How to Recognize and Respond to Toxic Behavior

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We’ve all dealt with toxic people but what do you do when someone’s actions begin to affect your emotional well-being? Sometimes, the answer lies not in changing the person who hurts us – but in changing how we react to them. Psychiatrist Dr. Patrick Runnels, Chief Medical Officer of Population Health at University Hospitals Cleveland, explains how to handle toxic people, even when removing them from your life isn’t possible.

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Macie Jepson
I read recently that there’s another pandemic out there and it’s attacking our wellbeing this time. Its victims, though, are left emotionally fragile. The culprit is toxic people. Now they’ll leave us feeling less than sometimes dismissed and unfortunately, very often emotionally broken.

Matt Eaves
Yeah, I’ve been hearing the word toxic a lot more in recent years. Toxic relationship, toxic boss, toxic workplace. And it got me thinking what does that term really mean? And are we really dealing with more toxic people in our lives? Or if we just become more sensitive as a society?

Macie Jepson
Hi, I’m Macie Jepson.

Matt Eaves
And I’m Matt Eaves, and this is The Science of Health.

Joining us today is Dr. Patrick Runnels who’s a professor, Department of Psychiatry and the Chief Medical Officer of Population Health at University Hospitals in Cleveland. Dr. Runnels, thank you for joining us today.

Patrick Runnels, MD, MBA
It’s great to be here. Thanks for having me.

Matt Eaves
Let’s start out with just we talked about toxicity in the beginning. What does that word mean. How do we how do we define it.

Patrick Runnels, MD, MBA
So I’m a psychiatrist, right? And the first thing I want to say as we start this conversation is right now, it’s what we call a colloquial term. It’s a term that we’ve applied and it has great meaning. It doesn’t necessarily have a specific scientific definition or a definition that we would agree upon. That said, when people talk with us about experiencing toxic people, they’re typically talking about people who are having a bad influence on their emotional state in their life.

So, quite simply, someone is bothering me, someone who’s given me grief all the time, someone who is sometimes toxicity is something I enjoying the moment. So sometimes a toxic person is someone who I have a lot of fun with. But the long term outcomes of being around that person are bad. So we use it that way. More recently, though, it’s come to represent a term, I think, in which people are describing someone that they feel is causing them to be in a negative emotional state on a pretty regular basis.

Macie Jepson
So toxicity not necessarily being a clinical diagnosis. Is it even possible then, to find out why someone is toxic? Could we go there? Because I’d like to start there before we talk about how to deal with the toxic person.

Patrick Runnels, MD, MBA
When we say toxic, we probably all mean slightly different things. And the way in which someone is toxic can be very different depending on the person in the situation, right? So I absolutely want to dig in and start by saying, can you identify what feels toxic? How do you know this person is toxic? What are those instances like?

What is the nature of your relationship? There’s a big difference between someone that is toxic that I get, that I have a lot of fun with, but causes me bad things in the long term versus someone who makes me feel bad about myself. And there’s a big difference between a distant uncle who makes me feel bad about myself and my wife, or my husband making me feel bad about myself.

Those are very different spaces and different ways of thinking about it. So understanding how close this is, how often this is happening, what it means to you and why it’s toxic for you. And I even then get into and what have you done? What’s what? You know what kinds of things have you tried to do to essentially reduce this or make it go away?

We use the term mitigate, right. In psychiatry. What have you done to mitigate the toxicity? Not as a judgment but as a what’s happened when you try to do something? Why is this person still part of your life?

Matt Eaves
And is that a relative term depending on the person? You know, I think about when I’m watching a sport on television and I see a coach laying into a player. You know, some people may view that as being toxic, but the player may want that kind of feedback, or even for me. And I, you know, as an organization, we’re getting ready to go into annual review time.

And I have some employees that say, look, I want you to just tell me exactly where I need to improve be. Be hard on me. And then others who would interpret that same sort of feedback in a very different way.

Patrick Runnels, MD, MBA
So I’m going to pull on two bodies of literature. One is on what we call psychological safety. And so two year point not all negative emotion is bad emotion. Not all negative. You know. So feeling stressed can be a valuable thing of it helps me meet a deadline. Feeling unhappy with my performance can be helpful thing if it helps me improve my performance.

There are negative emotions that I want and that aren’t bad as long as I get them in the right dose. And so on one hand, psychological safety is about people feeling like they can be in a space where they’re free from retribution and free from judgment, and like their voices, is heard and valued and acted upon and included on any actions that are taken.

Right. That’s kind of where you would define psychological safety. And so if I’m in a psychologically safe space, one of the benefits that affords me is the ability to have friction with people, but not feel bad about it. The ability for someone to give me feedback, that is about how I can improve, about something I didn’t do well, the ability for me to do the same thing back to someone to hear that feedback and have a back and forth is actually really valuable in the same way as you described.

If I have a good relationship in a psychologically safe space with those who I report to, then the ability to get feedback is something that I’m going to take as an opportunity to grow, which is very different if I don’t have that psychological safety. So that psychological safety is really, really key. And if we apply this, then to the family member who is ribbing us all the time from the other side of the political spectrum, right.

We kind of go there as being some of this toxic. There’s absolutely five of the dynamics that I run into in which people with each other and they look like they’re in having an argument, and then they get down and they’re slapping each other in the back and having a good time and no big deal, right? And it’s totally different in another circumstance.

Right. And who other family members are miserable and always feel terrible around each other. So in that regard, whether or not it’s performance at work or good natured versus ribbing about something on which you disagree versus feeling really attacked for an opinion you have, right? Those things absolutely are incredibly relative, and that relativity is a really important part of identifying what’s going on.

Usually, though, when I hear someone say, I’m in a toxic space, it’s in an absence of feeling psychologically safe in that space, right? So this is not usually a place where people feel that.

Macie Jepson
I picked up on something you said about asking a patient what how they feel, why they feel, what’s happening. What have you done to mitigate this situation? And what I learned from that is you’re not asking about the perceived abuser. Is it not a good idea to go in saying, I think I can change this person. Let’s, let’s, let’s address the person and let’s see what we can do about that.

Because it sounds to me like you’re addressing the person who feels badly and more concerned about what you can do about that. Does that make sense?

Patrick Runnels, MD, MBA
It does. And I start by saying most people don’t come to me saying, there’s this toxic person in my life, and I want you to take care of it. So on the good news front, most people come in to talk with me about what they can do to change the circumstance, change the dynamic, figure out how to make someone less a part of their life.

Right? But you’re right to say I have no control over someone that I am not meeting with. And so as a behavioral health professional, my job is to tend to the person in front of me. It’s not that there aren’t really toxic people out there who don’t need help. But in the moment when someone’s come to me saying, I have a problem with another person, that’s toxic.

My job has to be to focus on them and what they’re, you know, and what’s going on in their lives and what opportunities they have to take control back from a situation that just doesn’t feel like it’s in their control.

Macie Jepson
And so when someone’s thinking about coming in to see you setting those expectations, and I think your listeners could benefit from understanding this, it’s really preparing themselves to come in and to be helped by you to get themselves in a better place. Not I need you to fix this thing.

Patrick Runnels, MD, MBA
Yeah, I’d add a caveat to that. Right. So, a lot of people come in and the answer is they don’t know what they want. We start with this place of what they want is to share and, you know, and we can all relate to this. We’ve had a bad experience, or we have some we’ve identified that is toxic in some small way, at least.

And we start opening up to someone not because we expecting anybody to solve our problems, but because we often start by describing right. And our own journey is describing what’s going on and sharing and commiserating. Right. And by the way, commiseration is a there’s a psychotherapeutic technique that’s being really geared towards just being there and letting people kind of, you know, express emotion, get stuff out, just process stuff and feel like, you know, and that can be really helpful for folks.

So having a place to, you know, quote unquote vent. That said, often it is in the context of them wanting to take action or wanting to figure something out. And so the next step is, well, this means that we’re going to talk about what you can do. And so I think being aware of that is a really important first step.

Matt Eaves
We’re focusing a lot on the folks who have identified the problem. And now or sitting in your office and and my guess is there’s a much larger group who are probably on the receiving end of toxic behavior, who haven’t yet identified, and people who are being toxic or typically not doing so in a loud, kind of in-your-face manner, like that’s happening sort of gradually over time.

And is it is it hard for people to recognize when that’s happening to them? And a lot of times on the outside will look and be like, man, that’s a bad relationship. But the person who’s on the receiving end doesn’t see it is because it’s this gradual thing, or what is it that causes sort of that disconnect of, hey, I’m in a bad spot.

Patrick Runnels, MD, MBA
We, all can relate to having observed someone who’s in a bad situation and doesn’t realize the degree to which they’re in the bad situation, or doesn’t fully identify the situation as bad. It is often that if I’m in a space where it’s happened a lot, I am normalizing it. Even though it is a bad situation, I shouldn’t be, but it’s what we do as human.

Macie Jepson
As a person on the outside, looking in on an uncomfortable relationship. I’d love to talk about some advice that you could give them. I’ve been in situations where intervention, if you will, of a, you know, group of girlfriends talking to a friend. Then we see clearly how that a toxic relationship is affecting that person, and we see the actions that are offensive, but that person doesn’t see it.

It truly, I walked away feeling like I had accomplished absolutely nothing, because it was like talking to a wall. I would have loved to have had some advice from a professional about how to approach that.

Patrick Runnels, MD, MBA
If we’re a third party observer, there’s a lot of evidence that directed by telling people what to do is not an effective way to help people right to borrow. Psychotherapy and coaching have this in common. So if you’ve ever had a personal coach, whether that’s for, an activity you’re doing or just a life coach or a professional like leadership coach, there is a lot of similarities here, which is the job of that person isn’t to tell them you need to do this, not that you can’t say that.

It just is likely not to land very well. And it has a lot more to do with helping them verbalize and pick out what they’re unhappy with. What’s not going well for them, and what they, you know, and what actions they might take. Right. It’s helping them kind of walk through that. If they ask if they say, hey, what do you think’s going on?

Giving an opinion is perfectly fine. But the degree to which people are going to change, it’s about where they’re at, and it’s about having them and helping them frame what’s going on. And, you know, what they see is the problem. Identify what they see as problem, and then start to identify the solutions that make the most sense.

You can absolutely go back and forth in your head. That may or may not be a good idea, but it has to be driven by them.

Macie Jepson
Okay, I’m getting a clear vision of why my conversation didn’t go so well. Thank you very much, Dr. Runnels. Yes, did not handle it that way.

Patrick Runnels, MD, MBA
Well, but listen, you’re in the majority of people, right? It’s so easy when you’re outside a situation to see exactly what’s going wrong. And it’s pretty darn easy to see an action that would really resolve the problem. I’m not perfect at this. I’m not even perfect. So my patient’s right? Like I ought to not be doing this.

And sometimes it slips out right. And it’s just it’s how we are as humans. We see a problem. We want to attach a solution. It takes patience and a little bit of kind of self training to restrain yourself from trying to throw answers out there all the time.

Matt Eaves
Projection and blame shifting seem to be common traits of a toxic person, and therefore sort of there’s an inability for them to see themselves as potentially the cause of the problem right there. They are stirring the pot, but don’t necessarily see themselves that way. Do you find that often with your patients that those sitting down for help with others, really the solution sort of starts with them?

Patrick Runnels, MD, MBA
Right. You know, so, I, I would even take a step back and say the solutions kind of start with, you know, a very common scenario I get all the time is I’m having a holiday meal with a family, and I’ve got this uncle, I’ve got this brother in law, I’ve got this so-and-so, or there’s this, you know, they’re there.

You know, our kids get at it, right? They’re identifying a situation that isn’t common, but it’s there. Right. And so the start of it is kind of I’ve got this stressor, I got this person that I see is problematic. You start by saying, describe it, tell me what’s going on and identify it and put parameters on it. What is really the toxic part of this?

If you’ve identified, if you don’t like it, if it’s a fly in the ointment, okay, let’s color that in and understand where it is a problem, where it is not a problem. Right. Is this a global thing where this person is just always really rough to be around other specific scenarios? Okay, so now that you’ve colored it in, what’s color, in what action steps you’ve already tried and what made you want to try those?

What motivated you? What was the response? Did it help? Did it not help? And you, if you start with that first step, describing it, coloring it and all that, oftentimes when you help people do that work, that clarity helps them start to move towards an idea for a solution.

Matt Eaves
Yeah, I think that’s really good advice that I think about that sort of my own behavioral reaction to situations that are either unpleasant or uncomfortable. But when you start to you walk away from the situation and say, wow, that was really uncomfortable. But when you start to break down, okay, what exactly about that interaction was? What was it that what made it go wrong or that made me feel bad or awkward or, you know, like I was being disrespected or whatever the case may be.

How can I change that in the future? What can I do differently? Or maybe then I can react differently or it doesn’t hit me is hard emotionally when somebody says that.

Patrick Runnels, MD, MBA
Yeah. So if I’m someone who’s got a toxic person in my life, a natural human response is to develop a sense of despair. Nothing I can do about it. This is out of my control. It’s hopeless. And this is just going to suck. And I just have to persevere or contempt. That person is terrible. That person is awful, I hate them, I’m angry at them.

And you start to paint them as all bad or all good. I am certain that many audience members listening to this right now, in this election season, have relatives and or friendships that have ended and or severely curtailed and that is that is a natural human tendency to kind of think things is all or nothing. It’s a natural human tendency to look at someone and define them entirely by a specific set of actions or specific set of thoughts or ideas.

It turns out a lot of the time that’s it’s not. Most the time, that’s not a very useful way to think about how to come to a resolution. And so a lot of the work that you do, once you’ve kind of asked all those questions, is to help find ways for people to think differently about what’s going on or about what kind of action they might take.

If their frame is one of despair, it’s hopeless and I just have to persevere or contempt. This person is awful. There’s nothing that can be done. They’re just a terrible person. Then you’ve just shut off any avenues for resolving the conflict, right? Because if I go to you and say you’re a terrible person, guess what? Every toxic person on the planet doesn’t agree with you, right?

And so that’s not going to get you very far. But if instead you find ways to think about, well, maybe that person doesn’t know how I’m feeling, or maybe that person doesn’t have my perspective and I’ve said something to them, but we haven’t gone down well. Let’s talk a little bit more about what’s going on here. A lot of times when you dig in and see the person delivering that toxicity as a human, someone that is worthy of trying to figure out and learn more about.

If you go in there with curiosity, people change pretty quickly what they’re doing. I want to be very clear. Make a disclaimer. There are times in which that’s not totally appropriate, but it’s way more appropriate, way more of the time than people give it credit for.

Macie Jepson
I’d like to do some role playing really quickly, though, before we move forward, and this could happen with the political climate. It could happen any time, not just after, you know, a big election. You’re part of the problem. Don’t you understand that what you did in the booth is is ruining our country? Dr. Reynolds, you made you made a mistake.

I can’t believe you did that. How do you get out of that? Because now we’re in the middle of a conversation, maybe in front of people. Could you walk us through how to constructively get out of that?

Patrick Runnels, MD, MBA
Two things just happened there. And I just said, just as we think or really common scenario, this happens all the time. And toxicity is being received on both ends, right? This is a mutually toxic experience because the person who’s attacking you feels as though you’re you’re attacking values they hold dear. And they responded by attacking you right back in a way that makes you feel attacked.

The natural response for most people is to defend themselves and say, I’m not the problem. You’re the problem. And the answer. When someone says, you did this, you did this, you did this is to say, you know, is to take a step back and say, whoa, whoa, whoa. Yeah. We’ve talked about some of the decisions I’ve made and know we’ve had this discussion.

And, you know, we haven’t always agreed. But I think one way to for us to think about this is to really say that I’d like to understand a lot more about what’s driving how you’re feeling about me right now. And I want to learn about you and what values you have in exchange that I’d like to kind of talk about me and what values I have and what’s going on.

That’s just one way to kind of reframe it and say, let’s get to know each other a little bit better before I make these global judgments. Right, right. It’s really hard to do. You got to stop your own reaction to being attacked and wanting to defend yourself. That’s not so easy. That can take some practice. Sometimes you can take a break and say, hey, you just said that.

I get you’re upset now I’m upset. We’re not going to have a productive conversation. Let’s take a break. And but I’m going to be over in the kitchen or I’m going to be outside in the backyard or whatever that is. Maybe there’s more we can learn about each other once we’ve had a time to cool down.

Matt Eaves
Because you’ve described a pretty ideal situation where you have the ability to say, I’m going to walk away for a second and you can, I’m going to be in the kitchen, or I’m going to be in the backyard. And I think today, the world that we live in, one highly social media, so not as much face to face interaction.

I can say something and I can walk away from it and don’t have to deal with any consequences but to make it, to make it a little more real. But even in the workplace, it’s now especially a lot of companies are almost all virtual. So my only interaction with you is a few times during the week, potentially in a meeting.

And I’m only seeing you on camera sometimes if you have it on. And so it’s very easy for me to then, based on a couple of interactions or just the way that you’ve presented yourself to then say, okay, I think I have a whole picture of you versus in years past, I would hear you on the phone with your family while we’re in the same cubicle area, and I get a sense of who you are as a person.

We lunch together. Do you feel like this has gotten worse post-pandemic or no, or we potentially just deciding, like what I just did, I’m assigning blame. Oh, it’s the virtual world. It’s the social world.

Patrick Runnels, MD, MBA
Or so there’s going to be some of my own just personal opinion here. I guess as someone who’s maybe an expert in this space. So we’ve got a pretty good body of evidence, right now that shows that since the advent of social media, we have seen a marked up increase in a number of factors. We’ve seen a market up in teenage depression, anxiety and suicidality, a uptick in teenage substance misuse, a increase in people describing themselves as lonely, as describing themselves as having few or no friends.

And we are seeing people disengaged from the community forums they used to have. We know, by the way, that those things have disproportionately impacted people who are of lower economic means, meaning the more economic distress people are experiencing, the more those things are likely to impact them. Which is just to say, there is an unequal ness to society right now based on your income, in terms of your ability to connect into that.

What we have as a social media environment in which we have the dissolution, a lot of the common community forms that we used to have in person that have been taken over by these kind of online spaces, as you’ve described, and we’ve had the concomitantly had a total increase in people’s just individual misery and really their isolation. Right.

All those things are happening as so we know those things are happening. And when people are in bad spaces, they start to behave in ways that aren’t really thoughtful about others as much. And by the same token, I stopped seeing people as much as people. Right? And so if I’m only getting a snapshot of you, that is your digital footprint or your social media footprint or, YouTube video or a TikTok or whatever you’re putting out in the world now that’s defining who you are by the way, the algorithms for those things encourage people to say outrageous, polarizing things, because that’s what gets reactions.

We know that our amygdala in our brain is very primed. That’s the anger center in our brain, amongst other things. It is very primed to latch on to things that are strong, polarizing emotions with us. We know Facebook has spent time actually tweaking that to stimulate that response, which is to say we want to be angry. And if they’re then feeding that and then our feeds for whatever social media thing you’re on are pulling in all that stuff, well, what do we now learn when we learned that everybody is terrible, everyone’s oh wow, look at how awful everybody is.

When you then go and talk to all the people that look awful, what you find is they’re the same people we’ve always known, and they’re not all bad or all good. But boy, is that the world we’ve been presented with.

Matt Eaves
Yeah, it’s really interesting.

Macie Jepson
That does kind of lead us into this trigger warning society. And, and so I’ve often wondered if people who’ve touched on this just love drama, love to be triggered. And it leads to, to my question, which is the difference between feeling uncomfortable and feeling unsafe, you know, and then also between direct communication and abuse. So people are feeling triggered, but by different levels of activity around them.

Patrick Runnels, MD, MBA
So my first response is what’s delineate between so you said people like drama, right. And what I’ll say is sure. Who doesn’t like a good drama? I don’t think people like feeling bad though. There’s a difference. And so, having something that catches my interest and outlet survivor still a popular show, 50 some odd seasons into the thing, right?

That is a bunch of people getting together and really making life tough for each other, right? That’s the game, right? Very popular. But we walk away from that feeling, okay. Right. You know, people walk away. Getting enjoyment out of that doesn’t personally impact its reason it’s popular, and it’s popular because it entertains and it doesn’t cost too much distress.

So, sure, we like, you know, soap operas still exist. You know, I’m still surprised by that. Popular movies are ones that are often melodramatic, right? You know, political headlines. Absolutely. We’re all guilty of looking at the political headlines that sound like the biggest kind of point of, you know, of friction. Right? And that’s true. There’s a difference, though, then, between I’m attracted to, things that have a certain amount of drama to them, and I’m, it’s causing trouble in my life.

What? I do not think people are attracted to what they do not want their lives to be unpleasant. They don’t want to experience high levels of distress as a result of what’s going on. Right. And so in that regard, I would shift and say it is, however, interesting to kind of point out that behavior is we are now primed to do checking, and I’m going to use a paper that I read, The New York Times.

When you look at the headlines and you compare those to how those headlines looked 30 years ago, what you’re going to see is a whole lot more language that is subjective, that is polarizing in terms of how it’s framing things. And if you then go to The Wall Street Journal, you find the same thing and we go do that.

And this happens all the time, the doomscrolling side of things. Right? Doomscrolling does not make us feel better. No one actually wants to feel bad in the way that Doomscrolling does that to them, but they can’t help themselves, right? So a part of our brain is taking over the habit, part of our brain. And that habit, part of our brain is driven by our amygdala.

Right. And it’s also driven by other things that, you know, things like the nucleus accumbens. There’s chemicals in our brains. Dopamine is something that helps us form habits, the things that give a small bursts of joy. How many times when you put your phone down, you then look at your phone? How long is it before you look at your phone and pick it up and pick it up and pick it up?

Is that bringing you joy? No. Is that what you want to be doing? No, boy, it’s just what you do. Doomscrolling falls right in that same category. I don’t want to feel bad. I’d really not like to read headlines like this. That would be really good. So it’s important for us to recognize as humans that our pathways for repeating behavior can be hijacked by all kinds of things, not always intentional brains can be hijacked in ways that mean that we’re engaging in the activities all the time and can’t necessarily stop.

I then want to say one more thing, which is I want to differentiate between the idea that we get ourselves into spaces where this is happening and dynamics that are toxic, that are creating ongoing, distress that we’d really like to get ourselves out of. It is true that some people get themselves in a situation that are of their own making, that are also distressing to them.

Right? And, you know, sure, that happens. It is also true that lots of people really do feel like they’re in an oppressive situation. And maybe are contributing to it, but it’s not clear, obvious as to what’s going on. And there are ways in which you can kind of reframe people’s thinking of those situations and those people to help them identify what they might be doing to, feed into that or choices they’re making.

The ability to be fully aware of that kind of inflaming a situation.

Matt Eaves
You’re so right on the phone. You’re setting it down on the desk. If my Excel file takes more than three seconds to open, then I’m like, oh, I got able to grab my phone and check something, so I’m not wasting any time, right? I’ve been filling time, right? But of course I’m not. I’m just distracting myself. Probably from what I should really be doing.

Patrick Runnels, MD, MBA
Yeah. No, it’s people think the filling time it takes about five to 10s for your brain to shift from one task to another. If you look at how often people are picking up their phones, it is way more than every 10s, right? If you look at it, they’re picking up the phone. There’s no way you’re doing anything productive.

It’s just not a thing. Stop it. That’s not what’s happening right? I think I’m being productive. So it’s the unrest of not doing something that you’re acclimated to. And by the way, when you open your phone, I’m waiting for my Excel spreadsheet to load. You’re probably pulling up something that’s polarizing.

Matt Eaves
Is there any advice to helping with that behavior or getting it to stop or something you can supplement? So that doesn’t happen.

Patrick Runnels, MD, MBA
The degree to which you’re feeling distressed by the world, by the news, out in the world, by the sense that you can’t change anything in the whole world’s going, going, going down. That’s probably a symptom that you’re over engaging information. And that news can be from a professional news source, like The New York Times, or that news can be from the people on your Facebook page.

You can limit your time. You do not need to check the news every day. You certainly don’t need to check the news every hour. If you’re feeling bad about the world and you’re feeling overwhelmed, hopeless by all the terrible things, cut that back. Cut back news to once a day. If you’re doing it all the time, say if it’s.

If that’s not working, cut it back to once a week, right? You can cut back these things. You can absolutely narrow and contain the time you spend on those things. You can dis install those apps from your phone and only use them on a sit down computer. There’s so many ways to do that. That sounds painful to a lot of people.

There are a lot of people who will find ways, well, I can’t really get Facebook or X off my phone because of this and that. And what I say is sure. And like you can make all the choices, but the easiest recipe for this is to decrease the amount of time you’re in front of the sources that are causing you the distress.

Right? It is simple and it is doable. And by the way, it’s more doable if you do it with similar meaning. And I’ll use this example. If you’re married, you go to your spouse and say, I need to stop this. I’m feeling bad. You see me all the time. I’m always checking my phone. I’d like to stop. Hey, can we both get off of Facebook, or can we both limit our time on that?

Enough. Or can you help me with that? Can we, you know, can you police me a little? Like, you can do any number of things. But having a partner in crime is so important to actually having a shared a lived activity or live change and changing activities. Really take it.

Matt Eaves
Has there been an overcorrection to some of this? I’m also hearing about toxic positivity, where we sort of are refusing to recognize any fault and telling people, this is great, you’re doing awesome, and not letting people that kind of feel the way that they feel is, is there danger in that? Is that a real thing?

Patrick Runnels, MD, MBA
Yeah, a little bit of distress is okay. That’s life man. Right. And and that’s okay. Right. It’s okay to feel bad some of the time. Feeling bad some of the time is what makes the great times feel great, right. It kind of keeps things real. And I do think there is an increased quick fix, this kind of infecting our society that has always been there.

Just to be very clear, I’ve always gotten folks in front of me in my office who are really hopeful that I’ll have a medication that will make all the distress go away. And so there’s this level setting, right? And I do think we are sending cues to people that there ought to be fixes for what’s going on in the same way, like wrinkles, you know, stuff those this Botox, you like, which is so much more accessible than plastic surgery used to be.

Right. There’s any number of, you know, and this is not to knock the medication, but diets forget diets. We’ve got ozempic now, right? And, like, there’s a whole lot of this stuff that is about, oh, if I can just take the pill and I’m good. This is awesome, right? I think that’s true in a lot of ways about distress tolerance and the, you know, the story is, yeah, I know having some distress is a good part of life.

And I do think we’re getting signals that there are things we ought to be fixing. And I think there’s a bit of ubiquity to that. Like, no, you don’t have to always feel great. You don’t always have to feel like your life is going in exactly the direction you need to be going. You don’t always have to feel like you are the best person on the planet right?

You can have some existential distress. You can feel badly about something you did. You can actually feel a little depressed about the state of the world after the election. Didn’t go the way you want for a day or two, right? That’s different than wallowing at it. But you can have those feelings and there’s no need to fix it.

I will say lots of people still do just fine with us and they recognize us. We maybe don’t say it quite enough to help people normalize. It’s okay to feel bad. The answer is nuance in both directions. Having the ability to kind of say, yeah, things look really bad right now, but they can be okay. And also, oh, I feel bad.

It’s okay to feel bad, right? Those two things all exist together.

Macie Jepson
But are you finding that oftentimes it’s not so real and that we’ve just become a more sensitive society? I don’t want to downplay the real. Maybe we should talk about both.

Patrick Runnels, MD, MBA
When you are depressed and anxious and distressed and overall not feeling good, you are more sensitive to slights. That’s just part of the deal, right? I have a lower depression. One of the features is lower self-esteem. Coming with lower self-esteem is the perception that I am being attacked more often right when I am anxious. One of the things I’m worried about that ruminating about things that maybe are not so clear.

Right? Like, but I can’t stop thinking about the what ifs. Right? That’s a core feature of anxiety. In both those cases, if we’re seeing an increase in anxiety, an increase in depression, you would absolutely see people being more sensitive to the idea that things, that distressing things are causing them trouble, or feeling less like they have armor to protect themselves from those those issues.

Right. They’re kind of hyper attenuated to feeling put upon or feeling distressed or feeling paranoid or feeling anxious. Right? So if I am already in a low place, my ability to kind of talk myself out of it, kind of shake it off, all that kind of stuff is less good, right? That said, I think it’s less that we are inherently less good at it.

I think we just set up an environment full of that makes it very hard for us to be good at it. I’m actually in a studio here right now with people. I’m looking at you in the face and I’m making eye contact. This is glorious. I don’t get to do this nearly as much as I’d like. Back to your point, Matt.

We set up an environment in which we’re on zoom so much. We’re so used to that that, you know, we miss this. And when you do this, when you’re in person, you make eye contact. You’re in the same room with someone. Guess what? It is a whole lot easier. All of which is to say, no, I don’t think we’re set at I do think we’re in environments in which we can’t possibly be any better.

And I do think that if we’re as a nation, more distressed and more mentally unwell, that that does reduce. When you are in that space, you have a reduced capacity to manage to that stuff.

Matt Eaves
For someone who’s seeking help from a behavioral health specialist. So when is the right time to seek help? Or what is the difference between a psychologist and a psychiatrist? How do you know which one to go to or when is one appropriate over the other?

Patrick Runnels, MD, MBA
So the purpose of our conversation psychologists are, in other types of therapists, social workers, licensed counselors are much more likely to be the ones you go see to do talk therapy. You can go and just say, look, something my life’s off and I want to talk it through. That’s a thing you can do with it, right? For a lot of people, they have other parts of their lives that help balance and help them kind of reflect and think through what’s going on.

For some people, the right answer is to go talk with their support circle, right? Their closest friends, family and all that. Sometimes it’s both what ought to be the case is that you’re able to go somewhere and share what’s going on, describe it, and then have that person be able to reflect back with you and think through what would be some steps you could take or should take.

What are the things you can control? What are the things you can’t control? Kind of put this situation in a new light and allow you to kind of move past it.

Macie Jepson
And your advice for when that time is right, because someone may mull over these issues for a long time and not get anywhere. When do they need to seek help.

Patrick Runnels, MD, MBA
With regard to toxicity with regard to someone that’s making them unhappy? The short answer is if you’ve tried everything and you’ve gone inside and you don’t have any other places to turn and you’re feeling distress, that is kind of persistent and always there, and you don’t feel like there’s an easy resolution and you’re starting to know your emotional state over time.

Getting to a point where you’re pretty unhappy. That would be the signal. It’s the change over time. Your virtual state. If something makes you upset once a year. I’m probably not seeing a therapist for that. But if you’re in a situation where you’re you’re not sure how to get out of something, you don’t have other people to help with a situation in which you’re feeling pretty bad a lot of the time, maybe regularly.

My overall view of life has diminished over the last three or 4 or 5 weeks. Yeah, that might be a time to go check in with someone.

Matt Eaves
Dr. Patrick Runnels, professor, Department of Psychiatry and chief medical officer, Population Health at University Hospitals in Cleveland. Great conversation today. Thanks for joining.

Patrick Runnels, MD, MBA
Oh, it’s a pleasure. This is a great conversation. And, as always, it’s a joy to be here.