96: A psychiatrist's perspective on financial decision making under acute or chronic stress

In this episode, you’re going to hear from a psychiatrist on a number of topics directly and tangentially related to finances and financial decision making. Later in the episode we talk about some financial behaviours under acute mental distress, a number of various pathways that lead to hoarding behaviours, and more. But we also discuss the effects of chronic decision fatigue, burnout, and corona insomnia that almost everyone seems to be experiencing. And I need to point out that today’s guest, Dr. Ajmal Razmy is one of my very best friends. We studied neuroscience together during our undergrad days at UofT and he continued with his masters and medical school, whereas I, after my last undergraduate exam, went to auto-racing school.

Dr. Razmy is a psychiatrist and mental health specialist at Cleveland Clinic Canada with a background in healthcare with a special interest in sleep medicine and hospital administration. He is currently a practicing psychiatrist and Head of Service (HoS) for Mental Health at Joseph Brant Hospital with a focus on acute care psychiatry. In the HoS role, he is helping lead Burlington’s mental health response to the novel Coronavirus across the hospital and community systems. Prior to this role, he worked at Trillium Health Partners, where he was the Service Medical Director for Acute Care Psychiatry, and has also served as a psychiatry member of the Consent and Capacity Board of Ontario.

Links

Twitter: https://twitter.com/AjmalRazmyMD

Website: http://ajmalrazmymd.com/

Cleveland Clinic: https://my.clevelandclinic.org/canada/staff/razmy-ajmal

Transcript

Dr. Ajmal Razmy: 0:00

I've had many patients with bipolar disorder during manic states, where you feel lated you feel high, you feel some grandiose thoughts. And all of a sudden you have a Ferrari F 12 in your, in your driveway, right? And you know that. And maybe that's great if you can afford it. But if a lot of people can't, and I've had, I've had to write a couple of letters to not Ferrari, but to different companies saying that, Mr. or Mrs. So and So, purchased this item under duress. And so you know, it's a little bit of a fight, but most most companies understand, but not all.

Preet Banerjee: 0:50

In this episode, you're going to hear from a psychiatrist on a number of topics directly and tangentially related to finances and financial decision making. Later in the episode, we talk about some financial behaviors under acute mental distress, a number of various pathways that lead to hoarding behaviors, and more. But we also discuss the effects of chronic decision fatigue, burnout, and Corona insomnia that almost everyone seems to be experiencing. And I need to point out that today's guest, Dr. Agarwal, razzing me is one of my very best friends. We studied neuroscience together during our undergraduate days at U of T. And he continued on with his master's in medical school, whereas I, after my last undergraduate exam, went on to auto racing school as one does. My parents are so proud. This is mostly money and I'm your host Preet Banerjee, and today's guest is one of my very best friends Dr. Osmo rasmea. He's a psychiatrist and mental health specialist at Cleveland Clinic Canada, with a background in healthcare and a special interest in sleep medicine and hospital administration. He is currently a practicing psychiatrist and head of service for mental health at Joseph Brant hospital with a focus on acute care psychiatry. In that role, he is helping lead Burlington his mental health response to the novel Coronavirus across the hospital and Community Systems. He has also served as a psychiatry member of the consent and capacity Board of Ontario, Aaj Ma, my friend, welcome to the show. prayed this is a dream come true. Thank you for having that. Okay, so I don't want to go way back. So I think he's going to maybe reveal a little bit on today's podcast. Before we start that, I wanted to say why I wanted to have you on this podcast a couple of reasons. One is to talk about how the pandemic has been affecting our states of mind, and how that translates into performance not only at work, but also with making financial decisions. And this is something that you and I have talked about quite a bit over the last, you know, 12 months, 18 months. And secondly, I wanted to ask you about areas of personal finance, that don't really get covered a lot in the personal finance sphere that much or at all. And that is when financial decisions are made under acute mental crises, or psychiatric disorders. So we want to talk a little bit about that, and your experience dealing with some of the financial aspects when it comes to you know, when you're dealing with patients. Now, I also wanted to actually start with expressing gratitude to you and Tina for the listeners, Tina's his wife, also a physician, and all the colleagues that you work with who are part of the healthcare system battling during this pandemic, because I know, it's been taking an incredible tool, you know, not on just society as a whole, but also everyone working in healthcare. So thank you so much for what you guys are doing. I think it's amazing. And my first question is, how are you doing?

Dr. Ajmal Razmy: 4:06

Well, we're taking it day by day, truly is a remarkable experience. I think, the way that I've wrapped my head around just personally, this whole experience is just thinking about this as a as a once in a lifetime, hopefully, opportunity to to really, you're in the middle of history. Right. So I'll give you an example. At the hospital where I work at St. Joseph's Joseph Brant Hospital in Burlington, you know, we are actually considering at this point, redeployment of physicians to different areas of the hospital they've never worked with before. And so you can take that, like, Oh my god, like, what am I going to do? I'm a psychiatrist, how am I going to like, you know, put an IV in someone or I think you can kind of take the the growth mindset of saying, Wow, I've now I'll probably never be asked to do this again. And I'm going to be working with other people who have a certain expertise. And we're going to work in teams. And, you know, this is this is one of those like photo book moments where you, you'll never you'll be able to tell this to your, your grandkids, that we were in this scenario, and we How did we kind of bind together to make it through this. And, for me, that's what keeps me going is, is understanding the historical context of where we're in, and also lining that with some optimism that we will grow to a different perspective to a new world, and hopefully, to a better one, and that's honestly, I take every day,

Preet Banerjee: 5:38

you know, I on one hand, I'm not surprised that, you know, your perspective is, is has that sort of framework, you know, you you basically you're talking about your coping strategy with this. Incredible, like I said, once, hopefully once in a lifetime scenario, but not everyone has been able to sort of see it with that same perspective. And I know, it's like been wearing a lot of people that are including physicians, and I remember, we were chatting because it was in the news, you know, as a couple of physicians who took their own lives because of the stress and dealing with what was going on. And I remember that you were called by the media to talk about what was going on. Because not only are you in the healthcare system, you focus on psychiatry, and how people think. And so what might come naturally for you, and in creating these coping mechanisms and strategies to help get through this for yourself, is foreign for a lot of other people who are struggling right now. So I guess that's kind of where I wanted to start is to, if you can go back to the beginning of the pandemic, which was, you know, I guess, 14 months ago, but it feels like on one hand, yours, and at the other time, it feels like, I don't know, maybe it was just like, it feels like it could have been just a couple months ago, because time is so blurred together now. And I think that's one of the first things that people noticed was when we went into lockdown. We didn't even know what day of the week it was anymore. So can you walk us through what happened during the onset of the pandemic, in terms of just our overall outlook on our regular daily lives?

Dr. Ajmal Razmy: 7:18

Yeah, for sure. And I think I mean, you like Formula One? Right. So there's been a lot of sort of shifting involved. I think, you know, there's been Sprint's and marathons, and then sort of just fatigue that we've we've been oscillated amongst these waves. I mean, I guess we're speaking from a Canadian perspective, but certainly globally has been experienced differently based on how the pandemic has impacted different countries. But I think initially, there was a lot of uncertainty, a lot of fear. Maybe a bit of denial. Oh, yeah, this is Yeah, I remember. I mean, personally, I remember just thinking, well, this is probably something localizes terrible, something localized in, in, in Asia, and, you know, I don't just we've heard about little things like this before, and maybe it'll be just localized and, and hopefully contained and dealt with, and then as it was encroaching and impacting Canada. Yeah, people were like, what is this? What is the nature of this, and we had the backdrop of SARS, I guess, in the early 2000s, where that was a very localized in within the hospital kind of condition, and, you know, didn't seem too bad. In fact, I was a medical student during that time, and it was actually, to some medical students, you know, it was a good learning experience, but wasn't devastating, like us. And so, I think we, we, we started off in the sprint and this kind of chaos of anxiety and fear and not knowing where this is going to go. And then having that kind of like that break of Okay, well, this is the first spring and maybe that was it, is it gone? Is it not gone? You know, quote unquote. And then I think the subsequent waves have really sort of like piggybacked on the initial fears, and have gone from the acute distress to more of a chronic toll on people, people's mental health. And that's what the data shows, too. So we're in our third wave and in Canada, and the rates of depression and anxiety are the highest that they've ever been. And in particular, some of the risk factors, the drivers of that work from home, social isolation, and a lack of optimism, just because it was yet another way. How many more do we have to go through that kind of thinking? It's been devastating.

Preet Banerjee: 9:45

One of the things that we saw was the the toilet paper hoarding. It was making news around the world, you would see pictures of just empty aisles at grocery stores. Why did that happen? What what what caused people to say, Hey, this is the thing that I need to stock up on.

Dr. Ajmal Razmy: 10:06

While crises can bring out some interesting human behavior, I think, remember, we're also like, I can only speak locally in Canada, but we're also a country of, I guess, immigrants in a way, like people who've made this a home for themselves. And it really is such a beautiful country in that regard. But we also bring our own traumas to this. I remember, like my folks there from of Ghana, Stan, and and when this was happening, they right away go back to like when they were fleeing from Kabul, and it's like, Okay, well, you know, you better stock up and you better be prepared for whatever is going to happen. And, and so people, I think there was a cohort of individuals that that their previous traumas of experience coming to this country may have been triggered. But I think there's just mass hysteria, there's people with uncertainty, people act in very strange ways, financially and otherwise, as we'll discuss. But it's interesting that I think that has become less and less of an issue, as the waves of have gone forward. But you might see an initial spike of it each time, there's another way. And then it kind of dies off again.

Preet Banerjee: 11:18

And so you talked about how Initially, it was more acute stress and anxiety, and now it's switched to more of a chronic burden that people are dealing with, that's creating burnout. So can you talk a little bit about burn, because I know you've been studying, you know, the burnout that's being exhibited now, as well as what I think you call Corona insomnia. And I have spoken anecdotally, to a number of people who've had a number of sleepless nights. And I'm wondering, is there some kind of commonality? So let me know what, what you've been studying in, in the area of burnout and how it affects us?

Dr. Ajmal Razmy: 11:59

For sure, I mean, it's, I'm also like, my area of interest is preventative mental health and wellness. And so within the hospital I work for, for I, I'm their wellness lead, I guess and so within that bracket there, you know, hundreds of physicians that, you know, I am in some ways responsible for for their wellness and trying to help address that. So for me, burnout is is an absolute passion, partly because, you know, I've, you know, like many people I've been through too. But burnout, the problem with burnout is it's like many terms in mental health. It's kind of overused, like what is depressed means if you had a bad day, or, you know, Blue Jays loss, are you really depressed? I guess it depends. But, you know, the, the terms in mental health can often get blurred, because they become a little bit too common in the vernacular. But burnout is a term that's been around for decades. I the best research done on burnout, the highest quality, I would say is by Christina maslach out of Berkeley, who has studied this for since the 80s. And, and only recently, the World Health Organization has identified burnout as an actual condition. So in their International Classification of Diseases, their latest version of 12 love their 12th edition and 2019, they came out with actually defining what burnout is about. Interestingly, they classify burnout as an occupational phenomenon. So depending on which organization you're part of, people may not like to use the term burnout, because it may reflect some sort of perceived flaw by the organization to address sort of a toxic environment, if you will. But there are three sort of Cardinal components of burnout. In no particular order. The number one sort of, quote unquote symptom, although it's not a it's not a symptom, it's part of a syndrome is a exhaustion. So that ties into the cronyism, which we'll talk about, but just feeling like completely an utterly wiped out. People have been there, but this is sustained, right, every day feeling the same way like that. The second sort of component is cynicism. the raising of the brow, the, you know, absolute disregard, or almost discontent, I guess, with policymakers, whether it's government or your organization, people work for etc. People who lay down the rules, just people becoming increasingly cynical, if you find that's happening, that's another component, and then just not feeling effective. Not feeling like you're doing your job right. And I think at some level, many of us, myself included, you know, we Just the nature of being sort of alpha driven, if you will, can have these components and it's not one. It's not just the exhaustion. It's not just the cynicism. It's not just feeling ineffective. But it's a little component, a little hybrid of all of these things, a Venn diagram, that if you have over a sustained period of time, likely yourself suffering from burnout, the important point and Dr. masstige very elegantly brings us forth is that burnout is not a me problem. But it's a wee problem. It's something that's endemic to the system that's that's built around you, much like environmental toxins and stuff like that. And in workplace it's, it's, it's something that's endemic to the the organizational structure. And certainly, I would say before COVID-19, burnout was rampid, in many different organizations, especially in healthcare. But this is just sort of, I think, the COVID-19 is served as an accelerant to all of those problems related to burnout.

Preet Banerjee: 16:09

When it comes to the burnout that's being exhibited by people, my understanding is that people with kids, single parents, two parent households, when you have kids, it seems like they're just on a totally different, like quantum level, because they've had to deal with what do we do with the kids? What are the schools doing? What is the government saying? The rules are for, you know, going back to school online learning or daycares open? What's open, what's closed? And why are we getting these messages with, you know, like, 24 hours notice, juggling that with your work and making concessions. Do you have any insights into you know, what, what categories of people are being affected most right now? With respect to burnout?

Dr. Ajmal Razmy: 16:54

Yeah, for sure. I mean, it's interesting, right? Everybody experiences at a different level? I would say the millennial, the millennials also have a different type of burnout. You know?

Preet Banerjee: 17:09

Oh, tell me more about that. What do you mean by a different type of burnout?

Dr. Ajmal Razmy: 17:13

Well, this is just the way I see it. But I mean, you can imagine people who are sort of early on in the career just like maybe you just landed your, your job with the organization of your dreams. And you're like, Okay, I want to start where my mentors and boom, everyone's like, gone virtually, right. There's none of the what happened to the, you know, sort of like shadowing along with with some of these more senior vets within your organization, and just feeling that sense of like, not necessarily belonging, which is like an important component of resilience, for example. So I think millennials feel that kind of isolation, maybe devalued, a little bit. I think there's been a lot of talk about the parents and people who have kids, and that kind of like, hug a little bit of the sympathy around burnout, and rightfully so, as a parent, like, it's, it's true, but I think that the millennials, themselves, if you know, for those that are single and, and or, you know, with our children, they've also had a very different struggle, and I don't want to minimize that. But when you look at the, the data in healthcare, so we look at healthcare industry, it's been the, the Gen X population that suffered a lot kind of The Inbetweeners, right. So you're kind of like dealing with like, aging parents, and you're dealing with like, you know, breastfeeding or whatever you're dealing with. And so you're right in the middle there. And I think, for how that's that's proved to be a sticky point. Depending on the way your organization structured, it's important to look at these different categories and understand and appreciate that everyone's impacted but just differently, right?

Preet Banerjee: 19:01

Yeah, cuz I would, one of the things that I've noticed as well is, you know, if you're younger, and you've been living on your own, maybe you don't have a life partner, yet, you've got isolation and being isolated with everything that's happening right now, is a different sort of stress than the stress of you know, having family and kids and dealing with, you know, overload a different sense, because you can say, well,

Dr. Ajmal Razmy: 19:25

so that the person who's isolated can say to the person who's not saying that what you have your husband and you're not alone, and blah, blah, blah, and then you know, that person, that person Yeah,

Preet Banerjee: 19:36

I've got my husband and I'm not alone.

Dr. Ajmal Razmy: 19:41

Oh, yeah. It's hilarious, but it's, it's, it's hilarious to talk about, but it's certainly very stressful to experience. Yeah,

Preet Banerjee: 19:47

well, yeah. I mean, you and I, obviously, we're friends and we joke around all the time. So there's going to be a bit of levity here, but that is also part of a coping strategy for a lot of people as well finding, trying to find the humor where you can because there's so many things Just bring us down right now. Yeah. So let's talk. I think this is really a good segue, because we've talked about these different sort of situations, you know, families, individuals living in isolation. And then there's been, there's been this apparent exodus from city centers into, you know, the rural areas, and people are looking at moving to, you know, the East Coast. And there's, there's just people migrating, apparently, to the city centers, people don't know if that's going to be long lasting or not, but what can you What can you talk about in terms of why this is happening, and what you've been what you've been seeing?

Dr. Ajmal Razmy: 20:38

Yeah, I, again, full disclosure, I'm not a financial expert, by any means. But I think, you know, just behavioral sort of analysis here, the reptilian brain is powerful man, it can really do it, you know, the tail does wag the dog, in many cases here. And I think that when people are under distress, and there's a lot of uncertainty, you know, decision making in financial decision making just part of that people can make interesting choices. I, you know, there's I've treated some of my patients that have moved on from, you know, urban centers, to more quieter settings. And, you know, some, some are very happy with that, and others are saying, Hey, you know, what, what did I do this board is all of all that I have around me a couple of Tim Hortons, and I don't know, I miss Toronto, or I miss the urban life. But when I go back there, everyone's wearing masks, and we get doing so but but again, that's a very narrow perspective. Right? So to me that's speaking and those examples of how during fight or flight kind of thinking, people's decisions are become a little bit skewed. And I think, from from what I understand about financial decision making as well, the motions take a big part, and they kind of like, they actually take over the cognitive processes and many times, right, and so I think that's, it's probably a little bit of that I would anticipate, from a mental health perspective and from like, like, a brain science perspective, that that'll probably course correct a little bit as time goes on.

Preet Banerjee: 22:16

Yeah. And I think tied to that, we've also seen pretty strong increases in housing prices. And we're seeing, you know, incredible bidding wars, we're hearing stories about houses going up for sale, and there'll be like 49 competing bids, people are bidding 400,000 over asking, and people are talking about FOMO, the fear of missing out on getting in on a housing. And so it's causing a lot of people to really stretch themselves thin. And we're not talking about people would show up in the ER, in some kind of, you know, acute episode of mental distress. This is like, you know, a lot of people, what can you What can you say about the fear of missing out or keeping up with the Joneses? how prevalent is that in people? And how much of an impact does that have on our financial decision making?

Dr. Ajmal Razmy: 22:58

I think it's huge. I see it all the time. I've had I've had a handful of patients over over the course of this winter, that you talk about FOMO. But they're also kind of what is called buyer's remorse, as well. And they were in situations where they were out bidding, and it became personal, on a property. And they ended up paying way more than they wanted to, but they just wanted to close it. They didn't want to give it up at some point. And I'm sure many, many of the listeners have been in those scenarios. And it's almost like when you're in that zone, it's like you're playing roulette, or you're at a table in Vegas, and you just can't stop. So it's an interesting phenomenon. And but there's something innate about wanting once you're kind of like committed this kind of fear of losing out on on what you think is right. And and people, I guess it's evident right now, especially in, in Ontario, I guess, just people really paying through the roof. And it's interesting, it's going to be interesting to see what people think six months down the road when things kind of swing in different directions.

Preet Banerjee: 24:13

One last thing I want to talk to you about the pandemic before we change gears a little bit, and that has to do with this Corona insomnia. So I personally have had a number of nights where I am just awake all night long. And you know, I keep on maybe rationalizing to myself like I have a such an unusual schedule. You know, I don't have to be anywhere at 9am in the morning, whether it's online or and I don't go anywhere anymore. Every now and then I'll do a morning radio show, which I have to get up at 5am to do some prep for occasional do morning TV shows maybe once every two weeks kind of thing. But other than that, you know, I have no real set schedule. So I thought well, maybe it's just because you know, I go to bed and wake up at totally different times all the time. And my body's just like Yo, what are you doing? Keep your mind. But I think I'm not alone. Because I've been hearing from a lot of people that they're just up all night, and it's something that they've never experienced before. So I know you, you and I have talked a little bit, you've talked about something called Corona insomnia. So what is that?

Dr. Ajmal Razmy: 25:18

Yeah, so I'll wear my Sleep Medicine Hat. Now, but Corona insomnia. I wish I coined the term myself. But it's something that's used sort of in the sleep medicine world to reflect the sleep disturbance that's been sort of triggered. During COVID-19. It's been seen on all across different sleep research centers. throughout North America, and globally, actually, some of the data just coming through now. I mean, insomnia is a very common condition. If we think of sleep in general, like if we take a step back, sleep has a homeostatic function. So like, basically, as the day goes on, there's this drive for sleep that builds. And it also, there's also a circadian element, which is based on light in training, our sleep patterns and, and so if you think of, just from that mechanistic perspective, you think about the pandemics done in terms of people working from home and working at different hours and maybe not taking breaks, and having all this blue, blue light that's they're exposed to through their devices all throughout the the night, potentially, it's no wonder that both the homeostatic and circadian functions of sleep are kind of like offset. And so we're seeing a sleep researcher seeing both an increase in insomnia, so people having difficulty either falling or staying asleep, and also hypersomnia, where some people just because they have no schedule, or like going to bed at like, midnight, we're not waking up till noon. So

Preet Banerjee: 26:53

yeah, there's some nights I get up, I was like, I just cannot get out of bed. And

Dr. Ajmal Razmy: 26:58

it speaks to how important I think routine is. And it also speaks to that function that work actually plays, you know, I think in terms of having, you know, the, the kind of like, if you think of how many hours are you actually productive at work now, you're probably an exception, you I'm sure you have a very productive all the time,

Preet Banerjee: 27:15

two hours, tops.

Dr. Ajmal Razmy: 27:16

Yeah, I was saying for myself, maybe half an hour. If I'm good, and but it's all the other stuff, it's all the other scaffolding of like getting up, hopefully showering once in a while driving to work, you know, saying hi to Tim Hortons person, or whatever, or if you work at Tim Hortons, saying hi to your colleagues. And then coming back, you know, and and so all of those things, that that what I call the scaffolding of work is is stripped away. And so you know, what you're left with is, you know, for a lot of people, I don't you find, but work from home has actually increased demands on productivity, I think people are actually working more much more than when they were going into their office spaces.

Preet Banerjee: 28:03

Yeah, and we talked about, you know, the, all the things these demarcations of time, you know, that you have with a routine that is just blown out the window, when you know, when the restriction started and work from home for a lot of people. Because I remember back when I did used to, you know, go to an office and work, everything was such a routine. And if I wanted to work out, I would have to plan around my work schedule, say, Alright, if I'm going to work out, I got to get up at five, get to the gym at 530. I got to get home shower, and then make it to work, leave by a certain time. You have your breaks at a certain time of day, you have your lunch break, maybe you have the same people that you hang out with at lunch, you got your afternoon, break, the end of the day, you've got some time to decompress on the way home and change gears from work life to home life. And that all changed when I you know before the pandemic when I went, you know, completely self employed Just wherever myself, I find it was harder to get a lot of things done unless I reinstituted some kind of routine or schedule into my life. Otherwise, it was always I could do it any time because I have no Boss, I could just fit in in whatever I want. And that would never fit it in unless I put it into my schedule. And then now with a pandemic, I think everyone is sort of experiencing all those things that we had that that was our routine, our scaffolding, if you will, is gone, and everything is blurred together, you're at home, you're working from home and your kids are home and they're like, hey, I need lunch or, you know, we need to get out and get some exercise. And so you'd be working and then the next minute you're, you know, home life, and then you're right back to work life. And so the there was no there was no change from home life to work life. It's all sort of blended together. And I think that that has taken quite a bit of a tool. Now we've talked a lot about, you know, the burdens on people whether it be through burnout through disturbing Isn't sleep? How do these things affect our ability to make financial decisions?

Dr. Ajmal Razmy: 30:07

tremendously. I just want to make one quick point. So although the pandemic is kind of like hit our workplace structure, like a meteorite and kind of blowing things up, I think it's also uncovered some other like positives, too, right? Like, there's lots of people actually like the flexibility and maybe don't always want to commute maybe there's maybe that has a benefit in terms of our own carbon footprint as well. And, you know, what are some of the, I guess, to when I speak to CEOs of companies we talk about? Like, what are some of the opportunities to really take some of the pluses that the pandemic has served for the average worker or for the manager, middle management, or even CEOs? Like how do we like restructure things for the new corporate athlete to really survive in this new terrain? I think there are a number of positives. I mean, I've enjoyed, you know, having the flexibility to work out more, you know, whether it's using the bike or whatever. And, and sometimes actually seeing my kids a little more because they happen to be home too, right. So that it's not all doom and gloom. And I know, you're not saying that at all. But I think how do we how do we take some of those things and work in this hybrid structure going forward? So that that is not all bad? Right? So I do think those are options. I think a lot of people are looking at that. And I'm excited to see what the new corporate landscape will be.

Preet Banerjee: 31:32

And do you have Do you have, cuz I know you work with corporations to talk about stuff like this, because this is, you know, productivity is core to many organizations. And and I agree with you, 100%, I think a lot of people's eyes have been opened to, hey, there's a different way of working. And that's part of why I would never go back to to work for a big organization in an office commuting to it, I could, once you've tasted what it's like not to have to commute. For me, I don't think I could ever go back. But I think a lot more people are realizing, hey, not only is it possible, because they were forced to do it. But it turns out that there are some benefits to it. And I think some people say, hey, when things get back to whatever the new normal is, maybe there will be a different split. So what have you been hearing from from CEOs that you consult with? about, you know, organizations and Nv structures? What do you what do you think is going to happen?

Dr. Ajmal Razmy: 32:25

So what I'm really encouraged about is, and this is some of the work I do through Cleveland Clinic Canada is, is the pandemic has given an opportunity for corporations to also look at the work life balance in a true way. And really looking at what is the ROI on mental health and well being. And so adapting to the hybrid lifestyle in terms of work, but also going forward in terms of how that's going to impact the organization and how things are structured. It's actually put wellness at the table of conversation, not just lip service. And I think the message that I try to send out when I'm when I'm doing some of these sort of engagement points is how do we win with beta. And what I mean by that is, there's been a cost with always having sort of alpha producers within your organization in terms of go getting and not stopping and going, you know, 110 miles an hour every day, in terms of the results and impact on burnout. And so when I say winning with beta, I mean, adapting whether it's a hybrid, corporate lifestyle, whether it's making more time for breaks, whether it's making more time for exercise and nutrition and mindfulness. Are you actually in the long run more successful as a beta organization? Or do you want to have a bunch of alpha thoroughbreds in your corner? It's it's an interesting debate. I'm not saying one is right or the other. But I think there are some benefits to considering the beta approach.

Preet Banerjee: 34:06

That's, that's interesting. For my listeners who are more financially focused. Alpha and Beta mean totally different things in the world of fine. Yeah. However, winning with beta is actually kind of an overarching theme in the financial world as well. It's associated with index investing anyways, I don't want to nerd nerd out on that too much. I want to go back to a question that asked you but before we do that, Cleveland Clinic, this is Oh, I don't know if you've been to other Cleveland Clinic locations around the world. When I was working in Abu Dhabi once the hotel room that I was staying in, right across, there's I guess it was a manmade River. There's the Cleveland Clinic, Abu Dhabi. And this place was huge, and at night, it had like this glowing lattice all around. It looked like a club like honestly, I thought, like, you go there to get treated or you go there for ball. service like it was insane. Have you seen that one?

Dr. Ajmal Razmy: 35:04

I haven't been there. But I've seen it. It's absolutely spectacular. Yes.

Preet Banerjee: 35:16

The conversation with Dr. Arch Mel rasbian continues in just a minute. But first, a few thank yous to listeners who left comments on Apple podcasts. jtb. Good. Thank you for your very kind comments. And Rajiv, who goes by the moniker, Surrey old timer. Thank you, as well for leaving a kind of review. And thank you to everyone who leaves ratings and comments on Apple podcasts. I appreciate them. And I do read them all. And now, back to the conversation with Dr. octanol. resume. Let's let's go back to the question I asked you about the impacts of burnout, and crony insomnia on people's financial decision making, you said it was tremendous. But tell me more about that.

Dr. Ajmal Razmy: 36:10

What I'm seeing is some more desperation, in terms of like narrow, like a narrow mindset in terms of like, you know, what is what are the long term forecast looking here, like your Do we need to get out of urban centers and buy rural, for example, we already spoke about that. What about, you know, investing in things that you would normally wouldn't do, right, making, like decision points that just don't make sense. And you see it financially, but you also see it, you know, in terms of everyday decision making with with some of the people that that I see on an on a regular basis, and it has like tremendous impact on their well being. An example is, and this is not a financial decision point. But it's in terms of coping, right. Some people buy things to cope. I mean, I'm sure like, how many Amazon boxes do people have people sort of collected and have to get rid of, right? It's like a whole business to get rid of these boxes? And I would say, that's like, why did I buy those? You know, why did I buy those, like, eight t shirts that are all the same? They don't fit me? You know, and they come into these boxes, and you're like, what am I doing with all this stuff? But I think there is some some of that happening as well. But it's interesting, because I think when you get into that kind of state of being overwhelmed, being ineffective, feeling cynical, it definitely impacts your cognitive abilities to make sound decisions. And I've seen that trickle down in terms of financial decision making as well. Yeah.

Preet Banerjee: 37:43

Let's shift gears a little bit. And I want to talk to you about some of the extreme financial situations that you've, you've seen your patients present with. And you end to put it into context. You know, when when you're dealing with people you're not dealing with, with people who sort of say, hey, I need to talk to someone, I got some problems to work out, you know, let me find a therapist to work with. You're dealing with people who are like, facing trauma, like when they present to you like, like, things are dire. Right. So can you can you sort of talk about some of the extreme situations that that you see, in terms of the financial aspects?

Dr. Ajmal Razmy: 38:27

Yeah, for sure. I mean, whenever So, in general, when I asked my patients questions about like, what what are your main stressors in your life right now? Certainly, I mean, right now, COVID is at the top, but it's always relationships and money are the top two things that come out almost every time I assess somebody. And and so I think that's, that tells you about the indelible kind of like, a relationship between money matters and mind matters and how how the two, sort of toggle one another and, you know, there's a number of different mental health conditions that impact that, I mean, classic examples or not, I've had many patients with bipolar disorder. During manic states, where you feel lated you feel high, you feel some grandiose thoughts, and all of a sudden you have a Ferrari F 12 in your, in your driveway, right? And you know, that and maybe that's great if you can afford it, but if a lot of people can't, and I've had, I've had to write a couple of letters to not Ferrari, but to different companies saying that, Mr. or Mrs. So and So, purchased this item under duress. And so you know, it's a little bit of a fight, but most most companies understand, but not all, and so and the financial toll that, like bipolar, surfing, take on a fan. Emily, for example is devastating, right. And sometimes people never recover. Certainly, there's cases of people with dementia. And, you know, maybe their financial capacity hasn't been established. And they're selling, I've been on cases where they've sold their entire estates to random strangers that they've just met, for example. And so that all of the, you know, working back through that kind of messy situation with families, etc. Or you have family members trying to take advantage of people whose faculties are, are weathering, unfortunately, I want to make a point A lot of people with mental health and mental illness in general make great financial decisions as well. But it's just that finances relationships are very, very fragile when your mental health is in duress. And right now, with with the pandemic, going from acute to chronic, we're seeing that impacted in various ways.

Preet Banerjee: 41:04

I actually had a situation maybe about a year ago, someone who reached out to me, I hadn't spoken to them in a couple of years. And they were looking for help to rebuild their, their financial situation in general, because they were bipolar. And during a period of mania, they had gone on an extreme spending spree. And so they just bought anything and everything in sight. They just felt good and felt like, you know, they were invincible. And then it caught up with them, because, you know, eventually all their credit cards got maxed out. And and then I guess, I don't know the details of what happened later. But I'm assuming the mania ended, and then reality sort of set in, and they had to dig themselves out of a big financial hole. And so these things can become quite extreme. Another area that I know gets a lot of attention, and and I think sometimes is almost glorified, at least for television purposes, is hoarding, like some of the most popular shows are covering people who hoard things, right. And people gawk at them and whatnot, but it's really, it's really quite, you know, disturbing, and I really feel for them, because from what I understand, it's not something that they just say, Hey, you know, I think I'll just collect stuff. There's there's something more behind it. Can you talk about what is sort of, like the underlying factors with extreme hoarding?

Dr. Ajmal Razmy: 42:32

Well, I mean hoarding is, I mean, that's, there's different sort of pathways to that. One pathway is almost through obsessive compulsive disorder. And there's certain obsessions about like collecting things and not letting them go, for example, or having a fear that if you were to let something go, something bad would happen to somebody else. And, and so that's from an sort of an anxiety spectrum issue where people hoard, oftentimes, people with dementia or when they start having cognitive disorders, for various reasons are just like, not able to process why they're there keeping on to certain things. And so basically, it's a weathering of your brain in that condition. So there are different pathways to hoarding. Yeah, it's, it's, it does break your heart, when you hear about that. It does affect a lot of people, I would say most of the people that I've ever treated with with hoarding behavior were more from the cognitive disorder spectrum, usually, usually is a sign of like some sort of Alzheimer disease, a neurodegenerative condition like that, that's where I've seen it mostly. But again, often not seen. And you may not even know, right, so somebody in your bank is just coming in walking home. And if you ever go to their house, you see that there's a sandwich on the table that was there from, you know, last Christmas, and it's just there. So I think there's a number of chronic illnesses, that mental health illnesses that can impact people's financial decision making capacity. Most of the people actually you're not in that state. And I think that within the pandemic, there's sort of like a lighter sort of inflection points related to this, but you're seeing it in different ways. I think mostly from sort of an anxiety perspective where people are, are making decisions that they normally wouldn't

Preet Banerjee: 44:28

want to ask you about your your work on the consenting capacity Board of Ontario. First of all, can you explain what that board is?

Dr. Ajmal Razmy: 44:38

Yeah, so it's basically a a multi disciplinary board, which consists of a usually a mental health or psychiatry member, a lawyer member and a community member that helped make decisions where people aren't usually where people are related to their capacity to make decision makings, if they've been if they've suffered from a mental illness, or their consent to certain treatments, for example, or being in hospital, against their will, for example. So yeah, it's my work that I did with the board is really quite quite a privilege to be able to work with with them. And they do great advocacy for people suffering from mental health issues.

Preet Banerjee: 45:35

And, you know, this, this idea of consenting capacity is something that's becoming a bigger issue in the financial services. So regulators are now putting a lot more attention, they haven't ignored it before, but they're putting a lot more attention to people who are older and may not be able to make decisions in their own best interests due to whatever dementia or Alzheimer's, whatever could be affecting their ability to make decisions, especially when you're older, you know, maybe you've got a bigger portfolio, you've had more time to accumulate money, it's more people want to take advantage of you. Or you have family members who are trying to take advantage of you. And so they may have decided a while ago, I'm going to put someone else in charge of these decisions. And sometimes they may not make decisions that are in the best interest of that person who's assigned them that power. So what are the general things to look for? And this is a tough one to sort of, you know, provide advice to people on but you know, if you've got people around you, or you're worried about your own capacity to make decisions, what are the signs that someone doesn't have the capacity to make their own decisions?

Dr. Ajmal Razmy: 46:54

Right? Well, just if I could take a step back to I think what's interesting from a societal perspective is if you ask millennials, how they feel about baby boomers, right? They're like, Oh, man, those guys are so spoiled, they got home, and it was like 10 cents, or whatever. But I think that there is, I don't want to, like, I'm not trying to generalize here. But I have seen a bit of a resentment of this new crop of individuals in our society, who may never have the opportunity to buy a house, and they never have an opportunity to do some of the things that were privy to these old, getting older generation, right. And that sets the table, I think, for potential abuse of that. I'm not saying it's happening in a rapid fashion, but people there's a desperation there. Like in terms of like, Okay, this is the old cohort, and they had a good and they may have, like you said, they've had a longer time to kind of have a certain portfolio. And it could set the stage for them being vulnerable to, you know, unfortunately, a little more desperation from the millennials, or from, you know, younger generations as well. I'm not saying it's happening everywhere, but I have seen it happen. And so that's an interesting societal setup, because even within a couple generations, we have huge disparity in opportunity. So something doesn't get always talked about, right. So I think that if you're looking at signs of, you know, as an individual, if you're going through this, and you're wondering, you know, am I am I losing my some of my capacity here. Some of the subtle signs are things like predicting people's names. So, you know, people within your family, especially for getting routes that you drive that you normally you know, to sort of, you might be driving all the sudden you find yourself in a completely different environment. Those are subtle signs. Interestingly, depression, anxiety, sometimes somebody comes in, and let's say 70 Plus, and it's their first episode of like, mental breakdown, I guess people would call that it doesn't add up because they never had that before. I've seen that be a harbinger of potentially cognitive disorder that's in the waiting. So if those type of things are happening, then you may want to get your memory checked up their memory clinics, you may want to talk to your first your family doctor and see what's happening. And because that the worst thing, I think, is not to be prepared, and then and then to have like, that kind of breakdown, and like I was saying earlier, the tables already set for this kind of dynamic of there's a sort of, there's going to be a debacle potentially, if especially if the younger generation artists fortuitous.

Preet Banerjee: 49:53

I think the last thing I want to end off with is, you know, maybe on a more positive note. Yes. For for people who are out there right now they're, they're trucking along. They're stressed, there might be anxiety, there's uncertainty, there's burnout. It's chronic. Yeah. And I know you focus on wellness, what do you recommend to people to say, Hey, listen, you know, if there's one thing you can focus on to put yourself in a better position to make better decisions, to to reduce, you know, some of the stress anxiety that we're feeling, we're just to promote, you know, mental wellness, what are the things that you see a lot of people just they keep not doing even though they know they're supposed to do? What are some of those things that that we really should be doing to take, take more care of our mental wellness?

Dr. Ajmal Razmy: 50:43

Right? And yeah, by the way, May is Mental Health Month. So I think it's good timing, you're asked to separate for me that see, wellness sits on like three major components of your life, which is sleep, exercise, and nutrition. And I think everything kind of stems out from that. So we talked earlier about making sure that you have some sort of regular routine so that you're getting proper sleep, you're you don't want to be exposed to all sorts of blue light all throughout the night, that's going to throw off your circadian pattern. sounds simple, but I think having regulated sleep is sets the table for your mental health, at making time for regular exercise, and healthy nutrition and not not talking in breach, but you know, making like wholesome meals and taking the time to do that maybe having fun with it. Those those are the three main components, I would say, a sense of belonging. If you look at resilience, resiliency in general, and some of the core traits of resiliency, a sense of belonging community is so important. And we can do that in all sorts of ways. Even if you're isolated by yourself just sort of saying hi to someone in the elevator, if you live in a condo, checking in or neighbor, you know, socially distance, I guess, but you know, saying hi people are people with mass add on people or I say hi to people all the time, they look at me, like, Why are you saying it? And so I think whatever you can do, to have that kind of sense of belonging will help your resilience, having a growth perspective and understanding that we will get through this, it will be different, we may need all sorts of different things down the line for different, you know, whether it's booster shots, or whatever. But, you know, let's gain a growth mindset and a different perspective about where things are going to go forward. accepting the fact that, you know, this is a tough time 2% of our population is going to be hit hard. And we're doing this because we care and as a species. That's pretty cool, right? I mean, I don't know if you if you had a bunch of lions, and they had this method, like talk about the Coronavirus and said, well, 2% of us are going to die. So are we going to like band together for this? They may not. I think as a species we have and we want to care for one another and, and we don't want to live knowing that we did it. And so I think that that perspective is important. We talked about humor. So I think it's important to still take time to, to to have some joy to have some moments of awe and appreciation for what we're seeing. And experiencing even though it's it's difficult. And lastly, I guess to end on hope, right, like to be hopeful for a better future. And just like we're talking about in terms of organizational structure, you know, the hybrid model might be awesome, and how do we incorporate some of the positives that we've gained out of this pandemic? as tragic as it has been, with the hope for a new corporate athlete for a new corporate environment where we can all Excel? I think, if you if you incorporate those elements, then I think maybe the future's bright.

Preet Banerjee: 54:03

All right, well, we'll leave it there. But the last part of every podcast normally what I do is I give every guest like a two minute commercial. Would you would know if you're a regular listener, but I guess you're not.

Dr. Ajmal Razmy: 54:18

I talked to you enough. Yeah,

Preet Banerjee: 54:19

no, I get your fill. Yeah. Okay. All right. So So yeah, I mean, everyone gets too many careers, but I don't know what you would promote like, hey, come see me in the ER, I mean, you obviously would not want that. But is there anything that you do want to to plug?

Dr. Ajmal Razmy: 54:38

Well, I a couple things. So. You know, if you're, I think I think if you're if you're cognizant about your sleep and you're wondering, what is the quality of your sleep and am I going through a tough time? I happen to work at sleep on the bay, which is a really fantastic sleep clinic that looks at my Sleeping is but also alertness and other facets of your overall sleep function. So, sleep on the bay.ca you can check that out. I think also just in terms of a plug, I mean, like, like, let's give kudos to Cleveland Clinic Canada for all the amazing work that they've done in terms of providing health care during this tough time. Kudos to just a brand new hospital that really banded around their community. You're not just positions, the health care workers, the the people in the locker room, you know, Tim Horton staff, everybody's sort of banded together and people I've worked with, it's been such a privilege to be with them. And ultimately, you know, this is just to help our community grow and survive in this difficult time. So, those are my only plugs.

Preet Banerjee: 56:00

If you want more personal finance content, or you have questions for me or topic suggestions for the podcast, you can follow me on Twitter or Instagram and ask away same handle in both cases at Preet Banerjee, also have two YouTube channels, you can subscribe to my main channel, which covers personal finance and investing topics that are more global in scope, and a Canadian specific channel as well. That's it for this episode. Thanks for listening.