Suzanne O'Sullivan (on over diagnosis)

Summary

Armchair Expert with Dax Shepard - Episode Summary: Suzanne O'Sullivan on Overdiagnosis

Release Date: March 5, 2025

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Introduction: The Issue of Overdiagnosis

In this compelling episode of Armchair Expert with Dax Shepard, host Dax Shepard and co-host Monica Padman delve into the contentious topic of overdiagnosis in the medical field. Joined by renowned neurologist and author Dr. Suzanne O'Sullivan, the discussion explores whether society is medicalizing normal variations in human experience and the profound implications of this trend.

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Guest Introduction: Dr. Suzanne O'Sullivan

Dr. Suzanne O'Sullivan, an award-winning writer and neurologist from Ireland, brings her expertise to the conversation. With a deep background in epilepsy and psychosomatic illnesses, Dr. O'Sullivan authored the insightful book, The Age of Diagnosis: How Our Obsession with Medical Labels is Making Us Sicker. Her work critically examines the expanding boundaries of medical diagnoses and their impact on individual well-being.

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Overdiagnosis in Neurology: Epilepsy and Psychosomatic Seizures

The episode begins with Dr. O'Sullivan presenting alarming statistics from her clinical experience. She states:

"In the best week or the best year, a fifth of those do not have epilepsy. The seizures they're having have a purely psychological cause."
[05:52] – Dr. Suzanne O'Sullivan

Dr. O'Sullivan explains that distinguishing between epileptic and psychosomatic seizures is straightforward for specialists but often perplexing for general practitioners. She emphasizes that approximately 20-30% of seizure cases in her clinics stem from psychological rather than neurological origins.

Key Points:

• Differentiation: Epileptic seizures are brief and exhibit specific patterns, whereas psychosomatic seizures are longer and behave differently.
• Diagnosis: Electroencephalograms (EEGs) reveal normal brainwave activity during psychosomatic seizures, contrasting with epileptic bursts.
• Brain Imaging: Functional MRI scans show altered connectivity between emotional and motor regions in psychosomatic cases.

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The Broader Spectrum of Overdiagnosis

Dr. O'Sullivan expands the discussion beyond epilepsy, highlighting how medical overdiagnosis permeates various health conditions:

"We're very good at capturing more and more disease, but we're not terribly good at measuring the implications of that down the road."
[45:55] – Dr. Suzanne O'Sullivan

Highlighted Conditions:

• Autism and ADHD: Diagnostic criteria have broadened, potentially labeling individuals with mild or non-verifiable traits.
• Diabetes: The introduction of "pre-diabetes" has expanded the diagnosed population without clear evidence of improved long-term health outcomes.
• Long COVID and Chronic Lyme Disease: Early definitions lacked scientific backing, leading to widespread self-diagnosis and misinformation.

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Social Media and Self-Diagnosis

The conversation shifts to the role of social media in exacerbating overdiagnosis. Dr. O'Sullivan cites studies showing a significant portion of informational content on platforms like TikTok contains inaccuracies:

"Of the top 133 videos providing informational content on autism, 27% were classified as accurate, while 73% were just full of inaccuracies."
[67:21] – Dr. Suzanne O'Sullivan

Implications:

• Misinformation Spread: Social media platforms can distort public understanding of medical conditions.
• Psychosomatic Effects: Exposure to misleading information may lead individuals to perceive normal experiences as pathological.
• Community Formation: While providing support, self-diagnosed groups can reinforce misconceptions and stigmatize genuine conditions.

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Impact of Medical Labels on Individuals

Dr. O'Sullivan discusses the psychological burden of medical labeling:

"If you tell a child that they have a neurodevelopmentally abnormal brain, you're really running the risk that you have this labeling effect where you concentrate on the things you can't do."
[54:54] – Dr. Suzanne O'Sullivan

Key Insights:

• Self-Fulfilling Prophecy: Labels can limit individuals' self-perception and hinder personal growth.
• Stigmatization: Differentiating compassion between physiological and psychosomatic causes can lead to unequal support.
• Treatment Challenges: Psychosomatic conditions often require nuanced approaches like Cognitive Behavioral Therapy (CBT), which are only partially effective.

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Case Studies and Personal Stories

Dr. O'Sullivan shares poignant stories illustrating overdiagnosis and its consequences:

1. Mass Psychogenic Illness in Colombia:

   • A peaceful town plagued by sudden, widespread seizures likely triggered by environmental stress and amplified by misinformation.
   • [25:57] – Dr. Suzanne O'Sullivan

2. Long-Term Impact of Misdiagnosis:

   • Valentina's 20-year ordeal believing she had Huntington's disease, leading to severe psychological distress despite testing negative.
   • [63:32] – Dr. Suzanne O'Sullivan

These cases underscore the destructive potential of premature or incorrect diagnoses and the importance of accurate medical evaluation.

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Solutions and Recommendations

Towards the end of the episode, Dr. O'Sullivan proposes several strategies to mitigate overdiagnosis:

"We need to support people without labels... teach people what normal looks like and learn how to support children without labeling them."
[81:44] – Dr. Suzanne O'Sullivan

Suggested Approaches:

• Revising Diagnostic Criteria: Establish clearer boundaries distinguishing normal variations from genuine medical conditions.
• Enhancing Medical Training: Equip healthcare professionals with better tools to diagnose psychosomatic and functional disorders accurately.
• Developing Support Systems: Create non-medical avenues for individuals to seek help and community without necessitating formal diagnoses.
• Encouraging Critical Consumption of Information: Foster media literacy to help individuals navigate and critically assess health information online.

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Conclusion: Emphasizing Compassion and Accuracy

The episode closes with a call for compassionate medical practice and a balanced approach to diagnosis. Dr. O'Sullivan advocates for a healthcare system that prioritizes individual well-being over the proliferation of medical labels:

"Mental health problems are rising significantly, and there is no evidence at all that giving people with a very borderline diagnosis a medical label is actually helping anybody."
[59:21] – Dr. Suzanne O'Sullivan

Final Thoughts:

• Overdiagnosis may not make society healthier but rather more pathologized.
• Emphasizing accurate diagnosis and compassionate care is crucial to addressing the root causes of distress.
• Moving forward requires a collective effort from the medical community, society, and individuals to redefine health and well-being beyond rigid medical definitions.

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Notable Quotes:

• “Our brains shut down in certain overwhelming situations all the time. That is dissociation. That's what our brains do to protect us in moments of being overwhelmed.”
  [07:26] – Dr. Suzanne O'Sullivan

• “Imagine your next door neighbour's in a wheelchair... Even the most caring and understanding of person, there's something in us that kind...”
  [10:50] – Dr. Suzanne O'Sullivan

• “Diagnosing things that don't need to be diagnosed... We're going to change that parameter and say you can have pre diabetes at five point.”
  [45:40] – Dr. Suzanne O'Sullivan

• “What's really noteworthy... we didn't see people with this constellation of diagnoses ten years ago.”
  [43:33] – Dr. Suzanne O'Sullivan

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Recommendations for Listeners:

For those intrigued by the intricate balance between medical diagnosis and human psychology, Dr. Suzanne O'Sullivan's insights offer a thought-provoking perspective on how society defines and treats illness. Her book, The Age of Diagnosis, provides a deeper exploration of these themes and is highly recommended for further reading.

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Transcript

[Dax Shepard]

Wondry plus subscribers can listen to Armchair Expert early and ad free right now. Join Wondry plus in the Wondry app or on Apple Podcasts or you can listen for free wherever you get your podcasts. Welcome, welcome, welcome to Armchair Expert. Experts on Experts on Experts on experts.

[Monica Padman]

Whoa. So many.

[Dax Shepard]

I'm caught in a loop still because we just did a personality test that seemed to be loop a loop. I feel like we answered the same five questions.

[Monica Padman]

It's meant to throw you.

[Dax Shepard]

Yeah, it did a good job. Today we have a guest on a fascinating topic that I think a lot of us talk about all the time. Are we getting over diagnosed? Are we medicalizing everything? Is everything a pathology?

[Monica Padman]

This episode was really interesting because we talk a lot about over diagnosis but also about kind of psychosomatic. Psychosomatic contagions.

[Dax Shepard]

Yes, yes, yes, yes, yes. This is across the board fascinating because she's here to talk about her new book. Well, first of all, Dr. Susan O'Sullivan, she's an award winning writer and neurologist and her new book, which we're gonna talk about a lot is the Age of how our obsession with medical labels is making us Sicker. But her previous few books are also fascinating. We get into those and that's about psychosomatic illnesses and contagious illnesses. All of it is.

[Monica Padman]

So I told a lot of people about this.

[Dax Shepard]

Me too. So interesting and so funny too. Cause we just immediately contradict ourselves and then we get another expert on and learn about a new pathology.

[Monica Padman]

It's good to have all the information.

[Dax Shepard]

To hold two conflicting ideas in the head at one time is a sign of intelligence. Please enjoy our ever charming guest from Ireland, Dr. Suzanne O'Sullivan. We are supported by the all new Galaxy S25 Ultra from Samsung. This phone is a true AI companion that evolves with you to do more for you. Like handling multiple tasks with just one ask. For example, you can tell it to find a restaurant nearby and text it to my friends or look my favorite basketball team schedule and add it to my calendar. And it does it just like that. You just speak the request naturally and the new Galaxy S25 Ultra takes care of the rest. Okay, this is what AI was meant for. That is seamless plus now brief with Galaxy AI gives you personalized daily briefings that keep you a step ahead. It'll show you your appointments, the weather, your energy score and more all in one place ready to let AI do more for you. So you can do you then get your Galaxy S25 Ultra now at compatible with select apps requires Google Gemini account results may vary based on input. Check responses for accuracy. Now brief with Galaxy AI displays daily. Select information from select apps may require Internet connection. Galaxy AI features by Samsung free through 2025 and require Samsung account login. We are supported by Ring. You don't have to miss out on what's happening at home. With Ring cameras and doorbells, you can see and speak to who's there from anywhere with Ring's battery doorbell. Plus you can greet, get notified about packages and see what's going on at your front door. And head to toe video lets you see more of what's happening up high and down low. Another great way to check in on home is Ring's Pan Tilt indoor cam. You can control the camera from your phone and pan around to see what your pets are getting up to. And with two way talk, you can even say hi to them.

[Monica Padman]

Oh, that's so cute.

[Dax Shepard]

It is.

[Monica Padman]

If I get my dog, I'm definitely going to talk to him through with the Pan Tilt indoor cam I love. I have a Ring video doorbell and I really like it and it makes me feel very safe.

[Dax Shepard]

Yeah, they're fantastic. And they're so simple to install. With Ring, you can check on home from anywhere. Learn [e-mail] he's an UPCH. He's an exper. So you've been here since Friday. Did you do anything fun?

[Dr. Suzanne O'Sullivan]

I was the absolute ultimate tourist. I did everything that you'd expect a tourist to do. First, I did the Universal Studios tour.

[Dax Shepard]

Okay, great.

[Dr. Suzanne O'Sullivan]

I was very surprised. So because I'm only here for a brief period, I paid for like the most expensive tour and it was six hours around the studios. What I thought. I didn't realize it was a theme park. I didn't know that.

[Dax Shepard]

Well, you didn't even know. You thought you were just gonna see the sound stages and the live.

[Dr. Suzanne O'Sullivan]

I did it for six hours and the very first thing that happened was they put me on the Harry Potter ride. Oh, y.

[Dax Shepard]

How was that?

[Dr. Suzanne O'Sullivan]

The effects and everything are amazing, but it was just very disorientating when you were expecting something entirely different.

[Dax Shepard]

Now, are you wearing green as a nod to your Irish heritage or do you always find yourself in green?

[Dr. Suzanne O'Sullivan]

I wear a lot of green, but I do identify very strongly as Irish. I mean, I'm from Ireland.

[Dax Shepard]

You have the most Irish last name. You got a Sullivan and an Owen.

[Dr. Suzanne O'Sullivan]

Yeah, exactly. It's 100% Irish. But I've lived in England for a long time.

[Dax Shepard]

Well, you've written maybe more, but I'm aware of three books. And I would love to just tap dance lightly through some of them before we get to the new book. Because I do think there's definitely gonna be concepts in the new one that were laid out and built on the back of these other ones. And this is gonna get Monica so excited. I think we should first talk about. You're a neurologist. You also have a master's in creative writing, which is impressive, but you specialize in epilepsy.

[Monica Padman]

I have epilepsy.

[Dr. Suzanne O'Sullivan]

Oh, do you?

[Dax Shepard]

Well, let's find out. Let's find out. The first book is all in youn True Stories of IMAG Illnesses. So let's just start with some actual data, which is your guesstimation and you acknowledge it's an estimate. But of all the people that come in that have had seizures, a symptom of epilepsy, 30% of them are not epileptic.

[Dr. Suzanne O'Sullivan]

Correct.

[Dax Shepard]

And then you found also that's largely true for cardiologists when people come in with chest pains. It's common for people with heart palpitations that about a third of people that are experiencing symptoms, often it doesn't align with the actual underlying disease.

[Dr. Suzanne O'Sullivan]

Yeah. So I run seizure clinics, and most people who are referred to me, they've been having a variety of different kind of convulsions or other types of seizures. Usually they come to me with a pre existing diagnosis of epilepsy. And in the best week or the best year, a fifth of those do not have epilepsy. The seizures they're having have a purely psychological cause. So their brains are shutting down for a purely psychological reason. And that's something that we as neurologists see all the time. That is so common. As I always explain to patients, our brains shut down in certain overwhelming situations all the time. You know, that sort of. You're really overloaded with information. You're listening to the radio, you're trying to hear a sports result or a particular thing, and you miss it like 10 times. And you keep rewinding and rewinding and rewinding and missing the same thing multiple times. That's dissociation. That's what our brains do to protect us in moments of being overwhelmed. It's like everything in the body. Some people have too much hair, people have too little hair. Everything goes a bit wrong in some way. And this thing called dissociation, which is designed to just help us to control the overwhelming amount of information in our environments, sometimes goes wrong. And when it goes wrong, it can cause people to faint, it can cause People to collapse. It can cause people to have convulsions. And it's so common that this would be part of the bread and butter of a neurologist's job.

[Dax Shepard]

How do you distinguish those seizures from epileptic seizures?

[Dr. Suzanne O'Sullivan]

For a neurologist who deals with seizures, it's phenomenally easy because they don't look anything alike and they don't behave in the same way. I won't go into the small details, but epileptic seizures tend to be incredibly brief. They last a few seconds or a minute, they behave in a certain way. Whereas these seizures that you get for psychological reasons tend to last for much longer and have a sort of different pattern of behavior. I think it's very difficult for a non specialist doctor to tell the difference. But if you've heard people describing epileptic seizures enough times, you can tell the difference very easily.

[Dax Shepard]

If we were to observe the brain with an FMRI and maybe it's already been done, do we see any difference in how it plays out electrically?

[Dr. Suzanne O'Sullivan]

Absolutely, regionally. First of all, if you do a brainwave test where you just put the stickers on the head where you're measuring the brain waves, an epileptic seizure is caused by a burst of unwanted electrical activity. You will see that electrical burst when the person has a seizure. If you do an EEG in someone having these psychosomatic seizures called dissociative seizures, even when they're unconscious and completely unresponsive, you see a normal waking brainwave pass through.

[Dax Shepard]

So the brain's very busy.

[Dr. Suzanne O'Sullivan]

In some quadrant it looks awake, but for some reason people are not able to access that awake part of the brain.

[Dax Shepard]

So they're like maximum disassociated?

[Dr. Suzanne O'Sullivan]

Absolutely. If you looked at the brainwaves of someone in one of those seizures, they look normal. If you look at the brain in a different way. So you mentioned fmri. So that's where you look at blood flow activity in the brain. If you look at that, you will see slightly different patterns of activation of people having these seizures to otherwise healthy people, because you will see increased connectivity, say between the emotional parts of the brain and the motor parts of the brain. So something is going on that shouldn't be. But it's not necessarily a brain disease per se, but rather this emotional part of the brain is connecting in some way to the motor part of the brain to produce these symptoms in a way that it shouldn't.

[Dax Shepard]

So you're seeing 30% of the people come in, or 20% on a great year where these are psychosomatic And I think we have a paradigm which is very dismissive of psychosomatic in the same way that people are dismissive of placebo effect. People have this association that placebo effect is not real. Of course it's real. It doesn't have the causality we thought it had. So do you think that by writing a book about psychosomatic disorders you ran the risk or you would be afraid people were thinking you're dismissing them as opposed to, I like what you say, which is the symptoms are the symptoms, they're the same. Why do we have compassion for one cause of the symptoms and not the other?

[Dr. Suzanne O'Sullivan]

The purpose of writing the book was very often this something affects really young people. And I was seeing these young people who were having hundreds of seizures every week and I would explain to them what was wrong with them. And it was like I was reinventing the wheel or something. I am seeing it every day. But they can't even believe that such a thing exists in the world.

[Dax Shepard]

Do you feel like they felt invalidated by that?

[Dr. Suzanne O'Sullivan]

Absolutely. Well, I always say to people, imagine your next door neighbour's in a wheelchair. You understand that they've got multiple sclerosis or motor neuron disease, and obviously you've got a huge amount of sympathy for that and support for that. And then next week someone tells you, well, actually their nervous system is normal. This has a purely psychological cause. Even the most caring and understanding of person, there's something in us that kind.

[Dax Shepard]

Of says, oh, none of us like feeling bad. It's an emotion that's uncomfortable. So if we can say it's your fault, I think it relieves us of that responsibility to be compassionate and understanding. It's like, well, they're choosing to be this way or they're.

[Monica Padman]

I think a lot of. It's like they need attention.

[Dr. Suzanne O'Sullivan]

I think that's where the problem arises, is that people think that they need attention. Even though you can tell people it's not consciously generated, people secretly think that people are doing it on purpose and that they're doing it for attention.

[Monica Padman]

They know they're doing it and they.

[Dr. Suzanne O'Sullivan]

Could stop doing it if they wanted to. And again, I say to my patients, so many analogies in life for this. Imagine something terribly frightening has just happened to you. Your heart rate goes up to 120 beats per minute. It's really happening. You're not doing it on purpose. If I told you, snap out of it, slow your heart down, you wouldn't be able to do it. So it's the same with these Sort of seizures. When my heart races because I'm frightened, it's not because I have a heart disease, but neither am I doing it on purpose and neither could I stop it.

[Dax Shepard]

And it has a self perpetuating physiology. Right. Which is once my heart rate is so high, I'm actually going to be in my amygdala whether I want to or not. I can't bring on my frontal cortex really.

[Dr. Suzanne O'Sullivan]

And that's how these things get worse. It happens once and then the next time you face a similar situation, you become really focused on your body and thinking, I hope that awful thing that happened to me before doesn't happen again. And it's all feeding back into itself. So I think that's another thing that people misunderstand is they think that psychosomatic conditions are less serious than others. In fact, they can be in many ways more serious. Say a fairly average patient with epilepsy. There's a huge range of differences. But let's say they might have a seizure every month if they're quite bad, or once a year, things aren't so bad. Or once every 10 years if they're pretty good. A person with non epileptic or dissociative seizures can have 100 a day. And yet because they have a psychological origin, we kind of think that's less serious.

[Dax Shepard]

You can't put the latter patient on Keppra or a medicine that would help.

[Monica Padman]

It will work.

[Dr. Suzanne O'Sullivan]

It may work.

[Dax Shepard]

It could be a placebo.

[Dr. Suzanne O'Sullivan]

Yeah. So often I will find stumbling block for them is someone has told them it's epilepsy, they go on the epilepsy drug and the seizures stop for three months, say. But the epilepsy drugs won't solve the problem if it's not epilepsy. So then generally the seizures will come back.

[Monica Padman]

Okay. You want me to. Should we?

[Dax Shepard]

Yeah, yeah, absolutely. Yeah. Dead honest with you. I don't think one thing or another. I do think both sides should be explored as passionately.

[Monica Padman]

I agree. Okay, so you can tell me.

[Dr. Suzanne O'Sullivan]

First of all, I'm very unlikely to tell you because I would have to ask so many deep personal questions that I wouldn't ask.

[Dax Shepard]

I've probably already said them up.

[Monica Padman]

Yeah, that's what we do.

[Dax Shepard]

Because we're not going to force you to try to diagnose one of those. We know that's unethical.

[Monica Padman]

Sure. You don't have to diagnose this one. But I had a seizure. Nocturnal. I woke up, I was sleeping by myself. I didn't know, but I was like, I Feel crazy. I peed in the bed.

[Dax Shepard]

You had a lot of muscle sore.

[Monica Padman]

Really bad muscle soreness. I thought maybe I had a kidney issue. So I went to the doctor. They took a urine test, and they were like, nothing's wrong with your kidneys. We don't know what it is. They gave me a steroid shot for the muscle pain. That was that.

[Dr. Suzanne O'Sullivan]

I'm just gonna stop you there. So the bottom line was you woke up, you'd wet the bed, and you had aches and pains. Did you suspect a seizure then?

[Monica Padman]

No, I was very disoriented.

[Dax Shepard]

That was chalked up to a mystery.

[Monica Padman]

A year goes by, and then I'm on vacation with girlfriends and I have another seizure in sleep again. And they're there. So they see what happened. Then I go to the hospital, they do an mri. It's all fine. And then when I got back home, I saw a neurologist. He looked at the scans, and he said, based on the fact that they were a year apart, they were at night, it's epilepsy. And I've been on Keppra ever since. That was in 2020. I've been on it for five years. I haven't had one.

[Dr. Suzanne O'Sullivan]

That's epilepsy. Yeah.

[Monica Padman]

Okay.

[Dr. Suzanne O'Sullivan]

Yeah.

[Dax Shepard]

That's nice, right?

[Monica Padman]

I always knew it.

[Dax Shepard]

Oh, yeah, yeah. Again, I didn't not know it.

[Dr. Suzanne O'Sullivan]

The question is, why did you doubt it?

[Monica Padman]

I'm a hypochondriac. I feel fair to say that.

[Dax Shepard]

Yeah. I wouldn't say that out loud, but, yeah, I think she has a bit of hypochondria. I didn't doubt it. I just am curious.

[Monica Padman]

Well, now that we know that it could, maybe not.

[Dr. Suzanne O'Sullivan]

That's fairly typical of how epilepsy behaves and seizures in sleep. But I think the important thing is that this is the conversation I would like people to have. Because very often the conversations I'm having with patients are they're saying, but it must be epilepsy. But it must be epilepsy, because it feels so impossible to them that the brain could do this without a disease. And what I would love, you know, it's much like if you're deciding, does someone have migraine or do they have something else? You just have a conversation about, it could be this, it could be this. And people are fine with the alternatives. But most of the conversations I have are people are almost begging to have epilepsy because they know how stigmatized the alternative is. So this is exactly what I would like to see happening, is you've got two Possibilities, and both are equally respected so that either can be considered.

[Dax Shepard]

Right. There's no shame in one of the diagnoses.

[Dr. Suzanne O'Sullivan]

Exactly.

[Monica Padman]

Yeah.

[Dax Shepard]

So, well, I guess what I'm curious about is do we understand the mechanisms that can create symptoms psychosomatically? Talk about Matthew.

[Dr. Suzanne O'Sullivan]

Maybe from the book we don't fully understand. Now, when I was studying, training as a neurologist, so let's say in the 1990s, we didn't have a clue about this stuff, but we are beginning to develop theories. But they are only theories. But an awful lot of it really is around the concept of what we call predictive coding. So how your brain processes information, it isn't absorbing information as if we were video recorders or something. Our bodies behave as we expect it to behave. In the case of Matthew, I'm going back a bit now with Remembering the Story 2015.

[Dax Shepard]

I'm asking you to go back a decade.

[Dr. Suzanne O'Sullivan]

Yeah. I can hardly remember what I had for my breakfast apart from that. So Matthew had some tingling, I think, in his legs. I've forgotten exactly how it started, but it started with some disturbed sensation in his legs. And then he was reassured by his doctor, who didn't find anything wrong with him, but he wasn't really reassured. And he felt that he had a more serious problem than that, that tingling in his legs then progressed into a feeling that he wasn't coordinating or using his legs correctly. And that then progressed further until he got to the point where he wasn't able to walk and he was completely wheelchair bound. Now, as a neurologist, when you examine someone who cannot move their legs at all, there is a big distinction between what you find when you examine someone who's got, say, a spinal cord disease or brain disease, and something psychosomatic because the nervous system is arranged in a very complex way. And when you can't move your legs because you've got a brain disease, it looks one way. If it's a spinal disease, it looks another way. So when I saw Matthew, it was very obvious to me his reason. Reflexes were normal, lots of things were normal, and yet he couldn't move his.

[Dax Shepard]

Legs in ms, specifically, if I remember right, the myelin sheath is eroding around the nerves is the issue. So can we observe the myelin sheath?

[Dr. Suzanne O'Sullivan]

First of all, you can tell from the history how multiple sclerosis behaves. It's flitting symptoms that move around the body. And then basically you would be able to see certain signs in the legs, such as a particular kind of spasticity or Stiffness in the muscles, reflexes that are very brisk, patterns of sensory loss that fit with the brain. And then when you do brain imaging, mri, you can kind of see the result of the loss of myelin rather than the loss of myelin itself. In Matthew, none of these kind of abnormal signs. When you examined him, apart from not being able to move his legs, everything was normal. And brain imaging, et cetera, was all normal. It was very obvious that this had a psychological cause. So the question Matthew would have for me is, how could I not be able to move my legs? You're telling me my nervous system is healthy, why can't I move my legs?

[Dax Shepard]

Oh, it must be another layer of anguish on top of everything.

[Dr. Suzanne O'Sullivan]

Well, I think it's very unbelievable for people. There are kind of, again, analogies for this in life. If you think about your foot or your feet for even a moment, they feel different than if you're not thinking about them. Because our bodies are awash with all of these sensations at all times that we could feel if we paid attention to them. But because our brains can only handle so much information, we just eradicate that white noise so we can pay attention to the conversation we're having or important things in the room. So first of all, it takes very, very little for your body to feel different. All you have to do is pay attention to it and you will notice stuff.

[Dax Shepard]

It's like when you start thinking about your heartbeat.

[Dr. Suzanne O'Sullivan]

Exactly.

[Dax Shepard]

You can almost immediately give yourself a palpitation just by considering it.

[Monica Padman]

If you're starting to have a panic attack. If you start thinking about having a. It gets so exacerbated because these things.

[Dr. Suzanne O'Sullivan]

Are supposed to be automatic. You've been learning them your whole life. But Matthew became aware there was something wrong with his feet. So the minute he pays attention to his feet, they feel strange. And then what does that do? It makes him pay even more attention to his feet. It becomes a kind of a looping thing that gets out of control. So that's how you change the sensation in your body. But then think about motor activity. So I always give examples like sports people. So only some sports people can take penalty tries. You might be brilliant at something when no one's looking at you, but the scrutiny of the crowd completely affects your ability to coordinate your muscles. Or I give examples like walking on a cliff path where any other day you just walk, you don't think about it. But if you're walking somewhere where there's jeopardy.

[Dax Shepard]

Yeah. If someone's asked you to walk along a 6 inch line on the ground, you could do that to eternity and never misstep.

[Dr. Suzanne O'Sullivan]

Exactly. We can change the quality of both our movements and how our body feels by the scrutiny that we pay to our bodies. Very often these things happen because we are paying so much attention to the body, and then we expect the body to behave in a certain way, and therefore it does. So it's not actually that unusual for people to have problems a little bit like Matthews. That's an extreme example, but for a neurologist dealing with these kind of issues, it's also a common example.

[Dax Shepard]

A depressing side of this is that in the folks you work with, 30% of which are having psychosomatic seizures, only 30% of those people will have success treating it with CBT, which is our best option currently.

[Dr. Suzanne O'Sullivan]

If you talk about dissociative seizures, people think, oh, that's less serious than epilepsy. 70% of people with epilepsy will become completely free on medication, but only 30% of people with dissociative seizures will get better. It is phenomenally hard to make people with these problems completely better. And I think a little bit of that is because it's been such a neglected area of medicine. There are great scientists working on it now, but during my training period, there was nobody.

[Dax Shepard]

As soon as the doctor has decided it's in their head, they're kind of off their plate. Go see someone else. I only know how to prescribe you these medicines or send you to this physical therapist. There's no tools on the table for a doctor.

[Dr. Suzanne O'Sullivan]

Exactly. As a neurologist. So I've told you how often I see these kind of seizures, but I'm in no way trained to treat them. If it's such a big part of my day job, I should be better trained to treat them. But there would be a real expectation for many neurologists that if you see someone and you rule out a brain disease, then it's sort of like, that's fine. Then you can discharge that person. And that's a big part of the reason why I became interested in it, because. Because I was a young woman and a lot of the patients were young women my age. I was finding myself in a position of potentially sending people home, having lots of seizures.

[Dax Shepard]

Is it gendered?

[Dr. Suzanne O'Sullivan]

It is more common in women. So about two thirds of the patients who develop psychosomatic conditions, seizures in particular, are women.

[Dax Shepard]

So the part I still would love to know the mechanics of is if I wanted, with all my might, to give myself a seizure, I don't think I could Replicate the level of seizure you're seeing what happens in the brain.

[Dr. Suzanne O'Sullivan]

I don't think we really understand it. We can liken it to things in daily life, but do we really know how that is possible? Well, I don't know is the answer to that question. I mean, with regards to some of these things, we talk about how predictive coding. So predictive coding is how we process information. So if I show you this object, you've never seen it before, and I tell you what it is, then you recognize it. But the next time you see this, you will be able to manipulate it in your brain. So the next time you see it from this angle, you don't have to have learned what this looks like from this angle in order to recognize it. So our brains aren't just.

[Dax Shepard]

They're modeling machines.

[Dr. Suzanne O'Sullivan]

Exactly. And they're manipulating everything that comes in to try and make sense of it. We're making sense of the world according to our experience. So this kind of prediction machine, that is the brain, is making a best guess at what the body should do in this situation and how the world should look in this situation. And you know what? It makes mistakes. That's the bottom line. And these are some sort of mistakes that come out of these faulty predictions or prediction errors.

[Monica Padman]

I mean, is anti anxiety pharmaceuticals ever tried for this?

[Dr. Suzanne O'Sullivan]

Other than in a placebo way? Medication doesn't really work for this. What can often work is much simpler than that. This probably will shock you a little bit, but I have seen patients who are having 100 seizures a day. In one conversation in which you explain what is happening, we'll stop the seizures there dead on the spot.

[Monica Padman]

Oh, wow.

[Dr. Suzanne O'Sullivan]

Because what you've done then is you've broken the pattern of the expectation. Actually, the one thing that can make these better very quickly for some people, as long as they haven't been there for that long, is just for them to understand what's happening, to be less frightened of it, and then distract themselves. Because often it's a kind of a snowball. So you feel the dizziness, and then you think, oh, what comes after the dizziness? I don't mean this in a conscious way, unconsciously. So I just say to patients, you feel the dizziness. So next time you feel the dizziness, look for everything in the room that is green or list all your favorite football teams. Just do something that breaks the pattern.

[Dax Shepard]

Okay, so the third book, the Sleeping Beauties and other Stories of Mystery illness. You have a story in there about contagious seizures and schoolgirls in Colombia Yeah, boy.

[Dr. Suzanne O'Sullivan]

This is a story that could have begun anywhere in the world actually, but it happens to be set in Colombia. So I visited this little town in Colombia, beautiful town near Cartagena, about 2012, in a school in Columbia. It was a very hot classroom. The windows were closed, it was overcrowded. A girl collapsed. We presume she fainted. And following that, multiple people in the class collapsed all over the school. They heard the commotion coming from this classroom. So suddenly, you know, everyone's rushing out into the corridors. You can imagine what a heightened situation this was in that single day in that one classroom. There were multiple people fainting, collapsing, having convulsions, rushed to the hospital. Those stories are a dime a dozen. You will find similar examples to that exact story happening in the us, happening in England on a semi regular basis throughout the world. Usually that stops very quickly. So it's a very frightening situation. What's likely happened is that one person has fainted and then other people have sort of collapses in sympathy really with that person. Sudden emotional, overwrought situation.

[Dax Shepard]

Well, if you are uncomfortable with the heat and the lack of. And then you witness it, take someone else out. Now a new reality is on the table, which is I might pass out from this.

[Dr. Suzanne O'Sullivan]

Other people may simply have fainted. Also, young people who have low blood pressure, especially girls because they have lower blood pressure, sudden fright, your blood pressure drops, you faint. So probably the first person fainted, maybe the second person fainted. Eventually it was more of an emotional contagion. More likely. We call that poison.

[Dax Shepard]

Well, it was correlation, not causation.

[Dr. Suzanne O'Sullivan]

Exactly. And then that rumor then spread around the town. I spoke to some of them who had recovered completely. You know how you make these things better, is you positive? So I'm saying to these young women, you look great, you're better. Isn't that wonderful? And they would say, but I know the poison is still inside me, this sort of attitude. And there was a real malign influence moved to the town. There are anti Vax people and if they get a whiff of somewhere where they can recruit new members to the anti Vax movement, people from all over the world heard of these seizures and went to the town and stoked the fear. So something which should have been gone in 24 hours, it was still on ongoing years later.

[Dax Shepard]

Wow. Because it became weaponized by the anti Vax movement.

[Dr. Suzanne O'Sullivan]

And these poor girls, they were so terrified. Let's say you got some doctor from Germany, America, wherever, coming into your town and saying, you've been poisoned and you come from this kind of deprived area in Colombia, who are you to believe? Also, you're in a country where perhaps you trust this outsider more than you trust your local government. I'll give you another one, which is the belief in the sonic weapon. Somebody who is clearly intelligent and educated and works for a embassy in Cuba, hears a noise in the middle of the night and develops symptoms with hearing loss and dizziness and ringing in the ears and believes that they have been targeted by some sort of weapon, which was actually perfectly reasonable in some regards because the embassy had been closed in Cuba for a long time. And these sort of things do happen.

[Dax Shepard]

And they were a Russian proxy.

[Dr. Suzanne O'Sullivan]

Exactly. I think the sort of Russian spies. I don't have the terminology for all of this stuff, but they do have a reputation for going into people's houses, moving things around to mess with people's heads. And so for. I mean, it was perfectly reasonable for this person to think that something had happened to them. The difficulty, again, was the idea that there was such a thing as a sonic weapon took off within the embassy community. It's exactly where these mass psychogenic illnesses happen, in these contained communities potentially under threat that are quite insular. So people really began to believe in this concept that there could be a sonic weapon that were being directed at individuals. The problem is that scientifically it makes no sense because sound doesn't damage the brain in that way. You know, if you've got a big explosion that's big enough for everyone to hear it and to displace your whole body, well, then, sure, your brain could be damaged and so could the rest of your body. But sound cannot be directed at a brain to damage it. Sound just travels along nerves into the brain. So scientifically it made zero sense whatsoever. But unfortunately, people really bought into it.

[Dax Shepard]

60 Minutes even did a segment on it, and I was very disappointed. I love 60 Minutes. My bigger issue was, and this is disrespectful to the people suffering from whatever it is they're suffering from. But. But I was like, okay, so Russia has this crazy weapon and they deployed it on you. Not to be mean, but truly, if we made a hierarchy of who would be most advantageous for them to cripple, we wouldn't start with the ambassador in Cuba. It just also was illogical in the motivation.

[Dr. Suzanne O'Sullivan]

The whole thing was so illogical. You've got to feel for these people's position, because I think Marco Rubio was saying things about this weapon. They were being called in and they were being told by the highest forces in their country. To hide behind walls and to be.

[Dax Shepard]

Oh, they're trying to retrofit embassies. Yeah. Really. To what is the Tourette's like syndrome that was spreading through New York high schools? Do you know about that?

[Monica Padman]

I've heard this.

[Dax Shepard]

You've heard about this? Oh, I know nothing about it.

[Dr. Suzanne O'Sullivan]

These are the TikTok tics, essentially. So there were a few quite active people on TikTok who were demonstrating their Tourette's syndrome. It led essentially to an outbreak of not exactly Tourette's, but Tourette's like syndrome throughout the world. So young people began presenting to doctors with Tourette's like symptoms. But they obviously didn't have Tourette's because often these psychosomatic conditions, they are your idea of what a seizure would be like, or they are your idea of what Tourette's syndrome is like more than they are like the actual thing that swept the world. But the problem with these things is that most people will be fine, because most people, this will be a passing thing. It'll happen to them and it'll disappear. But vulnerable people will go to doctors and have tests, and this can all get very out of control. So for a small number of people, it's probably been a persistent problem. Problem.

[Dax Shepard]

And we didn't delineate. But I want to now because I'm now remembering even Monica. So you draw a very hard distinction between a hypochondriac and someone with a psychosomatic condition. A hypochondriac is worrying about getting things, but they don't have the symptoms. And a psychosomatic person has got a big plate of symptoms.

[Monica Padman]

I wonder if, because I often say this, I'm like, yes, I'm a hypochondriac. It's not like I'm like, ah, you're a lazy hypochondriac. I gotta go to the doctor and get tests. Don't you think a real hypochondriac is.

[Dax Shepard]

In the doctor all the time?

[Monica Padman]

Yeah, that's a good question.

[Dr. Suzanne O'Sullivan]

Again, that's coming back to my current theme of over diagnosis, which is, when does worrying about your health become hypochondriac?

[Monica Padman]

Exactly.

[Dr. Suzanne O'Sullivan]

It's when it stops you living a normal life and it disables you. So it's perfectly okay to worry about your health and to be a person who thinks, what's that? What's that? We all have a different kind of personalities and we all have different foibles and so forth. If it isn't disabling you, I wouldn't call it hypochondria.

[Monica Padman]

Oh, I love this.

[Dax Shepard]

This has been very validating. Yeah. You're getting a clean bill of health from this whole thing.

[Monica Padman]

Okay, that makes sense. No real consequences.

[Dr. Suzanne O'Sullivan]

That's precisely the thing, isn't it? We're really into using medical words to describe our personalities and the way we feel now. It's a trend. And then once you start using the medical words, then sudden you find yourself potentially being diagnosed with something.

[Monica Padman]

Right.

[Dr. Suzanne O'Sullivan]

But the line in the sand has got to be disability and impairment. And that's something I think people need to think about when they're kind of using medical terms in a casual way.

[Dax Shepard]

Yeah. Great. So that's next. Before we get to the new book, I just want to know about the sleeping sickness in Kazakhstan. What was that?

[Dr. Suzanne O'Sullivan]

This little town in Kazakhstan called Krasnogorsk. It's literally in the middle of nowhere. Really hard place to get to. In again, about 2012, 2010, a woman working in the market there, she couldn't be woken up. They noticed that she appeared to be asleep or unconscious. Her name was Lyubov. The other people in the market tried to wake her up. They couldn't. They took her to the hospital. Nobody could understand what it was. Although it was a small town, it had good healthcare facilities. So they did all the usual kind of scans and stuff and everything was fine. They said maybe you've had a stroke. Which, to be honest, wasn't a great diagnosis because stroke wouldn't really present like that.

[Dax Shepard]

This is now. She has woken up.

[Dr. Suzanne O'Sullivan]

Yeah, she's woken up. They say you probably had a stroke. Go home.

[Dax Shepard]

No sweat. You've had a stroke. Go home.

[Dr. Suzanne O'Sullivan]

Exactly.

[Monica Padman]

That's what they do.

[Dr. Suzanne O'Sullivan]

I should have applied. They had done as much as they could.

[Dax Shepard]

Stay tuned for more Armchair expert, if you dare. We are supported by Tropical Smoothie Cafe. Unwind and refresh at Tropical Smoothie Cafe with freshly made smoothies and tropic bowls that instantly transport you to tropic time. One bite or one sip and you'll instantly feel like you're cabana sauce. Made with refreshing fruit and tropical flavors. Eating your fruit and veggies has never been this fun.

[Monica Padman]

We could make our own armchair tropic thyme smoothie. And it could have cherries in it.

[Dr. Suzanne O'Sullivan]

Oh, oh.

[Dax Shepard]

It could taste like our favorite ice cream with cherries.

[Monica Padman]

Oh, yeah. So we would add cherries, maybe almond. Let's add some spinach in there for.

[Dax Shepard]

A little spring in your step.

[Monica Padman]

Yes.

[Dax Shepard]

Add more good vibes to your smoothie with fresh Add ins like almonds, spinach, kale, chia seeds and ginger or even supplements like protein and energize at Tropical Smoothie Cafe. It's always tropic time because you deserve a little vacay every day. Order ahead, take the scenic route and earn rewards with the Tropical Smoothie Cafe app. Download it today. Visit tropicalsmoothicafe.com to find a cafe near you. We are supported by Liquid iv. You know curiosity. It is the source of our livelihood, so I'm quite fond of curiosity. Curiosity and staying engaged with the world and people around us fuels what we do on this show. However you explore life or find interesting people. Fuel your journey with extraordinary hydration from Liquid IV, powered by Liv Hydra Science. Visit LiquidIV.com to explore flavors like the zesty new hydration Multiplier Sugar free Raspberry Lemonade. I just had that on my bike ride and Use code DAX to save 20 off your first order order. Break the mold and own your ritual. Just one stick and 16 ounces of water hydrates better than water alone. And they're small and light so they fit easily into any backpack, purse, diaper bag, whatever you're using. Convenient, quick and effective hydration. It just makes sense. Fuel your curiosity with extraordinary hydration from Liquid IV. Get 20 off your first order of Liquid IV when you go to LiquidIV.com and use code DAX at checkout. That's 20 off your first order with code DAX@LiquIDIV. This message is brought to you by Apple Card. Apple Card is everything a credit card should be. It's easy to manage, built to be secure, and gives users up to 3% daily cash back on every purchase. The best part about Apple Card is applying is quick and easy. Apply in the Wallet app on iPhone and see your credit limit offer in minutes. Subject to credit approval. Apple Card by Goldman Sachs Bank USA Salt Lake City Branch Member FDIC terms and [e-mail].

[Monica Padman]

What they really don't want to say is we don't know. I think a lot of doctors don't want to say that.

[Dr. Suzanne O'Sullivan]

See, I'm not sure that's what they don't want to say. I think that saying you don't know when you don't know isn't that hard. So if someone comes to you and says, I've got a pain in my toe and you don't know, there's not really any recriminations from saying, you know, I'm sorry, I've looked at everything I can. I don't know what that is. Patients don't get angry at that. I think the thing people don't want to say is what they think they do know, which is that perhaps it has a psychosomatic cause.

[Dax Shepard]

But this is in your hat.

[Dr. Suzanne O'Sullivan]

A lot easier to say, you don't know than to say that yet. So I don't know what her doctors actually thought, but they said possibly a stroke. They did do lots of tests. I was a bit casual in saying they sent her away, but they did care for her. But shortly after the nurse were affected and as it spread, the symptoms changed. And that's kind of what happens with these things. They spread from older people to children, and when it went to children, they started having different symptoms like hallucinations and things.

[Dax Shepard]

Oh, my goodness.

[Dr. Suzanne O'Sullivan]

I mean, this town. I read about this in the newspaper and you should have seen the pictures of this town. Imagine the most depressing town in the middle of the Kazakhstani steppe. Sort of dilapidated buildings and all of the people were pictured beside rusty swing sets.

[Monica Padman]

Oh, God.

[Dax Shepard]

I have an exact image of what the scene is.

[Dr. Suzanne O'Sullivan]

Astonishingly depressing. When the sleeping sickness happened, it was a big mystery for the country. The government did loads of investigations. They sent engineers and people to the town. It was a uranium mining town. So they thought maybe a toxin was coming from the uranium mine and really went into overdrive investigating this. But also loads of foreign journalists came. So this town went from being a town of 300 people to being a town that was kind of awake with activity of all these people visiting it. So when I read about it, I just thought, well, I would fall asleep in that town. It looks terrible. I sort of assumed that this happened because it was such a depressing place to live.

[Dax Shepard]

I want someone to do work on this and maybe they already have. But someone in the social scientist needs to think about, about the impact of 40 years ago. You could be in this Kazakhstan town and you wouldn't really know it was that bleak. The only swing sets you had seen were rusty. Maybe you saw some movies from the West. I wonder what the impact of being aware of what everyone else is living like on planet Earth with the Internet, where some of these symptoms might be a result of that. It's like, what are we doing here? And this is miserable and I'm going to just not wake up.

[Dr. Suzanne O'Sullivan]

Yeah, because the world is so small.

[Dax Shepard]

Now and you're very aware of what you don't have now, whereas I don't think you were in the past.

[Dr. Suzanne O'Sullivan]

Let me tell you the end of that story, because then I visited the town. So I'd seen how depressing it looked, and I thought, well, I'll go and interview the people and see if I can kind of understand this a little bit better. And I met the people who'd been in the sleeping sickness. And the first woman I met, lovely lady, Tamara. Beautiful, well into her 70s, but had kind of bleached blond hair. And she was really making an effort. She was lovely. And she basically was telling me that this town was paradise to live in. What it really was not paradise. It went down to something like minus in the winter. And they had no running water, most of them. The town had been dying slowly. They had no electricity. I visited the hospital and there was a bath full of water where they could come and get a bucket of water if they needed it kind of thing. This town was not paradise. And I just thought, this is bizarre. But then the more people I met, the more I realized that I was not understanding the story, which was that this town once upon a time, actually had been paradise for these people. So basically, it was a secret uranium mining town for the Russians during the Soviet era. These people all came from Russia and they were basically mining families. And they had been put on a bus one day in somewhere like Siberia and told, you're going to Kazakhstan. They didn't have much choice in it. And they got on this bus and they drove to Kazakhstan. I don't know how long that took. They stopped in multiple bleak places and thought, oh, God, I hope this isn't it. And eventually they came to this actual paradise town in Kazakhstan where they had built brand new apartment blocks. They had a brand new hospital. They had a facility for looking after the children. There was fruit and vegetables in the shop that nobody in the Soviet Union ever saw. And the reason it was set up that way is because they wanted to keep this mining town secret. They wanted these people to stay in the town. They wanted these people to be happy. So I had thought that people were delusional when they said this town was paradise, but actually it had been relative.

[Dax Shepard]

To where they came from.

[Dr. Suzanne O'Sullivan]

Yeah. And then what happened was the Soviet Union broke and the uranium mine shut down. And one by one, all these amazing facilities they had were lost. Most people left the town. There had been thousands living there, but this Stalworth 300 stayed. And I think they stayed, kind of thinking this was once paradise. I raised my children here. This place means a lot to me. They told me stories about having picnics by the riverside, and it was all very beautiful. They thought that it would eventually go back to Being paradise. But instead what was happening was it was just becoming more and more decrepit. What happened when you got the sleeping sickness? The only way to cure you was to leave the town. I think it was just a really phenomenally sophisticated way of making that really hard decision. In the end, I thought it was kind of a love story for this town. You know, it meant so much to them and leaving it was so painful. Sometimes these psychosomatic disorders, we think of them as illnesses. But sometimes they are a way of our brains helping us through a problem.

[Monica Padman]

There's survival mechanisms in some way seems.

[Dax Shepard]

To have a gene about saving us.

[Dr. Suzanne O'Sullivan]

Dissociative seizures. Very often they happen for the first time at a time of great stress. There's only so much you can handle and this is your brain protecting you from the thing you can't handle. Then it all goes a little bit.

[Dax Shepard]

Awry or your body will make your back hurt so much you can no longer do the job that's killing you mentally. The body will somehow protect itself.

[Dr. Suzanne O'Sullivan]

Absolutely.

[Dax Shepard]

Okay. So the new book, the Age of Diagnosis. How our obsession with medical Labels is Making Us Sicker. Now. I sought out an expert like you because you'd have to be asleep to.

[Monica Padman]

Have missed sleeping disease.

[Dax Shepard]

This wave of self diagnosis that we all are giving ourselves the current one and we'll just put an earmark in it, is every single person I know and I convinced myself of it, maybe has ADHD right now. That's the one. We'll get to it. But let's walk through why this felt like a natural progression in the books you were writing and why you felt like it's time to shine a light on this.

[Dr. Suzanne O'Sullivan]

Yeah. Everything I write comes from the patients I care for. I'm in full time NHS practice. I'm seeing patients every day. And the patients I'm seeing have changed over the decades. A lot of my patients are very young. I will see people in their 20s and they're coming to see me now and they will have a list of nine, 10 different diagnoses that they've given.

[Dax Shepard]

Themselves or they've accumulated from medical.

[Dr. Suzanne O'Sullivan]

No, they're accumulated. This is a kind of a collusion between society and the scientific world and the medical world.

[Dax Shepard]

The doctors live in the same culture that. That has its powerful impact on us 100%.

[Dr. Suzanne O'Sullivan]

And we are responding to the needs of the culture in which we live. So it's a kind of collusion of multiple different sections of society. But basically I see these young women. I always say women, but it's not Only women, but it is slightly more women. And I think perhaps I became interested because I could kind of relate to these people in this situation being dismissed. They'll come and they'll have adhd, autism, a condition which people may or may not know called pots. Postural Orthostatic Tachycardia Syndrome. If you haven't heard of it, you will see. It's best you don't. No, it's coming.

[Dax Shepard]

It might be best you never hear.

[Monica Padman]

It and then you can't get it.

[Dr. Suzanne O'Sullivan]

You can't get what you don't know. Stop listing them. But they'll have 10 diagnoses that often come in a little batch together. What's really noteworthy, I was chatting about this with a colleague recently, is basically, we didn't see people with this constellation of diagnoses ten years ago, but we also didn't see these people with a constellation of undiagnosed symptoms that fit with these diagnoses 10 years ago. So it's not like you can say that 10 years ago or 20 years ago or 30 years ago. There were loads of people suffering in this way and no one knew what it was. And now there are names for it. People are developing groups of symptoms that people didn't have 30, 40 years ago. And we're giving it names.

[Dax Shepard]

Right? So you say, like, worldwide, 537 million people are living with diabetes. That's incredible. That's half a billion. 783 million are predicted to be affected by 2045 with diabetes. Oh, God. We kind of have three explanations on the table that would make sense. One. One is we're sicker. A second explanation would be we are just finally able to diagnose all these people because we now have the language and it's in the DSM and it's in these other places. And maybe we're getting healthier because now we're getting treatment. And you're offering a third explanation.

[Dr. Suzanne O'Sullivan]

When you talk about medical over diagnosis or you say you're writing a book about medical over diagnosis. Everyone thinks of the autism, ADHD things, but you've already raised diabetes. This actually over diagnosis kind of epidemic applies to both physical and mental health problems. So it applies to cancer, it applies to diabetes, it applies to asthma, it applies to high blood pressure, high cholesterol as much as it does depression, adhd.

[Dax Shepard]

Yeah. I was shocked to read in your book that asthma diagnosis have gone up 48%. That's fricking Teddy Roosevelt had asthma. This isn't a new diagnosis.

[Dr. Suzanne O'Sullivan]

No, there's different ways that this happens. The two main ways that it happens is one, you are kind of diagnosing things that don't need to be diagnosed. So if we take diabetes, we now have this state of pre diabetes. You don't have diabetes yet, but you're almost getting it. It's not really a diagnosis in itself, but it's becoming one.

[Dax Shepard]

Everyone I know is panicked about their pre diabetic.

[Dr. Suzanne O'Sullivan]

Basically the way these things come about is that we as doctors and scientists are encouraged to make sure we keep as many people healthy as possible and therefore to find as many people who might be at risk of disease as possible and treat them. So we are incentivized to find as many people who might get diabetes as we can. And an absolutely religious belief in the assumption that finding diagnosis early and treating it is the right thing to do. So what we'll do is we'll say, okay, to be pre diabetic used to mean that you had to have a fasting blood sugar of six, but you know what, I think that's too high. We might be missing some people. So we expert committee get together and we say, let's change that parameter and say you can have pre diabetes at five point. Nothing has changed in science, nothing has changed in our bodies or in society. The only thing that has changed is that in order to make sure we are missing as few people at risk of diabetes as possible, we are going to change the number at which you can be diagnosed. And the idea then is obviously you identify all these extra people with pre diabetes. And that particular change, if applied to the entire population of China, would have meant that 50% of men in China were pre diabetic and something like a third of people in the US would be pre diabetes diabetic. So these thresholds are being set phenomenally sensitively. The thing we're not great at is proving that that actually is making people healthier. And there isn't an awful lot of evidence to suggest that by adjusting thresholds in order to identify pre diabetes at an earlier stage, you're actually preventing lots of people from getting sick further down the road. Well, actually probably aren't. And we tend to move these goalposts and consider success to be how many new sick people can we find? Rather than the more important endpoint, which is what difference has that made to these people's long term health? What we very often don't do, say in the case of cancer, we'll say, well, we screened 1,000 women for cancer and we saved one life, but we potentially treated 10 people for cancer who didn't need to be treated. And what was the impact of that? What was the impact emotionally, physically, psychologically? Everything. We're very, very good at capturing more and more disease, but we're not terribly good at measuring the implications of that down the road.

[Dax Shepard]

Yeah. How successful that was. Yeah. Let's talk about diabetes a bit further. I guess when I was growing up, if you were suffering from the condition of diabetes, you were having amputations, you were dying quite prematurely. Have we reduced the amount of people getting amputations or dying prematurely?

[Dr. Suzanne O'Sullivan]

I don't know specifically about amputations, but have we reduced the number of people who are ultimately developing diabetes? No, diabetes is still rising. And that's always my issue with these things, is now we've got this whole new population with pre diabetes, which isn't really a disease state, but a kind of a warning. And if identifying those people and then giving them advice really worked, we should ultimately have fewer people with diabetes and fewer people with serious diabetes. But we don't. So what are we doing? Why are we doing it? And what has been the impact for those people newly labeled pre diabetic?

[Dax Shepard]

Yeah. You say many of the diagnoses aren't what they seem. The quest for certainty turns borderline medical problems into ironclad diagnosis, pathologizes the normal and hurt those who are most vulnerable. In other words, we are not getting sicker, we are attributing more to sickness. Break that down a little bit.

[Dr. Suzanne O'Sullivan]

Autism was developed as a concept in 1943. And when it was developed, the people who were affected by autism had very severe communication problems. They're so severe that they would have no interest in people at all. So they were very, very disabled young people. And it began in infancy. It began at a very young age. It was obvious from an early age. And the people who had it could not function normally in the world. Now, at some point in the 1960s, Lorna Wing, a scientist, she said, well, I think perhaps this thing called autism, we're probably missing cases of it. We can see these really severely affected children. You don't have to look very hard to see them. But I think if we look in these schools, we can see there are other children who are being poorly served by society because perhaps they have a milder version of this. And I think that's really valid because when I was in school in the 1980s, there was no people with special learning needs. There must have been people who were being neglected.

[Dax Shepard]

Oh, certainly, you kind of go back in your mind and you go like, oh, right, yeah, that kid was ADHD and that kid was this. We had no terms for any of it.

[Dr. Suzanne O'Sullivan]

Exactly. And there was no support systems. And imagine how differently those young people's lives could have gone if people had realized they just learned differently.

[Dax Shepard]

It's such a complex issue. I'll add that I just interviewed Bill Gates two days ago and I said to him, he knows everything. He was consuming all things. He read all 21 volumes of the encyclopedia at 9 years old. I'm like, when did you first hear autism and did you connect with that concept? And he said, I was aware of it, but at that time they were such extreme examples that I would have never put myself in that bucket. Because again, these were people who were anonymous in it. Now, yes, he says recently, and that's what's interesting is he recognizes he is on the spectrum of it. And then the natural question is, would he have been served with that title or not? That's the big unknowable.

[Dr. Suzanne O'Sullivan]

This is the difficulty. So let's say someone realized that some children were not being properly supported and they changed the diagnostic criteria so that slightly subtler signs are sufficient to make the diagnosis. The problem we have now is that has continued since into, I would say, to a certain degree, going to be a little bit harsh. The realms of the ridiculous. Because you've got to the point now where you not only are looking for signs that are so subtle that they are barely perceptible, we are also including something which people are calling masking. And masking is you don't appear in any way autistic, but you feel autistic on the inside. This concept of masking or camouflaging made complete sense for people with severe autism. There's a program on tv, I don't know if you've seen it. It's called Love on the Spectrum.

[Dax Shepard]

Yes.

[Dr. Suzanne O'Sullivan]

And I was resistant to watching it at first because I thought it would be kind of mocking or something exploitative.

[Dax Shepard]

Yeah. But it's beautiful.

[Dr. Suzanne O'Sullivan]

There's really lovely examples of masking in that where you kind of see that the people are being taught. When you go on this date, have back and forth conversations, you can see them masking in the sense that they're learning the social rules and applying them, but it doesn't really look completely natural ever. The masking is obvious.

[Dax Shepard]

One I like to add is when the movie Rain man came out, the man it was based on was interviewed with his father and Leslie Stahl did the interview from 60 Minutes. And this was in the 80s. And he was very hard to conduct an interview with. He also memorized every book in the Salt Lake City Library and he could read with his eyes separated, both pages at the same time. So she did a follow up story on him like 10 years ago, went and revisited him. He's still at the library reading and the dad's still there and he greets her and he's making eye contact with her and he's interacting in all these ways. And when he's not there, Leslie says to the dad, he seems to have improved a lot. Has there been some treatment? And he said, well, make no mistake, he's exactly the same. He has just learned more tricks over the years. He knows to force himself to look at you and he knows to say, yes, Leslie. And so that's all that's happened. You haven't seen an improvement in the condition.

[Dr. Suzanne O'Sullivan]

That sort of masking or camouflaging, that's real masking. Yes, that's learning the social rules and applying them. But often it's hard to sustain. It can be exhausting for people who have autism and it often is very difficult. But these concepts like masking have been taken to the point now where someone can be masked all the time so that they never look like they have social communication problems and that still qualifies as a diagnosis. So we're being asked to make diagnosis in people who don't show the typical features of autism, but the self reporting of it. Yes, more people needed to be diagnosed for sure. And there were children who needed help, who were not getting help and who benefited from the relaxing of the diagnostic criteria. But now the diagnostic criteria are relaxed to a point that it's not fair to the very, very mild people who are being labeled. I'm not worried about Bill Gates at all. He seems to be doing fine for himself.

[Dax Shepard]

Yeah, yeah, yeah, yeah.

[Dr. Suzanne O'Sullivan]

I'm worried about children. So you got a 16 year old child who perhaps has some social communication problems, but they're quite mild and they're able to compensate and they're able to mask to the degree that they can function normally, albeit maybe they're nervous and they don't enjoy things and they're exhausted afterwards, but they can function. What happens to a person like that when you tell them that they have autism? You're essentially tell them that they're neurodevelopmentally abnormal, that there are things they can't do because their brain's not normal. That is a self fulfilling prophecy for a child. We've all gone through those difficult Periods. And we've had to learn to overcome our shortcomings. But if you tell a child that they have a neurodevelopmentally abnormal brain, you're really running the risk that you have this labeling effect where you concentrate on the things you can't do. You become the thing that you've been labeled as.

[Dax Shepard]

As it's so nuanced. Because what's interesting is I think the diagnosis of autism's almost more for all of us neurotypical people in quotes. Because what it does do, and I've witnessed it around me, and I myself know I'm guilty of it. If someone says, this dude's autistic, when you meet him, just know he's autistic. I can go into all these other things that might trigger me when I'm interacting with them. And I have a level of compassion now that I didn't have, which is just a shortcoming of my own. Monica and I have talked before, like, really, the end goal for all this would be to be compassionate to everyone with all their idiosyncrasies. But that label helps us. It helps us write off stuff that would otherwise irk us.

[Monica Padman]

Help it when you can't help anything about your personality, but it is a.

[Dax Shepard]

Complimentary situation because now I have lower expectations of you and you have lower expectations of me.

[Dr. Suzanne O'Sullivan]

Exactly.

[Dax Shepard]

So it can be also a self perpetuating.

[Dr. Suzanne O'Sullivan]

And it also isn't as straightforward as to say you can't help. That part of maturing is learning to adapt. You know, I was a very shy child. You would never imagine that I would be sitting here in the future. What if my shyness had been pathologized? It disincentivized people from trying to overcome their difficulties. It reinforces symptoms instead of helping people to kind of get over their problems. And I know that you're saying if someone tells you that they're autistic, you think, okay, well, I understand you a little better now. But I don't think that's everybody's attitude. I think there's also people, people who, if they hear that someone's autistic in the mild range, I should say that when I'm talking about this, I'm really talking about people who are in that borderline zone. There's always value to being diagnosed if you have significant problems. I'm talking about the value of being diagnosed if you're in that borderline zone. Some people might be understanding, but other people will be quite judgmental of that. It's also very worrying that the milder and milder the diagnosis get, the more we're trivializing this disorder for people who are really disabled by it. People with mild autism, again, this very borderline area of autism have very loud voices now because we see there's a lot of people in the public eye who have these diagnoses, and it gives people the idea that they know what these things are. I doubt they've seen many people who have what I would call significant moderate to severe autism because they don't get to be on telly and they don't get to be on podcasts.

[Monica Padman]

They're often nonverbal. It is so ubiquitous, you almost have to delineate. There's that new podcast, Telepathy Tapes, and it is about nonverbal autistic children. But you have to, oh, it's about autism, but, you know, really extreme. You have to say that as opposed to just before. That's what it meant.

[Dr. Suzanne O'Sullivan]

And the sort of tone of conversation sometimes can be quite difficult for people in that severe category, because there is a sort of conversation that says, it's okay to have these mild autistic traits. You shouldn't overcome them. You should embrace them, be your most authentic autistic trait. But I've talked to the families of people with severe autism. If they didn't help the children in the family to overcome their difficult behaviors, they would be institutionalized. They would not be safe in the world. And they find it really quite disparaging to have people going, be your more authentic autistic self. Because really, what their children need is a lot of support and to learn to control the sort of outbursts that they can sometimes, sometimes have. I don't want to say to people, well, I don't truly believe that in the very, very mild category, everyone diagnosed with autism really is autistic. I'm not absolutely convinced, however, I don't think that's the most important question that I need to answer. I think the question needs to be answered is, is it benefiting them to be labeled? Because no one can say where the line between being autistic and not autistic is. There is no such line. So it will always be difficult. I want to ask people who support the more inclusive diagnosis, how is it helping people? Because as far as I can see, it's not helping people at all if it was helping people. We've been expanding the concept of autism since the 1990s, so we're now like, a good 30 years into this. And the story I'm being sold is that you Know, if we can recognize children and give them these diagnoses and give them support, then we'll be creating happier, better adjusted adults. Are we. As far as I know, mental health problems are rising significantly, and there is no evidence at all that giving people with a very borderline diagnosis, a medical label is actually helping anybody.

[Dax Shepard]

I think, as you said earlier, this is a collusion of many, many facets. And so one that I can immediately see is parents whose children exhibit behavior that is embarrassing to them in their own ego because they're an extension of your identity. I think they themselves are comforted by some medical diagnosis as opposed to just living with the embarrassment that, yeah, sometimes your kids are really embarrassing. That's part of the fucking ride. It's not you. You don't need to go find some diagnosis so you can tell everyone, she's this, he's that, and then you alleviated yourself of that.

[Dr. Suzanne O'Sullivan]

I think that's a bit harsh.

[Dax Shepard]

You do?

[Dr. Suzanne O'Sullivan]

Yeah, I do.

[Dax Shepard]

Oh, I see so many peers excitedly sharing the diagnos. Is their kid just got.

[Dr. Suzanne O'Sullivan]

I think it's a little bit more that everyone's desperate for their children to do as well as possible, and they're desperate to do the best for their children. And this, at the moment, is perceived as a way of doing everything you can for your child because they'll get the maximum amount of help and support possible. First of all, our society is too perfectionist. You know, this kind of concept that we'll all succeed. Well, we can't all succeed. It's simply not realistic. And the idea that if you try really hard, you will ultimately get the thing you want. Well, doesn't actually work that way.

[Dax Shepard]

You have better odds of getting what you want if you try really hard.

[Dr. Suzanne O'Sullivan]

Yeah, you need to try really hard. But I was shy. I worked to overcome it, but maybe I might not have managed that at some point. And that's the point you need to recognize the things you can overcome and the things you can't overcome. And I think we still have this expectation of our children are struggling in school, that if we get them the maximum amount of help and if we push them hard enough that they will become the person we believe they can be. And. And maybe we'd be kinder to our children if we accepted that sometimes children are mediocre at certain things and instead of concentrating on that thing, funnels into.

[Dax Shepard]

One of the topics of your thing is this kind of false notion of the norm.

[Dr. Suzanne O'Sullivan]

I think that's the message that needs to get across to parents is Irrespective of what their motivation may be, I think that people perceive diagnosis as, at the least, something that will help their child. What people are not understanding is that diagnosis is not inert. You don't just diagnose someone and then it's all rainbows and sunshine. From then on in, there'll just be help and nothing bad comes with it. There are substantial harms with giving people a medical label. Other people expect less of them, as you've said. So underestimate them. They underestimate themselves. They become more aware of the symptoms. Like no one ever said to me, you're very shy. I was just aware of it. But perhaps if you have these things pointed out to you and pathologized, you become more aware of it and kind of dig into it. So I think a parent may be well meaning. We as a society must find a way of supporting children without labels. And parents who seek out labels for the children must understand what a dangerous thing that is to do to label your child at such a young age.

[Dax Shepard]

What's happening with Huntington's disease?

[Dr. Suzanne O'Sullivan]

I just think this is a really powerful story to teach us about how your experience of your body is altered, about beliefs about your. Your health. So Huntington's disease is a degenerative condition. It's very, very unpleasant. It usually Begins in someone's 30s or 40s with psychiatric symptoms and behavioral changes. It's a neurodegenerative condition. So you get frontal lobe symptoms like impulse control, and then you start getting involuntary movements. They're called choreoform movements, like funny, writhing movements. And then ultimately you lose control of your speech and of your swallow. So you have both essential psychiatric decline and you have a physical decline. It's an inherited condition. And they discovered the gene for Huntington's in 1994, I think it was. If your parent has a Huntington's disease gene, then you have a 50, 50 chance of getting it. I think this is a fascinating concept because there are people walking around knowing that they have a 50, 50 chance of getting this disease and knowing that there is a test that they can get that will tell them whether they have it or they don't. And of all those people who could have that test, only about 10 or 20% of people actually have the test.

[Dax Shepard]

Oh, interesting.

[Dr. Suzanne O'Sullivan]

They have this opportunity to know this enormous part of their health future, and they don't take it up. I spoke to a lady called Valentina. Her mother was adopted, so didn't know this was in the family. Valentina was 28 and pregnant when she discovered her mum had Huntington's disease. So the minute she discovered that, she knew she had a 50, 50 chance of getting it, and she knew that her unborn child had a 25% chance of getting it, obviously, it was devastating. She had siblings who had children. The family were very anxious, and their first impulse was to think they would be tested. They met genetic counselors, and then it was pointed out to them that the minute you test, your whole life changes if it's positive and it's a devastating diagnosis. So they put it off. Now, what happened to Valentin in the following years is, although she hadn't tested, she became absolutely convinced she had Huntington's disease. She could just tell she had it. Organization problems and anxiety, anger outbursts are common at the beginning of Huntington's disease. She began having arguments with her husband, or if she went to the airport, she couldn't organize her documents. If she was walking, she'd walk into walls. So she was aware that her symptoms were accruing, but she was frightened to have the test, to have it confirmed, because the minute it was confirmed for her, her children were at a much higher risk. And she just couldn't face the idea of looking at her children and thinking, I'm going to die, and you've got a 50, 50 chance of going the same way. So she actually waited about 20 years to have the test. And she only had the test when she was so disabled by these symptoms that she realized she just had to have it confirmed. And when she went and had the test, it was negative. She didn't have it.

[Monica Padman]

Oh, my God.

[Dax Shepard]

Oh, my God. Well, in that case, I wish she had had the test, obviously.

[Dr. Suzanne O'Sullivan]

But you see, that works both ways. It works both ways, you see, because all of her little symptoms didn't all go away. She still got flustered in airports, but it didn't get out of control. And that was what was happening, is she's noticing little things. And because she thought she has Huntington's, then she was examining her body and thinking, what's gonna happen? Cause she'd seen her mom get sick. She knew exactly what was gonna happen next. So she was really focused. But imagine if 20 years ago, she had the test and it was positive. Then every one of those symptoms, none of which were due to. To Huntington's, would have persisted. That's the difficulty with knowing you're at risk of a disease that might not happen for 20 years. The symptoms will start long before the disease starts. And every ordinary thing that happens to you, that happens to all of Us every time you lose your keys, every time you trip over a paving stone.

[Dax Shepard]

Yeah, it's confirmation bias. You're excluding a ton of data and focusing on a very tiny bit of data to validate what you already have. A hunch is true.

[Dr. Suzanne O'Sullivan]

Exactly. And it shows the power of thinking you have a disease. And that's why it's so important into this discussion about pre diabetes or autism or adhd. If you think you have the disease, some people will display the features of the disease, and that can be really hard to overcome.

[Dax Shepard]

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[Monica Padman]

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[Dax Shepard]

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[Monica Padman]

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[Dax Shepard]

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[Monica Padman]

You don't want it to be greasy? Yeah. I mean, I'm. I have loved Drunk Elephant for years and years and years, and I'm happy that you've gotten into it.

[Dax Shepard]

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[Monica Padman]

Yeah.

[Dax Shepard]

Yeah. We are so excited about this season. And we just had Walton Goggins on the show. We're inordinately excited to see his character's journey in Thailand. And then, of course, we're tuning into Severance season two on Apple TV plus with recent guest Adam Scott. Instead of toggling back and forth between different streaming platforms, you can watch both of these shows and so much more amazing content without ever leaving the premises. Prime Video app unlock a world of movies, TV and sports all in one app. Check out subscriptions on Prime Video. Well, even when I see on Instagram, because it's everywhere. ADHD is the thing. And I see these videos and of course, it's like astrology. Like, if you say enough adjectives about me, you're gonna find some that are fitting. So I'll see the couple things that are identical to me. Like, if I start brushing my teeth, I've got to immediately do something else. There's no way I can stand there and just brush my teeth. And I'll see that one. Oh, yeah, that's me. But I've also ignored the six they said that I have no connection to whatsoever.

[Dr. Suzanne O'Sullivan]

And also, we're back to something we said at the start about when does worrying about your health become hypochondria? It becomes a medical problem if you're impaired or disabled. And these are the subtleties of diagnosis that people don't really understand. I could look a list of ADHD symptoms and have them all, but they have to obey certain parameters for me to have an actual medical problem. And the Parameters they have to obey is they have to be there in every environment. You're not just autistic in school, you're autistic at home, you're autistic in every environment. And they have to be there to a degree that you are disabled by them. We've become very casual about this. Sort of like, I'm on the spectrum.

[Dax Shepard]

Or I have adhd.

[Dr. Suzanne O'Sullivan]

Well, listen, we all have some of the traits of these things, but we do not have a medical problem unless we are impaired. And it's the impairment that makes it a medical diagnosis. And that's what everyone in TikTok is really failing to appreciate. Also, I can't remember whether it was ADHD or autism, but there was something like 11 billion TikTok videos about, I think, autism. And when they scrutinized top 133, 27% of them provided accurate information, and the other 73% were just full of inaccuracies. But that's interesting, too, because those inaccuracies are seeding themselves into medical culture as well.

[Dax Shepard]

Well, it's funny, when I see the ADH eclipse, which I see all the time, it triggers something that happens a lot in aa, which is I'll be listening to someone sharing aa and they'll say, like, this, this, and this. My alcoholism. And I often go like, no, that's your humanism. You're being a human right now. And similarly with adhd, I'll go, that's just being a human in a highly stimulating world. Yes, you have that. I don't deny that. But that's normal and natural, and we all have some degree of that.

[Dr. Suzanne O'Sullivan]

Exactly. And I think we're just getting worse and worse at drawing the line between what's a normal amount of it and what is an abnormal amount of it.

[Monica Padman]

Do you think part of the problem is with social media? I feel like people want a thing that makes them specific. They want a thing that makes them special. They want something to be able to talk about, be an expert in. I wonder if the upstream.

[Dax Shepard]

Do you think they want to excuse some of their shitty, unappealing behavior? Like, yeah, I always am interrupting, but I have adhd. Don't you also think they want an excuse for some stuff?

[Monica Padman]

Yeah, I'm sure that's part of it. But I also think there is this, like, inclination to have a thing now to present to the world.

[Dax Shepard]

Like, you don't even have a personality if you don't have a thing.

[Monica Padman]

Exactly.

[Dr. Suzanne O'Sullivan]

I struggle a little bit with that because I'm seeing people who are. I'm the 15th doctor they've seen, and they've got 10 different diagnoses. And I'm seeing a slightly different population than the TikTok population. Right.

[Monica Padman]

That's what I'm talking about.

[Dr. Suzanne O'Sullivan]

And I think it's difficult because you can make generalizations about what's happening on TikTok, and then I assume the people who come to me are suffering. And perhaps I don't agree with the labels and perhaps I don't agree with specific diagnosis, but I do appreciate that if they've made it all the way to my clinic, then they're not well and there's a problem. You know, it can be very difficult for them to hear us saying things about looking for attention. There is something nice about being part of an illness group. It makes you feel validated.

[Monica Padman]

Makes me feel validated.

[Dax Shepard]

Seen.

[Monica Padman]

Yeah.

[Dax Shepard]

But the distinction you're making is great. Of all the people I'm seeing on Instagram, the declaring themselves, my guess that I feel strong about is like 90 of those people have never seen a doctor for, and they have no program of treating it.

[Monica Padman]

They don't want to treat. That's my whole point. They don't want anything to change necessarily. They just want to say, I have this or I'm this.

[Dr. Suzanne O'Sullivan]

Most of them in that sort of category. Next year, there'll be something else on TikTok, and these social trends occur on social media. But the difficult thing is that a small proportion of people, these diagnoses will stick, and that becomes really problematic.

[Dax Shepard]

What's going on with chronic Lyme and long Covid?

[Monica Padman]

Oh, God. Yeah.

[Dr. Suzanne O'Sullivan]

Lyme disease is caused by bacteria, which you get from a tick, when the ticks come from deer. Lyme disease is just essentially an infectious illness. But there is a subset of Lyme disease called chronic Lyme disease, I think they're called. The National Institute of Allergies and Infectious Diseases would define chronic Lyme disease as a set of symptoms that has nothing at all, all to do with a borrelia bacterial infection and nothing at all to do with Lyme disease. There's a large number of people throughout the world who have been labeled as having a form of Lyme disease called chronic Lyme disease, which probably is not an infectious illness. Now, the difficulty is that Lyme disease can cause symptoms that we all get, like fatigue, aches and pains and things like that, which, quite frankly, are symptoms of everything. What happens in society is when people are suffering with those kind of symptoms and they're struggling to get a diagnosis, they will take the diagnosis that's salient at a moment in time. And chronic Lyme disease is a very salient diagnosis at the moment. It's for people who are struggling without a diagnosis. It can explain a lot and it allows people enter a community where they can get support and they can get treatment with antibiotics, which don't work, but gives them the sense that they are being treated. Lyme disease is a very good example of how medicine is an art. You know, it's not a matter of someone comes to see you and you think they have a bacterial infection, so you do blood and they either have it or they don't. Tests are so much more sophisticated and hard to interpret than that. You know, every single blood test we do, every single brain scan we do comes with 100 caveats. If you live in a Lyme disease area. There was a study in the UK in a place called the New Forest where there's loads of Lyme disease and foresters who work there. Something like 25% of them will test positive for Lyme disease. If you test them, doesn't mean they have Lyme disease, just means they've been in this area for a long time. You have these kinds of variables and this is a problem in Lyme disease. If I wanted to make a lot of money, I could diagnose a lot of people with Lyme disease by doing that blood test and telling them you've got an abnormal blood test and therefore you have Lyme disease.

[Dax Shepard]

So some people have Lyme disease and really no symptoms.

[Dr. Suzanne O'Sullivan]

Well, it's not they have Lyme disease, they've been exposed to the bacteria, they've had an immune reaction and antibodies and they never got sick and therefore they fought it off. Perhaps they had a really mild case, they didn't notice. People are kind of aware that perhaps mental health problems and things may be a little overdia, but they don't think quite so much about how the parameters of physical diseases have changed and led to over diagnosis. It's fine that we do what we do as long as people are able to go to their doctor and ask the right questions and understand the issues.

[Dax Shepard]

Long Covid. This is one that I just intuitively when I hear it, I'm a little.

[Dr. Suzanne O'Sullivan]

Skeptical of how it came about is so interesting really because as a hashtag it appeared on Twitter. An Italian woman tweeted long Covid on 20th May 2020, raising awareness about chronic symptoms after COVID infection. For the mildly affected, you say March of 2020.

[Monica Padman]

May.

[Dax Shepard]

May.

[Dr. Suzanne O'Sullivan]

Okay, so only three months in well, that's precisely. You know, we're already predicting disability for millions and we haven't even had time really for chronic illness to develop. But this concept that a mild illness could lead to chronic disability took off after that hashtag. It was shared throughout the world. And this story spread the concept that the mildly affected could develop long term symptoms. You know, it went from Twitter to mainstream news to medical newspapers with phenomenal speed, with no scientific study whatsoever with just it being sort of a word of mouth.

[Dax Shepard]

We would have to be years out to ever actually declare something long Covid.

[Dr. Suzanne O'Sullivan]

There was so much that was counterintuitive to this being related. Let's just say that of course there are people of chronic symptoms if they were hospitalized. I volunteered in ITU during the pandemic, I saw how people bad things were. You would not be surprised. A very sick person would have chronic symptoms. Also, all viral illnesses cause chronic symptoms in a small proportion of people. There is really good evidence that most people, however, with long Covid probably didn't get it related to the virus, but rather to the kind of idea of long Covid. Firstly, it's a different population. So people in hospital were older people with diabetes, they were mostly men. People with long Covid were younger people, healthier people and, and mostly women. And studies that have emerged have been very interesting. Like loneliness is a precursor for long Covid. A study in Germany followed healthcare workers from the beginning of the pandemic and people who had an expectation of symptom severity developed long Covid. So if you expected to get it, you got it. Depression.

[Monica Padman]

I kept hearing brain fog. I'm like, we're in a pandemic, our brains are foggy.

[Dax Shepard]

Yeah, we're down. We've knocked out 80% of the stimuli we're used to.

[Dr. Suzanne O'Sullivan]

And that point is so important because what they were doing in the studies at the beginning on long Covid is they were surveying people, they were self diagnosed and a self diagnosed person is more likely to get long Covid. And they all had huge constellation of symptoms, but there was no control group. And later when they'd had time to do the science properly and they were now comparing people with long Covid with people who were in the pandemic who didn't get Covid. They also had hundreds of symptoms.

[Monica Padman]

Of course it was crazy times psychologically.

[Dr. Suzanne O'Sullivan]

So science of long Covid was very poor at the beginning and the general public was scared witless by this concept that they could get chronically ill even if they weren't hospitalized. And much like other People I've described, like the lady with Huntington's disease. If you think you're going to get chronically ill, then a small proportion of us will get chronically ill. I don't want to be dismissive of it because it served a very important purpose. There were people dying, and that was terrible. And there were people losing loved ones and that was terrible. And there were people losing jobs and that was terrible. But there were also a lot of other people who were suffering and there was no space for them. Where did they go? People at home, alone, with nobody to talk to, who weren't necessarily physically very ill. Long Covid gave them a voice, it gave them a group, it gave them place to go, and it gave them a name for their suffering that other people gave more respect to than just we're all in a pandemic and I'm having a horrible time. Nobody had any sympathy for that. So it served an important social purpose.

[Dax Shepard]

How do we correct. How do we keep all the upside of figuring out a lot of these diseases and providing help for people and how do we shave off this large group that's also shouldn't be seen as having a pathological disease?

[Dr. Suzanne O'Sullivan]

I think it's kind of a multifactorial. Lots of people have to change a lot of things that they're doing. First of all, as a medical community, we need to really challenge this assumption that early diet diagnosis works. Because we've been diagnosing cancer, blood pressure, diabetes earlier, we're not making anyone any better. I think we do need, and this might sound a bit strange to dial back on some of the mental health campaign awareness work that we're doing, because there was a very interesting study out recently that showed that raising mental health awareness in schools actually added to emotional distress rather than subtracting from it. We perhaps would do better, better to teach people what normal looks like and learn how to support children without labeling them. Why can't we recognize that a child is struggling a bit in school and can do with learning differently without calling them neurodevelopmentally abnormal? So I think maybe we change the names. Support people without labels would be really useful.

[Dax Shepard]

Yeah, you get into the structural and logistical issues there. It's like there are X amount of resources given to the those added hours of teaching and test taking. And then it's kind of the same way the insurance reimbursement works is we've got to get this one thing so we can get this other thing we need.

[Dr. Suzanne O'Sullivan]

I mean, you're right. I don't think it's very simple. It would require a huge overhaul of systems in order to allow us to support people without medicalizing them.

[Dax Shepard]

Right.

[Dr. Suzanne O'Sullivan]

Also, we've got no support systems outside of medical institutions. Where do people go who are suffering? A doctor is a place you can still go. Perhaps we need better support systems for people that are not surrounding medical institutions. They don't feel the need to be labeled, to belong to a group and to get support.

[Dax Shepard]

Yeah. If there was just a place you could go to that was funded, that was like, I feel shitty therapy.

[Monica Padman]

Or is that still too.

[Dr. Suzanne O'Sullivan]

I think that's still sort of medicalized. People just want to belong to a community. And the uk, the church isn't quite so prominent. It's slightly different in the US in the uk, I'd say that system of being supported by your church has really been lost. But, you know, I'm not advocating for that idea, but there is something to be said.

[Dax Shepard]

We want church without all the collateral charges that came with it. Yeah. Without God, without priests, without pedophiles. I love this topic, and I think it's actually kind of brave, but I do think you do it with a ton of compassion. Even tackling psychosomatic disorders in the way that you have. With compassion and actually a call to treatment for the people.

[Dr. Suzanne O'Sullivan]

It's difficult for people to hear some of the things that I'm saying. And I do understand that it'll be.

[Dax Shepard]

Threatening to a lot of people.

[Dr. Suzanne O'Sullivan]

You know, I think that a lot of people in the world are aware that something isn't going right. Mental health problems. Something like one in five people in the world now has a mental health diagnosis, and there is something definitely wrong there. Sometimes it can be frightening to be honest about what you think is going wrong. But I think a lot of people have a lot of suspicions that aren't being voiced. And we do need to have these discussions more openly.

[Dax Shepard]

Well, Dr. O'Sullivan, this has been wonderful. I'm so grateful that you're. You made the long trip to be in rain and be at Harry Potter.

[Dr. Suzanne O'Sullivan]

I was absolutely thrilled and delighted to be here. I'm honored. So thank you so much.

[Dax Shepard]

Oh, yeah. Everyone check out the Age of Diagnosis. Incredible book. Incredible message. Thank you. Hi there. This is Hermium. Permium. If you like that, you're going to love the fact check, Ms. Monica.

[Monica Padman]

It's a little chilly.

[Dax Shepard]

Wow. Talk about a reverse reversal. Reversal.

[Monica Padman]

Double reversal.

[Dax Shepard]

This is a reverse back. Oh, my God.

[Monica Padman]

Reverse back.

[Dax Shepard]

Because last fact check, I was in a sweatshirt. You were in a T shirt. You were not cold.

[Monica Padman]

Yeah.

[Dax Shepard]

Now you're freezing. I'm in a tank top.

[Monica Padman]

I know.

[Dax Shepard]

And I'm hot.

[Monica Padman]

I had walked yesterday.

[Dax Shepard]

Oh, and you didn't walk today.

[Monica Padman]

No, I didn't.

[Dax Shepard]

And I just exercised with.

[Monica Padman]

That's the answer.

[Dax Shepard]

Resistance training. The aliens would be really confused by weightlifting.

[Monica Padman]

Oh, yeah.

[Dax Shepard]

Because initially they'd be like, oh, this. He. That monkey. He has to get that thing up and he's gonna move it somewhere. Oh, he's. Now he's setting it down. Oh, maybe it was too heavy. No, he's picking it back up again. Where's he gonna. No, he's setting.

[Monica Padman]

Yeah. They don't get it.

[Dax Shepard]

Just repetition. Useless.

[Monica Padman]

Do you think aliens have to worry about bone density?

[Dax Shepard]

There's zero gravity.

[Monica Padman]

They do.

[Dax Shepard]

They don't even need. Really Muscles.

[Monica Padman]

So jealous. Yeah. Speaking of. Well, this episode, which is for Dr. Susanna, Dr. Seuss. Yes. It's connected to this episode, but it's also a ding, ding, ding for a future episode. I'm starting to panic that I have something. Oh, and interesting. It might be psychosomatic.

[Dax Shepard]

Yeah. I would have thought your conclusion after Dr. Suzanne O'Sullivan would have been. I'm not gonna ignore that. All that stuff. But it. You're saying it got worse?

[Monica Padman]

Well, it didn't. It didn't get worse. I was like, oh, yeah, I'm fine. Nothing's, like, really getting in my way, you know?

[Dax Shepard]

Yeah, yeah.

[Monica Padman]

But then we have another expert coming up. Easter egg. And there is something brought up in that episode.

[Dax Shepard]

I'm as lost as the rest of perimenopause. Oh, perimenopause.

[Monica Padman]

Well, I want to cut it.

[Dax Shepard]

Yeah, yeah. No, we've been saying we're going to have one for a long time. That's okay.

[Monica Padman]

I know, but I want. I don't want to get into the details because it's not. I think I have perimenopause. It's. I think I am getting further frozen. Shoulder.

[Dax Shepard]

Oh, you're probably. Your just. Shoulder hurts.

[Monica Padman]

Maybe.

[Dax Shepard]

Can you track. Can you trace it to any activity?

[Monica Padman]

If I must.

[Dax Shepard]

Okay. What would be your guess?

[Monica Padman]

I mean, sometimes I do some little lifting.

[Dax Shepard]

Some lifting?

[Monica Padman]

Yeah.

[Dax Shepard]

Did you lift weights?

[Monica Padman]

Yeah, sometimes I do.

[Dax Shepard]

And then your shoulder hurts?

[Monica Padman]

Well, no, it also happened when I.

[Dax Shepard]

Was home in Georgia.

[Monica Padman]

Yeah, I had.

[Dax Shepard]

But you don't call that home anymore.

[Monica Padman]

Oh, God, it's so confusing. It happened when I was. Was home. Something happened when I was home that made me think, oh, gosh, I might have this thing that my mom had and my grandmother had.

[Dax Shepard]

Yeah, but what Age did your mom have at.

[Monica Padman]

Let me ask.

[Dax Shepard]

I think it's rally.

[Monica Padman]

Okay, let me ask. I have a crazy sim.

[Dax Shepard]

Okay.

[Monica Padman]

It's bad. Like, I feel bad saying it, and I think people might be mad at me for saying it, but I have to. This wild.

[Dax Shepard]

Gonna get it off your desk.

[Monica Padman]

So because of the SAG Awards, there was a bit in there about Gossip Girl that I wrote. And because of it, I was mimicking the opening of the pilot. So I started the pilot to hear the voiceover to write it.

[Dax Shepard]

The Gossip Girl pilot?

[Monica Padman]

Yes. And so it was just on og.

[Dax Shepard]

Original Gossip Girl or the reboot?

[Monica Padman]

Original.

[Dax Shepard]

Okay, great.

[Monica Padman]

With Kristen. So then when I listened, I just kind of had it. I kept it going.

[Dax Shepard]

Yeah.

[Monica Padman]

So I've been watching it at night back in. I've just had.

[Dax Shepard]

You watched it when it was airing.

[Monica Padman]

Yeah.

[Dax Shepard]

Oh, you did? That was one of your shows. Okay.

[Monica Padman]

So I was doing a little rewatch, casual rewatch, which was nice and nostalgic. Liked that. And I just got to this part with Michelle Trachtenberg.

[Dax Shepard]

Oh, wow. Okay.

[Monica Padman]

And. And I was watching. She was on, you know, a bunch of episodes, but this was her first time on it. And I was. And I thought, whoa. I haven't, like, seen her in a while. And she has a really great part on that show. And she plays a horrible villain who I. Who is scary and manipulative and skewy. And so I've been thinking a lot about her, and even yesterday I said to Jess, I said, I'm rewatching Gossip Girl. And did you see it? Michelle Trachtenberg has such an interesting part in it.

[Dax Shepard]

Yeah.

[Monica Padman]

And then she passed away today.

[Dax Shepard]

Yeah. That is weird.

[Monica Padman]

It's really sad. I mean, I don't know any of the details.

[Dax Shepard]

Nor do I. By the time this is out, maybe there will be some details.

[Monica Padman]

Yeah.

[Dax Shepard]

But I just go through a checklist in my mind because I like everyone else, or I think we all want to make sense of the world. It's like, I know if it's nonsensical, it's very scary. If it makes some kind of sense, I can deal. Deal with it. And so I. Yeah, I just go, 39 is too young to die of all the other things.

[Monica Padman]

Yeah.

[Dax Shepard]

And then I just start doing, like, probabilistic guesses.

[Monica Padman]

I know. Me too. We all do, I think. And I mean, when things are ruled out, like a car accident or things like that. Yeah. We start making.

[Dax Shepard]

But I remember people, we. We were pretty early, or I was. Or I. I felt no tension for me Personally, to guess that Matthew Perry had OD'd, but people were really mad at me about that.

[Monica Padman]

Well, you knew him. I mean, that's.

[Dax Shepard]

I knew him. And it's just. It's my disease. I.

[Monica Padman]

Like, I know she did have a liver transplant.

[Dax Shepard]

Oh, she did.

[Monica Padman]

Oh, it's really sad. So tragic. And. What? That's so weird.

[Dax Shepard]

Oh, yeah, yeah, yeah, yeah, yeah.

[Monica Padman]

I mean, I haven't. I haven't thought about her in a really long time. And then yesterday I said it. Said her name out loud for the first time. I don't. My rings back. That's what Jess said. He says you really need to be careful.

[Dax Shepard]

You need to be a little more careful.

[Monica Padman]

What am I supposed to do?

[Dax Shepard]

Just watch new stuff? Just watch new stuff.

[Monica Padman]

Oh, my.

[Dax Shepard]

I'm rewatching something, too. I started something over again, which I don't really do. I've done Patriot three or four times, but I'm unsatisfied with the amount of gogs. Goggins I'm getting in White Lotus.

[Dr. Suzanne O'Sullivan]

Oh.

[Dax Shepard]

It's like. It's a. It's a tease hit of Goggins.

[Monica Padman]

I'm not caught up.

[Dax Shepard]

Okay. Did you watch the first episode? There's only two. Yeah. So it's like, you know, it's like when someone would offer me one Vicodin, I'm like, I would just go, I would pass. I would go, well, do you have four?

[Monica Padman]

Interesting.

[Dax Shepard]

And if they'd say no? No. I go, oh, okay. Thanks for the offer, but I don't want a hint of the feeling I'm going for. I'll just get really agitated.

[Monica Padman]

I understand that.

[Dax Shepard]

This is no knock on White Lotus. It's great.

[Dr. Suzanne O'Sullivan]

Yeah.

[Dax Shepard]

It's just an ensemble, of course. And I just. I want some guy.

[Monica Padman]

You wish he wasn't even in it.

[Dax Shepard]

No, no, no. I'm not going to put him on. I'm not going to fully map on the Vicodin analogy. But I did start Fallout over again.

[Dr. Suzanne O'Sullivan]

Oh, no.

[Dax Shepard]

Last night, I'm like, I need to see him for like 17 minutes with no nose, tons of dialogue, making moves. Yeah, yeah. And it's. And I watched it recently, but I'm. It's. It's great. O'Sullivan has come up a lot in my life since we interviewed her.

[Monica Padman]

Me too.

[Dax Shepard]

Yeah.

[Monica Padman]

I loved this episode, but I loved what it made me start thinking about and questioning and I think everyone is over diagnosed.

[Dax Shepard]

I think everyone's over diagnosed. And then. And also it put. I'm glad she asked this, like, second round of questioning about Psychosomatic disorders. Because I think I was. I kind of. I think I would have guessed about the number. She said, like, it wasn't shocking to me that 30% of all neurological seizures are psychosomatic or that 30% of that was shocking. No. I know so many people who go to the personally. I know a lot of people who've gone to the doctor having a heart attack. And it's not that it's anxiety.

[Monica Padman]

Yeah. But a seizure.

[Dax Shepard]

So you would think, like, you can't trick it. But then again, I don't, I don't. I've never thought they were tricking them. That's right. Like that's Moon House where you're faking something. I've thought, no, people are experiencing this. I don't doubt that.

[Monica Padman]

Right.

[Dax Shepard]

But I didn't go the step further, which I like that she did. Which is like, yes, they're psychosomatic. They're not the cause of them aren't this other thing.

[Monica Padman]

Yeah.

[Dax Shepard]

But the, the results and the symptoms are actually the same symptoms. They're just as ser. And in fact more so in epilepsy, as she said, an epileptic would probably have one seizure a year or maybe one a month would be a lot.

[Monica Padman]

Well, medication would help if you can.

[Dax Shepard]

Have a hundred seizures a day.

[Monica Padman]

No medication.

[Dax Shepard]

Yeah. Her going, I think I was in the past. Like, yeah, that's psychosomatic. You can't do anything about that.

[Monica Padman]

Yeah.

[Dax Shepard]

Like it's in your head.

[Monica Padman]

Yeah.

[Dax Shepard]

So what do we. What would we do? But the notion that she's really screaming we need treatment for psychosomatic illnesses.

[Monica Padman]

I know.

[Dax Shepard]

It's the same experience.

[Monica Padman]

Exactly.

[Dax Shepard]

Yeah.

[Monica Padman]

Well, she said for some people it helps to know that that's what's happening. And that makes sense. That's almost like a DBT.

[Dax Shepard]

CBT. DBT. Boys to Man DVD A W Velvet DeVoe, but it's only works 30% of the time.

[Monica Padman]

I know.

[Dax Shepard]

Which is a bummer. But again, the same with recovery for addicts. Nothing's above 30%. But for me, I'm at least going to go try the thing that I have a 30% chance at. And for me it worked. So I think people should still try pursue it. Whether it's 30%.

[Monica Padman]

I agree. I wonder how many neurologists know. I mean, do you think they all know this?

[Dax Shepard]

They must. Because.

[Monica Padman]

Yeah.

[Dax Shepard]

As she said, she would start talking to other specialists.

[Monica Padman]

Yeah.

[Dax Shepard]

Asking the pulmonologist, asking the cardiovascular, asking the.

[Monica Padman]

Yeah.

[Dax Shepard]

And they immediately are like, oh, yeah, it's like 30% that aren't actually having.

[Monica Padman]

The thing so weird because like I had not heard that at all and I had gone to it. Or it's not like he said, well let me see if they're psychosomatic. Like that was not a thing.

[Dax Shepard]

Right.

[Monica Padman]

At all.

[Dax Shepard]

But what's. What is unfortunate. And it probably. I'm surprised this didn't come up because you can delineate the difference. So you can observe the brain having an epileptic surgery seizure versus a psychosomatic seizure. And there's a clear difference.

[Monica Padman]

Yeah.

[Dax Shepard]

Same with the heart stuff.

[Monica Padman]

Yeah.

[Dax Shepard]

Same with the breathing stuff. All of it. The mental stuff is not observable.

[Monica Padman]

Yeah.

[Dax Shepard]

We cannot tell the difference between whether you have psychosomatic depression or any of these disorders.

[Monica Padman]

Yeah.

[Dax Shepard]

We can't tell if you have some base biology or biochemistry or anything.

[Monica Padman]

Yeah.

[Dax Shepard]

So what do we do about those.

[Monica Padman]

Like the over diagnosis of adhd?

[Dax Shepard]

You could have all the symptoms of adhd. It would be weird to me that this tracks almost perfectly across all of the different medical conditions. And then it would stop at ADHD.

[Monica Padman]

No.

[Dax Shepard]

Right.

[Monica Padman]

Yeah, it is. It is.

[Dax Shepard]

So third, I would argue probably conceivably 30% of people with ADHD, they definitely have the symptoms of ADHD.

[Monica Padman]

Sure.

[Dax Shepard]

But they don't have ADHD as we think of it.

[Monica Padman]

Yeah. But also because we just decided what that was like. I. It's not. I mean.

[Dax Shepard]

Yeah. What level are you distracted?

[Monica Padman]

Diabetes are like clinical and medical and ADHD is. But now we've diluted it into that. Like everyone, everyone has it.

[Dax Shepard]

Right.

[Monica Padman]

And I. That's just personality traits to me. I'm gonna get in so much trouble for saying that. But I think a lot of it is us taking personal personality traits that aren't.

[Dax Shepard]

Are making them disorders.

[Monica Padman]

Yeah. That are our favorite personality traits and calling it a disorder.

[Dax Shepard]

Yes. But. But she was quick to acknowledge too. Even the markers in the heartless calm. The hard sciences of biology. Like taking a blood sugar level.

[Monica Padman]

Yeah.

[Dax Shepard]

That's a metric.

[Monica Padman]

Yeah.

[Dax Shepard]

But even if they set it at 3 or 9 or 20, 23 or that is arbitrary to some degree. They've all decided like when do we think this really tips into exactly. Something very destructive for the body. And they set a, A number. Then you get into like okay, attention deficit. What level of fragmented attention requires is. Before we get to a pathology, the.

[Monica Padman]

Bar should be that it's disabling.

[Dax Shepard]

Yes. Disabling. Unless you're going to separate identical twins and raise one with a label. One without a label. And I say this in total good Faith. I just want to know what the best.

[Monica Padman]

Yeah.

[Dax Shepard]

Outcome is.

[Monica Padman]

I agree.

[Dax Shepard]

I'm not really against or for any of it, really. I just would like to know what's the best outcome.

[Monica Padman]

I mean, I think also unfortunately, that's nebulous. It's for. For one person having diagnosis is probably very helpful. For another, it could get in their way. I mean it. It's hard to know.

[Dax Shepard]

The risk I think I'm most afraid of is that you inadvertently limit someone's potential.

[Monica Padman]

Yeah.

[Dax Shepard]

Because you accept that this condition has these limits.

[Monica Padman]

I agree.

[Dax Shepard]

And just setting a limit before it's really discovered is just a little precarious and dangerous.

[Monica Padman]

It's so personality driven. I mean my brother. I saw my brother last night which was really nice.

[Dax Shepard]

Yeah. How was it? What did you get? Did you guys go out to eat?

[Monica Padman]

Went to dinner. Where all time. It was really nice.

[Dax Shepard]

Yeah.

[Monica Padman]

But we talked a little bit about this. I think he felt like he wasn't good at school. And then so then he. I think subconsciously. And he was like maybe even a little consciously just said it.

[Dax Shepard]

Yeah.

[Monica Padman]

Like if I can.

[Dax Shepard]

You're probably in the mix of that equation. I think. I think he's also going, I'm not gonna be Monica.

[Monica Padman]

Yeah.

[Dax Shepard]

So maybe I'm not even gonna try to be Monica.

[Monica Padman]

Yeah.

[Dax Shepard]

Because I've decided I've given up on that. And to even try to improve myself would be seemingly like trying to be her. And I. I can't be her.

[Monica Padman]

That's possible. I mean he's. Yes. He's so different from me. He made a many different choices.

[Dax Shepard]

I have fucked up my younger sister in lots of ways. I wish I hadn't. But.

[Monica Padman]

Yeah. And I don't need. Is it them up or just making them. It might just make them have their own. Like really feel the need to define themselves.

[Dax Shepard]

But like Nikki's life was hugely impacted by having a sister 18 months younger than her that was being told she was beautiful. Everywhere they went like that. Just her up. It's not the younger sister's fault.

[Monica Padman]

Of course not.

[Dax Shepard]

But I think living in immediate proximity to somebody.

[Monica Padman]

Yeah.

[Dax Shepard]

Is. Is. You know.

[Monica Padman]

I guess so. I mean I think my brother was spared a lot of it because of the eight year gap. Like I was out by the time he was 10, you know.

[Dax Shepard]

Yeah. But he certainly knew. I'm sure your parents said Monica got these grades or she.

[Monica Padman]

They might. Well, they definitely were shocked at what was going.

[Dax Shepard]

Yeah. Yeah.

[Monica Padman]

By things that weren't. Shouldn't have been shocking.

[Dax Shepard]

Yeah.

[Monica Padman]

So. Yes. I Do think maybe the bar was set?

[Dax Shepard]

Do you think they just. Because I would have just gone like, yeah, he's a boy.

[Monica Padman]

I said that he did. I was like, it's gonna be fine. It was building on itself. Like, the more he felt like he wasn't doing the right thing, then he would do something else that was not the right thing. And something else. Something else. Like, it was. It's. Yeah. But you know what's also funny is they were so worried, of course. And he's doing great. Just got a promotion. Like, he's great. It all is fine.

[Dax Shepard]

This is like, you know, I have a few different friends in my life who. And one just totally admittedly, and I love him. And his honesty. Insane. Is like, he's hell been on getting his kid out of one school into this other school and the kids evaluated, and the other school's like, I think he needs more time at this school. And he's taking that personally. And, you know, at a certain point, he had the sobriety to go, I want this.

[Monica Padman]

Yeah.

[Dax Shepard]

My son doesn't want this.

[Monica Padman]

Yeah.

[Dax Shepard]

I'm Will run riot. I'm trying to control everything in the world. And it's so true. It's like, you don't have to end up in these places. You don't have to end up in the fucking school, and you don't have to end up with good grades.

[Monica Padman]

And you don't.

[Dax Shepard]

It's.

[Dr. Suzanne O'Sullivan]

It's just.

[Dax Shepard]

It's just one version of how you can go through life.

[Monica Padman]

I know.

[Dax Shepard]

And I know people have done every version, and it has no prediction on their happiness or their fulfillment or their sense of purpose.

[Monica Padman]

I know. I agree. And that's also a ding, ding, ding of this episode because that's sort of what she was saying. She's like, the expectation is that everyone's supposed to hit a hundred at everything. She, like, it's not realistic.

[Dax Shepard]

Yeah.

[Monica Padman]

And then we say there's a disorder that's causing them to not, you know, reach the highest potential. And it's just like, that's just life.

[Dax Shepard]

Two of our best friends, our mutual best friends are. Will tell you, at the drop of a hat, admittedly, they hardly got through school. They both would be like, we can't. We didn't know anything at school. And they are. I would list in all the people I've met in my life, they're among the most successful humans I've ever met. They have more friends than anyone I know. They have more fun. They're better parents. They've totally made a Great living and have a great life, 100%, and who gives a flying fuck? They had a bunch of people we know, much smarter, did way better academically, and they're not having be nearly as big of a life.

[Monica Padman]

No, I know, I know. I agree.

[Dax Shepard]

When he and your dad have a drink, what do they have?

[Monica Padman]

They don't really. I mean, if we're out at dinner, my dad will get beer, I will get wine. Normally, my mom sometimes will get a cocktail. Like a sugary cocktail.

[Dax Shepard]

Sure. Like some kind of paradise.

[Monica Padman]

Yeah, exactly. Sangria loves a sangria. And my brother will get like a tequila soda or a.

[Dax Shepard]

Sure.

[Monica Padman]

Whiskey something, you know.

[Dax Shepard]

You and your dad are the drinkers.

[Monica Padman]

Yes.

[Dax Shepard]

Yeah.

[Monica Padman]

Yeah.

[Dax Shepard]

And will you and your dad ever get kind of drunk?

[Monica Padman]

Yeah.

[Dax Shepard]

Yeah.

[Monica Padman]

Well, yeah, he does. And so I guess I am. I'm sure I am, too. Not drunk. Not drunk. But, like, loose.

[Dax Shepard]

Yeah, yeah. Loose.

[Monica Padman]

Yeah. Yeah. But my mom. I'm so critical of my mom.

[Dax Shepard]

Yeah, that's standard.

[Monica Padman]

And he's so critical of my dad.

[Dax Shepard]

Yeah, very standard.

[Monica Padman]

I know. It was funny because Jess was there and he was like, oh, a daddy's girl and a mama's boy. Like, duh. Classic.

[Dax Shepard]

Textbook.

[Monica Padman]

And my brother was like, oh, yeah, I guess. I guess it is. It's not special, but. Yeah, it is.

[Dax Shepard]

It's a lot easier to project onto the same gender.

[Monica Padman]

Yes.

[Dax Shepard]

Yeah.

[Monica Padman]

It's tough.

[Dax Shepard]

Yeah. My mom, you know, Carly will give my mom a good run. I was. I was. I would give my father the hardest of runs.

[Monica Padman]

Yeah.

[Dax Shepard]

Oh, I don't know how he loved me.

[Monica Padman]

It's hard. I mean, my mom and dad are on a cruise right now.

[Dax Shepard]

Oh, they are? Where are they going?

[Monica Padman]

Oh, I forget all these places. Yeah.

[Dax Shepard]

In the water somewhere.

[Monica Padman]

And they sent a picture, or my mom took a picture and sent it to my brother. Brother and I on the group chain. And then I woke up to this, and my. All I saw was my brother say, why aren't you smiling? And then he had, like, laughing emojis. And I looked. And then, yes, my mom had taken, like, a selfie of the. Of her and my dad. Yeah, my dad is smiling and she is looks.

[Dax Shepard]

She's probably nervous about it, taking the picture.

[Monica Padman]

So. Yes, I do think that's what it is.

[Dax Shepard]

But, like, she had a lot on her voice.

[Monica Padman]

My brother is laughing, laughing. And I'm like, yeah, why can't you just. Why aren't you smiling?

[Dax Shepard]

You had the same reaction.

[Monica Padman]

Yeah, I have the same reaction, but his is like. He can. He's like, that's silly.

[Dax Shepard]

Yeah, yeah, yeah.

[Monica Padman]

But I am like, mom, why?

[Dax Shepard]

Come on, Mom.

[Monica Padman]

I know.

[Dax Shepard]

And I would have saw it and go like, oh, yeah. Nermie's nervous about having to take this self.

[Monica Padman]

I know. Which is the. Exactly what it is. And she said, oh, I wasn't paying attention and was like, yes. What do you mean? Like, then you. It's like, of course you were paying attention because you took the picture. That's.

[Dax Shepard]

Well, she was paying attention. Attention on how to operate the camera, not how to pose in a picture. Yeah. She forgot she was in the picture because she was.

[Monica Padman]

They sent another one yesterday and everyone.

[Dax Shepard]

Was smiling for smile.

[Monica Padman]

Yeah.

[Dax Shepard]

Because you're doing to her what they did to women historically. Smile more.

[Monica Padman]

Why don't you smile more?

[Dax Shepard]

You know, you should smile more.

[Monica Padman]

I know. I feel bad. But you know what? This is the way.

[Dax Shepard]

It's true that that's good advice for everybody, not just women. Everyone should smile more.

[Monica Padman]

I agree.

[Dax Shepard]

Yeah. It's infectious.

[Monica Padman]

It can work the outside in.

[Dax Shepard]

Right.

[Monica Padman]

But yeah, so I felt bad about that. But what can we do?

[Dax Shepard]

Yeah, we gotta try to do our best.

[Monica Padman]

We're all just really doing our best.

[Dax Shepard]

Stay tuned for more Armchair expert if you dare. We are supported by Quince. Quince is one of our favorite apparel brands with luxury fabrics and finishes at affordable prices. Everyone I know is obsessed with Quince.

[Monica Padman]

Quince is amazing. I was gifted an incredible blanket from Quince from a Elizabeth and Andy.

[Dax Shepard]

Oh, wow.

[Monica Padman]

And it's so warm and soft and fuzzy and cute.

[Dax Shepard]

Yeah. All their fabrics are so nice. You get the best of both worlds. Killer style at prices that don't break the bank. Quint has some great wardrobe staples, all at prices that are way less than similar brands. We're talking 50 to 80% less.

[Monica Padman]

This is a gift givers.

[Dax Shepard]

Like paradise.

[Monica Padman]

Paradise. Correct.

[Dax Shepard]

Well, that's because Quint partners directly with top factories, so they cut out the cost of the middleman. And they also make sure the factories they partner use safe, ethical and responsible manufacturing practices so you can feel good about your purchase. Indulge in affordable luxury. Go to quint.comdax for free shipping on your order and 365 day returns. That's Q-U-I-N-C-E.comdax to get free shipping and 365 day returns. Quints.comdax.

[Monica Padman]

That was nice to spend some time.

[Dax Shepard]

And he's off to Big Bear.

[Monica Padman]

He's off to Big Bear with some friends.

[Dax Shepard]

Did you find out if they're gonna ski?

[Monica Padman]

They're gonna ski.

[Dax Shepard]

They are gonna ski.

[Monica Padman]

Yeah.

[Dax Shepard]

And he. Your brother has as well.

[Monica Padman]

No. And so now. So, okay, this is another thing. I'm like, why? Why do we do this? Why did we fall into these roles? So it's so exhausting. It's so ex. Exhausting to be like, I'm nervous about him skiing. I'm nervous about him getting to Big Bear at night.

[Dax Shepard]

Oh, you have all these fears for him.

[Monica Padman]

Yes, because he's my eight year old. Young. He's my little brother. Like, it's never going away. And we all. And he mentioned it too, at dinner. He said, you still think of me like that? And I. And I said, well, when you're around me, you still act like that.

[Dax Shepard]

Oh, boy. Okay.

[Monica Padman]

It was a good conversation. We were like, smiling, unlike my mom. But because even when he was trying to park, he like, called things he wouldn't do if he was meeting somebody else, he reverted too.

[Dax Shepard]

We're all reverting, I think, for Carly. And it's really interesting because I have such a clear role in our family when we're all together. And that's not the role I want. Wanted in life.

[Monica Padman]

Yeah.

[Dax Shepard]

And I have purposely become a much different person than I am when I'm fulfilling my role. And so we were just all together like a week ago in San Francisco.

[Monica Padman]

Yeah.

[Dax Shepard]

And Carly has done a very good job at joining me in my new role. She doesn't force me to be the old role.

[Monica Padman]

Right.

[Dax Shepard]

And I think that maybe the old role. The old role is depressurizing every situation.

[Monica Padman]

Okay.

[Dax Shepard]

Lowering the temperature at all times, intercepting criticisms of different people and making jokes and really just trying to distract the right person who's having a thing, you know?

[Monica Padman]

Yeah.

[Dax Shepard]

That makes my. That I hope doesn't sound like I'm throwing my family under the bus, but whatever. That. That's my role. And I find it quite exhausting. And it's not me. I want to be the person that's deciding how I want to.

[Monica Padman]

You want other people to depressurize you?

[Dax Shepard]

Sure, yeah, that would be preferred.

[Monica Padman]

Yeah.

[Dax Shepard]

I don't think I require that too much. But at any rate, so I think Carly's done a really good job of recognizing what my role is outside of the main family, adjusting to that. And she herself has her own role. Right. I think she was the baby of the comparison sickness. My oldest brother was my mom's partner, business partner. They built this incredible business together. I'm like at UCLA doing great or whatever and then getting on tv. It's A lot. So I think in her own life, she's been able to be the star of her life, which is fantastic. And I try to make her the star of our life as much as I can when we're together, but when we go back, we both snap right in.

[Monica Padman]

Yeah.

[Dax Shepard]

And we had snapped right in. In for three days. And then we got home and both of us were inordinately exhausted. Like, she took a five hour nap, was up for two hours, and then slept the entire night through. I, too, was exhausted.

[Monica Padman]

Yeah.

[Dax Shepard]

And then the following day, I said to her, man, I get exhausted. I'm out of shape for that. My role. And when I have to do it, it's just very exhausting. She's like, oh, my God. Yes. Same. I was like the baby of the family all over again and, you know, vying for attention and all the.

[Monica Padman]

Oh, interesting. Yeah.

[Dax Shepard]

All the things. Yeah, it's a lot.

[Monica Padman]

It's a lot.

[Dax Shepard]

You're not on. You've only watched one episode of White Lotus.

[Monica Padman]

Yeah.

[Dax Shepard]

You know, they. This one family on the show is just vomitus. Right.

[Monica Padman]

They're just the North Carolinians.

[Dax Shepard]

Yes. They're repugnant and.

[Monica Padman]

But they're funny.

[Dax Shepard]

Well, so far they're funny.

[Monica Padman]

Yeah.

[Dax Shepard]

The next episode you'll see, you're like, oh, my God. You got to spend your whole life in that dynamic. I flash forward to, like, man, if you have shit kids. Kids. And you did a bad job raising them and they're. And you're an. You deal with that for, you know, it doesn't go away and just. You stay in this little cancerous puddle of talking and fighting and bickering. I'm like, oh, my God, I would hate if that.

[Monica Padman]

But they. I don't think they hate it because if it came from. If it comes from the top down.

[Dax Shepard]

Well, it's just normal for them.

[Monica Padman]

Right? Exactly.

[Dax Shepard]

So, yeah. I don't even think they're so, so aware of how yucky the situation is, but it's like every kid's grossed up by the other one and judgmental of the other one.

[Monica Padman]

I'm excited to see where this goes, but I'm also confused.

[Dax Shepard]

It's very weird. Yeah, it's getting. It's only getting weirder.

[Monica Padman]

Oh, my God.

[Dax Shepard]

Yeah.

[Monica Padman]

Yeah, we just. It's just.

[Dax Shepard]

It's just normal.

[Monica Padman]

Normal. It's normal.

[Dax Shepard]

And you can kind of become numb to it. You have to exit it for a while. For me.

[Monica Padman]

Yeah.

[Dax Shepard]

To recognize, like, I wouldn't have been able to describe what my role was until I moved to California.

[Monica Padman]

Exactly. Yeah.

[Dax Shepard]

And I return home and I'm like, oh, right, yes. My brother's getting a little heated. I gotta. I gotta get in there with some magic sauce.

[Monica Padman]

I know, I know. I think the same thing. I would have never been able to pinpoint unless I. Without leaving that, like, oh, I'm just making. I feel like I need to make sure everyone is safe.

[Dax Shepard]

Yeah, Yeah.

[Monica Padman]

I would never have been able to put two and two together about that.

[Dax Shepard]

Right.

[Monica Padman]

Without being in it.

[Dax Shepard]

It's also a great gift, I'll add, because I think of how much my relationship with my brother has played out in my professional life. Like, Ashton's a great example. Bill Gates is a great example. There's been these folks that I can weirdly be beta because it's implicit that I'm beta with my older brother. Like, I grew up that way. I'm a bit like Delta, though. I'm also kind of a fight.

[Monica Padman]

But, like, are you beta?

[Dax Shepard]

Let's just say I've learned how to flatter people that are above me.

[Monica Padman]

Yeah.

[Dax Shepard]

And honor them and be deferential to them and then come in and still be out of the role with my comedy, if that makes any sense. Like, very deferential. But then weird zinger that like a beta wouldn't try.

[Monica Padman]

Yeah.

[Dax Shepard]

That ends up allowing me to rise up a bit and join them more as a peer. Like, I'd have these moments with my brother, of course, as any younger brother probably has, is like there would be peership quite often.

[Monica Padman]

Yeah.

[Dax Shepard]

Often we're both racing go karts and it's equally as fun and it's the thing. And then there's another dynamic where he's the older brother and I'm annoying and I gotta shut up. But I could break through and we'd have very peer to peer moments.

[Monica Padman]

Yeah.

[Dax Shepard]

And I got good at manufacturing those or. Or instigating them. And so I was thinking when I was with Bill, it's like I have this weird thing where I. I revere him so much and I couldn't be more deferential. I'll also tease him.

[Monica Padman]

Yeah.

[Dax Shepard]

Right. And so I got that from practice with my brother.

[Monica Padman]

Yeah.

[Dax Shepard]

That's.

[Monica Padman]

So now that you're saying it like that, I think because, you know, you do. I mean, anthropology and all of these reasons. There's a million reasons why. But you have. You pay attention a lot to status and Alpha Bay, all these things. Yeah. It's very much on your mind a lot. And in the way you think about the world and Can I add really.

[Dax Shepard]

Quick why my dream is to be peer to peer with everyone.

[Monica Padman]

Yeah.

[Dax Shepard]

I don't want to be silencing myself because I don't have the status.

[Monica Padman]

Yeah.

[Dax Shepard]

To be myself.

[Monica Padman]

Yeah.

[Dax Shepard]

So it's like, yes. I'm in a race to be able to just be myself.

[Monica Padman]

Yeah. No. Yeah.

[Dax Shepard]

Yeah.

[Monica Padman]

But I think that's weirdly because you are a younger sibling. Like, I don't have that.

[Dax Shepard]

Yeah. You were built in alpha.

[Dr. Suzanne O'Sullivan]

Right.

[Monica Padman]

I. But I don't think. I'm not thinking about that ever though.

[Dr. Suzanne O'Sullivan]

Right.

[Monica Padman]

And I'm never thinking like, like, oh, I'm in. I'm never. I just. It's not even a part of the pro. My processes.

[Dax Shepard]

But can I say one thing I can observe about you?

[Monica Padman]

Yeah.

[Dax Shepard]

When you aren't.

[Monica Padman]

Yeah.

[Dax Shepard]

When you're in a very rigid status structure and you're not equal, it really rubs you the wrong way.

[Monica Padman]

That's an interesting question.

[Dax Shepard]

So I don't know if you know why it's so uncomfortable to you, but I think that's why is you just had baseline. You were the alpha. You. You were old. And then you get in these situations where people have much higher status than you and you're like, oh, what the fuck is this?

[Monica Padman]

But, well, depends, because it might. I mean, I don't know what you're referring to. You can tell me. I'm happy to hear it. But I think what I'm allergic to is people feeling like they are above. Because I'm like, for me, I'm like, I don't under. I don't understand what that is. We should all be peers. Like, I don't feel like that around Bill Gates. I wasn't like, oh, God, I'm like uncomfortable talking to him or that didn't. That doesn't scare me. Well, no, I guess I'm also not trying to get his, like, approval, I don't think.

[Dax Shepard]

It's not about being scared to talk to him. You recognize he has earned the right to take up the most space if we're sitting and we're talking about biology or literally any topic in the world.

[Monica Padman]

Well, no, see, that's where I disagree with you. I don't think literally any topic in the world. He has the right to talk the most on so many topics. He does because he has an expertise there. But I don't. I'm not in a room with somebody and think just because they have done X, Y and Z or become this or famous or.

[Dax Shepard]

Well, that's not a real thing. But knowledge is so Me and Neil Degrasse Tyson, the three of us are hanging out.

[Monica Padman]

Yeah.

[Dax Shepard]

I shouldn't take up any amount of the time talking about astrophysics. It's ridiculous because his. That's his thing.

[Monica Padman]

That's his thing.

[Dax Shepard]

And Bill, uniquely you and I can't cover it. There's maybe 1 or 200% of him.

[Monica Padman]

And I are talking about his tie that was on the floor. His Tom Ford tie.

[Dax Shepard]

Yeah.

[Monica Padman]

I am more than happy to take up space in that conversation.

[Dax Shepard]

That's right. And that's one you have. And we could count them. I might have automotive knowledge over him.

[Monica Padman]

Yeah. Great.

[Dax Shepard]

But in general, you and I aren't going to be around any, Anybody ever who, who has a more comprehensive knowledge of all things.

[Monica Padman]

Yeah.

[Dax Shepard]

Like that man. You and I are going to have a couple of things. When you and I meet a normal person, it's very equal. We probably know equal amounts about the world.

[Monica Padman]

Yeah.

[Dax Shepard]

But Bill knows the entire history of the planet, geologically and chemically.

[Monica Padman]

I'm uncomfortable with him having that knowledge and me not.

[Dax Shepard]

I'm not either.

[Monica Padman]

I think it's great. He should, he should keep. Let's engage about it.

[Dax Shepard]

Absolutely. And you're deferential because you know better than to enter the conversation about the green revolution or biology while he's giving information because it would be a waste of everyone's time. You're not going to add more than he can add to it. There's a reality to the space that can be taken up and who should take it up because who has the expertise. That's just a reality, reality of life. I mean if it's fashion, you should be talking.

[Monica Padman]

But it depends on. I, I guess it, it's like if I'm in a one on one conversation or the four of us are together, group dynamic.

[Dax Shepard]

That's where it's really.

[Monica Padman]

Group dynamic. With four people on a plane. It's not like he's, it's not like he's on a stage and he's giving a lecture. This is. These are people in conversation.

[Dax Shepard]

Yeah.

[Monica Padman]

I think it's totally allowed for anyone to ask a question, to bring up a topic, to say a thing. I don't think it's like, well, we have to sit here in silence and let Bill just talk for four hours because he's the smartest person here. I don't think that's.

[Dax Shepard]

I think you're being pretty extreme about it. Like shut up and let Bill talk for four hours. I'm saying if we're talking about software, if the conversation is about software.

[Monica Padman]

Yeah.

[Dax Shepard]

You and I should have much less to say than Bill Gates has to say. We could give some experiential experience, you know, some firsthand anecdotal account of how we feel about interacting with software, but he should probably do most of the talking about that.

[Monica Padman]

I don't disagree with that.

[Dax Shepard]

Great. So we agree on it, on software. And what I'm saying about Bill is you can pretty much then add any category of knowledge, and that's consistent with him. He's uniquely like this.

[Monica Padman]

Okay. Yeah. I'm not arguing with you about that. I don't under. But I don't feel, I don't feel inadequate.

[Dax Shepard]

I don't either. This isn't a question of value. I think you're, you're having a conversation about value as humans, and I'm having a conversation about deference to knowledge.

[Monica Padman]

Yeah, but you're saying I'm uncomfortable in those situations, but I don't feel uncomfortable in that situation.

[Dax Shepard]

I'm talking about someone doesn't have a chair for you at the thing and wants you to sit somewhere and. And it's like it levels you.

[Monica Padman]

Yeah. That to me is not that. That's like a human respect thing. That's not about who should have. Who should have, who has knowledge or who has something to say. It's if, if you're at. You come to a party and there's no chair for you there. I don't think that's unique in feeling like, ah, that doesn't feel good.

[Dax Shepard]

Right. But if, if the table you want to sit at happens to be a table of people on tele. The Golden Globes, and you feel disrespected that you're not allowed to sit at that table, even though you're not that thing.

[Monica Padman]

Yeah.

[Dax Shepard]

That would be, in my opinion, in denial of reality, which is like. It's a table for people on television.

[Monica Padman]

Yeah.

[Dax Shepard]

On a show about television.

[Monica Padman]

To be fair, that's not. That hasn't happened.

[Dax Shepard]

No. Well, what was the thing that you didn't have? It was a.

[Monica Padman]

It was a. It was a gala of sorts or something that I was with Kristen. Yeah, she was invited. She told them she was bringing me. She was bringing. I was her assistant at the time.

[Dax Shepard]

Yeah.

[Monica Padman]

So. Yes. No, I wasn't like, yeah, I should be invited to this gala. That's the difference. I wasn't like, oh, yeah, I belong here. I came as her guest. And then, yeah, there wasn't a seat and they had to move one and put one in the middle of the thing. And it was very uncomfortable. That has not. That wasn't. I wasn't like, well, I deserve to be at this table. And why isn't there a seat? See, for me, it was, oh, my God, this is so uncomfortable. I'm. I'm obviously not supposed to be here. It's become way more obvious now that there's a chair blocking everybody that they scooted over, that Mariska Hargitay is like, you can share my. See with me. Like, that's uncomfortable.

[Dax Shepard]

Right.

[Monica Padman]

That's not. Because I think I should have been invited all along or I should have been invited. There's a difference there. I mean, maybe you're different. I think anyone in that situation would have felt unhappy.

[Dax Shepard]

I have a ton of experience with that situation, which is like my whole childhood I tried to sit at a table that he decided sometimes I was old enough to and sometimes I wasn't, or I wanted to join an activity that sometimes I was old enough for and cool enough for and sometimes I wasn't. So I have a ton of experience that. With that.

[Monica Padman]

Yeah, but you don't like it. Just like, I don't like if you had gone. If you've even said it, you're like, even at the. At the Golden Globes, like, when there's a shot on Christian, what do you do? Do you get in it? Do you stay out of it? It's. It's uncomfortable when you don't know your place. That's normal to think, like, this is uncom. This is weird.

[Dax Shepard]

Yeah. Yeah. So I. I just know that I'm very used to being low status and being disinvited. And so it doesn't. It's not new to me. It's not novel.

[Monica Padman]

It's not new to me either. As far as feeling like I'm not enough. Growing up feeling like I'm not enough.

[Dax Shepard]

Yeah.

[Monica Padman]

So I have to do these things to be enough.

[Dax Shepard]

My thing with Bill Gates is I don't have a. There's no. There's no right or wrong. There's no value for me. Me. There's no. There's no injustice. I. I'm going to shut up when we're talking about things that he knows a lot more. And also I'm going to recognize I have comedy and he doesn't. So I'm going to take up a lot of space comedically because it's real. I deserve to take up a lot of space comedically. And everyone likes to laugh, and he likes to laugh, too. And so I. I know what zone I should be being a tall poppy in. And I know which ones I shouldn't.

[Monica Padman]

Right.

[Dax Shepard]

And I think that's a good skill set for people to have. Yeah, I think it's dunning Kruger if you don't have it. I think if you think you should be educating Bill on software or any other topic. Mostly.

[Monica Padman]

Yeah. I mean, I don't know anyone who. I don't think anyone would do that.

[Dax Shepard]

A lot of people don't recognize that you should evaluate whether you're adding value to something.

[Monica Padman]

Sure, of course.

[Dax Shepard]

Well, I don't know. Of course, like if it's just everyone has the right to talk equal amounts in all situations.

[Monica Padman]

Well, part of it is social awareness. There's social awareness.

[Dax Shepard]

That's what I'm arguing for. I happen to be framing it in status because that is a big elephant in the room in social awareness. If you are three months into the job and you're at the border, meaning and you're going to take up all the time when the CEOs been doing it for 25 years, that is your blind to the reality of that situation. And I think you. I don't think it's wrong that some people take up more space at times than others. I don't think everyone's entitled to equal space. That's what. Maybe that's the underbelly of what I'm rejecting about your argument is that everyone deserves equal space at all times.

[Monica Padman]

Well, I didn't say. When did I say that?

[Dax Shepard]

Well, you're saying I'm going to talk. Everyone should talk the same. There shouldn't be.

[Monica Padman]

I didn't say the same.

[Dax Shepard]

Okay.

[Monica Padman]

I said everyone should be able to in a conversation provide a question, an anecdote, a not be afraid to talk. I don't think people should be afraid to talk. No. I think you should know when in any conversation you're having with anyone doesn't matter. Status doesn't matter anything if you're the only one talking. If you're making everything about yourself, if you're. That you don't have social awareness. That's a big problem for people. But I don't. The status element of that is. Is to me irrelevant. It's understanding a social dynamic when you're in it and being able to read that.

[Dax Shepard]

I think you and I often use words. We have different definitions for words and then we keep bumping up against each other. Like the way I use alpha is. You have a very negative connotation of alpha.

[Monica Padman]

A lot of people do. Yeah.

[Dax Shepard]

Yeah. Great ton of people do. I Have a very, very anthropological definition of alpha and beta and all these things. And I think status for you is like. That's a negative word.

[Monica Padman]

Yeah. I think. I think chasing it is. Is leads people to be crazy.

[Dax Shepard]

And I think what you. I think what you're saying is popularity.

[Monica Padman]

No.

[Dax Shepard]

Okay. So for me, status is not negative. It's a reality of social creatures. It's not negative or positive.

[Monica Padman]

Positive.

[Dax Shepard]

It is the actual structure of social hierarchies.

[Monica Padman]

Yep, I agree.

[Dax Shepard]

So it's like, it's not good or bad. It's just. It's a real thing that all social animals adhere to. And then in any given context, status is achieved in different ways. On a basketball court, it's one way.

[Monica Padman]

Totally.

[Dax Shepard]

In an intellectual conversation with Bill Gates, it's that way. In a investors meeting, it's money. In some other department domain, it's looks.

[Monica Padman]

Sure. Yeah, yeah. All that's true. I agree. I think status. Status to me is problematic when you are chasing it and manipulating your way in. It's not by effort or prowess, but by manipulation. You will. You want to be at the top of that totem pole.

[Dax Shepard]

I think everyone should probably pursue status. I think your life is better the more status you have in any given situation. And I think what you should not do is misuse status. I think the real issue maybe that people have in conflating these is they're thinking of how people misuse and mistreat others because they have status, which I would be in lockstep agreeing. That's the problem. People being dismissive of people, not hearing people.

[Monica Padman]

That's a problem. Yeah, that's a problem. But there is a huge problem problem in social climbing. It's disgusting and it is repellent. People who. Who are around it.

[Dax Shepard]

Are we disgusting for trying to be the number one podcast?

[Monica Padman]

That's it. That's a skill.

[Dax Shepard]

Yes, everything's a skill. If you want status in the Math 55 class at Harvard, you have to get the highest on the test. That will give you the status of smartest mathematician.

[Monica Padman]

No, what I'm speaking of for a lot of people now is followers.

[Dax Shepard]

See, that's what I think. You're always using status as popularity. I think that's why we fight well in this world.

[Monica Padman]

It's connected.

[Dax Shepard]

But status in the math class is the highest test status in the podcast world is your ranking.

[Monica Padman]

Yeah.

[Dax Shepard]

And you should always try. That's why I'm saying you should try to climb status. That means you're the best at the thing you're doing.

[Monica Padman]

Try to be your best at what you're doing. I agree.

[Dax Shepard]

Yeah.

[Monica Padman]

But I'm talking about you should try to get to the top of the thing. That's a different beast.

[Dax Shepard]

I don't think you should try to be the most popular person. Person in your friendship group.

[Monica Padman]

Yeah. Or in the world. Like, that's the. That's that you have the most followers or the most approval or the most likes or the most famous friends.

[Dax Shepard]

I'm trying to help us because I think when we're arguing so much, you think I'm making a. I'm. I'm in support of. Of. Of chasing popularity.

[Monica Padman]

Right.

[Dax Shepard]

And I'm not.

[Monica Padman]

Yeah.

[Dax Shepard]

And I'm not talking alpha. Like, you bark orders at people.

[Monica Padman]

Oh, yeah. I know that.

[Dax Shepard]

I'm talking about who in the room do you most trust to make the decision about X, Y, or Z. Yeah. That's alpha. And it can change in every context.

[Monica Padman]

I. I agree. When we had Allison on about conversation and we talked about group conversations. Yes. That's. She's like, at any given moment, somebody has the status.

[Dax Shepard]

Yeah.

[Monica Padman]

But part of it is understanding everyone does have status in different domains. Even when we talk about, like a CEO or something. Yeah. I actually. Actually think it. It has to be very. You have to be very aware when you are the CEO or the person on top, that everyone defers to you as having the most status because you're in charge.

[Dax Shepard]

Yeah.

[Monica Padman]

But let's say you're talking about something very specific and probably you don't know as much as the. Per your employee.

[Dax Shepard]

You have to police yourself a ton if you have status. To not presume status in all domestic domains when you don't have it.

[Monica Padman]

Yeah. And allow other.

[Dax Shepard]

Chasing status is repugnant. Like that. You and I would have. Like, we're totally crossing paths at that point.

[Monica Padman]

What?

[Dax Shepard]

When you say chasing status is repugnant.

[Monica Padman]

Yeah.

[Dax Shepard]

We're like, totally crossing line. Like, we're talking about completely different things.

[Monica Padman]

That's fine.

[Dax Shepard]

Yeah.

[Monica Padman]

Okay. Hold on. A couple facts for Suzanne. Okay. Sonic weapons. Sonic weapons effect. Can they. Can they affect the brain? Yes. Acoustic weapons use sound waves to injure or incapacitate an opponent by emitting very loud noises that they can cause pain, nausea, dizziness, and even permanent hearing loss. You said you wanted one in the.

[Dax Shepard]

Bathroom to make me shit. Yeah, I basically had that today.

[Monica Padman]

You had a sonic boom.

[Dax Shepard]

Well, I did three servings of Metamucil yesterday. Spaced out throughout the day.

[Monica Padman]

Well, were you constipated?

[Dax Shepard]

I was underwhelmed with what I was getting.

[Monica Padman]

Yeah, me too.

[Dax Shepard]

I almost prefer constipation to 40% output. I'm like more bothered by 40%. I'm like, what is going on?

[Monica Padman]

I know.

[Dax Shepard]

So I went really, really hard yesterday. And then, you know, I have a routine in the morning, as you know, but I, I, I was like mid meditation. I'm like, am I going have to quit my meditation?

[Monica Padman]

Wow.

[Dax Shepard]

Like, no, you got to get through your meditation. But it was dicey. And then I'm like, there's no way I can journal through this.

[Monica Padman]

Wow.

[Dax Shepard]

Yeah.

[Monica Padman]

Well, that's good you fixed your problem.

[Dax Shepard]

Yeah.

[Monica Padman]

And then we wouldn't recommend three servings of Metamucil. I think go by the jar. No, go by the prescription amount on the jar.

[Dax Shepard]

I might do three more today. I have very high status right now in evacuation.

[Monica Padman]

You do, because mine isn't going well today. Teddy Roosevelt did have asthma, as you said. He was a sickly boy, but cured.

[Dax Shepard]

By his time on the ranch.

[Monica Padman]

Exactly. And then I think his was psychosomatic.

[Dax Shepard]

Yeah, maybe.

[Monica Padman]

Because if he got cured by the ranch, which is outside and lots of dusties.

[Dax Shepard]

Doesn't make sense working with animals.

[Monica Padman]

He was on dander.

[Dax Shepard]

Dander. Pet dander.

[Monica Padman]

Yeah. Right. Okay. Have we reduced the number of amputations from diabetes? Yes, yes, we have.

[Dax Shepard]

Asterisks.

[Monica Padman]

Asterisks. Because care is much better.

[Dax Shepard]

Right.

[Monica Padman]

For like to catch before you're gonna have to have an amputation. It doesn't mean we've done better. Really? As far as lowering diabetes problems by diagnosing it more.

[Dax Shepard]

This is like the gun. Death by gunshot data is misleading.

[Monica Padman]

Exactly.

[Dax Shepard]

We've just got really good at treating gunshot wounds. Just as many people are getting shot.

[Monica Padman]

Yep. Videos associated with the hashtag autism. Hashtag accrued 11.5 billion views collectively.

[Dax Shepard]

Billion.

[Monica Padman]

Yeah.

[Dax Shepard]

Billion. Whoa.

[Monica Padman]

An examination of the top 133 videos providing informational content on autism, which totaled 198.7 million views and 25.2 million likes showed that 27 of the videos were classified as accurate, while 41 were classified as inaccurate and 32% as over generalized. She got that stat. She nailed it.

[Dax Shepard]

That's. That's a disheartening stat.

[Monica Padman]

I know.

[Dax Shepard]

If you're getting your medical information from TikTok.

[Monica Padman]

Yeah, exactly. And then she also said one in five people in the world has a mental health diagnosis. Correct again. According to the National Institute of Mental Health in the world, one United States.

[Dax Shepard]

Oh, going to say that seems high for the world.

[Monica Padman]

United States.

[Dax Shepard]

One Indians aren't fucking with all these Diagnoses yet.

[Monica Padman]

I don't know.

[Dax Shepard]

Our guest Blaze is like, there's not a single CBT certified therapists in a country of a billion people.

[Monica Padman]

But he's. But there's a high rate of suicide. That's why he's going there. So they. There is.

[Dax Shepard]

I just don't think they've been diagnosed yet.

[Monica Padman]

Yeah, maybe not.

[Dax Shepard]

They'll get there. There's a great signal in developing.

[Monica Padman]

It's true.

[Dax Shepard]

Yeah. You'll stop having kids and you'll have a ton of mental health issues.

[Monica Padman]

Exactly.

[Dax Shepard]

All the aim for.

[Monica Padman]

Well, they've had a ton of mental health. So then this is another one of the, like, they have mental health stuff a lot. Lot.

[Dax Shepard]

Yeah.

[Monica Padman]

But it's. If it's not diagnosed. But is that better? Because it's still. It's all the same if people are suffering. I guess.

[Dax Shepard]

I think it ends up being mutually assured annihilation at some point where it's like everyone has a diagnosis and everyone stops caring.

[Monica Padman]

Yeah. So one in five adults have a diagnosed mental health condition. That's. I'm in there. So that's it.

[Dax Shepard]

That's it.

[Monica Padman]

That's it for Dr. Susanna Sullivan.

[Dax Shepard]

All right.

[Monica Padman]

Okay, bye.

[Dax Shepard]

Love you. Follow Armchair Expert on the Wondry app, Amazon Music or wherever you get your podcasts. You can listen to every episode of Armchair Expert early and ad free right now by joining Wondry plus in the Wondry app or on Apple Podcasts. Before you go, tell us about yourself by completing a short [e-mail] survey At.

[Dr. Suzanne O'Sullivan]

24, I lost my narrative, or rather it was stolen from me.

[Monica Padman]

And the Monica Lewinsky that my friends and family knew was usurped by false narratives, callous jokes, and politics. I would define reclaiming as to take.

[Dax Shepard]

Back what was yours.

[Monica Padman]

Something you possess is lost or stolen.

[Dr. Suzanne O'Sullivan]

And ultimately you triumph in finding it again.

[Monica Padman]

So I think listeners can expect me to be chatting with folks both recognizable and unrecognizable names about the way that people have navigated roads to triumph. My hope is that people will finish an episode of Reclaiming and feel like they filled their tank up, they connected.

[Dr. Suzanne O'Sullivan]

With the people that I'm talking to and.

[Monica Padman]

And leave with maybe some nuggets that help them feel a little more hopeful. Follow Reclaiming with Monica Lewinsky on the Wondery app or wherever you get your podcasts.

[Dr. Suzanne O'Sullivan]

You can listen to Reclaiming early and.

[Monica Padman]

Ad free right now by joining Wondery plus in the Wondery app or on Apple Podcasts.