David Letterman was talking about the shame or sense of inadequacy he experienced taking on after Johnny Carson, and Conan O’Brien was talking about shame and sense of inadequacy felt and continues to feel – I could hear that he was getting choked up a little bit, but now 20 years later when he’s so successful because for a year, they kept telling him they were going to fire him, and as I was listening, I was just thinking about this conversation we were about to have that what does it take, like what are the signs of success you need to not feel shame? And apparently, it’s not dependent on anything outside.

Dr. Bhargave: That’s right, that’s right. Now, that’s the high five moment. If you were sitting here right now, that’s where we would high-five because I think ultimately, we all come to that conclusion that at some point, to understand and to tackle shame means we have to take the conversation out of what it is that I’m doing or what role it is that I’m playing where as we’ve been conditioned to think, I think, from a very young age that what you do is what defines who you are and that the two are intertwined, and I challenge people to actually do the exact opposite, separate the two completely. What you do is not who you are. What you feel is not who you are.

Sucheta: I love that.

Dr. Bhargave: And the difference between guilt and shame, because people mix those two together just like we makes who I am with what I do, guilt is regret for what I’ve done but shame is remorse for who I am.

Sucheta: Wow, say that again? Sorry, say that again.

Dr. Bhargave: Yeah, yeah. Guilt is regret for what I have done, but shame is remorse for who I am, and what people do is they take guilt and they convert it into shame, and look, I’ve learned as an anxious temperament child and I’ve learned as someone who gets to sit with people all day long and deal with anxiety that guilt is kind of a go-to emotion for anxious people. We are just waiting to jump to guilt where it’s our go-to that we hate but we somehow train ourselves to feel guilty about things. There is one purpose of guilt. One purpose of guilt is to teach you, so if you ever feel guilty, stop and ask yourself, what should I have, could I have, or should I be doing differently, and then really learn it, right? Really learn it and make amends if you need to, and then finally, the most important part about guilt is release it. Say thank you to it and release it, but people hold onto guilt or they feel guilt when there was nothing to learn, and it becomes shame, and shame is so much heavier. This idea that’s what I have done now results in me not being good enough. I don’t know very many people who have not struggled with shame at some point in their lives, and the most successful people perhaps struggle with it the most because they may feel like as soon as they stop doing what it is other people want them to do, now suddenly, their sense of self goes away down, so not surprised to hear that someone as famous as Conan O’Brien would still suffer, right? I think until you define who you are that has nothing to do with what you do and in the role that you play, it will continue to hurt you.

Sucheta: And I think one thing that I picked up from you is this idea that guilt is there to teach you something, learn from it, and let it go, and guilt, as I read from literature, it talks about a moral emotion that says you didn’t do what you were supposed to do. So, as long as you frame it that way and say, oh, wait, I didn’t do it, so maybe I was supposed to wish my mother on her birthday and I forgot – oh, how bad, my bad, but the guilt is you never call her because you are feeling ashamed that I’m a horrible son or daughter.

Dr. Bhargave: That’s right, that’s right. Exactly. The guilt part of it was the piece that was supposed to say you didn’t do something you shouldn’t have done, and look, we’ve all done – I’ve done at least three things today I probably should not have done and I hope that I feel guilty about it and I hope that I learn from it, and hopefully, I’ll make amends and I’ll move on, but if every time I did something wrong or felt something that was bad, if I thought that was a reflection of who I really am, then you can see why making a mistake would carry such a heavier weight than it really needs to, so for me, I can say that as a child who felt like I kept making mistakes, and then my life that were done to me, I mean, every experience in my life seemed to, in my head as an anxious person, indicate that I wasn’t good enough. So, at some point, I had to, just like all my patients have to, and the listeners will certainly understand this too – at some point, you have to tackle that. You cannot go through life fooling yourself that as long as I do good, that I’m going to be fine because there’s no one who can perpetually do good things all the time.

Sucheta: Yes!

Dr. Bhargave: Yet we need the sense of our self that is constant. We need to know that no matter what happens today, I will still be innately worthy and good, and lovable, and if you do have that, well then, bring life on. Life is just life, but if you don’t have that sense of who you are, then it is up-and-down.

Sucheta: You know, if you just saw me here, I’m sitting here speechless and nodding my head vigorously. I hope I don’t knock the microphone off.

Yes, I think that’s why this message is so powerful that the change should be not yielded or desired because there is something wrong with you because that’s what people on this earth to do. We are here to make changes because change is a greater sense of attainment and the only attainment – I mean, I always like to frame it for my patients and clients that by making changes in you, you are making an environment around you a better place for people to be in, and that is the gift, so you don’t need to go to the store and buy a gift, just the fact that you change, that’s a gift.

Dr. Bhargave: Yeah, that’s beautiful, that’s a wonderful reframe, right? Because again, we tend to view making these mistakes as such a heavy negative burden, but you’re exactly right. I mean, anything that allows for us to evolve is a gift to ourselves as it is to people in our lives, exactly.

Sucheta: Yeah, so what do we know about executive function is that it’s a set of skills that help us organize our ideas, guide our emotions so that we can take better decisions and make good choices. So, how do psychiatry conditions complicate the self-regulation and interfere with the decision-making and problem-solving which is so essential for self-management?

Dr. Bhargave: Well, whether it’s depression or it’s anxiety, or really any of the conditions that I get to see in my office, it will definitely throw your thinking off and your feeling a certain way, right? So, we tend to feel something, and then think something, and then act on it, and so our feelings of sadness or irritability, or anxiety ultimately is going to affect our thinking process which you are much more the expert on it than I am but I can tell you that as someone who’s an expert on the feeling, feeling always results in thinking that is in some ways skewed, and thinking that is skewed will then result in behaviors that will ultimately not be in your best interest, perhaps. So, I think one leads to the other and they just siphon into the other.

Sucheta: You know what it does is it changes the inner dialogue, the self-directed talk that we often use as a tool to guide and self-regulate, that becomes quite skewed as you mentioned at it becomes tainted. You become the worst sour mouth friend who’s always annoyed that you have to do it.

Dr. Bhargave: That’s right, that’s right. There’s a couple of exercises I describe in the book about how even for myself, I had to turn around once I realized that the dialogue wasn’t serving me that I had in my head, I had to find a way to change it, and so the five gifts was a way of doing that, but also one of the other things that I did for myself and this really changed my life is what I call kind of the reverse golden rule, so do unto others as you would have them done to you is the rule, but my rule became I would do unto myself as I would do unto others. So, as someone who had –

Sucheta: Wait, wait, back up, so talk about both of these things. These are so valuable, so let me backtrack and talk about five gifts first, or you can talk about reverse golden rule because 90% of the kids that I work with and adults I work with with executive dysfunction, they are famously unkind to themselves, and their years of hardship and difficulties in not yielding the desirable goals and never feeling fully self-actualized, they often are framing their entire life that I am no good and nothing I touch is worthy, so talk us through that very quickly, if you don’t mind.

Dr. Bhargave: Yeah, no, no, I would love to. I’ll come back to the five gifts. I think that the reverse golden rule, to me, when I say that it changed my life, that’s not meant to be dramatic. It really, really changed my life forever. I recognized in doing the exercise of the five gifts that one of my gifts, which I’ll talk about in a second, is empathy. I know I have empathy and even back then when I was my most insecure self, I couldn’t deny that I had empathy. I could understand how other people felt, and so as someone who had a great deal of empathy, I was and am a tremendous friend because empathy lends itself to good friendship, right? If I can understand how you feel, I can relate more to you, and what I realized was, as a good friend, there were things that if someone came up to me at a difficult time and I would say truthfully to them to help them feel better and see things differently which is why people would come to me over and over again, even before I became trained to be a psychiatrist, I was listening to people’s problems because my friends would come up to me and be vulnerable and talk to me, but what I realized was that in my head, I would say things to myself that I would never say to someone in that same scenario. If someone came up to me in a time of feeling overwhelmed, I would never say the things to them that I did to myself. I somehow took pride in being my own worst critic, and that’s a terrible thing. I tell kids now, you should never be your own worst critic if you’re also going to be your own best supporter, so if you can do the balance of that, then fine, but otherwise, really, to be your own worst critic is not a good thing, so I charged myself in a point of my life that if I wouldn’t say it out loud, I can’t say it in my head, and I was so surprised how often I would catch myself about to say something else to myself that I would never say out loud, and then I would stop myself and say, well then, you can’t say it, stop, you can’t, you can’t say it, and what I came to realize was that the most abusive relationship I had in my life was the one I had with my own inner self and that that had to change, that it was taking a toll, but I was feeling empty, and my soul was trying to tell me something has to change, that was my moment of insight: something has to change, so the reverse golden rule became my way of catching it and trying to stop a pattern, and it didn’t do that for me, so that was powerful.

Sucheta: Wow, very, very powerful. I can maybe translate that the way I’m thinking for myself, like I had a friend who was a psychologist and he used to say every day, you get up and you are standing for election and you have to go canvassing to get every single vote, so part of what you need is you need a PR manager, so if you’re going to carry your worst critic with you, then take your PR manager too.

Dr. Bhargave: There you go, there you go. I needed a good PR manager for the first half of my life. I didn’t even know I was missing that person in my life but I was, I was missing it for the first half of my life, and I think that’s what happened is because I didn’t have that balance, the weight of walking around the world top-heavy, if you will, with thoughts that were only about that I wasn’t doing well, only noticing the things that weren’t going right in my life is why it finally all hit a wall around the age of 20, and I finally realized I’ve got to change this because if I don’t change this, I can’t keep going, I can’t keep going the way it is right now. It has to change.

Sucheta: What’s so remarkable about you though is so much wisdom at a very young age and you were able to direct that to bring on change that was meaningful and sustainable. Many people don’t have that. Either they don’t have the wisdom or they are so engulfed by pain. I like to use this analogy as I was reading this book that what you’re asking people to do is really admire a single snowflake, but when they are facing the avalanche, they have no respect or regard for the snowflake, you know what I mean?

Dr. Bhargave: Exactly, yeah. No, totally, and I appreciate you saying that. I have thought about that sometimes. I wondered kind of even the idea of the five gifts which came in that moment, I don’t know where that came from exactly, Suchi. I give full credit to soulful experiences that are beyond what I really understand as my human capacity, so I think there is more within each of us than we ever really realized and I’m just glad that in moments that I needed it that that came forward to it, number one, and number two, I think that it was such a desperate point in my life that I had really thought it has to change – I can’t, I physically cannot keep going the way that I was thinking to myself, and so in that really, really low point of walking around the world for the first 20 years in a way that I had again described as top-heavy, I finally realized I’ve got to find a way to see myself in my own life in some other way besides what I was doing, and so this five gifts exercise kind of popped into my head space, and it’s interesting to me now, I look back on it and it was so clear. I knew exactly what it was that I was asking myself to do. What I was asking myself to do was to actually write down my five gifts, the qualities and traits about me that I could not deny. So again, at the worst point in my life where I was my own worst critic and could tell you 20 of my faults, I needed to now write down five traits that I just couldn’t deny where my gifts, and I remember even as I gave myself that task, that the chatter that responded to that was, oh, gosh, it’s so egotistical to sit around and think about your strengths, which again was, I think, the critic’s way of trying to pull back, right? “No, no, no, you can’t go there. We are staying here,” but it was so clear that that’s what I needed to do, write down my five gifts, and I even gave myself a 10-day deadline, and I said, by the following Sunday, you have to write down your five gifts, and I don’t know where five came from, I don’t know where 10 came from. I think what it was is I thought if I don’t give myself a deadline, I knew me enough to know I probably wouldn’t do it, and even an anxious rule follower will follow his own rules, so I gave myself that rule, and I think five gifts felt like it’s something that wasn’t too easy for me because again, my own worst critic thought if you do two gifts, anyone can do that, and that it wasn’t so impossible. So, I did that, and if you have never done this task, I would really encourage listeners to do it because it was again in no dramatic term, it was life-changing and it took all 10 days, by the way, for me. I thought I had so plenty of time but I remember Sunday night telling my roommate, said that I had a big test, I’m going to my room and closing the door, and trying to think of the fifth gift, and then once I had these five gifts written down in the list in front of me, I thought, well, if these are my gifts, these are the things that were God-bestowed on me, because I wasn’t just somehow randomly on this earth. I was actually put here, that these are the gifts that I was bestowed with and I don’t want to waste them, and therefore, I should look for opportunities and relationships and goals in my life that will make the most of these five gifts, and to fast forward it, what I cannot realize is it caused me to start changing my filter, so I wasn’t just going through the day looking at what I didn’t do well. I was now going through the day trying to find an opportunity to use at least one of my five gifts that day, and in doing so, I realized that the opportunities were everywhere because again, these gifts are just a part of me, and so I couldn’t help but use them. I couldn’t help but find opportunities to be able to use them, and so it started the balance of not walking around the world so top-heavy, and even on a terrible day, even when I thought I had messed up all over the place, I couldn’t deny that I have used at least one of those gifts.

Sucheta: Wow, and you actually listened to yourself. I mean, talk about the growth where you actually believed yourself and you had the kindness and compassion to accept it which just shows a great incredible inner growth, and you did that by yourself and that just gives me so much hope for all those people who struggle and don’t necessarily put weight on this process or give that process a chance. Do you mind telling us what those five gifts were?

Dr. Bhargave: So, I say in the book that I never do tell anyone what the five gifts are.

Sucheta: Oh, okay.

Dr. Bhargave: However, the reason for that is not because I wouldn’t love to. I would actually love you to tell what my five gifts are. I don’t because I’m trying to make a point, that when you write down your gifts, it’s for you to get to know you, and as soon as you share it with someone, the tilt of their head or something about the way they reacted might make you somehow doubt the experiment, and now that I have proven it to myself, there is no doubt in my five gifts, but when you first start doing this, you really ought to not share it, so that you don’t have that happen, but the one gift that I do share is the one that I’ve already talked about, that I knew right away. It was the very first one that I wrote down on that list and presented itself quickly and that was empathy. I knew I had empathy, so as an example, what I would tell you is, on a very bad day, if I was noticing everything that I didn’t do right, I would, in the midst of that horrible day, say wait a second, wait a second, you say you have empathy, show me, and it really was just like that. It wasn’t even so much of a loving, oh, come on, you have empathy, you can do this. It was, you think you have empathy? Fine, show me, and I would immediately sort of walk out back into the world, looking to find a way to use empathy and of course, it would show up all over the place because again, you can’t help but use your gifts and they do show up everywhere, and so I would use my empathy and how to walk away from an interaction or even a thought that used empathy, and I would mentally pat myself on the back and say, alright, you know what, you do, you do have empathy, and it was my way of becoming my best PR person because a good coach will tell you what you should do, but a good coach will also say, hey, that was really good. That’s when I had shifted to what I didn’t realize.

Sucheta: Well, as we come to the end of this podcast, I cannot believe the time has just flown by, I guess, I wanted to talk about your last chapter which is my favorite and I understand it is yours too, and you titled it so appropriately, Wielding Hope, so tell us why you titled it that way. What do you want our listeners to think about with respect to their destiny, agency, and suffering, and why should we keep the flame always burning no matter how hard the journey might be?

Dr. Bhargave: I feel like in reflection of my own experiences but more so in the privilege of getting to sit with people in these difficult times that the unspoken force that was always in the room was hope, so you wouldn’t even have made the appointment if you didn’t have some hope that it could get better and hope to me is simply the possibility of something good. It doesn’t even have to be proven in that moment. It’s just the possibility of something good, so you wouldn’t have shown up to the office if it wasn’t the possibility of something good. We wouldn’t hold on if there wasn’t a possibility of something good. So, ultimately, without even realizing it, what was getting us to just take the next step in our own suffering was hope, and the hardest thing to deal with and for people who have experienced depression, I think this is the heaviest price of depression, is that it’s very, very hard in certain moments to find hope, and people in those moments do not think that there is any hope, and what I would want listeners to know is hope is always there, it could be really, really hard sometimes to remind ourselves or to see it, but it’s in the background the entire time, and so the chapter is called Wielding Hope, and the idea that is if it’s always there, as hard as it might be to see it at any given moment, know that it is and know that with effort and sometimes great effort, you can tap into it and not only tap into it but then actually wield it because again, the greatest weapon against fear is our hope, and if there are –

Sucheta: I love that.

Dr. Bhargave: Yeah, there’s two big forces in our life, and one is love and one is fear, then the greatest weapon against fear and the greatest weapon that love allows us is hope, the possibility of something good. So, I would tell you that in whatever moment I thought that I had messed up so much or that things have happened to me that were clearly showing me that I wasn’t good enough, God’s grace was that I could find some sense of help, and sometimes, it was the person in my life told me how much they love me. Sometimes, it was I got a good grade and I couldn’t deny that and it was like wow, I guess there is a possibility I might pass this class, or whatever it was in that moment, I feel like God, the universe, the grace of that force was that it allowed me to have hope even in the worst of times. So, I do think it is crucial that we recognize the value of hope, so that we can use it purposefully.

Sucheta: Wow. You know, what makes me so happy right now is we have had these conversations forever, and every time I’m with you, I feel like I need to take out my notebook or something or record. Now, this is forever captured and I mean, these beautiful ways that you phrase things and the way you speak, and this is genuine compassion and caring, and an incredible sense of peace and optimism, and nobody will ever say that you work with people who are going through hardship because you look like you are walking in a park with them as if it’s a sunny day and they are with Suvi.

Dr. Bhargave: Yeah, yeah, and I appreciate that, I appreciate that, and you know, again, life happens and there are times in my life where I’m on the down and there’s times when I’m riding the wave, and knowing who you are and knowing that there is hope, and knowing that there’s always purpose in things isn’t a Pollyanna rose-covered glasses false optimism. It’s an assurance that despite it all, there is an innate worthiness within me which I believe is that spark of a divine, that there is a reason why things happen and it’s up to me to glean from it when I can, and as long as I can understand that there is a possibility of something out there that could be better, then I need to keep going. So, I believe that that is really the reason why I cannot approach life in a way that I could never have imagined when I was a child or in my 20s.

Sucheta: Well, thank you for capturing these brilliant ideas into a book, so people can read it. I have bought books off so I can give – as you know, I’m on a sabbatical, so I don’t have a lot of clients that I’m working with, but this has been one of my gifts to them, a simple little manual for life that we don’t often get, so thank you for putting this together for us and sharing your brilliant ideas and thoughtfulness. I think it’s going to go a long way as every listener engages with this, and particularly, I think to me, you really demystified this issue of anxiety. I think striving and anxiety go hand-in-hand, and every day, we get up and there is incredible striving that we somehow are woken up to, but that is not to be considered as a flaw or a folly. Some of us may have greater amounts than necessary, but I really appreciate you taking the time. Any parting wisdom as we call it a day?

Dr. Bhargave: I think you and I have shared so much wisdom today and we will continue to do so in our discussions, but I’m sure that listeners not only get that when they listen to your podcast, but I would encourage – to me, wisdom is knowledge that is gained from living life and yet what good is wisdom if you will hold on to it? So, my last words to people is, share the wisdom, and wisdom doesn’t mean I know stuff and you don’t know stuff. It means this is what I know, tell me what you know, and I think that in this world of fast-paced instant gratification, we don’t have enough purposeful reasons or time to sit down and share wisdom, so I would just say to your listeners, share your wisdom, share it with each other and listen to the other, and that wisdom will, in some form or fashion, always give you a moment of insight.

Sucheta: Thank you so much, Suvi, Dr B, for being here with us and spreading joy. I really am grateful to you.

Dr. Bhargave: Thank you so very, very much for all the joy you spread too.

Producer: Alright, that’s all the time we have for today, sadly. Wow, Sucheta, unlike you, I did fill a notebook even though we did record this great episode. I think my favorite is if I can’t say it out loud, then I cannot say it in my head. Boy, my life would have been folded very differently if I had had this guideline a thousand years ago.

Alright, dear audience, I suspect you know someone who will benefit greatly from this conversation, so we would be grateful if you would forward it to them. On behalf of our host, Sucheta Kamath, today’s guest, Dr. Suvrat Bhargave or affectionately known as Dr. B and all of us at Cerebral Matters, thank you for listening today and we look forward to seeing you again right here next week on Full PreFrontal.