How Can We Find Joy When Awful Things Are Happening?

Hi, welcome to the MindBodySpace podcast where you can boost your resilience just by listening. Please subscribe and share to support this free evidence-based content curated just for you. I'm Dr. Juna Bobby MD, a board-certified radiologist and lifestyle medicine specialist. I'm here to help you stress less and thrive in today's complex world. Join me as I meet fascinating experts in meditation, neuroscience, education, and lifestyle medicine. To get special tips and tools, head on over to mindbodyspace.com and sign up for the newsletter. Links are below.

I'm so excited I'm so excited to welcome Dr. Tanmeet Sethi today. Dr. Sethi is a board-certified integrative family medicine physician, and she's a clinical associate professor at the University of Washington School of Medicine. She spent 25 years working on front lines of the most marginalized communities, as well as working globally with victims of school shootings, survivors of hurricanes, citizens impacted by police violence, and psychologists in Ukraine under attack. She's delivered babies for two decades for high-risk women in Washington State and those recovering or in active addiction. Dr. Sethi is also a mother of three amazing children, and she is the author of Joy Is My Justice. This book is rooted in powerful stories of the human capacity to heal, along with guided exercises and meditations that are accessibly translated from neuroscience. She says, if you think finding joy is too hard, too much hope for you, or only for people who are resilient enough, this book is for you.

Hi.

Hi, Tanmeet.

How are you?

I'm so happy to see you again. Yeah, it's been so long.

So nice.

So nice.

Thank you so much for joining me today, Tanmeet. I'm so excited to see you. Can you tell our audience a little bit about where do you wanna start? We can start with your book. Excited to hear about everything you're doing right now.

Thank you for having me. This is so great. I feel like my book is a good place to start because it's full circle, but really I was pregnant with my third child on top of the world when my second was handed a death sentence and he was given a diagnosis of an ALS-like disease called Duchenne muscular dystrophy in children. I've been an integrative family physician for 25 years, a social justice activist fighting on the front lines, both in the exam room, the streets, the courtroom, everywhere. Wow. And it, this was the first time that I didn't know how to fight back. You know, there was no justice to be had. And, um, even the doctor who gave us the diagnosis said, there's not nothing we can do. I'm so sorry.

And so it was a real turning point. And really, when something's unfair, I fight back. And this was the first time that I couldn't fight back until I really started learning that if I fought for myself, if I fought for my joy, that the justice I could feel was in my body was the truest liberation I would ever know. And so it's really transformed and heightened my practice as well, because really, as you know, as a physician, especially in primary care, what we're taking care of a lot is people's spiritual disconnection from life. They're lost in the world. And really, when I realized finding my own joy was my most potent medicine, it really brought me full circle with my patients as well. And so I've been doing trauma work globally for the last 20 years. For the Center for Mind-Body Medicine and really trying to understand the human capacity for joy and our ability to face our pain and meet it lovingly head on. And so this book, Joy Is My Justice, is really a full circle professional and personal culmination of all of my work with patients as well as with myself and really melding it with personal— with, I'm sorry, with self-inquiry. Practices and translatable neuroscience. So that really is the book. And then, as you said, I'm an integrative physician. And so after these 25 years, I've now really segued into out of primary care and into only integrative work and psychedelic work. And so that's really the two areas I'm focusing on. So that's a little bit of my journey. That's a lot.

That's a big journey. You started out doing all of this mind-body work in the first place, and I was similar to you. I fight back for so many things. You know, if you are diagnosed with something, you know, fight for it, fight to get better, fight to prevent things, especially as a mother. So how did you handle all that?

Yeah, I would say it's been a path. It doesn't happen in a moment, but I feel like it's serendipity that I was doing all this mind-body medicine work because really, if anyone listening could know anything, it would be that work has saved my life. It really has been the way that I have found joy and found that my life is perfect, not despite my son, but because of my son. And so What I would say is that this work of connecting to yourself, connecting to your pain, being with it in a way that is not how we're taught or how we're even wired. We're wired to escape it and run away from it, to get away from threat. This way of reconnecting to myself really is the way that I thrive. And it is why I'm so passionate about what we both do with patients and with individuals, which is really work to help them, guide them to how to sit with their pain and how to practice skills and tools that allow them to sit with it and yet learn from it and be with it and know that that's their humanness, that it isn't about getting away from things. It's about being with it and that life is beautiful and brutal all at the same time.

Yeah, like you said, it doesn't happen in a moment, right? You could be practicing for decades and yet something like this happens and you're back to square one, or it feels like that. But like you said, I do believe that all the training you had probably did come in handy. I was watching your TEDx talk and maybe you could describe that for us a little bit. So go listen to her TEDx talk. It's awesome.

Yes. Well, and that was really a lesson in gratitude, right? And so, um, I was told by her counsel to go say thank you.

Wait, can we talk about who this is and what she does?

Oh yeah, she's in my book as well and I talk about her. She's actually by training a psychologist, but a, and a leader in mind-body medicine and really has been lifesaver for me in really being able to be authentic and firm and compassionate with me in terms of how to really manage this suffering. And, uh, and was she your personal therapist or your mentor at the time? No, my mentor.

Okay.

Yeah.

She did become my personal therapist after that. But she really told me, you have to practice gratitude. And I thought, well, you, how could you do that? Yeah. I mean, I actually was so upset with her.

I would be the same.

Yeah. I mean, what kind of mother would be thankful for their child dying, right? But she said, no, just trust me. Go say thank you to him every night after he falls asleep, go lay with him and say thank you. I was so resistant to it. I thought it sounded hokey. I thought it sounded stupid. And I also thought it sounded ridiculous. What would that do? Um, but you know, I was desperate, so I did it and I did it night after night and slowly but surely what happened was what the power of gratitude can do, which is it can melt your resistance. Distance to this life. And it can help you understand how to turn toward your life rather than away from it. And so it isn't that I'm thankful my child is suffering. But what I'm thankful for is my ability to be with him through it. I'm thankful for what he teaches me through it. And I'm thankful for, you know, this life, whatever it is, whatever it brings me, I'm grateful for it. Doesn't mean that it's easy or it's what I want all the time, but now I'm at a point, you know, where I wouldn't change it because you can't say I'll take this and not that, right? And so the fact that I've learned to unconditionally love my children, the fact that I've learned how to be more present, the fact that I've learned how to really truly feel joy, not happiness only, but joy, joy, those are all gifts that I wouldn't give back.

Also, we can't change it, right? That's one of the main lessons with a diagnosis or anything that happens in our lives. Eventually we can't change some things.

Exactly. Mm-hmm. Exactly. And we have that illusion that we have control over our lives. We really all have that illusion. So even when people say, what's it gonna be like when you lose him? First of all, I can't like really predict that. So I'll just have to wait for that. But honestly, how do they know that I won't die before him? I mean, we all have this illusion that we have control over how things will happen or how it will look. And that's why when deep tragedy occurs in our life, we're almost like sideswiped. How could that happen to us?

And— But yet it happens every day to people.

Right. So, you know, it's an illusion that we have. And so then when something bad happens, We want it to be gone, but the truth is some things are changeable and many things are not, but how we are in the moment is changeable. And so that's where these tools like gratitude can really help us reclaim our power. And so people always ask me, isn't gratitude false positivity or isn't it something just contrived? And especially when things are wrong or hard. And I always say, no, first of all, gratitude is your choice. Always. You don't have to ever do it. I do it because I deserve to do it, but I also only do it in a way that helps me reclaim my power in my life. And so there are ways that people, I think we got bad PR and marketing for some of these skills like gratitude and self-compassion and, um, If we understand them as reclaiming space in our bodies, reclaiming ease and safety and power, then we can understand how that then brings us to more joy.

Yeah, I think it does get a bad rap because it sounds so such like a blanket thing to say, oh, just say thank you. Just, but when we describe like in the moment when you're doing that, when you're going into your son's room every night saying Thank you. And thank you. I don't know exactly what you said, but as you say that almost, it's a practice, right? It's almost like instead of saying all those other things you could be saying, like, why me? Why is this happening to us? What did we do to deserve this? Et cetera. Then you are practicing saying the grateful things and yeah, so I almost see it as like a mantra, which is actually just repetitively saying something to yourself and practicing a different perspective. And neuroscientifically, it's just setting down roots for a different way of thinking.

Oh yeah. I mean, it's radical acceptance. Also, as you, you talk so much about the neuroscience that I think the neuroscience here is particularly interesting because when we actually practice gratitude, we light up the same areas of our brain that light up when someone we love holds our hand, when when we're in pain or nurtures us. So gratitude, you can think about it almost as becoming your companion through suffering, this radical way to accept what is happening and turn towards it again, like we talked about. And it's so interesting you said, "Why not me?" Because in the beginning of my book, I talk about this, but on the day that we learned of my son's diagnosis, my husband and I were sitting on our porch with our hands on our heads and just not sure what to do. And we started saying that, why us? Why him? You know, and somewhere in there, we debate who said it first, but one of us said, why not us? Why not me? And it was this moment of, it didn't solve everything, but it became an anchor of, When we say, why me? We're almost acting like I did, I did so well. I was such a good person. Why did I deserve this? And the truth is no badness happens to any of us because we deserve it. Why me is some sort of way of saying I shouldn't have this. It's a very natural question, but when we flipped it to why not us, why not me, it just shifted it to this radical acceptance of we're all human. We all suffer. We all have this chance to also rejoice and find joy through the suffering. So it's why not me in both ways? Why not me as one who's human and who suffers? And why not me to find joy? So it's an interesting question flip.

I love that. Amazing way to look at it. Why do you think that people always feel like something bad is happening to them because they've been bad or something. I mean, I know that's like a cognitive, magical thinking or something that's everybody thinks, but why are we always doing that? Why are people always asking, what did I do to deserve this? Yeah. I guess some of it might be religious. I don't know. Backgrounds. I don't, I'm not really sure.

Yeah.

I mean, I think there's undertones of that for some people, right? And I don't have that religious background, so that's not why it came up for me. I think that for many of us though, it's a sense of what I've talked about already about turning away from pain is that we want the human experience of beauty and joy and happiness, but when it comes to the human common shared experience of pain, we don't want that. That's not how we've survived this far, right? That's not how our ancestors survived. And so we're primed to say, no, that's not for me. I don't want that pain.

Yeah. But then why the blame? Like, why is it that we deserve something or not?

Yeah.

It's interesting.

I think, I think, yeah, I think there's probably no good one answer for that, but I wonder if, um, at the core of it is in a little bit of our self-worth. I think we all could do with a little more self-love and self-worth, but yeah.

How old is your son now?

He just turned 18. Wow.

And this diagnosis was when he was 2?

Almost 3. Yeah.

Almost 3. Wow. So you've been taking care of him for 15 years now. That's incredible. Yeah. And you've done so many other things. Just mother to mother, as a professional physician to another, how are you managing to do all of the things that you're doing? You just wrote a book. You are obviously in the community helping so much, and you have 3 kids. How are you juggling all of this?

I would say some days is easier than others and balance is elusive. So I don't think anyone should, I don't know about this sort of, people will say, how do you stay balanced? And I said, does anyone stay balanced? I think you are working towards balance always. And I like the idea of integration more than balance. And what I mean by that is that the way that I do all this is that my work really is part of my healing. You know, it's not separate from my life. When I work with patients and communities in these trauma-ridden areas, it is as much healing for me, I think, as for them. And I think when you can make your work part of your life, I think then it doesn't feel like a separate entity that you're balancing. I also think that part of the gift of having real tragedy in your day-to-day life that you have to face, 'cause this is not easy. I'm not gonna paint a rosy picture for you. I mean, it's a lot. A lot of grief, a lot of loss, and it's hard work. When you use skills like gratitude and acceptance and self-compassion and breath and movement and on and on, when you use these skills, what happens is you also are able to construct meaning out of your pain in a different way. You actually, from a brain perspective, light up the areas of your frontal cortex that allow you to set meaning and context to suffering. And so there is this way, as Viktor Frankl said, who's, you know, the famous Holocaust survivor turned psychiatrist, he says suffering is just suffering unless it has meaning. And I agree with that. I think that my suffering has so much meaning in my life. It gives me so much gift. The sort of doing other things doesn't feel like doing as much as giving back and serving.

That's wonderful. I love that it's part of your therapy to do the work that you're doing. Viktor Frankl said when he was in the concentration camps, he said that he would imagine himself teaching and bringing all of his stories out into the world. He would use his imagination to not be there.

Oh, you're right. I did read that. Yes.

You said before, earlier in our conversation, that all of the work you've done, the mind-body work that you've done, the integrative work you've done, has changed your life, maybe saved your life.

Yes.

Can we talk a little bit about how you feel like it's saved you? And you and I are both allopathic medical, right? So we know about pharmaceutical surgery and that stuff is amazing and saves lives. We'll talk about your psychedelic practice at the end. Hopefully we'll get to that. So yeah, so we are both allopathic doctors. How do you think that this sort of mind-body practice actually saved your life? In a way that medicine or surgery can't.

Because it connects me back to myself in a way that those things almost separate me, would separate me from. I mean, taking a medication, for instance, I'm all for using medication as bridges and everybody should use all the tools available to them. So absolutely, I don't at all discount medications, but what I'm gonna say is they're not everything. And when I give, in fact, if I give a patient an SSRI or a medication for depression or anxiety, I always say this is a bridge to what the work we need to do. And I always also say, I'm so grateful we have this tool, but it's not enough.

And also it could cause harm in the long run. In the short run, it's good. Short run, it's good.

Exactly.

Yeah.

I think in a way I find after 25 years of practicing, people get disconnected from themselves. They're almost numb to their continuum of emotions. And people say that to me all the time. I just don't feel much of anything. You know, I don't feel depressed, but I don't feel much of anything. And whereas these tools and practices allow me to feel everything. Now that means that I also feel the pain quite exquisitely. So some people hear that and think, Oh, I don't want that, you know? But what I would say to people is, first of all, it's an invitation to do it a different way. It's all it is, it's an invitation. And also, the way I try to explain it is, if you shut down to all the pain, then you cannot be open to all the joy. The emotion shut, you shut down to everything. And so if you wanna feel that bliss and that joy, then I, I do, I'm afraid you do have to feel some of the pain.

Whether it's in your own suffering or joy, because oftentimes people have guilt when they're feeling joy and somebody else is sick or has a chronic illness, that's survivor guilt. So allowing yourself to feel joy when your kid is sick, that's also a gift that you can give yourself. That's from Mind Body Medicine.

Definitely. And I don't know about you, but I have a lot of cultural and community sort of family stigma and guilt around that because in my culture you don't feel joy if your child is suffering. You, you're not a good mother. Nobody says that outright, but it's implied over and over. And I had to really work against that and rewrite that story. But I do think what you're saying is really powerful is this sense of How do you have joy when someone else is suffering and the guilt? And what I would say to people, that's a real foundational concept of my book, is that joy may be the most important thing you could do. And the reason I say that is because any trauma, suffering, tragedy, or oppressive society or ways that we're fighting oppression live in our body every day. The way they work is they strip you of your power and your humanity. And you feel loss of all of that power of your ability to be a full human, to live the full scope of your life. And if you can reclaim joy along with the pain, then you're winning. Then you're fighting back and you're offering that not only to yourself in a cellular way, but you're offering that to your family. I think of the role models I had with suffering, and it was that you were sad all the time. Then what kind of, what are you passing down in that way as a way of being with pain.

Also, you're giving pain to everybody around you then at that point, your other children and even your sick child. Yes. Right. So when I was teaching lifestyle medicine, one of the medical students had a, their mom was in the hospital and they were just so distraught and she just felt so guilty. And I, you know, asked her to give herself permission to have fun when she wasn't in the hospital. Taking care of this person. That was something that wasn't natural to her or most people. But once you realize that, you can actually understand how you can be more for those other people who need you, right? Cuz you're replenishing at the cellular level, actually.

Yeah, exactly. And I used to think there's a huge dictum of self-care that you, you have to take care of yourself to take care of others. I do believe that, but I, what I would add to that is I also think it's powerful and revolutionary to remember that you deserve to take care of yourself because you're a human being and you're sacred. You deserve to be cared for and nurtured. And just because, you know, and you're alive. Yeah. And there is an outcome of that, that I then am a better mother and a better partner and a better physician. But that can't be my only reason to do it. I've decided.

That's something that I have to remind myself of more. Because that is true. You just, because we are here, we are also life and we need to take care of ourselves.

Really, when we're suffering, we're not feeling safe or at ease. And so we need to give that back to ourselves. And mind-body medicine skills can help with that because they allow us to re-instill ease and safety in our body, as you talk about all the time, through the vagus nerve, the parasympathetic nervous system. Really understanding we have power in how we care for ourselves and we have power in how we reclaim our body and that space. Does it always have to be a place of pain or can it be a wider container of everything?

Or just really feel that pain when it's happening in the moment. You know, you said it saved your life. It definitely saved mine. I started studying mind-body medicine and 3 years into it, my husband, almost died. He went into sepsis and I, I literally, I had two kids at home. I had to rush him to the ICU. They didn't know if he was gonna make it through the night. And I remember those times and those moments where I sat and I would just take a moment and take a breath and not have to think about what was gonna happen next. And we got through it. He's perfectly fine. He's healthy. I remember those moments and it really saved me through that time too. Somebody came to visit and she said, Why don't you take something to calm yourself? And I said, no, actually I have to be very present so I can understand what's going on with this care. And in fact, I was very involved in it, so it wouldn't have been good for me to take a Valium or, you know, something that would dull my senses. I really needed to be there. So these practices are life-saving, literally.

Yeah.

And I'm glad you said that because I talk to a lot of people who are caregivers like me, or for either children or elderly or partners, and they will say, well, I don't have time to do anything. And I think that what you just described is so powerful because I talk about often the breath and in those moments and how we really can reclaim some moments of ease in our body, right? I know you know this. I don't know if your listeners know that telomeres are very affected by caregiver stress.

And actually in a study of mom caregivers, which is a study of me, Yeah, the aging of their telomeres was 10 years older than a normal non-caregiving mom. It was specifically about moms who are dealing with chronic caregiving of their children.

When I read that study, I, it was really frightening and I, I believe it. I understand that stress.

Dr. Blackburn, she won the Nobel Prize for that, that work. But didn't they also empower you that you could do something about it, right?

Yes. You've probably read that book, The Telomere Effect, was so empowering, but there are ways that we can impact our our genetic code. And that is so empowering. Not only has it saved my life, but I feel like I just— it almost feels evangelical. I want— I'm so glad you have podcasts like this to just keep spreading that message that there is work we can do on our own and that we can make a difference and an impact, right?

And so, and then just taking that mini breath, like you said, throughout the day can really counteract Even the stress that could cause the shortening of telomeres.

Yes.

For example, is that what you remind yourself of?

Yes.

I'm interested in your upbringing. You had Ayurveda.

Yes.

In your childhood, and then you also have Western medicine. You went to an allopathic medical school. What part of this spoke to you more? And now I know you're integrating the two, but you know, all these epigenetic studies that are coming out, the fMRI studies that are showing the neuroimaging, there's a lot of evidence, but it's not as exact as we would like. However, we do know more about the brain than ever before. So what spoke to you more in terms of convincing you to not only change career paths, but to integrate all of this into your personal life?

I think that I always, when I growing up, we really didn't do much Western medicine and I would always ask my mom, why are we taking turmeric now? Or why are we using this? Or why are we swallowing black peppercorns? I mean, it was on and on. She could never tell me. She just said, that's how we do it. We do it. That's how we do it. And I really wanted more of an understanding of it. And I think that's what drove me to go to medical school was to get more of that science understanding. But I always knew I was going to blend it. I always did. Now, uh, really that's my whole work is blending ancient and modern medical practices for people and understanding that there's a harmony between the two. You know, it's not that I think non— that Western medicine isn't useful.

I'm—

it saves lives. I am so thankful for my training and for the work that we do. But to say that it's enough is— if anyone believes that, I think they're woefully misguided.

I think it's interesting because all the ancient practices, philosophers and Buddha who studied the mind, Plato, Socrates, they studied their minds and they understood the mind-body effect. But for me, that evidence was most important to me. Understanding and studying to see if there's a different dose of something or how to actually even prescribe breathwork or exercise. Those things are the most important thing for me on a day-to-day basis. Like you said, I needed that evidence and I also wanna be more precise. I don't know how you feel about that.

Well, I know, I think it's a good blending because for instance, when people ask me, in supplement form, how much turmeric should I take for this osteoarthritis? I think it's so helpful to now understand how much actually of curcumin, of the essential, you know, ingredient we need to be taking at least this much to make a difference. You know, I think there's also the ancient wisdom of turmeric in your food every day as a way of anti-inflammatory eating. There's both the sort of synergy of living a certain way and then the preciseness of dosing and treating conditions. I agree.

And also everybody's so individualized, I guess those things would be dependent on you. What's your favorite turmeric recipe? Mm-hmm. Or ginger, ginger turmeric. I'm making juice today.

Nice.

So any tips?

Actually, we do a lot of turmeric ginger teas. If it's pretty simple, we just shave fresh ginger and fresh turmeric and steep in a tea with dash of black pepper to make it absorbable. And then you need to take it with fat. So either with coconut milk or regular milk even would do, but coconut milk's even better. It's an anti-inflammatory tea that we use often in my house. So that's one of my favorites.

Nice.

And is it black peppercorn?

Just black pepper can be, doesn't have to be corn. It can be just dash, a ground black pepper.

That helps you absorb the turmeric.

Yes. By more than 200%. Yes. It's a, okay. And you were gonna say your favorite thing is, oh, it just, and I love, you just said juice. I love turmeric and ginger and juices. So I think that's great that you're doing that.

I'm gonna try that recipe. Do you heat up the coconut milk? In the heat or do you just add it after?

Just at the end so it gets warm, but yeah, don't boil it for, with the tea.

I'm gonna try this.

It's so good.

Awesome. I love it. We have a few minutes left. I just want you to talk to us about your psychedelic work now. Mm-hmm. Because I guess it's less controversial now.

Yeah.

However, I do know that it's being used very widely and maybe without supervision, which I would love to talk to you about a little more.

Yeah.

Again, with the dosing and the preciseness of things, cuz like everything in life, too much is maybe not good and everything has a balance, right?

Yes. Uh, I've gotten certification and training in all the plant medicines. And then I researched psilocybin at the University of Washington in trials. We just finished the clinical portion of our trial on COVID burnout in frontline medical workers, docs and nurses with psilocybin. It was amazing. And then in practice, I use ketamine right now because that's the only legal medicine right now. I think in the next few years we'll have psilocybin and MDMA to choose from as well. But for now, ketamine legally in practice and psilocybin in research. It is a really full circle for me. It blends all of my integrative medicine, plant medicine, spirituality, trauma work, and social justice.

Wow.

And it's really the first time I felt hopeful for mental health in two decades.

Okay.

Ketamine is everywhere. It's an amazing drug. I've had one of the research scientists on here who's working with PTSD in soldiers. Oh, with ketamine. And she's doing incredible work and she's shown that if you administer a certain amount within a few weeks after trauma, you can significantly decrease actual PTSD from forming. And my daughter just had 4 of her wisdom teeth out and they put ketamine in the mix. Nice. So she's not afraid to go back to dentists. I guess it worked. But how do you use it and what do you think about when people use it recreationally and they're snorting it or—

Yeah, they snort it and take it orally. It's a very high abuse potential and has become a big problem actually. So I don't feel good about that. And I don't advise using it recreationally. Um, ketamine—

Is it addictive then, you think?

Ketamine can be, yeah. It's really amazing to use it under supervision in a way therapeutically though. So we can really allow patients to come into their body in a powerful way and be non-reactive with their trauma to gain new insights, new perspectives. We have a high, high production of BDNF after using ketamine, which is brain-derived neurotrophic factor, which allows us to really form new pathways and remember things better. It also really allows a dis— the way that we've used in anesthesia is dissociative, of course, and it is a dissociative medicine. So it allows people to get almost out of their body a little bit and see things in a different way. It's powerful medicine. And you'll see a lot of ketamine clinics popping up using it IV. I don't use it IV. I use it orally or intramuscularly. Not because IV is bad, they all work well, but IV, I don't like the being tethered to the cord. It feels pathologizing. And for me, it doesn't allow for people to understand that they're accessing their inner wisdom as much as getting this external medication.

Uh, so give us a quick little walkthrough. If I walked into your clinic and you were doing a ketamine session with me, you would take a thorough, I'm sure, medical history and psychiatric history.

We'd have to do a full consultation, medical and psychiatric, to clear you for it, make sure that it's safe for you. And after we did a consultation, then I would do at least one prep session with you, which would be a sort of preparatory, almost like a preparatory counseling session, but a little bit of exploring why you wanna use it, what your intentions are, what to expect from it, how the session journey, the trip will feel, that kind of thing. And then the ketamine session itself would be a few hours. This ketamine itself lasts about 90 minutes, but we do vitals. We make sure you're safe. I'm with you one-on-one through the whole thing. We integrate a little after when you come out of the ketamine in terms of how that experience was. And then post-ketamine, within the first 72 hours, we'd have a full integration session where we really go go through what that journey was like and pull on the threads in a real intentional way on how to help that gain those insights, how to make them practical and durable in your life, how we can change things for you. And it's a real process, the whole journey. It involves always preparation, the medicine, and integration, always.

And then it's always follow-up, like you don't just leave them with one session.

So I recommend people do a few in the beginning. 3 is what I recommend. But nobody's tethered to do anything. They could do one and say, I don't like this and stop. And usually I start with oral. It's a gentler way to start. It's also safe for me to see how dosing, what dose you need, that kind of thing. And then I move to intramuscular because it's a more intense experience. So I don't start with that first.

And then do you give counseling about how not to use this outside of therapy or?

Yeah, they don't have the medicine at home. It's medicine I give them. So. If they're getting ketamine outside of therapy, then they're buying it somewhere that I'm not sure where that's happening. Yeah, we, no one should recreationally use ketamine at par— it's a big party drug right now.

And what are the side effects?

Yes, it can very significantly raise your blood pressure and have cardiac risk profile for anyone who's already at risk or older or has other comorbidities. It's also has a risk for psychosis and schizophrenia. In people who are predisposed to that or have certain symptoms that might make that more concerning.

Mm-hmm.

So those are the biggest ones, but there's other things like increased intraocular pressure and, and all sorts of neurologic things. So we want, it's actually a very safe medicine if you're cleared right.

Could you give us a few of your favorite ways to calm yourself down throughout the day or give us some tips?

Yeah. My favorite ways to calm myself are breath. We talked about that. I do a lot of deep belly breathing. Breathing, diaphragmatic breathing. And I do that when I wake up, I do that through the day, I do it in the checkout line, I do it when, you know, all kinds of places where I might just be prone to my mind racing and moving into the Rolodex of what I need to do and getting stressed out about it. I do a lot of movement to calm myself down, and I really hope people know that you don't have to always be sitting still to get calm and ease. Movement is actually one of my favorite ways. My favorite movement are dancing and walking. And so those are things I do every day. Music is a big part of my day always. And then honestly, gratitude practice is a huge part of my day still. So I really, sometimes if I feel my brain just going, let me tell listeners, nobody doesn't perseverate on negative. That's a human thing. So when I feel my brain spiraling into the negative, I start to practice some gratitude to remind myself of the goodness, not only in the world, but in myself. Those are my 3 biggest ways.

I love that you said the movement thing because you don't have to be sitting for 60 minutes or even 20 minutes meditating. I mean, right now my meditation is my Pilates reformer.

Yes.

And you have to get so much into your body, your neuromusculature. That you are in. You're doing a body scan.

Yes.

You know? Yeah. So I'm glad you mentioned that. The other thing that's interesting is the gratitude. So when you find yourself being critical, for example, of your loved ones, cuz most of the time it's usually like somebody you love that you're being critical about, or yourself, then you recognize that, you catch it, and then do you say certain things to yourself? Do you have a little script?

Not a script, but I just remind myself, what are you grateful for right now? And then I, I do that and I really will go through it. And if I feel like I'm really swimming in the negative, then I'll make sure that in the evening to do it again before I go to sleep. What were the 5 things today that I was most grateful for? You don't have to do 5. You could do 1 or 3. I just do 5 now, but it really is a moment-to-moment practice for me of sometimes I'll just feel myself getting anxious or getting sad about something. And if I take a walk and say, I combine these all the time, so I'll take a walk and just look for things to be grateful for. And sometimes it's just, you know, the spring flowers or the trees around me, or the fact that I can walk. My son can't walk anymore. Just knowing that this is a gift that I've taken a walk. The more mundane it is, I think the more powerful it is. The fact that hot water comes outta my faucet, I can't believe it. We lose sight of those cuz we're looking for the biggest things to be grateful for all the time. And I don't think it has to be so big. I think the more you can get into the ordinary of your day, the more extraordinary things can feel.

Oh, that's wonderful. I also wanna add that sometimes if it's too much still, then using a mantra is very helpful. Like I did yoga training with Dharma Mitra and They gave us this mantra, you kind of sing it and it, he said it's better if you don't even know what it means. And in a way it is because you just kind of sing it to yourself and then it quiets down the other thoughts that are unnecessarily critical or not serving anyone really. You're a Sikh, right?

Yes.

Yes.

So does that ever come into play?

Yeah. The way that we pray is through song, through singing, kirtan, and, um, yeah. I'll put on kirtan and sing to it. Or I love that you mentioned singing because it's a great vagal toning exercise. Right. And so it really, really stimulates that vagus nerve. And so humming or singing are big ones. Yeah.

Humming.

I just, I just read about that. The nitrous oxide is increased, which slows down everything bronchodilator. Yeah.

It's amazing. Right.

Yeah.

I love it. I can't wait to talk to you again. Thank you so much for being here and all all the wisdom that you helped us to see today.

Oh, thank you for having me. It's so good to see you again. I'm looking forward to it happening again.

Absolutely.

Thank you.

And big hugs across the country.

Thank you.

All the way to Washington.

That was Dr. Tammeet Sethi. Look for her book, Joy Is My Justice. You can find out more about her and all the amazing work she does on tammeetsethimd.com. The link is in the show notes below. Head on over to mindbodyspace.com/podcast and sign up so you can get new podcast episodes and extra tips on getting focused, productive, healthy, and wise right into your inbox.

Thank you so much for listening. Forward this to a friend, a family member, anyone who needs to stress less, and soon enough you'll be surrounded by more Zen people. Your support is literally what makes this possible. Subscribe and head on over to YouTube to my Fall Asleep Easy channel. Until next time, this is Dr. Juna wishing you wellness.