14 episodes

Interviews with various mental health experts to help create herd immunity to anxiety and depression (TM)

documental.substack.com

docu-mental: mapping the american states of mind Whitney Fishburn

    • Mental Health

Interviews with various mental health experts to help create herd immunity to anxiety and depression (TM)

documental.substack.com

    It's Etsy for your mind: the world's first marketplace for mental health and personal growth tools

    It's Etsy for your mind: the world's first marketplace for mental health and personal growth tools

    vol. 2 issue 30

    Greetings,

    I love this podcast episode with Marie Leznicki. She’s the creator of Mindstead.org, the world’s first marketplace of personal growth tools, including for a variety of mental health challenges such as anxiety and depression. Imagine it being like Etsy, only for personal growth and mental fitness, a sort of 24/7 mental health fair.

    What’s exciting to me about this is how it offers virtually everyone access to the wide range of mental health tools and modalities that otherwise would remain out of reach either because of insurance restrictions, budget, or simply unfamiliarity with the number of techniques that exist.

    The tools are all vetted, and either evidence-based or validated, created by a range of credentialed therapists, life coaches, best-selling authors and Ted Talkers, all dedicated to helping individuals free themselves of the emotional and mental blockages that keep them from fully living a purposeful, intentional life.

    Marie explains in this podcast how she saw a need for the “middle range” of people who aren’t in acute mental health crisis or who don’t have gobs of cash to pay for elite mental fitness services, but who nonetheless want to find professional support for their personal growth goals, whether it be to quell their anxiety or live life more purposefully.

    Similarly, therapists and others who have developed tools but who only have so many hours in the day to work with their patients and clients can now have a wider reach, and can also improve their methodologies using feedback from Mindstead’s customer review process.

    Whereas self help books don’t offer support, apps are costly and might not suit a person’s style and personality, Mindstead offers a range of options such as cognitive behavioral therapy, dialectical behavioral therapy, meditation, breath work, and many other techniques you might not be aware exist, but which might be exactly what fits your goals. Often, this leads to working one-on-one with therapists per your own budget and other considerations, or to “cross-training” the mind with a combination of techniques.

    What I love about Mindstead is that above and beyond its egalitarian yet individualized approach to centralizing the supply and demand for tools of mental balance, it offers a way to avoid being, as Marie calls it, “mind hacked”, and thus helps us expand our individual freedom. This aligns with the raison d’etre of docu-mental, which is dedicated to mapping and documenting the connections between democracy and our personal empowerment, our freedom, and ultimately how these lead to peace.

    Our minds are the last frontier, even beyond space. Our minds and our imaginations are infinite, unlike all the other resources on this planet. That’s why “they” — whomever they are, whether it be purveyors of goods, religions, or politics — are coming for our minds. If we don’t protect them, grow them, guard them, and exercise them, then someone else will, and we will lose control over the one thing we have that connects us to our future, grounds us in the now, and delineates our uniqueness.

    Marie abandoned her original plans to pursue a PhD in anthropology, instead applying her years of training in it to creating better branding. “It was ‘anthropology for evil’,” Marie jokes. Her head for business and marketing led Marie to work with Bridge International Academies, where she strategized the founding and development of more than 900 schools primarily in Africa, where access to any kind of formal education was lacking. Over the decade she worked in Africa, Marie saw how when academics were paired with social and emotional skills, children developed more resilience as well as academic success, yet often these skills were not modeled in their homes. This got Marie thinking about how to offer adults access to too

    • 1 hr 8 min
    Brain science is showing what "normal" mental health is. Can it also help us evolve humankind?

    Brain science is showing what "normal" mental health is. Can it also help us evolve humankind?

    vol. 2 issue 18

    Photo: Tara Thiagarajan, PhD, courtesy of Sapien Labs.

    Greetings,

    Key to docu-mental is the discovery of how mental illness diagnoses have the power to promote or restrict democracy and freedom. To assess this, it’s essential to be clear on just what mental “illness” is, how it is defined, who is determining that definition, and for what purpose.

    docu-mental already stirred up a ruckus with the previous two podcasts dedicated to these questions, in which we explored the extremes between mental illness diagnoses as arbitrary constructs that favor profit, to them being essential for the health of those who truly suffer from potentially severe disease.

    This episode of the docu-mental podcast is especially rich and provocative, and returns to the questions of who gets to decide what normal is and on what bases, and offers a novel perspective thanks to cutting edge brain science.

    My guest is Stanford neuroscientist Tara Thiagarajan, PhD, founder of Sapien Labs and creator of the Mental Health Quotient. Dr. Thiagarajan has been applying her background in neural network physiology to build a global database that matches brain activity with cognitive and emotional states in order to provide hard science that shows what the range of good and normal mental health actually is so we can once and for all answer the question of what does it mean to have good mental health, even across a range of highly diverse populations.

    “If we don’t understand the whole spectrum of how people behave, we don’t really know where to draw the line between what is normal and abnormal,” Dr. Thiagarajan says in this interview. “How do we define mental well-being? Until now, there have been no tools that account for the full spectrum of human responses to life’s experiences.”

    In describing her work, Dr. Thiagarajan addresses three key shortcomings of our current mental health diagnostic tools: mental illnesses themselves are ambiguously defined, mostly according to symptom clusters instead of actual underlying diseases; screening tools are highly inconsistent; and they are negatively biased, meaning they don’t look for how symptoms might also be positively adaptive.

    “A lot of assessments don’t consider the consequences of the symptoms. Something could be flagged as problematic, like sadness, but perhaps that is a marker of empathy that makes a person better at work,” Dr. Thiagarajan explains.

    To address these shortcoming, Dr. Thiagarajan and her colleagues have created the Mental Health Quotient, an online survey tool that anyone can take at any time. Data from all the survey participants is collected anonymously and analyzed to track population mental health status worldwide. It’s forming the basis for a global repository of data on “normal” and “abnormal” mental health states.

    Having taken the survey myself, I can say it is easy to use and provides a snapshot of one’s state of mind in the moment. Rather than make a diagnosis based on that, it goes deeper, helping uncover how we cope with how our life is unfolding. In short, rather than view our various states of mind as pathological, it sees them in context of whether they are functioning as obstacles or tools for how we live our lives. For example, the score I got when I tool the survey indicated I am highly functioning, but if I chose to get better sleep, I would perhaps score higher on certain domains. This is empowering and leaves the choice up to me.

    To date, the Mental Health Quotient study has tracked with epidemiological data, indicating that even though the data is self-reported, it is clinically valid, which public health policymakers should find reassuring. Another public health gold brick: the data also indicate who in the population truly do need mental health intervention but aren’t receiving it, and who among us are seeking

    • 1 hr 10 min
    Deconstructing the News: The pros and cons of hydroxychloroquine for COVID19

    Deconstructing the News: The pros and cons of hydroxychloroquine for COVID19

    Special issue: Deconstructing the News

    What’s the risk-benefit ratio of using of an unproven drug to help prevent deaths from COVID-19?

    A dispassionate interview between a world renown expert on hydroxychloroquine and a healthcare and clinical medicine reporter, not one whose beat is White House politics.

    Photo of Remington Nevin, MD, MPH, DrPH, courtesy of Dr. Nevin.

    Greetings,

    As a former full-time healthcare and clinical medicine reporter, I have been annoyed at the frequency by which this public health emergency starring the novel coronavirus has been reported through a political lens and not much else.

    Of course, we all want to know what the economic fallout will be. We all want to know when we can visit with our kids and grandkids or other family members again. We all want to know when we can go out for a cup of coffee!

    But, really, what we need first is an understanding of the actual risks, benefits, costs, and procedures for evaluating what public health measures to take before we take them. I am finding such information hard to come by, and especially where concerns the use of high-risk treatments such as hydroxychloroquine.

    Here is that information in this special podcast and transcript.

    To cut through the politics, and to get a clear idea of what the actual risk-benefit ratio is, here is a special edition podcast with Dr. Remington Nevin. As the executive director of The Quinism Foundation, Dr. Nevin is the world’s leading authority on the harms of quinolines, the class of drugs to which hydroxychloroquine and chloroquine belong. Dr. Nevin is also a leading consultant on their use to governments and militaries internationally, and an in-demand expert witness for plaintiffs harmed by their use.

    Background:The president speaks frequently about using hydroxychloroquine and chloroquine in our nation’s strategy for preventing and treating COVID19, the potentially lethal illness resulting from the novel coronavirus pandemic.

    Some suggest it is because he stands to gain from promoting the drug.  Others suggest it is because he stands to gain from the economy firing up again (wouldn’t we all?).

    Still others say let’s try it!

    While urging the FDA to issue an emergency use authorization of the drugs, the president has asked the nation, “What have you got to lose?”

    Well, as it turns out, a lot. And yet, if you’re at high risk for contracting COVID19 – and little by little we are starting to form datasets that indicated who is most at risk beyond just the older among us – or you already have it and need acute intervention, then the risk-benefit analysis is probably going to tilt toward living, even if it means doing so in an impaired fashion.

    For those who choose to take these drugs, the potential harms are grim, and will likely progress into being a life-long medical condition most recently delineated as “quinism”, a neuropsychiatric illness that closely mimics PTSD and traumatic brain injury, in some cases, severely so.

    In this discussion, Dr. Nevin breaks down how these drugs work and what harms they potentially cause, gives us a brief history of their use, and explains how they came to be central to the debate over how to stop the pandemic.

    He then explains the potential upside of including their use in a federally coordinated pandemic response, using the Strategic National Stockpile to prevent hoarding and to ensure equal access to these drugs, as well as indemnity for clinicians and health systems that choose to use these drugs.

    Dr. Nevin also poses some compelling questions about whether promoting wide use of these drugs is actually more reasonable than promoting social distancing, and discusses what evidence there is for both. He also suggests that both sides of the political aisle are putting politics before data and analyzes what the potential long-term outcomes of d

    • 1 hr 58 min
    When psychiatry is life-saving: in defense of diagnoses

    When psychiatry is life-saving: in defense of diagnoses

    vol. 2 issue 11

    Greetings,

    The first psychiatry papers I ever edited and published were ones I was handed the very day I was named managing editor of a continuing medical education-focused journal in psychiatry.

    The collection was by a group of outré researchers headed by a Yale-trained psychiatrist fascinated by the Chinese “Book of Changes”. More commonly known now by its actual name, the I Ching, this 9th Century divination tool is largely considered a sacred text in China, while most Western scientists, given its random nature, view it with suspicion. This particular psychiatrist, however, insisted the papers were important in that they established how at least some forms of divination could be validated and used as a therapeutic tool.  

    There was considerable discussion behind the scenes as to whether it should even go to print. In part because the papers offered some data on whether the I Ching’s seemingly random patterns had any statistical value that might be seen as instructive, the papers at last won the editor-in-chief’s imprimatur, and that was that.

    Still, it was seen by some on the editorial board as an episode never again to be mentioned nor repeated, lest the journal be seen as a joke.

    For me, however, a clinical reporter and writer experienced in covering mental health issues, but not an academic who’d spent years learning, defending, and practicing from a canon of medical literature and clinical experience, the scramble over what to do with the papers showed me how much psychiatry has changed since its conception in the late 19th Century, and how fraught with opinions the field can sometimes be.

    It is more than safe to say that most practicing psychiatrists – especially those in academia – would not aver that divination is good medicine. Some would even call it malpractice. On the other hand, many psychoanalysts and psychologists who practice in the tradition of Carl Jung, are quite comfortable working with symbolic systems such as the I Ching or the Tarot.

    For Jungians, fairytales, myths, and spiritual symbols are indicative of archetypical energies that animate us all, but when ignored and left unacknowledged, help create neurosis.

    So then, what is good medicine in psychiatry, or even psychology, for that matter?

    To answer that, I suggest something George Washington University School of Medicine psychiatry and behavioral sciences department chair, James Griffith, MD, told me once: good medicine is whatever brings a person into balance.

    But what is that? It sounds rather personal, doesn’t it? Yes! That is the point. Good medicine is what brings you into balance with whatever your life is about. There is, therefore, an implicit existential quality to our mental well-being, regardless of how we seek to treat it. In America, I see it as being inextricably linked to the promise in our Bill of Rights to pursue our unique view of happiness.

    [For an excellent podcast on how to define, achieve, and maintain resilience – and balance – and the role of hope and purpose in one’s life, I recommend this conversation between Dr. Griffith and my friend and colleague, Lorenzo Norris, MD, GWU SOM’s Asst. Dean for Students and an assistant professor of psychiatry.]

    There is plenty of clinical literature in support of a variety of mental health treatments, and novel therapies and insights are in development all the time. Until only a few decades ago, for example, being gay was considered a clinical psychiatric condition. It no longer is, but questions surrounding how best to define and treat mental health concerns in the transsexual community currently challenge the field.

    Because of the existential and personal nature inherent in our states of mind, treating mental illness in populations poses a unique challenge. How do we factor in the ineffable while creating evidence-based st

    • 41 min
    Does psychiatry reduce or increase our suffering, and are we powerless to change how it is practiced?

    Does psychiatry reduce or increase our suffering, and are we powerless to change how it is practiced?

    vol. 2 issue 7

    Greetings,

    It was 2017. I was in a posh conference room at a five star hotel in Scottsdale, Arizona. An elder statesman of the psychiatric community who’d recently stepped down from his post as leader of one of the nation’s oldest and most venerated mental health hospitals and research facilities, was giving an honorary address. The room was filled with esteemed psychiatrists. I was there to report.

    Among the man’s many startling claims was that psychiatry was broken, and was likely to get worse before it got better, especially if the field continued to view patients as pathways to profits instead of persons in need of succor. I had never heard anyone in the profession take such a public stand before. One psychiatrist in attendance, not unsympathetic to what the speaker was saying, nonetheless referred to it in conversation with me later as a “fever dream”.

    Most intriguing of all was the speaker’s assertion that by 2067:

    “Most physicians will be employees of one out of four major health care nonprofit corporations that are vertically or horizontally integrated systems of care…managed care will be perceived as a regrettable experiment of the late 20th century ending in the first part of the 21st century. With the enactment of a universal single payer system of care, the high-cost intrusive middle management of carve-out behavioral health care companies will become moot… [Further,] significant advances [in science]…will make the prior 200 years of psychiatric care seem crude, quaint, and absurd.”

    More than a decade before this, the psychiatrist and noted humanitarian, as president of the American Psychiatric Association, had chastised his colleagues for allowing a dissolution of their professional values, and thus a loss of credibility in the eyes of the public. In particular, he’d called out the need to reverse the influence of the pharmaceutical industry the field, and declared war on his fellow psychiatrists’ reluctance to fight for the rights of their patients across many fronts. He also called out the lax standards of scientific inquiry in the field.

    As the speaker re-iterated in an interview with me later, he was deeply disappointed in his colleagues for not sharing his alarm over the drop in psychiatry’s professionalism. What struck me then and stays with me now is the sense that the speaker was genuinely broken hearted over what he had seen his beloved profession become.

    I thought about his sorrow as I was editing this podcast episode of docu-mental. It occurred to me that whether or not he realized it, what he was describing was the erosion of freedom in psychiatry.

    Freedom’s erosion looks like this:

    It is the insurance industry with their need to deliver shareholder profits, not psychiatrists with their clinical judgement, that has ultimate say over the treatment algorithms, the time spent with patients, and the length of time for treatment. With help from the pharmaceutical industry, insurance got and keeps that power to determine treatment through policies held in place by legislators. Why do they put such restrictions in place? Because too often, as I have also seen firsthand, the legislators don’t really understand what they are agreeing to, and take at face value what the lobbyists tell them makes sense.

    The lobbyists justify their position with scientific data derived from studies designed in favor of their interests. When there is protest against their findings, they claim that science is science, and their results are scientific.

    Yes, science is indeed science, but there are many ways to occlude the whole of the scientific findings. One is that when outcomes aren’t favorable, too often they are kept quiet, never to be seen by the public, despite calls to publish them in a public database.

    The result is drugs that are marketable, in part because

    • 59 min
    Family legacies that hurt: The secret heart of actor Harry Dean Stanton

    Family legacies that hurt: The secret heart of actor Harry Dean Stanton

    vol. 2 issue 2

    Greetings,

    It seems we’ve moved on from “finding our tribe”, as was the thing to do in the 2010s, and are now onto identifying our “family of origin”. There are even so-called “family of origin” therapists. I haven’t ever spoken to one, so I don’t know what that’s all about, but it seems iterative to me. Really? We’re only now starting to consider that the pain of our progenitors is our inheritance?Well, okay then. Here’s my own entrance into that pursuit of inquiry.

    The character actor Harry Dean Stanton will be best known to you depending upon your generation, as the singing convict in Cool Hand Luke (not Paul Newman, the other one), Travis in Wim Wender’s Paris, Texas, or Roman the arch patriarch of a polygamous Mormon family on the HBO show Big Love, or the star of Lucky. I know him as the family member who shows up in nearly every dang movie I am casually watching, unsuspecting that at any moment he’s about to appear.

    In fact, Harry Dean was in hundreds of movies, but with the exception of Travis, never had a lead role. He co-starred with a young Emilio Estevez in Repo Man, but that was it. He died in September of 2017 at the age of 91.

    Of the four boys born to Ersel Moberly Stanton McKnight of West Irvine, Kentucky, only one remains: my father, Harry Dean’s youngest sibling and half-brother, making Harry Dean my uncle.

    My guest in today’s podcast is Joe Atkins, Harry Dean’s biographer and a professor of journalism at the University of Mississippi in Oxford. His book Harry Dean Stanton: Hollywood's Zen Rebel is due out later this year from the University of Kentucky Press.

    I adored Mama Ersel, my grandmother. But I was not in the majority. So much of Atkin’s book explores the tortured relationship Harry Dean had with his mother. Talking with him both in this podcast and off record, I learned more about how that relationship also informed the one Mama Ersel had with my own father, and thus, how her demons and his, were handed down to me.

    It’s a strange thing to sit in a movie theater, as I did for Harry Dean’s final work, the semi-autobiographical Lucky, and to see your own family photos featured in a scene where the main character reveals how these people let him down.

    But it did reinforce my observation that pain and suffering in one family member, particularly when unresolved, will take similar forms across successive family generations until someone afflicted by it all looks backward and says, “No. This ends with me.”

    In my family, as Atkins reveals, it seems that depression, addiction, abandonment, and rage are coded in my father’s family’s DNA. Personally, I have known the depression and the rage of being exposed to the rest of the family “gifts”. But, somehow, I also was blessed, and I do mean blessed, with an abundance of stubbornness that has translated into resilience and ultimately, into soundness of mind.

    Was Harry Dean so blessed? He lived long and worked nearly until the day he died. Stubbornness: check. But how willing was he to look back and say “No thanks. You can keep that,”?

    It seems to me that the abandonment he experienced along with the attendant rage and pain were too much for him to fully exorcise and examine, which is why he could go on in circles about god and philosophy, but never really get anywhere: It hurt too much. Maybe it made him a better actor, I don’t know. Was his pain his secret sauce?What’s funny is that all that preaching and philosophizing — that’s another family gift that ironically tied him to his kin, even though he otherwise kept his distance.I was close with the woman who haunted him, and much as I loved her, she haunts me, too. In fact, she and I, and her second husband, my grandfather, all shared the same birthday. What I’m getting at is that in families of origin, the lega

    • 1 hr 7 min

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