Dr. Paul Conti: How to Improve Your Mental Health | Huberman Lab Guest Series

Improve Mental Health (00:00:00)

• This section introduces the second episode in a four-part series with Dr. Paul Conti, dedicated to improving mental health.
• The discussion covers guiding oneself through self-inquiry, addressing key aspects such as aggressive Drive, pleasure drive, and generative Drive.
• Dr. Conti suggests ways to assess our internal narratives and construct a positive self-awareness.
• He talks about understanding where these narratives stem from in our childhood, and using this knowledge to move past obstacles, such as intrusive thoughts.
• Cultivating the generative Drive, a cornerstone of mental health, can be developed with the information provided.

Structure & Function of Healthy Self (00:05:26)

• The discussion focusses on the structure and function of self as a blueprint for mental health.
• Two pillars, structure and function, comprise a series of elements which, when understood, can provide a pathway to feelings of empowerment, humility, agency, and gratitude.
• The structure of self starts with the unconscious mind and its contributions to conscious thought and awareness, followed by how defense mechanisms and character structure impact our engagement with the world.
• Function of self starts with self-awareness, followed by defense mechanisms in action, determining one's options, and understanding salience (what we pay attention to).
• Following the structure and function of self leads to feelings of humility and empowerment, which translate into agency and gratitude.
• These aspects, along with a generative drive to know, understand, learn, and create, result in achieving the much sought-after states of peace, contentment, and delight.
• This process involves both introspective relaxation (meditation) and active engagement in activities or tasks that a person loves or finds fulfilling.

Agency & Gratitude (00:16:25)

• Agency and gratitude are regarded as verb states that can lead to feelings of peace, contentment, and delight.
• These states emerge from active engagement in activities and experiences that bring joy and pleasure; they aren't passively entered into.
• Agency and gratitude can also lead to experiencing a generative force that brings about a sense of delight in various domains in life.
• For instance, experiencing joy in interactions with animals can be tied to a sense of agency and gratitude in handling life's situations.
• A generative drive, expressed through nurturing and caretaking, can contribute to experiencing delight, peace, and contentment in day-to-day interactions and experiences.

Aggressive Drive, Pleasure Drive, Generative Drive (00:21:14)

• Human behaviour is motivated by internal drives, traditionally defined as aggressive drives and pleasure drives.
• Aggressive drives refer to active engagement and forward movement in the world, and they can manifest as a strong sense of agency. However, an excess can lean towards harmful aggression.
• Pleasure drives are motivations seeking gratification and relief, which can be found in various experiences such as food, friendship, and safety. But again, an excess of this drive can also be problematic.
• Apart from these two, there is also a generative drive that is beyond the self and focuses on nurturing, caretaking, and contributing to making things better for others. It explains instances of altruistic behaviors that are not purely driven by aggression or pursuit of pleasure.
• The relative balance and functioning of these three drives – aggressive, pleasure, and generative – can help understand and assess the healthiness of a person.
• If there are imbalances in these drives or resultant issues, they can be traced back to foundational life aspects (the ten cupboards), providing a way to address and rectify the imbalance.

Physical & Mental Health Similarities, Verb States (00:30:00)

• People aspire to both physical and mental health, with the former often being more tangible and easy to address through exercise, nutrition, etc.
• The discussion relates mental health with physical health, explaining it as having different components to work upon and improve, similar to various forms of exercise.
• Psychiatry has often been treated differently from other fields of medicine, focusing on categorizing and diagnosing mental health conditions, much like identifying a physical illness.
• This approach, however, might not be effective in dealing with issues concerning the psyche and mental health.
• Psychiatry should look at understanding the components of mental health and addressing each individually, similar to how other medical fields address physical health.
• The approach to mental health should shift from diagnosis-centric to action-oriented, focusing on what can be done to enhance well-being.
• Rather than relying solely on medications, which can be beneficial yet not a complete solution, the focus should be on understanding the appropriate role of medicines in managing mental health.

Lack of Motivation, Drives (00:38:32)

• A common question in mental health is regarding motivation, or the lack thereof, which can be influenced by factors like fear of failure or success, or existence of trauma.
• A clinician's assessment can be anchored to the individual's drives, such as aggressive drive, pleasure drive, and generative drive, which can be diverse in different individuals.
• When someone is not deriving enjoyment or gratification from activities, it could indicate an issue related to their pleasure drive.
• Achieving a balance in these drives helps in improving motivation and overall mental health.
• The focus in dealing with a lack of motivation should be to understand an individual's drives and where the imbalance lies.
• By understanding the root cause of the person's lack of motivation, it's possible to strategize for change, and improve the person's state of mental health.

Video Games/Social Media & Distraction, Generative Drive (00:43:06)

• The discussion touches upon the modern phenomenon of people, especially the youth, relying excessively on non-productive activities such as video games and social media. While these provide temporary pleasure, they can also lead to stagnation and a "failure to launch" in terms of life milestones.
• It points out that these activities can become a rut or a reservoir for someone's aggressive and pleasure drives, leading to overindulgence, but not propelling them towards their life goals or milestones.
• A clear imbalance in the "generative drive" or the internal motivation to create or produce something of value is observed in such situations. This could be due to their inability to express this drive in the appropriate way or towards the right goals.
• An example is given of a person with a prestigious, high-paying job who started neglecting themselves and their environment due to a lack of interest in their job. This individual derived no joy from their work and began resorting to destructive behaviors such as overindulgence in alcohol.
• Upon changing to a less paying job that they loved, a positive improvement in their behavior and attitude was observed, indicating their generative drive was finally being expressed in the right way.
• It is argued that such people with a frustrated generative drive can definitely improve themselves, but the problem must first be identified and understood. Therapies that help people to understand themselves rather than redirecting their thoughts, and medicines that regulate anxiety or tension could potentially aid in solving these issues.
• However, it is emphasized that medicine alone may not provide a complete remedy, but used in conjunction with therapy, it may help a person to navigate towards a better path.

Asking Better Questions, Psychiatric Medicine, Physical Health Parallels (00:51:46)

• Better questions about oneself and better forms of inquiry lead to understanding and better mental health.
• Medication, therapy and thought redirection play a part in psychiatric treatment, yet if a treatment isn't holistic, it risks causing harm.
• There's a parallel to physical health: repeating the same exercise routine may lead to physical improvement but ultimately results in overuse injuries. A complete regimen requires a variety of exercise types to maintain balance and prevent injuries.
• Just as improving physical health isn't solely about one form of exercise, improving mental health isn't just about medication or cognitive behavioral therapy (CBT).
• Just increasing physical activity (like walking briskly up stairs) or using CBT or medication alone isn't a successful pathway to mental health. A comprehensive approach is necessary.
• Since CBT and medication are convenient for healthcare systems and insurances, they're often over-utilized while other aspects of psychiatric care may be neglected.
• Prescription medication is often chosen because it's cheaper than people, and it's faster to provide. This convenience often leads to over-prescription and under-treatment.
• The short-sighted approach of quick fixes contributes to systemic problems such as over-utilization of emergency rooms and over-reliance on medication.
• The cost of such an approach isn't just financial but also includes the loss of individual patients' generative drive or potential.
• The existing mental healthcare system not only fails individual patients but also society at large, underlining a need for a more comprehensive, holistic approach to mental health.

Self-Reflection & Structure of Self “Cupboards”, Trauma & Agency (01:00:30)

• The discussion focuses on improving mental health beyond traditional methods like medication and Cognitive Behavioural Therapy (CBT), emphasizing these are only parts of a larger picture.
• For a more comprehensive understanding of the self, one should use a metaphorical “map” (available for download), which provides a description of various “cupboards” or aspects to look into.
• Discussion uses an example of a man making the choice to leave a high-paying job despite societal pressures due to personal dissatisfaction and misery. This serves to underscore a larger narrative that different people experience struggles and may not be doing things they know they should be doing.
• Session discussions comprise of questions revealing both structure and function of self, allowing the individual to move from frustration and maladaptive behavior to satisfaction, contentment, and productivity.
• Exploring different cupboards leads to insights on unconscious bias, defensive mechanisms, the impact of trauma, and the possibility of re-discovering aspects of self that used to be healthy and functional.
• The talk stresses that the ingredients for success exist within us and can be rediscovered, especially if we know we've had that ability before.
• Money and societal pressure play a significant role in decision making; the example used underscores that despite the values ingrained in him since childhood, the individual still chose his mental health and happiness over financial gain.
• Emphasized that trauma can cause a shift in self-view, leading to feelings of disempowerment and a reduction in the sense of agency.

Feeling Stuck, Defense Mechanisms & Sublimation, Character (01:08:53)

• Discusses the case of a successful man who feels stuck, unable to create change necessary for happiness.
• Despite past achievements, the man feels a sense of loss and considers himself broken and hopeless.
• The man recognizes the overvaluation of money, ingrained in him from childhood, as a source of his unhappiness.
• Defensive structures, previously channeled into positive actions and achievements, now twisted, leading to negative habits and rationalizations.
• The man struggles to create change even when he acknowledges the need for it.
• He understands what he wants (a feeling of contentment, a meaningful job), but is hindered by the fact that such jobs pay less than his current job.

Self-Reflection & Function of Self “Cupboards”, Self-Awareness (01:13:58)

• Discusses the need for self-awareness and understanding the 'I', the self that we shepherd through life.
• Reflects on the abstract nature of building a sense of self that provides positive agency in the world.
• Suggests a measure of self-understanding and agency can be achieved by recognizing the internal voices that impact our thoughts and actions.
• The internal voices may echo opinions of others, like parents or mentors, affecting our self-perception and decision-making.
• Suggests that becoming firmly rooted in who we are and what we value can help us differentiate our own voice from the 'other' voices in our head.
• References the case of the man conflicted about switching to a lower-paying job. On closer introspection, it's revealed that he is not genuinely conflicted. The conflict arises from the automatic internalized voices that are not truly representative of his own values.

Defense Mechanisms & “Acting Out” (01:19:24)

• Defense mechanisms in action, such as denial and acting out, often indicate a shift in mental state and can predict future negative consequences.
• Acting out is an unhealthy manifestation of aggression, usually caused by a high aggressive drive or a regular drive amplified by negative situations.
• Acting out can result from internal anger aimed at the world or self, leading to behaviors such as excessive drinking, showing up to work hungover, or self-denigration.
• These behaviors are forms of self-sabotage and self-denigration, often indicated by a shift from sublimation (constructive use of negative energy) to acting out (destructive use of negative energy).
• Rather than seeking help or committing immediate self-destruction, individuals often choose more subtle forms of acting out which can lead to slow degradation and sabotage while avoiding immediate consequences.

Salience, Intrusive Thoughts (01:26:43)

• The concept of salience in the function of self refers to what is most apparent or demanding of our attention, both internally and externally.
• One's internal state, such as states of alertness or arousal, can significantly influence salience and hence the type of thoughts that dominate the mind.
• Salience includes a person's internal dialogue and the thoughts that become more prevalent when the mind is at rest or under high arousal or when there's a lot of competition for attention.
• Intrusive thoughts are often markers of distress, guilt, shame, or vulnerability, potentially indicating unresolved trauma or issues.
• Identifying and addressing these intrusive thoughts is crucial for understanding and improving one's mental health condition.

Self-Reflection, Behaviors & Strivings; Roadmap Forward (01:31:24)

• The main point here is about understanding and addressing intrusive thoughts as a roadmap to better mental health.
• Intrusive thoughts can be linked to trauma or a continued pattern, like remaining in a job one dislikes without seeking other opportunities.
• Behavioral changes and understanding one's own motivations or "strivings" are important in shifting these patterns.
• The idea of "self-awareness" is fundamental in making decisions, evaluating defensive structures, and making necessary behavioral changes.
• The path to improvement often involves cultivating self-awareness to change behaviors, enhance personal skills, and assert personal will towards achieving aims.
• A person who achieves these steps will generally find themselves in a healthier and happier state—where they seek pleasure in healthy ways, enjoy things they like, and have a contentment that is palpable.
• This healthy state of mental wealth includes components of peace, contentment, and delight in one’s choices, actions, and life.

Internal Narratives, Childhood (01:38:25)

• Narratives we encounter or absorb as children can significantly influence our behaviors and beliefs in adulthood.
• Children learn from observing and overhearing parents’ conversations and reactions, as well as from verbal and non-verbal communication.
• Children also internalize negative stimuli or insults profoundly; this points to a salience bias towards negatives in human cognition.
• Children are liable to interpret parental disagreements as personal defects, often internalizing these as evidence of their own worthlessness.
• Children may also internalize observed societal standards or parental projections of what men or women "should be like" or what constitutes beauty or disgust.
• Overcoming these deeply rooted internalized narratives requires a process of understanding and addressing them, highlighting the importance of paths to better mental health.

Internal Narratives: Self-Scrutiny & Overcoming Trauma (01:44:44)

• The exploration of early narratives, both direct and indirect, is critical. Messages received during childhood, especially about self-perception, may become deeply ingrained but can be scrutinized and questioned.
• Reflective self-scrutiny is crucial to understanding what's happening within us. It helps us identify recurring internal narratives, many of which might be harmful to self-perception.
• Identifying and understanding these internal narratives can often lead to realizations about false beliefs we carry about ourselves, often concerning attractiveness, intelligence, and worthiness. These can often be traced back to childhood influences.
• The process of overcoming harmful internal narratives involves becoming aware of their existence, understanding their origins, and separating them from our intrinsic self.
• Recognizing and challenging harmful narratives can often lead to unexpected revelations, forming a powerful driving force for change.
• Personal narratives can vary widely depending on individual experiences - while some people may need to scrutinize harmful work-related narratives, others may need to delve into unconscious trauma.
• Negative self-talk and entrenched beliefs are often rooted deep in one's unconscious mind and stem from unprocessed childhood trauma. Manifesting as intrusive thoughts, they can breed negative self-perception.
• The process of psychological therapy often involves bringing these unconscious, harmful narratives to conscious awareness, providing an opportunity to interrogate, understand, and transform them.
• The key to this process is inquisitive introspection accompanied by an openness to change, fostering self-understanding and growth over time.
• Adverse inner dialogues may not disappear easily, but over time they can atrophy and one can recognize them as automatic rather than factual thoughts. This self-understanding fosters beneficial changes and supports the journey to improved mental health.

Time Required for Change, Understanding Intrusive Thoughts (01:55:18)

• Intrusive thoughts can be acknowledged and examined without trying to push them away.
• The process of dealing with intrusive thoughts can take time and change is gradual.
• It's essential to understand that change takes effort and does not happen quickly.
• The belief that change happens quickly can lead people to give up and go back to negative patterns.
• Intrusive thoughts and negative internal voices can eventually diminish over time through self-reflection and work.
• It's still possible to engage in positive actions and maintain functions while working through intrusive thoughts.
• Suppressing intrusive thoughts, especially those born of trauma, is not effective.
• It's important not to fear or deny these intrusive thoughts but embrace them and understand them.
• Often, we may carry a sense of not being good enough due to internalized reinforcements, not necessarily due to overtly negative messages.
• The process of introspection is not about placing blame on others or oneself, but understanding how life evolved and challenging the self-critical thoughts.
• It's crucial to remember that, even if something negative is found during introspection, it is better to face it sooner rather than later.

Self-Reflection on Internal Drives; Envy (02:03:13)

• The internal drives of a person - namely the generative, aggressive, and pleasure drives - play a critical role in determining their success and wellbeing.
• These drives are influenced by both nature and nurture, and while they can be shifted through self-awareness and effort, they are not locked in place.
• The optimal state of health involves a prominent generative drive, with aggression and pleasure drives acting to serve this generative aspect.
• When aggressive and pleasure drives are excessively high, it can lead to destructive feelings of envy.
• High aggressive drive can manifest as continual desire for more and can be associated with narcissism and internal vulnerability.
• High pleasure drive can similarly result in continual desire for more pleasure, leading to temporary satisfaction followed by increased longing.
• Envy is not just the desire to improve or have more, but it's to feel better about oneself, either by self-elevation or bringing others down.
• If the generative drive is insufficient to control the aggressive or pleasure drives, it can result in envy, resentment, and vulnerability.

Generative Drive; Strong Aggressive Drive & Envy (02:09:56)

• Generative drives are pro-social and tend to foster benevolent interactions between people. They are the driving force which make us want to love, nurture, and learn.
• Overactive aggressive drives can lead to an unhealthy level of control, manifesting in different ways including intimidation, manipulation, and passive aggression.
• A real-life example of a strong aggressive drive is given, where a colleague had an extreme reaction to rescheduling meetings and ultimately broke off a collaboration project based on minor setbacks. This demonstrated an inability to handle disappointment and a heightened need for control.
• This aggressive behavior eclipsed the positive, generative drive and negatively impacted not only the individual's professional relationship, but also the overall scientific research project they were working on.
• The person's behavior reflected envy, a result of high levels of aggression and insufficient levels of pleasure seeking. This led to destructive actions.
• This person's behavior didn't foster gratitude or cultivate a sense of agency. It was clear they weren't enacting agency in the service of science or career effectively.
• Despite being successful in academia, the person's behavior suggests they did not have a sense of peace or wellbeing. Their actions indicated a lack of personal contentment and happiness.

High Aggressive Drive & Social Relationships, Narcissism (02:21:50)

• The section discusses the topic of narcissism as manifested in social settings. Narcissism can be seen in individuals who dominate social interactions, often appearing to take over and control the environment, such as by speaking or telling stories incessantly.
• Narcissism is not related to self-confidence or arrogance; instead, it is rooted in inadequacy and vulnerability. The narcissist tries to mask their internal feelings of inadequacy, which is why they often dominate conversations.
• Such individuals tend to lack the ability to tolerate the give-and-take nature of human interactions. They often perceive positive reactions to their actions, such as telling a story, as a momentarily satisfying validation.
• Narcissistic individuals never find lasting satisfaction and continuously seek validation, leading them to dominate the room or social setting. This behavior can be seductive and create an appearance of mastery or control.
• However, this domination often leaves others with a negative impression. Highly dominant narcissistic behavior can repel potentially valuable collaborators as it does not promote a mutual, interconnected social dynamic.
• Despite receiving momentary validation, the narcissist’s behavior in the long run is counterproductive as it isolates them from meaningful, reciprocal social relationships and exchanges. Their overbearing nature repels those who could be valuable connections, leading to a lack of support and collaboration.

Narcissism, Destruction, Envy (02:28:43)

• The discussion focused on the concept of narcissism as a form of aggression and envy demonstrated by individuals in positions of power, often negatively impacting those around them - from their professional partners to students in a lab setting.
• A key example was of a lab head who manipulated the parameters of a basketball game to assert his superiority, although he was only mediocre at the sport, and would punish competent players.
• People surrounding the narcissist often perpetuate their behavior by playing along with their game or presenting no resistance.
• The example was further expanded to talk about the implications of unchecked narcissism in grander scales, such as war.
• The dictators who wage wars out of perceived self-importance lead to widespread destruction, a perfect exemplification being Adolf Hitler.
• Narcissism, when carried to its logical extreme, results in the destruction of the narcissist as well, no matter the scale at which they operate—lab or global stage.

Narcissism & Childhood, Change (02:37:18)

• Narcissism is often rooted in childhood trauma related to feelings of inadequacy, but this is not an excuse for narcissistic behavior but an explanatory mechanism.
• The individuals fail to feel good enough, a sentiment that persists from childhood, leading to aggressive tendencies and envy, which evolve into the narcissistic behavior seen in adulthood.
• Given their deep-seated vulnerabilities and insecurities, it is challenging for narcissistic people to reflect on their behavior and seek change, leading to limited success when treating persistent narcissism.
• However, there are cases where narcissists have made significant changes, often motivated by the threat of losing something vital, like family or financial resources.
• Though barriers to treating full-blown narcissistic personality disorders are high due to the heightened self-defense mechanisms of the individuals involved, the possibility for change and treatment remains and should not be entirely dismissed.

Engaging with Narcissists, Disengagement (02:41:26)

• A non-clinician individual has a very low probability of changing a narcissist due to the need for a high level of clinical intervention to bring positive modifications in the narcissist's behavior.
• Changing the narcissistic behavior often requires a team of clinicians and varied treatment modalities rather than a singular approach.
• An individual dealing with a narcissist can choose to disengage or limit their interactions. This disengagement can come with the promise of re-engagement upon behavioral improvement.
• Setting strong boundaries or disengagement is the suggested method of self-care for a person dealing with a narcissist.

Demoralization, Learned Helplessness (02:44:47)

• Aggressive drive, pleasure drive, and generative drive play key roles in a person's mental health. Ideally, the generative drive should be the strongest.
• An imbalance in these drives, either on the higher side resulting in envy or the lower side resulting in demoralization, affects a person's mental state negatively.
• Demoralization, characterized by the feeling of inability to engage with the world or lack of enjoyment in activities, is not a psychiatric diagnosis itself but can lead to psychiatric problems like depression.
• The demoralization can often be compared to 'learned helplessness', where repeated futile efforts eventually lead to a state of passive resignation.
• Both high levels of aggression and pleasure drive resulting in envy and low levels resulting in demoralization can be identified in both clinical and non-clinical scenarios. Understanding these can provide insights into an individual's mental state and potential remedies.

Self-Inventory of Drives, Optimization (02:49:34)

• The concept of self-inventory is about assessing your level of aggressive drive, pleasure drive, and ability to experience pleasure.
• The goal of mental health is to have a balance between these two main drives.
• It's productive to reflect on how you impact others, whether you are a positive or negative force in the world around you.
• An honest look at your life may reveal if you're being generative (productive and beneficial) or if aspects of your life are out of balance.
• If the generative value is high, then it can be said that the person is in a good place, which would result in healthy confrontation of shortcomings.
• It's important to assess your level of assertiveness and pleasure-seeking habits.
• In cases where these drives dominate to the point of addiction or self-destruction, it may be necessary to seek clinical care.

Social Media & Salience, Generative Drive (02:56:09)

• Social media has the potential to either enhance or detract from a person's generative drive.
• The human inclination towards pleasure can lead to excessive use of social media, which could result in a distraction from the generative drive.
• Social media's ability to draw on our attention (salience) is unprecedented and can potentially be harmful.
• Overuse of social media may stem from our underlying narratives or from the sheer pervasiveness of the platforms.
• If social media becomes too salient, it can negatively impact one's self-perception (especially among teens) and prevent a person from dedicating time and energy towards generative efforts.
• Understanding and managing one's use of social media can help preserve balance among one's internal drives.

Rational Aspiration (03:03:21)

• The concept of the generative drive is admired for its pro-social dimension, bringing about positive changes for individuals and the world. It signifies active states of peace, contentment, and delight, rather than just passivity, such as enlightenment.
• Unlike more traditional understanding, the generative drive is associated with creating things in us and in the world, cultivating our experiences, our actions and reactions.
• Psychological well-being tends to focus on goals, values, how others influence us. The generative drive redirects our focus inward through structured introspection and inquiry.
• The pillars 'structure of self' and 'function of self' encompass principles leading to agency and gratitude - desirable mental health states.
• Rational aspiration is understanding oneself in the process of change – it is recognizing the current state, having a vision for a future state, and acknowledging the processes, time and efforts required to get there.
• Goals should be seen as paths to navigate towards, rather than possessions to be acquired. Focusing on the process rather than the end point facilitates feelings of achievement and satisfaction.
• The structure presented: structure of self, function of self and the 10 sub-categories within the two, is a method for self-awareness and understanding behavioral patterns.
• The structure encourages states of empowerment, humility, agency, and gratitude, and ultimately leads to peace, contentment, and delight through the generative drive.
• Subsequent discussions will focus on the relational aspects of human existence, including interaction with selves, personality disorders and ways to build healthy relationship.