If there is one book that I think every parent, educator, coach, and health care provider should read to under stand the preteen/teen brain and the way decisions are made by OUR youth it is “Born To Be Wild” by Dr. Jess Shatkin.
Here is the podcast.
Dr. Denise: This is the Dr. Denise Show. I’m Dr. Denise McDermott an adult and child psychiatrist specializing in an integrated approach to mental health. I believe in prescribing the least amount of medication, coupled with a comprehensive treatment plan. My goal is to empower you to thrive and I take a multi-dimensional approach to wellness, not illness. You are not your symptoms. Call upon your best and highest self to embrace your mental health. On this program you will meet many doctors, experts and pioneers who have helped pave the way to shift the paradigm of getting rid of the stigma of mental illness in our society. This show was created for those of you who would like new ways of thinking and understanding about mental health and helping your loved ones to thrive and cope in empowered ways. Today I have the honor of interviewing a nationally recognized child and adolescent psychiatrist Dr. Jess Shatkin. He is one of the country’s foremost voices in Child and Adolescent Mental Health. He serves as Vice Chair for Education at The Child Studies Center and Professor of Child and Adolescent Psychiatry Pediatrics at New York University School of Medicine. Dr. Shatkin has been featured in top print, radio, TV and Internet outlets including The New York Times, Good Morning America, Parade, New York Magazine, to name a few. In addition, for the past eight years, Dr. Shatkin has been the host of About Our Kids, a two-hour radio call-in show radio broadcast live on Sirius XM Doctors radio. He lives in New York City with his wife and two teenage children. His book, Born to Be Wild: Why teens take risks and how to keep them safe will be released on October 3rd 2017. I’m so excited to have him on the show today. Hi Dr. Jeff Shatkin it’s so great to have you on the show today. And have you back on the show.
Dr. Shatkin: Thanks for having me. I’m thrilled to be with you.
Dr. Denise: Thank you. And so we are going to be discussing Dr. Shatkin’s new book Born to Be Wild : Why teen take risks and how we can help keep them safe. You know, I have to tell you Dr. Shatkin, that this book and how we as a society can prime our teens and our tweens and our young adults for self-efficacy and self-regulation is near and dear to my heart as a mother, as a child psychiatrist and a kindred spirit of your vision. And so I just want to thank you right now because I think you just knocked it out of the park with this book and you have done an amazing job of bridging the science, the clinical, your clinical expertise and your personal experience as a parent of teens.
Dr. Shatkin: Well thank you Denise. That’s lovely to hear. It makes me so very good. I’m glad that it resonates and, you know, when you start a project like this you have all these big ideas and I hope that they came to fruition on this. I’m pleased with it. And I hope that it speaks to people like it’s spoken to you. So thank you for saying that, I really do appreciate it.
Dr. Denise: Well and also my understanding is this is has been a seven year journey right?
Dr. Shatkin: So I started, this book really comes out of, you know, like so many things in our lives as clinicians we cross so many different boundaries all the time, and for me what happened was I started working with a high school in New York City on the Lower East Side, trying to help them build a resilience program, or a sort of a mental health prevention program, so wellness program of sorts, basically trying to help their kids to have resilience against things like drugs and alcohol and taking risks. And in the process of starting that in 2010, I started reading a lot of research to help me understand really what does enhance resilience because so often in mental health, psychology, psychiatry, social work, we learn about what goes wrong and we learn about how to help identify that and then treat that. And that’s a big and important mission and journey. But we don’t often learn about what goes right and how to enhance that. So standing things on their head and thinking about things from a resilience perspective in terms of adolescent development and risk taking was novel for me and I started reading a lot of material in that area. I started recognizing where we could intervene and that led me to understand risk taking a lot better. As so often happens in so many fields, the research starts 30 years before it gets in the hands of the clinicians. And what I tried to do is speed that process putting this information in the hands of parents and teachers and clinicians as soon as possible.
Dr. Denise: That’s fantastic and I think we’re living at such an amazing time with the ability to have access to so much information and you address that in your book how fast society is moving. And so for us as doctors there’s been some old myths that we were taught in medical school. And I think one of the things that you started talking about is sort of the myth that teens think they’re invincible. Can you sort of take us through your aha moment that ignited this myth busting realization?
Dr. Shatkin: Yeah that’s a really great one, I started reading a review article by a woman named Valerie Reyna and Charles Brainerd. And it’s a wonderful review, but it literally took me about three nights to read it. And I was reading this as part of this development of this program. It’s about a 30 page, single-spaced, two or three-column paper with lots and lots of details. And I remember, I underlined every other sentence in that article, which I don’t tend to do very often. And one of the first sections of that article was the idea that kids actually don’t think they’re invincible, and that’s what I, and perhaps you, and so many other people have been taught when we think about why adolescents take risk? Why would you have unprotected sex when you know that the risk of pregnancy is there at least? Why would you drive 100 miles an hour down the freeway while drunk? Why would you jump off of a bridge into a river that’s moving swiftly? Why would you be drinking on the shores of the lake and then swim across the lake when you had a few beers in you, who would do something like that? What the hell are people thinking? And so for me, what I’ve been taught and what I learned to think, was that adolescents think they’re invincible. And many people have thought this for many years and there was a lot written about this in the 60s and 70s and 80s about this. So clinicians were even taught this very straight message that adolescents think they’re invincible. So I read this article, I couldn’t believe what it said, and I did what probably any parent would do was go home and ask their kids, so my daughter at the time was 13. And, I know this sounds like a funny thing to ask your daughter, but she knows I’m a Child Psychiatrist and she knows what I think about and what I do when she heard these words before so it wasn’t shocking to her. But I said, my daughter’s name is Parker, and I said Parker if you were to have sex one time unprotected with a man or a boy what’s the risk that you would get pregnant? And she looked at me very straight and thought about it and said 90 percent. And I said what’s the risk that you don’t know anything about this boy’s sexual history, you don’t know if he’s straight or gay or anything in between, you don’t know if he’s ever had sex before, what’s the risk that he would pass HIV to you? And she said 75 percent. Now the risks for those things are so much lower. But what that did then was start me on a journey of asking some of my patients and my students in college and different things. What are the risks of these things? What do you think? And what you find when you ask these questions of young people, older people too, but particularly young people that they do not think they’re invincible at all, in fact, they think they are very vulnerable to these things happening. Ask them about a bad thing an earthquake or a hurricane, dying this year, or getting a sexually transmitted infection, they will tell you the risks are enormous. And so that can’t account for why they take risk. That was the first aha moment.
Dr. Denise: Well that’s a big aha moment, because now we can kind of look back and I think you and I should go back and share some of our own teen stories because we’re obviously, we’re at a different phase of our life, just to kind of really connect with our audience. But that realization that we’re not, that we don’t as teens think we’re invincible and then understanding the why, Dr. Shatkin’s going to take us through that in many ways. But what I want to say is, when you started your book, I loved how you shared your experiences that colored probably who you are as a man, as a doctor, as a psychiatrist and as a health educator. So can you share some of your teen experience and tween experiences that you did in the book and I’d love to just hear that and how that relates to this book?
Dr. Shatkin: Sure. So you know, I was born in the early 60s and I’m the youngest of five kids. So the 60s were a funny time and I was living just a few miles north of San Francisco in a rural, semi-rural kind of suburb area. And my brothers and sisters, I have two of each, all older again. They were, you know, my brothers were a little bit of hellions. They were out there, you know, smoking grass and driving fast cars. Everybody was fooling around with the opposite sex and different things of that nature as I grew up and I would see this and I was exposed to a lot of it very early I remember very early, at seven years of age, I remember my brother handing me a joint, you know, a reefer, a marijuana cigarette and saying, you can’t smoke this but smell it. You can hold it, and me knowing that that was a drug of some sort. And I remember the next year, my third grade and at eight years of age my friends and I used to be able to grab cigarettes sort of from behind the check register at a grocery store and we would steal cigarettes now and again. And we lived in Davis for a few years. Davis, California. My parents moved for a couple of years and during those years my friends and I we would steal cigarettes and then we would go to the dorms, the college dorms and we would go up on the rooftop because you could access the rooftop of these eight or ten story dorms in Davis and we’d sit on the top. And I remember sitting on the rooftop with our legs hanging over the edge of the roof cause there was a rail you could hold on to, our legs would hang over. And college students would come up and bum cigarettes off us when we were eight years old.
Dr. Denise: Oh my goodness. Wow, that’s precocious.
Dr. Shatkin: Yeah. So there was a lot of that going on, you know, other things happened, I was pulled over by the police, not pulled over, I was apprehended. We were smoking in a field and a couple of us. And some of the cops, I guess the neighbors heard us coughing. We were using a metal pipe and they called the police and the police came and confiscated our pipe and took a lot of information from us and never told our parents which is wild. But all sorts of things like that happened growing up. I was drunk when I was 11 at my brother’s wedding. I pulled a bottle of champagne with a buddy of mine and went off into a room and got drunk and then embarrassed my father and were dancing around the wedding clinging cans together saying here comes the bride. So, you know, I told these stories in the book.
Dr. Denise: Yes
Dr. Shatkin: I didn’t want to make it the feature of the book. I wanted to say that, you know, I think that what happened with me is that I was exposed to a lot. I had a lot of opportunity to make a lot of mistakes and it happened early and my parents finally sort of got the message and sat on top of me and when they did it made a huge difference and a lot of my plea in the book is for the role of parents to sit on their kids a little bit more carefully than they want to, it’s not comfortable or fun for us, but it makes a big difference. I mean really monitor them, and be with them and engage with them, you know, spend time with them. This is a big part of what helps our kids to stay safe.
Dr. Denise: Well we’re going to go there. I just wanted to have everyone here, kind of a human approach that Dr. Shatkin was once a child and teen. And I know that your parents really clamped down when your grades were dropping, they had you quit the band and football and then you went from B to A’s. And then I can share, when I was, I think 13, one of my wildest friends, she was just so much fun, her dad on New Year’s Eve was like took us up to the counter Jess, I couldn’t believe, this is like an example of what not to do as a parent, and he sort of let us pick alcohol to drink and this was our first time drinking alcohol and we got, we literally blacked out that night. We were 13 years old and I remember one time, you know people would drag race. And I remember going 100 miles per hour at one point down a street. So we’re going to dip in now to why the tween brains, the teens and young adults, which by the way we know extended it’s, we’re going to talk about the time span of that. And so I wanted to make it real that you and I both were with this age at one time and you know we have resiliency and self- efficacy that’s gotten us to this point, but let’s go there. Let’s start now about why our teens and tweens and young adults take risks from a neuro developmental standpoint, hormonal and peer standpoint.
Dr. Shatkin: Yes, so there are a bunch of reasons, and invincibility isn’t one of them. Now I just want to give credit where credit is due in terms of the idea of invincibility, while almost every young person, with rare exception, and I haven’t found exceptions yet, so I say rare, extremely rare exception. Well most young people will tell you that the risk of these terrible things happening is very, very high. Some of them, not most in my experience, but some of them will say that they do certain things to prevent these bad things from happening. So they may have unprotected intercourse, but they pull out in time. And they know how to do that. And that would be considered optimistic bias. There is some of that with some young people, and for those few people who have optimistic bias being clear with them about the fact that, in the example I just gave, that men often have some, or boys often have some pre-ejaculation, some sperm does come out of your penis before you actually have an ejaculation and that you can get pregnant that time. You know, some bits of information for some people are important, but the vast majority do not believe that they’re, well no one believes they are invincible, as far as I can tell, and a few people have optimistic bias, but the reality is that adults actually have just as much, if not more, optimistic bias as young people. So while I want to give credit to the fact that some people do have some optimistic bias, it doesn’t account for risk taking still. The reasons people take risk, are really, it looks like a neuro-biological based on everything we understand at this point. And there’s a handful of reasons and I’ll lay them out and we can go into much detail as you want. But the first thing is how the brain is actually purposefully designed and how it comes online in terms of how it talks to itself and the kinds of parts of the brain that develop, namely that the emotional part of the brain limpic system develops earlier than the prefrontal cortex and is better integrated with the rest of the brain earlier than the prefrontal cortex and takes a while for the prefrontal cortex, which is really the brains CEO, the chief executive officer, the guy who makes the decisions and plans and is organized and has good memory of recent events, that part of the brain takes a longer time to get networked. And I don’t think that that’s a mistake, I think that’s a purposeful outcome of nature. So that young people will take risks. I think born to be wild is the title, which is a pop title, but the goal really is of that title is to say, hey this is actually, you know, adolescents are doing just what they’re supposed to do according to evolution – take risks, because we need some thousands of people in our species to run across the hot savanna, find the new water source, find the new mate, outrun the elephant and take it down in a battle so that we can have food. And if we don’t sacrifice some thousands, we’re going to die, of course the millions in our species won’t survive. So we are built this way, some of us are going to do those things, and then they’re going to pass those risk taking genes, those risk taking memes, or ways of approaching the world, on to their prodigy. So that’s the first, and really overall arching concept, then there’s a number of others, the fact that dopamine is higher in the brain, how the hormones work, which is new to us in terms of how we understand them now, how peer effects work and why peers are important to how we engage in behavior, how the social attachment to the pain system work in the brain. So all of those things I’m happy to talk about in more detail. But the first example I gave is the overarching kind of reason…
Dr. Denise: Well and I think educating, I think one of the points you made in the book is also the way now, how do we talk to our teens? How do we talk to our preteens? And, I what I love is that programs like Scared Straight and all those don’t work. And I think we should just jump in and discuss why they don’t work, and how important, you were sort of stating that the quality of how we give the gist of what would happen for the kids. For instance, I want to kind of go through like a specific example Jess, like that one about unprotected sex. I think you talked about if there’s a 5 percent chance what we would do, you and I as clinicians, and also as parents, how we can talk to our teens and tweens and explain what is going to work in helping them because we can’t hijack, I think one of the big things you talked about is that, we can’t give our children when they’re 14 years old the experience, the life experience, that you and I’ve had, and what we can do as parents, clinicians and educators, as we can effectively communicate with our teens and provide the support system so they can make the best decisions, so that they don’t get into crisis. So can we go through some examples of that so that people get some real ideas and tips and tools on what they can do in their homes and we can then integrate it with your concepts of the book?
Dr. Shatkin: Sure. Well, do you want to start with, you mentioned why those programs like DARE and things don’t work?
Dr. Denise: Perfect. Let’s do that.
Dr. Shatkin: Maybe we start there; DARE, Scared Straight, even driver’s education, sex education. In many cases these programs have zero tolerance policies, and in many cases these programs have actually made things worse. There is effort to improve these programs and some of the newer iterations that programs may be better, the data isn’t really there yet. But what I can say about what’s been done in the past is that most of our effort in health education and risk prevention with kids has been focused on teaching them that they are at risk, because we have assumed, erroneously as we described already, that kids think that they’re invincible because we assume they believe they’re invincible and that’s why they take risks. All of our efforts have been focused on, don’t you see you’re not invincible? Don’t you see that driving 100 miles an hour while drunk can get you in an accident, if you have an accident boy you’ll be sorry, you’ll be dead or you’ll be maimed the rest your life or maybe worse you’ll kill someone else and have to live with that. You don’t want to go through that. So therefore don’t drive drunk and don’t drive fast. So these kinds of admonitions succeed in so far as kids believe the risk is really high these things are happening. I think it’s because we talk to our kids this way through DARE and Scared Straight that our kids think wow bad stuff could really happen, the risk is really high. They get that but it doesn’t change their behavior. And, in fact in many cases, it works against us and we see more risk from kids who’ve gone through these programs because these programs scare the hell out of them and then they get a little bit older and they find their friends are smoking grass and still getting pretty good grades, or still on the swim team or we find that they’re not becoming heroin addicts or whatever else it is so maybe it’s OK to smoke grass and maybe the cops who told me it was so bad were really full of crap. They didn’t really know what they were talking about and so they kind of rebel against the message and even go far the other way. So there are a lot of reasons related to this idea of invincibility and are unclear understanding of that historically that has led to the programs that we’ve developed that have essentially not been working. So what we know now is that if we understand the reasons kids take risks, the way the brain is built, the way the hormones work, the way the brain’s pain system works, then we could actually target interventions, some of which can’t change that of course, but we can have empathy for our kids, understand where they’re coming from, recognize that they’re not doing these things because they’re personally angry at us or trying to get back at us or trying to show us that they’re so smart and capable, but really understand where they’re coming from, and then we need much more thoughtful about the kind of strategies we employ.
Dr. Denise: Right. And I think the neuro developmental piece is so key. So when you’re explaining to your kids, teens or patients that the CEO the brain is the logical part that really has a deeper connection to the limbic system and the emotional part after age 26. Right? So when I was explaining that I drew a brain to someone, a teen in my practice, and obviously I relate to them, they tell me if they’re smoking pot… But I said to them listen, you’re at the age where you’re going to want to do things because your friends think it’s cool. And this is why, because in the moment, and I think you called it hot cognition versus cold cognition. Right?
Dr. Shatkin: Yes
Dr. Denise: In the moment, you’re like, oh my gosh, like your limbic system which is your excitement part of your brain, if we just want to make it really simple. And you’re like wow that seems like fun and that seems like my peers are going to want to do it. So when you’re in the moment, when you’re faced with should I smoke a joint or should I have unprotected sex. That’s the time when you’re wanting the most social acceptance. And we’re hardwired neurologically because our limbic system isn’t fully myelinating and kind of develop with our CEO of the brain; and then also all the hormones, the dopamine system, the hormones, the testosterone of all wanting that connection, that human connection. And so I think the education piece, I think you made a really great point in the book, is that when we are talking to our kids, our teens, our patients, to do it in a state where they’re not, they’re in cold cognition. Can you talk a little bit about hot and cold cognition and sort of the best time to teach and maybe the qualitative tips to give someone?
Dr. Shatkin: Sure. So that’s a great place to start. So we know that when kids hit about 16 their frontal lobes are well developed enough that they can have logical conversations on just about any topic and they can make really good decisions. They can make decisions just about as well as adults can often. You know they don’t have the experience and sophistication and knowledge of a lot of areas, but still they can make some really good decisions that are as good as any adult would make. But when they are around peers, when they are observed by peers, or think a peer might be watching them, their behavior changes a lot and they start to take more risks. So we would call that a moment of hot cognition, hot because there is some pressure or intensity there that is making them engage with the world a little bit differently. And, you know, my son said to me the other night, this is so funny, literally last night he was in bed. It’s Monday today when you and I are talking, so this was a Sunday night. It’s a little of a Sunday night anxiety blues as you head into the week sometimes, and you say, you know, I don’t want to go to school tomorrow. You know. It’s so relaxing to be home or with my friends on the weekend and I go to school and there’s so much pressure and I feel like I’m not even the same guy I used to be. He’s 16 now, almost 17, he says you know he used to be so friendly and so brave with everybody. And now I sometimes feel a little shy around people or a little bit like I need to just act a certain way and I’m thinking about what they’re thinking about me. And the reality is he’s exactly where he should be, his brain is exactly where it should be. That’s typical, if he weren’t thinking that he would be strange. And so first of all acknowledging that, you know, instead of saying to your kids get over yourself or stop thinking that way, it’s like no, that’s exactly what he should be thinking because this is the time, evolutionarily speaking, when our kids would go off and mate and they would procreate and they were lucky to get the best mates and the best most fit mate and the healthiest, most attractive, whatever it is mate. And so you have to be concerned about what your peers are thinking so get that mate.
Dr. Denise: Absolutely. And I think one thing you said is our adolescents are living with a caveman brain in modern day society.
Dr. Shatkin: Yeah, evolution happens really slowly, but our society moves at light speed. I mean, think about the fact that, you know, when I was born there were no color TVs and now everybody has color TV. You can’t find a black and white TV, and we didn’t have cell phones and you and I we were in residency when cell phones came out. And yet in the in the early 90s or something or late 80s I had a phone that they could be about 100 feet from the controller, you carry around your house the remote phone that was radical you know. So much has changed and our access to things has changed so much, our speed has changed and the knowledge moves so quickly. But our bodies, our biology change over millennia, they don’t change that quickly. So that’s exactly I think the point. As a result we need to be thoughtful about our strategies and recognize that in moments of hot cognition our kids need a lot of help with what to do. So one of the things you brought up a moment ago, was the idea of planning for these moments and acknowledging as parents that, yes I can have a conversation with my kids at the dinner table and say, don’t smoke, don’t drink or you know what. You know, be careful the party tonight, or don’t overdo it at the party tonight. But that’s not really going to have any effect because you’re having that conversation in a moment of cold cognition. And when the kids are around their friends, we know from lots of experimental evidence and studies and interviews observations, that when kids are around their friends they are going to behave differently. I talk about that in my own experience in chapter two when I talk about my trip to Germany how I behaved differently with my peers than I did at home. And you know when I was drinking or climbing Withal Tower or whatever dare I was taking, and the same thing happens with our kids. So we need to plan. One way to plan, to help them be prepared, is to actually talk about the likelihood or even inevitability of these situations unfolding. So you say, look I’m going to let you go to this party, which parents may not want to do ok, but if a parent decides, I’m going to let you go to this event or this party, you can be pretty sure as a parent if it’s high school party and it’s not well supervised there will be alcohol, there’s going to be marijuana, there might be cocaine. I mean it just happens. You know maybe not a ninth grade for everybody, but by 17 or so, that stuff is happening. And so how are you going to handle that? Are you going to forbid your kids to go to those events? Which is one way to do it and may make a great deal of sense. Are you going to make sure your kids are in very structured activities so that they don’t do those things? And that’s another good approach. If they do go how are they going to handle that? And even if they don’t go to these parties, just being in high school they’re going to be exposed to these things at lunch, outside the building and the after school time, at the gym when the gym teacher doesn’t show up. You know someone’s going to be smoking grass, someone is going to be doing something. So how do you prepare kids for that? You prepare them by having these very frank conversations, you prepare them by role playing. you prepare them by getting them ready for actually what they’re going to do and making their decisions in advance so they don’t make the decision at the moment of hot cognition because they’re much more likely to make a decision that puts them at risk.
Dr. Denise: And also, the data that you drew to this information is so important for everyone listening, we have the data, and this actually applies, not just to parenting, it would be your mentoring style, your style as a physician or an educator. I think we can kind of transfer that when we are looking at authoritative versus passive versus authoritarian style of giving information to our teens and tweens. Dr. Shatkin can you talk about that? That to me is a great template for how we then give the support and how we give the information to really have it be firm and caring boundaries that are given to our teens that actually respect us. Because if they respect our style of communication and the time we spend with them, whether it’s at our home or in our offices, they’re more likely to connect with the information and then follow through.
Dr. Shatkin: Yeah, absolutely. So back to the 1960s when a woman named Dana Boundrand??? at UC Berkeley was studying kids in preschool and she started to observe the styles of the kids and what the kids were doing and how their parents engage with them. And what she found was that the parents who were not permissive and indulgent, and the parents who were not authoritarian like you did just because I said so, but the parents who were, what she called authoritative, who had very clear limits and guidelines but were also loving and engaging to their kids. So they gave effective commands, they gave positive reinforcement. They selectively ignored what they could ignore. They were very clear with their kids, but they weren’t going to let the kids get away with stuff either, that those parents had kids who behaved better in school. And she followed those kids for a few years and she found they behaved better in not just preschool and kindergarten, but in elementary school. She followed them a few years more, she found they did better on their SAT’s in high school. The other kids who were raised by the other parenting styles, she found that even in adulthood they had more satisfying jobs, more satisfying relationships, and now we know that even in their 50s those individuals as parents are authoritative, not overly harsh and authoritarian, not overly permissive and indulgent, but those parents who drew clear guidelines, who were warm and loving, and they’d also say here is what your expectations are very clearly, that those parents have kids who are less obese, who are in better physical shape, who have less hypertension, diabetes, who have higher levels of education, more satisfaction with their jobs and their spouses. Those early onset sort of patterns that the parents created led to kids who are now adults who are happier and more successful.
Dr. Denise: Excellent and in Dr. Shatkin’s book there’s a section that talks about authoritative, warm and involved ways to be and there’s specific examples about praising the good behavior, what effective commands are, selectively ignoring, scheduling and positive rewards so you can, when you purchase his book, and get this book in your hands you can look at that and then I think Dr. Shatkin since you and I are both into prevention and well-being in mental health I want to jump to the points about screen time in social media, because I think you and I are in absolute alignment of how to handle that. But I think I was, one of my big points when I was just taking the launch into more of a global arena is that there’s been such an increased suicide rate in society and it’s really interesting that it parallels from the late 90s till now. And so I think your book Born to Be Wild and looking at the way the children, teens, tweens and young adults the way their brain is and the way people respond on social media, I think if you could talk about the study that the FMRI study that showed with the online gaming, if you could explain that so we can then have a discussion about prevention and mental health as well.
Dr. Shatkin: There’s so many studies that reference which one are you thinking of?
Dr. Denise: The one where they were playing a game on the computer and they thought it was a peer and the FMRI study showed that the way people experience pain because I think this is such a crucial topic that it almost is like its own other podcast. But couldn’t you just go for it?
Dr. Shatkin: Yeah. So this is the work of Nancy Eisenberger at UCLA and she’s done some really interesting work. She was a graduate student at UCLA in Cognitive Psychology and she wanted to understand why it is when you ask someone what’s the most painful experience in your life. Why it is that they almost never talk about something physical and almost always talk about something emotional. When you say what’s the most painful thing that’s ever happened to you people almost never say, oh when I broke my leg, when I had a surgery on my gall bladder, whatever, they may, but the vast majority of people say things like, oh God when my girlfriend in high school broke up at me or when my wife and I got divorced or when my child got cancer, these are the things that really hurt people. And so she started to wonder if the brain’s pain system is on the same plane as the brain’s emotional system in some way. So she set up an experiment, a really thoughtful experiment, where you bring a child, she’s done it with children, she’s done it with college students, she’s done it with young adults, adults and she basically brings them in and puts them in a scanning device functional MRI which looks at the blood flow in the brain and tells you which part of the brain is active as you do certain tasks or activities. And so she said I’m going to put you in pod B and you’re going to be here in this FMRI, you’re going to be watching the screen, you’ll be playing a game called Cyber Ball. And in this game you’ll just be playing catch with the other kids your age who are in FMRI’s screening room one and screening room three. You’re in room two and you guys will just be playing a little game back and forth and we’ll ask you some questions before the game and after the game and that’s it. It’s very simple. We’re learning about the brain and the kids would say fine, thank you and they go into their scanner and for the first five minutes or so they’re playing this game with these other kids in the scanner and the ball is being bounced back and forth and everybody’s playing nice fair catch and then after a few moments the kid in the middle scanner or the adult in the middle scanner starts to get passed by, that is the kids in the other two scanners on either side of them, which they don’t see because they’re in different rooms. They start playing ball and kind of doing monkey in the middle, beating that kid out. Now, in point of fact, there’s no one in the other two scanners. These are simply sort of a mock experiment where the kid believes there are other kids there, and the kid is being left out. And when you watch what’s happening with that kid’s brain. Well, first of all, when you survey the kid before the survey they’re nice, normal, typical kid, they like other people etc.. And when you survey them after they come out of the scanner they say you know I felt kind of bad, I got angry, I felt left out, I felt hurt because they started playing monkey in the middle and not letting me play catch. And when you look at their brains during this experiment, you find the same thing, you find that they actually felt real pain. The parts of the brain that signal pain, that get excited when you stub your toe or break an arm or get poked with something, that those same parts of the brain that register pain registered this emotional being left out and the conclusion of the research team, and this has never been replicated not only at UCLA, but elsewhere, the conclusion of the research team is that when you leave someone out, that painful feeling they get is due to this social attachment system which seems by evolution to have piggybacked on the brain’s pain system, and this makes a lot of sense because it’s so important for us to couple, and to be successful with other people because that’s how we succeed. We don’t pass our genes on without a mate. We don’t build a family without a mate. We can’t protect ourselves very well without other people in our tribe and people we connect to. So being left out, particularly when you’re an adolescent, has to really hurt you because if it didn’t you wouldn’t respond to it so acutely. So our kids will do anything to avoid the pain of social exclusion. And that’s what this research is really about. And this is one of the reasons kids take risks because they don’t want to be left out. So when you don’t get tagged in a Facebook photo, when you don’t get invited to a party, that has to hurt you a real lot so that you pay attention to it, and will do things to avoid that happening to you. One last thing just to top it off for people. This pain is so real, that if you take kids who have this painful experience in the scanner and you give them Tylenol, which is a non-steroidal anti-inflammatory medication that’s available over-the-counter. their brain actually cools down and they don’t show as much pain in those sensors and they tell you they feel better. So, even these pain medications actually work to dull some of the pain, which also might help explain some of our addiction. Many people who become addicted to substances of abuse are people who are in a lot of emotional pain. And this helps to dull that pain.
Dr. Denise: The implications of that research in itself was so profound because it’s what I believe. So I think what’s happened with evolution and all of our technology, is as parents and educators and doctors, we have not caught up on how to educate our children. To me, Dr. Shatkin, we should have in our schools, which we’re going to jump to schools too, I’d like to see, we have an integrative kindness curriculum in my son’s school that I’ve talked to you about before, the Mind Up curriculum. But I think we need to have – how to know your own neuro style, how to understand the brain, why you would want so many likes, why you could start to feel not OK. And I’m wondering if, are you planning on doing another version of this book to kind of address, almost like a tips and tools book or maybe we can discuss that another time because I feel like there needs to be curriculum integrated, wide spread, so the people are educated so that the parents don’t just say, oh you shouldn’t be on your electronics as much or you shouldn’t… to me if they understand the quality of why we could have a lot more prevention.
Dr. Shatkin: Yeah I think it’s important. I think that, I don’t have another book planned on this at this moment to answer your question, but I do believe that we should be teaching neuroscience in schools and I think again, we’re just a little behind the curve. Much of the data I’m talking about really just came out in the past decade, and that’s why most people don’t know about it because clinicians can only keep up with so much stuff, and we have to keep up with the therapies and the medications and the diagnostic tools and their rating scales and all those things. We also have to make a living seeing patients, and so there is, it takes a while for this message to get passed on. But I think also since schools and parents are often concerned that we don’t do too much character education in schools, I think starting with neuroscience is a great place because what you find is that if you understand the brain you can make a lot of difference. So that’s one thing, I do want to also point to another thing I talk about in the book though, in a couple of chapters I talk about in how people make decisions. Our intentions only map to our behavior about a third of the time, which means that we might intend to do things like, you wouldn’t find anyone in America, or anywhere in the world probably, who doesn’t know that exercise is good for you or that eating a low fat diet or a modest fat diet is good for you. Or that being more slender as opposed to more heavy is good for you. But we don’t all get there in terms of maintaining that diet, doing that exercise regimen and managing our body weight well. Now some of this might have to do with biological reasons we don’t yet understand, but the point is that everybody knows this, but 30 percent of America is overweight or obese. So we’re not able to do it for some reason. That’s because our intentions don’t always match up with our behavior. So explain the why back to your point matters. There’s no question that we should be explaining the why and we have to do more than that because the why won’t make everybody change their behavior.
Dr. Denise: So let’s jump in with real examples. I feel very fortunate, I live in a beach city where, let’s just talk about what the information in your book and sort of how to apply that to real life. So at my, at the Manhattan Beach schools, they have the Mind Up program, which is Goldie Hawn’s program, which includes a mindfulness, all based on neuroscience, like my son today was talking, my son’s eight, right before school he was talking about the hippocampus and memory. And so in our schools we have a program that’s teaching the kids about their brain impulsivity. They have mindfulness integrated. And then once a week, Jess, which I’m so happy to say, they have a school assembly on Wednesdays, which is outside, kids wear their school colors, and we do the Pledge of Allegiance, we sing the school song and then there’s Acts of Kindness Awards that are given from kindergarten to 5th. They also give awards for who’s been walking to school and also who’s been recycling. And they also, they do not allow sugar snacks for birthdays, there’s no sugar snacks allowed at all on campus, because they get nutrition. With the students and parents we have to volunteer to do to teach our kids different things so art, movement, all the things you talked about in your book that are so important are integrated into our elementary school curriculum. So my son would say, oh gosh mom, I just had a popsicle. I’m like, I know we got to limit the sugar, but I don’t say never have a popsicle because then he’ll probably binge eat later. So can we talk a little bit about kind of the research we have and how much that supports the resiliency and self-efficacy in tweens and teens and how that matches up.
Dr. Shatkin: Yeah there’s an increasing amount, you know, back in the 70s, it’s funny, I mentioned earlier that I grew up in the Bay area, just north, a stone’s throw from San Francisco. And so my upbringing was filled with things like playing new games where there were no winners and everybody competed, but they didn’t compete against each other, they competed against the game itself or where there was a lapset everybody would sit together and sing songs and there was always campfire things and there was mindfulness back then, there was practice on breathing. I learned to deep breathe and do restful breathing as a child. But there was no data for these things back then and so people kind of viewed it as a little goofy, a little, you know, hippy dippy, and that was OK for the 70s, but then the 80s came and more about making money and our whole society changed and a lot of those practices went away except for some fringe elements who kept them going. Well what’s happened in the last 20 years we’ve developed now, increasing amounts of research showing that, you know what, a lot of these practices actually work. Not only does breathing and meditation work, but yoga works and exercise works, and all of these things help to regulate the nervous system, calm us down, increase the contact, the connection between the emotional brain and the CEO, or the frontal cortex, so that the emotional brain can be a little bit better managed and controlled when it gets a little out of touch and it gets a little angry or a little too hurt or whatever it is. So these practices like breathing and meditation, again all the mindfulness things related to concepts like yoga and exercise, these really work. There are things that we don’t know work at this point, and we still try them, like there’s not a ton of data on gratitude and kindness these things. Most of the studies that have been done have been done amongst people who are doing these things without control groups. So we see improvements, but we see improvements in lots of practices when we don’t compare them against randomized control groups. That doesn’t mean they’re not worth doing, it’s just we don’t have the data on that yet, but there are a couple of things that we really know. We know that mindfulness meditation, mindful practices like mindful walks and mindful eating. We know that yoga and we know that exercise, cardiovascular exercise, really do work to help control emotions and calm us down and give us tools we can use. And I think strongly that we should be teaching those things in schools and having those as part of our practice. We just got a lot of data that they work.
Dr. Denise: Absolutely, a lot of the different guests I’ve had on my show, I talk about different forms of mind medicine, which is prevention, and so much of the literature is also showing the role of inflammation. So different food types that we choose can cause our fat cells to become inflamed. I had an interview with Dr. Lori Shemek, I’d love for you to meet her maybe you’ll even want to have her on your radio show. And so I think what you talked about in the book is very basic things of exercise, which I think from Dr. Frailties from Harvard, when I listen to her, we want 150 minutes of moderate exercise, vigorous 75 minutes. We want to have mostly leafy greens, nuts. We want to have our protein, but we really need to do more of a plant-based diet, and then we have the sleep study. And, by the way Dr. Shatkin, can talk about your sleep work at NYU and what you do with your students because I think those things right in there, if we can get nutrition, sleep and exercise, there’s a lot of prevention in those three care categories.
Dr. Shatkin: Absolutely, and that’s a big part of what I think we need to be doing in schools that we’ve left out. And that’s a chunk of my book as well. This idea that we have moved away, in education, from a lot of the things that we know are going to help our kids to regulate the engagement with good nutrition, that nutrition in schools is about as bad as it can be. On average, the exercise programs, which are shrinking in schools and the regulation of the time of schools so our kids can actually get the sleep they need, and the amount of homework we give them, and extracurricular activities we expect them in order for them to get into a quote unquote good college. So we have a lot of pressures working against us and getting back to some of those very basic things that that you and I thankfully had more of when we were growing up in schools; exercise, sleep, nutrition make a big difference and clearly help kids, the work I do at NYU. Years ago when you and I were both residents, I saw a case of a kid who had a very tragic outcome from a sleep disorder and that started thinking about sleep and I’ve spent a good chunk of the last 17, 18 years thinking about sleep and learning it and educating my peers and writing about it and doing studies in it. And we found that we can actually, with education alone, we can improve people’s sleep. And if we started that earlier, I do that work with college students at NYU, but we can start earlier and we’re just publishing a study now on students that took a class with us, a full semester course, but they improved their sleep based on that class. We build a unit into class where they actually had to log their sleep and do some practices and then follow it up again and write about it and so forth. But we haven’t done that randomized, controlled fashion, we will but some groups have and they found some benefit from that. If we start teaching sleep early that’s important. More important is building our systems and our own lives so that we actually get to sleep. And then our kids learn from us and we know that the problem is, of course Denise, is that we can get by without sleep.
Dr. Denise: I know and I have to admit I mean in residency we had to. Right? So you and I were sort of primed for getting not enough sleep.
Dr. Shatkin: Yeah. And, in fact, in our society it’s kind of a mark of courage or a badge of courage.
Dr. Denise: Like it’s sexy, like roar. I just did like only four hours of sleep and I can take my kids to the soccer field and start writing a book. You know what I mean?
Dr. Shatkin: That’s right. And so we have these real expectations of ourselves, imagining that five hours of sleep is probably enough and then on the weekends I get seven hours. You know, that’s not enough. They are very few people for whom that is enough. And most of us really do, as adults, need seven to nine hours of sleep and you can bank some of that sleep, yes you can catch up on the weekend or take a nap for what you don’t get at night. It’s not tragic. Our brains, particularly in adolescence, when we don’t get enough sleep, we can still do single brain function. So that if I don’t get a lot of sleep before math test I can still do the algebra problems for the most part. That’s OK. But what we can’t do is well we don’t get enough sleep, is integrate different parts of our brain. So yes I can do it an algebra problem, but when you give me a word problem and I’m under-slept and now I have to juggle lots of different ideas using reading parts of my brain, interpretive parts of my brain, math parts of my brain. Now I’m going to really struggle. So writing an essay is much harder under-slept than it is to do basic math, but doing math word problems makes it pretty hard too. So you and I study a lot of science to be physicians and some of those science problems we could do pretty well without sleep so we would do that. But what we’re counting on our adolescence to do all the time is make decisions. Should I have sex with this person or not? Should I drive drunk or not? Should I try this drug or not? Our kids are out there in the world, no matter how much we protect them, they’re faced with these situations and with less sleep, they’re going to make worse decisions.
Dr. Denise: Absolutely. And so one of the things I want to do is just kind of go through. So from a parenting standpoint Dr. Shatkin and I address the importance of authoritative parenting, which is firm, kind, caring, involved and having discussions with our children, role-play, things to give them an idea and a platform. We have the data that shows that they make better decisions and then from the school’s standpoint Dr. Shatkin and I spoke about the importance of integrating wellness strategies such as good nutrition, good sleep, good exercise, mindfulness, yoga, and character programs. And then Dr. Shatkin’s a book tag this, we have the data to show that from the specifically from the schools. Can you just discuss the Iceland data? The data and what happened cause I mean that’s just a fantastic example. Of how that can then have resiliency and prevention from a mental health standpoint.
Dr. Shatkin: Yeah Iceland has done some great stuff in the last decade, again which I don’t think has gotten enough airtime. They had, like every country, problems with kids smoking lots of cigarettes and drinking alcohol and getting drunk, and binge drinking and all of that and they instituted a few policies that would seem somewhat radical, like a weeknight curfew for kids under, I think, 16 of 10 P.M. on a weekend curfew of midnight, which helps because then kids have to stay in and not be hanging out in the city parks or roam the streets. They also built a lot of in-school programming and extended the school day so that everybody has after school programming. And the result of this is a longer school day, but the reality is that if you have your kids starting at 9:00 in the morning for high school, which is an ideal time, 9:00 or 10:00 in the morning. I know it’s hard to, but it’s for a variety of reasons, but that’s a good time because they’re more awake by then and you extend the school day to five or six at night. In fact, you don’t need our kids getting out of school at 2:00, 3:00 o’clock, like most of our high schools, cause they just go hang out at the mall a lot of these kids and they’re just sort of roaming the streets and they’re not doing their homework necessarily
Dr. Denise: Or they’re on their screens.
Dr. Shatkin: Or they’re on their screens, right. A lot of well-behaved kids who were just playing games and hanging out. So if we build conscious programs for them in the schools and the afterschool programs at the YMCA you have them doing arts and crafts, playing in a band, doing sports, doing theater or whatever it is they like doing and you give them some options. You find that the rates of smoking and binge drinking, premarital sex or unprotected sex, all those things tend to go down. And Iceland’s had great success with this. They’ve also, for families that don’t have much money, they’ve given leisure passes or leisure cards to them, and they give families of low income some money, a few thousand dollars a year. It’s not a ton, but it’s something so they can take their kids to amusement parks, so they can take their kids bowling, and do things with their kids on the weekend, evening, afternoons, so that their kids have some meaningful engagement with the parents. And these are really good uses of money and they’ve seen cigarette smoking drop many fold, which is a huge issue because cigarette smoking still is targeting teenagers and tweenagers, it’s basically designed to get kids addicted when they’re young age, because then they smoke their whole life, buy the product forever. Smoking is still the greatest cause of preventable death in every country in the world. We kill a half million people this year, just about, every year in this country from cigarettes and that’s a big chunk, that’s more than driver’s accidents, that’s more than the affects of obesity or diabetes or hypertension or whatever else.
Dr. Denise: Well and I’m glad you just brought that up because that ties back into our understanding of the neuro development of the teen and tween brain right than all the data supports. If you’re CEO of the brain isn’t sort of communicating with your limbic system, don’t do it, don’t take, don’t try that cigarette, don’t drink that alcohol, don’t have unprotected sex. We know that more mental health issues the earlier our children and teens start trying out substances there’s more of a chance for addiction, there’s more of a chance of mental health issues. And so one of the things that you and I both know, I don’t think we mentioned in this show is that 50 percent of our youth start having lifelong mental health issues before age 14 and 75 percent before what is it age 24? And so all of these tips and tools that Dr. Shatkin’s talking about. You know Dr. Shatkin has a master’s of Public Health. He went on a whole journey that he talks about in his book. But we’re talking about prevention Dr. Shatkin and I would prefer you not need to call a psychiatrist, that’s why we’re having this podcast, he’s writing these books. And, but here’s nothing wrong with calling a psychiatrist from a wellness perspective, but we’re talking about prevention. We’re talking about early intervention and even if you have a family history of depression, anxiety, ADHD. All of these tips and tools of good exercise, sleep, nutrition, mindfulness, are going to have you have a more resilient outcome in knowing your own specific neuro style.
Dr. Shatkin: I think that’s great and I think that’s exactly right. Our job is to put ourselves out of business. And yeah there are a lot of things that we can do for ourselves and sometimes we need a little help, we need a little therapy, a little medicine, that’s all good and that can affect everybody at every level. There’s nothing wrong with that. We also want to do everything we can do ourselves to prepare ourselves to manage these kinds of difficulties.
Dr. Denise: Yeah, I look at it as tools, I talk about things with my patients and my families. There’s just a lot of tools in our tool box and we don’t want to pass judgment but we want to do no harm. And we want to set a foundation for health and well-being and there’s nothing wrong if someone needs to go and see a physician or possibly be on meds, but it’s a very important decision to make and it should be done after all these other wellness strategies have been implemented. And then the other thing I just thought here wrapping up Dr. Shatkin, that I think. Can you discuss, this is so incredible, the way you address this in your book that extended adolescence is good for neuroplasticity and health for life and sort of the flexibility in cognition versus rigidity etc..
Dr. Shatkin: Yeah. So you mentioned this earlier when we were talking about the brain, that one of the key developmental changes that happens during adolescence is that we lose gray matter, gray matter is the neuron cells themselves, and we use them naturally about 1 percent per year starting in our teen years or maybe around 11 or 12. And that’s replaced by white matter, so the volume of the brain doesn’t change, the weight of the brain doesn’t change. But the white matter is like the superhighways or the freeways that allow messages to be passed. This is the myelin coated fat, fatty sheave that coat the neurons and allow messages to be passed quickly and for the brains to recover more quickly between transmission of messages so that things can look 3,000 times faster. Which is why adults, as they get older, are able to make decisions often more quickly and to integrate more parts of the brain when making a decision. When the brain is tired as we were talking about before, these superhighways don’t work as well which is one of the reasons why when we’re tired our decisions aren’t as good because we don’t integrate our thinking as well as we could. So as we age, we replace gray matter with white matter that happens about 1 percent per year at least starting around 11, 12. We’re not sure how far it goes but probably until the early twenties and during this time that’s the usual progression. For people who end up in a job right away at 17 or 18 , they start working at a grocery store, they go off and they do something very serious a task that requires them to be an adult and grow up right away, that transition from gray matter to white matter happens more swiftly for those who go to college, travel the world for a year, have a lot of different ideas in their head, start thinking and learning new things, start learning a foreign language at 20 or continue learning that language, go live in a foreign country at 22. For those people, the prolongation of how long it takes for the gray matter to turn over to white matter is slower. And there seems to be a real advantage in that when you look at the animal kingdom. Animals that have a longer childhood have more flexible brains as adults and they have more, they’re more open to change and opportunity, so that if you have a lot of education growing up and if you have a, I’m not talking about an extended adolescence like drink for longer or have unprotected sex for more years, that’s not what I’m talking about, we’re talking about exposure to new ideas, exposure to types of thinking and cultures, exposure to languages and foods, those who are getting more diverse pallet of those things throughout their early years, teenage years, early 20s, will have more gray matter. They have a more flexible brain, what we call a more neuro plastic brain and they’ll be more flexible adults and they’re generally going to be people who are better at problem solving and thinking outside the box.
Dr. Denise: And that is a big key factor in resiliency. So if you’re having any mental health challenges and you have this level of resiliency you’re able to make better decisions that are more flexible, you don’t get stuck, cause a lot of times of rigid thinking, you know we can all have that at times, it’s just part of how are hard wired, but this flexibility gives us a more open mind to ways to be well to engage in the world and progress.
Dr. Shatkin: Absolutely. And I think that this is just all the more reason, and you know, there’s a lot of concern I think parents have. Are we being too indulgent with our kids or are we over babying them? I’m still paying for my kids cell phone and he’s 32. You know there are things to adjust and to think about. I think that parents have to handle some of those specific things on their own, but at some point around 26, 27, 25, whatever, we are ready to be grown up and there are still brain changes going on some of the more recent data suggest even till 30, but at least until the mid 20s having an open, exploratory perspective is very helpful. The average age at which medical students start medical school in the U.S. is now 25. The average age for my class over 20 years ago was 26. That’s actually a really good thing. It’s OK to go right into medical school from college but it’s also fine to take a few years off, play in a band, work at Starbucks, work in a lab, do something that, you know, travel the world, learn, go live in Mexico City for six months and help with the earthquake and learn Spanish. This kind of stuff really expands somebody’s mind and it helps them to see the world differently. We’ve known it observationally for a long time and we know neurobiologically it makes a difference too.
Dr. Denise: Excellent. So Dr. Shatkin, can you let us all know how we can reach you on social media, your web site, as well as how we can order your book that’s being released next week?
Dr. Shatkin: Yes. Thank you Denise.
Dr. Denise: October 3rd is the release.
Dr. Shatkin: October 3rd, the book comes out October 3rd, it can be bought from all booksellers, it’ll be in bookstores. It’s also online. It’s, the publisher is an imprint of Penguin/Random House so they have a good distribution it will be available all over. It’s in hardback, it’s in Kindle, it’s in audio book if you want to hear me read I, and it will be in paperback a year from now. There will be book events running all over the country. For the next year or two talking about the book, I’m going to PTAs, I’m really interested in going to PTAs and talking to parents and teachers so if you have a meeting and you’re interested me being there. Give me a shout because I would be very happy to do that. I have a website which is d r je s s p s h a t k i n dot com or Dr Jess P Shatkin dot com. I’m also on Twitter with the same handle. I’m on LinkedIn. I’m on Facebook, Dr. Shatkin page. So lots of places to reach me. But if you Google the book or my name Jess Shatkin and the book you’ll find a lot of information on it.
Dr. Denise: OK and I’ll link everything up with the show. The other thing that comes to mind is do you have a YouTube channel?
Dr. Shatkin: You know, I do but I don’t have anything on the book there. I have stuff about child psychiatry there, it’s child psych doc.
Dr. Denise: OK. You need to have a YouTube channel Jess.
Dr. Shatkin: Yeah, maybe, I got to probably make some videos first though.
Dr. Denise: I know, I’m just having fun with you. We’ve got to get this information out. I’m so appreciative of your work.
Dr. Shatkin: Yeah. Well thank you Denise, I really appreciate your appreciation and I appreciate you having me on the show and I’m thrilled to talk about this. So if people want to learn more take a look at the book, give me a call, shoot me an e-mail and I’m very happy to come speak with you more about it but I think there’s some basic understanding that most of us have not had and I know that if I didn’t have it, and I’ve been in this field for over 20 years, then obviously a lot of people don’t have it. And then beyond that, this translates into some of the tools that we’re observationally, we’re learning now, are great tools, but we’re also getting the data from them that they actually do work. So it leads to a whole new area of excitement.
Dr. Denise: Well that’s fantastic. So thanks again for being on the show and I hope to have you on again.
Dr. Shatkin: Yeah, my pleasure. Thanks for having me.
Dr. Denise: OK, thanks Jess. Bye. Thank you for joining us today on the Dr. Denise show. If you are interested in more mental health tips, tools and discussions. I’m also on the web at Dr. Denise md dotcom DRDENISE MD dot com. I’m also on Twitter at Dr. Denise MD and on Facebook. OK. Thank you again everyone. Have a nice week. Bye-bye.