I'm back because I failed again. Dr. K,

please give me some closure if you can.

Earlier times, I can't handle things.

Maybe I should try harder. I can do

this. Other must have worked hard too.

Even if I can't do anything or handle

anything, I must keep doing. I would

eventually learn how to deal with stuff.

I should try harder. Everything will be

fine. Right? So, you kind of force

yourself to work hard. After a long

time, I kept fooling myself. I thought

things would work out. I knew something

was missing within me. I couldn't even

do the simplest stuff. I took so much

stress on simple stuff, I couldn't even

begin to live. I'm a waste who can't do

anything properly. I just want to be a

parasite. I am wrong. I have failed at

everything. Money, time, myself, nothing

but a walking corpse. Bleak. So, I think

one of the biggest scams that we

propagate in the world today is that

hard work will fix your problems. Right?

So, we live in a culture where like you

have one lever that theoretically you

can pull to improve your situation,

which is that you can expend more

effort. Right? If you get a B in a

class, if you just study more hours, you

will get an A. And it's like sort of

true, right? Like in the examples that I

provided, if you do study more, that is

correlated with getting better grades.

If you do work more hours, it is

correlated with making more money. So,

it's kind of this like simple cure all

for your problems. But I think there's

like a basic basic basic problem here

which is that the people who are very

successful in life and I've worked with

like degenerate gamers living in their

parents' basement. I've worked with like

literal billionaires. The difference is

not in the amount of time they spent

productive. The difference is actually

in their effort. The degenerate gamer I

think actually spend is far more

effortful than the successful

entrepreneur. And I know that sounds

weird but like I'll give you all an

example. Okay. So, you know, I'm a

psychiatrist. So, I work with people who

have depression. And when people have

depression, basic things require a lot

of effort. Getting out of bed requires a

lot of effort. Cleaning your room

requires a lot of effort. And then also

when we've got ADHD, I was talking to a

colleague of mine who's a professor and

the my colleague was telling me that,

you know, he he's got two students in

his class with ADHD and he was like

really surprised by this because he's

like, you know, they're able to carry on

conversations, they participate well in

class, all this kind of stuff. So he was

like confused by the diagnosis and he's

not like trying to suggest that they

don't have it. He he was genuinely

trying to learn about this. So he's

like, "Can you explain this to me?"

Because it it seems to my perception of

what ADHD is is different, right? So I

thought like people would struggle, but

they seem to be well engaged. And so I

explained to him that one of the key

things about ADHD is not that you can't

do something, but that the effort

required is way higher. Right? So when a

neurotypical person has participates in

a conversation in class, the cost to

them is pretty low. like I can

participate in conversations for eight

hours a day without a problem, right?

Maybe I feel tired at the end of it, but

I can do it. The problem with ADHD is

that the effort is way higher. So we

live in a society where we tell people

work hard, right? Like so especially in

America, lift yourself up by your

bootstraps. This is the land of

opportunity. The harder you work, the

more successful you will be. There's a

lot of research that shows that this is

probably not true. And this is something

that I realized as a psychiatrist like

you know everyone talks about I was in

residency and residency is like hard.

It's a lot of work. You work 80 hours a

week basically every week on average. In

psychiatry if you're in surgery or

neurosurgery it's like 100 110. There

are these other um there are these other

you know professions like investment

banking or big law or things like that

where you just work crazy amounts of

hours. And so like I had this kind of

perception that you know I'm successful

because I work hard. like I'm working 80

hours a week, 90 hours a week. And then

I realized like I have some patients who

actually work way harder than I do. I

have patients who have three part-time

jobs because a single employer like

Walmart won't give them full-time hours

because then they have to pay for

benefits. So they work like 24 hours at

three companies because no one's willing

to pay them benefits. That's the most

that they can get. And so this concept

of hard work, I think like this idea

that if you have this idea in your mind

that hard work will fix my problems. And

I'm not saying that you shouldn't be

productive and you shouldn't be

effortful. Right? This is what's really

hard about this is like if hard work

doesn't fix your problems, like what are

you advocating for? You know, I work six

to seven days a week. We'll we'll get to

that in a second because when I talk

about that, a lot of people get upset or

not upset, but they're like, "Is Dr. K

becoming a hostile culture bro?" Not

really. And we'll we'll get to that in a

second. But the key thing here is that

effort is usually not what we want to

do. Actually, effort, I think this is

this is sort of the scam that this idea

of I just need to work harder. I just

need to work harder. I just need to work

harder. And when I work with patients

who have things like addictions, right?

There's this idea that I need more

self-control, more willpower, more

effort, more effort, more effort, more

effort. I don't think that's the right

way to live. I think actually, so this

is something so silly. My daughter and I

were playing a board game. This is like

two years ago. And I don't know if you

guys have ever had this issue where

like, you know, you have like a box for

a board game and then you put the lid on

top. And she didn't understand this

because if the lid is slightly tilted,

you can push really, really, really,

really, really hard and the box will

never go down. Whereas, if you reorient

the box just a little bit, it goes down

effortlessly. And this is what I think

life is like, right? So when I work with

people, when when we have like coaches

and stuff working with people, the goal

there is not to get them to just work

harder. I think that's actually a

mistake because when you just work

harder, this is how you end up, right?

You end up in this situation where you

have all of this hard work that you've

expended, all of this energy, and then

you're absolutely burnt out. And then we

get into this like pendulum of I just

want to be a parasite. I just want to

take it easy. I'm tired of working hard.

I want to do nothing, right? So, I've

done everything and more for a long time

and now I want to do nothing and even

less. I want to be a degenerate. I just

wish I had money. I wish I won the

lottery. I wish I had participated in

that Starcraft tournament 20 years ago

where third place was 300 Bitcoin and

first place was $250. I wish I had done

that. I I wish I could just be a

parasite because we're tired. Our

relationship with effort is all messed

up. And so I think the first thing to

understand is that like you know if my

problem is not solved by a certain

amount of work we have this idea that

like okay more work right so how do I

build more motivation how do I build

more discipline how do I how do I do

this stuff and I've worked with people

like that so the I'd say I've worked

with a lot of people who are let's say

between the ages of 27 and 45 and this

group of people is classically

successful so they have early life

crises and they have midlife crises

they've got stuff like imposttor

syndrome they force themselves to work

really hard. They end up getting

promoted and then like they're doing

stuff that they don't really want to do

and it never really gets better and they

kind of find themselves sort of like

trapped where they've worked really hard

and and now they find themselves high up

on a mountain that they don't like. So

this is where I think a fundamental

thing that is missing for a lot of these

people is actually understanding that if

you are working really hard and things

are not working for you. What you need

is better understanding right you need

to shift that box just a little bit. You

need to understand what is the source of

resistance and instead of powering

through shift a little bit and a shift

of your efforts will drastically change

the yield on the energy that you put in.

And this is something that it's like

it's so silly, but you know, I sometimes

think we can learn a lot from gaming.

And I think like any sort of ranked

multiplayer game, this is a really good

example of where if you understand one

or two additional mechanics, that's

worth like a rank or a medal. It's not

mechanical skill. It's not effort,

right? It's not necessarily being locked

in. It's like, okay, if I learn how to

creep pull from Dota 2 or if I get a

little bit better at last hitting or if

I learn how to do this, if I learn, you

know, so I I remember seeing this post

from a Dota 2 player that if you're a

carry and you're on the other side of

the river and two people are missing,

you should leave the enemy's side of the

map. It's like really simple stuff. And

the climb from low rank to high rank is

not playing more games, right? This is

why we have people who have played

10,000 hours of League of Legends,

Valerant, Dota 2, Take Your Pick, and

they're still like hard stuck at bronze

or whatever. So there, this this idea

that working hard will improve your

life, I think is like fundamentally

incomplete at best and wrong at worst.

Like it's wrong. Now, should you invest

your energy productively? Absolutely.

But we'll get to that in a second. So,

what you need is more understanding. And

and what I want you all to notice about

this post is what are they learning from

the friction, right? This is a person

that eventually I'll learn how to deal

with stuff. I should try harder.

Everything will be fine. Their body,

their brain, their life is sending them

signals that this is not working. And

they are ignoring those signals. So,

this is something that like you know

this is a problem. This is a classic

problem in our community. When I

developed the coaching program, this was

the problem that was designed to sort of

target. And the way that it works, I'll

just share this with you all and we'll

sort of walk you all through this a

little bit is understanding first. So

really simple. If a patient has if I

have the wrong diagnosis for a patient,

this medication doesn't work, this

medication doesn't work, this medication

doesn't work, I can keep on increasing

the doses on medications, I can try

additional medications. They have this

treatment refractory problem. I can

increase the intensity of treatment that

I provide, but it's not going to work if

I'm misdiagnosing the problem. Simple,

right? You can play a thousand games of

Dota 2 or whatever, Fortnite, whatever,

but if you don't learn from your

mistakes, if you don't understand why

the effort is not translating into

improvement, it's never going to work.

So, here's what's kind of interesting.

We were looking at some quality

improvement data and a lot of coaching

out there is about action and

accountability and and our coaches are

trained in that too. But the interesting

thing is I think our coaches work

slower.

It takes them longer. So we see optimal

changes in 12 to 16 weeks not 4 to 8

weeks but we see larger changes because

it's focused on understanding your

problem. So let's talk about what your

problem is. So here's the first thing

that you've got to do. This is kind of

weird, but if you think about this idea

of hard work, okay, think about where

you learned hard work will improve your

life. Basically, you learned it from the

outside, right? Because if you look at

your own experience like this, hard work

is not working. If you're someone who

has worked really hard, and this can

include things like someone who's got

ADHD or someone who's got depression,

where a ton of effort gives you a tiny

little yield. So, we've been taught all

of this stuff on the outside. Everyone

tells you just keep working hard, keep

working hard, keep working hard.

Eventually, you'll figure it out. That's

what you learn from the outside. And

that works for some people. But if it

doesn't work for you, what you need to

do is do a better job of understanding

yourself. Understand what the diagnosis

is. So, what I find when I work with

these people is they ignore their

internal signals. Just ignore them. So,

when something doesn't feel good, I need

to power through. and they kind of get

stuck. Like part of the reason that they

sort of ignore their signals is if they

listen to themselves,

they end up just numbing. Oh, what do I

feel like? What does my body feel like?

What does my brain feel like? My body

and brain feel like doing nothing. So,

I'm going to do nothing. Well, that's

not working. So, then I have to ignore

what my body and brain do. You'll kind

of get that, right? So, if I I learn to

ignore my body or brain because

listening to my body or brain doesn't

work. And then I have to push myself.

But then that doesn't work either. So,

this is what I recommend you all do.

This is a bit hard. Pay attention to

what leads to contentment. And we have

to define contentment precisely here.

Contentment is the opposite of regret.

Okay. So the first thing is contentment

is after the fact. The action is

completed. And if you are at peace,

great. If you are not at peace, what is

the way in which peace gets destroyed

after you're done? It's basically what

we call regret. Oh, I should have done

things differently. It's not enough. I

should have done things more. So pay

attention to what leads to peace and

what leads to regret. And here's the

interesting thing. Even if you want to

be a parasite, if you want to waste your

time, you know, if you're like, "Oh, I'm

exhausted. I all I want to do is play

video games all day. I don't want to

work anymore. I'm tired of working."

That will lead to numbness. It will not

lead to peace. You will wake up the next

day and you will have regret. Okay? So

then we get to another problem which is

that if you work, if you are moving in

the right direction, there's still a

chance that you will have regret even

when you shouldn't have regret. Here's

the options. I feel like doing nothing

and now I have regret. Okay, so that

doesn't work. Do something and I have

regret. And what is the nature of this

regret? Now here's the fundamental

problem. So look for peace. But these

people have difficulty finding peace

because it's not enough. Should have

done it sooner. Okay. So this is what

you need to look for. So look for when

you move in the right direction. What

are the ways in which your mind turns a

W into an L? This is what happens. The

other thing is that there's a there's

one really really really key clue,

right? So, so it's it's kind of hard,

but so this is going to be oftenimes

related to the aamara or ego. So earlier

I I I talked about coaching and so I

would venture that there's a lot of

people in the audience who resonate with

this idea and then when I say okay like

you know you can work with somebody else

and the reason you know I'm a

psychiatrist so I saw firsthand the

value of the impact that a professional

can have on somebody's growth like

that's what I do in my day job. It's a

model that works really well, super

evidence-based. But there's a problem,

which is that I don't want to work with

somebody else, right? So the problem

with blind spots is that you're blind to

them. That's why it helps to work with

somebody else. But you don't want to

work with somebody else. You want to be

able to do it on your own, right? And so

what I find with these people, it's

really subtle is that there are many

things that they are unwilling to do

because they have this idea that there's

like lazy people and then there's the

hardworking people. And I want to be

this. I don't want to be this. So

oftentimes these people will reject

help. So this is beautiful. There's a

great paper taking care of the hateful

patient. So Jim Groves, absolute

brilliant man, works at MGH, had the

privilege of studying with this guy

briefly. So he talks about manipulative

help rejectors. So these are people who

will ask for help. They actually seem

the opposite of entitled. They appear to

feel that no regimen will help.

Appearing almost smuggly satisfied, they

return again and again to the officer

clinic to report that once again the

regimen did not work. Their pessimism

and tenacious naysaying appear to

increase in direct proportion to the

physician's efforts and enthusiasm. So

sometimes I'm not saying that everybody

who who you know falls into this

category is a is in the hateful patient,

but often times these people are very

what we call helpseeking, help

rejecting. They ask for help and when

someone says, "Okay, here's what you

should do." They don't want to do that

because they have a model of, "I want to

do it in this way. I want to do it

without help. I want to be the kind of

person who pulls myself up with my

bootstraps." Now, some of y'all may fall

into that category, some of y'all may

not. That's the challenge of trying to

talk about this, right? Because this

this is my whole point is that this has

this pattern has a lot of different

reasons internally. So the patterns that

we can look for, this is why it's useful

to work with people, right? So I'm

sharing some of the patterns that I see

frequently. So one pattern is that when

you engage in effort and you make

progress, something in your mind tells

you that it's not good enough. So even

though you're moving in the right

direction, instead of feeling peaceful

about it, instead of feeling proud or

positive about it, your mind adds

something else. Look for your mind

adding insufficiency. It's not enough.

It's too late. I've fallen behind. I

should have started this a long time

ago. You're moving in the right

direction and your mind is punishing you

for it. Not going to work. Second thing

to look for, if you are theoretically

moving in the right direction, is that

impacting your ego in some way? Is

moving in that direction make you feel

like you're someone that you don't want

to be? I don't want to do it that way. I

want to do it by myself. I don't want to

show people how pathetic I am. I don't

want to have have to say, "Oh, I went

and saw a therapist and they helped me

with my stuff." I want to be able to do

it myself. I want to be the thing that

the rest of the world taught me about

which is like the hard worker who

conquers adversity. Look for ego.

That'll be your second clue. And the

most important thing, so this is where

you know some sometimes in India they

like when I went to India and you know

you hear these stories about people

going to places like monasteries and

stuff and they're you know transformed

by it which is great. Let's transform

people. All for it. What is it that

accounts for the transformation? One of

the most important things that I learned

in India is getting data from here

instead of out there. What is it that

works for you, right? And that's where

there are certain things like speaking

of like effort and working hard. So I'll

just explain this very simply. So

there's a lot of people who say that you

should work really really really hard

and expend a bunch of effort right

hustle culture people. You'll find these

people on LinkedIn and they're like I

work seven days a week bro you got to go

hard and like going hard is the way to

go. Like oh my god like let's go hard.

That's not what I'm talking about. So I

I want y'all to ask yourselves a

question. Do yogis in the Himalayas

take weekends off? The answer is no.

Every day is the same. Right? And this

is where you can say rightly so. That's

easy to do because they're in the

Himalayas and they don't have my

b their boss emailing them at Friday at

5:38 p.m. telling them that they need

something done by Monday. They're not

existing in the world. And exactly

that's why they don't exist here because

this world is a mess. But here's the key

thing that I learned in residency and

and now when I work a lot, here's the

key thing to understand. Being able to

engage in sustained effort is about not

going into the negative. Right? So this

is the problem with people who work

really hard and get burnt out is they

work harder than they have the capacity

to work. That's the key problem. Right?

Is the moment that you dip into reserves

to get something done, you are signing

up for a debt of exhaustion. And this is

where people will say, "But Dr. K, I

don't have a choice. My boss demands

this of me. I have to do it in my

circumstance. I have no choice. I have

no choice. I have no choice." And that

may be true now, right? And this is the

hard thing about this is crafting your

life to where that is not true a year

from now. Being very intentional about,

okay, if I have to do this now, so be

it. But how can I make things better 6

months from now? And this is where there

are people who do this. There are people

who will, you know, job hop every 2

years because that's what optimizes, you

know, income and things like that. But

it's not so much about necessarily

optimizing income. It's about improving

the basic state of your life, right? So

building that sustainability is the

goal. It's I'm not saying that it's easy

to do right this second, but that's what

you should strive for. And put your

effort in a direction that reduces the

burden of your effort, reduces the

demands of your environment over time.

That's hard to do, right? So that's why

like often times the details of your

situation I I mean generally speaking, I

think there isn't generic advice that

works for this. This is where you really

have to understand what your situation

is and try to improve things by 1 to 2%.

move the needle a little bit at a time

and there's all kinds of stuff from

going to bed on time and fixing your

sleep which we by the way have a great

lecture tomorrow on you know so it's

hard to do but I think it's doable and

like this is the hardest thing as a

psychiatrist is see I have so many

patients who don't have power in their

life and I can't like they genuinely

don't have power but just because you

have power today doesn't mean that you

don't have power today doesn't mean that

you won't have power tomorrow and the

hardest thing to do I see this most

often in in people who have are in

abusive relationships is helping them

reclaim the power. I understand that you

don't have a choice in this moment. How

can you get a choice tomorrow?