Oby: Content warning, during this episode, we discuss a person's experiences with depression, anxiety, and briefly mention suicide. We acknowledge this content may be difficult for listeners and encourage you to care for your safety and well-being if you choose to listen to this episode.

From the campus of Harvard Medical School, this is ThinkResearch, a podcast devoted to the stories behind clinical research. I'm Oby, your host.

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ThinkResearch is brought to you by Harvard Catalyst, Harvard University's Clinical and Translational Science Center, And by NCATS, the National Center for Advancing Translational Sciences.

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The state of mental health within the medical and science communities is a growing area of concern, some even calling it a mental health crisis. Reports of stress, anxiety, depression, and even suicide are increasing in these groups. Yet, the conversation around mental health can be overlooked. Today kicks off the first episode in a series on mental health in medical training and graduate education in collaboration with the Mind Project, a working group at Harvard University dedicated to tackling the challenges caused by neuropsychiatric and neurodevelopmental disorders and improving mental health for all.

We are joined by Dr. Castanho, a postdoctoral research fellow at Beth Israel Deaconess Medical Center and Communications Director of the Mind Project, and Dr. Ward, psychiatrist and assistant professor at Vanderbilt University.

Hi, Dr. Costanho and Ward. How are you? Great to have you here.

Isabel Castanho: Hi.

Heather Burrell Ward: Thank you for having us.

Oby: Before we get started, could you each briefly introduce yourselves and how your work intersects with mental health?

Isabel Castanho: Sure. So my name is Isabel Costanho. I am a postdoctoral research fellow working with Dr. Winston Hide at Beth Israel Deaconess Medical Center, or BIDMC, at Harvard Medical School. I have a background in biology, neuroscience, and genomics having completed my PhD at the University of Exeter in the United Kingdom in 2019.

I was fortunate to be recruited by Dr. Hide and joined his lab last year, where I'm currently delving into computational biology and bioinformatics to build models that advance our understanding of Alzheimer's disease. In parallel to my research, I have developed an interest in mental health and illness. As a result of both working in labs researching anxiety, and depression, as well as schizophrenia, but particularly as a result of having struggled with depression myself in the past, and living with anxiety my whole life really. Anxiety and depression are part of my family history. And today after embarking on the neurobiology track, it is fairly easy for me to look back and recognize it.

So I guess as a result of self-discovery and personal interest since my PhD, I have been trying to be more vocal about the topic of mental health and illness, promoting conversations, and fighting the stigma associated with it. And a few months after I moved to Boston, I came across the Mind Project, which is an effort working towards solving major challenges of the mind.

Since I joined last year, I have been busy trying to achieve the Mind Project's mission of improving mental health for all. This collaboration with ThinkResearch is an example of that for which I would like to use this opportunity to thank the team behind this fantastic podcast, for accepting to embark on this adventure with us at the Mind Project. I'm very excited and happy to be here today. And this is such an important topic that I'm so, so very grateful that ThinkResearch joined forces with the Mind Project and gave us a platform to talk openly and honestly about mental health in science and medicine today.

Heather Burrell Ward: My name is Heather Burrell Ward. I am a psychiatrist and an assistant professor in the Department of Psychiatry and Behavioral Sciences at Vanderbilt University Medical Center in Nashville, Tennessee. A psychiatrist is a medical doctor, so someone who graduated from medical school, and completed specialty training in the diagnosis and treatment of psychiatric disorders, such as depression, anxiety, schizophrenia, and substance use disorders. Psychiatrists provide treatment for these disorders. And these treatments can include medication, therapy, and forms of brain stimulation.

I attended the Duke University School of Medicine and then completed my residency in psychiatry at Brigham and Women's Hospital and Harvard Medical School. And after my residency, I completed fellowship training in research and behavioral neurology at Beth Israel Deaconess Medical Center and Harvard Medical School. And I just joined the faculty at Vanderbilt this summer.

And so in my current role at Vanderbilt, I conduct research using brain stimulation to develop new treatments for disorders like schizophrenia. I see patients. And I also teach psychiatry resident physicians.

Oby: So mental health concerns among medical trainees, graduate, and postgraduate students have grown in recent years. What can you tell us about the state of mental health within these groups?

Isabel Castanho: According to the literature from students to faculty, reports of stress, anxiety, depression, and even suicide have been increasing in recent years. And a recent study by Dr. Evans, who will be a guest at a later episode so stay tuned, estimate that graduate students, for example, are six times more likely to experience depression and anxiety than the general population. And unsurprisingly, the COVID-19 pandemic seems to have worsened the situation with a more than 10% jump in the number of students reporting to experience depression and anxiety during their studies.

And many are naming it as mental health crisis in graduate education, calling academia and policymakers to action in setting intervention strategies. It is worth noting that research on the topic is still very limited, mostly focused on within institution reports. Furthermore, most of the research to date lays out existing issues. But even less studies dig deep into underlying causes and effective solutions.

There is definitely an increased discussion of the topic, which is a great initiating step, I must say. But sadly, there is still much to be done in terms of solving existing problems. And throughout the series, we are lucky to have brilliant guests who will discuss their studies and findings in more details, such as Dr. Evans that I mentioned. And something that I'm particularly excited about in this series are the conversations around potential solutions, which I know our guests will cover superbly in the upcoming episodes.

Heather Burrell Ward: Yeah. And I would say that there's, at least from the medical training perspective, there's increased awareness that medical training itself can have negative effects on the mental health of medical students and resident physicians. These mental health concerns exist on a spectrum ranging from things like burnout, anxiety, depression all the way up to at its most severe things like suicide.

And so you may have heard this term burnout. That's used a lot to talk about healthcare workers. And so it describes this job related stress felt by healthcare workers. And it's typically defined as emotional exhaustion, depersonalization, so sort of losing this sense of empathy for others, dehumanizing them, treating them in a dehumanized way, and a low sense of personal accomplishment, so a decreased sense of competence, feeling like you just aren't as effective as you used to be.

And we know that nearly 50% of us physicians experience burnout. And this costs $4.6 billion to the US healthcare system. This is a huge issue on a national level. And we know that burnout is associated with more medical errors, lower quality of care, and lower patient satisfaction. And then for physicians at the individual level, we know that burnout is associated with higher risk of depression, of alcohol use, and of suicide.

And actually I'll also plug a future episode, Dr. Douglas Motta is going to come and speak about his research that he's done to characterize the scope of this problem. And basically what his work has shown, I'll summarize a little, is that approximately 30% of resident physicians and medical students experience depression or depressive symptoms. And another recent study from the United Kingdom found that about 25% of physicians experience anxiety.

So let that sink in. That's a one in three physicians are experiencing depression and one in four are experiencing anxiety. That's profound. So there's a real urgency to find ways, both, to prevent the development of burnout, depression, anxiety and also to treat these conditions when they do arise and make sure that physicians can get prompt treatment for these conditions.

Oby: You started to touch on it a bit. But what are some common symptoms of mental illness, whether you've seen that in patients or experienced that yourself?

Heather Burrell Ward: As a psychiatrist, so I treat depression all the time. But sometimes people don't quite understand what symptoms of depression really are. So of course, we talk about depressed mood or sort of low mood, like you aren't feeling like your normal self. Anxiety often accompanies depression. There are separate anxiety disorders. But you can have depression and just feel anxious, or nervous, worrying all the time. People can also feel this lack of motivation. They don't have the drive to do things or apathy. Like, they just don't care anymore. It's sort of like everything is futile. Like, why? Why do something. It just doesn't matter anymore. People can also have trouble concentrating.

They can also have difficulty with their sleep. And we see sleep changes both ways. We see some people who are sleeping too much, like they're sleeping for 12 hours. We also see people who can't sleep at all. They have trouble falling asleep, trouble staying asleep. They wake up in the wee hours of the morning and can't go back to sleep. We can also see changes in appetite. So again on both ends of the spectrum, people eating too much, eating too little, not eating at all.

Accompanying changes in mood, changes in irritability. Some people are just-- they're just negative or everything sort of puts them-- they're just on edge all the time. Anything will set them off. And then alongside, anxiety. People can even have panic attacks. Sometimes people feel like they're just slowed down. Like their movements are slowed. Their thoughts are slowed.

People with depression often struggle with suicidal thoughts, which can range from feeling profoundly hopeless and thinking they'd be better off dead to actually wanting to kill themselves and thinking about a way to do so.

So I would say any sort of constellation of these symptoms and if you're feeling like you aren't feeling like your normal self. Or also if friends or family members, they can also be the earliest people to notice. They might say, you don't really seem-- you haven't seemed like your normal self lately. Things have been a little off. These can be really important warning signs.

Isabel Castanho: As I mentioned, depression and anxiety are part of my personal story. It's been an interesting journey also because I became a neuroscientist. And this was after or in parallel of experiencing many of the symptoms that Dr. Ward just mentioned. Today, I know myself very well. I recognize that anxiety has been part of me as far as I can remember. And I actually live in peace with it, taking good care of myself physically and mentally.

But in the case of depression, it hit me hard in the two years after I lost my mom to cancer. I was 17. And I was at this stage of my life where I was making big decisions about my future, so choosing my undergraduate degree. The following years were a real struggle. I won't lie. And the lack of motivation to do or feel anything and to even live at some point was probably the worst part of my experience. Dr. Ward touched on something important on anxiety and depression. Honestly, it is also hard to say where anxiety finished and depression started at that point.

The additional things I remember experiencing included stomach issues for years, now thought to be related to anxiety, crying a lot for no reason, lack of energy, sleeping issues, lack of concentration. So studying was difficult. But despite it, I continued being a great student, which amazes me now, looking back. I would say therapy saved me at a time when I absolutely hated myself and particularly because of what I was experiencing. So I thought something was wrong with me. I had no real reasons to feel like I was feeling. But as a result of therapy, I was able to enclose my depression in a box. And I started chasing my dreams that eventually led me to become a neuroscientist and pursue a PhD.

So during my PhD, some of the symptoms came back. I absolutely loved my PhD, doing exciting science, working alongside incredible people. But as a PhD, usually is, it was hard. I worked long hours. I felt constantly pressured, surrounded by an overworking culture. I pushed myself to the limits. And actually now that I say it as a postdoc now, not much has changed in terms of triggers. But during my PhD, some days, some weeks, I did feel depressed. But I didn't pay the deserved attention to it and kept pushing forward.

Until I think this was by the end of my second year of my PhD, I started experiencing panic attacks out of nowhere. So in the middle of an experiment, at home. And that was quite scary until I understood what was going on. I decided to look for help. But I was not very successful. I know that things have changed since then. But to be completely honest, I did not find the help I needed at that stage of my PhD. And my panic attacks were-- I felt dismissed as not being serious enough.

I am aware that the system that I was part of then did not have enough resources for all demands to help everyone. There was a lot of people around me that was trying to seek help too. I did start to talk more about it with my peers, including on social media. And more and more of my colleagues started reaching out and opening up about their own struggles, many sharing how they had been fueled to talk about it and seek help by listening to me share my experiences.

And even today, I always have second thoughts about talking about my own experiences like I am doing just now. But when I see and feel that it's helping other people, that's why I do it. I guess I hope my story serves as an example that we do not have to let mental health struggles dictate to where we can go and what we can do. But they are very real. They should be taken very seriously. I guess the message is with the right support, we can overcome them.

And my story is my own personal experience. But it does share many common characteristics with stories from others. Every now and then, like I said, I do have people thank me for talking about my journey, saying how I have helped them with their own struggles. And this is especially true with friends. But also, acquaintances and colleagues had made me aware of it being way more common than I thought. And it makes me happy to make someone else's journey feel better, even if it means making myself vulnerable.

By sharing my experiences with people around me, I usually receive two types of feedback, either people that say that I'm very transparent and that they knew what was going on or they were suspicious. And I guess more and more now that I'm talking about it more openly like I'm doing today. But also, I used to get a lot of people saying that they had absolutely no idea because I looked like someone that was on top of everything. I would say that this would be a good reason, a reminder not to judge a book by its cover.

During my PhD, I did look for ways to help me with my mental health. I sat through the institutions that was part of. I didn't find therapy. But I did find other things. So things that helped me a lot were yoga and meditation, a lot of reading on the subject, and then on my own, I did find therapy through virtual setting that helped me immensely. I learned to be with myself, to accept all parts of me, including my own limitations, but also to recognize my strengths and all I have survived in the achieved.

And one thing that I would also highlight is the importance of a supporting environment. I must admit that I am lucky to be surrounded by a husband and friends that support me and check up on me frequently. And I've been also been lucky enough to work with colleagues and mentors that really support me.

On a more positive note on the institutional help, until I finished my PhD and during the following years, I did find an increase in resources for graduate students. I saw colleagues taking time off for mental health reasons, being supported by the institutions, most of them struggling with depression. And I also saw colleagues leaving academia for mental health reasons, which is a less positive note. There's definitely still a lot that needs to be done on this.

To finish, we are talking much more about this topic. And that's fantastic. But there is still much to be done, for sure, to provide proper support and especially to avoid initiating factors in the first place.

Oby: Wow. I appreciate both of you sharing just even the knowledge about how this is impacting these different groups of people. I think that is not information you commonly hear. And then, you sharing your personal story. I think, to a point, you made about knowing yourself well and being at peace with it I think is a very resonant point. Everyone has limitations. Right? We all have strengths, and weaknesses, and how to navigate that. So I appreciate you putting your personal story to that truth.

Heather Burrell Ward: Sorry. I just want to echo what Isabel said about really that mental illness affects people from all walks of life. It doesn't matter how much education you have. It's not any a weakness, that it just it affects all different types of people. And importantly, that it is treatable.

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Oby: So now I want to talk about these groups that we're talking about, medical trainees, graduate, and post graduate students. And some of the factors that are prevalent in these learning environments, in particular, that can be damaging to mental health, and I feel like I may take it one step further because I heard both of you talking about this a little bit. But what are some ways that these factors you identify can be more critically looked at, assessed, changed to help in this area?

Isabel Castanho: So that last part of your question is the most difficult part because the easiest is to identify what are the triggers. And then, to identify how we solve them, that's definitely the most difficult part. Just to name some of the factors that may contribute to graduate students and postgraduate researchers, overall worsening mental health in academic environment, there is a high expectation on high productivity.

We hear things on the publishing side. It's publish or perish. And you're expected to publish in high impact journals, which are constantly seeking for novelty. And then, there's pressure to get funding, which is now more and more limiting for the number of people that are trying to get funding. It's an overall competitive environment. And there's a big culture of overworking in order to be able to respond to this competitive environment. So that includes overload, long hours, can lead to burnout, as Dr. Ward mentioned.

And then, something that is unfortunately quite common, way more than it should be, is abusive and toxic environment. So there is a lot of pressure on all sides. And that this often leads to toxic environments with bad mentorship or mentors asking for more than they should be asking for. Then, on top of that, there is the uncertainty and lack of job security from students, postdocs, usually the salaries are lower compared to other jobs. There's additional financial stress, student loan debt is incredibly common here in the US.

This all leads to difficulty to balance with personal, social, and family life, which are so important to keep us balanced. Often there is isolation. The academic work can be very lonely where you're very focused on making the experiments work, writing your papers. And these are just some of the factors that may contribute.

Heather Burrell Ward: Yeah, I would say that in medical training, there are certainly factors that are very similar to PhD training, especially if you're doing a lot of research, if you're publishing, you're in academic medicine. And then, there are definitely factors that are different. Like PhD training, I would say, becoming a physician requires a significant amount of training. And so, each of the challenges faced by trainees vary or differ at each phase.

So the first phase is medical school, so four years of getting this broad medical education. So some classroom based topics like learning biochemistry or attending a gross anatomy lab. And then in your later years of medical school, you're actually in the hospital, working with medical teams. You're learning how to be a doctor. You're interviewing patients. You're coming up with your diagnosis, coming up with a treatment plan.

And like I said, working on teams. And these teams switch every couple of weeks or so. So you have to learn very quickly how to interact with lots of different people with lots of different styles and know that you're being graded the entire time. So those are challenges for medical students. Again, they're long hours. And you're having to study on top of all these demanding clinical rotations.

And then when you become a resident, you have a lot more autonomy. So as a resident, you are a licensed physician. But you have to practice under the supervision of more senior physicians because you're still training. So you have a lot more autonomy, more responsibility. But what residents also very quickly find is that with this increased autonomy and responsibility, you also have a lot more administrative work.

And our healthcare system is just filled with administrative work. And most prominently for residents, this takes the form of using the electronic medical record. So reviewing patients' histories, writing notes, placing orders. There's just a lot of time spent in the electronic health record. And we know that the research has actually shown that increased time using the electronic medical record is associated with increased burnout in residents and attending physicians. And this makes sense. Right? You went to medical school. You did a residency to treat patients and to be face-to-face with people, not to be face-to-face with a computer all day.

And so, your question as to what sorts of interventions could we do? I've actually been involved in work studying trying to characterize what aspects of the electronic health record are associated with burnout. And one aspect that we found was actually physicians who left their notes open for more than one day, who didn't just see a patient and finish the note that day. Leaving that note open actually was more associated with burnout. It's almost like having this nagging to-do list. If you can just get this note off your to-do list quickly, you're going to then be able to go home and maybe spend time with your family, do other things that you enjoy personally, rather than sort of dragging these notes along leaving them open. So that's one potential aspect.

And then, I would say other challenges to medical training are interacting with this gargantuan healthcare system that we have in the United States. Sometimes there are systems' level issues that can make you feel like Sisyphus. You're rolling this stone up this hill just to have it roll right back down again. So I think that is a major contributor to burnout.

And so, it might be a physician having to make sure that the tests that you ordered, make sure it's actually getting done at the hospital, making sure the patient's on the schedule. It might be taking care of the same patient over and over because they're getting readmitted because the system has failed them. They haven't done anything wrong. We just don't have the right system to properly care for their illness. And so I think these sorts of experiences for physicians, in general, can just really grind them down and really contribute to burnout.

There are also, Isabel mentioned there's obviously tremendously long work hours. And I will say that for residents in the sort of recent history, they did institute duty hours restrictions. So residents have to work fewer than 80 hours a week averaged over 4 weeks, which is still a tremendous amount of work. And they can work a maximum of 24 hours continuously, with an extra four hours to finish all those notes I was talking about before. So there are restrictions. However, they're still tremendously long continuous periods of work and also just cumulative periods of work in a week.

We know that physicians citing this lack of personal time to spend with their families or do things that they want to do is also a contributor to burnout into depression. If you don't have that time to recover from the tremendous stresses that you've been under every day at work, eventually, it's going to take its toll.

And then finally, another aspect that I wanted to bring up is that, Isabel also mentioned, that we know that trainees can be mistreated. And one area of mistreatment that we're actually studying more and more are things called microaggressions. So derogatory comments or behaviors that are most commonly made on the basis of someone else's gender, race, or ethnicity, or their age. And so, one common examples of microaggressions, at least in healthcare, would be being told, oh, you're too young to be a doctor, or a female doctor being mistaken for a nurse, or a Black doctor being mistaken for support staff. These are all these happen all the time.

And actually, a recent study found that 60% of medical students experience microaggressions on a weekly basis. So it's very common. And you can imagine hearing these comments over, and over, and over, it just sort of wears you down. And another recent study found that lesbian, gay, and bisexual individuals are more likely to experience mistreatment and burnout. And so, we can see that particular populations are more susceptible to mistreatment and therefore are also more likely to experience burnout, and depression, and other mental health struggles.

As Isabel said, there are definitely factors in common between PhD training and medical training. But there are also very different challenges faced by medical trainees.

Oby: What is the larger implication for the medical community if these mental health issues are not addressed? This is significant.

Heather Burrell Ward: Yeah. I mean, the implication is that this system is not sustainable. So we cannot continue to have a healthcare system where the idealistic individuals who have chosen to dedicate their lives to service and taking care of others are becoming burned out, depressed, and anxious, and even in rare cases, killing themselves. The health of, really, our physicians and the quality of our medical care is at stake. So the stakes really could not be higher.

Oby: So even with that in mind-- funny, no pun intended. How does the Mind Project working to address these issues and combat stigma around mental illness?

Isabel Castanho: You touched on the right spot. The stigma about mental illness and neuropsychiatric disorders is still very strong. And academia is no different. So we've been discussing medical and graduate training. And stigma still exist in these environments. So at the Mind Project, we want to combat this and actually promote the conversation in a way to normalize it. But when I say normalizing it, is the conversation, not the challenges. What we're trying to do is to raise awareness about the topic in order to promote positive environments where everyone can excel.

We're putting together various efforts to achieve it. And this podcast series with ThinkResearch is one example of one of those efforts. Again, I am very grateful for the opportunity to collaborate with ThinkResearch to promote the conversation and spread awareness. And also, I would like to thank Heather for joining me today in embarking in this adventure at the Mind Project. Personally, I have been focusing on science communication, especially using social media, particularly Twitter.

And for instance, in February, we hosted an open mic conversation on Twitter spaces about mental health struggles and self care in academia, especially for women in science. And this was for the International Day of Women and Girls in Science. It was a great and honest conversation. And I would like to mention also that we also have a new initiative on neurodiversity at the Mind Project for which we recently won a Culture Lab Innovation Fund Award from Harvard's Office for Equity, Diversity, Inclusion, and Belonging.

And our goal with this program is to make the Harvard community more neurodiversity friendly. At the Mind Project, we define neurodiversity in the broader sense of brain diversity. And we plan to apply this evolving concept to embrace all brain differences and variations. And by advocating neurodiversity through this new program, we intend to foster a welcoming and inclusive environment to transform the culture and to promote and improve mental health for all within Harvard and the external community. So stay tuned about that.

Oby: So from both of your personal and professional perspectives, if someone is currently struggling with mental illness and unsure where to turn, where would you advise them to seek help?

Heather Burrell Ward: If you're struggling with mental illness, there are many places to turn for help. So I would say for most people, the easiest resource would be just to go to your primary care doctor. I want people to know that primary care doctors are very good at treating the most common psychiatric disorders, such as depression and anxiety. And if you'd like, they can refer you to a therapist. They can help you to find that resource in the community.

If your psychiatric disorder is more complicated or if you and your primary care doctor have been trying a couple of treatments and things aren't working, at that point then, it might be appropriate for you to see a psychiatrist. But not everyone with a mental health concern needs to see a psychiatrist. Primary care doctors, like I said, are excellent.

And for trainees, let's say whether a PhD student or another type of graduate student, there are typically student mental health centers that are designed to provide short-term treatment or to help to connect you to longer term treatment. And so, that can also be one of the easier access points if you're a student in a training program.

And then for medical trainees, whether you're a medical student, or a resident, or faculty at an academic institution, there are also resources that are specifically designed for physicians. As you can imagine being a physician, it can be difficult to get care from another physician, especially if you think you might be working with them in the same health care setting or even caring for the same patient together. So there are very specific challenges that we have to think about to make sure that physicians can access care.

And I will say that given the high rates of burnout, depression, and anxiety, medical schools and residencies now are particularly attuned to the needs of trainees. And they know that it can be challenging for their trainees and other physicians to seek mental health care, especially in the face of all these long work hours. If you're working 80 hours a week, how can you possibly find the time? So residencies and medical schools, they're supposed to give you time off to attend medical appointments. That is essential to maintaining the health of our workforce and of our trainees.

With that in mind, some institutions have actually established programs that are specifically designed to connect resident physicians to mental health care. So for example, at Brigham and Women's Hospital, where I did my psychiatry residency, we would have psychiatrists who are designated to specifically care for resident physicians. This is important because those people who are designated psychiatrists, they would not otherwise interact with residents in the hospital setting.

So for example, if you're an emergency medicine resident, you know that you can be seen by a psychiatrist and know that you're not going to cross paths with that person in the hospital. You're not going to literally be caring for the same patient in the emergency department. And so, there are similar programs set up at different institutions to facilitate access, even if it's just a single consultation or a referral for mental health care elsewhere, that we have specific systems set up to facilitate mental health care for resident physicians and also for medical students.

More broadly, if there are listeners who are struggling with mental illness, I want you to know that there is help. There are effective treatments available. I chose to become a psychiatrist because I saw how important mental health care is and also because I saw how mental health treatment can make a profound impact on someone's life. So I am absolutely a believer. And I want people to know that there is treatment available and things can get better.

Oby: Thank you both so much. It's been such a pleasure having this conversation with you. We look forward to the episodes that are coming after this and people being more engaged in this conversation.

Isabel Castanho: Thank you. It was a pleasure to be here today. And I'm looking forward to hearing the next episode.

Heather Burrell Ward: It's been wonderful having this conversation with you and Isabel. And we really are thankful for ThinkResearch and for the Mind Project for highlighting these issues.

Oby: Thank you for listening. If you enjoyed this episode, please rate us on iTunes and help us spread the word about the amazing research taking place across the Harvard community and beyond. We are always looking to connect and collaborate with the research community and would like to hear from you. Please feel free to email us at onlineeducation.catalyst.Harvard.edu to inquire about being a guest on the podcast.

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