Dr. Gabor Maté and Dr. BJ Miller — The Tim Ferriss Show

Start (00:00:00)

• Dr. Gabor Maté and Dr. BJ Miller discuss addiction, trauma, and the significance of compassion in healthcare.
• Addiction is a disease, not a moral failing, and it can result from trauma.
• Compassion is crucial in treating addiction and trauma, and we need to change our perspective on these issues.
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Notes about this supercombo format. (00:05:53)

• This is a special episode celebrating the 10th anniversary and 1 billion downloads of the Tim Ferriss show.
• The episode features a compilation of some of the best moments from over 700 episodes.
• The goal is to introduce listeners to both famous and lesser-known guests who have had a significant impact on Tim Ferriss's life.
• Bios of all guests can be found at tim.blog/combo.

Enter Gabor Maté. (00:07:13)

• Dr. Gabor Maté is an addiction and trauma expert and bestselling author.
• His books include "In the Realm of Hungry Ghosts," "When the Body Says No," and "The Myth of Normal: Trauma, Illness, and Healing in a Toxic Culture."
• He is known for his work on the connection between trauma, addiction, and illness.

Compassionate inquiry and trauma vs. traumatic. (00:07:38)

• Tim Ferriss reflects on his recent shift in perspective regarding his coping mechanisms.
• He mentions applying loving-kindness meditation to younger versions of himself and thanking them for their roles in his survival.
• Ferriss introduces the concept of "compassionate inquiry" as a tool for understanding one's actions.
• He explains the difference between asking "why did I do this?" (a self-condemnation) and "why did I do this?" (a question that seeks understanding).
• Ferriss emphasizes the importance of recognizing the role of childhood pain in shaping behaviors and the need to transform that pain.
• He defines trauma as what happens inside a person as a result of traumatic events, leading to disconnection from emotions, the body, the present moment, and a negative view of oneself and the world.
• Ferriss stresses the significance of recognizing the manifestations of trauma in the present and the need to transcend them through reconnection with oneself, primarily through the body and emotions.
• The essence of trauma is the loss of self, and the purpose of addiction treatment, mental health treatment, and any form of healing is reconnection.

Self-reconnection resources. (00:11:22)

• Trauma can result from negative events (bad things happening that shouldn't have) or positive events (good things not happening that should have).
• Developmental trauma occurs when parents are unable to provide the necessary attention, acceptance, and attunement due to their own issues, leading to disconnection from the self.
• Various forms of therapy can help reconnect with the self, including talk therapy, body therapies (such as somatic experiencing and EMDR), emotional freedom tapping, motor sensory integration techniques, and traditional therapies like yoga (when practiced with a meditative aspect).
• Yoga, meaning "Unity," was initially developed as a practice to regain unity with oneself and the larger creation.
• Intentional yoga, with a meditative aspect, is taught by various disciplines and can be a powerful tool for reconnection.

How Gabor benefits from yoga. (00:14:56)

• Gabor practices inner engineering, a form of yoga taught by Sadhguru.
• He found that yoga has made a significant positive impact on his ADHD.
• Yoga helps him stay present and focused, and provides a meditative component.
• Gabor recommends inner engineering to others and has received positive feedback.

Gabor’s thoughts on the therapeutic value of psychedelics. (00:16:43)

• Gabor started working with psychedelics as a healing modality about 10 years ago.
• He emphasizes the importance of working with experienced and knowledgeable practitioners.
• Psychedelics can be a powerful tool for self-awareness and can accelerate the healing process.
• Gabor has had personal experiences where psychedelic sessions felt like 10 years of psychotherapy in one day.
• Psychedelic healing should be integrated with other forms of therapy and not used in isolation.
• There is a growing movement among healthcare professionals to incorporate psychedelic healing into therapeutic practices.

What’s been revealed by Gabor’s experiences with ayahuasca? (00:18:30)

• Dr. Gabor Maté's experience with ayahuasca during a book tour led him to explore its potential as a healing modality.
• In a ceremony, he experienced profound love and realized how childhood trauma had closed his heart against it.
• He recognized ayahuasca's potential to reveal self-protective mechanisms and the enduring presence of love.
• Dr. Maté and his colleagues developed a retreat model with trained shamans and facilitators to provide a structured and integrated approach to ayahuasca use, emphasizing proper induction, processing, and a supportive setting.
• Through 10-year-long experiments involving group therapy in a safe setting, individuals have experienced significant healing, including recovery from depression, improvement in autoimmune diseases, and resolution of addiction and relationship problems.
• Dr. Maté stresses the importance of proper integration after therapy to sustain positive changes.
• According to his teacher, Alas, life's challenges and conflicts are not random but specifically designed for personal growth and self-discovery, serving as learning opportunities to guide individuals toward their true selves.

Essential intention. (00:25:48)

• Intention in life is essential to avoid problems and upsets.
• Every morning, it's important to set an intention for the day.
• An intentional holiday can help avoid conflicts and disagreements.
• Dr. Gabor Maté and Dr. BJ Miller were guests on The Tim Ferriss Show.
• They discussed various topics, including intention in life, addiction, and psychedelics.
• Addiction is a way of coping with trauma or pain.
• It can be difficult to overcome addiction without addressing the underlying trauma.
• Psychedelics can be helpful in treating addiction by helping people to process their trauma.

We don’t respond to what happens, but to our perception of what happens. (00:26:46)

• Our perception of events, not the events themselves, drives our emotional responses.
• When upset, we often assume the worst about others' intentions, believing they don't care about or respect us.
• This automatic response stems from past experiences where we felt hurt and angry due to perceived neglect or disrespect.
• Childhood experiences significantly shape adult behavior and well-being, impacting physical and mental health, relationships, and overall fulfillment.
• Dr. Gabor Maté and Dr. BJ Miller emphasized the importance of understanding childhood experiences to address the root causes of human behavior and promote healthier lives.

Enter BJ Miller. (00:33:04)

• BJ Miller is a hospice and palliative care specialist, author, and speaker.
• His TED Talk, "What Really Matters at the End of Life," has been viewed over 17 million times.

What does BJ do? (00:33:23)

• BJ Miller is a physician and palliative care doctor.
• He works at the Zen Hospice Project and UCSF.
• He gives speeches and advocates for people to pay attention to the inevitability of death and to live with hard truths.

What does the first meeting look like for a new patient at the Zen Hospice Project? (00:35:48)

• When patients come to the Zen Hospice Project, they are usually aware that they are dying soon.
• BJ Miller also meets with patients who are still fighting their disease and struggling with their symptoms.
• He works in a clinic called the Symptom Management Service at UCSF, which provides palliative care to cancer patients.

Defining palliative care. (00:37:34)

• Palliative care focuses on improving the quality of life for individuals with serious illnesses.
• The primary goal of palliative care is to alleviate suffering and provide comfort.
• Palliative care can be provided alongside curative treatments and does not require放弃ing aggressive medical interventions.
• Hospice care is a type of palliative care specifically provided at the end of life.
• Residents at Zen Hospice are often in a fragile state when they arrive.
• The first day is usually spent helping residents settle in and getting to know them and their families.
• The focus is on creating a warm and welcoming environment that feels like home.
• Residents are encouraged to express their preferences and needs, and the staff works to accommodate them.

What happens when a patient dies in Zen Hospice compared to a regular hospital? (00:41:10)

• In Zen Hospice, death is usually peaceful due to familiarity with the patient and collaboration with hospice agencies for medical care.
• The hospice environment is designed to provide comfort and minimize distractions, unlike hospitals.
• A flower ceremony is performed when the body is retrieved, allowing for reflection, closure, and easing into the grieving process.
• Hospitals are not designed for a beautiful death experience and often feel sterile and rushed, with little time for reflection or grieving.

How many deaths has BJ experienced? (00:45:19)

• Dr. BJ Miller has witnessed or experienced many deaths during his work in palliative care and hospice care, likely approaching a thousand.

What has observing hundreds of deaths taught BJ about living? (00:45:58)

• Paying attention to the fact that you die can help you live a lot better.
• Being aware of our finitude makes us more likely to be kind to ourselves and others.
• We can learn a lot from the vicarious deathbed moments with our patients and their families.
• Avoiding regret is an important theme in this work.
• We can avoid regret by paying attention to our decisions, how precious things are, and getting good at forgiveness and reconciliation.
• This work can help us live better and has the potential to create a bond among human beings.
• Being better at calling out relationships or situations that don't feed or work well.
• Not squandering time in friendships and relationships.
• Taking relationships seriously and not wasting each other's time.
• Feeling delight and basking in the grandeur of being alive.
• Being glad to feel anything at all, even pain.
• Getting better at forgiveness and letting go of grudges.

On keeping a mindfulness or meditation practice. (00:50:55)

• Realizing when you're holding onto grudges or repeating negative patterns is the first step to letting go.
• Watching the silliness of anger and grudges can help disempower them.
• Deep breaths, walks, and laughter can help unwind and let go of anger.
• Tara Brock's book "Radical Acceptance" can be helpful in practicing acceptance and forgiveness.
• Empathy is a crucial part of this work and can be practiced in daily life.
• Personal mindfulness practices, such as bike rides, time with pets, or sitting in nature, can be meditative.
• Present-state mindfulness practices, like bike riding, can also be effective.

About the Dinky (a terrifying story of electrocution). (00:55:21)

• While at Princeton University, Dr. BJ Miller and his friends climbed a parked commuter train called the "dinky."
• Dr. Miller accidentally touched the train's power source, resulting in an electrical shock that threw him off the train.
• His friends, Jonathan and Pete, risked their safety to help him and prevent him from falling.
• Dr. Miller was rushed to St. Barnabas Hospital, New Jersey's only burn unit at the time, where he underwent treatment for severe burns.
• After several days in a coma, Dr. Miller woke up in a state of confusion and tried to get out of bed, accidentally pulling out his intubation tube and Foley catheter, causing intense pain.
• Realizing his situation was not a dream, Dr. Miller fell to the floor screaming until a nurse came to his aid.

The miracle of a snowball in the burn ward. (01:04:45)

• A burn unit is a sterile environment where patients are isolated and cut off from the natural world.
• Dr. Maté was in a burn unit and felt isolated and disconnected from everything.
• A nurse smuggled in a snowball for Dr. Maté, which he found incredibly therapeutic.
• The snowball reminded him that he was part of the world and that things change.

BJ’s experience as an undergraduate student at Princeton. (01:08:04)

• Dr. Miller started at Princeton in 1989, intending to study East Asian studies.
• After an injury, he became more interested in art and switched his major to art history.

On the idea of art. (01:09:02)

• Art, despite its inherent uselessness, is a defining human characteristic that we create and value.
• Art serves as a tool for individuals to explore their identity, find meaning in their experiences, and positively channel their energies by altering their perspectives.
• Humans' compulsion to create music and dance is comparable to animal mating rituals.
• Art history often emphasizes appreciation rather than delving into the reasons behind human artistic creation.
• Justin Burke, a philosopher and art historian, engaged in philosophical discussions with the speaker, shedding light on the existential questions surrounding art.
• Mark Rothco's abstract expressionist paintings profoundly impacted the speaker, offering a powerful and poignant experience.
• The speaker's relative had a friend named Jackson who frequently showed up drunk at their house with his dogs.
• To avoid Jackson, the relative and their spouse would pretend to go out for dinner, leaving Jackson alone in the house.
• Jackson would forget about his dogs, leaving them in the car and creating a mess, which he would then blame on the relative's spouse, causing them to clean up the mess.

How BJ would support someone who suffered injuries similar to his own. (01:15:02)

• BJ believes that the most important thing he can do for someone who has suffered similar injuries is to simply be there for them and listen to their concerns.
• He feels that it is important for people in this situation to see someone who has been through a similar experience and is still able to live a full and happy life.
• He also believes that it is important to avoid giving advice unless it is specifically asked for, as people in this situation are often not in a state of mind to receive it.

What helps people most in hospice care? (01:17:13)

• Simple things that are often undervalued can bring the most peace to people in hospice care.
• Realizing that much of our daily lives are spent navigating societal structures and systems that may not be natural or important can be liberating.
• People often realize that they have wasted time on unimportant things and start to reevaluate their priorities.
• Simple things like feeling anything, having a body, and being capable of movement can be profound and potent.
• Moments where the rules get to go out the window and things are put in proper proportion to the natural world can be reorienting and help people find peace.
• Looking up at the night sky and pondering the cosmos can help people put their anxieties in perspective and feel awe and wonder.
• When facing death, people can be more in tune with the cosmos and less focused on their day-to-day worries.

Why cookies matter. (01:21:38)

• The sense of smell is primal and powerful.
• Food, especially the smell of fresh bread or chocolate chip cookies, triggers primal responses and brings joy.
• Smelling a cookie provides immediate pleasure and reward, without the need for a future purpose.
• Art, like music and dance, can have a similar effect, offering delight and poignancy in the present moment.
• The speaker suggests that finding joy in small moments, like smelling a cookie or appreciating art, can help us live fully until the end of our lives.
• Cookies are baked at the Zen hospice for this precise reason.

Thoughts on the use of psychoactive compounds in end-of-life care and treating existential suffering. (01:23:28)

• Psychedelics are being studied for their therapeutic potential in reputable institutions like UCSF, UCLA, Johns Hopkins, and NYU.
• Psychedelics may benefit the aging population, especially baby boomers who have experience with these compounds.
• Existential distress, a common end-of-life crisis, poses a challenge in palliative care, and current treatments are limited. Psychedelics offer a promising approach to address this issue.
• Palliative care focuses on understanding the human condition, suffering, and the meaning of suffering. It provides a gateway to integrate non-medical fields like the arts, philosophy, and design into healthcare to address the human condition.
• Psychedelic compounds like MDMA and psilocybin show promise in helping individuals find meaning and belonging, addressing existential suffering.
• Organizations such as the Hefter Research Institute, Compass Pathways, and MAPS are conducting research and advocating for the integration of psychedelics in healthcare.
• Dr. Gabor Maté and Dr. BJ Miller discussed their personal stories and experiences on The Tim Ferriss Show, but not all questions could be addressed due to time constraints.

BJ’s secret habit that might surprise most people. (01:34:02)

• BJ finds himself increasingly interested in the aesthetic domain, which prizes purposelessness.
• He believes in making meaning for ourselves, but also wants to carve out space for meaninglessness and purposelessness.
• He suggests finding joy in simple, sensory experiences without any purpose or meaning.
• He cites Kurt Vonnegut's quote, "We are here on Earth to fart around," and shares a story about Vonnegut taking a long walk to mail something and finding value in the seemingly trivial interactions along the way.
• BJ argues that the small, tangible things with sensory inputs may be more important than the big, abstract things.

Suggested material for an introverted hospice patient. (01:38:48)

• Dr. Gabor Maté recommends various forms of media for understanding life and human nature, including Mark Rothco's paintings, Beethoven's music, and movies like "Waiting for Guffman," "Kentucky Fried Movie," "Groove Tube," and "Grizzly Man."
• Dr. Maté finds therapeutic value in spending time in the vast desert of southern Utah, which evokes a sense of smallness and insignificance in the face of nature's grandeur.
• Dr. Maté and Dr. BJ Miller discussed the therapeutic effects of reconnecting with nature and the vastness of geological time, which can help reduce self-focus and alleviate human suffering.
• Tony Robbins suggests that much of human suffering stems from a self-centered perspective.

What comes to mind when BJ hears the word “successful?” (01:45:20)

• Success is a self-actualization process where one fully realizes and expresses themselves, regardless of external recognition.
• Success involves seeing oneself in others and others in oneself, recognizing the unseen connections between all.
• Mortality can be an equalizing and uniting force, promoting a sense of success.
• Oprah Winfrey is an example of someone who embodies success through her life's work and promoting others.
• Many successful people go unnoticed, and their happiness and success may not be outwardly apparent.
• Presuming success in others can change how we perceive and treat them.
• Gabor Maté believes that success is not about external achievements or recognition, but rather about internal growth and self-actualization.
• True success involves becoming the best version of oneself, embracing one's quirks and awkwardness, and living authentically.
• Success also entails expanding the sense of self to include others and recognizing the interconnectedness of all beings.
• Mortality can serve as a reminder of our shared humanity and the importance of compassion and connection.
• Examples of successful individuals include those who have achieved self-actualization and positively impacted the lives of others, such as Oprah Winfrey.
• Many successful people may go unnoticed, as their happiness and success may not be outwardly apparent.
• Presuming success in others can change our perspective and interactions with them, fostering a more positive and compassionate society.

Daily practices for seeing good in people. (01:48:29)

• Daily exercise of assuming the presence of good in others.
• When there's a choice, choose to see good or assume good.
• Builds an argument to your day of gratitude, happiness, and comfort.
• When walking by someone who the world assumes is a failure, invert that assumption.
• Fill in the blanks and assume whatever they're going through is vital to them.
• They may be more alright with who they are than many successful people.
• Learned from a Deepak Chopra conference to say "bless you" when someone sneezes.
• It's a neural loop of goodness that resonates and registers somewhere.
• Project well-wishing onto people you see.

How to ride a motorcycle when missing three limbs. (01:51:16)

• BJ Miller lost three limbs due to an infection.
• He always wanted to ride a motorcycle but couldn't find a mechanic willing to help him modify a bike.
• He eventually found a machinist named Mt Lawll who built a prosthetic component that allowed him to attach his prosthetic arm to a handlebar.
• He also found a clutchless motorcycle model called the Mana that made it easier for him to ride.
• Randy, a patient of BJ Miller's, helped him modify the bike further by splicing the brakes front and rear into a single lever and moving all the controls to the right side of the bike.
• BJ Miller encourages people not to make excuses for not pursuing their dreams.

What purchase of $100 or less has most positively affected BJ’s life? (01:55:17)

• A bottle of Pinot Noir from Joseph Swan in Sonoma County.
• He collects the corks from finished bottles and has friends write something on them.
• The corks serve as a reminder of close friends and experiences.

BJ’s billboard. (01:57:09)

• His favorite bumper sticker is "Don't believe everything you think."
• He would put this on a billboard to remind people not to take themselves too seriously.

BJ’s advice to his 30-year-old-self. (01:58:40)

• He was in his last year of medical school and had recently lost his sister.
• He would advise himself to:
  • Not take life too seriously.
  • Let go of guilt and playfulness.
  • Not pretend to know where life is going.

What has BJ changed his mind about in the last few years? (02:00:14)

• He has allowed himself to feel that he has a true vocation in palliative care.
• He has become more ambitious and takes his work more seriously.
• He believes the healthcare system can be fixed.

BJ’s requests/asks/suggestions of the audience. (02:01:42)

• Dr. BJ Miller suggests focusing on our commonalities as a species and prioritizing kindness and forgiveness in daily life.
• He encourages support for hospice and palliative care, especially the Zen Hospice Project, which relies on philanthropy.
• Dr. Miller highlights the potential of palliative care to improve end-of-life experiences and enhance the quality of life throughout an individual's journey.
• Tim Ferriss promotes his "Five Bullet Friday" newsletter, sharing interesting discoveries, articles, books, gadgets, and tech tricks.
• Drs. Gabor Maté and BJ Miller discuss the significance of compassion and connection in healthcare, emphasizing the need for doctors to listen to patients and understand their experiences for effective care.
• They also stress the importance of self-care for healthcare professionals to prevent burnout and maintain well-being.
• Key points from their discussion on The Tim Ferriss Show include:
  • Understanding the root causes of addiction and treating underlying trauma.
  • Adopting a more compassionate and empathetic approach to healthcare.
  • Utilizing mindfulness and meditation for well-being and resilience.
  • Recognizing the role of connection and community in recovery and healing.
  • Practicing self-compassion and self-care for maintaining health and well-being.