Mind Dive The Menninger Clinic

 Many people who struggle with a mental illness or disorder may not know that clinical research data suggests that new treatment options may be just around the corner. On this episode of Mind Dive Podcast, board-certified psychiatrist, physician-investigator with Segal Trials, and assistant professor at The Johns Hopkins University School of Medicine, Dr. David Mathai, joins hosts Dr. Bob Boland and Dr. Kerry Horrell to discuss the importance of understanding the cultural and historical context of psychedelic drugs and why the first FDA-approved psychedelic drug therapy could come as soon as 2024.
Dr. Mathai simplifies the definition of psychedelics as "drugs, whose most prominent subjective effects often involve dramatic changes in thought, in mood and cognition." He says that, historically, these substances have been used in different cultural traditions across the globe for the purpose of healing and connection. 
He further explained that the  earliest wave of research surrounding psychedelics was focused on  LSD, which was discovered in the 1940s. “Realizing some of the therapeutic qualities such as LSD treatment for alcohol use disorder, anxiety and depression related with end-of-life illness...all of that was bubbling up,” said Dr. Mathai. 
But the Vietnam War would serve as a gateway to dismantle that research. 
For example, Dr. Mathai says there became a “complicated” social association between psychedelic drugs and  counterculture, particularly with American protestors  of the U.S. involvement with the war, often referred to as “hippies.” Dr. Mathai suggests this clash of cultures led to a growing animosity between proponents of  psychedelic use, like American psychologist Timothy Leary,  and politicians who were overseeing studies and held different views.
These opposing views, along with cases of reckless use of psychedelics, eventually led to the federal government's effort to combat illegal drug use in the 1970s, which Dr. Mathis credits with “shattering” psychedelic research for several decades -- until the early 2000s.
The resurgence of psychogenic research is often credited to a paper on psilocybin (a hallucinogen in certain types of mushrooms) written by Dr. Mathai’s mentor, the late American neuroscientist, Roland Griffiths. The research shows that users of psilocybin reported their experiences as among the most meaningful or spiritually significant experiences of their life. 
Dr. Mathai was involved with trials of psilocybin at Johns Hopkins for people who wanted to quit smoking, which resulted in a 60% to 70% success rate of participants cutting down on tobacco use. Similar results were found in treating individuals with alcohol use disorder. 
But it’s the optimism surrounding the drug MDMA that could mean big changes for psychedelic-in
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This episode, the Mind Dive Podcast turns the guest microphone on its co-host, Dr. Kerry Horrell, psychologist at The Menninger Clinic, to talk about her research into the dilemmas that arise with religion, spirituality, sexism and mental health.  Growing up in a religious family, Dr. Horrell became interested in this topic as a student because her early experience of studying psychology was that “religion was something you checked at the door.” As a Christian, she was confused by this and knew she had to delve deeper, deciding to pursue a graduate psychology program that focused on religion and spirituality. 
 
She soon became interested in the intersection with sexism, noting that elements of sexism are present in most religions.  Dr. Horrell notes that there are two types of sexism, benevolent and hostile. She explains the three pillars of benevolent sexism: protective paternalism, heterosexual intimacy, and complementary gender roles. She notes that, generally, the assumption is that men and women are psychologically very different. Then points out that the available data does not support that conclusion. Conversely, the research shows that, when it comes to psychological make up, men and women are strikingly similar. 
 
Dr. Horrell’s research led her to explore whether sexism could positively impact well-being. She discusses two types of wellbeing, hedonistic and eudemonic. Hedonistic focuses on happiness and defines well-being in terms of pleasure attainment and pain avoidance; while eudemonic well-being focuses on meaning and self-realization and the degree to which a person is fully functioning. She discusses research that demonstrates sexism correlates more positively with hedonistic well-being and negatively with eudemonic well-being, giving examples from studies that have been done. 
 
Dr. Horrell says the benevolent sexism in religion can lead to shame. She gives examples, such as the focus on a women’s purity.  She notes that when patients are having struggles with spirituality or religion, it often relates to gender, sexuality, and shame. She observes that these conflicts can cause trauma.  
 
In working with patients, Dr. Horrell says clinicians must “hold space for the importance of religion, family and spirituality in a patient’s life and empower them to think about their values and identify those things that are at odds with that.”  She says one of the best things a clinician can do is to offer patients the space to stay with the tension and the pain, to think about and it talk about it, without closing quickly on what might feel easy. 
 
“I think there's so much goodness in having things in our life that are sacred to us, and having things that feel bigger than us,” said Dr. Horrell, “Whether that's the concept of love, whether that's nature, whether that is divinity or God…and it's why I'm so passionate about it and about giving people space to get to know that side of their life.”


Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!
Visit www.menningerclinic.org to learn more about The Menninger Clinic’s research and leadership role in mental health.

Happy Monday to all  Mind Dive listeners.  This episode has been by far our most popular since we started Mind Dive in Feb. 2022.  Thanks again to Dr. Jonathan Shedler for giving his expertise and time to the discussion.  This week we replay  it for those who may not have heard it. 

Hotly debated in mental health care, psychoanalytic therapy has been criticized for lacking evidence compared to other approaches. Now, many clinicians attest to the benefits of this evidence-based treatment and see a great need in their patients for relationship-centered therapeutic approaches from their doctor and an emphasis on knowing oneself in order to heal. 
Dr. Jonathan Shedler, psychologist and author of, “The Efficacy of Psychodynamic Psychotherapy,” staunchly advocates for clinicians to keep an open mind about what suits their patients best on this episode of Menninger Clinic’s Mind Dive. This internationally acclaimed clinician is known for his work in establishing psychotherapy as an evidence-based treatment.  
Alongside hosts Dr. Kerry Horrell and Dr. Bob Boland, Dr. Shedler explores the dilemmas and nuances of psychotherapy throughout its history and how clinicians can view it through a modern lens.
Jonathan Shedler, PhD, is a consultant, master clinician, clinical professor of psychiatry at the University of California (UCSF) and faculty member at the San Francisco Center for Psychoanalysis. He also leads workshops for professional audiences, consults to U.S. and international government agencies, and provides clinical consultation to mental health professionals worldwide. 
“I think it’s perfectly fine to say we don’t fully know our own hearts and minds. The things that we don’t know cause suffering and can cause symptoms and limitations. Because of this, there’s a tremendous value in coming to know ourselves more fully,” said Dr. Shedler. “That’s what can happen in the context of psychoanalytic therapy and what can allow our patients to ultimately feel more free and more whole.”
 
Resources mentioned in this episode: 
"The Efficacy of Psychodynamic Psychotherapy" by Dr. Jonathan Shedler 
Mind Dive Episode 6: Building Trust in Therapeutic Relationships with Dr. Jon Allen 
“That was then, this is now: An introduction to contemporary psychodynamic therapy” by Dr. Jonathan Shedler


Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!
Visit www.menningerclinic.org to learn more about The Menninger Clinic’s research and leadership role in mental health.

What happens inside a child’s brain in the first three years of life is critical to their long-term mental health, says Jyrah Knight, early intervention specialist and professional development director at the nonprofit, First3Years.  So, if a child can’t even remember their encounters with parents and caregivers, how can it affect them so profoundly? 
“Understanding Infant Mental Health” is the topic of this episode of The Menninger Clinic’s Mind Dive podcast.  Join hosts Dr. Kerry Horrell and Dr. Bob Boland as they explore the fascinating topic of the developing brain in the first three years of life. 
Knight explains that trust relationships are critical to a child’s early brain development and mental health.  “You can’t talk about infant mental health without talking about relational health as they essentially go hand in hand,” she says. She notes that infant mental health isn’t about illness…it’s about helping a child develop well right from the start.  Knight says “Safe, stable, and nurturing relationships are essentially the foundation for all other infant brain development that happens.” 
“Babies may not have memory, but their brain is keeping score, and it’s keeping score every time a need is met,” she says.  For example, when mom and dad come when a baby cries, the brain is keeping score, and those interactions help to build trust.  Babies are aware of when they are cuddled, hugged, talked to and swaddled, says Knight.  She adds that the infant brain is keeping track of those positive interactions, even when memory is not present. 

So how do you help a parent or caregiver and a child?  Knight says the best approach is a strengths-based perspective and positive reinforcement. Parents and caregivers can easily get overwhelmed with the notion that they are responsible for their baby’s mental health. That’s why the goal is to highlight things that are going well between the parent and the child dyad. Knight suggests “lighting them up with the positive of what’s happening.” She adds that they will then feel empowered to do more. 
Knight, Dr. Horrell and Dr. Boland all acknowledge the importance of attachment to overall mental health and how the first three years is a critical time to develop these relationships. Dr. Horrell addresses how attachment trauma can show up later in life as depression or even suicidality.  Knight explains Trust Based Relational Intervention as a research-based methodology for addressing attachment relationships. 
Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!
Visit www.menningerclinic.org to learn more about The Menninger Clinic’s research and leadership role in mental health.

Perinatal mental health concerns affect as many as 20% of US women. Among Asian-American moms, ingrained cultural values can be an impediment to both diagnosis and treatment. In this episode of Mind Dive Podcast, hosts Bob Boland, MD and Kerry Horrell, PhD welcome two colleagues from The Menninger Clinic, psychologists who focus on women’s mental health and the particular needs of perinatal women in the Asian American Pacific Islander (AAPI) community. 
Nausheen Noor, PhD became passionate about women’s mental health as a community provider in Karachi, Pakistan, working with women struggling with domestic violence, depression and traumatic stress. She is also a strong advocate for mental health and wellness in the AAPI community, working to address lingering stigmas. The podcast also features Rose Yang, PsyD, the adult division coordinator and faculty leader for Diversity, Equity and Inclusion at The Menninger Clinic. Dr. Yang became invested in AAPI mental health in her early career, but her own subsequent experiences as a mom led her to explore maternal mental health challenges and attendant cultural issues in the Asian-American community. She is a certified perinatal mental health provider.
While it may be helpful at times to consider AAPI individuals as a community and to acknowledge intersecting experiences, Drs. Noor and Yang emphasize that it is critical to also recognize that the community is not a monolith, and is comprised of people from diverse backgrounds and cultures. Dr. Yang notes that the “model minority” stereotype—a 1960’s era term coined in a news article about Japanese American success—has been problematic, as it minimizes the struggles of many AAPI sub-groups, both ethnic and experiential (e.g., refugees). The panel also discusses the impact of the COVID pandemic as a stressor in the AAPI community, as it both catalyzed anti-Asian hate crimes and contributed to “lumping” all Asians together without regard for the rich breadth of their heritages.
 Drs. Noor and Yang discuss the meaning of perinatal health—perinatal covers the period before, during and after pregnancy—and the factors that can lead to mental health challenges.  While pregnancy can exacerbate pre-existing psychological vulnerabilities, other factors are contributors as well, including hormonal and psychosocial changes and disrupted sleep. Dr. Noor notes that fertility challenges and treatment can also contribute to feelings of stress and depression. Among Asian-American women, cultural and familial norms and differing levels of acculturation can discourage these moms from acknowledging and/or speaking about the feelings they are experiencing and from seeking help. 
 The solution? Drs. Noor and Yang emphasize the critical importance of timely, frequent and culturally sensitive screening by a variety of health practitioners—at Ob/Gyn and Pediatrician visits, and also by lactation counselors, midwives and doulas. Because this is a time that their focus is on care for the baby, women may be missing out on themselves; multiple check-in points may help to identify mental health concerns early on. They note that the American
Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!
Visit www.menningerclinic.org to learn more about The Menninger Clinic’s research and leadership role in mental health.

Did you know there are very few psychiatrists in Rwanda? That country, whose population has experienced an intense amount of strife, is not alone. Many mental illnesses go untreated in developing nations because of the lack of mental health resources.  Dr. Stephanie Smith, director of the Program in Global Mental Health Equity at Brigham and Women's Hospital, learned this and many other key insights while working abroad in Rwanda to help improve the population’s access to mental health care diagnosis and treatment. In this episode of The Menninger Clinic’s Mind Dive podcast Dr. Smith shares her insights and experiences with hosts Dr. Bob Boland and Dr. Kerry Horrell,  in looking at how to create greater access to mental health care globally where resources are scarce. 
An instructor in Psychiatry for Harvard Medical School and a co-director of Mental Health at Partners in Health, Dr. Smith worked in Rwanda to set up a collaborative care model for mental health care. She worked through the government to utilize the existing primary health care clinics and systems to incorporate mental health care resources for patients. This has been particularly successful in treating noticeable and severe mental illnesses such as schizophrenia and bipolar disorder by providing the appropriate medications. 
“We were at rural continuums, like general hospitals, primary care centers, and the community in thinking about how we incorporate mental health into that care continuum,” says Dr. Smith about her experiences in Rwanda, where she objective, on behalf of Partners in Health, was to strengthen the mental health care system.  “At the time each district in the government had been successful at getting one psych nurse and one psychologist at each district hospital…about 40 or so in the country. Knowing the population is 10 million, it's not very many. That’s why integrating into primary care system makes a lot of sense.”
Dr. Smith further explains that expanding care involved looked at existing providers and what basic mental health care services could be provided by a non-specialist provider, in a continuum where they are supported by specialists. Dr. Smith served as one of the specialist consultants. This consultative model is how services were incorporated into the general hospital or clinic setting, with basic mental health care delivered by primary care nurses, and working at the community level, where community health workers are this liaison between villages and communities and the health system. 
Follow The Menninger Clinic on Twitter, Facebook, Instagram and LinkedIn to stay up to date on new Mind Dive episodes. To submit a topic for discussion, email podcast@menninger.edu. If you are a new or regular listener, please leave us a review on your favorite listening platform!
Visit www.menningerclinic.org to learn more about The Menninger Clinic’s research and leadership role in mental health.