Leverage Your Time Balance Your Life

Dealing with Anxiety - Part 1

• Dr. John Ingram Walker, MD

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Seems like everyone is feeling existential anxiety these days! We had so much to talk about that we divided our conversation into two parts. In this first part, Dr. Walker explains several of the clinical diagnoses of anxiety, including General Anxiety Disorder (GAD), OCD, PTSD, and more. Dr. Walker draws on his 50 years of practicing psychiatry to bring us a wealth of information in this podcast. Click HERE to take the GAD-7 assessment mentioned in this episode. 

NOTE: This podcast is not meant to diagnose or treat anxiety. Please share any concerns you have about your anxiety with your doctor or mental health provider. 

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Discover more about Dr. Walker HERE and Wende HERE


Wende:

We have a real treat for you. The next two sessions, we have a two-part series on anxiety. We're going to talk about existential anxiety and general anxiety. So, this is part one. We're going to talk about uh from Dr. Walker's background as a psychiatrist, his 50 years of being a psychiatrist, he's going to talk about clinical anxiety, when to see a psychiatrist, uh, how to determine if you have an anxiety disorder. So you're going to want to pay attention to this one. And then next time we're going to talk about some of the milder forms of anxiety and treatments that we can do from the comfort of our own home to help us deal with anxiety and stress.

John:

Leverage your time, balance your life. Dr. Walker with my delightful daughter, Wendy Blindest.

Wende:

Hello, everybody. Let's talk about what we're all feeling. We have a name for it.

John:

What?

Wende:

Well, you you discovered it.

John:

Okay, well, we were talking about before the podcast began. Wendy said, hey, she texted me and said, I want to talk about anxiety. And so I thought of the regular anxiety that we have: panic disorder, obsessive, compulsive anxiety, generalized anxiety. And then Wendy, I said, wait a minute, what are we all experiencing now? All around us, everybody's experiencing anxiety.

Wende:

Yeah.

John:

Well, Wendy, that's called existential anxiety. Okay. What that is?

Wende:

No, define this for me. But I can guess.

John:

I had to look up exactly what existential anxiety is. What do they say?

SPEAKER_01:

So I looked up the experts.

John:

A form of deep distress, dread, or panic arising from contemplating fundamental, often unanswerable questions about human existence, such as the inevitability of death, search for meaning, isolation, or the burden of freedom. That's one of them, the burden of freedom. That's interesting. And I think that's what we're experiencing is the burden of freedom. Can you expand on that a little bit?

Wende:

Well, I think we're at an inflection point in America anyway, with freedom. Do we have freedom or are we becoming, you know, uh controlled by dictators? Autocrats, dictatorial entities, um, oligarchy, all of that things, all of those things that are trying to control us. And I read somewhere that really 30% of populations historically have preferred an authoritarian rule because they don't really.

John:

I didn't know that.

Wende:

Yes, because you don't have to make decisions. You don't have to um have that that you have responsibility. The response responsibility. 30%. 30% actually like an authoritarian. My goodness.

John:

Well, that explains something.

Wende:

And Wendy, that explains his poll numbers. That explains his poll numbers.

John:

Uh but Trump is causing a lot of anxiety.

Wende:

Yeah.

John:

And then Wendy, when I went back, I started reading yesterday, Scott Peck's book, The People of the Lie. Now, I started reading that before we you asked me to talk about anxiety, but that the dovetails right into what we're talking about. Because in that book, uh Scott Peck talks about group evil and how it's very easy to get into a group evil and to rationalize your evil intents or even and make them feel normal. So when we're in the midst of something evil, like for example, Trump's 40%, they're in this evil arc, if you will. And they think they're doing everything right. Yeah. They desire a dictatorship, for example. Right. They feel like they're doing everything right. And then what an evil group does, it projects their doubts and fears on some group. Like the other, like the Jewish people in World War II.

Wende:

Like the immigrants that the brown immigrants now that we're talking about.

John:

Right, exactly. So what Trump is doing is setting up a projection, somebody that evil group can hate that bonds them closer together.

Wende:

It's their fault. It's not our fault that things are going poorly, it's their fault. We just have to project all of all of the hate towards them and rationalize that because they're not and then they they'd also do a very good j job of dehumanizing that people. Right.

John:

And so we're these Trump people are in this circle of evil that they think is rewarding.

Wende:

And I think we gotta we gotta step back and say, like, not everyone who supports Trump is evil. I want to make that clear.

John:

Oh, yeah, that's true. That's true.

Wende:

But they uh but the I would say the Stephen Miller architect of some of these, I mean, he's if you have to define an evil person, he's close. Yeah. Um, because he really is filled with hate and a lot of his policy is coming not from you know, I don't think Trump is smart enough really to come up with some of these. Stephen Miller is the big mastermind behind it, but that people they are very good with the rhetoric of like, hey, join join us in this, you know, circle of hate or whatever you want to call it. And they would call it the opposite, right? Because, you know, it's it's really this is for for two. Well, because they are diluted. They are true Americans would be like it.

John:

So they've diluted theirs themselves and got into this circle of evil. Yeah, and I want to reiterate that not everybody who supports Trump is in that circle of evil.

Wende:

Absolutely.

John:

But I also want to dovetail on what you said about 30% of people would like to have a dictator. Yes. Right. Okay.

Wende:

And I'd say, so instead of, you know, calling calling people who agree with his policies evil, it's that they are, you know, many of them don't want to really think about the actual policy policy decisions and what those are meaning for people. They believe they're much more prone to rationalize, like you said. And you know, I've I've seen a lot of people who've been interviewed, just man on the street type interviews about like, oh, that's not really going on. No, that's those are fake. You know, right. So that's not that you know, they do have a conscience, they're just not letting themselves believe their own eyes or ears or reports.

John:

That's exactly what Scott Peck was talking about.

Wende:

Yeah.

John:

That you get into this deal and you can rationalize it and say it's not that bad.

Wende:

It's not that bad. It's not really happening. AI, deep fakes, all of those things. You know, nothing. Stick your head in the sand and pretend it's not happening.

John:

Another thing that was interesting about that say group evil is Scott Peck was talking about it takes people inside of that group to finally recognize what's going on and speak out. Yes. And so to take that analogy a little bit further, the Republicans, the congressmen and senators, we can say, well, they support Trump because they're greedy or because they want to get re-elected, or because they're afraid of the consequences.

Wende:

Yes.

John:

And so they don't speak out. But according to Peck, what it takes is several people in that group realizing, hey, this is wrong, and speaking out.

Wende:

It's starting to happen. You're starting to see a little glimmer of that happening. So let's go back to the game.

John:

Yeah. Yeah. Now let's go back to anxiety. Let's go back to what we originally started talking about. Is all the anxiety all of us feel, probably the ones that are outside that loop, because the people who are in that loop probably don't feel all that anxious. Right. They probably feel angry and that sort of thing.

SPEAKER_01:

They feel protected, actually.

John:

Right, feel protected. But the rest of us out here, that's why we're so anxious.

SPEAKER_01:

Yes.

John:

Is because we have no control over that. Right. We say, man, look at all this stuff's going on. Why didn't somebody stand up? Why didn't somebody say something? And here we are trapped individually in our own homes and so forth, talking to our neighbors. Neighbors say, What can we do? We can't do anything. Yes. That causes existential anxiety.

Wende:

Yeah, another big point that we had. I think it's piled, you know, I'm thinking about 2020 and COVID. That was another big point in time of existential anxiety, right? Right. So we had that, and now this, it's like compounding existential anxiety. The compound effect is uh probably not very good for us. So I for it, so it's for good reason that I wanted to talk about anxiety today.

John:

Well, let's take a step and talk about panic and all this.

Wende:

I I'd love to because you're a psychiatrist and you have studied and treated people with anxiety disorder. So I have a couple of questions for you, Daddy.

John:

Okay, now we're let's tell everybody we're taking another jump. We're not talking about existential anxiety now. We're talking about clinical anxiety, which is a difference. Okay.

Wende:

Yes. So I wanted to ask you as a psychiatrist a couple of questions about anxiety. First of all, what is you hear about GAD or GAD general anxiety disorder? Um, what is how would you define anxiety? First of all, let's talk about anxiety.

John:

Okay, there are a lot of subsets under anxiety. There's a general anxiety, then there's panic disorder, then there's obsessive compulsive anxiety, then there's post-traumatic stress disorder anxiety. All of those have different sets of symptoms. Okay, great. Now, let's talk about generalized anxiety. Yes. Now, the people that are real smart came up with this test called the GAD 7. Have you heard of the GAD 7?

SPEAKER_01:

I have not.

John:

Okay, the GAD-7 is administered a lot of times by family practitioners, by psychiatrists, to kind of pinpoint generalized anxiety. So it's called GAD 7, generalized anxiety disorder 7. Okay. Seven questions. And here are the questions for generalized anxiety. Are you feeling nervous, anxious, or on edge? And in this little paper and pen test, the you have four categories. Not at all, several days a week, more than uh half the time, and all the time, nearly every day.

Wende:

Okay, I'm gonna try to find like a link to this resource online so we can put it in the show notes and people can click on it and take that test.

John:

Yeah, and you have to remember this is generalizing anxiety, might not identify panic disorder, some of these others. But let me just run through quickly these questions. First one is feeling anxious, nervous, or on edge. The second one is not being able to stop or control worrying. The third one is worrying too much about different things.

SPEAKER_01:

Okay.

John:

The next one is trouble relaxing. Number five, being so restless that it's hard to sit still. Number six is becoming easily annoyed or irritable. And seven, feeling afraid as if something awful might happen. Okay, wow. And then you rate yourself on that scale depending on the city. Like zero to three, yeah.

Wende:

Or it's not at all too nearly every day. At least it has points.

John:

Okay. And you figure out how much anxiety you have.

Wende:

Is there like a score of the colour? Yeah, okay. Well, here's the scoring. Okay. Uh-huh.

John:

Zero to four is minimal anxiety. Uh-huh. Five to nine is mild anxiety. Ten to fourteen, moderate, fifteen to twenty one, severe. You need to be in this hospital. So you can rate yourself. Again, this is generalized anxiety. And I guess you could look at it and say it's also existential anxiety. When you look at that.

Wende:

Yeah, it's generalized.

John:

That's now how do you treat that? Now, general anxiety, you don't treat this so much with medication. You might treat this with relaxation response, meditation, prayer, maybe psychotherapy, that sort of thing. So it's not treated with medicine.

Wende:

Okay.

John:

I would say. I would say just minimally treated by medicine. Right.

Wende:

So look, yeah, in a little bit, let's talk about some of those other methods, but let's continue on this path with the types of anxiety and and um from a second.

John:

Okay, the one that I really want to talk about, which I think is very important, is panic disorder. Okay. Now that occurs uh in about five, six percent of the population. Panic disorder can be now. If you look at the studies from DSM 5, it says 1 to 2% of the population have panic disorder. I think it's a little higher than that, actually. Of course, I'm kind of biased because I see so many people. I see people that the statistics of one to two percent may be correct. But anyway, panic disorder can be overwhelming, and it's characterized by an overwhelming fear of dread, feeling that you're going to die associated with sweating, rapid heartbeat, um pulse goes up, you can't think right. You had one panic attack too.

Wende:

I was gonna ask, is that is panic disorder is that from situational occurrences, or do people have who have panic disorder just out of the blue, they may feel it for no apparent like trigger?

John:

Well, you know, that's a good question. Um, panic disorder is caused, when you really look at it, is caused by a lesion in the locus ceruleus of the brain.

unknown:

Wow.

John:

Now, what is the locus ceruleus? Now, the reason they call it that, if you do a dissection of the brain and you do a real good cross-section of the pons, P-O-E-N-S, that's part of the brain, but you have to do a real good gentle dissection. If you do that on gross anatomy, you'll see a tiny blue spot. Ceruleus means blue.

SPEAKER_01:

That's what I thought I was absolutely.

John:

It shows up, and so the locus relus. Now, this is real complex complicated um physiology, and so I'm gonna kind of parry that down to something easier to understand.

SPEAKER_01:

Thank you.

John:

The locusrulis is what I call the chemical fuse box of the brain. So, what causes panic is that chemical fuse box starts misfiring, that goes to the limbic area of the brain, the area that controls anxiety, that goes to your cerebral cortex, the frontal part of your brain. So when that fuse box starts acting up, you're overwhelming with this flood of symptoms. Now, tell people what those symptoms are because you had it.

Wende:

For me, it was I didn't believe it was panic because I didn't have the sweaty and the sweats and the rapid heart rate. I had uh mine manifested with pain in my neck, literally.

SPEAKER_01:

I had pain in my neck.

Wende:

Yeah, and it traveled up to it felt like there was a gaping hole in the artery leading up to my brain, and I could just imagine like blood pouring out. And it really felt anxious physically painful, and you're anxious, too. And well, after that, I felt very anxious. Um, but I I had this physical symptom that I could not explain. Uh it was during a very stressful time in my life uh where I was preparing to move overseas and I was having a garage sale, and we had a student with us from France that was staying with us, and all the move and all sorts of stresses just compounding. And, you know, as you do, you kind of deal with life, and it just had been accumulating all this stress, and that is what I attribute that panic attack to. So I don't know if you call that panic or some kind of stress reaction.

John:

The classical pain, the classical panic is like I said, fear of impending them, just feeling like you're gonna die.

Wende:

I did feel like I was gonna die.

John:

Uh but usually have a lot of symptoms with that rapid heartbreat, breathing around fast. In fact, some people breathe so fast they pass out.

Wende:

Yes, and I didn't have that. Okay. So that's my question, my related question is what differentiates anxiety from stress?

John:

Okay. Now, yeah, look, you're getting into a nebulous, a hazy area there. You're getting back into existential anxiety, okay? The generalized anxiety, these questions, these seven questions can pinpoint generalized anxiety, okay, which is a clinical symptom. If you have enough existential anxiety, you could develop generalized anxiety, right?

SPEAKER_01:

Yeah.

John:

But panic disorder is different. Let's go back to panic because people that come to see me have this overwhelming fear of impending doom. Yes. Associated with all those symptoms. Frequently, guess what they do? They go to the emergency room thinking they have something physically wrong with them. Yep. And so they get all sorts of cardiac workups. Which I didn't hear. Yeah. They look at the gastrointestinal part, they look at all this, nothing is there, and then they say, Well, you have panic disorder. And usually what happens in the emergency room is say, Well, shrug it off or whatever. You know, it's a panic. It's just stress, don't worry. Oh, yeah, don't worry about it. And of course, that is a serious brain lesion.

Wende:

Yeah.

John:

You know, it's just medically serious as a heart attack. Wow. Okay.

Wende:

So with mine not recurring, would you say that that wasn't true panic disorder, that panic disorder recurs in the past?

John:

You have to have to really have panic disorder, you have to have two to four of those attacks every week.

Wende:

Oh my goodness. So I can't imagine.

John:

And you know, here's another interesting thing about panic that a lot of doctors don't realize how serious this illness is. Yes. Because the suicide rate for panic disorder is higher than the suicide rate for depression.

SPEAKER_01:

Oh my goodness.

John:

Now, there are a lot more people that are depressed. So if you look at the gross numbers, that's you know, depression is going to outweigh panic disorder. But if you look at the microscopic numbers, you'll see comparatively speaking, more people commit suicide with panic than with depression. Wow. So that shows you how serious that is.

Wende:

That's very serious. I can imagine because if I had four of those incidents a week, I would, yeah, it's pretty pretty, pretty low.

John:

Pretty soon you don't get out of the house, you're afraid to get out of the house, you develop agoraphobia. You don't want to get out of the house. And you start drinking, and it really dovetails into a lot of other secondary symptoms or secondary illnesses. So the treatment for this now is real iffy and very controversial.

Wende:

Okay.

John:

Now I want to talk about that because this is really important. Uh, benzodiazepines came out really in the late 70s, when you really started looking at it. And they're the drugs that we heard about Valium, Xanax, Chronopin, Cerax, Traxene, all these medicines for anxiety. Well, because it cured anxiety so much to take a benzodiazepine, people started over-prescribing benzodiazepines. So now it's classical, you see a movie or something, somebody will say, Well, get some Valium, right? Or get some Xanax.

SPEAKER_01:

Yeah, I think about the 70s, that was all the wimp housewives taking Valium, right? Yeah.

John:

And so it became overuse. Okay. Now, on anything that's overused, guess what happens? When you're overextended on something, everything in society, you look at this overextended, what happens? The pendulum swings back to the other way, which goes back to what we were talking about with Trump. We became anxious about immigrants and the and so we swung radically to the other side.

SPEAKER_01:

Yeah.

John:

So this is happening with the benzodiazepines. Overuse swings radically to the other side. And now psychiatrists and family practitioners are reluctant to ever give benzodiazepines to anybody, including panic disorder. Now, in my clinic disorder. In my clinical experience, panic disorder can only be treated adequately. In my clinical experience, is with the benzodiazepine clonazepam. Clonazepam works directly through GABA receptors and all sorts of fancy things, works directly to shut down that chemical fuse box of the brain. Shut down the locuseruleus, right? So it shuts it down. And it shuts it down almost immediately. All right. From over firing. Right, from over firing. Now, because they're reluctant, and this is psychiatrists, too, and because they're reluctant to over to use benzodiazepines, they go back to all sorts of drugs. Seroquel, antihistamines, antidepressants, and all that stuff. Well, that works later and it works slowly, and it really doesn't treat that locus ruleis as well as benzo, as well as clineestropam does. So I see patients coming in to see me all the time with panic, but they've been tried on all these other secondary medicines, which really don't work. But if you look at the literature, look at the literature. I just looked at it yesterday. It'll go through all these lists of medications to use, and benzodiazepines is down at the bottom, are not mentioned at all.

SPEAKER_01:

Wow.

John:

So it's an overreaction. Yeah. So I get these patients on clonazepam, and they're immediately quilt cured. All right. Now, people with panic disorder, in my vast experience of 50 years practicing psychiatry, those people with true panic disorder don't abuse their medication. Okay? So I've had people with chronic panic disorder that have been on low doses of clonazepine for years. It allows them to function. They don't overuse it, they keep taking that same dose year after year. Now, if they get off of that, guess what happens? Their panic attack comes back. Now, let me hasten to say that clonazepam, in my view, of all those benzodiazepines fits in better than any of the others. Because valium is very long-acting, 96 half-life of 96 hours. Stays in your body forever. So it'll numb you out. Okay. On the other end of the spectrum is Xanax, opprazzal lamb, very sharp acting. It acts for about four to six hours and it gets out of your system. So here's a rule of thumb. The shorter the acting the medication, the more addiction potential. Okay.

Wende:

Yeah, because then it wears off and you feel like, oh, I need another one.

John:

And so you do not want to, nobody should take alprazelant. Okay, Xanax. Don't take it because it'll precipitate a panic attack.

SPEAKER_01:

Yes.

John:

If you're taking it, get withdrawn from it, you get panicky. You start looking at another one. So clonezepin fits into that nice little spectrum of the benzodiazepines that takes care of the panic without causing addiction and that sort of thing. Does that answer the question well? It sure does.

Wende:

That's great. Um so let's talk briefly about the other two that you mentioned, um, because I think, you know, these are probably fewer people, so we won't spend a whole lot of time. But the uh PTSD and Yeah.

John:

Well, post-traumatic stress disorder, of course. Post-traumatic stress disorder, of course, is caused by a stress like war, a big terrible accident or something. And your type of anxiety with that is you're gonna have a lot of nightmares, dreams, intrusive thoughts of the accent, flashbacks, that sort of thing.

Wende:

So that's precipitated by incidence. Right.

John:

Okay. So post-trauma by incidence. So that is hard very difficult to treat because a benzodiazepine won't get rid of a lot of the symptoms. Okay. It might help some with the anxiety, but then you have all these secondary symptoms of depression and nightmares and so forth. So you could end up with a bunch of medications to treat that. It's very difficult to treat. One of the best ways to treat it is with that rapid eye movement. Oh, yeah.

Wende:

Um, oh, what is that called? What is the name?

John:

Yeah, I can't think of it, but it's RIM. I well, I can't remember, you know, here I'm a psychiatrist, but I can't think of what the acronym is. But it's uh you get in a relaxed state of mind, you move your eyeballs back and forth in a relaxed state of mind, you re-visualize what caused the anxiety that gets rid of some. It rewires the brain. Yeah, rewires it.

Wende:

So interesting. I've heard a lot about it. Um I know I have a family member that's done that and tried it, and that's very interesting. Yeah.

John:

And so that's different. And then there's the obsessive compulsive anxiety that you have. That I'll give you an example of this, an extreme example. OCD. You know, overreacting, washing your hands all the time, feeling anxious. You feel like you have germs, you got to wash your hands. You're rechecking the refrigerator see if the light went out. You're re-rechecking to see if the house is like, you know, obsessive compulsive uh ideas. I had one that's had such severe obsessive compulsive disorder that she iron her shoestrings.

Wende:

Oh my goodness.

John:

And one of them, I hate to, I don't mean to laugh about this, but this shows you the extremes.

SPEAKER_01:

Yeah.

John:

One lady kept opening and closing her refrigerator door to see if the lights went out inside the refrigerator.

Wende:

Oh my goodness. Isn't that a truth?

John:

So it's says a compulsive disorder can be overwhelming with all these rituals that you feel like you have to do, and the rituals don't get rid of the anxiety.

Wende:

Is that due to is that because of like a need for control?

John:

Well, you know, that's a good question. Where does OCD come from? It usually is in people who are perfectionistic and they want everything exactly right, but I don't want to say that because that's overgeneralizing. So obsessive compulsive disorder comes from different psychological issues and different genetic issues. You know, you could have a genetic tendency to have a obsessive compulsive disorder.

Wende:

So we've got a lot of stuff. This is great, Dad. A lot of um clinical anxiety. Let's let's I want I want to say if people are resonating with any of these symptoms or see it in themselves or a you know a close family member that they're concerned about, what should they do?

John:

Well, if you have panic disorder, you need to go see a psychiatrist. For sure. Now I want to get back to one thing that's vitally important, Wendy, because there's so many psychiatrists that are against um benzodiazepines. Well, an article came out in JAMA, Journal of American Medical Association, about reducing the risk and or balancing, balancing the risk and benefits of benzodiazepines. An excellent article in here that talks about the challenge with benzodiazepines, balium, xanex, clenazine. And I'm gonna read directly from this. Okay. The increased caution regarding benzodiazepine's use is warranted. Fewer benzodiazepine prescriptions are needed. However, here's the however, when considering without an appropriate patient-centered context, this enhanced warning statement might lead to fewer appropriate prescriptions and unintended consequences. So, psychiatrists out there, if you're listening, don't be reluctant to use clinazepam in proper areas, use it prudently. Don't just write a prescription and say, here, take this. See the patient back regularly, assess what's going on, use psychotherapy and other modalities to help reduce the panic. You can add a uh serotonin drug and SSRI, an antidepressant, which helps modulate that panic. And generally speaking, generally speaking, after two to four years, those people with panic disorder can be drug-free.

Wende:

Oh, that's amazing. That's great.

John:

But don't be reluctant to use that clinezepham and stop using all that other junk.

Wende:

So a good psychiatrist a good psychiatrist would be able to really, so it's not just about prescribing drugs, it's about knowing the patient, assessing if it's working or not. Right. And and so I know this is prudently using it. So if you're most people listening to this probably aren't psychiatrists, they're more on the patient. So you should look for a psychiatrist that has a very uh good reputation of being treating the whole patient, not just prescribing drugs.

John:

And I'll say this too, it's a problem with general medicine. Uh, is psychiatrists, many psychiatrists, all they do is prescribe medicines, okay? So now, in my view, I'm an old-fashioned psychiatrist, okay? I was trained in psychoanalytic psychotherapy, okay, which is uncovering uncovering unconscious conflicts. Also, I was trained in um cognitive behavior therapy, which you change your thinking.

SPEAKER_01:

I know, I want to talk about that next.

John:

Change your thinking the way it helps you. So if you're really a good psychiatrist, you need to be trained not only in medication, but you need to be trained in cognitive behavior therapy. And it's good if you understand the unconscious conflicts that contribute to that. So look for So you're not going to have a lot of psychiatrists that do that.

Wende:

Look for a psychiatrist that also does CBT.

John:

Right.

Wende:

So I we got I've got a question. Do we keep going with this podcast and talk about, or should we do a part one and part two?

John:

Oh, I think this is enough.

Wende:

I don't think I think we want to do a part two that is more about some of the modalities that we can use at home, right? Call right behavior therapy, meditation, mindfulness, all of those things. Let's do a part two. I love this. This is like the clinician's the psychiatric viewpoint of what is uh, you know, an actual anxiety disorder. But then for people who are experiencing mild to moderate anxiety or existential disorder. Or I can't say that word, existential anxiety. There are things that we can do on our own. So let's do that.

John:

Yeah, and then I can look up that acronym for the here. I am bragging about all the stuff I've knowing psychiatry, and I can't remember that little acronym. So go see somebody else.

Wende:

M D E M D R M D R something like that. Something like that.

John:

Something with M D R you know if you go see a psychiatrist, go see one that knows an acronym.

SPEAKER_01:

All right, Dad, thanks. This is really helpful. I think it's gonna help a lot of people.

John:

You're welcome.