There's a group of people who has a big

problem which is that the signal that

they have their experience of things is

actually an absence of signals. So I

don't feel anything and then that

creates a very very special problem

because if you don't feel anything how

do you know what you're supposed to

correct? And so today what we're going

to talk about is sort of a differential

diagnosis. This is not medical

treatment. This is not actually a

diagnosible condition of numbness. So if

you feel numb, why, right? What are the

different reasons that you could be

feeling numb? And in order to do that,

what we have to do is look at the

systems of feeling. Because if you want

to understand why you feel numb, the

first place to start is to look at where

feeling comes from. And if we understand

where feeling comes from and what kinds

of feelings are developed by what

systems then we may even be able to

diagnose our numbness because not all

numbness is the same. We can think about

numbness across a person. And what do I

mean by across? So we can look at

numbness from the perspective of

neurotransmitters. We can look at the uh

perspective of numbness across circuits.

We can look at numbness as emergent

neurossychiatric

phenomenon. Now what does that mean?

What the hell does that mean? Right? So

emotional blunting associated with SSRI

induced em sex sexual dysfunction. Do

SSRIs inhibit emotional responses? So

this paper looks at serotonin and we

know that one of the side effects of

SSRIs is that people feel emotionally

numb. Some people argue that actually

that's the only benefit of SSRIs is that

they numb us. Right? So their

fundamental thing they don't improve our

mood. What they do is numb our negative

mood. So if we look at SSRI induced

emotional numbness, this is at the level

of neurotransmitter 5HT is serotonin.

Then if we look at numbness across

another level, we can look at something

like our lyic system. So let's just say

our amygdala. And if we feel numb that

something is suppressing our amygdala.

So either we have a substance or we

using social media or things like that.

But then there are higher order levels

of numbness. So if we talk about

something like dissociation is a good

example. Alexia. So alexathyia is

emotional color blindness. So it's not

that we're numb, it's that we're color

blind. So we see a color, right? And I

know this sounds kind of weird, but like

if you're color blind, can you see

color? Like sort of, right? You can't

technically see color, but you can see

shades of gray. So, like, does that kind

of make sense? It's not the same as

being completely blind. It's that

there's a certain level of perception

that we lack. And then we've got

psychology.

So, this is the mind. So, things like

defense mechanisms like suppression. So,

when I sit with people and they they

come into my office and they say, "I

feel dead inside. I feel numb." I think

about all of these dimensions. And the

problem here is that if you're asking,

"Okay, Dr. Okay, which one is it? The

answer is all. Right? So, an individual

person may have this and another

individual person may have this

where the majority of their numbness

comes from a psychological defense

mechanism, but they are also a little

bit alexathyic and they happen to be on

an SSRI. When people hear about our

coaching program, their first response

is usually, "Why would I work with

another human being when I can watch

YouTube videos all on my own?" Working

with a coach is about amplifying your

time and effort. We're great at wanting

things and even making some progress,

but we usually struggle with followrough

or have some kind of setback. And that's

exactly where working with a coach can

help. Coaches provide personalized

support to help you set appropriate

goals, make progress, and even work

through setbacks. Just let us know what

your goals are, what kind of support

you're looking for, and we'll match you

with the best coach for your unique

needs. Check out the link in the

description below to see if coaching is

right for you. The good news is if we

can understand what kind of numbness you

have, then we may discover a way to

start feeling again. Okay, so let's

start with neur uh neurotransmitters.

We're going to start with 5HT,

serotonin. So like we looked at earlier

there's a you know there's a paper that

shows so patients reported significantly

less ability to cry irritation care

about others feelings sadness erotic

dreaming creativity surprise anger

expression of their feelings worry over

things or situations sexual pleasure and

interest in sex right so this implies

there is numbness so let's understand a

little bit about how serotonin works so

serotonin tends to be associated with

mood when we see dysfunctions

in the serotonin

system will have problems like anxiety

and depression. So let's examine this

for a moment. So there are polymorphisms

of serotonin receptors. So we have

genes, right? And then some people will

have a green over here, some people will

have a red over here. This is what we

call polymorphisms. So there are some

people who their serotonin transporters

are short. And when they have short

serotonin transporters, their risk for

things like depression and anxiety go

up. So we know that the serotonin system

is associated with mood, depression,

anxiety. Now, here's the really

interesting thing. The serotonin system,

cuz everything is connected in the

brain, is connected with our

dopamineergic system and our

norepinephrine system. So sometimes when

we increase serotonin transmission, we

will see a paradoxical decrease in these

two systems. So the dopamineergic system

especially in the VTA or nucleus

ccumbent is associated with pleasure and

reward and the norepinephrine system is

associated with arousal. So if you look

at for example a medication called

bupropriion this is a also affects the

norepinephrine system. So when people

have SSRI induced sexual dysfunction

induced numbness, we will oftentimes add

bupropri because this kind of boosts

this up. Okay. So the SSRI increases our

5HT which in turn decreases our

norepinephrine transmission which in in

turn decreases the sense of arousal. And

I we don't just mean sexual arousal.

People feel sluggish. It's a wakefulness

too. And then what we'll do is we'll add

a little bit of bupropriion which bumps

this up and then hopefully bumps this up

and it can deal with the side effects of

an SSRI. So one system of numbness is

potentially the serotonin system. Now

there's another really interesting kind

of example of this which is that when

people are depressed they become

anhidonic. So we're not quite sure how

this works. Um but there's some degree

of anhidonia, inability to experience

pleasure and this is probably mediated

by dopamine in some way. Right? So if

our if our dopamineergic system is

messed up then we become anhidonic.

Another good example of this is this is

why sometimes people who are depressed

become vulnerable to addictions. So

let's think about this. Okay. So if my

serotonin levels are low, which it's not

clear that they are in depression to

begin with, right? Then I can have an

increased dopamine sensitivity.

I feel crappy, so I'm going to eat a

bucket of ice cream. It's going to give

me some some sense of pleasure, some

sense of of joy, right? It's going to

give me something. And then this is

where if we look at happiness and

pleasure, there's something called

hydonic pleasure and there's something

called udemonic pleasure. Not really

udemonic pleasure, udemonia. So this is

udeand udemonia.

This is sort of a sense of contentment,

peace, arguably mediated by serotonin.

And hideonic is mediated actually by

endockinabonoid

and dopamine. So if you're numb could

have something to do with 5HT. Okay. Now

you may say, "But Dr. K, if it has

something to do with 5HT, what do I do

about that?" We'll get to that. Second

thing, let's talk about dopamine because

we're already here. So when we're

talking about numbness, there is a

numbness that is an absence of negative

feeling and there is a numbness that is

lack of pleasure. So when you have a

problem with your dopamineergic system,

often times these people don't feel

excited by anything. They don't feel

drawn to anything. They start to feel

apathetic, like they don't care. Now I I

want to be clear about what this kind of

is and what this isn't. So this is like

I get up in the morning and everything

just kind of feels blasze. They may

actually have access to some degree of

curiosity. They can have some degree of

pride. They can even have some degree of

sadness. But what's missing is sort of

like the spark that gets you going.

These people have no spark in their

life. So this paper really explores, you

know, effortbased decisionm to obtain

rewards. So we're going to talk about

this for a second. Okay. So our

dopamineergic system gives us pleasure,

gives us motivation, gives us craving.

This kind of numbness is an absence of

like wanting things in the outside

world. We have this thing in here. It's

not that I'm incapable of feeling in

here. It's that if we look at like us,

right? We like we like want stuff from

the outside and it motivates us. So even

if you look at that motivation, we think

about motivation as a good thing. But if

you look at it subjectively, that

motivation can be the desire to get rid

of something bad. I'm tired of feeling

this way. I want people to look at me

with respect. I want to walk into a room

and have everybody be impressed like

zest

of life. And when our dopamineergic

system gets impacted, right? So what are

the ways that we impact it? Num top of

the list right now is technology. So we

have this whole scale bombardment of our

dopamineergic system. And then the

problem with our dopamineergic system,

remember y'all, is that our

dopamineergic system is like a lemon

that gets squeezed. So our dopamine

system is full of dopamine. And when it

gets squeezed, the dopamine kind of

comes out and then there's not a whole

lot left. So when we chronically use

technology, we exhaust our dopamine

system. And once the dopamine is gone,

this is what gives us pleasure. It's

what gives us drive, motivation.

And then there are a couple of other

things that go into this. There are

things that can increase the squeeze in

your dopamineergic system. And I I I

want you all to pay attention to this.

There's a component that is anhidonic.

This means I can't feel pleasure. And

then there's a component that is

apathetic, which means I don't feel like

doing anything. I'm not motivated. So if

we look at the hydonic impact this is

the pleasure of engaging with something

right that's anhidonia hyonia anhidonia

but apathy is triggered by other things

see if you feel apathetic you may think

okay I can't experience pleasure that's

why I'm apathetic because these things

get tied together right if I don't

experience pleasure then I don't feel

like doing anything but apathy the

desire to do something isn't necessarily

tied to hedenism I know they're separate

and I'll explain Cuz sometimes you don't

feel like doing anything, but when you

go and you actually do it, you're like,

"Hey, you know what? This is actually

pretty fun. I should do this more." That

signals to us that our system of

motivation generation is impaired. But

our system of hedonism, our system to

experience pleasure is actually intact.

So if you've ever had the experience of

I don't feel like doing anything, but

when I do it, it actually turns out to

be pretty fun. That shows us that it's a

motivational problem. not a hydonic

problem. And the cool thing about nature

reviews is that they actually give us

some guidance here about what we can do

about this. So one key thing is option

generation. So if you give human beings

options, they are more likely to act,

right? So a really good example of this

is, you know, when when you're when you

have a young kid, pediatricians will do,

you know, some counseling for new

parents and they'll say like, "Okay, if

you're having your tr trouble getting

your kid out of the house, ask them

which one they want to do first. Do you

want to put on your jacket first or do

you want to put on your shoes first?

Human beings are more likely to engage

in behaviors if we give them options.

So, dating apps figured this out.

Grocery stores figured this out. If we

give people options, they're more likely

to do stuff. Now, what do we see in

today's world? A whole scale perception

of a lack of options. You may say, "Hold

on a second, doctor. Didn't you just say

dating apps and Amazon and grocery

stores give us tons of options?" Yeah,

but you don't feel like you have options

in life. You have to go to work every

day. Oh my god, I have to deal with this

person at work. Oh my god, I have to

deal with customers at work. Oh my god.

And it's so simple. This is why it's so

easy to shop online, but so hard to go

to work because you don't have a

perception of options. So literally part

of the work that I I do with people,

this is a huge part of of what coaching

has also figured out as a field is we

want to give people options, right? So

in motivational interviewing we'll sort

of when someone is developing a plan for

sobriety we don't tell them hey you got

to go to meetings and you got to do this

and you got to do this and people don't

listen instead we ask them where do you

want to start would going to meetings

work better do you want to do

psychotherapy with me do you want to try

medication let's give people options

because people like options so if you

are finding yourself in a situation

where you don't feel like doing anything

ask yourself what your options really

are second thing that we want to do is a

costbenefit analysis.

Reward, effort, time, and risk. We want

to evaluate our options. And here's the

really tricky thing from a psychological

perspective. Y'all may think that you do

this, but you don't. Y'all may think you

do this, but you don't. What are your

options at work? Ah, there's nothing I

can do. What are your options? Oh my

god, I guess I could do this, and I

could do this, but the chances of that

working out may be low. Here's the

biggest problem. I could put in all of

this effort, but there's not any

guarantee that I'll get something in

return. So, this is where you have to be

a little bit more critical about your

option generation. This is why sometimes

it works to help with a person. There

are a lot of people that I know that

think that they are very very good at

option generation and option evaluation,

but if you really pay attention, what

goes on is their mind like doesn't

critically think about it. It's actually

an emotional response. And then the

other big thing that we're going to talk

about is the hydonic impact and

consumatory phase of behavior. So often

times people make a huge huge huge

mistake when they are doing something

that they don't like which is that they

try to skip the experience. So savoring

is a huge part of increasing your

hydonic activation which will then

reinforce the behavior. And oftentimes

if people are numb, what happens when

they don't feel like doing something is

even when they do it, they try to skip

the experience. You numb yourself out to

it. Oh, I don't want to do the dishes.

Let me put on a podcast so that I don't

have to suffer through doing the dishes.

I don't want to be on this flight. Let

me skip past the suffering. So, you guys

see how there's a subtle numbness there.

There's a there's a suppression of what

you experience because we're trying to

avoid those negative feelings. But when

we suppress all of that stuff, what we

are doing is we are not helping

ourselves with this system. So think

about the kinds of things that you run

away from in your life, the experiences

that you run away from. And often times

what we discover is people who are

avoidant of the negative things in their

life, the people who mentally check out

when their boss says, "Hey, can I talk

to you for a minute?" You're mentally

checked out before you even go in. And

then we wonder why we're numb. So if

you're mentally checking out through a

lot of your day, your brain will be

mentally checked out. Which is why when

I work with someone, right, like this is

why we like ask you so much about your

feelings, bro. Let's get how does how do

you feel about that? How does that make

you feel? We're encouraging the

awakening of these circuits.