Living the Real

A conversation with Dr. Abraham Nussbaum about seeing wisely vs seeing much

• Matt Boettger and Dr. Abraham Nussbaum • Episode 12

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A great conversation with Dr. Nussbaum about how the value of human experience hinges on the concept of "seeing wisely" over that of "seeing much." In this episode, you will be encouraged to get out of the shallows of life to experience fulfillment in the deeper end. Bring the floaties!

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[00:00:00] Do you sometimes feel like the people around you aren't really necessarily the best ones for your own personal growth? Have you ever felt a little disconnected from your friends and not even really knowing exactly why you're feeling like you're not quite there present when you're with your friends, do you feel like you're going from one thing to the next whole day long, often feeling at the end of the day, exhausted and not even fulfilled.

[00:00:23] Do you feel a lack of purpose from time to time feeling a little drifting, kind of a sense of drift in your life? And do you feel like this image, this image of quote, shallow water reflects maybe at least part of your life. Like sometimes that's the image you're just treading on shallow water when you could be standing.

[00:00:40] If any of these questions resonate with you, then I know you're going to love my conversation with dr. Abraham Nussbaum. He is going to provide an anchor for you. They'll provide direction and a greater purpose. And give you some tips on how to move toward the more exciting fulfilling, deep end of life.

[00:00:57] So let's get going because [00:01:00] there is some good stuff up ahead. Okay.

[00:01:08] Are we living the most real life possible? I asked myself this question all the time. Most of the time, the answer is I just don't know. Sometimes the answer is definitely not. This is why, how this podcast I'm Matt vodka. And welcome to the show. Before we get started just three small things first, please, please leave a review.

[00:01:26] Were all reviewed. These are accepted like Apple podcasts. It's the main way by which this podcast gets into the hands of other people. Second, please consider supporting living the real through a small. Recurring donation at patrion.com/ltr or a onetime donation through Venmo or PayPal all in the show notes, third and last, please visit  dot com and sign up for my newsletter or you'll get updates on future resources like upcoming blogs, YouTube channels, guest appearances, and exclusive content on my living.

[00:01:56] The real method. Okay. On with the show.

[00:02:04] [00:02:00] Welcome to episode 12 of living the real. My name is Matt  and I am your host today. I have a conversation with dr. Abraham Nussbaum. He is a psychiatrist. He is the chief education officer at Denver health. He studied literature and religion and Swarthmore college completed his medical school and his psychiatry residency at the university of North Carolina.

[00:02:26] This individual is absolutely an expert in his field, but also a profoundly deep thinker. I use his book that post published about three and a half years ago, entitled the finest traditions of my calling one physician search for the renewal of medicine. We use this as kind of a launching pad to discuss this idea that came from a quote.

[00:02:46] You're going to hear about it in just a few moments about this idea of the value you've experienced being pursued by seeing wisely. Rather than seeing much, it is a powerful quote. I'm excited to share my conversation with you with [00:03:00] dr. Nussbaum, Abraham. Thank you so much for taking some time out of your crazy busy day.

[00:03:06] The reason why I'm having you on. So we actually quote met during the lockdown of the pandemic. When we did a previous podcast called pandemic. It was early in April. So we were still kind of in the midst of the lockdown. And taking your view of like, what's going on? How can we like live the most real life possible?

[00:03:22] And there's a couple of things you said at the end of the podcast, really seen crises as a house of virtue and how we can actually, we build that up in our lives. And I want to talk about in the context of this book that you, you wrote three and a half years ago was published and I have to do full disclosure, Abraham, I'm only a third of the way through it, by the time we had this conversation.

[00:03:41] So it is. A great book. It's great. For those of you who maybe have a sensitive stomach, there are a couple of times where you've made some really detailed analysis of your medical school, that I was like eating lunch while I was listening to it. And that was not the best combination at that point in time.

[00:03:56] But I want to use this as a launching pad of how [00:04:00] have you imbibed this in your own life and how can we. Like myself included, be able to practice this in a particular way. So it's called the finest traditions of my Colleen and I love the subtitle one physicians search for the renewal of medicine. And it seems as though there's a particular quote from the dr.

[00:04:19] William also, that seems to be again, I'm only the third way through, so you can talk back about whether this is not, it seems like the anchor of this book and the quote is the value of experience is not in scene much. But in seeing wisely. So two questions I want to throw to you first is what motivated you to write this book?

[00:04:37] And second, how has this quote shaped your life as well? Thanks so much for having me on Matt. I appreciate it. The first third of the book, but even more than the last two thirds of the book where I think I kind of figured out more of how to write it was the first time I had written a book to engage a pocket erotic.

[00:04:55] As you can tell, there were some places where I may have gone a little overboard with the medical details. [00:05:00] but medicine's a physical act. It's this physical act, but sending other people. And so part of it is that you name those material things because they matter. And one thing that's important when thinking about the author quote, the value of experience is not in seeing much wisely, the material situation he was describing.

[00:05:22] I encounter that quote as an inspirational quote on the bulletin board, in a hospital conference room. When people, the kind of place where people would go and kind of give you a pep rally about trying to increase your revenue or decrease your bad patient outcomes, all of which are important things. And people, people put it on the wall mint, right?

[00:05:42] He thought I decided to go back and read the original quote. The original quote is really about this question about an army physician. In Beaumont, there's a middle school named after him in the United States who really discovered how [00:06:00] digestion works and that's important. I don't know how the stomach digests, the things that we consume, but.

[00:06:06] If you think about it in terms of the material ways that he did that he did. So by effectively abducting, a native indigenous Canadians, and keeping him sort of semi hostage for several years as a research subject. And it's important that you think about at what cost is wisdom obtained. And I would say that I think that's a weird example to invoke in contemporary medicine, because I don't think we think that we ought to hold people.

[00:06:35] Especially indigenous people as research subjects in order to obtain wisdom. So you're right. No, actually the original title of the book was seen wisely and it was meant ironically and the publisher wisely was too obscure that it wasn't necessarily a medicine topic. you know, The question of vision and wisdom, [00:07:00] isn't limited to medicine.

[00:07:01] So they pushed me, I think, appropriately towards a more medical title. So the title I picked both from the Hippocratic oath, I would hope that readers could find something to think about it that applied beyond medicine. What it means to see people and what it means to be white reading this, it kind of opened my eyes to name.

[00:07:24] This podcast is living in the real, it's all about trying to just reconsider my own life. And the people lives of how we live the most real life possible. And then reading the first third of your book. And this is not the only place, but it really put an anchor in this that the complexity of even just asking that question.

[00:07:38] Cause you have that, that great beginning. It was great. But you started off with your, I don't know if you were in med school, Abraham, or if it was like your residency, but you started off with this story about, you had some physician who was overseeing you and he sent you off to deal with basically a dying patient in the hospital.

[00:07:56] And you're really kind of juxtaposed the levels are like an onion, the levels of real [00:08:00] and people's lives that they have to address because the physician who I think for him, it seemed like the way you're proposing at least one level is. The real was I got to keep the lights on and there's this kind of pressure too.

[00:08:12] You were saying that if he's 10 minutes in, he makes money. 12 minutes is even 13 minutes. He's, you know, he loses money. This is his reality. And then, but then there is the other sense of the real of the caring of a patient. And just the complexity of asking the question, what is real. Which I'm assuming is kind of part of this whole quest in search of what you were trying to do with this book and, and the conclusions you made of what does it mean to be a real physician and now waiting for a position to a psychiatrist, right?

[00:08:40] Yeah, absolutely. I talked about an experience early in my med school rotations where the internist, who I I'm working with. I had a patient in the emergency department next door, and he asked me to go and inform the family what was going on. and I think one way to think about that, right? Is it that in that old [00:09:00] school version of what it means to be a doctor, what author was talking about was this idea that you threw people into the deep end and they learned through experience.

[00:09:10] But the problem is that that in that metaphor, right? Seeing much part, the deep end is actually other people's lives. And what was hard about it happened there wasn't that it asked a lot of me was that I really asked a lot of the patient's family, that part of why they had a primary care doctor was journey with them through these difficult events.

[00:09:32] And instead they got me somebody more skilled and experienced than me. I didn't know. I was a first year med student, so. But that is the old school way of training doctors that we just say, Hey, go out there, figure it out. And telling somebody that their family members did, probably something that train people and model for them wisely along the [00:10:00] way.

[00:10:00] Unpacking a little bit of this phrase. So come on, learn how you use this idea of not seen much but seen wisely. I see that sense of much. I could get it. It makes sense that that experience is not seen much. I, you know, the, the things that come to my mind, I'm not a doctor, but I'm thinking of I work on the university.

[00:10:16] So I see students and there and there they're in this kind of muchness. It's constantly moving from one podcast to the next. One video to the next gaming. They're frantically moving from one thing and I'm absorbing tons of material on a mate on a shallow end. Almost preventing them to go deeply with anything, including people as a byproduct of this.

[00:10:36] So this is my immediate reaction. I can see this, this other kind of quote, pandemic and the university of Colorado among students. And, but then the interesting juxtaposition is. The opposite is not little, the opposite is seen wisely. And as you've wrestled with this, what does it mean to see wisely? It's a, it's a way more abstracted concept than the word much.

[00:10:58] Yeah. I think people talk [00:11:00] about, I read somewhere and I don't recall where, and I apologize for stealing the idea that in the 19th century, we really built extractive technologies of the earth. you know, taking trees and animals and oil and building wealth that way. And then in the 21st century, the extractive technology is really our attention.

[00:11:18] And we've figured out how to use the neuroscience and the technology devices. We have devices and extract your attention. And so it's become the case that one of the most important things is to think very consciously about what you give your attention to, because what you give your attention to largely reveals what you love.

[00:11:40] And whom you serve and what will be your master. And to the extent that you can, it's important to control that many factors are designed instead to divert you. So you're in Boulder or Boulder area. One book, you know, your interest is in how you live better on some level or [00:12:00] a little bit of real life, but I've really enjoyed it.

[00:12:03] Nicholas cars. Hm, the shallows, have you read that book, but somebody else has recommended it just like a month ago. So it's the second person. So he's, he's based up there in Boulder and it's really cool book about what the Internet's doing to our brain. And sometimes when I'm talking to people about this, I'll talk about how he uses that metaphor of the shallow.

[00:12:24] And so I'll talk about that shallow in that we don't ever get to deep thought. and that other book that I really like, in the vein of the work you're doing is Cal Newport. Yeah. And I think those are two books that I've read together. I thought about, you began this conversation by asking me sort of what prompted me to write this book.

[00:12:46] And there are many answers to that, but one of them is, is that I had a grant and I, and I think people don't. Focus enough about the material events that allow people to do work. And so [00:13:00] halfway through, my time isn't attending here, I got a grant that paid for two years of my labor half time. And so one month I would do my usual job, which is awesome, but distracting, I've seen lots of patients answering lots of emails being in charge of drop off and pick up for the kids with my wife and then the other half of the time.

[00:13:26] I really had an opportunity to read for the first time, since I was a small, like a teenager to read seriously and deeply. and, and it ultimately being a version of the kind of deep work that Cal Newport talks about. Yeah. There's just ways of being in the world and the reading that you forget you have.

[00:13:44]So it really made that possible. I could not have written this book without the materials support of a grant. to be able to just read deeply and reflect on the things that have been done to me and that I do to other people, as a [00:14:00] physician, you mentioned a healthcare turned into a commodity. The first thing that came to is when you treat things as a commodity and this, this hit home for me just personally, not only things, but people as a commodity, then you treat things as if you're solving a problem.

[00:14:13] I think that's kind of the nature you go to because that's the marketing strategy. That's how you get people to like people Google problems and you want to be at the search results. And that's kind of what healthcare has become as a problem solver rather than dealing with the person and in proactive healthcare reform, all these things come together.

[00:14:30] And I totally get that, that sense of in my own life, how I've treated people as commodities and try to be, yeah, it's a great challenge, right. as a psychiatrist, I would say that many of those encounters that we have today are transactional. There's nothing wrong with transactional encounter, if it's the right encounter to have, but the best encounters, the ones that exchange you are relational.

[00:14:54]and you have to know that going in. And one of the great mistakes we've made in medicine today is, is [00:15:00] that we've largely pushed it to a transitional encounter. Some things can be. I personally don't want to have a deep relationship with the person who gives me a flu shot. Honestly, I'm happy to stand in a line at a Walgreens or a King Soopers and get my flu shot.

[00:15:19] But if it's about to talk to somebody about my mood, Big existential questions, whether or not I have cancer or not, or chronic disease of some kind. Yeah. I want a person to look me in the eye and be in the room with me and be some company along the journey. Right. I don't want to, just to be a series of numbers, I get texted.

[00:15:38] So I think the best version of this, right. It's to say, let's do a grid what's transactional in my life and then build those things out of transactional algorithms. Right. That's fine. But some things need to be, you know, I, I have a, I have a car and it needs servicing once in awhile. [00:16:00] That's transactional for me, as it happens for me, I ride my bike.

[00:16:04] And so that actually is more relational. I have a bike mechanic that I have a relationship with that he knows the bike and he knows what I like about the bike. my grocery store is mostly transactional, right? But my meal, the dinner table I have is deeply relational. Right? You talked about my son, but one of the things that you have to do is get kids to see that the dining room table, wherever you eat is a place where you stay even after the meal is over.

[00:16:36] Teenagers sometimes want to say I have the nutrients. Not only I leave the table. No. The important part, I'm not going to just give you like a little pellet with everything in it that you need. We're gonna actually sit here. It's what matters. How do you help people? I mean, clearly it's [00:17:00] not just genetics.

[00:17:01] Get out, have this victim mentality in be able to, you see life in a sense of discovery. There's opportunity to hear like your son. Like that was a perfect example of, I don't know if you remember this story. I don't know how many times you said this. I think it recently happened where it was the lockdown.

[00:17:16] And it was maybe a few days prior, he was let go out of his, he was like grounded or something for something. So three days, and then all of a sudden, a lockdown down happened. He could have just sat there and being like, man, this sucks. And my parents just scripted this and I'm just going to pout until the, until the lockdown is over.

[00:17:33] Instead, he made something of it and it was awesome. He learned how to cook a three course meal. How, how do we get other people to cook three course meals out of, out of difficult times. And right now it's really a struggle. It's a really struggle. I mean, I think my son probably might tell a little story differently.

[00:17:48] Right. Cause he would tell you, how does he, there's the real question is how he's managed to survive as father. But if you want to that example, right? Like how do you get your son to cook three course meal? [00:18:00] Well, he's 16. We've been doing this now for 16 years. First of all, he's a great kid. He's a great person and I'm grateful.

[00:18:07] He's a gift to me, but we've also been doing this for him for a decade plus. Right. And in general, That's the question. So I would tell you that I, when I'm training people about how to do a thing in a psychiatric interview, we talked about their habits, how they relate to other people. So I'll try to talk to them about how to clear their mind before they encounter another person to remember why they're there or the other person's there.

[00:18:33] I'll read them a quote, which I love tension is the rarest and purest form of generosity. And then I'll tell them. Just sit with somebody for a minute or two after you set the stage, let them in silence. I'll read them a quote from Thomas Aquinas Eagle was silent at first. Right. And then I'll say to somebody, if you tell somebody I've got 10 minutes with you, [00:19:00] tell me, I've read about you.

[00:19:01] I've thought about you. Tell me what you think is going on. And then you listen to him for two minutes. There's studies that show that they'll think people will think that you spend much more time with them because of that. All of these things, the flip side is that you'll feel more purposeful and engaged.

[00:19:20] So I try to make it a habit to teach that, but in my personal life, I try to make sure that every day I have at least for one encounter like that one encounter that reminds me that I can attend to somebody else. Hopefully they can attend it back to me. So I guess I would say you just, it's just like every other habit you have to.

[00:19:42] Well, last thing I was, it's important not to just accept that the people you're going to be in a relationship with, or the people within your group, whether that's a racial group or socioeconomic group, a political tribe or religious tribe. [00:20:00] Know, I think one of the most important things is that you be in relationship with people who are not like you in some way that you think is important and substance.

[00:20:08] And if you look at why hospitals, public hospitals exist, for example, it's because people wanted a place where they could encounter the poor, because they believe that the poor could be a pathway to the encounter of the divine. They believed it was important that you met people different than yourself.

[00:20:30] So it's not sufficient to say I'm just going to talk and have relationships with my family. Emily's great is also painful. You need to have relationships with people who will surprise you. That's great. Thank you so much, Amy, for beyond. I don't want to keep you much longer. I just thank you for just sharing some of this valuable content for me and for my own life and hope we can reconnect soon.

[00:20:52] Matt, I wish you the same. I wish there's some time in the deep end and some time in some good relationships. [00:21:00] I hope you enjoyed that conversation. One small thing before we close this episode, I just want to do a quick one minute reflection on this idea of experience that everyone experiences something similarly, but the value is dramatically different from person to person.

[00:21:19] And I really encourage you all to be on the value side of your experience. Not to take the victim and salad, not to take the victim mentality that when we experience life, our first and foremost question, we ask ourselves, especially difficult moments is where is the gift in this? What does this make possible?

[00:21:40] So I encourage you this week to discover, do not determine life and the people around you. See you all next episode. Bye bye. Thank you for listening to this episode of living the real. If you want to check out more information, go to living the real.com and sign up for my newsletter. If you want to support this podcast, you do that at [00:22:00] patrion.com/ltr as well as one time.

[00:22:04] Payments at Venmo and PayPal in the show notes. See you all next episode. Take care. Bye bye.