E89 - What do we need to be Mentally Healthy? (with Dr. Benji Waterhouse)

Dr. Benjiman Waterhouse is a consultant psychiatrist. He is also an award-winning stand-up comedian. He has written for the Guardian and Independent and was included in a list of ‘Inspiring Psychiatrists’ by the Royal College of Psychiatrists. You Don’t Have to Be Mad to Work Here, his first book, was released in May 2024

In this episode we discuss the ups and downs of psychiatry training, his experiences with psychotherapy, common misconceptions about mental illness, some of the problems with modern psychiatry and our cultural understanding of mental illness , the potential value of psychedelics, the placebo effect and much more. 

Interviewed by Dr. Alex Curmi, consultant psychiatrist. 

If you would like to enquire about an online psychotherapy appointment with Dr. Alex, you can email - alexcurmitherapy@gmail.com.

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Transcript

 Welcome back to the Thinking Minds podcast. My name is Alex. I'm a consultant psychiatrist. Today I'm in conversation with Doctor Benjamin Waterhouse. Doctor Waterhouse is a consultant psychiatrist, too, and he's also an award winning stand up comedian who's performed sellout shows at the Edinburgh Festival. He's written for The Guardian and The Independent, and he's just come out to this first book. You don't have to be mad to work here all about what it's like to train as a psychiatrist in the UK, treating acute and severe mental health conditions. So today we discuss what changed for him psychologically as he went through the ups and downs of psychiatry training, his experiences of undergoing his own psychotherapy, what people often misunderstand about psychiatry, some of the problems with modern psychiatry and our cultural understanding of mental illness, the potential value of psychedelics, the placebo effect, and much more. This is the Thinking Mind Podcast, a podcast all about psychiatry, psychology, psychotherapy and related topics. If you like it, there's a few ways you can support it. You can share it with a friend. Give us a rating on Apple, Spotify, YouTube, wherever you listen, follow or subscribe on whichever of those platforms you use, as that helps new people to find us. Or if you want to support us further, you can check out the Buy Me a Coffee link in the description. In addition, if you're tired of just hearing about psychotherapy and maybe just something about your life, you want to be different. I'm now offering private psychotherapy sessions, both online or in person in the South London area, so something like that interests you. You can email me at Scream Therapy to find out more. Thanks for listening. And now here's today's conversation with Doctor Benjamin Waterhouse. Thanks so much for joining me today. Oh, thanks for having me, Alex. We're here to discuss your new book. You don't have to be mad to work here. And before I ask you loads of questions about it, I would actually like to thank you for writing this book for a very specific reason, which is, you know, similar to you, I trained as a psychiatrist in the NHS over a ten year period. And as I was listening to the book, I listened to the audio version. I realised there was a there was a need for this book actually, which I wasn't aware of prior to listening to it. And I was so grateful that you were able to capture this very specific set of experiences. And I'm sure you've heard this from other psychiatry psychiatrists who have listened. You know, you were able to capture such a very specific set of experiences, which it's very hard to express, you know, when friends or family ask me what I do. What's it like to be a psychiatrist, even talking about it on this podcast? It's so complicated. You really do need a book to explain it all. So firstly, I'd just like to, um, express my gratitude to you for for writing it. Oh, that's very kind. Thank you. Yeah. Well, I mean, I suppose I did partly write it with, with a kind of psychoeducation function in mind because there is a lot of noise about mental health nowadays. But, um, it, as you say, still loads of ignorance really. And people seem quite confused even about, you know, the difference between a psychiatrist, a psychologist and a psychic and um, so yeah, if only to, um, stop people asking me if I can read their mind. I thought, uh, it might be helpful, but more than that, really, I wanted to bust the myths, I suppose, about the patients that we we kind of help with it. It seems slightly, um, unjust to me that the mental health conversation is dominated by. People at the far milder end of the spectrum. Um, whereas people who are actually really disabled, people with things like schizophrenia. Those people I help or at least try to help in my work. Um, those ones for whom some cold water swimming and mindful colouring in isn't going to do much. They ironically never seemed to kind of get a look in. So was that the main motivation for writing the book, do you think? Was it to dispel misconceptions that people might have about some of the more severe forms of mental health conditions like schizophrenia, like bipolar disorder and things like that? A little bit, yeah, because I think we sort of know that, you know, some people benefit from the this classification system that we have of giving names to things, but also labels can be very stigmatizing. You know, you get this bizarre arrangement now where some are even desirable and, you know, people will be I've never had this before, but when people get angry at me, when they come to me, one thinking they've got ADHD, and I tell them what I think is the good news, which is that I don't think they do. And then they're kind of furious with me, you know, which I've never experienced before. But there are others, more stigmatized ones, things like schizophrenia. And I think we know there that because of the stigma around something like that, where the associations are of kind of acts wielding murderers with split brains, that label can be as disabling as the condition itself. Sometimes when society essentially just ostracize you and, and leaves you on your own. And we know how damaging loneliness and can be for your kind of physical and mental health to. Yes. And people have a strange relationship with labels. Like you mentioned, there are some labels that people gravitate towards, and I suppose this party depends on what happens to be in vogue in the current culture. Although I would want to be careful to say that just because a diagnosis is desirable, it doesn't mean that's the only motivation, you know? Uh, it is really cool. I'm mentioning it because it seems like almost every other podcast now. I've talked to an ADHD expert recently. I've talked to an expert on evolutionary psychiatry recently, and we're constantly having this back and forth about whether or not labels diagnoses are useful or not. And there's this sort of ongoing tension. I'm curious about your thoughts. What do you think is the best case, the best use case for a diagnosis or a label? What are the biggest advantages of that, do you think? Well, I think the reason these kind they arose was it does. There are clearly benefits in kind of ease of communication. It helps for professionals doesn't it, to be able to say, oh, I'm referring you, this person with ADHD or schizophrenia or whatever it is, and we have a vague idea about what sort of problems that person might be experiencing. It also obviously helps for kind of research and things like that. But I suppose. And I suppose the seduction of a label for a patient is is often that it kind of validates. There's a feeling of being invalidated, of their pain and suffering, and there's a reason, you know, an explanation is given to it, even if that isn't necessarily particularly scientifically robust. And, um, I suppose the downside we look at is that more people have these labels than ever. And yet society is more just seems more disabled than ever. So I think a kind of the flip side is that sometimes it can be counterproductive. And, um, you know, uh, actually get in the way of recovery because I think we've seen that as, as the biological explanations of being given for these things, often without, again, scientific basis, there's a kind of unhelpful sense of, um. Kind of, uh, fatalism, almost sort of in that. Oh, well, this is it. And, uh, and I think that is, that sometimes gets in the way of recovery. Mhm. Do you use diagnosis much in your clinical work. Is it something that you rely on and if so. Are there specific things you keep in mind when communicating a diagnosis to a patient when trying to deliver a diagnosis? I mean, I try. You know, I work in, um, uh, emergency and emergency services, really just kind of seeing people when things have got to that. Very almost too late, I suppose. And then it's kind of a sad case of kind of either sectioning them or not. And in that instance. You know, you sort of. Unfortunately, our system relies on diagnoses. You need the diagnosis to access the the services. That's kind of important for the gatekeepers, isn't it? Um, so you kind of you have to and usually they have existing diagnoses, but if it's someone with new problems, I will certainly avoid using using terms, I think where I think it might be unhelpful and instead kind of talk more, more vaguely about, you know, the symptoms that they're experiencing instead of giving names to things. You're coming up with more of a problems list than a kind of overarching, one word explanation of what the difficulty is. A little bit a little bit. Yeah, exactly. So instead of kind of, you know, if someone was hearing voices, you could then talk about, you know, the hearing voice kind of network, for example, and what other how other people manage hearing voices instead of saying, oh, I think you've got schizophrenia, which to a lot of people feels like a death sentence and lifelong really. Mhm. I think similar to you, I don't always use diagnoses in clinical work. It depends on the context. But if I do deliver a diagnosis or communicate the diagnosis to a patient, what I've found to be helpful, and I don't know if you've experienced something similar, is just to be extremely transparent about how the how the our diagnostic systems came about, the strengths, but also the limitations of our diagnoses, that they're not always 100% based on some sort of scientific reality, but often they're based more on just studying outcomes in people over time. And I've found that by being transparent about the weaknesses of a diagnosis, actually, we can capitalize on the strengths of a diagnosis that can help you understand how disparate problems can be connected, how it can help you understand that you're not uniquely flawed. There are other people who have the same problems that the diagnosis can help to inform treatment. And it was my friend Rob who have given a shout out to before on this podcast. I'll give him a shout out again to Rob, who basically taught me this like a sense of when you're in the clinic, a kind of radical transparency about how we work and how we think. And not only does that help clinically, but I think it's also just in genders, a different, a deeper level of trust, you know, between clinician, clinician, patient, you know, they feel like the clinician is leveling with them and showing them, you know, almost from an insider's point of view, how these. I think that sounds a really great approach that you have there. Yeah, I think more transparency would be great. I think psychiatry sometimes being guilty of hiding behind, um, or being dishonest, you know, I suppose the most obvious example is this kind of the chemical imbalance theory of depression that we kind of pushed around and told that we were even taught to spell it out in, you know, to pass my medical school exams. And now we know, you know, there's not even any reliable evidence for that. But it obviously made us sound very kind of medical and legitimate and made us feel better being at the kind of almost more like proper doctors, which obviously our medical colleagues always kind of say that we're not. And, um, yeah. So transparency, I think certainly, as you say, when, when psychiatric diagnoses lack, you know, validity and reliability, and you get that bizarre phenomenon whereby if you put the same patient in front of ten different psychiatrists, they could leave with as many different diagnoses. And I think, I think all we can do is be is be honest about that. And just so that people maybe hold these ideas a little bit more lightly, because when people say to me, oh my, this, my, this diagnosis or my that, I sometimes want to say to them that getting a diagnosis from one person at one time in one private clinic is really, it really a lot more meaningless than you, than you realize, you know, that these things people do think there's been all this kind of chatter about mental illness is no different to a broken leg, but we obviously know they're very, very different because, as you say, we still don't really know the basic etiology or pathology of these mysterious things that we call mental illnesses, where as you do in general medicine. Yeah, yeah. And and use the word mysterious a couple of times, and that's a word I use more and more in my clinical practice. You know, there's still some mystery around this problem. We don't we don't fully understand. And again, you know, I think when you have a doctor who's willing to acknowledge that they don't know everything, all of a sudden there's a some defenses, you know, are broken down and you think, okay, I can probably trust this person if he's acknowledging that he doesn't know everything. And, and I, you know, going to your point about mental illness, having a broken brain is no different from a broken leg. I think what people are trying to get across there with that point is that mental health problems are equally valid. You know, they're equally important. They're of equal societal importance to address. And I think that's correct. But then the misconception, as you say, is people say, oh, it's as valid in a in terms of it's as well understood. We understand the cause and the mechanics. And obviously, you know, even in physical medicine, there's a lot of things we don't understand. There's a lot of mystery there too. And certainly mental health, there's there's a lot of mystery. But getting back to your book, you can see, you know, there's a lot of attempts to really get into the reality of what acute mental health care looks like in the UK. But I also got the sense that it was you processing the experience that actually training as a psychiatrist is really hard. Is it fair to say that was part of the motivation for writing the book as well? A little bit, I suppose. Yeah. The selfish part is that, you know, I do find writing helps me to work out how I think about things. You know, I guess doctors are encouraged to have reflective diaries, aren't they? And I suppose this was just a reflection that got a bit out of hand and ended up being an 80,000 word book. Um. But yeah, um, a point I was going to say, because you spoke about honesty, uh, about your kind of transparency, about the mysteriousness and about how little, actually, we really do know. And it struck me, I think I sound it sounds like we practice in quite a similar way. And it's really surprised me, the kind of describing word that's most commonly been used with my book in all the reviews and all the rest of it is, is honesty. Um, and I think that's that's kind of interesting, isn't it? I wonder why. Yeah, I don't really know what that is. Only there's only really one way. Maybe it's my upbringing, but there's kind of only really one way of being. And that is, to be honest, I suppose. But I think, yeah, maybe or maybe previously psychiatry has been. Because of its ice, maybe because of its inferiority complex. It has perhaps been less transparent about how little we really know. Yes. I mean, there was honesty on different levels in the book. Honesty in terms of how the UK mental health system works. You know its flaws. Honesty about the severity of mental illness and how debilitating can be. But also honesty about your own personal process of going from, I guess, a sense of not really knowing what psychiatry would be like an a sense of idealism, of wanting to be, you know, the best doctor you can be, which so many of us in the mental health field go into that with a sense of idealism. And you're also willing to be transparent about how difficult it was and how that can can make a person jaded and cynical. And I think a very common. Arc that people go through is idealism, cynicism, and then hopefully on the other end of that wisdom. And that's that's almost the transformation I see in the book. Yeah. Well, that's definitely how I, you know, I, we, I feel like at medical school where we obviously learned with. Uh, practice patience and things and doing off skis often. I felt like if we got the diagnosis right, you know, we could prescribe this treatment. And we were allowed to believe that the drugs would always work and that the patients wouldn't wait, you know, on therapy waiting lists longer than the average marriage. And, um, and they'd just walk off into the sunset. But obviously the the grim reality, especially in NHS of actual clinical practice is nothing like that. And you're often left wondering, are there other solutions to people's messy lives, really, even within medical school textbooks? And I suppose that's what often always grappling with and, and um. Yeah. You see it in our patient outcomes. You know, we can't pretend that. Uh, you know, our outcomes are more marginal, you know, and on lots of measures actually getting worse, which is kind of alarming. Um, according to medical anthropologists. And, you know, you just see it just day to day, you. I certainly get fewer Thank-You cards and chocolates than I did when I worked in other medical specialties. So obviously that's plays on your mind sometimes if you're causing more harm than good, especially when there are now survivor groups and there's a anti-psychiatry movement and a whole movement, you know, created to that wants to destroy the speciality in a way that you don't have in any other medical specialties. You know, there's no like anti dermatology movement. You know, you don't get people protesting in the streets of us about the evils of E45 emollient cream. So yeah, it throws up a lot of moral and philosophical and practical questions I think. Why do you think the outcomes are getting worse? Why do you think things are getting worse, not better? I wonder if it's because we've conceptualized human misery most recently via this biomedical model. And often, you know, we're supposed to practice, aren't we? This biopsychosocial way of working. But certainly my experience in the NHS, when your time is short and you don't have the availability of, say, more thoughtful treatments like a psychologist or you don't have the power due to the desiccated social care system here of being able to sort out their crap housing or their, you know, their lack of employment or their bad relationships or whatever. You don't have that power. All you then are left with is your prescription pad. So I suppose it becomes more of a bio bio bio model. And inevitably, of course, you know, I think a lot of what we end up calling mental health problems are really more strictly social problems. And obviously psychiatrists don't have the power to to change those. So to some extent, I think this, this, this chemical imbalance thing has become an unhelpful distraction from what seemed to me often the more pertinent kind of, um, psychosocial political drivers of human misery. And interestingly, though, I think society's wising up to that because there's been this kind of, um, what's it called, like the beyond? Have you heard of these guys? That kind of. I think they're called The Beyond pales into parliamentary inter-party parliamentary group. And they've kind of noted this. Yeah, they've noted this, this pattern whereby people are kind of more diagnosed and more medicated than ever and yet more disabled than ever. And they're kind of thinking, well, that isn't a pattern that you would expect if if this model was working. Right. And so they are looking for an overhaul in kind of the way that this paradigm that we're using. In a slightly more thoughtful way of, um, yeah. Like I say, looking at other things like social circumstances and politics and way the way that people are living their lives. Because often I feel as a psychiatrist, like, like I'm kind of a at the bottom of a cliff trying to patch people up, just wishing there was more of a protective barrier at the top. And we know, you know, there's an adage in medicine isn't that like prevention is better than cure? And I think that's certainly true in psychiatry, and we don't really have any cures. And so instead, you know, if governments looked at, like I say, improving housing and jobs and relationships and inequality and poverty and loneliness and, and all these things, lack of purpose and, and hope, and then I think a lot of these things wouldn't, wouldn't present to us in the first place. Yeah, absolutely. Something I was discussing on the podcast last week with, uh, a consultant who's really interested in evolutionary psychiatry is that, you know, aside from biopsychosocial factors, which, as you say, often the psychosocial bits are kind of a tick tock tick box exercise, which we barely acknowledge in the NHS, even if we did those correctly, even having an understanding of human beings as evolutionary creatures, which can inform what people need to be mentally healthy, like for example, connection, like having a strong sense of community, like having access to nature, um, like regular exercise, all of those things. And we even talked about someone's existential needs, which you mentioned, you know, a sense of purpose, a sense of meaning, a sense that their life is building towards something. I think all of these things are lacking. And I don't think it's I think it's easy to. Rail against the government or politicians. And, you know, there's a fair amount of blame to be thought about there. But there is something to be said about aid, kind of just the general problems of being a human, the human condition that we've had, problems that have always been around and will likely always be around to some degree, but also the inadvertent effects of modernity, I think, and of technological process whereby lots of things just happen purely based on momentum, without anyone really thinking about it, without anyone considering what the outcomes might be, or having the ability to comprehend what the outcomes might be like. I doubt Mark Zuckerberg, when he was thinking about Facebook, could even have fathomed the downstream effects of that on loneliness, or what the retweet button could mean when it comes to getting people publicly shamed on Twitter. You know, there's all these outcomes that just kind of happen without people ever necessarily intending for them to have happened. Of course. Yeah, yeah, yeah. But I think you're right. Like we often get. I suppose human beings like things to be simple, don't. Then we like quick fixes. And there's a there's a joke I used to do when I did stand up comedy, which was, um, you know, how people always would ask me, uh oh, go. And Benji, what's the secret to happiness? And I'd always say to him, oh, you know, it's really very simple. All you need is a healthy birth, secure attachment, happy childhood, no trauma, high resilience, loving friends, family partner, fulfilling work, financial security, manageable targets, eight hours sleep, regular exercise, healthy diet, moderate drugs, alcohol and social media plus or minus antidepressants, therapy and 100% charge on your phone. And is that more holistic? That more holistic look is sort of often what we're missing, isn't it? Yeah. I mean, that was that was in your book. And when I was listening to it, I thought, yeah, that's kind of a lot of what I just go through in my consultation sessions, except for the phone charging. Um, tell me about stand up. So when when did you become interested in standup? When did you start trying it, and why did you try it? Yeah, I think it's not a coincidence that I started doing standup when I moved to London to specialise in psychiatry. Um, I think, you know, humor can help, uh, help to make the, the kind of intolerable, more tolerable content. And I think it's for that reason that the NHS often runs on gallows humor as well as strong tea and, um. Yeah. And then I think I saw a value in it in helping to get across kind of public health messages, you know, like I think each struggle to fill a room in Edinburgh. Um, you know, just talking to people about schizophrenia and suicide for an hour. But if you put some punchlines on the end, obviously sensitive ones where the patient is never the butt of the joke, then you can sell out an entire Edinburgh run. So and I guess I was looking to, to use that sort of use that, you know, use humor as the Trojan horse to get these kind of ideas across. Um, in the book. And, uh. Again. I was very lucky. Yeah. Like to get on the on the Sunday Times bestseller list. I don't think you'd. I don't think I would have managed that if I didn't have some lightness in there to, to offset the darkness. Yeah. And again similar question was part of the humor to help you process some of the difficulty of, of what you were facing and, and how that affected you psychologically? Yeah, definitely. I mean. Uh, you know, Freud talked about humor being one of the more mature defenses, didn't he? And, um. Uh, I certainly think there's value in that. I mean, I've been open about my own struggles and, you know, with staying well, as it certainly when I was working full time as an NHS psychiatrist and even with humour then, that wasn't it wasn't enough to kind of keep me well, but without it, I think I would have, I would have lasted even less long, you know, um, I think it's a for me anyway, a very it's the only way of processing what's often the kind of hopelessness and the frustration and the tragedy a lot of the time of psychiatry. Um. What do you think? Us? You know, a lot of people training in mental health. Listen to this. What are some of the best ways do you think of? Coping with the ups and downs of training, the demands of training. Ooh, I suppose the obvious, the obvious thing is that from that list, like of keeping yourself. Well, um, I mean, I was privileged to have my own therapy as well. I thought that was a good space to kind of process the difficult things that would be going on during training. Um. Maybe not everyone feels they can afford that, but I did do that and I found that quite helpful. Uh, basic things like trying to. But it's hard, isn't it? Having a healthy work life balance, you know, like having friendships, having a relationship, maybe like speaking to family, exercising, getting your eight hours sleep. Those are the things that often I wasn't doing, you know, when I was working full time. And I think that was really not helping my wellbeing. So now I have this, um, much more luxurious arrangement whereby I've now finished my training. So I'm a locum consultant and I work part time, which, uh, keeps me well, and also means that I have, you know, spare time to have nice chats like this and to write books and TV adaptations and things like that, which is what I'm doing at the moment. But I do feel conflicted because, you know, you get indoctrinated with this idea in the NHS. Well, you're aware that there aren't enough staff as it is, you know, and you kind of, I feel, still internalise this guilt about not being on the floor full time, just getting through the backlog of patients. But the kind of this, the this, the piece I've had to make with myself is that it's probably better being a happy, healthy, part time psychiatrist than it is a burnt out full time one. Although I'm not sure that medical staffing would necessarily agree with me. Yeah. Do you think there is still a culture in the NHS of some implied level of self-sacrifice that's necessary on behalf of basically all healthcare workers, that there's this sort of giant healthcare almost. I mean, every time you hear about the NHS for the past 20 to 30 years, it's in crisis. And. You know you can't be in crisis for 30 years. It's just, you know, there's major problems with the system, which haven't been fixed. But every year it's like, oh, there's a new crisis, apparently. And there's this. When I was training, there was also this unconscious expectation that because of this behemoth crisis that we all expected to be a little bit bent out, that that if you're not bent out, maybe you're doing something wrong and and maybe you should work a little harder, actually. Do you think this culture is still prevalent? Oh of course. Yeah, yeah. The crisis thing as I started training in 2010, which I guess is when the yeah, the conservative government first came in. And even then people talk about how the NHS is on its last leg. So and then the next objective, the next like metaphor was like, oh, the NHS is on its knees. And then it's like, oh, I'm not sure where we are now. The NHS is like face planted into the floor. And I suppose the, the worry is that the next one will be it's like six feet under when the NHS is no more. But yeah, it's how do you continue to work in a, in a, in a, in a system that's so broken is a, it's a tricky one. And what I think is even more pernicious is when inevitably people localize the problem within the individual and question their resilience. That's the kind of modern take, isn't it? Like, oh, the train is just not resilient enough yet. Rather than looking at the the wider broken system in which they work, which essentially is a sort of modern gaslighting, isn't it? Yeah, yeah. And and not even just the broken system, but as you were mentioning before, the flaws, the deep flaws of our culture and society, which caused so much more, both mental health and physical health, because we see very similar problems. I mean, it should be said, there are unique problems that you outlined in your book with the mental health system in this country. But it's also worth pointing out there are also a lot of similar problems in in physical health. You know, we think about something like the obesity epidemic, which is not just a UK based problem, but a global problem where you have a the the obesity issue is not a health care problem, it's a societal cultural problem. And that we have a food landscape, as far as I can understand this, which means the obesity crisis is all but inevitable and. I think that combined with a a health care system which isn't particularly holistic, even around metabolic syndrome and obesity, combined with particularly in the UK, a kind of sense that people shouldn't really take responsibility for their own health. But really, there's this unconscious outsourcing to the NHS that kind of it's the NHS job to look after my health, which both for things like obesity and for mental health problems, a huge mistake. You know, I think, I think letting the government be in charge of how healthy you are is, is a huge mistake for reasons I can go into. But I think a combination of all those things, this sort of ongoing health crisis is inevitable. Yeah, I think I think the diabetes thing is a good parallel, isn't it? Um, it's quite dystopian, this arrangement now whereby, yeah, we just have all big food and big Pharma, I suppose, continued to, you know, with this as, as epic. Now it's kind of like you can still keep eating your crappy processed food and but don't and we'll still just get and now we've got this medical cure for it as well. So nothing ever really changes, which is. Yeah, it's very like. It's a bit like at the end of Wall-E. If you saw that, that film where they just got the fat guys in there, we're actually sort of going to be living that life almost. And, um, yeah, it's distressing, but I suppose people are quite short termist, aren't they? And they and no one really wants to deal with prevention. And these forces and are quite big now, aren't they. So no one's going to give up their. Yeah. It's quite hard to change this now. And when we, we even have like that ridiculous scenario of having. You know, um, vending machines in the diabetes clinics and stuff is crazy. To be fair, uh, to ozempic and similar drugs. I have looked into this. I do think. I do think for a few reasons, it could be a valid option for a lot of people. And I would add that when you're on a drug like that, you're probably not going to eat very much junk food because it actually makes junk foods a lot more unpalatable than it would be otherwise. And it really does help to to cut your appetite. I think there's also reasons to be cautious about those. And it's kind of it's a whole conversation I did, if anyone's interested. I released a whole podcast about that with a gastroenterologist, a gastroenterologist from the Mayo Clinic. And I think that was, should we inject drugs to lose weight? Something like that. So if you like, if you're interested in that, I'd encourage you guys to go and look that up. But something I'd be interested in getting a bit more depth around is, uh, so you had some therapy when you were in training. For those who maybe are uninitiated, what is therapy like and and what can therapy offer you if you've never tried it before? Well, therapy, I suppose, is this huge umbrella term, isn't it? And, um, you know, lots of people have different. I think the common association is usually kind of that Woody Allen movie picture of someone on a couch and, um, kind of just free associating and, uh, the therapist listening out for slips of the tongue, you know, like when they say one thing, but they mean their mother. And I did do I did do I suppose I had that, that more traditional. Thing that more traditional model. And when it's just once a week, it's called. Psychodynamic psychotherapy. And that's very much preoccupied with the kind of early life and making sense of how you really life impacts you in adulthood. Um. And, you know, there's there's kind of this value in that. But it is an expensive it's a luxurious model and that it doesn't have an end date necessarily. And some people have it for a lifetime, and some people even have it up to five times a week, which, you know, I certainly didn't have the the money or the time to do. Um, but, you know, it's not like, you know, you were talking about, again, just going back to your earlier point, I think sometimes we run the risk of saying, oh, it's just that the NHS isn't isn't funded enough. I just need more funding. And of course, that is all true. But also, I think it's a fantasy to pretend that even if we were fully staffed, that, uh, our treatments would mean that people lived, like vastly different lives because therapy only has a marginal evidence base. Two. You know, I suppose the NHS loves shorter term therapy, things like CBT, cognitive behavioral therapy, because that's usually 8 to 10 sessions. So you can kind of kick people out quite quickly and sort of help in theory, give them the lessons to the life lessons that they can take with them for the rest of their lives. Um, but again, that's very different to psychodynamic psychotherapy because that's more focused in the here and now. And there's more, um, more kind of interested in this idea that that depression, so-called depression, is caused by faulty thinking or cognitive distortions. So but I sort of worry a little bit about that often because I will see people with, you know, objectively awful lives, you know, living in crappy council housing with antisocial neighbors, no job prospects on the breadline, single mums, and then I'm supposed to refer them for some CBT because they're just not seeing this beautiful world quite right, you know. And it seems like a sort of gaslighting to me. So I'm not sure that's necessarily always the answer. Neither am I sure that psychodynamic psychotherapy is always the answer because I, for example, have now have some quite nice theories about why I am as I am or, you know, think as I think, um, but how transformative it is being, you know, and the jury's still out on that one for me. Um, yeah. And also, for example, I talk a lot about my family in the book because I suppose this is one of the themes of a therapy like that. And I guess the other the counterargument to that is my mum being one, my mum, for example, she seems to think that therapy has been unhelpful for me and has reared stuff, you know, in this unhelpful way. And that's despite the fact that your mother is a clinical psychologist. Yeah, she's an unusual character. My mum, she believes in therapy for other people, just not for her or her family. But there's a few. There's quite a few people like that. There are. I mean, there's quite a few psychiatrists like that who kind of am. I mean, when I say quite a few, I do think they're the minority, so I don't I don't want to scare people, but there are some psychiatrists. Who use psychiatry, psychology, and a set of ideas within those realms as a defense to make them feel really good and to make them feel notably separate from the patients or clients that they're seeing. And obviously, I think it's minority, but it's very ethically strange and and dangerous when that can happen. I'm not sure it's such a minority, because I think research suggests that psychiatrists stigmatize mental illness even more than the general public. So I think there is this othering that we do, consciously or unconsciously. I suppose maybe you could, you could, you could hypothesize, because we are so close to it all the time. The danger is that you could the lines become blurred and you, you find yourself on the wrong side of that locked door yourself. Scary thoughts. And I'd like to pick up on your point about therapy across the sort of socioeconomic spectrum. And I actually have delivered therapy across the socioeconomic spectrum. So I've delivered therapy for free in a charity and low cost therapy. I also work privately, so I've gotten the benefit. I've done therapy, you know, even within NHS contexts. So I've got to do therapy in all these different settings. And I am a definitely a believer that therapy can help across the spectrum. But it might look very different on one end or the other, you know, and I think helping someone to write their CV, for example, helping them to look for, for employment can be a form of therapy, if that's, you know, the main thing that the client needs in that moment, or helping them to disconnect from an abusive relationship or helping them to find housing. Um, I think all of those things could potentially be a form of useful therapy. And I say that because I, I kind of, I think obviously the practicalities of life are very important. But not only that, the practicalities of life are. Truly inseparable from our inner world. Like what we do, and even the most seemingly mundane tasks that we might do, like filling out a form, are often reflective of our inner state of mind, and our ability to do them or not do them can be very much linked. To what we believe is possible and to our to our even some of the deeper aspects of my of our psychology, I believe. And so even even using like a CBT model very much heavy on the B. On the behavioral aspects, you know, might not just be merely about trying to help someone adapt to a sort of terrible set of conditions, but how can they look at those set of conditions ever so slightly differently, in a way that they can act differently and sort of incrementally go about the process of, of, of changing their lives for the better. That's the kind of the way I think about it. Yeah. No, that sounds that sounds nice. I wasn't rubbishing therapy. No, I know totally. I'm just again, just just coming back to that thing of, um, again that, that fantasy that I think we sometimes have in the mental health conversation, which is just that, oh, we just need more money and then everything will be fine. Um, yeah. I mean, it's also worth noting the counterargument. Yeah, the counterargument, which would be what? That our treatments are causing more harm than good. Uh, the counterargument in terms of what I just said would be that some people aren't ready for therapy, some people aren't ready to have their perspectives shifted, and some people are facing obstacles that are truly enormous. And it can be very it can be. To almost demanding to expect someone to change psychologically in that context. Like actually the psychological change that therapy demands can be really difficult and draining. And a lot of itself, even the ability to show up consistently to engage with the therapist can be really hard, you know, if people aren't in the right conditions. And I've certainly experienced some of that in my practice as well, a type of psychotherapy that I have become slightly interested, or I guess the only one I have to have any real training in giving myself outside of training has been psychedelic assisted psychotherapy. Um, which I think people are kind of excited about because it seems to be a kind of almost like an accelerated therapy, like a catalyst. Some people talk about one dose being like one dose of a psychedelic being, like five years of therapy, you know. And, um, and I found that. I found that slightly persuasive. Again, I don't think it's the magic pill, but it does seem to accelerate the insights that people can get it, um, in quite helpful way when people when we just don't have enough therapists or, um, time as it is. So hopefully, maybe that might be something in our armour in the future. What? Could you tell me a bit more about your experience with psychedelics as psychedelic assisted psychotherapy? Was it a particular substance? What context was it in a research trial? It was actually the very first randomized controlled trial comparing psilocybin, which is the stuff in magic mushrooms with a conventional SSRI for treatment resistant depression. And, um, it was actually filmed. It was made into a BBC documentary called The Great Psychedelic Drug Trial. And I was a I was a kind of a figure as one of the study guides, which meant that I was with the participants when they had their experience and would kind of do the. Uh, do the kind of the integration of the experience afterwards as well. And it was a, it was a very, um, meaningful, um, experience for me because I'd never really seen people seemingly get better so quickly. It was like magic, you know? And, um, but also the insight, again, not running the risk of because I think sometimes with psychedelics, the hype is kind of unhelpful. And people are now saying, oh, this is the miracle pill, and this is Psychiatry's penicillin moment. And I don't even necessarily think it is that, but I think there's still maybe some value there. But I guess the main learning point I took from from that time was that things don't always necessarily work for the reason that we think that they do. And I sort of remembered this one case of someone who had, um, a decade long history of depression that hadn't budged with like 20 different, you know, different types of antidepressants, all on maximum doses, and gave her the, the stuff and she put the eye mask on and the earphones in and lay back, and she was just perfectly still for like six hours. So I knew she'd had the good stuff. And, um, afterwards she just took her eye mask off and the earphones off. And she looked around and she said, I think it's gone. And she remained like depression free for like the whole six months that we followed her up. And it was like like I say, it was like as close to a medical miracle as I'd ever seen. You know, she was even different that six hours later, like, she just had this lightness that she'd not had before. And, um, anyway, so that was a nice, a nice victory. And then as a formality at the end of the study, we obviously did the unblinding. So everyone discovered what dose of medication it had. And it was only then that we realized that she had received the placebo. Yeah, yeah, yeah. But I think we all know, don't we? How powerful. That's why all, you know, trials have to kind of compare against placebo. We know how profoundly powerful that can be. And some people argue a lot of our treatments are nothing more than active placebos, don't they? So, um, but still, to see it in that context, and I suppose it makes sense, you know, when there is such hype around psychedelics right now. Um. There are high expectancy effects in that in that group. And I used to think that you really burst my bubble with psychedelics to some extent, because actually, when the numbers were crunched, the psilocybin only performed as well as the one in the study. And we kind of know that style is only, you know, marginally superior to placebo anyway. So that was slightly disappointing. But obviously I think there are less fewer side effects. And you don't have to take it all the time. And you know, you know, discontinuation syndrome and all of that. Um, and I used to think that she'd like not got anything, but she had really I suppose she'd got that that feeling or that belief or that sense that maybe just something might make her better. And, um, I always think there's not really a more powerful drug in the world than hope. Mhm, mhm. And did the patient ever find out that they're on a placebo. They did. And my worry we all found out at the same time. She opened the envelope and it was just written there on the thing placebo. And we were worried that I was worried anyway that she'd instantly, as quickly as she'd been cured, should fall back into depression. But she wasn't. She just sort of was a little bit embarrassed, but said, well, you know, I can't explain that, but. You know, I feel better. I'm not going to argue too much with it, you know? Yeah. I guess she had by then had at least six months of knowing that. I guess life without this feeling of depression was at least possible. Exactly. Exactly that. Yeah. And. Yeah, definitely. And that's that's powerful, isn't it? I mean, speaking of placebo, we can also talk about nocebo. And I don't know if you've heard this story, which I've heard on a few podcasts, about the construction worker who. Had accidentally had a nail habit into his boot and was screaming in pain and went to hospital, and they had to treat him because a nail went through his foot. And I'm sure you know where I'm going with this. But his heart rate was like 120. His blood pressure was dropping, screaming in pain, and then they took off the boot and found that the nail had been gone right between his toes and hadn't touched his foot at all. So as much as there's a placebo effect, there's also an Aussie. Perfect. And I was I was hearing I was hearing, you know, in your episode with the, the, the kind of TMS guy, Professor Nolan Williams. Yeah. Sorry, I didn't didn't have his name on the tip of my tongue, but he was talking about how interestingly, I was amazed to hear this. Um. People were given people with sham knee replacements did, as well as people with actual knee replacements. That was that was very surprising to hear. So maybe we're not quite as far away from physical health medicine as we think we are. Well, we're talking about the mind body connection, actually, when we're talking about placebo, nocebo and similar phenomena, we're talking about the mind body connection. And again, uh, Nolan Williams, we talked about, uh, brain stimulation with he's from Stanford. I also talked to Doctor David Spiegel from Stanford, Stanford last year, who is a world expert on hypnosis and the clinical applications of hypnosis. And he talked about some very interesting research about using hypnosis as a substitute anesthetic for some fairly invasive procedures and being as effective as nerve blockers for such procedures. You know, and hypnosis is definitely something that's really helping the mind to propagate beneficial effects on the body. So again, we talked about mystery earlier. There's a lot of mystery. And I think the mind is certainly has a huge capacity for things we don't fully understand yet. Of course. Yeah. Yeah I agree with you. There something I like to ask a lot of people is, you know, especially if they've worked with people clinically for a long time. What are some of the more useful insights you, you think you've had about human nature, as you've worked with people but also developed your own self-awareness as well? I think probably. Well, there's this story that I tell in the book about where had this. There's this patient I always remember who I write about in the book who was a homeless, alcohol dependent man. You might remember in the book is called Tarik. And obviously these stories are all anonymized. But he's a he's a homeless, alcohol dependent guy who always who came to his first clinic appointment with me, uh, with his dog, which I remembered distinctly because I have quite a crippling dog phobia. And I kind of let slip again, talking about that, breaking down of boundaries and a bit more transparency instead of maintaining the traditional psycho, you know, psychiatric stance of non-disclosure of any personal information. I sort of did let slip that I had a dog phobia, but that was actually really helpful for our relationship because it meant that Tarik all of a sudden took it upon himself as someone who'd never previously come to multiple appointments before he took it upon himself to come to his appointments with his dog, to try and cure me of my phobia through exposure therapy. And, um, I suppose that taught me that, you know, everyone needs a bit of purpose in life. And he was a very forgotten about member of society. And in a very small way, he felt purposeful. And it's important if people don't have purpose, then they don't really have much. But another thing I learned from that same guy was that, um, you know, he was suicidal, which, you know, is not particularly unusual, um, for people in a depression clinic. But he always reassured me that he would never do anything to end his life, um, because he had to be around to feed his dog. And, you know, it's those protective factors that help psychiatrists to sleep at night, isn't it? And so, you can imagine, he was one person who I thought I didn't have to worry about. So you can imagine my surprise when at four in the morning, you know, several months later, I was referred to someone, um, from a nurse in A&E who survived after trying to take their life. And it was it was Tarik. And when I saw him, it transpired that his dog had died and. You know, he'd lost his sort of reason to live, really. And so he was still really hopeless and wanted to die. So I had to section him. And as you know, there's not a lot of continuity of care in the NHS. And he moved jobs all over the place, so I didn't actually see him again. It was only when, several years later, just through coincidence, I happened to see him in another clinic, in another job, and he was actually he looked like a totally different guy, like he'd, he'd, he'd had the alcohol detox as an inpatient that I'd always kind of been encouraging them to have, but he wouldn't have in the community. And he trusted social services to rehouse him, um, which they'd done, albeit above, uh, an off licence, but still. And um, and he had it. And when he came, he had a puppy. So he had a kind of new reason for living. So I suppose that was the other learning point is that people, patients, I think, really needed a reason to live and a purpose, not patients, people, human beings. And it's when they don't have those things that, um. Yeah. I don't feel so comfortable. Um, what do you think shifted for Tarik? Was there anything obvious that maybe he told you or that you noticed, which helped him to turn his life around to that degree? It's hard to say no because I wasn't involved in his inpatient care. But maybe sometimes people talk about this is very more eastern, kind of psychedelic assisted psychotherapy kind of language. And I've never really thought this through, but maybe I've heard some people talk about sometimes a break down can be a break through. I wonder if there's something in that. You know, if the booze, the drinking kind of three liters of vodka a day was a defense against any of these uncomfortable? You know, it was it was a it was a shield against all the. The trauma and the disappointments and the sadness that he'd experienced in what had been a very sad, unfortunate life. And when that was kind of stripped away when he'd had. He had this alcohol detox and that, I suppose, maybe without that blanket. Yeah. And he had some psychology as an inpatient as well. He'd actually maybe kind of come into contact with that a little bit. And um. Yeah, he moved through, but he just got to try things a little bit differently in the absence of his dependency, really. And we all know that, you know, alcohol dependent any sort of dependency. Uh, it becomes your only real thought. And, um, he was able to kind of look into other things a little, I think. Yeah. And that's, you know, that's the kind of story we like to hear. And it's always encouraging to hear stories like that because, you know, going back to that sense of idealism, you know, that's kind of what we think is going to be the norm is we're going to have people turned their lives around. And it can be hard to realize once we start training how difficult that can be and how rare that can be. So always good to learn. And I think kind of try and dissect those stories and a bit and trying to figure out what the X factor is, and I think. Uh, not only do I think a breakdown can be a breakthrough, I would go so far to say all breakthroughs happen through breakdowns, and breakdowns can be voluntary or involuntary, and they can be big and small. But I basically think there's no way to grow and mature and develop a new part of yourself unless you're willing to have an old part of yourself decay or die off. And then the question is how acute, how fast, how severe is that going to be? So for example, you know, for for. For someone to get rid of their phobia as you did, as you kind of expose yourself to your fears. To get rid of phobia, you have to have a bit of a mini breakdown. It's really hard to expose yourself to the thing that you're afraid of to get over the fear. You know the two are interlinked and and that the part of you that's afraid essentially has to die. And it's not going to die without a fight, like it's going to be a painful business. And so I think I almost encourage people to think about, you know, and I, I talked to a really amazing therapist named Martha Stark a couple of years ago who talked about this. It's like it's all you need to have a balance of chaos and order a bit of breaking down to rebuild. And that's something as dynamic creatures. That should be happening with us all the time. We should constantly be breaking ourselves down a little bit and manage the pieces so we can build new parts of ourselves, new capacities. And that's kind of the what the process of life is. I'm sorry for the philosophical rant, but yeah, that's something I think about a lot. No, I'm very sympathetic to that view. I think because of through my I think this, this slight experience in this, um, research, psychedelic research and world, I'm much more open to this idea. Uh, going back to it, I think it is that we've had this more Western philosophy, which is that uncomfortable feelings are to be kind of knocked down, almost like, um, uh whac-a-mole. You know, like sadness, get it whacked. Anxiety get it whacked, grief get it whacked, whatever the thing is, and you know, we can whack it in a variety of ways with different chemicals and potions and stuff. Whereas the more kind of psychedelic, eastern psychedelic approach would be actually you kind of numbing yourself through or applying all these defenses, be that with booze or antidepressants or whatever. The thing is, is actually unhelpful. And the only way there's this, uh, phrase they use in psychedelic assisted psychotherapy, which is in and through. So a lot of people will say, oh, I don't want to take psychedelics because I don't want to have a kind of, you know, if I have a bad trip. And it's kind of like, well, unfortunately, the we sort of believe in the right setting and environment, as long as it's safe, a bad trip is not is not really going to happen. But it may be uncomfortable. And as you say, it's kind of about looking the it's kind of in and through. You've got to look the monster in the eye. And that's the only way that people can kind of sometimes come out the other end. Otherwise before, which was, as you say, going back. It's a bit like exposure therapy, as you say with the dog. I can just avoid the dogs for the rest of my life. Or I could actually just tolerate that pain and then maybe come out the other end and, uh, feel comfortable answering this question. Are psychedelics something you've ever tried? Do you have any experience first hand with these substances? Yeah, well, it was you know, I was taught on the on the trial. They taught us because they are a very unique class of medicine in that they're not their effects aren't just pharmacological. They seem to also their efficacy is impacted by literally things like whether the therapist themselves has had psychedelics. And so, um, in the name of medical research, I took myself off to Amsterdam, uh, where psychedelics illegal to have a, an experience, and I did I had sort of psilocybin magic mushrooms there, and it was one of the most profound, meaningful experiences of my life. Yeah, I had this. I felt like I had, um. I thought I was dead. Like, I thought I was. I was dying or dead and I and, um, which I now know is called the kind of ego dissolution, um, which is kind of one of the pinnacles supposedly of a psychedelic experience and I think explains why. Um, and just, just so just to say an a tangible benefit of that for me anyway, which is slightly I used to have a lot of existential angst, you know, like I used to always even as a little boy, I used to lie in bed and think, try and think about what happened after we died. And I would obviously never be able to comprehend that. And then I'd start crying, and then I'd go and seek comfort from my mum and she'd be like, have you been thinking about infinity again, Benji? And, um. And so but interestingly, with the psychedelics, when I had this feeling of being dead and I was asking the person who I was with, I was like, am I dead? And they said, no, you're not dead. And I thought, wow, well, this is incredible because this feels like death, but it's actually perfectly blissful. It's actually nicer than life was totally pain free. So it really reconceptualize this idea of food did something for me. And I just remember on that flight home, usually I'm quite a fearful flyer because of that. Perhaps existential, but I was just I was so zen on the on the return flight. And I think it's for this reason that studies have shown that psychedelics have been really helpful for people with terminal cancer in removing their existential angst and making their piece something like 95% of them kind of were at peace with the idea of dying after a psychedelic experience. So yeah, that was a slightly to give a person on it, though. That was something that I took from them. And would you say those effects were long lasting for you? Yeah. They were. I mean, they don't last forever, but this is sort of the feeling in psychedelics research is that it's not a magic pill. You take one dose and that's it. Sometimes people need to top up kind of every 3 to 6 months. Um, but again, still, I don't see that as a huge limitation because, I mean, you have to take an antidepressant every morning, don't you? Yeah. That's true. And the last question I'd like to ask you is about the writing process. You know, you. Writing a book seems like such a huge feat to most people, and also even just the willingness to try and achieve success in a creative endeavor, which is notoriously difficult, you know? Do you have any insights about writing or creativity that you learned through, through standup or through the book, which you'd like to share? Yeah, I mean, I think, um. I think a lot of psychiatrists are kind of more creatively kind of inclined, aren't they? Kind of that kind of right brain people, to use an outdated term, you know, and, um. So I'd always. I mean, my three little brothers, uh, one's an artist, one's a chef, one's a jeweler. So it's kind of in our family to be. My mom used to be a potter. She was a psychologist, and our dad built our house. So it's kind of a doctor. Is, like, a little bit more of an unnatural fit in our family, really. So I was always looking. I think that's why I was open to the greatness of psychiatry, you know? Um. And then as for insights into writing, well, I suppose it comes as you say. It can be a very daunting task to write an entire book. What I found helpful was just small, small steps. First of all, I suppose I learnt how to tell a joke or short stories on stage. And then I also host a storytelling night called The Moth, which is like an international storytelling night, and I host the one in in London. And one of my jobs there, I suppose, was to tell slightly longer form stories, um, without punchlines. And that's quite nice, because sometimes. Uh, you realize there's more? I think comedians think there's only punchlines, but actually, there's more to art than just the humor. You know, you can have pathos and sadness, and there are other emotions as well that's quite nice to elicit in people. Um, and then I started doing Edinburgh shows, which I suppose put all these short stories together. And then I think it just made it telling these shorter, formal hourlong shows made that the, the, the idea of writing like a kind of 300 page book a bit less daunting. Yeah. And also what I did was, yeah, small stabs with everything. Um, also what I found helpful is I actually did an online writing course, which I would always recommend. It all came about in lockdown. It was all very organic, really. There wasn't a lot to do besides, like, go for another run, you know, which I didn't want to do. So I did an online writing course called Curtis Brown Creative, and it was through that that, um, at the end of the course, someone on the course offered to send my work to an agent, and then that agent signed me up. And then we pitched the book and then had an auction for the book, and then pitched the TV thing and had an auction for the TV thing. And yeah, it was all it was very bizarre how the stars aligned for me that that day. Yeah, I was very lucky. And it's so interesting how just incremental steps can be so powerful. And again, tell me if you're comfortable answering this question, but a lot of people aspire towards the kinds of success that's really happening for you at the moment. And I kind of like to dispel illusions about success on the podcast. What does it feel like? Does it feel like what you anticipated would feel like, or does it feel different? That's a that's a really interesting question. Um, my editor was saying to me on the day of my book launch, we just had a really nice, um. Review come out in The Guardian, and the book had gone to be reprinted, like the first day that it had kind of come out and she was sent me up. And you must you must be so happy. And it was that weird thing where people tell you what you're meant to be feeling. And I just had to say to her, oh, yeah, yeah, yeah, but I wasn't. I wasn't feeling it at all. These things never feel like. I think you think they're going to feel. And, um. Of course, because, um, they don't really change it in a world all that much, as I think we at least know. And it kind of in abstract terms. And it was funny because I was, I was speaking to some I know a few fellow writers now, and I was speaking to another writer about this strange, this strange realization that, of course, you know, being a published author doesn't really change anything. And he said, oh, Benji. Yeah, but I know it doesn't feel like it now, but I just want you to know that, like in about in a few months, like, you'll be able to look back on all these nice reviews and all these lovely messages you've had from readers. And I just want you to know you still won't feel anything at all. That's incredible. Yeah. And it's an important lesson because. People who are trying to achieve a certain level of success kind of feel like the life will be empty. Their lives will be empty until they get that external validation. And. It puts you in this sort of perpetual state of desire, and not realizing that ultimately, your life can only be as good as the mental lens through which you view it. And you can have what some might consider to be very meager circumstances. But if you have the correct mental lens, you can feel you can have a very rich and happier or higher quality existence, which is why people can meditate in a cave for 20 years and be some of the happiest people. There's also an interesting expression. It's easier to become enlightened in a prison than it is on a private jet, because at least in the prison, there's no illusion that it's your circumstances that are going to make you happy. You're forced to look within. Whereas when you're in the private jet, you're constantly caught in this chase of what? I'm supposed to be happy because I'm here, but I'm not, and that makes me feel worse. So that's like, I don't know why, but this is a mantra I like to talk about a lot on the show. Yeah. Well, there's a there's a phrase that, um, that I, that I've heard before, which again, people use in the psychedelic world, which is that pre enlightenment is, uh, collecting water and chopping wood and post enlightenment is collecting water and chopping wood. You know, and it's not about adding extra stuff to your life. And arguably, I think you're right. It's interesting. I wasn't writing this book just to try and make myself happy, although I think unconsciously that might have been a little bit of it. You know, there's certainly more selfish part of it. Um, but then, yeah, as you say, it's been really nice. And like, objectively, I was thinking, yeah, getting number two on the Sunday Times bestseller list, you should be feeling great, but at what cost is this actually this this process, the process of writing a book is actually, you know, my life is different now to how it was before I wrote the book. I think, right, doing something like writing a book makes you very, uh, preoccupied and single minded and, um, selfish. And, you know, it's at the expense of your relationships often. And it's kind of weird that now I found myself with this physical book. But, like, one thing in my life is, you know, I've now broken up with my partner, which I sometimes wonder how much that was related to, you know, and it's all really ultimately, I think I know. You know, I think I'm pretty sure my relationships aren't as friendships aren't as good or as nurtured as they were pre-booked. Just because I haven't had the amount of time and and I think really we it comes back to that idea of connection really, I think the, the real secret I suppose to, to wellbeing or to happiness or whatever you want to call it, is probably about connections and um, yeah. And I think sometimes if you pursue these creative, artistic things that they can, they come at a cost of other things. You know, it's a bit like pushing. It's like you can't have everything. It's like, what's that analogy of like, um, I forget what it is where you push something in and something comes out the other side. You can't you can't have everything complete. Yeah, exactly. That's the other thing we don't talk about. There's a price to success, and high level success has a high level price. And often that's the things that make us the happiest. Like our friendships, our relationships and things like that. Yeah. I think, um. That's something I've been pondering these last few weeks. Well, Benji, thank you so much for spending some time with me. I would really would encourage people to go read your book. You don't have to be bad to work here. Where can people find you if they'd like to learn? Thanks. Jam on Instagram and on Twitter. Um, just put in Benjy Waterhouse. Um. And, yeah, my books are available. Uh, it's published by vintage and it's on. You can get it online and also it's on audible as well or on Spotify. Yeah. And I'm also doing a Edinburgh show if I can just shamelessly plug that. I'm doing a show at Edinburgh this year called maddening, which is at 435 at a place called The Mash House, and that is road testing, uh, chapters for a possible second book. Perfect. Benji, thank you so much. Thanks for having me, Alex. Cheers.