Dr. Andrew Weil
Hi, Victoria.

Dr. Victoria Maizes
Today we have a very interesting integrative family physician, Tanmeet Sethi. She is a medical doctor who helps her patients find joy even in the most difficult of circumstances.

Dr. Andrew Weil
And I understand she also is a practitioner enthusiast for psychedelic medicine.

Dr. Victoria Maizes
Well, let's get her on.

Dr. Victoria Maizes
Dr. Tanmeet Sethi is an integrative family physician and a clinical associate professor at the University of Washington. She is an activist, the author of Joy Is My Justice, and a TED Speaker. Tanmeet has dedicated herself to caring for marginalized patients in Seattle's refugee, uninsured and homeless populations, as well as in global communities traumatized by manmade and natural disasters. Welcome Tanmeet.

Dr. Tanmeet Sethi
Thank you, Victoria. Hi, Andy. It's so good to be here.

Dr. Victoria Maizes
Well, we're excited to have this conversation with you. And I want to start with your book. You wrote, “You are not broken the systems that we live in are… joy is an innate human right, accessible to all, regardless of our financial status, race, or gender.” Can you please expand on that idea of joy as an innate human right?

Dr. Tanmeet Sethi
Well, I think what really I'm going at with that is this idea that joy is accessible to all of us and that our mental health conversation does not always imply that we talk about happiness as a construct and the hacks to happiness and what you can do to be happier and happiness is beautiful. I take it any day of the week. But joy is different. Joy is an embodied experience, not a cognitive construct. It actually stems from the same deep well as our capacity for pain, as our capacity for love, meaning connection and joy actually is something that's accessible to all of us, even in or after trauma, suffering or through oppression. Whereas the constructs of our life are not always happy. And yet the the problem I see in my mental health practice with patients and with myself, I will add, is that if you are not happy because your constructs are not happy, you feel broken, that you're not able to be good enough or feel good enough or be resilient enough. But the truth is, we all can access joy. It was always in us and we all can have it. No one can take it away.

Dr. Andrew Weil
How often are we supposed to feel it?

Dr. Tanmeet Sethi
Yeah. You know, this is the this is the thing, Andy, I think, is that a lot of people confuse Joy with feeling happy all the time. Right. So people will say, Well, how can I feel, joy, if I'm sad or I'm grieving or I'm such… And what I would offer as a construct is that joy is actually the ability to sit with all that life has given us.

And it is a sense of being open and alive to our life and not trying to escape it, turn away from it, distract ourselves from it. That doesn't always feel good, but it's what I like to give a comparison to people is I think it's a same way that we can be at a funeral and be deeply grieving someone we love and in the same moment, laugh with others about that person, about some memory of them, or how they irritated us or, you know, and that joy and pain live so close to each other.

And I think when we numb ourselves to our pain, we also numb ourselves to our joy.

Dr. Victoria Maizes
And you've written about this as well in spontaneous happiness. You wrote ceaseless joy is neither possible nor desirable. It's normal for moods to vary, but your ups and downs should balance each other. And then you basically say the goal should be things like serenity, calm, a sense of contentment. So how do you balance that with what Tanmeet just said?

Dr. Andrew Weil
Well, first of all, in that book, I said that happiness is not something to strive for. The word happy comes from an old Norse root for or fortune. And if you pin your high emotions on external circumstances, you're bound to be disappointed. And I think a much better thing to aim for is contentment, which is an inner sense of fulfillment and evenness, you know, rather than a temporary up. So I think that's the goal of many meditation practices and various philosophies that we like to be attain more contentment. If in the course of that you have moments of joy, I think that's terrific.

Dr. Victoria Maizes
Joy is, I think, a stronger word than contentment. And Todd Mead, you actually say that it can be a practice. So how do we practice so that we have more joy in our life as opposed to dependent on luck?

Dr. Tanmeet Sethi
Yeah. Yeah. Well, actually, this is a lot of Andy, this will resonate with a lot of what we learned in our fellowship as well joy practice actually stems from a sense of how we regulate our nervous systems as well. So it's really about finding some sense of safety and ease and calm in our body again.

And that's what I would really offer, as Andy was saying, happiness is this luck or fortune? It's it's cognitive evaluation. Whereas if we can really get into our body and feel our breath, feel movement, feel different practices in our body, we actually can practice joy because actually there are ways when we calm and regulate our nervous system, where we're actually giving our body and our minds the message, “You're okay. You're safe right now.” Even if the world doesn't feel safe or if life isn't completely okay. You're okay right now in this moment, I'm giving you this moment of nurturing. I'm giving myself that moment. And so there is a way that we practice that through our nervous system. There's also other many tools I talk about in the book, such as gratitude or self-compassion, where What we're doing in the neuroscience has caught up to show how this works in our body and our brain, But we're really giving ourselves that companionship, that nurturing, that looking for the good in us and the good in the world, even when life is not good.

Dr. Victoria Maizes
So I would have to say one of the ways that I experience joy is dancing. And I for many years now, since my children grew up, interestingly enough, have taken dance classes. And I am aware when I'm in these classes that I'm often smiling and I'm often really feeling joyous. So I would say that's a practice for me. And I'm wondering for for both of you, do you have a personal joy practice or Andy I can I just can imagine your dogs might be part of it.

Dr. Andrew Weil
Dogs are part of it. Also plants and flowers and producing them. They give me much joy. I'd say cooking also. And I think of joyful experience a lot in the company of others, you know, with getting together with friends and laughing and telling stories and whatever. Doing things together.

Dr. Tanmeet Sethi
Mm hmm. Yeah. And for me, actually, Victoria, dancing is my number one, so it is the fastest way I can move my body and my mind to somewhere else. There's no doubt in the data and the neuroscience, the researchers even show that as we contract our muscles with any movements, we produce anti-inflammatory cytokines and they call them hope molecules. You know, and I actually think that's so empowering to think that, you know, we can feel down, we can feel sad and we can move our body and create hope that there might be another moment lying ahead of us. And so, you know, movement is a really, really big one for me. My children joke that they say that my most joyful place would be if I were swimming in a warm ocean while I was cooking and dancing.

Dr. Victoria Maizes
All right. So dancing and that's a more globally movement is number one. What's number two, three, four and five.

Dr. Andrew Weil
I would say laughter, especially laughter in the company of others brings me great joy. Music also, and singing, which I don't get to do as much as I used to. But singing with a group brings me great joy.

Dr. Tanmeet Sethi
Oh, that's really cool. And, you know, I think what's interesting, Andy, is that every one of the things that we've all named so far really are about connection, right? And their connection to people, to loved ones, to nature, to food, to this world around us. And, you know, there's this sense that all these practices connect us deeper to others and to ourselves and to help us find a sense of belonging in the world.

So it's really there's commonality in all of it for me to three, four and five would be things like breath is actually really big for me. I'm actually quite an anxious person, you know, that's my inclination is to get anxious and think that maybe something bad will happen. And so I really use my breath often to really bring myself into a different place in my body.

And I think metaphorically, the breath helps me remember that every moment is a new moment. I can start over. This breath is new and so is this moment. Every moment doesn't have to be just like the last one. And then gratitude is very, very big for me. You know, I used to poo poopoo gratitude. I'll be honest.

It's gotten bad PR, but it's kind of taken as this like, you know, contrived kind of false positivity, kind of too soft, as people will say. And what I will tell you is that, with my son's disease and my for those listening don't know I have a child with a fatal illness and gratitude was really one of the biggest ways that I found healing and joy through this really daily tragedy that I face. So gratitude helped me understand that that is how you turn towards your life when you say thank you or appreciate what is in front of you rather than what you wish you had all of a sudden you're looking at your life and living your life instead of wanting it to be different.

So gratitude really helped me reclaim power and joy and feel like the the sadness that was stripped and the power that was stripped with this disease gave it back to me. So I really gratitude is very big for me too.

Dr. Victoria Maizes
I with all respect for what you just shared on me, I'm going to just say that in some ways, the three of us are privileged. You know, we're all physicians and we maybe haven't struggled the way some people struggle. And so I'm wondering how does this relate to the work you do with people who have faced trauma or people who are homeless?

Because it feels easy for me to talk about dancing, or gratitude, breathwork, cooking with friends. But obviously that may not be so accessible to others. So can you talk about how this has informed your work with people who have less resource?

Dr. Tanmeet Sethi
Yeah, actually this is one of the biggest things for me is that joy has become part of my activism work, whereas it used to be separate and I used to feel that way. Victoria, where I felt like my activism could not have joy linked to it because then I wouldn't be I would be not suffering with the people or I would be having too good a life or, you know, frivolously joyful is how it felt. And I now understand that all systems of oppression work to strip us of our power and our humanity. And when we can reclaim joy in our bodies and in our lives in any way that is our capacity will allow us to whatever that means for us, any time we can do that, we are reclaiming who we are and our humanity in that moment, and we have reclaimed some power.

And so now I am understanding actually it through my son's illness, thinking that there was no way I could have joy again, that once I really started committing to these practices, I realized that actually I was healing wounds of racism and oppression from long ago. And now I really work at sort of working with people in terms of liberation.

That joy is actually liberating. It's actually not only possible through trauma, it's almost necessary to reclaim any moments of ease, joy or hope that you can.

Dr. Andrew Weil
When you refer to people who have suffered trauma, my impression is and experience is that everyone has trauma in their past in one form or another. That's just what I have found.

Dr. Victoria Maizes
Yeah, I wouldn't disagree. One of the things that I have felt in my life is that great suffering has expanded my capacity for joy. It's almost like because I know what the deeper downside is I know like the range of going down into sorrow and suffering. I can go up higher because I'm so much more appreciative when something joyous occurs.

Dr. Andrew Weil
Yeah, in Spontaneous Happiness. I used the metaphor of a seesaw, you know, to to look at the way our moods work and the downs equal the ups. And, you can go so far down. You don't want to get stuck though, at the bottom. You're probably not at the top either.

Dr. Tanmeet Sethi
Yeah, yeah, exactly. I really resonate with that. I think that also there's a way in which, you know, people will say, well, on a day where I'm so depressed or if you're so depressed or how you're feeling, how, why would gratitude even be useful and or how would you find it? And some days I tell them, some days I think I only have gratitude that I'm crying and then I'm still feeling, you know, that that I'm still feeling is means that I'm still here.

I've still not lost my humanity and my capacity to be alive. Now I know that that there is this tenuous balance, as Andy is referring to, about getting stuck in that too much. And, you know, how do you keep this going? And that's where these practices really keep you in the seesaw of life. But there is no way to evade pain is the real truth of life. There is no way. And when we know what we're feeling, when we're acknowledging it, when we know how we are feeling and can express that we are still here, we have not lost our humanity.

Dr. Victoria Maizes
So I want to give you a chance to talk about this because it's so important just a little bit more. And one of the things that you wrote is you can't positively think your way out of poverty, dangerous situations or oppression When others tell you to look on the bright side and you're unable or unwilling to do so this feels toxic because it is your nervous system is hyper vigilant of pain, loss and the attempts of others to dismiss it. So I just really want to give you that chance because of course there is the kind of new age-y message that you can just, you know, put a happy face on it and then it's all okay.

Dr. Tanmeet Sethi
Yeah, yeah. You know, there's actually science to show that when we try to suppress our own emotions, we not only just regulate our nervous systems, we just regulate others around us. That we actually raise blood pressure of people around us. And there's the same thing happening when people try to dismiss your emotions and say, Just be happy or look on the bright side, then we actually are having our nervous system is further incited by feeling invisible or not seen, I think is really important to understand this delicate balance.

I am sure you've both maybe, I mean, I think everyone is experienced this. I sure have. Where people will tell me, you know, particularly in relation to my son, they will say, well, at least you have two other healthy children.

Dr. Victoria Maizes
Yeah.

Dr. Tanmeet Sethi
As if that is supposed to make it okay. And actually, it feels so dismissive. It feels so hard to hear right. And or I you know, I don't I'm so glad you're strong enough to manage this as if, this was some race for spiritual strength of capacity when I'm just trying to be a human right, I'm not superhuman.

So there's this way that if people can understand where we actually can say something like, I love you, I don't know how this pain feels, but I'm willing to sit here with you in it. I want to be here for you, and I will figure out what way that would look best as we go on. All of that is still acknowledging people's pain and knowing they have to be where they are, but supporting them through it.

There is a difference between, hey, you know, just think about something good. You'll feel better. I mean, if somebody doesn't want you at that moment or if they can't, that is very harmful, I think.

Dr. Victoria Maizes
I'm glad you gave some examples of better things to say because I think a lot of people struggle with this, like what is the right thing to say? And then sometimes people retreat and they they feel so unable to know how to be supportive, so unable how to stay in a circle. And it happens all the time. For example, when someone becomes ill with cancer, when someone has a death in their family and some people just for whatever reason, maybe we're not teaching this well enough in our society, don't know how to show up as just showing up as either witness or companion, knowing there are no right words.

Dr. Tanmeet Sethi
Yes. And actually,I had family members as well as good friends, not call me for a year or two after this diagnosis was really hurtful, And and until it wasn't until I had some sort of sense of how I was going to thrive through this, that I could approach them and say, you know, that really hurt me.

Why didn't you call me? Why didn't you come? And they all said the same thing. I didn't know what to say, exactly what you're saying. And, you know, I have empathy for that. But I also told them, I said, you know, you say, I love you. You say that I'm here for you. That's all you have to say.

But you should say something. And and actually, I don't know if you remember Victoria in the book. I actually even say that people tell me that this is one that I think a lot of people say, and it comes from such a beautiful place, but people say, I can't imagine what you're going through. And I think that's true.

None of us can step into someone else's shoes. I think that's true. And yet I think that there's some way that we could understand that imagination is a bridge of justice. It's a bridge of connection. So when I have the strength and the energy, when someone says that to me, I will say back to them, I really wish you would imagine what it feels like for me because you'll know your own pain better.

Imagination is how we will all connect at a deeper level. And so there are even ways that we that we say good things that I think we could even say things that are more helpful. Because when someone says, I can't imagine how you're doing this, it just makes me feel excluded, makes me dizzy.

Dr. Victoria Maizes
Disconnection instead of compassion.

Dr. Tanmeet Sethi
I don't feel connected at all.

Dr. Victoria Maizes
I do want to tell our listeners that if you haven't had a chance to look at Tanmeet’s book, Joy is My Justice. It's a beautiful book, and in it Tanmeet does share the journey she has had with her son. But it's so much bigger than that. And there is so much that we can all learn from it.

And you're a wonderful storyteller, and so thank you for writing it. I want to change topics, though. Yeah, I just recently became aware that you are working with ketamine with health care professionals, and I'd love for you to tell us a little bit about what led you down that path and what you're learning.

Dr. Tanmeet Sethi
Well, psychedelic medicine actually feels full circle for me. It feels like all of my integrative medicine plant work, spiritual work within trauma work, integrative mental health. I've been doing a lot of complex mental health in the population. I've been caring for managing complex addiction and mental health conditions, all of that coming full circle with my social justice work really felt like it was just so full circle and right that I pursued certification.

And then I'm one of the main researchers on a psilocybin trial at the University of Washington for frontline medical workers, docs and nurses who are burnt out from COVID from the pandemic and caring for patients. And so that's really where I started. And now I'm using ketamine in clinical practice and running groups for health care professionals for burnout as well.

There was a recent study with ketamine in health care professionals and burnout that was really, really quite reassuring and hopeful. And so that's where I've moved into, Yeah, with my integrative work. I mean, I'm doing integrative medicine and to me it's all together, it's all the same. But yeah, so I've just been doing that for the last few years and it's really been fulfilling, it feels actually, and I hear you talk about psychedelic medicine all the time and I know you've been in this field forever.

I'm just coming into it in the last few years, but it feels so hopeful. I don't think it's the cure all for everything. I think there's a lot of hype around it, but I do think there's a lot of hope for a lot of mental health conditions that we have been throwing, you know, medications, other kinds of medications that for a long time.

Dr. Andrew Weil
Now, I couldn't agree more. And I think I just read that there is legislation in the House that just happened, you know, which may make psychedelics available therapeutically, you know, long overdue, by the way. I don't consider ketamine a psychedelic. It's not a psychedelic chemically or pharmacologically or experientially. It travels with them and I think it has its uses but I think mostly now it's functioning as a placeholder, until psilocybin especially becomes available. MDMA, you know, that's got to be happening very soon.

Dr. Tanmeet Sethi
Yeah, I think in the next couple of years I'm hopeful.

Dr. Andrew Weil
Yeah. Yeah.

Dr. Victoria Maizes
So tell me, you studied psilocybin, which is understandable because psilocybin at this point is only legal within the context of a study or a few places where it's been decriminalized. But you're using ketamine in practice. What are you noticing in terms of the difference between using the source I've been with in a research study versus having access to legal ketamine?

Dr. Tanmeet Sethi
Yeah, well, I agree with what Andy's saying. And then I also would put an end to that, which is that there's still a way that it is still altered state work. And so there is some real commonality there.[VIDEO 3] I kind of thought ketamine would be only a placeholder until I was able to access psilocybin and MDMA, which I studied in my certification and working in academics. But I have been profoundly impressed. Really? Honestly.

Dr. Andrew Weil
Really? Okay.

Dr. Tanmeet Sethi
Yeah.  I'm impressed with how well it works, how people have been having big shifts. I think it's more that there are people who just have never done altered state work that are finding ways of new insight perspective. There's also some interesting pharmacokinetics around ketamine, around BDNF and ketamine. And so really, really hopeful studies around the neuroplasticity potential of ketamine.

And so I don't know that I will stop using ketamine even after they're there accessible only because it allows a variety of choices. First of all, of which one is right for who? But also there's a sustainability aspect of ketamine being much shorter, acting and being able to, you know, actually offer it psilocybin. You know, I spend all day with a patient in research trials in psilocybin, which is somewhat not sustainable in our health care system.

So that's the social justice aspect that I'd like to work on, how to make it accessible. But I am actually profoundly impressed with ketamine, and so I hope that I'll still be using it, but we'll see.

Dr. Victoria Maizes
For our listeners BDNF just let them know.

Dr. Tanmeet Sethi
Yeah, sorry. Brain derived neurotrophic factor, which is a chemical that we neurochemical, that we make ourselves in our brain, but things stimulated and stimulated by exercise, by certain meditative strands transit states by curcumin by many things, but it is definitely stimulated by ketamine, and it has quite the potential for neuroplasticity.

Dr. Andrew Weil
What I found I find very impressive about the research on psilocybin especially, is that a single dose, a single session can produce very long lasting effects with depression, for example. And I don't hear that about ketamine. I often hear that the effects are short, lasting, and it requires frequent treatment. The other comment I would make is the compound that I'm finding most interesting these days is 5MO EMD.
And in terms of convenience, you know that is a 15 minute experience, definitely only profound. So that's one I hope, you know, will get more play and become more available.

Dr. Tanmeet Sethi
Yeah, I agree with that. And I do think psylocibin is more durable for sure than ketamine. And I think, you know, it's so funny because you hear all the naysayers about any of them saying, yeah, well, you know, somebody would have to use it again. I say, Well, we are giving people daily medications.

Dr. Andrew Weil
Exactly.

Dr. Victoria Maizes
Yeah. Okay. Well, I made earlier on you talked about your role as an integrative physician and you spanned from dance to plant medicine, integrative mental health, psychedelics. How do psychedelics and joy connect in your current thinking about your work?

Dr. Tanmeet Sethi
I find I have found so far is that they are a catalyst, that they are a catalyst for people to find new perspective in, in particular on their life situation, on their history, on their pain, on their trauma, and actually it can be a catalyst to do the practice as we're talking about, to actually be motivated to find new ways to manage whatever it is that they're managing in their life, whether it be mental health or grieving or so forth, burnout.

And so I think that, you know, there's just, you know, people will say this all the time. They'll come out of a psilocybin session or even a ketamine and say, I feel like I just did ten years of therapy and, you know, this one session. And I think that's that's a true feeling. I resonate with that with my experience as well.

And it feels as if there's just a way to shift on a deeper level. And so I think that there's also in the integration phase, after a psychedelic journey, there is so much, as we said, neuroplasticity to to be motivated to make behavior change, to say, I'll try this new meditation practice, I'll try this new, gratitude practice.

And so I think they are just such an important tool in the work around well-being and joy.

Dr. Andrew Weil
Tanmeet, I have an off the wall question for you. I came across a diagnosis in traditional Chinese medicine of excessive joy, and that's considered a pathological condition. What would you say about that?

Dr. Tanmeet Sethi
Well, don't you think it's a little bit I've actually seen that. Don't you think it's akin to mania?

Dr. Andrew Weil
Yes, I do.

Dr. Tanmeet Sethi
Yeah, I do in our West. And I do think that's true, right? I mean, I think that there's a way then when we're in that state of excessive joy or as we say, mania, we can be impulsive.

Dr. Andrew Weil
It's excitement.

Dr. Tanmeet Sethi
Yeah. And I think that there is this danger of being too far on one side for sure. And so I think that they it just shows how smart and wise these ancient systems are. Right. That they do this all before we are labeled ICD ten codes to them.


Dr. Andrew Weil
And the importance of balance.

Dr. Tanmeet Sethi
Yes. Yes, exactly. I agree.

Dr. Victoria Maizes
Well, this has been just a wonderful conversation, and I'm so grateful to you, Tanmeet for sharing your rich experience. I'm just wondering if you have a question for Andy or for me that you'd like to ask.

Dr. Tanmeet Sethi
Yeah, you know, I well, first of all, I want to thank you for having this is just such a beautiful thing to be with two of my mentors for whom, you know, really, we're at the beginning of all this for me in terms of my integrative medicine training and what I've done with integrative medicine in academics and onward.

Dr. Tanmeet Sethi
And so it feels really potent and so grateful to be here. I am wondering what you two think are the really most exciting or hopeful things happening right now in integrative medicine? I mean, what are you most hopeful for in terms of either where the field can go in academics or what is happening within the clinical aspect? I'm just wondering where you are with that.

Dr. Victoria Maizes
Well, one thing I'm so proud that our center is doing is we're really training very large numbers of health care professionals at this point and the full range of health care professionals. And if anyone is listening who is in academia, we have a 200-hour curriculum that's called Integrative Medicine in Residency. It embeds into existing residencies and we have 116 residencies across the country in a wide range of specialties family medicine, internal medicine, pediatrics, psychiatry, physical medicine, rehabilitation, OBGYN, and soon emergency medicine and this means that people are getting integrative medicine training as part of their foundational training as physicians. So I think that's so hopeful. The second thing I'm going to say is that I do think we're on the cusp of very important I'll use your word, potent paradigm shifting therapies. So whether that's psychedelics which are clearly coming, whether it's being able to change the microbiome in ways that make diseases really go away, whether it's understanding energy.

So these things that stimulate the vagus nerve or microcurrent that help people with pain, you know, these were things that people completely disregarded. You know, the gut meant nothing, electricity meant nothing. And, psychedelics were only evil. So here we are with these really revolutionary new therapeutics that I think are going to radically change the way we practice medicine.

Dr. Andrew Weil
And, you know, I've always said that one day we'll be able to drop the word integrative. It'll just be good medicine. Our health care system is in such disarray, it may totally collapse. And what we're doing has to be the foundation of a new system.

Dr. Tanmeet Sethi
Yeah, yeah, I agree. I mean, my patients would always ask, what is integrative medicine? And the first thing I would say is, well, first of all, it's just good family medicine and then, you know, and then I would go on and to explain different things to them. But and I would say if anyone's listening, the integrative medicine and residency program, I couldn't agree more.

I did that with my residents for quite a few years, and it was really life changing for some of them. I'm so impressed with how the fellowship has grown. It's just so exciting. I think about where it's come from and how people didn't even know what I was doing. And now it's, you know, kind of mainstream to hear the word.

Dr. Victoria Maizes
Well, thank you so much for coming on. Thank you for doing our fellowship and then taking this work out into the world, expanding upon it, making it part of normal good medicine. And and for your book and your activism, we're just so grateful to know you and to work with you. Thank you.

Dr. Andrew Weil
It's been a very enjoyable conversation.

Dr. Tanmeet Sethi
Oh, thanks. Thanks to both of you. This was really my pleasure.