Move It or Lose It | Episode 140 | Dr. Anthony Feinstein: How is Your Brain Treating You?

Summary

Move It or Lose It | Episode 140 | Dr. Anthony Feinstein: How is Your Brain Treating You?

Podcast: Move It or Lose it – The Podcast
Host: Kathy Chester
Guest: Dr. Anthony Feinstein, Professor of Psychiatry, Neuropsychiatry expert
Date: November 19, 2025

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Episode Overview

In this engaging episode, host Kathy Chester reconnects with Dr. Anthony Feinstein, renowned neuropsychiatrist and author, to delve into the cognitive and emotional challenges faced by people living with Multiple Sclerosis (MS) and other neurodegenerative diseases. Together, they break down the latest advances in brain imaging, cognitive rehabilitation, stress management, and discuss Dr. Feinstein's powerful new book on moral courage among journalists. Throughout, Kathy mixes personal experience and practical advice, keeping the conversation accessible and motivating for listeners dealing with similar health journeys.

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Key Discussion Points & Insights

1. Dr. Feinstein’s Background (00:40–03:10)

• Born in South Africa, medical school and psychiatry PhD in London, then emigrated to Toronto (00:56–02:40).
• Director of a major neuropsychiatry clinic at the University of Toronto since 1993.

2. Why Focus on MS and Cognitive Research? (03:15–04:20)

• Fascination sparked by the advent of MRI technology revealing MS brain lesions unseen in earlier times.
• "It was having this new tool called MRI which really was a game changer." (B, 04:09)

3. Advances in MRI & Understanding of MS (05:09–07:41)

• MRI strength went from 0.15 Tesla to 3 Tesla, vastly improving lesion detection.
• Ability to measure not just lesions but subtle changes and atrophy (brain shrinkage).
• “We now know that there’s gray matter disease in people with MS as well.” (B, 07:16)
• Gray matter pathology is increasingly recognized as crucial for cognition.

4. Cognitive Symptoms in MS: Myths and Realities (07:41–09:34)

• Cognitive changes can occur early in MS, not just in older patients.
• Challenges the myth that cognition is spared in youthful MS.
• High prevalence: ~40-45% in relapsing-remitting, 60-70% in secondary-progressive, higher in primary-progressive.

5. The Need for Baseline Cognitive Assessment (08:37–09:34)

• Strong recommendation for all MS patients to have initial neuropsychological testing to document cognition and monitor changes over time.

6. Impact of Stress on MS Cognition (10:24–11:46)

• Stress can worsen symptoms and lesions, per UCLA study with stress reduction therapy (10:37–10:56).
• Emotional stress is distracting; reducing stress can benefit cognitive function.
• "If you can correct the stress...those kind of cognitive challenges you face can improve." (B, 11:46)

7. Therapeutic and Coping Strategies for Cognition (12:24–13:31)

• Evidence supports psychotherapy for anxiety/stress and cognitive issues.
• Dr. Feinstein’s clinic now offers computer-based cognitive rehabilitation therapy:
  • 5-week programs with two 45-minute sessions weekly (13:13–13:25)
  • Programs target specific impairments (memory, processing speed, etc.)
  • “We now have interventions which we think can subtly improve your cognition.” (B, 13:26)

8. Challenges in Making Cognitive Rehab Accessible (13:36–16:33)

• Resources limit ability to provide therapy for everyone—priority for those most likely to benefit.
• REACOM, a German program, used both in-clinic and virtually.
• Notable: Uncertainty remains if improvements in the program translate to daily life (16:33).

9. Pandemic Effects on Cognition & Clinical Practice (18:27–21:29)

• No clear global increase in cognitive decline post-pandemic, but some individuals worsened, especially those with severe COVID or long COVID.
• Biggest change: Shift to telehealth/remote practice and empty hospital corridors.
• Social and intellectual engagement suffered during lockdowns, threatening cognitive reserve.

10. Depression, Anxiety, and Access to Psychotherapy (22:02–24:13)

• Dr. Feinstein clarifies the distinction: “Anxiety is not the same as depression. It’s different.” (B, 22:28)
• Treatment options: psychotherapy (especially CBT, mindfulness-based therapy), or medications.
• Rise of computerized CBT when therapists are inaccessible; “Some of those programs can be very effective as well.” (B, 23:57)

11. Cannabis Use in MS: Benefits & Pitfalls (24:36–26:16)

• About one third of Dr. Feinstein’s clinic patients use cannabis.
• Patients describe benefits for pain, spasticity, sleep, anxiety—but THC can worsen cognition.
• Encourages patients with cognitive problems to consider stopping THC.
• “When you stop cannabis…your cognition can improve.” (B, 26:09)

12. Recognition of Cognition and Mood in Neurology (27:52–29:25)

• Huge change over two decades: neurologists now recognize cognitive and mood symptoms as central to MS management.
• “Now…there’s a very broad recognition that this [cognition and mood] is absolutely pivotal to good clinical management.” (B, 28:36)

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Dr. Feinstein’s Book: Moral Courage: The Front Line (30:10–39:14)

Book Theme & Motivation

• Focuses on journalists reporting in countries with poor press freedom (Russia, Bangladesh, Iran, Zimbabwe, India).
• Explores “moral courage”—the willingness to risk personal safety for truth and societal good.
• “If you keep quiet, if you don’t say something, you compromise yourself morally.” (B, 33:04)

Standout Story

• Gwen Lister, Namibian journalist, stood against apartheid despite extreme risk (35:24).

Broader Societal Relevance

• Press faces global challenges, from overt repression (Bangladesh, Russia) to intimidation in democracies like India (37:03–39:13).
• Moral injury: The psychic distress of witnessing or enabling moral transgressions by remaining silent.

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Closing Advice: Keeping the Brain Active (39:34–40:39)

“You want to boost your cognitive reserve, and you do it by keeping your brain active…through intellectual activity, social activity, and physical activity.” (B, 39:36)

• Read, join a library, listen to podcasts/audiobooks, do puzzles.
• Engage in social activity, exercise (even from a wheelchair—“sitting cardio”).
• Avoid excessive passive activities (like TV watching).

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Notable Quotes & Moments

• On MRI’s impact:
  “It was having this new tool called MRI which really was a game changer.” (B, 04:09)

• On cognitive symptoms in MS:
  “Cognitive problems can begin very early in the disease…that’s why it’s very important that you have access to someone who can test you.” (B, 08:37)

• On stress and cognition:
  “Stress problematic for the disease. Absolutely.” (B, 10:58)
  “If you can correct the stress…those kind of cognitive challenges you face can improve.” (B, 11:46)

• On rehab innovation:
  “We now have interventions which we think can subtly improve your cognition.” (B, 13:26)

• On cannabis use:
  "The good news is that when you stop cannabis...your cognition can improve." (B, 26:09)

• On moral courage:
  “If you keep quiet, if you don’t say something, you compromise yourself morally.” (B, 33:04)

• On advice for those struggling cognitively:
  “You want to keep your brain active. That’s the best medicine.” (B, 39:36)

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Important Timestamps

• 00:40-03:10 – Dr. Feinstein’s background and early career
• 03:15-04:20 – What drew Dr. Feinstein to MS cognitive research
• 05:09-07:41 – Advances in MRI and lesion/atrophy assessment
• 07:41-09:34 – Prevalence and early onset of cognitive symptoms in MS
• 10:24–11:46 – Stress, emotional impact, and cognition
• 12:24–13:31 – Cognitive rehabilitation therapy details
• 18:27–21:29 – Impact of COVID-19/pandemic on practice and cognition
• 22:02–24:13 – Differentiating depression and anxiety in MS; therapy options
• 24:36-26:16 – Cannabis benefits and risks in MS
• 30:10-39:14 – Discussion of Dr. Feinstein’s new book on moral courage
• 39:34–40:39 – Dr. Feinstein’s top advice for MS cognitive health

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Overall Tone & Takeaways

The conversation is warm, relatable, and informative—combining rigorous expertise with empathy, and ending with hope and practical motivation for listeners navigating the cognitive ups and downs of MS. Dr. Feinstein’s insights offer validation, up-to-date science, and a sense of community for patients and caregivers alike.

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Resource Links

• Dr. Feinstein’s books: Mind, Mood & Memory and Moral Courage: The Front Line
• REACOM cognitive rehabilitation program (for information and purchase options)
• MS cognitive and mood resources (CBT, mindfulness, online therapy options)

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Transcript

[A]

Foreign. Your host, Kathy Chester, and welcome to the Move it or Lose it podcast, a podcast about all things that move the mind, body and soul. The Move it or Lose it podcast is for information, awareness, and inspirational purposes only. I am not a doctor and I don't even Play 1 on TV, so please consult your doctor before making any medical decisions. The views expressed by advertisers, guests, or contributors are their opinions and not necessarily the views of the Move it or Lose it podcast. Hello, welcome to another edition of Move it or Lose It. Today. You might have remember a long time ago, I think it's been three years, I interviewed Dr. Feinstein and it was when the first. When the first book came out, the Mind, Mood and Memory. So if you've not read it and you have vision problems like I do, it is on audible, so make sure you snag that up on Amazon. Dr. Feinstein, I'm so excited to have you back again. You actually were the person who encouraged me to get into some neuropsychology and cognitive therapy. And so that was really a blessing to me because I knew I needed it, but I had kind of put it off. So. So it was. Thank you for. Thank you for your wisdom, sir.

[B]

Well, my pleasure. And I'm very pleased to be back. Thank you for the invitation.

[A]

Absolutely. So I know you got. I want to go into your other book in a bit, but how are you doing first off?

[B]

I'm doing well, thank you.

[A]

Good.

[B]

All good.

[A]

And you're still that. So just people that have not seen the other interview that I did with you. So your first off, your education takes about 45 minutes to read. But you were born. I always find it interesting. You're born in South. South Africa, correct?

[B]

Yes, that's right.

[A]

And from time you were a little boy until what age?

[B]

Oh, I lived there until I was 29 years of age. So, okay. I went to medical school in South Africa, but I did my. My specialty training in the United Kingdom.

[A]

Yeah, you did that. And that's where you went to when you were in London?

[B]

Yes.

[A]

You completed. That's where you completed your psychiatry training, right?

[B]

Correct. Yes. And that's why I did my PhD as well. Correct.

[A]

Okay. And where did you do your MPhL, your master's in philosophy?

[B]

London as well. All my degrees after medical school come from London.

[A]

And you said, see ya. No. So you were, you were there for a bit and then you came.

[B]

I was there for seven years, and then I got a residential offer from the University of Toronto to come across and start up A Euro psychiatry clinic at the university, which is what I did in 1993.

[A]

Okay. And you're still there.

[B]

I'm still there. Very happy.

[A]

Yeah. That's. And so I know I've asked you this before, but no one in your family had multiple sclerosis. You don't have it. But what got you so intrigued with it? With. As far as the cognitive. The mind, I love, by the way, right now, as our podcast is going, there's about 14 people doing their lawn right now, so no background noise. So what got you so interested in the cognitive areas?

[B]

So when I started to do my PhD, MRI was very new. I had just come, Right?

[A]

That's right.

[B]

And that was one of these great moments in medicine, because suddenly you had this remarkable technology that allowed you to look at the brain with very great clarity. Much better clarity than a CT scan, for example. So the MRI really showed people who were interested in Ms.

[A]

Right.

[B]

These lesions in the brain, which you really couldn't see with the CT scan.

[A]

Sure.

[B]

And so when he got that image, it begged the question, well, what were these images doing?

[A]

Right.

[B]

Psychiatric perspective? The question was, how is this affecting cognition?

[A]

Right.

[B]

How is this affecting mood? And that's what I started to study with my PhD. It was driven by technology. It was having this new tool called mri, which really was a game changer.

[A]

Yeah, absolutely. For sure. And so finding that with. I mean, I. I mean, for us, even through the years, how it's changed. I mean, I'm going on my. Do I get anything for going like 20 something years with MS? When you hit 30 years, do I get a prize? I don't know. But so, I mean, I remember. I mean, it's interesting to me how the MRIs have changed through the years. And, you know, I never want to tell when I have my. My newer support group with people that have been just diagnosed, it's the best time. I try to never say that because I remember them telling me that, but now the MRIs are so different and even stronger. And I know I'm telling, not telling you something you don't know, but they're even getting better. And so it's exciting.

[B]

Yeah. I mean, I'll give you an example. So when I did my PhD, the field strength, which is the strength of the MRI, was 0.15 Tesla. Now it's 3 Tesla.

[A]

Wow.

[B]

Shows you 0.15 to 3. It's a huge leap in terms of sensitivity and what the machine is able to show you in the brain.

[A]

So I know spider webbing, what Are So in your, your impression, what are some of the, the greatest advances for Ms. As far as the MRI that we can see now that we couldn't as far as the lesions. And I know there's all that talk and disputes about the gray lesions. The. I know there's all that, but what. What would you say so.

[B]

Well, number one, you can see a lot more lesions with a more powerful machine. You're also able to look at the degree to which the brain shrinks. We call that atrophy. Yes, that's a very important clinical marker, which I'll explain a little later. And now we've got sophisticated MRI that allows you to look at parts of the brain that look normal to the naked eye, but it's not. So you can extract information from normal appearing brain tissue that basically gives you a clue as to what's going on at a much more micro level. And you can look at pathology that way as well. And that's also been key to understanding this disease. So lesions, you've got your. But then you've got all these very subtle metrics that you can. Normal appearing brain tissue that give you further information about the progression or lack.

[A]

Of the disease, which is so crucial. And so I'm glad you're going to explain this next because I. Don't make me explain it. So the atrophy and all that and the parts in the brain that we're talking about, like the different things that you can see, the gray and all that explain that.

[B]

All right. So the brain has the white matter where there's the myelin. And that's always thought to be very typical of multiple sclerosis because Ms. Is a demyelinating disease. But as we've got more sophisticated with our imaging, we now know that there's also myelin within the gray matter. And so we know that there's gray matter disease in people with multiple sclerosis as well.

[A]

Right.

[B]

And indeed, the gray matter disease may be even more important when it comes to things like cognition. So sophisticated MRI allows us to have a very careful look at the brain, at the white matter, at the gray matter, at parts of the brain that appear normal. We look at all that information, we get metrics that tell us about how stable the disease is, how rapidly progressing, et cetera. We can monitor that. So MRI becomes in many ways your very best biomarker of the.

[A]

Right. Absolutely. I think that that. Because I, it's funny because cognitive. Cognitive issues were one of my very first things. So I like, I was in my. Maybe just 20. And I was driving and realized instead of driving myself home, I ended up following my cousin back to her house. Adding, subtracting those kind of things just left me. So it's funny because through the years and different, different neurologists will say, well, cognitive stuff, they don't even happen until you're much older. And like, not true, not true. So, and so I think that that gets nerve wracking when I would say red flag when that happens or if you're in a neurologist office and you ask for a, a neuropsychologist or a cognitive test and they don't have any answer for you.

[B]

All right, so you raise a number of important points there. Number one, cognitive problems can begin very early in the disease. They don't have to, but they can. And sometimes they can be present from the very beginning. So that's why it's very important that you have access to someone who can test you to see what your cognition is like. And that testing is generally done by neuropsychologists or people trained by neuropsychologists. And there's now a very clear recommendation that everybody with Ms. Should have a baseline cognitive assessment because cognitive difficulties can begin early and they're also very common. So for example, if you've got relapsing, remitting MS, about 40 to 45% of people will have cognitive difficulties. You've got secondary progressive MS, 60 to 70% will have cognitive problems. If you have primary progressive MS, it may be even higher. So you can see a lot of people with Ms. You need to document them.

[A]

Yeah.

[B]

You can follow them over time to see whether they're getting worse or are they stable, right?

[A]

Yeah, very much so. I, I see that even I've stayed, I remained in relapse and remitting, but I can see, you know, how things. And so that goes to my second question, and I asked you this before, we chatted a little bit before. Do you notice a big difference in what you're doing now? And I shared with you this year and my listeners know has been more of a traumatic year for me. And do you notice people that are having more of a traumatic year and they're feeling like, oh my gosh, cognitively now this is happening? I can't remember this. And they're seeing, people are seeing it visibly. Do you see it once things have calmed down for them cognitively, they're able to do better?

[B]

A couple things. So stress potentially can worsen Ms. Symptoms. We know that.

[A]

Sure.

[B]

It was a fascinating study done by My colleague, David Moore, at the time, he was at UCLA.

[A]

Okay.

[B]

He had a group of people with MS, and he gave them MRIs every couple of weeks. And one half of the sample was given stress reduction therapy, and the other half was given no therapy. And he looked at the mri, and he showed that the individuals who got the stress reduction therapy had an improvement.

[A]

Wow.

[B]

Because of the therapy. And then when.

[A]

That's fascinating. It is.

[B]

And when the therapy ended, the lesions started to get worse again. So stress problematic for the disease. Absolutely. But the other point.

[A]

Well, I'm screwed then. No, I'm just kidding.

[B]

No, you're not. I think you're resilient. But the other point is this. When you're stressed, when you're emotionally troubled. I'm sorry, I have environmental lights.

[A]

I was like, wait, wait, my eye really went bad. Neuritis is bad.

[B]

So when you're stressed, when you're emotionally stressed, it can distract you. It can impair your performance because you're distracted by your emotions. So that's the second problem. So you've got to be careful now. If you can correct the stress and you can get yourself towards a point of greater emotional stability and potentially those kind of cognitive challenges that you face can improve.

[A]

Yeah. Yeah. What would you say? Even if someone has so much going on? I'll hear from different clients that I work with. And I told you, I work with people that have all the fun things that I have and different things. Parkinson's, stroke. Even if it's 10 seconds, go in a room and just two big deep breaths. Even if it's that. That you can get your mind or doing some of the things I'm sure you give out. Like black. There's five black of these, four red of these. Something that just, you know, retrains and gets the thoughts back. So it's not that flight or fight and just can kind of re.

[B]

Yeah, well, I'm. I'm, you know, I'm a big proponent of therapies. In other words, if you've got a lot of stress, if you're feeling anxious.

[A]

Yeah.

[B]

That's impeding your quality of life and, you know, getting in a way of you functioning effectively. You really do need therapy. And the evidence. Evidence suggests that there's some really good psychotherapies.

[A]

Yeah.

[B]

Multiple stories that we can talk about 100%.

[A]

Yeah.

[B]

I think it's really fascinating, since I last spoke to you, is that the clinic that I run, we've. We've introduced cognitive rehabilitation therapy.

[A]

Okay.

[B]

This is the therapy that is geared towards actually improving a person's cognition. So if someone comes to see me and we do the cognitive assessment and we find out that they've got memory difficulties, you bring them in for a five week program, okay. Trying to actually improve their memory.

[A]

Wow. I love that.

[B]

If they've got processing speed deficits, we have five weeks of therapy, two sessions a week, 45 minutes each session to improve their processing speed. So we now have, we now have interventions which we did.

[A]

Right.

[B]

And we think can subtly improve your cognition.

[A]

I love that. Now, how are we going to get more hospitals to get that?

[B]

You know that that is such an important question. Because the therapy that we use is a computer based program. You know, we buy it from a company that has programmed it. They're a German company. The program is called reacom. It's a very widely used cognitive rehabilitation program that you have to buy it, you have to purchase the license. I work at has over 10,000 people with Ms.

[A]

Okay.

[B]

There's a very high clinical need and we cannot give it to everyone. And indeed we know that not everyone is going to benefit from it. So we have to work. Who do we think is going to get the maximum benefit from the therapy? And then we target those individuals to try and get the maximum bang for your buck, as it were, from this program. So we have to be very selective about who we give the therapy to.

[A]

Right.

[B]

We're learning as we go because this is new, this is new territory. What we're doing is very innovative. Not every clinic has this kind of intervention for people.

[A]

Right.

[B]

As we use it, we learn and we're learning from our experience. We start getting who's going to get better, who's not, who do we give it to, who do we say, no, this is not for you. This is all part of our learning process. So we have 11,000 people with Ms. Of whom at least 50 to 60% are impaired. We cannot give therapy to 5 or 6,000 people. We don't have the manpower.

[A]

Right, right. Of course not. Of course not. Yeah. So it's a. It's. You just are deciding who will get the most benefits from it, who's going to make the most progress it and so on and so forth. So very interesting, very exciting that you guys are doing that because I often think about. It's funny, I often think if I could have a couple weeks, I'm just working on this and then I'm just working on this part. So very fascinating, very neat.

[B]

We can give the therapy virtually so it's two sessions a week. And the person can stay at home. They log into the computer, the therapist joins them and them through this program, starting at a certain level and building up with complexity so that the end of the five weeks they're doing things that they thought they couldn't do at the beginning of this.

[A]

Wow. Yeah, that. I love that. Now are you able to do. It's only through your hospital, though. So it can't be like someone who's.

[B]

Not a patient, Correct, that's right. Yeah. So. So within the Canadian healthcare system, you know, has to be referred by a doctor to my program and then we have a look.

[A]

Sure.

[B]

Assessment to bring them in. But the program that we use, Rearcom, is available. You know, anybody. Realcom, I think it costs something like €3,000. So you can buy the program. The program is there. It's out there in the public domain.

[A]

Right.

[B]

Program. Because most of the published Ms. Literature on cognitive rehab uses reacom. So there's some good data now to show that REACOM can indeed help people with Ms. Good.

[A]

That's very good. I wonder if anybody.

[B]

I don't want to overstate the benefits. So people come in, might improve with the program. We do not yet know whether that improvement translates into real world benefits for them.

[A]

Sure.

[B]

That's really. You come in, you do very nicely. The program shows that you're doing much better on the program. But does that translate into improvements in your life from day to day? We're not sure yet. And that's one of the key variables that we've now got attached. We want to give a therapy that's meaningful.

[A]

Right? Right, Absolutely. Yeah. So it's all in stages. Trying to figure that means didn't take. Absolutely no. Thank you for sharing that. I love, I love that. Okay, back to you. So I've got that part down. I've got all of your. I got all of the history of all that you've done as far as your. As far as your degrees. So obviously we talked about where you started. What do you. Do you think the numbers cognitively have gone up since the pandemic? Introducing the pulse device. Cutting edge wearable device. Revolutionary wellness. Designed to stimulate circulation, reduce harsh pain and tightness and speed up recovery. The pulse device uses advanced vibro tactile technology trusted by patients, clinicians and wellness professionals. Whether you're recovering from an injury, battling a neuro condition, or just want to feel the best every day, Pulse helps you rechange, recharge so that you can live and feel better. Lightweight, powerful and easy to use experience. Better performance, better recovery, and a better you. Order now and save $30 using my code Ms. DISRUPTED. @paulsdevice.com the Pulse device. Is your health recharged? You won't be disappointed. Get it now for yourself. I have it. I love it. Go ahead and grab it.

[B]

Great question. You know, I think if we did get Covid badly, it may well have worsened some people's cognition. Okay. There's no hard evidence to show that globally the level of impairment has gone up, but I think for certain individuals who have Covid or long Covid, they can certainly struggle more cognitively.

[A]

Okay.

[B]

But the pandemic was a very, very difficult time, as you know.

[A]

Sure.

[B]

And, you know, it cut people off from so many activities that are good for us.

[A]

Right.

[B]

That's really important because people with Ms. Need to keep their brains active. They need to do things. And you've got all these restrictions that says, you know, you can't socialize, you can't do this, you can't. You're cutting out many activities that can boost to preserve.

[A]

Right.

[B]

The big challenges that people with Ms. Face is that they were cut off from. That could boost their cognitive reserve.

[A]

For sure. Definitely. And I always get curious because I noticed, like, having. Doing what I do with people that are physically healthy, don't have Ms. And. And people that have ms, I noticed with both my. My clients that were healthy would come in struggling cognitively, almost the same. And I always checked it with me, I was like, okay, I'm remembering more than they are, so I'm okay. But I noticed even after there is. I'm still seeing a lot of the clients and a lot of people still really struggling cognitively. So I thought I was. I wanted to ask you, are you seeing that in the clinic and stuff? Just it. It's just this struggle and it just not coming back yet. It's just really such a hard time.

[B]

You know, I think the individual patients who are like that, overall, I think the situation is probably pretty close to what it was before the pandemic. What the. Has done, what it's done in a very profound way, has completely changed the nature of practice, because now people don't come into hospital anymore. It's all done by zoom.

[A]

Right. Right.

[B]

That's striking. And as if you had to look down our corridor outside our department, you've got a very big department. The corridors are empty because the patients are not here.

[A]

That has to be so weird.

[B]

So the whole nature of how you administer mental health therapy fundamentally changed by the.

[A]

Right. That's How I do mine is on. Is through, you know, telehealth. I do it on zoom and. Absolutely. And I think too, I mean, one of the good things I think that came out is it united us as far as. I mean, I know we sometimes the Internet is so discouraging, but it united us in different countries in different areas that it was like, oh, gosh. And I mean, I know that I. That I have had so many different friends and so many different people that I've met through the pandemic that I still have good relationships with. And so I think. And so many different support groups that are still running and doing very well through that. Because there was. There's that desperate need to connect.

[B]

Yes, yes.

[A]

And so we found it regardless. It was like if you wanted to, you found a way. Of course, the scary thing is, as we've talked about before, and I love that you put that is you're studying, you know, in the beginning, we talked about. You're studying the. Through the imaging depression in Ms. So of course we're talking about disease, that depression is a part of the disease. So you have people that are getting more depressed and they're going to stay introverted and stay in.

[B]

Right.

[A]

So that was difficult. I'm just obviously very hard.

[B]

You're right.

[A]

How do you. How do you. I hear this a lot. I'm not depressed, I'm anxious. As a psychologist, how do you defer. How do you help as far as medication or exercises? How do you help someone understand if there's a difference? If there's not a difference, there's a difference.

[B]

Just a quick correction of a psychiatrist, not a psychologist, but I do this.

[A]

Sorry, sorry, sorry.

[B]

But you're right, anxiety is not the same as depression. It's different. And you've got to work out clinically. Is the patient suffering from anxiety? Is it depression or frequently, is it both? You can be anxious and depressed. So once you've followed the medical model and you've made your diagnosis, that's when you've got to recommend treatment. And the treatments fall into two broad categories. You've got your medications or you've got your psychotherapies. I can tell you that most people want psychotherapy, not medication.

[A]

Yeah, yeah, yes.

[B]

But, you know, people still take medications. Some of the medications can be effective. Certainly medications might come with side effects. So that could be a potential problem with medications.

[A]

Right.

[B]

Definitely a role for me. If people want psychotherapy, then the challenge is you've got to have access to a psychotherapist.

[A]

Right, right.

[B]

Got to have the therapy there. You've got to have the therapist to give it to you. And there are many different kinds of therapy, a couple of which we know now are very effective for people with Ms. Okay. There's cognitive behavior therapy, which is helpful for depression and anxiety.

[A]

Yeah.

[B]

Also mindfulness based therapy, which is very helpful. And we've got good research data to show that both of those therapies work. Interestingly enough, with the world becoming more computerized, there are computerized cognitive behavior therapy programs, computerized CBT programs. Really computer provides the therapy.

[A]

Of course it would. Right.

[B]

Research data shows that some of those programs can be very effective as well.

[A]

Wow.

[B]

So if you don't have access to the in person therapist.

[A]

Right. You can go to that, able to.

[B]

Get your therapy from a computerized CBT program for your anxiety or your depression.

[A]

Never did. I think that would happen.

[B]

Yeah. It's moving more and more in that direction.

[A]

Wow. Okay, interesting. Okay, so my next question is, you also talked about the depression and the confusion using cannabis because of course that's a big thing with ms, even in the online discussions Are a lot of people use cannabis?

[B]

Yes, a lot of people use cannabis. Correctly. We find that at our clinic, when we test urine of patients, about one third, one third are using cannabis. It's very high.

[A]

Okay.

[B]

Now with any drug, you want to know what are the benefits? Right. Side effects? The patients tell us they found the cannabis helps their pain or spasticity or the urinary symptoms might help them fall asleep at night. Anxiety or sometimes it's just a lifestyle choice. I want to use cannabis because it's my lifestyle.

[A]

Right.

[B]

So the patients say to me, look, the cannabis is helping me. I listen very carefully to them because they're life. They know what they. But we also have some data to show that a particular form of cannabis. Cannabis, thc, the cbd. The THC probably causes cognitive difficulties as well.

[A]

Sure.

[B]

So you've got a disease that's already giving you some cognitive problems. You potentially make it worse by using cannabis thc. And that's what we've got, cognitive problems. Why don't you come off the THC and see what happens to your condition? Some patients will say, well, then I'm getting 70 benefits from it. I want to stay on it. So we accept that. Of course, we have, we have this discussion about the advantages and the disadvantages of cannabis use.

[A]

Sure. So sure. Absolutely. No. And I, yeah, I agree. I see the same things. And I'm just like, well, I not sure that's the Best for you. So yeah, I'm sure that happens often.

[B]

The good news is that when you stop cannabis, and we've got good data to show this, when you stop cannabis, your cognition can improve.

[A]

Yeah.

[B]

It's not as though like you fry in your cognition by using cannabis. If you stop, your cognition can bounce back.

[A]

Yeah, for sure, definitely. Yeah, I see that a lot. And it comes up in the groups all the time, you know, and then it becomes kind of like this big argument thing. It's like, okay, we're off topic. So I can understand, can imagine how big it becomes.

[B]

Cannabis. Is cannabis legal in Michigan?

[A]

Yes. Yeah, yeah, definitely it is. And you know, and I've, I've definitely found different things like the cbg, cbn, things that have anti inflammatory stuff. But you know, it's a misunderstanding of, you know, I do, I just need more thc. I'm like, no, no, no. But you know, it just gets to a point where you can't keep arguing that because if they, if that's their lifestyle, like you said, that's their lifestyle and so make people a choice, right? Yeah, absolutely. So anything else before we go on to your new book, anything else that you'd like to talk about as far as what you're seeing now as a psychiatrist, you. And anything's coming up that you're excited about?

[B]

I mean, I think the big, the big advance for us has been we are now using cognitive rehabilitation for the first time. So, you know, you would do the testing and you would show that the patients have got deficits. And then, and then, you know, the question will be, well, now what? You know, you found the deficit but you can't do anything about it now we think we may be able to change it through cognitive rehab. So that's, I think potentially a very significant advance. Although we still have to tease out the nuances and we still have to work out what are the real world benefits. And that's a big change.

[A]

Yeah, I'm excited about that.

[B]

The other one is that, you know, conventional neurology now recognizes that cognitive problems and depression are very common in people with Ms. Yeah. And I know it sounds obvious to you when I say that, but you know, when I got to Canada 25 years back and I called all my colleagues in urology, they would say, why are you doing this work? They never saw the cognitive and mood problems because they were quiet. Now with the younger generation of neurologists with re education, there's a very broad recognition that this is. And so with my clinic, which is attached to The Ms. Clinic, all the neurologists refer to us. They send the patients in for testing. They recognize that this is absolutely pivotal to good clinical management.

[A]

It's so good.

[B]

Yeah.

[A]

It's so important because, I mean, I've had it that long where that was never even brought up. Never brought it. And never. No one ever said anything about cognitive anything. Yes, I remember actually, the first time it was brought up. This will bring you back. Is one of my neurologists said, you're going anti Sabry. You will never have to worry about anything cognitive again.

[B]

Oh, is that so?

[A]

So I thought, like, hallelujah.

[B]

That's a very dramatic statement. Right.

[A]

Yeah, I remember hearing that. I was so excited. I thought, I'll be able to add against the trial. No more cognitive. But that obviously wasn't true. So. But it was. It was very. I just think they didn't know. They just didn't know.

[B]

Yeah. So my profession had to educate them about it.

[A]

Absolutely. Yes. Thank God for you.

[B]

Medicine can move quite slowly, you know.

[A]

Yes, it. Yes, it did. We are very grateful for what. What you have done. Because I know getting my cognitive therapist was a huge blessing. I mean, it has been. It has been definitely. It has helped a great deal and I know for many others. So it is. It is huge. So now totally going to a different area, but very interesting. I think that's what I love about this podcast, is we can go different areas, different things. Your new book is the Front Line.

[B]

Yeah, It's Moral Courage. Right.

[A]

I have that front line because I wanted to ask you about that moral Courage. Where did you. What. How. What helped you do this? I know it's about. Well, you tell me.

[B]

Right. So you know, it's about journalists who live in countries that have very poor records of press freedom, and they still want to tell the news. They still want to tell the story. So, yeah, so these are countries like Russia, Bangladesh, Iran, Zimbabwe, places like that, where the regimes are very brutal to journalists. And when you go after journalists, you see essentially destroying civil society, because if the news doesn't come out, what kind of society do you live in? And so these are the journalists who take enormous risks and they show incredible courage to essentially keep their countrymen, country people informed about what's going on. The question that intrigued me as a psychiatrist was, well, why do you do this? Because, you know, in advance, just if Russia is an example, if you write bad things about the government, if you basically, you know, call out Putin for all the things that he does wrong, you're going to have A very hard time with it. They're not going to silently accept what you say.

[A]

Right.

[B]

You know, they'll lock, they'll beat you up. In fact, they might kill you.

[A]

Right.

[B]

Despite this, you know, very great dangers, the journalists still do it. And it comes back to this idea of moral courage. You know, you have to have physical courage to do, but you have to have moral courage.

[A]

Right, right.

[B]

That kind of moral courage that these individuals have. And I find a focus on 18 journalists from different countries, that kind of moral courage is very, very unusual. You know, the kind of person who will step up and say, never mind what you're going to do to me, I am still going to report the news. I'm still going to keep, you know, the country informed of what's going on. And so it's an in depth inquiry as to what motivates these people. Why do they do it?

[A]

Yeah.

[B]

How do you explain their behavior?

[A]

Right.

[B]

Really relevant to our world in general. You know, how do we keep our moral compass in difficult times?

[A]

Right, right. And where, where does that moral compass come from?

[B]

Yeah. You know, and that's, that's the intriguing question. So when you look at individuals, there are 18 essays in this book, one devoted to a single journalist. You know, you could take the two journalists from Russia, for example, one of whom was murdered on Putin's birthday.

[A]

Wow.

[B]

Yeah. The other one had to flee, go into exile after Russia invaded the Ukraine. So why are they doing this work? Where does that courage come from? And there's going to be all sorts of complex reasons why they do it. But the gist of my argument is this. If you keep quiet, if you don't say something, you compromise yourself morally.

[A]

Right.

[B]

So there's something there called moral injury. And what is moral injury? Moral injury is a condition that can arise from perpetrating or witnessing or failing to prevent acts that transgress your moral compass. And it comes from what other people do, acts of commission or what you do, but also from what you don't do. Quiet. I should. And I think for these journalists, keeping quiet is intolerable.

[A]

Yeah.

[B]

If they keep quiet, they feel they are compromising themselves morally to such a degree that they can't live with themselves.

[A]

Yeah.

[B]

Even if by speaking out, they know that, you know, the government is going to come after you and lock you up and beat you up or take away your money, they still feel that by speaking out, they've maintained their own moral compass.

[A]

Yeah, yeah.

[B]

I mean, it's extraordinary to do this because the consequences are so severe. You know, we're not talking about these journalists having a minor impact. We're talking about these who might get killed.

[A]

Right. Who are literally going in knowing that. Yeah.

[B]

Get locked up in prison for, you.

[A]

Know, which could be worse.

[B]

Absolutely. You know, and yet they still do it.

[A]

Yeah, that's what the book is. So the first one that you tell. Tell me about the first one that you opened up with in the book.

[B]

Right. So this was, I believe, a woman that came from Namibia.

[A]

Yes.

[B]

Her name was Gwen Lister, and she actually was a South African journalist, but she went to live in the neighboring country of Namibia. This was during the apartheid years when there was very strict racial segregation.

[A]

Yeah.

[B]

And she found apartheid morally offensive. And she campaigned to have a free press in a country that really wasn't free because of apartheid. And so, you know, the government came after her very hard. They would try and break the newspaper. She would be threatened. The work was dangerous and very, very stressful. It cost her, I believe, her two marriages because her husbands couldn't live with the heat, as it were. It was just difficult to be married to someone who was, you know, constantly. Constantly under threats and danger. But she stuck with it. She stuck with it. At the end of the day, Namibia became independent and the press became free, and there was a free press. So it was a remarkable outcome, a great success story. But she was instrumental in helping that happen. And then the fascinating part was after there was a democratic government in power, came to Gwen and said to her, you were so helpful in terms of your fight. We would like to offer you a. A government position. We'd like to offer you head of the broadcast. She turned it down. She said, no. She says, I do not want to be close to government. I need to be government so that I can call you out as well.

[A]

Right, right.

[B]

Transgress.

[A]

Right.

[B]

She did that. And so she had this, you know, remarkable moral compass that.

[A]

Right. This very strong moral compass that never.

[B]

That never bent over doing this kind of work, even though the cost for her at times was very, very high.

[A]

Wow. Very, very interesting. Inspiring people.

[B]

Very inspiring people.

[A]

Yeah. So now, is this one on audible yet or.

[B]

No, no, it's not. No, it's just the hardback version.

[A]

Okay. Well, it'll be at some point.

[B]

The audible thing right now is. You probably know this. It's becoming AI driven, you know.

[A]

Yeah, yeah. And that's. I can do that as well. So I can do that. The only thing on the audible is that I love your voice. And when I got it, I was like, whose voice is this? Where. Where is Anthony? So I was bummed about that, but at least I got to, you know, I could read a little bit of it, but my eyesight so bad. But. But it was. I was very excited about that. But you're right, AI is. Is a great gift. So we can just. I can do that. So that is. I was very excited to see that book and thought, gosh, this is something I really want to. Want to read.

[B]

So it's relevant to where we find ourselves as a society as well. Because, you know, the press is under pressure, right. In many places, you know, there's a whole thing of fake news and journalists are getting demonized and they're getting. Etc. You know, and so, you know, it's not easy to be a journalist at times, right, in democratic countries, although it's much, much more difficult in places like Bangladesh and Russia, Turkey, India, you know, India, this great democracy. But, you know, if you're an Indian journalist and you say something that the government doesn't like and I wrote, then that's it. And they try and break you. They try.

[A]

Yeah, that's what I. Yeah, I thought was. So, you know, I. When I went to India, I was in India 2010, and I went on. I went as a missionary, and I was there in Hyderabad. And so, I mean, I had to be very aware of every move I made. And I was helping with schools and stuff. And so not a journalist, but we saw journalists there, and it was, you know, you were very proud of what they were doing. And so I think that's why I immediately was drawn to this book, is because, you know, I've been able to see in some mission stuff the journalists that come to do the things that a lot of people don't have the courage to do. So I think I'm very proud of you, Dr. Feinstein, for writing this book.

[B]

Your observation about India is really important because the Indian journalist that I wrote about, her name is Neha Dixit, okay? She's harassed sexually in the most vicious way. That becomes the main form of intimidation, which is relentless sexual harassment online, and also bogus lawsuits. You know, they try to break you with bogus lawsuits, and you've got to defend yourself because if you don't, you can go to jail, but the government keeps the lawsuit running and running and running and running. So they're trying to wear you down to really financially, to, yes. Cast doubt on your. Your credentials. So they go after journalists in a very, very nasty way.

[A]

Yeah. Very vicious.

[B]

And that's India, you know, yeah.

[A]

Yeah. Well, I thank you for that. I'm looking forward to this. And if you had to say one thing to an Ms. Patient that feels cognitively like they have just kind of given up and that they're too far gone.

[B]

Right.

[A]

What would you say?

[B]

I tell them you want to keep your brain active. That's the best medicine. You want to boost your cognitive reserve, and you do it by keeping your brain active. And you do that through intellectual activity, social activity, and physical activity. So if you.

[A]

I was gonna. I was waiting for that.

[B]

That's it.

[A]

Yeah. Bless you.

[B]

Sorry. So, yeah, you want to keep your brain active because you're going to boost your reserve through it.

[A]

Right.

[B]

You do not want to sit on a couch with a remote control and spend all day watching television.

[A]

Right?

[B]

Absolutely. Is good. But engage with things. Read, become a member of your local library, get out podcasts, audiobooks, et cetera, you know?

[A]

Absolutely.

[B]

Get onto your computer, do games, do puzzles.

[A]

For sure.

[B]

Socialize, even if you're disabled. Try and get a bit of activity if you're using a wheelchair, get, you know, do upper arm strength, upper arm exercise, build up a light sweat that way.

[A]

Sitting cardio.

[B]

Exactly. But, you know, do things to keep yourself active.

[A]

Yes. Well, thank you so much and thank you again for being on the podcast and I hope to have you on again. If you wouldn't mind, I'd love to have you on again. So it's always interesting. You're fascinating to me and I just really, really, really appreciate you being on. So I appreciate you. Thank you, guys. Don't forget, I will let Dr. Feinstein know when it's on and I will have all of his millions of things that he's accomplished on the bottom of the show notes. So don't forget that. That will be on there. And Again, thank you, Dr. Feinstein, for joining us. And thank you guys for joining another episode of Move it or Lose It. Don't forget to subscribe and give us your feedback of what you thought about this interview. Thank you so much. Thank you so much for joining me for another episode of the Move it or Lose it podcast. It would mean the world to me if you subscribed and left a review. Remember, you can find me on Apple, Spotify, Stitcher, and YouTube new episodes of the Move it or Lose it podcast air every other Wednesday. If you have any suggestions for future guests or topics, please visit my [e-mail]. until next time. Next time.