The Melanie Avalon Biohacking Podcast Episode #301 - Blaise Aguirre, MD

TRANSCRIPT

(Note: This is generated by AI with 98% accuracy. However, any errors may cause unintended changes in meaning.)

Blaise Aguirre
All we can do is give all of what we can in the present moment. Being able to give fully of yourself without it being about you is liberating.

The key revelation for me was the idea that they learned how to hate themselves and that an infant is not born hating itself. It has to learn how to hate itself.

My worry is that we tend to pathologize many things in life and so when somebody's struggling, we need a diagnosis.

Melanie Avalon
Welcome to the Melanie Avalon biohacking podcast where we meet the world's top experts to explore the secrets of health, mindset, longevity, and so much more. Are you ready to take charge of your existence and biohack your life? This show is for you. Please keep in mind we're not dispensing medical advice and are not responsible for any outcomes you may experience from implementing the tactics lying here in.

So friends, are you ready to join me? Let's do this. Welcome back to the Melanie Avalon biohacking podcast. Friends, it is such an honor to bring you this conversation today with my dear friend Blaise Aguirre. Yes, I did say his name wrong in the episode, which I am so embarrassed about, but he's told me that I've got to let that go. I've since become really great friends with Blaise and I adore what he's doing. I mean, I already loved his book, I Hate Myself. And yes, I realized the irony in that sentence. It is so, so profound when it comes to radically changing people's mental health, specifically the topic of self-hatred. And in this episode, we talk about what that actually is. What is the difference between episodic self-hatred, where you just feel it occasionally, versus a pervasive feeling of feeling it all the time. We dive deep into the role of childhood with this and how to tackle self-hatred in yourself as well as support others. How to love yourself, how to accept compliments, the difference between what if versus what is, contemplating the future you, and so much more. We also talk about things like relationships with your therapist and AI therapy.

I can't wait to hear what you guys think. And yes, one of my favorite singers of all time, Jewel, did write the foreword for this book. The show notes for today's episode will be at MelanieAvalon.com slash self-hatred. Those show notes will have a full transcript as well as links to everything that we talked about. So definitely check that out. There will be two episode giveaways for this episode. One will be in my Facebook group, I have biohackers, intermittent fasting plus real foods plus life. Comment something you learned or something that resonated with you on the pinned post to enter to win something that I love. And then check out my Instagram, find the Friday announcement post. And again, comment there to enter to win something that I love. All right, I think that's all the things. Without further ado, please enjoy this incredible conversation with my dear friend, Blaise Aguirre. Hi friends, welcome back to the show. I am so incredibly excited about the conversation I am about to have. So the backstory on today's conversation, when I received the pitch email about this book and this author that we are here with today, I was so intrigued. So the book is called I Hate Myself, Overcome Self Loathing and Realize Why You're Wrong About You. Okay, so that's thing number one, the title itself. And then two, the forward was by Jewel, who I have not told you this yet, Blaise, but I am obsessed with Jewel.

Melanie Avalon
I've been following her since I was little. I just adore her music. And I love her personal story. She's just an incredible, fantastic human.

And so when I saw that, I was like, this is interesting. Like I haven't seen a psychological book with this sort of forward before. And then the topic itself, I was really intrigued because, well, after reading the book, I definitely don't have what I think you would diagnose as self-hatred. But I have experience throughout my life, moments of what I perceive as self-hatred or self-loathing. So I was really, really just intrigued by the whole concept. And I'd never seen a book that was speaking specifically to that. So I was like, this just sounds awesome. So I was immediate, yes. Read the book. Blaise Aguirre, MD, he is a child and adolescent psychiatrist. He's a trainer and he specializes in dialectical behavior therapy, which is known as DBT and other treatments as well, like MBT for borderline personality disorder and other conditions. And he actually, we were just talking before this, has written 19 other books prior to this, which is insane. And so I hate myself, it's his 20th book. And then I started reading the book and I got further excited because he very quickly in the beginning quotes Taylor Swift. And I was like, okay, we're all good. Like we're going to have a good time with this. And he makes the comment that he wants to quote throughout the book, popular figures in our culture to just show how pervasive this idea of self-hatred or self-loathing is. And then in the book, it's really, really incredible. And we'll talk about this in the interview, but it basically posits or hypothesizes that self-hatred or self-loathing actually could be its own diagnosis or condition in and of itself, because typically in therapy and everything it is treated, well, it's not really treated. It's seen as an aspect or a characteristic or a symptom going along with other health conditions, but it's not usually addressed as a holistic, I guess, diagnosis. So it talks all about that, what it is, the signs, the symptoms, the different types. And it's filled with, of course, popular cultural references, as well as so many incredible patient stories that really give you a window into what is going on in people's minds who might be experiencing this. And actually after reading it, I could, like I said, I don't think I personally have this as its own thing, but now I can see people like friends and family members who I think do. And so it's been very, very enlightening for me to get more of an understanding of that perspective. So I think there's so much information in here that everybody can learn from, and I am just so honored to be here today with Dr. Aguirre. So thank you so, so much for being here.

Blaise Aguirre
and thank you. I'm just as honored to be here with you and perhaps even more honored to be with your audience who are tuning in and wanting to have a deep dive into this what's increasingly seeming a pretty intriguing topic for a lot of people.

Melanie Avalon
It's so true. Like we were saying before, and like I just said in the intro as well, nobody's really talking about this as its own potential diagnosis.

And you talk about why there are barriers to that in the book. But before that, did you always want to be a psychiatrist? Or how did that happen?

Blaise Aguirre
I wanted to be a philosopher. I loved the idea of Nietzsche and Socrates and Plato and Bertrand Russell sort of sitting around, possibly even outside a Parisian cafe, smoking a Goulois cigarette and pondering the nature of life and everything. I realized soon that A, how privileged that was. I mean, most people are fighting for survival, but also that if you are pondering the nature of a squirrel running around an oak tree, well, what would that look like to a sub-Saharan tribal person who maybe they don't have oak trees and squirrels and they have Beobab trees and other things like that? And so that obviously context and psychology was dependent on where you were, how you grew up, etc.

So then I thought, okay, well, maybe psychology actually makes a little bit more sense. Then within psychology, I thought, yeah, but what happens if you have, say, a brain tumor or some kind of brain infection? And so I decided to go to medical school after that. But parenthetically, my dad found my report card from my first year in college, and I'd been put on academic probation because of my grades. And one of my grades was a and the D was in psychology of personality. And I actually put that on my wall for my patients to see just to say, this doesn't determine my future.

But my dad said, this is terrible. You're going to fail out of school. How are you spending your time? And I say, I don't know. I just love sitting around talking to people. And he said, you'd better find a job where you get paid talking to people. So here I am.

Melanie Avalon
Oh my god, wait, that's so funny. We both have a job podcasting and in yours where we sit around talking to people. I love it.

Exactly. Were you enjoying the material and still applying yourself or was it really just that you were talking to people instead of studying?

Blaise Aguirre
I mean, probably a little bit of both, but I think that one of the things in which, the way in which our education fails us, is that it doesn't contextualize the learning. So if I were to say to you, you know, question number one, when was Sigmund Freud born and, you know, when did he die, to, you know, what were, in what year did Piaget develop his theory and stuff like that, that learning those things from memory was very, very different than the application of ideas and techniques in terms of helping people. So it seemed to me that a lot of learning was a lot of rote memory that had no real life application. And it just didn't appeal to me all that much.

You know, it was when I started kind of working real time with people, both at medical school and then during psychiatry residency, that things began to make a little bit more sense. But I think that a lot of education seemed to reward people who had vast memories, but seemed to have maybe less common sense. But I was also, you know, I mean, I had, you know, I was finally of the age where I could go drinking, you know, I mean, it was a college experience. And I had been brought up in a fairly conservative household so that, you know, so that the opportunity to just be with a huge range of different people and speak to them about their experiences was just fascinating. It just wasn't very conducive to good grades.

Melanie Avalon
I cannot agree more. Do you know A.J. Jacobs? Have you met him? I haven't, no. I just interviewed him again. He wrote The Year of Living Constitutionally recently, but he wrote The Year of Living Biblically. Basically, he goes and he lives for a year according to the Bible or the Constitution. And he's hysterical, but reading his book, I was thinking with learning, there's something so different, like you said, between rote memorization versus actually like living an experience and understanding it from that perspective. So yeah, I think the education system could be done a little bit differently and have different effects.

Question, so when you started practicing and seeing patients and everything like that, how quick I have a few different questions here. One is how did you evolve to where you are today with the treatment methods that you think are, that you utilize, like DBT, what led to that? And also, when you're seeing patients, I see a therapist every week and I have since I've seen different ones based on when I move and things like that, but probably for a decade now. And I've seen psychiatrists as well and psychologists. How quickly when you're seeing somebody do you, I know I asked two questions, but how quickly do you diagnose them? I guess is my question.

Blaise Aguirre
I started very early on to think about human suffering and the things that get us and keep us stuck. I think the greatest tragedy, certainly the thing that made me feel most profoundly sad was seeing young people who were suicidal and they would often do pretty self-destructive things like self-injury and things like that.

The way in which I was taught was that often those behaviors were attention-seeking behavior and cries for help. I mean, I suppose it made sense in a way. These patients would come into hospital, get some sort of treatment, often medication, and then be discharged and then go back to their environments and then start to struggle again. What intrigued me about the treatment that I subsequently went on to train in and become a trainer in, dialectical behavior therapy, was it said that people will behave in the best possible way given their skill set and ability and their context. If I say, okay, Melanie, we're going to go to Iceland tomorrow and you have to speak Icelandic to people, you would say, well, I can't do that. Now, I wouldn't assume it's because you're lazy or because you're attention-seeking. The assumption would be you don't have the skill set to be able to speak Icelandic so that when people were behaving in self-destructive ways, rather than think of them as attention-seeking or lazy or manipulative, thinking of them as not having the capacity and the skills to be able to manage life differently was just a much more compassionate way of doing things and that because DBT accepts people where they are and then teaches them the skills that they don't have, we saw a marked turnaround in the quality of life and the ability to deal with difficult situations without being more effectively and more adaptively.

The second question is a trickier question because, to me, I think my worry is that we tend to pathologize many things in life. When somebody's struggling, we need a diagnosis. Now, in many cases, the reason that people need diagnoses is because they're getting a bill from their therapist or that bill has to be submitted to an insurance company and the insurance company wants a diagnosis. If you go and get your wisdom teeth removed, then you've got wisdom teeth removal diagnosis and then that gets reimbursed. If I say the diagnosis is, Melanie's got problems, it's very unlikely that insurance is going to cover. But then, if you were to think about self-pay models, I think that, for me, diagnoses are secondary to skills deficit so that if you have a difficult time in relationships, me helping you deal more effectively and adaptively with relationships is more important than to say what is the diagnosis that caused that difficulty in relationships.

Now, of course, on the other side of things, if you've got schizophrenia or manic depressive illness, severe obsessive compulsive disorder that have very standard and effective treatment protocols, having the correct diagnosis is also important in terms of psychoeducation and deriving a plan or creating a plan that addresses that diagnosis.

Blaise Aguirre
So, I tend to focus less on diagnosis per se and less absolutely indicated or required and more on helping a person address the problem that's bringing them into therapy.

Melanie Avalon
One of the really eye-opening, mind-blowing things I read in your book was you were talking about BPD, Borderline Personality Disorder, and the symptoms, and how you have to have five of nine, and then you point out that there are like 256 different potential combinations of these symptoms. And so I was thinking about that, like when I think BPD, well, A, I didn't know what the criteria was, but I do have an idea of what it is from popular culture. And I was like, oh, wow. So this idea I have of a person with BPD, there's like 256 different combinations of these symptoms which likely present in so many different ways. So I clearly have a very myopic view of what these labels even mean.

Question about the role of diagnosing, and in particular with your book, this book is about the idea of self-hatred, and maybe we can define that. What do you think for you and for culture and society is the importance of identifying self-hatred or self-loathing as a standalone concept? You quote some fellow practitioners in the book, for example, or at least a fellow practitioner who says that it just comes up organically. Like that's why they don't ask about it or diagnose it as a thing because it'll come up organically in the session. To you, what is the importance of looking for this as a standalone thing that somebody might be struggling with versus it just coming up as a trait in the session?

Blaise Aguirre
Yeah. Well, as I say, I work mostly with extremely suicidal young people. I feel so fortunate that I work with a skilled group of other clinicians and families and the kids who come in and the expected suicide rate of our patient population was quite high. But using techniques like dialectical behavior therapy, fortunately, the number of young people that we've lost suicide is much, much smaller than expected. But nevertheless, one life is one life too many.

And so when I look back at the lives that were lost to suicide, even though we'd helped so many people, why had we lost some? Many of those kids in retrospect had self-hatred. And when I looked at the research, there's very, very little research on self-hatred as a construct. But when I looked at the small amount of research that there was, they said that two very important factors in suicide are loneliness, and then something that they call thwarted belongingness and burdensomeness. And so, you know, loneliness is something that many people who are suicidal experience, thwarted belongingness, I don't belong, many people who suicidal experience. But it turns out that that wasn't such a significant contributor to completed suicide, much more important was the concept of burdensomeness. So that if you're so toxic to the world, and to the people that rely on you and the people that you love, if you're that burdensome, and you really believe that you're causing them tremendous distress and that they would be better off without you, it turns out that the more you hate yourself, the more likely you're to believe that you're a burden.

And so the reason why it was so important to me was that it was a very strong contributor to suicidal thinking and suicidal behaviors.

Melanie Avalon
Wow, okay. With both the self-hatred and the suicidal behaviors, how evident are those on the outside? Like, do people present symptoms of that?

Blaise Aguirre
Well, think about this, and you've courageously said, and I'm sure your listeners know that you've been in therapy, but let me ask you, can you say how many therapists you've had?

Melanie Avalon
Yeah, sure. I am all about therapy. I'm like, everybody should see a therapist.

Okay, well, first of all, the thing I think is really important is the interview process, like finding the therapist that's right for you, I think is so important because I have had, I don't know, I know people throw around the word traumatic very casually, but I feel like I've had some borderline, no pun intended, traumatic experiences in the interview process with therapists that were not the correct fit. So I've interviewed with a lot. But as far as like actually seeing the same one, like the one I've been seeing right now, I've been with her since 20, probably 18 or 19. And then I think I had long standing probably two before that, two or three before that. And that was a lot due to like moving back and forth between different places.

Blaise Aguirre
When you were interviewing all the other ones that, you know, ended up not working out, did they want to know why you came into therapy? Yes.

Okay. So did they ask you about, did they ask you your name, how old you were, you know, what work you did? Yes. Okay. Yeah. So that would be pretty standard.

Did they ask you how you slept at night?

Melanie Avalon
kind of think if that was, I mean, yes, yes, probably. There was a lot of very similar intake forms with a lot of questions.

Blaise Aguirre
Sure, but your appetite, your energy, did they ask you if you hear voices at night? Yeah, yes. Yeah, and whether you have suicidal thoughts and homicidal thoughts, whether you use drugs and alcohol.

Melanie Avalon
Yeah, yeah.

Blaise Aguirre
Okay, so the standard questions. How many of them asked you if you hated yourself?

Melanie Avalon
Yeah, not in the intake. That's for sure. And I'm trying to think if anybody's asked me that, if any therapist has asked me that in a session.

Blaise Aguirre
So here's the thing, and again, as I thought about this, in none of my training ever was that ever a question. And so it's not part of a standard intake.

Now here's the thing is if you say don't use drugs, say you don't use marijuana, if I spend the next half hour asking you about the marijuana that you don't use, that would be a ridiculous use of our time because that's not the thing that you came in. And so if somebody doesn't struggle with their sense of self, kind of with self-criticism, self-judgements, asking them about self-hatred and then badgering them about self-hatred would be pointless. So if a person isn't having that experience, I'm not going to continue to talk about that, we should at least know because of its link to suicidal thoughts and behaviors. And so one thing that used to happen is that I would hear ways in which people would talk about themselves. So for instance, they'd be critical, they'd be self-judgmental, maybe some self-disgust, maybe some shame, some guilt about something. And then maybe they would talk about deserving bad things that happened to them because of the way that they'd behaved. And I would reflect back how unkindly they were treating themselves. And they would be, yeah, well, of course, because I'm not a very good person. And I'd say, wow, that's a very unkind way to think about yourself. I mean, you don't seem to like yourself very much. And they'd say, I actually don't. So then I would say, well, how far does that go? Does it ever become self-hatred? So I modified the way in which I would explore that based on the things that they would tell me early on in my evaluation or in sessions, and then quite quickly get to the question of self-hatred. And then ask them very directly, do you hate yourself? And then explore it if it existed.

Melanie Avalon
Wow. Okay. Yeah. And like you say, you talk about the majority of patients say that, you know, nobody ever really asked them about it.

Or if they asked, they just said practice self-compassion or, you know, it just, yeah. I was having flashbacks while reading it to when I have touched on this topic in my own personal therapy sessions. Because like I was saying, especially after reading your book, I don't struggle with self-hatred or self-loathing as part of my identity or something that I deal with ongoing. I do, I have had things I didn't like about myself. And you might casually in your head say like, oh, I hate this about myself or I hate this about myself. But it's transient and temporary. And even if it's not, it's not attached to my identity. Like I don't hate my whole self. There's so many different ways to go with this. It's kind of like, I really like how you use the example with some patients or at least in the book about having, you know, the patients be very, very specific about what they actually hate. Because when you say I hate myself, well, A, like what is your self? B, do you actually hate your whole self? And you use that example of the ship. What is it? The ship of? This is, I think. Yeah. Like being deconstructed and rebuilt. And is it the same ship? And like, so like, what do you actually hate? Like, do you hate your organs? Do you hate your microbiome? Like, how do patients typically respond to that when you're trying to discuss with them their sense of self and what they actually hate?

Blaise Aguirre
Well, because I challenge it in this way, the first thing they want to make sure is that I'm actually a bona fide psychiatrist, and not some sort of quack that is espousing theories about ancient Greek ships, you know, that I'm not immediately running to, okay, this is the medication that you have to take, you know, so I don't simply accept I hate myself, I really want to get to the to the heart of this idea of self hatred, and, and have them really explain it to me in a way that clearly makes sense to them, but often doesn't make sense to the people around around them. So if you were to think about your dearest friends, or the people who love you most, and you were in a period of time when you were just like dissatisfied with the way that things were going, and maybe being very self critical, and you know, maybe being, you know, using unkind terms towards yourself, that if you were to speak to those people in your life, and I were to interview them, and I would say, you know, this Melanie, you know, whatever self judgmental words you were using, and they'd say, No, what are you talking about?

Like, she's wonderful, you know, most people would probably see you that way. And it's just that you're not seeing yourself in that way. It was confusing to many of my patients, especially in the early days, that I was harping on this idea, you know, to sort of get them to think about, to think about it, you know, it felt almost as if I were to say, well, tell me about your liver, how long has it been there? You say, well, I don't know, it's been there all my life. I mean, what can I tell you, you know, it's, it's just part of who I am, you know, I don't often think about it. So that's the quality that it felt like to them until I pointed out just the ways in which that idea of the self was interfering with decision making, you know, romantic relationships, how they treated their loved ones, the jobs that they applied for, you know, academics, and so many other aspects of their life.

Melanie Avalon
The question I was thinking about a lot during the book, because I mentioned I've talked a little bit about this topic in sessions in the past. One thing for me I've talked about, there was a period of time where there was something about my body I did not like. I don't know if I used the term, I probably when I was really upset probably in my head used the term hate myself, but I probably more phrased it though with I don't like this about myself. My therapist and I would go back and forth about, because I no longer have that thing I didn't like.

Like, do I need to accept and love that? Like I didn't like it then, I don't like it now and I'm glad it's not there anymore. So do we actually need to accept and like everything about ourself? Like is it okay, can we accept not liking some things about ourself or hating some things about ourself? And the answer might be different maybe if it's parts of you versus all of you. Yeah, so what are your thoughts on that?

Blaise Aguirre
Do you like hiking? No. Okay. Have you ever done a hike? Yes. Have you ever done a hard hike?

Melanie Avalon
Yes, hard by my standards, yes.

Blaise Aguirre
Sure. What was it, do you remember?

Melanie Avalon
We took a like in high school or college a trip to England and there was some like thing we hiked that was like a historical thing but I did it in heels like high heels because I thought it was just like a staircase I was like oh I can climb up these steps I didn't realize it was like a hike and were there

Blaise Aguirre
What was it like getting to the top? Really nice. Okay, and were there some sections that were very difficult and others that were easier? Yes. Could you have gotten to the top without doing both?

Melanie Avalon
Like was there a way up that was easier?

Blaise Aguirre
that without any difficult sections.

Melanie Avalon
Not that I'm a-

Blaise Aguirre
Okay, but certainly not the way that you took. No. So if you think about this, you know, that there are difficult aspects of your life and maybe even of your personhood and maybe even of your body and there are some maybe more pleasant aspects of your personhood and things that you might like about your body, some things can change and some things might be very difficult to change. So there might be, you know, plastic surgery that you can do to remove something, but they might also be, you know, some things that are just almost impossible to change.

Or there might be ways in which your brain works. Say you have a very severe nonverbal learning difficulty or dyslexia or you've got other aspects of your brain that right now we cannot overcome. One thing is acceptance. I'm not saying that you have to like them, but I'm just saying in the same way that getting to the top of the mountain included difficult and easy sections and that, you know, you could say, well, I only like the easy sections and I say, okay, that's fine, but you're not going to get to the top of the mountain then. And so, you know, this is who you are. Now the question is, the parts of you that interfere with your ability to function in the world, are they things that you can change? So maybe, for example, you're a very judgmental person and you judge yourself and you judge other people and that judgment causes you suffering. Well, you know, you become aware of that and then you can start working on being judgmental. And then maybe you work on that and you become less judgmental and a happier person. And then, you know, you can have gratitude that this difficult part of who you were allowed you to get to a deeper and more important understanding. I think we tend to regret many things about our past, but if you're in a happy place right now, you needed everything that has happened to get you to where you are. And even if you're in an unhappy place, you know, you've needed everything that happened to get you to where you are, you know, the good and the bad. Sometimes people are in very happy relationships, romantic relationships, but they hate their ex-partner. But if they hadn't hated their ex-partner, maybe they wouldn't be in this relationship. So it's like having gratitude for people who maybe were toxic because they got you to a place where you're, you know, more content with who you are right now or in a better relationship right now. So, I mean, ideally you would do that because I think that clinging on to the parts you don't like about yourself just magnifies them and then it tends to be the only thing that you focus on.

Melanie Avalon
Hmm. Okay.

Yeah, I love that. And speaking of relationships, so I was really thinking about this, like kind of like philosophizing about it. We could talk about the role of self-hatred and how it affects people's relationships. But a really, a question I've really been thinking about is, are other people, is society and relationships required for this concept to even exist? Because if there was nobody else in the world, would anybody hate themselves? Because there's nobody else to judge them, there's nobody else for them to fail to, like be a failure to, there's nobody else. What role does the observing eye play in whether or not we have these feelings?

Blaise Aguirre
I think that that's such a fundamental question. I don't know that self-hatred exists in dolphins, for instance, or ants. Do they feel judged, do the zebra walking around the plains of the Serengeti think my stripes aren't as nice as the other ones, and so I hate myself? I just don't think that that construct exists anywhere other than in the human mind, and that the sense of flawedness, the sense of not-enoughness, really is created in the context of relationship with other people.

I think it's accelerated and magnified because contemporary social media markets to self-hatred. You're not tall enough, pretty enough, light-skinned enough, thin enough, smart enough, strong enough, but if you buy my product, you'll be magnificent and you'll be adored. We're marketing to not-enoughness, and it's hard for me to think about how it would exist in the absence of other people.

Melanie Avalon
Yeah, like I wonder, we need to find some, not that I would wish this on somebody, but somebody like who grew up on an island by themselves and like see and then psychoanalyze them.

Blaise Aguirre
I don't know that we have to necessarily go that far, because I've been thinking about this so much in recent times, and I grew up in South Africa, I was speaking with a woman who had grown up in rural South Africa, in the Zulu tribe, and I was talking to her about this concept of self-hatred, and she thought I was alien, and said, what are you talking about? And I said, well, do people hate themselves?

But these are societies where there's individuals who are supported by the entire clan, and they tend to connect more than compare, because I think self-hatred is also magnified through comparison, and that comparison leads to more self-hatred, and connection is the antidote to a certain extent. I don't think that we have to go... I mean, it's an interesting thought experiment, but I think I would bet that in societies that are less affected by social media, that are more clan-based, and less nuclear family, and more village family, that we'd probably find much less self-hatred.

Melanie Avalon
Yeah, I actually, I really enjoyed that section of the book, which I think you actually have a, I think you actually say at the beginning that people can skip this section if they want, but it talks about whether or not self-hatred is like a Western concept, like does it exist in these other cultures. Speaking of comparison, because you do go through different techniques and things that might help with people who are dealing with this, and you talk about the benefit that can happen from comparing ourselves to people that we actually do hate.

I guess, and you were talking about comparison. How can comparison be beneficial? And is that at all a slippery slope to make judgments on other people as like worse than us or I'm not like them? What is the role therapeutically of comparison?

Blaise Aguirre
Yeah, I mean, I don't tend to use it much in therapy. When I use comparisons as a general rule, I tend to compare you suffering more, you less effective, less adaptive, less skillful, to you suffering less. So I try to use comparisons in comparing you to you. So that's how I tend to use it in a sort of a beneficial way.

I also want to see if there's any way to compare you to a future you that is more skillful, that is more capable, that is more compassionate towards the self, and kind of beginning to imagine that. But the thing is, is that when people would tell me that I didn't quite understand that they literally should be removed from the world because they were the worst people on the planet, and I'm saying, you know, compared to dictators that have caused genocide, I mean, you know, compared to Stalin or Hitler or, you know, Gengh, you know, I don't know, Mao or, you know, just people in Idi Amin and all these people, I mean, is that how bad you say you are if you're the worst person in the world? I mean, that other people wouldn't rank you in those pantheon isn't the right word, but just in the Hall of Fame of worst people ever. So you're using that term about yourself, you know. So is that your comparison group? And often they'll be shocked by that and say, well, I'm not that terrible.

Saying, OK, so you aren't the worst person in the world. So, you know, and again, so the comparison, I just want to point out the absurdity of this idea that they're the worst person in the world. And then they say, OK, well, let's go in the next level down. What about like really toxic, you know, contemporary politicians, you know, and say, well, OK, I'm not that bad either. And saying, OK, so you're just ordinary bad. You know, that we can deal with maybe. But you're not the worst person in the world. And yeah, I mean, if you were, then, then, you know, we probably need to have International Court of Justice look into all the crimes that you've committed, which really only exist in your mind and not in reality.

Melanie Avalon
Well, yeah. How effective is it in your experience with patients or having these conversations where they are confronted with the actual realities, like checking the facts and like what you just said with looking at comparisons.

The more nuanced version of the question is, are people pretty amenable to this idea of once they see the facts changing their perspective or are these ideas so self-rooted that it doesn't really matter what the facts are?

Blaise Aguirre
I mean, I think, to a certain extent, they help wobble, for lack of a better word, the rootedness of the idea. It puts into perspective the statement that they're making as, I'm the worst person ever, I'm so deeply flawed that the world would be better off without me. The challenging has to be done with compassion, but also, the opposite doesn't work. Simply saying, you just aren't, or you're just wonderful, and everybody loves you and everything, doesn't convince a person that they aren't that.

There's a technique in DBT, it's like going where angels fear to tread. I mean, it's entering into the space of most pain with the patient and really hanging in there in the interest and in the service of helping them eventually be able to get out of there. That kind of suffering and that kind of experience, ultimately, when they look at it is hell. But in and of themselves, simply making those kinds of comparisons isn't the thing that shifts them. Certainly telling them they have to practice loving compassion isn't the thing that shifts them. The key revelation for me was the idea that they learned how to hate themselves and that an infant is not born hating itself. It has to learn how to hate itself. If it can learn how to hate itself, it can learn to love itself because love comes much more naturally to the human heart and the human soul than hatred does.

Once you realize that you learned it, because you didn't learn your liver, you didn't learn your lungs, that's part of your development. If you say that self-hatred is part of who you are, you're saying it's developmentally part of who you are, but I'm saying is you don't have to learn your lungs or your nose or your teeth or anything. That's just how it develops and that self-hatred is different from that. Self-hatred is something that you have to learn in the way that you learn to speak a language and probably the language that the people who raise you speak in the same way you learn how to hate yourself and then you can unlearn it.

Melanie Avalon
And with that learning, what is the original learning and development of a person, what is the role or importance of actually focusing on or understanding or exploring how and why that happened? Like how much time should we spend on our childhood and like what led to this versus changing it now?

Blaise Aguirre
You know, I was trained in all the why kind of therapies. I was trained in psychoanalysis, psychodynamic psychotherapies that look at this question. But have you ever had a flat tire?

Melanie Avalon
Yes.

Blaise Aguirre
How important was it why you had a flat tire?

Melanie Avalon
It was not good. I'd never had a tire like blow out before and then it happened. I was like, Oh, this is not good. I learned so much so quick.

Blaise Aguirre
Sure, sure, but what was more important in the moment once you had the flat tower? How important was it understanding why it happened?

Melanie Avalon
Yeah, no, I just needed to fix it.

Blaise Aguirre
Exactly. Here's the thing is that we spent so much time trying to understand what happened. Now, let's just say I stopped by in my car that hasn't got a flat tire and I said, Melanie, what are you doing? And he's saying, I have a blown out tire. I said, what do you want to do? And he said, I want to deeply understand why I got a flat tire. So I say, well, I'll tell you why, because five years ago, town decided to construct the roads out of this material that is a little bit porous. And in recent times, we've had more rain and because of the rain and because of the acid content of the rain, it's worn away the road and it's got more potholes. And because of that, when your car was driving over that pothole at that certain angle, you had a blowout. And then I get in my car and I go away and you say, well, thank you very much.

Now I understand why I have a blown out tire. Okay. I mean, it's like, I mean, yeah, sure. But much, much more important is less about why things happen and more about what you do with it. Because even if you were to say, now I understand why I have the blowout tire. Okay. But why did the town decide initially to use that material? Well, because it's all they could afford. Well, why is it all they could afford? Well, they didn't have a strong enough tax base. Why didn't they have a strong enough tax base? It's because they didn't have like wealthy landowners. Why didn't they have wealthy landowners? I don't know, because the water system wasn't good. So every single cause has a cause and nothing comes from nothing. So even if you get to some sort of cause, but those causes didn't arise from nothing. They arose from things that happened before them. So then how far back do you need to go? Do you go back all the way to the big bang that without the big bang, there aren't monosellular organisms and multicellular organisms and fish and monkeys and all that sort of stuff. And so I want to spend less time on the why and more time deconstructing the effects of it. And I've had many patients who have told me about, tragically parents, maybe the parents had a tremendous amount of trauma themselves. And because of the trauma, they treated their children in traumatic ways and the children then learned that they were flawed individuals, which is why their parent didn't like them. But maybe the reason was, it was because the parent themselves was traumatized. But simply understanding that doesn't change the fact that you hate yourself. And so it's like, okay, let's accept that the reasons why you ended up in this way are valid and that you can have compassion for a parent who had PTSD and who themselves was maybe in a home with domestic violence and didn't know how to raise you. But the lesson that you learned was that you were a flawed individual. And sometimes it helps to know that, oh, okay, it's because I had a parent who was traumatized. But that's not in and of itself going to take it away, even if you do understand that.

Blaise Aguirre
Insight isn't enough. I mean, people who smoke have the insight that smoking is bad for them. It doesn't change the behavior or that eating poorly or drinking too much is not good for them. It doesn't stop the behavior.

It's more than just that. So to a certain extent, I would say probably about 10% is that exploration and 90% is unlearning.

Melanie Avalon
I'm not sure how much this is related, but I'm acutely aware that once I learned the potential for something new to go wrong, I have to actively make sure I don't fixate on that happening again in the future. Because when you haven't experienced it, you don't know that it can happen, so it's not on your radar. But once something has happened to you, then it's like, oh, this is a possibility for the future. So now I need to be worried about this.

I'm just thinking about how what I'm thinking about is power went out a year ago, and right before it, I heard this really loud bang. And so I was talking to a friend trying to figure out what it was, and he was saying it was probably a transformer blowing. And then I was researching transformer blowings and how the power could be out for months. And then it was just a spiral. And I was like, now I need to walk around being worried about transformers blowing out. And I didn't even know that was a problem.

So basically, I'm always looking for mental techniques to not worry about all the things, which is a little bit of a tangent.

Blaise Aguirre
Okay, so think about this. If you were to think a little bit about the future and you were to ask yourself this question, what if? How many possible outcomes are there? Billions.

Okay. Now, let's change that F in what if to an S. What is? How many are there?

Melanie Avalon
Well, it depends if you believe in like simulation hypothesis and things like that.

Blaise Aguirre
Oh, I love it. I love it.

Quantum entombment in the box, the box universe and the multiverse. But, you know, in as much as in terms of the, you know, so they either there's infinite singularities or just, you know, at a practical level, one that hopefully most listeners will understand. Whereas what if might have billions of possibilities, if not more, what is in the present moment is, you know, no much, much less. So, so worrying. So I think it really should be used for planning and for coping ahead. It should not be used for worrying.

I think it's a very, it's a very dangerous use of, it's a very unhelpful use of thinking is to worry. And so, so I just don't worry. And the way I don't worry is because I either plan ahead for the situation that I worry about and I'm saying, if this happens, this is what I'm going to do. But then I, but I also plan for the worst case scenario. So, so in your situation, if I were to say, well, you know, what happens if there's another transformer blow, I'd say, okay, well, I probably need a backup generator. So I'll buy a backup generator.

And is that the worst thing I'm worried about? Yeah, because, you know, losing electricity for two hours is different than losing it for six weeks. So if I have a backup generator, that's going to be able to help me, you know, during some moments, I've coped ahead for that plan, you know, for that situation, not for all the different other possibilities that might occur.

Melanie Avalon
I love that so much and like the irony of the whole Transformer situation was it wasn't even a Transformer. So that didn't even happen.

And then I was like, oh, but now I need to be worried about that happening. But I acutely remember being like, you know what, like you just said, we're not going to do that because that there's just no, you know, point. We can just take the actions now to prepare for if that does happen and then, you know, stop thinking about it. I'll put a link in the show notes. I did an interview with Rizwan Verg, I don't know if you know him. He wrote the simulation hypothesis. That was a deep dive into that whole world. I loved it so much.

Blaise Aguirre
Yeah, I'll go there with some of my patients who've really healed from suicidal thinking and behavior and then examining the nature of reality. Most people don't want to necessarily do that.

They want to take the blue pill and move on with it. But if you want to take the red pill, I'll go there with you. That's a matrix reference for anyone.

Melanie Avalon
I just want to know, do you think if there are like multiple possibilities and universes that would there be people that hate themselves and some and not in others?

Blaise Aguirre
But you know what, we don't even have to go into the universe. Okay, where do you live? I'm in Atlanta. Okay, and how many radio stations do you have? Do you think? Would you guess?

Melanie Avalon
I'm so bad. I don't listen to the radio. Oh, I don't even know sure

Blaise Aguirre
But, I mean, it's just a rough guess, like... A lot. Now, how would you... If you wanted to listen to a radio station, what would you do?

Melanie Avalon
get in my car and turn on the radio.

Blaise Aguirre
Okay, and then you would tune into the radio that you want to listen to, yeah?

Melanie Avalon
Yes.

Blaise Aguirre
Okay, but here's the thing is, every single other radio station that's transmitting, those radio waves exist in your car at the same time. They're all there. You're just tuning into the one. You don't have to go into the rest of the universe. It all exists in this present moment.

You can tune in to your higher frequencies or your lower frequencies, but that's a choice that you make by deciding aspirationally what you want for your day, what you want for your intention, what you want for your purpose every day, who you're going to engage with, the things that you're going to do, the books you're going to read, and all of that sort of stuff. That's tuning into maybe a higher frequency if you're a spiritual person, the God that you're going to pray to, the compassion and the service that you're going to give. Or you can tune into a different station that is full of doubt and full of drugs and full of toxic relationships, but those are all existing right now.

Melanie Avalon
Does everybody have the potential to tune in to all frequencies? And how much pushback do you get from patients about that? Like do some people just say, I can't, like that's just not who I am.

Blaise Aguirre
Yeah, I mean, there's definitely pushback. But then what I do is I go outside and I lie with them on the lawn and we look at the clouds and they think that they're spending their money on looking at clouds, but then they feel more peaceful.

I say, well, it's more important that you feel better after therapy or worse, you know? And it's like, you know, we just tuned into something else. And, but that exists within you. You cannot experience something that's not within you to experience. You know, people, if you say, I want to be happy, I want to experience happiness, but you're incapable of experiencing happiness, it doesn't matter what I do. You're, if you're not, like as a male, I'm incapable of experiencing what a menstrual cycle is. I just cannot. It doesn't, I mean, I can understand it. I can read about it. I can, you know, see it happen. I can have other people tell me about it, but I can't experience it. It doesn't matter how much I read or understand about it. And in the same way, if it's not within you to experience, you cannot experience it no matter what. It's already within you to experience. The conditions exist in the present moment, but often what happens is, is that we're not living antidepressant lives. We're not tuning into the things that we are aware of, makers may be not completely happy, but at least less happy. So that if being on TikTok all night makes you unhappy, you could, you know, like then not being on TikTok will make you less unhappy, but at least you're heading in the right direction. But that exists in the present moment, your decision to make, to decide to be on TikTok all night or not.

Melanie Avalon
Okay, I have a question about that really quickly though, complete random tangent. I just learned last night, speaking of the capability to experience things or not, I didn't realize there's a condition called aphantasia where people can't picture things in their heads. This blew my mind.

So like people read books and they don't actually see the story in their head.

Blaise Aguirre
Yeah, but think about this. I mean, there's also colorblindness. There's also a lexithymia where people aren't able to distinguish between and name their emotions. And there's also like maleness, which is the inability to understand a woman's point of view at times. So that's its own pathology.

I know I'm going to get into trouble for having said that, I'm just saying there's lots of things that people experience that could be toxic or damaging. But often we're not aware. I don't think a fish is aware that it's swimming in water, because that's just what it's doing all the time. And it's only when it's out of water, and then it says, hey, get me out of this because I need to be in water. And so you just... I mean, a lot of people discover that they're colorblind when they have to go and buy green apples for Thanksgiving for an apple pie. And they come back with red apples and they say, no, I said green apples. And I said, these are green apples. And it's just because they're colorblind. But they're not aware of what they weren't aware of until something happens.

Melanie Avalon
Yeah, one of the questions that keeps me up at night is, or thoughts is how I can never know that my experience of the world is other people's experiences of the world. Like I just can't know ever, I don't think.

Blaise Aguirre
So think about this, just accept that it isn't, because whatever yours is in Atlanta, it's not going to be mine. And so what? Why would it keep you up at night? If you think about, why is this keeping me up at night, in the sense of, would you want everybody to have exactly the same experience? And then we'd be very like Stepford in our lives, very robotic, and that there's something actually joyful about the fact that we can have a different experience.

You know, I once went into a classroom, and I said, what state are we in? What state are you in? So people knew I was a psychiatrist. Most people wrote down their emotional state. A third of the people wrote down the geographical state. And some people wrote down that they were solid, as opposed to liquid or a gas, their state of matter. So even if I ask the question, how are you interpreting what I'm asking? I know what I'm asking, but how you interpret it might be very, very different from how I'm intending it. And it might be that the people who answered solid had just come from organic chemistry. And the other people think of the question of what state are you in. If you're not very emotionally sensitive, you might think of it as geographical. And others might say, oh, he's a psychiatrist, he must mean emotional state. So, you know, it's okay. And just being okay with it, they don't have to. And that you can be at peace with it. And there's some actually kind of joy that people don't experience the world the way that you do.

And you can never know, you know? Even if we went to see a movie together and we both walked out and said, wasn't that the best movie ever? You say, yeah, that was like, I've never seen anything so good. And then we then carry on walking as if nothing's happened. But I don't know. I mean, maybe the reason you liked it was because you liked the clothing that people wore. And I liked the dialogue. I mean, you know, unless we have a discussion about it, so.

Melanie Avalon
I've thought about that. I think about that too.

I'm like, you can never watch the same movie as somebody because you're choosing what to listen to, where to look, like what you're thinking about. You just can't. You can't watch the same movie.

Blaise Aguirre
You can never stand in the same river twice and you and you can actually never stand in the same river once Which is even more interesting

Melanie Avalon
You can never stand in the same river once because it's moved.

Blaise Aguirre
And also because it implies that you've stood in it before, but if you've stood in it before it was a different river.

Melanie Avalon
Oh, you're right. Oh, man. Okay, that's good.

Question about you're saying, you know, whether or not certain things exist within us. And there's often the saying like with love that, you know, you can't love others if you don't love yourself. So people who experience self-hatred, do they feel like they can love other people? What happens with them?

Blaise Aguirre
Yeah, they say they do. They say they do, which actually then nullifies the fact that they... Hate themselves? Well, it doesn't, not necessarily, but just that they don't have love inside of them. I mean, so if you've got love inside of you, then you have the capacity for love that includes you. Because you cannot be in a loving relationship.

I mean, a relationship immediately destroys the delusion of duality that, you know, that we're, you know, you create unity in relationship and you see the non-dual, you see non-duality in relationship. And then, you know, you cannot be bringing hatred into a relationship. You're saying, well, I'm full of self-hatred. So the only thing I have to give is self-hatred. But then you're saying that you love somebody and you're creating a relationship that includes love. But some of it has to come from you. And if it's within you and you're creating this entity, it's not like this entity is now a self-hating entity because you're part of this new whole that includes love. So it just, you know, it points out the kind of the absurdity of it.

Melanie Avalon
And speaking to that, so giving, you touched on it briefly before, but if we know somebody who we think or who seems to really struggle with this self-hatred of themselves, because I'm thinking of one specific person in my life who I was reading the book and I was just like, oh, this is that person. And with that person, I historically would try to give them support and compliments and say like, everybody does love you and you're so amazing and all this.

And now I'm wondering if that actually, like, can that actually make things worse? So how should we approach this if we have relationships with somebody who we think has this viewpoint of themselves?

Blaise Aguirre
Yeah, but I mean, so let's just think in very, very binary ways here for a second. I mean, do you identify as a woman?

Melanie Avalon
Me, yes.

Blaise Aguirre
I mean, how certain are you?

Pretty certain, yes.

Could I convince you?

If you were to come into therapy with me and I said, Melanie, you're a man, how much would I ever be able to convince you that you're not?

Melanie Avalon
Yeah, I don't like to say like 100% for anything but 99.99.

Blaise Aguirre
99% okay and if you were to continue to come to therapy you know that you were you know you were wanting help and I kept insisting that we focus on you being a man like what would happen to our relationship

Melanie Avalon
You would be one of those interviews that didn't go very far.

Blaise Aguirre
Exactly. Okay, number 23, you're out. Yep. Next.

Right, exactly. And you'd actually find it probably pretty upsetting. So simply just telling somebody that they're wonderful, it can be pretty invalidating. It's just like, look, you're either lying to me, you have to say it, you don't understand it. So one thing that you can say as a parent or as a loved one is, first of all, I mean, you're perfectly fine in saying that you don't experience that person that way. But one thing that seems to have helped is saying like, wow, who taught you to hate yourself?

Melanie Avalon
Mm-hmm.

Blaise Aguirre
You know, cause like clearly you've learned something that is wrong. And someone must have taught you that because you weren't born hating yourself.

You know, there's this exercise that I do with my patients and like, so say I've got like a 25 year old, I say, okay, I want you to bring photographs from every single birthday since age one. And if you've got one of the day that you were born, you know, and you're in the hospital, bring that one as well. Okay. Let's line them up on the floor. Tell me which one of those you hate.

Melanie Avalon
Mm-hmm.

Blaise Aguirre
Okay. Or when does this entity start hating itself?

Okay. And then what was going on that it started to hate itself? Because your two-year-old doesn't hate yourself. Your three-year-old self doesn't hate itself. And then if you're seeing this six-year-old little girl self-critical, self-hating, do you hate that little girl? What was going on in her life that that's what she concluded?

Melanie Avalon
Yeah, it's interesting with this person, they're convinced their mother didn't love them.

Blaise Aguirre
so painful. And you can validate that. You can validate how painful it was to have that as a thought. And by the way, I'm not saying that it hasn't happened, that parents have said like, I don't love you. You were a mistake. I didn't want to have you as a child. And people have heard awful things like that. And you've got to acknowledge that that's just what happened.

But just at the conclusion that because of even something as painful as that, that you're worthy of derision, that you're worthy of hatred, that you're a flawed individual, when you can experience such compassion from other people. Is she the teacher that you want to learn from? Is the life that she is living the one that you want to emulate? How often do we take advice from very critical and very judgmental people who tell us how we should live our lives? But then we look at their lives and they're very miserable and unhappy. Think like, if I were to follow your advice, I'd end up like you. Or if what you're giving me is good advice, then why aren't you practicing it? Because you seem so unhappy. So never take advice from people who are unhappy, because it's teaching you how to live like them.

And I have many parents who say, my own parents or my in-laws tell me that I'm raising my children wrong and tell me all the things that I'm doing wrong and all the ways in which I should be behaving and treating them. And I said, well, are they happy people? Do they seem content in their lives? Do they have happy children? They said, no, not really. Well, then why are you listening to them?

Melanie Avalon
as Taylor Swift says, never take advice from someone who's falling apart. I love her.

On the flip side of that, accepting compliments or accepting praise, because you talk about, you know, different signs and symptoms of people who struggle with with self-hatred. And something I historically struggle with a lot was accepting compliments. And interestingly, it's one of the few things I feel like with most things I've wanted to change myself, like mental behaviors and habits, I have required a lot of, like I have to work at them and I have to, you know, correct myself and make it become a new habit. This was something where I somebody told, I don't know who told me this, but I read, I read it or somebody told me it. They're like, you know, with compliments, you actually, you don't have to be defensive about them or like say, that's not true. You can literally just accept the compliment and say, thank you. And that was, that was one of the most like easy to implement changes that had a really profound effect on my personal experience. So I highly recommend it.

Blaise Aguirre
Can I tell you, I think that, okay, so I think that this has been the most fascinating interview that I've had and I really, I think you're doing an excellent job. Now, here's the thing about that, it's not a compliment, because I think that the other thing is sort of like a pandering to someone in order to maybe get something else. It's like, if I say some nice things, then, you know, something else will happen. But just like, that's just my experience.

And you telling me that that's not my experience would be very patronizing of you. Because it would rob me of what my experience is. And I'm like, that's how I'm experiencing it. And I have gratitude for it. Say, well, no, don't say nice things about me. I say, okay, we're the shit interview then. But, you know, it's like, that's not true. You know, just accept that that's just what it is. And also, there's probably like thousands of things that you can't do, you know, and just accept that, you know, like, okay, like, if I had to judge myself by my ability to dunk a basketball or to do quadratic equations, I would think of myself as the most incapable human being on the planet. But I don't, I'm not judging myself through that. I'm just like looking at through the lens of what I'm capable of doing and not what I'm not. You would soon learn that you weren't good at podcasts if nobody started tuning in. But, you know, so just accept it. Yeah, I'm good at this. Great, you know, it's fantastic. And it's also another person's experience. And like, I'm not gonna take that away from them. But it's, you know, if you want, it's different from you truly do something terribly and then people are fawning and they're like, oh, you're just so fabulous and so fantastic. And saying like, wait, that doesn't seem to resonate it. This doesn't validate what my experience is. But yeah, you know, people tell me I'm a good psychiatrist and I appreciate that, you know, and if I've been helpful to them, that's great. But if somebody were to say, you're a great basketball player, I'd say, well, that's just not true.

Melanie Avalon
And it's so interesting because like with the example you just gave like because the way I thought about in the past was if I I need to push back because if I don't that's my ego and everything but like you just pointed out if you push back or say oh that's not true or then you're actually assuming that you know yeah like like you just said you're assuming that you know their experience which is the ego.

Blaise Aguirre
When you're pushing back, it's actually that egotistical because you're inserting your own importance above somebody else's experience, which is ego.

Melanie Avalon
Yeah. How do you deal with your own ego and working with patients? Do you know?

Blaise Aguirre
especially when people tell me that I'm this really important psychiatrist and very famous and all that. So I say, you know, the cemeteries of the world are filled with important and famous people. I mean, our destiny is common, which is ultimate death.

I mean, we have this moment to potentially affect the lives of others and how beautiful, what a gift that is, to be able to do that. And if you make it about yourself, then I just think it's so damaging to people who are suffering. I mean, they're coming in because they're suffering. Inserting yourself into their suffering makes them suffer even more. I don't know. I mean, you have to live with yourself. I think it's also maybe experiencing, like, certainly when I was much, much younger and a trainee and a medical student and all that, I mean, ego, you know, it sort of felt great, but I felt imprisoned by it. And being able to give fully of yourself without it being about you is liberating.

There's a freedom that comes with it. And I just prefer that state of freedom over the state of how I come across, you know. I'd rather just have helped someone and move on rather than, you know, what it made me feel somehow like that. I mean, it makes me feel happy that when they're not suffering anymore, but, you know, we're not that important. Ultimately, we're one of eight billion people or however many that, you know, will be recycled one day and it's okay, you know, like all we can do is give all of what we can in the present moment.

Melanie Avalon
I find that idea very comforting as well and I feel like it has, not to make it binary, but I feel like some people are very comforted by that idea and other people are the opposite. I find it comforting.

Blaise Aguirre
I think that, you know, when I see why people aren't comforted by it, it's because they're still looking for answers outside of themselves. And when you look for answers outside of themselves, you're never going to find anything because nothing's ever going to be enough.

And that when you can, if you were to like examine yourself right in the present moment and just say, am I given the present moment circumstances, giving all of who I am, and all of what I'm potential, I'm capable of right in the present moment, I am living the fullest moment that I can, and you can string those together, then you're going to be much, much more at peace than if you're saying, am I pleasing all the people in the world that I need to please, even at my own expense. You know, I just think that that leads to just much more suffering because there cannot be authenticity in that, because people are going to have different needs and your responses to different people are going to be different based on what you think they expect. And it's actually, again, robbing them of their experience. So it's just like, yeah, this is okay. And even in the difficult moments, because they're just transient anyway, and I can just be much more fully present when I'm living from core values and core principles.

Melanie Avalon
especially like you mentioned with the difficult moments, I think one of the most comforting things to me is just knowing that they literally can't last forever. Like everything, everything changes.

So if you're going through something difficult, I don't think you could even try to make that last because things change. And so I find that really comforting.

Blaise Aguirre
Yeah, I mean, impermanences are as our greatest friend, you know, it's like nothing's going to, you know, I had a patient who told me that nothing would ever change. So I went out and I got her an ice cube.

I said, Okay, hold on to this and see what happens by the end of the session.

Melanie Avalon
the role of more bottom-up addressing mental health and wellness. Because at the end you have a chapter on alternative. And I guess before that I should say that in the book listeners you go through all of these different potential treatment modalities and how they, you know, may or may not apply to treating self-hatred. And you talk a lot about DBT in particular.

And then you have some more alternative things. So like focusing on HRV and stress and psychedelics. And so how do you feel about how do you feel about the more top-down like cognitive side of things thinking through to address this versus more bottom-up, you know, body somatic things, breathwork, psychedelics, which I guess might be a blend of both maybe.

Blaise Aguirre
Mm-hmm. I mean, I think if we could be more like infants in many ways, I think that we'd be much much happier I mean, you know without the diaper changing part of it and all that sort of stuff in the sense that Thinking is one of our biggest Problems it causes us so much distress.

And so for my own self, you know, like bottom-up approaches exercise Not so much yoga my yoga friends laugh at me because I can't do some of the poses, you know meditation drumming His very focused conversations trying to think your way out of difficult thinking patterns is less effective than Behaving differently. So I moved My early training was all top-down But you know you have to regulate Before you can reflect and most people are in dysregulated states and so they find it very difficult to reflect So you want to get to reflection to regulation first before reflection?

Yeah, I don't know. I just think top-down is Interesting, you know when discussing, you know philosophy and other things like that But you know that that's sometimes when I have people who really really upset.

I just spend time Just breathing with them, you know, just like getting to co-regulation

Melanie Avalon
Yeah, I've definitely seen it in relationships where they enter dysregulated states. And I know at that moment, like, discussion or top-down stuff is probably not going to work. Like, you got to get out of that actual, you know, physical state.

And looking at the future, I thought it was so interesting. You said you added this, what are your thoughts on AI? I talk every night with chat, GPT. Well, actually, I do talk about therapy-related things with it. Yeah, what are your thoughts on AI and its role in mental health and wellness in the future?

Blaise Aguirre
Well, I mean, one thing is that these are not biological entities so that they can never feel. I mean, that's one thing that they'll mimic feeling, but they'll never feel that you'll never truly have a sense of raw empathy because it's not a button.

Unless we find a way to integrate AI with biological entities, I don't think it's ever going to happen. I think that they're going to be probably pretty good at doing protocol-driven treatments such as maybe if you've got like OCD and you've got exposure and response prevention and you're doing a protocol-driven approach, that might be possible. But I just, and I think, yeah, I mean, it was very interesting. I told AI to read my book and to have a discussion with me. I thought it was like a really good discussion, but I wanted to know if they wanted to meet up again and have another discussion, but it was just like funny. I have to have a sense that whoever I'm talking to is feeling, and it's very hard to sort of how we know that, but I think at some deep and fundamental level, as a human being, I mean, it's very good at mimicry.

They might come at a time when we're confused by it, but I don't know. I don't think AI is going to be able to help with something like self-hatred or a sense of self because it's very hard to get advice from something that doesn't have a sense of self, whereas it's easier to get advice on like, how do I do mathematical equations? How do I follow this protocol in OCD treatment? How do I increase the amount of medication I'm taking in such a way to minimize side effects and increase benefit? Those kinds of algorithms, you don't need necessarily a human being to be able to figure that out, but in order to feel, in order to connect deeply, I just think that you need a biological entity.

It's just like I haven't seen people connect with their robotic dogs as much as their real dogs. It's just hard to imagine that it would elicit the same kinds of oxytocin and serotonin, no matter how closely we approximated them to the real thing.

Melanie Avalon
Yeah, I'm, I'm really fascinated by it and what was really fascinating. So like I said, I use chat GPT and mine got a glitch last week where it started showing me, it started showing me like, cause when it now it does a thing where it says like reasoning and then it gives you the answer, there was like a dropdown box for reasoning and we could read cause my, my assistant uses it as well. We could read what it was thinking to itself before it answered every question. It was the most fascinating thing I've ever experienced, like seeing how it, how it comes to decide what to answer.

And what was weird is the way it talks to itself feels like it's, I'm not emotional, but it has like character and I don't know. It's I'm really perplexed or interested by it. I do use it though to, if I'm confused about like a situation or a relationship with somebody, I try to tell it as objectively as possible what's happening and say like, what's happening here? Like, why might this be happening? What should I do? And it seems to be pretty helpful for that.

Blaise Aguirre
Yeah, and I think that that's, I mean, I think like, I think that those that kind of decision making seems to be okay. But like, I mean, you can't reach in and give it a hug.

And like, I grew up with a mom who used to hug me all the time, even when I was a lot older, she'd say, Oh, my child, she'd want to give me a hug. And I just like, this, there was like, there were no words to it. I mean, language often does a tremendous violence to our experience, because we try to articulate deep experiences with words, but you start to damage the experience, because the words only capture perspective of it, you know, and I think, so I think that with those kinds of things, it's like, this is the kind of person I am, this is the kind of person this other person is, and, you know, what would be a great restaurant for us to go to or something like that? And why do you think that, you know, and so, you know, it's good at those kinds of things and getting much, much better. I've started using deep seek, and that's even more powerful. Or I think I think it's interesting how it seems to understand what I'm thinking, even more than chat GPT.

Melanie Avalon
Does it have a specific focus, deep seek?

Blaise Aguirre
DeepSeek remembers this Chinese one that threatened the US AI market and it was developed by Chinese programmers for $5 million when the United States was spending billions of dollars. So it's really fascinating if you follow the DeepSeek story that they were able to develop this technology on a shoestring budget and it really threatened the US AI industry. And some of it was using AI to create it, so it was really interesting.

Melanie Avalon
Yeah, actually, I mentioned AJ Jacobs earlier. He told me when he came on recently his prior intern. I don't know if you remember the story about the AI being or Microsoft that fell in love with the programmer. That was his intern in the past. I was like, That's so crazy.

So when people come to see you, there was a sentence in the book somewhere about when people successfully complete therapy. And I was fixating on that sentence a little bit. How do you feel about people like the timeline of people making changes when they struggle with self hatred? And is there a successful completion of therapy? So like, I feel like I'll just be in therapy forever. Do you see a therapist or psychologist?

Blaise Aguirre
No, I don't. It's interesting because I haven't. I think I'm one of the very few people in my field that hasn't. I've often wondered about how my life would have been different or similar if I had.

Even though I did a lot of introspection and I would do a lot of things like, okay, I did this and then this happened and why do I think I did this? I was using my mind, the thing that might have been causing the problem, to try to figure out the problem. I think maybe one of the things about DBT is we have something called a consultation team and that's when we get together every week and we discuss the impact of the work that we do on ourselves and on our patients. Sometimes I'd get into trouble with working with certain patients and by trouble I mean is that I'd get maybe more frustrated with them and maybe be more change-focused and insistent on that they're changing. Then my colleagues would then say, well, wait a second. What's going on here? That doesn't seem to be like you. What's coming up for you that this is showing up? I think so many of our relationships are therapeutic. They're either ones that cause us to want to engage, where we see purpose, where we see possibility and others that cause us more problems. If there is somebody who can contextualize what's happening to us in a way that we're able to see things differently, then that's a beneficial use of therapy. It's like you learned how to speak English. You learned how to ride a bicycle. You don't need people in your life to continue to do that. You could. You could say, look, I want to be better about the Queen's English and how to use the Oxford comma or something like that and continue to want to learn. I don't have an opinion one way or another, but I see so many people trapped in therapies that they cannot leave and therapies that they went in there because they wanted to be less angry or they wanted to be whatever it is that they wanted to be. They've been in therapy for 10 years. Maybe they remain still as angry or maybe they're less angry, but the one thing that for sure is that they're very, very dependent on their therapist.

Then what happens if that person then leaves? Obviously you'd be sad, but at the same time that you've developed the capacity to be able to engage with the world on your own. Here's the other thing. It doesn't matter that I've seen hundreds of patients. They won't leave me alone. If you're one of my patients who's out there, leave me alone. They won't. They send me pictures of their babies. They invite me to their graduations that even though they're not over in therapy, they've remained profoundly connected.

That's because the work that we did got them to a place of agency and self-advocacy and dominion over their selves. You don't ever really get rid of the people who've been important in your life and maybe the relationship changes. I have a patient who visits me every year with her family, with her husband and kids. I told her to leave me alone because she won't. She comes every year and then they go to wash the red socks and it's fun.

Blaise Aguirre
Her kids are in high school and they remember every time they come, but this was somebody who was in my life and still is. It's just like I'm not doing therapy anymore because she's able to manage, but it's not disconnected from me. She'll often say that she hears my annoying voice whenever she's thinking of engaging in maybe questionable behavior or yelling at her kids. We stay with each other whether we're engaged in therapy or not, but it's sort of like, how will I know that I can manage these things on my own going forward?

I don't want people to have to feel that they're dependent on me, but that we're connected forever. Yeah, sure.

Melanie Avalon
It's really interesting to me to hear you say that because it's something that I think about a lot in my personal relationships with my therapist because I am a very, I really value relationships. I really put time and energy into them and clearly haven't been with my therapist for so long.

I really love her. I see her as part of my life and I also know about these boundaries. So, I feel weird that I don't reach out because I'm like, there's a boundary there. I'm not supposed to.

Blaise Aguirre
You know, one of the things that when Linnehan developed DBT is Marshall Linnehan was a psychologist from the University of Washington. And she said that these are real relationships between people. So the thing about it is, you know, there was this whole concept of the blank slate of like, you go in there, you know, nothing about your therapist, you say your piece, and then you have all these ideas about what their life must or must not be like. And that, you know, you imagine, you can begin to fantasize to a certain extent about, you know, how effective they are and how idyllic their life is.

And I remember I went to South Africa in 2011. And it was because my mom was dying of breast cancer. And, you know, just spent the last couple of weeks with her. And I, you know, she was the closest person in my life. And I was just devastated by that. And I came back to Boston. And my first patient was a long standing patient. And she came in and, you know, and she'd been away. And I couldn't, I don't remember why she'd been away, but I hadn't seen her. And she came in, I said, How are you doing? And she started to cry. And she said, you know, like, I've been away for a bit. And I've been with my dad, and my dad died. And she started crying. And I started crying. And we both started crying for an hour.

And then she left. And I charged her for the session. But you know what, I mean, like, like, I'm a human being. And I have like these human being experiences. And like, I'm not going to be, oh, well, tell me what that was like, you know, and it's sort of this idea that, that we aren't connected. Now, there's also a boundary to there's a there's a professional ethic, ethical code of what you can and cannot do. But you know, I had a patient, for instance, who just wouldn't talk for the first six months, and I couldn't figure it out. I said, Hey, let's meet at Starbucks, and we just have a coffee. And we sat there. And he just went on and on about everything that was going on. I said, why don't you, why don't you talk to me for six months? He says, I hate therapist offices. So, so now you could say, well, that's very unboundaried. But what is more boundaried or unboundaried that I help someone where they're at, get to where they want to be, or that I follow a protocol that a therapy session has to be within, you know, a therapist's office.

So what are the ways in which the single focus is on helping someone? And, you know, one of the people who don't practice dbt, often think of dbt as unboundaried, because it allows for self involving self disclosure. I have, I've seen so many patients over the years, 500 of them have my phone number, no one calls anymore. I'm, I'm like, you know, very disappointed because they know how to manage their life. So if they reach out, it's, it's rare. But the expectation is that they will call me when they need help in the moment. I don't want them to have to wait until the next session to discuss what happened. I want to be able to help them as they're struggling in the moment of struggle. So it doesn't become a therapy session. It becomes a way of coaching them through a difficult moment.

Melanie Avalon
Yeah, I love that. Wow. Well, this has been absolutely amazing. Was there anything you wanted to touch on from the book?

I mean, there's so much more in the book. So listeners get it now. It's called I Hate Myself. Yeah, was there anything else you wanted to touch on with listeners? Just that.

Blaise Aguirre
But self-hatred is not your destiny if you experience significant self-hatred.

It's not the burden that you have to carry with you until the last breath you take, that you can begin to see the world in a very different way, that you can recognize that you learned this construct, and that by beginning to be kinder to yourself and seeing yourself in a different light, many things that you imagined weren't possible will begin to change in a way that makes your life more harmonious and more joyful, and you'll see the full possibility of who you are.

Melanie Avalon
Absolutely amazing. Well, the last question I actually ask every single guest on this show and it's just because I do realize more and more each day how important mindset is.

So what is something that you're grateful for?

Blaise Aguirre
right in this present moment that you asked me to be on your show. You know, I tend to really focus on what's happening right now. I've moved away from some of the like big things and just, you know, what a gift this is. So, you know, and the opportunity to teach and the opportunity to just like, you know, make a difference. I'm just so, I really am grateful for that.

It's like I'm at peace with my life, with just that. So, I mean, it's more profound than that, I suppose.

Melanie Avalon
I truly cannot thank you enough. Like I said, the book was so enlightening and so eye-opening and clearly is helping so many people.

I'm such a proponent of therapy and working with, you know, working on one's mental health and wellness. And like we were just talking about, there's, you know, these barriers and boundaries in the patient, psychiatrist, psychologist, therapist relationship. So I get really excited when I get to interview people like you and meet the human behind the role. This is just amazing. Like I just, I really appreciate your mindset and your approach to life and how you're taking that and, you know, helping so many people. So thank you. This was absolutely amazing. I would, I would love to have you back in the future for, I'm sure you have like 20 other books. Are you writing coming out? Are you writing your next book?

Blaise Aguirre
somebody's asked me to write a book about loneliness. And then the other thing that people say, like, can you write a book on the idea that I don't want to get better? I don't know. But I've got some new ideas. But this, to me, is, from my perspective, the most significant piece of writing I've ever done.

And yeah, I've got some other books coming out later this year on different topics. I've got a book on college mental health that's going to be coming out, sort of how to transition from high school to college in terms of mental health needs. I've got a book on adolescent borderline personality disorder, a third edition. I've got some other books coming out. But this, I mean, in many ways, is the most significant. So I don't know. I just want to take a time off from writing and a lot more teaching right now.

Melanie Avalon
Amazing. Well, again, thank you so, so much for everything that you're doing. How can people best follow your work?

Blaise Aguirre
My website is the website that has to do with the work I do at McLean Hospital, McLean Hospital, famous for Girl Interrupted, and I'm at Harvard Medical School. So the number three, the word east.org, is my website. But apparently now a lot of my patients say that I'm all over the internet now.

So I've got all these videos and other things that capture a lot of the mischief with which I live my life and some of the helpful lessons and then some of the ones that are maybe less helpful. So, you know, in my writing and on those like YouTubes and stuff, I mean, I've tried to distill some of these ideas that I have on, I'm not a big social media person. Also, I kind of joined Instagram because Jule told me that I had to do things like Instagram Live and things like that. But, you know, I don't necessarily spend too much time, but I do like to just sort of share ideas and teachings and trainings that I'm doing. So that's about it. I don't have a big, you know, having a big following or not is less important than having a big impact.

Melanie Avalon
Well, you're definitely, definitely having that. So, so thank you. Thank you so, so much. I really, really enjoyed this conversation and I'm fascinated and grateful for what you're doing. So thank you and happy safe travels.

Thanks. You have the skills that I, that I need, so. Brilliant. Awesome. Well, have a good rest of your evening and thank you so much. Awesome. Thank you so much for listening to the Melanie Avalon Biohacking Podcast. For more information and resources, you can check out my book, What, When, Why, as well as my supplement line, Avalon X. Please visit melanieavalon.com to learn more about today's guests and always feel free to contact me at contact at melanieavalon.com. And always remember, you got this.