Latest / Why We Do What We Do / First Episode Psychosis

Transcript

First Episode Psychosis · Why We Do What We Do

• 0:03
  Speaker 1: You're listening to Why we do what we do? Welcome
• 0:15
  Speaker 1: to Why we do what we do. I am your
• 0:18
  Speaker 1: empathetic towards psychosis Host Abraham.
• 0:22
  Speaker 2: And I'm your you never really know what people are
• 0:25
  Speaker 2: going through host Shane.
• 0:26
  Speaker 1: We are a psychology podcast. We talk about the things
• 0:29
  Speaker 1: that humans and non human animals do, and sometimes we
• 0:32
  Speaker 1: talk about sort of under the radar diagnostic conditions that
• 0:38
  Speaker 1: you may not have heard of, but are actually very
• 0:40
  Speaker 1: relevant and affect a surprising number of people.
• 0:43
  Speaker 2: Yes, and so today we are talking about a phenomenon
• 0:46
  Speaker 2: called first episode psychosis, which we will unpack in more
• 0:50
  Speaker 2: depth as we get going.
• 0:52
  Speaker 1: Indeed we will. And if you're joining us for the
• 0:55
  Speaker 1: first time, then welcome. We hope that you enjoy what
• 0:57
  Speaker 1: you hear in this discussion. If you're a returning person
• 1:00
  Speaker 1: and then welcome back. Can we hope that you also
• 1:01
  Speaker 1: enjoy what you hear in this discussion, finding all of
• 1:04
  Speaker 1: the wonders that brought you here in the first place,
• 1:06
  Speaker 1: and then keep bringing you back. And either way, if
• 1:09
  Speaker 1: you'd like to support us, you can leave us a
• 1:11
  Speaker 1: rating and a review, like subscribe, tell a friend, or
• 1:14
  Speaker 1: join us on Patreon. I'll talk more about those things
• 1:16
  Speaker 1: at the end of this discussion. But this episode publishes
• 1:20
  Speaker 1: on March twenty fifth, So everyone listening, Happy American Red
• 1:24
  Speaker 1: Cross Giving Day. Yay.
• 1:27
  Speaker 2: It's also bed in for Peace Day, but not like
• 1:30
  Speaker 2: John Lennon did. We're like he and Yoko Ono were
• 1:34
  Speaker 2: betting in but then they were having like their staff
• 1:37
  Speaker 2: come in and like make their bed for them, and
• 1:40
  Speaker 2: like we're doing rich people things while they were betting in,
• 1:42
  Speaker 2: like do like something good with it.
• 1:46
  Speaker 1: I do think that's where this comes from, though, Yeah, yeah, probably.
• 1:51
  Speaker 2: Yeah. It is Green Independence Day. It is. It's also
• 1:57
  Speaker 2: International Day of Remembrance of the Victims of Slavery in
• 2:00
  Speaker 2: the Transatlantic Slave Trade.
• 2:02
  Speaker 1: Stephen Miller's favorite day probably or celebrates in a different way.
• 2:06
  Speaker 2: He probably celebrates in a different way. Yeah, Stephen Miller.
• 2:09
  Speaker 1: It is International Waffle Day.
• 2:12
  Speaker 2: It is. It is Manite Appreciation Day. I love those guys, ah,
• 2:16
  Speaker 2: me too, They're so great.
• 2:18
  Speaker 1: It is National Cerebral Palsy Day. Have you ever done
• 2:21
  Speaker 1: an episode on ceuber palsy? I don't think we have.
• 2:23
  Speaker 1: That's all. Make some notes, give me just a second.
• 2:26
  Speaker 2: I want to write this.
• 2:27
  Speaker 1: We're going to do an episode on cerebral palsy. We're
• 2:29
  Speaker 1: going to do an episode on manates.
• 2:31
  Speaker 2: I think that's what I just learned. Beautiful, beautiful. Well,
• 2:37
  Speaker 2: while you make notes, it's also worth celebrating National Michelle
• 2:39
  Speaker 2: Schaffer Half Moon Cookie Day. I am back briefly.
• 2:43
  Speaker 1: Well, I need to make more notes about the things
• 2:44
  Speaker 1: that we're gonna be talking about at some point in
• 2:46
  Speaker 1: the future.
• 2:47
  Speaker 2: It's National Pecan Day. Is a pecan or Peacan? That's
• 2:50
  Speaker 2: always the debate. But I heard pecan m I heard
• 2:54
  Speaker 2: from a far a pecan farmer that it's peacan.
• 2:57
  Speaker 1: I heard from a bunch of language experts who tracked
• 2:59
  Speaker 1: down themology of this word, that both of them are wrong,
• 3:02
  Speaker 1: but the closest one to the original native word is pecan. M.
• 3:07
  Speaker 2: Well, I don't trust those people, all right. It is
• 3:10
  Speaker 2: also Old New Year's Day.
• 3:13
  Speaker 1: I guess that's New Year's Day for old people. It
• 3:15
  Speaker 1: is Tolkien Reading Day.
• 3:17
  Speaker 2: Indeed, let's do it. I love that. I love that.
• 3:20
  Speaker 2: It is Autism Acceptance Week.
• 3:23
  Speaker 1: Excellent, we accept It is English Tourism Week.
• 3:27
  Speaker 2: M It is National cleaning Week.
• 3:30
  Speaker 1: It is National Tsunami Awareness Week. Yes, note there are tsunamis. Yes,
• 3:37
  Speaker 1: big waves, big waves, that's what we plan to do
• 3:41
  Speaker 1: with this episode is make big waves, not in the ocean, though,
• 3:43
  Speaker 1: cultural waves, because big waves in the ocean can be
• 3:46
  Speaker 1: bad for people. We try to do things that are
• 3:47
  Speaker 1: not bad for people, maybe barring bad people, right, which,
• 3:53
  Speaker 1: I have thought that the people who are in power,
• 3:56
  Speaker 1: if I were to try and attack them, what I
• 3:59
  Speaker 1: would do is put fifteen bags of popcorn in their
• 4:02
  Speaker 1: microwave and put it on for like three hours and
• 4:04
  Speaker 1: let that smell permanently ruin their home.
• 4:11
  Speaker 2: I like that. See, I was thinking, like, you know,
• 4:14
  Speaker 2: fish in the air ducts, but you know that works too. Yeah.
• 4:17
  Speaker 1: Yeah, that also, that would do it, at least for
• 4:19
  Speaker 1: a while. Yeah, all right, but that's not what we're
• 4:22
  Speaker 1: talking about. We are talking about first episode psychosis. And
• 4:27
  Speaker 1: as we mentioned at the top of this and psychosis
• 4:30
  Speaker 1: is a unique and often confusing experience that actually affects
• 4:34
  Speaker 1: a surprisingly large number of people. The first time it happens,
• 4:37
  Speaker 1: it is called, appropriately enough, first episode psychosis, and that
• 4:42
  Speaker 1: is the topic today.
• 4:44
  Speaker 2: Yeah, so this episode is going to delve into what
• 4:46
  Speaker 2: psychosis is, first episode psychosis also called FEP, what to expect,
• 4:51
  Speaker 2: and what treatment exists, as well as an attempt to
• 4:53
  Speaker 2: analyze the behaviors happening inside of this experience. Yes, so
• 4:58
  Speaker 2: that is I guess ready to dive into this.
• 5:00
  Speaker 1: Unless there's anything I'm missing or the Noular introduction, I
• 5:03
  Speaker 1: guess I'm right perfect. Let's go ahead and do it.
• 5:06
  Speaker 1: Let's start with the definition here. So psychosis. You might
• 5:10
  Speaker 1: hear that and have sort of some preconceived notions about
• 5:13
  Speaker 1: what that is. They might be on varying degrees of accuracy,
• 5:17
  Speaker 1: so we want to do our best to unpack it.
• 5:18
  Speaker 1: But psychosis is when a person has changes in their
• 5:21
  Speaker 1: behavior that are often surprising, often harmful, but not always
• 5:25
  Speaker 1: to themselves or others. They might be confusing, and they
• 5:29
  Speaker 1: often will consist of reports of hallucinations of some sort, auditory, visual,
• 5:34
  Speaker 1: or both.
• 5:35
  Speaker 2: So they also may say things and behaving ways to
• 5:37
  Speaker 2: indicate that they are not clear on what is real
• 5:39
  Speaker 2: and what is not real. They may talk about beliefs
• 5:42
  Speaker 2: that are extreme, demonstrably false, paranoid, or nonsensical. They may
• 5:46
  Speaker 2: be unwilling to accept any arguments that contradict their stated beliefs.
• 5:49
  Speaker 2: I've been on the receiving end of a phone call
• 5:52
  Speaker 2: of somebody going through this, and it is it is.
• 5:56
  Speaker 2: It is shocking it's really intense.
• 6:00
  Speaker 1: I can imagine the word heroin comes to mind.
• 6:03
  Speaker 2: Yes.
• 6:04
  Speaker 1: Part of my decision to want to talk about this
• 6:08
  Speaker 1: is that someone I know may have experienced this somewhat recently,
• 6:12
  Speaker 1: and it had me wanting to investigate further because I
• 6:15
  Speaker 1: already had some familiarity with it, but I wanted to
• 6:18
  Speaker 1: really dig into some of the science and research here
• 6:21
  Speaker 1: and get a better understanding. So some do describe this
• 6:25
  Speaker 1: as a break from reality or disturbances of thought and condition,
• 6:29
  Speaker 1: and these can be symptoms of psychosis. But it's important
• 6:33
  Speaker 1: to actually understand that psychosis is not actually a disease
• 6:36
  Speaker 1: or illness in and of itself. It's a description of
• 6:40
  Speaker 1: those things right.
• 6:42
  Speaker 2: Instead, psychosis is a symptom of other mental health related issues,
• 6:45
  Speaker 2: such as schizophrenia or trauma, as such as mental or
• 6:48
  Speaker 2: physical abuse. Some have stated that there is a genetic
• 6:52
  Speaker 2: environmental interaction, which, by the way, is there any mental
• 6:55
  Speaker 2: experience we have that is not genetic and environmental? Anyway
• 6:59
  Speaker 2: we digress, it can be brought on by substance use
• 7:02
  Speaker 2: for those who are already prone to psychosis, so it's
• 7:06
  Speaker 2: important to maybe know a little bit about your family
• 7:09
  Speaker 2: history to be mindful of that. So just there's lots
• 7:13
  Speaker 2: of reasons why it might show up.
• 7:15
  Speaker 1: Yeah, so you want to actually get like an actual
• 7:19
  Speaker 1: diagnosis of psychosis. But psychosis describes the symptoms that often
• 7:24
  Speaker 1: come from those other issues. And I do think I
• 7:28
  Speaker 1: actually don't know if there are clear statistics on this,
• 7:30
  Speaker 1: but trauma from mental health issues, for physical abuse, those
• 7:36
  Speaker 1: account for a large proportion of these, right, But again
• 7:40
  Speaker 1: I'm not sure that there are clear at least I
• 7:41
  Speaker 1: didn't find any clear statistics on what they're like the
• 7:45
  Speaker 1: number of people for whom that is the case, but
• 7:47
  Speaker 1: it is quite a few. Brain injury actually is another
• 7:50
  Speaker 1: super common one that's related here.
• 7:52
  Speaker 2: Yeah, that makes sense.
• 7:53
  Speaker 1: Okay, So let's go ahead and get into the symptoms here.
• 7:55
  Speaker 1: When we're talking about psychosis, what does that mean, what
• 7:57
  Speaker 1: will actually look like? Importantly, what might be a little
• 8:02
  Speaker 1: bit surprising is that symptoms can, if not usually, arise
• 8:07
  Speaker 1: very slowly. The first phase of what might actually be
• 8:11
  Speaker 1: identified as psychosis consists of many, often very subtle changes
• 8:16
  Speaker 1: that go unnoticed by the people who are around the
• 8:19
  Speaker 1: person who is like building up to psychosis. And if
• 8:22
  Speaker 1: we think about the ideology of this where it comes from,
• 8:26
  Speaker 1: it kind of makes sense that if someone has experienced
• 8:29
  Speaker 1: trauma or is experiencing trauma that as that compounds as
• 8:34
  Speaker 1: the struggle to deal with what has happened just sort
• 8:38
  Speaker 1: of festers underneath for a while, the struggle with that
• 8:44
  Speaker 1: becomes more apparent over time.
• 8:47
  Speaker 2: Right. And these often start in younger people, although this
• 8:50
  Speaker 2: can happen to anyone. As with most diagnoses, the symptoms
• 8:53
  Speaker 2: are broadly classified as positive, negative, or cognitive, which is
• 8:57
  Speaker 2: to say, something new that was not occurring but now
• 9:00
  Speaker 2: is positive, something that is no longer occurring that used
• 9:04
  Speaker 2: to negative or disturbed thoughts and emotions.
• 9:07
  Speaker 1: Cognitive right, So people often hear positive symptoms and think
• 9:11
  Speaker 1: positive meaning good. In this case positive meaning present new
• 9:16
  Speaker 1: right extra and negative meaning doesn't mean bad, it means
• 9:20
  Speaker 1: it has gone away now. Positive symptoms, as I said,
• 9:23
  Speaker 1: something added that was not present before includes hallucinations is
• 9:27
  Speaker 1: really common. So that is something that was not occurring
• 9:29
  Speaker 1: now is occurring positive symptoms and that is auditory, visual,
• 9:32
  Speaker 1: or both. As we mentioned, it can include delusions is
• 9:36
  Speaker 1: another thing way that this occurs. Negative symptoms are when
• 9:40
  Speaker 1: behaviors occur less often, so negative symptoms might look like
• 9:43
  Speaker 1: withdrawing from people might look like a lack of affect
• 9:46
  Speaker 1: or emotion, decreased motivation to do things, lacking the experience
• 9:51
  Speaker 1: of pleasure in general, those are some of the negative.
• 9:54
  Speaker 2: Symptoms right now. Cognitive symptoms are expressions of thoughts and
• 9:59
  Speaker 2: performing is on cognitive exams that are characterized by confusion, incoherence,
• 10:03
  Speaker 2: or inconsistency. This might look like difficulty remembering things, difficulty
• 10:08
  Speaker 2: maintaining a consistent incoherent train of thought, and struggling to
• 10:12
  Speaker 2: focus attention on things and concentrating.
• 10:15
  Speaker 1: I do ask the question thinking about these, how important
• 10:18
  Speaker 1: is it to separate symptoms into positive, negative and cognitive?
• 10:22
  Speaker 1: Not really? I mean, if they're happening, if there are
• 10:24
  Speaker 1: symptoms that are happening, then we just classify those as
• 10:28
  Speaker 1: symptoms that are happening. I don't know what, like where
• 10:30
  Speaker 1: we get any useful information out of categorizing them in
• 10:35
  Speaker 1: that way.
• 10:36
  Speaker 2: Those are quite obortrary.
• 10:38
  Speaker 1: Some people like to categorize things and then others just
• 10:40
  Speaker 1: sort of follow that lead, and that seems to be
• 10:42
  Speaker 1: where we ended up here. Maybe some people would disagree
• 10:45
  Speaker 1: with me, but anyway, Yeah, people disagree with the fact
• 10:48
  Speaker 1: that we play ads, so.
• 10:49
  Speaker 2: Oh, you're right, they do. We do too, Okay, we're back.
• 11:01
  Speaker 1: We've been unpacking the classifications and sort of types of
• 11:05
  Speaker 1: symptoms you might see with psychosis. But I cut you
• 11:08
  Speaker 1: off with leading into an ad break. So what were
• 11:11
  Speaker 1: you going to say about the decision? I was arguing,
• 11:14
  Speaker 1: essentially that it's not very useful to categorize those symptoms
• 11:17
  Speaker 1: as positive, negative, and cognitive because they just kind of
• 11:20
  Speaker 1: are what they are, and I don't really get the
• 11:22
  Speaker 1: point of taxonomizing them in that way.
• 11:26
  Speaker 2: Sure, I think I was gonna say, I don't really
• 11:28
  Speaker 2: particularly understand the positive and negative, but I do understand
• 11:31
  Speaker 2: the cognitive in that, Like, if we can explain something
• 11:35
  Speaker 2: as like a cognitive change, like where there is something
• 11:38
  Speaker 2: that appears to be neurological, maybe that might lead to
• 11:41
  Speaker 2: different questions and maybe different ways to evaluate. So like
• 11:44
  Speaker 2: that might that to me, that could lead to different referrals.
• 11:47
  Speaker 2: But like you know, like oh, a new behavior or
• 11:50
  Speaker 2: lack of behavior probably wouldn't do the same as like
• 11:52
  Speaker 2: something that might be classified as cognitive to me, Like
• 11:55
  Speaker 2: I would hear that like, oh, you're having a hard
• 11:56
  Speaker 2: time focusing, which before you did something is change? Right,
• 12:00
  Speaker 2: Like it would still prompt me as a behaviorist to
• 12:03
  Speaker 2: ask environmental questions. But I think that there's probably maybe
• 12:07
  Speaker 2: some indicators that would maybe lead to having a neurological
• 12:09
  Speaker 2: exam before a psychological exam or something. Interesting point.
• 12:13
  Speaker 1: Okay, I would have to think about that more to
• 12:15
  Speaker 1: decide whether I disagree, but I think that you make
• 12:17
  Speaker 1: a very coherent point, So I for now I'm going
• 12:20
  Speaker 1: to go with it.
• 12:21
  Speaker 2: Hey, I'll take that for now. I'll take that for now.
• 12:23
  Speaker 2: I mean, we are just coming off of an ad break,
• 12:25
  Speaker 2: so I think we're just we're just ready to be
• 12:27
  Speaker 2: in the content, you know, that's right.
• 12:28
  Speaker 1: Yeah, we're just a little rattled. Okay, so we'll get
• 12:30
  Speaker 1: back into it. It is important to point out here
• 12:33
  Speaker 1: that you don't have to have all of those symptoms
• 12:37
  Speaker 1: to have experienced an episode of psychosis or to have
• 12:40
  Speaker 1: that be a description of the experience that you might
• 12:43
  Speaker 1: be having. Even just a couple are enough to recommend
• 12:46
  Speaker 1: seeking assessment and possibly treatment. If the only symptom you
• 12:49
  Speaker 1: had whatsoever is you are hallucinating a giant invisible bunny,
• 12:54
  Speaker 1: I would say go see a psychologist immediately, and yeah,
• 12:57
  Speaker 1: probably a neuropsych and get like a full work up,
• 13:00
  Speaker 1: because as you said, like that is that speaks to
• 13:04
  Speaker 1: possible issues that would likely need to be addressed and
• 13:07
  Speaker 1: might be related to other things. So yeah, there's that.
• 13:10
  Speaker 2: Yeah, I agree. Now, Unfortunately, a lot of misunderstanding, stigma,
• 13:14
  Speaker 2: and culture that blames individuals for their mental illness, their
• 13:17
  Speaker 2: mental health issues, and any of those things, and shames
• 13:20
  Speaker 2: them for communicating their thoughts and feelings leads to underreported
• 13:24
  Speaker 2: and likely many missed opportunities to seek treatment early or
• 13:28
  Speaker 2: even seek treatment. Ever, it can be very punishing and
• 13:31
  Speaker 2: very stigmatizing to bring up that you may be experiencing
• 13:34
  Speaker 2: some mental health crisis in a world that blatantly chooses
• 13:38
  Speaker 2: sometimes not to understand what that even means.
• 13:40
  Speaker 1: Yeah, I think you know people who might be sitting
• 13:44
  Speaker 1: there experiencing like, Wow, I see things other people don't
• 13:47
  Speaker 1: seem to see. I'm struggling with some thoughts here. If
• 13:52
  Speaker 1: I tell someone that could get me in trouble, I
• 13:56
  Speaker 1: shouldn't tell anyone, right, that is the culture in which
• 13:58
  Speaker 1: that exists, where that they would have that fear. Now,
• 14:01
  Speaker 1: to be fair, like, it could be the case that
• 14:03
  Speaker 1: some of the fear that they have comes from some
• 14:06
  Speaker 1: of the underlying condition they might have, such as schizophrenia,
• 14:08
  Speaker 1: but also like we certainly don't provide a lot of
• 14:11
  Speaker 1: a very supportive environment that would facilitate people feeling safe
• 14:15
  Speaker 1: to come forward with those issues and seeking help and treatment,
• 14:18
  Speaker 1: instead letting them sort of fester and grow and potentially worsen. Yeah,
• 14:22
  Speaker 1: without receiving the care that they deserve. So that's I
• 14:26
  Speaker 1: guess just the point to make there. Okay, So as
• 14:30
  Speaker 1: far as understanding the prognosis of psychosis, did not mean
• 14:35
  Speaker 1: to rhyme that that way, but that does feel like
• 14:42
  Speaker 1: that could be some kind of like neu metal album
• 14:44
  Speaker 1: name prognosis psychosis.
• 14:46
  Speaker 2: Yeah, that would be as it's the title of a
• 14:51
  Speaker 2: song somewhere.
• 14:52
  Speaker 1: Yeah, anyway, is understanding that you can broadly conceptualized psychosis
• 14:56
  Speaker 1: is occurring in three phases what they call pro dome,
• 14:59
  Speaker 1: acute episode, and then hopefully recovery. That's generally what they
• 15:04
  Speaker 1: sort of talked about in terms of the arc of
• 15:06
  Speaker 1: the experience.
• 15:07
  Speaker 2: Right, So let's start with pro doome. This is when
• 15:11
  Speaker 2: early signs may or may not be detectable. That's really
• 15:14
  Speaker 2: important that they may not be detectable for lots of reasons,
• 15:17
  Speaker 2: and we'll kind of unpack that a little bit.
• 15:19
  Speaker 1: Yeah, clearly like they might be there, but just like
• 15:22
  Speaker 1: not so over that people notice them right.
• 15:25
  Speaker 2: So further, it can develop slowly over weeks, months, or
• 15:27
  Speaker 2: even years. Rarely does FEP emerge out of nowhere with
• 15:31
  Speaker 2: no signs. Although the signs might not be at all
• 15:34
  Speaker 2: obvious to the person experiencing the psychosis, it is more
• 15:38
  Speaker 2: likely obvious to the people around them. So it might
• 15:40
  Speaker 2: start with people beginning to describe difficulty with thoughts, perceptions,
• 15:43
  Speaker 2: and emotions. Just to provide some examples, this is not
• 15:47
  Speaker 2: an exhaustive list, but here are some common symptoms that
• 15:50
  Speaker 2: include things like difficulty concentrating, reduction in grades or job
• 15:55
  Speaker 2: performance as relevant, a decline in self care personal hygiene,
• 15:59
  Speaker 2: difficulty sleeping or experiences with sleep disturbances, or isolating with
• 16:03
  Speaker 2: or in withdrawing from friends and families.
• 16:05
  Speaker 1: They might also report or demonstrate trouble thinking clearly. They
• 16:09
  Speaker 1: might be feeling or again expressing that they are feeling
• 16:13
  Speaker 1: suspicious or paranoid. They might start having and talking about
• 16:18
  Speaker 1: odd beliefs and sort of demonstrating some magical thinking. If
• 16:23
  Speaker 1: this is sounding like a conspiracy theorist conservative person, you
• 16:27
  Speaker 1: know you're not wrong not to say that, right, That
• 16:31
  Speaker 1: is how they would all be diagnosed. There might be
• 16:33
  Speaker 1: some other things going on there, but that is a
• 16:37
  Speaker 1: red flag.
• 16:38
  Speaker 2: Sure. Sure. They may also experience persistent, unusual thoughts, strong
• 16:43
  Speaker 2: emotional reactions of things that do not seem to warrant
• 16:46
  Speaker 2: such reactions, and starting to experience a report experiencing or
• 16:50
  Speaker 2: seeing or hearing things that no one else can see
• 16:54
  Speaker 2: or hear.
• 16:55
  Speaker 1: Right, Okay, so that's again. This is not an exhaustive list.
• 16:59
  Speaker 1: There are other things to know about this and that
• 17:01
  Speaker 1: that could occur, but those are some really common ones
• 17:04
  Speaker 1: that are the sort of major red flags to be
• 17:06
  Speaker 1: on the lookout for or that someone might be experiencing
• 17:09
  Speaker 1: just to know what they are.
• 17:11
  Speaker 2: Right.
• 17:11
  Speaker 1: The word acute means what it means, so in acute episode,
• 17:15
  Speaker 1: of course, refers to the first time the symptoms of
• 17:17
  Speaker 1: psychosis escalate into a full blown episode, characterized by a
• 17:21
  Speaker 1: relatively sudden and profound change in behaviors. At this stage,
• 17:26
  Speaker 1: which is also called the critical period, people experiencing psychosis
• 17:30
  Speaker 1: are likely to behave and what the people around them
• 17:34
  Speaker 1: would likely describe as alarming and unpredictable ways. They will
• 17:38
  Speaker 1: often report that they are extremely distressed by their situation.
• 17:42
  Speaker 1: This is also when many people start reporting vivid hallucinations,
• 17:45
  Speaker 1: indistinguishable from reality where they are. They're saying that there
• 17:49
  Speaker 1: are things that they see or hear that We're like,
• 17:53
  Speaker 1: that's not there, and they're like, yes, it is. It
• 17:55
  Speaker 1: very clearly is You're wrong, And they have trouble even
• 17:58
  Speaker 1: believing that someone would disagree with them on that point.
• 18:00
  Speaker 2: Yeah. And this could look like believing that you are
• 18:03
  Speaker 2: some deific or demonic figure, or that external forces are
• 18:08
  Speaker 2: controlling you, like angels, demons, or computers in your mind
• 18:10
  Speaker 2: or your brain.
• 18:11
  Speaker 1: It might look like reacting strongly to trivial remarks or
• 18:15
  Speaker 1: glances or actions or other events that might take place,
• 18:19
  Speaker 1: and just like really having an intense emotional reaction to
• 18:23
  Speaker 1: very small things that happen.
• 18:25
  Speaker 2: Yeah, or believing you have special powers or on a
• 18:28
  Speaker 2: special mission. I will never forget this day. When I
• 18:31
  Speaker 2: received this phone call from this friend of mine, it
• 18:34
  Speaker 2: was absolutely in line with what you're talking about, describing
• 18:38
  Speaker 2: a reality that did not exist, describing paranoid like feelings.
• 18:43
  Speaker 2: They had reported there were children outside staring at them
• 18:47
  Speaker 2: when they had gotten home from work. They'd closed all
• 18:50
  Speaker 2: their blinds, they were clearly stressed, and they had refused
• 18:54
  Speaker 2: to call any police or any sort of like first
• 18:57
  Speaker 2: responder because they were afraid that they were quote unquote
• 19:00
  Speaker 2: in on it, and so it was really distressing. Sure, yeah,
• 19:04
  Speaker 2: to get a call out of nowhere and like really
• 19:05
  Speaker 2: not expect that as somebody who received the call. I
• 19:08
  Speaker 2: couldn't imagine what it was like for somebody who's going
• 19:10
  Speaker 2: through that in that moment.
• 19:11
  Speaker 1: Right, yeah, And I mean they believe it, like they
• 19:14
  Speaker 1: to them, that is the new reality. Is the situation
• 19:17
  Speaker 1: the reality, And like how frightening that must be if
• 19:20
  Speaker 1: that's the thing that you believe that that's what's going on,
• 19:23
  Speaker 1: because it's what your perceptions are currently doing, right, and
• 19:27
  Speaker 1: how you're engaging with that. So all right, understanding that
• 19:30
  Speaker 1: without treatment, what can happen with this is that behaviors
• 19:33
  Speaker 1: can solidify into habits what start as possible temporary significant
• 19:38
  Speaker 1: reactions to things that may be neurological and may have
• 19:42
  Speaker 1: some it's going to have some environmental components no matter what.
• 19:44
  Speaker 1: But whatever that's happening, the behaviors they're engaging in to
• 19:47
  Speaker 1: navigate that new situation. If they are not managed in
• 19:51
  Speaker 1: some way, then they'll start to become more ingrained in
• 19:53
  Speaker 1: their repertoire and start to become habits, and they become
• 19:56
  Speaker 1: that much more persistent and more resistant to further treatment
• 19:59
  Speaker 1: or any kind of care plan. So the longer those
• 20:01
  Speaker 1: goes without any kind of intervention, the more difficult it
• 20:04
  Speaker 1: will be to and the less it will respond to
• 20:07
  Speaker 1: intervention in the future.
• 20:09
  Speaker 2: Right, which leads to the final phase of this process,
• 20:12
  Speaker 2: which is hopefully again recovery. With treatment, doctors expect about
• 20:17
  Speaker 2: twenty five percent of patients to never have another episode. Again.
• 20:20
  Speaker 2: Around fifty percent of people might have more than one episode,
• 20:23
  Speaker 2: but will otherwise go on to live pretty normal or
• 20:27
  Speaker 2: pretty episode free lives for the most.
• 20:30
  Speaker 1: Part, meaning that there's sort of a final twenty five
• 20:32
  Speaker 1: percent who might spend the rest of their life trying
• 20:35
  Speaker 1: to manage the situation and likely have multiple episodes where
• 20:39
  Speaker 1: they have hallucinations where they have sort of severe reactions
• 20:42
  Speaker 1: to things. Right, and that it again, it just is
• 20:46
  Speaker 1: more persistent. So again, treatment here is really key. The
• 20:51
  Speaker 1: most successful treatment so far, according to the research, is
• 20:54
  Speaker 1: called a coordinated Specialty care SCS, and really that doesn't
• 20:59
  Speaker 1: that's not a type of treatment.
• 21:00
  Speaker 2: Really.
• 21:01
  Speaker 1: What that means is that you get a team of
• 21:02
  Speaker 1: healthcare professionals and specialists who work with the person and
• 21:06
  Speaker 1: their family to tailor treatment to the person's individual needs
• 21:10
  Speaker 1: from a variety of interdisciplinary models. So you're going to
• 21:13
  Speaker 1: have psychologists, psychiatrists, social workers, people who are basically just
• 21:18
  Speaker 1: social sort of coordinated liaisons. Like, there's going to be
• 21:20
  Speaker 1: a whole bunch of people who are involved in this
• 21:23
  Speaker 1: person's treatment, all making a contribution to providing some kind
• 21:27
  Speaker 1: of care. That comprehensive team of people is called the
• 21:30
  Speaker 1: coordinated specialty care. That has been shown to be the
• 21:33
  Speaker 1: essentially the best You get the best outcomes with that approach.
• 21:37
  Speaker 2: Yeah, I mean, I'm sure that we see time and
• 21:39
  Speaker 2: time again that that's kind of the case, right when
• 21:42
  Speaker 2: working on individual care, Like how many times do we
• 21:45
  Speaker 2: see that We're like, oh my god, if we could
• 21:47
  Speaker 2: all just get together and like make sure that we
• 21:50
  Speaker 2: were all treating these various facets of this person's life,
• 21:53
  Speaker 2: I bet we would have way better outcomes.
• 21:55
  Speaker 1: Yeah, interdisciplinary coordinated teamwork. I feel like that just it
• 21:59
  Speaker 1: needs to be the gold standard for how we approach
• 22:01
  Speaker 1: care and treatment of people. I think that most people
• 22:04
  Speaker 1: have been saying this for a while now. Maybe we
• 22:05
  Speaker 1: need to do a full episode on just like interdisciplinary teams,
• 22:08
  Speaker 1: because it is a lot of people have been siloed
• 22:11
  Speaker 1: for a long time, and they're sort of relative professions
• 22:13
  Speaker 1: and they sort of see it as a piecemeal approach,
• 22:15
  Speaker 1: but it really a coordinated effort just hands down works better.
• 22:19
  Speaker 2: It just does. Yeah, you're absolutely right. Like marketers generally
• 22:23
  Speaker 2: don't work in intersciplinary teams, which is why their ads
• 22:26
  Speaker 2: don't work the way that treatment works for somebody that
• 22:29
  Speaker 2: we're talking about here, So like, don't be like marketers.
• 22:33
  Speaker 2: I mean, listen to this ad and see how it
• 22:34
  Speaker 2: doesn't work.
• 22:35
  Speaker 1: Right, Okay, we're back. We've been talking about the kind
• 22:46
  Speaker 1: of care and treatment that is most important for supporting
• 22:49
  Speaker 1: people who are going through psychosis.
• 22:51
  Speaker 2: Yes, so right now, are you brought up a coordinated
• 22:56
  Speaker 2: Specialty care or cs So a CSC plan will include
• 22:59
  Speaker 2: caseman and usually that's kind of like your point person
• 23:02
  Speaker 2: who helps coordinate some of your other services. You have
• 23:05
  Speaker 2: got a family support, education and training, which is really
• 23:08
  Speaker 2: helpful for folks for the outpatient part of this. You've
• 23:12
  Speaker 2: got medication management. You've got psychological intervention or therapy which
• 23:15
  Speaker 2: is going to be your direct one to one or
• 23:16
  Speaker 2: group therapy. You have supported education and employment which provides
• 23:21
  Speaker 2: accommodations and support for being able to maintain healthy employment
• 23:25
  Speaker 2: and gainful employment. Then you've got peer support systems, which
• 23:28
  Speaker 2: include people who have experienced something similar that you can
• 23:31
  Speaker 2: share and relate to so that you don't feel like
• 23:33
  Speaker 2: you are alone and in this experience. And all of
• 23:36
  Speaker 2: these things come together to create this tapestry that is
• 23:39
  Speaker 2: this CSC plan that makes sure that a person is
• 23:42
  Speaker 2: individualized support in that space.
• 23:45
  Speaker 1: Man, any one of those pieces could be worth unpacking
• 23:48
  Speaker 1: and some type of discussion too, because just briefly mentioning them,
• 23:54
  Speaker 1: it's not necessarily clear to all people who hear that
• 23:57
  Speaker 1: what those things entail. Like the supported education we're thinking about,
• 24:02
  Speaker 1: like education and training for people who are like in
• 24:04
  Speaker 1: their family members and support group, that is a really
• 24:07
  Speaker 1: important piece. Like they don't necessarily know how to respond
• 24:10
  Speaker 1: when someone comes to them in an episode of psychosis
• 24:12
  Speaker 1: and they're just they're afraid and confused, and like they
• 24:16
  Speaker 1: might try to withdraw, they might try to do too much,
• 24:18
  Speaker 1: they might try to call the police, which will probably
• 24:21
  Speaker 1: end really badly. Right, So, like there's giving them some
• 24:25
  Speaker 1: tools for like, all right, this is how to manage
• 24:27
  Speaker 1: a situation where it occurs. Is another critical piece, and
• 24:30
  Speaker 1: like we could talk about that in depth. So just
• 24:32
  Speaker 1: you know, as you're listing those I'm thinking, man, these
• 24:36
  Speaker 1: there's a lot to each one of these components that
• 24:37
  Speaker 1: are probably worth a larger discussion.
• 24:39
  Speaker 2: Oh most definitely.
• 24:40
  Speaker 1: Anyway, as we were saying, with the importance of this
• 24:43
  Speaker 1: coordinated plan here is that any one of these components
• 24:46
  Speaker 1: is likely to be at least somewhat helpful. But the
• 24:49
  Speaker 1: approach that has been scientifically validated to use is a
• 24:54
  Speaker 1: comprehensive approach that includes all of those relevant components. As
• 24:57
  Speaker 1: we've described. That is where the research has shown time
• 25:00
  Speaker 1: and again that that you get the best outcomes.
• 25:03
  Speaker 2: Right, And like you mentioned earlier, the earlier the intervention
• 25:06
  Speaker 2: is applied, the better. An early intervention decreases risk of
• 25:09
  Speaker 2: harm to themselves or others, including reducing the risk of suicide,
• 25:14
  Speaker 2: super super important. There there are fewer or no opportunities
• 25:18
  Speaker 2: to disrupt school or work. It decreases the likelihood of
• 25:21
  Speaker 2: needing severe interventions such as hospitalization. It reduces the potential
• 25:25
  Speaker 2: for strife and anxiety among family supports, and early intervention
• 25:29
  Speaker 2: significantly reduces the potential for relapse and increases the likelihood
• 25:33
  Speaker 2: of treatment. Efficacy. So it's almost like, if we had
• 25:37
  Speaker 2: a more responsive medical care system, we would be able
• 25:41
  Speaker 2: to prevent so many of these episodes from escalating to
• 25:43
  Speaker 2: such a degree that it would be harmful to everybody
• 25:46
  Speaker 2: that is involved with that person, including the person themselves.
• 25:49
  Speaker 2: It's almost like that.
• 25:50
  Speaker 1: Yeah, not quite like that, but it's almost like, you know,
• 25:56
  Speaker 1: and we beat those drum so many times and you
• 25:58
  Speaker 1: just can't say it enough till the world operates this way.
• 26:01
  Speaker 2: But prevention is key.
• 26:03
  Speaker 1: And like obviously when we're talking about immediate treatment, you're
• 26:07
  Speaker 1: past the point of prevention, but you are the earlier
• 26:10
  Speaker 1: you can catch this. The money you invest in providing
• 26:14
  Speaker 1: support for the immediate treatment pays off in the long run, yes,
• 26:18
  Speaker 1: because without the funding of the immediate treatment, these problems
• 26:22
  Speaker 1: are going to escalate to something that is much more expensive,
• 26:25
  Speaker 1: it takes a lot longer, it might not work as well,
• 26:28
  Speaker 1: and in the meantime, like, these are behaviors that are
• 26:32
  Speaker 1: difficult and challenging not only for the person who's experiencing them,
• 26:35
  Speaker 1: but for the people around them, for the community at large.
• 26:38
  Speaker 1: And this probably goes without saying, but you know, we
• 26:41
  Speaker 1: live in the country we live in so I'm gonna
• 26:43
  Speaker 1: say it, which is like, these people have a right
• 26:45
  Speaker 1: to live. The reaction often that people have is like, well,
• 26:50
  Speaker 1: if they're broken, may as well just put them out
• 26:52
  Speaker 1: of their misery. I'm like, for some reason, human life
• 26:54
  Speaker 1: just has so little value, at least in American cultures,
• 26:58
  Speaker 1: that the response is, well, if we don't like how
• 27:00
  Speaker 1: someone's behaving, we should probably just kill them. I'm like,
• 27:02
  Speaker 1: what are you saying, Like, yeah, stop killing people? Why
• 27:05
  Speaker 1: is that the first the go to everybody has so anyway?
• 27:08
  Speaker 1: Point being that, like, if we provide those supports, it
• 27:12
  Speaker 1: pays off in the long run. Prevention is key. If
• 27:14
  Speaker 1: we can reduce the amount of abuse and like trauma
• 27:17
  Speaker 1: that are happening to people, that will prevent the need
• 27:20
  Speaker 1: for us to do this at all. But if we
• 27:21
  Speaker 1: at least fund and provide support and treatment for the
• 27:24
  Speaker 1: people who are going to experience this for a variety
• 27:26
  Speaker 1: of reasons. As we said, it's not always explicitly trauma,
• 27:29
  Speaker 1: not explicitly brain injury, but for whatever reason it happens
• 27:33
  Speaker 1: for people who might be prone to this, If we
• 27:34
  Speaker 1: provide that early, that is the best outcome for them
• 27:37
  Speaker 1: for everyone around them, And it just makes sense to
• 27:39
  Speaker 1: invest in.
• 27:40
  Speaker 2: That, right, pooh, absolutely nailed it. Had to soapbox that
• 27:45
  Speaker 2: for a minute. Yeah, yeah, and well worth it too,
• 27:47
  Speaker 2: because that's exactly it. Like so many people talk about
• 27:50
  Speaker 2: how much money's going to cost to do prevention compared
• 27:54
  Speaker 2: to treatment, and that's just always what we find is
• 27:57
  Speaker 2: like the more we invest in prevention, so less it
• 28:00
  Speaker 2: will it will ultimate cost at the back end for
• 28:03
  Speaker 2: all of this stuff. So like, it's just so funny
• 28:05
  Speaker 2: that people get so hung up on the cost part
• 28:07
  Speaker 2: of it. It's like, oh my god, it would be
• 28:08
  Speaker 2: so cheaper to prevent everything.
• 28:09
  Speaker 1: It would it'd be so significantly cheaper if we had
• 28:13
  Speaker 1: universal health care and better comprehensive, coordinated teams of medical
• 28:19
  Speaker 1: professionals in our country, Like the amount we would spend
• 28:22
  Speaker 1: on that would be significantly less, I mean just fractions
• 28:26
  Speaker 1: of what we spend on reacting to problems that occur.
• 28:30
  Speaker 1: So that's why we have to just keep beating that
• 28:33
  Speaker 1: drum because until things change, we just have to keep
• 28:37
  Speaker 1: advocating for that change. Yeah, absolutely never happen. Like people
• 28:42
  Speaker 1: love digging themselves their own graves. So anyway, I think
• 28:45
  Speaker 1: it's all clear from this point, I hope, But maybe not,
• 28:48
  Speaker 1: but you might imagine, and you would be correct if
• 28:51
  Speaker 1: you did that. Untreated patients are more likely to have
• 28:55
  Speaker 1: a lot of complications. They're more likely to experience homelessness,
• 28:59
  Speaker 1: they'll be in house, they're going to have other psychological
• 29:02
  Speaker 1: issues such as oppression. They are going to have a
• 29:04
  Speaker 1: deeper and more unfortunately, like thorough and I guess, untetherable
• 29:11
  Speaker 1: connection to the delusions and hallucinations that they experience, and
• 29:17
  Speaker 1: they might also develop other beliefs that emerge the beginning
• 29:20
  Speaker 1: of these episodes, and then we'll continue to manifest and
• 29:22
  Speaker 1: grow and become stronger at subsequent episodes. So that is
• 29:27
  Speaker 1: another piece of this is that, like again, left untreated,
• 29:30
  Speaker 1: the complications can be fairly profound and then there's not
• 29:34
  Speaker 1: a lot to come back from that. And unfortunately, again,
• 29:37
  Speaker 1: most people see the people who end up in that
• 29:40
  Speaker 1: situation and think it's your fault, You suck, you deserve this,
• 29:43
  Speaker 1: die on the streets. Yeah, And I just to them,
• 29:45
  Speaker 1: I say, first of all, you, and second of all, like,
• 29:48
  Speaker 1: let's try to do better because we are a part
• 29:51
  Speaker 1: of the same species, believe it or not, and that
• 29:53
  Speaker 1: we should try to support each other.
• 29:55
  Speaker 2: Again, agreed, I love the soapbox.
• 29:57
  Speaker 1: Okay, but I do think we hear all this. Many
• 30:00
  Speaker 1: of you who find yourselves in our podcast are interested
• 30:04
  Speaker 1: because we are behavior analysts. We come from a behavioral perspective.
• 30:08
  Speaker 1: We want to unpack these things in a way that
• 30:11
  Speaker 1: aligns without worldview. Many of you don't come here for
• 30:14
  Speaker 1: that reason, but you get a dose of it anyway,
• 30:16
  Speaker 1: and so that's I think what I'd like to turn
• 30:18
  Speaker 1: to now is thinking about how do we understand this
• 30:21
  Speaker 1: behaviorally when someone sort of disappears into their mind, what
• 30:25
  Speaker 1: does that mean? How do we interpret this? Are we
• 30:28
  Speaker 1: going to take this callous mathematical equation approach to this? No,
• 30:33
  Speaker 1: but we do have some thoughts that we will try
• 30:36
  Speaker 1: to unpack and sort of suggest a way to think
• 30:39
  Speaker 1: about this that is useful from a treatment perspective, which
• 30:42
  Speaker 1: is a behavioral perspective, which again is not to say
• 30:44
  Speaker 1: that's the only perspective. Interdisciplinary team is very important, but
• 30:47
  Speaker 1: this is our contribution to that is when we're thinking
• 30:50
  Speaker 1: about the behaviors the environment.
• 30:52
  Speaker 2: Right, absolutely, so first it is critical will point out
• 30:55
  Speaker 2: that we understand and appreciate the biological aspects of behavior.
• 30:57
  Speaker 2: Right brain damage and other physical damage which alters the
• 31:00
  Speaker 2: context of the individual and how they interact with the
• 31:03
  Speaker 2: rest of the world. That's just we know that to
• 31:05
  Speaker 2: be true.
• 31:06
  Speaker 1: Yes, I think people have had the experience or the
• 31:09
  Speaker 1: thought that behaviorists think that that's not important.
• 31:12
  Speaker 2: It is.
• 31:13
  Speaker 1: We understand that it is, so making sure we get
• 31:15
  Speaker 1: out that out of the way. So let's take, for example,
• 31:18
  Speaker 1: if you lose your vision, you will interact differently in
• 31:21
  Speaker 1: the world than you did when you had vision, right, Like,
• 31:23
  Speaker 1: that doesn't seem like anything we would have trouble agreeing to. Similarly,
• 31:27
  Speaker 1: if you experience some physical trauma or neurological degradation, such
• 31:30
  Speaker 1: as you might experience with Parkinson's, it makes sense that
• 31:34
  Speaker 1: your interactions with the world will be different to your
• 31:36
  Speaker 1: biological context has changed. Therefore, your interaction with your environment
• 31:40
  Speaker 1: will also change. It's just making sure we're really clear
• 31:44
  Speaker 1: that we do, like appreciate that perspective just because we
• 31:47
  Speaker 1: are are thinking about like the environment, the reinforcers, the motivation,
• 31:52
  Speaker 1: et cetera. The history of learning that has happened. Those
• 31:54
  Speaker 1: are also pieces of behavior that are entirely relevant. We
• 31:58
  Speaker 1: understand that we appreciate them. That is a way to
• 32:00
  Speaker 1: think about this.
• 32:01
  Speaker 2: Yes, now the second point that we want to make
• 32:04
  Speaker 2: it underneath this behavioral on packing situation. If you really
• 32:08
  Speaker 2: want to see some truly random behaviors from someone you
• 32:10
  Speaker 2: thought you knew, put them in a novel situation that
• 32:12
  Speaker 2: you can conjure up. When we have no familiar cues
• 32:16
  Speaker 2: or no history to draw upon, when we have no
• 32:18
  Speaker 2: salient indicators of reinforcement, there is a very very high
• 32:22
  Speaker 2: likelihood that we'll start doing some bizarre things that look surprising,
• 32:27
  Speaker 2: and they'll get more bizarre if attempts to navigate that
• 32:29
  Speaker 2: situation fail to produce desirable outcomes, or if those bizarre
• 32:34
  Speaker 2: behaviors contact some level of reinforcement as a result of
• 32:38
  Speaker 2: whatever is going on, Like it could go either way
• 32:41
  Speaker 2: and we're going to produce some kind of like unique
• 32:43
  Speaker 2: and gnarly new behaviors. Yeah.
• 32:45
  Speaker 1: So it's like if someone experiences a neurological issue that
• 32:48
  Speaker 1: happens all the sudden, things are confusing, all of a sudden,
• 32:52
  Speaker 1: they are seeing things that aren't there. Can you imagine
• 32:54
  Speaker 1: if you were in that situation, how afraid and confused
• 32:57
  Speaker 1: you would be, and not to mention that, Let's assume
• 33:00
  Speaker 1: that you're approaching this with mostly all of your emotions
• 33:03
  Speaker 1: following the normal pattern that they do, which most of
• 33:06
  Speaker 1: them don't. When people who are experiencing psychosis like that
• 33:09
  Speaker 1: would still be very alarming and confusing, and you'd probably
• 33:12
  Speaker 1: be reacting a way that was like, oh my god,
• 33:14
  Speaker 1: I'm in crisis. This is an emergency right now. You
• 33:16
  Speaker 1: put on top of that the fact that they're having
• 33:18
  Speaker 1: trouble even regulating their thoughts, that their emotions are on
• 33:22
  Speaker 1: high alert and very reactive to things. The situation that
• 33:26
  Speaker 1: find themselves in is like, it's very understandable that they'd behaving.
• 33:30
  Speaker 1: They would be behaving in those ways. And similarly, if
• 33:33
  Speaker 1: we think about highly traumatic of events and the cues
• 33:36
  Speaker 1: that are associated with those events, those often set the
• 33:39
  Speaker 1: context for these variable, unpredictable new types of behaviors that
• 33:43
  Speaker 1: we see. Traumatic events are often characterized by experiences with
• 33:46
  Speaker 1: a lot of very powerful aversive cues and signals where
• 33:52
  Speaker 1: the only motivation when that context happens, and therefore the
• 33:55
  Speaker 1: only effective reinforcement is escaping that situation. It is me
• 34:00
  Speaker 1: out of here. That could be get me out of
• 34:02
  Speaker 1: here by attacking someone nearby who represents a threat, by
• 34:06
  Speaker 1: attacking yourself. Because it is like anything that changes this
• 34:11
  Speaker 1: situation is good. It could be attacking physical objects around you, walls, materials,
• 34:17
  Speaker 1: things that can break.
• 34:18
  Speaker 2: Whatever is.
• 34:19
  Speaker 1: Just change the situation, get out of it, make it
• 34:22
  Speaker 1: go away. And though the behaviors that come with that
• 34:25
  Speaker 1: can be very scary for someone who's just observing from
• 34:28
  Speaker 1: an outside perspective, and they're also very scary for the
• 34:30
  Speaker 1: person who's in experiencing the trauma or the psychosis at
• 34:34
  Speaker 1: the moment as well, So think about from that perspective
• 34:37
  Speaker 1: as well.
• 34:38
  Speaker 2: Yeah. Absolutely, Normally, when it comes to an adbreak, we
• 34:41
  Speaker 2: would usually make a joke or something. Given the nature
• 34:44
  Speaker 2: of what we're talking about here and how serious this
• 34:45
  Speaker 2: can be for some folks, I think we're just gonna
• 34:46
  Speaker 2: take a quick gab break, give me some time to reflect,
• 34:49
  Speaker 2: and then we'll come back in a minute and unpackt
• 34:51
  Speaker 2: ue a little bit more.
• 35:00
  Speaker 1: We're back. Yeah, there's I was having the thought. I
• 35:03
  Speaker 1: was like, there's some joke about escaping from ads or something,
• 35:06
  Speaker 1: and but you know, I like the idea that you
• 35:09
  Speaker 1: ignore the AD and take some time to reflect instead.
• 35:11
  Speaker 2: That works too. Yeah, I enjoy good reflection time. Yeah, exactly.
• 35:16
  Speaker 2: So we're still unpacking kind of like what's happening behaviorally speaking, right,
• 35:20
  Speaker 2: And we're really kind of talking about this idea of
• 35:21
  Speaker 2: escaping in different ways people escape. So when people physically
• 35:25
  Speaker 2: escape a situation, or when you know, normally in like
• 35:28
  Speaker 2: a situation where there's not like a persistent illucination or delusion, like,
• 35:33
  Speaker 2: we may experience some relief when we're escaping a situation
• 35:37
  Speaker 2: that is impossible or effective to escape. One way to
• 35:41
  Speaker 2: escape is to behave with respect to imaginary stimuli. So
• 35:44
  Speaker 2: with respect to stimuli that are not there but are
• 35:47
  Speaker 2: fabricated in the mind, we have some kind of like
• 35:50
  Speaker 2: unique behaviors related to that. We might believe that we
• 35:53
  Speaker 2: are somewhat important and strong to justify the thing that's
• 35:57
  Speaker 2: happening to us. Extreme things happen to import people being
• 36:01
  Speaker 2: powerful means controlling or escaping the situation, et cetera. Believing
• 36:04
  Speaker 2: you're some god creature can lead to some of these
• 36:08
  Speaker 2: beliefs in some of these behaviors. So, like, there's a
• 36:09
  Speaker 2: lot of things that can happen here related to these
• 36:12
  Speaker 2: kind of unseen, unresponsive stimuli because they're not responding to
• 36:18
  Speaker 2: the normal cues or the normal motivations or the normal
• 36:21
  Speaker 2: behaviors that we might engage in on a day to
• 36:23
  Speaker 2: day basis.
• 36:23
  Speaker 1: Yeah, and I mean what it means to believe something.
• 36:27
  Speaker 1: Certainly a fun conversation to have at some point. But
• 36:29
  Speaker 1: if I were to ask you, pretend that you're a
• 36:32
  Speaker 1: mim who's trapped in a glass case, like you could
• 36:34
  Speaker 1: do that, and you're behaving with respect to something that's
• 36:36
  Speaker 1: not there. Now, let's imagine that the thing that you're
• 36:39
  Speaker 1: interacting with that is not there is the tool that
• 36:42
  Speaker 1: you have to escape from that situation is like, why
• 36:44
  Speaker 1: is this happening to me? It's because I am so important.
• 36:47
  Speaker 1: I must be a god And that helps that situation
• 36:50
  Speaker 1: feel less aversive because nothing else that you can do
• 36:53
  Speaker 1: gets you out of that experience, right, And so that's
• 36:56
  Speaker 1: sort of the important thing to think about, Like what
• 36:58
  Speaker 1: consequences could be functioning as a reinforcer for the kind
• 37:02
  Speaker 1: of behaviors that we're seeing. That could be a way
• 37:04
  Speaker 1: that that happens. Again, this is not an exhaustive, comprehensive analysis,
• 37:09
  Speaker 1: but thinking about some reasonable things that exist that would
• 37:13
  Speaker 1: account for some of those behaviors and why they occur
• 37:16
  Speaker 1: is in these cases, that is how they get their
• 37:19
  Speaker 1: needs met is by adopting behaving with respect to things
• 37:23
  Speaker 1: that aren't because doing so can help try it relieves
• 37:26
  Speaker 1: some of the attention the tension from the experience that
• 37:28
  Speaker 1: they're having. Right, Okay, Further, imaginary events or situations can again,
• 37:34
  Speaker 1: as we're thinking about, like, help make sense of a
• 37:36
  Speaker 1: situation that seems like it could not exist without the
• 37:39
  Speaker 1: intervention of powerful external forces such as aliens or the government,
• 37:43
  Speaker 1: or robots or gods or all of those things all
• 37:47
  Speaker 1: packed into one. That is a way to try and
• 37:51
  Speaker 1: help again navigate the situation that we can rap because
• 37:56
  Speaker 1: our language allows us to appreciate the severity of a situation,
• 38:00
  Speaker 1: our language also allows us to escalate the situation, and
• 38:05
  Speaker 1: that we can therefore, like, we can appreciate like, this
• 38:10
  Speaker 1: is the worst thing ever. No one should have to
• 38:12
  Speaker 1: experience this as far as we know. Sorry, this is
• 38:15
  Speaker 1: like a weird sort of like I guess free associating.
• 38:19
  Speaker 1: I'm not trying to do that. But where I'm trying
• 38:21
  Speaker 1: to go with this is like, as far as we know,
• 38:23
  Speaker 1: no animal can appreciate this bad thing that's happening to me.
• 38:26
  Speaker 1: This is the worst No other animals have to go
• 38:28
  Speaker 1: through this. Why do I have to go through this?
• 38:30
  Speaker 1: Because they their language as far as we know, again,
• 38:33
  Speaker 1: we have no actual way to measure this, but as
• 38:35
  Speaker 1: far as we know, their language doesn't give them an
• 38:37
  Speaker 1: eye that is different from all the other animals, Like
• 38:39
  Speaker 1: there is no distinguishing themselves. There's no like historical context
• 38:42
  Speaker 1: for what makes sense for this poor squirrel to be
• 38:44
  Speaker 1: going through or poor whatever to be going through, butterfly
• 38:48
  Speaker 1: to be going through.
• 38:49
  Speaker 2: There is nothing.
• 38:49
  Speaker 1: So for their perspective, it's just all bad in the
• 38:52
  Speaker 1: moment that it's happening, and that's just it, right, whereas
• 38:55
  Speaker 1: we can appreciate something bad that's happening, is like, wow,
• 38:58
  Speaker 1: nobody else has to go through this because I have
• 39:01
  Speaker 1: a distinct me from a distinct you and you that
• 39:04
  Speaker 1: forms the they and the me that forms the eye,
• 39:08
  Speaker 1: and that I can appreciate that like relative to other people,
• 39:11
  Speaker 1: which is a very complex, languaging thing to be able
• 39:13
  Speaker 1: to do. This thing that's happened to me is so terrible. Therefore,
• 39:18
  Speaker 1: to make this make more sense, I construct a narrative
• 39:21
  Speaker 1: around this conversation. Again, very complex language thing to be
• 39:24
  Speaker 1: able to do to make this make sense to me.
• 39:27
  Speaker 1: And so now I've established a pseudo reality that makes
• 39:32
  Speaker 1: the situation the context. The feeling that I'm having makes
• 39:35
  Speaker 1: sense to me in this moment, which is I am
• 39:38
  Speaker 1: a god, there are aliens, robots are doing it, the
• 39:41
  Speaker 1: government has secret drones or something.
• 39:44
  Speaker 2: That birds aren't real.
• 39:45
  Speaker 1: Yeah, and that birds aren't real like that. Yeah, that
• 39:49
  Speaker 1: is how that starts to make sense. That was a
• 39:51
  Speaker 1: long time, right, I'm sorry.
• 39:52
  Speaker 2: No, no, no, but I think it makes sense. I think
• 39:54
  Speaker 2: when we start to kind of unpack that, that's important
• 39:56
  Speaker 2: to know. It's important to see how people can slip
• 39:58
  Speaker 2: slide into that, right, And I say slip slide like
• 40:01
  Speaker 2: it's a slow it's a slow descent. But when it
• 40:03
  Speaker 2: does happen and all of a sudden, you know, for
• 40:06
  Speaker 2: some folks, they don't realize that they're having a like
• 40:10
  Speaker 2: this type of episode until they're well within it. If
• 40:14
  Speaker 2: they ever realize it at all, it's usually somebody else
• 40:16
  Speaker 2: that does recognize it. Right. They don't recognize that the
• 40:19
  Speaker 2: gods or the aliens of the robots are you know,
• 40:22
  Speaker 2: illusionary or imaginary or any of those things. They don't
• 40:25
  Speaker 2: realize that, and that's what makes this a little bit
• 40:27
  Speaker 2: more complicated.
• 40:28
  Speaker 1: Which you know, just for the raises the need to
• 40:30
  Speaker 1: have a discussion about like belief and what it is
• 40:32
  Speaker 1: and how it works. Because if I were to describe
• 40:36
  Speaker 1: to a naive audience them, like there's an invisible sky
• 40:38
  Speaker 1: wizard who has a zombie child and they control everything
• 40:41
  Speaker 1: that has ever happened ever will happen, You'd be like
• 40:43
  Speaker 1: that person is having an episode of first episode psychosis. Now,
• 40:46
  Speaker 1: but actually know that someone that is actually.
• 40:48
  Speaker 2: Just a religion.
• 40:49
  Speaker 1: They'd like firmly believe that thing, right, very common one.
• 40:51
  Speaker 1: Actually there's a lot of people who have that same religion.
• 40:53
  Speaker 1: They still believe that. So like, yeah, if you were
• 40:55
  Speaker 1: to take any one of those beliefs and actually just
• 40:57
  Speaker 1: break them down in what they are, they sound like
• 41:00
  Speaker 1: someone experiencing psychosis. So while it feels like it's difficult
• 41:05
  Speaker 1: to appreciate that someone could have that experience, all you
• 41:09
  Speaker 1: have to do is look at the people who have
• 41:11
  Speaker 1: that experience is part of the regular routine, Like as
• 41:13
  Speaker 1: part of the regular routine, that's their day to day
• 41:16
  Speaker 1: is experience, is having the experience. So like, you can
• 41:18
  Speaker 1: talk yourself into believing some stuff, but again we should
• 41:22
  Speaker 1: say that for a comprehensive discussion about belief.
• 41:25
  Speaker 2: Yeah, yeah, well we'll get there. So all of This
• 41:27
  Speaker 2: actually raises an important aspect of psychosis itself, which is
• 41:30
  Speaker 2: that language seems to be a critical component of this.
• 41:33
  Speaker 2: We have no evidence that any organism like you mentioned
• 41:36
  Speaker 2: experience a psychosis. It could be due at least in
• 41:39
  Speaker 2: part to a limited ability to access or assessed whether
• 41:42
  Speaker 2: or not so psychosis is happening. I mean, we've seen
• 41:45
  Speaker 2: animals do some kind of bizarre things that are kind
• 41:47
  Speaker 2: of like, not quite the same as like other animals
• 41:51
  Speaker 2: that we like what we expect of them, right, Yeah,
• 41:53
  Speaker 2: But it also makes conceptual sense, as a quote, break
• 41:56
  Speaker 2: from reality applies the conceptualization of what reality even is,
• 42:01
  Speaker 2: such that a break could be it could even be detected.
• 42:04
  Speaker 2: So this requires sophisticated cutting of language processes to be
• 42:07
  Speaker 2: able to identify and distinguish between something like reality and
• 42:10
  Speaker 2: the ability to identify reality versus the ability to identify
• 42:13
  Speaker 2: when we have broken from reality and so on and
• 42:15
  Speaker 2: so forth.
• 42:16
  Speaker 1: Yeah, yeah, there's again, as far as we know, non
• 42:20
  Speaker 1: human animals don't have any concept of what reality is,
• 42:23
  Speaker 1: so there's no concept of what not reality is.
• 42:26
  Speaker 2: Right, It's not to say that they can't hallucinate.
• 42:27
  Speaker 1: I'm sure that we could feed them some psychedelic drugs
• 42:29
  Speaker 1: and have them hallucinate a lot. But the point is that, like,
• 42:33
  Speaker 1: there seems to be an aspect of this that seems
• 42:35
  Speaker 1: to be rooted in language, which means it's probably unique
• 42:38
  Speaker 1: to humans at least in the way that it occurs.
• 42:40
  Speaker 1: We'd have no way to assess this in non human animals,
• 42:43
  Speaker 1: So it's possible that they do experience something like this.
• 42:45
  Speaker 1: We just don't know. But right the way that the
• 42:48
  Speaker 1: shows up in humans seems to be rooted pretty much
• 42:51
  Speaker 1: primarily in those who have enough language to facilitate this
• 42:54
  Speaker 1: kind of behavior, which implies there is cultural learned experience
• 42:58
  Speaker 1: that plays an enormous, if not critical role in how
• 43:02
  Speaker 1: this shows up, to what extent it shows up. The
• 43:04
  Speaker 1: fact that it even can show up so right, I
• 43:07
  Speaker 1: think that's something worth considering. And again just coming back
• 43:10
  Speaker 1: to the fact that our language allows us to behave
• 43:13
  Speaker 1: with respect to stimulus, cues and functions, real or altered,
• 43:17
  Speaker 1: whether or not they are really there. Like we can
• 43:19
  Speaker 1: behave with respect of those things. We can behave with
• 43:21
  Speaker 1: respect to something that has never happened. We can behave
• 43:24
  Speaker 1: with respect to something that does not exist. We can
• 43:27
  Speaker 1: quite easily do that because our language enables that kind
• 43:29
  Speaker 1: of behavior. So our language and other behaviors that we
• 43:33
  Speaker 1: engage in are reinforced in some ways by escaping the situation.
• 43:37
  Speaker 1: They might be reinforced by specialized care that's provided by
• 43:40
  Speaker 1: family and professionals. It might be reinforced by access to
• 43:43
  Speaker 1: resources that are usually withheld. That's not to say that
• 43:47
  Speaker 1: those are the things that enable or maintain psychosis should
• 43:51
  Speaker 1: it exist. Is just to say that, like, that's how
• 43:54
  Speaker 1: our language works, broadly speaking, and so it can, it
• 43:58
  Speaker 1: can do a lot of things. But it just coming
• 44:01
  Speaker 1: back to the importance of language and the role that
• 44:03
  Speaker 1: it plays in our unique way of interacting with the world.
• 44:06
  Speaker 2: Yeah.
• 44:07
  Speaker 1: Absolutely, Okay, we have some interesting tidbits to bring in
• 44:12
  Speaker 1: here that we'll get to right after some uninteresting ads.
• 44:16
  Speaker 2: Yay, all right, we're back.
• 44:25
  Speaker 1: Let's start with the fun tidbit and then we'll get
• 44:28
  Speaker 1: to the more difficult tidbit.
• 44:32
  Speaker 2: Yeah. So, when you brought up psychosis, there is a
• 44:36
  Speaker 2: wrestler from the nineties in early two thousands named Psychosis.
• 44:39
  Speaker 2: He's a lugador. He's a Mexican lugador and he spelled
• 44:43
  Speaker 2: it in the Spanish way. But he was very popular
• 44:46
  Speaker 2: in WWC or WCW, I should say, and he is
• 44:51
  Speaker 2: costume was awesome and he had horns. He got himself
• 44:54
  Speaker 2: into some trouble later in life as an adult, maybe
• 44:57
  Speaker 2: stealing cars and stuff, but he was a fun lututor
• 45:00
  Speaker 2: wrestler and like it was actually pretty pivotal as part
• 45:03
  Speaker 2: of the bringing lucidor style wrestling to the United States
• 45:07
  Speaker 2: forefront during the kind of like the late nineties wrestling wars,
• 45:12
  Speaker 2: and so Psychosis was one of the folks that was
• 45:14
  Speaker 2: as part of that like Luchador lucha librace style wrestling
• 45:17
  Speaker 2: that was occurring at the time. So it was all
• 45:20
  Speaker 2: over wrestling at the time, where you know, the announcers
• 45:23
  Speaker 2: are saying the word psychosis kind of quite a bit
• 45:26
  Speaker 2: because they were naming this guy. So it's kind of fun. Wow. Okay.
• 45:31
  Speaker 1: I don't know if anyone expected wrestling to make an
• 45:33
  Speaker 1: appearance in an episode about Psychosis, but we did.
• 45:37
  Speaker 2: Man, it happened. Sometimes it happens.
• 45:38
  Speaker 1: Yeah, That's the beauty of these types of episodes is.
• 45:41
  Speaker 2: You never really know where it's going to go. That's us,
• 45:46
  Speaker 2: that's us. Okay, one more thing.
• 45:48
  Speaker 1: This is a difficult line to walk, So I'm going
• 45:50
  Speaker 1: to do my best to manage it and probably offer
• 45:52
  Speaker 1: a whole bunch of like caveats and yeah butts and
• 45:55
  Speaker 1: things to know. So, as we mentioned, psychosis is not
• 45:58
  Speaker 1: by itself an illness. It is often underlying or a
• 46:02
  Speaker 1: symptom of other things like schizophrenia, very things that can
• 46:07
  Speaker 1: happen et cetera, a mental health crises. Now, what can
• 46:12
  Speaker 1: happen sometimes is that people who are eventually like they
• 46:18
  Speaker 1: get to first episode psychosis is they sometimes present in
• 46:22
  Speaker 1: the ways that we see their behavior all of a
• 46:24
  Speaker 1: sudden shift, become different. Maybe they do that gradually has
• 46:28
  Speaker 1: to do with sexual things as well. They might become
• 46:31
  Speaker 1: hyper sexual, so just very very interested in all things sexual.
• 46:35
  Speaker 1: They might start experiencing sexual preferences or reporting sexual preferences
• 46:39
  Speaker 1: that are different than they once had. And they might
• 46:41
  Speaker 1: also express transgender identity. And what's very important the caveat
• 46:47
  Speaker 1: that throw in there is this does not at all
• 46:49
  Speaker 1: mean that people who are transgender or non binary or
• 46:52
  Speaker 1: fall anywhere on that spectrum are experiencing psychosis. Not all
• 46:56
  Speaker 1: people who are experiencing psychosis are going to have anything
• 46:59
  Speaker 1: to do with the different or unique about their sexuality.
• 47:02
  Speaker 2: But it can be I.
• 47:04
  Speaker 1: Think useful to note that people who have these sudden shifts,
• 47:09
  Speaker 1: it might be worth investigating is their psychosis happening that
• 47:15
  Speaker 1: would present in this way, Barry Well, could not be
• 47:19
  Speaker 1: the case. Might just be someone who is having that
• 47:21
  Speaker 1: sort of awakening in a different part.
• 47:22
  Speaker 2: Of their life.
• 47:24
  Speaker 1: But it is not unheard of for someone who's experiencing
• 47:29
  Speaker 1: first episode psychosis to start to demonstrate gender dysphoria, hypersexuality,
• 47:34
  Speaker 1: transgender sort of experiences and reports, and just to say that, like,
• 47:41
  Speaker 1: should those things come as a surprise, it could be
• 47:44
  Speaker 1: worth getting some evaluation to make sure is this a
• 47:48
  Speaker 1: normal thing that is experiencing or is this a part
• 47:50
  Speaker 1: of psychosis that makes sense?
• 47:53
  Speaker 2: Yeah, yeah, yeah, I think it's important to kind of like,
• 47:57
  Speaker 2: I think what you're trying to say is that can
• 48:00
  Speaker 2: present in a lot of different ways. One of the
• 48:03
  Speaker 2: ways that it has been noted to present is in
• 48:07
  Speaker 2: gender just dysphoria or hyper sexuality. That does not necessarily
• 48:12
  Speaker 2: mean that like there is a very there's a small
• 48:16
  Speaker 2: overlap between like I don't even want to say overlap.
• 48:21
  Speaker 2: That's not even the fair that's not even a fair assumption,
• 48:23
  Speaker 2: Like there are they are not the same people who
• 48:26
  Speaker 2: are experiencing transgender like transgender identity, gender identity questions, stuff
• 48:31
  Speaker 2: like that, are not having psychosis. However, it is important
• 48:35
  Speaker 2: to be able to rule that out because in some
• 48:37
  Speaker 2: folks that are experiencing psychosis, this is how it presents.
• 48:41
  Speaker 1: Yes, thank you, Okay, good, Yes, I appreciate you adding
• 48:46
  Speaker 1: that way of describing.
• 48:47
  Speaker 2: I think that was helpful. Yeah. Yeah, I'm reading a
• 48:50
  Speaker 2: book about logic right now, and it's like one of
• 48:52
  Speaker 2: the really great things that talks about is like how
• 48:54
  Speaker 2: you can't reverse an argument sometimes, like you can like
• 48:56
  Speaker 2: in some ways, like the way that you make the
• 48:59
  Speaker 2: argument is that it goes from A to B, but
• 49:01
  Speaker 2: that just because it goes to A to B doesn't
• 49:02
  Speaker 2: mean that B always equals A. Like the directionality really matters. Sure,
• 49:06
  Speaker 2: So that's kind that I think what we're saying, right, Like,
• 49:08
  Speaker 2: transgender does not equal psychosis, but in some folks, rarely
• 49:15
  Speaker 2: psychosis appears to look like transgender or but gender questioning
• 49:21
  Speaker 2: hyper sexuality, right, So, like that's that's kind of what
• 49:24
  Speaker 2: we're trying to say. There.
• 49:25
  Speaker 1: There's We've actually mentioned this another episode and other discussions
• 49:29
  Speaker 1: we've had in the past, but like there's even like
• 49:31
  Speaker 1: a very specific cultural form this can take. There's one
• 49:35
  Speaker 1: I forget this is an Asian country. I forget which one.
• 49:37
  Speaker 1: I apologize, but it's it's called coro. It is the
• 49:41
  Speaker 1: belief that one's penis is shrinking.
• 49:44
  Speaker 2: Yeah, it's culture bound. It's a culture bound in syndrome. Yeah, yes, yeah,
• 49:47
  Speaker 2: talks about that.
• 49:48
  Speaker 1: Yeah, we have Yeah. And there might be the like
• 49:50
  Speaker 1: the belief that, like for someone who is masculine, that
• 49:52
  Speaker 1: their Adams Apple is shrinking, that their voice is becoming
• 49:55
  Speaker 1: higher pitched, that their genital the genitalia are transforming, that
• 49:58
  Speaker 1: their hair is transforming. Go the other way too, like
• 50:01
  Speaker 1: that they're growing a penis, that their breasts are shrinking.
• 50:04
  Speaker 1: Any form that the hallucinations take that their body is changing,
• 50:09
  Speaker 1: that represents again, a hallucination of some sort could be
• 50:14
  Speaker 1: sort of part of how this looks and how to
• 50:17
  Speaker 1: recognize this as possibly being an episode of psychosis. Again,
• 50:20
  Speaker 1: not exclusively, but that is a thing to keep in
• 50:23
  Speaker 1: mind when those occur.
• 50:24
  Speaker 2: Yeah, most definitely. Who Okay, I think we did it.
• 50:26
  Speaker 1: I think we got through first episode psychosis. If we
• 50:30
  Speaker 1: miss anything, you would like to add anything, then please
• 50:32
  Speaker 1: feel free to reach out to us and help us
• 50:35
  Speaker 1: better portray all of the accurate components of this. You
• 50:38
  Speaker 1: can email us directly at info at wwdwwdpodcast dot com,
• 50:43
  Speaker 1: or reach us on the social media platforms, and we
• 50:46
  Speaker 1: do look forward to hearing from you. Okay, at the
• 50:48
  Speaker 1: end of our discussions, we like to recommend some things.
• 50:51
  Speaker 1: If you're a person who is here for the first time,
• 50:53
  Speaker 1: you probably didn't know that. If you're a returning person,
• 50:55
  Speaker 1: you probably did. Either way, I think it is a
• 50:57
  Speaker 1: very fun aspect of the conversations that we have and
• 51:00
  Speaker 1: I really look forward to them every time that we
• 51:02
  Speaker 1: get to record, and I hope that again you can
• 51:05
  Speaker 1: take our recommendation and throw in the trash, but you
• 51:07
  Speaker 1: know you can listen and check it out and maybe
• 51:09
  Speaker 1: you'll find something of value there too. So that's what
• 51:12
  Speaker 1: we're doing today. But before we do that, we have
• 51:14
  Speaker 1: some credits to get through, which is to say thank
• 51:17
  Speaker 1: you all for listening. Also, if you'd like to support us,
• 51:19
  Speaker 1: you can do so non financially by leaving us a
• 51:22
  Speaker 1: rating and a review.
• 51:23
  Speaker 2: Make sure you give us.
• 51:24
  Speaker 1: Episode a nice five stars or some kind of like,
• 51:26
  Speaker 1: and subscribes that you catch over future episodes because you
• 51:29
  Speaker 1: made it here once. Hopefully you'll make it here again,
• 51:31
  Speaker 1: and that's one way that you can do that. And
• 51:33
  Speaker 1: of course you can join us on Patreon. There you'll
• 51:35
  Speaker 1: get add free episodes, early episodes, and bonus content, and
• 51:38
  Speaker 1: you get to join the list of very cool people
• 51:40
  Speaker 1: who help us do this podcast that we appreciate so
• 51:42
  Speaker 1: so so much because they are part of a foundational,
• 51:46
  Speaker 1: pivotal part of how we keep being a podcast. So
• 51:50
  Speaker 1: a huge thank you and shout out to Mike m Megan,
• 51:53
  Speaker 1: Mike T, Justin, Kim Brad, Stephanie, Brian Ashley, and Kiara.
• 51:57
  Speaker 1: Thank you all for your continued support and helping us.
• 51:59
  Speaker 2: Do we do? Ah, We love you so much. You
• 52:02
  Speaker 2: are why we do what we do. Yes, that's true.
• 52:06
  Speaker 2: That's true.
• 52:08
  Speaker 1: Also, thank you to my team of people without whom
• 52:10
  Speaker 1: I could not make this podcast running in fact checking
• 52:13
  Speaker 1: from Shane and myself. Thank you for recording with me today, Shane.
• 52:16
  Speaker 2: Hey, thank you, I appreciate it.
• 52:18
  Speaker 1: Our social media coordinator is Emma Wilson, and our person
• 52:21
  Speaker 1: who does these really quick turnaround episodes sometimes and we're
• 52:25
  Speaker 1: sorry to have him do it, but he is very
• 52:26
  Speaker 1: good at it is Justin, who's our Empire editor.
• 52:31
  Speaker 2: Empire editor that's what he is. Now, yes, he says, yes, yes,
• 52:34
  Speaker 2: and apparently.
• 52:35
  Speaker 1: Host yeah, yeah, that has also happened. So the wearer
• 52:40
  Speaker 1: of many hats, So yes, thank you to Justin. All Right,
• 52:44
  Speaker 1: I think I said the things. Anything else I missed
• 52:46
  Speaker 1: or do you like to add before we recommend some things?
• 52:49
  Speaker 2: No, I think that covers it. All right, let's get
• 52:51
  Speaker 2: to some recommendations. Yay, recommendations. So I'm recommending a book shocker.
• 53:06
  Speaker 2: I know. This book is a nonfiction book called Our
• 53:10
  Speaker 2: Band Could Be Your Life, written by Michael Azirod. Now
• 53:15
  Speaker 2: this comes from a line from the band the Minutemen,
• 53:19
  Speaker 2: and it is a book about the kind of like
• 53:22
  Speaker 2: the brief oral history of thirteen highly influential punk and
• 53:28
  Speaker 2: like rock bands from the years of nineteen eighty one
• 53:32
  Speaker 2: to nineteen ninety one. So the bands of covers are
• 53:35
  Speaker 2: Black Flag, Minuteman, Mission of Burma, Minor Threat, Hohoscurdu The Replacement,
• 53:39
  Speaker 2: Sonic Youth, Butthole Surfers, Big Black Dinosaur, Junior, Fugazi, Mud Honey,
• 53:43
  Speaker 2: and Beat Happening. And it tells the story of what
• 53:47
  Speaker 2: it was like to play in the punk bands during
• 53:51
  Speaker 2: the eighties. And you know it's I think it's one
• 53:55
  Speaker 2: of those things that it's it's it's necessary to read
• 53:57
  Speaker 2: if you ever want to understand what the experience of
• 54:00
  Speaker 2: being in a band is really like. It's not going
• 54:03
  Speaker 2: to be that you get signed to a label and
• 54:05
  Speaker 2: that you put out a hit song and then you
• 54:07
  Speaker 2: get a fancy recording studio. I mean, they talked about
• 54:10
  Speaker 2: these guys making their own t shirts for tours. They
• 54:13
  Speaker 2: talked about how they were recording their records for like
• 54:17
  Speaker 2: two hundred dollars in the middle of the night because
• 54:19
  Speaker 2: that's the only time that the studio was even available
• 54:21
  Speaker 2: for them, and they were sleeping at the studio during
• 54:24
  Speaker 2: the day because they had nowhere to sleep because they
• 54:26
  Speaker 2: were all houseless while they were recording. So and how
• 54:30
  Speaker 2: they had sold lots, like, i mean, one hundreds of
• 54:32
  Speaker 2: thousands of copies of records while they were still struggling
• 54:34
  Speaker 2: to make ends meet. So I think it's a really
• 54:38
  Speaker 2: valuable read in terms of just understanding what punk rock
• 54:43
  Speaker 2: looks like and how bands still experience this. It's a
• 54:47
  Speaker 2: little bit different, but they still experience this level. And
• 54:50
  Speaker 2: it's just really interesting to hear it directly from them.
• 54:52
  Speaker 2: It's not like people are telling the stories for these bands.
• 54:55
  Speaker 2: You're hearing it directly from these bands, which is really cool.
• 54:58
  Speaker 2: So it's worth a read if you like, if you
• 55:00
  Speaker 2: like music, if you like underground stuff. The Butthole Surfers
• 55:03
  Speaker 2: chapter is absurd cool if you couldn't guess by the
• 55:08
  Speaker 2: band name Butthole Surfers, right. But it's really a great read.
• 55:12
  Speaker 2: It's a very funny read. Awesome, Yeah, all right, very good.
• 55:15
  Speaker 1: I am recommending a movie that just came out of
• 55:18
  Speaker 1: the time of this recording, and at the time of
• 55:20
  Speaker 1: this is publishing, it's still like barely a week in
• 55:22
  Speaker 1: the theaters. This is the book I recommended at least once,
• 55:25
  Speaker 1: if not multiple times. Project Hail Mary. I read this
• 55:28
  Speaker 1: book three times because I loved it that much, and
• 55:31
  Speaker 1: read it again in anticipation, well mostly because of a
• 55:34
  Speaker 1: book club, but also anticipation of the movie coming out.
• 55:37
  Speaker 1: And the movie was just absolutely fantastic. If you liked
• 55:40
  Speaker 1: the book, this is essentially the abridged version of the
• 55:43
  Speaker 1: book and movie form because it is that close. There
• 55:46
  Speaker 1: are a couple of things that they changed and obviously
• 55:48
  Speaker 1: cut a ton, But if you've never seen the book
• 55:51
  Speaker 1: then you might even like it even more because it
• 55:53
  Speaker 1: is just such an incredibly good story.
• 55:55
  Speaker 2: And the movie is.
• 55:56
  Speaker 1: Gorgeous, extremely well done and just a visual treat and
• 56:02
  Speaker 1: just such a good story. So that is my recommendation
• 56:05
  Speaker 1: is Project Hail Mary the movie.
• 56:07
  Speaker 2: Go see it.
• 56:08
  Speaker 1: It deserves all the praise and attention and all the things.
• 56:10
  Speaker 1: So it's it's awesome, and I'm very pleased that they
• 56:13
  Speaker 1: did justice to a book I love so much.
• 56:15
  Speaker 2: I love that. That's perfect.
• 56:17
  Speaker 1: All right, Well that is Project Hail Mary the movie
• 56:19
  Speaker 1: and Our Band Could Be Your Life, the book by
• 56:22
  Speaker 1: Michael Azara azarad to say that, right, Yeah, okay, cool.
• 56:26
  Speaker 1: That is what I have to say about first episodes
• 56:27
  Speaker 1: like Kosis and those two recommendations. So as I said,
• 56:30
  Speaker 1: I think you know, reach out to us your thoughts,
• 56:32
  Speaker 1: but I think we're ready to wrap this one up.
• 56:34
  Speaker 2: So thank you all for listening. This is Abraham and
• 56:36
  Speaker 2: it's a Shane. We're out se Yah. You've been listening
• 56:40
  Speaker 2: to Why we Do what we Do. You can learn
• 56:42
  Speaker 2: more about this and other episodes by going to WWD
• 56:46
  Speaker 2: WWD podcast dot com. Thanks for listening, and we hope
• 56:50
  Speaker 2: you have an awesome day