What Everyone Gets Wrong About Semen Retention! Ft. Dr. K

where does pornography activate the brain and it turns out that it's like everywhere just about every lobe of the brain is associated with sexual arousal and and in some way you know you can get visual cortex stimulation auditory cortex stimulation imagination emotional engagement so every part of the brain dopamine is involved in pornography and then the other thing that pornography is really good at is is really shutting off our negative emotional circuitry sex is really important and so our brain is willing to push everything else away in order to have sex and procreate so it's

it's incredibly effective at really suppressing our negative emotional circuitry and what we tend to see in any addictive behavior is that it gives pleasure and it takes away pain a lot of people who watch pornography don't necessarily masturbate with it mhm so I've had um you know people that I've worked with that will like just be watching it while they're like doing work like on a second screen because it somehow sends those signals to the brain to like suppress our negative emotional circuitry so it's a it's a really weird kind of Beast welcome back to

the Reena Malik MD podcast I'm your host Dr Reena Malik urologist and pelvic surgeon today our guest is Dr Alo kenoa he's a Harvard trained psychiatrist with a tremendous social media platform that reaches millions of people with online educational content his expertise is in mental health and technology and he's co-founded the healthy gamer platform that coaches thousands of people on healthy gaming today we talked about screen addiction as well as porn addiction what is porn addiction who gets affected by it and how you can deal with it we also talked about thric or tantric sex

and how it can benefit you physiologically and spiritually and what people are getting wrong about SE in retention we also talked about the challenges that young people face in dating these days as well as the rise of artificial intelligence particularly the future of artificial intelligent people or dolls that may impact the way we interact with Society and potentially have devastating consequences we hope you enjoy Dr K Alo thank you so much for joining us thank you for having me I'm so excited to have this conversation because you bring such a unique perspective right you have

both Eastern Traditional Values that you've obtained from your life experience as well as of course be going through the medical system here in the United States and becoming a physician trained in the US so I think you're bring a very unique perspective and of course obviously mental health and the things that you deal with are so so important yeah thank you and your content is so valuable so if you haven't checked out Dr K's uh YouTube channel healthy gamer and on every other platform uh it's very very helpful so you know when I was listening

to some of your older interviews the one thing that I remember you saying is don't take your phone to the bathroom and I remember listening to that and being like Oh my God like yeah we shouldn't be taking our phone to the bathroom but it's like this visceral reaction like no like I can't go without my phone yeah absolutely yeah and so like how first of all why are we so addicted to our phones that we have to take them with us to the bathroom I I think a couple of things one is if we

look specifically at the phone and specifically at the bathrooms so I think one of the things that we've like lost is the ability to be bored MH so if you really look at it we try to externalize our attention and we try to have our attention constantly be on like a particular thing and be somewhat entertained because if we especially look at the bathroom it's like what are you giving up right it's not like you're doing any important work in there it's not like you're be laughing really hard like you know sometimes like social media

and technology is about like lots of fun like let's watch some cat videos and and so really it's about sort of fast forwarding our mind accelerating through that boredom and um and I think what we've sort of found is that there is a device that's able to do that to constantly externalize our attention and it even though it's super low stakes I think we sort of see the depth of the addictive nature when we're so unwilling to give up something that's like who cares if you're so innocuous right you don't need it you really don't

but it's like such a like oh that's my some people use it as their time to like oh they just spend more and that can create its own problems but like they spend more time in the bathroom like scrolling through their phone and like no one's going to bother me in here absolutely I mean by some people like probably all people and especially people like young parents you know I think it's like especially with how much because the other challenge with technology is that it invades every corner of our life so if you're working like

your boss is going to be texting you emailing you whatever if you're a parent like you know if your your kids subconsciously know that if you're kind of around that they can bother you and so sometimes the bathroom is like the only place of Refuge where you get privacy yeah but it's it's important to be bored right like I think that's a really important part of our life that we've lost to some degree because of all this constant stimulation yeah I mean I I think there's so many consequences of no longer being able to be

bored so some of the things that I see is that there's just a complete lack of like introspection MH you know I sort of fell into this in an interesting way because for me it was like I want to be super efficient so I remember when I was in med school like okay it's like I wake up in the morning and when I'm like making breakfast I'm going to be listening to a lecture listening to a lecture when I'm walking to the train I'm going to be like reviewing something when I'm you know on the

train and then like every moment of my time is like podcast or learning about something or being efficient but at this at the end of the day it's still like externalizing my attention and I don't listen to myself mhm and if we look at it kind of evolutionarily like human beings used to have a lot of time with themselves like we'd be like hunter gatherers and doing like rot work where the mind is unoccupied so I think evolutionarily we really need that for things like emotional processing and stuff like that yeah and I can relate

to that trying to be very efficient I'm sure it's a lot of people who are high achieving or trying to be high achieving will do that like I will I remember studying for the boards when I was a full-time resident working all the time having two kids at home and being like okay I need to like maximize this time that I have in the car because this is like time I can get some work done but you're right it does lead to this sort of like go go go go go and never taking a moment

to just be like oh you know what like maybe I need to just take a second yeah so the the really crazy thing there is that I I think that a lot of people don't realize that spending more time doesn't actually improve things M so my first year of med school I struggled a lot cuz everyone was like studying so much and then I sort of realized like this is not working for me and so I I actually started only studying like 2 hours a day and that was like it yeah so I'd study for

2 hours in the morning I'd go to my classes and stuff like that and then I'd be like done by 4 p.m. and what I sort of found is that my retention actually went way up and like my focus went way up and even now when we work with content creators one of the big things that we're able to do is help them improve their metrics so they'll get like 171 to like 200% increase like view counts and stuff sub counts follower counts um but without increasing the amount of work that they do so I

think one of the big things that we've sort of lost is that like we don't know how to make our mind efficient and I'm sure you've experienced this where there are some days where you're studying for boards and it like everything just sinks in and it's like a really good day and then there are other days where you're like highly distracted and you're you're on your third cup of coffee and it's like you're really struggling absolutely and I think it's so interesting when you tell that story is I very very similar so my husband who

went to medical school also was like a studier like he's like always studying so like I remember him telling me like start studying for step one which is a big exam we take you know this but for the audience it's a big exam we take in medical school that helps determine how competitive you can be to match into residency and so he started studying like months earlier and he told me you should start studying but I am not that kind of person like I tend to do well if I do a focused amount of studying

for a month or two like but not six six months out right and so I tried to do it and it was futile for me and I also am the kind of person who does like very focused amount of small amount of studying but I don't tend to do hours and hours of it because it doesn't work for me and I think that's an interesting concept that a lot of people yeah they they don't realize like spending more hours and the first time I realized that I think in and externally was reading that book The

4-Hour Work Week by Tim Ferris because he talks about how much work he would get done in four hours and it's like yeah if you are efficient and think about it clearly you can get a lot done absolutely yeah I want to talk about uh porn addiction because I think that's a really um Hot Topic and I think you know in terms of the mental health uh space there's no real term for porn addiction it's like problematic porn use right uh but we see it and in the literature it's probably like 4% it's been described

but I think you know we're seeing more and more of it uh particularly in the younger population as they're sort of um seeing pornography earlier how often are you seeing porn addiction and what are your thoughts on it so I see it a ton mhm and and um I I think there are some problems in the literature so like I'm not going to talk about porn addiction specifically but just to use an analogy so if we look at gaming addiction so in 2010 the incidence of or the prevalence of gaming addiction was about 6% I

think in 2020 it was like 9 to 11% M but remember that's pretty high it's very high so 6% is around the same rate as alcohol so like we're like we have twice as many video game addicts but then the other really troubling thing is remember this is prevalence of the whole population and we don't have a lot of people over the age of 50 who are addicted to video games mhm so what we're really seeing is that even if you look at 10% of the population it's not the population as a whole what we're

really seeing is like 20% of kids which is staggering that's a lot one in five yeah probably something like that um and and so you know I I talked to some like I remember I just had a conversation with like a second grade school teacher who is like 100% of the boys in my class play fortnite and this was about four years ago so if we look at pornography addiction I think we probably have a very similar thing because especially with the tech addictions the likelihood that these people will enter a psychiatrist's office is very

low so men are more are less far less likely to seek mental health support I think if you look at it historically about 70% of patients are women yeah um and so first of all there's like a gender kind of lack of recognition there I think even amongst patients who come in for things like mood disorders or anxiety disorders they're very reluctant to volunteer that they have a pornography addiction so you really have to ask it is not a very common part of like a standardized interview yeah I I suspect that it's probably higher than

4% I think so especially with newer types of pornography but I will say that there are plenty of people who watch pornography in a healthy Manner and don't develop addictions so what is sort of and this can be in any field gaming addiction Point addtion what happens to the brain are that causes these addictions so with porn addiction I think there are a couple of Interest things the first is that so this is more of a clinical practice as opposed to literature search but what I've noticed is that prepubertal exposure to pornography seems to like

really increase the risk now there could be some confounding variables there because if you think about what kind of childhood does someone have to have to be exposed to pornography at the age of eight so there may be like less parental supervision and other kinds of factors at play but often times these people are exposed to pornography like very young the second thing that we sort of know is if you look at like the neuros science of pornography I tried to figure this out I was like okay we know that alcohol addiction is like Gaba

receptors in the brain so where does pornography activate the brain and it turns out that it's like everywhere so if you look at it just about every lobe of the brain is associated with sexual arousal and and in some way you know you can get visual cortex stimulation auditory cortex stimulation imagination emotional engagement so every part of the brain dopamine um is involved in pornography every neurotransmitter is involved in pornography in some way or the other so we we sort of have this kind of whole brain effect and then the other thing that pornography is

really good at is is really shutting off our negative emotional circuitry so if we think about evolutionarily like sex is really important and so our brain is willing to push everything else away in order to have sex and procreate so it's it's incredibly effective at really suppressing our negative emotional circuitry and what we tend to see in any addictive behavior is that it gives pleasure and it takes away pain MH and over time the amount of pleasure that it gives actually goes down MH so as we develop some degree of like dopaminergic tolerance and things

like that it doesn't even offer much pleasure and so then people really get hooked on it from like an emotional regulation standpoint the more stressed they are the more pornography they watch and the last thing that a lot of people are super confused by is that a lot of people who watch pornography don't necessarily masturbate with it mm so I've had um you know people that I've worked with that will like just be watching it while they're like doing work like on a second screen because it somehow sends those signals to the brain to like

suppress our negative emotional circuitry so it's a it's a really weird kind of Beast well then they develop sort of they feel even worse when they're not watching it right that's their Hallmark of addiction yeah so that that's absolutely true so and that gets really ugly really fast so there's all the shame from being addicted to pornography and then how do we manage that Shame by watching more pornography and suppressing it yeah and then when we stop watching it all of those dormant emotions there's almost this rebound effect and we feel like in very intense

shame and things get way worse and that's how we get hooked yeah you know just on your point about children getting exposed to porn so I actually just spoke to an expert on this who's done a lot of research and essentially it's the average age where kids are being seen seeing porn is like 12 or 13 but as early as 8 or 9 or 10 and and often it's not that they're getting it because they're they're getting sometimes it's access to devices that they are there are no parental controls but often times it could be

a friend's device or a friend shows them something a picture that they don't really understand and and actually they're seeing issues of it in schools even because they'll be like talking about it and showing them things and so I think it's i i i caution in saying that I don't think parents are intentionally not supervising their children I think that generally like there's it's so accessible right like it's so easy to get access to free pornography now yeah that's a point and and I think that in many of the cases that I've seen it's even

things like older siblings or friends of older siblings who are showing them this kind of stuff because like if you're eight right and you've got an older brother and your older brother is going through puberty with his buddies and they're like watching something you're super curious about it yeah and so we Absol yeah i' completely agree with that thanks for clarifying yeah and I think so you said like being exposed to it a younger age puts you at a higher risk but what are some other risk factors like how can if you are either with

someone or your child and you're you want to maybe catch them not in a bad way but like protect them from developing this addiction and you might start seeing Hallmark signs or gaming addiction for that matter yeah so I I think it depends on which addiction we're talking about so you know we're still learning this stuff but we're not really sure how different gaming addiction is from pornography addiction I happen to think that they're quite different there's even a fair amount of research that within gaming addiction it's not all homogeneous so there are many different

types of gaming addiction that's kind of the first thing that I would say but in terms of how to protect people from it I think there are a couple of things to consider the first is that generally speaking as we said the earlier you get exposed to something it actually Alters your nucleus accumbens and how it develops so we sort of know that marijuana is a gateway drug and the reason it's a gateway drug is because it Alters your brain's receptivity to other dopaminergic or addictive substances and so porn pornography addiction I suspect will probably

work in a similar way where it sort of predisposes you to certain things um in terms of what we can do about it I think sort of like having a really good relationship with your kid and even sort of talking to them about some of this stuff that hey pornography exists and I guess we have to start pretty young like I have an eight-year-old and I've never thought to talk to her about pornography but it makes me really wonder because eight is like really really young right I think I started talking to my son about

sex around 8 or n uh I didn't talk about pornography until he was 10 uh but I definitely have talked to him about it um already yeah so that's I think you're ahead of makes me super uncomfortable but I've done it yeah so I I think just sort of an awareness of it and I think that a lot of parents I think maybe like we're a little bit luckier because I think we sort of grew up with some technology but I think a lot of parents really just let their children use devices right so there's

sort of this idea especially in the west that like if you get an object it's yours mhm and so this gets really problematic when grandparents want to like give them something for Christmas right but grandma or grandpa doesn't have to deal with the iPad every day after the kid gets it they don't have to get them to like stop uh using it so that they can study and do their chores and wake up and go to bed and all this kind of stuff so I think really being involved in your child's technological life is like

really really important MH um and especially when it comes to like gaming addiction I think where a lot of parents really sort of mess up I mean that's kind of harsh to say but what we found really is very effective is that see as as a parent we get scared and once we get scared we sort of have this instinct to like let's take this thing away that's bad but often times what we find with like gaming addiction and Technology addiction is that when you try to take the child's device away they fight you and

I've heard like really dra not heard I mean people have that I've worked with really drastic stories of you know parents locking up power cords in the liquor cabinet and then the kid will like learn learn how to pick locks on YouTube and we'll go downstairs at like 12:30 when everyone's asleep unlock the power cord we'll play games until 5: in the morning we'll lock it back up and then we'll go to sleep wow so if your child like wants to do it right it's going to be really hard you can try to be very

controlling but even then I don't know if you're doing a great job of preparing them for the world because at some point they're going to get access to technology and you're not going to be around to control it so what we really advocate for is like forming a good relationship with your kid where you're really communicating with them and that can be really hard for any number of reasons which we can go into and then also recognizing that people who fall into addiction do so because they're getting something from the addiction that is hard for

them to get in the rest of Life MH so for something like pornography addiction very poor emotional coping mechanisms in general right and that's not the person's fault it's just this they just weren't taught this kind of stuff and they didn't get develop it because they develop the addiction instead of devel absolutely right so as you develop the addiction your other emotional coping mechanisms start to atropy because your brain knows we have this thing over here that works so incredibly well at suppressing our emotions so we usually recommend that parents will like talk if you

if if you have a kid who is addicted to video games or pornography or or anything you know the underlying that is going to be some kind of emotional turmoil so sort of asking them a little bit about other parts of the their life and recognizing that addiction and there are some people in the psychiatric community that don't even believe that technology addiction is real um and these are experts who work with these people day in and day out they think it's a manifestation of a deeper problem which there's absolutely some evidence for but really

sort of recognizing that if you're dealing with an addiction really trying to get to know your kid and asking them like hey what's going on in your life how's school going how do you feel about romance relationships things like that uh cuz a lot of times like adolescence and teenag is like you know it's really hard for them to engage in that stuff I think sometimes they can hide it quite well in term they may be irritable and they may be sort of not chipper and happy all the time but are there other sort of

signs that maybe someone could say like hey they they could have something going on that I'm maybe I should delve a little deeper into how they're using technology or pornography or things like that yeah so I I think parental Instinct really goes a long way like if you think your kid has a problem there's a pretty good chance that they have a problem and I think what we tend to look at is like functional impairments right so is there any change in their grades or has there been a change in their like professional life physical

health mental health relationships including family relationships so if you're finding that you're getting into arguments with your kid a lot um and I think parents are very quick to like attribute that to oh this is like Teenage whatever right it's just a phase and that that can be very true it can be just a phase but really sort of opening the door to talking to your kid and really figuring out okay okay what are you upset about often times it is things like moodiness and stuff like that that parents will see the most of when

was the last time a doctor spent an hour with you and truly focused on your goals and when was the last time you left feeling like you really understood what was going on with your body and had a clear plan of what was going to happen next at my practice Reena Malik MD I aim to do just that I specialize in sexual dysfunction bladder health Hormone Health and pelvic pain for all people and I want to revolutionize how we take care of patients I want to really get to know each and every one of you

that's why at my practice when you come to see me I'm 100% present with you for an entire hour and after you leave if you forgot to ask me something or need clarification on something we talked about don't worry I'll respond to your issues and questions quickly through our secure messaging portal without any additional costs just go to www.ram Malik MD /a appointments and schedule your visit today we see patients in Irvine and Beverly Hills California and virtually for patients from California Florida Illinois Maryland New York New Jersey and Virginia if you aren't located in

these states consider making an educational visit where we can talk about your conditions generally but I can't diagnose or treat you I can't wait to see you you actually um be became a monk right you went to India um and and you learn sort of many practices from Eastern uh philosophy and one of the things I've heard you talk about is tantric or thric sex and so can you talk a little bit about what that is and is it something that people should be trying to achieve yeah so it's interesting I've never gotten that question

um but yeah so we can absolutely talk about it so in order to understand tantric sex we have to understand what meditation is and what Tantra is and how sex can be used so this is going to get a bit technical so the first thing to understand is that anytime you meditate you need something called an Al lumana which is a support so usually there is a focus of meditation so you can have something like prayer beads You Can chant a mantra um you can gaze at a candle or even like an idol or something

like that there there's usually a an object of your attention so if we look at meditation the word meditation gets translated into three sunt words and this is what confuses a lot of people DH and samadi so dhana is a focusing technique it's a verb it's something that you do so I'm focusing on let's say a candle so I'm looking at that and the whole point of that is if you look at your mind it has lots of thoughts so how do you get your mind to not think lots of thoughts by having it focus

on one thing so if I concentrate on one point then all of the other thoughts as I train myself and I practice all of those other thoughts will go away then what happens is the mind has a very natural tendency to lose track of a constant stimulus so when we we'll acclimatize to a stimulus so if I like um you know if you step into a restaurant at the very beginning you hear everyone talking but then your brain acclimatizes that stimulus and it weeds it out so what we do in meditation is we focus on

one thing to push everything else away and then we're left with one thing and over time we will acclimatize that in the same way that we'll ACC climatize as soon as I put my jacket on I feel it but then my brain sort of recognizes this is a constant stimulus and it goes away mhm once we acclimatize to that candle then our all mental function stops and we enter the meditative state which is Dian so Dian is a meditative state that is a state of consciousness it's not something that you do the best example here

is going to bed and falling asleep technically like no human being on the planet can go to sleep we can't say I'm asleep now we can lay down and in the right circumstances sleep is a state of consciousness that will happen to us and if you're like me it's like in Biochemistry right so we don't want it to happen but it happens anyway that's how the states of Consciousness happen so we have Al Lanas which are like objects of focus and then we want to enter the state of meditation so now let's talk a little

bit about sex and then we'll put them together so uh and then the third state of meditation is Sami which is like a more Transcendent State of Consciousness which is blissful and whatever we'll get to that so now if we look at sex like if if we look at orgasm or sexual activity it's a very potent draw for your attention mhm so if we look at kind of the Neuroscience of it like it's really easy to not get distracted when you are engaged in a sexual act and then the next thing to understand is that

people will say that the state of orgasm is like a state of Dian or samadi so it's a blissful State and if you really pay attention to your mind and orgasm during the moment of orgasm you actually don't have any mental functioning you can't think about anything you can't think about anything right so the moment after orgasm is over then you're like was it good for her too right and and like before you're thinking lots of thoughts and after you're thinking lots of thoughts and this is why we love sex so much because if you

really look at when the mind is peaceful the mind is peaceful when it's actually shut off this is why we love drugs this is why we love sleep this is why we love losing ourself in a Sunset and orgasm mhm so that there's uh orgasm kind of creates that like no mind State it's one of a very easy accessible physiologic ways so when we put these together what we end up is end up with is sex is a powerful aluman that focuses our mind and then the state of orgasm is a very very good way

to get to samadi Oran then we get into some problems so the the whole point of tantri sex is that okay so but if we want to enter that no mind State like generally speaking orgasm is incredibly brief m um if you're a dude um and many women yeah and and so then the goal of of tantric sex is there are certain like yogic techniques that you can use to prolong the state of orgasm and basically what you're trying to do is avoid ejaculation because that's the thing that triggers the orgasmic state in the brain

to end because then we're done right we've done our our thing evolutionarily so some of those techniques around thoric sex are to delay ejaculation but but then you can actually get this sweet spot where there's orgasm without ejaculation MH which is some of the point of tantric sex now there's a whole other layer to thrixxx which is even more spiritual this is sort of more neuroscientific and Technical but uh during really traditional tantric sex people are chanting mantras um and you're chanting a mantra with your partner over the course of potentially ours and it's almost

like doing a ritual or a bja or something like that where it's like part of a religious practice and for some reason using the sexual act as like a focus and like kind of getting into these states of Consciousness enchanting Mantra which is really the traditional way to do thric X um is is what it's about and I think that's I mean I can go into more detail if you really want to but there's a whole spiritual side yeah so then you know people talk I think they've try to adapt those things in today's day

age with Seaman retention they there's things like no nut November where people and they don't don't always practicing that tanic method but that's sort of the goal is to orgasm without ejaculation so from an Eastern perspective benefits in terms of doing it on a regular basis or or trying to achieve that benefits of thric sex MH well I mean it depends what kind of answer do you want do you want like a physiologic answer a neuroscientific answer or a spiritual answer give all three okay so this is where things get weird um and it you

know so part of what I try to do is like reconcile these spiritual answers with like neuroscience and phys ology so if we start with the physiology I'm not sure so if you look at like basically every religious tradition restricted sexual activity is part of most religious Traditions we're not quite sure why but chances are that when you engage in sexual activity it Alters your physiology in some way so what I've sort of found is that when I am celibate for periods of time um which is interesting being married and when I'm celibate for periods

of time it really enhances the quality of my meditation so I don't know what's going on physiologically there um what I just a couple of things to theorize so if you look at some of the yogic postures that we do when we are celibate we'll do something called sidas so in Sid Hassan you press your heel against your perenium so especially for men the the blood flow to your scrotum in your sex hormone production can be gently suppressed by reducing the blood flow to that area so you're kind of like you know and then you

you'll even get sometimes I imagine testicular atrophy if you do it for a long period of time which is what yogis are trying to do and so then if you look at okay if we reduce our testosterone levels what effect does that have on our brain it probably has some kind of positive effect for attaining Transcendent States Of Consciousness okay so we're not quite sure what of that is true there's another layer which is that which is a little bit more like spiritual Theory but we don't really know if it's true and that's that see

anytime you have sex it creates a powerful impression mhm so if we think about how something enters your mind generally speaking the more active your mind is the less something enters so let's take the example of studying if I'm in a library and the library is burning down and people are making lots of noise and my mind is paying attention to all of that stuff anything I read on the page is not going to sink in mhm if in a quiet place and I'm not distracted and anyone knows this if you're not distracted then you

can study and then the knowledge will literally sink in otherwise it's like the information is bouncing out of your mind right so the more no mind State we have the more stuff sinks in and if we look at stuff like the Flow State flow state is a very almost no mind state so the mind is fully focused on one thing so you have a lot of like whatever you're studying in that moment will will really sink in so now let's look at sex so what happens in sex we enter that that no mind State during

orgasm so in that moment there is a very powerful impression that sinks into your mind from an evolutionary standpoint this is probably has something to do with like if we look at oxytocin the oxytocin release after orgasm which is usually induced especially by things like cuddling and and human human uh you know contact but there's something that goes on that there's a physiologic bond that forms with people who have sex now I've worked with people like sex workers and they have to train themselves to shut off that Bond so their natural reaction at the very

beginning is to release oxytocin but the whole point is then they try to like avoid that so if we look at sex then what happens is we create a very powerful impression and then what happens is once we shut off our mind whatever is lying in the subconscious will start to float to the surface so when I work with patients who have a history of trauma I don't tell them to do standard mindfulness techniques where they just let whatever is in the mind come out so often times it will trigger traumatic experiences M so if

you look at the evidence-based techniques around mindfulness for trauma they're usually grounding techniques or like sensory techniques things like ice diving where I'm taking a bucket of ice and I'm sticking my face in it that's not letting whatever is in my mind flow up it's actually doing the opposite there's lots of stuff in my mind and I empty my mind by sticking my face in ice so whatever is in the mind will come up and anytime we have sex it goes deep into the mind yeah and so if you sort of think about it right

like if you meet someone once and and you have a one night stand and then you're going to start thinking about them the next day right so most human beings I think will yeah and so if you sort of think about it there's powerful Impressions that form so then what happens is if we like try to meditate and you've like had sex it becomes very hard to enter those transcendental states of mind I don't know if that answers your question but no I think it's very interesting because you know I don't I what I tell

people is like if you want to practice seman retention or celibacy for the purposes of spiritual or um betterment that you feel better I think it's wonderful but I do worry that there's a lot of pressure for people to uh participate in these sorts of things and they actually develop they it becomes so Forefront of mind because they're like when am I going to have sex like I can't wait to have sex because they're so like they're they're trying so hard to abstain and then they also start clenching their pelvic floor and they develop pain

or other issues and so that's sort of where I worry as a clinician who sees those patients yeah so I think those people are doing it backwards right so like let's talk about you know in the yogic Traditions the word for celibacy is brahmacharya but brahmacharya doesn't mean celibacy it means to dwell in Brahman which is to dwell in the infinite MH so technically you can have sex if you're a yogi and you can still be a brahmachari which means celibacy so brahmacharya what it really means is non- lustfulness so forcing yourself and struggling with

yourself in the mind to not have sex still means that your mind is obsessed with the sex you're missing the point right so if you look at like a yogi um you know when a yogi is like people I don't know if this makes sense but people will try to deprive themselves in order to like become more like detached right so I'm not going to have sweets I'm not going to have this kind of food I'm not going to have this but the Mind still wants it the Mind still wants it they're trying to basically

starve their mind of the stimulus yeah but the real thing is if you practice itation for a long period of time the desirelessness becomes natural right so if I stop and I like look at let's say we've got like two glasses of water here and one is the temperature I want and one is the temperature that I don't want and as I look at this if I drink water that I don't like the temperature this creates unhappiness within me but as I do yogic practice and I detach from that unhappiness then it doesn't matter which

one that I have because I the negative impact of the desire doesn't actually land so I think a lot of these people are doing this backwards whereas if you practice yoga you will become more detached from the world naturally your mind will be less desirelessness you're not bludgeoning it into submission that's so useful because I think you're right most people are doing it wrong they are like forcing themselves into submission when it's actually the way you're describing and if tell me if I'm wrong is that it's part of your meditative practice like you continue to

become free of all these thoughts in your mind through a meditative practice and then the desire for SE goes down and then you realize when you have sex that oh it's actually affecting your meditative practice negatively so then the desire to avoid sex or abstain for periods of time is stronger very well said right so so I think this is something that people don't like so I think it's important sometimes you have to conquer a desire fine you have to strengthen your frontal lobe and restrain a sexual impulse fair enough but I think what with

what you're describing like doesn't work like even in Psychotherapy so if we understand something like OCD right so this is a case where someone has these intrusive thought which there's wrestling with and fighting with and the more that you fight with your mind the less healthy you're going to be so really good example for people who don't have OCD is think about like stressing about going to sleep oh my God I need to go to sleep I need to go to sleep I need to go to sleep you the more that you stress about sleep

the more you're like a [ __ ] can I say it's fine so like [ __ ] it I need to sleep right and then like the more you stress about it the harder it becomes to sleep so in that same way there's almost this weird thing that we see in psychi with like defense mechanisms and reaction formation that the more you suppress something you're sort of fueling that tension in the mind and tension in the mind and conflict in the mind will never lead to peacefulness so what I usually have when when I I

work with people who are interested in like no not uh November and we have a lot of people who have unhealthy relationships with pornography in our community is we try to teach them this kind of stuff right you can try to force yourself to do it and that can have some value but it's way easier to sublimate your desire than it is to conquer it yeah because the other thing physiologically right is your body will sometimes e jackly on its own at night right you'll get nocturnal emission so it's not the act of ejaculation I

think it's probably the act of being with someone and having those other hormonal connections with that person that that may have a physiologic impact but we know that people are Jack it at night right it happens especially the younger you are the more testosterone you have the more ejaculation you're going to have at night and that's normal physiologic he not a and so I think that people get very fixated on like oh I need to not ejaculate and then they'll have a nocturnal erection ejaculation and they will feel so much deep shame that they failed

and that's not the point I think that's really important because I um you know again this is something that people struggle with and they really they want permission to not do it because they're like hearing all these benefits but I think again the thought is that you have to conquer it versus you actually have to yeah so when I work with people who are like really interested in in no nut November like usually my question is like why yeah like what's driving your desire to like not nut and and usually it's like some kind of

weird transmutation of something else like they it becomes a proxy battle for them where like I need to conquer this thing because I'm unable to conquer something else generally speaking I I don't have you know I've never worked with anyone who's like happy and content and is obsessed and beating themselves up over no nut November usually the picture that I see anyway is someone who's like addicted to pornography and in an effort to conquer their pornography addiction they're going to do no November or noof fap or something like that and then in that process it

can be good because it's not that noof fap has all these magical benefits but if you look at the harms of pornography addiction and then you start doing nofap and you free yourself of that physiologic cycle that can be a net positive I think that's reasonable um what are what are some techniques that you use for people who have porn addiction like how do you help them get through that I I think a lot of it is like understanding their emotions so when I think about pornography addiction so remember that any addiction brings pleasure and

takes away pain so if you can reduce the need to take away pain then you're you're going to melt away the pornography addiction so there are a couple of things that are correlated with pornography addiction so if you look at um multivariate regression analyses there are two variables that correlate very highly with pornography addiction one of them is meaninglessness in life so generally speaking if you can help someone have a reason not to watch pornography and jerk off in the middle of the day then that will help them a lot so what happens is this

is my population but like you know these are people who are often times young men in their 20s and they're like falling behind in some way and it's like 400 p.m. on a Thursday they're not really working and like what else do they have to do so as we start building a life of meaning like the need for pornography seems to decrease that's one thing the second thing is that often times remember this is emotional regulation and people will have a lot of stored emotions from things like traumatic experiences growing up romantic relationships all kinds

of other stuff so as we metabolize that Storehouse of emotion it becomes easier to manage emotions from day to day they're kind of like built up and your mind kind of stores them in the subconscious so if we look at something like processing trauma so I do a lot of like trauma processing for people with pornography addiction and that sort of takes some of the gas out of the tank that's fueling the addiction the third thing to do is to reduce emotions in the present so teach them alternate coping mechanisms um that can they they

can use to manage emotions and often times it's like really life oriented stuff so if I'm living at home and my parents are toxic like learning to set better boundaries is one of the best things to teach someone who struggles with pornography addiction because usually what's going on is these are people that have someone in their life who is sending them to toxicity but they feel so guilty at cutting them out this can even be someone like a a romantic partner or spouse it can be a parent and as they're like receiving the stress it's

almost like I I'll joke with some of my patients that you have an emotional umbilical cord they're connected to someone else and another human is like transmitting negative emotions to them like a waste product and then they have to turn to substances or pornography or whatever to like offload that emotional stuff so boundary setting emotional regulation techniques processing trauma and like really building purpose in life tends to be like a pretty good like good outcomes you know so many things come to mind but I think we're seeing particularly in young men like we know that

amounts of sex or frequency of sex is decreasing and that the even birth rates are decreasing um and so do you think this is ort of part of all of this like external stimulation that's around and then they feel sort of I mean this is a theory for me right they feel wor less meaning right because they're not actually having success in finding someone or meeting someone or it's just easier to access pornography and then they're like you know they're still not connecting with other people they're they're using pornography because they still feel bad of

course we talked about the cycle a little bit but is it sort of like are these things contributing to that when you say these things what do you mean like meaning are we seeing people get porn addiction because they're either having stress in their life so say they're not coupled with somebody say they are trying to meet people but they're having difficulty because I think the dating the dating world has changed right with dating apps and how people communicate and meet each other it's very different from when you and I were younger and so um

I think that is is a very different different sort of place to navigate like women are looking for a certain kind of man and if you don't fill that category you are immed medely filtered out right so women are dating the top 5 10% of men are trying to aim for them and and then there's a a lot of men who are not having success in meeting women yeah so so it sounds like you have a theory that that's at play and I think that's completely reasonable so let's just play around with that a little

bit so the first thing is that you know this idea that women are dating the top 5 to 10% of men I assume you're talking about like Tinder statistics yeah like those I mean because that's where you can filter by height and by you know yeah so I think that that there's a couple of interesting like once you really look at the data which I don't know if you have but I'm I'm sure you know anyone who's trained in statistics so when when they say they're dating the top 10% of men there's this idea that

one dude is dating like nine women whereas that's not usually what happens so if you look at something like Tinder it's like a 7 to n men to one woman like ratio so when they say they're do dating it's still often times one dude is dating one guy or maybe people are kind of at the top but like there's such a lopsided gender that it's still like closer to one to one in some ways it depends on the studies that you look at and stuff like that so I think that this creates this idea that

a lot of men have that like oh my God there's like these Chads at the top that are like banging lots of girls I don't think the reality is quite like that when you really look at the statistics so that's one piece but I think another thing to really consider that that I think you kind of hit the nail on the head is that it is harder for men and women to find a good match yeah there are many reasons for that I I think one reason is that so if we look at like what

women want in partners and this is generalizations um so you can look at statistics right so like the idea of a dating a dude who lives at home at the age of 28 is like ah I don't want someone who's living with their parents but 50% of people under the age of 30 who are adults still live with their parents men and women both yeah so the economic situation is changing so the idea of like an independent man at 28 just doesn't apply to 50% of the population yeah another good example of this is most

women I want to say like statistics orally somewhere around 70 to 80% of women will want to date a man who makes more money than they do but 60% of college graduates are now women yeah so what we're starting to see is as equality of income increases that expectation becomes harder and harder to fill so whatever the reason is and there are all kind of challenges that women have as well they get tons of dickpics and all kinds of other things yeah so it's definitely making it harder for men to date now that's just on

the gender side but there's a whole other set of things that's like screwing up dudes too which is that you know as men like we have very poor emotional regulation skills we're not really taught how to express emotions Beyond anger um we're unlikely it's like hard for us to engage in Psychotherapy which I don't think is a weakness of men I think there's some systemic biases in Psychotherapy that are against men so if you look at studies on couples counseling like you ask ask men why don't you want to go to couples counseling and what

they what happens is they feel outgunned so anytime they go see a Coupes counselor their female partner assuming a heteronormative relationship knows how to articulate their feelings and the man doesn't know how to do that so the the the wife is like articulating like he does this and this makes me feel this way and the therapist kind of like gets on their side and so men sort of feel like outmatched and I think that there's a good reason for that mhm so men are are really struggling right now I think there's a lot of this

dating stuff going on there's a lot of expectations that are changing and then there's a lot of like distortions so if you look at I recently saw a paper on incels where their beliefs about what women want are quite divorced from reality so there are these ideas that oh like you know the top 10% of dudes are dating all the women so they assume that okay like what that means right we can sort of like apply the transit of property is that this woman I'm talking to is only interested in a dude who's in thep

10% but if you actually ask women like who are you interested in and who do you date it's much more wide and accepting than most men are like understand you know it's interesting because in the same breath I I I don't disagree with you but I I want to kind of push back a little bit because you said it's not cute to date someone who's living at home whatever right you're like that's sort of a turnoff and so that's half the male population who's living at home with their parents right and then um you want

people who make more than you and women are more often graduating college getting higher deg degrees getting higher positions and the average salary of a man is $45,000 in the US so it sort of seems like there are I mean maybe they're not dating the top 10% of men only maybe they're just not dating right yeah you know I think that's part of it too so I'm how is that a push back no no so my point is like so so meaning that there is the the large majority of men are not finding matches is

exactly what you said but they're not finding matches because women are choosing not to date because their expectations are not being met which is sort of what you said but it is I mean so they're not wrong in the that this woman wants something different than what I have to offer but they're wrong in saying they only want the 10% of men they just want something different than what I can offer yeah so I think that there's like both can be true so I think the challenge now is that like see we used to need

Partners mhm so now what's happened is our society has become so independent that a man is not even competing against another man a man has to add value to a woman's life more so than the or annoyance that he brings and that's true for both genders so like this is what's going on is like now it's just easier for me to live by myself than it ever used to be and so now really what what both genders are competing against is like is this other person's life better alone or with me there's also other interesting

statistics like if we look at like men under the age of 30 and stuff like that so if you look at like there's also a gender I mean sorry an age Gap issue so if you look at women who are 28 and you compare them to like men who are 28 that's kind of a mismatch but if you look at like uh I forget what the statistics are but there's like a interesting statistic about people under the age of 30 and like I think maybe like 50 to 70% I'm Rusty on the statistic of men

are not dating or don't have aren't partnered under the age of 30 but that number is lower for women and the reason for that is because they're dating older men yeah so it's very common so that excuse the the statistics in some way too so the younger generation is having less sex they're less often they're less often than having children and that leads to the possibility of our our difficulty in perpetuating our population having a aging population that's not replaceable okay I think it's important to remember that globally this is a trend in some places

right so basically developed nations are seeing this way more so I remember talking to a colleague of mine in China and so basically like you know China had this one child policy for a while and I heard recently that they have this new policy well they they will subsidize your third and fourth child mhm so what's going on in parts of China in South Korea in Japan less so in the US is exactly what you're describing which is that for every I think we're having like the lowest birth rate is like 67 so they're not

even having one to one yeah so this is very scary from an aging population but there are other parts of the world like if you look at like South America or areas of like the Middle East or Africa where people are having still lots of kids um and so I don't I don't think the species is going to die out I think what's going to happen is like in developed Nations they're going to have this huge problem of like not having enough young people to support the old people yeah so that I agree with was

there I I sorry I forgot your question no I think that's the issue and so like my question is like what can we like this is an issue right this is a is more societal issue than an individual issue but it's a problem and so what do you think like are there things that you think that we should be addressing yeah so I I think that I don't focus on societal issues it's kind of weird so despite the fact that we have this like large scale approach I still at my heart am a clinician so

when I work with men who are struggling to date or working with women who are struggling to date what I always focus on is the individual and so I think what we really need to do like what I would love to do is like make a school for crappy boyfriends I don't know if I could do that for crappy girlfriends because I don't know what it's like to be a crappy girlfriend like but I I think that there's a lot of like skills training that we're seeing so like what what should we intervene in I

think social skills atrophy is huge so what's happening when we start to use technology is like as you know any part of your brain that you don't use like rusts so if you don't speak a language you'll forget it because your brain is like hey we don't need this so as we move to like text based communication what started to happen is our empathic C circuits have started to atrophy so we're seeing a rise of social anxiety and why is that that's because when I sit with you I see body language I see facial expression

I interpret it and so this part of my brain works well but now the more that we text then when we meet in person I'm going to feel incredibly anxious so we're seeing a rise in social anxiety in both genders so that's really what I think we need to Target is like how can you be a more emotionally available partner how can you be like more confident in yourself we're seeing like low self-esteem problems a lot of Shame you know and social skills atrophies so these are the things that I kind of focus on and

like how can you whether you're a man or a woman we have everyone in Community like become just a better human being and then I think as you become a better human being what we tend to see is that the relationship kind of like comes pretty naturally but this is not a societal program I'd love to make it one what I think I think if you did it on an individual level for many many people at scale it would help Society overall right like because I think you're right social skills are definitely less less robust

right in the in the age of technology I worry about how our kids I mean I sort of force my kids to like communicate with people we go out like you have to have a conversation you have to learn those skills because otherwise you know they'll be looking at their phone or looking at devices or I mean they don't have a phone but like they'll be looking at some TV or something else or trying to get a dopamine fix through something else and so um that is you know a real problem I think in society

today in our at least in the developed countries where there's lots of access to these things absolutely and I I think now that I realized it so so we have lectures on those topics so even at scale I know I sort of said I work with individuals but what I've sort of done is like we did two lectures on communication and relationships and we have two lectures coming up on like how to build meaningful connections and and so there's a lot of science that we can really utilize and once we understand how connections form so

I think like a good example of this is people don't realize what leads to attraction so the science of Attraction is like really fascinating and the interesting thing is that Tinder does the data points that Tinder collects don't correlate at all with attraction so your interests and things like that don't actually govern attraction in the brain so it's interesting things like shared emotional experiences so there's a super fascinating study where they had people go on first dates on a rickety Bridge or a stone bridge and on the stone bridge it's stable and it was like

whatever but when you have people meet in the middle of a rickety Bridge your sympathetic nervous system is activated both people are a little bit scared and anxious and when there's an a similar emotional experience it can even be negative um this results in like some kind of bond being formed emotionally so there are some of these things like you have to you know keep your date under 75 minutes because something happens in terms of like attraction and stuff like that there's a lot of stuff that we can actually teach people to help them kind

of like compensate for the social skills atrophy that's interesting that's really fascinating are you loving the Reena Malik MD podcast well I love each and every one of you and I'm truly honored that you choose to spend a bit of your day day or a bit of your week with me did you ever hear the actual story of why I started making content online well when I was a resident I remember having a patient who had bladder cancer and in order to treat her bladder cancer we had to remove it and then reconstruct a new

bladder called an Indiana pouch now with this new bladder she would have to catheterize herself through a stom or an opening on her abdomen in order to empty her bladder so after surgery immediately she did great she went home and no major issues but subsequently over the next couple months she started getting readmitted over and over again to the Intensive Care Unit and we were really wondering what was going on eventually we figured out that she didn't truly understand that she now had to catheterize herself to empty her bladder just the simplest thing that was

so pivotal she didn't understand that and it was then that I realized as a urologist I could do the perfect surgery but if my patient didn't understand the consequences of that surgery then I failed as their doctor and once I started practice I realized that I couldn't teach people everything they needed to know in the 15 or 30 minutes I saw them in my office and that's when I started creating all my Reena malic MD content to offer free education to people around the world and I can tell you that it has been truly one

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back to you mentioned something about when you have sex with someone you create a bond with them right and so how does that work in terms of casual sex like in terms of the brain like you're having casual sex with multiple partners how does that affect you in your brain and how you see future Partners or see yourself yeah so that's a great question um let me try to approach it from a couple different angles so the first thing that I found is that I think is natural in the sense of from an evolutionary perspective

to bond with someone that you have sex with that being said what we're seeing is different kinds of behaviors now in which that doesn't happen so or happens in different ways so I was like just looking at research on polyamory for example and and the research on polyamory shows that people who are polyamorous and in relationships are relatively happy but I think there are some biases in the research because they're doing research on people who are in polyamorous relationships they're not studying the people who were in a polyamorous relationship and are no longer one so

all of the research on polyamory is biased towards the success cases and no one is looking at people who tried to open up their relationship and fell apart which I suspect is the majority of people so anytime you have sex with someone there's a tendency to bond and what I tend to find is that with people who are having more and more casual sex we are seeing more and more more emotional suppression so this is from technology so we're just numbing out our amigdala and liic system on the whole which I think makes it easy

we're also seeing a lot of dehumanizing behavior so the other thing that people that allows people to have casual sex and not bond is like burnout so the more burnt out you are the more your empathic circuitry is exhausted the harder it is to form a bond and when I have patients who are in relationships where they have like casual sex I often times find that as we do like emotional healing casual sex becomes more difficult that being said there are absolutely people who are able to have casual sex and can even form like somewhat

of a healthy emotional bond that does not necessarily mean like romantic ownership you can still appreciate someone and like acknowledge them and like bond with them um and if you look at studies on poly Amry you actually find that there's like very strong positive emotional they're able to have emotional connections without it sort of resulting in ownership so polyamory is a good example of like it's not actually casual sex there's like emotional parts of it that they're able to manage it's ethical non- monogamy right yeah yeah sort of or consensual non- monog yeah so so

and and people like to think it's ethical but you know I've been on the flip side where I see people who often times feel trapped because if their partner says like I want this and it's like the end thing to do and I want to be supportive of my partner even it's emotionally hurting me I've seen that a lot I just don't think that that gets advertised very much you know I will share this with you I just interviewed somebody about choking in during sex rough sex and apparently it's it's a very vanilla thing to

do these days with the younger maybe you know this but um it was news to me I didn't know that it was so commonplace um and again there was a lot of sort of in these you qualitative interviews of like Yeah well my partner likes it so I do it and I accept it and I wonder why um you know of course when you're young and your brain is developing but like why you would as a as a species where asphixiation is essentially dangerous that you would accept something like that if you didn't like it

yeah so I mean I I think there's a physiologic aspect right so so the es fixation does something to the neurochemistry of the brain MH and even if you look at it like even meditative states that are induced usually by very low respiratory rates so we'll have like a respiratory rate like you know the average respirator like 12 to 14 but in some states of meditation you're having one breath like every 5 minutes and so we we know that for some people there's a physiologic change in the brain that intensifies the sexual experience once you

add as fixation I understand why people like it but I'm saying people who self-proclaim that they don't really like it that they don't in they don't find the pleasure in it but they do it because their partner likes it that's sort of where I think it's it's a little murky because it's they may not be getting that benefit from it but when you say these people like it they do it because their partner likes it are they the ones doing the asfixia no they're the ones getting asphyxiated oh but but then the so the partner

wants to esate them yeah that's weird so most of most I mean I'm not trying to judge people but most of the people that I've worked with who enjoy asphixiation they're the ones getting asphyxiated yeah no and so it's the other way around and again this is not the standard not everybody but the majority of the in heteronormative relationship it's the male doing the aixia and they are sometimes asking for it or um saying let's try this and then the partner says yes doesn't really like it and then they're like oh but it's okay that

my partner likes to do it yeah so I think that's like weirder I mean like not to be judgmental but like so so I I think that there's why weirder I mean there is more to it than a simple physiological induction of a neuroscientific state that enhances sexual pleasure is it a way that we feel like we have to appease are Partners is there like a you know psychological explanation for that absolutely so I mean like let's start with the psychological explanation of why I would want to choke someone who doesn't enjoy it so this

well they may not realize because the person is saying yeah it's good right because they want to please their partner so they're not realizing that maybe there's a lack of communication maybe the partner is doing it because they think the partner the the the female partner likes it and the female partner think yeah it's good because they want to please their partner and there sort of this miscommunication but whatever the case is um if if it is truly that the male partner likes it and the female partner doesn't but she's saying yes to appease them

that's sort of where my questioning is yeah so what what exactly is the question there like why does that yeah why do people why it doesn't have to be asfixiation but why do people do things to appease their partner when I mean this one is an example because it could be dangerous right like you could actually have injury so that's why it sort of gives me pause an alarm to hear about that me too but I mean I I think if we ask like you know like you know I hope you're married right and there

are things that we're not talking about sex here but there are all kinds of things in a marriage that a partner does to that's fine I get that right that but I'm wondering like why you would why because it doesn't make sense evolutionarily that you would put yourself In Harm's Way to appease someone else if you didn't like it maybe and maybe don't realize it's harmful but your body should give you some signal that that's not feeling very good yeah so so I mean I I think that what I tend to see is like I

don't want to standardize and I can't hypothesize on these people but generally speaking what I've worked what what I've seen in my patients is that when someone the more willing someone is to appease their partner in an unhealthy way the more Disturbed their attachment style is the more likely there is to be history of trauma often times these people don't feel comfortable communicating and it's not even necessarily like their partner's fault so I I'm like thinking about one particular patient that like never fought with their partner and like that's not healthy for anybody right right

so so this person was just grew up in such an environment where they like learned very like in a in a very conditioning way that I'm not allowed to express any kind of like discomfort or disagreement or something like that and so I think that the more extreme your survival signals should be going off because someone is joking you the stronger that psychological conditioning probably has to be yeah but I I think one thing I've learned as a psychiatrist is that like once you get someone in in your office the reasons that someone does or

doesn't do something is actually way more vast than you would realize yeah um but I I think there may be something trauma related which is like a good safe guess if we're talking about like a board question like that's what I would Circle that's really interesting um so what do you think um you know I've been thinking about this a lot lately and I don't know the answer but now with VR AR um being able to like feel like you're in a erotic film or potenti say the future of like sex dolls that are realistic

and AI what do you think that's going to do in terms of our mental state and how we bond with people okay so this I think so you were worried about like you know the lack of birth rate or whatever like this I seriously think could like end the human race like I'm worried about that so so I think this is what's going to happen Okay so someone is soon going to figure out so if we look at the trend in technology addiction okay this is what's going on so first we had a video game

and then a video game activated our dopamine and then we had like friends lists we had communities we had guilds we had massively multiplayer online RPGs and so over time what what has happened is gaming scratches different itches in the brain so we're getting more whole brain effects and the more of a whole brain effect you can create the more likely someone is to play a video game so we look at relationships something weird right which is that sometimes you're dating someone or you're married to someone or whatever and like even though there's drama in

the relationship somehow the drama pulls you in yeah and so I think what we're going to see is like AI girlfriends that start or boyfriends that start like having drama like they're going to start like getting mad at you and they're going to start having fights and someone is is going to figure out from an algorithmic sense what is the right amount of denial of reward which I'm I'm sure you understand right random reinforcement schedules and like gambling they're going to start inputting gambling mechanics into virtual systems we're so [ __ ] we really are

we really are and then this is going to addict people even more and then as these virtual AI like girlfriends or boyfriends or whatever become more and more robust um as they become like more as you mentioned like they're going to get integrated into sex dolls and like physical Sensations and things like that you're going to have emotional connections where they're going to be like activating emotional circuitry you're going to and and then like the crazy thing is that after she like denies you she's going to come and apologize and then that's going to make

you feel really great right and so the closer we get to approximating a real relationship I think the more pulled into this we're going to get yeah so my Hope was that they would be at least the and I I'm sure this is correct that the initial ones will be very like acquiescent like they will just be very nice and they will do they will say yes to everything there won't be that that negative sort of random reinforcement so I was like that that won't people won't like that forever but if they do evolve to

what you're saying we're totally [ __ ] absolutely so I that's what's going to happen right so so unless someone stops it and then we're going to we're going to slowly add other qualities to AI girlfriends adding the physical Dimension like who know like I I don't know exactly what's going to happen but then like you know they're they're going to evolve and to do everything you would want a real person to do in the perfect way actually the perfect amount of way like yes so what I would say everything they're going to be so

perfect that they do things that you don't want them to do right because because we need that we need that yeah that is oh my gosh okay okay that's scary so if you were Surgeon General and you could put in any policy that you want to like to to better the universe right now what would you do if I was Surgeon General I would resign and make Vic Mory I would tell him to take my place so he's he's a fantas great answer I'm trying I'm not trying to kiss his ass it's just like honestly

like so so I mean if I could put any policy in place probably what I would do is create a mental Health Training curriculum as part of our core K to 12 education yeah so in Ancient India like we taught kids like mathematics and how to meditate so we taught kids how to control your desires how to train your attention so if we look at some of this like you know this work that we do with like ADHD and stuff like that we train people how to control their mind and I think that like everyone

needs to learn this because what's going on right now is that we don't know how to control our mind but the people who develop technology are getting better and better and better at it so literally what is happening is that Psychiatry is the only field of medicine where we are losing the war so I I Me Maybe This is untrue I don't know about your logical outcomes but I would bet money that over the last 50 years Urological outcomes have improved yes yes but I think that comorbidities have gotten worse because of other things and

that's overall mologic outcomes like you know more prevalent so erectile dysfunction and Cancers and and those sort incontinence all the things that we see I'm sort of more common even then I would say that that is losing that's a loss on Psychiatry so what we're what we're seeing is we're not able to control human beings behaviors right and so even though our technology Urology Cardiology things like that we've gotten better at pet scans and MRIs and whatever our science has improved but we're losing the war on mental health and I think the reason for that

is because we have stopped learning how to utilize our mind and then on the flip side we have people like app developers which like I don't think they're all evil but there's like two groups of people who call their users users drug dealers and app developers right otherwise it's like clients or patients but they're users and and so what's happening is all of these people are getting more sophisticated and as they get more sophisticated they know how to pray on your brain and they're even like scientific studies on something called the attention marketplace where you

have people who are now economists who are studying like human behavior and trying to figure out like you know this is Way Beyond advertising and marketing like how can I control someone's mind so that they buy something we see this a lot there's actually like a sports betting epidemic right now and a big part of that is that we now allow people to place bets at 2 a.m. when their frontal lobes are completely exhausted and they can't like control what they do so technology is getting better at exploiting us and so I think what we've

seen at least in our our community is thankfully if you learn like yoga and meditation and all this kind of stuff if you learn how to train and control your mind it can help you control technology addiction pornography addiction video game addiction all that kind of stuff so that's probably what I would Implement yeah I mean I think education at a young age needs to be revamped to include a lot of things um from my perspective I always talk about how sexual education would do Leaps and Bounds because there's one so much misinformation two people

don't know anything right they don't they learn how to put on a cont they learn basic consent they learn how to avoid STI and pregnancies that's it and they don't learn what the anatomical parts are they don't learn how to and their parents aren't talking about it enough so they're learning about how to pleasure someone through pornography which is not reflective of real life right so actually one in like 1/4 of teenagers are learning through pornography Based on data that we have and so just 1/4th well at least that's a few years old but yeah

I mean it's probably more than that right but at least 1/4th admit to it whatever survey they did so that's a lot like like and so if people knew what sex should be like and what actually uh female Partners like what male Partners like I mean there's on both sides right men have a lot of expectations of for performance women are expected to enjoy penetration immediately an orgasm within minutes like none of this is accurate right and so if they were taught what is normal function what is normal Anatomy what is pleasure I think people

would be so much happier because you know just as well as I do the devastation that comes with difficulties in the sexual domain do you have a good resource for what you consider like what they should be taught like is that something that you put together at some point I haven't yet and I'm going to I'm going to work on it there is actually I just learned of today there's a website called Make Love Not porn where that's essentially what this person is trying to do and um it's fascinating because she couldn't get any funding

and and like from anyone cuz nobody found it worthy of investing whereas like you know you can think about all the other things that are sexually Orient to that get lots of funding and lots of you know uh lots of advertising that allows them to offer it for free so yes I'm going to work on making a sexual education course that hopefully schools will use but um you know I think and the same I think in terms of digital media they're doing digital media education in like Australia now and probably in some schools here they're

trying to start implementing that but I think it's super important yeah yeah absolutely is there anything we didn't talk about that you want to talk about nope I I think this was great okay well I have a few question question I ask everybody just sort of like um more about you than than your expertise but what's something you know now in your life that you wish you knew earlier you know that's interesting I I mean I hope this isn't an annoying answer but I'd say nothing one of the things that I've come to appreciate is

like ignorance earlier in my life has helped me like kind of become the person that I am and like there are certain things like I failed out of college for example and so like there were times in my life where I wish I could go back and change that but I I really wouldn't cuz if I knew different things then I would have acted differently and then I wouldn't be where I am now yeah and I'm really happy with where I am now that's great I mean that's really great yeah and it's not a BS

answer I know it sounds like a BS no but I mean I think I really believe that strongly is that your journey is individual to you and and if one thing was different you wouldn't be where you are right so like if you hadn't almost failed out College you wouldn't have gone to India you wouldn't have learned all the all the you know Eastern traditional things that have influenced you and perhaps gotten into medical school later and and pursued Psychiatry and all the things that absolutely so I'm with where I am and like I'll take

all the decisions and all the ignorance that's great what is a non-negotiable for you something you have to do every day I mean aside from like physiologic functions yeah like not like people say sleep a lot but I'm like okay everyone has to sleep right I I I don't I don't know that I have a non-negotiable I think Theo the thing that I enjoy the most is like often times watching Esports while I have like a cup of coffee or tea in the morning that is the thing that I enjoy the most and is like

the one thing that I try to hang on to but really after like being in an asham for a while like there not you don't need anything yeah that's what you learn is that we think we have all these non-negotiables but like you know if you don't have what like can I ask you like what's one I don't have one yeah so like like if you oftentimes parents learn this the hard way is like you had all these non-negotiables before you became a parent yeah and then like your kid gets rid of that and it's

like it's not that bad like you don't like I would love to say I have to go outside every day and I would love to say that I could do that but there's some days where I just can't I can't I can't literally um maybe I can step outside for a couple minutes but I can't like do a walk in nature like I would love to or I can't meditate every day um and I think that's okay but I always find it really inspirational and people are like yeah I have made it my like my

thing to do this XYZ every day and it's helped me in some sort of way yeah but um what's a health hack or life hack that you would share so one is that meditating twice a day is exponentially better than meditating once a day can I ask how long yeah so I will meditate for 20 to 30 minutes twice a day so if you look at most most of the studies like probably around 18 minutes is what you need to shut off act production and reduce cortisol and things like that most of the clinical studies

on mindfulness or meditation show clinical benefits with like 20 minutes of meditation but I think this is where there's a big difference between physiologic benefits and spiritual benefits and what I found is meditating twice a day for 20 to 30 minutes the first time you meditate is going to give you physiological benefits but if you really want to accelerate your spiritual growth you need to meditate twice a day because it's that second day where you clean out all the physiology stuff and then you're really like primed for like spiritual growth that's fascinating um and is

it like certain times of day or any any two times you can no I mean so any two times will work but generally speaking Dawn and Dusk and there's like interesting stuff about our circadian rhythm and things like that so even if you look at like visual Acuity during Dawn and dusk is like the highest which is why sunsets are so beautiful um so Dawn and dusk are the two best times to meditate during the day so if you can do that great and what's your second thing the second thing is this concept in ayurva

of satvik rajik and thik so see a lot of people like I don't know if this kind of makes sense but on some days you're sluggish and it's like harder to get yourself to do the things that you want to do and then there are other days where it's like easy for your body and your mind to listen to you MH and so basically what the yogis figured out a long time ago is that there's a way to balance your mind by making it satvic and rajik means overly passionate or active and thick means like

inert but there's certain pra certain things that you can do like food that you can eat and things like that so eliminating most if not all psychoactive substances will help you over time so the main kind of Life Hack is what can you do today that will put you in a better frame of mind tomorrow so if you like drink even like a glass of wine at night that will interfere a tiny bit with your REM sleep overnight which can affect you the next day so what I really try to tell people to do is

do like whatever you can today and it's not about today it's like set yourself up for like a good day tomorrow that's like also impinge in UND delayed gratification which is tough for people right like you are sort of looking for so that's what I mean so your ability to handle delayed gratification depends on how sfic your mind is yeah so that's that's it's kind of like the Lynch pin is like yeah you're absolutely right that it's hard but that's the whole point is like once you get started on that path once you sleep a

good night it's easier to delay gratification tomorrow and then you do the next thing and then you do the next thing and this is sort of from the yogic literature like being saic so you're doing Mind Body practices changing your diet eliminating psychoactive substances all that stuff is really good that's great I'm going to add one more question because because you've been in the Eastern medicine sort of Eastern philosophy you know there's a lot of sort of uh ayurvedic medicine herbal supplementation are there certain things that you've taken from that uh that that you recommend

your patients take oh I mean so I I like started a consult service at Mass General that was evidence-based complimentary and alternative medicine um so it just depends on the patient so I I know we're seeing like good evidence for things like brami ashwag gandha um turmeric sometimes is an anti-inflammatory so it depends on the condition so I don't I don't recommend that everyone there's not like one thing for yeah so the closest thing I would say is probably meditation so we have clinical trials on meditation for all mental health issues and so that's like

the one thing that seems to be like a Panacea it's kind of like exercise where it helps everything yeah okay awesome well thank you so much thank you thank you so much for tuning in to the Reena Malik MD podcast if you're enjoying this content please be sure to go on to YouTube subscribe to our Channel and go to Apple and Spotify and leave a rating or review this really helps us reach more people and it's a free zero cost way to support the podcast and I will greatly appreciate you also if you like my

content content feel free to follow me on social media my handle is at ream Malik MD on most platforms and as always I'm going to take care of yourself because you're worth it