Episode 36 – Mental Health advocate Dyane Harwood on PostPartum Bipolar

Dyane Harwood holds a B.A. in English and American Literature from the University of California at Santa Cruz. A freelance writer for over two decades, she has interviewed bestselling authors including Dr. Kay Redfield Jamison, Anthony Bourdain, and SARK. Dyane founded a chapter of the Depression and Bipolar Support Alliance (DBSA) and facilitated support groups for women with mood disorders for nine years. She is the author of Birth of a New Brain – Healing from Postpartum Bipolar Disorder (Post Hill Press) with a foreword by noted perinatal psychiatrist Dr. Carol Henshaw. Dyane has written for SELF Magazine, BP/Bipolar Magazine, The Huffington Post, and Postpartum Support International. Dyane lives in the beautiful Santa Cruz Mountains of California with her husband, two daughters, and their Scotch Collie.

Dr. Denise and Cam Adair Discuss How To Build Resiliency in Kids

It was such a great synergy between Cam and I on my show that we thought it would be great to get together at my office in Manhattan Beach and create some video content in honor of holistic health that gives parents tips, tools and more.
Thank you Cam Adair for all that you are doing for OUR youth in honor of mental health and collective wellbeing!
~Dr. Denise

Episode 31: Cam Adair on Video Game Addiction – Podcast Transcription

What an honor to do this interview with Cam Adair! Here it is transcribed:

Dr. Denise: This is The Dr. Denise Show. I’m Dr. Denise McDermott, an adult and child psychiatrist specializing in an integrative 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 and empowered ways. Today I’m excited to interview Cam Adair on my show. Cam is the founder of Game Quitters, the world’s largest support community for video game addiction serving 25,000 members a month in 81 countries. His work has been featured in two TedX talks and in Forbes, BBC, ABC News, VICE, CBC, CTV, The star of The Huffington Post, Sirius XM and TV Asia, amongst many others. He is an internationally recognized speaker, host of the Game Quitters podcast and has over one million views on YouTube. I’m so excited to have him on the show today. Cam, good morning.
Cam Adair: Good morning, so happy to do this.
Dr. Denise: Oh me too. I’ve spent a lot of time this weekend looking at all your material and I think everyone listening who hasn’t already met you is going to really enjoy meeting you today. So I really appreciate you being on the show.
Cam Adair: Thank you.
Dr. Denise: Great. So I want to let everyone know that we are recording the show on 9/11 so it won’t release today of course. But I just want to take a moment and be in the day that we’re in and just sent a lot of love out to everyone with the remembrance of their loved ones and also for all the people that have been affected by the hurricane, their loved ones, our earth. And I really want to be present to that because it’s very important time in history.
Cam Adair: Yeah. That’s very well said, and I definitely agree. It’s actually the first time I realized it was 9/11 today, which automatically kind of shifts my state a bit, and I just want to be present with that.
Dr. Denise: Yeah. And it’s really interesting because we’re going to talk about the importance of social media and we’re going to jump in on, you know, game addiction; but it’s really an unbelievable way we can use social media. I get to meet people like you because of social media, so there’s good things about that. And we can send love and prayers and good thoughts out to others. There’s a lot of positive things we can do with the Internet.
Cam Adair: Absolutely and I think that’s, you know, one of the most important points is it’s not about whether that technology is, or even activity is, necessarily inherently good or bad, but really just understanding what your relationship is to it and understanding whether it’s really serving you or not, and in the ways in which it can serve you to the highest, you know, for instance, I was connecting here and being able to spread the message and be able to help people while also being aware of, you know, some ways that maybe it’s not serving you. And for me, especially with gaming that got to a point where, you know, it was kind of perpetuating a lot of depression and anxiety I was feeling and it wasn’t really going to be the solution. And so I had to kind of like step back and really re-evaluate why it was that I was so drawn to the games or why I’m so drawn on the social media and be able to make the shifts to realign with my highest kind of excitement.
Dr. Denise: You know and I love the way the word choice that you’re using. And from a holistic health, mental health and collective well being, I think what we’re talking about for all of us, whether it’s about gaming, nutrition, mental health; how can we be the best version of ourselves? And I think that’s a question for our children. I’m a child psychiatrist and an adult psychiatrist, and I think what we’re going to talk about today is not only your journey and path, and I have specific questions and we want tips and tools for everyone; however, we want to raise children and we also want to ask ourselves how can we have good self-regulation from a mental health and physical health and also self-love. And I think that’s going to tie in to you sharing your story. You know I was looking at an article about the days when you were playing games for 16 hours straight and I’d just love to hear your path and your journey and share that with everyone.
Cam Adair: So growing up, you know, I was a fairly normal Canadian kid. I went to school, played hockey and then I would go home and play video games. Now I’m 29 years old currently, to kind of give context to that. So I’m very much a millennial. And in the eighth grade I began to experience a lot of bullying and that’s really when I began to need to find an escape. I no longer really felt safe at school, I no longer really felt safe on my hockey games because both of those environments were where a lot of this bullying was happening.
Dr. Denise: Can I ask you what kind of bullying because this is such an important topic for what I deal with as a doctor. This year Cam I had 14 people that have been suicidal, 12 of which are under age 18. And you know I look at the holistic approach I’m not just about here is a diagnosis, we need to talk about the DSM I mean I know that. However I really connect with people and when children are at school and that’s not a safe place to me that’s a big societal like alarm that needs to go off. So can you share a little bit about what kind of bullying was happening and what was going on with maybe the teachers or parents or how much you felt like you could share that?
Cam Adair: Yeah. Thank you for asking that question. So to give kind of context to the actual experience, I’d love to touch on the teacher side afterwards. For instance, in the eighth grade at lunch hour, a lot of grade nine kids would chase me around the school trying to put me in a garbage can. And it was this kind of fun game that they played called, you know, can we put Cam in a garbage can? And for me, you know, I knew that if they actually did that I would be completely humiliated. And so I would kick and scream and squirm and kind of basically do anything possible to ensure that did not happen. Which kind of only brought it on more because I was willing to fight back, but not fight back to the point of like actually, you know, maybe like being violent and punching someone in the face or something. You know, like I was willing to fight back as in not allowing them to do it, but not enough to really actually stop it in that instance. All my hockey teams, there was a lot of teasing and just constant teasing over and over and over and over again. But there was also an instance where after a game we played in Red Deer, Alberta, which is about two hours away from my hometown, we got back on the team bus and one of the coaches’ sons, who was kind of accompanying us on the trip, came and started to spit on me and I was kind of laying in the back. And at this point I was kind of just exhausted from all of it like the year of being.
Dr. Denise: I just want to tell everyone that the way I’m connecting right now with Cam is and also the way I connect when people come to me and people on my show. If I sort of went back in time with you and I want everyone to know we can feel feelings but then we can shift them. And I just want to say Cam I’m just sending you so much love here. I know you’re a very evolved 29-year old that’s empowered, but that ninth grader and that child in that team in that kind of like why is the world like this? You know you can see how a child’s mindset can be like us versus them or why aren’t people helping me? Right? So like what is going on? Why aren’t the coaches helping or why aren’t parents noticing? And so I think we really all of us need to come together, and we can talk about this after we talk about some of the gaming, but I want to give some tips to parents and teachers on how they can engage in a way that’s very thoughtful so that you don’t have to be like that. Did anyone say or see what was going on or how did people handle that when that was happening to you?
Cam Adair: That one was really tough because I’ve always kept a lot of this to myself. And even that night, you know, after the bus that went on for about an hour and I just kind of laid in the back in fetal position holding onto a picture of a girl I had a crush on at the time, kind of to give me some strength to get through it. And kind of like I had a very strong freeze kind of response where I was just completely frozen I didn’t know what to do. And after the bus dropped us off my dad picked us up and then we drove a teammate home. And as soon as we dropped the teammate off I just started bawling hysterically and my dad didn’t know what was going on. He was kind of like what happened? And I wouldn’t talk about it.
Dr. Denise: Do you remember why you wouldn’t talk about it because this is such a common theme when children have been emotionally or verbally or physically treated in an unkind manner often times there’s this level of shame or gosh I don’t want to tell because of fear that the adults are going to make it worse? Do you remember why maybe you weren’t sharing it at that time?
Cam Adair: I was definitely ashamed. I was definitely uncertain of how my parents would respond. And on some level I think I was also unsure of if that even actually just happened. And I was just having such a strong emotional response. I had to kind of go through it. After that, the next day I basically told my parents like I was quitting the hockey team, and I was playing high level hockey and hockey is like the most important thing in Canada.
Dr. Denise: Of course.
Cam Adair: And for the best team possible. You know I was an elite hockey player and I started saying I was quitting the team. And so of course my parents were very confused here. They’re like what happened? I just wouldn’t talk about it. And then, I remember they convinced me like let’s go to practice and like let’s actually talk to the coaches and let’s see what’s going on. And I remember telling the coaches what kind of happened and all they cared about was the fact that I was not committed to the team and I was willing to quit on them.
Dr. Denise: Oh my goodness!
Cam Adair: And it was very much kind of thrown back on me of like how can I be that sort of teammate to want to quit on my team now after this experience and that kind of guilt trip really shook me up and then I realized I couldn’t quit the team. And so I stayed on the team, but I just couldn’t believe it especially as I’ve gone forward in my life like, that’s where the response and I feel like that was a response I got a lot throughout my life where, you know, I have amazing parents and they would always, you know, try to talk to teachers or principals and guidance counselors and try to help with some of the stuff that was going on but they would just kind of be met with walls and there wasn’t really space for there to be a conversation about this. And so I ended up just kind of holding on to a lot of it until many years later where I was speaking at TED X in 2014 and my parents were in the crowd and that was the first time they heard about a number of the stories.
Dr. Denise: and they were like shocked, or
Cam Adair: it was hard for them. It was definitely hard for them. I know that they wish that I would have told them sooner, but I just didn’t feel comfortable with that. And I think that my experience of not feeling like I was getting a lot of help from teachers in previous years didn’t really make me feel very. It didn’t make me feel like that was going to happen in the future either. And it’s actually a big part of why I ended up actually dropping out of high school twice and never graduated.
Dr. Denise: So I’m hearing that there was like pretty much a learned helplessness, like adults, you know we, everyone we create this idea of what the world is in our mind and if we have enough situations where we’ve told a teacher, we’ve told the coach, we’ve come to our parent and then nothing changes. There becomes this learned helplessness like OK that is not working. So I’m just going to say to you, given the variables you said and the fact that there wasn’t an intervention or maybe the people in your life and combined with maybe you had just shut down it makes sense that you’re like I can no longer be in this environment I cannot survive and live. So it makes sense to me as to why that was a choice that you made. We can talk about some other solutions in a little bit, but I want to focus on your story and so you then dropped out of school. And I also read that there were times when you were having 16 hour game binges and telling your parents you were at work when you really weren’t at work and so things just start to really escalate. There was even a time that was life threatening for you.
Cam Adair: Yeah. So when I dropped out of school a lot of where I would kind of escape from the bullying even when I was in school was in the games and it was kind of a place where I could get fully immersed in a different world. And I felt a lot greater sense of control over my experience because if you know someone was picking on me or whatever I could just block them I could move to a different game like I had a lot more control over whether people were interacting with me in that way whereas at school I had no choice. And so what happened was I dropped out of school, and then I was just living in my parents basement and I was just gaming 16 hours a day. It was just I did all day long. And my parents didn’t really know what to do. And so they were just kind of like hoping I would grow out of it and at different points they would say you know you need to go get a job. So long story short I pretend I have jobs a few times and I was really depressed and experiencing a lot of anxiety and as much as gaming allowed me to escape from it, it didn’t fix it until I actually got to a point where I wrote a suicide note. And that’s the night where things really shifted for me because I realized that I was actually serious about it. And there’s a bit of a story behind, a couple of friends invited me to go see a movie. We went to go see the movie Superbad. If anybody remembers that and
Dr. Denise: Was it like an inspiring movie?
Cam Adair: It was a comedy. If you remember, like Anchorman those movies like
Dr. Denise: Like super out there funny, like where you’re like about to wet your pants funny.
Cam Adair: Yeah. And Superbad was like you know that
Dr. Denise: Sorry. Maybe you don’t do that. I’m sorry, that’s too much information.
Cam Adair: Superbad was one of the first ones. And a couple of friends and I we ended up smoking a bunch of pot and going and seeing this movie and what happened was that I was watching this movie and I was laughing and the shift in my state from tonight I have written a suicide note and I’ve planned to follow through with it tonight, and I’m serious about that…to go to this movie with a couple of friends and laughing my face off kind of shifted my state to a point where I realized like, whoa, I’m actually really serious about this and I need to get some help and I can’t continue to just try to do this on my own. So I went home that night and just kind of confessed to my father and said you know Dad I’m not really doing very well and I need to get some help, will you help me find a counselor? And he did and I started to see this counselor. One of the first things that the counselor did was he made me a deal and he said you either have to go on antidepressants or you have to get and keep a job. Because he ultimately knew that what I needed was some stability and some structure. And me going to jobs and quitting after a couple of days, like I did a lot, or even pretending to have jobs was not part of the solution. So at the time I was more or less against antidepressants at least for myself. And now it’s much more of I think there is a place for it for certain individuals, but for myself I’ve always been very worried about me going on antidepressants especially just with some addictive kind of tendencies I have. And so I got a job.
Dr. Denise: Fantastic!
Cam Adair: And this job kind of gave me some stability, some structure. And I began to have this sense of, I have a second chance, I have a fresh start at life and what do I want to make of it? And where I came to was if I wasn’t going to end my life I had to do the total opposite and that was to truly try to live it to the fullest and realize my potential and really see what I could make of myself. It’s been about nine or ten years now and I’m super grateful for where I am.
Dr. Denise: Oh, that’s fantastic and it sounds like you had a really great connection with the therapist that you met.
Cam Adair: He was the only therapist I would work with because he had worked with my best friend who was very important to me. And we definitely had a great connection. He was willing to listen to me, but he also was willing to hold me accountable, and I think that was something really important that I needed at the time especially in just having, you know, I’m only realizing this now, but one of the things I share a lot with parents is the importance of enrollment and enrollment with your kids. And I know that’s not always easy. It sounds a lot better than the actual practical side of it but it is really important. And what I’m kind of realizing in this moment is that with that therapist I worked with, the deal he presented to me I was a part of it, where it was hey if you don’t want to go on antidepressants then this is the other option. Which one do you want to choose? And he gave it, it was my choice. And so I was enrolled in the experience versus just being completely checked out. And I’m super grateful for him.
Dr. Denise: Oh I love that. And actually I, there are no coincidences I believe as to why we met. And I am someone who really respects that we all have different, I like to use the word neuro-style, because we all process and perceive our environment in our unique way. And so you know whether someone has a propensity to addiction or sadness or attention issues or focus issues we are multi-dimensional beings. And when I meet with people that what you just said engaging with you, buying you into it, into your life. Right? Because I work with children teens and adults and I, one of the first questions I ask kids or teens is was this your idea to come here or? Because sometimes parents are like they just throw their kids in a car and it’s like OK you’re going to Dr. Denise and I really am like these kids just got out of school they’re probably like wanting to go home to be with their friends or go to their sport or play their games. And so I really ask them, and then I ask them, I say, I’m a feelings doctor and of course I meet them at the age they’re at so I use the language that’s appropriate and I can tell by the way you’re talking that you not only believe in this earth realm but that there’s a level of soul awareness that you have I can tell by your words that you’re choosing. And so when I look and interact with people I look at them not only as like a ten-year old boy, I look at them as oh, this is another soul. And where are they on their journey of realizing their own level of self awareness and the self awareness part, awareness is so key for all of us. And I really like to ask kids like what are your favorite things to do? What was the time when you were the happiest? And then I have them write down maybe habits or things they’re doing that they might enjoy, but they can’t really stop doing them. There’s an issue of self-regulation. And what I love when I was looking at sort of your thought process and how you talk about things you know in society there’s a linear language so people tend to go black or white and there’s really shades of gray. And I love when you mentioned in your talk that you did in Colorado your TED talk you know that 97 percent of children in the U.S. play video games and the fastest growing populations age two to five. So it’s not a matter of, am I going to allow my child to play games or to interact with social media, it’s how can I be the best parent to engage with my child in an interactive way to provide them the template for a holistic life and learn about self-regulation and learn like OK it’s now time to shift to another activity because I want you to kind of talk about this and outlined the four things, you know, what videogames do. I would love for you to talk about it from a neuro style and how it hooks kids in and hooks adults in. So I think, I’d love for you to talk about that, but I want everyone to know that our biggest job as teachers, parents, coaches, is to help our children on their journey. It’s their journey. We’re there to support them, to have a level of self-efficacy so they can function in the world and then have self-regulation. So they know what choices are good for them whether it be with games, nutrition, who should I hang out with is that person being kind to me. And then also learning about self-love in a non-selfish way, self-love kindness to oneself and love of others. I mean if we can do that as a society and kind of work with where we’re at, games are here to stay, social media is here to stay. Now, we need people like you and I and other people in the world to come together and all kind of scaffold our wisdom of all different age groups. So I’d love to hear your thoughts on that and then I’d love for you to just educate everyone on some of the things you talked about in your TED talk with you know what videogames actually do and then what you’ve done with your game quitter’s and everything.
Cam Adair: Supporting your children is one of the most important things I heard you say, and an error that I see a lot is kids are kind of just left to figure things out on their own and it’s just quit gaming and go do something else or go hang out with your friends. What I’ve been most inspired about with our community just to give people context so game quitter’s dot com is a community of 50,000 members in 82 countries around the world, mostly college students kind of male college students. The average age is about 23, but we see everything from ten years old to 70 years old. And what I’m most inspired about with this community, you are all coming to this community saying, I need help with a video game addiction or I struggle to quit gaming or I struggle with technology is that when they’re educated on why they do what they do, I believe there are four reasons why we’re drawn to games, including some of the brain science which I’ll go into, but when they’re educated as to why they do what they do, the amount of leverage that they now have within themselves to make changes and to do that on their own is so inspiring and so transformational. And I think one of the lessons is that when you support your children in helping them understand what is going on or how they can do this thing or why they’re so drawn to the things they’re drawn to. That gives them the knowledge and the self-awareness now to be able to make different choices if they want to.
Dr. Denise: I agree and I wanted to share this with you and everyone I have an eight year old and my son is just a beautiful soul. He’s not into sports. He is very much a comedian. He’s strong, he’s a swimmer and he has some school challenges with focus. I was very fortunate, I adopted him at birth, and so what you’re talking about when I am with him, because he loves playing games and I have not made video games or the iPad quote unquote the enemy, but I’ve talked to him, I meet him where he’s at and I’ve educated him, I’ve even used the word addiction. I said, videogames are fun, they’re awesome, but the adults that make them know how to hook kids in. I’ve actually explained this to him. And so I’m glad you’re having so much fun and I’ve even defined the word addiction. It’s like, mom I think I’m addicted. Like he can use that word. But then I explained to him that it’s my job as a parent to teach him about this stuff and that’s why I use timers and he’s fine with it because I’ve explained to him that in order to have like a really cool life there’s a lot of different parts of you you’ve got to get some exercise, he knows he’s got to eat his protein. He knows that I want him to have fun. But he’s totally cool with like the self-regulation, like OK 20 minutes of this. And then he’s got an amazing imagination and I’ve explained to him how important it is to have an imagination and that how some of the brightest people in the world come up with ideas or maybe someday with his imagination he could be a great writer or a comedian. And so when the timer goes off he knows, OK now it’s time to shift off games and I’m going to go and do my imagination play now. I’m going to be honest with you Cam, I have restructured my entire child psychiatry practice in order to be the best mom I can be. And so I actually make sure, and I don’t have a nanny, that between my husband and I, we have incredible play dates at our house. All the kids are educated that games aren’t the enemy. You know I take them out doing fun things even Pokémon hunts, but then they come back and they have Nerf gun wars. Right. But the amount of energy it takes to be that kind of an engaged parent is a lot. And I practice mindfulness and all the stuff that I’m doing from the Dr. Denise brand, I look at my son as my biggest teacher. I want to use, I want to bridge my knowledge that I’ve been doing for years, I’ve seen 40,000 hours worth of patients to kind of what I’m doing as a mother and then meeting someone like yourself. This is like my reality. Like my son’s like did you bring the iPad like when I pick him up from school right? Because he’s had a day where it’s been sensory overload because he has sensory issues, and so I think sometimes when a child, and I know not everyone’s neuro style can handle playing games, some people truly have to quit cold turkey and we’ll talk about that. But I use electronics or social media like as a way he knows that it kind of lets him calm down and de-stress after a sensory overload day and then he has his imagination play, we go outside and spend time in nature. But I mean Cam, this is my reality and I love what you did. I went on to your site. You have programs, like when you go on to Cam’s site everyone for Game Quitters, there’s a box that says I am a gamer or I’m a parent and the I am a gamers respond and then I am a parents reclaim and then Cam has all these incredible holistic strategies and real life real tools. And I just wanted Cam to know that I’m a mom and I’m like walking the walk at home and I’m also walking the walk in my office with how I help parents. So like do you know how excited I am to have you as another tool in my toolbox. I was like yeah I get to interview Cam so can you talk to me what are your thoughts on some of the strategies and some of the things I just said?
Cam Adair: One of the most important things that you said that was a balance in different activities and I think this is a crucial part of all of this is parents are busy, right parents are busy they’re working jobs and maybe they don’t have the flexibility in the same way of being able to restructure their whole career around being the best parent that they can. But I do think that looking at those options is really important and most importantly are you being the role model yourself of the behavior that you want your or your son or daughter to model? And so it always kind of begins with you. Most important though is making sure that there is a balance of different activities especially ones that are outside, especially ones that are creative, you know the imagination activity, I love that you mention that and ones that involve some sort of physical exercise, I think especially for boys. Our community is 90 percent male, and these boys are just isolated in their rooms gaming all day long after they fulfill their obligations for the day, which tend to be school. Once they’re done with school for the day, now it’s their time that they can do anything that they want with it. When they feel this lack of control over the obligations that they have to fulfill in school, then they feel a heightened sense of ownership of their free time to just be able to do whatever they want. That tends to be gaming for a bunch of reasons, both in the human needs that it fulfills which is temporary escape, social connection, constant mentionable growth and a sense of purpose. Games are intentionally designed in a way to hook your brain due to heightened levels of dopamine and stimulation, like that game is so fully immersive in a way that real life just can’t kind of achieve. Your brain gets used to that. And when you’re over exposed to it, which in my opinion, goes to playing for longer periods of time, at the same time more frequently. Your brain gets used to that. And then what I see a lot with our community is, you know when they go to move on from games, they’re dealing with withdrawal symptoms, they’re dealing with anxiety, they’re dealing with the fact that gaming has become a core sense of their identity, they’re dealing with the fact that to quit gaming is actually for them to lose their friends because that’s how they connect with all of their friends and start dealing with a lot of different obstacles in moving on from games that don’t even have anything to do with games themselves. And all of that can be kind of navigated if you have a good balance of activities of both, you know, a little bit of gaming or technology is fine, but also making sure that they’re out in nature and making sure that they have some ways that they connect with friends outside of the gaming world and making sure they have some creative outlets as well.
Dr. Denise: From a neural science standpoint the brain for a child and teen doesn’t finish myelinating until age 25. And so for everyone listening, the prefrontal cortex, which is your CEO of the brain is, there’s something called myelination, which is like the roads that connect throughout the brain. And so there’s the part that’s sort of exciting like the emotional part that gives you the excitement, the drive and everything that connects with the CEO of the brain. And so what happens is there’s the dopamine one and dopamine two neurotransmitters the dopamine one says yes this is fun this is cool this is great. The dopamine two are the ones that put the brakes on it. And so what can happen is we all have different neuro styles so let’s say if one child or team has a genetic history of ADD or sensory issues or addiction. Right. And you kind of over saturate, you, whether it’s with alcohol, shopping, gaming, over time it makes it really difficult for those D two dopamine receptors to sort of say stop. And so I really think it’s important, and I’m very fortunate, looks like you live in California now too. But where I’m living a lot of the parents come to see me from a prevention standpoint, like if they know they’ve had a family history of depression or suicidality. And so a lot of parents where I’m living are educating their children about their neuro-style. And so I’ve told my son that, because I’m very fortunate to have a lot of his birth history. So he knows, I’m like, oh you got some really fun relatives. But you know we’ve got to be mindful that your brain’s going to want to have more fun and that’s OK. And so Cam, like I teach him like, you know, we have teens, we have a blended family. And so Kieran is so funny Cam. In fact, I hope you get to meet him, I’ve got some fun ideas that we could do together like a YouTube video. So Kieran will be like wild and screaming and dancing and doing inappropriate things that he would get in trouble with at school. Right. And so this is an example where I say to him, oh my gosh Kieran, you are so funny. You’re a comedian, you’re like a little Will Ferrell. I said now but please you’re not 18 yet, please don’t do that at school. You know what I mean, so I give him sort of his time to be the comedian, because I don’t want to stamp out his charisma cause that’s a part of who he is. And so I want everyone to listen that we want to give our children the tools and tips to know when it’s OK to be that fun and loud, when it’s OK to be wild. And if they’re neuro-style can handle playing video games for parts of times or it doesn’t just kind of override the dopamine and they’re just so addictive where they really might need to do cold turkey. I think we need to give, we need to model to our kids, that there’s an appropriate time and place for things. And like let them be proud and self-aware. Like Kieran’s able to say Mommy I’m very hyperactive so I try to be super wild on the playground. I’m like well that’s fantastic, that’s where you should, and he’s like, but do you know how hard it is for me to sit in class and like I know honey I go if I could end school for you every day at 12:30, like this week, that’s what I would do. So I just think that it’s really important Cam. How do you interact when parents reach out to you and you’re giving them sort of the tips on your reclaim plan? How do you handle it when maybe you think like not only did they need your help but maybe Wow you should go see a therapist. How do you handle that overlap when people are asking you questions?
Cam Adair: Yes. So just to touch on a point that you made which I made a parent one time here in L.A. and she said that the way that she teaches her son about gaming is she related to sugar. And she teaches him that you know he knows it if he eats too much sugar, then he doesn’t feel as good as if he has a little bit every once in awhile, he really gets to enjoy it. And she said that when she taught him that gaming was similar, it was like sugar that he was really able to see that connection or a little bit. Sometimes it’s fun, but too much seems fun in the moment but then you don’t feel so good after.
Dr. Denise: Right.
Cam Adair: And so I think sometimes finding those ways that you can kind of relate it to your kid especially even using a metaphor like sugar can be really beneficial. I refer parents to therapists all the time I think it’s super important. My biggest challenge right now is finding therapists that are able to navigate the conversation around gaming. And you know there is only so many, especially in the US where with state laws, you know, I get parents from all over the world and with therapy sometimes there is rules around being able to work with, you know, some therapists don’t do Skype. Some therapists only work with clients in their states. And so actually right now around video game addiction one of the biggest challenges is just having more therapists who are really educated on the subject and really understand it. And I do a lot of training addiction conferences for therapists and I’m just teaching them you know what to screen for and how to really navigate the conversation around gaming because one of the things I notice, and I’m curious if you’ve seen any of this, but gamers have a very kind of unique personality…
Dr. Denise: Well, can I speak? This is the first time this has come up, but I know it’s going to be fine. My first husband, who we’re on great terms now, he was the ultimate gamer. I mean he designs games, he played World of Warcraft. So Cam I lived it for 12 years. So I not only understand it as a psychiatrist, as a mother, but I understood it as a wife and I would go and like there’s something called moonlighting that doctors do. So when I was at UCLA I did a moonlighting gig up in a prison and assessed inmates and whatnot and I would come home and my ex-husband would have been in his underwear and with pizza boxes so he would have like been beyond gaming, like unbelievable, like World of Warcraft. I don’t know if you know that game? Do you know that game?
Cam Adair: What game is that?
Dr. Denise: World of Warcraft. It’s like crack for gamers. My first husband grew up in England right at the time where the evolution of gaming happened, I mean he was there, like when the excitement and like he’s an artist, and by the way he’s a very successful, he’s up in Washington, we’re on great terms. He, you know, it’s been a really growth part of my life. I have a new family, but I’m just telling you I lived a gamer’s, I lived a gamer wife, like, you know, how there’s like football wives. I lived the life of a gamer’s wife. So you were asking me a question about that.
Cam Adair: Yeah,, around the unique personality, so when you have gamers come in to either your clinic or even as parents, and this is a huge takeaway for parents, you have to understand how to talk to your son or daughter about their gaming and in order to do that you have to understand a couple of things even just some basics around like gaming lingo or even being able to say the type of game or the game name properly, so you know being able to say World of Warcraft properly instead of world of guitar.
Dr. Denise: Or even know the acronym. Wow. So like it’s like wow why even say World of Warcraft when you can say Wow.
Cam Adair: And being able to relate with them and meet them on that playing field is really important because if you’re unable to speak their language they’re not going to open up to you and they’re not going to take you very seriously. And we see that a lot where you know we’ve had members of our community go into seek therapy and say that the therapists laughed at them because they said that they had a videogame addiction and that’s not something that’s real. We’ve also had parents where they’re trying to talk to their son or daughter and they’re saying hey, you know, it’s time for dinner. But if that game is in the middle of a game where for them to stop the game in that moment means that they end up like causing the whole team to lose or something like that that can be a huge sense of tension right because their reputation is on the line online and that’s more important than the dinner that can be a little bit flexible for another 15 minutes. So even being able to understand that certain games have a natural pause within the game.
Dr. Denise: Yes
Cam Adair: You pass a level, and then there’s a place where you can save the game and come back to it later.
Dr. Denise: Yes
Cam Adair: That’s a very different experience than being in the middle of a battle with their entire friend circle online line
Dr. Denise: Yes
Cam Adair: where if they leave they’ve just ruined it for everyone. So being able to understand a little bit about the games is really important for you to then be able to have conversations where you’re able to navigate some of the tension points. And just to give parents some resources. Pretty much every game out there in the world right now is available for you to watch on YouTube, which is also a huge part of what your gamers are doing in the research that we’ve done. The average member of our community plays games for 25 hours a week, but then also is just online in other activities whether it’s browsing the internet, watching YouTube videos, watching other gamers play or watching porn for over 25 hours a week as well. And so as parents you can, you know, YouTube type in the search box World of Warcraft game play and you’ll be able to actually see what the game is all about. So if you even want to learn a bit more about the games that your kids are playing or you why you maybe check out the game before you purchase it. You can do that in YouTube now and be able to learn a bit more about these games so that you’re able to interact with your son or daughter about it in a way that now they know that you’re able to develop rapport.
Dr. Denise: I understand and I agree with you. I do that with Kieran. He like looks at how can I beat the levels or how can I do this. And so I engage with him and he’s like oh I love Daniel I want to be Daniel because there’s some kid on YouTube with his dad showing how to beat a game. Right. And so I agree with you we have to just like we take interest in someone soccer game or their day at school we have to look at like what’s their imaginary world. I don’t want to call it imaginary. Their mindset with regard to how they’re interacting with their game and their online friends. And I think that’s super important. And one thing I want to say to everyone, there’s some construction going on outside if there a noise in the background there’s we’re going to do the best to get rid of it but please just know that we’re doing our best here. So if you hear that Cam I’m sorry.
Cam Adair: I recorded a podcast in Tanzania recently and there is a church right next to our family’s home there and they were doing their evening prayers. And you’ll probably hear some singing in the background right now but that’s just, you know, welcome to a different culture right. They have their prayers and that’s going to be a part of the show.
Dr. Denise: Yeah. And this is just, welcome to my reality, there’s a lot of construction. Welcome to California. So I just want everyone to know that if you’re hearing that we love you and we’re still going to keep going. OK. So Cam I can’t even tell you how excited I am because OK so a couple things everyone when you go to Cam’s site you can you can be the parent or you can be the gamer where you can get all this incredible information so Cam can you just tell us about that? Tell us about how that works. I saw that there’s like a package, there’s a book. Can you tell everyone about it?
Cam Adair: Yes. Thank you. So we have a program for parents and we have a program for gamers and the program for gamers is called Respawn and basically walks them through a 90 day Detox which is what we recommend based on just the brain science and attachment theory and being able to build sustainable habits and so it’s called Respawn and it’s really the guide that we created from working with thousands and thousands of gamers and it works really well. We have research now behind it with Dr. Daniel King of Australia who, you know, we found like two x increases in the quality of their life from going through the program so Respawn is available for gamers but it’s really important that for gamers they’re enrolled in that. And so just purchasing it and then giving it to your son or daughter if they’re not bought into the process isn’t going to work very well. And so if you’re a parent who’s really looking to learn more about video game addiction and some practical steps beyond what we’ve talked about here today to really be able to support your son or daughter then we have a program called Reclaim and that’s really an information package on being able to understand what this is, why it happens and what you can do about it. And that will really help you be able to open up the conversation with your son or daughter in a way that ideally get some to a point where then they’re in role than excited to begin to take some steps and then you can do that And that’s called Reclaim on the Web site.
Dr. Denise: Fantastic and you made a very important point about really being able to connect kind of like that holistic well being so yeah people come and they find you. But then how do they engage? Let’s say their child does have attention issues or sensory issues. By the way, everyone, you know by now from listening to me that I look at medication as only one of many of the tools, you can tell I’m very holistic in the way I practice psychiatry and what I’m thinking Cam is, I’d like to have, I don’t know what your timeline is like today, for us off this call just to talk about ways we could co-create and collaborate. Because I think what happens is there’s a lot of disconnect. Right. And so having the tools, but then giving parents specific tools or scenarios. I know you’ve got all these incredible YouTube videos which I’d love to hear, can you tell us about all the YouTube videos you have for people already because I have some ideas that maybe ones we could do together later especially since you’re in California, but can you share what’s out there that you have for everyone to watch?
Cam Adair: Yeah, thank you for mentioning that because as much as we have programs and those are structured ways that people can go through and really understand this stuff. My vision has always been to ensure that if there’s a gamer out there, you know, I was getting e-mails from 10 11 12 year olds when I first started talking about this issue who are saying you know please help. And I’ve always felt very called to ensure that no matter who you are, where you’re from, what kind of economic state you have, you’re able to get the help that you need and the best help possible. And so YouTube is how we do that. So we have 150 and more now videos for free on YouTube. That just kind of answer every possible question that I’ve seen around gaming. So what do you do with your time? What do you do about your friends? What do you do about cravings? And it’s a really powerful community. And in the comments section where people are all supporting each other you know we also have a forum where people journal and really kind of open up about their emotions for the first time maybe ever. And people even support each other in their own native languages in Korean and French and Portuguese and Spanish and all these different languages, Dutch. And so it’s a really powerful community and that’s what we’ve really seen work is when you’re able to surround yourself by peers who are on the same journey as you, you’re able to really kind of make some positive changes. So regardless of the programs the YouTube channel is there it’s Game Quitters on YouTube and the forum is there which is on Game Quitters dot com.
Dr. Denise: Do you have any videos where you and someone like my son’s age, like an eight year old, talking and just talking about a game and like what’s that like.
Cam Adair: We haven’t done one with someone that age. I would love to. I’m totally open to all these ideas.
Dr. Denise: OK good because we’re going to talk about it because I think we’re living in such a different time you are a millennial. My intention, I really Cam, I threw myself way out of my comfort zone. I just launched my site last April and I thought if I’m going to really connect with high level thinkers of all different ages and backgrounds and being of service right with mental health and collective well-being I’ve got to go online. I can’t not do Twitter I have to meet the masses where the landscape of communication is and so now we have children that never picked up a landline and never called someone and mostly do all their plans via texting and I think one of the things we wanted to talk today about was digital media overuse and maybe we can do that on another show. Right? Because we’ve spent some time. So a couple things I wanted to make sure. So for everyone listening, Cam has Game Quitter’s dotcom. There’s also a YouTube channel. He has Ted talks. And his name is Cam Adair (C-A-M—A-D-A-I-R). And I think Cam do you want to go over just some top tips and tools that are like the most common things you would tell a gamer when you first initiate their conversation then also with the parents, just to give our listeners just a framework so that they know how it can start.
Cam Adair: Yeah, absolutely. So for gamers the most important thing is to help them understand why they do what they do. And so there are four specific reasons why they are drawn to games and I’ll just go over these quickly again. So the first is temporary escape, games actually allow you to escape from stress and maybe the problems you’re experiencing. The second is social connection. And so for any parents out there those friends that your gamer has online are their real friends. Those are very genuine relationships and gaming is just the activity that they’re doing to hang out with their friends. And so for them to quit is for them to have a total shift in their social experience. Even if at school gaming is the main topic of conversation. So for them to remove themselves from the gaming world is to remove themselves for and become the social outcast at school. Right so that’s a huge point that you’re going to have to navigate the third is content measurable growth. Games are specifically designed for you to be able to see your growth in progress and you get it through instant gratification. So you’re going to have to help them find a new activity that is a skill-based activity, not programming, learning a new language, martial arts, anything where they’re able to see their growth and progress is really important. And the fourth reason they game is a sense of purpose. So again, games are specifically designed for you to always know what to do next. You have to beat this boss, beat this level, or beat this boss, beat this level, get this weapon. And life, it’s a lot more abstract right? You don’t always know what to do next. I actually just moved out of San Diego and I was kind of feeling like I want to make a change in where I was living and I was like where should I go and so I’m just going to travel for a bit and I just chose Portugal and I chose it just, I’m going to Portugal, I actually fly there tomorrow.
I chose that just because I needed some sense of like OK let’s go here. Right. And I could basically go anywhere. And so you know games, it’s a structured sense of purpose, and people know why they need to play. And they wake up everyday knowing what they need to do and in life that’s a lot more abstract. And that’s a huge component of why they play. And so those are the reasons they play. Now once you understand that you can understand that you have to find new activities for them to fulfill those same human needs because they have a human need to escape, to socially connect, to see growth and progress and to feel a sense of purpose. And those are genuine. And there’s nothing wrong with them. They just need to find replacements so I recommend three different replacement activities. The first is something mentally engaging, it’s a skill, a goal to achieve. A second is something social and the third is something resting, so something they can do when they’re at home and they are tired and they’re bored. And on Game Quitters dotcom we have a guide called 60 plus new hobby ideas that will list out all these different hobby ideas to fulfill those different needs. And beyond that, developing a lot of awareness around their time is really important because gaming has been the autopilot response for any time that they’re bored, which also just means any time that they’re not doing something that they’re forced to do like go to school. And so really helping them improve their time management skills using like an agenda. Actually listing out these different hobbies that they can do during our free time that really helps a lot. Really helping them with their time management skills. And we’ve seen you know we do a study and we found a 44 percent increase in their time management skills as they quit gaming for 90 days. And so that’s a huge part of it. For parents, a couple other tips, understand what types of games your son or daughter plays. If they’re playing first person shooter games, they like to be the character, which means something like sports, is going to be a lot more appealing to them because they get to be in the moment. If they’re playing role-playing games, they like to play a character. So things like improv or theater or drama are going to be a lot more interesting to them where they get to actually play a character or maybe filmmaking is something that they’ll be interested in. So really understanding what kind of games are they playing that gives you insights into the different types of activities that they’ll be more drawn towards. And it’s the things they’re getting out of the games that are the reasons why they’re playing. And so always coming from that place to be able to help them find different things that they’ll be interested in. And it’s just important to know what the brain science that they’re not going to find a lot of interest in other activities right away. So they’re not going to go from being extremely passionate about gaming, to being extremely passionate about filmmaking overnight it’s going to take some time usually about three weeks for their brain to kind of come back to just some more normal levels where they’re not going to experience boredom in the same way without gaming. And so just being a little bit patient and really helping them navigate those first couple weeks, really supporting them, helping them get out of the house, helping them have other activities, helping them to be able to invite their friends to go do things outside of their homes. Those are all really important to help their children be able to live healthy and happy lives.
Dr. Denise: That’s fantastic. Have you seen, I know that yours is Game Quitters, but what has your experience been with sort of this gaming, like how to still have games in your life and thrive? Because I’m I know that my son, that from a sensory standpoint, that games are serving kind of a purpose. And then we shift, but it is I have to admit, I know on your TED talk you said, you know the iPad should not be a baby sitter. And so that’s why I hold myself accountable as a parent, but I mean I really have compassion for dual working households, which by the way we are too, but we are entrepreneurs. We have our own schedule and our own businesses, which is very different. So I have a lot of compassion for the parents who can’t regulate and can’t do the timers and can’t shift or don’t have the time to do some of these things so I’m wondering just kind of here at your end sort of end of the interview just the landscape of people who need to quit cold turkey versus those who maybe can integrate. What are your thoughts on that? I know what mine are as a professional, but I want to just hear yours.
Cam Adair: Yeah. Generally, just as a general recommendation, I’d really like to encourage the 90 day program of just 90 days cold turkey from gaming. A lot of that comes from, you know, obviously I work with people who come into our community from the research we’ve done we know that they meet six and a half criteria of gaming disorder so you know they would be diagnosed gaming addicts if that was the criteria that was proposed. And 90 days is just what I’ve seen really support them in being able to make changes and even for those who maybe aren’t on the worst side of the spectrum. Part of what I share with them is just if you can’t go 90 days without gaming, maybe you shouldn’t be gaming and really just using it as an experiment because for so many people nowadays gaming has been the central activity in their life from a very young age – two, three, four, five years old and they’ve never really had a period of their life where they haven’t been gaming. And so they don’t even know what life is like without going.
Dr. Denise: Right.
Cam Adair: And from an opportunity for them to be able to create a reference point in their life where this is what life is like without gaming, that really helps some be able to self regulate more even if they’re using gaming again in the future.
Dr. Denise: Right.
Cam Adair: And so I really like to create that reference point. Because it just, even if they go back to gaming, it gives them an opportunity to see the contrast between the two.
Dr. Denise: I agree.
Cam Adair: We just see a lot in our community where even if you know some of our members do relapse, they do end up coming back and saying hey, I relapsed and I’ve been gaming a lot recently over the past few months, but knowing what gaming or knowing what my life was like before, without it for a period of time really gave me the opportunity to be able to make this change again, it gives them leverage. So I just personally recommend giving people the opportunity to see 90 days without gaming, because if they go back to gaming or not, they have a lot more information of what their life and relationship is to it. And that gives them a lot of leverage over their self-regulation.
Dr. Denise: Absolutely. So we’re really talking about mindful awareness. What is my life like without this level of electronics and the 90 days? I work with a lot of people that are sober and dual diagnosis. I see 60 percent children and teens and 40 percent adults. And so it’s amazing what people say when maybe they’re no longer smoking pot or they’re no longer drinking and the activities, like I want to be outside more. It looks like you shared that you had some great relationships you got out surfing. So you know just tell us a little bit about what it was like for you. Like when you did that when you started and you weren’t using games anymore.
Cam Adair: So I started “DJ”ing! A group of friends and I put money together, I think about three or four hundred dollars each, and we bought DJ gear and that was a passion that I had always thought that would be a big passion. I just never experienced it. So a couple of friends I bought gear and that became a big passion. When I moved to San Diego, I had always wanted to surf, but I had never lived somewhere where I could do it so I bought a wetsuit off Amazon and just going out every week, twice a week, to experience it. Working out, yoga, I travel a lot. Obviously I started my own business that is a huge sense of purpose and passion for me as well. And I’m also just very intentional on hanging out with friends. I just find so much value in really being more social. And it’s something that, you know, I go to Tanzania every year to build clean water wells. And seeing the contrast in that culture, where, in the West I think that we’ve done amazing things when it comes to infrastructure and services and having clean water and homes and all these things, roads are amazing, but when I go to Tanzania and I see this culture of people who have, quote unquote, nothing, not even clean water, maybe one pair of clothes that’s ripped, but yet their happiness levels and their sense of community is so strong. I’ve really taken a lot away from that. And so just really trying to be integrated into being connected with friends and being connected to family and really having a strong sense of community has really brought a lot of value to my life, far more than gaming ever did. And so those are some ways that I really kind of engage in the world, but it’s really just being mindful as well, like when stress levels are high, and noticing my desire for escape and choosing a healthy way for me to do that which tends to be yoga or working out or getting in the ocean or nature, going for a hike versus going in gaming which there’s nothing inherently wrong with it, but for me it also brings a lot of baggage in the fact that I can do it all day long every single day. And it kind of holds me back from really having a desire to do other things like travel or call friends and so just being mindful of the way that I’m channeling my desires and my talents for good instead of evil as I describe it.
Dr. Denise: It’s fantastic and it’s such an honor to have you on this show today and I’m excited for your new adventures in Portugal, but I’m like oh no, he’s leaving L.A.
Cam Adair: Well I’ll be back in October actually I’m doing a speaking tour across the west coast I’ll be in San Francisco, San Diego, Phoenix and Seattle in October speaking in schools and then I’ll be stopping in L.A. on the way so you and I can definitely meet up and shoot some videos and then November, December I’m going on tour in Australia and so I’ll be I’ll be there. I’m really excited to go to Australia, I’ve never been there before, but it just there seems to be an energy there that’s just magical. And so I’m really excited about that. And then eventually when I decide to stop traveling, sometime early next year, I’ll be moving officially to LA I believe. So I won’t be far.
Dr. Denise: Oh that’s fantastic. Well can you, right now, just let all the, just let everyone listening know all the ways they can reach you and all the ways that I know we’ve mentioned them in the show. Let’s just tell everyone again.
Cam Adair: So Game Quitters dot.com, Game Quitters on YouTube, for parents we have a program called Reclaim which is available on Game Quitters dot com. For gamers we have a program called Respawn. And then my email is Cam at Game Quitters dot com I love to hear from everyone on Twitter, Instagram. It’s at Cam Adair. And again any questions please reach out. I really love to hear from people especially people who have listened to a podcast and just can’t thank you enough for having me on and help spread this message.
Dr. Denise: Oh, I’m smiling. Actually I’m smiling so big so thank you again Cam. And I can’t wait to meet you in person and discuss other things that we can do together in the future.
Cam Adair: Likewise.
Dr. Denise: Thank you. 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 dot com d r d e n i s e m d 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.

Episode 35 – Rebecca Lombardo on the stigma of mental health challenges

Rebecca Lombardo is the author of “It’s Not Your Journey“, a moving account of her 25-year battle with mental illness. She is a Huffington Post blogger, contributor for The Mighty, and a podcast host. She was diagnosed with bipolar disorder at the age of 19. She has battled that as well as several other conditions for over 20 years. In 2013, she attempted suicide. Grateful that she survived, she decided to tell her story in the hopes that she could help others choose a different path.

Episode 34 – John Finch discusses his powerful new book, “The Father Effect”

John Finch always struggled after his father committed suicide when he was eleven, but it wasn’t until he was raising his own three daughters that he truly understood their futures relied on his coming to terms with his difficult past. To move forward, he needed to forgive both his father for choosing to leave, and himself for not being the best father he could be.

This journey led to THE FATHER EFFECT, a book containing practical help for anyone, man or woman, with a deep father wound from losing a dad through divorce, death, or disinterest. Through positive lessons on forgiveness and approachable advice on how to change your legacy as a parent, partner, and person, THE FATHER EFFECT is the ultimate healing tool for anyone who has suffered the absence of a dad.


The Father Effect YouTube Channel
The Father Effect GodTube Channel
Facebook – The Father Effect Movie
Twitter – @johnpfinch
YouTube – The Father Effect

Neurosurgeon Dr. Ramin Javahery on Humility in Medicine – Podcast Transcription

It was an honor to interview Dr. Ramin Javahery, here is our important discussion on “Humility in Medicine:”

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 multidimensional 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’m excited and honored to interview Dr. Ramin Javahery. He is a Board Certified Neurosurgeon. His education began at UCLA where he graduated Magna Cum Laude with a degree in English Literature. During his undergraduate years, he also engaged in research in the field of Molecular Biology. He went on to medical school at USC and became Editor-in-Chief of the USC Journal of Medicine. Beyond his academic pursuits, he was also interested in humanitarian activities and organized the USC-Rwanda Relief Fund to send money to the victims of the Rwandan genocide. At this time he is Chief of Adult and Pediatric Neurosurgery at Miller Children’s Hospital, where he practices both Adult and
Pediatric Neurosurgery, as well as Spine Surgery. His interest in patients extends beyond curing their diseases. He has passion about caring for patients and is a member of the ethics committee at Long Beach Memorial.

Dr. Javahery:: Good morning!

Dr. Denise: Good Morning Ramin, thank you so much for being on the show today.

Dr. Javahery:: Thank you for having me.

Dr. Denise: How much time do we have today? I want to respect your surgery schedule.

Dr. Javahery:: I have patients at 10am so we have plenty of time.

Dr. Denise: OK, fantastic! Ok, so everyone, I’m so excited and honored we have Dr. Ramin Javahery, Chief Neurosurgeon at Miller’s Hospital here for an interview and he and I met very fortunately on social media. We actually, it turns out, Ramin, it looks like we’re neighbors.

Dr. Javahery:: We are?

Dr. Denise: Yah. I live in Manhattan Beach too.

Dr. Javahery:: Then we are neighbors.

Dr. Denise: Did your kids get a good start to their school week?

Dr. Javahery:: My kids actually go to school at Chadwick so they don’t start for another two weeks.

Dr. Denise: Oh, ok. We’ve got one at Rolling Hills Prep, one that’s on their way to college and another one at Pacific. So we’ve kind of got a lot going on.

Dr. Javahery:: That does seem like a lot.

Dr. Denise: Yah, but a lot of good stuff too. So I really appreciate you being on the show. Can you give us a little bit of background on your path to being a Neurosurgeon and also some of your other humanitarian activities, just to give us an idea of who you are and what you do?

Dr. Javahery:: Sure, I, let me just start by saying that there are really two types of doctors I think, doctors who enter the field as scientists who want a practical application of that field and doctors who want to do things that are good for humanity and pick medicine as the path. And those doctors may not be scientifically minded; it’s more of a desire for connectivity and being a humanitarian in some ways. And I think for me it was more of that path. I was an English Lit major in college and I really couldn’t decide what I wanted to do, I had thought about going into ah, the law or going into business and it just never resonated with me, I wanted to find something that allowed me to be connected to people, to do things that made a difference in people’s lives. And my dad happened to be a surgeon and it kept calling to me and it was, despite my father’s best efforts that I went into medicine. He actually consistently tried to dissuade me from going into health care as a field.

Dr. Denise: You know I have to say something about that, my uncle, Raymond Vahl, Dr. Vahl is a Dermatologist in the Chicago area and I experienced the same thing. My uncle was like, I don’t know, medicine’s changing, you don’t get the sort of the essence of the art of medicine and he really, really kind of did the same thing, so I find that very interesting. And it sounds like on your path, which was similar to mine, you know, I love surgery, you know I got an A on surgery, I was into Ophthalmology stuff, I was one of those people, sounds like you, that had so many interests, but I followed my path of being more of an innate healer that I really wanted to make a difference in a care-giving profession and so I was really interested when I read your bio and saw that you were an English Literature major and you were editor at USC, so it sounds like you’ve always had a lot of interests and you kind of then, how did you things, how did you listen, not listen to your father? How did that happen?

Dr. Javahery:: So, it’s interesting. I think that my perspective about health care was really because of my dad, despite what he said, you know, the old adage, look at what people do, not what they say. And I lived in a home where my father was respected and loving in his community because of what he did, through his work. And that seemed unique to me. No other profession, I mean there are other professions, but no profession that was open to me at the time seemed to have that where, again, a trite cliché, where you can do good and do well at the same time was available to me. And, but it wasn’t just to do well that was the animating factor, it was that I didn’t think that I would be a successful enough businessman to have a Gates Foundation. I didn’t think that I would necessarily be able to do as much good on a daily basis if I was a lawyer even if I was in a philanthropic organization as I could as a physician. Literally on a daily basis I can affect people for the better. And, more importantly, than that is that the community that you build in health care with your patients and their families is much more robust, I think, than in almost in any other position. Just think about the fact that you walk into an office and you see a physician and without having anything told to you about their background, who they are, what they believe, you trust them. That innate faith in the person that’s in the office that you’re seeing is remarkable and it’s a um, it’s a privilege that physicians have and we should work extremely hard to preserve it, not, and I think that some of the problems that we see are because there’s a certain amount of abuse of the inherent faith that society places in physicians by certain physicians and I think that, we should fight that, but it also means that we are such a privileged group and it makes our jobs very satisfying.

Dr. Denise: Well, the, what you are talking about is very much the doctor patient

Dr. Javahery:: Absolutely

Dr. Denise: and I know that in the line of work I do as an adult and child psychiatrist, I always enjoyed the whole picture of a person. I was not someone who could see myself in a clinic where I had five to ten minutes to say are you depressed are you sad are you this and so I took a leap of faith and I started my private practice when I was finishing up. It looks like you and I have the UCLA connection. I was finishing up my Child Psychiatry at UCLA and I was like, you know what, I am just going to go for it, I want to be able to practice medicine in the way that I want to, create the office environment and really I decided not to do a managed care route because I didn’t want to lose the art of medicine and I’m in a unique situation, I know with surgery there’s different challenges and I think we need to address that because I think you want to talk about the doctor- patient relationship and how doctors and patients can have the best relationship whether you’re in managed care or you’re in a kind of fee for service or a private practice. But what you’re talking about when I actually look at my schedule my patient schedule every day and I really connect I have some people that come to me for therapy some for med management some for a second opinion. I have people in my practice that I’ve had for 15 years. I might only see them twice a year cause they’re just thriving. But there is a real connection and the essence and the art of connecting. When you say humanitarian I look at things as we’re really connecting soul to soul. And so I think it’s such a privilege and such an honor and I think it’s such an important time for us as doctors to be role models. And I’d love to get your take on what it’s like being a surgeon and I know you wanted to talk about the doctor-patient relationship and the future of medicine. I’d love to hear your A quote from history:” It when you want to find a diagnosis go to the patient if you’re confused go back to the patient.” It’s really the patient that is the key, the patient is the place you have to go and the doctor- patient relationship is the key to it. And I think one of the things that is lost in the healthcare reform and the conversation about healthcare reform is that everything we talk about seems to be diminishing the doctor-patient relationship and part of the problem is that much of it is animated by this progression and it’s not the health care reform under President Obama wasn’t a change it was just a natural progression of what’s been happening which is that health care went from mostly small mom and pop small businesses and then academic institutions to more and more big business, large, I mean large multi-billion dollar corporations that own the facilities and own the physicians. I think that is, I can’t stop that. I don’t think anybody can. I think that we have to involve doctors in the process and at least make people understand that there is a cost when you eviscerate the bonds between patients and doctors, and the again another cliché; nobody cleans a rental car. When doctors don’t own their patients, when the patient belongs to the system and the doctors aren’t individually responsible, then there’s really nobody responsible, you need to own your patients they have to feel that at the end of the day you are going to be responsible for what happens to them because that feeling of responsibility, which is inherent in a doctor-patient relationship, will encourage you to be a better physician and encourage the patients to trust you. I think that that bond is being broken and I will say one thing about the whole health care reform system; it lacks humility. One of the things I love about being doctors and one of the things I hate, I hated about when I was first going into surgery, about a lot of the surgeons I met was humility. The lack of it and the surgeons I met and the prevalence of it among most good physicians. I think that, one of the real assets. I’m sorry, go ahead.
Dr. Denise: No, I just want to jump in because I’m so aligned with you. I actually, I did a tweet that said ego is the enemy.
Dr. Javahery:: Yes.
Dr. Denise: I really wish all of our children, because I’m a child psychiatrist, and I think about health and prevention and people being empowered with their health and kind of having self-awareness. And, can you imagine, I know in our schools here in Manhattan Beach they’re doing a lot of integrated kindness and care and character, but can you imagine a world where our children were being taught about what ego is, what humility is, learning how to say they’re sorry and also feeling almost honored and privileged? I was raised that if you have gifts, and you know everyone has their different spiritual beliefs or their higher power their God their source or maybe in just this lifetime they don’t believe and there’s the high morality. But I believe if you have a level of intelligence and compassion I think if you’re able to take care of yourself and your family and you have more left over and you have the ability to be a surgeon or a doctor or a humanitarian in any way, we want to be of service to others. And you know not everyone has the same capabilities. I have a lot of humility because I work with a lot of children with learning issues, ADD, autism spectrum and those people are working, you know, at a different more strenuous rate just to get through their day. So if someone has the intelligence to get through medical school on pretty much any different type of profession in medicine and someone’s coming to be helped you want to make sure, I do agree with you, there needs to be humility. And also I think it’s so important to meet our patients where they’re at. And I think I’m just so excited to have you on the show because I feel like you’re a kindred spirit. I bet you spend a lot of time really connecting, educating your patients, making them feel like they’re empowered. Would you, can you speak to this?
Dr. Javahery:: So I do think we have a similar perspective on this. I think the belief that I am flawed and that I am not, me meaning anybody, that I as a person am flawed and that I shouldn’t think too highly of myself because there’s always there’s always someone smarter, there’s always someone better educated, there’s always someone better looking, there’s always someone taller, thinner, more attractive, whatever it may be. We should all have a little bit more humility because, we are, we all have our flaws and I think that walking with that understanding makes us much more compassionate to everybody else around us. Again, the cliché, he who has no sins cast the first stone. We seem to be living in a world where people are so confident of the truth of what they believe, that they are almost blind themselves to the ability to connect with other human beings. I read a book, the name of which I don’t want to share because the name of it will kind of temper the perspective, but what the book said is that it was about Miller-Urey Gnostics which were the Christian version of modern day Islamic fundamentalists at the turn of the first millennium when they were, they believed that Christiandom was not Christian enough and then needed to be more adherent to the laws of Christianity so that there would be the second coming, and the quote is that, “the believer knows that he believes, the zealot believes that he knows,” and this blind faith in our own knowledge is completely antithetical to what being a good doctor is. Doctors are inherently insecure we question, we have M & M’s and we criticize each other and we’re confrontational with one another.
Dr. Denise: So that for everyone out there in M & M is morbidity and mortality correct?
Dr. Javahery:: Yes.

Dr. Denise: When you have conferences when something doesn’t go quite right and doctors want to learn like what could we have done better. So that’s what Dr. Javahery: was talking about.
Dr. Javahery:: Sorry about that. Yah…
Dr. Denise: That’s ok. No problem.
Dr. Javahery:: I got into the weeds.
Dr. Denise: No, but what I want to say though, we’re talking about compassion, we’re talking about love, we’re talking about humility. And so when I was in medical school, I have to admit, the first year of med school I actually went and saw a therapist and you know why?
Dr. Javahery:: Why?
Dr. Denise: I thought people weren’t kind enough. I actually went and talked to a therapist and I said I thought 80% of people, by the way I don’t want it say that I have this exact number right, I just like to do estimates, I thought 80 to 90% of the people were smart enough to be there, but only 40% felt kind and compassionate enough. I was a little bit disappointed I know as a young I went straight from undergrad right into med school so I had to do a couple of therapy sessions because I’m like, oh my God, these people are mean like how are they going to grow up in like four years and turn kinder. So I just wanted to share that just came back to me when you’re talking about, you know, maybe this kind of segues into young doctors. But I have this idea that doctors, you know, are supposed to be healers, they’re supposed to be helpful. And this does tie in with your ego discussion. I saw a lot of ego at my medical school.
Dr. Javahery:: I did too. I was. I was a little bit taken aback by the egos in the in the world of neurosurgery when I was first applying for residency. I was truly shocked because growing up my dad was a surgeon but he was a very humble man. And I always thought, physicians, and especially surgeons is more like just privates in an army where we just did the grunt work. We just worked and worked and did good things for people and that’s what we did. And I didn’t view, this is funny because I didn’t view doc. as surgeons as, the smartest. I always thought I was always impressed by the cognitive ability of internal medicine docs. But I viewed surgeons as just, we, we took it. We just were tough and we worked and we were kind of manual labors in the world of health care. And as such we should be humble and, in our deficiencies. And take pride in just the fact that we worked hard. And when I was applying I saw so much ego and it was, I agree, off-putting and going back to this issue of humility. I think on a global scale what we can do as physicians is first police ourselves and remind each other that humility in what we do is a necessity, it’s not a flaw. And then take that and apply it to the bigger issues of reforming the health care insurance market, access to care, because I think those things do need to be changed they need to be fixed, but they should be fixed maintaining a doctor-patient relationship and they need to be fixed with a certain amount of humility about what it is that on a macro scale we can never anticipate occurring on a micro level when you change macro policies. And, I think again, people who work in the trenches like I do have should have a voice and should participate in the health care reform because I think all too often people who have, who do public health and who do large scale analysis don’t really pay attention to the ground level affects on patients and their families and the relationship between the patients and doctors.
Dr. Denise: I agree with you and I think I’d love to meet with you outside of the show to discuss ways we can do that, but one thing that we’re also talking about, for any young physicians listening and also for patients, but for young new physicians, I think they have to have they have to make you have to make the decision, like you and I did, and it sounds like you are just naturally this is kind of innately who you are. But if you’re somewhere in-between the science and the healer you describe two types and you’re maybe a little bit of both, really standing in your own truth as an M.D. and making sure that you decide that your patient-doctor relationship is sacred and that, meaning you are, that is your patient, that is your doctor, and that no matter what managed care is telling you, that you need to sort of stand up if you don’t agree, that you need to shorten your appointments or you need to do this coding or whatever you need to do, stand true and also try to do whatever you need to do for good self-care. We all need to do this good fitness, good nutrition, because I think when doctors and anyone’s overworked you can get a bit jaded and sometimes you can just go along with the program. And so you need to really still stand in your truth and it looks like this is a good time to talk, and I know there’s a couple of other topics we want to get to, but you’re on the Ethics Committee.
Dr. Javahery:: Yes
Dr. Denise: So it sounds like what you’re talking about is something you’re so passionate about can you tell us a little bit about your work on the Ethics Committee?
Dr. Javahery:: Yeah. I joined the Ethics Committee because I was so disturbed by a lot of the ways that patients were being treated by physicians. One of my pet peeves and then one of the things that I always bring up with families and I’ve never heard anybody else talk about it, but I see them practice this in the wrong way is the difference between moral and medical futility of care. So we live in a world where doctors don’t think about what they do in a moral paradigm, but it is, and yet they approach patients and give them moral advice believing that it is purely medical advice; I’ll give you an example: a patient comes in with a bleed in their brain, a hemorrhage, the patient is 80 years old. The bleed is devastating, but if we do everything we can as a physician that patient will survive, they will survive with a pretty poor quality of life, but they will nevertheless survive. The physicians go in the room. And talk to the family and say well this is futile to do anything and therefore we would recommend withdrawal of care. Now, the family may believe that it is futile and that the quality of life that that person will have is not worth fighting for or they may disagree. And, but that is their choice. The physician in that situation is making a decision about moral futility not medical futility. You can help medically. You just don’t agree with the outcome morally. We should be more humble. We should present it, and I do often, I go listen, the strategic goal here is the moral perspective you bring. If this is a quality of life that you find acceptable, on a tactical level, I’ll fight the fight for you because medically I can make a difference, but I have to tell you, and I’ve said this to patients, I’m, from a moral perspective wouldn’t fight it. My moral code tells me that this is not a fight worth fighting. But I will fight for you if you feel that this is what you want for your family. And it is such an empowering conversation. I can’t tell you how many people will say wow I get it. No let’s not fight it, in a circumstance where they were, they were defensive prior to my conversation with them. And I think that one of the things that I do with the Ethics Committee is I constantly try to push back against the moral blindness of a lot of physicians when they try to impose their morality on the families of patients especially in a culture, in a multicultural environment like ours where, you know, you’ve got often white upper middle class physicians who are religious, but maybe more on the periphery of religiosity and we’re dealing often with, in my case, I mean they’re very heavily Hispanic population, very Catholic and very religious who don’t view, it doesn’t have to be Catholic, you can be in an Orthodox Jewish environment where they are very reticent to withdraw care or to diminish the care that their family receives, and that creates conflict. Well it’s not your job to change this person’s morality, if they believe this is a life worth living, even if I don’t, my job isn’t to teach them my morality my job is to care for them and as long as it’s not medically futile, I will do as my patients families request because that is my, it’s my oath.
Dr. Denise: So everyone I think what I love about what Dr. Javahery: is talking about is really meeting the family. There’s the medical outcome of yes I can keep this person alive. But then respecting the person having a conversation where you respect them soul to soul, person to person, human to human, and you look at what their beliefs are, but you do what a doctor needs to do is have compassion and also patient education. So you’re letting someone know. If we do this here’s the quality of life. And you’re really educating and telling someone here all the possibilities. But you’re not telling someone well they’re goner, or this. And so I’m wondering, can you give all the listeners out there that might be going into like a surgery situation maybe some tips on how If they could talk to their surgeon depending on their surgeon’s style like what tips you would give people? And how to have that conversation?
Dr. Javahery:: So one of the things I tell all my patients is that any doctor who’s afraid of a second opinion is a doctor you should be afraid to see.

Dr. Denise: I love that. Thank you. I do too. Go ahead. I’m like, go ahead see as many because you want them to feel good. So keep going. So first of all a second opinion is something that no one should be afraid of, we should encourage that.
Dr. Javahery:: Right. Because either I’m wrong and you get a second opinion and it opens my eyes to a bad, an error in my judgment or you get a second opinion and it corroborate what I had said and you are more faithful in what I have to say. you believe more strongly in what I have to say.
Dr. Denise: Or there is even a third option right, that there’s a little bit of both. I’ve had that people go and get like three or four different opinions for really complex surgeries in my practice and they come to see me for the psychological piece of what to do.
Dr. Javahery:: No absolutely. I think as all good health care there is a collaborative aspect to it. But what I was going to say in terms of your question about what families should do. I tell them this and the reason I say this is that families should, or patients and their families should not only seek a second opinion if they are looking for more medical information you should also feel connected to your physician because at the end of the day what I do as a surgeon is an extraordinarily intimate act. I enter people’s bodies. That’s not a small issue. Forget about the technical ability or whether I do a good job or not. Just think about it. Do you like this person enough to have them violate your, your being. If you don’t find some of that you do feel is you’re OK with letting them into your body. This is, it’s kind of like dating, find someone that you are in sync with. If it’s not me, fine, find somebody that you’re comfortable with because every surgeon will have complications. Everyone, if there’s a doctor who tells you a surgeon tells you that they’ve never had a complication they’re lying, everybody does and you want to feel that if there is a complication you have faith that this doctor did the best for you they could, and that the complication was unavoidable. So I think that connection with a physician is important that emotional link that you speak the same language, that you view life through the same prism of life experiences, morality, ethics, all of those things that matters. Now, some people it matters less, some people are just, you know, they go I don’t care as long as he’s a good doctor if doesn’t affect me, more power to you, then that’s as much of an issue. But, whatever your metrics are for trusting your physician, if you find a doctor that doesn’t fit it, don’t be afraid to find someone who does.

Dr. Denise: I completely agree and we’re talking about the therapeutic alliance, and when someone comes to us, I believe that we are all a part of our own healing, so whether someone is coming to me and they have depression or anxiety, or if they’re coming to you for a surgical procedure, yes but we’re facilitators of health and well being, we need to have that partnership and the hope and belief and the relationship, because the outcomes are so much better. In fact, I don’t know which journal I read, but a lot of surgeons, when people are sort of like, “I know I’m going to die, I know I’m going to die..” sometimes you’re like I don’t know if I want to work with that patient. I want to be very specific here, there are situations where the surgery is so complex where there’s a high chance of dangerous surgery, but my point is we need to engage our patients in the healing process and the hope. So when someone comes to me and says nothing can help my depression, and I’ve worked with them for four times, but they keep repeating that thought to themselves and they’re maybe not engaging in exercise, good nutrition, cognitive therapy, mindfulness, then I don’t have a partnership for them to engage in their health and well-being. So, I think it works both ways, I think we want our patients to find doctors that they trust and care, and I will say and I’m sure you can agree that there are different character styles in medicine. Just like there are in law, and everything, and there can be an exceptional surgeon, that maybe is a bit shy, and is an outstanding surgeon, but maybe doesn’t like to do a lot of the talking, but it still doesn’t mean they’re not compassionate, so you can pick up on their vibe that they’re very caring, but maybe they don’t talk as much to their patients because they’re ready for the next thing. Would you agree that there sometimes there’s that style, too?

Dr. Javahery:: Oh, yeah, I think that the, our judgments about people are tempered by our experiences, and sometimes people who are shy come off as aloof, totally agree. And especially for patients who are looking for someone to comfort them through the process, if you’re shy and don’t reach out to the patient, it can come off that way, I.. my perspectives are generalities, I don’t profess to say on every specific case they are applicable, there are going to be exceptions. Just like, you know, when I was dating, there were girls who thought that I was one thing, even though I would just happen to be shy about dating, and they were not interested, and the same thing applies to the doctor-patient relationship, you may think that someone is aloof just because they’re shy. But, can I just make a… I want to share a story about the doctor-patient relationship because I think it really animated it in my perspective. Since I was in residency, and there was a woman who had broken her back, she was paralyzed, we operated on her, stabilized her back, but obviously made no change in her paralysis, she was a former nurse and had some respiratory issues, she would have recovered if we were fully aggressive in her care, she decided to request that we remove her chest tubes, and she would go on hospice, and, meaning that she was going to die, and she was would have died because she still had respiratory issues, she had gotten pneumonia, and eventually passed away. But, she wanted to die because she didn’t want to live as a paraplegic. And I remember, nobody else broached the subject with her, her son, I did, I went in the room and I said, “Listen, life, you know, just because you can’t walk, doesn’t mean that you can’t be productive, my dad died of ALS and he was paralyzed, and it was… I felt very strongly that human beings exist between their ears, not below their necks, and that our physical abilities should not define our humanity…” And I told them this, and I told the son, “Listen, I’ll do what you ask, I’ll do what she asks, but I have to tell you it makes me sad, that I think you guys are doing, from my perspective, the wrong thing, but I will definitely help you, I mean I won’t stand in your way, I just have to tell you, I think that you’re not giving life a chance here.” So, she eventually did this and died. The son came back and said, “I so much appreciate that you were honest with us, that although you disagreed, you told us what you felt, and we did what we felt was right, but at least there was an honest conversation.” And I think that that was really significant in my life, because it told me that I can disagree with people, and they will still respect me if.. If I do so honestly and with respect, again, with humility.

Dr. Denise: Absolutely, so we’re talking about respecting another individual’s world view, soul view, and that you, you have the advantage as an M.D. of also seeing people feel that way, about, “Oh my Gosh, I might be paralyzed,” but then you see on the other side people thriving, and so do I, I see people go through unbelievable medical issues, surviving cancer, surviving things, and finding out that their inner world or their mindset, that they’ve actually enjoyed life to an even greater extent, but at the same time, we have to respect another individual’s viewpoint, so giving options and sort of being true to your feelings, but not saying you have to make this decision because I feel this way, really also, I believe everyone allows for the doctor-patient relationship to be vulnerable, and to be real and authentic and not from a distance. When you start talking about statistics, but also feelings, that allows our patients to kind of open up and share their feelings more so I think that was a great example and I really appreciate you giving that.

Dr. Javahery:: Yeah, I think…Thank you. I think that overall these issues, like you said, humility, respecting other people… makes us better physicians, and, you know, if you go back historically, physicians were respected way before we could actually help people, for centuries. We had very little in our armamentarium to help most patients, most of our patients died, and there was a few cases where we could help, there was some things, but the mortality for surgery was so high, diseases were often untreatable, but people still respected us, why?

Dr. Denise: Well, there was innate desire to be a healer. There was an innate desire to connect with another soul and help them thrive and have the best life.

Dr. Javahery:: I agree, and I think it was also a perspective that linked us to the clergy. You know, miracles don’t happen all the time, yet people believe in the value of clergy, why? Because they were guides, they helped you through a process. Whether or not you achieved the goal that you desire, a miracle or whatever, or health from the doctor, was secondary to you were a guide through the process. And too often, physicians, because we so much rely on our ability to heal, we forget about our ability to comfort and to guide people through the disease process. If I guide you through a disease process, no matter the outcome, if my job is to guide people through a disease process, no matter the outcome, I, and the patients, always win. Even if the disease takes that patient, if my job is only to cure, the patients lose, I lose. But if my job is to cure, and to guide, there’s always victory in that process…

Dr. Denise: Can I say something? What you’re saying is so fantastic, because we’re- the world’s using a lot of buzz words these days, and what you’re really talking about is the journey, not the end point, so we’re talking about not just the material result, does the person live or not from the OR, we’re talking about the process of, the engagement, and we did the best we could, but we also honored someone’s belief system, so we’re really respecting someone’s mindset, and their kind of the unspoken energy exchange between two people, so we’ve got the human, material realm science, but what we’re really talking about is also post material connection, the unseen energy exchange of, you know, we can use words like compassion, humility, and so I agree, I completely agree with you.

Dr. Javahery:: Oh, good.

Dr. Denise: And I think it’s fantastic, and I wanted to ask you because we have a little bit more time, I think that one of the topics you wanted to address, I know that you work with children, you work with teens, you work with adults and I saw on Twitter, I saw one of your cases about a six-year-old who, you know, you removed a tumor on their brain stem, and you’re dealing with post-op recovery, with healing, so can you give us a little bit of an idea of your treatment philosophy on pain management? And how you educate your patients and how they can be an active participant in their recovery?

Dr. Javahery:: Yeah, so this goes, my philosophy about pain goes back to, to my mentor in residency, Dr. Heros, he’s the, he was the Chairman at University of Miami where I did my residency. And he used to tell us stories about the old days of Neurosurgery, and one of the stories is, that, back 30 years ago, 40 years ago, there was a very vibrant field in Neurosurgery which no longer, which is no longer as vibrant. And this field, this part of Neurosurgery was basically surgery pain management, it was surgical management of pain. There was a surgery that they did, not very often, but when patients had incapacitating pain, it was called cingulotomy, bilateral cingulotomy. The cingulate gyrus is one of the gyri in the brain that is part of the circuit that controls our emotional response to pain, and it’s basically, what that means is it controls suffering. If people were, had incapacitating pain, the surgery would be to disrupt both cingulate gyruses and what would happen is that the pain would still be there, and he would describe, I’ve never actually seen a patient like this, I only know the stories that Dr. Heros said and he’s, his veracity is unassailable. He would say, these patients, you would do the cingulatomies, and they would wake up and he would go, “Are you in pain?” And they would say,”Yes.” And he would say, “Well, does it bother you?” And they would say, “No.” And it was this epiphany for me that pain and suffering are distinct and they shouldn’t be brought together. That pain is a body’s physical response to a noxious or dangerous stimuli, like a, sharp object, heat, fire, things like that. We all have that same nervous response, goes up the sensory nerves into our spinal chord into our thalami and then to our consciousness, that’s pain. Suffering is the emotional overlay on our pain, that emotional overlay is adjustable-

Dr. Denise: I agree.

Dr. Javahery:: You can, sorry…

Dr. Denise: No, I love it, it’s the mind body connection, so I want to hear your perspective as surgeon and then I see and hear that in my office.

Dr. Javahery:: So, my, my, what I tell patients is you can do it surgically, you can disconnect that surgically or you can do it emotionally. We all walk in life with a certain amount of emotional reserve, the more you exhaust your emotional reserve, the more you will suffer. The less you… The more emotional reserve you have in life, the less you will suffer for the same amount of pain. I have patients, two patients, same surgery, one patient is in agony, riving, the other patient, you walk in the room and they’re smiling, and you go, “How much pain do you have?” And they go, “Oh, I’ve got pain doctor but it’s OK.” It is the emotional response, and you can teach people to have a more measured response, and you can encourage them to build more emotional reserve to face those difficult physical ailments. And part of that I think is encouraging patients emotionally to have more connectivity with the people they love and the people around them. I think isolation is an extraordinary emotional suck, it basically, being isolated is an emotional vacuum cleaner, you become completely exhausted. Obviously, it’s a chicken and egg thing, do people who have chronic pain become isolated because they have chronic pain? Or do people who have more emotional issues develop chronic pain issues? I think that these are conversations you should have with your patients, because I think that once you have them, people are more aware of the intellectual tools they have to overcome their pain, and so…

Dr. Denise: Do you refer your patients or does your team at your office have someone that’s very savvy with cognitive, I know it sounds like you’re an educator and very compassionate surgeon, do you have a team approach that helps people rank their pain, and look at quality of life and holistic healing and how much sleep they’re getting, how much exercise, what’s your physical therapy, what is your wrap around service at your particular clinic with this discussion?

Dr. Javahery:: So, unfortunately, no, I don’t. Part of it is that, there’s a paucity of neuropsychologists, psychiatrists who are able to participate in these processes. If you’re in a, because I work in Long Beach, I mean I do get a lot of affluent patients, but the majority of my patients are not, I take care of Medical, patients. I, my practice is broad and therefore the patients I get often don’t have access to the psychological aspects of these things, so, I’m sorry go ahead-

Dr. Denise: No, I was just thinking that kind of something that’s not the extent of a neuropsychologist or a psychologist would be a really amazing nurse practitioner that floats between a couple different surgeons and then you haven’t sort of an empathy outcome rating scale or something where someone’s even checking in with them. Because there has been data to show that, you know there’s apps and things that have been created, and when people feel that someone’s connected and they care, that helps them feel engaged in what they need to do to heal, and then they have less pain because they are more hopeful, and they’re not lonely. So maybe with that patient population that you’re talking about, and this is by the way, something that’s more of a global solution, it’s not something that’s such an easy fix .I know change takes time, however, if you had a very engaging nurse practioner or it doesn’t have to be that, it could be a social worker that floats that kind of just checks on people. It would be really interesting to see the outcome, and maybe the faster recovery and less pain.

Dr. Javahery:: I would love to have somebody that could do that, and we’ve been, I’ve been trying to get funds from the hospital for a variety of things, like a research nurse, and all these other things, I got to tell you, it’s, in the world of, you know…

Dr. Denise: Corporate redtape, medical…

Dr. Javahery:: Yeah, big corporate no- even though it’s a non-profit, it’s still a corporation. It’s financially at the end of the day. And the majority of children’s hospitals are run off of Medical CCS dollars, there’s very little, unless you have a private foundation funding it, to pay for all of these things. And I think that in my world, at least in the pediatrics side, there is, a lot of the onus falls to the parents to kind of provide that support structure for their children. We do have neuroscientists for the oncology program, but, like, I have a hard time getting my traumatic head injury kids into a supportive environment, but I do think you’re right, we should get somebody.

Dr. Denise: Well, I just had another idea too, and again, talk about this more on a phone call or I’ll meet with you at some point, but you’re such an innate healer on top of being a surgeon, and I think our patients really connect. Like I know when I, I’m going to tell you this, I’ve had a lot since the, and I’m not trying to make this political, the current world milieu environment, in all my years, I’ve been in practice for 20 years, and I’ve had more people that have been suicidal this year than any other year in practice. And I’ve had 12 people under age 18 that have wanted to kill themselves, and I had to, right before I went on vacation, ‘cause I had to make sure I had the emotional reserve. Now, I have 14 people who are no longer suicidal, I think we need to, like when I call my patient back, like, I thought, “Oh, my goodness, that week,” and I just have this, I’m really in tune with my patients and when they hear my voice, immediately they’re like, “Oh my God, I had hope, that feels great.” I’m wondering, Dr. Javahery:, because you’re so compassionate and kind, maybe part of your follow up is just getting a beautiful voice recording that you tell people there’s this recording thing that you do, it doesn’t mean that it forgoes them going to see someone, but that you really care about them, and it’s not realistic for you to call every patient back yourself all the time, but maybe there could be something, because I think when they hear your voice, and your care, there’s a level of healing, it reinstates the connection and we know that there’s so much healing that goes on that’s not just the knife healing, or the here’s your meds healing, there’s the actual, “Wow my doctor really cares.” So I’m wondering if there’s not the funding to get the full on neuropsychologist or nurse practioner, there can be some other protocol put in place because, I would think, if your patients even heard your voice more frequently, that would help engage them in the process of healing. You know?

Dr. Javahery:: Well, it’s funny you say that because I actually.. You know, even though I’m busy, I do.. If my patients call, I try to get back to them. My office knows to let me know. And I have another theory, I don’t, most of your listeners may not know this, there is a physiologic term about the heart muscles, it’s called the Starling Curve, it’s basically it’s a theory about how best heart muscles contract, and then the preload and afterload. Preload means how much do you stretch the muscle, and afterload means how much does that muscle contract and there is an optimal preload, meaning an optimal amount of stretch for a muscle that allows it to give you the best contraction on the back end. If you don’t stretch the muscle enough, the preload is too low, the muscle doesn’t contract well. If the preload is too high, you stretch the muscle too far, the muscle can’t contract well. Just think about when you lift the barbell, the easiest point is at the midpoint of your arm you can, you have the best strength, that is your optimal preload, doctors are the same way, we have an optimal preload. There’s a certain number of patients that allows us to be the best version of ourselves…

Dr. Denise: I love that, keep going… I agree with you.

Dr. Javahery:: If we have to few patients, we’re not good we don’t have enough practice to be good at what we do. If we have too many patients, it dilutes our ability to do our job well and be committed to each patient individually. So that’s what’s happening with the corporatization of health care, your doctors are seeing too many patients in order to, which prevents them from doing a good job for each individual patient. I don’t do that. I have, we run a private practice, I don’t have, it’s not a mill, on office day I may see…

Dr. Denise: Can I say something? Way to go! Yay! I do the same thing, so keep going, cause I had to do a waitlist, not because I don’t want to help people but because I wanted the current patients in my practice, and I’ll be very honest, I told someone, “The acuity of what’s going on in my current practice doesn’t allow me to take someone on, but here’s a great referral,” and then I put people on waitlist, because I believe what you’re saying, we can’t, you want to stand up strong and have your A game as much as one can in everyday when we’re working with our patients.

Dr. Javahery:: Yeah, absolutely. I think that I, our practice, I’ll see like 12 or 13 patients in a day, maybe14, but I can’t see more than that because then I’ll be rushing them in and out of the office and that’s not fair. The…forget about fairness, it’s not good medicine. So, that allows me to be much more available for my patients, now, I have the advantage over you in that my, I have episodic relationships. I see patients, and there’s a blip in time where they’re really, really sick and I’ll take care of them and then everything settles down and I’ll see them once a year and those once a year visits are short, brief, they’re OK with it, they know I care.

So, they know to trust me because I’ve committed to them in the past. But, overall, I get what you’re saying and I feel it. I don’t overdue it because I don’t want to be, I don’t want to be an economy of scale kind of person, and I don’t want to ramp up the number of patients to make more money. I make money based on the quality of my work, not the volume of my work. And I don’t need to make 20% more money by providing 30% less quality of care. I’d rather do my best work and make less money.

Dr. Denise: Well, and I think that this is a conversation where often times you’re in the field helping your patients, we’re on the front lines helping our patients, and I think a lot more doctors, and then you get on these committees, and then there’s bureaucracy. ‘Cause I’ve been on committees where I’m like, “Why am I on this committee? They’re not getting much done. They just kind of want to say they’re on a committee.” But this type of thinking, this mindset, the kind of a patient, compassionate, humble , and ethical mindset is something that I think needs to be taught in medical school, and then it would be really incredible if doctors took back medicine a bit more, and that we didn’t allow it to be so corporate, that’s like a whole other podcast, but I think that it’s really fantastic to hear that you’ve done that, and hopefully I’ve had some people that have come to me for supervision or mentoring that are young new psychiatrists, I think it’s very important that in all fields of medicine that people stay true to the best quality care and really the best doctor-patient relationship.

Dr. Javahery:: Totally. My mentor Dr. Heros used to say, we were so busy, we would not get our notes done often and he goes, “I don’t care about the notes. As long as you provide good care, everything else is B.S.” and he would say, you basic-, “If you do good care for my patients, you’re basically bullet proof. Nothing will hurt you. No one will criticize you, and I’ll stand in their way. I don’t care if the hospital says you didn’t do your discharge summaries, you didn’t do your notes on this day, you do good work, you take care of the patients, everything else is secondary.” And I would say to most doctors who are coming out, if you’re afraid of the hospital or the insurance companies or lawyers or whatever, just concentrate on being a good doctor, it will make you bullet proof.

Dr. Denise: Have you thought about writing a book about this? For surgeons, for young surgeons, almost like a How-to, some quick tips, and then you know, kind of every surgeon needs to have this book before they go out there.

Dr. Javahery:: I haven’t thought about that, no.

Dr. Denise: You might want to do that because we are living in such a fast forward economy and this is why, I’m doing my private practice but I’m growing my following and I’m meeting fantastic people all around the world, and I think we are here to inspire one another and I really, truly think, I’m not saying you have to do this right away, but can you imagine if there was some book that you did with great bullet points that the medical school could have? It would really help. I really think that our young doctors need to hear that. They need to hear that you can practice medicine like you’re practicing surgery and I am practicing psychiatry. And then also we have to give back, like you are, you’re working with Medical, so I give back with some sliding scale and also by the social media stuff I’m doing by providing education. So, I don’t know, I think it would be cool, I mean, the title could be Bullet Proof. Bullet Proof Surgery or something. I think people would love that, I really think so. The way…the clarity with the way you speak, about humility and compassion and just giving exercises, and examples would be fantastic.

Dr. Javahery:: I’ll think about it. I enjoy the process of thinking through life, and thinking about the methodology of how to be the better version of myself. If people, if you think that people would want to hear more of it, I’d be interested, I just hadn’t really thought about it that much. My wife makes fun of all my theories by the way.

Dr. Denise: What kind of medicine does your wife practice?

Dr. Javahery:: My wife’s a dermatologist.

Dr. Denise: Oh, you know what’s great about you is I feel like you’re a Psychiatrist Neurosurgeon. You’re a mindset Neurosurgeon. You, and I guess I’d love to talk with you off-air just about your belief systems, but I feel very aligned and I think you really understand and I’m so happy with that incredible mentor Dr. Heros, he sounds fantastic.

Dr. Javahery:: He is.

Dr. Denise: Wow. You had a gold standard doctor, and I think that’s what we need patients to realize that there’s hope out there, that there’s doctors out there, that it’s not just here’s your prescription, or here’s your surgery or here’s this. In fact, my patients know that the last thing I want to do is prescribe a medicine, I’m not afraid to do it, of course, usually by the time people come to me, that is possibly what’s needed, but I talk with them about lifestyle, medicine, holistic thinking, I empower them, one doc- one patient really thought her last psychiatrist was like a God, there was such a pedestal and I was like, “Whoa. I’m like, I don’t know if any..” I said, “I just want you to know that the fact that you made the decision to feel well, and to get better, you’re your own biggest fan.” And so I think empowering people and I think that’s what our society needs to realize, that you are a big part of your own healing process and that there are doctors out there…that most people that go into medicine don’t go into it just for the money, would you agree with that these days?

Dr. Javahery:: Oh, I totally agree with it. I didn’t go into it for the money. I remember I had a job opportunity that was at the time worth, I was going to get paid significantly more than I’m making now and this was 25 years ago and I didn’t take it because I really feel that I do better at this. And I got to tell you that it’s made me such a better person to be a doctor, and I am so fortunate because, I was as a teenager kind of moody, and I had a depressive personality, and I was angry, I’d lived through the Iranian revolution and all this stuff. And my dad and my grandfather were in prison in Iran and were beaten and I was kind of like angry, and I found that I was, I’d become a better person because I’ve been in medicine and it’s given me perspective. I would describe it, there’s a Farsi expression that says, “Health is a crown worn by the healthy that only the sick can see.” And..

Dr. Denise: I’m smiling by the way about everything you’re sharing. I’m just smiling. I know that we’re on an audio show, but I am just so excited to hear what you’re saying.

Dr. Javahery:: And I, and I was blind to it. And, I, being a doctor opened my eyes to how stupid I was as an adolescent to be depressed about things that I couldn’t change and that were not that important. And now I, you go, “Well, don’t you get depressed about what you do?” I go, “No!” And, yes, the things I deal with are sad, but I have no right, no right to be sad. Because it’s an insult to people who have real problems if I walk around depressed. These, there are people who have it really bad in this world, and for me to be moping when I have so many blessings is an insult and I will not give myself that level of self indulgence. And I try to teach my children and my family the same lessons, and I would have never have learned this if I wasn’t a physician. So, no, it’s not about the money. It’s about the ability to be the better version of yourself.

Dr. Denise: Can I say that with what you, you’ve said, be the better version of yourself, I think that’s a fantastic way for us to wrap up our interview, because that is where we’re in alignment and that’s how we met. I think, if we’re raising our children at a very young age, you know, what’s my neurostyle? I came up with the word neurostyle, like how do I think? Am I shy? Happy? Am I this? And so having a level of mindfulness, of being in the present moment when our young children realize that they have to love themselves, and self love that’s not a selfish love, but a healthy self love, then you’re actually able to align with the best version of yourself. I think the biggest thing for us being able to be the best version of ourselves is coming from a place of love, humility and service, to ourselves and to our neighbors.

Dr. Javahery:: Yeah, no I totally agree and because I, my dad used to say a lot of things, the most important thing is to love other people. And I used to make fun of him when I was a teenager, and I was like, “What do you mean? What’s love?”

Dr. Denise: Oh, my, that would be an interesting conversation with our 16 year old right now..

Dr. Javahery:: Exactly, Are you just quoting the Beatles? What does this mean exactly? And I remember a few years later I realized what he meant. Because, what is the definition of love? Love is the ability of a human being to care for another human being as much as they care for themselves. That is love. In my view, that’s what love means. Now, there are people that you love more than yourself, like my wife, my kids, I love them more than I love myself. Everybody else I can love, maybe, I’m not perfect, so maybe close to as much as I love myself, but the goal is to care for others as much as you care for yourself. And if you do that, that’s love. And if you bring that feeling to your outward relationships, then you will, I think, be the better version of yourself. And, they will be better versions of themselves because your ethics and your morality will change other people.

Dr. Denise: I agree with you. We’re talking about the tsunami or ripple effect of love resonating back and forth between one another. So, I really appreciate our discussion on kindness, compassion, and the doctor-patient relationship. I’m very excited that you are one of my neighbors, and I want to make sure I connect with you after the show’s released, and, is there anything else you want to say? I just, I’ve been, it’s been so great to have you, and maybe I can have you on the show again.

Dr. Javahery:: Sure, if you’d like. No, I think I’ve spoken too much already, and you can’t shut me up sometimes.

Dr. Denise: Thank you so much and you have a great day seeing all your patients, and it’s been an honor to have you on the show today.

Dr. Javahery:: Well, thanks for having me and take care.

Dr. Denise: Thanks you.

Dr. Denise: Thank you 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 DrDeniseMD.com and I’m also on Twitter @DrDeniseMD and on Facebook. Ok, thank you again everyone, have a nice week, bye-bye!