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Episode 117: Paul’s Best Friend Dr. Michael Sebahar
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The Intervential Pain Specialist has been Paul’s best friend since 1982.  They recount the evolotuion of their relationship, especially both dealing with the effects their father’s alcoholism had on their families.  Mike also talks about the tightrope of treating people with chronic pain while trying to weed out potential abuse.  Mike recounts the intimacy he finally felt at the end of his father’s life.


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Paul: Welcome to episode 117 with my guest Dr Michael Sebahar. I'm Paul Gilmartin, this is The Mental Illness Happy Hour: 90 minutes of honesty about all the battles in our heads, from medically diagnosed conditions and past traumas to everyday compulsive negative thinking. The show's not meant to be a substitute for professional mental counselling. What are you, a jackass? It's a waiting room that hopefully doesn't suck. I'm not good at mixing things up and throwing new shit in there, because then I forget what the next thing is that I'm supposed to say. The website for this show is mentalpod.com. Please go there, join the forum, post on it, take a survey, see how other people responded to surveys, join the— sign up for the newsletter, buy something through our Amazon link, donate to the show or just stare at the homepage and fuck yourself. How's that? How's that grab you? Right out of the gate, I'm coming out swinging. What did I want to say? Day six of... what is this new med that I'm on, what the fuck is it called? Lamictal. I'm tapering up, so I'm on just 25mg and have got that feeling that I think so many of you who've been trying to treat your depression for years know, where your fingers are crossed and you're like, 'in six weeks, will I feel better?'. 'Cause it usually takes like anywhere from, depending on the med, anywhere from a couple of weeks to like eight weeks for you to feel anything and that's always so disappointing when you get to the eight week or the twelve week mark and you're like, 'yep, guess this one doesn't work! Back to the drawing board'. But, I've been through this before, and I'm sure I will go through it again, and I'm just trying to be patient and gentle with myself, not beat myself up for sleeping ten, sometimes twelve hours a day, and trying to be grateful actually that I have a life where some days I can sleep that long or that late.

So, let's dive into it. I want to read an email I that got from a woman who calls herself Fan. She says, "Hi Paul. I'm a big fan, but heard something disturbing on episode 115 with Ashley. You both just got through talking about how there are serious social drivers for disproportionate male violence, etc. related to men not being able to find socially acceptable emotional outlets. Totally true, totally fine, which is why I was surprised when you threw women under the bus in the next sentence. Right after that, you go on to say that every misogynist you've ever met has had a domineering mother. Essentially you're blaming women for sexism against women, a very sexist thing to do. Sure, you're sharing your anecdotal evidence, but if we're not supposed to think that means something about how misogynists are made then why share it at all? I was really disappointed to hear that and hurt that you go on to claim you now see women as your 'sisters' after you essentially just blamed them for their own subjugation. I think of your podcast as a great place for people to learn things, which is why I felt the need to send this to you. It makes me sad to hear things like that on a usually forward-thinking podcast."

And to that, I would say that was, that was not my intention. That was, I was speaking partially. What I normally say when I posit that theory that I have is that domineering mothers were usually raised by a father that abandoned them or objectified them in some way and it's all a part of the cycle of abuse. I don't think anything happens in a vacuum. I think anyone that abuses or mistreats somebody usually themself was mistreated or abused, and who knows where the fuck it started? And, to be honest, I think if you were to keep a tally of one sex mistreating the other, I think a lot more men would be guilty for mistreating women than women mistreating men because I think classically men tend to take it out in outwardly aggressive ways and I think women tend to internalise it in ways like self-abuse and self-hatred, so that freaked me out when I read this because that is not at all what I think, and I just thought about how many other people that might have heard that and thought that, that I lost as listeners and so you can imagine the fucking panic spiral I went into, but guess that's one of the risks you take when you do a podcast is that you're not going to completely finish a thought and it's going to be misinterpreted, and people wind up thinking the opposite of what your real point is. One of the things I do take pride in about this podcast, though, is talking about the ways that, when they do abuse males, the ways that the females do it because I don't think it's covered very often and it was something I was not even aware of until I was in my twenties and I feel like that's a dark corner that needs light shone on it and so I also hope that, if I tend to disproportionately talk about those instances on the podcast, it's not interpreted as me saying 'this is what's wrong with society, this is the major cause', and that's why I'm showing it. It's just that I don't think it gets covered as much because it's not as prevalent as the reverse, but... now I'm just repeating myself.

Anyway, this next email is from a guy who calls himself D and he says, "I recently severed all ties with my brother due to his untreated mental illness. I have my own problems that I'm in therapy for and I don't need his added stress. My parents, on the other hand, feel I should just forgive him for telling me that he wants me to, quote 'die in a fire'. If this was the only time something like this had happened it would be different, but he consistently crosses the line with everybody in his life when he gets mad and says horrible things. Growing up, he also had anger issues that he would sometimes take out on me. So, because of the history, I told my parents that I will not have any contact with him until he seeks professional help. He is not healthy for me. The reason why I'm telling you this is because I know you have severed your relationship with your mom. How does your family feel about that? Do they try to get you to talk to her again?" Well, my only family is really my brother and my cousin, who was raised with us and neither of them have made me feel bad about that, neither of them have tried to get me to talk to her again and I don't know if I've severed my relationship with her as much as I've taken a break that I don't know where it's going. I don't know if I can ever completely write somebody off. There's moments when I think to myself, 'I'm never going to have any contact with her again' and there's moments when I think, 'maybe I could be in the same room with her, y'know, some time in the future'. Because we change, y'know, as we heal and we process all that stuff that was so painful when it first came up. It begins to feel a little bit different. So that's kind of where I am about that, and the reason I wanted to read your email is because I want to applaud you for setting boundaries with your brother. You know, if your brother doesn't want to help himself, you shouldn't... [laughter] I don't know what my dog is doing behind me, but— he's doing a reverse sneeze. If your brother doesn't want to help himself, I think it makes total sense to protect yourself from him. Even if your brother is getting help and he's still being abusive towards you, you still have the right to protect yourself until you feel safe to give it another shot, or maybe even not. I hope the people who listen to this and are the loved ones of people suffering from mental illness realise that giving consequences to people that aren't getting help for themselves can be the most loving thing that you can do sometimes, because sometimes that's what it takes for them to wake up and go, 'Hey!', y'know, 'I got a fucking problem here and I need to do something about it instead of just lashing out at everybody, because my emotions are overwhelming'.

Alright, this next one is from a survey that doesn't get filled out very often. It's the survey called Younger Male Abused By Older Female, and it was filled out by a woman who calls herself Marley Moo. She writes, "I was twenty-eight and took advantage of him at age eighteen years old. He was a virgin and I was just lonely. I never told anyone though it was legal and consensual, I do feel that I took advantage of him because he was so underexperienced and innocent."

Remembering these things, what feelings come up? She writes, "I hope that what I caused to happen doesn't hurt him now."

Do you feel any damage was done? She writes, "I'm not sure. I surely hope not." And then she writes, "I've never ever thought about anyone that was underage, ever. I've seen some fellas that were eighteen to twenty that I would slightly fantasise about. I'm thirty-three now." I think the most disturbing thing in this survey is that you used the word "fellas". And I think that outweighs all of these other by about a thousand to one. I don't see anything wrong with— what were you, twenty-eight? And he was eighteen. Y'know, it's legal, it's consensual. So what if he's underexperienced and innocent, y'know? It was probably exciting for that guy, y'know. Unless you got a vibe from him that he was freaking out or he seemed like he shut down or froze up or he started to cry or something, y'know – fuck, that's just a part of the human experience in my mind. But let's get back to this disturbing use of the word "fellas". Did you just fall off a turnip truck? You're thirty-three years old, so you were born... your parents shouldn't even been using the word "fellas"! I want to get to the bottom of this, Marley Moo. I want you to email me and I want to find out what happened in your life that made you resort to using the word "fellas" because I don't see this going any place good.

[Intro music]

Paul: I'm here with Mike Sebahar, my best friend in the whole wide world. We've been friends since 1982 or '83. We were roommates in college, and we're actually on vacation together, we're skiing a couple of hours north of Los Angeles, and I decided to bring the gear because I was like, 'y'know, I think Mike would be a good guest', even though there's nothing dramatic in your story. You're a seeker and I think those make the most interesting guests – the people that, when they're met with a challenge, they really kind of search, not only outside themselves, but kind of inside themselves for what's the best way to handle this situation, and... you're one of those people. So thanks for, thanks for being on here.

Mike: It's great to be here, Gilly.

Paul: Mike is an interventionial pain doctor. Tell the listeners what horseshit this is that you do for a living.

Mike: [laughter] Well, I want to clarify, for the record, we've been friends since '81.

Paul: Well, we met each other in '81, but you and I didn't get to be friends until '82.

Mike: Actually, we were a little prickly at first, I think.

Paul: Yeah, I don't think I liked you very much. Mike and I met through both being in a fraternity, which makes both of us roll our eyes because it was strictly a place for us to drink beer and meet girls and all of the ceremony and the self-importance that a lot of people – they were like our big targets, the guys that took the fraternity experience seriously, and we got out of there pretty quick. What, we lived there like two years and were like, 'this is... we're done with this'.

Mike: I think we got out of there. Actually, I think we made it three years. The third year was brutal, but we were definitely the deviants of the house. There were a couple situations where... [laughter] ...we could have potentially been harmed very seriously had people found out the pranks we pulled.

Paul: Yeah. I remember in particular one... I was on the track to be a doctor as well and Mike was actually the person that talked me into trying out for the stand-up competition, which then inspired me to change my major to theatre. But we had both, when I was still pre-med, I think we were sophomores, and we had had a particularly brutal courseload of all these pre-med classes, and you and I, I think, were one of the last people in the house to have our finals, so we were I think the only two people left in the house. Everyone had already left for winter break, and you and I lived in this little, shitty, dark room that had this hideous hanging lamp. I don't know if it was like papier-mâché or – do you remember that lamp? It was just ugly, but neither of us had ever said, 'goddammit, that is a fucking ugly thing, hanging down in the middle of this room'. But Mike and I decided to blow off steam that we'd do mushrooms, so we do mushrooms and we're sitting in our room and we start laughing about something, and I can't remember. I had my hockey equipment in there and we both had one of, we each had a hockey stick and we're like, suddenly it dawned on us how much we hated that fucking lamp. And we both just started beating this lamp with my hockey sticks like it was a piñata. We started laughing so hard, we didn't want it to stop, so the next thing we looked for was things that we could destroy in the house. I don't know what we were thinking, how we were thinking we were going to get away with this, but the next thing I remember is we had found somebody's set of weights and we were throwing weights through walls, like they were, like it was a discus, to see who could make a bigger hole in a wall, and it was like, it was almost like this orgasmic release of all of this pent-up studying and pressure and I don't know, what do you remember about that?

Mike: Well, the... not a lot!

Paul: We were pretty fucked up.

Mike: But I do remember tearing walls down and literally doubling the size of that room and I remember, yeah, we paid later, but that was quite a night. I think we did engage one guy. There was a six foot five guy who was still in the house with us, and I remember him clawing at the walls with his hands. His first name was Conrad, and he was around, and he got into the act, so we weren't the old ones. We definitely tapped into some energy. Yeah, oh... yeah. And another great time was when the whole, the entire frat house was out front, getting a picture taken and that was the days of Izod so everybody was all prepped out. It was our formal house picture. Do you remember this? And you and I were kind of getting pretty cynical about the house, we needed to leave. And we went up in the top front bedroom, third floor and dumped water on everybody simultaneously as the picture was being snapped and eighty five guys turn around and just infiltrate the house—

Paul: Looking for us.

Mike: —looking for us. And somehow, to this day, I don't know how we were not found. [laughter] I remember literally being terrified, like it... our life would not end, but it would be just short of that.

Paul: What else do you remember about anything in particular about the college experience that kind of stands out?

Mike: I still have a picture tucked away in a box of you nude on my sailboat. [laughter] And I think my current wife is on the boat with you.

Paul: I remember! It was the three of us went out sailing, and I was like, "you guys mind if I nude up? 'Cause I think I need to be on the front of this boat, nude on this beautiful summer day", and you're like, "go for it!".

Mike: I tucked that away, I tucked that one away just in case you got really famous.

Paul: I actually think I have a copy of that. I think you might have made two copies of it because I have that somewhere. But, y'know, Mike was the first person to say, in a very loving way to me, "I think you might have a drinking problem", and I will never forget that. 'Cause you didn't shame me about it, but you said it with a sense of compassion for me, and you might have been— was that the time that I fucked up your chance to have sex with a cheerleader?

Mike: I was gonna say, that was when I took the Notre Dame cheerleader back to the room and I could not arouse you to get you out, so I don't know that it was all that altruistic [laughter]. I was just maybe hoping that wouldn't happen again.

Paul: Yeah. Mike and I were not, like... I wouldn't say we were successful with women, certainly in our first couple of years of college. It wasn't like we had a lot of dates and were socially successful, so Mike having a chance to fool around with this Notre Dame cheerleader—

Mike: Way out of my league.

Paul: Way out of both of our leagues. And it was, to this day I still sometimes will apologise and go 'Oh my god'... Because I was so drunk he couldn't drag me off the top bunk bed and get me out of the room so he could see this girl in there, but... Yeah, you didn't let me live that down for a while.

Mike: I've gotten over it.

Paul: But there was something I felt immediately when we became friends – I guess it would have been our sophomore year – and maybe it was because we were both pre-med, but there was, yeah, there was like a cynicism about the whole experience that we were going through because there was a lot of people around us that were like 'rah rah rah', y'know, 'this fraternity is great', and we then were just like 'how could anybody think that this is something other than a place to get beer and get laid?'.

Mike: Well, I think, y'know, we... I think in a very dysfunctional way we kinda saw through that a little bit. We saw that, yeah, this fundamentally was not something to attach to or to have a lot of faith in. And I still feel like it wasn't something that I fundamentally have a lot of faith in. I have gratitude that I met people like you through that house and all that was worth it, but I think... and you and I, we actually talked about this today in the chair lift, how similar our backgrounds were and maybe that's what drew us to each other, repelled us maybe at first a little bit, 'cause that energy was so strong, but then drew us together and we become pretty close for, y'know, college buddies and lived together a lot. And I think a lot of that came, y'know, from – we had such similar fathers, I think a lot of it, and households.

Paul: Mm-hm. Though I was so envious of your house – and by the way, we went to Indiana University in Bloomington. We were there from '81 to '86. We both went five years.

Mike: I did a couple of victory laps.

Paul: Your... the first time you took me – Mike is from Columbus, Indiana, which is about an hour away from Bloomington, where the university is – and when we got to be good friends you were like, "hey, y'know, I'm going home for the weekend, why don't you come with? You can meet my family", and I just way struck by... I wanted to be a part of your family because there was laughter at the dinner table, you had a couple of cute sisters and it was just, I don't know, there was kind of a... it was just kind of a life to it, there didn't seem to be this tense silence.

Mike: Well, I mean... yeah, there were real connections there in my family, no question about it, and I think part of what drew us together is we were clinging together on the life raft of craziness and chaos. My father, this brilliant, brilliant, gifted guy who was a seeker at heart, but was pretty much ravaged by alcoholism his whole life and—

Paul: He was a general practitioner, an internist?

Mike: A general internist, yeah. Very, very good doctor, but so we did. We had a big, boisterous, y'know, just rambunctious—

Paul: Five kids, all pretty close in age.

Mike: Yeah, rollicking sort of adventure of a life, and those look fun on the outside, and there were moments of fun on the inside. It's an interesting example of, though, how a family can look from the outside versus how mechanically it's working on the inside, and what you take out of that.

Paul: Yeah, y'know, it was so idyllic. You lived on this lake, kind of in the woods, not in the midddle of nowhere, but it just seemed like something out of—

Mike: A story book, yeah. Dogs and chickens and lots of cars and bikes and a sailboat. Yeah, it was, and a small town, big fish in a small pond. Yeah, we lived great and people did enjoy being around big families like that, and I was the oldest, I was, y'know, Peter Brady. Greg Brady was the oldest, I was totally Greg Brady. Everyone else was younger so if I brought a friend home they just sucked them up like a sponge.

Paul: I think that's what I liked so much when I sat down at dinner was, like, I don't know, it just felt like people were paying attention to me – not that my family didn't, but there was a sense of fun, a sense of play that I think I was really jealous of. Talk about your family, what were the kind of dynamics? Obviously the big elephant in the room was your dad's alcoholism. Did you have any idea that your dad was an alcoholic at that point?

Mike: Yeah, I think I realised it somewhere... y'know, when I was old enough to maybe put that together. I would say, it's hard for me to remember, but I would say it really began bothering me around age fifteen or so.

Paul: What would you see, for instance?

Mike: Well, y'know, just... I mean he was, y'know, intellectually so gifted and so... but the unpredictability of that was pretty maddening so one dinner we'd sit down and we'd have this incredibly engaging conversation and he may or may not – probably had been drinking some beer, was there. Other nights, y'know, he'd be kind of three sheets to the wind and sort of not there, not emotionally available and y'know, and so I think I began acting out. Fortunately not in ways where I really dug myself a hole, but I remember going to— what's the school, some Catholic school for teenage things [Catechesis?] and getting high in the parking lot instead of going in and coming home when I... I remember specifically coming home one night and I'm just high as a kite, sitting there, and my dad is drunk as a skunk and he's wanting to start this intellectual dinner conversation and says, "Mike, you look very insightful, you have something to say", y'know. [laughter] I'm just really high, Dad. But, y'know, I think I sensed it then, somewhere in early high school, and I think my first feelings about that were anger, that I wanted, I wanted it differently and I remember looking at other... I remember some interesting things, like I remember, y'know, he was a very busy guy with a great career, very successful and a lot of people looked up to him, but I remember for instance going to swim meets and, y'know, I remember there was one guy, his parents were at every swim meet, every single swim meet and I remember thinking, 'that's weird, that guy must not be very important, he must not be busy'. I remember... y'know, what a crazy thought for me to have.

Paul: The dad, you mean?

Mike: The dad. Thinking that, whereas my dad was, y'know, I always felt was just too important, too busy, too professionally saturated with tasks that he couldn't come, when in fact that wasn't the case at all, but now I think, as a, now that I am a father, I think, I hate to miss any of that stuff.

Paul: And you have four kids, and that's a load on your plate.

Mike: Yeah, it's all I do sometimes. But, at the same time I remember how interesting in hindsight... my own view of the world was so skewed at that time that thinking 'that's really weird, that guy's dad's at every swim meet'—

Paul: That's creepy!

Mike: Yeah! What the hell's going on there? [laughter] And that was was just a loving supportive father, but that's, to me that looked weird because I didn't get that.

Paul: My dad's drinking, it wouldn't interfere with his job, he didn't—

Mike: No, he was able to really, somehow he was able to keep that wall of separation, and so that's probably what he thought – 'I'm functioning here', and he had kind of dragged the old sort of family structuring from his upbringing. He was that transistional generation, y'know, dads now are really, I'm generalising, but so many of them are so engaged with their kids and activities and coaching and now you look and every dad's up in the stands and, heck, they're watching practice, probably too involved, but he... I think he dragged that old kind of, y'know, 'my job is to work and I'll make a lot of people, but it's my mom's job to'... it was my mom's job to pretty much raise him, I think.

Paul: I'm bringing home the money, that's enough. You guys figure the rest out.

Mike: Yeah, I think so. That's not really fair, y'know, I don't want to throw him under the bus. There were some great moments that we had together. We definitely had an intellectual kinship 'cause I was a pretty good student, academically I did well and I was a seeker at that age already a little bit, trying and he was, he was just so sick and he couldn't get out of it, and I also got to hear a lot about his drinking from my mom. That was, so even if I didn't necessarily, even though I didn't recognise that, and I think sometimes kids, when you're in it, you don't even know, you think everybody's dad drinks all night when they come home. But I got to hear about the emotional disconnect from my mom even before that.

Paul: Just in case, to make sure I don't forget this, I want to interject that I've said that Mike is an interventional pain doctor, which means he deals with people that have chronic pain and one of the things that he does is he will install morphine pumps in people's spines, a procedure that... I can't imagine how complicated it is and yet me being impressed with that is always tempered by the memory I have of seeing Mike reach into a wastepaper basket in college, pull pizza crust out of it and eat it. And I never let him forget it.

Mike: I'm a survivalist, Paul. [laughter]

Paul: Do you want to touch on your dad's family and any of the sickness there? Is any of that kind of worth going into?

Mike: Yeah, well... so, I mean, there was, what we discovered later in life was that there was a history of some molestation and I'm not comfortable specifically naming who was involved in that but there were people that I was very close to and we put that all together later in our early twenties and so it was, I mean these were all females that were molested by a male figure on my dad's parental side of the family and so when that came to light that was an interesting period of time, and that eventually was brought to my dad's attention, who I think was horrified by that, because I think, y'know, that's something he would have never, that's a line he would have never crossed. I think he loved his kids pretty dearly, and I think he, that's not an area that he had a sickness but it was in his lineage and it definitely affected relationships on downstream and so he directed confronted this individual and there was denial, and I don't think it ever went any farther, but—

Paul: But they had to know that he knew.

Mike: Right. Well, they definitely knew that he knew, because he directly spoke with them.

Paul: But even though they denied it, they had to know. Y'know this is just me. And you've described those grandparents before and it just made me so sad. They sounded like just the coldest, most kind of cut off...

Mike: Yeah, well there wasn't a lot of warm and fuzzy to them. Yeah, they were just, y'know, kind of post-Depression babies and – or actually, Depression-era kids. They were born in the, they would be over a hundred years old now so yeah, early/late teens in 1910 or '11 or '12. Kids, they grew up in giant families, Irish Catholic families with twelve, thirteen kids and, boy, I've spent some time kind of just considering what must have gone on in that generation. Somewhere down the line there's some darkness and some sickness that lead to that kind of behaviour where people, blood relatives were being molested, and so.

Paul: I'm struck by the, there's so many parallels in our stories but especially as you talk about that. You and I never talk about this, but my dad – his dad was verbally abusive, and one of his sisters claims also sexually abusive, and my dad, like your dad, retreated to his intellect, was emotionally cut off and took great joy in knowing facts, knowing about the world, but was kind of sad and lonely in that. That being his God, his intellect being his God, kind of cut him off from other people, but I was just struck, and he came from a family of seven kids, Depression-era.

Mike: Yeah, my father, he was an extraordinary person if you took him as a whole, because I've done a lot of work because of my relationship with him and—

Paul: And he did get sober before he died?

Mike: Well, yeah, he died of cancer and there was some forced sobriety because he was unable to eat or drink, but what was interesting is that at the end of his life he sort of found recovery and became very, and found the spirituality that was underneath all that. I had started going to support groups at that time to sort of deal with my feelings about his disease and really look hard at how that had affected me and so it was kind of this miracle where I was able to come to him with pure love and total forgiveness and be able to honour him as the man that probably he always could have been and at the same time he was able to find a spiritual connection with me and tell me things that he had never been able to tell me, and so—

Paul: What were some of the things?

Mike: So, right near the end of his— so, we were literally in the last few weeks of his life and I had gone down when I realised... As a physician I was able to, y'know, really be a good support for him and he was almost childlike in how much he counted on me to help him make decisions about his treatment, but when it was obvious that the end was imminent, he was sitting in a bed one day and I was just there just kind of taking care of him, just being of service to him and feeling grateful that I was able to do that, just not have any hard – or any resentment whatsoever and how good that felt. Cleansing for me to do that and he just looked at me like he had never looked at me before and just said, "tell me about your job, tell me what you do", and I started telling him what I do, y'know, what I do in my work, and just this, like... it was almost unbelievable and this, y'know, two weeks from death and lines of wear and tear and kind of regret just washed away on his face and he just looked at me and just listened to me for three or four minutes and just said, "I'm just so proud of you" in a way that he had never said it. It was probably the first time I'd ever felt that and I realised how much, how long I'd been waiting to hear that from him, and I think, y'know, that's my stuff, that I needed to hear that from him because I think that spiritually I don't want to live my life needing that, but it sure felt good to hear that from him at that time, y'know, and realising all these crazy behaviours and stuff that had occurred over the years that I took personally had nothing to do with me. Underneath this was a man who loved me so much, and later that night, or later that day, I just crawled right in bed with him, in his hospital bed and he just held me in my arms, he held me in his arms and just kind of cradled me, and to this day, probably the most amazing moment in my life and I realised how long I'd... my whole life I'd waited for that, that moment of tenderness from him and being just held like a baby and him stroking me and he wasn't worrying, he wasn't thinking about his cancer or dying, he just wanted me to know that, y'know, and it was a miracle for me to have that.

Paul: Wow, that's beautiful.

Mike: I'm just glad I didn't cry telling you that story. It's hard not to.

Paul: It would have been okay. People cry on this show sometimes. Um... so, what were some of the dynamics with your dad having all those years not been present. I mean, I know because we've talked about it, but I just kind of want you to...

Mike: Yeah, I mean, so I think anybody that knows about kind of the disease of addiction probably knows already what I'm going to say, but, yeah, I became... yeah, I was already Greg Brady, and I was, I think, I was viewed as a superstar of the family anyhow. Good student, good athlete, y'know...

Paul: Responsible, takes care of his siblings?

Mike: Responsible, yeah, and I became kind of a surrogate father and husband in that family and I think the age was about thirteen when my mom began confiding in me about things... because she didn't know where else to go, y'know? She, she didn't know where else to go and didn't know how to find help and I think that's kind of where I emotionally stopped growing and I decided "I don't have to have a normal trajectory", y'know, or the forces prevented me from having a normal trajectory of growth for a teenager. Rather, I became the responsible adult at that age. And, in short, just took the world on my shoulders and decided "I have to be able to figure everything out", and if I couldn't, I could be pretty fricking hard on myself about that. And so I spent a long time working through that, and still working through that, and the resentments of being put into that role, y'know?

Do you remember consciously resenting your mom back then or did it, as you grew up and got into support groups and you saw that this was not a normal thing, to be the confidant?

Yeah, it wasn't 'til really my dad became sick that all this came to a head and I knew... about a year before he died I knew I could not deal with that pain of losing him and all the feelings and emotions surrounding alcohol and alcoholism without getting into those support groups, and that's when I began realising. But, no, did I know? I don't think so. I don't think I had any idea and what's interesting is it was probably the driving force behind my life up until that point. But like so many behaviours, and as a physician I'm in a unique position to get to observe this too, because I deal with people with acute pain, chronic pain, the families of chronic pain patients. There are patients I prescribe pain medications for, some of those patients have addiction issues, many times I know, sometimes I don't, so I've really got a front row seat for that whole process of that dysfunction, y'know. So I know that those behaviours that you learn, that I learned when I was a teenager... they didn't suit me as I became older, they really became more of a character fault—

Can you be more specific?

Yeah, well, just—

Needing to control things?

Yeah, controlling. I mean obviously, at age thirteen, when I was, y'know, when the insinuation was that I was the most responsible male in the house I began, I think... I didn't have the tools in place so I began to go towards sort of the default of control. I wanna control this, I wanna control that, much of that probably out of fear that, hey, I don't know what I'm doing! But inside that fear of—

Can't let my mom down.

I can't let her down, y'know, I gotta be there, I gotta be the guy and so, yeah, control was a huge issue for me, and controlling every aspect of my life as much as possible, and then that turned into, for me, controlling even things that were wildly out of my control—

Like?

Every little thing in life, y'know! Just looking at someone who isn't operating under my sort of belief system and saying, "wow, why is that person that way? That's not my belief system!" So that's the evolution of my disease, I grew into a control freak.

Do you think, inherent in the control freak is the egotistical belief that you really can get an outcome? Do you think that egotism comes from being given that responsibility, which can be kind of a high from an adult, y'know, when they look at you like you're an adult, you feel kind of important, but do you think that's where that comes from? Because there's such an arrogance in that sickness that you think you know and nobody else really understands the way you do?

Yeah, I mean, I—

Do you think it's more fear? I guess I'm asking, do you think it's more from a place of fear that things are going to fall apart and you're going to enter this unknown void that's going to be terrifying, or is it this arrogance that, "Well, hey, if my mom made me man of the house when I'm thirteen, I must be pretty fucking special so my way of doing things must be unquestioned"?

Hmm. Interesting. I think they're closely tied together to be honest with you, because I think the ego frequently derives its power from fear, and so...

Without really recognising it!

Right, I don't think it has any... yeah, I think they're very closely tied and I agree. I don't think your ego knows it's fear, but the coal in the oven is fear and, so, yeah. And there is a high, you're right, there's an intoxicating high, and there may be a component of addiction to that as well. I remember being put on this pedestal, being introduced to people by my mother, Dr So-and-so, somebody that my father, who's also this physician, in our community was kind of the upper echelon of this small town, and that look of pride, and I thought, "Ooh, I'm like, I'm the golden child both inside and outside the house" and, yeah, that was a lot to take to college! [laughter] That was, y'know, it's too much. There's no way I could have continued at that level.

I have to say, having lived with you all those years, you hid it pretty well from your peers. I knew other people, friends of ours, who were way more controlling and neurotic. You never struck me as that type of person, so you kept it hidden pretty well.

So, I think something for me that sort of tempered this process of what I could have become in a place like college was I kind of had a really great experience where I got to work at this unbelievable summer camp in my late teens and early twenties where I just lived with this group of people all summer long and I got thrown in with these people. The philosophy of the camp and the owner of the camp were just very grounded and kind of a spiritual path and we became, there was a big adventure component, so the introduction to the outdoors and living simply was brand new to me. I was this kid from a pretty rich doctor's family and all of a sudden I'm living out in a cabin and stuff, and I loved it, y'know. I really, really drank that up, and I think that that altered my life substantially as I found things to sort of grab onto that felt more real and felt very, very wholesome, and I'd never seen that. And I was put into a situation where I was around people who were very kind of just loving and open and accepting of everybody and at that time it was just kind of the tail end of the hippy stuff, but it was hanging on at that camp and so it felt... I think you visited and remember that camp and it was wonderful. There were kids running around in warpaint, there was no— it wasn't a tennis or computer camp, it was just a kids fun camp.

Play.

Just live outside for two weeks and you're gonna sleep outside and you're gonna play and, y'know, you're gonna swing off a rope swing and it's all about the joy of that moment, so seeing that was huge for me because up to that point... at age thirteen I pretty much gave up play. I mean, I played, I went and got drunk and swam in the lake with my friends and did some crazy stuff, but it felt more like acting out, maybe. But truly, joyfully playing stopped for me, y'know, right there in my early teens and so there I got into that and felt like this whole world opened up to me where, wow, I can play. And so, when I left that and went back into the real world—

And those guys are your best friends.

Yeah, to this day, they're some of my best friends, y'know. Besides you, there's three or four of those men who I stay in touch with to this day.

Can you rank us numerically?

[Laughs] You're all one. [Paul laughs] Yeah. So that was hard when I went back into a professional world. Suddenly I felt that drive to sort of compete again and be the golden child and impress people and impress my parents and so that play thing became something that I struggled to keep back in my life.

And getting into medical school wasn't necessarily a non-brainer for you. From what I remember there was a little bit of difficulty getting into medical school originally.

Well, yeah. So I hadn't set myself up well and I had to jockey for a position for another year to get in there because I just really hadn't quite put in the effort and so, yeah, that was... but fortunately it did happen and then that was the beginning of a long course of time when you pretty much give up your entire life and I think it's hard sometimes to grow spiritually when you're in training that is that intense. It just takes so much out of you that I don't know that there's a lot of time for attention or self-care, which is unfortunate.

Yeah. I remember Mike getting out of medical school – he went to medical school in Indiana – and when he got out, it would have been like the late 80s?

I got out of medical school early 90s, yeah.

And I was getting ready to move to California. When I moved to California I selfishly wanted you to come out there, so I kept pestering Mike to look for jobs when he finished his residency to consider sending some applications out to California and he and his wife Karen came and visited and were just kinda sold. Do you remember that weekend when you came out?

Yeah, it was great. Yeah, the interview... we pretty much found out we were going to get the job and I remember calling Paul that night and it was like ten o'clock, ten thirty, eleven maybe when we finally found out and I called you and you were there within like an hour and fifteen minutes.

I drove about ninety-five miles an hour to get down there.

So excited, yeah!

So excited.

We all just jumped up and down in that little room, y'know, and it was right by the beach, remember that? Yeah, that was a big, big change from the Midwest.

I can't imagine that you would have made that move if you hadn't have had the Camp Palawopec experience of connecting to the outdoors.

No, no. I don't think that... right. It introduced that whole concept, the camp, and we called ourselves the Peckers by the way. Palawopec Peckers was the shorthand. To this day they probably call themselves the Peckers. But yeah, it did, it instilled this sort of spirit of adventure and I did, I found strength through the friendships and one guy in particular, a buddy of mine, Bruce, who worked there. I remember I was struggling over this decision because I had this incredible job all set up after I finished my training and—

Could have started making great money right away in Indianapolis.

Great pay, great money, great job, everything. We had it all set up there. It would have been the easiest transition and I remember struggling over this, knowing in my heart that this would have been a sellout for me, that I wanted more, that I wanted more for my life, I wanted to get somewhere close to, y'know, the mountains or the ocean, and I looked for jobs in those places, but pulling that switch was probably the first time I ever really walked over the hot coals of fear in my life and walked into the void, and it was very, very, very hard because I was always looking for that solid ground because I'd grown up in this place of chaos and so, y'know, control was all about trying to find solid ground when it's just not there. We really don't have that much solid ground in our lives, and so this, I had all this solid ground set up and I remember talking to this friend of mine, Bruce, and him saying, "Yeah, well, I don't know what to tell ya, and I'm sure not going to tell you what to do", but he said, "if I were you, I'd worry about waking up in ten years on a November day and looking at a forty-five degree rain out the window and saying 'what if I'd moved out there to Southern California? What would that have been like?'" So, yeah, we made the move and the rest is history. One thing has lead to another and it's worked out. But I remember that excitement of moving to, and if you grow up in the Midwest like you and I did, California...

It's like Disneyland.

Yeah, it's a fantasy world. You literally can't even conceive of it.

A place where you can ski and surf in the same day. Mindboggling. You can't do either in Illinois and Indiana.

Right. And I don't think you even think that it's a place where you can live. I don't think, y'know, for me, I don't think that I could even conceive that I could live a life there and raise a family and do all that. I think it seemed like a magical world out there, y'know, so, yeah. I remember somebody told me, "do this before you get comfortable", which was great advice because getting too comfortable oftentimes for me has cut off pathways that I perhaps should have taken.

It makes taking a chance much scarier because you've given up more.

Right. Exactly.

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Let's talk about your job as a pain specialist and what that involves. Describe an average day for you as a pain specialist. First you were an anaesthesiologist and then you decided to do a little bit more schooling to learn to be an and interventional pain specialist.

Yes, well, it's called a fellowship, so I did the four years of medical school and then I did four years of anaesthesia training, and then it's interesting that interventional pain management, or pain management, is a bona fide sub-specialty of anaesthesia, but it's very, very different. It's sorta like people, y'know, go into internal medicine and become a dermatologist. It's a very, very different field. However, I did that extra year of training, and so an average day for me is... oh, y'know, I might go into work at eight and I see, I usually divide my days in half days, so I'll spend half of the day doing spinal injections. So there's specific injections that I've decided I can diagnostically determine where pain comes from in the spine or I can therapeutically inject certain medications into the spine and usually in the spine and help people with acute and sometimes chronic pain as well. A lot of elderly people need these periodic injections 'cause they really don't have surgical cures that are going to help them. And then the other half of the day is I'm evaluating new patients and seeing follow-ups, so I may see a handful of patients that have had injections and I check up on them a month or two later. "How's it going? Are you also working on weight loss? Are you also doing some exercise? I want you to do these exercises." And then I may see three or four new patients, new consultations that primary doctors send me. Some of them may be people with acute herniated discs or there may be an elderly person who's got bad degenerative disease, some of them may be people, their primary doc's said, "this thirty-five year old guy has back pain, I'm writing him Vicodin every month and I'm getting kind of uncomfortable because he always wants more and he needs more". And then I'll see a handful of follow-ups on those kinds of patients who come into my practice and are there continuously on a monthly to every other month basis. We're writing medications usually for those people. Frequently it's opiates if they're appropriate.

Talk about the tightrope that you kind of walk as a pain specialist, because some pain specialists get a bad rap because they overprescribe things and I would imagine, as you and I have had many conversations about this, you are a sanctuary for somebody that wants more pills, an addict that is going to exaggerate their pain. How do you navigate that tightrope of, you want to serve somebody that has pain, but you don't want to be a sucker for an addict who is lying?

Yeah. That's the toughest part of the job. I mean, one thing to remember, and most people don't know this, a lot of physicians forget this, is that pain is essentially an emotional, it's a very personal experience that no one else can ever measure your pain and there's no external measure of pain. It's one hundred percent patient report. So, an MRI doesn't tell you how much pain a patient's having. There's no study in the world that will tell you that. Now, sometimes, we can get signs from people in the recovery room or something where, y'know, they're laying there in their bed and their heart rate's ticking away, their breathing fast and we can say, 'that patient's probably having pain', so that's a kind of a cardiovascular parameter we can use. But, especially chronic pain, it's a hundred percent patient report, so anybody can walk into my office and say, 'I have pain'. And, so, if you just think about that, no way to measure it and you get your one hundred percent patient report, it's really tough, and almost everyone is clutching an MRI saying 'I got a disc bulge' or 'I got this' or 'I got that'. Y'know, 'I got a degenerative joint disease', 'my doctor says I have a little scoliosis in my spine' or 'I got spinal stenosis, which is narrowing the spine up in my neck', and those are valid findings on those imaging reports taken in the context of the whole patient, but they've done a lot of studies on those and actually they don't measure up very well with symptoms. When you take those and you match them up against patients' symptoms, there's virtually no correlation and that's pretty fascinating. So, yeah, you get patients coming in, they say they have pain, and the job for me is to have to put that all together. Alright, do I believe the patient? That's a gut feeling, alright, and I'm pretty good at that, I think. Y'know, I get tricked and fooled and sometimes I buy a story that I probably shouldn't have because I want to be compassionate, but I think once you've been in the field a while it's very hard to just be openly compassionate and believe every single story, because if you do you'll become a pill mill for these patients, y'know. People that are abusing pain meds or selling them or misusing them in some form – we call selling them meaning diverting them, they're getting them and doing something else for them – they quickly figure out who are those doctors that are too easy? And so those people have been highly criticised in some circles. I remember there was this recent series in the LA Times that focused very much on doctors that are outliers, that prescribe too much and some of their patients have died, but I know a couple of those doctors by reputation and actually I think their main fault was that they were just too compassionate and they were duped by more people. You're gonna sorta have a scale of people who are, y'know, suspicious, maybe too suspicious of everybody, and other people that are just way too generous. And I probably am appropriately suspicious, but I try to believe people, but that's a tightrope, and then I always worry, y'know, about... people are going to find me and so when patients are needing more and more pain medication for their pain, I have to sorta put on this different hat of being, alright, now I have to be real, real, sorta... well, not, say, suspicious, but I have to be very, very, um—

Conservative?

Conservative, and investigative about the different type of data I have access to. Are they getting pain medications from other doctors? I have some means of looking at that, I have to do urine tests on these people, and so that wasn't something I necessarily saw coming into it, that I would have to test people by urine, but it's become the culture of what I do and most of the studies say 'you should be doing this and you shouldn't only do it on people you suspect, you gotta do it on everybody'. Because I've had nice little grandmothers all the way to twisted mean people and I've had, y'know, I've been fooled many times by dirty urines or people that some up dirty on their prescriptions, y'know. We find that a given prescription's from multiple providers, and in hindsight most of them you can detect but sometimes you get tricked and so you just have to test 'em all.

You told me last night that there is no education about addiction for doctors in medical school, in their medical training.

Very little. Virtually none when I was in medical school and, from what I hear, nowadays it's quite minimal. I mean, in general, if you think about it, one in ten people are addicts, addicted to something or have the addictive personality. It's almost unforgivable that we don't have more education about this.

I can't tell you how many doctors I've been to that are willing to give me a bottle of a hundred Vicodin for, y'know, soreness, and it's like, 'What? What are you doing?' If I was looking to get high... that's crazy!

Well... but remember, five to ten years ago, somewhere in there, there was a big movement of 'pain is tremendously undertreated' and the hospitals all adopted this as a new vital sign and there was a lot of pressure on physicians to treat pain more aggressively and hospitals in particular were really under the gun, y'know. You gotta really treat these people's pain, there was legislation, doctors are supposed to... you cannot ignore a patient's pain and all that. I kinda... I laugh at that slightly cynically and say, 'well, how do you know?'

How can you legislate that?

Yeah. And so, as a physician I've had a lot of experience through my life, understanding addiction and addictive behaviours, but also through my job I feel like I'm kind of somewhat gifted, being able to see, and there are patterns you can even academically start to learn. People that lose their pain meds all the time – 'the dog ate them' – behaviours that are almost always associated with abuse or selling or diversion of the medicines, but the real bottom line is that doctors, I think, in their training don't get enough of this training, as prevalent a problem as this is. Y'know, kind of mental illness in general, it's really overlooked in medical education, and you and I were just talking about this today. It's not... I think you probably still get the mental illness training of things like schizophrenia and the big diagnoses that are well-established. It's the nuances of mental illness where I see most physicians struggle in primary care. People with borderline personalities, and—

Where a large component of it is manipulation and they do tend to be smart and charming and clever. People that don't understand addiction, they don't understand, most addicts have been doing some form of acting their whole lives to treat their pain or their depression or whatever it is, so you're coming into contact with someone who is a seasoned pro at reading people and projecting what they need to project to get what they want and, if you don't have any experience with that, from being in a support group or having someone who is in your family like that, so you don't have that kind of spidey-sense – man, you're up against a lot, 'cause I know that I could go get as many pain pills as I wanted to. I've been to enough doctors that I know what I could say and how I could portray myself to get it, and I think even to somebody who's fairly seasoned at it.

Well, yeah. I used to lose a lot more sleep over that, that I was part of that loop, and unwittingly perhaps, but that I was part of it. And at times it made me kind of want to reject the whole field and go back into anaesthesia or completely stop prescribing medications, but I do have patients and a lot of them that I know get benefit from this. A lot of the elderly people, they're pretty straightforward, y'know, they hurt, and they do—

You told me some of the conversations you have that thank you, some of the older people that were in terrible pain and they just – tears in their eyes, they're thanking you for giving them a quality of life that they didn't have before. That's gotta be incredibly gratifying.

It is, it's wonderful. And I remember the first time I came home with some lipstick on my shirt and my wife, she's not a suspicious person, but I walked in and she kinda looked at it and I said, "it was an eighty-five year old lady, don't worry" and so... [laughs] ...who hugged me after her epidural steroid injections.

Talk to me about the importance of attitude in people that you see. As we were driving up here you were telling me the story about this woman who had, I think she was ninety four or something, who had...

Yeah, well, so... doing what I do, I get this incredible front row seat to the ageing process, which I think for a lot of us is terrifying. Culturally... look at our culture. So much of our culture is driven by the desire to avoid that, this inevitable process that we're going to get old.

If old people had better abs, we wouldn't have this problem.

[laughs] Right. Just all it takes is more Botox and it's all gonna be fine.

Some crunches. I don't care if you're in a diaper, crunch up.

Well, I always get a kick out of the family that's really just needling the eighty-five year old about some little thing in their diet, and they're eighty-five. There's a reason that they're eighty-five, y'know? And, 'you need to do this, or take that herb'. So not to debunk all of that, but I see it as much more attitude. So I get to watch how people age, and I've literally had patients from seventeen to... I think my oldest patient is ninety-eight, and she's going to make it to a hundred. There's no doubt in my mind that she's going to make it to a hundred. But I had a little lady the other day—

Paul: I'm gonna push her down just to smite you.

Mike: Well, y'know, I actually think that everybody should get to sit down with a delightful individual in their nineties, somebody who's open, who's maintained that kind of seeker attitude, because it is absolutely transformative if you really look and listen to what they have to say and feel their energy, because – this is just an example from the other day. I was telling you, I see patients – most people as they get older, I see them, many of their behaviours and their sort of adaptive ways, the ways that they function and adapt to situations—

Paul: Like their body breaking down, or...?

Mike: Well, more just the tools they use to get through life and deal through stresses. I'm talking about more mentally and emotionally and how they deal with, y'know, change and how they deal with, y'know, conflict and they're open and curious and they maintain some kind of level of hope and optimism and delight in life for itself and spirituality. I'm not talking about going to church as you know. When you and I talk about spirituality, it's not going to church. It's what church is supposed to be giving you, but a lot of times it doesn't. So I see most people and a lot of them unfortunately close down and harden because they're fighting the process of ageing. And I'm not being judgemental, it's more of an observation that I— so I see them, some of them are quite angry and bitter about the fact that their bodies are shutting down and they're dealing with pain. I'm not saying that's easy to deal with, but I occasionally get somebody in their nineties, eighties who's just kind of remained this open thing, this open attitude and this delightful way that they view life. Those people are usually very non-judgemental, they haven't walked around saying 'look at that, that's not like I like it', y'know. Everything doesn't have to follow their belief system, which... it's interesting because I find that encouraging as somebody who is trying to seek in my life and grow and be more open, be non-judgemental. It's pretty obvious to me that those people are way healthier, not just mentally, but physically, because those two are so closely tied together. It's expansive. It's like they're still growing and, even though their bodies are getting old, they're still growing emotionally and mentally and spiritually and so they tend to cope with their stuff much better. This little lady, she was walking and her hip wasn't working right because it's arthritic and she's got a bad back and she's kind of limping and she's sorta giggling about it as she walked through the room and it was the cutest thing I've ever seen. Y'know, 'look at that hip, it just doesn't work right!' and I thought, 'wow... wow'. I mean, this lady knows she's never getting a normal hip back and there's nothing I can do about it. She's just looking at it with amusement like, 'yeah, this is happening, but nothing I can do about it'.

Paul: I'm gonna embrace it. Talk about it.

Mike: Yeah. And so I now view that as a real benefit to my job and I find myself going into and looking at that a lot and deriving a lot of strength from that, and having gratitude for the opportunity to meet with these elderly people.

Paul: So does that mean you didn't fuck her?

Mike: [laughs] Oh my god. Now I know I can't ever run for Congress, we're talking about me having sex with elderly people and doing mushrooms in college. Okay. Noooo Congress for me. [more laughter]

Paul: Every once in a while I just have to completely shit on the beautiful tone that has been set, and... there was no way I was gonna record you and not have one of those moments, 'cause you and I do it constantly with each other. I mean, one of the things that I love about you, many things I love about you, but one of the things I love about you is you will follow whatever tone a conversation takes. You can be sincere and you can be irreverent and you know when to switch back and forth, when your buddy needs sincerity and when your buddy needs levity, and that to me is one of the greatest things to have in a friend, is somebody who can not only sense when you need that, but can roll with it when you're kind of switching up gears. You and I have laughed at some of the darkest shit, I'm not gonna share it on this program. Some of the inside jokes Mike and I have, I just love it.

Mike: Well, right back at you, Gilly. Yeah, I feel the same way. It's an incredible thing to have, for me, to have a male friendship that's lasted thirty one years, and I think sometimes men don't have that. I know a lot of men that don't. I always felt badly that my dad didn't have long sustained male friendships, because I think men are capable when we put down our guard and open up our hearts, we're capable of incredible connection with other men and I think it goes way back. I think the Native Americans were sitting in sweat lodges and that was healthy male bonding and I kinda feel like sometimes it's hard to maintain that because there are a lot of things that disconnect us from that – jobs and families and stuff.

Paul: Well, I know this last summer I went through a lot of shit and driving down to San Diego and feeling comforted by you and Karen and you guys let me stay for a couple of days and it really recharged my soul and it felt nice to not worry about how I looked in front of you, about how much snot I had running out of my nose and how much I was crying or whether you were going to judge, y'know, 'he's being a little sensitive about this'. I just felt like I could be myself and I think that's a super important thing. If you can find two or three people in your life that you feel like you can collapse in front of without worrying about draining them or being judged by them. That's a pretty important part of a support network to have and it's nice.

Mike: Yeah, I just wanted to remind you, you still owe me for the rent and the professional fees from that weekend. Paul, you haven't forgotten that, right? No, I just had to poop on that.

Paul: I love too how, since you've become a dad with four kids, that you use these words like "poop" and "delightful", which like thirty years ago would have never been in your vernacular, but, y'know, you having matured emotionally, I feel like in many ways that I'm still like a twenty year old and you're kind of this person who's done all the responsible things that come with it, y'know, including not just saying whatever word comes to your mind, but sometimes...

Mike: When I ask my wife whether I'm a kid or an adult, yeah, you get a little different... [laughs]

Paul: Is there anything else you wanted to touch on before we wrapped up?

Mike: No, y'know, I just... I'm honoured that we have this friendship and this opportunity to talk and I sit in amazement at what you do with your life, Paul, and this path that you've created. I remember watching you at the Frangipani Room and do your first stand-up and I was just thinking a while ago how I could work this into conversation, but I remember you making a joke about – this is how far you've come – one of your big jokes was a joke about gay people, y'know, and I can only laugh now because you're somebody who's so non-judgemental and so embracing of people and who they are and there's not a racist bone in your body, but I specifically remember that and laughing at that myself and now, y'know, maybe we've grown up in our bodies, but in our hearts and our minds is where we've grown up together and helped each other along, and that kinda joke wouldn't even...

Paul: It wouldn't be funny.

Mike: It wouldn't be funny to us now... I remember you standing up, and the balls it must've taken for you to stand up in front of those people, and coming from all you had come from, and I remember feeling that excitement for you and then watching your career take off and what you became, and now here you are in another chapter and what's great is this is coming from the heart and the best work does, in my opinion, always come from the heart.

Paul: Well thanks, buddy, y'know, I... I truly believe that I wouldn't have had the courage to be in this field that I'm in if it weren't for that day that you said to me, "I know you love stand-up comedy. I think you should enter this stand-up comedy competition". And so I took an acting class to overcome my fear of doing that and discovered acting and stand-up and all this other stuff, but it was... you could see something that I love but the fear that was standing in front of me and you gently encouraged me to do that and I'm so grateful, because I feel like I'm on the path that I'm meant to be on and I feel like you had a huge part in that and I never forget that, so thank you.

Mike: My pleasure, Paul, y'know. It's just another story about the reasons people come in our lives, y'know. It's kind of amazing.

Now go eat some pizza crust out of the garbage can. [Mike laughs] Thanks, buddy.

Love my buddy Mike. I hope you enjoyed that as much as I did, 'cause as I was editing that I was – and I emailed him this – I was just like, 'man, you're just a great example of a man', y'know? Good dad, good husband, good friend. Wish I could get over that eating the pizza crust out of the wastepaper basket, that is a bit disturbing. What did I want to say? Oh! I liked too how that letter I read in the beginning of this show about how what I had said a couple of episodes ago was misinterpreted as misogyny... and in the middle of this episode I talk about asking if he fucked his ninety-six year old patient. Oh... maybe I am a pig and I just don't know it. I don't think so. Alright, let's, before we get to some, and I have quite a bit of surveys and a couple of emails to read, because I've been getting some great feedback from you guys, letting me know that you do like the surveys and that, I really love that. I love how much feedback I get from you guys, I just... I could not do this show without that. I'm just not that intuitive or confident, so I appreciate it when you take the time out to let me know what you like or, like the fan did in the beginning of the show and was like, 'hey, y'know, I'm not too crazy about this thing you said'. I appreciate that as well.

There's a couple different ways to support the show, if you feel so inclined. As I mentioned, the website for this show is mentalpod.com. You can support the show financially by going there and making either a one-time PayPal donation or, my favourite, the recurring monthly donation, which you can do for as little as five bucks per month. You just have to set it up once and then it just keeps going until you decide to cancel it or your credit card expires and— can I just say how important that part of support of the show is to me? It's like the foundation for me knowing whether or not this can be my full-time gig and it just means the world to me when you guys sign up and become monthly donors because advertising comes and goes. I don't exactly have a ton of advertising slated for the next year. I mean, who knows, things may change, but even if I did, I still really need monthly donors, so... fucking cough up, that's what I'm saying. You can support the show non-financially by going to iTunes, giving us a good rating. That boosts our ranking, brings more people to the show. You can also spread the word through social media, that's greatly, greatly appreciated. Don't underestimate how important that is. When I get a new listener that says, 'oh, I heard about you on Reddit or read something on Tumblr', I really appreciate that. Oh, that's the other thing I want to mention! If you go to, I created a Tumblr site where you can ask me questions and I will post the answers to them. It's paulgilmartin.tumblr.com. And Tumblr, for those of you not in the know, is T-U-M-B-L-R. so, um, and the other thing I forgot to mention is next time you wanna buy something on Amazon, do it through the search link on our homepage, and that way we get a couple of nickels and it doesn't cost you anything.

Alright! Onto the emails and surveys. This is from a listener named Luna who writes, "I feel like your podcast has really helped me to understand men and the way men deal with depression and stress. I notice that a lot of surveys you read that were filled out by men involve a lot of sexual shame. The poor tortured guys who hate themselves for having sexual fantasies about power, rape, control, whatever. I really feel for them. There are women out there who are open about sex and kink and who would totally indulge those fantasies in the context of a loving relationship." I love, by the way, that she clarified that because that's so fucking important that it's in the context, I think, of a loving relationship or at least a trusting relationship where both parties are comfortable with it. She continues, "just because your fantasy seems fucked up, doesn't mean it's not okay. As long as it's carried out in a consensual way or just not carried out at all, my recommendation for these guys, if they want to talk to their partner about their fantasies, bring it up like it's a cool, fun, sexy thing. If you talk about it like it's something to be ashamed of, girls will see it that way too. I hope all these guys can stop overthinking their fantasies. They don't make you a bad person, and if you look you can find some who will dig it, I promise. As for the guys being jealous of guys with big dicks, honestly, I'm dating a guy with a small penis and the sex is amazing." Thank you, Luna.

This next thing I want to read is from the Shame and Secrets survey. This was filled out by a woman who calls herself DJ. She's eighteen, she's bisexual, was raised in an environment that was totally chaotic.

Ever been the victim of sexual abuse? "Some stuff happened, but I don't know if it counts as sexual abuse. I think some things happened when I was a kid, but I'm not sure. I try to confront myself about it, but I get this very uncomfortable feeling and shy away or brush it off." That's the thing that can be so fucked up is it can sometimes be this ball that's just in there that's a feeling and I don't know whether or not it's real or imagined, but I think it's worth exploring. That's my two cents.

Deepest, darkest thoughts: "I fantasise about my entire family getting into an accident or growing up without a family. Either way it ends up with me being alone and feeling relieved that I have no family." Well, I think that would be a great place to start in therapy, talking about that.

Deepest, darkest secrets: "I used to cut myself. I don't any more unless I'm feeling very overwhelmed. I have a problem with eating. Once I didn't eat for more than seventeen days. I count calories like a madman. It's a habit I can't get rid of. I used to be an insane binger when I was younger and I attempted to throw it up afterwards, but it never worked out for me. I eventually stopped bingeing, although it happened sometimes, but I also developed bad eating habits and would starve myself sometimes."

Sexual fantasies most powerful to you: "I fantasise about sleeping with one of my teachers, more specifically on his desk as he is being dominant."

Would you ever consider telling a partner or close friend these fantasies? "Maybe. Personally it's hard to tell anyone anything about myself. I'm very introverted. I'd just probably feel ashamed if I told someone my sexual fantasies, especially because it's about someone who's twenty years older than me and is my teacher."

Do these secrets and thoughts generate any particular feelings towards yourself? "It makes me feel different than everyone else because I fantasise about a teacher rather than a boy or girl at school. Throughout these four years of high school I've never been interested in anyone romantically except this teacher. It just confirms that I'm very different than most people I know." You are not very different from most people you know, that is an extremely common fantasy. I read that one all the time. The fantasising about an older person in a position of authority.

This next survey was filled out, actually by a listener who I've corresponded with before, and I think she's filled out surveys before and she calls herself Marlene the Psych Nurse. She is in her thirties, she's bisexual and was raised in an environment that was totally chaotic.

Ever been the victim of sexual abuse? "Yes, and I reported it. I reported it to my mother and she called me a liar. The abuse continued for many years after. She still thinks I lied." Few things break my heart more than that. That is, man, that is just the one-two punch to somebody's soul and self-esteem – when they go to a parent – why would they make that up? Now, I know there's the .001% of the population that does make that up for whatever reason, I don't know, but... my god, why would you not believe your kid, y'know? Or at least investigate?

Deepest, darkest thoughts: "I am bisexual, so I have many fantasies about women and being in control of them sexually. I also have fantasies with very strong and manly men. My husband is not a strong man and he is not very sexual, so our sex life is as boring and vanilla as it could get."

Deepest, darkest secrets: "I think about causing a great amount of physical pain on my mother and stepfather. Torture, beatings, re-enactment of trauma they caused me. When I was a child, four years old and on, I was sexually molested by my stepfather, father, stepgrandfather and a neighbourhood friend of my brother. When I got a little older my stepfather started to chase me around the house, trying to catch me so he could beat me for not going along with him. I told my mother and asked her for help. She called me a liar, which caused the abuse to continue for years. I've recently started medication and some therapy so I am filling this questionnaire out again. I believe my main issue with depression and rage is with my mother. She sacrificed my safety and my wellbeing just to keep drama out of her life. The ultimate display of cowardice and selfishness. I feel so betrayed and hurt. I can barely explain the depths at which I'm hurt. I wish my Asperger's would make it so I didn't feel these feelings. I have nightmares where I dream that I seduce my father and stepfather, something my mother said I probably did to encourage the behaviour. She told me no one gets abused by that many people. 'You must have started it with them.' I swear I wish she would just be brutally raped so she knows how it feels." You know, it's interesting... well, besides this being so heartbreaking to read that that happens to somebody and, y'know, clearly not the only one I've read of this happening to... I was just corresponding with somebody today, a listener, who was beating herself up because she wakes up from dreams where she is instigating sex with her abuser and she wakes up frightened and turned on at the same time. And so I shared some stuff with her in an email to kind of let her know that that's how human beings sometimes process stuff, to go back and get some kind of semblance of control. We're the initiators and that doesn't mean we wanted it or we liked it, and I know this comes up a lot on the podcast, but I think it's such an important thing to stress, that... get ready for me saying this for the next twenty five years.

Sexually fantasies most powerful to you: "As I said before, thinking about other women. Brunettes with huge breasts and curvy waists and hips. I wanna both be someone who looks like that and I wanna have sex with someone like that."

Would you ever consider telling a partner or close friend? "No. I don't share things like that with other people. I've tried to explain to my husband about our boring sex life, but he's mainly just interested in getting his rocks off. When it comes to me, he doesn't really care if I get mine or not. Most boring sex partner ever." Sounds pretty selfish too, y'know. That sounds like zero intimacy and that's a bummer.

Do these secrets and thoughts generate any particular feelings towards yourself? "I don't think poorly of myself for these thoughts and feelings. It is what it is: a fantasy that will probably never happen."

And then I just have to read this. Any comments to make the podcast better? She writes, "Paul, you are fantastic. I have little papers I carry around in my pocket at work that have contact info for this podcast that I pass out to certain patients at our clinic. I'm a psychiatric nurse in community mental health. Most of our clients can't afford therapy or they don't believe it works. That's when I break out the podcast and tell them to check it out. I've gotten many people who get back to me and say how appreciative they are for the recommendation. Keep it up." That just warms my heart.

This is also from the Shame and Secrets— I think all the surveys are from the Shame and Secrets that we have left. This is filled out by a guy who calls himself WC. He is gay, he's in his twenties, was raised in a stable and safe environment, never been sexually abused.

Deepest darkest thoughts: "A lot of my sexuality is tied up in ideas and images of humiliation and rape and bondage and darkness. I've conditioned sex to be intrinsically tied with violence from my early teenage years. I don't have much sexual experience and it's to the point that I don't think I could ever be in a loving relationship, a loving sexual relationship. Sex for me is about degradation and I feel that I could never love someone and be sexual with them at the same time. Sex would be about mistreating them and I don't want to do that to somebody." Um... well, let me read this other part next.

Deepest, darkest secrets: "I will spare the specific details, but the way I taught myself to pleasure myself sexually growing up is not really the correct way and I have been doing it for so long that I don't know how to get off in a normal way." First of all, I would stop you and say, "Is there a correct way? Is there a normal way?" Y'know, we're such a huge continuum of experiences and expression. I think you should stop thinking of your sexuality in that way and start thinking about how it makes you feel, whether or not it's a healthy expression of your feelings, and trying to consider having your emotional needs met in the future, because I think if our emotional needs are being met, how we express our sexuality tends to fall in line in terms of how we feel about it because... I don't know how to explain it other than that, but the emotional connection to somebody, I think, kinda needs to be the meat and potatoes and then the sex can kind of be the dessert. Whereas I think if we make what gets us off the meat and the potatoes of our emotional life, it's really hard for an emotional connection to people to just be an afterthought. Then we tend to burn through relationships, get really excited about people, and then get disappointed six weeks into dating them. I think when you see people that have been married like nine times, that's the classic example of, I don't know, the horse before the cart or whatever fucking tired old— I'm gonna start saying 'fellas' by the end of this. And I hope that woman knows I'm kidding when I was laying into her about that, I just find that to be a very funny, funny word. When I do my congressman character, he loves to use the word 'fella' and 'gals'. Loves to call the women 'gals'.

Sexual fantasies most powerful to him: "The majority of fantasies I have or images I seek out involve men being abducted or taken advantage of. I seem like I need to be clear that it's not like I have explicit fantasies of going out and doing this myself, but it's more just the idea of it."

Ever considered telling a partner or close friend? He writes, "I've never been super open about anything with anyone." And, y'know, I think that would be the place to start – and I'm not saying find someone you barely know and open up about all this shit, but maybe start with a therapist, maybe start with a support group for sexual compulsion. I don't even know if you belong in that support group, but investigate instead of writing yourself off as, y'know, this creature you seem to think you are. I think you're just a human being that's dealing with emotions that are really intense and you just need to find a way to channel them and be more accepting of who you are. If you're not hurting anybody, dude, more power to you.

Do these secrets and thoughts generate any particular feelings toward yourself? "I sometimes feel like I must be a sociopath of some kind if this is what I feel stimulated by, but I guess they say no one who is worried they are a sociopath actually is one." Well, WC, I am sending you a really, really big hug.

This is from the Shame and Secrets survey, filled out by a woman who calls herself Renée. She is straight, in her thirties, was raised in an environment that was a little dysfunctional. Never been sexually abused.

Deepest, darkest thoughts: "I wish I could disappear. Simply cease to exist. Just lay on my bed and fade away. I don't consider it suicidal as I've never contemplated how and I always know, even in my saddest moment, that I couldn't hurt my family that way." That is one of the most common things I read about deepest, darkest thoughts – they just wanna get in a car and just leave it all behind and start a completely new life.

Deepest, darkest secrets: "I am so incredibly hard on myself. I'm not proud of my accomplishments or value what I bring to the world. At the same time, I try so hard to be perfect, to be a good person who makes the world better. At least for some of it, I blame my body. I'm not skinny, definitely a plus-size girl, but I don't eat a fucking pack of Oreos a day like some horrible joke about the disgusting, lazy, sweaty fat girl. With girlfriends I tend to be self-deprecating about it, but in my heart I think, 'no one likes the fat chick'. I struggle with trusting that my friends truly care about me. If I didn't suggest the plans, then I wouldn't be included. It pains me when a friendship fades away without a reason and I blame myself. Did I do something wrong? I was unlikeable. I imagine the worst case scenario when anything comes up. I take it personally and when it comes to romantic relationships I've given up. I never try. Sex? Please! Being overly sensitive about my body breeds sexual repression. No one wants to fuck the fat chick." Uh, by the way, you are wrong about that. Men are turned on by a variety of body shapes and sizes, and that is— I'm going to be a little harsh here with you, that's you feeling sorry for yourself. That's you falling into the trap of self-pity. Am I saying it's easy to get laid? No, I'm not saying that, but it is not impossible to find a guy that will be attracted to you, and I think even more important than what you look like will be the vibe that you give off and I think if you walk around, eyes downcast, giving off the feeling that you're worthless, it's going to make it hard for somebody to want to be with you because your self-hatred is standing between you and that person trying to connect to you and they can only tell you so many times 'you're loveable', 'I like your body, it turns me on', y'know? Take a guy's erection at face value! If his penis is erect, something's working. And if it's not, it might be on him.

Alright, she continues, "I always assume that I will end up crushed, another story of foolish unrequited love, so I've spent years avoiding it. Why bother to try? And then when, despite my avoidance, I do like someone, it makes me miserable. I feel like I'm constantly waiting for the other shoe to drop, like I'm realising how I feel and then I see skidmarks as the trail he burned away from me, so I will hold my feelings inside, never admit to him and remain alone. Alone is better than rejected. But I never pictured this as my life and it breaks my heart. I couldn't tell you the last time I considered myself happy. I swear I am paying some karmic retribution in this life because I was a serious asshole in my previous life." I get the feeling that, with some therapy and maybe some support group work, you would be shocked at how quickly you might be able to get some self-love, get a little bit of confidence, and I tell you, no matter what your body shape is, if when you take your clothes off you really feel that you're sexy, it's sexy. It is.

What are the sexual fantasies most powerful— what's my fucking hurry? There's still that thing that I think that I'm keeping you, and you've emailed me and you've told me, 'you're not keeping us, we like the longer episodes'. I might just read it extra slow now for the next hour. Sexual fantasies most powerful to you: "Given my sexual repression, I tend to just imagine I'm someone else. Someone prettier, someone desirable, someone not me."

Would you ever consider telling a partner or close friend? "I doubt it, because I'm very closed off on this subject. I don't discuss it with friends and clearly there's no partner." Y'know, God, I just think getting into a support group with people who think and feel like you do would be so healing. It would be so healing. Because you can't force that kind of intimacy. It sounds like your friends aren't easy to get close to and maybe, maybe you need some different friends, some friends that have experienced what you've experienced. Nothing brings you closer than similar pain or setbacks, in my experience.

This is from the Shame and Secrets survey, filled out by a guy who calls himself Hyper Shut Down. He's straight, in his thirties, was raised in an environment that was a little dysfunctional. About his being straight, he qualifies: "I'm probably about ninety percent straight. I'm rarely attracted to anyone not female, though I do seem to be attracted to the penis itself." I gotta admit, the penis does have a certain charm, but I feel like the scrotum is like its ugly friend that tags along and is the deal-killer. It is just... God bless anybody that can put their tongue on a ball-bag because it, I've said it before, it looks like it just needs ironing.

Ever been the victim of sexual abuse? "Some stuff happened, but I don't know if it counts as sexual abuse. My sex drive kicked in somewhere around the start of fourth grade. I have a strong sex drive and it runs in the family, and I recall playing Hide and Go Suck – no movement, just put your mouth around it for a moment – with my older brother, but I think I came up with the idea."

Deepest, darkest thoughts: "I wish I lived in a world where everyone could enjoy any type of sex where all participants enjoyed themselves without stigma. I don't seem to have any of the natural icky reactions that people have, except when it comes to scat, injury and unwilling participants. This extends to things like incest, zoophilia, paedophilia, etc. and I'm sure that if people knew to what extent my fantasies included things like this that I would be rejected by many of my closest friends."

Deepest, darkest secrets: "Up to a certain age I used to try to see what friends of mine were willing to do sexual things together by playing Truth or Dare. They were male friends and I wasn't attracted to them, but wanted to do sexual things as often as I could. As an adult I've fooled around with dogs a bit, though nothing beyond foreplay and no commands or tempting with food as I don't want to be coercive. I have stopped all such activity, not because I think it's wrong, but because it's totally unacceptable."

Sexual fantasies most powerful to you: "Probably the idea of either being a sexual servant to my friends in a subservient way, but not an abusive or insulting way. Another one is the sort of situation where I'm the centre of attention and am played with by a large group of people and brought to many intense orgasms. In this setting some abusive talk is okay, but stuff that's more talking about my sexuality rather than being outright mean. Because of this, I tend to watch some porn that would be considered degrading to women, but I'm imagining myself in the women's role, even holding my breath during deep throat penetrations."

Would you ever consider telling a partner or close friend your fantasies? "Not anyone I know, but I can see myself being open with someone I knew was into strange porn." Maybe stop calling it strange porn, y'know? Maybe call it... I don't know, I don't know what the word would be. Maybe don't label it at all.

Do these secrets and thoughts generate any particular feelings towards yourself? " I don't feel bad about the thoughts and secrets themselves, but I have ended up hiding my sexuality since I've seen that even something as benign as incest between fully grown adults creeps people out, like people dating that later find out they're related." Well, thank you for that, Hyper Shut Down, I appreciate that. I appreciate all you guys' honesty.

This is also from the Shame and Secrets survey, filled out by a woman who calls herself Harbinger. She's gay, she is in her twenties, she was raised in an environment that was pretty dysfunctional, never been sexually abused.

Deepest, darkest thoughts: "I have problems with my gender identity. When I look at guys I feel terrible. Lately it gives me intrusive thoughts, the urge to stab myself in the neck, or I imagine something like a spear just going into my skull. I can almost feel it and see it. It's an urge, not just an idea or image. My friend asked me if I want to be like the guys and I told him it's so much deeper than that. I could want to be like anyone who is cool or hot or more successful than me in any way, but this is more as if... well, it's as if my life is a bad trip. It feels all wrong. It's very disturbing, like a horror movie. It's something I feel in my gut, as if I'm witnessing something horrific but it's inside me. A distorted reality? Okay, imagine looking in the mirror one day and seeing someone else there and how fucked up that would feel. Insane. Demented. Horror show. That's what my existence feels like and seeing guys just reflects to me what's wrong in myself. How do you kill something as horrific as that? You would have to kill yourself. I think about being a guy every day and sometimes I feel bad like this, but more often it's a pleasant fantasy. The thing is that during my day and for most of my life I have been okay with adapting to femininity. I want to look nice when I go out and that means wearing make-up and female clothes. I have a very female body, by the way. It's at night and when being out and about or watching movies that I get upset. I'm afraid to tell anyone except my best friend these things because I don't want anyone... I don't think anyone would understand that becoming transsexual would be completely wrong for me. It would only remind me more often of what I'll never be. A real born male. I would only be more miserable. I know I need to minimise my thoughts about being a guy and live my life as accepting of my condition as possible, not to mention I'm disabled and probably can't go through what it takes to transistion because of medical issues and my fundamentalist Christian family. Well, it would just be the end of the world. Not worth it. I wish I could find a shrink that I knew I could trust to understand. Right now I don't trust anyone. On top of being disabled/ill, I have PTSD. That's a whole other story as fucked up as the first. Maybe another day. Thanks for doing what you do." I just want to send you a big bouquet of love and compassion. I can't imagine how difficult that must be to have those thoughts and feelings every day and I really, really hope that you can find a professional to talk to or someone that can help you move forward, whatever path that may be, and I would say don't give up on that, y'know, keep searching online. I think every day there are more and more support groups and resources for people that feel as if they're in the wrong body.

Deepest, darkest secrets: "This is nothing to do with the previous topic, but in my twenties I continued the cycle of abuse I inherited from my father and his mother. It was the strangest thing to happen – to realise I was behaving exactly like the person I hated most. I don't hate him any more, I love him and he's a good dad now. I'm ashamed of the fact, but also proud of the fact I did very hard work on myself to work through those issues and ensure I will never do such things again. The person I victimised says she is fine and never thinks about it and for that I am lucky beyond words. This confession is for people out there who think they can't open up and fix the abuse they have done to others. You can fix it. You can get forgiveness, not only from others, but from yourself. I have forgiven my dad, he has forgiven his mother, and our family is happy and very close now." Oh, that is so beautiful. I forgot about that part of this survey. That is... that is just so beautiful.

Sexual fantasies most powerful to you: "I think about a lot of wild things and I'm not ashamed of them."

Ever considered telling a partner or close friend? "I've told my best friend."

Do these secrets and thoughts generate any particular feelings towards yourself? "Sometimes I feel disgusted, but then I will tell myself to shut up. I know my desires are not bad." Good for you. Right on. Digital high-five across the internet.

And this last one is from the Happy Moments survey, filled out by a woman who calls herself Iona and she is between eighteen and nineteen years old. I guess that would make her eighteen and a half. She writes: "I had nothing to do this evening so I went for a walk. I was listening to the podcast when a woman got my attention. She asked me if I play basketball. I was wearing a basketball hoodie. I said, 'yeah, I play for fun, recreationally'. She then said to keep working at it and it made me smile. Then she said I had a beautiful smile and it wasn't in a creepy way or anything. She seemed to really mean it. I said 'thank you' and smiled some more, then she said 'God bless and Jesus loves you'. Even though I don't believe in Jesus and I'm not entirely sure I believe in God it was still nice because they mean something to her and she was using them in a positive way, so I figured at that moment it didn't matter what my views or hers were, she was just trying to be nice. I said 'thank you' and told her, 'have a good evening'. I tried not to think about it too much, other than thinking about the energy we give out for the world to see. I don't think I realised how much negativity I was sending out just by the look on my face when I was walking and a total stranger was not only able to notice, but to help me notice my own negativity. If that isn't a clear enough sign from the universe, I don't know what is. I ended up walking for almost two hours and the whole time I kept thinking, 'I never want this feeling to end'." I love that.

Thank you guys so much for continuing to support this endeavour and... sometimes it just leaves me speechless. It just absolutely leaves me speechless, how lucky I feel to have found a way to turn things that were negative and painful in my life into things that help me connect to other people and I hope, if anything, that's what people get out of this podcast is the hope that what they've been through doesn't have to be for naught, as long as they're willing to reach out and ask for help and realise that nobody's ever really stuck unless you decide that you're stuck. So, remember you're not alone, and thanks for listening.

[outro music]

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