Psychiatrist runs 15+ marathons while juggling!

0:01 Thanks for watching episode #121 of the Doctor Podcast, Sicard Fox Show and I'm your host as usual, Doctor Robert Sicard. And I really appreciate it if you could subscribe and follow and share and repost this episode and Doctor podcast so we could have other great guests like we have today. Today our great guest is Doctor Jack Herschwitz. Dr. Herschwitz is a board certified psychiatrist with over 50 years of experience practicing psychiatry. He's currently in full time private practice in New York City and serves as a Clinical Professor of Psychiatry at the ICANN School of Medicine here in New York City.

0:43 At Mount Sinai. He's a former Vice Chair for Education at Mount Sinai School of Medicine, where he also served as the Director of Residency training. He's a recipient of multiple prestigious awards and continues as an examiner for the American Board of Psychiatry and Neurology. He's done extensive work on biological psychiatry with over 100 publications focused on schizophrenia subtypes. Lithium response in psychosis, dose reduction strategies for antipsychotics, and pharmacological treatments for bipolar disorder.

1:20 He's received numerous federal research grants and contributed to disaster psychiatry and care for homeless populations with mental illness. Dr. Herschwitz and I are both members of the prestigious Central Park Track Club, hence our shirts you can see, and his shirt as well. And we compete against other track clubs that are regionally in the New York area and also in some national events. Oh, and one more thing which I forgot. As you can see, Doctor Hirschwitz is known as the juggling psychiatrist.

2:00 He's an advocate for exercise. He promotes exercise as a role model for patients, linking it to mental health benefits like boundary pushing and resilience. He's a passionate juggler since childhood, and Dr. Herschwitz is renowned for joggling, which is juggling while running. He's done this in marathons for numerous years. He's completed 15 New York City Marathons while he's juggling and is about to do his 16th New York City Marathon in this November. He also did the Boston Marathon last year while juggling, and he's also going to do the Boston Marathon in 2026.

2:45 So, Jack, Doctor Herschwitz, thanks very much for coming today and juggling for us this. Is my pleasure. Yeah, this is a very unique interview. I love it. And it's, it's incredible that you're able to juggle for for so long and still concentrate on and running and doing other things. So tell us about your 50 year career. You started in South Africa, then you came to the USA at Mount Sinai, and now you're in private practice. What inspired you to go into psychiatry and then do all those things? Well, so I originally wanted to be a surgeon actually, and began training as a surgeon, had some experience with that, and then decided that I thought psychiatry was going to be more interesting.

3:37 It was going to be, you know, challenging and different each time and not doing the same thing over and over. So eventually I switched over to psychiatry and haven't looked back. That's great. And now you're in private practice in New York City seeing and and treating patients. That's great. Now you've published a lot about schizophrenia and bipolar disorders and done a lot of research in that. Can you explain the difference between schizophrenia, bipolar disorder, and there's another condition called schizoaffective disorder?

4:14 Can you tell? Us what the difference is. So first of all, schizophrenia and bipolar disorder are distinctly different. They're not the, they're not part of the same illness. They're not on a continuum from one to the other. They are separate conditions and they're they're very different. The presentation is different. Schizophrenia is a chronic illness that has two components, really positive symptoms, which are delusions and hallucinations and thought disorder. And then it has what are we call the negative symptoms we which are paucity of thinking, sort of emptiness.

4:54 And the treatment that we use targets the positive symptoms so that there are residual negative symptoms where someone can be sitting staring into space and not much going on in their thinking and so on. And that's harder to treat and has been sort of resistant to treatment over the years. The but it's a chronic deteriorating condition, regrettably. Bipolar disorder, on the other hand, is an episodic condition where there are episodes and they're very different. The episodes in bipolar disorder are manic where you're high and depression where they're low.

5:35 Where you're low, They last weeks to maybe a month or two an episode and between episodes in the best case scenario, people are well and can function in any capacity unless they're overtreated, which is another story I think that we can talk about. And so, but, but the one thing that's clear that I want to mention is that bipolar disorder is not a condition of mood swings. That's a misunderstanding. It's not people who have ups and downs in mood. I refer to that a lot of the time as emotionality, people whose moods go up and down and from high to low three times a day and so on.

6:18 But a lot of clinicians as well as the lay population, I often believe that that's a variant of bipolar disorder which is really not. So they it's easy to separate schizophrenia from bipolar disorder in a clear cut case, and it's easy to understand schizophrenia as being very different from mood swings. Now, what's schizoaffective disorder? How's that different? OK, so personally, I am very dubious about the existence of it in the, in the, in the big picture because because theoretically it's two illnesses.

7:03 People have schizophrenia symptoms and bipolar symptoms. Now, why I'm why I'm skeptical about this condition and I've actually done some work on studying it and, and can mention that to you is because the, the, the bipolar disorder people can have psychotic symptoms, whether they're depressed or they can have delusions, hallucinations. So being psychotic when you have a bipolar disorder doesn't have anything to do with schizophrenia. Secondly, if you have schizophrenia, you can have mood symptoms.

7:43 You can it's a very, very depressing condition. And there are many reasons why patients with schizophrenia are are depressed and the suicide rate in schizophrenia is high. So, you know, the fact that someone with schizophrenia has moods with symptoms shouldn't give them that diagnosis. So, but there are, it's confused a lot of the time. It's a common diagnosis that's made. I think it's made because clinicians are lazy. They're not making a careful distinction between the two conditions. And so, and then the patient ends up on treatment for two illnesses.

8:22 So theoretically it's patients with schizophrenia who have mood symptoms or patients with bipolar disorder that have psychotic symptoms.

8:34 There's a possibility that there are a few cases of people who have both illnesses. And we did a study in Long Island, the Long Island First Break study, where patients with psychotic illnesses of recent onset was studied throughout Suffolk County. And then they were diagnosed by clinician and then they were rediagnosed by another clinician a year or two later who didn't know anything about the preceding diagnosis. And then they were diagnosed again a couple of years later. And the idea was to see if the diagnosis stayed.

9:13 And what we found in that study was that patients with schizophrenia as with schizoaffective disorder, the second time they were seen they were they were not diagnosed with schizoaffective disorder. These were very carefully done diagnosis and subsequently too and it turned out that most of them in later years were diagnosed with schizophrenia. So, you know, I think the problem with over diagnosing this condition is that patients end up with illness treatment for two different illnesses, right? Now, how do you diagnose these conditions?

9:51 You speak with the patients, meet with them and and figure it out like that. Because there are no specific blood tests or or other markers for these conditions. No, while markers are beginning to emerge in. Genetic. Markers, genetic markers are beginning to emerge and are going to be very important in the future. We still rely on psychiatry, on the mental state examination and the history and the family history contributes to some extent as well. So that's how we diagnose them. And you know, if if you see somebody who's manic, they usually have an elevated mood, they're speeded up, they're talking really fast, they're jumping from topic to topic.

10:39 They have what we call flight of ideas. So they don't stay on the same topic. They're very distractible. They may be grandiose and have big ideas. And of course, when people are depressed, they're severely depressed. And patients who are depressed tell you they're depressed. So going from there, you know they don't sleep, they don't eat and so on. Now, once you've diagnosed the condition and you're certain what it is, there are different drugs that are used to treat these patients. So you would use different drugs for schizophrenia, different drugs for bipolar disorder.

11:12 Is that right? That's correct, yes. Now when I was back in medical school, there was like only one bipolar disorder. Now there's several different types. How do you differentiate the the different types of? Bipolar disorder, I think for the most part it's still like that. There's still really one type. There's you can. The more severe type is referred to as bipolar 1, and bipolar 2 is where people have a less severe form of the condition, but it's still the same term symptomatology. So it depends on the severity.

11:47 It really does. It does, and in some patients it stays that way if they have multiple episodes. Right now, recently I've seen surveys done where patients are using AI to get psychological help. In fact, I've seen some reports that the main use of AI these days in the USA at least, is to get psychological help. Do you think that's reliable? Is it safe? Is it going to lead to big problems? The Wall Street Journal had an article last week that there's something called now AI psychosis. Where? So that's two topics, but I'll the first one, of course, I don't think anything beats sitting down face to face with another person and understanding them and connecting with them and getting first hand impression of what's going on.

12:45 Patients communicating with AI and telling their story. Of course, there's a possibility that the diagnosis can be correct, but there are many subtleties in terms of understanding the, the, the patient as a whole person and, and knowing, you know, the insurance and outs of what's going on with them. So I think that that would be probably not the best way to do things and in terms of AI psychosis, so, you know, delusions of false beliefs held with conviction, right? And the context in which we call them delusions is in mental illness.

13:31 When it's part of a psychiatric illness, we call them delusions. But they're, of course, people can have false beliefs held with conviction all the time. So you can get those from conspiracy theories. If you're watching the same show every day and you're not getting your information from anywhere else and it's a conspiracy theory, then you can believe something with total conviction, which is false. So, and that's not really a delusion. So I don't believe that it qualifies as a delusion. It's just misinformation that's been believed by someone.

14:09 And so it doesn't enter into the And so I didn't buy that, that article about psychosis, you know, AI psychosis, because people are getting their information and it's misinformation and so on. Have you? Found that some of your patients have told you that they're using AI in between visits with you or substituting. Well, they're not even AII mean. Everyone goes to the Internet and googles everything. And so the positive thing about that of course is that our patients are quite well informed. They come with lots of good questions, and they often keep you on your toes.

14:52 You know, they're asking about the latest treatment that they've just heard about. The unfortunate thing in our country, unfortunate. The unfortunate thing is that marketing is done on television ads. And so you see people running on a beach, you know, looking very happy with some serious mental illness, with some new drug that's cured them. So it's all very. Everyday. But at least they see the name of the drug and they can come and ask you about it so and one can put that into a perspective for them.

15:25 Have you had any patients who've received incorrect information or advice from their AI? Not really so much about AI, more, you know, just searching the net. Because the problem on searching the Internet is if you go to reliable medical sites, you get reasonable information. Still misleading because we tend to interpret everything in the worst possible way when we see it there. But but when they go to sites, they find a lot of unhappy customers on the Internet who are complaining about their doctor and about the diagnosis.

16:02 And so there's a lot of that kind of information, too. You know this drug is terrible because you know somebody else hated it. Right now, going back to bipolar disorder, you've done research and work on lithium as a treatment for bipolar disorder and possibly schizophrenia as well. Is that still useful and beneficial treatment? Because I see ads now all the time for bipolar disorder on TV. Not about. Lithium, not lithium, antipsychotic drugs. So we can talk about that, right? That's another big subject for me.

16:38 But the, the, the lithium has stood the test of time. It goes back to the 1930s. It's a drug that has 75% efficacy in treating schizophrenia, bipolar disorder in main, and it has four jobs that it does. It treats the mania, treats the depression, It prevents the mania, prevents the depression, and it's still the gold standard treatment. And the reason we tested it in schizophrenia was not because we thought it was a treatment for schizophrenia, but because we thought patients in the early stages of their illness, we were looking for biological markers, if there was a way to do a blood test that could distinguish bipolar disorder.

17:24 And so we did all of the blood tests for that We use for for bipolar disorder, for schizophrenia. There are a number of tests that show various things and we try to find if there was an overlap and so on and and what. And so when we did find the overlap, then it made us look at the clinical side of of it more carefully. But I think that that was that was really trying to distinguish the two illnesses, not so much looking for treatment for schizophrenia and yes and so. Do we know how lithium works?

18:00 It's been around a long time decade. My colleague a number of years ago, there are many theories and there are newer 1. Bob Hitzeman, who was one of my colleagues who worked with us very closely for many years, showed that there were membrane transfer issues in the cells, so that the transport of lithium across blood cells, which is where we looked at it different in patients with bipolar disorder and patients who did not have bipolar disorder. And so that mechanisms were looked at in terms of of transport across cell membranes was one of the things, but there are many other theories that people have had since then and been looking at.

18:45 Things we hear a lot about lithium these days because it's what batteries are made of. Right. Yeah. Is that the same or or different form of lithium? Do you do you know? It's #3 on the periodic table, it's the same. It's the same, different quantum lithium, yes. Now, so lithium is a salt and it's mined in the ground, and therefore it has some disadvantages because it affects the kidneys and it can affect the thyroid and so on. And so it isn't for everybody, but it is very effective and there's no better treatment.

19:23 Now what's happened? To answer your other question, in recent years there's been a lot of marketing of antipsychotic drugs for the treatment of bipolar disorder, for mania. And the problem I have with that is that during a manic episode, everything is fair game. You use whatever medicine will work to bring somebody down. It could be antipsychotic drugs, it can be tranquilizers, the benzodiazepines, it can be anything. And you can big doses, it doesn't matter to bring them down from a manic episode.

19:55 But now in small studies they've shown that it's somewhat effective in maintenance treatment and suddenly that's become very popular. And what's what bad about that is the antipsychotic drugs of potent medicines with serious side effects. And they really affect health. They affect thinking abilities and and bipolar disorders and illness where people can be completely normal between episodes. And have a normal life if you can keep the episodes away. But if you're using antipsychotic drugs to keep the episodes away, it does impair functioning.

20:36 So when you know if it really if, if they're not as good as the as lithium. And so lithium still remains the best treatment. There are a couple of other mood stabilizers that are used that also not as as as good as the as the main medicine which is lithium. Right, which brings in a topic of polypharmacy, which is using too many medications for treating conditions, which leads to lots of side effects and problems. Yes, you. Touched on that a little bit, but you've done a lot of research. On it. Well, in schizophrenia, we did a study called the Doris study a number of years ago, dose reduction in schizophrenia study in which we looked at patients who were on high doses and we gradually lowered them antipsychotic drugs and we looked at them repeatedly to see at what point in the in the study where they're at their best.

21:32 And it turned out it was at a much lower dose than the majority of patients were getting. And then we did it the other way around. We gave people tiny doses and we kept increasing the dose and we looked, we measure, we evaluated them in a double-blind fashion so that the examiners didn't know and the patient didn't know what dose they were getting. And we showed that at the much lower doses they were doing their best. So that was one thing. The point is that now there's a lot of high doses of medicine used, there's polypharmacy used, where I do second opinions a lot in my practice and I see patients, they're brought to me because they can barely walk, they can barely stand up.

22:16 And it's the medicine, not the illness so much. And so I've seen patients on three antipsychotic drugs, not one, and on high doses of three antipsychotic drugs. And when you take the medicines away or you lower the doses, the patients do much better. So you know, over medicating. Yeah, over medicating, you know, as physicians, one of the problems with over medicating is that when physicians like to do something, when a patient comes to see a doctor and complaints, you know, this is bad, that's bad.

22:51 I'm not sleeping, I'm not eating. They doctors want to do something. So they can either do a test, which a lot of doctors do, or they can prescribe a medicine or they can up the dose, or they can up the dose and add a medicine. And if the patient comes back a lot, then they up the dose, add a medicine, add another medicine. So, you know, that's a problem because you don't. You have to be able to tell a patient every now and then, you know, we're going to figure this out, but it doesn't have to be with more medicine.

23:22 And also not adding a medicine always adds complexity to the case. So yeah, so I think less is better. You know, it's interesting. I see the same thing in ophthalmology. I'm an ophthalmologist and I see patients for second, third opinions with all sorts of eye problems and they're on multiple different eye drops. And I find in some of the patients they're just over medicated and they're having toxicity from their eye drops. And I say we need to cut back on your eye drops to the bare minimum and see how you do.

23:56 And in many cases, they actually do much better. So we have that polypharmacy problem in various specialties, not not only in psychiatry. Now, one of the things I see in my patients, as you mentioned, even though I'm an ophthalmologist, they tell me what medications they're on and I see that some of them take two 3-4 different medications for various psychological problems. One of the other trends I'm seeing is many of my patients don't see psychiatrists except for prescriptions for medications.

24:30 They see psychologists, social workers, other professionals and tend to only see those psychiatrists when they need a prescription for something. Is that a trend that that's increasing? Well, so. They well, there you go. So I see myself as a holistic psychiatrist. I do psychotherapy, I do couples therapy. I used to work with families. That's a little complicated when working on your own, but but I see patients, medication is used in my office in the context of psychotherapy and everything else. Now if a patient comes to me and they're seeing a therapist, then I work, try to work collaboratively with the therapist.

25:15 I still want to know everything that's going on now. You know, there's a thing that's been going on in recent years, and that is that some psychiatrists market themselves as psychopharmacologists. Right, I've seen. That and they're not really psychopharmacologists. They graduated from a residency program and set themselves up as a psychopharmacologist, which means they see themselves as a specialist of just prescribing the medicine. There aren't that many medicines in psychiatry, and it's not that hard if you're just prescribing them so, and they spend sometimes very short periods of time with the patient because the patient's seeing someone else for therapy.

25:56 So I don't condone that at all. I think that there are real psychopharmacologists in some way. I was for a number of years because I was studying medications, doing research in psychopharmacology. I also didn't have a formal postgraduate education in psychopharmacology, which sometimes requires APHD. But but when when someone calls themselves a psychopharmacologist, that's really the focus of their clinical practice, which is hard to understand when you know you're dealing with the mind and you're dealing with families and you're dealing with all sorts of complex problems where the patient may not need medicine.

26:39 Some of the psychotherapies, cognitive behaviour therapy for example, is as effective or more effective in for many patients then the medicines for treating things like anxiety disorders, depression. Very often there are different kinds of depression, yeah. Interesting. Now you're also an expert and you've done research and helped with psychiatric problems in the homeless population. As you know, we have big homeless problem here in New York City and most cities around the country. And unfortunately many of the homeless people have a variety of mental illnesses, especially schizophrenia.

27:23 And I think from my perspective, I'm not a psychiatrist, but the recent shootings that we're seeing around the country, they, they seem to be patients who have schizophrenia or maybe paranoid schizophrenia. What can we do to? Well, first let me just clarify that one thing and that is that it, it's true that in a couple of the recent shootings, the diagnosis is probably a psychotic illness. But the majority of people that are shooting people are not mentally ill. No, they, you know, there are, there are other dynamics.

28:00 They may have personality disorders, they may have a criminal history. They may themselves be influenced by radical conspiracy theories. We see various reasons that people are shooting people, and I think it's very unfair to the mentally ill to see them as high risk in terms of that because it's not the majority. The that's the first thing I wanted to say. The second thing is that the homeless issue that you talked about South, my work with the homeless was actually a while back. I was a volunteer in a psychiatrist in a, in a number of homeless mentally ill shelters and I would go there in the evenings, 2 nights a week.

28:50 I was going Tuesdays and Thursdays to two different shelters for a number of years and volunteering my time. At that period in time, they weren't paid psychiatrists working in those clinics. That changed over time. I'm not exactly sure what what the situation is right now because I've been removed from that for a while, but I volunteered and worked with patients in the mentally ill, the shelters that specialized in in keeping mentally ill homeless. Interesting. And then I got into, you know, joining the committee of the American Psychiatric Association and sort of helped, you know, to get education done and research and so on.

29:34 Right. So I want to move on to another very interesting topic. We're both members of the Central Park Track Club. Yeah, we're proud of that obviously. And we compete in in lots of races and run. And I think we both know that exercise is critically important not only for the physical part of your body, but for mental health as well. In fact, I have many psychiatrist patients who tell me that exercise is better than most of the medications that they prescribe. What's your take on that exercise and mental health?

30:13 Yeah, well, so I'm, I'm sold on that idea. I'm a true believer. And you know, there's a lot of evidence that exercise, in fact, it was a a piece in the New York Times last weekend about the value of exercise and preventing. They were talking about the number of steps you do, but it but it was in the same context that exercise prevents a lot of things, including Alzheimer's disease and other things seem to be prevented. So I'm a real proponent. I also think that if the doctors have to be role models to some extent, you know, the patients come to us and if, you know, we're smoking a cigarette and in the in the office, which I've had that experience of seeing a doctor and him smoking or, or, you know, not looking after themselves very unfit.

31:08 It it's gives a bad example. So I think that we want our patients to see. I talk about exercise with all my patients. You do absolutely. And do you wear the? Central Park track log T-shirt while we're seeing. Patients I I would if it would make a difference, but but yeah, no. So I'm a big proponent. You know, exercise increases blood flow to the brain, it increases new brain cells being developed, it's neurogenesis. It basically lowers cortisol levels. It does a lot of different things, increases endorphins.

31:54 So basically exercise is good for you. Very good. And not once a week, which some people do, or a bit of exercise. Yeah. And I actually promote people doing bodybuilding exercises as well as aerobic exercises so that you build muscle and, and then that's really the way to do it. And I, I exercise virtually every day. Every day, maybe one day a week. I don't do anything. Wow, that, that's incredible. And you've been doing that for many years now. We started this show by showing how you were juggling, which is incredible.

32:33 And tell us about that. How long have you been juggling? And then you also do joggling, which is juggling while you're running. So tell us how you got interested in that. So I got interested in juggling and I've also been interested in running. I didn't put them together. The juggling is become a passion of mine. I, I, for the last 30 years I've gone virtually every year to the International Jugglers Association convention, which is 24 hours a day of juggling for a week. And they've, you know, there they have the world joggling championships where we run against other jugglers juggling the whole way.

33:20 And I've won a bunch of gold medals from that, as well as participating. And then at some point I put the two together and started running just in the street and in Central Park. And I started running the races while juggling. And then I qualified for the first New York City Marathon, and I decided to run and juggle that marathon. It was in 2008 I believe. So you juggle the entire 26.2. I try to do that, yes. And most of the races that I've run in, I've run about 30 marathons and many other races.

34:04 Wow. When I run for our team, I don't juggle because it's uncool when you're competing in a team to also be playing with these things. Now, does the juggling while you're running slow you down at all? I like people to think so excellent. They they must be thinking how fast could this guy run if he wasn't juggling? Yeah, but. What's the truth? You can. You can. No, the truth is that it's harder to manoeuvre. Like if you're running in a race with 50,000 runners, right marathon you and this group of of runners in front of you, you can't just zigzag and in and out because you run juggling.

34:46 You don't want to bump into anyone, so you make detours this way and that way, which adds multiple miles to the race. I look at the amount of race miles I've done at the end of a marathon. Most people do, and you've gained a whole lot of extra miles, right? Yeah, right. Because you have to. In my case, it's a lot more. It's a lot more, yeah. So it's probably more difficult. And it's difficult in the beginning of a race where everyone in the adrenaline is flowing, the testosterone is flowing. Whatever's going on, people are running fast, which they shouldn't be doing at the beginning of a marathon.

35:21 They're cutting each other off. They're, you know, so you get bumped. You get bumped, yeah, and then you never drop. The ball and. Then you have to pick it up, which slows you down, yeah. Especially I, you know, I've learned tricks like you don't bend down when you drop a ball because someone's going to get flying over the top of you. So you, you have to, I kick the ball to the side and then go maneuver often. Yeah. Wow, all sorts of tricks of the trade there. Now you've I mentioned you've done 15 New York City marathons and you're going to be doing the 16th in a few months in November, all while juggling.

36:00 Yes. Well, I didn't do all of them while juggling. There were one or two that I didn't I see, but, but I've, I've juggled the most of them. And my son is a juggler as well, really. And he's juggled 3 New York City marathons with me. Wow. And his wife, who is not a juggler, also ran some of the major marathons we did together with us, right. And we, we ran all of the six majors. I've run all of the six majors. They're still going to do Boston and so, yeah. Wow, that's incredible. Now you did the Boston Marathon last.

36:37 Year, now this year. Oh, this right. In 2025, in April, I think it was, and you're doing it next year also in 2026. Well, I, I it's not official yet, but I've qualified for it. Oh, you have? Yeah. Right now, what's even more amazing is tell everybody how old you are. 80 years old. 80 years old now. It's incredible that you can run marathons at 80 and then on top of that juggle simultaneously. I mean, that's, that's just amazing. Do you have the world's record for the oldest? I am. I am the oldest.

37:17 Well, Guinness doesn't do age. Oh, it doesn't, unless it's a very special age, like if you're 110 and you do something right. So they don't do age. But I do hold a world record for being the oldest juggler to run marathon juggler in the world. I imagined I claimed it through record setters. And so, you know, I have that record that goes back to when I was under 68 years old. And I don't think, and I'm, you know, I don't think anyone's broken it. There are very few people 80 or above that run marathons to begin with.

37:58 The the number of people who do that is. That's nice because, you know, in 2021 I came third in the New York City Marathon in my age. Really. That was in 2021, right? So. You were in your high 70s at that. And I was invited to the World Age Group Championships in London the following year because I was up there. That's incredible how I just joined the Central Park Track Club earlier this year in January. How long have you been a member? So I've been a few years, not that long. Yeah, in this in this age group only.

38:33 Right, right. And I I must be one of the oldest. I think there's one or two others in my age group. Yeah, Yeah, there are a couple, but. But the the age group is the 70 and above age group. You forgot to mention that. Right now, how long does it take you to run a marathon while you're juggling like the the Boston that you did in 2025 earlier this year? Yeah. So what was your time? Well, so I ran a little slower there and I did it in 450 something. 450 that's incredible. The. Cut off for my age group 80 and above is 450 and to qualify I ran it in 435.

39:17 Wow. So and I had to run in to qualify for Boston. You have to run it within the year before. So I ran it in Michigan. Wow, and you've qualified for 2026 now? Right, because because the timing was such that I got it for two years. Yes, I. See. Wow, that's awesome. That's fantastic. And what are going back to psychiatry again? What are the emerging trends in psychiatry that you see You've been around a long time doing this 50 years. What do you see happening in the next few years? We talk briefly about biomarkers.

39:55 Yeah. So, so I think, I think, well, I think that's one of the big things that's happening in psychiatry. You know, I don't see a lot of other dramatic advances in the field at this point, but I do see that that's where the future lies. Unfortunately, a lot of people have jumped in early and you know, you can now get biomarkers for which medication you should take and so on. And I think that that's, that's, that's kind of thing is not quite where it should be yet. And I don't think it really informs our practice enough or meaningfully.

40:38 So I think we still have to wait a little bit longer for the biomarkers, still early. There we have the same thing in ophthalmology, like biomarkers for glaucoma haven't really been figured out. What's the key lesson from your career and hobbies that that you like to tell the audience out there that you've learned to maintain? And improve your mental health, right? So the first thing I'll is that I don't consider my juggling to be a hobby. I consider it to be a passion. A passion. I it's, it's another part of my life.

41:15 I juggle with a group of jugglers 2 nights a week. I go to juggling conventions, but then I'm also a runner, so I run. So I have these pieces to my life that give me a bigger dimension and keep me, you know, focused on not just. So I get up very early in the morning around 5:00 AM, and I go running. And then I go to work and I work all day and I love my work. And I hear people talk about retiring and I think, why would I want to do that, right? This is what I do. This is my life. My psychiatry's a passion, my juggling's a passion, my running's a passion.

41:56 And so I have all these exciting components and then I have my family, which is also my passion, right? So you know, so is. Is juggling A genetic trait you think because you mentioned your? My son, well, my mother taught me to juggle. Really, it is. There's there's a biomarker gene. For juggling, so I think so, yeah. Really. Your mother? How old were you when? I was very young when she taught me and I could juggle 3 balls. Now I'm, you know, getting there with five balls and 5 balls, bounce them 5 balls on the ground and in the air and really.

42:32 So, yeah, and. Can you demonstrate for us now some of your. Other I can demonstrate. I can demonstrate 5 balls on your floor if you can get your camera to get it. Sure, let me do that. Awesome.