4 Secrets (hiding in plain sight) to Improving our Health and Mental Health
An excerpt from: Improving Mental Health: Four Secrets In Plain Sight, by Lloyd I. Sederer, MD
On a week-long hike in Spain last year, walking eight hours a day, I had a lot of time to think. I was inspired by a (short) book by the Pulitzer winning Dr. Siddhartha Mukherjee, The Laws of Medicine: Field Notes from an Uncertain Science, about nature, medicine and three rather counter-intuitive laws. I wondered what might be said of my field, mental health and the addictions. I wondered, as well, what might be valuable to clinicians working with patients and families – as well as of use to all of us, our families, our friends, our co-workers and ourselves.
I came to four foundational truths, if you will, instead of laws, which I call ‘secrets’. That became a short book of patient stories; historical incidents and notable people; book, TV and film references; and (non-jargon) science reporting to reveal and illuminate each of the four secrets I proposed. This is a book for practicing mental health and substance use disorder clinicians, general medical and pediatric doctors, and trainees in all these disciplines. It also means to speak to people with mental disorders and their loved ones about what they too can do to make an immediate difference in their lives, right now.
The “secrets” I believe that are there for all of us to see and apply are: 1) Behavior serves a purpose; 2) The power of attachment; 3) As a rule, less is more; and 4) Chronic stress is the enemy. Here are some very brief excerpts about each secret:
Behavior Serves A Purpose: We witness in a patient or a relative, friend, or co-worker, or in ourselves, behaviors that perplex us, defy reason, seem downright contrary to that person’s interests – whether these be depressive, eating disorder or psychotic symptoms, or every day destructive habits, like smoking, drinking too much, taking drugs, and gambling. We can be prone to make judgments, exhort someone to change, raise our voices – as if deep down they didn’t already know what harm they are doing to their lives and those they love. But any connection, the first step towards a therapeutic alliance, or the first step with a family member or friend, even ourselves, needs to begin with appreciating that behavior serves a purpose, maybe not very well but the best that person has to muster so far. We can wonder aloud, inquire in a non-judgmental way, how a behavior is serving a purpose. Kindness replaces blame and conversation replaces distance.
The Power of Attachment: The Harvard Study of Adult Development goes back to 1938. It has asked for generations of men and women, what makes for a long and healthy life? It is not fame and fortune. The best predictor of a long and health life is enduring, trustworthy relationships – with our spouses, family, and friends. Someone we can turn to with confidence who will be there if we need her or him. That’s what we all can do: build trustworthy relationships, attachments, that cut through loneliness and isolation to have a long and healthy life.
As A Rule, Less Is More: Here I offer story that goes back to 1700 BC when an Egyptian doctor wrote on papyrus how to care for battlefield wounds. He offered the gentle, less is more approach of removing debris, washing with water and covering to allow natural healing. That standard of care lasted for almost 3,000 years, until gunpowder was invented and gunshot wounds became the principal problems (for those that did not die!) on the battlefields of Europe. And the treatment of these wounds - you may want to fact check this since it seems so preposterous yet it is true - was to pour boiling oil on the wound. Disastrous, of course. Yet this standard lasted 200 years until a French surgeon ran out of oil on the battlefield. So, what did he do? He removed the debris, poured an innocuous liquid on the wound and covered for natural healing. Less is more as a standard was again restored. This story, of course, is a metaphor for not just gunshot wounds but psychic wounds. And today, intensive treatments, be they psychotherapeutic or medicinal, threaten to produce more harm than good. Doing more, especially more of the same, may be well intended but it can be like pouring boiling oil onto psychic wounds.
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Chronic Stress/Chronic Inflammation Is The Enemy: We know that acute inflammation is a good thing: it promotes wound healing and protects against infection. But chronic inflammation is bad – it lays down those nasty, fatty plaques in our cardiac and cerebral arteries putting us at greater risk for heart attack and stroke; it eats away at the Beta cells in our pancreas creating insulin insensitivity and soon frank diabetes; it produces a steady flow of the stress hormone cortisol, which gets in the way of Natural Killer and T-cells doing their immunity job of protecting us from not just colds but cancer as well. But with robust lives, or trauma, comes chronic stress and inflammation, which we need to manage to lead the full lives we seek. And what works can be done right away, and it’s free: exercise (10,000 steps a day); staying away from processed foods, sugary drinks, too many French fries – and eating fish and vegetables, the Mediterranean diet; sleep, 7 hours for adults, which is restorative; healthy, safe and kindly relationships; and any number of mind-body activities like yoga, meditation, mindfulness and yogic (slow breathing).
These are the Four Secrets, Hiding in Plain Sight. If you would like a lot more stories – from science, history, films, and everyday life - about improving our health and well-being, and how you can make that happen, right now, take a look at my new book.