Episode Transcript
[00:00:02] My name is Alan Di Sabia. I am a psychiatrist and psychotherapist.
[00:00:08] And you're listening to Mental Health.
[00:00:26] I want to begin with something very simple.
[00:00:29] I think we all know what it is like to have one thought stay with us longer than it should.
[00:00:42] A phrase, a mistake, a fear, adapt.
[00:00:53] Something is small at first, and then somehow it stays.
[00:01:01] It comes back and comes back again.
[00:01:08] I think that is where rumination begins.
[00:01:13] Not always with something dramatic.
[00:01:17] Sometimes with something very ordinary. For example, a look, a message, a memory, a possibility.
[00:01:27] And then the mind starts cycling around it as if one more turn might finally bring peace.
[00:01:39] Rumination is a very common human experience.
[00:01:43] Maybe you have lived it many times, maybe you are living it now.
[00:01:51] From the outside, it may look like thinking.
[00:01:55] It may even look like careful thinking, responsible thinking, deep thinking.
[00:02:08] But inside it feels very different.
[00:02:12] Because healthy thinking usually opens something.
[00:02:16] It helps you see, it helps you decide, it helps you move.
[00:02:23] Rumination does not.
[00:02:26] Rumination is when the mind keeps moving, but the person stays in the same place.
[00:02:35] And that difference matters a lot.
[00:02:39] Because in my work as a psychiatrist I see this very often.
[00:02:45] We see this in depression, in general health and surgery, disorder in social anxiety, in panic disorder, in obsessive and compulsive disorder, in trauma related conditions, imperfectionist in personalities, in hypochondria, in insomnia, and also in people with a strong style of over controlled.
[00:03:10] Sometimes the content changes, sometimes the diagnosis changes.
[00:03:15] But the structure is often very similar.
[00:03:19] The mind goes back, the mind checks again.
[00:03:25] The mind tries to solve something by returning to it.
[00:03:31] But the returning itself becomes part of the suffering.
[00:03:37] That is why this matter so much in clinical work.
[00:03:43] Because if you only listen to the content, you may miss the mechanism.
[00:03:50] And many times in psychiatry, most of the time actually the mechanism is a real trap.
[00:04:00] I think of it like this. Imagine a person walking around the same tree, round and round, looking carefully, trying to find something, trying to understand something, trying to make sure there is no danger there.
[00:04:22] From far away it looks like movement, right?
[00:04:28] But the truth is the person is just cycling the same point.
[00:04:34] That is rumination.
[00:04:38] Let me show you another one.
[00:04:40] Think of a small stone inside your shoe.
[00:04:45] At first it is just a small discomfort.
[00:04:50] But after a while it becomes the center of your attention.
[00:04:57] Your whole awareness starts moving toward it.
[00:05:02] The day gets smaller, the mind gets narrower.
[00:05:07] And suddenly that little stone feels much bigger than its release.
[00:05:15] That is also how rumination works.
[00:05:19] One thought, one doubt, one fear.
[00:05:25] And then the mind keeps touching it, checking it, turning it, looking at it from one side.
[00:05:36] And then from the other.
[00:05:40] But nothing really changes.
[00:05:45] And this is where something important happens.
[00:05:49] Rumination is not the same as reflection.
[00:05:53] Reflection is more like opening a window.
[00:05:57] Fresh air comes in, you see more, there is space.
[00:06:06] Rumination is more like staying in a closed room.
[00:06:11] Same air, same walls, same thought.
[00:06:18] And after some time, the room feels smaller.
[00:06:25] Clinically, that also makes sense.
[00:06:28] Reflection tends to widen perspective.
[00:06:31] Rumination narrows it.
[00:06:35] Reflection helps the brain organize experience.
[00:06:38] Rumination keeps the brain looked on the same unresolved signal.
[00:06:44] And when the mind stays locked on the same signal, attention starts to change.
[00:06:52] Because attention is not neutral, what you keep looking at starts to feel bigger.
[00:07:00] In our clinical work, we could say the thought gains salience.
[00:07:08] Salience is what stands out, what catches your attention, What pulls you in, what your brain starts treating as important.
[00:07:25] In simple words, it is the brain's way of saying this matter.
[00:07:31] Look over there.
[00:07:35] And once a thought gains salience, it no longer feels like one thought among many.
[00:07:46] It moves to the front, it comes back faster, it catches your attention more easily.
[00:07:57] It feels louder inside, it feels closer, it feels unfinished.
[00:08:08] And many times that is where the person gets trapped.
[00:08:14] Because they start confusing salience with through or salience with danger.
[00:08:24] But they are not the same thing.
[00:08:28] Something can feel very important, very urgent, very loud, and still not be a real emergency.
[00:08:37] That is one of the central traps of rumination.
[00:08:42] The brain gives the thought more weight, more weight, more iron, as I sometimes say, as if the thought became heavier than it released.
[00:08:57] Then the person feels they need to think about it more.
[00:09:03] And then more attention gives it even more weight.
[00:09:09] So the loop feeds itself.
[00:09:14] The more you go back to the thought, the more important it feels.
[00:09:19] And the more important it feels, the more your mind goes back to it.
[00:09:25] And I think this is one of the places where rumination becomes so painful.
[00:09:32] Because the person often believes they are getting closer to an answer.
[00:09:37] But very often they are just making the thought more salient.
[00:09:47] Now, there is another layer here that I find very interesting.
[00:09:52] And it is more personal.
[00:09:55] Sometimes I think rumination carries a strange kind of hope inside it.
[00:10:03] Not strong hope, not living hope.
[00:10:08] Not the kind of hope that help you stand up, choose, speak, move or act.
[00:10:18] I mean a quieter hope, a more passive hope.
[00:10:26] The kind of hope that says maybe if I think a little more, I will finally understand.
[00:10:34] Maybe if I go over this one more time, I will finally feel calm.
[00:10:41] Maybe if I stay with this thought long enough, the answer will arrive by itself.
[00:10:50] And this is where something clicks for me, because then this is no longer self thinking.
[00:11:00] Now it is waiting.
[00:11:03] That is the word waiting.
[00:11:09] Waiting for relief, waiting for certainty.
[00:11:16] Waiting for one last thought that will finally make everything quiet.
[00:11:23] But that thought never really comes.
[00:11:31] And maybe that is why that all Greek suspicion about hope speak to me.
[00:11:38] Because the Greeks placed that kind of hope inside Pandora box, as one of the evils.
[00:11:48] Because there is a kind of hope that moves you toward life.
[00:11:53] But there is another kind.
[00:11:56] The kind that leaves your waiting.
[00:12:00] Waiting for the outside world of change.
[00:12:03] Waiting for certainty, Waiting for the perfect thought.
[00:12:09] Waiting for the moment when finally you will be allowed to rest.
[00:12:16] And rumination often lives there in that kind of waiting.
[00:12:23] A waiting that looks like thinking, but feels more like paralysis.
[00:12:32] The mind keeps moving, but the life of the person becomes smaller and tired. Is not a mind work here?
[00:12:44] Because rumination is exhausting, deeply exhausting.
[00:12:51] And this matters clinically as well. Because thinking has a cost.
[00:12:57] Mental effort has a cost.
[00:13:00] Attention has a cost.
[00:13:04] Working memory has a cost as well.
[00:13:07] Working memory is the part of the mind that hold things for a moment so you can think about them.
[00:13:15] Like holding a few objects in your hands at the same time.
[00:13:19] It's useful, necessary, but imitate.
[00:13:25] And when rumination keeps loading the same painful material into that space again and again, the system gets tired.
[00:13:36] I think of it like this.
[00:13:38] Imagine that every thought asks your brain for one small coin, just one coin.
[00:13:47] When you study, that makes sense.
[00:13:50] When you work, that makes sense.
[00:13:54] When you solve a problem, that makes sense, you spend energy.
[00:14:01] We all do this.
[00:14:03] We all ask the mind to carry things.
[00:14:07] We all spend inner energy trying to understand, decide, build or protect something that is a part of being human.
[00:14:19] But rumination is different.
[00:14:22] Rumination is like a hole in your pocket.
[00:14:27] The coins keep falling, but nothing useful is being built.
[00:14:35] The same thought comes back.
[00:14:38] And each time it comes back, it asks for more energy.
[00:14:45] A little more, a little more, a little more.
[00:14:51] And after. Sometimes the person feels empty, tired, heavy, foggy.
[00:15:01] Like the battery is low.
[00:15:05] And there is not only emotional, it is mental.
[00:15:11] And it is physical as well.
[00:15:14] Because the brain starts treating that thought like something important, unfinished or dangerous.
[00:15:26] So the alarm inside stays on.
[00:15:31] From a brain point of view, that means threat systems keep getting activated.
[00:15:38] In simpler, the mind keeps saying, do not relax yet.
[00:15:45] So the body listens.
[00:15:48] The body stays tense, sleep gets lighter, attention gets narrow.
[00:15:56] The whole system gets tighter.
[00:16:01] That is why rumination is not just a thought problem.
[00:16:06] It becomes a nervous system problem as well.
[00:16:11] I sometimes imagine it like a radio inside the body.
[00:16:17] Play the same bad news all day, even if nothing new is Happening, the body still listens, as if danger were close.
[00:16:31] And there is another very important point here.
[00:16:35] The brain learns from repetition.
[00:16:38] We have talked about this before.
[00:16:42] That is one of the basic rules of neuroplasticity.
[00:16:46] As I said in the previous episode, be careful what you repeat. Neuroplasticity means the brain changes with use.
[00:16:54] And what you repeat, you are strengthened.
[00:16:59] So when a person ruminates again and again, they are not only having the loop, they are trained in the loop.
[00:17:09] They are making that path easier for the brain to follow next time.
[00:17:15] Not because they want to, not because they are weak.
[00:17:19] Because the nervous system learns through repetition.
[00:17:24] That is why rumination can become such a strong habit.
[00:17:29] Not a habit in the moral sense, a habit in the brain sense, a path that becomes easier to walk.
[00:17:40] And that is also why change takes practice.
[00:17:44] Insight helps, understanding helps.
[00:17:48] But repetition shapes the system.
[00:17:52] That is true for suffering, and it is true for healing as well.
[00:18:00] So if we ask now, how do we notice rumination?
[00:18:06] The first is repetition.
[00:18:09] The same thought keeps coming back, maybe with different words, maybe in a different shape, but deep down, it is the same circle.
[00:18:20] Why did I say that?
[00:18:22] What if I made a mistake?
[00:18:25] What? Why did they look at me like that?
[00:18:27] What if this means something bad?
[00:18:30] What if I never get better?
[00:18:33] Different sentences, same loop.
[00:18:38] The second sign is that the thinking does not help you move.
[00:18:43] Healthy thinking usually helps you do something.
[00:18:47] Speak, decide, understand.
[00:18:52] Take one next step.
[00:18:54] Rumination does not.
[00:18:56] It is like moving your legs on a bicycle. There is no going anywhere.
[00:19:04] There is effort, there is movement.
[00:19:08] But you are still in the same place.
[00:19:13] And many people do not notice that.
[00:19:16] They confuse mental movement with real movement.
[00:19:23] But they are not the same.
[00:19:25] And this is important as well.
[00:19:28] Useful thinking tends to reduce uncertainty enough for action.
[00:19:34] Rumination increases uncertainty, so the person keeps thinking and acting less.
[00:19:43] The third sign is that you live the present moment.
[00:19:48] Your body is in the room, but your mind is not.
[00:19:53] Your mind is back in yesterday, back in that message, back in that mistake.
[00:20:01] Or far ahead, inside a future that has not happened.
[00:20:07] So life is happening here, but part of you is somewhere else.
[00:20:14] Like standing on one shore while your mind keeps swimming to another one.
[00:20:22] And this also explains why rumination hurts connection.
[00:20:27] A person may be with other people, but not really with them.
[00:20:32] They may be in the room, but not fully in the moment.
[00:20:38] The four sense is a feeling in the body.
[00:20:43] Rumination has a texture.
[00:20:46] It feels tight, heavy, narrow.
[00:20:52] It does not feel open.
[00:20:54] It does not feel like a space.
[00:20:58] It feels like your mind is sitting in a small, dark Room with one chair and one thought.
[00:21:07] And after some time that changes the body as well.
[00:21:14] Rest gets harder, sleep gets worse, recovery gets slower.
[00:21:24] Because the system does not feel safe enough to let go.
[00:21:30] There is a very psychiatric point as well.
[00:21:33] The mind and body are not separated. Here.
[00:21:38] When the brain keeps reading a thought as unresolved threat, the body organizes around that reading.
[00:21:48] The fifth sign is self attack.
[00:21:52] At some point, the mind stops asking and start what is wrong with me? Why I am like this?
[00:22:02] I always do this.
[00:22:04] I should be ready by now.
[00:22:06] That is no longer reflection, that is an inner attack.
[00:22:11] Like the mind turns into a church. And the person is standing alone in front of that church all day.
[00:22:21] That hurts a lot.
[00:22:24] And many people do not notice when that shift happens.
[00:22:30] They still think they are trying to understand themselves. But really they are hurting themselves from the inside.
[00:22:40] In depression, this often becomes guilt, worthlessness, failure.
[00:22:47] In anxiety, it often becomes danger, prediction, catastrophe.
[00:22:53] What if?
[00:22:54] What if?
[00:22:56] In obsessing compulsive disorder, it often becomes checking, reviewing mental replay.
[00:23:04] A desperate search for certainty and trauma can become a repeated return to the scene, the wound or the meaning of what happened.
[00:23:18] In hypochondria, the mind keeps scanning the body, interpreting signs and asking for one more reassurance.
[00:23:28] In insomnia, the person is tired, but the mind keeps monitoring, calculating and trying to force sleep.
[00:23:38] Different content, same loop.
[00:23:43] The sixth sign is false. Problem solving.
[00:23:48] The mind says, stay here a little longer. We are close.
[00:23:54] One more turn and we will solve it.
[00:24:00] Clinically, this is one of the most important distinctions.
[00:24:04] Problem solving creates direction, rumination creates friction.
[00:24:13] Problem solving gives enough clarity for a step.
[00:24:20] Rumination keeps postponing the step.
[00:24:25] So this does not mean the mind is bad.
[00:24:31] Not at all.
[00:24:33] The mind is trying to protect.
[00:24:35] It thinks.
[00:24:37] If I keep checking, maybe I can prevent pain.
[00:24:41] If I keep thinking, maybe I can stay in control.
[00:24:47] So the intention makes sense.
[00:24:50] But the method hurts.
[00:24:54] And I think healing often begins in a very quiet moment.
[00:25:01] A moment when the person suddenly I am not really thinking anymore.
[00:25:09] I am stuck inside in the same circle.
[00:25:14] That moment matter, because when you see the circle, A little space appears.
[00:25:31] A little air, A little distance.
[00:25:43] And that distance matters, Because distance is the beginning of regulation.
[00:25:58] When there is a little distance, the person can observe instead of only react.
[00:26:07] And when they can observe, new choices become possible.
[00:26:14] Enough to breathe, enough to step back, enough to come back to the present moment.
[00:26:24] Enough to stop feeding the same path, at least for a moment.
[00:26:33] And that is not small.
[00:26:37] That is how refraining begins.
[00:26:42] So maybe that is enough for today.
[00:26:45] Just notice.
[00:26:47] Notice when the mind goes around the same tree.
[00:26:51] Notice when the radio keeps playing the same bites in you.
[00:26:55] Notice when the coins keep falling through the hole in your pocket.
[00:27:02] Notice when the bicycle is moving but not going anywhere.
[00:27:08] That is rumination.
[00:27:11] And seeing it clearly is already the beginning of change.
[00:27:18] Because nothing can be changes until it is first seen clearly.
[00:27:26] So if you are listening to this right now and you recognize yourself in any of what I described, that is not a small thing, that recognition.
[00:27:46] The moment of saying yes, this is what I do.
[00:27:53] There is already a step outside the loop.
[00:27:59] Not a cure, not a solution, but a step.
[00:28:07] You do not have to fix it today, you just have to see it.
[00:28:14] And you did.
