You Must Be Some Kind of Therapist

Swell AI Transcript: 94. Johann D'Souza.mp3
Johann D'Souza: I would actually raise the ante and say that actually every emotional disorder can be conceptualized as an addiction. It just depends on what axis of the brain that you're taking in terms of. OCD can be conceptualized as an addiction to performing the compulsion. The more they do it, actually the less it satisfies them. They have to do it more often. They have to do it more frequently.
Stephanie Winn: You must be some kind of therapist. Today I am speaking with Dr. Johan de Souza. He is the founder of Values First Therapy, where he offers modern psychology with traditional values. He specializes in helping high achievers overcome anxiety or OCD by using science-based strategies. He earned a PhD and an MA in clinical psychology from the University of Houston on a presidential fellowship after receiving a prior MA from Boston University in psychology and BA from University of Dallas in theology. Dr. D'Souza's research publications focus on the psychological benefits of hope and optimism. Dr. D'Souza is a research affiliate at Harvard's Human Flourishing Program. He's also a coach for Optimal Work and the host of the Dr. Johan D'Souza podcast, which is how we met when he had me on his show recently. So it's good to see you again, Johan. Thanks for being here.

Johann D'Souza: Hey, great to see you, Stephanie. I'm looking forward to chatting with you and your audience.

Stephanie Winn: So you specialize in focus, flow, optimism. I mean, I guess you could say sort of positive psychology, although I'm not sure if that's a term that you use.

Johann D'Souza: Yeah, no, I do actually. Yeah.

Stephanie Winn: Okay. And you were studying these topics during or before your PhD program?

Johann D'Souza: Yeah, I would say that I had an interest in it from a young age. I remember in high school, I first got into mindfulness and I would practice on a daily basis and it made a big impact on me. And this was before it became popular and before I would say it had widespread acceptance in the scientific community. Um, so I encountered a lot of resistance to it. Um, uh, especially like being a person of like traditional faith, I think you could say it was perceived as something kind of like, uh, weird or strange. So now it's helpful that there's so much scientific backing for it. I have some legitimacy in, uh, in talking about mindfulness, which is an aspect of positive psychology, I would say. So now I use mindfulness regularly. I continue to use it in my personal practice, but then also in my therapy practice.

Stephanie Winn: And so does mindfulness form a core component of the work that you do on focus and flow?

Johann D'Souza: Actually, it does, yeah. So you can look at flow as being composed of three skills. So the first is a cognitive skill. We call that reframing. Seeing the challenge as an opportunity rather than a threat. The second is an emotional skill, which is mindfulness. Being fully aware of the present moment. Holding your attention on one thing at one time. The deepest way to practice it is focusing on the breath, the heart, or even just your active existence, so to speak. And then the third skill with flow is intentionally challenging yourself, hopefully according to a higher ideal or something that's just very deeply motivating. If you combine these steps deliberately, you can enter flow at will, which is an amazing skill to have.

Stephanie Winn: Seems like part of what you're talking about is honing your executive functioning skills.

Johann D'Souza: I think you can look at it like that because all these skills involve the prefrontal cortex because they're all deliberate. So deliberate as opposed to automatic. So think about how much of our lives we're in automatic mode, responsive mode, distracted mode, threat mode, whereas these skills of flow put us back in control and enable us to live our highest ideals throughout our whole day and achieve our optimal functioning and effectiveness.

Stephanie Winn: So some of the work that you do has to do with sort of coaching and mentoring highly successful people. You yourself are mentored by someone at Harvard. And then you also have a clinical psychology practice where I'm imagining you help people who are really struggling. Would you say that the work that you do around focus and productivity and flow is more geared toward the highly functioning people or do you find that people who are struggling with more basic things benefit from that too?

Johann D'Souza: That's a really great question and observation. So what I would say is the ones who get the most out of this are the ones who are already high achieving, who are already very intelligent, challenged themselves, or willing to challenge themselves, motivated. They don't have to be all those, because part of the coach's or therapist's job is to motivate. I think that's really what we're being paid for, because that's the hardest thing. But those are the people who, the high achievers, those are the ones who get even more out of this. Partly because there's a lot of psychoeducation involved. a lot of the scientific explanations, which can be difficult to understand or follow. So I do also implement these techniques to the extent I'm able to with people who are not in the, we're not talking about flourishing with them. We're more talking about just getting them to mental health because they're suffering from some psychological disorder. But I have seen time and time again that it takes longer for them to implement the skills and see the results. Although when they do, it's all the more transformative because they went from a very low level of functioning to much higher than baseline, which is the goal of positive psychology to get people to flourishing.

Stephanie Winn: I'm thinking about your sort of person of maybe average intellect who's struggling with a depressive or anxious episodes. They're below their normal baseline and then they're really struggling with function and How, for them, the goal is just trying to get back to their baseline. And for that person, let's say a 5% improvement is maybe going to help them possibly get promoted or possibly function a little bit better in their day-to-day life. But if you're talking about someone with, let's say, 160 IQ. who's trained at Harvard or something like that. They're already in the 99th percentile when it comes to IQ, let's say. For that person, a 5% improvement, if they're already in the top of their field or niche or whatever it is, I can imagine that that could make… I don't know. I'm just speculating about how that would make a relatively bigger difference if they're already in such a competitive place. Not to disparage the average person struggling with their mental health, because I actually want to talk about that side of things, because I think that's what I see more. Because I don't have this experience like you of coaching highly successful people and being even more successful. And as someone who, I have my consulting practice, which is for people who are struggling with very particular issues around communication and self-expression. But in my therapy practice, Here's what I see, and I really want to know your thoughts on this as an expert on focus and executive functioning related things, is that I think a lot of people in the early adulthood stages, what we used to call transition age youth, 18 to 24, or throughout a person's 20s, Coming to therapy, at least half of what they need on average seems to be more like life skills coaching, executive functioning coaching, and time management, and how to not procrastinate, and how to regulate their emotions in order to be consistent with their habits. And it seems like those really kind of practical, almost like ADHD coaching, with or without the ADHD, seems like what these young people need more than therapy on average. Now that's not to say that someone who's recently made it to adulthood who had a terribly traumatic childhood or a single incident trauma or something like that, that they don't need support with that. But it seems like a lot of the issues of early adulthood, a lot of the sort of anxiety, depression, shame spirals, and stuff really come from a lack of self-efficacy or a lack of ability to trust oneself to handle their responsibilities. And so sometimes I end up doing that kind of work with young people, or sometimes we look at ways that they can kind of supplement themselves in that area.

Johann D'Souza: I mean, that definitely resonates with my experience. And part of that might be because I'm in private practice, private pay, so I'm seeing a certain segment of the population who has more resources, they probably go to private schools. But yeah, I do often get the sense that in some sense, like a lot of my clinical training is actually not being utilized because person doesn't have an emotional disorder, anxiety disorder, depressive disorder, trauma, OCD or something else. And actually oftentimes it's often more, perhaps sometimes a result of the parent's concern or over-concern for the child's functioning, which I sometimes wonder if that in itself is a consequence of people having less kids these days than historically. So they're more concerned about the one or two kids that they do.

Stephanie Winn: That's a good point. Sorry, I cut you off. But I was just I was thinking about that. I mean, I'm I'm engaged to the youngest of seven. And, you know, in his family, his parents had a very lackadaisical attitude about him because, you know, he had six older siblings to watch out for that for him. So they didn't watch him like a hawk. It was just like, let the kids take care of themselves. So, yeah, I've heard a lot of explanations for helicopter parenting, but that one really makes sense. Having fewer children.

Johann D'Souza: Yeah, I mean, it's an enormous cultural change that we don't appreciate and we really are not in a position to appreciate since it's so recent. It's really since the advent of the contraceptive pill, right? Which is relatively recent. And so I'll give an example. I remember I was at a family picnic and I saw a mom who had several young kids. And one of her, she was holding a baby and then one of her kids was running and tripped and fell. And then he, he like paused, like he wasn't sure whether he was going to cry or not. He looked up at mom and mom was like trying to adjust the baby and like trying to decide like, well, can I reach the kid who just fell? No, not really. Like. And in that time when she didn't just go rush to the kid, he just got up, brushed himself off and kept running. I just wonder if she didn't have that baby to take care of, what would have been her behavior? And then how would that have affected the child's self-efficacy and development?

Stephanie Winn: Yeah. Gosh, that reminds me of a time I saw a family where the dad had a lot of anxiety and they brought their baby and And this was a safe environment, but the parents were, I think, aiming to be really empathetic with their child, like teach their child emotional intelligence by mirroring and naming the emotions they saw in their baby. But what the dad said to the baby was, oh, scary, in a non-scary environment, right? So the dad, who has anxiety, was noticing that the baby was having a normal baby reaction to a new environment. And then the dad, rather than recognizing his powerful role as the one essentially setting the tone for the child and showing the child how do we react to this environment, he sort of took the child's lead and saw his anxiety reflected in the baby and then confirmed, yes, you're feeling scared. That's what you're feeling. And it's like, no, no, this is not a place to feel scared. You're fine.

Johann D'Souza: Yeah, exactly. with young people and parents. The more I see that, I think a large part of the child's emotional reactions is based on the parents. And that's where it's helpful.

Stephanie Winn: And some of your expertise is in OCD. Do you notice that OCD tends to be more prevalent in high anxiety families in general? And is there a parent-child dynamic going on there?

Johann D'Souza: I would say OCD is a little different from other anxiety disorders. It used to be considered an anxiety disorder in the DSM. Now it's in its own category of obsessive-compulsive and related disorders, of which the foremost is OCD, as you would expect. The reason I say it's different is because it has such a strong genetic component I mean, there's still a lot we don't know about it, but we do know that it runs in families because of the genetic overlap, and there's genetic overlap between OCD and the other obsessive-compulsive-related disorders, such as skin picking, hair pulling, body dysmorphia, hoarding, tick disorders, including Tourette's. So things that you wouldn't, I think the average person wouldn't really associate with OCD. So all this to say that OCD is not something that we don't really think of it as a disorder that can be kind of caught or learned. It's more like you have a predisposition to it, and then some stressful event in your life triggers it, and then you manifest the symptoms of OCD. And the stressful event could be something as seemingly innocuous as going through puberty, so just like being a teenager. Whereas other anxiety disorders, I would be much more confident saying that, yeah, those can just be learned and picked up and based on. We still think that there is a certain predisposition that certain people have in part due to genetics, but I think environment plays a much larger factor in other anxiety disorders as opposed to OCD.

Stephanie Winn: So do you agree with that shift from the DSM-IV to the DSM-V, the relocating of OCD and related conditions as a separate category from OCD? Or do you personally think that OCD is just more like on the extreme end of the anxiety spectrum?

Johann D'Souza: Yeah, it's so hard to say because this is a big debate in the field, is whether we should even think in terms of disorders or whether we should just think in terms of symptoms. and symptom clusters. Because someone could have like a symptom of generalized anxiety disorder, a symptom of depression, maybe a couple symptoms of something else. And maybe they wouldn't even meet criteria for a specific disorder, but it's clearly affecting their functioning as much as if they did. I tend to be more on the side of, let's think less in terms of disorders and categories and more in terms of the individual and his or her presenting symptoms. But all that said, I think OCD is very distinct. Yeah, it's very distinct. I don't want to make a too fine a point of that because it can easily be conceptualized as an anxiety disorder, which is basically you got fear and then you got avoidance, and the avoidance feeds the fear. And eventually you avoid so much that you're afraid of being afraid, and that's when you have a disorder. So I think that's, you can conceptualize OCD like that. But what makes OCD unique is There is definitely like a presentation flavor you get when you're working with someone with OCD that strikes you as, okay, this person has OCD, even though some of the symptoms can very much overlap with generalized anxiety disorder. And so the specific difference with OCD is the presence of compulsions because the fear or obsession is irrational. I didn't really say that well because it's not because it's irrational. But there is this functional relationship between the obsessions and the compulsions, which feeds each other in a vicious cycle. And that's what's characteristic of OCD. So I could explain that in more detail, but that's it in a nutshell.

Stephanie Winn: Well, so here's one way to think about it. So for the psychology geeks out there, you know, we have our conceptualization of neurotic versus psychotic with borderline being in between. And anxiety, depression, and OCD are all considered neurotic rather than psychotic in the sense that there's not that reality testing remains intact. There aren't delusions or hallucinations. But with, let's say, a normal neurotic person with a high level of anxiety, they might worry a lot about people disliking me, underperforming at work, I'm going to mess up my children. Those types of worries that are not unfounded in reality, they're just exaggerated and distorted. But with OCD, it seems like one thing that makes it unique is that, on the one hand, reality testing is intact. This person is not delusional. They're not hallucinating. But like you say, their fears are irrational to the point where it starts to seem out of touch with reality. There's also this… Something I've been wanting to get into more this year is exploring egocentonic versus egodistonic. Because I feel like that's really relevant to a lot of the issues I talk about, and because this podcast is listened to by both psychology professionals and just people with an interest in topics that I talk about. Maybe we could take this opportunity to lay out the concepts of egosyntonic versus dystonic and then we could talk about how that's relevant to OCD.

Johann D'Souza: Yeah, absolutely. Yeah, those are two very good considerations. So, I usually don't think in terms of this scale from neurotic to psychotic, but the application to OCD is interesting because it does lie more in between than anxiety disorders. And in fact, 20% of people with OCD have poor insight, which is much higher than anxiety disorders. So that's one in five. That means that they're not great at distinguishing between what is attributed to their disorder and what is reality. So, and that leads right into the irrational nature of the fears that someone with severe OCD, they can think that like a child is hiding under the desk they're using and they've abused that child. So, that would be a taboo concern, pedophilia, which as strange as it seems is actually not an uncommon presentation of OCD. And perhaps unexpectedly, that person who has that taboo concern would be one of the safest people to be around children because they're so afraid of being a pedophile, of abusing children. that they will avoid anything that could possibly lead to doing that. And this gets into the distinction between egosyntonic versus egodystonic. The OCD concerns are egodystonic, meaning the person does not want to act on them, is not attracted to them, it's not in line with their values. Whereas, like, with generalized worries, it could be more egocentronic, that the person really does want to study harder in order to not fail out of school, in order to have a successful career. So that is just identifying whether the concern is ego dystonic or not, whether it's in line with the person's wishes, is a great way to distinguish OCD from a different anxious worry. Does that answer your question?

Stephanie Winn: Yeah, and I just want to break it down even further for people who've never heard these terms before, because they are super useful concepts, but they're also, you know, psychology-geek concepts. But they affect everyday life, and a lot of people listen to this podcast because maybe they're worried about themselves or someone they love. So when I'm explaining this concept to someone who's never heard it before, here are the examples I use. So egocentronic means that the condition is fused with your sense of self. And the classic example of this would be grandiose narcissism. So a grandiose narcissist is like, well, of course I'm the most attractive, intelligent, successful person in the room. I mean, just look at me, right? So the traits of narcissism are fused with their identity, their sense of self. And so there's no desire to be rid of them. which is what makes personality disorders hard to treat. So that's sort of the most egocentronic example that I think readily comes to mind. Egodistonic, an example of that would be like you're talking about, a highly conscientious neurotic person with OCD, with intrusive thoughts, you know, the sort of person who would never want to hurt anybody, but who has intrusive thoughts where they fear that they would hurt someone. So ego dystonic, the thoughts themselves are experienced as distressing to the sense of self. And it's generally understood in psychology that ego dystonic conditions are easier to treat because the patient is motivated to be rid of their symptoms. And I have some insights to share maybe later on about how this relates to the gender stuff, which a lot of my audience is very interested in that subject. So with OCD, you would say that it's mostly ego dystonic, at least the intrusive thoughts are experienced as unwanted, the compulsions, the person often feels out of control of the compulsions, they want to be rid of them. We also say 20% of people have poor insight. So would you say that there's a spectrum where some people with OCD, the condition is more kind of egocentronic for them? And then if so, at what point does it become obsessive compulsive personality disorder?

Johann D'Souza: First of all, that was an excellent explanation of ego-syntonic versus dystonic. That was the best I've heard. Thanks. Okay, so let's see here. Well, so maybe we'll have to think through this together because I wonder if even people who have good insight, wouldn't it still be ego-dystonic? So let's, and perhaps not, but let's take something that's what we more often associate with OCD like a contamination concern. So the person is afraid of germs and so he washes his hands excessively. So in that case, the person, yeah, what would you need to know to be able to identify whether that's an egocentronic or dystonic concern?

Stephanie Winn: Oh, you're putting me on the spot as the non-OCD specialist here. So a patient with contamination fears who has excessive hand washing, and what would I need to know to determine whether it was egocentronic or ecodistonic? Well, so I'd want to know how distressing he finds the compulsion itself, whether he's motivated to be free of the compulsion. I'd want to know his insight about how realistic these contamination fears are. Whether he had any insight about any particular… trauma that might have sparked that? Let's say he lost a loved one to an infectious illness. Does he realize that this behavior started when he lost a loved one to the infectious illness? Is he able to pinpoint when this happened? Is he somebody whose identity is merged with a sense of cleanliness? Does he take pride in being very fastidious? Also, how is he doing with this relationally? Does it bother his wife or is his wife also obsessed with cleanliness, you know, like sort of looking at the environment. But that's you know, that's just coming from me. I'm not an OCD specialist. So you could tell me when I got right or wrong there.

Johann D'Souza: Well, you're clearly an effective therapist, though, because those are great questions and ways of thinking about it. So, I would say that it would seem to me that if it were a direct result of a trauma related to contamination, then it probably would be less likely that it was actually OCD. We don't really think in terms of trauma-causing OCD, except in the case that, okay, well, trauma is a general stressor, and then so that stresses the symptom towards the OCD manifest, but it's not, it's typically not, it would be unusual that, like, the nature of the trauma is related to the specific obsession.

Stephanie Winn: So… So just to be clear, if you had a patient with all the symptoms of OCD, but it was sparked by a trauma, you would be more likely to diagnose that as a traumatic stress related disorder than an obsessive compulsive disorder?

Johann D'Souza: I guess more the way I was thinking about it is I would just be very surprised. I've never seen that before to where their first manifestation of OCD was because of a trauma and their trauma is directly related to the content of the OCD.

Stephanie Winn: I believe you because you're the OCD specialist. So usually if I see someone whose primary concern is OCD and they really need treatment for OCD, I refer them to an OCD specialist. So yeah, you would know.

Johann D'Souza: But to your point, yeah, I have worked with people who do have comorbid trauma and OCD. Let's see. I'm just trying to think of a particular case. And it's, but it's, the presentations of each is different. I mean, it's possible that there could be some overlap. And the reason I just make that clarification is I wouldn't want people to think that if their child has OCD, it's because he's experienced some trauma in the past, which is a way that is not an uncommon way of thinking about things. But anyways, to get back to the previous question, one of your reflections was, does the person identify as being more fastidious or clean or kind of take pride in it? hey, this is the way it should be, this is how I am. And I think in that case is precisely when it would be, we'd start thinking more in terms of like obsessive compulsive personality disorder, OCPD, which is more characterized by like, over control, rigidity, perfectionism, needing things to be a certain way, and not seeing any problem with that, It could be that they're very highly functioning because having all these rigid rules helps the person. Maybe they're more focused on ordering or arranging things, needing things to be in a certain way, whereas with OCD, it's more They experience the obsession and they feel an urge to do this compulsion in order to neutralize the fear. But the repetition of this cycle is leading them to live a more and more narrow and restricted life and is affecting their functioning and relationships, health, emotional well-being, and so on.

Stephanie Winn: And I would just add the caveat that I'd imagine a person with OCD could function very well in many areas of life, but not in relationships, because that is a really off-putting personality. But with regard to the OCD and how it's impacting their functioning, there's a lot of time spent on these rituals. What are some of the sort of, because there's a lot of stereotypes about OCD to the point where a lot of people kind of colloquially will say, oh, I'm so OCD. I'm, you know, when they mean that they're tidy or something like that.

Johann D'Souza: Right. Yeah. Yeah. And oftentimes I think the stereotypes are people speaking more in terms of OCPD, even though they're of course not aware of the distinction.

Stephanie Winn: Mm hmm. But, you know, everyone everyone is aware of the germaphobe or the person who's afraid that they left their stove on. But what are some of the less talked about ways that OCD can present?

Johann D'Souza: Sure. You know what, at this point, why don't I just give a breakdown of what OCD is, and then I can get into the different categories. Because I haven't done that yet, and I think that'll be fun.

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Johann D'Souza: So OCD, obsessive compulsive disorder. So we got obsessions and compulsions. So an obsession is a fear. It can be a thought, image, or an urge. So thought is like words in one's head. An image is like a picture in one's head. An urge is just like this kind of feeling that one has that's hard to put into words, but it's like a feeling that something is like, for example, just not quite right. Like if you're like one of your socks is like all scrunched all the way down or something, it's like, man, I just want to adjust that. I don't know if that ever happens to you. But we experience things like this and that could be on a much more severe level, distressing level, that would be a type of obsession. So it's a thought, image, or urge that's distressing, unwanted, repetitive, intrusive and irrational or unrealistic. And the last one is what separates it from a worry, because a worry is all those other things, you know, unwanted, distressing, repetitive, intrusive. So that's the obsession. The obsession, of course, leads someone to feel distress and they want to get rid of that feeling. They want to feel better. So they perform, their anxiety goes up, they perform a compulsion. So a compulsion is either a overt behavior or a mental behavior or ritual it's also known as a ritual that's performed in order to in order to neutralize the obsession and to cause the anxiety to go down so the person has a thought that this counter is dirty that would lead Well, actually, let's take a step back. The person sees like dirt on the counter. That would be the trigger. Then now he has a thought that the counter is dirty. I could get sick. I could spread that illness to other people. That's getting into the obsessions. Now the anxiety goes up. So he needs a way to neutralize this anxiety. So he performs the compulsion of either avoiding the situation or cleaning the counter or washing his hands. whatever is going to make him feel better that he's neutralized the obsession. And now what happens is, although the anxiety has gone down for this time, he's reinforced the fear that, well, the only way I can feel better is to perform this compulsion. And he hasn't learned that actually, if you don't do the compulsion, you will you'll feel a little bit anxious, but then it'll go away. And over time, you'll feel less and less anxious, which is why the treatment for OCD is exposure and response prevention, facing the fear without performing the compulsion. I hope that wasn't too much information there.

Stephanie Winn: No, that's perfect. And and it leads into something I've been thinking about, which is in what ways is OCD like an addiction? Because it's the it seems like there's sort of an addiction to performing the ritual. And I don't specialize in addictions. Just like if somebody had severe OCD, similarly, if somebody's primary problem was some kind of severe addiction, I'd refer them to a specialist. But that said, we all have mild behavioral addictions. And some of my patients might drink too much or have some kind of behavior that they're trying to change. And so when I'm talking with people about behavior change, unwanted habits, and things like that, I sort of guide them through understanding that every time you turn to that substance or behavior as a way to deal with distressing emotions, or for some people, it's a response to every emotion, even happiness, then you're sort of training yourself that this is the only way I can deal. And it's sort of you're only exercising that one muscle and the rest of your psychological muscles are atrophying. So it just makes you more and more dependent. And the only way out of that, again, not talking about severe addiction here, I'm not qualified to treat severe addiction, but the only way out of that is to start exercising other muscles to be able to experience that distressing event or emotion. and do something other than your preferred substance or behavior. And so OCD seems a lot like addiction. And as an OCD specialist, do you share that opinion or do you see it differently?

Johann D'Souza: That's a super insightful question. So I would actually raise the ante and say that actually every emotional disorder can be conceptualized as an addiction. And it just depends on what axis of the brain that you're thinking in terms of. So addictions I think in terms of the left-right hemispheres of the brain, satisfaction versus frustration. If you give in to the addiction, you're satisfied. If you're thwarted, you're frustrated, but you never experience fulfillment or meaning from satisfying the addiction. And yeah, you're exactly right that OCD can be conceptualized as an addition to performing the compulsion. That the more they do it, actually, the less it satisfies them. They have to do it more often. They have to do it more frequently. And it reduces their distress much lower to the point where they can feel the distress can return to the same level almost immediately. after giving into the compulsion. So you could see, if you were thinking about it in terms of an addiction model, you could see the treatment as well-used practice, like abstinence from the addictive behavior. And in doing so, they're going to experience with some withdrawal symptoms, which is basically going to be like emotional distress from not being able to satisfy that urge.

Stephanie Winn: Since you've worked with highly successful people and from fairly privileged backgrounds, do you think that in some ways our very comfortable, safe, modern lifestyles have made it harder for the average person, let's say the average person of an upper middle class background who didn't have a traumatic childhood, to tolerate routine distress? And does that render people more vulnerable to addiction?

Johann D'Souza: Yeah, that's a good question. I mean, I would be speaking like, I think largely anecdotally. But yeah, it does seem to me that people have much more comfortable lifestyles and as a result, their distress tolerance is much lower. And we know that distress tolerance is correlated with emotional disorders and psychological well-being or lack thereof. So, And, you know, on the flip side, there's a lot of research on hormesis or eustress. So, like, the benefit of intermittent stressors, both physically and psychologically. Hence, the increased interest in things like, you know, cold plunges or saunas. So, or intermittent fasting, which are all ways of triggering this stress that leads to greater longevity physically. And I would say that psychologically, yeah, it is extremely beneficial for people to develop a habit of stressing themselves intentionally. And now we know through this excellent research that's been publicized by Kelly McGonigal from Stanford, The Upside of Stress, that stress is only bad for you if you think it's bad for you. She has a great short TED talk on this.

Stephanie Winn: Didn't she write the book on the joy of exercise or the joy of movement, Kelly McGonigal?

Johann D'Souza: Interesting. I'm not familiar with that one.

Stephanie Winn: Yeah, I think that's her. Yeah, I read that. She's good.

Johann D'Souza: Okay, cool. Okay, great. I didn't know she got into exercise as well. That's great. So, but just to say that if we intentionally stress ourselves, face our challenges, face our fears, we'll be much more psychologically healthy, especially if we reframe it ahead of time as seeing the embracing the challenge as an opportunity rather than a threat. And so for people with OCD, the fulfillment of their exposures are a way of doing this. And then they notice that they're living a much richer, more fulfilled life, which is the goal of all positive psychology. It's not getting rid of the symptoms, but it's living the life that you want to live.

Stephanie Winn: So I imagine knowing the things that you know about what actually makes for a meaningful, fulfilling, and accomplished life is part of why you've sort of taken up the mantle of challenging wokeness. in your podcasts and in other areas because we're really looking at an ideology that teaches people that words are violence and that someone looks at you the wrong way. It's a microaggression and that it inculcates this mentality of fragility. Not that we need to go into the whole anti-wokeness conversation right now, but you have some real expertise in why a mentality of fragility is so destructive for so many people and you know what it actually takes to build success and resilience.

Johann D'Souza: Yeah. Yeah. When you're speaking, it reminds me of this book by Haidt and Lukianoff. I think it's called The Coddling of the American Mind, and that's one of their theses is that we're not doing anyone a favor by trying to protect them from life's challenges. Yeah, I do try to implement, I do try to help people change their mindset, really with anyone that I work with, whether it's they're working on focus or working on a psychological disorder, changing their mindset to want to embrace challenges, want to grow and improve, knowing that the only way of doing so is through challenge, through stress. It would be like someone who wants to be in great shape, be a star athlete, but he or she is afraid of being sore or being tired. The more one avoids being sore or being tired, then the less physically healthy one is gonna be. And I think we can make an analogy to psychological health. The more one tries to protect oneself from discomfort, the more restricted of a life that person will live. So this research can be largely summed up by the mindset research, growth mindset research, of which Carol Dweck is probably on the forefront. And the general idea there being, Our mindset can be either fixed or growth oriented. Fixed, it means that the person is putting himself in a box that I am this way and that's just how I am. So that means I can't change. Uh, and the consequence of that is I'm not going to test my limits because if I reveal what my limits, uh, because testing my limits will reveal what they are and they'll show everyone what my limitations are. So I can I'm only gonna do things that I know I will be able to do Maybe too easily and you can see how damaging that mindset would be for a student He never wants to ask questions in class because that could potentially reveal his ignorance He doesn't want to try because that'll reveal his his limitations and the opposite of that or the alternative will be the growth mindset which is I can always improve. I can always grow. I can always develop and practice skills. These are just skills to practice. And when you practice a skill, you get better at it. And testing your limits actually is the best and perhaps only way of growth. So this person wants to test his limits. He wants to ask the questions. He wants to try things that he's not sure he's going to succeed in because it's only in doing that, that he's going to stretch and grow himself. And that, that is the fundamental basis of human growth.

Stephanie Winn: Do you think that kids who are gifted are in some ways set back because they, I don't mean, yeah, I mean overall, a kid who is gifted is going to be more likely to have more successful life outcomes. We know that IQ correlates with more positive outcomes. But here's something that I've personally experienced and that I've talked to a lot of parents who seem to be seeing this in their youth. It's the ones who were so always at the top of the class without having to try, just ace the test, always have the right answer, just the kids who are just naturally really good at school without effort. When they finally reach that point, whether it's in high school or college, for me, I think it was like 11th grade chemistry when I hit that point, where it's finally like, this is frustrating. I don't get it. I have to make an actual effort. They're just not used to it. I feel like I see a lot of families struggling with this right now. They're like, their kid was always acing everything without trying. Then they finally get to that point where An effort is required, and in some ways it sets them behind their peers of maybe more average intelligence who have been practicing effort the whole time.

Johann D'Souza: Yeah, that's a great observation. Yeah, and it just shows that perhaps the primary role of education at that age is to develop the skills and habits and virtues in the young person rather than to accomplish a specific outcome of attaining a certain knowledge base. Because the skills are going to be what pays the person back over the course of a lifetime. And yeah, I think it's absolutely right that that person who accomplishes everything easily, it can easily lead to a self-narrative of, hey, I'm this certain way. And then when that narrative gets tested, they can respond through withdrawal and avoidance. And unfortunately, parents unbeknownst to them may be contributing to this inadvertently by how they praise their children. So the science on praise is very relevant here that when we praise, we want to do it with a growth mindset in mind rather than a fixed mindset. We don't want to praise, hey, you're this way. Hey, you're so smart. Hey, you did this. That means you're so smart. You got an A on the test. As if to say that, oh, if you don't get an A, you're not smart. Or if you, not speaking in terms of the effort that the person put into it, which is really what we want to praise, because that's what we want to reward. That's what we want them to do more of. We want to say like, hey, I'm really proud of the effort that she put into this, regardless of what grade you got. Because maybe they got an A and they didn't put any effort into it. And do you really want to be praising that? That's just going to incentivize them in the future. And it will crush them if they don't get an A. Because then if I don't get an A, that means I'm not smart. So, yeah, I think these narratives that we tell ourselves and that others inadvertently reinforce can be very, very limiting to our growth.

Stephanie Winn: I love sleep. Sound sleep is a crucial foundation of good mental and physical health, from mood and concentration to metabolism and cellular repair. And I sleep very well thanks to my Eight Sleep Pod Pro Cover. My side of the bed is programmed to be warm when I get in and cool down to a neutral temperature in the middle of the night so I don't wake up overheated like I used to. How would you customize your bed temperature? Visit 8sleep.com and use promo code SUMTHERAPIST to take up to $200 off your purchase. Even if they're already running another sale, this code will get you an additional $50 off. 8sleep currently ships not only within the USA, but also to Canada, the UK, select countries in the European Union, and Australia. Thanks for considering purchases that support the show. So going back to the science of focus, that could be just as relevant for the gifted kid that never had to try as for anyone in any other role. Before we started talking, I was asking you, gosh, what should I ask you about this? And one of your suggestions is, what is distraction? So maybe we'll start there. Because I feel like there's, on the one hand, it's easy to think about distraction as, yeah, we have notifications and things like that. But I think there's something a little bit more philosophical here. And I want to give you some room to riff on that. Because I know you said that you are a philosopher at heart. I've been thinking about distraction lately as temptation, or like, have you read The War of Art by Steven Pressfield?

Johann D'Souza: I'm familiar with the ideas. I haven't read it.

Stephanie Winn: Okay. Yeah, so The War of Art is, it's written in an almost an aggressive tone about sort of battling your own inner demons to harness your energy and actually make something of yourself and how you are your own biggest obstacle when it comes to actualizing your potential and achieving whatever it is that you're here to achieve, whether that's writing a book or a play or whatever it is that you're here to create. So it's all about sort of self-discipline and the inner battle, and he calls distraction resistance. And so resistance can take many forms, and it can take the form of drama, for instance, the distraction of getting wrapped up in what other people are doing. or the thoughts of other people's judgments, just as much as it can take the form of, you know, having a lot of emails that aren't relevant to your topmost goal. So I just want to kind of open the floor for you to muse on what sort of the essence of focus and distraction really mean to you.

Johann D'Souza: Sure. Yeah. Yeah. Well, I am a philosopher at heart and I would love to I'll talk more about that. However, for this, I'm going to rely on the neuropsychology of focus. These thoughts are not original to me. They come from my mentor, Dr. Kevin Majors, the founder of Optimal Work. He has his own podcast, the Optimal Work podcast, which explains this and other ideas very well, including he has an episode on the War of Art actually. So with a distraction, what is a distraction? So a distraction can actually be seen as an incorrect guess from part of your brain as to what you're going to do next. That may seem strange. So to understand that we have to get into, well, what are the two types of attention that we have? We're used to thinking in terms of one type of attention, which is task attention, attention in the present moment. What am I doing right now? But there's another type of attention in the background. You can call it, technical term is a default mode network. We can call it background attention or predictive attention, which is, and we can experience this. When our mind is just like pondering something else while we're having a conversation or in a meeting, particularly when we're bored or we don't know what to do or that type of attention is meant to prepare ourselves for the next step in the task. So as humans, we do highly complex behaviors like driving and. Imagine what it would be like if we had to think of each step for the first time in the moment of executing it. It would be practically impossible. But so what happens is this part of this background part of our brain is preparing ourselves for the next step, making a prediction on the next step, how based on our past behavior. So the more familiar we are with a task, the more we know how to do it, the more mastery, in other words, we have. the more accurate that prediction is going to be. If you drive to the same place, I don't know if you commute to work or not, or a friend's house, if you go regularly, well, congratulations for not needing to commute. But if you go to a place regularly, it becomes automatic. Your background intention is perfectly trained what to do next. You don't have to think about it. It helps you. Now, what happens if It doesn't know what to do next. What happens if you're doing a new task? A task with a lot of uncertainty involved. Maybe it's a bigger project that it's not clear what the steps are. Like for a student, it could be writing an essay. He just knows I have to write an essay and with this prompt, but he hasn't really thought through the individual steps that make up to writing the essay. So in that case, the background attention is going to make a prediction based on what he has responded to in the past. The technical term for this is what has salience. If you think of what has salience for any of us, especially for a young person, what has he responded to in the past, it's going to be things like checking his phone, watching a YouTube video, getting a snack, staring out the window, daydreaming. All those things have a lot of salience. We've responded to them. And that's what the background is going to provide as a next step. And that's what is experienced to us as a distraction. So an incorrect prediction, a next step that's not actually helpful. So then the question is, well, what do we do about it? We train the background attention. We train it so that it provides the accurate next step. How do you train it? You train it through thinking through the steps ahead of time. Before you start on a specific task, before you start on the essay, you said, you said a start time, a stop time. I'm going to work for 30 minutes. This is what I'm going to accomplish in 30 minutes. I'm going to do, I'm going to start with, so my goal, and then I'm going to break it down into steps. Uh, first I'm going to. I'll read the prompt. Then I'm going to brainstorm some ideas. Then I'm going to pick the most relevant ideas. Then I'm going to outline the paper. And we can break that even down into further steps. And the smaller the step, the easier it is for us to engage in it. And this is also a strategy for attacking, overcoming procrastination. And maybe even the first step I would give myself is I'm just going to walk to my desk and sit down. My second step is going to be, I'm going to take out my materials and just take out the prompt. Then I'm going to read the prompt. All of a sudden that seems much more doable and the clearer it is in my mind, then the more the background intention is going to facilitate that. The more I'm going to be focused and accompanied by other strategies, going to be able to enter into flow.

Stephanie Winn: That's a super interesting way of thinking about it. So I've learned myself about the task positive network and the default mode network. And, you know, when you explain driving, how we can go on autopilot with driving, especially a familiar route. So the default mode network is active. In other words, the wandering mind that is left to think about, let's say, social situations without putting 100 percent of your attention on driving. And when I've explained this concept to patients, I've explained think about how When you learned to drive, you were really thinking about every single thing you were doing, right? The consequences of getting any of it wrong are very steep, and this is all new. So you don't have room in your brain to think about anything else besides every step involved in driving. And so that's your task-positive network devoting your full attention. So I've provided the psychoeducation about the task-positive network and the default-load network and how depression and anxiety are associated with both more time spent in the default mode network, a harder time shifting out of it, and more self-critical and ruminative quality of default mode network thoughts. But I've never heard it put this way before, that one of the jobs of the default mode network When it's operating in the background is to predict what's going to happen next based on established patterns, which is part of why sitting here talking to you I'm not thinking about checking my phone. And yet, when we get up after this meeting. walk to the bathroom, I'm going to check my phone because I always check my phone when I'm walking, you know, the 10 seconds, right? So part of what you're saying is that being distracted is a habit that you've trained yourself to be accustomed to doing certain things.

Johann D'Souza: Yeah. Yeah. And just like all emotional disorders can be conceptualized as an addictive disorder, they can also be conceptualized as a type of distraction. So anxious worries or obsessions, those can be seen as a distraction. And with the distraction, so we want to, we can prevent distractions up front by just by being clear on our purpose and breaking it down into steps. But then what do we do in the very moment of distraction? How do we respond to that? Um, it's a, it's a three-step process, which is basically a type of mindfulness. So the first step is to just recognize that I am distracted. So that self-awareness, the second step is to unhook from the distraction, not to chase it. Even, even though there's a satisfaction in chasing it, because there's a satisfaction in responding to the prediction. But here we're trying to train the brain that no, this prediction is not right. So we're gonna have to face a little bit of discomfort by unhooking from the distraction. And then the third step would be to then put our attention back into the task at hand. So that applies to distractions in the case of study. It also applies to anxious worries or obsessions, which again, we can conceptualize as a distraction. That right now I'm having this conversation But then I have a worry about, well, what am I gonna make for dinner tonight? Well, let me just, okay, I recognize that, I let go of that, I come back, put my full attention back into the conversation. I'm treating the worry as a distraction, which is the same thing as saying that I'm treating it as something that's not real, because distractions are not real, they're in the imagination. And what we want to do is be more and more immersed into reality. You used a great descriptor. By the way, that was a hypothetical example. Dinner is the last thing on my mind right now. So I used a great descriptor when talking about checking the phone. You said the urge to check the phone. That's exactly right. Distractions are always manifest manifested physically in our body as an urge. So actually the first step, the first step of noticing the distraction could be reduced to noticing the urge in my body, in the front of my chest. And oftentimes just noticing that urge and feeling it and opening myself up to it, maybe rating its strength from zero to 10 is enough for it to dissipate and for us to be able to focus on the task. And that's the same technique. That would be a mindfulness technique, mindfulness of the urge that I would use when helping someone with anxiety or with addiction. So we can train both our brain and our body, if there's a difference in there, to reduce the frequency of distractions and to be able to handle them as they arise.

Stephanie Winn: I have a technique for managing distractions or those sort of back of the mind worries that pop up when I'm talking to someone because, you know, part of the reason I said that I have no urge to check my phone when I'm sitting here talking to you is because I've conditioned myself to sit right here talking to people in long conversations because I sit here and I do this for therapy, consulting, podcasting. But when something does pop into my mind, I just note it down in the same notes that I'm taking. If I'm taking notes with a patient, I'm talking to them, some distraction pops into my mind, I just write it right there in the notes. so that I can get it out as quickly as possible, then I just copy and paste that to my to-do list later. I also read a strategy that someone uses where when they want to read an actual physical paper book, keeping a post-it note on the front of the book and a pen nearby, so when they set a timer to read, they're allowed to do two things, either read or write on the post-it note. And so anything that pops up, instead of actually going and doing the thing or checking the They just note it on the post-it note and then get back to reading. This is all reminding me of this idea that the antidote to anxiety is action, which is something that has come up before in various contexts, but the most recent time I remember Encountering This Concept is in The Gift of Fear by Gavin DeBecker. Have you read that book? No, I haven't. Oh, it's excellent. It's one of those books that is like the book that everyone recommends who's read it whenever a certain subject comes up, which in this case, it came up for me when I had shared something on the internet about listening to your intuition and how intuition can protect you because you have all these subconscious pattern recognition abilities operating in the background that are designed to keep you alive. And I'd shared some personal story about that. And like 20 people in the comments were like, you got to read The Gift of Fear by Gavin DeBecker. And since I've read it, I'm now that person that whenever this topic comes up, you've got to read The Gift of Fear. And the closing chapter, I'm just reading the closing chapter right now, and it's so beautiful. And he talks about how the gift of fear is that it is designed to protect you so that you don't have to spend all of your time worrying. That's why we need to be able to rely on our intuition so that we can be relaxed when there's no immediate fear. And he had some really interesting concepts there that fear means something is not happening in the moment because it's fear about what's going to happen in the next moment. So you might live with a fear of your house being intruded. Thankfully, I don't live with that fear on a regular basis. But once your house is actually intruded, you're not afraid of it being intruded anymore. You're afraid of what the intruder is going to do next. So it's always this fear that's anticipating what could happen next. And so he distinguishes fear as a real visceral sensation where your intuition is telling you something in the moment about what could happen next. He distinguishes that from worry, anxiety, rumination. And he talks, and he breaks each of those down, and he talks about how the antidote to worry is action. You know, worry is always either telling you that there's something to be done, or it's giving you something that you can then evaluate and, well, is there anything to be done? You know, sort of like how and cognitive behavioral therapy might guide someone through a decatastrophizing process of well, how likely is that to happen? How bad would it be? What would you do? You know, and sometimes you interrogate your worries and you determine It's unlikely or it could happen, but there's nothing to do about it. So I might as well just take my chances and live my life. But sometimes your worries point you towards there's something that you need to take action on. And it seems to me like that's where a lot of people with anxiety get stuck from my clinical experience. I'm just speaking anecdotally here that sometimes it's the people with the most anxiety that paradoxically have the hardest time knowing how to act. on their anxiety? That makes sense? Like they're just not in the habit of doing the thing to prevent the thing you're worried about from happening.

Johann D'Souza: Yeah, yeah, no, that's certainly true in my experience. So to introduce a more philosophical concept, I would think of the powers of the soul, and three of which, intellect, will, and then I'll say heart, which is kind of a colloquialism, but encompasses the emotions. So intellect, will, heart. those are the three powers of the human soul. If you think of like modern psychology, cognitive behavior therapy, cognitive, that would be the intellect. Behavior, that would be the will, so one's actions. And then the heart would be the emotional element, which is not in the name CBT, but it's what the cognitions and behaviors impact and are impacted by. So in terms of the relationship between anxiety and action, I would say that my way of thinking about it is that the treatment is threefold as well. And one crucial element of it is the actions, is the behaviors which correspond to the will. And yeah, people often have very maladaptive behaviors in the face of anxiety. And at the same time, I think that there are these other two components which are also helpful. The cotton component corresponding to the intellect, which the chief skill would be reframing. So being able to reframe the threat or the challenge as an opportunity rather than a threat. and then the emotional component corresponding to the heart, which would be mindfulness. So I think we can intervene at either, at any of those three levels. The way I've been trained to see it is you start with the intellectual, you start with the reframe, then you move into mindfulness, and then you pick a challenging goal or action to execute on.

Stephanie Winn: That's beautiful. I love that sort of connection of psychology and spirituality and you'd mentioned before we started recording that the you know when it comes to psychology like psyche means soul. I recently told you about a group called Do No Harm, who's working to do just that. Eliminate the harm that so-called gender-affirming care for minors and political ideologies in medicine are causing. Do No Harm is made up of thousands of members across the country, from doctors to nurses to policymakers to concerned parents who see what's happening at practitioners around the country and are waving a red flag. Membership is free, and you get unlimited access to information from experts, on-the-ground updates from people working in medicine or state houses to take a stand, and collaboration with other thinkers. Learn more and sign up at do-no-harm-medicine.org slash some-therapist to learn more. That's do-no-harm-medicine.org slash some-therapist. I want to circle back to a couple of things that I said I would, or that I at least made a mental note to come back to, and then get to our locals question. So you mentioned body dysmorphia as a form of OCD earlier, and we have a question here that has to do with gender stuff, which we'll get to in a moment. And I also had some thoughts on the link between body dysmorphia, OCD, and gender issues, and then also how that connects to egocentronic versus dystonic. Now, I know you said that you don't have a lot of experience working with gender issues, but based on your experience with OCD and body dysmorphia, What similarities or differences do you see between people struggling with body dysmorphia that's not necessarily focused on their sexualized body parts versus people with gender dysphoria where it might look very similar but it's about their sex or perceived gender?

Johann D'Souza: Wow, that's a great question. Also, I just think it's cool that people are asking questions on Locals. I didn't know that was a thing here. So, and this will give me a chance also to respond to your preliminary question, which I never answered, which is the categories of OCD. So, you got like hoarding, contamination, taboo concerns, which are related to sexual content, ordering, arranging. things not feeling just right. And then body dysmorphia is another, in my experience, less common symptom. But that deals with, and body dysmorphia is a great example of how the fear is irrational or unrealistic. And they typically have a much harder time with insight. They have lower insights. So they're completely, they're so convinced that, yeah, my left arm is longer than my right arm. My left leg is bigger than my right leg. My ears look weird. So that would be, because it can be a symptom, body dysmorphia can be a symptom of OCD, or it can be a full-fledged, like, body dysmorphic disorder. And then, yeah, it could be, like, body image, like, totally convinced that, I'm overweight, and in fact, it's the opposite. So I wonder, so just thinking about this with you, yeah, I wonder if the difference between, like, so you could have body dysmorphia without, like, gender-related concerns and with it. It seems like there could be some people with body dysmorphia that they're very distressed with their appearance. They don't want it to be that way, but they maybe they have the insight that, hey, this is like excessive, like I really shouldn't be worrying so much about this and this is impacting my health. Whereas you could have others who think that, hey, it's actually, it's good that, let's use the gender example, it's good that I'm concerned about looking the way I do because in fact, the person, let's say he's a man, But in fact, I'm a woman, so it makes sense that I'm uncomfortable looking the way I do because it doesn't actually match my identity. So it seems to me, based on your explanation, that that would be more like an egocentronic concern.

Stephanie Winn: Yeah. Yeah. You just linked it. And yeah. That's so I really don't know where we should be drawing the line between OCD, body dysmorphia and gender dysphoria. But I do think that one major component amongst all of us who are worried about how gender dysphoria is being treated and well conceptualized and treated in in the 2020s. This concept of egosyntonic versus dystonic is something that I don't think we're talking about enough. So I have been sending messages to those who are subscribed to my Marco Polo sharecast, which you can join as a member of my locals community. I've sent a message there about this. And let me just explain one way that this has come up as an example. I've had similar conversations with multiple consulting and counseling clients who are all worried about their children, where the parents are coming at this from the standpoint of, I believe my child, when they say they have gender dysphoria, I just want them to get the best help. And I'm not convinced that medicalizing is the best. I think psychological help is the best help. How do I get them the best psychological help? And yet, when they try to say things like this to their children, they're met with a lot of resistance, which seems odd to them because, like, why would anyone have a problem with their loved one saying, I just want you to get the best help for your condition? And I think it's because to the parents, they're thinking about it in an ego-dystonic way. They're thinking, my child is suffering from a condition. I want them to get help overcoming or healing from that condition in the least harmful way possible. the least invasive, the least costly, with the fewest long-term consequences. The way that young people who identify as trans are thinking about their so-called gender dysphoria is very egocentronic. So there's this, that's when we bring in the identity piece, right? And this is very telling if you look at posts and forums. I've seen screenshots people have taken in like Reddit forums where someone has asked if you, so for people who are trans, If you could go back in time and be born again as the sex that you identify as, would you? There are all these people saying, no, being trans is a part of who I am. Right? So they're saying, I feel like I, you know, on the one hand, I feel like I was born in the wrong body. and I'd be happier if I was a woman or I'd be happier if I was a man. And then on the other hand, you say, okay, if I could wave a magic wand and have you be born that way, would you? So many people nowadays, and I don't think this was true 20 years ago, but with the current identity politics and social contagion element, so many people are saying, no, it's being trans that matters the most to me. This is who I am. Right, which is why I think that's part of what fuels things like the transgenocide myth, right? This idea that people like you and I who just want people to get the best help, ego dystonic framing, the fact that we want people to get the best help means we want people to stop existing, right? That we want them to die off because their sense of who they are as a person. is linked with having this condition and they don't want the condition to resolve in the least harmful way. So I think that this is something that we ought to be talking about a lot more. And I actually made a little diagram, which maybe I've been meaning to post on social media and get people's thoughts about this, but I made a little diagram showing what I imagine the sort of trajectory is over time of where someone falls on the spectrum between egocentronic and egodistonic with regard to their gender dysphoria. And so let's say it starts off And pretty soon after a rapid period of indoctrination, the person has very egocentronic gender dysphoria. And then at various points in the process of disillusionment, desistance or detransition, it becomes ego dystonic again. So either they still have gender dysphoria, maybe they still have gender dysphoria, but it's become reversed now where a female who now looks like a male and just wants to pass as female again and now is having the experience of dysphoria around looking male. There's all kinds of ways it can go to a more retrospective perspective where it's like, looking back, I wish that I had recognized or that professionals involved in helping me or my parents had recognized that these were the things feeding into my condition. So I think it sort of peaks in its egocentronic nature at the height of the social reward of really kind of being indoctrinated into this identity politics, and then becomes ego dystonic again. And I think, yeah, I just think a lot more research needs to be done around the eosintonic or dystonic relationship that people have with gender dysphoria.

Johann D'Souza: Yeah, that's a really good point. Yeah, and I will take that opportunity to emphasize that people with body dysmorphia, they do often have lower insight, and they've been completely convinced that their concern is true, even though no one around them would observe that. And the last thing that she would ask their loved ones to do is to confirm them in their fear, is to say, yeah, you know what? Your left arm is smaller than your right arm. Maybe you should get that checked out. In fact, maybe you should get surgery. Maybe you should have your left arm shrunk down.

Stephanie Winn: It's just so funny for me because I actually have one leg that's longer than the other. I literally have that. And the only time I obsess over it is when it causes me hip pain. From like the structural problems.

Johann D'Souza: Well, and in that case, so this gets to the fundamental question of what is our basis of judgment? And I hope we can say it's truth, reality. Like in that case, if you have hip pain, there is a real thing you can attribute that to. Whereas with dysmorphia, that's not the case. It's not based in reality. It's not based in truth. And so that's the other, I know these concepts are very unpopular and archaic these days, truth and reality. But that's the question that people with, we have to ask ourselves regarding people with gender dysphoria, is it based in reality? Does the person have the insight to recognize that? And then how do you work with someone who has poor insights? And it is very difficult, because yeah, there can be a lot of resistance.

Stephanie Winn: poor insight or secondary gain or an egocentronic relationship, right? So we should move on to the locals question. It ties in with this, but from a different angle. So a question from the locals community, which if you haven't heard this already and you are a listener of this podcast, it's only $8 a month. for the privilege of asking questions of me and my guests, getting early access to new episodes, and the newest feature, well, also in addition, meeting other like-minded people, but newest feature in the Locals community is you can join my sharecast on Markup Below where I send customized messages based on my work consulting ROGD parents that I think are super useful. for people. So join my Locals community if you want to be able to ask a question of an upcoming guest. So we have a question from Locals community. Oh, by the way, that's somekindoftherapist.locals.com. All right. So our question from Locals community, Dr. D'Souza, given your research on the role hope and optimism can play in healing, do you see a way that hope and optimism can help people who are seeking gender transition? Is gender transition itself a result of false hope?

Johann D'Souza: Hmm. Okay. Is gender transition a result of false hope? So it's like the people who are undergoing the transition, they have a hope of achieving something, and then we would have to ask ourselves, is that actually going to be realized to their satisfaction? So just to break down, in terms of hope and optimism in the scientific literature, they have technical definitions which I honestly don't necessarily agree with on a philosophical level. But optimism is basically the expectancy of something good happening in the future. And hope, you can think about it in terms of the end and the means. So you have a specific positive end in mind, and then you have the means of how to achieve that end in mind. So neither of those addresses whether your end is a good one or whether your perceived good is actually a real good. So yeah, you could have someone undergoing a transition could have hope and optimism that the transition will benefit them and But then it's a separate question as to whether it will, in fact, benefit the person. So it could be that the person's object or end or goal is actually something that's very harmful for the person. So according to the literature, yeah, hope and optimism are associated with a number of positive well-being factors, including emotional well-being, But I think if we make an analogy to something where someone has a hope in something that will actually, in fact, be harmful to the person, like let's just say like a drug addict has a hope in satisfying their addiction. then the benefits of hope, I think, are not going to outweigh the drawbacks of the actual harm of the action or the outcome that they're pending, which is what I would expect to happen with someone who undergoes a transition because it's not based in reality. They're not going to have the long-term outcome that they're seeking.

Stephanie Winn: I'll add my spin on it. that I think a lot of these young people are looking for hope and optimism and something to work toward in a world where they're being sent a lot of messages about how hopeless everything is. So I think You know, a lot of these are middle class kids, although I've worked with people from all kinds of backgrounds. I've worked with parents who are, you know, very working class all the way to parents who are quite wealthy. Most of the families involved in this are white, but I've worked with families of different racial and ethnic backgrounds. I've worked with immigrant families where there's a cultural divide too in the parent-child relationship, where maybe the parent's first generation an immigrant and then the kid is much more Americanized. And so this is all very strange Western stuff to the parents. They're like, well, where we come from, we have bigger fish to fry than changing sex. But that being said, For a lot of these kids who do come from, let's say, sheltered middle class backgrounds where they really haven't had it too hard, you know, we've talked about sort of the coddling the American mind. I think on the one hand, there's like the helicopter parenting, the fragility messaging, but then at the same time, kids are spending a lot of time online and they're learning Let me put it this way. While they're sheltered, they're also simultaneously getting so much more exposure vicariously to things happening around the world, all with the media's spin on things without having developed yet a good filter for taking in information from the media and recognizing that media is driven to create hype and stir up your emotions. Or even if they know that cognitively, it still doesn't impact their ability to filter for things on media and social media. So it's like on the one hand, you have these very comfortable existences. The only things that they've typically had to work hard for have been like either grades or maybe performance in sports or music or something like that. But many of them have never gone without their basic needs met. And they don't have a lot of experience doing actual labor. So they don't have experience like building houses or baking bread from scratch or taking care of livestock or things that are just more physical ways of contributing directly to the world around you. So they spent all their times in their heads while their physical experiences are very comfortable and safe. And then with all this time spent in their heads, they're being sent all these messages about climate change and robots taking your jobs and all these things to make youth feel like there's no place for them in the world, like there is no hope, nothing to work for. So they're having that before they've developed the experience of actual problem solving, of something's dirty, I'm going to clean it. Something's broken, I'm going to fix it. So it becomes very daunting and overwhelming before their brains have even fully developed. I think in that context that all of this gender stuff is like a welcome distraction for many of them. I mean, going back to that concept of distraction because they don't know how to solve climate change. They don't know how to solve the war in the Middle East, although many of them would like to think that it's so simple as liberating Palestine. You know, like they think that that'll do it, right? They oversimplify global conflicts. But the point is they don't know how to actually solve problems. And so the idea that my body is the problem, my gender is the problem, my transphobic family is the problem. And here's the solution. Step one, go to a gender-affirming therapist. Step two, get your letter. Or step three, go to the doctor, Planned Parenthood, whatever it is. Then you do this drug. Then you do that drug. Then you need to get this surgery. Then you get that surgery. And you come out. This sort of step-by-step plan for here's how you're going to solve a problem, even though it's a made-up problem. And even though it doesn't actually solve anything because it creates more health problems for them down the line, I think is very appealing. And I think that's part of how we got here. And I do think it creates false hope. And it's dangerous in that because people are spending critical developmental years sort of chasing this carrot thinking, I'm going to feel better when this next thing happens. Meanwhile, they're making steps that will impact the rest of their lives. And it's often after these irreversible steps have been taken that they realize they've been going down a path that's not actually leading anywhere except towards more health problems and permanent social consequences of what was actually a temporary social phase.

Johann D'Souza: Yeah, and I think we couldn't find a better example to support one of my favorite hypotheses, which is that we live in an intellectual and cultural dark age, which is characterized by complete divorce from reality. That if you think of like, well, what is the essence of civilization or culture? I think you have to say one aspect, if not the whole thing, is reason. dependence on reason rather than circumstances, whims, emotions, hype, hearsay, gossip. And there's just no, there's no reason here. We're denying the most basic facts of, of nature and human nature. And in fact, denying that nature even exists or human nature even, even exists. And we're not doing these poor kids a service with that. Yeah, it's uncomfortable when you admit that nature exists, it makes things uncomfortable because that means we can't do whatever we want. We want to be happy. That there is a certain, there are certain things that will lead to our flourishing and there are certain things that will lead to our suffering. And we don't have complete autonomy and control. and ultimate liberty and license, which is the promise of secular humanism, and which is the heart of its creed. So ultimately, secular humanism is incompatible, I think, with human flourishing, which is based on nature, as Aristotle says. So, you know, maybe in use, there's, in particular, there's an idea of, well, we can achieve anything and do anything and be anything or anyone. But part of our confrontation with reality that we come to accept more and more as we become adults is while there's a lot of things that we have control over, we don't have control over everything. And the more we accept the fact that we accept the things that we don't have control over and try to organize our lives around those things, the happier we'll be.

Stephanie Winn: And maybe that's the bright side of all this discussion, is that there are things in each of our lives that we can have influence over. And the more time we spend fixing the problems that we can fix, the more self-efficacious we feel, the lower our anxiety, the better our hope and optimism, because it's based in experience. And I think that's what a lot of these young people need. I think anything where they're accomplishing something, especially with their hands or with their bodies, the more they'll have that sort of felt sense in their bodies.

Johann D'Souza: Yeah, absolutely. That's a great point. It is important for people to have a sense of, I can get better. at something if I practice over time. And then that can then be generalized to other areas of life, which are more difficult, but it can also result in improvement, including one's own emotional life and social life, which may actually be the cause or trigger or exacerbating factor of the person's gender dysphoria and subsequent behaviors.

Stephanie Winn: Well, thank you so much for joining me. Let's talk about where people can find you.

Johann D'Souza: Sure. Well, yeah, I have this podcast, the Dr. Johan D'Souza podcast. My personal therapy website is valuesfirsttherapy.com. One of my missions is to help form loving families. And to that end, I'm going to be giving a webinar on how to save your child from digital destruction, which is a very relevant topic these days. So perhaps I'll send you a link to that and with a discount code for your listeners.

Stephanie Winn: Oh, that'd be perfect. Thank you so much. Are you on any social media?

Johann D'Souza: I'm getting on there. I haven't quite decided whether social media is compatible with my vision of human flourishing.

Stephanie Winn: Fair enough.

Johann D'Souza: So I haven't completely committed to it. So I'll leave it open.

Stephanie Winn: And you also do coaching and mentoring. Can people find that through your Values First therapy website as well?

Johann D'Souza: Oh yeah, that's a good point. Yeah, so I can do it through Valley's First Therapy, but I'll also just genuinely encourage people to check out my mentor's work on the Optimal Work podcast or OptimalWork.com. They can use, if you do OptimalWork.com slash discount, then there'll be a discount to those services. It's something that's personally changed my life. I apply it every single day. I have seen it make a big impact on other people's lives. Not everyone resonates with it, but those that do, it can make a big impact.

Stephanie Winn: Awesome. Well, thank you so much. It's been a pleasure.

Johann D'Souza: You too. Thanks, Stephanie.

Stephanie Winn: I hope you enjoyed this episode of You Must Be Some Kind of Therapist podcast. To check out my book recommendations, articles, wellness products, guest episodes on other podcasts, consulting services, and lots more, visit SomeTherapist.com or follow me on Twitter or Instagram at SomeTherapist. If you'd like to go deeper, join my community at somekindoftherapist.locals.com. Members can dialogue with other listeners, post questions for upcoming podcast guests to respond to, or ask questions for me to respond to in exclusive members-only Q&A live streams. To learn more about the gender crisis, watch our film, No Way Back, The Reality of Gender-Affirming Parents, at nowaybackfilm.com. Special thanks to my producers, Eric and Amber Beals at Different Mix, and to Joey Pecoraro for our theme song, Half Awake. If you appreciate this podcast and want more people to find it, kindly take a moment to rate, review, like, comment, and share on your platforms of choice. Of course, just because I am some therapist doesn't mean I'm your therapist. This podcast is not a substitute for medical advice. If you need help, ask your doctor or browse your local therapists online. And whatever you do next, please take care of yourself. Eat well, sleep well, move your body, get outside, and tell someone you love them. You're worth it.